The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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Characterization of facial asymmetry phenotypes in adult patients with skeletal Class III malocclusion using three-dimensional computed tomography and cluster analysis

  • Ha, Sang-Woon (Department of Orthodontics, School of Dentistry, Seoul National University) ;
  • Kim, Su-Jung (Department of Orthodontics, Kyung Hee University School of Dentistry) ;
  • Choi, Jin-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Baek, Seung-Hak (Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University)
  • Received : 2021.06.17
  • Accepted : 2021.09.01
  • Published : 2022.03.25
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Abstract

Objective: To classify facial asymmetry (FA) phenotypes in adult patients with skeletal Class III (C-III) malocclusion. Methods: A total of 120 C-III patients who underwent orthognathic surgery (OGS) and whose three-dimensional computed tomography images were taken one month prior to OGS were evaluated. Thirty hard tissue landmarks were identified. After measurement of 22 variables, including cant (°, mm), shift (mm), and yaw (°) of the maxilla, maxillary dentition (Max-dent), mandibular dentition, mandible, and mandibular border (Man-border) and differences in the frontal ramus angle (FRA, °) and ramus height (RH, mm), K-means cluster analysis was conducted using three variables (cant in the Max-dent [mm] and shift [mm] and yaw [°] in the Manborder). Statistical analyses were conducted to characterize the differences in the FA variables among the clusters. Results: The FA phenotypes were classified into five types: 1) non-asymmetry type (35.8%); 2) maxillary-cant type (14.2%; severe cant of the Max-dent, mild shift of the Man-border); 3) mandibular-shift and yaw type (16.7%; moderate shift and yaw of the Man-border, mild RH-difference); 4) complex type (9.2%; severe cant of the Max-dent, moderate cant, severe shift, and severe yaw of the Man-border, moderate differences in FRA and RH); and 5) maxillary reverse-cant type (24.2%; reverse-cant of the Max-dent). Strategic decompensation by pre-surgical orthodontic treatment and considerations for OGS planning were proposed according to the FA phenotypes. Conclusions: This FA phenotype classification may be an effective tool for differential diagnosis and surgical planning for Class III patients with FA.

Keywords

Acknowledgement

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI18C1638). This article is partly from the PhD thesis of S.W.H.

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