ORIGINAL ARTICLE

Gender as a Variable Influencing the Mesiodistal width of

Permanent Maxillary Anterior Teeth: An Analysis using AutoCAD
Software
Momena Rashid1 BDS, M.Phil
Shamayem Safdar2 BDS, M.Phil
Munawar Aziz Khattak3 BDS, M.Phil
Sana Arbab4 BDS, M.Phil
Syed Amjad Shah5 BDS, FCPS, MFDSRCPS, FDSRCPS
Imran Khattak6 BDS

OBJECTIVE:The objective of this study was to determine potential differences among male and female genders regarding
the mesiodistal widths of permanent maxillary anterior teeth in adult dentate individuals.
METHODOLOGY: This was an analytical cross-sectional study which was conducted in Out Patient Department of Peshawar
Dental College, Peshawar from February to April 2019.
The sample comprised of 180 individuals with a mean age of 15-25years selected from a population visiting Peshawar Dental
College that fulfilled the inclusion criteria. JPEG file format of OPG images were graphically analyzed by Autodesk AutoCAD
software 2017 version to calculate the mesiodistal widths of permanent maxillary anterior teeth. Independent t test was used
to compare mesiodistal teeth dimensions between males and females.
RESULTS: Mesiodistal widths of permanent maxillary anterior teeth, in males, were greater than females but the difference
in their mean values were statistically insignificant (P>0.05). The mesiodistal width of permanent maxillary right lateral incisor
in males was larger (8.023± 1.083 mm) than females (7.853± 1.319 mm) but the difference was statistically insignificant
(P>0.05).
CONCLUSION: It can be concluded that gender had statistically non-significant association with the mesiodistal widths of
permanent maxillary anterior teeth.
KEYWORDS: Gender, Mesiodistal width, Permanent maxillary anterior teeth, Autodesk AutoCAD software
HOW TO CITE: Rashid M, Safdar S, Khattak MA, Arbab S, Shah SA, Khattak I. Gender as a variable influencing the mesiodistal
width of permanent maxillary anterior teeth: an analysis using autocad software. J Pak Dent Assoc 2022;31(2):70-75.
DOI: https://doi.org/10.25301/JPDA.312.70
Received: 06 January 2021, Accepted: 15 March 2022

INTRODUCTION attractiveness and encompasses not only tooth colour, size

and shape2 but also other aspects like upper lip position3 and

D
uring the last few decades patients and dentists gingival morphology.4
have taken greater interest in dental esthetics.1 Maxillary anterior teeth are considered the most dominant
Dental esthetics is most dominant aspect of facial element in dental and facial esthetics because of the amount
of visible coronal structure.5 Research has been carried out
1. Lecturer, Department of Oral Biology, Peshawar Dental College, Riphah International
University. on determining the approximate width of maxillary anterior
2. Department of Oral Biology, Peshawar Dental College, Riphah International University. teeth by studying their relation with gender, race6 facial
3. Assistant Professor, Department of Oral Biology, Assistant Professor Oral Biology,
Peshawar Dental College, Riphah International University.
profile7 facial measurements8 and malocclusions.9
4. Assistant Professor, Department Oral Biology, Assistant Professor Oral Biology, A study conducted in Chile observed that mesiodistal
Peshawar Dental College, Riphah International University.
5. Professor, Department Oral and Maxillo-Facial Surgery, Peshawar Dental College,
width of maxillary central incisors and canines had different
Riphah International University. statistically significant values between males and females.
6. Lecturer, Department of Oral Biology, Peshawar Dental College, Riphah International
University.
A flaw in the design of that study was the use of sample
Corresponding author: “Dr. Momena Rashid” < idrmominarasheed@gmail.com > size of 303 subjects (177 females and 126 males), while for

