1 Volume 24 2025 e256378 Original Research Braz J Oral Sci. 2025;24:e256378http://dx.doi.org/10.20396/bjos.v24i00.8676378 1 Department of Oral Medicine and Radiology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal. 2 Dental Department, Seti Provincial Hospital, Dhangadi, Kailali, Nepal. 3 Professor, Department of Pediatric & Preventive Dentistry, Seema Dental College & Hospital, Veerbhadra Road, Rishikesh, India. 4 Department of Community and Public Health Dentistry, Kathmandu University School of Medical Science, Dhulikhel, Kavrepalanchok, Nepal. 5 Department of Oral and Maxillofacial Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal. 6 Professor, Department Oral Medicine and Radiology, Seema Dental College & Hospital, Veerbhadra Road, Rishikesh, India. Corresponding author: Dr. Nitin Khanduri Professor, Department of Pediatric & Preventive Dentistry, Seema Dental College & Hospital, Veerbhadra Road, Rishikesh, India. 249203 Email: nitinkhanduri658@gmail.com Telephone: 9520321009 Editor: Dr. Altair A. Del Bel Cury Received: April 20, 2024 Accepted: November 26, 2024 Gender determination using maxillary sinus parameters and distance of mental foramen from lower border of mandible: a cone beam computed tomography analysis in Nepalese subpopulation Harleen Bali1 , Manisha Neupane2 , Nitin Khanduri3* , Swagat Kumar Mahanta4 , Chandan Upadhaya5 , Gaurav Pratap Singh6 Aim: To assess the reliability of morphometric measurements performed on the maxillary sinus and the distance of mental foramen from the lower border of mandible for gender determination by cone beam computed tomography (CBCT). Materials and Methods:  A total of 390 CBCT images were included in this study. The length, width and height of the maxillary sinus and the distance from the superior and inferior border of the mental foramen to the lower border of mandible were assessed. All the measured parameter data was then subjected to discriminative statistical analysis and analyzed using unpaired t-test. P-value ≤0.05 was considered as significant. Logistic regression analysis was done to determine which measures were more predictive of sexual dimorphism. Discrimination values were determined by receiver operating characteristic curve analysis, thus generating area under the curve (AUC) values, which ranged from 50% (very weak) to 100% (very strong). Results: The overall values of the maxillary sinus dimensions were significantly greater (p ≤ 0.05) in males as compared to females except right maxillary sinus length and left maxillary sinus width (p =0.162). The distances from the superior and inferior border of mental foramen to lower border of mandible were significantly greater (p ≤ 0.05) in males as compared to females. The accuracy of the maxillary sinus and the mental foramen for gender identification was found to be 65.5% and 73.8% respectively. Conclusion: CBCT measurement of the maxillary sinus and distance from the mental foramen to the lower border of the mandible can be used as a supplementary tool for gender determination in forensic anthropology. Keywords: Maxillary sinus. Mental foramen. Sex characteristics. Cone-beam computed tomography. Forensic anthropology. https://orcid.org/0000-0001-8647-9582 https://orcid.org/0009-0005-2780-2948 https://orcid.org/0000-0001-7001-5599 https://orcid.org/0000-0003-2928-0774 https://orcid.org/0000-0002-5115-6385 https://orcid.org/0000-0002-4711-9581 2 Bali et al. Braz J Oral Sci. 2025;24:e256378 Introduction Human identification holds significant importance in forensic medicine. Among var- ious methods of human identification, gender determination plays a crucial role in identifying skeletal remains of missing individuals1.  Fingerprints, DNA profiling, and dental evidence are essential techniques in human identification. Among osseous structures, the skull and pelvis best demonstrate sex- ual dimorphism2. The maxillary sinuses, situated bilaterally in the maxilla, are the largest paranasal sinuses. They typically begin development around the end of the second embryonic month and generally stabilize by the second decade of life3. The mental foramen is also a stable landmark on the mandible. It can be easily recog- nized by the forensic odontologists on radiographs4. CBCT provides clinicians with three-dimensional and multi-planar views, enhanc- ing diagnostic precision and treatment planning while avoiding the financial costs and radiation exposure associated with conventional CT scans5. Additionally, CBCT enables quicker and more accurate measurements of the maxillary sinus and mental foramen