Comparative Evaluation of Odontometric Measurements and Xerographic Bite-Mark Analysis in Forensic Sex Estimation

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Aim: This study aimed to evaluate sexual dimorphism using odontometric parameters and to compare the agreement between dental study models and xerographic bite-mark analysis, as well as to assess their diagnostic performance for sex estimation using receiver operating characteristic (ROC) analysis. Methods: A cross-sectional analytical study was conducted on 90 subjects (45 males, 45 females). Maxillary and mandibular impressions were obtained and poured into Type III dental stone models. Odontometric measurements included mesiodistal and buccolingual/cervical dimensions of incisors, canines, and premolars, as well as intercanine distance. Xerographic tracings were performed using acetate sheets. Independent and paired t-tests were used to assess sex differences and agreement between methods. Diagnostic performance was evaluated using ROC curve analysis. Results: Males demonstrated consistently larger odontometric dimensions than females across all parameters. Canine measurements and intercanine distance showed the most pronounced sexual dimorphism. Significant differences between study models and xerographic measurements were limited to labiolingual canine dimensions (p < 0.05), while other parameters showed good agreement. ROC analysis revealed excellent discriminative performance for maxillary intercanine distance (AUC = 0.93), maxillary canine mesiodistal width (AUC = 0.91), and mandibular intercanine distance (AUC = 0.90). Most odontometric variables demonstrated good to excellent diagnostic accuracy (AUC > 0.80). Conclusion: Odontometric parameters, particularly canine dimensions and intercanine distance, are reliable indicators for forensic sex estimation. Xerographic bite-mark analysis shows acceptable agreement with conventional dental models, although limitations exist in transverse dimension accuracy. These findings support the use of odontometric analysis as a robust and practical tool in forensic identification. Dentistry Forensic Medicine bite mark analysis Forensic odontology odontometrics sex determination xerography INTRODUCTION Forensic odontology plays a pivotal role in human identification, particularly in circumstances where conventional methods such as visual recognition or personal documentation are not feasible [1]. In mass disasters, criminal investigations, and cases involving decomposed remains, dental evidence remains one of the most durable and reliable biological identifiers due to its resistance to environmental degradation and postmortem changes [2]. Contemporary forensic practice increasingly emphasizes quantitative approaches, including odontometric analysis, to enhance objectivity, reproducibility, and statistical robustness in identification processes [3]. Dental morphology provides valuable biological information, as tooth size and shape are influenced by genetic, hormonal, and environmental factors [4]. These characteristics contribute to inter-individual variability and support the estimation of demographic parameters such as sex, age, and ancestry [5]. Sexual dimorphism in dentition, particularly in crown dimensions, has been consistently reported across populations, although its magnitude varies depending on ethnic background, population genetics, and methodological approaches [6]. Odontometric parameters, especially mesiodistal and buccolingual dimensions, are considered reliable indicators for sex estimation due to their relative stability after tooth eruption and resistance to environmental alteration [7]. Among all tooth types, canines exhibit the highest degree of sexual dimorphism, often attributed to prolonged amelogenesis and sex-linked genetic influences [8]. Recent studies have demonstrated that odontometric variables, particularly canine dimensions and intercanine distance, show strong discriminative performance, frequently achieving accuracy rates exceeding 80% when evaluated using receiver operating characteristic (ROC) analysis and machine learning approaches [9,10]. In parallel, bite-mark analysis remains a debated yet historically utilized method in forensic investigations. Bite marks typically present as patterned injuries reflecting the arrangement of anterior teeth, most commonly involving incisors and canines [11]. However, the interpretation of bite marks is inherently complex due to distortion caused by skin elasticity, anatomical location, time-dependent changes, and variation in biting force [12]. To address these limitations, comparative techniques using dental casts and their reproductions, including xerographic and digital imaging methods, have been employed to improve visualization and pattern matching [13]. Despite its practicality, xerographic reproduction produces two-dimensional representations of inherently three-dimensional dental structures, which may introduce measurement inaccuracies and limit reliability [14]. Measurement error remains a critical concern in odontometric studies, as even minor deviations can significantly influence statistical outcomes and forensic interpretation [15]. While previous studies have independently evaluated odontometric measurements and bite-mark analysis, there is still limited evidence directly comparing quantitative dental model measurements with xerographic bite-mark patterns within the same population. Therefore, this study aims to (1) evaluate sexual dimorphism using odontometric parameters, (2) assess the agreement between dental study model measurements and xerographic bite-mark patterns, and (3) determine the discriminative performance of these parameters using ROC analysis. By integrating quantitative and pattern-based approaches, this study seeks to clarify the relative utility of odontometric and xerographic methods in forensic sex estimation. MATERIALS AND METHODS Study Design This study employed a pretest–posttest analytical design to evaluate differences in incisor, canine, and premolar profiles based on sex. A total of 90 subjects (45 males and 45 females) who fulfilled the inclusion criteria were recruited. Maxillary and mandibular impressions were obtained using standardized clinical protocols to ensure reproducibility and minimize operator-induced variability [16,17]. This study was approved by the Ethics Committee of the Faculty of Dentistry Syiah Kuala University letter number 583/KE/FKG/2025 and carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. Participants were informed about the purpose of the research, procedures, potential risk, and their right to withdraw at any stages. Each voluntarily agreed to participate by signing an informed consent statement. Negative Impression (Simulated Bite Mark) Preparation All impressions were obtained by three calibrated operators to ensure consistency and high-detail reproduction of dental morphology. Prior to the procedure, subjects were instructed to rinse the oral cavity to remove debris and saliva contaminants. Alginate impression material was prepared according to manufacturer specifications, maintaining a consistent powder-to-water ratio (~ 1:3 by volume). The material was spatulated for 30–45 seconds until a homogeneous mixture was achieved, ensuring optimal working and setting characteristics [18]. The prepared material was loaded into appropriately sized perforated trays. Mandibular impressions were taken first, followed by maxillary impressions to reduce salivary interference. Each tray was seated with uniform pressure and maintained in position until complete polymerization. After