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Article

Novel Quantitative Approach for Age Estimation Using Facial Suture Closure and Modified Scoring Systems

by
Siriwat Thunyacharoen
1,
Chirapat Inchai
1 and
Pasuk Mahakkanukrauh
1,2,*
1
Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
2
Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai 50200, Thailand
*
Author to whom correspondence should be addressed.
Appl. Sci. 2026, 16(7), 3591; https://doi.org/10.3390/app16073591
Submission received: 12 February 2026 / Revised: 21 March 2026 / Accepted: 2 April 2026 / Published: 7 April 2026
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Abstract

Background: While human cranial sutures are well-established indicators for age-at-death estimation in forensic anthropology, facial sutures remain an underutilized resource despite their critical role in facial growth and development. Macroscopic examination of craniofacial suture closure patterns reflects physiological aging processes and can provide valuable information at crime scenes. This study aimed to address the gap of knowledge by quantitatively evaluating the efficacy of facial suture closure patterns for age estimation. Methods: A sample consisting of 296 Thai skulls was analyzed to assess facial suture closure based on anatomical morphology. The sutures were evaluated using various established classification systems to determine the most effective method for predicting age ranges. To ensure consistency and reliability, the evaluations were conducted by three independent raters. Results: The assessment demonstrated good Intraclass Correlation (ICC = 0.755, df = 14, p < 0.05). Among the classification methods tested, the Modified Meindl and Lovejoy Scoring System yielded the highest sensitivity, ranging from 90.9% to 100% in males and 75.4% to 96.1% in females. Specifically, the zygomaticomaxillary suture showed the highest sensitivity in males, whereas the frontonasal and sphenozygomatic sutures were the most sensitive indicators in females. Utilizing the total sum score (TSS), the following sex-specific linear regression formulas for age-at-death were generated: (Males: Age-at-death = 1.7625(TSS) − 17.094. Females: Age-at-death = 1.7325(TSS) − 12.865). Conclusions: Facial sutures exhibit distinct, sex-specific closure patterns that serve as robust and reliable indicators for estimating age, with higher sensitivity generally observed in males. The utility of this novel method is heavily dependent on the scoring system employed, highlighting the critical importance of utilizing modified, sex-specific analyses. While these population-specific models tailored to the Thai demographic effectively refine age estimation outcomes, integrating this methodology with broader biological profiling remains essential for high-confidence forensic identification.