compared to traditional radiography. Due to the need for gender estimation when postmortem data from primary identifi- ers is unavailable, the desire to utilize a more advanced radiographic tool in the human identification process, and the limited studies in this field, especially using the cone beam computed tomography (CBCT) technique this study aimed to examine maxil- lary sinus and mental foramen variables measured via CBCT for sex determination in Nepalese subpopulation. Materials and Methods Before conducting the present research, ethical clearance was obtained from the Institutional Review Committee of Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu (No.41/20). The procedures followed the ethical standards of the responsible committee on human experimentation (institutional or regional) and the Helsinki Declaration of 1975, revised in 2013. A retrospective study was carried out in the Dental Department of a tertiary care cen- tre from February 2021 to June 2021. The following inclusion criterias were adopted : age group more than 20 years, high-quality images with known patient’s age, gender and origin, patients with at least 28 teeth and with no missing teeth or systemic disease were selected. Dis- torted, overlapped, unclear images, images with gross artifacts, images that did not show proper anatomic details of the area of interest, patients associated with periapical infections, periodontal pathologies and sinus pathologies, subjects with pathologic lesions in the jaws near site of interest were excluded from the study.  Convenience sampling technique was used to collect the data and sample size was calculated using the following formulae 3 Bali et al. Braz J Oral Sci. 2025;24:e256378 n= [Z2 x p (1-p)] / e2  = 385  Where, n= minimum required sample size  Z = 1.96 at 95% of Confidence Interval (CI)  p = proportion of population is taken as 50% for maximum sample size calculation e = margin of error, 5% A total of 600 CBCT radiographs were scanned, of which 390 were included. All radio- graphs had been taken using Dentium Rainbow CBCT machine (having specifications as scan Time: 20 seconds, peak Voltage: 100 kVp, tube Current: 12 mA, Field of View: 16cm x 18cm, voxel size: 300 µm). All CBCTs were shot at 80kVp, 7.0mA and scan time 17 seconds in standard mode. Volume CT data was acquired. Multi-planar reconstruc- tion was performed on a viewing workstation to obtain axial and coronal images. The axial and sagittal slices in the CBCT were aligned by default according to the orthogonal planes, with a slice thickness of 0.5 mm. The obtained images was viewed and analyzed in RainbowTM Image Viewer Version 1.0.0.0. The images were viewed on the same com- puter screen using the same image viewer, under ambient light with all curtains closed by an oral radiologist with more than three years of experience in CBCT reporting. The width of the maxillary sinus was measured as the longest distance from the medial wall to the lateral wall of the maxillary sinus in the axial view (Figure 1). The same length was measured as the longest distance from the anterior wall to the pos- terior wall in the axial view (Figure 1). The height was measured as the longest dis- tance from the superior wall to the inferior wall or floor of the maxillary sinus on the coronal view (Figure 2). Figure 1. Width and length of maxillary sinus in axial view 4 Bali et al. Braz J Oral Sci. 2025;24:e256378 Figure 2. Height of maxillary sinus in coronal view Figure 3. Measurements of mental foramen The mental foramen was measured by drawing tangents along the lower border of the body of the mandible. A perpendicular line was drawn separately from the inferior (ILM) and superior (SLM) point of outline of the mental foramen to the tangent drawn along the lower border of the body of the mandible (maximum parabolic curvature) and the distance was measured on both sides. (Figure 3). Statistical analyses was done using SPSS (version 20.0, Statistical Package for the Social Sciences, IBM, USA), with differences considered significant at the 95% level. Mean value of each linear measurement was then calculated. Statistical analysis was done by calculating the mean and standard deviation of both maxillary sinuses and mental foramen measurements which were calculated and compared. All the mea- sured parameter data was then subjected to discriminative statistical analysis and analyzed using unpaired t-test. P-value ≤0.05 was considered as significant. Logistic 5 Bali et al. Braz J Oral Sci. 2025;24:e256378 regression analysis was done to determine which measures were more predictive of sexual dimorphism. Discrimination values were determined by receiver operat- ing characteristic curve analysis, thus generating area under the curve (AUC) values, which ranged from 50% (very weak) to 100% (very strong). Results In the present study, total of 390 CBCT scans were analysed. Of these, 46.2% (180) were females and 53.8% (210) were males. The mean patient age was found to be 34.14 years with a standard deviation of 14.71 years (range 20-79 years).  