ASSESSMENT OF MANDIBULAR ASYMMETRY IN SKELETAL CLASS III MALOCCLUSION USING CBCT

Abstract

Mandibular asymmetry represents a key diagnostic determinant in skeletal Class III malocclusion, yet conventional two-dimensional evaluations often fail to capture the full extent of three-dimensional discrepancies. This study aimed to quantify condylar, ramal, and body asymmetry using cone-beam computed tomography and to identify structural patterns predictive of transverse and sagittal imbalance. A prospective cross-sectional design was employed to analyse 98 subjects diagnosed with skeletal Class III malocclusion, revealing several previously underreported asymmetry gradients across mandibular subregions. Significant differences were observed between the deviated and non-deviated sides in condylar volume (p < 0.01), ramal height (p < 0.001), and body length (p < 0.001). Novel findings demonstrated that rotational asymmetry correlated strongly with condylar angulation rather than condylar size alone (p < 0.05), suggesting a more complex biomechanical basis for mandibular deviation than linear discrepancies can explain. Additionally, subjects with greater ramal discrepancy exhibited more severe transverse midline deviation (p < 0.01), indicating a potential early diagnostic marker. These results highlight the capacity of CBCT to detect subtle skeletal variations that influence surgical planning, offering new insights into three-dimensional mandibular morphology. The findings support the integration of volumetric assessment as a standard component of orthodontic diagnostic protocols to enhance precision in treatment planning for skeletal Class III deformities.