Age estimation is considered to be ideally based on the combination of clinical, skeletal, and dental examinations. However, it is not easy to determine from available published series if the estimated age of a given individual is a precise age or a spectrum of possible ages, and in this case how broad is the proposed spectrum. Indeed, the information in the radiological atlas by Greulich and Pyle is statistical, not individual. The use of such data for forensic purposes has never been intended by the authors, nor validated. Moreover, the ethnic and socioeconomic characteristics of the adolescents examined today in Western Europe may differ largely from those presented in the atlas, as previously suggested. The role of ethnic factors in skeletal maturation has been repeatedly studied and gave conflicting results. In most series evaluating skeletal age in different populations, hand and wrist X-rays were obtained from healthy subjects or patients received for evaluation of trauma. The conclusions of these studies may not be validated, or at least should be considered cautiously, when extrapolating results to adolescents without documents involved in judicial procedures, who have heterogeneous and largely unevaluated psychological and socioeconomic characteristics. A number of forensic physicians do not integrate published recommendations or the results of published studies into their daily practice. Previous studies have shown that medical practice is heterogeneous in this area. Factors determining this heterogeneity are unknown.