Comparison of Accuracy Between Pulp/Tooth Ratio and Tooth Coronal Index Methods for Dental Age Estimation Using Digital Panoramic Radiographs


  • Mehrdad Abdinian
  • Hossein Emami
  • Maedeh Aminian


Age Determination by Teeth, Radiography, Panoramic, Dental Pulp Cavity


Objective: To evaluate the reliability and the accuracy of Tooth Coronal Index (TCI) and Pulp/Tooth Ratio (PTR) methods in dental age estimation using digital panoramic radiography. Material and Methods: In this cross-sectional study, 237 dental panoramic images were collected. The two methods (TCI and PTR) were applied to all left mandibular first and second molars based on inclusion and exclusion criteria. In order to analyze the acquired data, statistical methods were used. The estimated ages derived by exclusive formula were compared to the chronological age, and the error ranges for each indicator were measured to determine their accuracy. Results: There were negative correlations between PTR in the first molar (r=-0.89) and in the second molar (r=-0.788), as well as TCI in the first molar (r=-0.587) and in the second molar (r=-0.242). In this study, we found that the Pulp/Tooth Ratio (PTR) accuracy rate for mandibular first and second molar teeth was 79.21% and 62.09 %, respectively, although the Tooth Coronal Index (TCI) value for these teeth was 34.45% and 5.85%. Conclusion: Pulp/Tooth Ratio and Tooth Coronal Index are potential age estimation indices. Although PTR was the more accurate one in our study. The results also demonstrated that indices related to the first molar tooth could be used to estimate age with greater accuracy and validity.


Shrestha A, Yadav R, Shrtestha S, Majarjan I, Camelio S. Measurement of open apices in teeth for estimation of age in children. Health Renaissance 2015; 12(1):33-7.

Cameriere R, Ferrante L, Cingolani M. Precision and reliability of pulp/tooth area ratio (RA) of second molar as indicator of adult age. J Forensic Sci 2004; 49(6):1319-23.

Marroquin T, Karkhanis S, Kvaal S, Vasudavan S, Kruger E, Tennant M. Age estimation in adults by dental imaging assessment systematic review. Forensic Sci Int 2017; 275:203-11.

Jeon H-M, Kim J-H, Heo J-Y, Ok S-M, Jeong S-H, Ahn Y-W. Age estimation by radiological measuring pulp chamber of mandibular first molar in Korean adults. J Oral Med Pain 2015; 40(4):146-54.

Jeevan M, Kale AD, Angadi PV, Hallikerimath S. Age estimation by pulp/tooth area ratio in canines: Cameriere's method assessed in an Indian sample using radiovisiography. Forensic Sci Int 2011; 204(1-3):209.e1-5.

Dehghani M, Shadkam E, Ahrari F, Dehghani M. Age estimation by canines’ pulp/tooth ratio in an Iranian population using digital panoramic radiography. Forensic Sci Int 2018; 285:44-9.

Mathew DG, Rajesh S, Koshi E, Priya LE, Nair AS, Mohan A. Adult forensic age estimation using mandibular first molar radiographs: A novel technique. J Forensic Dent Sci 2013; 5(1):56-59.

Murray PE, Stanley HR, Matthews JB, Sloan AJ, Smith AJ. Age-related odontometric changes of human teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93(4):474-82.

Godge P, Sharma S, Vibhakar P, Kulkarni S, Shroff J. Age estimation using orthopantomographs-a forensic study. IJOCR 2014; 2(4):26-30.

Moorrees CF, Fanning EA, Hunt Jr EE. Age variation of formation stages for ten permanent teeth. J Dent Res 1963; 42(6):1490-502.

Kvaal SI, Kolltveit KM, Thomsen IO, Solheim T. Age estimation of adults from dental radiographs. Forensic Sci Int 1995; 74(3):175-85.

Igbigbi P, Nyirenda SK. Age estimation of Malawian adults from dental radiographs. West Afr J Med 2005; 24(4):329-33.

Saxena S. Age estimation of Indian adults from orthopantomographs. Braz Oral Res 2011; 25(3):225-9.

Afify MM, Zayet MK, Mahmoud NF, Ragab AR. Age estimation from pulp/tooth area ratio in three mandibular teeth by panoramic radiographs: study of an Egyptian sample. J Forensic Res 2014; 5(3):1-5.

Babshet M, Acharya AB, Naikmasur VG. Age estimation from pulp/tooth area ratio (PTR) in an Indian sample: A preliminary comparison of three mandibular teeth used alone and in combination. J Forensic Leg Med 2011; 18(8):350-4.

Willems G. A review of the most commonly used dental age estimation techniques. J Forensic Odontostomatol 2001; 19(1):9-17.