The mean of different variables of right maxillary sinus (width, length and height) for males were 25.58 mm, 36.54 mm and 33.93 mm respectively and for females were 22.84 mm, 35.14 mm and 30.79 mm respectively (Table 1). According to the Stu- dent’s t-test, there was a statistically significant difference between males and females in the right maxillary sinus width and right maxillary sinus height (Table 1). The mean of different variables of left maxillary sinus (width, length and height) for males were 24.38 mm, 36.47 mm and 34.66 mm respectively and for females were 22.56 mm, 34.43 mm and 31.39 mm respectively (Table 1). According to the Student’s  t-test, there was a statistically significant difference between males and females in the left maxillary sinus length and left maxillary sinus height (Table 1). Table 1. Comparison of parameters (width,length,height) of right and left Maxillary Sinus between males and females Parameter Gender Mean±SD(mm) T p value Right maxillary sinus width Male 25.58±4.67 2.673 .009* Female 22.84±4.65 Right maxillary sinus Length Male 36.54±4.68 1.411 .162 Female 35.14±4.31 Right maxillary sinus Height Male 33.93±5.96 2.515 .014* Female 30.79±5.45 Left maxillary sinus width Male 24.38±4.83 1.663 0.10 Female 22.56±5.06 Left maxillary sinus Length Male 36.47±3.31 2.549 .013* Female 34.43±3.83 Left maxillary sinus Height Male 34.66±6.36 2.503 .014* Female 31.39±5.56 Based on the logistic regression analysis (Table 2), the gender predictability was the highest for Right maxillary sinus length and the lowest for Right maxillary sinus height. With the help of maxillary sinus, the gender determination was established correctly with accuracy of 65.5%. 6 Bali et al. Braz J Oral Sci. 2025;24:e256378 Table 2. Accuracy level for each parameter in determining gender. Parameter % Correctly Classified Right maxillary sinus width 60.7 % Right maxillary sinus Length 64.3% Right maxillary sinus Height 58.3% Left maxillary sinus width 60.7 % Left maxillary sinus Length 60.7% Left maxillary sinus Height 60.7% Based on the regression coefficients, a formula was developed to predict the probabil- ity of the gender based on height, length and width of maxillary sinus. Predicted probability (P) =1/e− (β0+β1×height+β2×length+β3×width) Where β0 is the intercept, and β1,β2,β3 are the coefficients for each of the predictor variables. Right maxillary sinus: Predicted probability (P) =1/1+ e –[4.489 + (-0.09×right width) + (0.000 ×right length)+ (-0.062× right height)]. Left maxillary sinus: Predicted probability (P) = 1/1+ e – [6.278 + (-0.001×left width) + (-0.112 ×left length)+ (-0.06× left height)]. The mean of right and left SLM for males were 17.14 mm and 17.27 mm respectively and for females were 16.001mm and 15.42mm respectively. The mean of right and left ILM for males were 13.54 mm and 13.29 mm respectively and for females were 12.57 mm and 12.35 mm respectively. According to the Student’s t-test, there was a statistically significant difference between males and females in both Right and left SLM and ILM (Table 3). Table 3. Comparison of different parameters of right and left Mental Foramen between males and females. Parameter Gender Mean±SD(mm) t p value RightSLM Male 17.14±2.002 2.68 0.009* Female 16.001±1.88 Right ILM Male 13.54±1.84 2.32 0.023* Female 12.57±1.92 Left SLM Male 17.27±2.29 4.34 0.000* Female 15.42±1.6 Left ILM Male 13.29±2.37 2.18 0.031* Female 12.35±1.55 SLM- Distance from superior border of mental foramen to inferior border of mandible. ILM- Distance from inferior border of mental foramen to inferior border of mandible. Based on the logistic regression analysis (Table 4), the gender predictability was the highest for left SLM, followed by left ILM and right ILM and the lowest for right SLM. 7 Bali et al. Braz J Oral Sci. 2025;24:e256378 And with the help of location of mental foramen, gender could be correctly predicted with accuracy of 73.8%. Table 4. Accuracy level for each pa rameter in determining gender. Parameter % Correctly Classified Right SLM 63.1 % Right ILM 66.7 % Left SLM 75% Left