Journal of Forensic and Legal Medicine 53 (2018) 79–86

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Journal of Forensic and Legal Medicine

journal homepage: www.elsevier.com/locate/yjflm

Age estimation approaches using cranial suture closure: A validation study T

on a Thai population
Sittiporn Ruengdita,b, Sukon Prasitwattanasereea,c,d, Karnda Mekjaideea,c,e,
Apichat Sinthubuaa,b,c, Pasuk Mahakkanukrauha,b,c,∗
a
Forensic Osteology Research Center, Faculty of Medicine and Graduate School, Chiang Mai University, 50200, Thailand
b
Department of Anatomy, Faculty of Medicine, Chiang Mai University, 50200, Thailand
c
Excellence in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, 50200, Thailand
d
Department of Statistics, Faculty of Science, Chiang Mai University, 50200, Thailand
e
Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, 50200, Thailand

A R T I C L E I N F O A B S T R A C T

Keywords: Cranial suture closure, one of the most commonly used age estimation methods, for decades, however, is often
Forensic science viewed with caution and its reliability is still debated. Few methods of estimating age using the skeleton,
Forensic anthropology especially cranial suture, have been tested on Thais. This study aims to test the traditional aging techniques using
Age estimation cranial suture closure on Thai individuals in order to identify the error rate of each method when applied to a
Validation study
Thai sample. Meindl and Lovejoy (1985), Acsádi and Nemeskéri (1970), and Mann (1991) methods were applied
Suture closure
Thais
to 175 Thai dry crania. Bias and inaccuracy in the Meindl and Lovejoy, Acsádi and Nemeskéri, and Mann
methods resulted in overestimation in young adults and underestimation in older individuals with an inaccuracy
range of approximately 13–22 years. The Mann method approached 100% in predicting age in older males, but
the method did not fare as well on Thai females. The results confirm inter-population variation does exist.
Additionally, differences in age composition between populations used to develop the methods and Thais may
lead to an increase in error. This study indicates that these three aging methods should be used in conjunction
with other techniques. Further research which develops specific methods for Thais might give better results for
age estimation.

1. Introduction
Anthropologists have been challenged with delivering accurate age
estimates for decades.1–3 Some of the commonly used methods to es-
timate chronological age in human skeletal remains are pubic sym-
physis,4 auricular surface of the ilium,5 and sternal end of the fourth
rib.6,7 Cranial suture closure is one of the age indicators which has been
used for more than a century, although its reliability is still debated.8–12
Three traditional aging methods have been used as standard pro-
cedures worldwide. Acsádi and Nemeskéri (1970) method13 developed
from Hungarian samples by examining endocranial sutures and yielded
satisfied result of estimation.14–16 One drawback to a reliance on en-
docranial sutures is that they are not always available for examination,
for example, when a skull is badly damaged, eroded or missing, or when
scientists are hesitate to cut the skull open to see the internal sutures.2
Meindl and Lovejoy,8 in comparison, proposed a method of estimating
age utilizing ectocranial sutures. They offered vault (V) and lateral-
anterior (LA) systems for age estimation and suggested that LA system
provided better results than V system. A few years later Mann and
colleagues17 developed an alternative age estimation method using
maxillary sutures, since skeletal remains are frequently incomplete.
Mann et al. provided a predicted age range derived from simply ob-
serving the maxillary suture obliteration. The Meindl and Lovejoy
(1985) and Mann (1991) methods are widely used in the United
States,14 while, that of Acsádi and Nemeskéri (1970) is more popular
among European anthropologists.18
The Acsádi and Nemeskéri (1970) and Meindl and Lovejoy (1985)
methods have been tested on diverse populations.14–16,19,20 Also, the
Mann (1991) method has been validated and applied with many po-
pulations.21–25 All research suggested that Acsádi and Nemeskéri
(1970) method aids in categorizing individuals into broad age ranges
and works better in young individuals.16 Meindl and Lovejoy (1985)
method was also tested on American and European as well as few Asian
samples.14,20 Ranges of overall inaccuracy for estimation were

∗
Corresponding author. Excellence in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, 50200, Thailand.
E-mail addresses: neu.sittiporn@gmail.com (S. Ruengdit), sprasitwattanaseree@gmail.com (S. Prasitwattanaseree), turquoise0401@gmail.com (K. Mekjaidee),
Apichat_nine@yahoo.com (A. Sinthubua), pasuk034@gmail.com (P. Mahakkanukrauh).