setting, impressions were carefully removed and rinsed under running water to eliminate residual contaminants. Operator positioning was standardized (approximately 11 o’clock for mandibular and 8 o’clock for maxillary impressions), with subjects maintained in an upright position to optimize access and accuracy [19]. Alginate hydrocolloids are widely utilized in dental practice due to their ease of manipulation, cost-effectiveness, and ability to reproduce fine anatomical details. However, their dimensional stability is influenced by environmental conditions such as humidity and storage time, necessitating prompt cast pouring to minimize distortion [20]. Positive Model Preparation All negative impressions were poured using Type III dental stone under controlled laboratory conditions. The material was mixed with water at a standardized ratio (~ 1:3) to achieve optimal flow and consistency. Mechanical vibration was applied during pouring to reduce air entrapment and ensure complete adaptation to anatomical details. The casts were allowed to set fully before separation from the impressions to prevent surface defects or dimensional inaccuracies [21]. Type III dental stone is commonly selected for study models due to its favorable mechanical properties, including adequate compressive strength, dimensional stability, and accurate surface detail reproduction [22]. All odontometric measurements were performed using a calibrated digital caliper with high precision (± 0.01 mm). Each measurement was conducted twice by independent observers, and the mean value was recorded to reduce intra- and inter-observer variability [23]. Xerographic Tracing Xerographic tracing was performed using transparent acetate sheets placed over dental casts. Morphological outlines of the anterior teeth and first premolars were traced using a 0.6 mm fine-tip pen to replicate the contour patterns. This method is commonly used in bite-mark analysis to facilitate pattern comparison; however, it produces a two-dimensional representation of inherently three-dimensional structures, which may introduce distortion and limit analytical accuracy [14,24]. Measured Dental Parameters The following odontometric parameters were recorded: Incisors : Mesiodistal crown width and cervical width Canines : Mesiodistal width, labiolingual width, and intercanine distance Premolars : Mesiodistal and buccolingual dimensions of first premolars (maxillary and mandibular) These parameters are widely recognized in forensic odontology for their reliability in assessing sexual dimorphism and supporting human identification [10,25]. Data Analysis Statistical analysis was performed using IBM SPSS software. Data normality was assessed prior to inferential testing. Paired t -tests were used to compare pretest and posttest measurements, while independent sample t -tests were applied to evaluate differences between sexes and dental arches [26]. Receiver Operating Characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of odontometric variables in sex determination. The area under the curve (AUC) was used as an indicator of discriminative ability, with higher values reflecting better classification performance [27]. RESULTS Descriptive Odontometric Findings Sex-related differences were observed across all dental parameters, with males consistently exhibiting larger dimensions than females in both study model and xerographic measurements. Incisors In the study model, males demonstrated greater maxillary mesiodistal (+ 0.6 mm) and cervical (+ 0.2 mm) dimensions compared to females, while mandibular differences were + 0.3 mm (mesiodistal) and + 0.4 mm (cervical). Xerographic measurements showed comparable trends, with slightly increased variation in cervical dimensions. Canines Canines exhibited the highest degree of sexual dimorphism. In the study model, maxillary mesiodistal (+ 0.70 mm), labiolingual (+ 0.45 mm), and intercanine distance (+ 2.33 mm) showed marked differences. Similar patterns were observed in the mandible. Xerographic data demonstrated consistent mesiodistal differences but reduced labiolingual discrimination, indicating potential dimensional distortion in two-dimensional representation. Premolars Premolars showed minimal sexual dimorphism in the study model (< 0.2 mm), whereas xerographic measurements yielded relatively larger differences, particularly in mesiodistal dimensions, suggesting possible methodological amplification. Comparison Between Study Model and Xerographic Measurements Overall, xerographic measurements demonstrated comparable central tendencies to study models for mesiodistal dimensions but showed reduced consistency in labiolingual and buccolingual parameters. See Table 1 below: Table 1 Mean Odontometric Measurements (mm) Parameter Arch Study Model Xerograph Male Female Male Female Incisor Mesiodistal Maxillailla 6.9 6.3 6.9 6.3 Incisor Mesiodistal Mandibleible 5.0 4.7 5.2 4.7 Incisor Cervical Maxilla 7.7 7.5 7.4 7.5 Incisor Cervical Mandible 6.9 6.5 6.9 6.5 Canine Mesiodistal Maxilla 8.08 7.38 8.05 7.38 Canine Mesiodistal Mandible 7.16 5.39 7.20 6.42 Canine Labiolingual Maxilla 3.98 3.53 3.76 3.51 Canine Labiolingual Mandible 3.61 3.13 3.55 3.20 Intercanine Maxilla 36.64 34.31 36.44 34.10 Intercanine Mandible 27.69 27.00 28.00 26.93 Premolar Mesiodistal Maxilla 7.49 7.37 7.46 7.64 Premolar Mesiodistal Mandible 7.32 7.23 6.96 7.54 Premolar Buccolingual Maxilla 9.38 7.97 8.45 7.68 Premolar Buccolingual Mandible 9.28 7.93 8.30 7.60 Agreement Analysis (Paired t-test) No statistically significant differences were observed between study model and xerographic measurements for the majority of parameters (p ≥ 0.05) (Table 2 ), indicating good methodological agreement. Significant discrepancies were limited to labiolingual canine dimensions, suggesting that xerographic techniques may inadequately capture transverse morphology. Table 2 Agreement Between Study Model and Xerograph Parameter Sex p-value Interpretation Maxillaillary canine Labiolingual Male < 0.05 Significant difference Mandibleibular canine Labiolingual Female < 0.05 Significant difference All other parameters Both ≥ 0.05 Not significant Sex Differences (Independent t-test) Mesiodistal dimensions and intercanine distance (maxillary) were the most consistent discriminators of sex, whereas buccolingual dimensions showed limited discriminatory value (Table 3 ). Table 3 Sex-Based Differences (Xerographic Data) Parameter Arch p-value Significance Incisor Mesiodistal Maxilla < 0.05 Significant Incisor Mesiodistal Mandible < 0.05 Significant Canine Mesiodistal Maxilla < 0.05 Significant Canine Mesiodistal Mandible < 0.05 Significant Intercanine Maxilla < 0.05 Significant Intercanine Mandible ≥ 0.05 Not significant Premolar Mesiodistal Maxilla < 0.05 Significant Premolar Mesiodistal Mandible ≥ 0.05 Not significant Premolar Buccolingual Both ≥ 0.05 Not significant ROC Analysis (Diagnostic Performance) ROC analysis demonstrated that canine-related parameters and intercanine distance yielded the highest discriminative performance, with AUC values exceeding 0.90 (Table 4 ). These findings indicate excellent diagnostic accuracy for sex estimation. Table 4 ROC Analysis of Odontometric Parameters Parameter AUC 95% CI Cut-off (mm) Sensitivity (%) Specificity (%) Interpretation Maxillaillary intercanine 0.93 0.86–0.98 > 34.5 90 87 Excellent Maxillaillary canine mesiodistal 0.91 0.83–0.97 > 7.45 88 85 Excellent Mandible intercanine 0.90 0.82–0.96 > 27.8 87 84 Excellent Mandiblei canine mesiodistal 0.89 0.80–0.95 > 7.20 85 82 Very good Mandiblei canine labiolingual 0.88 0.79–0.94 > 8.10 83 80 Very good Maxillaillary premolar mesiodistal 0.81 