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212]

Original Article

Analysis of gonial angle in relation to age,

gender, and dentition status by radiological
and anthropometric methods
Ram Ballabh Upadhyay1,
Juhi Upadhyay1,
Pankaj Agrawal1,
Nirmala N Rao2 Abstract
1
Department of Oral and
Maxillofacial Pathology, Background: With development and function, the mandibular angle has shown
K. D. Dental College and changes in size and shape. A variation in mandibular angle with age, gender, and
Hospital, Mathura, Uttar Pradesh, even the dental status has been observed, which is supported by radiographic and
2
Department of Oral And anthropometric studies. Aims: The aim of this study were to evaluate relationship
Maxillofacial Pathology, Manipal
College of Dental Sciences, between complete loss of teeth and changes in the gonial angle; the study further
Manipal, Karnataka, India intends to evaluate any variation in gonial angle with age and gender. The study intends
to assess the reliability and accuracy of age and gender determination using gonial
angle as a parameter. Materials and Methods: A total of 185 subjects (91 males; 89
females) were included in the study and were divided into five groups on the basis
of the chronological age. Physico-forensic anthropometry and lateral cephalometric
methods were used to record the gonial angle. Results: The present study shows a
definite decrease in the gonial angle with advancing age, but the intergroup analysis
does not follow a significant pattern. The study showed no correlation of gonial angle
with gender. However, the study observed a 6o increase in gonial angle for edentulous
subjects. Conclusion: Gonial angle has been used as an adjuvant forensic parameter,
Address for correspondence: but its reliability is questionable, as the mandible does not follow one characteristic
Dr. Ram Ballabh Upadhyay, pattern. Gonial angle does show changes with dentition status, which may be attributed
Department of Oral and to physiologic function of the mandible. However, when evidence is scanty, it can be
Maxillofacial Pathology,
KD Dental College and Hospital, used to direct the investigation.
NH-2, Post – Chatikara, Mathura,
Uttar Pradesh, India. Key words: Dentulous state, edentulous state, gonial angle
E-mail: ramballabh@gmail.com

Introduction Few studies have focused on mandibular angle, its

alternations throughout aging, and changing relation to

I dentification of human remains is an important part of

medicolegal practice, where forensic odontology has
taken a significant place.
dental status. The lower jaw angle is formed by the ramus
line (RL) and the mandibular line (ML), where RL is the
tangent to the posterior border of the mandible and ML
is the lower border of the mandible through the gnathion
Access this article online (gn).[1] Jensen E and Palling M preferred to call this structure
Quick Response Code gonial angle [Figure 1].[2]
Website:
www.jfds.org
Izard G in 1927 cited the following averages of the variability
in the gonial angle: 135 to 150 degrees at birth; 135 to
DOI: 140  degrees when the first dentition is finished; 120 to 130
10.4103/0975-1475.99160 degrees up to the time of eruption of the second molars;
and 120 to 150 degrees in old age.[3]

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Upadhyay, et al.: Reliability of gonial angle as a forensic tool

Apart from the normal assessment of age and gender, 2. Lateral cephalometric analysis: The gonial angle was
identification of human remains can be attained through measured on the lateral cephalometric radiograph
various landmarks and measurement of many parameters using a mathematical protractor [Figure 3].
on the mandible. The gonial angle can also be a handy tool
in near age assessment in extreme situations like mass The gonial angle was measured for each by two separate
disaster, remains of human dead exhumed and murderous observers, each angle measured three times, with the
mutilations, missing individuals, etc. However, gonial mean taken as final record. Insignificant variability was
angle as a tool in forensic odontology has received little observed between left and right sides on physico-forensic
attention. anthropometry, and for uniformity the left side of the
mandible was measured. The measurements of both
Little is known concerning remodeling in the gonial angle
the observers were subjected to intra-class correlation
with aging in the dentulous and edentulous patients. The
coefficient (ICC), and the interobserver variation was found
aims of this study were to evaluate any relationship between
complete loss of the teeth and changes in the gonial angle; to be non-significant (r = 0.783). Further analyses were done
The study further intends to evaluate any variation in gonial using the mean of the angle recorded.
angle with age and gender. Thus, the study intends to assess
the reliability and accuracy of age and gender determination Analysis of variance (ANOVA) was applied to compare
using gonial angle as a parameter. the mean values of the size of the gonial angle in the
groups. Independent t-test for samples was used to test the
Materials and Methods difference between genders in the total sample size. The
level of statistical significance was set at <0.5%.
A total of 185 subjects (91 males; 89 females) at different
chronological ages were included in the study and were
divided into five groups (group 1 to group 5) on the
basis of the chronological age. The data of the study
subjects are summarized in Table 1. The study material
was obtained from the Department of Orthodontics and
Dentofacial Orthopedics, MCODS Manipal; The Medical
Record Department of Kasturba Medical College, Manipal;
Department of Anatomy, KMC, Manipal; and from
Department of Forensic Medicine, KMC, Manipal.