https://doi.org/10.1016/j.jflm.2017.11.009
Received 14 March 2017; Received in revised form 4 October 2017; Accepted 27 November 2017
Available online 29 November 2017
1752-928X/ © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
S. Ruengdit et al.
approximately 12.5–13.5 and 14.2–21.1 years for Acsádi and Ne-
meskéri (1970), and Meindl and Lovejoy (1985) methods, respec-
tively.16,20 The explanation for causes of inaccuracy in prediction is
unclear. Additionally, tests of the Mann (1991) method have reported
more than 80% correct estimation in American, South African, Greek,
and Belgian skeletal samples.21–24 However, efficiency of the Mann
(1991) method obtained from the study of Sakaue and Adachi on Ja-
panese skeletal samples was relatively low (36.9% correct estimates for
males and 25.7% for females).25
Although a number of test studies of traditional aging methods have
been conducted on various populations,12,26–28 little research has been
performed using Asian samples.20,29 Gocha et al., for example, con-
ducted a test study of the Meindl and Lovejoy (1985) method on Thai
skeletal samples and suggested that it not be used to juristically apply
for a South East Asian sample. They did, however, suggest further study
using a larger sample size.20 The purpose of the present study is to test
the traditional aging techniques using cranial suture closure that uti-
lizes the ectocranial, endocranial, and maxillary sutures on a large
skeletal sample of Thai individuals.
2. Materials and methods
This study was ethically approved by the Research Ethics
Committee of the Faculty of Medicine at Chiang Mai University
(Research ID: ANA-2558-03191).
2.1. Sample composition
The sample of the present study consists of 175 crania of 94 Thai
males and 81 females between 22 and 90 years, with mean age of 61.95
years (SD = 17.03), from the Chiang Mai osteological collection at the
Forensic Osteology Research Center (FORC) at the Faculty of Medicine,
Chiang Mai University, Thailand. Composition of the sample in 10-year-
age categories is shown in Table 1. The FORC consists of known-iden-
tity individuals who donated their bodies for educational purposes and
religious beliefs.30,31 The osteological sample in this collection re-
presents a modern Thai population.
2.2. Methods
2.2.1. The Meindl and Lovejoy (1985) method
Ten ectocranial suture sites based on the Meindl and Lovejoy (1985)
method were examined for their closure using a 4-point scale (0–3): 0
(open) represents no evidence of obliteration on the ectocranial side at
the site, 1 (minimal closure) indicates presence of minimal to moderate
closure in the form of a bony bridge across the suture to about 50%
obliteration at the site, 2 (significant closure) is more than 50% at the
site, but some open parts of the suture can be seen, 3 (complete ob-
literation) indicates complete closure of the suture at the site. One
centimeter length or area (diameter) of the suture at 10 sites from both
cranial vault (V) and lateral-anterior (LA) parts were evaluated.8
Table 1
Age and sex distribution of the study sample.
Actual age (year) Male (n1*) Female (n2*)
20–29 3 1
30–39 10 6 16
40–49 12 13
50–59 13 14
60–69 21 15
70–79 19 14
80+ 16 18
Note: *n1 indicates a number of male cases, n2 indicates a number of female cases, and n
indicates a number of both male and female cases.
Journal of Forensic and Legal Medicine 53 (2018) 79–86
2.2.2. The Acsádi and Nemeskéri (1970) method
According to the Acsádi and Nemeskéri (1970) method, 16 en-
docranial suture parts were investigated applying a five-point scale
(0–4): 0 (suture open) indicates suture part which still has space left
between the edges of the adjoining bones, 1 (incipient closure) shows
closed suture (no evidence of any space), but clearly visible as a con-
tinuous line, 2 (closure in progress) reveals suture line is interrupted by
complete obliteration with no evidence of suture can be recognized or
sometimes, suture of which some parts have completely disappeared
while others are still open, 3 (advanced closure) displays only pits along
the suture line, sometimes like punctuated dots on paper, and 4 (closed
suture) indicates complete obliteration of the suture, even its location
cannot be recognized. For all 16 endocranial suture parts, the coronal
suture and lambdoidal sutures were equally divided into three parts on
each side. The sagittal suture was equally divided into four parts.13,19
2.2.3. The Mann (1991) method
Obliteration of the four maxillary sutures: incisive, posterior median
palatine, transverse palatine, and anterior median palatine, was in-
vestigated according to the Mann method.17 Estimated age of each in-
dividual was obtained based on pattern of suture obliteration as de-
scribed below:
If incisive suture (IN) is obliterated, so the minimum age will be 20
years old. Then look for any obliteration in posterior median palatine
(PMP), transverse palatine (TP), and anterior median palatine suture
(AMP). If there is no evidence of obliteration in the PMP, TP, and AMP,
the age range will be 20–24 years. If the PMP is completely obliterated,
the minimum age estimate is 29 years. If any obliteration is found in the
greater palatine foramen (GPF), the minimum age is 30 years. And, if
the TP is obliterated less than 50%, the age range will be 30–40 years. If
the TP is obliterated more than 50%, the minimum age will be 41 years.
If there is no evidence of obliteration of the AMP, the age range will be
less than 50 years. If the TP is completely obliterated (IN and PMP are
also completely obliterated), and any obliteration (even 1 mm) is found
along the AMP, the minimum age of the individual will be 50 years.
Also, if the AMP is obliterated more than 50%, the minimum age will be
50 years,17 (Personal Communication, Mann RW 2016). Based on the
description above, estimated age range phases are provided in Table 2.
Obliteration scores obtained from Meindl and Lovejoy (1985) and
Acsádi and Nemeskéri (1970) methods were computed for composite
score or index based on each method. Composite score of Meindl and
Lovejoy (1985) method is the sum of the obliteration score for each
suture group: vault (V) and lateral-anterior (LA).8 Index of Acsádi and
Nemeskéri (1970) method is an average of all 16 suture obliteration
scores. Estimated age of the individual was derived from the mean age
of the assigned stage.13
2.3. Data analysis
Fifty-eight crania were randomly selected from a total of 175 sam-
ples for intra- and inter-observer repeatability analysis of all methods.
Repeated examination on these crania was conducted by the same ob-
server with one month interval from the original examination. Also, the
same procedure was utilized by different observer in order to perform
inter-observer repeatability test. Cohen's kappa was used to analyze
Total (n*)
Table 2
4 Estimated age range for Mann (1991) method.
25 Maxillary suture Age range phase (year)
27
36 IN 20–24
33 PMP 25–29
34 TP (obliterated less than 50%) 30–40
TP (obliterated more than 50%) 41–49
AMP 50+
80
S. Ruengdit et al. Journal of Forensic and Legal Medicine 53 (2018) 79–86

