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International Poster Journal of Dentistry and Oral Medicine



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Int Poster J Dent Oral Med 7 (2005), No. 2     15. June 2005

Int Poster J Dent Oral Med 2005, Vol 7 No 02, Poster 275

The Demand in Forensic Medicine to Assess the Age of Adolescents and Young Adults in Crime Procedures

Forensic age diagnostics mean multidisciplinary teamwork.
A contribution of the German Academy of Forensic Odonto-Stomatology.

Language: English

Dr. med. Dr. med. dent. Klaus Rötzscher,
German Academy of Forensic Odonto-Stomatology
Dr. med. Dr. med. dent. Claus Grundmann,
Institut für Rechtsmedizin der Stadt Duisburg

2.-3. April 2004
1. Deutsch-Polnisches Stomatologisches Symposium
Frankfurt am Main, Jahrhunderthalle Höchst


In Germany the age thresholds of relevance for criminal proceedings are 14, 18 and 21 years (5). In many other countries the age thresholds which determine criminal liability are similar.
For the purpose of estimating age, the German Study Group on Forensic Age Diagnostics (AGFAD) recommends combining a physical examination of the suspect, a dental examination which records dentition status and evaluates an orthopantomogram, Xray examination of the left hand, and radiographic or computer tomographic survey of the clavicle (9,10).


In establishing whether an individual has attained the criminal liability threshold of 21 years, the ossification of the sternal clavicular cartilage is of particular interest, as the other systems on which development analysis is based have usually matured fully by this time. Xrays of the clavicle are important in helping to ascertain whether a suspect was 18 years old at the time of an offence committed some years prior to clinical examination (10).

Material and Methods

Physical, dental and radiological methods differ considerably due to their limits, possibilities and risks (5), i.e. radiological examinations are admitted by medical indication (§ 23ff RöV) or by court order (§ 81a StPO) (Table 1).

Table 1: Age estimation of adolescents and young adults (5).


The scientific base of age diagnostics means genetic control of ontogenesis. The temporal variability of development stages is limited.
By common consent the best usable methods are the physical examination (height, weight, physic, sexual maturity, relevant developmental disturbances due to age; the dental examination including the dental status; photography (Fig. 1); dental x-ray i.e. orthopantomogram (Fig. 2 and 3); x-ray of the left hand and wrist (Fig. 4 to 7) and under special circumstances additional x-ray survey of the clavicle (Fig. 8 and 9).


Fig. 1: Age: 15, male


Fig. 2a Fig. 2b
Fig. 2: Age 19, male Stage H (by DEMIRJIAN)

Radiological assessment of the third molars:

The development of the roots of the wisdom teeth is not finished before the age of 18 (2,13) corresponding the stage H (by DEMIRJIAN).
The mineralisation of the teeth is more interesting than the eruption (2). This process is mostly independent facing external factors (1). The classification (by DEMIRJIAN) is most suitable (Fig.3; Table 2 and 3).

Fig. 3: Age 19, male Stage H (by DEMIRJIAN)

Table 2: Third molars. Stages, male, by DEMIRJIAN.

Table 3: Third molars. Stages, female, by DEMIRJIAN.

Maturity indicators of individual bones and epiphyses

Fig. 4: Age 15, male
Maturity indicators of individual bones and epiphyses The epiphysis of the radius has capped it's shaft. All carpals have attained their early adult shape. Fusion is under way in the epiphyses of all distal phalanges.

Fig. 5: Age 21, male
The fusion of the radial epiphysis with its shaft completes the skeletal maturation of the hand and wrist.

Radiological assessment of the left hand and wrist:

The skeletal development of the hand and wrist represents the development of the whole skeleton as "pars pro toto" and informs about the skeletal age corresponding with the chronological age (4, 12).

Fig. 6: Age 16, female
Epiphysial lines of ulna and radius still smooth marked. The interstices of ulna and radius mostly ossified, but perceptible. THIEMANN / NITZ and GREULICH / PYLE define the roentgenogram of the left wristbone belonging to a 15-16 years-old female.
Fig. 6a: Age 16, female
Beginning fusion of the distal epiphysis ofthe radius with its shaft. Fusion is completed first in the distal,next in the proximal or distal phalanges.

Fig. 7: Age 17, female
In the ulna and in the heads of all fingersthe epiphyseal lines have been almost completely obliterated. In the radius thin terminal lines extend completely across the shaft (see arrow).
Fig. 7a: Age 17, female
Epiphysial lines of ulna and radius still smooth marked. The intersticesof ulna and radius mostly ossified,but perceptible. Fusion is nearly complete.

Radiological assessment of the clavicle:

Fig. 8 Age 27, male
Radiological assessment of the clavicle. The comparison of both sides shows regular structures of the bones. No signs of degenerative or inflammatory alteration. The maturity of both clavicles is finished.

Fig. 9: Age 27, male
12 degrees angled x-ray of the left clavicle. The epiphyseal cartilage shows completely fusion with its shaft. The epiphyseal scar is no longer visible (Stage 5).

Table 4: Gender comparison at stages 3, 4, 5. Male and female.