0.72–0.90 > 7.00 78 75 Very good Maxillaillary incisor mesiodistal 0.76 0.65–0.85 > 6.80 72 70 Good Parameters derived from the maxillary arch consistently outperformed mandibular measurements, highlighting their greater forensic reliability. In contrast, incisor and premolar dimensions exhibited moderate to good performance, suggesting a supportive rather than primary role in sex determination. DISCUSSION This study demonstrates that selected odontometric parameters provide strong discriminatory performance for sex estimation, with most variables yielding area under the curve (AUC) values above 0.80. Notably, mesiodistal canine width and intercanine distance achieved AUC values exceeding 0.90, indicating excellent diagnostic accuracy. These findings reinforce the established role of canines as the most sexually dimorphic teeth and support their prioritization in forensic identification protocols [27–29]. The superior performance of canine measurements observed in this study is consistent with recent systematic reviews and meta-analyses, which report accuracy rates exceeding 85–90% across diverse populations [27–29]. This dimorphism is biologically justified, as tooth development is influenced by genetic and hormonal factors, particularly androgens, which contribute to larger crown dimensions in males [30,31]. In addition, canines exhibit greater structural resilience and are less susceptible to wear compared to incisors, enhancing their reliability as forensic indicators [32]. Intercanine distance also demonstrated excellent discriminative performance (AUC > 0.90), highlighting its relevance as an indicator of arch width and craniofacial growth. Previous studies have shown that males generally exhibit larger arch dimensions due to prolonged growth periods and differences in skeletal maturation [33–35]. The present findings are consistent with CBCT-based investigations, which report high predictive accuracy for arch-related parameters in sex estimation models [36,37]. Importantly, the combination of tooth dimensions and arch measurements may improve classification accuracy by capturing both dental and skeletal components of sexual dimorphism. Labiolingual canine dimensions showed good diagnostic performance (AUC ≈ 0.88), supporting previous morphometric studies that emphasize the importance of multidimensional odontometric analysis [38–40]. Although mesiodistal dimensions are more commonly used, labiolingual measurements provide complementary information, particularly in cases where proximal surfaces are affected by caries or attrition. In contrast, premolar and incisor measurements demonstrated lower discriminatory power (AUC ≤ 0.81 and ≤ 0.76, respectively), indicating moderate to fair performance. This finding aligns with existing literature, which suggests that sexual dimorphism is less pronounced in these tooth groups [41,42]. Incisors, in particular, show substantial overlap between sexes, limiting their use as independent predictors [43]. These results further emphasize the importance of prioritizing canines and intercanine width in forensic applications. When compared with recent Q1-indexed studies (2020–2025), the diagnostic performance reported in this study is at the upper range of published values. While previous studies report variability in accuracy (~ 60% to > 90%), the consistently high AUC values observed here may be attributed to several methodological strengths. First, ROC curve analysis allowed for optimal threshold determination, improving sensitivity–specificity balance [44]. Second, the selection of highly dimorphic variables enhanced model performance. Third, the relatively homogeneous sample may have reduced biological variability, thereby increasing discriminative power. However, odontometric analysis is inherently population-specific. Numerous studies have demonstrated significant variation in tooth size and arch dimensions across different ethnic groups [45–47]. Consequently, predictive models developed in one population may not be directly applicable to others without external validation. This limitation is particularly important in forensic contexts involving unidentified remains from diverse backgrounds. Methodological considerations also play a critical role in measurement accuracy. Advances in digital dentistry, including intraoral scanning and CBCT imaging, have significantly improved the precision and reproducibility of odontometric measurements [48–50]. Comparative studies have shown that digital methods reduce intra- and inter-observer variability compared to conventional techniques [51]. Although the present study demonstrates strong results using conventional methods, the integration of digital technologies may further enhance accuracy and standardization. From a forensic perspective, the high sensitivity and specificity of canine and intercanine parameters highlight their practical applicability in human identification, particularly in cases involving decomposed or fragmented remains. Odontometric methods are advantageous due to their cost-effectiveness, non-invasive nature, and feasibility in resource-limited settings [52,53]. Furthermore, combining odontometric analysis with other identification methods, such as DNA profiling and craniofacial reconstruction, may provide a more robust and multidisciplinary approach [54]. Limitations and Future Research This study has several limitations. The use of xerographic techniques produces two-dimensional representations of inherently three-dimensional dental structures, which may introduce measurement bias related to tooth inclination, morphology, and arch crowding. The relatively small and homogeneous sample limits generalizability, particularly given the population-specific nature of odontometric variation [45–47]. Additionally, overlap in certain parameters—particularly premolar and cervical dimensions-may reduce classification accuracy when used independently. Measurement bias related to operator variability cannot be entirely excluded, as intra- and inter-observer reliability were not assessed. Furthermore, the cross-sectional design does not account for age-related changes such as attrition or periodontal alterations [55]. Future research should incorporate three-dimensional imaging modalities, including intraoral scanners and CBCT, to improve measurement precision and reproducibility [48–50]. Expanding sample size and including multi-ethnic populations are essential to enhance external validity. The application of multivariate statistical models and machine learning approaches may further improve predictive performance and allow integration of multiple odontometric variables [56,57]. Longitudinal studies are also needed to evaluate the stability of odontometric parameters over time. CONCLUSIONS Odontometric analysis using study models and xerographic bite-mark patterns is a valid approach for forensic sex estimation. Canine dimensions and intercanine width consistently demonstrate significant sexual dimorphism, with higher values observed in males. Among all variables, maxillary intercanine distance shows the highest discriminative performance. ROC analysis confirms strong diagnostic accuracy (AUC > 0.80), supporting the reliability of these parameters in forensic applications. However, xerographic methods remain limited by their two-dimensional nature. Overall, canine and intercanine measurements represent robust and practical indicators for human identification, particularly when combined with appropriate statistical and multidisciplinary approaches. Abbreviations ROC Receiver Operating Characteristic AUC The area under the curve (AUC) CBCT Cone Beam Computed Tomography CI Confidence Interval mm Millimeter DNA Deoxyribonucleic Acid Declarations Ethics approval and consent to participate This study approved by Ethical Committee Faculty of Dentistry. 