intra- and inter-observer agreements. According to Landis and Koch,32 Table 3b

agreement can be classified (using kappa statistic) as followed: Poor Intra- and inter-observer observer agreement of the Acsádi and Nemeskéri (1970) en-
docranial suture method on a Thai sample.
(< 0.00), slight (0.00–0.20), fair (0.21–0.40), moderate (0.41–0.60),
substantial (0.61–0.80), and almost perfect (0.81–1.00). Suture Intra-observer Inter-observer agreement
Descriptive statistics of the estimated age from each method ap- agreement
plying on Thai individuals were calculated in order to compare with
those of actual age. Bias and inaccuracy were analyzed for assessing Acsádi and Nemeskéri (1970) Kappa p-value* Kappa p-value*
endocranial suture method coef. coef.
reliability of the traditional age estimation methods from cranial suture
closure on Thai individuals. These analyses have been widely used for 1. Coronal (left medial part) 0.74 < 0.001 0.51 < 0.001
validation studies on aging methods.14,27 Bias is the mean of error in 2. Coronal (left intermediate 0.79 < 0.001 0.92 < 0.001
predicting age, over or under estimation. Error in estimating age re- part)
3. Coronal (left lateral part) 0.60 < 0.001 0.52 < 0.001
ferred to the difference between estimated age and actual age. In 4. Coronal (right medial part) 0.74 < 0.001 0.64 < 0.001
comparison, inaccuracy was defined as the average of absolute error of 5. Coronal (right intermediate 0.68 < 0.001 0.61 < 0.001
age estimation, without reference to over or under prediction. The part)
formulae for calculating bias and inaccuracy are as follows 27: 6. Coronal (right lateral part) 0.63 < 0.001 0.54 < 0.001
7. Sagittal (anterior part) 0.85 < 0.001 0.48 < 0.001
Bias = ∑ (estimated age - actual age)/n 8. Sagittal (vertical part) 0.59 < 0.001 0.49 < 0.001
9. Sagittal (obelion part) 0.66 < 0.001 0.52 < 0.001
Inaccuracy = ∑ |estimated age - actual age|/ n 10. Sagittal (lambda part) 0.60 < 0.001 0.64 < 0.001
11. Lambdoidal (left medial 0.70 < 0.001 0.43 < 0.001
The proportion of cases when the actual age fell within ± one part)
standard deviation (SD) of the mean age reported for a closure stage of 12. Lambdoidal (left 0.73 < 0.001 0.39 0.001
intermediate part)
each method was also taken into account.29,33 Besides testing method
13. Lambdoidal (left lateral 0.59 < 0.001 0.42 < 0.001
reliability, relationship between estimated age and actual age was part)
evaluated. Pearson's correlation analysis was analyzed in order to ob- 14. Lambdoidal (right medial 0.63 < 0.001 0.41 0.001
tain the relation between estimated age and actual age. Although the part)
estimated age mean was not provided in the original article of the Mann 15. Lambdoidal (right 0.67 < 0.001 0.47 0.001
intermediate part)
method, middle point of the estimated age range was used in de-
16. Lambdoidal (right lateral 0.73 < 0.001 0.48 < 0.001
scriptive statistics, bias and inaccuracy, and Pearson's correlation ana- part)
lysis. For the open-ended terminal interval (50 + years), 85 years,
which was the maximum age of individuals in the original study, was Note: * p-value < 0.05 = statistically significant.
used as an upper limit while 50 years was considered as a lower limit.
Table 3c
Intra- and inter-observer observer agreement of the Mann (1991) maxillary suture
3. Results
method on a Thai sample.

