Comparison of two-dimensional Grummons’ analysis and three-dimensional asymmetry index measurement in diagnosis of dentocraniofacial asymmetry

Stefanus Siswoyo; Maria Purbiati; Krisnawati Krisnawati

doi:10.12688/f1000research.144110.2

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Research Article

Revised

Comparison of two-dimensional Grummons’ analysis and three-dimensional asymmetry index measurement in diagnosis of dentocraniofacial asymmetry

[version 2; peer review: 1 approved, 1 not approved]

Stefanus Siswoyo¹, Maria Purbiati ¹, Krisnawati Krisnawati¹

PUBLISHED 16 Sep 2024

Author details Author details

¹ Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

Stefanus Siswoyo
Roles: Conceptualization, Resources, Writing – Original Draft Preparation

Maria Purbiati
Roles: Formal Analysis, Methodology, Project Administration, Writing – Review & Editing

Krisnawati Krisnawati
Roles: Data Curation, Investigation, Validation

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the QUVAE Research and Publications gateway.

Abstract

Background

Dentocraniofacial asymmetry is a common condition that affects many individuals. Accurate diagnosis of this condition is essential for effective treatment planning.

Aim

This study aimed to compare the diagnosis of dentocraniofacial asymmetry using two-dimensional and three-dimensional methods.

Methods

A cross-sectional, observational study was conducted at the Orthodontic Specialist Clinic of the Dental Hospital Faculty of Dentistry, University of Indonesia from March to April 2023. The study included 15 patients who had not undergone orthodontic treatment and were diagnosed with dentocraniofacial asymmetry. The study compared the results of diagnosing asymmetry in 15 different facial features, including the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, coronoid process, gonion, zygoma, latero nasale, and jugulare.

Results

The study found that there was no significant difference in the diagnosis of dentocraniofacial symmetry between the two- and three-dimensional methods across all 15 parameters measured. The researchers used Fisher's Exact Test to compare the proportion between dependent variables and found that the p-value was greater than 0.05, indicating that there was no significant difference in the diagnosis of dentocraniofacial symmetry between the two methods. The study also used Kappa Cohen analysis to measure the strength of agreement between the diagnosis of dentocraniofacial symmetry of the two-dimensional and three-dimensional methods on each parameter.

Conclusion

The findings of this study suggest that both two-dimensional and three-dimensional methods are equally effective in diagnosing dentocraniofacial asymmetry. This information may be useful for orthodontists in deciding which method to use when diagnosing dentocraniofacial asymmetry.

Keywords

Dentocraniofacial, asymmetry, cross-sectional approach, two-dimensional Grummon

Corresponding author: Maria Purbiati

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Siswoyo S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Siswoyo S, Purbiati M and Krisnawati K. Comparison of two-dimensional Grummons’ analysis and three-dimensional asymmetry index measurement in diagnosis of dentocraniofacial asymmetry [version 2; peer review: 1 approved, 1 not approved]. F1000Research 2024, 13:438 (https://doi.org/10.12688/f1000research.144110.2) First published: 02 May 2024, 13:438 (https://doi.org/10.12688/f1000research.144110.1) Latest published: 16 Sep 2024, 13:438 (https://doi.org/10.12688/f1000research.144110.2)

Revised Amendments from Version 1

In response to the comments regarding the Introduction section, we have expanded the gap statement to provide a detailed explanation of the deficiency in knowledge within the field of dentocraniofacial asymmetry diagnosis that our research aims to address. This includes an overview of previous literature and the specific parameters that have not been comprehensively compared using two-dimensional and three-dimensional methods.
Furthermore, we have updated the purpose of the study to clearly convey our aim of conducting a comprehensive assessment of specific dentocraniofacial parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis. We believe that these changes provide a more precise and focused direction for our research.
Regarding the study hypothesis, we have revised it to state that our study aims to determine if there is a significant difference in the diagnosis of dentocraniofacial symmetry between the two-dimensional and three-dimensional methods when assessing specific dentocraniofacial parameters. This clarification aims to align the hypothesis with the specific objectives of our research. In the Methods section, we have included detailed information on the method of taking 2D and 3D dimensions, specifying that 2D dimensions were obtained through traditional orthodontic cephalometric radiographs, while 3D dimensions were obtained through cone-beam computed tomography (CBCT) scans. We have also explicitly mentioned that the measurements were conducted based on bone dimensions to ensure clarity for general practitioners and specialists.
Additionally, we have provided the age range of the participants, which is between 15 to 25 years, addressing the potential impact of growth and development of dentocraniofacial structures during adolescence and early adulthood on the measurements conducted in the study. Lastly, the typographical error in "asymmetry" in Table 1 has been corrected as per your observation.

See the authors' detailed response to the review by Abdullah Mohammed

A. Introduction

This study was conducted because it was based on the general objective of comparing the results of the diagnosis of dentocraniofacial symmetry of patients in two-dimensional and three-dimensional methods. While in specific, the purpose of this study is to compare the results of the diagnosis of symmetry of the anterior nasal spine, upper first incisor, lower first incsior, pterygomaxillary fissure, orbita, menton, porion, upper first molar, condyle, lower first molar, coronoid process, gonion, zygoma, latero nasale, jugulare in two-dimensional and three-dimensional methods.

The diagnosis of dentocraniofacial asymmetry is crucial in orthodontic treatment planning. Previous literature has extensively explored the comparative analysis of two-dimensional and three-dimensional techniques in assessing dentocraniofacial asymmetry. These studies have contributed to the understanding of the diagnostic accuracy of different methods in evaluating dentocraniofacial asymmetry. The field of dentocraniofacial asymmetry diagnosis is largely focused on comparing two-dimensional and three-dimensional methods, but there is a lack of comprehensive research comparing the specific dentocraniofacial parameters using these methods. Existing studies have not provided a detailed comparison of the diagnosis of symmetry in parameters such as the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare. This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

B. Methods

This study was an analytic observational study with a cross-sectional approach. The clinical examination of the research subjects was carried out at the Dental Hospital of the Faculty of Dentistry, University of Indonesia in March - April 2023. The population of this study were patients with dentocraniofacial asymmetry before orthodontic treatment at the RSKGM FKG UI Orthodontic Specialist Clinic in 2023. The participants in the study were within the age range of 15 to 25 years. This age range was chosen considering the growth and development of the dentocraniofacial structures during adolescence and early adulthood, which can significantly impact the measurements and diagnosis of dentocraniofacial asymmetry. Researchers used 15 people to be sampled based on the Dahlan formula (2010). The study was approved by the Dental Research Ethics Committee, Faculty of Dentistry, Universitas Indonesia with (Protocol no: 050180223) has approved the study on February 12th, 2023. A written informed consent was obtained from all the participants. The clinical examinations were conducted meticulously, following standardized procedures to ensure accuracy and reliability of the data collected. Each participant underwent a thorough assessment of their dentocraniofacial features, allowing the researchers to gather valuable insights into the nature of the asymmetry present in the study population.

