Radiographic evaluation of mandibular morphometric differences in prepubertal and postpubertal individuals in a Turkish subpopulation

Burak Kerem Apaydin; Hilal Ozbey

doi:10.4103/srmjrds.srmjrds_77_19

ORIGINAL ARTICLE

Year : 2020 | Volume : 11 | Issue : 1 | Page : 16-20

Radiographic evaluation of mandibular morphometric differences in prepubertal and postpubertal individuals in a Turkish subpopulation

Burak Kerem Apaydin¹, Hilal Ozbey²
¹ Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
² Department of Pedodontics, Faculty of Dentistry, Pamukkale University, Denizli, Turkey

Date of Submission	27-Oct-2019
Date of Acceptance	10-Dec-2019
Date of Web Publication	11-Mar-2020

Correspondence Address:
Dr. Burak Kerem Apaydin
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Pamukkale University, Denizli
Turkey

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/srmjrds.srmjrds_77_19

Abstract

Introduction: Radiologic differences in the mandible between genders have been evaluated; however, studies are lacking in comparison of prepuberty and postpuberty. The purpose of this study was to measure the gonial angle (GA), ante GA (AGA), bicondylar breadth (BB), mental index (MI), minimum ramus breadth (MRB), bigonial width (BW), and ramus height (RH) on panoramic radiographs obtained from Turkish patients and to elucidate how those measurements relate with age and gender in pre- and post-pubertal period. Materials and Methods: Panoramic radiographs of patients aged between 5 and 50 years old were taken according to the manufacturer's instructions. A total of 760 radiographic images were evaluated (19 groups, n = 40). GA, AGA, BB, MI, MRB, BW, and RH values were measured on digital panoramic radiographs using Java Image Processing Software on the images. The data were analyzed by independent sample t-tests and regression analysis using a software program (P < 0.05). Results: Only AGA values were statistically significant between male and female patients in both prepubertal and postpubertal periods (P < 0.05). A statistically significant difference was found in AGA, BB, MI, MRB, BW, and RH in postpubertal period between male and female patients (P < 0.05). Besides, when the ages between 5 and 20 years were analyzed, all parameters except for GA and AGA were significantly correlated positively with age in both genders. Conclusions: Only AGA values can be used for gender determination both in prepubertal and postpubertal period. In addition, BB, MI, MRB, BW, and RH values were correlated positively with age in both prepubertal and postpubertal groups.

Keywords: Aging, gender determination, morphometric analysis of mandible, panoramic radiography, puberty

How to cite this article:
Apaydin BK, Ozbey H. Radiographic evaluation of mandibular morphometric differences in prepubertal and postpubertal individuals in a Turkish subpopulation. SRM J Res Dent Sci 2020;11:16-20

How to cite this URL:
Apaydin BK, Ozbey H. Radiographic evaluation of mandibular morphometric differences in prepubertal and postpubertal individuals in a Turkish subpopulation. SRM J Res Dent Sci [serial online] 2020 [cited 2023 Jun 3];11:16-20. Available from: https://www.srmjrds.in/text.asp?2020/11/1/16/280377

Introduction

Puberty is a developmental process manifested by physical and psychosocial maturation.^[1] Growth and development do not show significant differences between the gender until puberty, which occurs in girls at an average age of 10 years and in boys at an average age of 11.5 years.^[2] The age of normal puberty onset varies widely, and many conditions may affect the timing and progression of normal puberty, such as genetic factors, nutritional status, and ethnicity.^[3] Precocious puberty occurs if secondary sexual characteristics are identified earlier than 8 years in girls and earlier than 9 years in boys.^[1],[4],[5]

