journal article·2026-07-22Open access

3D Evaluation of Gnathion Soft-Tissue Asymmetry Across Different Angle Malocclusions in Kosovar Children and Adolescents

Fehim Haliti, Kaltrina Veseli, Enis Veseli

Applied Sciences· Volume 16· Issue 14

Abstract

Purpose: The aim of this study was to assess gnathion soft-tissue deviation in Kosovar children and adolescents with Angle malocclusions using structured light scanning technology. Methods: This cross-sectional study was conducted on 90 children (aged 6–9) and 90 adolescents (aged 10–14). Facial scans were obtained using the MetiSmile facial scanner (Version 2.2.5.6), while intraoral scans were obtained using Aoralscan 3. Gnathion soft-tissue deviation from the midsagittal plane was assessed and categorised as left- or right-sided. Associations of gnathion asymmetry with sex, age group and Angle’s malocclusion classification were analysed using chi-square, Fisher’s exact, Mann–Whitney U and Kruskal–Wallis ANOVA by ranks tests. Results: Right-sided gnathion deviation was prevalent in both children (66.7%) and adolescents (72.2%). Right-sided gnathion deviation was more frequently observed than left-sided deviation in both age groups. No significant association was found between gnathion position and age group (p = 0.99), sex (children: χ2 = 0.201, p = 0.654; adolescents: χ2 = 2.072, p = 0.150), or Angle malocclusion classification (children: Fisher’s exact test, p = 0.594; adolescents: Fisher’s exact test, p = 0.435). Likewise, gnathion deviation did not differ significantly among Angle malocclusion groups (children: H = 1.41, p = 0.49; adolescents: H = 4.77, p = 0.09). Conclusions: Within the limitations of this cross-sectional study, mild gnathion soft-tissue asymmetry appears to be a common form of normal craniofacial variation and not a characteristic specifically associated with the type of Angle malocclusion. Three-dimensional facial scanning may provide a clinically applicable and non-invasive method for assessing facial asymmetry in paediatric orthodontic patients.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Orthodontics and Dentofacial Orthopedics · Temporomandibular Joint Disorders · Craniofacial Disorders and Treatments

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Pediatric and Preventive Dentistry, Dental School, Faculty of Medicine, University of Prishtina, 10000 Prishtina, Kosovo

Department of Orthodontics, Alma Mater Europaea, Campus College Rezonanca, 10000 Prishtina, Kosovo

Department of Prosthodontics, Dental School, Faculty of Medicine, University of Prishtina, 10000 Prishtina, Kosovo

References (51)

