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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


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 Submission27-Oct-2019
Date of Acceptance10-Dec-2019
Date of Web Publication11-Mar-2020

Correspondence Address:
Dr. Burak Kerem Apaydin
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Pamukkale University, Denizli
Turkey
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DOI: 10.4103/srmjrds.srmjrds_77_19

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  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 2020 Jul 14];11:16-20. Available from: http://www.srmjrds.in/text.asp?2020/11/1/16/280377


  Introduction Top


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 5th week of pregnancy. The mandible is fibrous at birth and has two parts, which fuse anteriorly and ossify in the 1st 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 Top


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:

  1. 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]
  2. 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]
  3. 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]
  4. Bigonial width (BW): Obtained by measuring horizontally between the left and right gonion[29]
  5. Bicondylar breadth (BB): Obtained by measuring the distance between the most lateral points of the left and right condyles[14]
  6. Minimum ramus breadth (MRB): Obtained by measuring the smallest anteroposterior distance of the ramus[14]
  7. 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 Top


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 Top


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 Top


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.

 
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