Mandibular growth starts in the 5^th week of pregnancy. The mandible is fibrous at birth and has two parts, which fuse anteriorly and ossify in the 1^st year of life.^[6] Changes related to age and gender occur in the soft tissues, teeth, and bones.^[7],[8] As in other bones, the maxilla and the mandible grow and develop during puberty.^[9] Important morphological and dimensional changes (remodeling) occur on the mandible with age.^[10],[11] The structure of the mandibular ramus can vary in male and female, as the two genders' stage of mandibular growth and development is different.^[12] In addition, occlusal forces also vary in male and female, which affect the size of the mandibular ramus.^[10]

Identifying the different features of ethnic groups is important for anthropological analysis and medicolegal reasons.^[13],[14] As skeletal differences can be distinctive in different populations, population-specific standards are important and should be evaluated.^[15] Because the teeth and bones are more resistant to deterioration than soft tissues, they are very important in this process, typically serving as a key factor for forensic definitions.^[14] The skull has been reported to be the most dependable part of the human skeleton after the pelvis for determining gender.^{[12],[16],[17],[18]} However, in circumstances where an intact skull cannot be found, the mandible may play a crucial role in determining gender, as it is the strongest and most dimorphic bone of the skull and has a dense layer of compact bone.^[19] Morphological differences in the mandible have been evaluated by radiomorphometric measurements.^[20],[21] The authors evaluated the different anatomical structures on the mandible in their various studies.^{[17],[22],[23]}

Recent studies have assessed the reliability of panoramic radiographs for determining the morphological dimensions of the mandible.^{[24],[25],[26]} Although studies have evaluated the differences between males and females by comparing various mandibular parameters in postpubertal period,^[27] the authors are unaware of how the growth and development effects mandibular parameters before and during the pubertal period. Studies are lacking on the effect of puberty on mandibular parameters in both genders.

Therefore, the first aim of this retrospective study was to identify the sexual pubertal effect on mandibular parameters, by analyzing prepubertal and postpubertal periods. The second aim of the study was to evaluate whether there is a correlation between mandibular parameters and the growth and development period.

The first null hypothesis was that no significant difference would be found between genders in prepubertal and postpubertal period in the measured mandibular parameters. The second null hypothesis was that no correlation would be found between the age and the parameters measured from the mandible during the growth and development period.

Materials and Methods

This study was performed in the Department of Maxillofacial Radiology, Pamukkale University, Denizli, Turkey. Clear panoramic radiographs of patients aged between 5 and 50 years old were selected. The exclusion criteria of the panoramic radiographs were as follows: distortion, artifacts, presence of any pathology, fractures, facial asymmetry, orthognathic surgery, edentulism, and whether the anatomic regions to be measured were obscured.

All the panoramic radiographs were made with a digital panoramic machine (Instrumentarium OP 200D, Kavo Dental, Charlotte, USA) according to the manufacturer's instructions. All images were recorded as Tagged Image File Format files. Ethics committee approval was obtained from the Pamukkale University Ethics Committee for the study (Number: 60116787-020/2906). Written consent was obtained for all participants prior to taking the panoramic radiograph.

The age groups were standardized as follows: The 5, 6, 7 years of age groups were designated as prepubertal group; 21–30, 31–40, 41–50 years of age groups were designated as postpubertal group. The remaining 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 years of age groups were created to evaluate the interaction between mandibular parameters and age. Each group had 20 male and 20 female participants. Therefore, a total of 760 radiographs were evaluated, and the measurements were made by an experienced maxillofacial radiologist (BK.A.). All the measurements were performed bilaterally on the left and right side of the panoramic radiograph, and average values were obtained. The following measurements were made:

Gonial angle (GA): Obtained by measuring the angle between the tangent drawn at the lower border of the mandible and the posterior border of the ramus^[28]
Ante GA (AGA): Obtained by measuring the angle of the two lines parallel to the antegonial region which intersect at the deepest point of the antegonial notch^[23]
Ramus height (RH): Obtained by measuring between points corresponding to the most lateral point of the condyle and those corresponding to the most lateral point of the angulus^[22]
Bigonial width (BW): Obtained by measuring horizontally between the left and right gonion^[29]
Bicondylar breadth (BB): Obtained by measuring the distance between the most lateral points of the left and right condyles^[14]
Minimum ramus breadth (MRB): Obtained by measuring the smallest anteroposterior distance of the ramus^[14]
Mental index (MI): Measured as follows: A line was traced, which passed perpendicular to the tangent to the lower border of the mandible and through the center of the mental foramen. The cortical width was measured at this point [Figure 1].^[30]