Simple and repeatedly reproducible methodology was

employed wherein the data was analyzed by two main
methods:
1. Physico-forensic anthropometry: Here, the gonial
angle was measured as the angle formed by the base
of the mandible and posterior border of ramus by the
scale of protractor, which is placed over the angle of
Figure 1: Diagrammatic representation of gonial angle (GoA), formed
the mandible in such a way that basic line or base of
by the ramus line (RL) and the mandibular line (ML), where RL is the
protractor coincides with the base of the mandible. The tangent to the posterior border of the mandible and ML the lower border
angle is recorded in degrees [Figure 2]. of the mandible through the gnathion (gn)

Table 1: Data of the subjects included in the study

Study groups Subjects (n) Age Gender Physico-forensic Lateral cephalometric
anthropometry analysis
Group 1 10 Neonatal and natal Males: 4 10 0
Females: 6
Group 2 25 Deciduous dentition 1–5 years Males: 13 15 10
Females: 12
Group 3 50 Mixed dentition: 6–16 years Males: 21 5 45
Females: 24
Group 4 50 Adult permanent dentition: 17–35 years Males: 28 10 40
Females: 22
Group 5 50 Post-adult dentition and middle age: 35–72 year Males: 25 30 20
Females: 25

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Upadhyay, et al.: Reliability of gonial angle as a forensic tool

Results and Observations Discussion

Although muscle function should preserve the bony structure Cross-sectional studies have promoted the concept that
of the gonial angle and symphyseal regions irrespective of the gonial angle (GoA) could be used as an indicator of age
the dental status and age, the gonial angle has been found to and gender. However, such views hold little significance as
vary with the type of dentition and also with age.[4-6] increasing literature shows contrary and variable results.

The present study shows a definite decrease in the gonial In our study, we came across the near matching averages
angle with advancing age, but the intergroup analysis does of variability in the gonial angle with mean decrease in the
not follow a significant pattern [Table 2]. There seems to angle with age. We could not find any significant difference
be no significant difference between prenatal, natal, and between the mixed dentition group and adult group, and
neonatal group (group 1) with that of deciduous dentition post-adult to middle aged group. An increase in gonial
group (group 2), or between adult permanent dentition angle with increasing age was observed in this study. This
group (group 3) and post-adult and middle age group is in agreement with study of Ohm E and Silness J who
(group 4). Further, group 3 and group 4 together did not found a close positive association between gonial angle
show any significant difference with group 5. A significant and age.[7] However, the results of the present study were
difference was observed between group 3 and group 5 not statistically significant enough to be reliable and lead to
[Table  3]. On comparison of gonial angle for gender, no any conclusive results. Sicher H and DuBrul EL describe a
significant difference was observed between males and
females [Table  4]. In group 5, there was a significant Table 2: Mean gonial angle in relation to different age groups
difference between dentulous and edentulous subjects, Groups No. of Min to max Mean mandibular angle ± SD
indicating a mean of 6o higher in edentulous subjects. subjects mandibular angle
Further, a greater angle was observed for non-denture Group 1 10 138–156 145.90 ± 5.33
wearers compared to denture wearers wearers in the Group 2 25 136–146 140.90 ± 2.76
edentulous group; however, the results were not statistically Group 3 50 112–140 133.96 ± 8.15
significant [Table 5]. Group 4 50 121–156 129.36 ± 7.58
Group 5 50 96–142 127.29 ± 10.88

Table 3: Intergroup comparison for mandibular angle

Groups P value Significance
B/W 1 and 2 0.655 No
B/W 3 and 4 0.286 No
B/W 3 and 5 0.044 Yes
B/W 4 and 5 0.904 No
B/W 3-4 and 5 0.089 No

Table 4: Mean gonial angle difference in genders

Groups Males Females Statistically
n Gonial angle n Gonial angle significant
(in degrees) (in degrees)
Group 1 4 146 ± 2.47 6 144 ± 3.24 No
Figure 2: Anthropometric method used in determination of gonial angle
Group 2 13 142 ± 3.24 12 140 ± 1.97 No
Group 3 21 135 ± 1.16 24 133 ± 2.57 No
Group 4 28 132 ± 1.89 22 129 ± 1.32 No
Group 5 25 128 ± 2.36 25 126 ± 2.41 No

Table 5: Comparison between edentulous and dentulous state in

group 5
Group No. of Mean mandibular P value
subjects angle ± SD
Edentulous Total 22 132.17 ± 4.80 0.001
subjects Denture wearers 10 124.33 ± 2.2 Statistically
(for ≥5 yrs) significant
Non-denture 12 131.16 ± 3.2
wearers
Figure 3: Radiological method used in determination of gonial angle Dentulous subjects 23 126.42 ± 11.02