ILM 71.4% SLM- Distance from superior border of mental foramen to inferior border of mandible. ILM- Distance from inferior border of mental foramen to inferior border of mandible. Based on the regression coefficients, a formula was developed to predict the probabil- ity of the gender based on height, length and width of maxillary sinus. Predicted probability (P) =1/e− (β0+β1×SLM+β2×ILM) Where β0 is the intercept, and β1 and β2 are the coefficients for each of the predictor variables. Right Mental Foramen: Predicted probability(P) =1/1+ e –[5.131 + (-0.262×right SLM) + (-0.037× right ILM)]. Left Mental Foramen: Predicted probability(P) =1/1+ e –[9.118 + (-0.666×left SLM) + (0.155× right ILM)]. Figure 4. ROC curve for gender determination for different parameters. 8 Bali et al. Braz J Oral Sci. 2025;24:e256378 A receiver operating characteristic curve (ROC) was created which showed area under the curve for different parameters (Figure 4) and cut off value was determined (Table 5). If the values were greater than or equal to the cut-off values, the sex was estimated to be male. Table 5. Area under the curve for different variables and optimum cut off value. Test Result Variable(s) Area under the curve Optimum Cut-off Value (mm) Right maxillary sinus width 0.661 23.5 Right maxillary sinus Length 0.607 38.5 Right maxillary sinus Height 0.654 33.5 Left maxillary sinus width 0.603 23.5 Left maxillary sinus Length 0.655 36.5 Left maxillary sinus Height 0.629 33.5 Right SLM 0.692 16.5 Right ILM 0.684 12.5 Left SLM 0.762 16.5 Left ILM 0.700 13.5 Discussion Gender determination from human skeleton is an important forensic procedure. In the present study, the dimensions of maxillary sinus were found to be greater in males compared to females as consistent with many studies6-11. Contrary to our findings, Barros et al.12 (2022) and Gulec et al.13 (2020) in their study of volumetric analysis of the maxillary sinus did not find significant statistical differences between the genders. Deshpande et al.7(2022) in their study reported statistically significant difference between males and females in the maxillary sinus height (right and left side) and Left Sinus Length. Such statistically significant difference could not be found in the width and Right Sinus Length of the maxillary sinus for males and females7. Waluyo et al.9 (2020) showed significant differences in the maxillary sinus height, length and width between Indonesian men and women9. Whereas, in the present study statistically significant difference were found between males and females in the right maxillary sinus width, right maxillary sinus height, left maxillary sinus length and left maxillary sinus height. A similar study from Iran by Akhlaghi et al.14 (2017) reported statistically significant difference between males and females with respect to maximum height and maxi- mum width of sinuses of right and left sides. They also demonstrated that the female group had statistically significant lower values for both the left and right MS in context to the length, height and width dimensions14. However, in the present study no statis- tically significant difference was found between males and females concerning the width of maxillary sinuses of left side.  9 Bali et al. Braz J Oral Sci. 2025;24:e256378 In the present study the correctly predicted gender was 65.5% using maxillary sinus parameter and it was highest for right maxillary sinus length. Whereas Deshpande et al.7 (2022) reported that the gender predictability was the highest for height, followed by length, and the lowest for width. They found gender identifica- tion correctly with an accuracy of 71.3% in males and females. Teixeira et al.15 (2020) reported the overall accuracy rate of gender determination to be 73.6%. They reported right maxillary sinus Height (66.9%) and left maxillary sinus length (64.0%) were the best individual discriminators. Paknahad et al.6 (2017) and Mathew and Jacob16 (2020) also showed that the maxillary sinus height was the best pronounced variable in the differentiation of gender groups. The mental foramen, located on the mandible, is a consistent anatomical landmark among many others in the human skull17. Despite alveolar bone loss above the mental foramen, the distance from the foramen to mandible’s inferior border remains rela- tively consistent or stable over time, making it a reliable landmark on the mandible18. In the present study, SLM and ILM values in males on both sides were higher com- pared to the females. These findings align with many previous researches17,19-21. Con- versely, a