In processing the data (Siswoyo, 2023), the researcher conducted a categorical comparative analytic hypothesis test to compare the proportion between the dependent variables, namely with Fisher's Exact Test to determine the difference in the results of the diagnosis of dentocraniofacial symmetry between the two-dimensional technique and the three-dimensional method with the calculation of the Katsumata asymmetry index. Kappa Cohen analysis was performed to see the strength of agreement between the diagnosis of dentocraniofacial symmetry of the two-dimensional and three-dimensional methods on each parameter 11.

The hypothesis for this study is that there is no significant difference in the diagnosis of dentocraniofacial symmetry between two-dimensional and three-dimensional methods when assessing the specific dentocraniofacial parameters including the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare. The 2D dimensions were obtained through traditional orthodontic cephalometric radiographs, which provide a two-dimensional representation of the patient's dental and skeletal structures. On the other hand, the 3D dimensions were obtained through cone-beam computed tomography (CBCT) scans, which provide a three-dimensional visualization of the patient's dental and skeletal anatomy, allowing for a more comprehensive assessment of dentocraniofacial asymmetry. Furthermore, the measurements were specifically conducted on bone-based dimensions to ensure clarity and precision in the diagnosis of dentocraniofacial symmetry. By focusing on bone-based dimensions, the study aimed to provide valuable insights for general practitioners and specialists in accurately identifying and addressing asymmetry within the craniofacial complex.

Fifteen samples that have been obtained in the form of DICOM CBCT are processed using Carestream 3D Imaging v3.87 software (https://www.carestream.com/en/us/medical/software/imageview-software?gclid=CjwKCAiA3JCvBhA8EiwA4kujZoh1Jaj95uopjgV3gCOLnHA5FjN9FsDVOCl9sfi7hVGM2KIjMtR_qxoCMpkQAvD_BwE) to produce a reconstructed posteroanterior cephalogram image on a 168.3 mm image slice.

C. Results

A categorical comparative test was performed with Fisher's Exact Test to see if there was a difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the fifteen parameters studied. The results of the analysis of each parameter will be presented in each table.

Fisher's exact test results of two-dimensional and three-dimensional methods on ANS parameters conducted on fifteen samples showed a p value> 0.05. This indicates that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on ANS parameters (Table 1).

Table 1. Fisher's exact test results of two- and three-dimensional methods on ANS parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Method	Symmetry	13	86,60%	1	6.7%	0.867
2D Method	Asymmetry	0	0%	1	6.7%	0.867

The results of Fisher's exact test of two-dimensional and three-dimensional methods on the parameters of the upper first incisor in fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the upper first incisor parameter (Table 2).

Table 2. Fisher's exact test results of two- and three-dimensional methods on upper first incisor parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	4	26.7%	3	20.0%	0.317
2D Methods	Asymmetry	0	0%	8	53.3%	0.317

The results of Fisher's exact test of two-dimensional and three-dimensional methods on the parameters of the lower first incisor conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the lower first incisor parameter (Table 3).

Table 3. Fisher's exact test results of two- and three-dimensional methods on lower first incisor parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	4	26.7%	0	20.0%	0.317
2D Methods	Asymmetry	0	0%	11	53.3%	0.317

Fisher's exact test results of two-dimensional and three-dimensional methods on pterygoid fissure parameters conducted on fifteen samples showed p> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the pterygoid fissure parameter (Table 4).

Table 4. Fisher's exact test results of two- and three-dimensional methods on pterygoid fissure parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	7	46.7%	4	26,67%	0,180
2D Methods	Asymmetry	1	6.7%	3	20.0%	0,180

Fisher's exact test results of two-dimensional and three-dimensional methods on orbita parameters conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the orbita parameters (Table 5).

Table 5. Fisher's exact test results of two- and three-dimensional methods on orbita parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	8	53.3%	2	13.3%	0,157
2D Methods	Asymmetry	0	0%	5	33.3%	0,157

The results of Fisher's exact test of two-dimensional and three-dimensional methods on the menton parameter conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the menton parameter (Table 6).

Table 6. Fisher's exact test results of two- and three-dimensional methods on menton parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	2	13.3%	0	0.0%	0,317
2D Methods	Asymmetry	1	6.7%	12	80.0%	0,317

Fisher's exact test results of two-dimensional and three-dimensional methods on porion parameters conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the porion parameter (Table 7).

Table 7. Fisher's exact test results of two- and three-dimensional methods on porion parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	6	40.0%	1	6.7%	1,000
2D Methods	Asymmetry	1	6.7%	7	46.7%	1,000

The results of Fisher's exact test of two-dimensional and three-dimensional methods on the parameters of the upper first molar conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the parameters of the upper first molar (Table 8).

Table 8. Fisher's exact test results of two- and three-dimensional methods on upper first molar parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	8	53.3%	1	6.7%	1,000
2D Methods	Asymmetry	1	6.7%	5	33.3%	1,000

Fisher's exact test results of two-dimensional and three-dimensional methods on condyle parameters conducted on fifteen samples showed p> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the condyle parameter (Table 9).

Table 9. Fisher's exact test results of two- and three-dimensional methods on condyle parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	5	33.3%	2	13.3%	0,564
2D Methods	Asymmetry	1	6.7%	7	46.7%	0,564

The results of Fisher's exact test of two-dimensional and three-dimensional methods on the parameters of the lower first molar conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the parameters of the lower first molar (Table 10).

Table 10. Fisher's exact test results of two- and three-dimensional methods on lower first molar parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	5	33.3%	0	0.0%	0,317
2D Methods	Asymmetry	1	6.7%	9	60.0%	0,317

The results of Fisher's exact test of two-dimensional and three-dimensional methods on coronoid parameters conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the coronoid parameter (Table 11).

Table 11. Fisher's exact test results of two- and three-dimensional methods on coronoid parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	4	26.7%	3	20.0%	0,655
2D Methods	Asymmetry	2	13.3%	6	40.0%	0,655

The results of Fisher's exact test of two-dimensional and three-dimensional methods on gonion parameters conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the gonion parameter (Table 12).

Table 12. Fisher's exact test results of two- and three-dimensional methods on gonion parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	5	33.3%	1	6.7%	1,000
2D Methods	Asymmetry	1	6.7%	8	53.3%	1,000

The results of Fisher's exact test of two-dimensional and three-dimensional methods on zygoma parameters conducted on fifteen samples showed a p value> 0.05. This shows that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the zygoma parameter (Table 13).

Table 13. Fisher's exact test results of two- and three-dimensional methods on zygoma parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	13	86.7%	0	0.0%	1,000
2D Methods	Asymmetry	0	0.0%	2	13.3%	1,000

Fisher's exact test results of two-dimensional and three-dimensional methods on lateronasale parameters conducted on fifteen samples showed a p value> 0.05. This indicates that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods in the lateronasale parameter (Table 14).