JPDA Vol. 31 No. 02 Apr-Jun 2022 70

 Rashid M/ Safdar S/ Khattak MA/ Gender as a variable influencing the mesiodistal width of
Arbab S/ Shah SA, Khattak I permanent maxillary anterior teeth: an analysis using autocad software

a comparative study, it is better to consider equal number of mesiodistal width of permanent maxillary anterior teeth. In
male and female subjects. In the present study we will be Pakistan and India, mesial and distal contact points were
taking equal number of male and female subjects.10Another taken as reference.10,11,13,15 In a study conducted in Saudi
study conducted in Saudi Arabia stated that all maxillary Arabia mesiodistal measurements were taken from a line
anterior teeth had greater mean values for mesiodistal width drawn perpendicular to the long axis of teeth following their
in males as compared to the females with a mean of 49.4 maximum contours11. In present study we will geometrically
mm in males and 48.2 mm in females.11 find mesiodistal width in AutoCAD software by drawing
A study in India found that the mean mesio-distal width two vertical lines (tangent to mesial and distal contour) and
for central incisors was 8.9mm in males and 8.6mm in two horizontal lines (one on upper intersection of distal
females, while for lateral incisors it was 6.89 mm in males tangent and one on lower intersection of mesial tangent). A
and 6.79 mm in females and for canines it was 9.8 mm in horizontal line equidistance to previous two horizontal lines
males and 8.6 mm in females. It showed that mesiodistal will represent the greatest mesiodistal width. 8
width of maxillary central incisors and canines was The aim of this study was to determine that gender is an
significantly greater in males than in females with canines important variable for the mesiodistal width of permanent
showing significantly greater values as compared to central maxillary anterior teeth in adult dentate subjects of age
incisors.12 15-25 years, using AutoCAD software. This will help in
According to a study conducted in India, maxillary right providing data to dentists for fabricating denture teeth in
and left canines exhibit a mean width of 1.0cm in males and teeth selection for edentulous patients16, use in forensic
0.9cm in females but this study examined only canines13 due odontology for criminal identification.12,13,10 orthodontic
to the reason that canines are least frequently extracted teeth treatment planning 1 7 and restorative treatment. 1 8
possibly because of relatively decreased incidence of caries
and periodontal disease.14 METHODOLOGY
In a study conducted in Lahore, Pakistan on 14-30 years
old subjects with orthognathic profile having aligned and It was an analytical cross-sectional study which was
fully erupted set of permanent maxillary anterior teeth with conducted in Oral diagnosis department of Peshawar Dental
no caries or attrition were studied and it was found that the College, Peshawar from February to April 2019. This study
ratio of the mean mesio-distal crown width of the maxillary was ethically approved by instituitional review board (IRB)
lateral incisor to that of the maxillary central incisor was of Prime Foundation Pakistan. Data was collected in Out
approximately 80.7% in males and 78.6% in females, Patient Department (OPD) of Peshawar Dental College.
maxillary canine to that of the maxillary central incisor was Sample size of of 180 individuals was calculated by non-
approximately 90.77% in males and 87.95% in females, probability consecutive sampling. Both male and female
maxillary lateral incisor to that of the maxillary canine was gender were included, out of which 90 were males and 90
approximately 88.93% in males and 89.36% in females.15 were females. The age range was from 15-25 years. Informed
In all the previously conducted studies, old methodologies consent was taken from all subjects. Exclusion criteria was
were used for measuring mesiodistal width of permanent subjects with missing permanent maxillary anterior teeth,
maxillary anterior teeth. Most of the studies used vernier anterior prosthesis or restorations, developmental anomaly
calipers and took measurements either directly on the subjects of permanent maxillary anterior teeth, proximal surfaces
teeth12, orodental models.10,11,13,15, Thread11 and manual alteration, history of orthodontic treatment. Inclusion criteria
divider 1 2 have also been used for this purpose. was subjects having fully erupted, structurally and
According to a recent study conducted based on periodontally sound maxillary anterior teeth that are having
evaluating an association of tooth form with the face shape, satisfactory alignment.
photographs of subjects face and teeth were analyzed by Sexual dimorphism is defined as the effect of gender
using AutoCAD software.8 In present study however we will (i.e. male and female) on the mesiodistal widths of permanent
be taking standardized images obtained from maxillary anterior teeth.
OrthoPantomoGram (OPG). Mesiodistal width of individual Mesiodistal widths of permanent maxillary anterior teeth
teeth will be measured, from the OPG images, with the help shall be the widest horizontal distance between the maximum
of Autodesk AutoCAD 2017 version software which is the convex points of mesial and distal margins from labial surface
latest version in AutoCAD series and considered as the best of maxillary anterior teeth. It was calculated from OPG
tool for this purpose. images of subjects which were analyzed in Autodesk
Another limitation of previously conducted studies was AutoCAD software 2017 version by drawing two vertical
improper identification of landmarks for measuring the lines (tangent to mesial and distal contour) and two horizontal

