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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (1): 128-135. doi: 10.19723/j.issn.1671-167X.2025.01.019

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Establishment and evaluation of a similarity measurement model for orthognathic patients based on the 3D craniofacial features

Ling WU, Jiakun FANG, Xiaojing LIU, Zili LI*(), Yang LI, Xiaoxia WANG   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
  • Received:2024-10-08 Online:2025-02-18 Published:2025-01-25
  • Contact: Zili LI E-mail:kqlzl@sina.com
  • Supported by:
    the National Natural Science Foundation of China(82171012);Capital's Funds for Health Improvement and Research(CFH 2022-2-4104);Beijing Natural Science Foundation(7232222)

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Abstract:

Objective: To establish a similarity measurement model for patients with dentofacial deformity based on 3D craniofacial features and to validate the similarity results with quantifying subjective expert scoring. Methods: In the study, 52 cases of patients with skeletal Class Ⅲ malocclusions who underwent bimaxillary surgery and preoperative orthodontic treatment at Peking University School and Hospital of Stomatology from January 2020 to December 2022, including 26 males and 26 females, were selected and divided into 2 groups by sex. One patient in each group was randomly selected as a reference sample, and the others were set as test samples. Three senior surgeons rated the similarity scores between the test samples and the reference sample. Similarity scores ranged from 1 to 10, where 1 was completely different, and 10 was exactly the same. Scores larger than 7.5 was considered as clinically similar. Preoperative cone beam computed tomography (CBCT) and 3D facial images of the patients were collected. The three-dimensional hard and soft tissue features, including distances, angles and 3D point cloud features were extracted. The similarity measurement model was then established to fit with the experts' similarity scoring by feature selection algorithm and linear regression model. To verify the reliability of the model, 14 new patients were selected and input to similarity measurement model for finding similar cases. The similarity scoring of these similar cases were rated by experts, and used to evaluate the reliability of the model. Results: The similarity metric models indicated that the features of the middle and lower craniofacial features were the main features to influence the craniofacial similarity. The main features that were related to the expert' s similarity scoring included distance of anterior nasal spine-menton (ANS-Me), distance of right upper canion point-Frankfurt horizontal plane (U3RH), distance of left superior point of the condyle-left gonion (CoL-GoL), distance of left gonion-menton (CoL-Me), distance of pogonion-midsagittal plane (Pog-MSP), distance of right alar base-left alar base (AlR-AlL), angle of pronasale-soft tissue pogonion-labrale inferius (Pn-Pog' -Li), distance of trichion-right tragus (Tri-TraR), distance of left exocanthion-left alar base (ExL-AlL), lower 1/3 of skeletal face, middle and lower 2/3 of skeletal face and upper lip region of soft tissue. Fourteen new patients were chosen to evaluate the model. The similar cases selected by the model had an average experts' similarity scoring of 7.627± 0.711, which was not significantly different with 7.5. Conclusion: The similarity measurement model established by this model could find the similar cases which highly matched experts' subjective similarity scoring. The study could be further used for similar cases retrieval in skeletal Ⅲ malocclusion patients.

Key words: Dentofacial deformities, Craniofacial similarity, 3D morphological features

CLC Number: 

  • R782.2

Table 1

Landmark-based features for craniofacial hard tissue"