Singaraju S, Sharada P. Age estimation using pulp/tooth area ratio: A digital image analysis. J Forensic Dent Sci 2009; 1(1):37-41.

Kvaal S, Solheim T. A non-destructive dental method for age estimation. J Forensic Odontostomatol 1994; 12(1):6-11.

Ikeda N, Umetsu, K, Kashimura, S, Suzuki, T, Oumi, M. Estimation of age from teeth with their soft X-ray findings. Japanese Journal of Legal Medicine 1985; 39(3):244-50.

Mittal S, Nagendrareddy SG, Sharma ML, Agnihotri P, Chaudhary S, Dhillon M. Age estimation based on Kvaal's technique using digital panoramic radiographs. J Forensic Dent Sci 2016; 8(2):115.

Shah PH, Venkatesh R. Pulp/tooth ratio of mandibular first and second molars on panoramic radiographs: An aid for forensic age estimation. J Forensic Dent Sci 2016; 8(2):112.

Veera SD, Kannabiran J, Suratkal N, Chidananada DB, Gujjar KR, Goli S. Coronal pulp biomarker: A lesser known age estimation modality. J Indian Acad Oral Med Radiol 2014; 26(4):398-404.

Bodecker CF. A consideration of some of the changes in the teeth from young to old age. Dental Cosmos 1925; 67(6):543-9.

Gustafson G. Age determinations on teeth. J Am Dent Assoc 1950; 41(1):45-54.

Zaher JF, Fawzy IA, Habib SR, Ali MM. Age estimation from pulp/tooth area ratio in maxillary incisors among Egyptians using dental radiographic images. J Forensic Leg Med 2011; 18(2):62-5.

Cameriere R, Ferrante L, Belcastro MG, Bonfiglioli B, Rastelli E, Cingolani M. Age estimation by pulp/tooth ratio in canines by peri‐apical X‐rays. J Forensic Sci 2007; 52(1):166-70.

Drusini AG, Toso O, Ranzato C. The coronal pulp cavity index: a biomarker for age determination in human adults. Am J Phys Anthropol 1997; 103(3):353-63.

Karkhanis S, Mack P, Franklin D. Age estimation standards for a Western Australian population using the coronal pulp cavity index. Forensic Sci Int 2013; 231(1-3):412.e1-6.

Shrestha M. Comparative evaluation of two established age estimation techniques (two histological and radiological) by image analysis software using single tooth. J Forensic Res 2014; 5(4):1-6.

El Morsi D, Rezk H, Aziza A, El-Sherbiny M. Tooth coronal pulp index as a tool for age estimation in Egyptian population. J Forensic Sci Criminol 2015; 3(2):201.

Talabani RM, Baban MT, Mahmood MA. Age estimation using lower permanent first molars on a panoramic radiograph: A digital image analysis. J Forensic Dent Sci 2015; 7(2):158-162.

Nagi R, Jain S, Agrawal P, Prasad S, Tiwari S, Naidu GS. Tooth coronal index: Key for age estimation on digital panoramic radiographs. J Indian Acad Oral Med Radiol 2018; 30(1):64-67.

Cameriere R, Ferrante L, Cingolani M. Variations in pulp/tooth area ratio as an indicator of age: a preliminary study. J Forensic Sci 2004; 49(2):317-9.

Paewinsky E, Pfeiffer H, Brinkmann B. Quantification of secondary dentine formation from orthopantomograms—a contribution to forensic age estimation methods in adults. Int J Legal Med 2005; 119(1):27-30.

Cameriere R, De Luca S, Alemán I, Ferrante L, Cingolani M. Age estimation by pulp/tooth ratio in lower premolars by orthopantomography. Forensic Sci Int 2012; 214(1-3):105-12.

Sakhdari S, Mehralizadeh S, Zolfaghari M, Madadi M. Age estimation by using pulp/tooth ratio in digital panoramic radiographs. JIDAI 2015; 27(1):19-23.

Mehta S, Urala AS, Vineetha R, Mehta A, Lodha S. Ocena wieku na podstawie obrazu na zdjęciu pantomograficznym pierwszego dolnego zęba trzonowego. Dent Med Probl. 2017; 54(2):179-82. [In Polish].

Jain S, Nagi R, Daga M, Shandilya A, Shukla A, Parakh A, et al. Tooth coronal index and pulp/tooth ratio in dental age estimation on digital panoramic radiographs — a comparative study. Forensic Sci Int 2017; 277:115-21.




How to Cite

Abdinian, M., Emami, H., & Aminian, M. (2023). Comparison of Accuracy Between Pulp/Tooth Ratio and Tooth Coronal Index Methods for Dental Age Estimation Using Digital Panoramic Radiographs. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 23, e210165. Retrieved from



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