71 JPDA Vol. 31 No. 02 Apr-Jun 2022

 ge and mean

age and mean

age and mean

Rashid M/ Safdar S/ Khattak MA/ Gender as a variable influencing the mesiodistal width of
Arbab S/ Shah SA, Khattak I permanent maxillary anterior teeth: an analysis using autocad software

lines (one on maxillary intersection of distal tangent and one Table 1: Mean and standard deviation for age and mesiodistal
on mandibular intersection of mesial tangent). A horizontal width of maxillary anterior teeth
line equidistance to previous two horizontal lines shall

prosthesis age according toFailure

prosthesis age according to number of units

prosthesis age according to number of units

represent the greatest mesiodistal width8.

STATISTICAL ANALYSIS

The data were entered & analyzed using computer

program SPSS version 20.0. Frequencies and percentages
were computed. Mean and standard deviations were calculated
for all numerical variables like age and all maxillary anterior
mesiodistal teeth widths. Independent t test was used to
compare mesiodistal teeth dimensions between males and
females. P<0.05 was considered to be significant level.
Figure 2: Mean and SD values of mesiodistal
RESULTS wdiths of maxillary anterior teeth

number of units
Failure percentage and mean
number of units
number
12
Total 180 subjects were equally distributed in both 9.82
9.47 9.57 9.82
10
genders. Gender distribution was equal i.e. n=90(50%) males 7.94 8.031

percentage
and n=90(50%) females. The mean age was 22.19±2.57 8
(SD) years with a range of 15-25 years. The most common

of unitsand mean
Mesiodistal
Width (mm) 6
age group of the participants was 22 to 25 years with
116(64.44%) subjects followed by those having age group 4

of 19-21 years that had 45(25%) subjects. Subjects in the 2 1.038 1.206 1.43 1.37 1.105 1.085
age group 15-18 years were 19(10.56%). These details are
0
graphically depicted in figure 1. Right Right Right Left Left Left
Maxillary Maxillary lat. Maxillary Maxillary Maxillary lat. Maxillary
The mean mesiodistal width of right maxillary canine, Canine Incisor Central Central Incisor Canine
Incisor Incisor
lateral incisor and central incisor was 9.826±1.038 mm,
7.94±1.206 mm, and 9.47±1.43 mm respectively. The mean
Table 2: Comparison of mesiodistal tooth width of maxillary
Figure 1: Age distribution of all subjects anterior teeth between genders
140
to number of units
Failure percentage and mean prosthesis age according

to number of units
Failure percentage and mean prosthesis age according
120
116
64.44%

100
Frequency

80

Male
60 Female
59
57 32.78%
31.67% Both
40 45
25.00%

20 22
19 23 12.22%
10.56% 12.78%
10 9
prosthesis age according to

prosthesis age according to

5.55% 5.00%
0
15-18 19-21 22-25

Age Categories

mesiodistal width of left maxillary canine, lateral incisor

and central incisor was 9.82±1.085 mm, 8.031±1.105 mm,
and 9.57±1.37 mm respectively. The detailed mean and
standard deviation of age and maxillary anterior teeth is
shown in table 1 and figure 2.
Though the mesiodistal widths of teeth in males were