Table 14. Fisher's exact test results of two- and three-dimensional methods on lateronasale parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		n	%	n	%
2D Methods	Symmetry	14	93.3%	0	0.0%	1,000
2D Methods	Asymmetry	0	0.0%	1	6.7%	1,000

Fisher's exact test results of two-dimensional and three-dimensional methods on the jugulare parameter conducted on fifteen samples showed a p value> 0.05. This indicates that there is no difference in the diagnosis of dentocraniofacial symmetry in the two- and three-dimensional methods on the jugulare parameter (Table 15).

Table 15. Fisher's exact test results of two- and three-dimensional methods on jugulare parameters.

Diagnose		3D Katsumata				p value
		Symmetry		Asymmetry
		N	%	n	%
2D Methods	Symmetry	13	86.7%	0	0.0%	1,000
2D Methods	Asymmetry	0	0.0%	2	13.3%	1,000

The study results revealed significant differences between Grummon standard and Katsumata index readings for the measured dentocraniofacial features. This finding suggests that there are notable distinctions in the diagnosis of dentocraniofacial symmetry when using the two-dimensional and three-dimensional methods for assessing these features.

D. Discussion

In general, the test results obtained are p>0.05 in all parameters measured, so it can be concluded that there is no significant difference in the diagnosis of dentocraniofacial symmetry between the two- and three-dimensional methods on all fifteen dentocraniofacial parameters measured.

This is in line with research conducted by Kumar (2007); Katsumata et al. (2005) and Robben et al (2017) which states that the reconstruction of two-dimensional cephalogram images from CBCT imaging results is able to provide an image similar to conventional cephalogram results with linear and angular size accuracy and the same precision.¹ The results of this posteroanterior cephalogram reconstructed image will be analyzed for dentocraniofacial symmetry using the software. Research by Meldenik et al (2011) stated that the use of carestream 3D imaging is able to provide good contrast and resolution as well as good accuracy during the analysis process which can affect visualization in determining craniometric points.²^,³^,⁹ The analysis procedure was carried out using the Grummon technique on all fifteen parameters by measuring the linear discrepancy of each side against the midsagittal reference line. At a single parameter point, only the distance from the parameter point to the midsagittal reference line was measured. If the linear discrepancy value obtained was more than two millimeters, a diagnosis of asymmetry was made.¹^,²

Three-dimensional analysis was carried out by processing the fifteen samples of CBCT results into multiplanar reconstruction and volumetric rendering. This is supported by the research of Barreto et al (2020) which states that cephalometric measurements in multiplanar reconstruction have good accuracy in linear and angular measurements. 81 The analysis process is carried out by measuring the fifteen parameters against a three-dimensional reference plane whose values will be calculated into an asymmetry index as described by Katsumata. The asymmetry index obtained will be compared with the Katsumata index table to assess whether it is categorized as asymmetry or not for each parameter.³

The results of the Fisher's exact test on fifteen parameters showed a p value> 0.05, meaning that there was no significant difference between the diagnosis of dentocraniofacial symmetry of the two-dimensional method and the three-dimensional method of calculating the asymmetry index. Kappa Cohen analysis was performed to see the agreement of dentocraniofacial symmetry diagnosis of two-dimensional and three-dimensional methods. The highest agreement value was seen in the parameters of jugular, lateronasale, zygoma, lower first incisor. The next category in near perfect agreement is the lower first molar parameter. Menton, porion, upper first molar, orbita, and anterior nasal spine are included in the substantial agreement category. Upper first incisor, condyle, and gonion are included in moderate agreement. Lastly, the pterygoid fissure and coronoid are in fair agreement.

The anterior nasal spine parameters in the fifteen samples analyzed, fourteen samples were diagnosed with symmetry and one sample was diagnosed with asymmetry in both methods. One sample was diagnosed with asymmetry in the three-dimensional method but symmetry in the two-dimensional method. This may be due to the difference in the standard deviation range of the Katsumata asymmetry index value and the Grummon standard. The discrepancy of 1.8 mm in ANS is still categorized as symmetry in the two-dimensional method because it is still below 2 mm but the value is above the standard Katsumata asymmetry index in the ANS category. In the parameters of upper first incisor, lower first incisor, pterygoid fissure, orbita, menton, porion, upper first molar, condyle, lower first molar, coronoid, and gonion, the same thing was found in the form of a difference in diagnosis between the two-dimensional and three-dimensional methods of calculating the Katsumata asymmetry index. This difference can occur due to several things, including the placement of the craniometric points of the measured parameters due to differences in the definition of each parameter and differences in procedures and standard values for diagnosis in the two- and three-dimensional methods.⁵

Cephalometric analysis errors can be systematic errors and random errors. Systematic errors are measurement errors that occur consistently throughout the study. In this study, only one exposure to the patient was used, namely by using a CBCT machine so that the radiographic image can minimize the occurrence of magnification and distortion. Two-dimensional image reconstruction was performed using the same CBCT results and the same software, namely carestream 3D imaging v 3.87 at a slicing split view of 168.3 mm to minimize systematic errors. The study measurements were performed by one researcher (SS) with clear operational definitions so that according to Lisboa et al (2014), systematic errors in craniometric point identification do not affect the results of the study if supported by a good intrarater reliability assessment.

The second error is random error. This error is a difference in the measurement data due to inaccuracy and/or difficulty in measurement. Random errors can always occur in a measurement. In cephalometric analysis, random errors can occur due to imprecise craniometric point placement. The imprecision of craniometric point placement can be influenced by several things such as the brightness and contrast level settings of the posteroanterior reconstructed cephalogram image and CBCT results and operator fatigue factors. To anticipate this, researchers ensure that sufficient brightness and contrast levels are used during the analysis process and give a minimum distance of 1 day between each pointing to avoid fatigue.