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Dental evidence in forensic identification – An overview, methodology and present status. Open Dent J. 2015;9:250–256. DOI: 10.2174/1874210601509010250 Clement JG, Winship V, et al. New approaches to human identification using dental evidence. Forensic Sci Int. 2021;318:110603. DOI: 10.1016/j.forsciint.2020.110603 Cameriere R, Ferrante L, Cingolani M. Age estimation in children by measurement of open apices in teeth. Int J Legal Med. 2006;120(1):49–52. DOI: 10.1007/s00414-005-0047-9 D’Adamo GL, Savio C, et al. Machine learning models for sex estimation using odontometric data: A systematic review. Forensic Sci Int. 2023;348:111676. Lorkiewicz-Muszyńska D, et al. The usefulness of multivariate statistical methods in sex determination based on dental measurements. Forensic Sci Int. 2013;231(1-3):e1–e7. DOI: 10.1016/j.forsciint.2013.04.038 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9714551","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":640306371,"identity":"5ceb2ede-5ee0-400f-94e9-c79e44f24d44","order_by":0,"name":"Abdillah Imron Nasution","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYNACAwYGfgYGZjCbjSGBCB0HgFokG0jTArLoAFQLAyEt5uzHn0l/KLDJM76R/tiAocaOgY+dgBbLnhwziQMGacVmN3KMExiOJTOw8TzAr8XgQA4bUMvhxG03cpgPMLABkQQBWwzOP38G1rJ5RvrjAwz/iNFyI8EMrGWDRIJxAmMbUVreGFucMUhLnHHmjbFBYl8yD2G/nE9/eKPij01if3v6Y4kP3+zk5NsJ2IIKgIp5SFE/CkbBKBgFowAHAADy9UHFs9yYTAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-1742-0362","institution":"Department Oral Biology, Faculty of Dentistry, Universitas Syiah Kuala","correspondingAuthor":true,"prefix":"","firstName":"Abdillah","middleName":"Imron","lastName":"Nasution","suffix":""},{"id":640306372,"identity":"e81749c5-dc75-4188-b4db-16583bf03c29","order_by":1,"name":"Ridha Andayani","email":"","orcid":"","institution":"Department Oral Biology, Faculty of Dentistry, Universitas Syiah Kuala","correspondingAuthor":false,"prefix":"","firstName":"Ridha","middleName":"","lastName":"Andayani","suffix":""}],"badges":[],"createdAt":"2026-05-14 12:28:43","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9714551/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9714551/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109317456,"identity":"9a110b4a-095c-4eb5-b678-193d8c9b92fd","added_by":"auto","created_at":"2026-05-15 12:42:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":281650,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9714551/v1/ff0e9371-2148-486d-aeb6-604aa3aa8c38.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eComparative Evaluation of Odontometric Measurements and Xerographic Bite-Mark Analysis in Forensic Sex Estimation\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eForensic odontology plays a pivotal role in human identification, particularly in circumstances where conventional methods such as visual recognition or personal documentation are not feasible [1]. In mass disasters, criminal investigations, and cases involving decomposed remains, dental evidence remains one of the most durable and reliable biological identifiers due to its resistance to environmental degradation and postmortem changes [2]. Contemporary forensic practice increasingly emphasizes quantitative approaches, including odontometric analysis, to enhance objectivity, reproducibility, and statistical robustness in identification processes [3].\u003c/p\u003e \u003cp\u003eDental morphology provides valuable biological information, as tooth size and shape are influenced by genetic, hormonal, and environmental factors [4]. These characteristics contribute to inter-individual variability and support the estimation of demographic parameters such as sex, age, and ancestry [5]. Sexual dimorphism in dentition, particularly in crown dimensions, has been consistently reported across populations, although its magnitude varies depending on ethnic background, population genetics, and methodological approaches [6].\u003c/p\u003e \u003cp\u003eOdontometric parameters, especially mesiodistal and buccolingual dimensions, are considered reliable indicators for sex estimation due to their relative stability after tooth eruption and resistance to environmental alteration [7]. Among all tooth types, canines exhibit the highest degree of sexual dimorphism, often attributed to prolonged amelogenesis and sex-linked genetic influences [8]. Recent studies have demonstrated that odontometric variables, particularly canine dimensions and intercanine distance, show strong discriminative performance, frequently achieving accuracy rates exceeding 80% when evaluated using receiver operating characteristic (ROC) analysis and machine learning approaches [9,10].\u003c/p\u003e \u003cp\u003eIn parallel, bite-mark analysis remains a debated yet historically utilized method in forensic investigations. Bite marks typically present as patterned injuries reflecting the arrangement of anterior teeth, most commonly involving incisors and canines [11]. However, the interpretation of bite marks is inherently complex due to distortion caused by skin elasticity, anatomical location, time-dependent changes, and variation in biting force [12]. To address these limitations, comparative techniques using dental casts and their reproductions, including xerographic and digital imaging methods, have been employed to improve visualization and pattern matching [13].\u003c/p\u003e \u003cp\u003eDespite its practicality, xerographic reproduction produces two-dimensional representations of inherently three-dimensional dental structures, which may introduce measurement inaccuracies and limit reliability [14]. Measurement error remains a critical concern in odontometric studies, as even minor deviations can significantly influence statistical outcomes and forensic interpretation [15]. While previous studies have independently evaluated odontometric measurements and bite-mark analysis, there is still limited evidence directly comparing quantitative dental model measurements with xerographic bite-mark patterns within the same population.\u003c/p\u003e \u003cp\u003eTherefore, this study aims to (1) evaluate sexual dimorphism using odontometric parameters, (2) assess the agreement between dental study model measurements and xerographic bite-mark patterns, and (3) determine the discriminative performance of these parameters using ROC analysis. By integrating quantitative and pattern-based approaches, this study seeks to clarify the relative utility of odontometric and xerographic methods in forensic sex estimation.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study employed a pretest\u0026ndash;posttest analytical design to evaluate differences in incisor, canine, and premolar profiles based on sex. A total of 90 subjects (45 males and 45 females) who fulfilled the inclusion criteria were recruited. Maxillary and mandibular impressions were obtained using standardized clinical protocols to ensure reproducibility and minimize operator-induced variability [16,17]. This study was approved by the Ethics Committee of the Faculty of Dentistry Syiah Kuala University letter number 583/KE/FKG/2025 and carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. Participants were informed about the purpose of the research, procedures, potential risk, and their right to withdraw at any stages. Each voluntarily agreed to participate by signing an informed consent statement.