All the measurements on the images were made with Java Image Processing Software (ImageJ: A public domain program, U. S. National Institutes of Health, Bethesda, Maryland, USA, https://imagej.nih.gov/ij/). The data were analyzed by independent sample t-tests and regression analysis using statistical software (IBM SPSS 15.0 version IBM Corp, NY, USA) (α = 0.05).

Figure 1: Schematic illustration of the measurement points. GA: Gonial angle, BB: Bicondylar breadth, MI: Mental index, BW: Bigonial width, RH: Ramus height, MRB: Minimum ramus breadth, AGA: Ante GA

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Results

Whereas AGA values were statistically significantly different between males and females in prepubertal group [Table 1] (P < 0.05), the other values were not statistically different (P > 0.05). In postpubertal group, AGA, BB, MI, MRB, BW, and RH values were statistically significantly different between males and females [Table 1] (P < 0.05). All the parameters except from GA and AGA were significantly correlated with age in both genders [Table 2].

Table 1: Mean and standard deviation values of the mandibular parameters in pre- and post-pubertal period

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Table 2: The correlation between age and parameters

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Discussion

Both null hypotheses were rejected because a statistically significant difference was found in the measured parameters between the genders in prepubertal and postpubertal period. A correlation was found between the parameters measured from the mandible and age during the growth and development period.

In this study, the 5, 6, and 7 years of age groups were classified as prepubertal. Some authors have reported that sometimes girls can enter puberty at the age of 8 years.^[1],[4] In addition, Işeri and Solow^[31] reported that no systematic growth trend is seen in the mandible after 18 years of age. Hence, in the current study, the groups up to 20 years of age were classified into 1-year intervals to determine whether a relationship existed between growth and development and mandibular parameters. In the groups up to 20-year-old, a strong positive correlation was found in some mandibular parameters between the mandibular growth and age in both genders.

Akhlaghi et al.,^[32] in Iran, measured some mandibular parameters from cadavers to determine gender. They reported that the parameters obtained from individuals under 12 years of age could not be used in gender determination. In the current study, which shows partially similarity with the study of Akhlaghi et al.,^[32] no statistically significant difference was found between the mandibular parameters and gender except from AGA in the prepubertal group.

Consistent and inconsistent results have been reported concerning the changes in the GA with age in the literature. In this study, no statistical difference was found between male and female patients in terms of GA in postpubertal period. This finding is consistent with that of Chole et al.^[23] but conflicts with that of Abu-Taleb and El Beshlawy.^[17]

In the current study, a statistical difference in AGA values was found between male and female patients in both prepubertal and postpubertal groups. Male patients had significantly smaller values than female patients. These results are consistent with those of Dutra et al.,^[33] however, Ghosh et al.^[34] reported no statistically significant difference in AGA values between the genders. It can be expounded why these results were controversial is that the studies have been conducted in different ethnic groups.

The MI parameter is usually recommended to determine the lowest bone density.^[35] In the current study, males had higher MI values than females after puberty. This result is consistent with that of Bozdag and Sener.^[30]

According to some authors, ramus of the mandible has the greatest association with morphological changes in size during growth and development, and differences between the genders are apparent.^[17],[36] Therefore, in this study, mandibular ramus was selected for the measurements and supported this association. A statistical difference in the measurements of mandibular ramus was found between males and females in postpubertal groups.

The correlation increased with age in almost all the mandibular parameters measured up to 20 years of age. This situation is consistent with the three-dimensional growth pattern of the mandible.

