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J Bagh College Dentistry                            Vol. 25(4), December 2013                                  Digital panoramic 

Oral Diagnosis  44   
 

Digital panoramic estimation of chronological age among 
Iraqi adult population in relation to morphological 

variables of canine teeth 
 
Hiba Abdul- Redha Habeeb, B.D.S. (1) 
Ahlam A. Fattah, B.D.S, M.Sc. (2) 
 
ABSTRACT  
Background: Age determination of skeletal remains is apart of many medico-legal as well as anthropological 
examination. Many anatomical structures have been studied, but the teeth and their measurements seem to be the 
most reliable method since teeth represent the most durable and resilient part of the skeleton. This study was 
undertaken for estimating the chronological age among Iraqi adult subjects based on various morphological 
variables of canine teeth using digital panoramic radiograph.  
Material and methods: The sample in the current study consisted of 240 Iraqi patients attending to the dental 
radiological clinic at College of dentistry/ Babylon University taking panoramic radiographs for different diagnostic 
purposes, the study sample included both sexes with age ranged 20-60 years old, the following measurements of 
maxillary right canine have been taken with the aid of computer program (2008): Maximum tooth length, root length 
measured from midpoint of cemento-enamel junction to the root apex, pulp length, root width at cemento-enamel 
junction, root width at mid-root level, root width at mid-point between cemento-enamel junction and mid-root level, 
pulp width at cemento-enamel junction, pulp width at mid-root level, pulp width at mid-point between cemento-
enamel junction and mid-root level, tooth area,  pulp area. The data were subjected to statistical analysis using 
Statistical Package for Social Sciences version 13. 
Results: The result of the current study showed that from the various parameters measured, the differences between 
real age and estimated age of subjects were not statistically significant except for root length and pulp area which 
show significant difference between real age and estimated age with p-value 0.004 and 0.002 respectively. 
Conclusion: Age of the subjects can be estimated using regression equations including root length and pulp area for 
the examined tooth. 
Keywords: Forensic dentistry, Age estimation by canine teeth, Orthopantomography. (J Bagh Coll Dentistry 2013; 
25(4):44-48). 

  
   : الخالصة

ھا تعتبر األكثر كل العظمي یعتبر جزء من فحوصات الطب الشرعي وكذلك األنثروبولوجیھ ولقد تم دراسة العدید من الھیاكل التشریحیة ولكن األسنان وقیاساتتحدید العمرمن بقایا الھی 
  . كجزء من الھیكل العظمي" موثوقیة ومرونة واألكثر دواما

نھ من السكان العراقیین البالغین وذلك باألعتماد على مختلف المتغیرات الشكلیة لألنیاب باستخدام االشعھ البانورامیة أجریت ھذه الدراسة لتقدیر العمر الزمني لعی  :الھدف من الدراسة 
  . الرقمیة

خذ صورة بانورامیة ألغراض جامعة بابل أل/ مریضا عراقیا حضروا الى العیادة األشعاعیة في كلیة طب األسنان 240العینة في الدراسة الحالیة تتألف من   :المواد وطرائق العمل 
: من كل صورة بانورامیة اخذت القیاسات التالیة من ناب الفك العلوي األیمن بمساعدة برنامج حاسوب یدعى التصمیم الھندسي, سنة 60- 20مختلفة من كال الجنسین وبعمر یتراوح من 

، عرض الجذر في مستوى منتصف الجذر، عرض الجذر CEJجذر، وطول اللب ، عرض الجذر في إلى قمة ال) CEJ(الحد األقصى لطول األسنان، طول الجذر یقاس من منتصف ال 
و مستوى منتصف  CEJ، عرض اللب في مستوى منتصف الجذر، عرض اللب في منتصف نقطة بین CEJومستوى منتصف الجذر، عرض اللب في  CEJفي منتصف نقطة بین 

  . .SPSS.version13)(یانات للتحلیل التمییزي بأستخدام برنامج احصائي واستخدمت الب. الجذر، مساحة السن، ومساحة اللب
عدم وجود اختالف احصائي بین العمر الحقیقي والعمر المقدر بأستثناء طول الجذر ومنطقة اللب التي تظھر , أظھرت نتائج الدراسة الحالیة من مختلف المتغیرات التي قیست  :النتائج 

  . الجنس لیس لھ تأثیر احصائي على تقدیر العمر. على التوالي 0.002و  V 0.004عمر الحقیقي والعمر المقدر مع قیمة اختالف احصائي كبیر بین ال
  . یمكن تقدیر العمر بأستخدام معادالت األنحدار المتضمنھ طول الجذر ومساحة اللب للسن المقاس  :األستنتاجات 
 .االشعھ البانورامیھ الرقمیة, من اسنان االنیابتحدید العمر , طب االسنان القضائي: مفاتیح البحث

INTRODUCTION 
Forensic Odontology is a relatively new 

science that utilizes the dentist’s knowledge to 
serve the judicial system. Worldwide, dentists 
qualified in forensic science are giving expert 
opinion in cases related to human identification, 
bite mark analysis, craniofacial trauma and 
malpractice. 