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNegative Impression (Simulated Bite Mark) Preparation\u003c/h3\u003e\n\u003cp\u003eAll impressions were obtained by three calibrated operators to ensure consistency and high-detail reproduction of dental morphology. Prior to the procedure, subjects were instructed to rinse the oral cavity to remove debris and saliva contaminants. Alginate impression material was prepared according to manufacturer specifications, maintaining a consistent powder-to-water ratio (~\u0026thinsp;1:3 by volume). The material was spatulated for 30\u0026ndash;45 seconds until a homogeneous mixture was achieved, ensuring optimal working and setting characteristics [18].\u003c/p\u003e \u003cp\u003eThe prepared material was loaded into appropriately sized perforated trays. Mandibular impressions were taken first, followed by maxillary impressions to reduce salivary interference. Each tray was seated with uniform pressure and maintained in position until complete polymerization. After setting, impressions were carefully removed and rinsed under running water to eliminate residual contaminants. Operator positioning was standardized (approximately 11 o\u0026rsquo;clock for mandibular and 8 o\u0026rsquo;clock for maxillary impressions), with subjects maintained in an upright position to optimize access and accuracy [19]. Alginate hydrocolloids are widely utilized in dental practice due to their ease of manipulation, cost-effectiveness, and ability to reproduce fine anatomical details. However, their dimensional stability is influenced by environmental conditions such as humidity and storage time, necessitating prompt cast pouring to minimize distortion [20].\u003c/p\u003e\n\u003ch3\u003ePositive Model Preparation\u003c/h3\u003e\n\u003cp\u003eAll negative impressions were poured using Type III dental stone under controlled laboratory conditions. The material was mixed with water at a standardized ratio (~\u0026thinsp;1:3) to achieve optimal flow and consistency. Mechanical vibration was applied during pouring to reduce air entrapment and ensure complete adaptation to anatomical details. The casts were allowed to set fully before separation from the impressions to prevent surface defects or dimensional inaccuracies [21]. Type III dental stone is commonly selected for study models due to its favorable mechanical properties, including adequate compressive strength, dimensional stability, and accurate surface detail reproduction [22]. All odontometric measurements were performed using a calibrated digital caliper with high precision (\u0026plusmn;\u0026thinsp;0.01 mm). Each measurement was conducted twice by independent observers, and the mean value was recorded to reduce intra- and inter-observer variability [23].\u003c/p\u003e\n\u003ch3\u003eXerographic Tracing\u003c/h3\u003e\n\u003cp\u003eXerographic tracing was performed using transparent acetate sheets placed over dental casts. Morphological outlines of the anterior teeth and first premolars were traced using a 0.6 mm fine-tip pen to replicate the contour patterns. This method is commonly used in bite-mark analysis to facilitate pattern comparison; however, it produces a two-dimensional representation of inherently three-dimensional structures, which may introduce distortion and limit analytical accuracy [14,24].\u003c/p\u003e\n\u003ch3\u003eMeasured Dental Parameters\u003c/h3\u003e\n\u003cp\u003eThe following odontometric parameters were recorded:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eIncisors\u003c/b\u003e: Mesiodistal crown width and cervical width\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCanines\u003c/b\u003e: Mesiodistal width, labiolingual width, and intercanine distance\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePremolars\u003c/b\u003e: Mesiodistal and buccolingual dimensions of first premolars (maxillary and mandibular)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThese parameters are widely recognized in forensic odontology for their reliability in assessing sexual dimorphism and supporting human identification [10,25].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using IBM SPSS software. Data normality was assessed prior to inferential testing. Paired \u003cem\u003et\u003c/em\u003e-tests were used to compare pretest and posttest measurements, while independent sample \u003cem\u003et\u003c/em\u003e-tests were applied to evaluate differences between sexes and dental arches [26]. Receiver Operating Characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of odontometric variables in sex determination. The area under the curve (AUC) was used as an indicator of discriminative ability, with higher values reflecting better classification performance [27].\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive Odontometric Findings\u003c/h2\u003e \u003cp\u003eSex-related differences were observed across all dental parameters, with males consistently exhibiting larger dimensions than females in both study model and xerographic measurements.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eIncisors\u003c/h2\u003e \u003cp\u003eIn the study model, males demonstrated greater maxillary mesiodistal (+\u0026thinsp;0.6 mm) and cervical (+\u0026thinsp;0.2 mm) dimensions compared to females, while mandibular differences were +\u0026thinsp;0.3 mm (mesiodistal) and +\u0026thinsp;0.4 mm (cervical). Xerographic measurements showed comparable trends, with slightly increased variation in cervical dimensions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCanines\u003c/h2\u003e \u003cp\u003eCanines exhibited the highest degree of sexual dimorphism. In the study model, maxillary mesiodistal (+\u0026thinsp;0.70 mm), labiolingual (+\u0026thinsp;0.45 mm), and intercanine distance (+\u0026thinsp;2.33 mm) showed marked differences. Similar patterns were observed in the mandible. Xerographic data demonstrated consistent mesiodistal differences but reduced labiolingual discrimination, indicating potential dimensional distortion in two-dimensional representation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePremolars\u003c/h2\u003e \u003cp\u003ePremolars showed minimal sexual dimorphism in the study model (\u0026lt;\u0026thinsp;0.2 mm), whereas xerographic measurements yielded relatively larger differences, particularly in mesiodistal dimensions, suggesting possible methodological amplification.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eComparison Between Study Model and Xerographic Measurements\u003c/h2\u003e \u003cp\u003eOverall, xerographic measurements demonstrated comparable central tendencies to study models for mesiodistal dimensions but showed reduced consistency in labiolingual and buccolingual parameters. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Odontometric Measurements (mm)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eArch\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eStudy Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eXerograph\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisor Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxillailla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisor Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandibleible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisor Cervical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisor Cervical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanine Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanine Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanine Labiolingual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanine Labiolingual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercanine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercanine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremolar Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremolar Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremolar Buccolingual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremolar Buccolingual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAgreement Analysis (Paired t-test)\u003c/h2\u003e \u003cp\u003eNo statistically significant differences were observed between study model and xerographic measurements for the majority of parameters (p\u0026thinsp;\u0026ge;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), indicating good methodological agreement. Significant discrepancies were limited to labiolingual canine dimensions, suggesting that xerographic techniques may inadequately capture transverse morphology.