Age Estimation in Skeletal Remains: Lessons from Head and Neck Bones


  • Thamires Mello-Gentil Departamento de Anatomia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
  • Vanessa Souza-Mello Departamento de Anatomia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil



Forensic dentistry, age, sutures closure, mandibular angle, teeth, hyoid


Age estimation from bone remains is a challenge in forensic science, especially in adults. The bones of the head, neck and teeth are more resistant and are often the only pieces available for forensic expertise. This study aimed to critically review the methods available for estimating age from bone remains of the head and neck, as well as teeth in forensic practice. A literature review was performed, using the PubMed database for searches with the following descriptors: "cranial sutures", "teeth mineralization", "cervical vertebrae", "hyoid", "age estimation" and "human identification". Searches for articles were restricted to the last ten years. However, books, classic articles and theses were included, even if they were published longer ago. The literature review showed that the age of closure of the sutures should be used in association with another parameter due to the occurrence of frequent variations. The angle of the mandible (gonial angle) can offer important information to estimate age, but dental mineralization using imaging exams or histological techniques offers subsidies to estimate age more accurately. The bones of the neck can help to estimate age, but they should not be used alone. In conclusion, the teeth and bones of the head and neck can be used in addition to the analysis of other bones for age estimation. However, when they are the only pieces available, the degree of closure of the sutures, the gonial angle and the dental mineralization can offer sufficient subsidies to estimate the age, especially when analyzed together with imaging exams, histological techniques and in association with the bones of the neck.


Coma JMR. Estimación de la edad en el esqueleto. In: Coma JMR, ed. Antropología Forense. 2 ed. Madrid: Ministerio de Justicia; 1999. p. 539.

Weston DA. Human Osteology. In: Richards MP, Britton K, eds. Bioarcheology. Cambridge: Cambridge University Press; 2020. p.147-169. DOI:

Daruge E, Daruge Junior E, Francesquini Junior L. Tratado de odontologia legal e deontologia. 1 ed. Rio de Janeiro: Guanabara Koogan; 2019. 898 p.

Gupta A, Kohli A, Aggarwal NK, Banerjee KK. Study of age of fusion of hyoid bone. Leg Med (Tokyo). 2008; 10(5):253-56. DOI:

Gray H. Osteologia. In: Charles Mayo Goss, editor. Gray Anatomia Charles Mayo Goss. Rio de Janeiro: Guanabara Koogan; 1988. p. 80-237.

Scheuer L. Application of osteology to forensic medicine. Clin Anat. 2002;15(4):297-312. DOI:

Martrille L, Ubelaker DH, Cattaneo C, Seguret F, Tremblay M, Baccino E. Comparison of four skeletal methods for the estimation of age at death on white and black adults. J Forensic Sci. 2007;52(2):302-7. DOI:

Cappella A, Cummaudo M, Arrigoni E, Collini F, Cattaneo C. The Issue of Age Estimation in a Modern Skeletal Population: Are Even the More Modern Current Aging Methods Satisfactory for the Elderly? J Forensic Sci. 2017;62(1):12-7. DOI:

Ubelaker DH, Khosrowshahi H. Estimation of age in forensic anthropology: historical perspective and recent methodological advances. Forensic Sci Res. 2019;4(1):1-9. DOI:

Duc G, Largo RH. Anterior fontanel: size and closure in term and preterm infants. Pediatrics. 1986;78(5):904-8.

D'Antoni AV, Donaldson OI, Schmidt C, et al. A comprehensive review of the anterior fontanelle: embryology, anatomy, and clinical considerations. Childs Nerv Syst. 2017;33(6):909-14. DOI:

Lipsett BJ, Reddy V, Steanson K. Anatomy, Head and Neck, Fontanelles. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available from:

Lourenço M, Cunha E. Can we still use cranial sutures to estimate age at death of individuals after age 50? Braz J Forensic Anthropol & Leg Med. 2020;1:5-28.