Human identification relies heavily on the 
quality of dental records; however Forensic 
Odontologists can still contribute to the identity 
investigation in the absence of dental records 
through profiling the deceased person using 
features related to teeth (1). 
(1) M.Sc. Student, Department of Oral Diagnosis, College of 

Dentistry, University of Baghdad. 
(2) Assistant Professor, Department of Oral Diagnosis, College of 

Dentistry, University of Baghdad. 

It is often necessary to estimate an individual's 
age due to certain questions related to legal 
requirements in paleodemographic research or in 
a forensic context. 

Although several parts of the body can be used 
for age estimation, the poor condition of the 
remains in particularly severe crashes or fires in 
cases of those recently dead; or of moisture and 
burial conditions in the case of historic subjects, 
make many parts of the body unusable. For these 
reasons, teeth are the part of the body most 
frequently used for identification and age 
estimation (4) 

In children, age determination from teeth is a 
relatively simple, accurate procedure and is based 
on the stages of development and eruption of 



J Bagh College Dentistry                            Vol. 25(4), December 2013                                  Digital panoramic 

Oral Diagnosis  45   
 

teeth. However, in adults it is a challenge to 
medico-legal science (5). 

Up to now, a multiplicity of methods have 
been applied to this problem, including methods 
which analyze the various forms of tooth 
modification such as wear, dentin transparency, 
tooth cementum annulations, racemization of 
aspartic acid and apposition of secondary dentin. 
Canines were chosen to assess age and gender for 
a number of reasons: they have the longest 
functional survival rate in the mouth, undergo less 
wear as a result of  
diet than posterior teeth, are less likely than other 
anterior teeth to suffer wear as a result of 
particular work, and are the single-root teeth with 
the largest pulp area and thus the easiest to 
analyze (9). 

The study of tooth radiographs is a non 
destructive and simple process which can be 
applied to both living and deceased persons (10). 

Panoramic radiography is a radiological 
technique for producing a single image of the 
facial structures. It is become a very popular in 
dentistry (15) 

In the present study digital panoramic 
radiography used for determination of age and 
gender in Iraqi adults subjects. 

 
MATERIAL AND METHODS 

The study sample consisted of 274 subjects, 34 
subject excluded because they were not fit to the 
criteria of inclusion designed for the current 
study. After clinical and radio-graphical 
examination 240 subjects (108 male and 132 
female) of different age groups ranged 20-60 
years selected in the study sample, the collected 
sample include patients attended for different 
diagnostic purposes to the Dental Radiology 
Department at the College of Dentistry, 
University of Babylon.  

Those subjects were divided according to the 
age range into four groups, 
Criteria of inclusion 

Fully erupted right maxillary canine; 
1- Right maxillary canine free from any 

pathology such as caries, pathological lesion, 
periodontitis, abrasion, erosion or fracture.  

2- Absence of restoration and endodontic filling 
of the right maxillary canine. 

3-    Absence of mal-aligned or rotated right 
maxillary canine. 
  Digital Panoramic radiograph of each patient 

was taken, using certain exposure factors for each 
gender (male and female) according to user 
manual. 

The images were examined on the monitor for 
the clear representation enhancement of the 

resolution was done if needed then saved, the 
images were entered as 1024*768 pixel digital 
images (JPEG files) in the computer system, and 
then imported to Adobe photo-shop image editing 
software program (Adobe system Incorporated, 
San Jose, (A,USA) (1990-2002).  

  Minimum of 20 points around the edge of 
tooth outline and minimum of 10 points around 
the pulp outline of the right maxillary canine were 
identified, then image were printed and tracing of 
these points by 0.5 pencil, in order to evaluate the 
measurements of the canine tooth area and the 
pulp area from the radiographic image(12), figure 
1. 

Next the images were imported to the Auto 
CAD program, it was appear in the master sheet 
on which the points were determined, and then 
measurements were obtained, after correction of 
magnification by multiplying the readings by the 
magnification factor which was obtained as a ratio 
between a real distance measurements for a scale 
and the distance measurements for the same scale 
from radiographic image, after that the 
measurements were saved on an Excel sheet. 

The following measurements for the right 
maxillary canine were taken on the panoramic 
images: 
1- Maximum tooth length.  
2- Root length measured from midpoint of 

cemento-enamel junction (CEJ) to the root 
apex. 