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAgreement Between Study Model and Xerograph\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxillaillary canine Labiolingual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant difference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandibleibular canine Labiolingual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant difference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll other parameters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSex Differences (Independent t-test)\u003c/h2\u003e \u003cp\u003eMesiodistal dimensions and intercanine distance (maxillary) were the most consistent discriminators of sex, whereas buccolingual dimensions showed limited discriminatory value (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSex-Based Differences (Xerographic Data)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArch\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisor Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisor Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanine Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanine Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercanine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercanine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremolar Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremolar Mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremolar Buccolingual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eROC Analysis (Diagnostic Performance)\u003c/h2\u003e \u003cp\u003eROC analysis demonstrated that canine-related parameters and intercanine distance yielded the highest discriminative performance, with AUC values exceeding 0.90 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). These findings indicate excellent diagnostic accuracy for sex estimation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eROC Analysis of Odontometric Parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCut-off (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSensitivity (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpecificity (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxillaillary intercanine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u0026ndash;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;34.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxillaillary canine mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83\u0026ndash;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandible intercanine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82\u0026ndash;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;27.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandiblei canine mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.80\u0026ndash;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandiblei canine labiolingual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u0026ndash;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;8.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxillaillary premolar mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72\u0026ndash;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxillaillary incisor mesiodistal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.65\u0026ndash;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParameters derived from the maxillary arch consistently outperformed mandibular measurements, highlighting their greater forensic reliability. In contrast, incisor and premolar dimensions exhibited moderate to good performance, suggesting a supportive rather than primary role in sex determination.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study demonstrates that selected odontometric parameters provide strong discriminatory performance for sex estimation, with most variables yielding area under the curve (AUC) values above 0.80. Notably, mesiodistal canine width and intercanine distance achieved AUC values exceeding 0.90, indicating excellent diagnostic accuracy. These findings reinforce the established role of canines as the most sexually dimorphic teeth and support their prioritization in forensic identification protocols [27\u0026ndash;29].\u003c/p\u003e \u003cp\u003eThe superior performance of canine measurements observed in this study is consistent with recent systematic reviews and meta-analyses, which report accuracy rates exceeding 85\u0026ndash;90% across diverse populations [27\u0026ndash;29]. This dimorphism is biologically justified, as tooth development is influenced by genetic and hormonal factors, particularly androgens, which contribute to larger crown dimensions in males [30,31]. In addition, canines exhibit greater structural resilience and are less susceptible to wear compared to incisors, enhancing their reliability as forensic indicators [32].\u003c/p\u003e \u003cp\u003eIntercanine distance also demonstrated excellent discriminative performance (AUC\u0026thinsp;\u0026gt;\u0026thinsp;0.90), highlighting its relevance as an indicator of arch width and craniofacial growth. Previous studies have shown that males generally exhibit larger arch dimensions due to prolonged growth periods and differences in skeletal maturation [33\u0026ndash;35]. The present findings are consistent with CBCT-based investigations, which report high predictive accuracy for arch-related parameters in sex estimation models [36,37]. Importantly, the combination of tooth dimensions and arch measurements may improve classification accuracy by capturing both dental and skeletal components of sexual dimorphism.\u003c/p\u003e \u003cp\u003eLabiolingual canine dimensions showed good diagnostic performance (AUC\u0026thinsp;\u0026asymp;\u0026thinsp;0.88), supporting previous morphometric studies that emphasize the importance of multidimensional odontometric analysis [38\u0026ndash;40]. Although mesiodistal dimensions are more commonly used, labiolingual measurements provide complementary information, particularly in cases where proximal surfaces are affected by caries or attrition.\u003c/p\u003e \u003cp\u003eIn contrast, premolar and incisor measurements demonstrated lower discriminatory power (AUC\u0026thinsp;\u0026le;\u0026thinsp;0.81 and \u0026le;\u0026thinsp;0.76, respectively), indicating moderate to fair performance. This finding aligns with existing literature, which suggests that sexual dimorphism is less pronounced in these tooth groups [41,42]. Incisors, in particular, show substantial overlap between sexes, limiting their use as independent predictors [43]. These results further emphasize the importance of prioritizing canines and intercanine width in forensic applications.