1. Introduction

In adults, the human skull is composed of 22 bones interconnected by cranial sutures, providing structural support and protection. It can be categorized into the neurocranium, which safeguards the brain, and the viscerocranium, which forms the facial structure. Biological identification of skeletonized human remains is a critical task in forensic and medicolegal investigations, particularly for determining age-at-death [1]. The biological profile, which includes chronological age, biological sex, stature, and ancestry, can be assessed using metric methods (e.g., measurements and mathematical formulas) or nonmetric techniques (e.g., visual observation and categorical scoring) [2,3]. Among these components, age estimation remains challenging, especially in older individuals.
The skull, frequently recovered at crime scenes, provides valuable information for age estimation [3,4]. Craniofacial sutures have long been recognized as important indicators of age, with closure patterns reflecting physiological aging processes [4,5,6,7,8,9,10]. Sutures serve as growth boundaries, facilitating cranial and facial bone development during postnatal growth and responding to biomechanical and signaling cues throughout life [11]. Despite their significance, facial sutures have received relatively less attention in age estimation studies compared to other cranial sutures.
Several scoring systems have been developed to assess suture closure. Todd and Lyon introduced an observational system using scores from zero to four, documenting the degree of closure [1,4,12,13]. They suggested that suture closure follows a specific pattern over time [1,4,6,14]. The Acsádi and Nemeskéri method subdivides sutures into smaller segments, applying a weighted scoring system that reflects early rapid closure followed by slower progressive closure. This system has been applied to various skeletal age indicators, including pubic symphysis and cranial sutures, demonstrating its utility in multifactorial age estimation [1,2,4,5,15,16,17]. Meindl and Lovejoy further refined suture scoring by focusing on ectocranial sutures, which close later in life, providing a straightforward and reliable assessment for forensic purposes [1,8,11,18]. The Frédéric Rating Scale, employing a five-point scale based on percentage of suture closure, adds an additional evaluative framework, including radiographic assessments [19,20].
The development of the skull originates from the ectodermal neural crest and mesoderm during embryonic development. The process of suture formation begins with the emergence of sutural mesenchyme, which differentiates from embryonic mesenchyme and subsequently deposits an extracellular matrix that undergoes mineralization. Furthermore, the regulation of suture formation appears to be influenced by growth factor signaling along the osteogenic fronts of neighboring bones [21,22]. Stem cells in the cranial sutures play a crucial role in development by directly differentiating into osteoblasts [23]. Osteoblasts are responsible for the secretion of an extracellular matrix that includes type I collagen, along with various other collagens and proteoglycans. As mineralization progresses, the flat bones of the skull expand, extending from the cranial base toward the apex of the cranium [24,25]. Sutures serve as sites for bone growth that react to biomechanical environments and signals. These signals are converted into cellular communication at the sutures, leading to the activation of osteoblast differentiation and, consequently, the process of bone ossification [24,26]. The processes of craniofacial expansion and suture development are regulated by a diverse array of signaling pathways [27,28].
Although previous research has predominantly focused on cranial sutures, limited studies have systematically evaluated facial sutures for age estimation. Facial sutures are critical to facial development and present an underutilized resource for estimating age. When skulls are the well-preserved components of the skeleton available for constructing a biological profile or injury of vault sutures, the shape of craniofacial sutures can be extremely valuable in assisting with identification. This study aims to quantitatively assess facial suture closure in a Thai population, employ population-specific validation with specific demographic or ethnic groups, examine the correlation between suture union and age-at-death, and develop a reliable method for age estimation using modified scoring systems.

2. Materials and Methods

2.1. Sample Collection and Preparation

This research employed a methodological approach based on morphological observation coupled with cross-sectional considerations. The study utilized a skeletal sample representative of the Thai population, with a primary focus on individuals from Northern Thailand. These human skulls were sourced from the Osteology Research and Training Center (ORTC) at Chiang Mai University, Thailand, a premier osteological repository in Southeast Asia. The comprehensive dataset comprises crania derived from cadavers donated between 2012 and 2025. All cadavers were meticulously processed into dry bone by the academic staff of the Department of Anatomy, Faculty of Medicine, Chiang Mai University. The ORTC was selected as the research locus due to its status as a well-curated and expansive bone bank, providing the high volume of cranial cases necessary for statistically robust skeletal analysis and forensic validation. There were 296 cadaver skull samples; 159 males and 137 females with age range of 26–100 years old. Traumatic craniofacial fractures, craniofacial surgery, pathological disorders such as congenital abnormalities, thalassemia trait, and osteoporosis were excluded from the study. The structure of the facial suture of each skull, especially ectocranial sutures, must be observed clearly from Figure 1.
In the present study, the Acsádi and Nemeskéri Scoring System, the Meindl and Lovejoy Scoring System, and the Frédéric Rating Scale have been applied to discriminate the range of age and to verify the accuracy of each classification.