Kappa statistics indicating agreement of the observers were shown Suture Intra-observer agreement Inter-observer agreement
in Table 3 (a-c). Inter-observer repeatability test revealed slight to
moderate agreement for Meindl and Lovejoy (1985) V and LA systems. Mann (1991) maxillary Kappa p-value* Kappa p-value*
suture method coef. coef.
Moderate agreement was shown in most of the sutures described in
Acsádi and Nemeskéri (1970) method, except for lambdoidal (left in- 1. Incisive (IN) 0.89 < 0.001 0.85 < 0.001
termediate part) and coronal (left intermediate part) which showed fair 2. Posterior median palatine 0.63 < 0.001 0.45 < 0.001
and almost perfect agreements, respectively. Slight to moderate (PMP)
3. Transverse palatine (TP) 0.58 < 0.001 0.38 0.007
agreement was obtained from the Mann (1991) method, except for
4. Anterior median palatine 0.62 < 0.001 0.09 0.414
incisive suture which showed almost perfect agreement. Furthermore, (AMP)
intra-observer repeatability test exhibited moderate to almost perfect
agreement in all methods. Note: * p-value < 0.05 = statistically significant.
Descriptive statistics of estimated age obtained from each method
are provided in Table 4 (a-d). Bias and inaccuracy obtained from Table 4a
Descriptive statistics of the estimated age obtained from the Meindl and Lovejoy (1985)
method for estimating age using vault cranial sutures on a Thai sample.
Table 3a
Intra- and inter-observer observer agreement of the Meindl and Lovejoy (1985) vault (V)
Age Actual age Estimated age from Meindl and Lovejoy
and lateral-anterior (LA) cranial suture method on a Thai sample.
group V system
(year)
Suture Intra-observer Inter-observer agreement
n* Mean SD Range n* Mean SD Range
agreement
20–29 4 26.8 3.2 22.0–29.0 4 35.2 6.9 30.5–45.2
Meindl and Lovejoy (1985) V Kappa p-value* Kappa p-value*
30–39 16 35.5 2.8 30.0–39.0 14 41.1 4.6 34.7–48.8
and LA systems coef. coef.
40–49 25 44.5 2.9 40.0–49.0 25 42.1 5.0 34.7–48.8
50–59 27 53.3 3.2 50.0–59.0 25 42.0 4.9 34.7–48.8
1. Midlambdoid 0.50 < 0.001 0.21 0.008
60–69 36 63.3 3.3 60.0–69.0 36 44.1 4.4 34.7–51.5
2. Lambda 0.46 < 0.001 0.31 < 0.001
70–79 33 74.4 3.0 70.0–79.0 32 43.2 4.2 34.7–51.5
3. Obelion 0.95 < 0.001 0.41 0.001
80+ 34 84.9 3.0 80.0–90.0 34 42.8 4.7 30.5–48.8
4. Anterior sagittal 0.64 < 0.001 0.38 0.003
Overall 175 62.0 17.0 22.0–90.0 170 42.6 4.8 30.5–51.5
5. Bregma 0.44 < 0.001 0.49 < 0.001
6. Midcoronal 0.50 < 0.001 0.10 0.441
7. Pterion 0.64 < 0.001 0.48 < 0.001 Note: *n = a number of cases is different between actual age and estimated age in some
8. Sphenofrontal 0.40 < 0.001 0.53 < 0.001 age groups due to the cases which contained non-applicable suture site for this method
9. Inferior sphenotemporal 0.69 < 0.001 0.27 0.046 were excluded.
10. Superior sphenotemporal 0.49 < 0.001 0.54 < 0.001

Note: * p-value < 0.05 = statistically significant.

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S. Ruengdit et al. Journal of Forensic and Legal Medicine 53 (2018) 79–86

