Assessment of the Pulp/Tooth Ratio and Third Molar Root Completion Status for ‎Forensic Age Estimation in an Iraqi Population.

Objectives:  This retrospective cross-sectional study evaluates the effectiveness of using the pulp/tooth area ratio of mandibular second molars for identifying minors (<18 years) in an Iraqi population and compares its diagnostic performance to the third molar root completion status.

Methods:  A total of 216 panoramic radiographs were analyzed. Pulp/tooth area ratios were measured using ImageJ (National Institutes of Health, Bethesda, MD), and third molar root completion was recorded as a binary variable. Three logistic regression models were constructed and evaluated using sensitivity, specificity, and area under the ROC curve (AUC).

Results:  Incomplete third molar root development showed high sensitivity (0.90), while the second molar pulp/tooth ratio demonstrated superior specificity (0.99). The combined model (ratio + third molar) yielded the highest overall performance (AUC = 0.96), outperforming individual predictors (third molar only: AUC = 0.90; ratio only: AUC = 0.84).

Conclusion:  While the pulp/tooth ratio alone is less sensitive, it provides excellent specificity and enhances overall model performance when combined with third molar status. These findings support the combined use of both variables for accurate age estimation in forensic settings lacking reliable documentation.