2.2. Morphological Classification

(1)
Acsádi and Nemeskéri Scoring System.
Nemeskéri et al. developed a sophisticated technique for age estimation based on cranial suture closure in a Hungarian population. This method, known as the complex method, involves the assessment of age using four skeletal indicators, which include the degree of endocranial closure, the morphology of the pubic symphysis, and the internal structural changes observed in the proximal humerus and femur. The complex method relies on macroscopic visualization, and later iterations also included the ectocranial sutures. Acsádi and Nemeskéri proposed that cranial suture closure remains an essential age marker when combined with other age biomarkers. Table 1 presents the description and classification of the Acsádi and Nemeskéri Scoring System.
(2)
Meindl and Lovejoy Scoring System.
Meindl and Lovejoy investigated a novel approach to assess cranial suture closure using the Hamann–Todd collection (Cleveland, Ohio), focusing solely on the ectocranial surface. The researchers argue that this approach enhances the accuracy of age estimation in older individuals, a demographic that requires updated forensic standards. To apply this method, specific suture landmarks were carefully identified. All sutural activity within a one-centimeter circle around these landmarks was meticulously examined, while any activity outside of this boundary was disregarded. Scores were recorded for each site using a simplified scale to ensure consistency and inter-observer reproducibility. By applying this technique, the closure of sutures in each region was rated on a scale from 0 to 3 based on the degree of obliteration. Table 2 presents the description and classification of the Meindl and Lovejoy Scoring System.
(3)
Frédéric Rating Scale.
Frédéric conducted an initial examination of cranial suture closure utilizing a significant sample size. The closure patterns were evaluated using the Frédéric Rating Scale, which ranges from 0 to 4 based on the morphological appearance of the suture and the percentage of obliteration. Table 3 presents the description and classification of the Frédéric Rating Scale.
For this study, the novel platform modified scoring systems that utilize both the highest and subordinate levels for the purpose of establishing grades and computing the equation. In practical age estimation within forensic evidence, we utilize various pieces of evidence to assess the age range. The scoring of both the highest and subordinate scores must adhere to the definitions of each classification. The measurements for the closure of facial sutures across various classifications are collected and analyzed for sensitivity across different age groups.

2.3. Statistics Analysis

Suture closure patterns were evaluated using three established frameworks: the Acsádi and Nemeskéri Scoring System, the Meindl and Lovejoy Scoring System, and the Frédéric Rating Scale. Closure levels were determined based on the macroscopic anatomical appearance of the sutures. To mitigate subjective bias and ensure diagnostic rigor, two observers performed the assessments collaboratively, utilizing a consensus-based scoring approach to reach a mutual agreement on each specimen. The scores were then documented in a custom record sheet. The sensitivity was calculated by proportion of true positive (the age of sample with the highest level of each classification) divided by true positive and false negative (the age of sample with the other level of each classification).
To calculate the sample size of morphological study, follow the formula
n = z α 2 2 × p   1 − p d 2
  • n = Sample size.
  • z = The number of standard deviations that a certain value for the selected alpha level at 0.05.
  • p = The estimate possibility of corrected percentage of age estimation (received from pilot study; p = 0.8531).
  • d = Acceptance margin of error of proportion (5%).
n = 1.96 2 × 0.8531   1 − 0.8531 0.05 2 = 193   cases .