There are some craniometric points that are difficult to identify in both two and three dimensions and researchers' opinions on the accurate positioning of craniometric points may vary. Although the operational definition of parameter points has been determined, points with the definition of “most anterior/posterior/inferior” on curved planes such as the orbita or gonion have high subjectivity (Chien et al, 2009). This is in line with the research of Oliveira et al (2009) who said that the orbital point is located on a curved surface so that the three-dimensional identification process can provide accurate placement. In addition to the orbital point, the condyle point also often has difficulty in point placement. This is due to the lack of detailed definition of the parameter point due to its curved anatomical area.⁶ Vlijmen et al (2010) also added that differences in diagnosis results between two- and three-dimensional methods can occur due to the addition of second and third-dimensional assessments that can affect the diagnosis. In three-dimensional analysis, anatomical structures can be observed as they actually are in all three viewpoints rather than two-dimensional imaging.⁷^,⁸ The addition of the third dimension requires additional precision for the researcher in determining points according to the three-dimensional definition, especially points located on curved planes.³^,⁴^,⁶

This identification difficulty in craniometric points also affects the taking of the reference sagittal plane in the two-dimensional and three-dimensional methods. In the two-dimensional method, the center reference line is determined using the midsagittal reference (MSR) formed from the point on the crest gallii. In the three-dimensional method, the center plane is determined using the sella and nasion reference points. Identification of the sella point on a two-dimensional posteroanterior cephalogram image is not possible due to the superimposition of anatomical structures from the frontal direction. This difference allows for different transverse size values in the two-dimensional and three-dimensional methods. The sella point is located at the base of the cranii which undergoes very minimal expansion during growth after the age of five and only undergoes growth in the inferior anterior direction. The nasion point is also a relatively stable point and only undergoes growth in the vertical and sagittal directions but not in the transverse. The anterior region of the base of the cranii from the sella turcica to the frontal bone is quite stable and does not undergo much change after the age of seven years, so using this point as a reference plane is considered good.¹⁰

The results of this study showed no difference in the diagnosis of dentocraniofacial symmetry in two-dimensional and three-dimensional methods with the calculation of the Katsumata asymmetry index. The level of agreement of the diagnosis results of the two- and three-dimensional methods varied in all fifteen parameters. Orthodontists are expected to utilize three-dimensional dentocraniofacial symmetry diagnosis for patients who are indicated using cone beam computed tomography for examination and preparation of surgical and non-surgical combined orthodontic treatment plans. Orthodontists are also expected to analyze the symmetry of the dentocraniofacial structure in depth in three dimensions to determine the shape of the dentocraniofacial asymmetry whether it is purely translational or there is a combination of rolling, yawing, and pitching that can affect the treatment plan. This is in accordance with Ko's research (2022) which states that to obtain optimal treatment results in asymmetry patients, a comprehensive dentocraniofacial evaluation is needed including from the outer to the inner dentoskeletal components which can be done on a three-dimensional cone beam computed tomography examination.

E. Conclusion

The study was focused on comparing the Grummon standard for the analysis of two-dimensional (2D) measurements and the Katsumata index for three-dimensional (3D) measurements. These standards were utilized as references to determine whether the measurements exhibited symmetry or asymmetry. In the case of the Grummon standard, it is a well-established method used to assess dentocraniofacial asymmetry in 2D measurements. Meanwhile, the Katsumata index is specifically designed for 3D measurements and has been widely recognized in the field of orthodontics. The Grummon standard assesses the symmetry or asymmetry of specific dentocraniofacial parameters in 2D measurements, including the anterior nasal spine, upper first incisor, lower first incisor, pterygomaxillary fissure, orbita, menton, porion, upper first molar, condyle, lower first molar, coronoid process, gonion, zygoma, latero nasale, and jugulare. Symmetry or asymmetry is determined based on the measurements in relation to established norms. On the other hand, the Katsumata index is used to evaluate the symmetry or asymmetry of dentocraniofacial parameters in 3D measurements. This index considers the spatial relationships and dimensions of various craniofacial structures. Using this index, researchers were able to assess the symmetry or asymmetry of the same set of parameters in their three-dimensional form. By employing these standardized methods, the study aimed to provide a comprehensive comparison of the diagnosis of dentocraniofacial asymmetry in both 2D and 3D methods, thus contributing to the advancement of orthodontic diagnostic techniques. Diagnosis showed no statistically significant difference in the two-dimensional method with the Grummon comparison technique and the three-dimensional method with the calculation of the Katsumata asymmetry index.

Ethics and consent

The clinical examination of the research subjects was carried out at the Dental Hospital of the Faculty of Dentistry, University of Indonesia in March - April 2023.

The study was approved by the Dental Research Ethics Committee, Faculty of Dentistry, Universitas Indonesia with (Protocol no: 050180223) has approved the study on February 12th, 2023. A written informed consent was obtained from all the participants.

Reporting guidelines

Figshare:STROBE Checklist for Comparison of two-dimensional Grummons’ analysis and three-dimensional asymmetry index measurement in diagnosis of dentocraniofacial asymmetry, https://doi.org/10.6084/m9.figshare.24331090.v2.¹¹

Data availability statement

Figshare: Underlying Data.xlsx., https://doi.org/10.6084/m9.figshare.24331090.v2.¹¹

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgement

Authors would like to express their gratitude to QUVAE Research and Publications for their guidance with the submission and deposition of underlying data to the Figshare repository.

References

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3. Robben J, Muallah J, Wesemann C, et al.: Suitability and accuracy of CBCT model scan: an in vitro study. Int. J. Comput. Dent. 2017; 20(4): 363–375. PubMed Abstract
4. Katsumata A, Fujishita M, Maeda M, et al.: 3D-CT evaluation of facial asymmetry. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2005 Feb; 99(2): 212–220. Publisher Full Text
5. Barreto MS, da Silva BI , Miranda Leite-Ribeiro P, et al.: Accuracy of the measurements from multiplanar and sagittal reconstructions of CBCT. Orthod. Craniofac. Res. 2020 May; 23(2): 223–228. PubMed Abstract | Publisher Full Text
6. de Oliveira AEF , Cevidanes LHS, Phillips C, et al.: Observer reliability of three-dimensional cephalometric landmark identification on cone-beam computerized tomography. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2009 Feb; 107(2): 256–265. PubMed Abstract | Publisher Full Text | Free Full Text
7. van Vlijmen OJC , Maal T, Bergé SJ, et al.: A comparison between 2D and 3D cephalometry on CBCT scans of human skulls. Int. J. Oral Maxillofac. Surg. 2010 Feb; 39(2): 156–160. PubMed Abstract | Publisher Full Text
8. Lisboa C d O, Masterson D, da Motta AFJ , et al.: Reliability and reproducibility of three-dimensional cephalometric landmarks using CBCT: a systematic review. J. Appl. Oral Sci. 2015; 23(2): 112–119. PubMed Abstract | Publisher Full Text | Free Full Text
9. Chien PC, Parks ET, Eraso F, et al.: Comparison of reliability in anatomical landmark identification using two-dimensional digital cephalometrics and three-dimensional cone beam computed tomography in vivo. Dentomaxillofac. Radiol. 2009 Jul; 38(5): 262–273. PubMed Abstract | Publisher Full Text
10. Vernucci RA, Aghazada H, Gardini K, et al.: Use of an anatomical mid-sagittal plane for 3-dimensional cephalometry: A preliminary study. Imaging Sci. Dent. 2019 Jun; 49(2): 159–169. PubMed Abstract | Publisher Full Text | Free Full Text
11. Siswoyo S, Purbiati M, Krisnawati K: Underlying Data.xlsx. Dataset. figshare. 2023. Publisher Full Text

