{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:52Z","timestamp":1787027932631,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Graduate School and the Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Significant facial asymmetry can lead to both functional and aesthetic issues. Often, such asymmetry originates from irregularities in the jaw structure. It is critical to recognize that asymmetries can be concealed by soft tissue, which may be overlooked. The aim of this study is to investigate the relationships between bilateral landmarks in the vertical dimension of facial asymmetry among individuals with skeletal Class II and Class III malocclusions. Fifty-two adult patients with a mean age of 24.4 \u00b1 3.79 years with facial asymmetry who underwent orthodontic and orthognathic surgery were studied. Cone-beam computed tomography and facial scans were used to create 3D virtual head models which enhanced the accuracy in addressing facial asymmetry to ensure effective treatment planning. Each landmark was measured and digitized using the Dolphin Imaging program. The findings showed a correlation between gender and type of skeletal discrepancies with the menton deviation direction. In conclusion, the vertical discrepancy between bilateral landmarks was observable in both hard and soft tissues with more pronounced expression in soft tissues. This discrepancy was characterized by an elevation on the same side as the menton deviation, which was a feature observed in both skeletal Class II and Class III individuals.<\/jats:p>","DOI":"10.3390\/diagnostics14060590","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T07:25:32Z","timestamp":1710141932000},"page":"590","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Relationship between Bilateral Landmarks of Facial Asymmetry in Skeletal Class II and Class III in Vertical Dimension: 3D Facial Scan and Cone-Beam Computed Tomography"],"prefix":"10.3390","volume":"14","author":[{"given":"Tanapat","family":"Jearanai","sequence":"first","affiliation":[{"name":"Orthodontic Section, Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8429-9828","authenticated-orcid":false,"given":"Bancha","family":"Samruajbenjakun","sequence":"additional","affiliation":[{"name":"Orthodontic Section, Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3910-9807","authenticated-orcid":false,"given":"Pannapat","family":"Chanmanee","sequence":"additional","affiliation":[{"name":"Orthodontic Section, Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,11]]},"reference":[{"key":"ref_1","first-page":"43","article-title":"Skeletal asymmetry in esthetically pleasing faces","volume":"61","author":"Peck","year":"1991","journal-title":"Angle Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1016\/j.joms.2009.04.039","article-title":"Characteristics and corrective outcome of face asymmetry by orthognathic surgery","volume":"67","author":"Ko","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S1073-8746(98)80013-3","article-title":"Asymmetries: Diagnosis and treatment","volume":"4","author":"Lindauer","year":"1998","journal-title":"Semin. Orthod."},{"key":"ref_4","first-page":"50","article-title":"Dentofacial Asymmetry: A Literature Review","volume":"100","author":"Manosudprasit","year":"2017","journal-title":"J. Med. Assoc. Thai."},{"key":"ref_5","first-page":"341","article-title":"Facial asymmetry: Etiology, evaluation, and management","volume":"34","author":"Cheong","year":"2011","journal-title":"Chang. Gung Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1038\/372169a0","article-title":"Symmetry, beauty and evolution","volume":"372","author":"Enquist","year":"1994","journal-title":"Nature"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jcms.2021.04.005","article-title":"Surgery-first orthognathic approach for the correction of facial asymmetry","volume":"49","author":"Choi","year":"2021","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_8","first-page":"28","article-title":"Facial asymmetry in subjects with skeletal Class III deformity","volume":"72","author":"Haraguchi","year":"2002","journal-title":"Angle Orthod."},{"key":"ref_9","first-page":"171","article-title":"The prevalence of facial asymmetry in the dentofacial deformities population at the University of North Carolina","volume":"12","author":"Severt","year":"1997","journal-title":"Int. J. Adult Orthodon. Orthognath. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s00056-017-0100-6","article-title":"Craniofacial features affecting mandibular asymmetries in skeletal Class II patients","volume":"78","author":"Thiesen","year":"2017","journal-title":"J. Orofac. Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"209","DOI":"10.4041\/kjod.2013.43.5.209","article-title":"Comparison of the condyle-fossa relationship between skeletal class III malocclusion patients with and without asymmetry: A retrospective three-dimensional cone-beam computed tomograpy study","volume":"43","author":"Kim","year":"2013","journal-title":"Korean J. Orthod."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1590\/S1808-86942012000400028","article-title":"Mandibular asymmetry: Literature review and case report","volume":"78","author":"Andrade","year":"2012","journal-title":"Braz. J. Otorhinolaryngol. (Engl. Ed.)"},{"key":"ref_13","first-page":"89","article-title":"Dental and facial asymmetries: A review","volume":"64","author":"Bishara","year":"1994","journal-title":"Angle Orthod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"346","DOI":"10.2174\/1874210601509010346","article-title":"Photographic Facial Soft Tissue Analysis by Means of Linear and Angular Measurements in an Adolescent Persian Population","volume":"9","author":"Moshkelgosha","year":"2015","journal-title":"Open Dent. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.ijom.2010.10.013","article-title":"Digital three-dimensional image fusion processes for planning and evaluating orthodontics and orthognathic surgery. A systematic review","volume":"40","author":"Plooij","year":"2011","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jobcr.2017.04.010","article-title":"Facial asymmetry revisited: Part I- diagnosis and treatment planning","volume":"8","author":"Srivastava","year":"2018","journal-title":"J. Oral Biol. Craniofac. Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"De Groeve, P., Schutyser, F., Van Cleynenbreugel, J., and Suetens, P. (2001, January 14\u201317). Registration of 3D Photographs with Spiral CT Images for Soft Tissue Simulation in Maxillofacial Surgery. Proceedings of the Medical Image Computing and Computer-Assisted Intervention\u2013MICCAI 2001, Berlin\/Heidelberg, Germany.","DOI":"10.1007\/3-540-45468-3_118"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/00001665-200603000-00019","article-title":"A new method of 3-D cephalometry Part I: The anatomic Cartesian 3-D reference system","volume":"17","author":"Swennen","year":"2006","journal-title":"J. Craniofac. Surg."},{"key":"ref_19","first-page":"331","article-title":"3D stereophotogrammetric image superimposition onto 3D CT scan images: The future of orthognathic surgery. A pilot study","volume":"17","author":"Khambay","year":"2002","journal-title":"Int. J. Adult Orthodon. Orthognath. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1590\/2177-6709.21.1.089-100.oar","article-title":"3D virtual planning in orthognathic surgery and CAD\/CAM surgical splints generation in one patient with craniofacial microsomia: A case report","volume":"21","author":"Vale","year":"2016","journal-title":"Dent. Press J. Orthod."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Marradi, F., Staderini, E., Zimbalatti, M.A., Rossi, A., Grippaudo, C., and Gallenzi, P. (2020). How to Obtain an Orthodontic Virtual Patient through Superimposition of Three-Dimensional Data: A Systematic Review. Appl. Sci., 10.","DOI":"10.3390\/app10155354"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.ajodo.2015.07.038","article-title":"Evaluation of facial hard and soft tissue asymmetry using cone-beam computed tomography","volume":"149","author":"Nur","year":"2016","journal-title":"Am. J. Orthod. Dentofacial. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s40510-017-0188-7","article-title":"Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging","volume":"1","author":"Cantarella","year":"2017","journal-title":"Prog. Orthod."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s40510-020-00342-4","article-title":"An assessment of the magnitude, parallelism, and asymmetry of micro-implant-assisted rapid maxillary expansion in non-growing patients","volume":"21","author":"Elkenawy","year":"2020","journal-title":"Prog. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1080\/713754376","article-title":"Hemispheric and facial asymmetry: Gender differences","volume":"5","author":"Smith","year":"2000","journal-title":"Laterality"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1016\/0278-2391(94)90528-2","article-title":"Distance from symmetry: A three-dimensional evaluation of facial asymmetry","volume":"52","author":"Ferrario","year":"1994","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1093\/biomet\/22.3-4.324","article-title":"On the Asymmetry of the Human Skull","volume":"22","author":"Woo","year":"1931","journal-title":"Biometrika"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"491","DOI":"10.2307\/2528106","article-title":"Harmonic analysis of the human face","volume":"21","author":"Lu","year":"1965","journal-title":"Biometrics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1097\/PRS.0b013e3181babc1f","article-title":"Differential diagnosis of the idiopathic laterally deviated mandible","volume":"124","author":"Kawamoto","year":"2009","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ajodo.2008.08.029","article-title":"Assessing soft-tissue characteristics of facial asymmetry with photographs","volume":"138","author":"Lee","year":"2010","journal-title":"Am. J. Orthod. Dentofacial. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.ajodo.2007.01.017","article-title":"Classification of facial asymmetry by cluster analysis","volume":"132","author":"Hwang","year":"2007","journal-title":"Am. J. Orthod. Dentofacial Orthop."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"258","DOI":"10.4055\/jkoa.1990.25.1.258","article-title":"Three-dimensional evaluation of the correlation between lip canting and craniofacial planes","volume":"25","author":"Kim","year":"2020","journal-title":"Korean J. Orthod."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ajodo.2007.01.015","article-title":"Correlations of frontal lip-line canting with craniofacial morphology and muscular activity","volume":"132","author":"Cho","year":"2007","journal-title":"Am. J. Orthod. Dentofacial Orthop."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1093\/ejo\/25.5.443","article-title":"Quantitative evaluation of lip symmetry in functional asymmetry","volume":"25","author":"Weinreb","year":"2003","journal-title":"Eur. J. Orthod."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.jds.2022.11.031","article-title":"Correlation between facial asymmetry of skeletal class III jaw relationship and morphology of the temporomandibular joint: A cone beam computed tomography study","volume":"18","author":"Chou","year":"2023","journal-title":"J. Dent. Sci."},{"key":"ref_36","first-page":"141","article-title":"An assessment of asymmetry in the normal craniofacial complex","volume":"48","author":"Shah","year":"1978","journal-title":"Angle Orthod."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1073-8746(98)80017-0","article-title":"Diagnosis and treatment planning of patients with asymmetries","volume":"4","author":"Burstone","year":"1998","journal-title":"Semin. Orthod."},{"key":"ref_38","first-page":"651","article-title":"Can Cephalometric Indices and Subjective Evaluation Be Consistent for Facial Asymmetry?","volume":"75","author":"Masuoka","year":"2005","journal-title":"Angle Orthod."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.ijom.2007.02.003","article-title":"Towards building a photo-realistic virtual human face for craniomaxillofacial diagnosis and treatment planning","volume":"36","author":"Ayoub","year":"2007","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.ajodo.2009.04.016","article-title":"Working with DICOM craniofacial images","volume":"136","author":"Grauer","year":"2009","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/SCS.0b013e3181996803","article-title":"A cone-beam computed tomography triple scan procedure to obtain a three-dimensional augmented virtual skull model appropriate for orthognathic surgery planning","volume":"20","author":"Swennen","year":"2009","journal-title":"J. Craniofac. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0266-4356(97)90408-3","article-title":"A simple classification for surgical treatment planning of maxillomandibular asymmetry","volume":"35","author":"Reyneke","year":"1997","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.joms.2009.07.030","article-title":"Change of lip cant after bimaxillary orthognathic surgery","volume":"68","author":"Kim","year":"2010","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.ajodo.2008.01.019","article-title":"A 3-dimensional method for analyzing the morphology of patients with maxillofacial deformities","volume":"136","author":"Terajima","year":"2009","journal-title":"Am. J. Orthod. Dentofacial. Orthop."},{"key":"ref_45","first-page":"233","article-title":"Method for quantifying facial asymmetry in three dimensions using stereophotogrammetry","volume":"65","author":"Ras","year":"1995","journal-title":"Angle Orthod."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/6\/590\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:11:50Z","timestamp":1760105510000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/6\/590"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,11]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["diagnostics14060590"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14060590","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,11]]}}}