Sex Determination Using Linear Anthropometric Measurements Relative to the Mandibular Reference Plane on CBCT 3D Images

Sex determination is a fundamental component of forensic identification and medicolegal investigations. Several studies have investigated sexual dimorphism through mandibular osteometric measurements, including the position of anatomical foramina such as the mandibular and mental foramen (MF), reporting population-specific discrepancies. This study assessed the reliability and predictive ability of specific anthropometric mandibular measurements for sex estimation using three-dimensional (3D) cone beam computed tomography (CBCT) surface reconstructions. Methods: CBCT scans from 204 Greek individuals (18-70 years) were analyzed. Records were categorized by sex and age. Five linear measurements were traced on 3D reconstructions using ViewBox 4 software: projections of the inferior points of the right and left mental and mandibular foramina and the linear distance between mental foramina projections. A binary logistic regression (BLR) model was employed. All measurements showed statistically significant sex differences, with males presenting higher mean values. The final model achieved accuracy of 66.7% in sex prediction, with two vertical measurements-distances from the right mandibular foramen and the left mental foramen-identified as the strongest predictors of sex. The positions of the mandibular and mental foramina demonstrate sex-related dimorphism in this Greek sample, supporting their forensic relevance in population-specific applications.