Diagnostic validity of different gonial angle segmentation for the assessment of mandibular growth direction: A...

The development of the mandible largely determines the sagittal and vertical lateral appearance. The gonial angle (Articulare-Gonion-Menton, Ar-Go'-Me), as a composite indicator, represents the growth direction of the mandible. We proposed a method based on the Frankfort horizontal (FH) plane and its vertical plane (VFH) to divide the gonial angle into sagittal and vertical components (Articulare-Gonion-VFH / Menton-Gonion-FH, Ar-Go'-VFH / Me-Go'-FH) and to compare the accuracy of diagnosing the development of the mandible and maxillofacial structures with other methods.

Lateral cephalometric films from 736 volunteers aged 6-30 years were collected and analyzed for cephalometric measurements. Four groups of segmentation-based angle, including the FH-based segmentation (Ar-Go'-VFH / Me-Go'-FH), the SN-based segmentation (Articulare-Gonion- Sellion-Nasion plane' vertical plane/ Menton-Gonion- Sellion-Nasion plane, Ar-Go'-VSN / Me-Go'-SN), the Go'-S based segmentation(Articulare-Gonion-Sellion / Menton-Gonion-Sellion, Ar-Go'-S / Me-Go'-S), and the Go'-N based segmentation (Articulare-Gonion-Nasion / Menton-Gonion-Nasion, Ar-Go'-N / Me-Go'-N), as well as commonly used sagittal and vertical indices were measured. Pearson correlation analysis was used to show the representativeness of different segmentation methods on the mandibular growth direction.

As the gonial angle decreased with age, all the segmentation-based metrics decreased. The plane-based segmentation metrics, including Ar-Go'-VFH / Me-Go'-FH, Ar-Go'-VSN / Me-Go'-SN, were superior to the point-based segmentation metrics (Ar-Go'-S / Me-Go'-S, and Ar-Go'-N / Me-Go '-N) in evaluating vertical and sagittal development of the mandible. The sagittal indicators displayed alteration of ramus and condyle, while these vertical indicators responded to the alteration of the mandibular corpus and gonial angle.

The gonial angle should be clinically segmented with planes (including SN plane and FH plane) rather than points (including Go'-S and Go'-N) to assess mandibular development. The FH plane-based segmentation method facilitated chair-side diagnosis of the mandibular growth direction.