Third molar maturity on panoramic radiographs as an indicator of the 18-year threshold: a pilot cases study

This study aimed to assess the reliability of the Demirjian and Olze staging systems for mandibular third molars using panoramic radiographs in a medico-legal context. A retrospective pilot study was conducted on 25 medico-legal cases from a Medico-Legal Institute. Panoramic radiographs were evaluated using the Demirjian (A-H) and Olze (0-3) methods. Chronological age was compared with radiographic findings. Statistical analyses included sensitivity, specificity, predictive values, and Cohen's kappa coefficient. Demirjian stage H and Olze stages 2-3 were observed only in individuals aged 18 years or older, whereas stages C-G and Olze stage 0 were found exclusively in those under 18. Both staging methods demonstrated high diagnostic performance within this sample, with sensitivity, specificity, and predictive values reaching 100% for identifying legal adulthood. Agreement between methods was complete (κ = 1.00), with high inter- and intra-observer reliability (κ = 0.84; ICC = 0.92). No significant sex-related differences were observed. Panoramic analysis of third molars appears to be a promising, reproducible, and ethically acceptable approach for distinguishing minors from adults in this medico-legal context. However, given the pilot design and limited sample size, these findings should be interpreted with caution. Larger multicenter studies, including the integration of skeletal indicators, are required to establish robust and generalizable reference standards.