Gender comparison produced significant differences at stage 3 (p=0.006), with the female subjects reaching this stage one year earlier than their male counterparts. In both genders stage 3 first occurred at the age of 16, the maximum age for men being 24 and the maximum for women 27.

There were no statistically significant gender differences at stage 4 and 5. Stage 4 was first observed in male subjects at 21 years and in female subjects at 20 years. In each gender the lowest age for stage 5 was 26.
To assess the degree of ossification of the medial clavicular epiphyseal cartilage, the classification into four stages commonly applied in anatomical and radiological studies was applied as follows:
Stage 1: The ossification centre has not yet ossified
Stage 2: The ossification centre has ossified, the epiphyseal cartilage has not ossified
Stage 3: The epiphyseal cartilage is partially ossified
Stage 4: The epiphyseal cartilage is fully ossified
Stage 5: The epiphyseal cartilage has fused completely and the epiphyseal scar is no longer visible (11).
Stage 5 is characterised by total fusion of the epiphyseal cartilage and the disappearance of the epiphyseal scar.

Plain chest radiographs can essentially provide a basis for assessing clavicular ossification. lf overlap in posterior-anterior views impedes evaluation, a lateral view should also be taken to facilitate age estimation. At ossification stage 4 it cannot reliably be ruled out that a female subject is under 21 years old. At ossification stage 5 a minimum age of 26 can be assumed for both genders (10,11).


Radiological assessment of the hand and wrist allows diagnostics up to 18 years of age. The development ends with this age. The mineralisation of the roots of the wisdom teeth is finished at the age of 21. The radiological assessment of the clavicle in both genders shows the lowest age at which stage 5 of was observed was 26 years. Forensic age diagnosis of living subjects in the context of criminal investigations can assume that when this stage of ossification is observed the subject must have attained the age of 21 at least. years prior to the examination and the age of 18 at least 8 years prior to the examination.


Expertness and the combination of physical examination of the suspect, dental examination which records dentition status including orthopantomography, Xray examination of the left hand and wrist and radiographic or computer tomographic survey of the clavicle lead to conclusions regarding the estimated age - a useful support in criminal cases to assess adolescents and young adults due to legal protection in court.
Every year the Study Group proofs the practicability of the methods, points the way to the future and organises lectures regarding the results in research and in practice.


  1. Demirjian A (1986) Dentition. In: Falkner F, Tanner JM (eds) Human growth. Academic Press, New York London, pp.269-298
  2. Demirjian A, Goldstein H, Tanner JM (1973) A new system of dental age assessment. Hum Biol 45:221-227
  3. Geserick G, Schmeling A (2001) Übersicht zum gegenwärtigen Stand der Altersschätzung Lebender im deutschsprachigen Raum. In: Oehmichen M, Geserick G (Hrsg.) Osteologische Identifikation. Rechtsmedizinische Forschungsergebnisse. Schmidt-Römhild, Lübeck
  4. Greulich WW, Pyle SI (1988) Radiographic atlas of skeletal development of the hand and wrist. Stanford Univ Press, Stanford/CA, pp.58, 108-120, 166-176
  5. Kaatsch HJ (2001) Juristische Aspekte der Altersschätzung. In: Oehmichen M, Geserick G (eds) Osteologische Identifikation und Altersschätzung. Schmidt-Römhild Lübeck, S.243-254.
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  7. Kreitner KF, Schweden FJ, Riepert T, Nafe B, Thelen M (1998) Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 8:1116-1122
  8. Olze A, Schmeling A, Rieger K, Kalb G, Geserick G (2003) Untersuchungen zum zeitlichen Verlauf der Weisheitszahnmineralisation bei einer deutschen Population. Rechtsmedizin 13:5-10
  9. Rötzscher K (2003) Altersschätzung. In: Forensische Zahnmedizin, Rötzscher K (Hrsg). Books on Demand Verlag Norderstedt, S.122-130
  10. Schmeling A, Geserick G, Kaatsch HJ, Marré B, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K (2003) Empfehlungen für die Altersdiagnostik bei Lebenden im Strafverfahren. DGZMK-Stellungnahme. Dtsch Zahnärzte Kalender. Deutscher Zahnärzte Verlag Köln, S.140-145
  11. Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G (2003) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Leg Med, online Springer: 10.1007/s00414-003-0404-5
  12. Thiemann HH, Nitz I (1991) Röntgenatlas der normalen Hand im Kindesalter. 2. Aufl. Thieme Verlag Leipzig Stuttgart, S.26, 88-157
  13. Willershausen B, Löffler N, Schulze R (2002) Möglichkeiten der forensischen Altersdiagnostik anhand von Weisheitszahnentwicklungsstadien – eine Auswertung von 1202 OPG-Aufnahmen. Newsl AKFOS 9,3:89-96


RöV: Röntgenverordnung, x-ray degree
StGB: Strafgesetzbuch, penal code
StPO: Strafprozessordnung, code of criminal procedure

This Poster was submitted by Dr. med. Dr. med. dent. Klaus Rötzscher.

Correspondence address:
Dr. med. Dr. med. dent. Klaus Rötzscher
German Academy of Forensic Odonto-Stomatology
Wimphelingst. 7
D-67346 Speyer