study by Shams et al.22 (2019) conducted on the Iranian population revealed no discernible sexual dimorphism in the vertical positioning of the mental foramen. ILM were almost similar in gender predictability with respect to sides. Therefore, the distance from any of the sides of ILM can be used as a representative for gender discrimination and is in agreement with Vodanović et al.23 (2006), who found that the mean value of ILM of both the sides is equal to each other; any side can be used to determine sexual dimorphism23. SLM values shows higher predictability using left side. This results is in partial agree- ment with the study of Agthong et al.24 (2005), who have found differences in several measurements, suggestive that both gender and side should be considered when applying the anatomical variation data to an individual subject24. The variation observed in the reported accuracy rates of the previous studies were probably because of diverse ethnic and racial groups, various methodological and sta- tistical analysis applied, different radiographic techniques, and different sample size. As observed in this study, we found it difficult to identify the superior border of the mental foramen which is generally in continuation with the body of the mandible, could be also one of the key attributes to the variation in the results seen above. Our study also had a few limitations. Being a retrospective study, factors such as envi- ronmental factors, ethnic and racial groups, the history of maxillary sinus pathologies, etc., which could have caused variation in the maxillary sinus could not be known. In conclusion, the results from the present study showed that the length, width and height, perimeter, and area of the maxillary sinuses were greater in men compared to women. Thus, CBCT measurements of maxillary sinus can be used as a supple- mentary tool for gender determination in forensic anthropology, especially in cases where other traditional methods are not conclusive. 10 Bali et al. Braz J Oral Sci. 2025;24:e256378 Moreover, the distance from mental foramen to the lower border either side of the mandible shows clear sexual dimorphism, thus can be used as an effective tool for gender discrimination. Data availability Datasets related to this article will be available upon request to the corresponding author. Conflict of Interest The authors declare that they have no conflict of interest. Ethical Approval The Ethical approval was obtained from the the Institutional Review Committee of Kath- mandu University school of Medical Sciences, Dhulikhel hospital, Kathmandu (No.41/20) Author Contribution Harleen Bali: Conceptualization, Investigation, Methodology, Project administration, Writing- original draft, Writing-review and editing. Manisha Neupane: Conceptualization, Writing-review and editing. Nitin Khanduri: Visualization, Supervision, Writing-review and editing. Swagat Kumar Mahanta: Formal analysis, Result validation, Writing-review and editing. Chandan Upadhaya: Conceptualization, Visualization, Writing-review and editing. Gaurav Pratap Singh: supervision, Writing-Review and editing. All authors actively participated in the discussion of the manuscript’s finding, revised and approved the final version of the manuscript. References 1. Nagare SP, Chaudhari RS, Birangane RS, Parkarwar PC. Sex determination in forensic identification, a review. J Forensic Dent Sci. 2018 May-Aug;10(2):61-6. doi: 10.4103/jfo.jfds_55_17. 2. Christoloukas N, Mitsea A, Rontogianni A, Angelopoulos C. Gender determination based on CBCT maxillary sinus analysis: a systematic review. Diagnostics (Basel). 2023 Nov;13(23):3536. doi: 10.3390/diagnostics13233536. 3. Kandel S, Shrestha R, Sharma R, Sah SK. Sexual dimorphism of maxillary sinus: a morphometric analysis using computed tomography. J Lumbini Med Coll. 2020;8(2):264-9. doi: 10.22502/jlmc.v8i2.382. 4. Subash TS, Balaraj BM, Hema C. Determination of sex by cone-beam computed tomography analysis of mental foramen in South Indian Population. Int J Forensic Odontol 2019;4(1):21-6. doi: 10.4103/ijfo.ijfo_33_18. 5. Weiss R 2nd, Read-Fuller A. Cone beam computed tomography in oral and maxillofacial surgery: an evidence-based review. Dent J (Basel). 2019 May;7(2):52. doi: 10.3390/dj7020052. 6. Paknahad M, Shahidi S, Zarei Z. Sexual dimorphism of maxillary sinus dimensions using cone-beam computed tomography. J Forensic Sci. 2017 Mar;62(2):395-8. doi: 10.1111/1556-4029.13272. Epub 2016 Nov 16.   