Sexual dimorphism is defined as those variations in size, appearance and stature which can apply on female and male for identification because no two mouth are alike. Gender identification play important role in anthropological studies and solving medico-legal issues. Gender determination is done on different parts of the body like skull and other bones but teeth are considered as a strongest part of the body because teeth are resistant to chemical, mechanical, thermal, physical microbial and other post mortem insults for degradation of structures. In case of major catastrophes where bodies are damage and beyond recognition morphometry play a vital role in identification .tooth size can be used for gender and age estimation as human teeth exhibits sexual dimorphism.1 Male exhibit larger teeth as compared to female 2 the greatest difference in tooth size was found in upper lateral, lower lateral incisor and mandibular canine showed greatest sexual dimorphism while in female maxillary canine and mandibular incisor showed sexual dimorphism  as compared to male exhibits greater dimorphism in maxillary lateral incisor, mandibular lateral incisor and second premolar. shahid et al also stated that dimensions of teeth on the right side are same as compared to the dimensions of teeth on the left side of the oral cavity3thought teeth morphology is same only difference was found in size of the teeth which give an evidence to differentiate between sex4 adults teeth have anatomical land marks which are fixed and odontometric is the method for measuring these landmarks in easy way to gain satisfactory results for gender determination.5 The formula for sexual dimorphism given by Garn and Lewis as follows: Sexual dimorphism = [(Xm/Xf) − 1] × 100, Where Xm = Mean value of male and Xf = Mean value of female.6 Record keeping during dental procedures are the main source for antimortem records while postmortem digital radiograph are used for the measurements of landmarka of teeth and othe mesiodiatal width and buccolingual width on the surface of teeth, length to width ratio of teeth and root central angle for positive identification in mass disasters.7 Hence dental profiling is based on analysis of tooth size among adults. 8

Every individual has its own dental profile which marks them distinctive and inimitable from one another. In Pakistan, dental professionals are unaware of keeping antemortem dental records to create a profile of patients because creating a dental profile of an individual has great importance in the process of recognition and in finding out the identity of a person.

This was a cross-sectional exploratory study with 384 sample size calculated by software open epi at 95% CI (confidence interval).The study was conducted in the institute of basic medical sciences ,Khyber Medical University Peshawar. Research sample was collected after the approval of synopsis from the ethical committee of Khyber medical university Peshawar under DIR/KMU-EB/MA/000599. For sample collection non-probability convenience sampling technique was used. Sample was stratified into two groups male and female, there were 192 males and 192 females in the study from 25 to 45 years visiting to the radiology department of Khyber College of Dentistry. Semi structured questionnaire was constructed, consisting of teeth selected from the four quadrants of the oral cavity by FDI system (Federation Dentaire International). Oral cavity was divided into four quadrant upper two right, left and lower two right, left quadrant. Five teeth were selected from the each quadrant for morphometric analysis of mesiodistal width and buccolingual width of teeth. Teeth selected from the set of teeth were central incisors, lateral incisors, canines’ first premolars and molars. Individuals using dentures, partially edentulous patients, complete edentulous patients using fixed partial denture, any pathology in maxilla and mandible, anterior teeth crowding, patient with teeth anomalies, congenitally missing teeth, patient with overbite or deep bite and overjet were excluded from the study. Individuals from 25-45 years with upper central incisors 11, 21 upper lateral incisor 12, 22 upper canine 13, 23 upper first premolars 14, 24 and upper 1st molars 16, 26.Lower central incisors 41, 31 lower lateral incisors 42, 32 lower canines 43, 33 lower 1st premolars 44, 34 and lower 1st molars 46, 36 via Federation Dentaire Internationale (FDI system) were included in the study. The cbct (cone beam computed tomography) images were used for taking linear measurements on three different sections and planes. These planes or sections were panoramic, trans-axial and coronal. Measurements were made on multiplane view with voxel size thickness of 0.1 voxel, version 4.6.0 R with bit grayscale resolution of classic i-CAT, morphometric analysis was done for the completion of dental profile of an individual same conditions and methods were used for every individual throughout the study. All the data was recorded in Microsoft excel sheet, after obtaining, organizing and coding all the data in excel sheet was imported into SPSS for applying proper statistical analysis. Data analysis was done by Spss version 16 the relationship of tooth parameters for the assessment of sexual dimorphism chi-square test at 95% confidence interval with p≤0.05 and t-test for comparison of teeth

It was a cross-sectional exploratory study with 384 sample size age from 25 to 45 years with equal gender distribution as shown in figure 1. The study include five ethnic groups Urdu, Pushto and Punjabi with 80 number of individual in each group (20.8%) while Afghani were 64 (16.7%) with total 3840 maxillary teeth selected from the two upper right and left maxillary quadrants while 3840 mandibular teeth were selected from the lower two mandibular quadrant of the oral cavity according to the FDI system as shown in table 1,2,3,4. Mesiodistal and buccolingual width taken on teeth to find out the most dimorphic tooth. The mesiodistal width of male is greater than female. The highest sexual dimorphic tooth was 43 on mesiodistal width. The buccolingual width of male is also greater than female. p-value <0.05 results are significant. Teeth number 22 and 43 has the highest value for sexual dimorphism on buccolingual width p-value is 0.00 the result was significant.