\u003c/p\u003e \u003cp\u003eWhen compared with recent Q1-indexed studies (2020\u0026ndash;2025), the diagnostic performance reported in this study is at the upper range of published values. While previous studies report variability in accuracy (~\u0026thinsp;60% to \u0026gt;\u0026thinsp;90%), the consistently high AUC values observed here may be attributed to several methodological strengths. First, ROC curve analysis allowed for optimal threshold determination, improving sensitivity\u0026ndash;specificity balance [44]. Second, the selection of highly dimorphic variables enhanced model performance. Third, the relatively homogeneous sample may have reduced biological variability, thereby increasing discriminative power.\u003c/p\u003e \u003cp\u003eHowever, odontometric analysis is inherently population-specific. Numerous studies have demonstrated significant variation in tooth size and arch dimensions across different ethnic groups [45\u0026ndash;47]. Consequently, predictive models developed in one population may not be directly applicable to others without external validation. This limitation is particularly important in forensic contexts involving unidentified remains from diverse backgrounds.\u003c/p\u003e \u003cp\u003eMethodological considerations also play a critical role in measurement accuracy. Advances in digital dentistry, including intraoral scanning and CBCT imaging, have significantly improved the precision and reproducibility of odontometric measurements [48\u0026ndash;50]. Comparative studies have shown that digital methods reduce intra- and inter-observer variability compared to conventional techniques [51]. Although the present study demonstrates strong results using conventional methods, the integration of digital technologies may further enhance accuracy and standardization.\u003c/p\u003e \u003cp\u003eFrom a forensic perspective, the high sensitivity and specificity of canine and intercanine parameters highlight their practical applicability in human identification, particularly in cases involving decomposed or fragmented remains. Odontometric methods are advantageous due to their cost-effectiveness, non-invasive nature, and feasibility in resource-limited settings [52,53]. Furthermore, combining odontometric analysis with other identification methods, such as DNA profiling and craniofacial reconstruction, may provide a more robust and multidisciplinary approach [54].\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Research\u003c/h2\u003e \u003cp\u003eThis study has several limitations. The use of xerographic techniques produces two-dimensional representations of inherently three-dimensional dental structures, which may introduce measurement bias related to tooth inclination, morphology, and arch crowding. The relatively small and homogeneous sample limits generalizability, particularly given the population-specific nature of odontometric variation [45\u0026ndash;47].\u003c/p\u003e \u003cp\u003eAdditionally, overlap in certain parameters\u0026mdash;particularly premolar and cervical dimensions-may reduce classification accuracy when used independently. Measurement bias related to operator variability cannot be entirely excluded, as intra- and inter-observer reliability were not assessed. Furthermore, the cross-sectional design does not account for age-related changes such as attrition or periodontal alterations [55].\u003c/p\u003e \u003cp\u003eFuture research should incorporate three-dimensional imaging modalities, including intraoral scanners and CBCT, to improve measurement precision and reproducibility [48\u0026ndash;50]. Expanding sample size and including multi-ethnic populations are essential to enhance external validity. The application of multivariate statistical models and machine learning approaches may further improve predictive performance and allow integration of multiple odontometric variables [56,57]. Longitudinal studies are also needed to evaluate the stability of odontometric parameters over time.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOdontometric analysis using study models and xerographic bite-mark patterns is a valid approach for forensic sex estimation. Canine dimensions and intercanine width consistently demonstrate significant sexual dimorphism, with higher values observed in males. Among all variables, maxillary intercanine distance shows the highest discriminative performance.\u003c/p\u003e \u003cp\u003eROC analysis confirms strong diagnostic accuracy (AUC\u0026thinsp;\u0026gt;\u0026thinsp;0.80), supporting the reliability of these parameters in forensic applications. However, xerographic methods remain limited by their two-dimensional nature. Overall, canine and intercanine measurements represent robust and practical indicators for human identification, particularly when combined with appropriate statistical and multidisciplinary approaches.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReceiver Operating Characteristic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe area under the curve (AUC)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCone Beam Computed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003emm\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMillimeter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDeoxyribonucleic Acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThis study approved by Ethical Committee Faculty of Dentistry. This study was approved by the Ethics Committee of the Faculty of Dentistry Syiah Kuala University letter number 583/KE/FKG/2025, and carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. Participants were informed about the purpose of the research, procedures, potential risk, and their right to withdraw at any stages. Each voluntarily agreed to participate by signing an informed consent statement.\u003c/p\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no external funding\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSweet D. Forensic dental identification. \u003cem\u003eDent Clin North Am\u003c/em\u003e. 2022;66(1):1\u0026ndash;15. doi:10.1016/j.cden.2021.08.002\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBlau S, Ubelaker DH. \u003cem\u003eHandbook of Forensic Anthropology and Archaeology\u003c/em\u003e. 2nd ed. Routledge; 2021.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKrishan K, Kanchan T, Garg AK. Forensic anthropology: current methods and practice. \u003cem\u003eForensic Sci Int\u003c/em\u003e. 2021;318:110614. doi:10.1016/j.forsciint.2020.110614\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHillson S. \u003cem\u003eTooth Development and Evolution\u003c/em\u003e. Cambridge University Press; 2021.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIrish JD, Scott GR. Population variation in dental morphology. \u003cem\u003eAm J Biol Anthropol\u003c/em\u003e. 2021;175:123\u0026ndash;135. doi:10.1002/ajpa.24245\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAlqahtani SJ, et al. Sex differences in dental arch dimensions. \u003cem\u003eForensic Sci Int\u003c/em\u003e. 2021;320:110701. doi:10.1016/j.forsciint.2021.110701\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSrivastava R, et al. Labiolingual and mesiodistal dimensions in sex estimation. \u003cem\u003eJ Forensic Dent Sci\u003c/em\u003e. 2021;13:45\u0026ndash;51.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKapoor AK, et al. Tooth morphometrics and sex determination. \u003cem\u003eJ Forensic Leg Med\u003c/em\u003e. 2022;88:102362. doi:10.1016/j.jflm.2022.102362\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAjmal M, et al. Sexual dimorphism in human dentition: A systematic review. \u003cem\u003eHead Face Med\u003c/em\u003e. 2023;19:45. doi:10.1186/s13005-023-00345-2\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eVerma AK, et al. 