11 Bali et al. Braz J Oral Sci. 2025;24:e256378 7. Deshpande AA, Munde AD, Mishra SS, Kawsankar KD, Sawade RV, Mandar B. Determination of sexual dimorphism of maxillary sinus using cone-beam computed tomography in a rural population of western Maharashtra - A retrospective, cross-sectional study. J Family Med Prim Care. 2022 Apr;11(4):1257-61. doi: 10.4103/jfmpc.jfmpc_389_21. 8. Soman C. CBCT evaluation of gender dimorphism using maxillary sinus in a small subpopulation in Riyadh. Global J Res Anal. 2019;8(4):17-9.  9. Waluyo RF, Priaminiarti M, Yuniastuti M, Soedarsono N, Susilo BT. Measurements of sex related differences in maxillary sinus and mandibular canal characteristic using cone beam computed tomography. Forensic Imaging. 2020;21(1):200371. doi: 10.1016/j.fri.2020.200371. 10. Wanzeler AMV, Alves-Júnior SM, Ayres L, da Costa Prestes MC, Gomes JT, Tuji FM. Sex estimation using paranasal sinus discriminant analysis: a new approach via cone beam computerized tomography volume analysis. Int J Legal Med. 2019 Nov;133(6):1977-84. doi: 10.1007/s00414-019-02100-6. 11. Soares CBRB, Miranda-Viana M, Pontual AA, Ramos-Perez FMM, Perez DEC, Figueiroa JN, et al. Morphological dimensional assessment of the maxillary sinus for human identification sexual dimorphism: a study using CBCT. Forensic Imaging. 2020;23:200409. doi: 10.1016/j.fri.2020.200409. 12. Barros F, Fernandes CMDS, Kuhnen B, Scarso Filho J, Gonçalves M, Gonçalves V, et al. Three-dimensional analysis of the maxillary sinus according to sex, age, skin color, and nutritional status: a study with live Brazilian subjects using cone-beam computed tomography. Arch Oral Biol. 2022 Jul;139:105435. doi: 10.1016/j.archoralbio.2022.105435. 13. Gulec M, Tassoker M, Magat G, Lale B, Ozcan S, Orhan K. Three-dimensional volumetric analysis of the maxillary sinus: a cone-beam computed tomography study. Folia Morphol (Warsz). 2020;79(3):557-62. doi: 10.5603/FM.a2019.0106. Epub 2019 Sep 30. 14. Akhlaghi M, Bakhtavar K, Kamali A, Maarefdoost J, Sheikhazadi A, Mousavi F, et al. The diagnostic value of anthropometric indices of maxillary sinuses for sex determination using CT-scan images in Iranian adults: a cross-sectional study. J Forensic Leg Med. 2017 Jul;49:94-100. doi: 10.1016/j.jflm.2017.05.017. 15. Teixeira LCL, Walewski LA, de Souza Tolentino E, Iwaki LCV, Silva MC. Three-dimensional analysis of the maxillary sinus for determining sex and age in human identification. Forensic Imaging. 2020;22:200395. doi: 10.1016/j.fri.2020.200395. 16. Mathew A, Jacob LJ. 3D evaluation of maxillary sinus in gender determination: a cone beam computed tomography study. J Indian Acad Oral Med Radiol. 2020;32(4):384-9. doi: 10.4103/jiaomr.jiaomr_104_20. 17. Rathithya V, Sekizar V, Reddy RCJ, Sivasankari T. A comparative assessment for gender determination using mandibular linear osteometric measurements and localization of inferior alveolar canal using CBCT: a retrospective study. J Indian Acad Oral Med Radiol. 2023;35(2):262-6. doi: 10.4103/jiaomr.jiaomr_61_23. 18. Chandra A, Singh A, Badni M, Jaiswal R, Agnihotri A. Determination of sex by radiographic analysis of mental foramen in North Indian population. J Forensic Dent Sci. 2013 Jan;5(1):52-5. doi: 10.4103/0975-1475.114556. 19. Shankar P, Krishnan RP, Arthanari A. Gender determination by pantomographic analysis of mental foramen. J Popul Ther Clin Pharmacol. 2023;29(4):243-50. doi: 10.47750/jptcp.2022.1006. 20. Zmyslowska-Polakowska E, Radwanski M, Ledzion S, Leski M, Zmyslowska A, Lukomska-Szymanska M. Evaluation of size and location of a mental foramen in the polish population using cone-beam computed tomography. Biomed Res Int. 2019 Jan;2019:1659476. doi: 10.1155/2019/1659476. 12 Bali et al. Braz J Oral Sci. 2025;24:e256378 21. Rodríguez-Cárdenas YA, Casas-Campana M, Arriola-Guillén LE, Aliaga-Del Castillo A, Ruiz-Mora GA, Guerrero ME. Sexual dimorphism of mental foramen position in peruvian subjects: a cone-beam-computed tomography study. Indian J Dent Res. 2020 Jan-Feb;31(1):103-8. doi: 10.4103/ijdr.IJDR_557_18. 22. Shams N, Razavi M, Mehrabi A, Salehin S, Sarikhani P. Determining gender and age by mandibular anatomy landmarks in computed tomography with cone-beam (CBCT). J Mol Biol Res. 2019;9(1):33-40. 23. Vodanović M, Dumančić J, Demo Ž, Mihelić D. Determination of sex by discriminant function analysis of mandibles from two Croatian archaeological sites. Acta Stomatol Croat. 2006;40(3):263-77. 24. Agthong S, Huanmanop T, Chentanez V. Anatomical variations of the supraorbital, infraorbital, and mental foramina related to gender and side. J Oral Maxillofac Surg. 2005 Jun;63(6):800-4. doi: 10.1016/j.joms.2005.02.016.