Sex and age biological variation of the mandible in a Portuguese population- a forensic and medico-legal approaches with three-dimensional analysis

Sex estimation in a Chilean population by mandibular analysis in cone beam computed tomography images

BACKGROUND

Sex estimation is the first stage in the identification of an individual in the forensic context, and can be carried out from bone structures like the mandible. The aim of this study was to estimate sex from metric analysis of the mandible in cone beam computed tomography images (CBCT) of adult Chilean individuals.

METHODS

Six mandibular measurements were analysed, five linear and one angular, in CBCT of adult Chilean individuals of both sexes. ROC Curve analysis was performed, with cut-off points, and of the overall model quality. Univariate discriminant function analysis was used to determine the accuracy of each measurement for sex estimation. Multivariate discriminant function analysis, both directly and by steps, was used to obtain the predictive value of the mandible including all the measurements.

RESULTS

The data included were 155 CBCT, 105 of females and 50 of males. The mandible presented great sexual dimorphism, with the mandibular ramus presenting greater predictive power than the mandibular body. When each mandibular measurement was analysed separately, the maximum height of the mandibular ramus presented the greatest predictive power (76.5%), while the mandibular angle was the least accurate parameter for sex estimation (58.1%). Direct method analysis presented 87.1% accuracy for sex identification of adult Chilean individuals, and joint analysis of maximum mandibular ramus height (MRH), corono-condylar distance and bigonial breadth presented 86.5% accuracy. In ROC Curve analysis the MRH was the variable with the greatest discriminating capacity (AUC = 0.833), MA was the only variable which presented no discriminating capacity (AUC = 0.386) and also presented low quality in model quality analysis.

CONCLUSION

Metric analysis of the mandible in CBCT images presents an acceptable accuracy for sex estimation in Chilean individuals, and its use for that purpose in forensic practice is recommended.

Three-Dimensional Mandibular Condyle Remodeling Post-Orthognathic Surgery: A Systematic Review

Background and Objectives: The most popular surgical procedures among orthognathic surgeries for Class II and III patients are Le Fort 1 osteotomy for the maxilla and bilateral sagittal split ramus osteotomy (BSSRO) for the mandible. Keeping the condyle in its proper place during fixation is one of the difficulties of orthognathic surgery. One of the worst post-orthognathic surgery consequences in the temporomandibular joint (TMJ) area may be condylar resorption. Condylar remodeling refers to a group of processes that occur in reaction to forces and stress placed on the temporomandibular joint in order to preserve morphological, functional, and occlusal balance. A systematic review of the literature was performed with the aim of identifying the mandibular condylar component of TMJ changes after orthognathic surgery in class II and III patients. Materials and Methods: An electronic search was carried out using the PubMed, Cochrane Library, and Google Scholar, databases. The inclusion criteria included trials in non-growing patients upon whom orthognathic surgery was performed due to Angle II or Angle III classes malocclusion; in addition, a CT or cone beam computed tomography (CBCT) scan was performed before and after surgery to track the mandibular condylar component of TMJ changes. The quality of the studies was evaluated by two independent authors. The risk of bias was assessed by using the Downs and Black checklist. Results: The electronic and manual literature search yielded 12 studies that fulfilled all necessary inclusion criteria. Observed studies were evaluated as good (3), fair (8), and poor (1) quality. Two studies evaluated class II patients, six studies observed class III patients, and four studies were comparative. Most of the studies evaluated condyle angle and space changes, and the condylar surface and volume changes were also observed. However, the methodology of evaluation in the publications differs. Conclusions: Reduction of bone density, especially in class II patients, and morphological condyle reshaping, with the apposition of the bone, is the main adaptive mechanism after orthognathic surgery. However, all of the studies we examined were conducted using different methods of evaluation, measurement, and reference points.

Three-dimensional measurements of symmetry for the mandibular ramus

BACKGROUND

The study examines a sample of patients presenting for viscerocranial computer tomography that does not display any apparent signs of asymmetry, assesses the three-dimensional congruency of the mandibular ramus, and focuses on differences in age and gender.

METHODS

This cross-sectional cohort study screened viscerocranial CT data of patients without deformation or developmental anomalies. Segmentations were obtained from the left and right sides and superimposed according to the best-fit alignment. Comparisons were made to evaluate three-dimensional congruency and compared between subgroups according to age and gender.