The authors are unaware of any study measuring mandibular parameters on individuals who are in prepubertal period and identifying gender differences in these parameters. AGA may be important in this regard, there was a statistical difference in the prepubertal period in only AGA value between males and females in this study. In addition, AGA can be used as a parameter to determine the gender in forensic investigations of victims in prepubertal period. However, more study is needed to confirm the relationship.

Limitations of the study included that the measurements were made from panoramic radiographs. Dental tomography was not used for the study. Measurements might be more accurate with a three-dimensional imaging system.

Conclusions

Only AGA values were statistically significant between males and females in prepubertal period. It can be concluded that both in prepubertal and postpubertal period, AGA value can be a useful parameter in forensic evaluations. All the parameters except GA and AGA were correlated with age in both genders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Klein DA, Emerick JE, Sylvester JE, Vogt KS. Disorders of puberty: An approach to diagnosis and management. Am Fam Physician 2017;96:590-9.
2.	Schmidt S, Nitz I, Schulz R, Schmeling A. Applicability of the skeletal age determination method of Tanner and Whitehouse for forensic age diagnostics. Int J Legal Med 2008;122:309-14.
3.	Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: Variations around the world, secular trends, and changes after migration. Endocr Rev 2003;24:668-93.
4.	Chulani VL, Gordon LP. Adolescent growth and development. Prim Care 2014;41:465-87.
5.	Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: Diagnosis, treatment, outcome. Curr Opin Pediatr 2000;12:394-9.
6.	Puişoru M, Forna N, Fătu AM, Fătu R, Fătu C. Analysis of mandibular variability in humans of different geographic areas. Ann Anat 2006;188:547-54.
7.	Mohite DP, Chaudhary MS, Mohite PM, Patil SP. Age assessment from mandible: Comparison of radiographic and histologic methods. Rom J Morphol Embryol 2011;52:659-68.
8.	Poongodi V, Kanmani R, Anandi MS, Krithika CL, Kannan A, Raghuram PH. Prediction of age and gender using digital radiographic method: A retrospective study. J Pharm Bioallied Sci 2015;7:S504-8.
9.	Parfitt AM. The coupling of bone formation to bone resorption: A critical analysis of the concept and of its relevance to the pathogenesis of osteoporosis. Metab Bone Dis Relat Res 1982;4:1-6.
10.	Huumonen S, Sipilä K, Haikola B, Tapio M, Söderholm AL, Remes-Lyly T, et al. Influence of edentulousness on gonial angle, ramus and condylar height. J Oral Rehabil 2010;37:34-8.
11.	Xie QF, Ainamo A. Correlation of gonial angle size with cortical thickness, height of the mandibular residual body, and duration of edentulism. J Prosthet Dent 2004;91:477-82.
12.	Raj JD, Ramesh S. Sexual dimorphism in mandibular ramus of South Indian population. Antrocom Online J Anthropol 2013;9:253-8.
13.	Chandra A, Singh A, Badni M, Jaiswal R, Agnihotri A. Determination of sex by radiographic analysis of mental foramen in North Indian population. J Forensic Dent Sci 2013;5:52-5. [PUBMED] [Full text]
14.	Sambhana S, Sanghvi P, Mohammed RB, Shanta PP, Thetay AA, Chaudhary VS. Assessment of sexual dimorphism using digital orthopantomographs in South Indians. J Forensic Dent Sci 2016;8:180-8. [PUBMED] [Full text]
15.	Steyn M, Işcan MY. Sexual dimorphism in the crania and mandibles of South African whites. Forensic Sci Int 1998;98:9-16.