JPDA Vol. 31 No. 02 Apr-Jun 2022 72

 Rashid M/ Safdar S/ Khattak MA/ Gender as a variable influencing the mesiodistal width of
Arbab S/ Shah SA, Khattak I permanent maxillary anterior teeth: an analysis using autocad software

larger than those in the females but the difference for mean dimorphism cannot be used to determine gender in forensic
values were statistically insignificant (P>0.05). cases.
For right maxillary canine the mean width in females was Alqahtani et al recorded the mesiodistal width for central
9.79± 1.12 mm while in males it was 9.86± 0.94 mm (95% incisor was 8.8mm for men and 8.6mm for women, lateral
CI= -0.37 , 0.23; P=0.66). Similarly, right maxillary lateral incisor was 6.7mm for men and 6.4mm for women, and
incisor in males was larger (8.023± 1.083 mm) than females canines was 8.0mm for men and 7.6mm for women. He
(7.853± 1.319 mm) but the difference was statistically concluded that though the values for mesiodistal tooth width
insignificant (95% CI= -0.52, 0.18; P=0.34). Similarly, the were larger for males as compared to females but no
average value for the mesiodistal width of right maxillary statistically significant difference was found. These results
central incisor in males was larger (9.65± 1.29 mm) than were in concordance with present study.22
females (9.28± 1.53 mm) but again the difference was Srivastava et al assessed and determined the role of
statistically insignificant (95% CI= -0.79, 0.03; P=0.12). permanent maxillary incisors and cuspids for sex
Similarly, the difference in the mesiodistal widths values of determination of undergraduate dental students. They
teeth on the left and right maxillary arch were insignificant measured with the help of a digital vernier caliper as well
results. The detailed results are shown in table 2. as manual divider to measure the mesiodistal dimensions of
the maxillary front teeth from canine to canine. They found
DISCUSSION that mean mesiodistal width of central incisors was 8.9mm
in males & 8.6mm in females, for lateral incisors it was
Sexual dimorphism is a term used for the variations in 6.8mm in males & 6.7mm in females and for canines it was
stature, size, and shape between males and females. This is 9.8mm in males & 8.6mm in females this shows that the
applicable to dental identification too, as no two mouths are mesiodistal dimensions and left maxillary canines and central
similar.19 The sexual dimorphism existence in permanent incisors were significantly larger in males than females.
dentition is an established phenomenon and reported in They concluded that sexual dimorphism in maxillary canine
literature. Sexual dimorphism, therefore, has a vital and central incisors are helpful in gender determination.12
significance in forensic odontology and medicine.20 Teeth Neves et al23 stated that among the mesiodistal widths
are useful to differentiate gender by calibrating their of all maxillary and mandibular teeth, canines were more
buccolingual and mesiodistal dimensions. Use of teeth to sexually dimorphic as compared to other teeth. Peckmann
determine gender have an essential role in young people at al15 found that maxillary central incisors and canines
where the skeletal secondary sexual features like breast, hip showed significant sexual dimorphism (P<0.008) as compared
broadening and moustaches have not yet developed.21 Many to lateral incisors (P>0.008) while in this study none of the
reasons like genetic, environmental and ethnicity can be held maxillary anterior teeth showed significant results (P>0.05).
responsible for non-concordance between our study and These results were in accordance with our study that showed
previous literature. that canines were more sexually dimorphic as compared to
This study aims to determine if gender can be an important other teeth, although the difference was not statistically
variable for assessing the mesiodistal widths of significant.
permanent maxillary anterior teeth in adult dentate subjects Rajat et al.11 stated that all maxillary anterior teeth had
of age 15-25 years, visiting Out-Patient Department of a greater mean of 49.4mm in males and 48.2mm in females
Peshawar Dental College in a 6-12 months' time interval, while in this study it was 55mm in males and 53.9mm in
the measurements of teeth were done using soft images of females.
subjects OPGs using Autodesk AutoCAD 2017 version Leung et al measured the mesiodistal widths of incisors,
software for measuring widths of teeth. canines, premolars and first molars of mandibular and
For all permanent maxillary anterior teeth, the mesiodistal maxillary jaws from digital e-models with the help of 03DM
widths were larger in males as compared to females. In this digital model software and showed that females had
study mesiodistal width of central incisors was 9.7mm for significantly smaller teeth as compared to males. These
males and 9.3mm for females, for lateral incisors it was results were not in accordance with present study which can
8.0mm for males and 7.8mm for females, while for canines be attributed to the fact that two different types of softwares
it was 9.9mm for males and 9.7mm for females with P>0.05 were used for this purpose.24
(Table 2). Tehranchi et al.25 conducted a comparative study to
Our results showed that sexual dimorphism in mesiodistal measure mesiodistal widths of casts and reported AutoCAD
widths of maxillary anterior teeth was present but was not software provides more precise results while the manual
statistically significant. So, in our population the sexual method is only reliable when taken with extreme caution.