3. Results

Based on the established criteria, the skulls evaluated seem to be associated with a different sex. Concerning the description, the scale for the closure of different classifications is gathered to assess the sensitivity between score frequency and age. Table 4 presents the type of facial suture with different classifications compared to the sensitivity. These sutures elucidate the age range, about 7–30 years. The sensitivity of comparison comprises using the highest level only and using the highest level and the subordinate level.
The intra-observational assessment of 10 parameters of three classifications related to the facial suture revealed that the p-value indicated no statistically significant differences in the mean measurements at least once in each sample measurement with p > 0.05. The reliability of intra-observation was determined using the p-value from a one-way ANOVA test, which reflects the self-reliability of the measurements. Additionally, inter-observer error was assessed for all parameters of the facial suture to evaluate their reliability and repeatability. A total of twenty-five cases were randomly selected and remeasured by three observers. All measurements were compared using the technical error of measurement (TEM) and the coefficient of reliability (R) to estimate precision with range 0.90–0.98. Parameter observations indicated that the p-value did not reveal any statistically significant differences in the mean of measurements across at least one instance in each sample measurement (p > 0.05). In other words, there is no statistically significant difference in the mean among any pairs of similar samples. Three raters calculated Intraclass Correlation (ICC) with good reliability (ICC = 0.755, at df = 14, p < 0.05). The intra-observation reliability was assessed using the p-value derived from a one-way ANOVA test, which reflects the self-reliability of the measurements. Overall, while no significant differences were found between observations or among observers, slight variations indicate that methods utilizing a detailed classification achieve greater intra- and inter-observer consistency and reduce observer error.
The juncture where these two maxillary bones merge is the intermaxillary suture. This suture is observed in this study. From 18 to 20 years old, the intermaxillary suture has complete closure (using score four in the Acsádi and Nemeskéri Scoring System, score three in the Meindl and Lovejoy Scoring System and score four in the Frédéric Rating Scale) in about 74.1%, 80.3% and 62.4% of the male sample and 45.5%, 53.7% and 34.2% of the female sample by using the Acsádi and Nemeskéri Scoring System, the Meindl and Lovejoy Scoring System and the Frédéric Rating Scale, respectively.
In addition, the highest score and subordinate score of each classification are used to calculate the sensitivity of them. The sensitivity of each classification is 98.8%, 99.4%, and 96.3% in the male sample and 91.1%, 92.7%, and 85.4% in the female sample by using the Acsádi and Nemeskéri Scoring System, the Meindl and Lovejoy Scoring System and the Frédéric Rating Scale, respectively.
For example, in the case of the male sample, the sensitivity of the Acsádi and Nemeskéri Scoring System is 74.1%, and the intermaxillary suture is completely closed in score four. On the other hand, the sensitivity can be 98.8% if we apply the closing scores of three and four.
In 20–30 years of age, the internasal suture has complete closure (using score four in the Acsádi and Nemeskéri Scoring System, score three in the Meindl and Lovejoy Scoring System, and score four in the Frédéric Rating Scale) in about 73.5%, 80.3% and 61.7% of the male sample and 57.7%, 66.7% and 44.7% of the female sample by using the Acsádi and Nemeskéri Scoring System, the Meindl and Lovejoy Scoring System and the Frédéric Rating Scale, respectively.
Furthermore, sensitivity was determined by utilizing the maximum and minimum scores within each classification. For the male sample, the Acsádi and Nemeskéri Scoring System, the Meindl and Lovejoy Scoring System, and the Frédéric Rating Scale yielded sensitivities of 96.3%, 99.4%, and 95.1%, respectively. Corresponding sensitivities for the female sample were 90.2%, 93.5%, and 91.9%.
The frontonasal and sphenozygomatic sutures indicate an age estimation range of approximately 50–60 years. Sensitivity analysis in this context involves comparing the use of the highest closure level exclusively against a combination of the highest and subordinate levels. Similarly, the facial closure of the frontoethmoidal and sphenotemporal sutures typically occurs during the fifth and sixth decades of life. In contrast, the frontomaxillary suture provides an age estimation range of roughly 70–100 years, as cadaveric investigations demonstrate that closure does not initiate until the seventh decade.
The zygomaticomaxillary suture has been observed to remain inconsistently interdigitated through the seventh decade. As the most lateral suture of the face, the zygomaticotemporal suture is among the last to close, with interdigitation beginning in the seventh decade of life. Finally, the frontozygomatic suture, which is the sole suture of the lateral orbital rim, typically exhibits closure between the eighth and tenth decades. Table 4 compares these facial sutures and the sensitivity of their classification across different sexes and sides.
Figure 2 shows the correlation between total sum score using the summation score of the Meindl and Lovejoy classification on external morphology of all suture skull with age-at-death. The equations of age determination are constructed with
Age-at-death in males = 1.7625(TSS) − 17.094; R2 = 0.7644, RMSE 6.9304 and
Age-at-death in females = 1.7325(TSS) − 12.865; R2 = 0.7702, RMSE 7.5010.

