{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:17:11Z","timestamp":1788517031528,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthod Craniofacial Res"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Conventional facial diagnosis emphasizes skeletal and dental measures while lip features are assessed piecemeal. We aimed to identify data\u2010driven lip soft\u2010tissue phenotypes using unsupervised machine learning and examine their associations with skeletal and dental characteristics.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In a retrospective cross\u2010sectional study, 10 lip measurements were extracted from standardized lateral cephalometric radiographs. Variables were\n z<\/jats:italic>\n \u2010score standardized and analysed using k\u2010means clustering. Of 26 NbClust validation indices, 14 (53.8%) supported a three\u2010cluster solution. Cluster stability was assessed by bootstrap resampling (B\u2009=\u2009100) and 10\u2010fold cross\u2010validation. Post hoc feature importance was evaluated using PCA, Random Forest, SVM and XGBoost. A decision tree was trained and evaluated by 10\u2010fold cross\u2010validation repeated five times. Associations with craniofacial parameters were examined via within\u2010class ANOVA, Cram\u00e9r's\n V<\/jats:italic>\n and hierarchical regression. Concordant pairings were defined as Cluster 1\u2013Class I, Cluster 2\u2013Class II and Cluster 3\u2013Class III; all others were classified as discordant.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Three phenotypes emerged\u2014Thin\u2010Straight (\n n<\/jats:italic>\n \u2009=\u2009638), Protrusive\u2010Convex (\n n<\/jats:italic>\n \u2009=\u2009644) and Thick\u2010Concave (\n n<\/jats:italic>\n \u2009=\u2009389)\u2014showing broad correspondence with skeletal Classes I, II and III, respectively (Cram\u00e9r's\n V<\/jats:italic>\n \u2009=\u20090.386; overall concordance 52.8%). Lip protrusion and thickness were the primary discriminators (4\/4 method consensus for UL_EP_mm, Cm_Sn_Ls, SSD; 3\/4 for ULT). Within each skeletal class, all lip variables differed significantly across phenotypes (all\n p<\/jats:italic>\n \u2009<\u20090.001;\n \u03b7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.10\u20130.54 for lip variables), and lip phenotype independently predicted incisor inclination beyond skeletal covariates (\u0394\n R<\/jats:italic>\n 2<\/jats:sup>\n adj\u2009=\u20090.058\u20130.078,\n p<\/jats:italic>\n \u2009<\u20090.001). An interpretable decision tree achieved 88.0% cross\u2010validated accuracy (macro\u2010F1\u2009=\u20090.876) for phenotype assignment.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Unsupervised learning identified three reproducible lip soft\u2010tissue phenotypes that complement conventional dentoskeletal description by capturing within\u2010class soft\u2010tissue heterogeneity. The framework is exploratory and requires prospective external validation and outcome\u2010based studies before clinical triage application.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ocr.70138","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T12:20:19Z","timestamp":1778242819000},"page":"888-898","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three Data\u2010Driven Lip Soft\u2010Tissue Phenotypes and Their Dento\u2010Skeletal Associations in Orthodontic Patients: An Exploratory Unsupervised Learning Study"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0707-0928","authenticated-orcid":false,"given":"Xiaoqi","family":"Zhang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Oral Diseases, National Clinical Research Center of Oral Diseases, Department of Orthodontics West China Hospital of Stomatology, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Xing","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases, National Clinical Research Center of Oral Diseases, Department of Orthodontics West China Hospital of Stomatology, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7873-9516","authenticated-orcid":false,"given":"Waseem","family":"AI\u2010Gumaei","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases, National Clinical Research Center of Oral Diseases, Department of Orthodontics West China Hospital of Stomatology, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4056-0080","authenticated-orcid":false,"given":"Xiaoqian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Yunnan Key Laboratory of Stomatology Affiliated Hospital of Stomatology School of Stomatology Kunming Medical University Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6020-6559","authenticated-orcid":false,"given":"Hu","family":"Long","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases, National Clinical Research Center of Oral Diseases, Department of Orthodontics West China Hospital of Stomatology, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9980-1382","authenticated-orcid":false,"given":"Minqi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Bone Metabolism, School and Hospital of Stomatology Shandong University Jinan 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