3- Pulp length.  
4- Root width at CEJ.  
5- Root width at mid-root level.  
6- Root width at mid-point between CEJ and 

mid-root level. 
7- Pulp width at CEJ.  
8- Pulp width at mid-root level.  
9- Pulp width at mid-point between CEJ and mid-

root level. 
10- Tooth area. 
11- Pulp area.  

 
Statistical analysis was performed using SPSS 

v. 13(SPSS Inc., Chicago, USA). Linear 
regression model for age estimation was 
developed by selecting those variables which 
contributed significantly to age estimation. 
Student's t- test was used to compare the 
morphological variables of males with those of 
females and to compare observed age with 
estimated age. A p value ≤ 0.05 was considered 
statistically significant.  
 
RESULTS 

In the present study, 108 males and 132 
females (total 240 subjects) were divided into four 



J Bagh College Dentistry                            Vol. 25(4), December 2013                                  Digital panoramic 

Oral Diagnosis  46   
 

groups. The morphological variables did not show 
any significant difference between the sexes.  

Table 1 shows the regression analysis in 
males, while Table 2 shows the result in females 
and Table 3 in the total study sample. 

In the total study sample only root length 
(0.004) and pulp area (0.002)  showed significant 
difference between real age and estimated age, 
which yielded the following linear regression 

formula to estimate chronological age: Estimated 
chronological age  =18.73 + 2.55 (Root length) - 
0.92 (Pulp area). 

There was no significant difference between 
observed and estimated age for any of the age 
groups (Table 4). Also there was no significant 
difference between observed and estimated age 
for either males or females (Table 5). 

 
 
 
 
 
 
 
 
 
 
 

Figure 1: Panoramic radiographic image showing points on tooth and pulp outline. 
 

Table 1: Regression analysis for all morphological variables (predictors) and age as the 
dependent variable in males (n = 108) 

Model Regression Coefficients S.E. 
Significant level 

t-test P-value 
Constant 27.31 18.34 1.49 0.140 (NS) 

Tooth length -1.57 1.46 -1.08 0.285 (NS) 
Root length 2.23 1.30 1.71 0.090 (NS) 
Pulp length 0.29 0.65 0.45 0.656 (NS) 

Root width at CEJ 3.85 2.67 1.44 0.152 (NS) 
Root width at mid-root level -2.61 3.33 -0.78 0.435 (NS) 

Root width at midpoint 
between CEJ and mid-root level -0.63 3.65 -0.17 0.863 (NS) 

Pulp width at CEJ -3.09 3.47 -0.89 0.375 (NS) 
Pulp width at mid-root level 5.99 3.41 1.76 0.082 (NS) 

pulp width at midpoint 
between CEJ and mid-root level -3.11 3.56 -0.87 0.386 (NS) 

Tooth area 0.09 0.14 0.67 0.504 (NS) 
Pulp area -0.69 0.38 -1.82 0.073 (NS) 

 

Table 2: Regression analysis for all morphological variables (predictors) and age as the 
dependent variable in females (n = 132) 

Model Regression Coefficients S.E. 
Significant level 

t-test P-value 
Constant -1.90 22.43 -0.08 0.933 (NS) 

Tooth length -0.86 1.42 -0.61 0.546 (NS) 
Root length 2.54 1.41 1.81 0.074 (NS) 
Pulp length 0.09 1.25 0.07 0.946 (NS) 

Root width at CEJ 3.67 3.62 1.01 0.313 (NS) 
Root width at midroot level 0.45 3.82 0.12 0.907 (NS) 

Root width at midpoint 
between CEJ and midroot level 2.81 4.40 0.64 0.524 (NS) 

Pulp width at CEJ 12.46 5.64 2.21 0.29(NS) 
Pulp width at midroot level -1.43 6.73 -0.21 0.833 (NS) 

pulp width at midpoint 
between CEJ and midroot level -6.27 6.39 -0.98 0.328 (NS) 

Tooth area -0.14 0.23 -0.60 0.553 (NS) 
Pulp area -0.60 0.76 -0.80 0.428 (NS) 



J Bagh College Dentistry                            Vol. 25(4), December 2013                                  Digital panoramic 

Oral Diagnosis  47   
 

Table 3: Regression analysis for all morphological variables (predictors) and age as the 
dependent variable in the total study sample (n = 240) 

Model Regression Coefficients S.E. 
Significant level 

t-test P-value 
Constant 18.73 12.93 1.45 0.149 (NS) 

Tooth length -1.65 0.93 -1.76 0.079 (NS) 
Root length 2.55 0.88 2.91 0.004 ** 
Pulp length 0.27 0.57 0.48 0.629 (NS) 

