Age estimation from anterior cervical vertebral ring apophysis ossification in South Africans

Age estimation in living individuals around the age of 18 years remains a difficult challenge. In this study, the anterior inferior vertebral ring apophysis development of cervical vertebrae C2, C3, and C4 of 496 white and 478 black South African individuals aged between 15 and 22 years was assessed from cephalometric radiographs. Apophysis development was scored according to a four-stage scoring system. Ancestry and sex differences in apophysis maturation were assessed and likelihood values determined for individuals in each population group being 18 years, based on developmental stages. Regression equations were developed for each ancestry and sex group. The results indicated that the median ages for attainment of stages 0, 1, and 2 were below the 18-year threshold for all ancestry and sex groups. Additionally, WSA males and BSA females attained stage 3 for C2, and WSA females attained stage 3 for C2, C3, and C4, below the 18-year threshold. The presence of stage 0 for black and white males in all three observed vertebrae and stage 1 for black males for C2, C3, and C4, white females for C2 and C3, and white males for C4 indicates an age below 18 years (with a 95% or higher probability). The results indicate that anterior inferior apophysis ossification stages of C2, C3, and C4 can be used as a reliable indicator to determine the likelihood of being 18 years of age at a 95% confidence index level. Apophysis development provides a valuable addition to the methods that can be used to assess age in the adolescent years.