Chiba F, Makino Y, Motomura A, et al. Age estimation by multidetector CT images of the sagittal suture. Int J Legal Med. 2013;127(5):1005-11. DOI:

Boyd KL, Villa C, Lynnerup N. The use of CT scans in estimating age at death by examining the extent of ectocranial suture closure. J Forensic Sci. 2015;60(2):363-9. DOI:

Fan F, Tu M, Li R, et al. Age estimation by multidetector computed tomography of cranial sutures in Chinese male adults. Am J Phys Anthropol. 2020;171(3):550-8. DOI:

Nikolova S, Toneva D, Georgiev I, Lazarov N. Sagittal suture maturation: Morphological reorganization, relation to aging, and reliability as an age-at-death indicator. Am J Phys Anthropol. 2019;169(1):78-92. DOI:

Ishikawa N, Suganami H, Nishida A, et al. Utilization of bone impedance for age estimation in postmortem cases. J Forensic Leg Med. 2015;36:102-7. DOI:

Krogman WM. The Human Skeleton in Forensic Medicine. 1 ed. Springfield: Charles C. Thomas Pub. Ltd.; 1962.

Kanchan T, Krishan K, Kumar GP. Squamous suture--a rare case of asymmetrical closure with review of literature. Forensic Sci Int. 2013;231(1-3):410.e1-e3. DOI:

Gocha TP, Ingvoldstad ME, Kolatorowicz A, Cosgriff-Hernandez MT, Sciulli PW. Testing the applicability of six macroscopic skeletal aging techniques on a modern Southeast Asian sample. Forensic Sci Int. 2015;249:318.e1-e7. DOI:

Harth S, Obert M, Ramsthaler F, Reuss C, Traupe H, Verhoff MA. Ossification degrees of cranial sutures determined with flat-panel computed tomography: narrowing the age estimate with extrema. J Forensic Sci. 2010;55(3):690-4. DOI:

Hagelthorn CL, Alblas A, Greyling L. The accuracy of the Transition Analysis of aging on a heterogenic South African population. Forensic Sci Int. 2019;297:370.e370-370-75. DOI:

Milner GR, Boldsen JL. Transition analysis: a validation study with known-age modern American skeletons. Am J Phys Anthropol. 2012;148(1):98-110. DOI:

Xanthopoulou P, Valakos E, Youlatos D, Nikita E. Assessing the accuracy of cranial and pelvic ageing methods on human skeletal remains from a modern Greek assemblage. Forensic Sci Int. 2018;286:266.e261-8. DOI:

Beauthier JP, Lefevre P, Meunier M, et al. Palatine sutures as age indicator: a controlled study in the elderly. J Forensic Sci. 2010;55(1):153-8. DOI:

Ruengdit S, Prasitwattanaseree S, Mekjaidee K, Sinthubua A, Mahakkanukrauh P. Age estimation approaches using cranial suture closure: A validation study on a Thai population. J Forensic Leg Med. 2018;53:79-86. DOI:

Schmidt CM. Estimativa da idade e sua importância forense [Dissertação de mestrado]. Piracicaba: Faculdade de Odontologia de Piracicaba, FOP/UNICAMP; 2004.

Vanrell JP. Odontologia Legal e Antropologia Forense. 3 ed. Rio de Janeiro: Guanabara Koogan; 2019. 512 p.

França GV. Antropologia Médico-Legal In: Fundamentos de Medicina Legal. 3 ed. Rio de Janeiro: Guanabara Koogan; 2018. p. 49-75.

Favero F. Medicina Legal. 6ª ed. São Paulo: Martins; 1958.

Kotecha SD. Dental age estimation in children: a review. Forensic Research & Criminology International Journal. 2016;3(1):264-7. DOI:

Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol. 1973;45(2):211-227.

Miles AE. The assessment of age from the dentition. Proc R Soc Med. 1958;51(12):1057-60. DOI:

Panchbhai AS. Dental radiographic indicators, a key to age estimation. Dentomaxillofac Radiol. 2011;40(4):199-212. DOI:

Babar MG, Iqbal S, Jan A. Essential guidelines for forensic dentistry. Pakistan Oral Dent J. 2008;27: 79-84.

Johanson G. Age determination from teeth. Odontol Revy 1971;22:1-126.

