Dental Versus Skeletal Methods for Age Estimation in Growing Individuals: A Systematic Review

Accurate age estimation is crucial in forensic, clinical, and legal contexts. Dental age (DA) and skeletal age (SA) are commonly used markers, yet their relative accuracy across populations remains unclear. This systematic review aimed to compare the accuracy of DA and SA estimation methods relative to chronological age (CA) in children and adolescents. A comprehensive search of PubMed, Scopus, EBSCOhost, and the Cochrane Library identified studies evaluating dental methods such as Demirjian, Willems, Cameriere, and Nolla, as well as skeletal methods including Fishman, Greulich and Pyle, cervical vertebral maturation (CVM), and Gilsanz-Ratib. Studies involving individuals aged 6-19 years were analyzed, and the risk of bias was assessed using the modified Newcastle-Ottawa Scale. Nine studies from diverse populations, including Turkey, Egypt, and South Africa, were included. The findings revealed that DA methods, particularly Willems and Nolla, demonstrated a higher correlation with CA than SA methods, which often underestimated age in older children. Accuracy varied according to age, sex, and population, while combined approaches improved reliability. Overall, DA estimation methods generally outperform SA techniques in early to mid-adolescents, though population-specific calibration and combined DA+SA approaches enhance accuracy. Careful method selection remains essential in forensic and clinical applications.