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This study aims to explore tooth growth variation by regions and ethnicity in China, and to validate the modified Tibetan so as to assist in proposing a better approach. A total of 1320 orthopantomograms of Han children aged 4–14.99 were retrospectively collected from eastern and western regions of China. The Demirjian method and modified Tibetan method were applied. Results showed that dental maturity scores (DMS) in eastern children were significantly greater than western children. Age was overestimated by both methods in eastern children. MAE was 0.88 and 1.3 years by Demirjian method, 1.01 and 1.21 years by modified Tibetan method in eastern girls and boys respectively. In western children, age was significantly underestimated in girls and slightly overestimated by Demirjian method; by modified method, age was generally overestimated. MAE was 0.79 and 0.84 years by Demirjian method, 0.51 and 0.69 years by modified Tibetan method in girls and boys respectively. The current study reveals that tooth growth was significantly advanced in Eastern Han children compared with Western Han children. Ethnic variation between Eastern Han and Tibetan Chinese was substantial. Neither method was sufficiently accurate in Eastern Han children. The modified Tibetan method was reliable in Western Han children. [ABSTRACT FROM AUTHOR]