Feature Definition
SNA Angle sella-nasion-A point
SNB Angle sella-nasion-B point
N-A-Pog Angle nasion-A point-pogonion
N-Pog_FHP Angle formed by FHP and nasion-pogonion line
S-Gn_FHP Angle formed by FHP and sella-gnathion line
UI-UIapex_FHP Angle formed by FHP and UI-UIapex line
LI-LIapex_MP Angle formed by mandible plane and LI-LIapex line
MP_FHP Angle formed by FHP and mandible plane
OP_FHP Angle formed by FHP and occlusion plane
CoR-GoR-Me Angle right superior point of the condyle -right inferior gonion-menton
CoL-GoL-Me Angle left superior point of the condyle -left inferior gonion-menton
GoR-Me-GoL Angle right inferior gonion-menton-left inferior gonion
CoR-Me-CoL Angle right superior point of condyle-menton-left superior point of the condyle
Ba-S-N Angle basion-sella-nasion
Ba-N Distance between basion and nasion
Ba-S Distance between basion and sella
S-N Distance between sella and nasion
PoR-PoL Distance between right porion and left porion
ZyR-ZyL Distance between right zygoma point and left zygoma point
JR-JL Distance between right jugale and left jugale
N-Me Distance between nasion and menton
N-ANS Distance between nasion and anterior nasal spine
ANS-Me Distance between anterior nasal spine and menton
S-GoRL Distance from sella to the line right inferior gonion-left inferior gonion
MxR-MxL Distance between right maxillary basal point and left maxillary basal point
UI-APNS Distance from UI point to the line anterior nasal spine-posterior nasal spine
ANS-PNS Distance between anterior nasal spine and posterior nasal spine
UMcuspR-UMcuspL Distance between right upper first molar point and left upper first molar point
UIH Distance from upper incisor point to FHP
U3RH Distance from right upper canion point to FHP
U3LH Distance from left upper canion point to FHP
U6RH Distance from right upper first molar point to FHP
U6LH Distance from left upper first molar point to FHP
LMcuspR-LMcuspL Distance between right lower first molar point and left lower first molar point
CoR-CoL Distance between right superior point of the condyle and left superior point of the condyle
CpR-CpL Distance between right coracoid process and left coracoid process
GoR-GoL Distance between right gonion and left gonion
AgR-AgL Distance between right antegonion and left antegonion
CoR-GoR Distance between right superior point of the condyle and right gonion
CoL-GoL Distance between left superior point of the condyle and left gonion
GoR-Me Distance between right gonion and menton
GoL-Me Distance between left gonion and menton
CoR-Me Distance between right superior point of the condyle and menton
CoL-Me Distance between left superior point of the condyle and menton
UI-MSP Distance from UI point to MSP
LI-MSP Distance from LI point to MSP
Pog-MSP Distance from pogonion to MSP
Overbite Vertical distance from UI to LI
Overjet Sagittal distance from UI to LI

Table 2

Landmark-based features for craniofacial soft tissue"

Feature Definition
Tri-Me’ Distance between trichion point and soft tissue menton
N’-Me’ Distance between soft tissue nasion and soft tissue menton
N’-Me’-v Vertical distance between soft tissue nasion and soft tissue menton
Tri’-N’ Distance between trichion point and soft tissue nasion
Tri-N’-v Vertical distance between trichion point and soft tissue nasion
N’-Sn Distance between soft tissue nasion and subnasale
N’-Sn-v Vertical distance between soft tissue nasion and subnasale
Sn-Me’ Distance between subnasale and soft tissue menton
Sn-Me’-v Vertical distance between subnasale and soft tissue menton
Sn-Stm Distance between subnasale and stomion
Stm-Me’ Distance between stomion and soft tissue menton
TraR-GoR’ Distance between right tragus and right soft tissue gonion
TraL-GoL’ Distance between left tragus and left soft tissue gonion
Tra-Go’(mean) Average value of distance between tragus and soft tissue gonion
GoR’-Me’ Distance between right soft tissue gonion and soft tissue menton
GoL’-Me’ Distance between left soft tissue gonion and soft tissue menton
Go’-Me’ (mean) Average value of distance between soft tissue gonion and soft tissue menton
ExR-ExL Distance between right exocanthion and left exocanthion
TraR-TraL Distance between right tragus and left tragus
GoR’-GoL’ Distance between right soft tissue gonion and left soft tissue gonion
AlR-AlL Distance between right alar base and left alar base
ChR-ChL Distance between right cheilion and left cheilion
ULPR-ULPL Distance between right upper lip point and left upper lip point
ZyR’-ZyL’ Distance between right soft tissue zygoma point and left soft tissue zygoma point
Li-B’-Pog’ Angle labrale inferius-soft tissue B point-soft tissue pogonion
Pn-Pog’-Ls Angle pronasale-soft tissue pogonion-labrale superius
Pn-Pog’-Li Angle pronasale-soft tissue pogonion-labrale inferius
Tri-G Distance between trichion and glabella
G-N’ Distance between glabella and soft tissue nasion
N’-Pn Distance between soft tissue nasion and pronasale
Pn-Sn Distance between pronasale and subnasale
Li-B’ Distance between labrale inferius and soft tissue B point
B’-Pog’ Distance between soft tissue B point and soft tissue pogonion
Pog’-Me’ Distance between soft tissue pogonion and soft tissue menton
Tri-ExR Distance between trichion and right exocanthion
Tri-ExL Distance between trichion and left exocanthion
Tri-TraR Distance between trichion and right tragus
Tri-TraL Distance between trichion and left tragus
N’-AlR Distance between soft tissue nasion and right alar base
N’-AlL Distance between soft tissue nasion and left alar base
N’-GoR’ Distance between soft tissue nasion and right soft tissue gonion
N’-GoL’ Distance between soft tissue nasion and left soft tissue gonion
N’-Go’(mean) Average value of distance between soft tissue nasion and soft tissue gonion
ExR-AlR Distance between right exocanthion and right alar base
ExL-AlL Distance between left exocanthion and left alar base
ExR-ChR Distance between right exocanthion and right cheilion
ExL-ChL Distance between left exocanthion and left cheilion
TraR-AlR Distance between right tragus and right alar base
TraL-AlL Distance between left tragus and left alar base