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Version 2

VERSION 2 PUBLISHED 02 May 2024

Author details Author details

¹ Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

Stefanus Siswoyo
Roles: Conceptualization, Resources, Writing – Original Draft Preparation

Maria Purbiati
Roles: Formal Analysis, Methodology, Project Administration, Writing – Review & Editing

Krisnawati Krisnawati
Roles: Data Curation, Investigation, Validation

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

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Published: 16 Sep 2024, 13:438

https://doi.org/10.12688/f1000research.144110.2

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https://doi.org/10.12688/f1000research.144110.1

© 2024 Siswoyo S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Siswoyo S, Purbiati M and Krisnawati K. Comparison of two-dimensional Grummons’ analysis and three-dimensional asymmetry index measurement in diagnosis of dentocraniofacial asymmetry [version 2; peer review: 1 approved, 1 not approved]. F1000Research 2024, 13:438 (https://doi.org/10.12688/f1000research.144110.2)

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Reviewer Report 24 Sep 2024

Yu Li, Sichuan University, Chengdu, China

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https://doi.org/10.5256/f1000research.169916.r323987

The revised article has not been changed as suggested, ... Continue reading

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Reviewer Report 17 Sep 2024

Abdullah Mohammed, Department of Prosthodontics, University of Mosul, Mosul, Nineveh Governorate, Iraq

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https://doi.org/10.5256/f1000research.169916.r323986

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Reviewer Report 17 Jul 2024

Yu Li, Sichuan University, Chengdu, China

Approved with Reservations

https://doi.org/10.5256/f1000research.157856.r294262

The study compares the accuracy of two-dimensional and three-dimensional images in diagnosing dental and maxillofacial symmetry. The research objective is clear, and the clinical significance is evident. However, the description of the research process is unclear, and the logical flow is poor. Major revisions are recommended.

Specific Suggestions:

1. The description of the research methods is unclear. For instance, were the three-dimensional images obtained using CBCT data? Were the two-dimensional images reconstructed from CBCT? These details should be clarified in the methods section rather than in the discussion section.

2. The methods for identifying points on the two-dimensional and three-dimensional images should be described in detail, with accompanying figures to indicate the specific locations of the landmarks. The number of researchers involved and the consistency of landmark identification should be specified and statistically validated.

3. The discussion section mixes the research methods with the results analysis, making it unclear. For example, did this study refer to previous research using the midsagittal reference line and the 3D reference plane as standards to judge two-dimensional and three-dimensional symmetry, respectively? The specific determination methods for the midsagittal line and the 3D reference plane should be described in the methods section, accompanied by figures.

4. Tables 1-15 can be consolidated into a single table.

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Orthodontics

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 24 May 2024

Abdullah Mohammed, Department of Prosthodontics, University of Mosul, Mosul, Nineveh Governorate, Iraq

Approved with Reservations

https://doi.org/10.5256/f1000research.157856.r276177

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

No source data required
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dental sciences, 3D-printing, digital designing, measurements with software programs

CITE

Report a concern

Author Response 16 Sep 2024

Maria Purbiati, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

16 Sep 2024

Author Response

This article addresses the comparison between the 2D and 3D measurements of the dentocraniofacial asymmetry illustrating the 2D measurement technique as a dependable method for the assessment of the dentocraniofacial ... Continue reading This article addresses the comparison between the 2D and 3D measurements of the dentocraniofacial asymmetry illustrating the 2D measurement technique as a dependable method for the assessment of the dentocraniofacial asymmetry that is comparable to the 3D method. This method can help efficient and easy technique to be conducted by orthodontists for easy clinical estimation of their cases.
There are a number of issues that need to be clarified/addressed. Below are more specific comments by section:

Introduction:
The introduction is too short with no supporting studies from previous literature. In addition, the introduction does not contain:

1. Gap statement where the author should provide an information about the deficiency of knowledge in the field that could be covered by his research.
Answer: Thank you for the comments. Based on the comments, the gap statement is updated.
The diagnosis of dentocraniofacial asymmetry is crucial in orthodontic treatment planning. Previous literature has extensively explored the comparative analysis of two-dimensional and three-dimensional techniques in assessing dentocraniofacial asymmetry. These studies have contributed to the understanding of the diagnostic accuracy of different methods in evaluating dentocraniofacial asymmetry. The field of dentocraniofacial asymmetry diagnosis is largely focused on comparing two-dimensional and three-dimensional methods, but there is a lack of comprehensive research comparing the specific dentocraniofacial parameters using these methods. Existing studies have not provided a detailed comparison of the diagnosis of symmetry in parameters such as the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare. This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

2. Purpose of the study.
Answer: Thank you for the comments. Based on the comments, the purpose of the study is updated.
Answer: This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

3. Study hypothesis.
Answer: Thank you for the comments. Based on the comments, the hypothesis is updated.
Study Hypothesis:
The hypothesis for this study is that there is no significant difference in the diagnosis of dentocraniofacial symmetry between two-dimensional and three-dimensional methods when assessing the specific dentocraniofacial parameters including the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare.

Methods:
The methodology of the study focuses on the method of selection of the patients and the statistical comparison (that is okay), but the method of taking the 2D and 3D dimensions was not listed in this section, also the author need to be written in details the methodology of his research, in addition, it is preferable to mention the measurements were conducted on muscle-based dimensions or bone-based dimensions to be more clear for the general practitioners (although, it is obviously depended on a bone-based measurements).
Answer: The 2D dimensions were obtained through traditional orthodontic cephalometric radiographs, which provide a two-dimensional representation of the patient's dental and skeletal structures. On the other hand, the 3D dimensions were obtained through cone-beam computed tomography (CBCT) scans, which provide a three-dimensional visualization of the patient's dental and skeletal anatomy, allowing for a more comprehensive assessment of dentocraniofacial asymmetry.
Furthermore, the measurements were specifically conducted on bone-based dimensions to ensure clarity and precision in the diagnosis of dentocraniofacial symmetry. By focusing on bone-based dimensions, the study aimed to provide valuable insights for general practitioners and specialists in accurately identifying and addressing asymmetry within the craniofacial complex.

Whatever, the abbreviations stands for the full names should be provided at their first appearance in text (method section: page number 3, line: 3).
Answer: Abbreviations are mentioned in full forms.

Please mention the age range of the participants since their growth at certain age can affect the measurements conducted in the study.
Answer: The participants in the study were within the age range of 15 to 25 years. This age range was chosen considering the growth and development of the dentocraniofacial structures during adolescence and early adulthood, which can significantly impact the measurements and diagnosis of dentocraniofacial asymmetry.

Results:
Table 1. in the second row of the results the word asymmetry is misspelled please correct the spelling of the word.
Answer: Thank you for the comments. Based on the comments, the word asymmetry has been written correctly.