Figure 1: Frequency of age at different intervals

Table 1: Mesiodistal width of maxillary teeth, p-value <0.05 results are significant with gender,

t-test and Pearson’s correlation

Table 2: Buccolingual width of maxillary teeth, p-value <0.05 results are significant with gender,

t-test and Pearson’s correlation

Table 3: Mesiodistal of mandibular teeth, p-values <0.05 result is significant with

Gender, t-test and Pearson’s correlation

Table 4: Buccolingual of mandibular teeth, p-values <0.05 result is significant with

Gender, t-test and Pearson’s correlation

Table 5: Sexual dimorphism of Maxillary and Mandibular teeth in mesiodistal width

Table 6: Sexual dimorphism of Maxillary and Mandibular teeth in buccolingual width

In morphometric analysis of teeth mesiodistal width and buccolingual width can be used for identifying the specificity and sensitivity of the parameters seem to be most commonly assessed. The molars teeth show significant results in assessment of these parameters. A study done at department of Oral and Maxillofacial Pathology, Dental College Hospital and Research Institute, Bangalore, Karnataka, India has worked on 100 individuals from 19 to 23 years on mesiodistal and buccolingual width of maxillary incisors, canine, premolars and molars. The odontometric parameters were assessed on dental cast of maxillary jaw. The study concluded that buccolingual width and mesiodistal width show significant variations among selected teeth and can established sexual dimorphism. Among all the teeth canines were the most important tooth for sex determination because it showed highest sexual dimorphism. It was MDW which proved to be a better parameter than BLW for assessment of gender in case of molar and canine9 while in the present study 43 mandibular canine has the highest value for sexual dimorphism and in buccolingual width 22 and 43 has the highest value for sexual dimorphism

Sexual dimorphism was found in molars 3.1% on mesiodistal width while 3.5% on buccolingual width. 10 variation was found in other studies from 1.9 (11) to 6% (12) sample size, genetic and racial differences are due to difference in racial origin therefore significant sexual dimorphism occurs in molars in indian population.13 while in the present study mandibular molar (36) has 4.5 and maxillary molar (16) has 5.7% sexual dimorphism on buccolingual width while maxillary molar (16) has 3.4 and mandibular molar (36) has 5.2% sexual dimorphism on mesiodistal width, in other studies permanent maxillary canine was found to be the best tooth for sexual dimorphism 14while premolars on mesiodistal width showed no significant relation with dimorphism. 15The mean BLW of the canine in the males (7.63 ± 0.63) and the females (7.29 ± 0.56) was almost similar to results obtained in previous studies on the tooth.15

BLW of the incisor expressed a significant percentage of sexual dimorphism (3.81%) a feature recorded in previous studies.14 The mean values of MDW in males and females of the permanent maxillary central incisor in coincided with those recorded in a North Indian population by Khangura et al.13 and showed similar sexual dimorphism. Mesiodistal width of maxillary canine and mandibular canine was larger in male as compared to female16 Hashim and Murshid 17 noticed that canine exhibits dimorphism in Saudi population in the present study the mesiodistal width od maxillary and mandibular canine in male is greater than in female and mandibular canine exhibits sexual dimorphism in kpk population which is according to the previous studies done in indian and saudi population.

 among in 720 teeth studied on orthodontic casts age from 13 -20 years, he also determine that there was no difference between right and left canine he also suggested that measurement of teeth on one side was same compared with the opposite side.18 study done by Al-Rifaiy et al 19 found that canine teeth were present in oral cavity bilaterally therefore 55% to 65.5% showed correct difference between male and female on mdw and icd which is in agreement with the previous studies by  Kaushal et al.,20 Kapila et al.,21  show significant results in mandibular canine with 8.8 and 9.7 mean difference respectively it is also in accordance with the study present study canine showed highest value of sexual dimorphism as compared to maxillary canine while in the present study canine was the best tooth for sex determination by using canine index. Study done by Acharya and Mainali 22 that mesiodistal width of canine and intercanine distance were both large in male as compared to female the results were significant (P < 0.01). Rao et al.23 worked done on mandibular canine index for sex determination 384 female and 382 males. Sample was taken from south indian population age from 15 to 21 years. Study concluded significant sexual dimorphism in mandibular canine the mean value of male teeth is larger as compared to female which is in accordance with the present study. The highest difference was found in 43, 42 and 36 teeth. The best suited tooth was 43 which is mandibular right canine. In the present study mandibular canine showed highest value of sexual dimorphism on mesiodistal width while on buccolingual width 22 and 43 showed sexual dimorphism. In the present study the mesiodistal and buccolingual width of male teeth is larger than the mean of female teeth.These the teeth can be used for sex determination by using canine index further. In contrast to present study few studies on sexual dimorphism showed that females have larger teeth than females. Boaz and Gupta 9 worked on 100 dental cast from 14 to 20 years .the sample was collected from south indian population .The mean of buccolingual width and mesiodistal width of mandibular left canine and mesiodistal width of mandibular right canine in female were greater than males. While Acharya and mainali 24 found reverse mesiodistal width in mandibular second premolars in Nepalese population. Yuen et al 25 worked on primary teeth and permanent dentition on china population and observed reverse dimorphism in mandibular incisors and findings were not significant statistically. Using standard mandibular CI value, Rao et al.26 obtained a healthy 85.9% accuracy in sex identification. In the present study mandibular canine was the teeth with highest value of sexual dimorphism, which is the best tooth for sex identification among unknown victims

The present study concludes that morphological variations can be used for sexual dimorphism. Among these variations mesiodistal and buccolingual width of tooth 43 has the highest value for sexual dimorphism, which is the best tooth for sex determination of unknown victims. 

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