Contributions of anatomy to forensic sex estimation: focus on head and neck bones

Sex determination through maxillary dental arch and skeletal base measurements using machine learning

BACKGROUND

Cranial, facial, nasal, and maxillary widths have been shown to be significantly affected by the individual's sex. The present study aims to use measurements of dental arch and maxillary skeletal base to determine sex, employing supervised machine learning.

MATERIALS AND METHODS

Maxillary and mandibular tomographic examinations from 100 patients were analyzed to investigate the inter-premolar width, inter-molar width, maxillary width, inter-pterygoid width, nasal cavity width, nostril width, and maxillary length, obtained through Cone Beam Computed Tomography scans. The following machine learning algorithms were used to build the predictive models: Logistic Regression, Gradient Boosting Classifier, K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Multi-Layer Perceptron Classifier (MLP), Decision Tree, and Random Forest Classifier. A 10-fold cross-validation approach was adopted to validate each model. Metrics such as area under the curve (AUC), accuracy, recall, precision, and F1 Score were calculated for each model, and Receiver Operating Characteristic (ROC) curves were constructed.

RESULTS

Univariate analysis showed statistical significance (p < 0.10) for all skeletal and dental variables. Nostril width showed greater importance in two models, while Inter-molar width stood out among dental measurements. The models achieved accuracy values ranging from 0.75 to 0.85 on the test data. Logistic Regression, Random Forest, Decision Tree, and SVM models had the highest AUC values, with SVM showing the smallest disparity between cross-validation and test data for accuracy metrics.

CONCLUSION

Transverse dental arch and maxillary skeletal base measurements exhibited strong predictive capability, achieving high accuracy with machine learning methods. Among the evaluated models, the SVM algorithm exhibited the best performance. This indicates potential usefulness in forensic sex determination.

Sexual Dimorphism in the Musculoskeletal System: Sex Hormones and Beyond

Mounting evidence indicates that whereas some fundamental aspects of bone cell differentiation and function are similar in females and males, there is a clear contribution of sex/gender on the effects of signaling molecules on bone mass and strength and, consequently, on the effects of pharmacologic approaches to treat skeletal disorders. However, until recently, most studies were designed and performed using only 1 sex, resulting in a scarcity of published information on sexual dimorphism of the musculoskeletal system, including the mandible/masticatory muscles and the axial and appendicular bones and skeletal muscles. Further, it is now recognized that scientific rigor requires the study of both males and females. Therefore, there is an increasing need to understand the molecular and cellular basis for the differential outcomes of genetic manipulations and therapeutic agent administration depending on the sex of the experimental animals. Studies have shown higher muscle mass, cancellous bone mass, and long bone width in males compared with females as well as different traits in the pelvis and the skull, which are usually used for gender identification in forensic anthropology. Yet, most reports focus on the role of sex hormones, in particular, the consequences of estrogen deficiency with menopause in humans and in ovariectomized animal models. In addition, emerging data is starting to unveil the effects of gender-affirming hormonal therapy on the musculoskeletal system. We summarize here the current knowledge on the sex/gender-dependent phenotypic characteristics of the bone and skeletal muscles in humans and rodents, highlighting studies in which side by side comparisons were made.

Human gender estimation from CT images of skull using deep feature selection and feature fusion

This research endeavors to prognosticate gender by harnessing the potential of skull computed tomography (CT) images, given the seminal role of gender identification in the realm of identification. The study encompasses a corpus of CT images of cranial structures derived from 218 male and 203 female subjects, constituting a total cohort of 421 individuals within the age bracket of 25 to 65 years. Employing deep learning, a prominent subset of machine learning algorithms, the study deploys convolutional neural network (CNN) models to excavate profound attributes inherent in the skull CT images. In pursuit of the research objective, the focal methodology involves the exclusive application of deep learning algorithms to image datasets, culminating in an accuracy rate of 96.4%. The gender estimation process exhibits a precision of 96.1% for male individuals and 96.8% for female individuals. The precision performance varies across different selections of feature numbers, namely 100, 300, and 500, alongside 1000 features without feature selection. The respective precision rates for these selections are recorded as 95.0%, 95.5%, 96.2%, and 96.4%. It is notable that gender estimation via visual radiography mitigates the discrepancy in measurements between experts, concurrently yielding an expedited estimation rate. Predicated on the empirical findings of this investigation, it is inferred that the efficacy of the CNN model, the configurational intricacies of the classifier, and the judicious selection of features collectively constitute pivotal determinants in shaping the performance attributes of the proposed methodology.