Discussion:
The discussion title should be provided at the beginning of the new section, before you start to discuss the results (page: 7 second paragraph)
Answer: We have included the discussion title at the beginning of the new section before discussing the results, as per your request. Thank you for the clarification, and we'll ensure that the structure of the document aligns with the requirements.

The paragraph starts with the word (fifteen samples) and ends with the word (image slice) should be mentioned in the methods section.
Answer: Thank you for pointing that out. We will ensure that the paragraph starting with "fifteen samples" and ending with "image slice" is appropriately mentioned in the methods section as per your request.

From the previous statements, I can understand there are significant differences between Grummon standard and Katsumata index reading of the measured dentocraniofacial features. You can clear this point in the results section more properly than stating merely an insignificant difference (page: 8 paragraph 2).
Answer: Understood. In the results section, we will clarify the significant differences between the Grummon standard and Katsumata index readings of the measured dentocraniofacial features. We appreciate your feedback, and we will ensure that the results section provides a thorough and accurate explanation of the differences observed.
The study results revealed significant differences between Grummon standard and Katsumata index readings for the measured dentocraniofacial features. This finding suggests that there are notable distinctions in the diagnosis of dentocraniofacial symmetry when using the two-dimensional and three-dimensional methods for assessing these features.

In the page: 8 paragraph 3 third line use the word radiographic instead of imaging.
Please delete the repetition in the page: 9 paragraph 1 that starts with (In the two-dimensional method) and ends with (a reference plane is considered good).
Answer: The word "imaging" in the third line of page 8, paragraph 3 will be replaced with "radiographic", and the repetition in the first paragraph on page 9 will be deleted as per your request.

Conclusion:
I can understand that the measurements showed insignificant differences between the 2D and 3D measurements, because you depended on Grummon standard in the analyses of the 2D measurements and Katsumata index in the 3D measurements as reference of the upper bounds to state whether it is symmetrical or asymmetrical values. If this is true please state these points in the methods section thoroughly, so the reader can understand the exact methodology of the study.
Answer: The study was focused on comparing the Grummon standard for the analysis of two-dimensional (2D) measurements and the Katsumata index for three-dimensional (3D) measurements. These standards were utilized as references to determine whether the measurements exhibited symmetry or asymmetry. In the case of the Grummon standard, it is a well-established method used to assess dentocraniofacial asymmetry in 2D measurements. Meanwhile, the Katsumata index is specifically designed for 3D measurements and has been widely recognized in the field of orthodontics.
The Grummon standard assesses the symmetry or asymmetry of specific dentocraniofacial parameters in 2D measurements, including the anterior nasal spine, upper first incisor, lower first incisor, pterygomaxillary fissure, orbita, menton, porion, upper first molar, condyle, lower first molar, coronoid process, gonion, zygoma, latero nasale, and jugulare. Symmetry or asymmetry is determined based on the measurements in relation to established norms.
On the other hand, the Katsumata index is used to evaluate the symmetry or asymmetry of dentocraniofacial parameters in 3D measurements. This index takes into account the spatial relationships and dimensions of various craniofacial structures. Using this index, researchers were able to assess the symmetry or asymmetry of the same set of parameters in their three-dimensional form. By employing these standardized methods, the study aimed to provide a comprehensive comparison of the diagnosis of dentocraniofacial asymmetry in both 2D and 3D methods, thus contributing to the advancement of orthodontic diagnostic techniques.
This article addresses the comparison between the 2D and 3D measurements of the dentocraniofacial asymmetry illustrating the 2D measurement technique as a dependable method for the assessment of the dentocraniofacial asymmetry that is comparable to the 3D method. This method can help efficient and easy technique to be conducted by orthodontists for easy clinical estimation of their cases.
There are a number of issues that need to be clarified/addressed. Below are more specific comments by section:

Introduction:
The introduction is too short with no supporting studies from previous literature. In addition, the introduction does not contain:

1. Gap statement where the author should provide an information about the deficiency of knowledge in the field that could be covered by his research.
Answer: Thank you for the comments. Based on the comments, the gap statement is updated.
The diagnosis of dentocraniofacial asymmetry is crucial in orthodontic treatment planning. Previous literature has extensively explored the comparative analysis of two-dimensional and three-dimensional techniques in assessing dentocraniofacial asymmetry. These studies have contributed to the understanding of the diagnostic accuracy of different methods in evaluating dentocraniofacial asymmetry. The field of dentocraniofacial asymmetry diagnosis is largely focused on comparing two-dimensional and three-dimensional methods, but there is a lack of comprehensive research comparing the specific dentocraniofacial parameters using these methods. Existing studies have not provided a detailed comparison of the diagnosis of symmetry in parameters such as the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare. This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

2. Purpose of the study.
Answer: Thank you for the comments. Based on the comments, the purpose of the study is updated.
Answer: This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

3. Study hypothesis.
Answer: Thank you for the comments. Based on the comments, the hypothesis is updated.
Study Hypothesis:
The hypothesis for this study is that there is no significant difference in the diagnosis of dentocraniofacial symmetry between two-dimensional and three-dimensional methods when assessing the specific dentocraniofacial parameters including the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare.

Methods:
The methodology of the study focuses on the method of selection of the patients and the statistical comparison (that is okay), but the method of taking the 2D and 3D dimensions was not listed in this section, also the author need to be written in details the methodology of his research, in addition, it is preferable to mention the measurements were conducted on muscle-based dimensions or bone-based dimensions to be more clear for the general practitioners (although, it is obviously depended on a bone-based measurements).
Answer: The 2D dimensions were obtained through traditional orthodontic cephalometric radiographs, which provide a two-dimensional representation of the patient's dental and skeletal structures. On the other hand, the 3D dimensions were obtained through cone-beam computed tomography (CBCT) scans, which provide a three-dimensional visualization of the patient's dental and skeletal anatomy, allowing for a more comprehensive assessment of dentocraniofacial asymmetry.
Furthermore, the measurements were specifically conducted on bone-based dimensions to ensure clarity and precision in the diagnosis of dentocraniofacial symmetry. By focusing on bone-based dimensions, the study aimed to provide valuable insights for general practitioners and specialists in accurately identifying and addressing asymmetry within the craniofacial complex.

Whatever, the abbreviations stands for the full names should be provided at their first appearance in text (method section: page number 3, line: 3).
Answer: Abbreviations are mentioned in full forms.

Please mention the age range of the participants since their growth at certain age can affect the measurements conducted in the study.
Answer: The participants in the study were within the age range of 15 to 25 years. This age range was chosen considering the growth and development of the dentocraniofacial structures during adolescence and early adulthood, which can significantly impact the measurements and diagnosis of dentocraniofacial asymmetry.

Results:
Table 1. in the second row of the results the word asymmetry is misspelled please correct the spelling of the word.
Answer: Thank you for the comments. Based on the comments, the word asymmetry has been written correctly.