Show source-provided references
1. The carbon emissions of clear aligner therapy: A critical review10.25259/APOS_34_2024 ↗
2. Ke, Y., Zhu, Y., and Zhu, M. (2019). A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health, 19.10.1186/s12903-018-0695-z ↗
3. Recyclable aligners10.1038/s41415-024-7194-1 ↗
4. Analytical study of the psychosocial impact of malocclusion and maxillofacial deformity in patients undergoing orthodontic treatment10.25122/jml-2020-0022 ↗
5. Malocclusion and occlusal traits among dental and nursing students of Seven North-East states of India10.1016/j.jobcr.2021.10.012 ↗
6. Prevalence of malocclusion and its relationship with socio-demographic factors, dental caries, and oral hygiene in 12-to 14-year-old Tanzanian schoolchildren10.1093/ejo/cjn125 ↗
7. Oral health and quality of life in preschool children with autism: Evidence from Kosovo10.1007/s40368-026-01182-2 ↗
8. Dental, skeletal asymmetries and functional characteristics in Class II subdivision malocclusions10.1111/joor.12303 ↗
9. Facial asymmetry: A current review10.1590/2177-6709.20.6.110-125.sar ↗
10. Analysis of facial asymmetry in various facial forms
11. Symmetry of the face—Review of a complex matter10.1016/j.ajoms.2024.11.010 ↗
12. Facial and mandibular asymmetries: Etiology, diagnosis, and therapeutic strategies mandibular asymmetry: Narrative review10.1053/j.sodo.2025.06.005 ↗
13. Facial Asymmetry-Demystifying the Entity10.1007/s12663-023-02053-9 ↗
14. Chin asymmetry perception among orthodontists, general dentists, and laypersons10.4103/jos.jos_168_23 ↗
15. Three-dimensional perception of facial asymmetry10.1093/ejo/cjq146 ↗
16. Decoding Facial Dissymmetry: A Comparative Morphological Study on Human Skulls and Facial Structures10.1097/GOX.0000000000006514 ↗
17. Botezatu, A.-N., Cernei, E.R., Cărăușu, E.M., Anistoroaei, D., and Zegan, G. (2026). The Relationship Between Dentofacial and Body Postural Asymmetries in Patients with Malocclusions—A Cross-Sectional Clinical Study. Medicina, 62.10.3390/medicina62040626 ↗
18. Prevalence of mandibular asymmetry in different skeletal sagittal patterns10.2319/040921-292.1 ↗
19. Kadıoğlu, M.B., Yurttutan, M.E., Eriş, M.A., Durmaz, M., and Kocamaz, Ö.F. (2026). Skeletal Characteristics and Clinical Treatment Patterns in Orthognathic Surgery: A Virtual Surgical Planning-Based Study. Healthcare, 14.10.3390/healthcare14060809 ↗
20. Cenzato, N., Farronato, M., Tartaglia, F.C., Giannini, L., Inchingolo, A.M., Dipalma, G., Maspero, C., and Inchingolo, F. (2024). Soft Tissue Facial Morphology in Growing Patients with Different Occlusal Classes. J. Pers. Med., 14.10.3390/jpm14101042 ↗
21. Chin soft tissue thickness and mandibular divergency: A cross-sectional study10.1186/s40001-025-02957-x ↗
22. Relationship between skeletal malocclusion and chin soft tissue thickness in patients: A cross-sectional study10.24198/pjd.vol37no2.59309 ↗
23. Comparison Efficiency of Posteroanterior Cephalometry and Cone-beam Computed Tomography in Detecting Craniofacial Asymmetry: A Systematic Review10.4103/ccd.ccd_397_18 ↗
24. Digital Dental Radiology and Diagnostics-From 2D to 3D10.1111/adj.70024 ↗
25. Baldini, B., Cavagnetto, D., Baselli, G., Sforza, C., and Tartaglia, G.M. (2022). Cephalometric measurements performed on CBCT and reconstructed lateral cephalograms: A cross-sectional study providing a quantitative approach of differences and bias. BMC Oral Health, 22.10.1186/s12903-022-02131-3 ↗
26. The Impact of 3D Imaging on Orthodontic Diagnosis and Treatment Planning: A Systematic Literature Review10.63682/jns.v14i18S.5349 ↗
27. Stăncioiu, A.-A., Motofelea, A.C., Popa, A., Nagib, R., Lung, R.-B., and Szuhanek, C. (2025). Advanced 3D Facial Scanning in Orthodontics: A Correlative Analysis of Craniofacial Anthropometric Parameters. J. Clin. Med., 14.10.3390/jcm14217578 ↗
28. Facial Scans in Clinical Dentistry and Related Research: A Scoping Review
29. Pellitteri, F., Calza, M., Baldi, G., Maio, M., and Lombardo, L. (2025). Reproducibility and Accuracy of Two Facial Scanners: A 3D In Vivo Study. Appl. Sci., 15.10.3390/app15031191 ↗