4. Discussion

The human skull tends to exhibit greater substance compared to other bones in the forensic scene or in some circumstances, making it essential to enhance the utility of cranial indicators as a key objective [1,2,3]. The facial structure is one of the structures of the skull and can be used as one aspect for age estimation [4,10]. This study shows the novel method for age estimation by using three classifications for evaluating the range of age. In this study, facial sutures demonstrated distinct closure patterns that can be used for age estimation, with higher sensitivity observed in males than females across all evaluated sutures. This supports the potential utility of facial sutures as reliable cranial indicators in forensic age estimation.
The intermaxillary suture is situated directly beneath the anterior nasal spine, centrally between the maxillary bones. Typically, it is mostly closed by age 18, although it may remain partially open into the late 20s [29]. The process of closing the intermaxillary suture typically starts during the teenage years, with the rate of progression differing among individuals due to factors such as chewing forces, genetic diversity, and hormonal influences [30,31].
The closure of the internasal suture initiates in the 20s and is generally completed by the 30s in cadaveric specimens [32]. It was anticipated that the internasal suture would yield a high level of accuracy when assessing its closure through CT images, given that its alignment is fairly linear in the superior–inferior orientation [33].
Research indicates that closure of the frontonasal suture occurs during the fifth to sixth decades of life in cadaver studies [34]. While the closure patterns of the frontonasal suture exhibit significant variability, the distinctiveness of this suture for an individual has yet to be examined. The initial findings indicate that the morphological characteristics of the frontonasal suture may be a valuable tool for determining age-at-death with three-dimensional (3D) computed tomography [34,35].
Sphenozygomatic suture closure is observed between the fifth and sixth decades of life in cadaveric examinations [36]. Frontoethmoidal suture closure typically presents between the fifth and sixth decades of life [36]. The sphenotemporal suture links the sphenoid bone with the squamous part of the temporal bone. The closure of the sphenotemporal sutures begins in the sixth decade of life [37].
The closure of the frontomaxillary sutures begins in the seventh decade of life, as observed in cadaver studies [38]. The zygomaticomaxillary suture serves as the fibrous joint between the zygomatic process of the maxilla and the maxillary process of the zygomatic bone, remaining partially interdigitated until the seventh decade of life in the Cone-beam CT imaging examination [39]. The zygomaticotemporal suture is among the last to undergo closure, with interdigitation commencing in the seventh decade of life [40].
The frontozygomatic suture is the only suture found at the lateral border of the orbit. The alterations noted in the frontozygomatic suture developed progressively from 20 to 95 years. As individuals age, the bony surfaces of this suture generally exhibit greater irregularity. This irregularity arises from the elongation and proliferation of bony projections from both the frontal and zygomatic bones into the sutural region. The frontozygomatic suture in humans typically experiences synostosis in the eighth decade of life; however, it does not achieve complete fusion by the age of 95. As individuals age, the bony surfaces of craniofacial sutures tend to become progressively irregular [41].
The observed variation in suture closure, such as early intermaxillary suture fusion in the late teens and delayed frontomaxillary suture closure into the seventh decade, likely reflects differences in local biomechanical stress, genetic predisposition, and hormonal regulation. Facial sutures act as dynamic growth boundaries, contributing to craniofacial morphogenesis throughout life. These findings are consistent with prior cadaveric studies indicating progressive closure of the frontonasal and sphenozygomatic sutures during the fifth to sixth decades of life. Similarly, Meindl and Lovejoy’s scoring approach emphasized ectocranial sutures for reliable age determination, supporting the present results regarding the utility of lateral anterior sutures. The regression equation used for estimating age is regarded as moderately acceptable with R2 = 0.7644 in males and R2 = 0.7702 in females. In evolutionary biology, the reason males usually present prominent traits comes down to sexual dimorphism. Nevertheless, facial suture closing can be affected by high movement and high activity on the craniofacial structure. The sutural closing in males may be an error from these factors. The pattern of cranial suture obliteration assists in confirming an individual’s age during their later years. Cranial sutures serve as one of the criteria utilized for age determination. Similarly, the obliteration pattern of facial sutures aids in verifying an individual’s age in their later years. Near-complete obliteration of sutures is typically observed in individuals over the age of 60. It is essential for the observer to be diligent in grading according to the classification. Indeed, a significant challenge in forensic age estimation lies in the application of population-specific data alongside multi-ethnic datasets [16].
Sarnat described endochondral, appositional, and sutural growth as the fundamental factors driving the postnatal development and morphogenesis of the upper craniofacial structure [42]. Facial sutures are patent at birth and undergo a continuous process of ossification throughout life. Because craniofacial suture development and obliteration are genetically programmed and responsive to mechanical stimuli, they are precisely regulated along defined vectors—such as masticatory force—rather than immediately expansionary [4,23]. A facial morphometric study represents a non-invasive approach that has recently demonstrated promising applications, particularly in age estimation. This technique can be utilized independently or in combination with other established methods for assessing age [43]. As individuals age, facial sutures experience obliteration, a process that can be evaluated through a scoring system. The obliteration of cranial sutures demonstrates a statistically significant relationship with chronological age [44]. Lovejoy [18] demonstrated that the ectocranial closure of lateral anterior sutures serves as a reliable method for determining age. The quantitative assessment of facial sutures, specifically through scoring systems or three-dimensional imaging, provides a practical, non-invasive framework for age estimation. Such methodologies are particularly valuable in supplementing forensic protocols when only fragmentary cranial remains are available. These findings indicate that sutures undergo gradual closure over an extended timeframe, exhibiting a predictable pattern correlated with chronological age [1,4,8,18,34,36]. However, limitations of the current study include its specific focus on a Thai population and potential inter-observer variability in visual scoring. Future research should investigate the applicability of facial suture assessments across diverse ancestral groups and explore automated, imaging-based systems to enhance reproducibility and diagnostic accuracy.

