Testing regression and mean model approaches to facial soft-tissue thickness estimation.

Average facial soft-tissue thickness (FSTT) databanks are continuously developed and applied within craniofacial identification. This study considered and tested a subject-specific regression model alternative for estimating the FSTT values for oral midline landmarks using skeletal projection measurements. Measurements were taken from cone-beam computed tomography scans of 100 South African individuals (60 male, 40 female;  = 35 years). Regression equations incorporating sex categories were generated. This significantly improved the goodness-of-fit (-value). Validation tests compared the constructed regression models with mean FSTT data collected from this study, existing South African FSTT data, a universal total weighted mean approach with pooled demographic data and collection techniques and a regression model approach that uses bizygomatic width and maximum cranial breadth dimensions. The generated regression equations demonstrated individualised results, presenting a total mean inaccuracy (TMI) of 1.53 mm using dental projection measurements and 1.55 mm using cemento-enamel junction projection measurements. These slightly outperformed most tested mean models (TMI ranged from 1.42 to 4.43 mm), and substantially outperformed the pre-existing regression model approach (TMI = 5.12 mm). The newly devised regressions offer a subject-specific solution to FSTT estimation within a South African population. A continued development in sample size and validation testing may help substantiate its application within craniofacial identification.