30. Hung, P.K., Liu, J., and Shan, Z. (2025). 3D Photogrammetry-Driven Craniofacial Analysis in Orthodontics: A Scoping Review of Recent Applications. Bioengineering, 12.10.3390/bioengineering12111263 ↗
31. Progress of Multimodal Imaging: Bridging Orthodontics to Comprehensive Oral Multidisciplinary Care10.1016/j.identj.2026.109510 ↗
32. Veseli, K., Haliti, F., Veseli, E., Berisha, A., Veseli, A., Breznica, E., and Veseli, A. (2025). CRANIAL MORPHOMETRY: COMPARING TRADITIONAL METHODS AND 3D SCANNERS. Georgian Med. News, 25–30.10.59138/rsk3/2/7 ↗
33. Dental, S.D. (2026, June 04). Metismile Face Scanner. Available online: https://www.shining3ddental.com/solution/metismile-face-scanner.
34. Burlacu Vatamanu, O.E., Cristache, C.M., Drafta, S., and Nimigean, V.R. (2026). Evaluation of Four 3D Facial Scanning Technologies: From Photogrammetry to Structured-Light Systems in Clinical Dentistry. Dent. J., 14.10.20944/preprints202602.0496.v1 ↗
35. Major, M., Mészáros, B., Würsching, T., Polyák, M., Kammerhofer, G., Németh, Z., Szabó, G., and Nagy, K. (2024). Evaluation of a Structured Light Scanner for 3D Facial Imaging: A Comparative Study with Direct Anthropometry. Sensors, 24.10.3390/s24165286 ↗
36. Digital vs. Direct Anthropometry with MetiSmile® 3D Face Scanner: A Validation and Reliability Study on a Mannequin Model
37. Facial Asymmetry Detected with 3D Methods in Orthodontics: A Systematic Review10.2174/18742106-v16-e2111251 ↗
38. A Critical Review of the Efficacy and Safety of Radiological Imaging Techniques in Pediatric Orthodontics10.31661/gmj.v13iSP1.3698 ↗
39. Liu, J., Zhang, C., and Shan, Z. (2023). Application of Artificial Intelligence in Orthodontics: Current State and Future Perspectives. Healthcare, 11.10.3390/healthcare11202760 ↗
40. Kavousinejad, S., Ghazanfari, S., Manshadi, S.A.H., Biglar, N., Nahvi, G., Dalaie, K., Behnaz, M., Mirmohammadsadeghi, H., Tahmasbi, S., and Ebadifar, A. (2026). Artificial Intelligence-Based Multi-Stage System for Automated Angle’s Classification of Malocclusion from Intraoral Images in Orthodontics. J. Imaging Inform. Med.10.1007/s10278-025-01826-7 ↗
41. Applications of artificial intelligence in diagnosis and treatment planning of orthodontics: A narrative review10.1007/s44445-025-00077-0 ↗
42. Zhu, Y., Zhao, Y., and Wang, Y. (2022). A Review of Three-Dimensional Facial Asymmetry Analysis Methods. Symmetry, 14.10.3390/sym14071414 ↗
43. Heribanová, B., Janáková, K., Tomášik, J., Tichá, D., Harsányi, Š., and Thurzo, A. (2026). Current Applications and Future Perspectives of Artificial Intelligence in Face-Driven Orthodontics: A Scoping Review. Biomimetics, 11.10.3390/biomimetics11020146 ↗
44. Three-Dimensional Dynamic Analysis of the Reproducibility of Verbal and Nonverbal Facial Expressions10.1177/10556656211001998 ↗
45. Preedy, V.R. (2012). The Farkas System of Craniofacial Anthropometry: Methodology and Normative Databases. Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease, Springer.10.1007/978-1-4419-1788-1 ↗
46. Dental, S.D. (2026, June 04). Aoralscan 3 Intraoral Scanner. Available online: https://www.shining3ddental.com/solution/aoralscan-3/.
47. Evaluation of the 3dMDface system as a tool for soft tissue analysis10.1111/ocr.12178 ↗
48. Towards building a photo-realistic virtual human face for craniomaxillofacial diagnosis and treatment planning10.1016/j.ijom.2007.02.003 ↗
49. Facial asymmetry, the right-side dominance: A retrospective analysis of 315 consecutive series of patients10.1016/j.jpra.2022.11.001 ↗
50. Three-Dimensional Facial Imaging: A Comparative Assessment of the Clinical Applicability of State-of-the-Art Technologies for Three-Dimensional Facial Imaging10.1155/ijod/8822293 ↗
51. Veseli, A., Kosumi, S., Krasniqi, B., Mrasori, S., Veseli, E., Gjocaj, M., and Veseli, K. (2025). The efficacy of sensory-adapted dental interventions for children with developmental disabilities and sensory sensitivities. Georgian Med. News, 196–200.