Buccolingual and Mesiodistal Dimensions of the Permanent Teeth, Their Diagnostic Value for Sex Identification, and Bolton Indices

Abstract

Introduction. We aimed (1) to measure the mesiodistal and buccolingual widths of the permanent dentition in Iranian orthodontic patients, (2) to determine cut-off points for sex identification based on the mesiodistal and buccolingual diameters, and (3) to calculate Bolton indices. Methods. The mesiodistal and buccolingual dimensions of 28 maxillary and mandibular permanent teeth in 331 Iranian nonsyndromic orthodontic patients (dental casts and radiographs) aged 12 to 35 years old with fully erupted permanent dentitions (except the third molars and some sporadic cases of a few teeth missing or excluded) were measured. The anterior, posterior, and overall Bolton ratios were calculated in cases with no missing teeth in the 6-to-6 range. Potentially associated factors (the skeletal Angle classes, crowding, sex, jaws, sides, and age), as well as the value of these measurements for sex determination and cut-off points for sex identification based on these measurements were assessed using receiver-operator characteristic (ROC) curves, analysis of variance (ANOVA), Tukey, unpaired$t$-test, partial and Pearson correlation coefficients, and multiple linear regression ($\alpha =0.05$). Results. Sex dimorphism was very frequent ($P\le 0.05$in 41 out of 56 measurements). Only the buccolingual widths of the maxillary lateral and the mandibular central and lateral differed across the Angle classes (ANOVA/Tukey,$P<0.05$). Cut-off points were estimated for 38 dental measurements, which were proper for sex identification ($P<0.05$), with 8 (2 maxillary and 6 mandibular) measurements being highly appropriate (having areas under$\text{ROC}\text{curves}\ge 64\%$,$P<0.05$). Both the mandibular canines were the only teeth with all four measurements highly appropriate for this purpose. Controlling for the role of sex, aging was associated negatively with several crown dimensions (the buccolingual widths of the maxillary first and second premolar and mandibular second premolar and first molar; the mesiodistal diameters of the maxillary central, canine, first premolar, and first molar, mandibular central, lateral, first premolar, and first molar,$P\le 0.05$, partial correlation coefficient). There were significant correlations among crown sizes. All the 28 (right/left-averaged) measurements were smaller in microdontia cases ($P\le 0.002$). The anterior, posterior, and overall Bolton indices were 78.05, 105.42, and 91.87, respectively. There were correlations between the overall Bolton ratio with the other two Bolton ratios (Pearson$R=0.696$,$R=0.740$,$P<0.0005$) but not between the anterior and posterior Bolton ratios ($R=0.045$,$P=0.459$). The skeletal Angle classes might not be associated with the overall and anterior Bolton ratios (ANOVA, regression, Pearson,$P>0.05$). However, the posterior Bolton ratio was smaller in class II cases compared to classes I or III (Tukey,$P\le 0.045$). In the whole sample, there was no sex dimorphism in Bolton ratios ($t$-test,$P>0.05$). However, in Angle class II patients, the anterior Bolton ratio was greater in men than in women ($P=0.014$). Conclusions. Sex dimorphism might be very common in the dentition of Iranians, with aging significantly reducing some measurements. The buccolingual widths of some incisors might differ across the skeletal Angle classes. Mandibular canines are the most appropriate teeth for sex identification. The Angle classes might not be associated with the anterior and overall Bolton ratios; nevertheless, the posterior Bolton ratio might be smaller in class II cases compared to others. In general, sex might not affect Bolton ratios; however, in class II patients, the anterior Bolton ratios might be larger in men.