Table 4b over 50 years. These patterns of over- and underestimation of age were
Descriptive statistics of the estimated age obtained from the Meindl and Lovejoy (1985) found in all groups, except for females. For both systems, bias and in-
method for estimating age using lateral-anterior cranial sutures on a Thai sample.
accuracy were found to be lower in males compared to those of females.
Age Actual age Estimated age from Meindl and Lovejoy For overall age and sex group, this method tends to underestimate the
group LA system age of individuals and has an inaccuracy of approximately 20 years.
(year) Table 5c provides bias and inaccuracy values calculated from Acsádi
n* Mean SD Range n* Mean SD Range and Nemeskéri (1970) method. The method tends to overestimate the
20–29 4 26.8 3.2 22.0–29.0 4 39.4 5.1 32.0–43.4 individuals' age less than 60 years and underestimate the age of in-
30–39 16 35.5 2.8 30.0–39.0 13 41.3 4.9 32.0–51.9 dividuals at 60 years and above for all groups. This method tends to
40–49 25 44.5 2.9 40.0–49.0 25 45.5 4.4 41.1–51.9 underestimate age. The method delivered less bias when utilized with
50–59 27 53.3 3.2 50.0–59.0 26 44.2 4.6 32.0–51.9 males compared to females. The inaccuracy obtained was approxi-
60–69 36 63.3 3.3 60.0–69.0 35 45.8 3.9 41.1–51.9
70–79 33 74.4 3.0 70.0–79.0 33 44.1 4.5 32.0–51.9
mately 14 years. Similar results were found in Table 5d which depicts
80+ 34 84.9 3.0 80.0–90.0 33 44.8 4.8 36.2–51.9 bias and inaccuracy obtained from Mann (1991) method. The method
Overall 175 62.0 17.0 22.0–90.0 169 44.5 4.6 32.0–51.9 revealed underestimation in older age groups (70 + years) and over-
estimation in young and middle age groups (less than 70 years) in males
Note: *n = a number of cases is different between actual age and estimated age in some and overall sexes. In terms of inaccuracy, the lowest inaccuracy was
age groups due to the cases which contained non-applicable suture site for this method
delivered when applied the method on individuals aged of 60–69 years
were excluded.
old. Inaccuracy increased when tested on individuals aged away from a
group of 60–69 years. Inaccuracy was less when applied the method on
Table 4c
Descriptive statistics of the estimated age obtained from the Acsádi and Nemeskéri (1970) males than females. For overall, inaccuracy obtained from Mann (1991)
method for estimating age using endocranial vault sutures on a Thai sample. method was approximately 17 years.
Percentage accuracy of correct age estimation obtained from Mann
Age Actual age Estimated age from AN endocranial (1991) method is demonstrated in Table 6. For overall ages, the accu-
group suture method
(year)
racy percentage was higher in males than females. Accuracy in esti-
n* Mean SD Range n* Mean SD Range mating age was considerably higher in the group of 50 + years than in
the younger individual groups, especially in males when the accuracy in
20–29 4 26.8 3.2 22.0–29.0 2 28.6 0.0 28.6 predicting approached 100%. Magnitude of the deviation of the in-
30–39 16 35.5 2.8 30.0–39.0 12 49.8 12.2 28.6–60.0
correct age phase estimate from Mann (1991) method is also shown in
40–49 25 44.5 2.9 40.0–49.0 22 57.0 6.4 43.7–65.4
50–59 27 53.3 3.2 50.0–59.0 24 56.7 7.6 28.6–60.0 Table 7. Most of the cases were assigned more advanced phases than
60–69 36 63.3 3.3 60.0–69.0 36 58.0 6.0 43.7–65.4 actual age phases for males, in contrast, female were mostly estimated
70–79 33 74.4 3.0 70.0–79.0 32 58.0 4.9 43.7–65.4 into lower age phases than their actual phase.
80+ 34 84.9 3.0 80.0–90.0 33 58.7 5.9 43.7–65.4
Table 8 depicts the relationship between estimated age and the
Overall 175 62.0 17.0 22.0–90.0 161 56.8 7.7 28.6–65.4
actual age for each method. Statistically significant correlations
Note: *n = a number of cases is different between actual age and estimated age in some (p < 0.05) were obtained from Meindl and Lovejoy (1985) V system
age groups due to the cases which contained non-applicable suture site for this method for females, LA system for males, Acsádi and Nemeskéri (1970) method
were excluded. for both sexes, and Mann (1991) method for males. The highest cor-
relation coefficient was derived from Acsádi and Nemeskéri (1970)
Table 4d method when applied to Thai males, on the other hand, the lowest
Descriptive statistics of the estimated age obtained from the Mann (1991) method for correlation was obtained from Meindl and Lovejoy (1985) LA system
estimating age using maxillary sutures on a Thai sample.
when tested with female samples. Furthermore, proportion of the cases
Age Actual age Estimated age from Mann maxillary where actual age fell within ± 1 standard deviation (SD) of the re-
group suture method ported mean age for the assigned composite score or stage for each
(year) method tested is also shown in Table 8.
n* Mean SD Range n* Mean SD Range

20–29 4 26.8 3.2 22.0–29.0 4 59.0 16.0 35.0–67.0 4. Discussion

30–39 16 35.5 2.8 30.0–39.0 15 57.6 16.4 22.0–67.0
40–49 25 44.5 2.9 40.0–49.0 25 57.0 16.7 22.0–67.0 Although inter-observer repeatability test delivered wide range of
50–59 27 53.3 3.2 50.0–59.0 28 57.8 15.2 22.0–67.0
kappa statistics, from slight to almost perfect agreement, intra-observer
60–69 36 63.3 3.3 60.0–69.0 35 63.8 9.8 22.0–67.0
70–79 33 74.4 3.0 70.0–79.0 33 61.6 12.2 22.0–67.0
repeatability test, which effected to further analyses in this study,
80+ 34 84.9 3.0 80.0–90.0 33 61.5 12.8 22.0–67.0 provided satisfactory results. The results for inter-observer repeatability
Overall 175 62.0 17.0 22.0–90.0 173 60.3 13.6 22.0–67.0 showed that it is not easy for an observer to select the exact stage of
closure which is present in the skull based on cranial sutures. This may
Note: *n = a number of cases is different between actual age and estimated age in some
be due to the fact that the time and sequence of the closure of the
age groups due to the cases which contained non-applicable suture site for this method
cranial sutures are very uncertain. However, we could arrive at a sa-
were excluded.
tisfactory estimate of age by this means. This method should be taken in
conjunction with other age indicators given by different skeletal parts.
Meindl and Lovejoy (1985) method are tabulated in Tables 5a and 5b.
Additionally, more details on definition of scoring method for each
The method revealed underestimation for overall age and sex groups.
particular suture or illustrations of each suture position and degree of
For the V system, bias and inaccuracy in males, for overall age, were
closure are warranted.
less than those of females. In males, bias and inaccuracy were decreased
Overall, bias reflected over-age estimation in younger individuals,
until the age group of 40–49 years, and then they were considerably
in contrast, underestimating age often occurred in older individuals
increased with increasing age. Similar results were found in females.
using the Meindl and Lovejoy (1985), Acsádi and Nemeskéri (1970),
The results obtained from Meindl and Lovejoy (1985) LA system
and Mann (1991) methods. Considering the Meindl and Lovejoy (1985)
were consistent with those of their V system. The LA system showed
V system, overestimation of age was found when the method was ex-
overestimation of age when applied with individuals aged less than 50
amined with individuals less than 40 years old for both sexes, while
years. In contrast, the method underestimated the age of individuals
underestimation was found in persons 40 + years old, similar to those

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S. Ruengdit et al. Journal of Forensic and Legal Medicine 53 (2018) 79–86

Table 5a
Bias and inaccuracy for the Meindl and Lovejoy (1985) method for estimating age using vault cranial sutures on a Thai sample.

