Panoramic radiographic age estimation in Turkish children and adolescents: tooth-and sex-specific modelling using Cameriere’s open apex method

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Aims: To evaluate panoramic radiographic measurements of individual mandibular teeth as predictors of chronological age in Turkish children and adolescents, using Cameriere's open apex method, and to assess whether sex-stratified modelling improves predictive accuracy. Methods: This retrospective cross-sectional study analysed 199 digital panoramic radiographs (PRs) from Turkish individuals aged 5-14 years (111 females, 88 males). Normalized open apex measurements were obtained for the seven left mandibular permanent teeth. Univariate screening followed by backward elimination was used to construct multiple linear regression models for the overall cohort and stratified by sex. Internal validation was performed using 10-fold cross-validation and bootstrapping with 1000 resamples. Results: In the overall model, teeth 34 and 37 were retained as significant predictors (R²=77.0%; standard error of estimate [SEE]=1.06 years; cross-validated R²=70,4%). The female-specific model retained teeth 34 and 35 (R²=78.9%; SEE=1.00 year; cross-validated R²=69.6%). The male-specific model retained teeth 33, 35 and 37 (R²=84.0%; SEE=0.92 years; cross-validated R²=77.8%). Age-stratified analyses revealed systematic overestimation in the 12-13-year age range across all models. Conclusion: Individual teeth differed substantially in their predictive contributions, and sex-stratified models showed higher cross-validated performance than the pooled model. The moderate sample size (n=88 for the male subgroup), single-centre design and absence of external validation or head-to-head comparison with the classical composite framework limit the conclusions that can be drawn. The findings are hypothesis-generating and require replication before clinical or forensic application.

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