Quantifying Pulp Volume and Pulp-tooth Ratio in Maxillary Central Incisors for Age Assessment Using CBCT: A Systematic Review and Meta-analysis

Aim: Estimating dental age is essential in forensic and clinical settings. This systematic review and meta-analysis examined the correlation between chronological age and cone-beam computed tomography (CBCT)-derived metrics, pulp volume (PV), and pulp/tooth volume ratio (PTVR) to ascertain their diagnostic use for age assessment. Methods: A thorough literature review was performed to locate studies evaluating the correlation between PV or PTVR and chronological age utilizing CBCT. Meta-analyses were conducted individually for each parameter. The variability of studies, the strength of correlations, and methodological variances were thoroughly examined. Results: Five studies evaluating PV demonstrated a robust inverse connection with chronological age (pooled r = 0.56; 95% CI : 0.41–0.75; p < .0001), albeit considerable heterogeneity ( I ² = 96%). A meta-analysis of nine studies on PTVR revealed no significant link (pooled r = 1.11; 95% CI : 0.74–1.66; p = .61), exhibiting great heterogeneity ( I ² = 99%), which was ascribed to variations in tooth type, imaging techniques, segmentation methods, and demographic factors. Conclusion: The PV evaluated using CBCT is a dependable, non-invasive method for estimating age. Nonetheless, PTVR exhibits inconsistent diagnostic value owing to methodological discrepancies. Standardized methods and population-specific models are essential to improve the precision and relevance of CBCT-based age estimation. The International Prospective Register of Systematic Reviews (PROSPERO) Registration No.: CRD420251052457. Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251052457