Age group (year) Males Females Pooled sexes

n1 Bias Inaccuracy n2 Bias Inaccuracy n Bias Inaccuracy

20–29 3 10.5 10.5 1 2.5 2.5 4 8.5 8.5

30–39 10 5.1 6.2 4 4.4 4.4 14 4.9 5.7
40–49 12 −1.3 4.3 13 −3.5 7.4 25 −2.4 5.9
50–59 12 −11.7 11.7 13 −11.4 11.4 25 −11.5 11.5
60–69 21 −19.2 19.2 15 −19.1 19.1 36 −19.2 19.2
70–79 18 −31.6 31.6 14 −30.7 30.7 32 −31.2 31.2
80+ 16 −43.1 43.1 18 −41.1 41.1 34 −42.0 42.0
Overall 92 −18.9 21.2 78 −20.9 22.1 170 −19.8 21.6

Note: *n1 indicates a number of male cases, n2 indicates a number of female cases, and n indicates a number of both male and female cases.

Table 5b
Bias and inaccuracy for the Meindl and Lovejoy (1985) method for estimating age using lateral-anterior cranial sutures on a Thai sample.

Age group (year) Males Females Pooled sexes

n1 Bias Inaccuracy n2 Bias Inaccuracy n Bias Inaccuracy

20–29 3 12.5 12.5 1 13.1 13.1 4 12.7 12.7

30–39 9 4.6 5.9 4 5.7 6.6 13 4.9 6.1
40–49 12 3.1 5.2 13 −1.0 5.2 25 1.0 5.2
50–59 12 −6.8 6.8 14 −11.1 11.1 26 −9.1 9.1
60–69 20 −16.6 16.6 15 −18.4 18.4 35 −17.3 17.3
70–79 19 −29.8 29.8 14 −31.0 31.0 33 −30.3 30.3
80+ 15 −36.9 36.9 18 −42.7 42.7 33 −40.0 40.0
Overall 90 −15.7 18.7 79 −20.4 22.0 169 −17.9 20.3

Note: *n1 indicates a number of male cases, n2 indicates a number of female cases, and n indicates a number of both male and female cases.

Table 5c
Bias and inaccuracy for the Acsádi and Nemeskéri (1970) method for estimating age using endocranial vault sutures on a Thai sample.

Age group (year) Males Females Pooled sexes

n1 Bias Inaccuracy n2 Bias Inaccuracy n Bias Inaccuracy

20–29 1 0.6 0.6 1 0.6 0.6 2 0.6 0.6

30–39 8 12.1 14.7 4 18.7 19.9 12 14.3 16.4
40–49 11 14.9 15.5 11 10.4 11.7 22 12.6 13.6
50–59 11 3.8 5.2 13 2.6 8.1 24 3.1 6.7
60–69 21 −3.7 3.9 15 −7.3 7.9 36 −5.2 5.5
70–79 18 −18.0 18.0 14 −14.6 14.6 32 −16.5 16.5
80+ 15 −25.2 25.2 18 −27.1 27.1 33 −26.2 26.2
Overall 85 −5.6 13.3 76 −7.6 14.8 161 −6.6 14.0

Note: *n1 indicates a number of male cases, n2 indicates a number of female cases, and n indicates a number of both male and female cases.

Table 5d
Bias and inaccuracy for the Mann (1991) method for estimating age using maxillary sutures on a Thai sample.

Age group (year) Males Females Pooled sexes

n1 * Bias Inaccuracy n2* Bias Inaccuracy n* Bias Inaccuracy

20–29 3 30.0 30.0 1 39.0 39.0 4 32.3 32.3

30–39 10 20.8 22.0 5 23.8 30.2 15 21.8 24.7
40–49 12 23.4 23.4 13 2.5 18.8 25 12.5 21.0
50–59 12 12.2 13.0 16 −0.9 16.6 28 4.7 15.0
60–69 21 1.6 4.6 14 −1.1 8.9 35 0.5 6.3
70–79 19 −7.5 7.5 14 −19.9 19.9 33 −12.7 12.7
80+ 15 −18.7 18.7 18 −27.6 27.6 33 −23.5 23.5
Overall 92 3.7 13.8 81 −7.6 19.7 173 −1.6 16.5

Note: *n1 indicates a number of male cases, n2 indicates a number of female cases, and n indicates a number of both male and female cases.

obtained from the method utilizing LA cranial sutures in females. In
contrast, for males, using LA system, 50 years was the age that the
estimation turned from over-aging to underestimation of age. Gocha
and colleagues found similar patterns from the test of six aging tech-
niques including the Meindl and Lovejoy (1985) method on 88 Thai
skeletons20 For both V and LA systems, the study revealed over-
estimation for males under 40 years and underestimation for males
older than this age as well as to those found in the study of Wolff and
colleagues on Hungarian skeletal remains.15 On the other hand, a cut-
ting age of this over- and under-aging pattern was younger in females –