Figure 1

Iterative nearest point registration of test sample (blue) to reference sample (yellow) A, test sample and reference sample; B, coarse registration; C, fine registration using iterative nearest point."

Figure 2

Upper, middle and lower regions of 3D skull"

Figure 3

Schematic diagram of the 19 regions of facial soft tissue"

Figure 4

Workflow of similarity model construction CFS, correlation feature selection."

Table 3

Linear regression analysis of independent variables related to similarity score for 3 models"

Variable β(95%CI) P value Variance inflation factor
Landmark-based features
ANS-Me 0.171 (-0.545 to 0.887) 0.631 2.745
U3RH -0.350 (-0.942 to 0.241) 0.238 2.000
CoL-GoL 0.608 (-0.253 to 1.469) 0.161 1.075
CoL-Me -1.085(-1.984 to -0.187) 0.019* 1.962
Pog-MSP -1.082 (-1.693 to -0.471) 0.001* 1.153
Stm-Me’ -0.766 (-1.421 to -0.111) 0.023* 1.793
AlR-AlL -0.344 (-0.987 to 0.298) 0.285 1.498
Pn-Pog’-Li -0.656 (-1.260 to -0.052) 0.034* 1.232
Tri-TraR -0.277 (-0.764 to 0.211) 0.258 1.597
ExL-AlL -0.404 (-1.060 to 0.251) 0.220 1.578
Surface-based features
Lower 1/3 cranium 0.129 (-0.769 to 1.027) 0.773 2.065
Lower 2/3 cranium -1.975 (-3.497 to -0.453) 0.012* 4.173
Entire cranium 0.516 (-0.668 to 1.700) 0.384 2.855
Right cheek region 0.506 (-0.163 to 1.175) 0.134 1.081
Left paranasal region 0.543 (-0.166 to 1.251) 0.130 1.109
Upper vermilion region 1.308 (0.358 to 2.258) 0.008* 1.406
Lower facial region -1.140 (-1.838 to -0.443) 0.002* 1.271
All features
ANS-Me 0.031 (-0.634 to 0.696) 0.925 2.592
U3RH -0.226 (-0.807 to 0.355) 0.435 2.112
CoL-GoL 0.673 (-0.191 to 1.537) 0.123 1.188
CoL-Me -1.329 (-2.227 to -0.432) 0.005* 2.146
Pog-MSP -0.659 (-1.272 to -0.046) 0.036* 1.272
AlR-AlL -0.456 (-1.089 to 0.177) 0.153 1.592
Pn-Pog’-Li -0.678 (-1.259 to -0.096) 0.024* 1.253
Tri-TraR -0.082 (-0.545 to 0.381) 0.722 1.579
ExL-AlL -0.641 (-1.270 to -0.012) 0.046* 1.594
Lower 1/3 cranium -0.188 (-0.847 to 0.471) 0.568 1.929
Lower 2/3 cranium -0.626 (-1.492 to 0.239) 0.151 2.341
Upper vermilion region 0.814 (0.122 to 1.505) 0.022* 1.293
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[1] Lu YU, Ling WU, Xiaojing LIU, Zili LI. Feasibility study of a surgical planning protocol for orthognathic surgery utilizing similarity retrieval from database: A randomized controlled trial [J]. Journal of Peking University (Health Sciences), 2026, 58(1): 145-152.
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