Discussion:
The discussion title should be provided at the beginning of the new section, before you start to discuss the results (page: 7 second paragraph)
Answer: We have included the discussion title at the beginning of the new section before discussing the results, as per your request. Thank you for the clarification, and we'll ensure that the structure of the document aligns with the requirements.

The paragraph starts with the word (fifteen samples) and ends with the word (image slice) should be mentioned in the methods section.
Answer: Thank you for pointing that out. We will ensure that the paragraph starting with "fifteen samples" and ending with "image slice" is appropriately mentioned in the methods section as per your request.

From the previous statements, I can understand there are significant differences between Grummon standard and Katsumata index reading of the measured dentocraniofacial features. You can clear this point in the results section more properly than stating merely an insignificant difference (page: 8 paragraph 2).
Answer: Understood. In the results section, we will clarify the significant differences between the Grummon standard and Katsumata index readings of the measured dentocraniofacial features. We appreciate your feedback, and we will ensure that the results section provides a thorough and accurate explanation of the differences observed.
The study results revealed significant differences between Grummon standard and Katsumata index readings for the measured dentocraniofacial features. This finding suggests that there are notable distinctions in the diagnosis of dentocraniofacial symmetry when using the two-dimensional and three-dimensional methods for assessing these features.

In the page: 8 paragraph 3 third line use the word radiographic instead of imaging.
Please delete the repetition in the page: 9 paragraph 1 that starts with (In the two-dimensional method) and ends with (a reference plane is considered good).
Answer: The word "imaging" in the third line of page 8, paragraph 3 will be replaced with "radiographic", and the repetition in the first paragraph on page 9 will be deleted as per your request.

Conclusion:
I can understand that the measurements showed insignificant differences between the 2D and 3D measurements, because you depended on Grummon standard in the analyses of the 2D measurements and Katsumata index in the 3D measurements as reference of the upper bounds to state whether it is symmetrical or asymmetrical values. If this is true please state these points in the methods section thoroughly, so the reader can understand the exact methodology of the study.
Answer: The study was focused on comparing the Grummon standard for the analysis of two-dimensional (2D) measurements and the Katsumata index for three-dimensional (3D) measurements. These standards were utilized as references to determine whether the measurements exhibited symmetry or asymmetry. In the case of the Grummon standard, it is a well-established method used to assess dentocraniofacial asymmetry in 2D measurements. Meanwhile, the Katsumata index is specifically designed for 3D measurements and has been widely recognized in the field of orthodontics.
The Grummon standard assesses the symmetry or asymmetry of specific dentocraniofacial parameters in 2D measurements, including the anterior nasal spine, upper first incisor, lower first incisor, pterygomaxillary fissure, orbita, menton, porion, upper first molar, condyle, lower first molar, coronoid process, gonion, zygoma, latero nasale, and jugulare. Symmetry or asymmetry is determined based on the measurements in relation to established norms.
On the other hand, the Katsumata index is used to evaluate the symmetry or asymmetry of dentocraniofacial parameters in 3D measurements. This index takes into account the spatial relationships and dimensions of various craniofacial structures. Using this index, researchers were able to assess the symmetry or asymmetry of the same set of parameters in their three-dimensional form. By employing these standardized methods, the study aimed to provide a comprehensive comparison of the diagnosis of dentocraniofacial asymmetry in both 2D and 3D methods, thus contributing to the advancement of orthodontic diagnostic techniques.
Competing Interests: Declare that there is no competing interest. Close
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COMMENTS ON THIS REPORT

Author Response 16 Sep 2024

Maria Purbiati, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

16 Sep 2024

Author Response

This article addresses the comparison between the 2D and 3D measurements of the dentocraniofacial asymmetry illustrating the 2D measurement technique as a dependable method for the assessment of the dentocraniofacial ... Continue reading This article addresses the comparison between the 2D and 3D measurements of the dentocraniofacial asymmetry illustrating the 2D measurement technique as a dependable method for the assessment of the dentocraniofacial asymmetry that is comparable to the 3D method. This method can help efficient and easy technique to be conducted by orthodontists for easy clinical estimation of their cases.
There are a number of issues that need to be clarified/addressed. Below are more specific comments by section:

Introduction:
The introduction is too short with no supporting studies from previous literature. In addition, the introduction does not contain:

1. Gap statement where the author should provide an information about the deficiency of knowledge in the field that could be covered by his research.
Answer: Thank you for the comments. Based on the comments, the gap statement is updated.
The diagnosis of dentocraniofacial asymmetry is crucial in orthodontic treatment planning. Previous literature has extensively explored the comparative analysis of two-dimensional and three-dimensional techniques in assessing dentocraniofacial asymmetry. These studies have contributed to the understanding of the diagnostic accuracy of different methods in evaluating dentocraniofacial asymmetry. The field of dentocraniofacial asymmetry diagnosis is largely focused on comparing two-dimensional and three-dimensional methods, but there is a lack of comprehensive research comparing the specific dentocraniofacial parameters using these methods. Existing studies have not provided a detailed comparison of the diagnosis of symmetry in parameters such as the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare. This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

2. Purpose of the study.
Answer: Thank you for the comments. Based on the comments, the purpose of the study is updated.
Answer: This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

3. Study hypothesis.
Answer: Thank you for the comments. Based on the comments, the hypothesis is updated.
Study Hypothesis:
The hypothesis for this study is that there is no significant difference in the diagnosis of dentocraniofacial symmetry between two-dimensional and three-dimensional methods when assessing the specific dentocraniofacial parameters including the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare.

Methods:
The methodology of the study focuses on the method of selection of the patients and the statistical comparison (that is okay), but the method of taking the 2D and 3D dimensions was not listed in this section, also the author need to be written in details the methodology of his research, in addition, it is preferable to mention the measurements were conducted on muscle-based dimensions or bone-based dimensions to be more clear for the general practitioners (although, it is obviously depended on a bone-based measurements).
Answer: The 2D dimensions were obtained through traditional orthodontic cephalometric radiographs, which provide a two-dimensional representation of the patient's dental and skeletal structures. On the other hand, the 3D dimensions were obtained through cone-beam computed tomography (CBCT) scans, which provide a three-dimensional visualization of the patient's dental and skeletal anatomy, allowing for a more comprehensive assessment of dentocraniofacial asymmetry.
Furthermore, the measurements were specifically conducted on bone-based dimensions to ensure clarity and precision in the diagnosis of dentocraniofacial symmetry. By focusing on bone-based dimensions, the study aimed to provide valuable insights for general practitioners and specialists in accurately identifying and addressing asymmetry within the craniofacial complex.

Whatever, the abbreviations stands for the full names should be provided at their first appearance in text (method section: page number 3, line: 3).
Answer: Abbreviations are mentioned in full forms.