RESULTS

Two hundred and sixty-eight patients were screened, and one hundred patients met the inclusion criteria. There were no statistical differences between the left and right sides of the mandibular ramus. Also, there were no differences between the subgroups. The overall root mean square was 0.75 ± 0.15 mm, and the mean absolute distance from the mean was 0.54 ± 0.10 mm.

CONCLUSION

The mean difference was less than one millimetre, far below the two-millimetre distance described in the literature that defines relative symmetry. Our study population displays a high degree of three-dimensional congruency. Our findings help to understand that there is sufficient three-dimensional congruency of the mandibular ramus, thus contributing to facilitating CAD-CAM-based procedures based on symmetry for this specific anatomic structure.

[Complementarity of odontology and anthropology in the identification of unknown bodies]

The press regularly echoes disturbing disappearances of children and adults, suicides, victims of accidents, homeless, the often fortuitous discovery of bodies or human remains. The identification process of the person will be comparative when there is a presumption of identity and estimative in case of absence of presumed identity. In 2011, a retrospective study over 6 years at the Poincaré Hospital IML (Medico Legal Institute) in Garches states the surprising figure of over 1500 burials under X per year in France. This situation is the result of a series of dysfunctions. After having identified the causes, the identification in odontology and anthropology could contribute to solve this problem by adopting the following resolutions. Firstly, the creation of a single file for disappearances, grouping together the Ante-Mortem (AM) medical and odontological data files of persons reported missing, as well as the Post-Mortem (PM) odontological and anthropological data files collected on bodies under X during thanatological operations within the Medico Legal Institute. Secondly, the systematic collection of odontological evidence PM as well as an exhaustive anthropological analysis for any body under X without presumed identity, before burial.

Reproducibility of human landmark identification in morphological mandible prototypes: major parameters for a 3D CBCT approach

The establishment of anthropometric measurements is of fundamental importance for the correct identification of human bodies. The objective of this study was to evaluate the accuracy and reliability of two-dimensional craniometric landmarks obtained from three-dimensional cone beam computed tomography reconstructions for forensic identification of humans. Computed tomography images with voxel sizes of 0.25, 0.3, and 0.4 mm were obtained using i-CAT® three-dimensional equipment. Ten landmarks were randomly selected, and 10 measurements were demarcated in the three-dimensional reconstruction to evaluate the mandibular condyle, ramus, and body. This study demonstrated that protocols with voxels of 0.3 mm should be preferentially indicated for the evaluation of linear and angular measurements. Implementing our methodology using prototypes for clinical and forensic simulations allows comparisons with human databases in identification issues.

Evaluation of the Mandibular Condyle Morphologic Relation before and after Orthognathic Surgery in Class II and III Malocclusion Patients Using Cone Beam Computed Tomography

Simple Summary

In individuals with severe malocclusions, orthognathic surgery seeks to rebalance the relationships between the jaws by providing a stable occlusion, a healthy muscle balance, and the functioning of the temporomandibular joint. Cone beam computed tomography may be used to determine the position of the mandibular condyle in the glenoid fossa. This study aimed to assess how the position of the mandibular condyle varies in class II and III malocclusions before and after bimaxillary orthognathic surgery. Before and after orthognathic surgery, 56 TMJs from 28 patients were studied. Following surgery, both class II and class III patients experienced changes in the anterior joint space, posterior joint space, condyle position, and condyle angle. The preliminary findings are promising for determining changes in condyle position and joint spaces that might guide oral and maxillofacial surgeons to address a debilitating clinical affliction.

Abstract

This study aimed at evaluating the mandibular condyle position changes before and after bimaxillary orthognathic surgery in class II and III malocclusion patients. CBCT scans from patients who underwent bimaxillary orthognathic surgery were analyzed: Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). Both condyles were independently assessed for their largest anterior and posterior joint spaces, smallest medial joint spaces, and condyle angles concerning the transverse line. In the sagittal plane, the minimum size of the anterior and posterior joint spaces was measured. In the coronal plane, the smallest medial joint space was measured. The position of the condyle within the glenoid fossa was determined before and after surgery. A total of 56 TMJs from 28 patients were studied. Following orthognathic surgery, the anterior and posterior space in class II increased. Postoperatively, the anterior joint space in class III decreased. In 42.85% of malocclusion class II patients and 57.14% of malocclusion class III patients, the pre-and post-surgical position of the condyle changed, the condyle was anteriorly positioned (42.85%) in class II patients and centrically positioned (71.4%) in class III patients. Significant changes in the joint space, condylar position, and condyle angle were found in the class II and class III subjects.