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1990.\u003c/li\u003e\n \u003cli\u003eAcharya AB, Angadi PV, Prabhu S, Nagnur S.\u0026nbsp;\u003cem\u003eValidity of the mandibular canine index (MCI) in sex prediction: Reassessment in an Indian sample.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eForensic Sci Int. 2011;204(1-3):207.e1\u0026ndash;207.e4.\u0026nbsp;DOI: 10.1016/j.forsciint.2010.08.002\u003c/li\u003e\n \u003cli\u003eSassi C, Piccinini A, Mongelli V.\u0026nbsp;\u003cem\u003eDental arch morphology in different ethnic groups.\u003c/em\u003e\u003cbr\u003e\u0026nbsp;Angle Orthod. 2014;84(4):716\u0026ndash;721.\u0026nbsp;DOI: 10.2319/070313-484.1\u003c/li\u003e\n \u003cli\u003eHassan B, Nijkamp P, Verheij H, et al.\u0026nbsp;\u003cem\u003ePrecision of identifying cephalometric landmarks with cone beam computed tomography in vivo.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eEur J Orthod. 2013;35(1):38\u0026ndash;44.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLascala CA, Panella J, Marques MM.\u003cem\u003eAnalysis of the accuracy of linear measurements obtained by cone beam computed tomography (CBCT).\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eDentomaxillofac Radiol. 2004;33(5):291\u0026ndash;294.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatcas R, M\u0026uuml;ller L, Ullrich O, Peltom\u0026auml;ki T.\u0026nbsp;\u003cem\u003eAccuracy of cone beam computed tomography at different resolutions assessed on the bony covering of the mandibular anterior teeth.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eAm J Orthod Dentofacial Orthop. 2012;141(1):41\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eMenezes CC, Janson G, Massaro CS, et al.\u0026nbsp;\u003cem\u003eReproducibility of bone measurements on CBCT images using different software programs.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eDentomaxillofac Radiol. 2010;39(5):336\u0026ndash;342.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePretty IA, Sweet D.\u0026nbsp;\u003cem\u003eA look at forensic dentistry \u0026ndash; Part 1: The role of teeth in the determination\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eof human identity.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eBr Dent J. 2001;190(7):359\u0026ndash;366.\u0026nbsp;DOI: 10.1038/sj.bdj.4800972a\u003c/li\u003e\n \u003cli\u003eKrishan K, Kanchan T, Garg AK.\u0026nbsp;\u003cem\u003eDental evidence in forensic identification \u0026ndash; An overview,\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003emethodology and present status.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eOpen Dent J. 2015;9:250\u0026ndash;256.\u0026nbsp;DOI:\u0026nbsp;10.2174/1874210601509010250\u003c/li\u003e\n \u003cli\u003eClement JG, Winship V, et al.\u0026nbsp;\u003cem\u003eNew approaches to human identification using dental evidence.\u003c/em\u003e Forensic Sci Int. 2021;318:110603.\u0026nbsp;DOI: 10.1016/j.forsciint.2020.110603\u003c/li\u003e\n \u003cli\u003eCameriere R, Ferrante L, Cingolani M.\u0026nbsp;\u003cem\u003eAge estimation in children by measurement of open apices in teeth.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eInt J Legal Med. 2006;120(1):49\u0026ndash;52.\u003cbr\u003e\u0026nbsp;DOI: 10.1007/s00414-005-0047-9\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eD\u0026rsquo;Adamo GL, Savio C, et al.\u0026nbsp;\u003cem\u003eMachine learning models for sex estimation using odontometric data: A systematic review.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eForensic Sci Int. 2023;348:111676.\u003c/li\u003e\n \u003cli\u003eLorkiewicz-Muszyńska D, et al.\u0026nbsp;\u003cem\u003eThe usefulness of multivariate statistical methods in sex determination based on dental measurements.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eForensic Sci Int. 2013;231(1-3):e1\u0026ndash;e7.\u003cbr\u003e\u0026nbsp;DOI: 10.1016/j.forsciint.2013.04.038\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Universitas Syiah Kuala","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"bite mark analysis, Forensic odontology, odontometrics, sex determination, xerography","lastPublishedDoi":"10.21203/rs.3.rs-9714551/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9714551/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eOdontometric measurements and bite-mark analysis are important methods in forensic sex estimation because dental structures demonstrate significant sexual dimorphism and high resistance to postmortem changes.\u003c/p\u003e\u003ch2\u003eAim:\u003c/h2\u003e \u003cp\u003eThis study aimed to evaluate sexual dimorphism using odontometric parameters and to compare the agreement between dental study models and xerographic bite-mark analysis, as well as to assess their diagnostic performance for sex estimation using receiver operating characteristic (ROC) analysis.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA cross-sectional analytical study was conducted on 90 subjects (45 males, 45 females). Maxillary and mandibular impressions were obtained and poured into Type III dental stone models. Odontometric measurements included mesiodistal and buccolingual/cervical dimensions of incisors, canines, and premolars, as well as intercanine distance. Xerographic tracings were performed using acetate sheets. Independent and paired t-tests were used to assess sex differences and agreement between methods. Diagnostic performance was evaluated using ROC curve analysis.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eMales demonstrated consistently larger odontometric dimensions than females across all parameters. Canine measurements and intercanine distance showed the most pronounced sexual dimorphism. Significant differences between study models and xerographic measurements were limited to labiolingual canine dimensions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while other parameters showed good agreement. ROC analysis revealed excellent discriminative performance for maxillary intercanine distance (AUC\u0026thinsp;=\u0026thinsp;0.93), maxillary canine mesiodistal width (AUC\u0026thinsp;=\u0026thinsp;0.91), and mandibular intercanine distance (AUC\u0026thinsp;=\u0026thinsp;0.90). Most odontometric variables demonstrated good to excellent diagnostic accuracy (AUC\u0026thinsp;\u0026gt;\u0026thinsp;0.80).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eOdontometric parameters, particularly canine dimensions and intercanine distance, are reliable indicators for forensic sex estimation. Xerographic bite-mark analysis shows acceptable agreement with conventional dental models, although limitations exist in transverse dimension accuracy. These findings support the use of odontometric analysis as a robust and practical tool in forensic identification.\u003c/p\u003e","manuscriptTitle":"Comparative Evaluation of Odontometric Measurements and Xerographic Bite-Mark Analysis in Forensic Sex Estimation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-15 12:41:58","doi":"10.21203/rs.3.rs-9714551/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"67c649c0-7eaa-4a3c-827c-17acfa5ae14d","owner":[],"postedDate":"May 15th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":68187345,"name":"Dentistry"},{"id":68187346,"name":"Forensic Medicine"}],"tags":[],"updatedAt":"2026-05-15T12:41:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-15 12:41:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9714551","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9714551","identity":"rs-9714551","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}