5. Conclusions

Based on the criteria established, the skull examined appears to correspond to a different sex, as supported by the analysis of sutural closure across the entire skull. The study of facial sutures and their closure patterns offers valuable insights into age estimation, with different scoring systems providing varying levels of sensitivity for both males and females.
Various methodologies for age estimation through skeletal analysis—specifically focusing on facial suture obliteration—were evaluated within a Thai population. The results indicate that facial suture closure serves as a reliable proxy for chronological age, although individual sutural parameters demonstrate varying levels of sensitivity depending on the scoring classification applied. A comparative analysis between the age estimates derived from three distinct methods and the known chronological ages within the sample confirms that these criteria are effective for determining age-at-death. These findings suggest that while these three aging methods are efficacious, they should be integrated into a multi-methodological framework to enhance accuracy. Furthermore, developing population-specific models tailored to the Thai demographic may further refine age estimation outcomes. While these results are promising, additional biological profiling remains essential for high-confidence forensic identification. Ultimately, this study validates the utility of facial sutures as robust indicators of age and underscores the critical importance of sex-specific analysis and modified scoring systems.

Author Contributions

Conceptualization, S.T. and P.M.; methodology, S.T. and C.I.; validation, S.T. and C.I.; formal analysis, S.T. and C.I.; investigation, S.T. and P.M.; resources, P.M.; writing—original draft preparation, S.T.; writing—review and editing, S.T., C.I. and P.M.; supervision, P.M.; project administration, C.I. and P.M.; funding acquisition, S.T., C.I. and P.M. All authors have read and agreed to the published version of the manuscript.

Funding

The author would like to thank those who donated their body for study and research. The authors are very pleased with the subsidies from the Excellence in Osteology Research and Training Center, Faculty of Medicine, Chiang Mai University, and partial cooperation from Chiang Mai University. The research project has been funded by the National Research Council of Thailand (NRCT) to Siriwat Thunyacharoen (Contract No. N41A661175). Thank you to the prestigious Royal Golden Jubilee (RGJ) PhD Scholarship for this support.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Research Ethics Committee of Chiang Mai University (protocol CODE: ANA-2567-0499, EXE-2567-0139-001349; 29/08/2024).