Gonial Angle in Forensic Anthropology to Determine Age and Gender: A Population-Specific Analysis

Background The study highlights the gonial angle as a key craniofacial landmark for age and gender determination in forensic cases. It emphasizes population-specific analysis, enhancing precision by recognizing variations between populations. By clarifying the gonial angle's forensic use, the study offers clear guidelines, improving forensic practices. Moreover, the gonial angle and age and gender correlations are thoroughly examined, offering important information on their forensic relevance. The results highlight how crucial population-specific research is to improving the precision and dependability of forensic age and gender estimation techniques, which advances forensic anthropology and supports forensic investigations around the globe. Aim and objective The purpose of this study is to assess the accuracy of age and gender estimates using gonial angles. The objectives of this research are to evaluate the precision of age and gender estimates utilizing the gonial angle. Materials and methods This present study comprises two groups based on age groups: Group I belongs to 51 to 60 years of age, and Group II belongs to 61 to 70 years of age. Making use of G-Power software (version 3.1.9.4, Düsseldorf, Germany), the sample size was determined. The calculation ensured 95% statistical power at a significance level (alpha error probability) of 0.05. To achieve sufficient statistical power, a total of 1000 samples were included, with a projected required sample size of 92. A total of 1000 samples, consisting of 500 male and 500 female panoramic radiographs, were meticulously selected for the study. The samples picked were within the age range of 51 to 70 years. Orthopantomograms were determined using Planmeca software (Planmeca Romexis®, Version 6.0, USA Inc.). Descriptive statistics, including prediction classification analysis of age and gender, were conducted using SPSS Statistics version 16.0 (SPSS Inc., Released 2007, SPSS for Windows, Version 16.0, Chicago, SPSS Inc.). Results According to this study, the mean gonial angle of males aged 51 to 60 years is larger (124.7370 degrees) than that of females (119.6371 degrees). The female group's mean estimates are more accurate, as seen by the smaller standard error (0.20844) compared to the male group's (0.60998). A statistically significant difference in mean gonial angles between the genders is evident, with males having a larger gonial angle (p-value <0.001). In the age range of 61 to 70 years, the mean gonial angle of females is higher (128.4322 degrees) than that of males (124.0529 degrees). In this instance, the male group's standard error is smaller (0.14968) than the female group's (0.30028), indicating more accurate mean estimates. Once more, a statistically significant difference is indicated by a p-value of less than 0.001, with females having a larger gonial angle than males. Conclusion Our study revealed that the gonial angle of the mandible can be considered a reliable parameter for gender identification. The study's limitation is its inability to reliably identify gender in the subadult population and in cases of edentulousness. An orthopantomogram is a trustworthy and accurate method for taking the different measurements needed to identify the gender of a particular mandible.

Learn, unlearn, and relearn post-extraction alveolar socket healing: Evolving knowledge and practices

OBJECTIVE

This review was to offer a comprehensive analysis of currently available evidence on post-extraction alveolar socket healing, including i) the histological and molecular events during alveolar socket healing, ii) the dimensional ridge alterations after socket healing and controversies relating to sinus pneumatisation, iii) the patient-specific factors, procedural elements, and site-related variables influencing socket healing, iv) techniques and effectiveness of alveolar ridge preservation (ARP) procedure, and v) the philosophies and cost-effectiveness of ARP in clinical practice.

SOURCES AND STUDY SELECTION

To investigate the dimensional profiles of the alveolar ridge following unassisted healing, an overview of systematic reviews was conducted in February 2024 by two independent reviewers. Four electronic databases were searched in Pubmed, Embase, Web of science and Cochrane Library between 2004 and 2024 to identify all relevant systematic reviews on post-extraction healing. A further manual search of reviews was also conducted. The articles were further reviewed in full text for relevance. The AMSTAR-2 appraisal tool was adopted to assess methodological quality. Current research pertaining to other listed objectives was objectively analysed in narration.

DATA

11 out of 459 retrieved studies were selected and ultimately covered in this review on the dimensional changes of alveolar ridge following natural healing: Seven systematic reviews and four systematic reviews with meta-analyses. The methodological quality of all included reviews was critically low.

CONCLUSION

This review thoroughly examines the healing profiles of post-extraction alveolar sockets and highlights the dynamic process with overlapping phases and the inter-individual variability in outcomes. ARP procedure is a potential strategy for facilitating prosthetic site development, while the current evidence is limited. Herein, an individualised and prosthetically driven approach is crucial. Further well sized and designed trials with novel biomaterials need to be undertaken, and the role of artificial intelligence in predicting healing and assisting clinical decision-making could be explored.

CLINICAL SIGNIFICANCE

By advancing our understanding of alveolar socket healing and its management strategies, clinicians can make more informed decisions regarding patient and site level assessment and selection, surgical techniques, and biomaterial choices, ultimately contributing to the enhanced healing process with reduced complications and improved quality of life for patients undergoing tooth extraction and dental implant treatments.