Schour I, Massler M. Studies In Tooth Development: The Growth Pattern Of Human Teeth. J Am Dent Assoc. 1940;27(11):1778-93. DOI:

Solheim T, Vonen A. Dental age estimation, quality assurance and age estimation of asylum seekers in Norway. Forensic Sci Int. 2006;159 Suppl 1:S56-60. DOI:

Cunha E, Wasterlain S. Estimativa da idade por métodos dentários. In: Identificação em medicina dentária e forense. Coimbra: Imprensa da Universidade de Coimbra; 2015.

Krishan K, Kanchan T, Garg AK. Dental Evidence in Forensic Identification - An Overview, Methodology and Present Status. Open Dent J. 2015;9:250-6. DOI:

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

Demirjian A, Goldstein H. New systems for dental maturity based on seven and four teeth. Ann Hum Biol. 1976;3(5):411-21. DOI:

Vieira CR, Lima TBS, Costa RL, Nery IFNO, Corrêa GTB, Andrade RCDV. Análise radiográfica para estimativa de idade utilizando o método demirjian em uma população do nordeste do Brasil. Rev Bras Odontol Leg. 2016;3(1):32-40. DOI:

Liversidge HM. The assessment and interpretation of Demirjian, Goldstein and Tanner's dental maturity. Ann Hum Biol. 2012;39(5):412-31. DOI:

Lopes JR. Eficácia do método de estimativa de idade de Lamendin [Dissertação de mestrado]. São Paulo: Universidade de São Paulo; 2012.

Gelbrich B, Fischer M, Stellzig-Eisenhauer A, Gelbrich G. Are cervical vertebrae suitable for age estimation? J Forensic Odontostomatol. 2017;35(2):66-78.

Lajolo C, Giuliani M, Cordaro M, et al. Two new oro-cervical radiographic indexes for chronological age estimation: a pilot study on an Italian population. J Forensic Leg Med. 2013;20(7):861-6. DOI:

Albert MA, Maier CA. Epiphyseal union of the cervical vertebral centra: its relationship to skeletal age and maturation of thoracic vertebral centra. J Forensic Sci. 2013;58(6):1568-74. DOI:

Rhee CH, Shin SM, Choi YS, et al. Application of statistical shape analysis for the estimation of bone and forensic age using the shapes of the 2nd, 3rd, and 4th cervical vertebrae in a young Japanese population. Forensic Sci Int. 2015;257:513.e1-9. DOI:

Uys A, Bernitz H, Pretorius S, Steyn M. Age estimation from anterior cervical vertebral ring apophysis ossification in South Africans. Int J Legal Med. 2019;133(6):1935-48. DOI:

Gulsahi A, Cehreli SB, Galic I, Ferrante L, Cameriere R. Age estimation in Turkish children and young adolescents using fourth cervical vertebra. Int J Legal Med. 2020;134(5):1823-9. DOI:

Cameriere R, Giuliodori A, Zampi M, et al. Age estimation in children and young adolescents for forensic purposes using fourth cervical vertebra (C4). Int J Legal Med. 2015;129(2):347-55. DOI:

Miller KW, Walker PL, O'Halloran RL. Age and sex-related variation in hyoid bone morphology. J Forensic Sci. 1998;43(6):1138-43. DOI:

Fisher E, Austin D, Werner HM, Chuang YJ, Bersu E, Vorperian HK. Hyoid bone fusion and bone density across the lifespan: prediction of age and sex. Forensic Sci Med Pathol. 2016;12(2):146-57. DOI:

Balseven-Odabasi A, Yalcinozan E, Keten A, et al. Age and sex estimation by metric measurements and fusion of hyoid bone in a Turkish population. J Forensic Leg Med. 2013;20(5):496-501. DOI:

D'Souza DH, Harish SS, Kiran J. Fusion in the hyoid bone: usefulness and implications. Med Sci Law. 2010;50(4):197-9. DOI:

Harjeet K, Synghal S, Kaur G, Aggarwal A, Wahee P. Time of fusion of greater cornu with body of hyoid bone in Northwest Indians. Leg Med (Tokyo). 2010;12(5):223-7. DOI:



How to Cite

Mello-Gentil, T., & Souza-Mello, V. (2021). Age Estimation in Skeletal Remains: Lessons from Head and Neck Bones. Brazilian Journal of Forensic Sciences, Medical Law and Bioethics, 10(4), 566–584.