Informed Consent Statement

Informed consent was obtained from all subjects for the use of their anonymized data in the analysis and publication of this paper.

Data Availability Statement

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Acknowledgments

The authors gratefully acknowledge the Faculty of Medicine at Chiang Mai University, Thailand, for their valuable collaboration, and the National Research Council of Thailand (NRCT) for their generous grant support. We also extend our sincere gratitude to the researchers from the Department of Anatomy at Chiang Mai University’s Faculty of Medicine for their essential assistance and support throughout this study.

Conflicts of Interest

The authors declare no conflict of interest.

Abbreviations

The following abbreviations are used in this manuscript:
TSSTotal sum score
CTComputed tomography

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Applsci 16 03591 g001
Figure 1. The parameters of facial suture in anterior view including frontonasal suture, frontomaxillary suture, internasal suture, zygomaticomaxillary suture, intermaxillary suture and in lateral view, including sphenotemporal suture, frontozygomatic suture, frontoethmoidal suture, sphenozygomatic suture, zygomaticotemporal suture.
Figure 1. The parameters of facial suture in anterior view including frontonasal suture, frontomaxillary suture, internasal suture, zygomaticomaxillary suture, intermaxillary suture and in lateral view, including sphenotemporal suture, frontozygomatic suture, frontoethmoidal suture, sphenozygomatic suture, zygomaticotemporal suture.
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Figure 2. Correlation between total sum score using summation score of Meindl and Lovejoy classification on external morphology of all suture skull with age-at-death.
Figure 2. Correlation between total sum score using summation score of Meindl and Lovejoy classification on external morphology of all suture skull with age-at-death.
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Table 1. Acsádi and Nemeskéri Scoring System.
Table 1. Acsádi and Nemeskéri Scoring System.
ScoreDescription
0Open suture. Distinct separation between adjoining bone edges.
1Incipient suture. Continuous, visible zigzag line; no physical gap remains.
2Progressing suture. Thinning line with reduced serration and partial interruptions.
3Advanced closure. Near-total fusion; location marked only by surface pits.
4Closed or obliterated suture. No visible trace of the suture remains.
Table 2. Meindl and Lovejoy Scoring System.
Table 2. Meindl and Lovejoy Scoring System.
ScoreDescription
0Open: The suture remains entirely open, with no morphological evidence of fusion at the specified site.
1Minimal closure: Initiation of the closure process is evident, ranging from slight to moderate degrees of osseous bridging along the suture line.
2Significant closure: The site exhibits a marked degree of closure; however, the fusion remains incomplete, with visible remnants of the suture line still present.
3The suture has undergone total fusion, resulting in the complete disappearance of the joint line and total osseous continuity.
Table 3. Frédéric Rating Scale.
Table 3. Frédéric Rating Scale.
ScoreAmount of Suture Closure
0The suture remains entirely open.
1Partial Fusion < 50%; initiation of the closure process is evident, but less than half of the total suture length.
2Advanced Fusion > 50%; a significant portion of the suture is closed, with more than 50% of the length demonstrating osseous bridging.
3Total fusion has occurred, resulting in the complete disappearance of the suture line and total osseous continuity across the site.
