Reliability of palatal rugoscopy for sexual dimorphism in forensic dentistry: A systematic literature review and meta-analysis

Objective: This study aimed to assess the validity of palatal rugoscopy for sexual dimorphism in the casework routine of forensic dentistry. Design: A systematic literature reviews was established following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) and Cochrane guidelines. Six electronic databases were searched as the primary source of information. “Grey literature” was included to avoid selection and publication bias. As a secondary source of information, the reference lists of the eligible studies were also consulted to increase the search spectrum. Methodological quality and risk of bias were assessed with Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. Statistic tests, namely the meta-analysis of diagnostic accuracy, Cochran Q test, and I2 test, were performed to verify the heterogeneity between the eligible studies. Results: The systematic search resulted in 263 studies, out of each 8 fulfilled the inclusion criteria. An additional eligible article was included after the search in reference lists. From the 9 studies that underwent qualitative data extraction, six were selected for quantitative analysis. The meta-analysis of grouped sex estimates showed sensitivity and specificity rates of 89% and 83%, respectively. The Area Under the Curve reached 0.93. High heterogeneity and important methodological limitations were detected among the studies. Conclusion: Palatal rugoscopy seems to have discriminant power for sexual dimorphism. However, the limitations found specifically in each study and the strong heterogeneity across studies suggest that palatal rugoscopy lacks evidence-based confirmation for reliable application as a sole tool for sexual dimorphism in practice.