Metric evaluation of the anterior nasal spine to estimate sex and population group in South African individuals

INTRODUCTION

The anterior nasal spine is a pointed, midline projection of the maxilla. This bony structure dictates the overlying soft tissues providing the phenotypic features of the nose and upper lip and determines the differences in the mid-face morphology. Little data is available on the metric features of the Anterior nasal spine (ANS). This study aimed to perform metric evaluations of the ANS of white and black South African males and females to ascertain if morphological variations exist and if the differences are viable for the use in sex and population identification.

MATERIALS AND METHODS

The sample included 100 CBCT images for each population and sex group. Linear and angular measurements of the ANS were recorded in both the sagittal and axial planes.

RESULTS

Classification decision trees (pruned) were fitted to ascertain the relationship between population group, sex and the ANS measurements including and excluding age. For population group, all the ANS measurements were statistically significant for females but in males, all the ANS measurements were significant when performed individually. However, when fitted to the classification tree, Sagittal 2 did not show any statistical significance. When considering sex, only 2 of the ANS measurements (Sagittal 2 and Axial 1) were found to be significant. The results did not differ significantly when comparing the decision trees including and excluding age.

CONCLUSIONS

White South African individuals presented with a longer ANS that produced a more acute angle whereas black South African individuals presented with a shorter ANS and a more obtuse angle. Additionally, males presented with a longer ANS compared to females. ANS measurements were found to be more relevant for population discernment than for sex.

Evaluation of the differences in the localization of the lingula mandibulae according to pubertal development in children: A new anthropological and forensic approach

OBJECTIVE

This study aims to investigate changes in lingula mandibulae localization before and after puberty and sex differences.

DESIGN

288 panoramic radiographs evaluated retrospectively were divided into four groups according to pubertal development: under and over 10 years old for females and under and over 11 years old for males. Four anatomic sites were used as reference points: (a) the anterior border of the ramus; (b) the posterior border of the ramus; (c) the deepest point of mandibular notch; and (d) the angulus mandibulae. The ratio of the distances from the lingula mandibulae to points (a) and (b) and the ratio of the distances from the lingula mandibulae to points (c) and (d) were determined. Two-way ANOVA was performed to assess differences between subgroups based on sex and puberty, and a Bonferroni post-hoc test was performed for multiple comparisons.

RESULTS

Puberty and sex has a significant interaction effect on the vertical location of the lingula mandibulae. Postpubertal lingula mandibulae is positioned proportionally more anteriorly by prepubertal localization. In addition, the lingula mandibulae is situated more posteriorly in females compared to males. A significant interaction effect of puberty and sex was observed in relation to the vertical positioning of the lingula mandibulae.

CONCLUSIONS

The spatial localization of the lingula mandibulae and its spatial displacement with age can be used both in estimating sex and the onset of puberty. Changes in the localization of lingula mandibulae according to pubertal development and sex can be used in forensic and anthropological contexts.

Architecture of head and neck soft tissues and associated entheses: An exploration of sexual dimorphism in, and population differences between, New Zealand and Thai individuals

Understanding the musculoskeletal anatomy of soft tissues of the head and neck is important for surgical applications, biomechanical modelling and management of injuries, such as whiplash. Additionally, analysing sex and population differences in cervical anatomy can inform how biological sex and population variation may impact these anatomical applications. Although some muscles of the head and neck are well-studied, there is limited architectural information that also analyses sex and population variation, for many small cervical soft tissues (muscles and ligaments) and associated entheses (soft tissue attachment sites). Therefore, the aim of this study was to present architectural data (e.g., proximal and distal attachment sites, muscle physiological cross-sectional area, ligament mass, enthesis area) and analyse sex and population differences in soft tissues and entheses associated with sexually dimorphic landmarks on the cranium (nuchal crest and mastoid process) and clavicle (rhomboid fossa). Through the dissection and three-dimensional analysis of 20 donated cadavers from New Zealand (five males, five females; mean age 83 ± 8 years; range 67-93 years) and Thailand (five males, five females; 69 ± 13 years; range 44-87 years), the following soft tissues and their associated entheses were analysed: upper trapezius, semispinalis capitis and the nuchal ligament (nuchal crest); sternocleidomastoid, splenius capitis and longissimus capitis (mastoid process); the clavicular head of pectoralis major, subclavius, sternohyoid and the costoclavicular (rhomboid) ligament (rhomboid fossa). Findings indicate that although muscle, ligament and enthesis sizes were generally similar to previously published data, muscle size was smaller for six of the eight muscles in this study, with only the upper trapezius and subclavius demonstrating similar values to previous studies. Proximal and distal attachment sites were largely consistent with the current research. However, some individuals (six of 20) had proximal upper trapezius attachments on the cranium, with most attaching solely to the nuchal ligament, contrasting with existing literature, which often describes attachment to the occipital bone. With respect to sexual dimorphism, the Thai sample exhibited more sex differences in muscle size than the New Zealand sample, but for enthesis size (area), both samples had the same amount of statistically significant sex differences (5 of 10). Additionally, some significant population differences were found when comparing muscle and enthesis size data between the New Zealand and Thai samples. Despite these findings, no sex or population differences were found for ligament size (mass) in either group. This paper presents new architectural data for several understudied areas of the head and neck, as well as providing analyses on sex and population differences, two areas that have limited representation in anatomy.

