From skull to face: MRI vs. CBCT-based soft tissue depths in forensic 3D craniofacial reconstruction

Facial soft tissue thickness (FSTT) constitutes one of the most critical variables in forensic craniofacial reconstruction, and the application of advanced imaging modalities such as magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT) can strengthen confidence in these technologies. Using MRI, we evaluated FSTT at 29 anatomical landmarks in 36 healthy adults. We conducted standardised infrared facial imaging on the same participants to obtain 26 anthropometric measurements. We generated three digital facial reconstructions using anonymised three-dimensional skull models and ZBrush software. Under double-blinded conditions, we reconstructed two skulls, one male and one female. In the female case, we applied a postural correction factor to account for the supine imaging orientation, whereas we completed the male reconstruction without adjustment. We assessed the anatomical accuracy of both reconstructions using public recognition surveys and facial resemblance analysis with FaceVACS software. For the third case, we applied region-specific FSTT values derived from CBCT in a real forensic investigation in Karnataka, India. Investigators disseminated the reconstructed face as an investigative aid and subsequently contributed to the identification of a missing person, with identity confirmed through police records. These findings indicate that posture-corrected MRI-derived data and regionally calibrated CBCT datasets improve anatomical accuracy in three-dimensional facial reconstruction, thereby enhancing its utility in forensic identification, particularly within the Indian context.