Table 4. The type of facial suture with different classifications compared to the sensitivity.
Table 4. The type of facial suture with different classifications compared to the sensitivity.
Facial Suture with Different ClassificationMaleFemale
Sensitivity Using the Highest Level Only Sensitivity Using the Highest Level and Subordinate LevelSensitivity Using the Highest Level Only Sensitivity Using the Highest Level and Subordinate Level
Intermaxillary suture (Proper age range: 18–20 years)>Acsádi and Nemeskéri Scoring >74.1%>98.8%>45.5%>91.1%
>Meindl and Lovejoy Scoring >80.3%>99.4%>53.7%>92.7%
Frédéric Rating Scale62.4%96.3%34.2%85.4%
Internasal suture (Proper age range: 20–30 years)>Acsádi and Nemeskéri Scoring >73.5%>96.3%>57.7%>90.2%
>Meindl and Lovejoy Scoring >80.3%>99.4%>66.7%>93.5%
Frédéric Rating Scale61.7%95.1%44.7%91.9%
Frontonasal suture (Proper age range: 50–60 years)>Acsádi and Nemeskéri Scoring >55.2%>97.9%>37.3%>94.1%
>Meindl and Lovejoy Scoring >60.1%>98.6%>44.1%>96.1%
Frédéric Rating Scale39.9%94.4%26.5%89.2%
Sphenozygomatic suture (Proper age range: 50–60 years)>Acsádi and Nemeskéri Scoring>81.8%>98.6%>60.8%>94.1%
>Meindl and Lovejoy Scoring >83.2%>98.6%>64.7%>96.1%
Frédéric Rating Scale65.7%97.9%50.0%91.2%
Frontoethmoidal sutures (Proper age range: 50–60 years)>Acsádi and Nemeskéri Scoring >85.3%>98.6%>59.8%>92.2%
>Meindl and Lovejoy Scoring >85.3%>98.6%>63.7%>94.1%
Frédéric Rating Scale66.4%97.9%47.1%87.3%
Sphenotemporal suture (Proper age range: 50–60 years)>Acsádi and Nemeskéri Scoring >53.9%>89.5%>22.6%>70.6%
>Meindl and Lovejoy Scoring >57.3%>90.9%>22.6%>75.5%
Frédéric Rating Scale42.7%78.3%13.7%59.8%
Frontomaxillary suture (Proper age range: 70–100 years)>Acsádi and Nemeskéri Scoring >62.2%>97.6%>45.3%>81.3%
>Meindl and Lovejoy Scoring >64.6%>98.8%>50.0%>84.4%
Frédéric Rating Scale37.8%90.2%26.6%75.0%
Zygomaticomaxillary suture (Proper age range: more than 70 years)>Acsádi and Nemeskéri Scoring >74.4%>97.6%>50.0%>92.2%
>Meindl and Lovejoy Scoring >76.8%>100%>54.7%>93.8%
Frédéric Rating Scale64.6%95.1%29.7%82.8%
Zygomaticotemporal suture (Proper age range: more than 70 years)>Acsádi and Nemeskéri Scoring >81.7%>98.8%>60.9%>89.1%
>Meindl and Lovejoy Scoring >81.7%>98.8%>64.1%>93.8%
Frédéric Rating Scale74.4%96.3%43.8%81.3%
Frontozygomatic suture (Proper age range: 80–100 years)>Acsádi and Nemeskéri Scoring >36.8%>94.7%>36.4%>81.8%
>Meindl and Lovejoy Scoring >55.3%>94.7%>42.4%>84.9%
Frédéric Rating Scale18.4%79.0%18.2%63.6%
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Thunyacharoen, S.; Inchai, C.; Mahakkanukrauh, P. Novel Quantitative Approach for Age Estimation Using Facial Suture Closure and Modified Scoring Systems. Appl. Sci. 2026, 16, 3591. https://doi.org/10.3390/app16073591

AMA Style

Thunyacharoen S, Inchai C, Mahakkanukrauh P. Novel Quantitative Approach for Age Estimation Using Facial Suture Closure and Modified Scoring Systems. Applied Sciences. 2026; 16(7):3591. https://doi.org/10.3390/app16073591

Chicago/Turabian Style

Thunyacharoen, Siriwat, Chirapat Inchai, and Pasuk Mahakkanukrauh. 2026. "Novel Quantitative Approach for Age Estimation Using Facial Suture Closure and Modified Scoring Systems" Applied Sciences 16, no. 7: 3591. https://doi.org/10.3390/app16073591

APA Style

Thunyacharoen, S., Inchai, C., & Mahakkanukrauh, P. (2026). Novel Quantitative Approach for Age Estimation Using Facial Suture Closure and Modified Scoring Systems. Applied Sciences, 16(7), 3591. https://doi.org/10.3390/app16073591

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