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Objective <p>Chronological age is not always a reliable indicator of skeletal maturity. The Spheno-Occipital Synchondrosis (SOS), a key growth center of the cranial base, has been qualitatively linked to age. This study introduces fractal dimension (FD), a quantitative metric derived from fractal analysis (FA), to assess SOS fusion and its correlation with age using cone beam computed tomography (CBCT) images.</p> Methods <p>In this retrospective cross-sectional study, 102 CBCT scans (ages 6–22) were analyzed. SOS fusion stages were classified qualitatively and evaluated quantitatively via FD using ImageJ software. Inter- and intra-observer reliability, correlation between FD and age, and diagnostic performance via ROC analysis were assessed.</p> Results <p>FD significantly declined with age (males: <i>r</i> = -0.66; females: <i>r</i> = -0.80; <i>p</i> &lt; 0.001). FD differed significantly across SOS fusion stages and age groups (<i>p</i> &lt; 0.001), with gender-specific patterns in intermediate stages. Regression analysis demonstrated FD as a significant age predictor (R² = 0.44 for males, R² = 0.64 for females). ROC analysis showed excellent-to-outstanding diagnostic accuracy (AUC: 0.815 for males; 0.945 for females) in distinguishing legal age thresholds.</p> Conclusion <p>Fractal dimension analysis of the SOS on CBCT offers a reliable, reproducible, and objective method for age estimation. FD provides quantifiable insight into cranial base maturation, supporting its application in orthodontic planning and forensic age assessment.</p>

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Quantitative insights into cranial fusion: fractal dimension analysis of spheno-occipital synchondrosis

  • 期刊论文

  • 发表日期：

    2026年5月27日

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  • Fatemeh Akbarizadeh,
  • Kiarash Fereidouni,
  • Shakiba Benvari

摘要

Objective

Chronological age is not always a reliable indicator of skeletal maturity. The Spheno-Occipital Synchondrosis (SOS), a key growth center of the cranial base, has been qualitatively linked to age. This study introduces fractal dimension (FD), a quantitative metric derived from fractal analysis (FA), to assess SOS fusion and its correlation with age using cone beam computed tomography (CBCT) images.

Methods

In this retrospective cross-sectional study, 102 CBCT scans (ages 6–22) were analyzed. SOS fusion stages were classified qualitatively and evaluated quantitatively via FD using ImageJ software. Inter- and intra-observer reliability, correlation between FD and age, and diagnostic performance via ROC analysis were assessed.

Results

FD significantly declined with age (males: r = -0.66; females: r = -0.80; p < 0.001). FD differed significantly across SOS fusion stages and age groups (p < 0.001), with gender-specific patterns in intermediate stages. Regression analysis demonstrated FD as a significant age predictor (R² = 0.44 for males, R² = 0.64 for females). ROC analysis showed excellent-to-outstanding diagnostic accuracy (AUC: 0.815 for males; 0.945 for females) in distinguishing legal age thresholds.

Conclusion

Fractal dimension analysis of the SOS on CBCT offers a reliable, reproducible, and objective method for age estimation. FD provides quantifiable insight into cranial base maturation, supporting its application in orthodontic planning and forensic age assessment.