Mangulkar Ayushi P, Khelkar Prajakta C, S Bharathi, Karjodkar Freny R, Khanna Sunali, Sonawane Nilam, Pakhmode Resham V, Unnikrishnan Aswathi, Singh Shivani, Jadhav Tanushree
Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, IND.
Department of Dentistry, Gokuldas Tejpal College and Hospital, Mumbai, IND.
Cureus. 2025 Mar 6;17(3):e80141. doi: 10.7759/cureus.80141. eCollection 2025 Mar.
Background In forensic odontology, age estimation is vital for identification, legal, and investigative purposes. Teeth, resistant to external factors, serve as reliable indicators of biological maturity. The present study aims to assess the accuracy and reliability of age estimation by comparing pulp-to-enamel volume ratios from 3D imaging with the Tooth Coronal Index (TCI) method using panoramic radiographs. Methodology This prospective study analyzed 620 radiographs from participants aged 16-65 years, categorized into five age groups. Using random sampling, 320 images each were evaluated using the following two methods: TCI measured from panoramic radiographs and pulp-to-enamel volume ratio using cone-beam computed tomography (CBCT) and 3D Slicer software. TCI was calculated using crown and pulp cavity heights from maxillary first (MX1) and second molars (MX2) and mandibular first (MND1) and second (MND2) molars. CBCT scans were processed in DICOM format for 3D segmentation and analysis of pulp volume (PV) and enamel volume (EV). Statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA), employing t-tests, analysis of variance, and regression analysis. A p-value <0.05 was considered statistically significant. Results Among 320 teeth analyzed, TCI showed a statistically significant correlation with age only for MX2 (p < 0.05). The standard error of estimate for TCI-based age prediction was 14.57 years, with poor regression equations (R² ≈ 0). PV/EV analysis demonstrated a strong correlation with age (R² > 0.8), with a standard error of 4.34 years. Linear regression equations derived for PV/EV provided reliable age predictions. MX1, MX2, and MND2 PV/EV showed a significant positive correlation with age (p < 0.01), with R² nearing 1 for individual predictors. The youngest subject was 16 years old, and the eldest was 64 years old. Conclusions Considering certain limitations, this study concluded that 3D imaging, particularly utilizing maxillary and mandibular molars, demonstrates greater accuracy in age estimation compared to 2D imaging and shows significant potential for forensic applications.
背景 在法医牙科学中，年龄估计对于身份识别、法律和调查目的至关重要。牙齿对外界因素具有抵抗力，是生物成熟度的可靠指标。本研究旨在通过比较三维成像中的牙髓与牙釉质体积比和使用全景X线片的牙齿冠部指数（TCI）方法，评估年龄估计的准确性和可靠性。
方法 这项前瞻性研究分析了620张年龄在16至65岁之间参与者的X线片，分为五个年龄组。采用随机抽样，分别使用以下两种方法对320张图像进行评估：从全景X线片测量TCI，以及使用锥形束计算机断层扫描（CBCT）和3D Slicer软件测量牙髓与牙釉质体积比。TCI使用上颌第一磨牙（MX1）和第二磨牙（MX2）以及下颌第一磨牙（MND1）和第二磨牙（MND2）的牙冠和牙髓腔高度进行计算。CBCT扫描以DICOM格式进行处理，用于牙髓体积（PV）和牙釉质体积（EV）的三维分割和分析。使用SPSS 26.0版（美国纽约州阿蒙克市IBM公司）进行统计分析，采用t检验、方差分析和回归分析。p值<0.05被认为具有统计学意义。
结果 在分析的320颗牙齿中，TCI仅与MX2的年龄具有统计学显著相关性（p<0.05）。基于TCI的年龄预测的估计标准误差为14.57岁，回归方程较差（R²≈0）。PV/EV分析显示与年龄具有强相关性（R²>0.8），标准误差为4.34岁。为PV/EV推导的线性回归方程提供了可靠的年龄预测。MX1、MX2和MND2的PV/EV与年龄呈显著正相关（p<0.01）, 单个预测因子的R²接近1。最年轻的受试者为16岁，最年长者为64岁。
结论 考虑到某些局限性，本研究得出结论，与二维成像相比，三维成像，特别是利用上颌和下颌磨牙，在年龄估计方面显示出更高的准确性，并在法医应用中显示出巨大潜力。