83
S. Ruengdit et al. Journal of Forensic and Legal Medicine 53 (2018) 79–86

Table 6 Nemeskéri (1970) study seemed to have similar age composition to that
Percentage accuracy of the Mann (1991) method for estimating age using maxillary su- of the present study.
tures on a Thai sample.
Inaccuracy values obtained from the Meindl and Lovejoy (1985),
Age group (year) Males Females Pooled sexes Acsádi and Nemeskéri (1970), and Mann (1991) methods were rela-
tively high for overall sex and age. Utilizing endocranial suture method
n1 * % n2* % n* % performed better than using ectocranial suture sites and maxillary su-
tures by providing less inaccuracy – 14 years. Regarding sex, all
20–24 0/1 0 – – 0/1 0
25–29 0/2 0 0/1 0 0/3 0 methods worked well – having less inaccuracy – in males than in fe-
30–40 3/11 27.3 0/7 0 3/18 16.7 males. Although the inaccuracies obtained from the test seemed high,
41–49 0/11 0 0/11 0 0/22 0 they were relevant with those of other studies.14,20 The test of Meindl
50+ 65/67 97.0 43/62 69.4 108/129 83.7 and Lovejoy (1985) method on Thai samples in the study of Gocha et al.
Overall 68/92 73.9 43/81 53.1 111/173 64.2
gave the inaccuracy values between 14 and 15 years for LA system and
Note: *n1 indicates a number of male cases, n2 indicates a number of female cases, and n 15–17 years for V system for both males and females, respectively.20
indicates a number of both male and female cases. These results were reinforced by the finding from this study which LA
system tended to perform better than V system. Nonetheless, V system
Table 7 provided less inaccuracy for both sexes in Whites and for females in
Percentage of incorrect age estimates using Mann (1991) method in each deviation of Blacks from the test on the Terry Collection samples.14 Regard to the
estimated phase away from actual phase. same study, the Acsádi and Nemeskéri (1970) system provided similar
result of inaccuracy to the test of this method on Thais in the present
Sex Magnitude of the deviation of the incorrect age phase estimate (%)
study. It was evident that the inaccuracy values markedly increased
−4 −3 −2 −1 +1 +2 +3 when tested on older adults for all methods suggesting efficacy of the
methods significantly decreased when applied to elderly people. Re-
Male 0 0 0 2.2 12.4 10.1 2.2
gardless to the sample composition difference between reference and
Female 5.1 2.5 19.0 7.6 5.1 7.6 1.3
target samples, much error in estimation when deals with old in-
dividuals have been one of the key problems of all traditional adult
30 years old.20 In the present study, the turning age from over-to un- aging method for decades.2
derestimation of age derived from Acsádi and Nemeskéri (1970) and The test of the Mann (1991) method reveals high efficiency when
Mann (1991) methods was older than those of Meindl and Lovejoy applied to individuals aged 50 years and above, especially males. The
(1985) systems. This was consistent with the test of endocranial suture results of Ginter's study, a test of Mann (1991) method on the samples
method to the Terry Collection as well as the study on Hungarian from South Africa also showed correct estimating age for 90% who aged
samples.14,15 The turning age of overestimation in young adults to 50 years and above.23 This result was similar to those reported in the
under-aging in elderly people was 60 years old in the Terry Collection study of Apostolidou and colleagues on Greek samples. The correct
while 50 years of age was the cutting age found on Hungarian in- estimates for individuals over 50 years were higher than those of fewer
dividuals. Galera et al. also found the similar results when tested the than 50 years.22 Beauthier et al. also found a slower rate of obliteration
method of Meindl and Lovejoy (1985). The method overestimated in maxillary sutures than vault sutures on Belgian skeletal samples. The
young individuals (less than 40–45 years) and underestimated older authors suggested this finding could be used as corroborative in-
individuals (more than 40–45 years).14 formation on old individuals.21 Additionally, the authors noted that
These phenomenon described above seem to be affected by age correct estimates were better in males (85%) than females (80%), as
mimicry.2 The estimated age was biased to the age composition of the well as those reported in the original article of Mann17 and other studies
reference sample used to develop the method.34,35 For instance, if the of the Mann (1991) method.21–25 Similar to the results of deviation of
majority of individuals in the reference study was young individuals – estimated phase away from actual phase, percentage of the cases that
less than 50 years old, the probability that a target sample which had were incorrect age phase estimated in females (48.2%) was higher than
trait a, would belong to younger might be greater than the probability in males (26.9%). Most of the incorrect age phase estimates were
that the unknown having trait a would belong to older individual, even overestimation in males. In contrast, most of the incorrect age esti-
this trait is naturally a characteristic of old individuals. mated cases in females were underestimation. Underestimation of age
Considering the age composition of the samples in this study com- when using this method was also reported in the study of Ginter et al.23
pared to those of reference method and other studies, the present study and Apostolidou and colleagues22 as well as the original study of
has composition of relatively older individuals – mean age of approxi- Mann.17 In contrast, slight overestimation (0.09 years) was reported in
mately 60 years. Underestimation of age that found when applied the the study of Brown when applying the Mann (1991) method to the
Meindl and Lovejoy (1985) methods might because the age composition skeletal remains of missing American servicemen.24
of the sample in Meindl and Lovejoy (1985) study was younger than It was evident that the Mann (1991) method was effective for in-
that of this study. On the other hand, the sample of Acsádi and dividuals aged 50 years and older in a Thai population, however, the

Table 8
Pearson correlation coefficients and associated p-values for each age estimation method and the proportion of individuals where actual age was within ± 1 standard deviation (SD) of the
reported mean age for the assigned composite score or stage for each method tested.