73 JPDA Vol. 31 No. 02 Apr-Jun 2022

 Rashid M/ Safdar S/ Khattak MA/ Gender as a variable influencing the mesiodistal width of
Arbab S/ Shah SA, Khattak I permanent maxillary anterior teeth: an analysis using autocad software

While the previously conducted studies used vernier caliper gingival contours and proximal contact areas in the maxillary anterior
and manual measurement which are less accurate and time dentition. Gen Dent, 2017; 65: 7-e11.
consuming. These authors reported that vernier caliper and
5. Dashti M. Maxillary Anterior Teeth Width Proportion a Literature
manual measurement needs extreme caution during Review. EC Dent Sci, 2017;16:197-206.
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measurement.10,11,12,13,15. A. Comparison of mesiodistal tooth widths in Caucasian, African and
On the basis of this study, it has been observed that Japanese individuals with Brazilian ancestry and normal occlusion.
gender can be used for the purpose of selection of maxillary Dent Press J Orthod, 2013; 18:130-35.
https://doi.org/10.1590/S2176-94512013000300021
anterior teeth but it is not recommended to use it as a sole
method for selection of maxillary anterior teeth; rather it 7. Raghavendra N, Kamath VV, Satelur KP, Rajkumar K. Prediction
should be used as a supplemental method. This is a single of Facial Profile Based on Morphometric Measurements and Profile
centre, small sample and a hospital based study which may Characteristics of Permanent Maxillary Central Incisor Teeth. J Forensic
not represent the Peshawar population. Further large sample Sci Med, 2015; 1:26.
and community based studies are recommended which will https://doi.org/10.4103/2349-5014.155550
explore this area in depth. 8. Mehndiratta A, Bembalagi M, Patil R. Evaluating the Association
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According to this study, it can be concluded that gender had https://doi.org/10.1111/jopr.12707
a statistically non-significant association with the mesiodistal
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ACKNOWLEGMENT 10. Peckmann TR, Logar C, Garrido-Varas CE, Meek S, Pinto XT.
Sex determination using the mesio-distal dimension of permanent
maxillary incisors and canines in a modern Chilean population. Sci
We are deeply grateful to Dr Saad Sajjad, Dr Arbab Zia
Justic, 2016;56:84-89.
and Dr Shiraz Alam for this research and Dr Sobia Salam https://doi.org/10.1016/j.scijus.2015.10.002
who moderated this paper and in that line improved the
manuscript significantly. 11. Rajat RK, Rishav S, Romil S, Nauseen H. Comparative evaluation
of mesiodistal width of six maxillary anterior teeth in J&K population.
CONFLICT OF INTEREST Int J Sci Study, 2017;5:4-7.

12. Srivastava R, Jyoti B, Jha P, Gupta M, Devi P, Jayaram R. Gender

None declared determination from the mesiodistal dimension of permanent maxillary
incisors and canines: An odontometric study. J Ind Acad Oral Med
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