16.	Saini V, Srivastava R, Rai RK, Shamal SN, Singh TB, Tripathi SK. Mandibular ramus: An indicator for sex in fragmentary mandible. J Forensic Sci 2011;56 Suppl 1:S13-6.
17.	Abu-Taleb NS, El Beshlawy DM. Mandibular ramus and gonial angle measurements as predictors of sex and age in an Egyptian population sample: A digital panoramic study. J Forensic Res 2015;6:1-7.
18.	Hu KS, Koh KS, Han SH, Shin KJ, Kim HJ. Sex determination using nonmetric characteristics of the mandible in Koreans. J Forensic Sci 2006;51:1376-82.
19.	Durić M, Rakocević Z, Donić D. The reliability of sex determination of skeletons from forensic context in the Balkans. Forensic Sci Int 2005;147:159-64.
20.	Chen LL, Xu TM, Jiang JH, Zhang XZ, Lin JX. Longitudinal changes in mandibular arch posterior space in adolescents with normal occlusion. Am J Orthod Dentofacial Orthop 2010;137:187-93.
21.	Krarup S, Darvann TA, Larsen P, Marsh JL, Kreiborg S. Three-dimensional analysis of mandibular growth and tooth eruption. J Anat 2005;207:669-82.
22.	Bal B, Dikbas I, Malkondu O, Oral K. Radiological study on mandibular ramus asymmetry in young population. Folia Morphol (Warsz) 2018;77:724-9.
23.	Chole RH, Patil RN, Balsaraf Chole S, Gondivkar S, Gadbail AR, Yuwanati MB. Association of mandible anatomy with age, gender, and dental status: A radiographic study. ISRN Radiol 2013;2013:453763.
24.	Bhardwaj D, Kumar JS, Mohan V. Radiographic evaluation of mandible to predict the gender and age. J Clin Diagn Res 2014;8:ZC66-9.
25.	Ghosh SV, Pai KM. Remodeling of the human mandible in the gonial angle region: A panoramic, radiographic, cross-sectional study. Oral Radiol 2009;25:2-5.
26.	Leversha J, McKeough G, Myrteza A, Skjellrup-Wakefiled H, Welsh J, Sholapurkar A. Age and gender correlation of gonial angle, ramus height and bigonial width in dentate subjects in a dental school in Far North Queensland. J Clin Exp Dent 2016;8:e49-54.
27.	Aggarwal B, Gorea RK, Gorea A, Gorea A. Comparative analysis of clinical and experimental methods for determination of sexual dimorphism of mandibular canines. J Forensic Leg Med 2016;44:20-3.
28.	Mattila K, Altonen M, Haavikko K. Determination of the gonial angle from the orthopantomogram. Angle Orthod 1977;47:107-10.
29.	Lux CJ, Conradt C, Burden D, Komposch G. Dental arch widths and mandibular-maxillary base widths in Class II malocclusions between early mixed and permanent dentitions. Angle Orthod 2003;73:674-85.
30.	Bozdag G, Sener S. The evaluation of MCI, MI, PMI and GT on both genders with different age and dental status. Dentomaxillofac Radiol 2015;44:20140435.
31.	Işeri H, Solow B. Change in the width of the mandibular body from 6 to 23 years of age: An implant study. Eur J Orthod 2000;22:229-38.
32.	Akhlaghi M, Khalighi Z, Vasigh S, Yousefinejad V. Sex determination using mandibular anthropometric parameters in subadult Iranian samples. J Forensic Leg Med 2014;22:150-3.
33.	Dutra V, Yang J, Devlin H, Susin C. Mandibular bone remodelling in adults: 1Evaluation of panoramic radiographs. Dentomaxillofac Radiol 2004;33:323-8.
34.	Ghosh S, Vengal M, Pai KM, Abhishek K. Remodeling of the antegonial angle region in the human mandible: A panoramic radiographic cross-sectional study. Med Oral Patol Oral Cir Bucal 2010;15:e802-7.
35.	Dutra V, Devlin H, Susin C, Yang J, Horner K, Fernandes AR. Mandibular morphological changes in low bone mass edentulous females: Evaluation of panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:663-8.
36.	Indira AP, Markande A, David MP. Mandibular ramus: An indicator for sex determination – A digital radiographic study. J Forensic Dent Sci 2012;4:58-62. [PUBMED] [Full text]