Method Males Females Pooled sexes

r p-value ± 1 SD (%) r p-value ± 1 SD (%) r p-value ± 1 SD

(%)

ML vault system 0.139 0.186 27.2 0.234 0.039* 26.9 0.186 0.015* 27.1
ML lateral-anterior system 0.290 0.006* 41.1 −0.063 0.581 31.6 0.121 0.118 36.7
AN endocranial suture system 0.353 0.001* 52.9 0.258 0.024* 50.0 0.299 < 0.001* 51.6
Mann maxillary suture system 0.296 0.004* N/A 0.088 0.432 N/A 0.119 0.118 N/A

Note: * p-value < 0.05 = statistically significant.

84
S. Ruengdit et al.
age estimation range was very wide (50 + years), which might not be
useful in forensic circumstances that require narrow age estimation
ranges. It would be more advantageous if the method applying max-
illary suture closure could deliver more precise age prediction in old
adults, but the nature of maxillary sutures might not be suitable for this
idea.23 Nevertheless, the Mann (1991) method is useful for personal
identification in mass disasters or missing person situations as it can
effectively categorize unknown skeletal remains into three age groups:
young, middle, and old adults. It would be more effective, especially in
old males, if applied in conjunction with other aging methods such as
the auricular surface of the ilium5 which performs well in old in-
dividuals.
The proportion of cases fell within ± 1 SD indicates that, among
Meindl and Lovejoy (1985) V and LA systems and Acsádi and
Nemeskéri (1970) method, the method applying endocranial suture
closure showed the highest proportion of cases for both males and fe-
males. The results were suggestive to the relationship between esti-
mated age obtained from each method and actual age. The Acsádi and
Nemeskéri (1970) method provided statistically significant correlation
with the highest correlation coefficient for both sexes. These results
indicate that this method which considered the closure of endocranial
sutures worked better than Meindl and Lovejoy (1985) approach ex-
amining ectocranial suture closure and the Mann (1991) method uti-
lizing maxillary sutures. This was also supported by the lowest bias and
inaccuracy values obtained from Acsádi and Nemeskéri (1970) method
compared to those of the Meindl and Lovejoy (1985) and Mann (1991)
methods.
Considering the error rate obtained in this study, the results indicate
low efficacy when compared to other studies which applied traditional
aging techniques to Thai samples.20,29 The error in age estimation ob-
tained when applied cranial suture closure might cause from various
factors. The rate of suture obliteration and disparity between morpho-
logical change and age also vary in different populations.23 Genetic
factors do effect to the suture obliteration in terms of age relation.36
Pattern of obliteration and biomechanical stress have to be taken into
consideration. There are unobservable factors: diet and nutrition, en-
vironment and culture, and individual health which cause variation of
cranial suture closure among populations.37
The present study provides a test of traditional aging methods using
cranial suture closure. The results suggested that endocranial sutures
from Acsádi and Nemeskéri (1970) method, vault and lateral-anterior
systems of Meindl and Lovejoy (1985), and maxillary sutures of Mann
(1991) method provided poor efficacy, over-and underestimation of age
with high inaccuracy, when applied to Thai individuals. However,
anterior median palatine suture from Mann (1991) method indicates
obliteration in 50 years and above-individuals, delivered effective age
estimates for Thais. This study might be limited due to the majority of
the samples were older adults. It would be much better if all age ranges
had equal or similar sample size unless high bias (overestimation) and
inaccuracy when tested on young age group might not be solely affected
by the age composition of the reference sample in the original study.
Small sample size in young age group, especially in females, might be
not enough to present true bias and inaccuracy. However, these three
age estimation methods may still be utilized as age indicators and
should be used in conjunction with other adult aging techniques.
Advanced statistical techniques; for example, transition analysis and
Bayesian approach which considers the prior information that influ-
ences the estimation on the target sample are recommended for forensic
age estimation. Further research which considers cranial suture closure
as a whole would likely improve the age estimation performance.
Sutures on the other area of cranium; for instance, nasal sutures,
sphenomaxillary sutures, and endocranial sutures at the cranial base
probably perform as a good age indicator. In addition, application of
advance technique likes medical imaging might provide better detail
and information of suture closure which might be able to increase
knowledge and efficiency of aging technique from this skeletal trait.
85
Journal of Forensic and Legal Medicine 53 (2018) 79–86
Furthermore, methods utilizing suture closure as developed from a
sample of Thai crania might provide better results for estimating age of
Thai skeletal remains.
Conflicts of interest
None.
Acknowledgements
The authors would like to thank Prof. Dr. Robert W. Mann of the
John A. Burns School of Medicine of the University of Hawaii for his
guidance and suggestions on applying the Mann method. We are
grateful to Mr. Wirut Kantha at the Department of Anatomy, Chiang
Mai University who facilitated the examination of all skeletons. We also
thank the research administration section, Faculty of Medicine at
Chiang Mai University for their financial support of this project
(Research ID: ANA-2560-04492).
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