Root width at CEJ 2.80 2.18 1.28 0.201 (NS) 
Root width at mid-root level -1.75 2.43 -0.72 0.473 (NS) 

Root width at midpoint 
between CEJ and mid-root level 1.06 2.79 0.38 0.705 (NS) 

Pulp width at CEJ 3.54 2.55 1.39 0.166 (NS) 
Pulp width at mid-root level -0.09 2.40 -0.04 0.971 (NS) 

pulp width at midpoint 
between CEJ and mid-root level 1.46 2.69 0.54 0.590 (NS) 

Tooth area 0.06 0.12 0.52 0.605 (NS) 
Pulp area -0.92 0.30 -3.12 0.002 ** 

 
Table 4: Comparison between real and estimated age in subjects grouped according to age.(years) 

Age 
Groups 
(years) 

Age in years (mean ± SD) Significant level 

Real age Estimated age t-test P-value 

20-29 24.89 ± 1.89 24.72 ± 2.78 -0.49 0.873 (NS) 
30-39 34.66 ± 2.89 34.42 ± 2.97 -0.65 0.762 (NS) 
40-49 44.82 ± 2.58 44.22 ± 2.98 1.33 0.640 (NS) 
50-59 54.70 ± 2.78 54.78 ± 2.89 0.61 0.733 (NS) 

Over all 36.62 ± 11.45 36.56 ± 2.98 0.08 0.936 (NS) 
 
Table 5: Comparison between real and estimated age of subjects according to gender.(years)  

Gender Age in years (mean ± SD) Significant level Real age Estimated age t-test P-value 
Male 36.19 ± 10.44 36.67 ± 2.99 -0.51 0.609 (NS) 

Female 36.97 ± 12.25 36.47 ± 2.96 0.48 0.632 (NS) 
Over all 36.62 ± 11.45 36.56 ± 2.98 0.08 0.936 (NS) 

 
DISCUSSION 

The result of the present study showed that the 
regression analysis for all morphological variables 
(predictors) with age as the dependent variable 
showed no significant differences when compared 
between real age and estimated age in both males 
and females, as described in table 1 and 2 
respectively.       

And for the total study sample the regression 
analysis for all morphological variables 
(predictors) with age  as the dependent variable 
showed non- significant differences when 
compared between real age and  estimated age 
with exception of root length and pulp area which 
showed statistically significant differences  
between real age and estimated age in the total 
study sample(p-value for root length 0.004 and p-
value for pulp area 0.002) as described in table 3, 
so by using age as the dependent variable and root 
length and pulp area as the independent variable, 
the linear regression formula obtained in the 

current study to calculate or estimate 
chronological age for Iraqi population was: Age = 
18.73+2.55*(Root length)-0.92*(Pulp area).                                      

Cementum keeps forming throughout life, the 
continuous apposition of cementum is influenced 
by the functional state and dental changes like 
attrition and abrasion, correlation between age and 
root length infers the formation of cementum at 
the root apex with aging (6). Secondary dentin 
with advancing age is deposited along the wall of 
the dental pulp chamber leading to a reduction in 
the size of the pulp cavity (14). 

The pulp area acts as indicator of age because 
area decrease is due to secondary dentin formation 
(11). 

Saxena (12) studied the age estimation by direct 
orthopantomographs of 120 canines (maxillary 
right canine) of Indian patients of both sexes with 
age ranging (21-60 years old), and by measuring 
the same variables used in the present study and 
according to the total sample, he found that 
pulp/tooth area ratio and pulp/root width ratio at 



J Bagh College Dentistry                            Vol. 25(4), December 2013                                  Digital panoramic 

Oral Diagnosis  48   
 

mid root level showed significant differences, he 
put regression model for age calculation as 
follow: Age = 72.48-203.74*pulp/tooth area 
ratio -5169*pulp/root width ratio at mid-root 
level. 

This formula was designed for Indian 
population indicating that racial and cultural 
factors might play an important effect on age 
estimation. 

The present study showed that comparison 
between real and estimated age in relation to age 
groups showed no significant difference for all the 
age group(2), Table 4. 

The accuracy of age estimation diminishes 
with age, the possible reasons might be the 
reduction of the criteria and signs for the 
estimation of OPGs in older persons and the 
variability of the oral health status of patients in 
older age groups (8). 

The present study showed no significant 
influence of gender on age estimation using 
canine tooth measurements (3). Panoramic images 
are useful in the demonstration of the complete 
dentition, position and anatomy of the teeth 
including maxillary canines (7). The current study 
performed on single tooth since accurate 
measurements are difficult to perform on multi-
rooted teeth, and in order to create a uniform 
amount of distortion in all images, as the curved 
arch of the jaw is projected on to a flat film, so 
there will always be a certain amount of distortion 
when measuring the image (13). 
 
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