Fractal dimension, lacunarity, and cortical thickness in the mandible: Analyzing differences between healthy men and women with cone-beam computed tomography

Purpose

The objective of this study was to assess the fractal dimension, lacunarity, trabecular microarchitecture parameters, and cortical linear measurements in the mandibles of male and female individuals to identify differences between them.

Materials and Methods

In total, 116 cone-beam computed tomography scans of healthy individuals of different ages (57 men and 59 women, aged between 20 and 60 years) were selected. The following bone parameters were measured: 1) buccal, lingual, and basal cortical bone thickness in 5 standard parasagittal sections (the midline, the left and right sides of the lower lateral incisors, and the left and right sides of the lower canines); 2) the bone volume fraction of 10 sequential axial sections from each patient by creating a volume of interest in the area between the lower canines; and 3) fractal dimension and lacunarity using grayscale images of the same region of the volume of interest in the anterior mandible. Spearman correlation coefficients and the Mann-Whitney test were used.

Results

A significant and positive correlation was found between age and cortical thickness, especially in the region of the central incisors. Significant differences between sexes in terms of fractal dimension, lacunarity, and bone volume were found. Women revealed lower fractal dimension values and higher lacunarity and bone volume ratio values than men.

Conclusion

Fractal dimension, lacunarity, trabecular bone volume, and cortical thickness were different between men and women of different ages.

Evaluation of the usage of the cervical 7th vertebra in sex estimation with measurements on computerized tomography images

Sex estimation is the primary step in biological profiling via identification using skeletal elements. The aim of the present study was to evaluate the usefulness of the seventh cervical vertebra for sex estimation. The cervical computed tomography scans of 200 female and 200 male patients aged ≥ 20 years were analyzed. Eight different measurements of the seventh cervical vertebra were performed, including the transverse and anteroposterior diameters of the foramen vertebra, transverse and anteroposterior diameters of the corpus vertebra inferior surface, height of the corpus vertebra, corpus vertebrae-spinous process angle, and height and length of the spinous process. Independent two-sample t-test was performed; significant differences were observed between the sexes in all measurements except corpus vertebrae-spinous process angle. Further, univariate logistic regression analyses revealed that the length of spinous process showed the highest dimorphism. Among the univariate models created, the model obtained using only the length of the spinous process reached an accuracy rate of 80 %. Multivariate logistic regression analysis (via Forward LR Wald) was used for sex estimation with an accuracy of up to 90.8 % (89 % for men and 92.5 % for women). In conclusion, the seventh cervical vertebra is dimorphic in the Turkish population and allows sex estimation with high accuracy rates.

Oval Type of Human Mandibular Condyle in Panoramic Radiographs of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Mandibular condyle is a prominent structure in the mandible, which forms the temporomandibular joint. An oval-shaped condyle is considered to be present with a normal temporomandibular joint and any morphological variation of the condyle is assumed to be pathologic in temporomandibular disorders. The aim of the study was to find out the prevalence of oval shaped mandibular condyle among orthopantomogram radiographs of patients visiting the tertiary care centre.

Methods

A descriptive cross-sectional study was performed among 752 condyles visiting a tertiary care center from November 29, 2021 to April 1, 2022. The ethical approval was taken from the Institutional Review Committee (Reference number: 184 (6-11) 078/079) before conducting the study. Convenience sampling was done. The radiographs were first examined and the observed morphological type of mandibular condyle was noted. Data analysis was done using Statistical Package for the Social Sciences version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

Results

The prevalence of oval shaped mandibular condyles out of 752 condyles was 416 (55.32%) (51.77-58.87 at 95% Confidence Interval). The oval-shaped condyle on the right side was 205 (54.52%) and on the left side was 211 (56.12%).

Conclusions

The prevalence of oval shaped condyles among patients in this study was similar to the studies done in similar settings.

Keywords

condyle; mandible; Nepal; X-ray.