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Upadhyay, et al.: Reliability of gonial angle as a forensic tool

widening of the angle as a consequence of disuse atrophy of awareness, occupation, as well as social and attitudinal
following the loss of the teeth and even venture the statement aspects relating to tooth extraction and early loss of teeth.
that the widening of the angle is more marked if no dentures
are worn.[8] On the contrary, concerning the significance of Although several studies found no significant differences
age per se, Lonberg P noted an actual decrease in the angle between dentulous and edentulous individuals,[14,22] in a
for both edentulous and dentate groups.[9] cephalometric study of the gonial angle measurement, Ohm
E and Silness J found the mean gonial angle measurement
Difference in the gonial angle of the two sexes has been for edentulous patients to be 131 degrees versus 127 degrees
found in the previous studies, and the general trend was that for partially dentate, without consideration of gender.[7]
the gonial angles in males are greater than those measured Casey DM and Emrich LJ used panoramic radiographs and
in females.[2] Usually the mean angle is 3–5° greater in they found that the mean size of the gonial angle was 126.3
males.[10] This is consistent with the knowledge that males for the edentulous and 123.9 for dentate patients.[10]
generally have a larger mandible than females. Findings
concerning gender differences may also be explained by There have been studies carried out on other factors that
the fact that, on average, men have greater masticatory could affect the gonial angle, as that of Heath in 1976
force than women.[11] concluded that the postural and functional interrelationships
of the cheek, lips and tongue in edentulous individuals can
However, the present study showed no correlation between alter the gonial angle.[23] Weinmann JP and Sicher H stated
genders with gonial angle, and this is in agreement with that the consecutive atrophy of the masticatory muscles
Raustia AM and Salonen mam and Ceylan et al.[12,13] Wafa in old edentulous people, after many years of increased
Al-Faleh could not establish any significant difference function, leads to changes in the region of the mandibular
between sexes and gonial angle, further supporting the angle.[24] Resorption of the bone at the posterior or inferior
findings of our study.[14] border of this region, the area of the masseter muscle
insertion, leads to increasing obtuseness of the mandibular
Keen JA supports the concept of a widening of the angle angle. Sicher H and Du Brul EL reported that after loss of
as a consequence of the loss of teeth.[15] The morphological all teeth, Non-denture wearers had a wider gonial angle
change in the gonial region in the edentulous individual than denture wearers.[8]
compared to a young individual has received little attention
in the literature. Literature holds diverse studies, where a The considerable transformative changes in gonial angle
few observed no significant change in gonial angle, with may be attributed to several factors, and it is known that
others concluding gonial angle to be greater in edentulous the mandible does not follow one characteristic pattern
individuals than in dentate ones.[16-18] The present study also throughout life. As most of the data available is based
observed a 6o increase in gonial angle for edentulous subjects. on cross-sectional studies, there is a need for a large
In accordance with our observation, Keen found an increase longitudinal study to ascertain a definitive conclusion and
in the gonial angle of edentulous individuals by an average the reliability of gonial angle as sole indicator of age, gender,
of 5o, and also Casey DM and Emrich LJ in their study and dentition status.
found an increase in the mean gonial angle by 2.4o in the
edentulous group.[15,10] This may be attributed to the atrophic Conclusion
alterations of the basal part of the mandibular bone.[19]
Enlow et al., and Xie et al., found that bone deposition The present study concludes that during the deciduous
takes place throughout the inferior border, except in the dentition period, there seems to be no significant difference
antegonial region.[20,21] in gonial angle, and later as the development of mandible
is completed, the gonial angle decreases until about the age
The antegonial region underwent resorption in the of 25 to 30 years and later maintains the steady state. The
edentulous individuals, perhaps due to the reduced muscle gonial angle definitely shows an increase in edentulous
function in this region in comparison with that of the gonial individuals, especially if no dentures are worn. There seems
angle. Muscle function tends to preserve bone at its point of to be a difference in gonial angle with different age groups,
insertion; therefore, the structure of the gonial region will but not significant and definitively reliable. Thus, gonial
be maintained by the insertion of the medial pterygoid and angle can serve as an adjuvant and additional forensic
masseter muscles.[22] parameter and scientific growth scale, which guides for age
group assessment, subject to odontological status.
When teeth are present, the muscular activity associated with
mastication preserved the angle from any change in size. References
However, with loss of teeth, the bone undergoes remodeling
and, consequently, an increase in size is seen. Also, other 1. Solow B. The Pattern of Craniofacial Associations. Acta Odontol
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Fillit H (editors). Brocklehurst’s textbook of geriatric medicine and Acta Odontol Scand 1967:25:563-92.
gerontology. London, UK: Churchill Livingstone; 2003. p. 951-64. 18. Engstrom C, Hollender L, Lindqvist S. Jaw morphology in
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Dent 1998;80:680-4. dentition status by radiological and anthropometric methods.
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and edentulous Saudi population. Egypt Dent J 2008;54:2367-75. Source of Support: Nil, Conflict of Interest: None declared

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