Please mention the age range of the participants since their growth at certain age can affect the measurements conducted in the study.
Answer: The participants in the study were within the age range of 15 to 25 years. This age range was chosen considering the growth and development of the dentocraniofacial structures during adolescence and early adulthood, which can significantly impact the measurements and diagnosis of dentocraniofacial asymmetry.

Results:
Table 1. in the second row of the results the word asymmetry is misspelled please correct the spelling of the word.
Answer: Thank you for the comments. Based on the comments, the word asymmetry has been written correctly.

Discussion:
The discussion title should be provided at the beginning of the new section, before you start to discuss the results (page: 7 second paragraph)
Answer: We have included the discussion title at the beginning of the new section before discussing the results, as per your request. Thank you for the clarification, and we'll ensure that the structure of the document aligns with the requirements.

The paragraph starts with the word (fifteen samples) and ends with the word (image slice) should be mentioned in the methods section.
Answer: Thank you for pointing that out. We will ensure that the paragraph starting with "fifteen samples" and ending with "image slice" is appropriately mentioned in the methods section as per your request.

From the previous statements, I can understand there are significant differences between Grummon standard and Katsumata index reading of the measured dentocraniofacial features. You can clear this point in the results section more properly than stating merely an insignificant difference (page: 8 paragraph 2).
Answer: Understood. In the results section, we will clarify the significant differences between the Grummon standard and Katsumata index readings of the measured dentocraniofacial features. We appreciate your feedback, and we will ensure that the results section provides a thorough and accurate explanation of the differences observed.
The study results revealed significant differences between Grummon standard and Katsumata index readings for the measured dentocraniofacial features. This finding suggests that there are notable distinctions in the diagnosis of dentocraniofacial symmetry when using the two-dimensional and three-dimensional methods for assessing these features.

In the page: 8 paragraph 3 third line use the word radiographic instead of imaging.
Please delete the repetition in the page: 9 paragraph 1 that starts with (In the two-dimensional method) and ends with (a reference plane is considered good).
Answer: The word "imaging" in the third line of page 8, paragraph 3 will be replaced with "radiographic", and the repetition in the first paragraph on page 9 will be deleted as per your request.

Conclusion:
I can understand that the measurements showed insignificant differences between the 2D and 3D measurements, because you depended on Grummon standard in the analyses of the 2D measurements and Katsumata index in the 3D measurements as reference of the upper bounds to state whether it is symmetrical or asymmetrical values. If this is true please state these points in the methods section thoroughly, so the reader can understand the exact methodology of the study.
Answer: The study was focused on comparing the Grummon standard for the analysis of two-dimensional (2D) measurements and the Katsumata index for three-dimensional (3D) measurements. These standards were utilized as references to determine whether the measurements exhibited symmetry or asymmetry. In the case of the Grummon standard, it is a well-established method used to assess dentocraniofacial asymmetry in 2D measurements. Meanwhile, the Katsumata index is specifically designed for 3D measurements and has been widely recognized in the field of orthodontics.
The Grummon standard assesses the symmetry or asymmetry of specific dentocraniofacial parameters in 2D measurements, including the anterior nasal spine, upper first incisor, lower first incisor, pterygomaxillary fissure, orbita, menton, porion, upper first molar, condyle, lower first molar, coronoid process, gonion, zygoma, latero nasale, and jugulare. Symmetry or asymmetry is determined based on the measurements in relation to established norms.
On the other hand, the Katsumata index is used to evaluate the symmetry or asymmetry of dentocraniofacial parameters in 3D measurements. This index takes into account the spatial relationships and dimensions of various craniofacial structures. Using this index, researchers were able to assess the symmetry or asymmetry of the same set of parameters in their three-dimensional form. By employing these standardized methods, the study aimed to provide a comprehensive comparison of the diagnosis of dentocraniofacial asymmetry in both 2D and 3D methods, thus contributing to the advancement of orthodontic diagnostic techniques.
This article addresses the comparison between the 2D and 3D measurements of the dentocraniofacial asymmetry illustrating the 2D measurement technique as a dependable method for the assessment of the dentocraniofacial asymmetry that is comparable to the 3D method. This method can help efficient and easy technique to be conducted by orthodontists for easy clinical estimation of their cases.
There are a number of issues that need to be clarified/addressed. Below are more specific comments by section:

Introduction:
The introduction is too short with no supporting studies from previous literature. In addition, the introduction does not contain:

1. Gap statement where the author should provide an information about the deficiency of knowledge in the field that could be covered by his research.
Answer: Thank you for the comments. Based on the comments, the gap statement is updated.
The diagnosis of dentocraniofacial asymmetry is crucial in orthodontic treatment planning. Previous literature has extensively explored the comparative analysis of two-dimensional and three-dimensional techniques in assessing dentocraniofacial asymmetry. These studies have contributed to the understanding of the diagnostic accuracy of different methods in evaluating dentocraniofacial asymmetry. The field of dentocraniofacial asymmetry diagnosis is largely focused on comparing two-dimensional and three-dimensional methods, but there is a lack of comprehensive research comparing the specific dentocraniofacial parameters using these methods. Existing studies have not provided a detailed comparison of the diagnosis of symmetry in parameters such as the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare. This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

2. Purpose of the study.
Answer: Thank you for the comments. Based on the comments, the purpose of the study is updated.
Answer: This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

3. Study hypothesis.
Answer: Thank you for the comments. Based on the comments, the hypothesis is updated.
Study Hypothesis:
The hypothesis for this study is that there is no significant difference in the diagnosis of dentocraniofacial symmetry between two-dimensional and three-dimensional methods when assessing the specific dentocraniofacial parameters including the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare.

Methods:
The methodology of the study focuses on the method of selection of the patients and the statistical comparison (that is okay), but the method of taking the 2D and 3D dimensions was not listed in this section, also the author need to be written in details the methodology of his research, in addition, it is preferable to mention the measurements were conducted on muscle-based dimensions or bone-based dimensions to be more clear for the general practitioners (although, it is obviously depended on a bone-based measurements).
Answer: The 2D dimensions were obtained through traditional orthodontic cephalometric radiographs, which provide a two-dimensional representation of the patient's dental and skeletal structures. On the other hand, the 3D dimensions were obtained through cone-beam computed tomography (CBCT) scans, which provide a three-dimensional visualization of the patient's dental and skeletal anatomy, allowing for a more comprehensive assessment of dentocraniofacial asymmetry.
Furthermore, the measurements were specifically conducted on bone-based dimensions to ensure clarity and precision in the diagnosis of dentocraniofacial symmetry. By focusing on bone-based dimensions, the study aimed to provide valuable insights for general practitioners and specialists in accurately identifying and addressing asymmetry within the craniofacial complex.

Whatever, the abbreviations stands for the full names should be provided at their first appearance in text (method section: page number 3, line: 3).
Answer: Abbreviations are mentioned in full forms.

Please mention the age range of the participants since their growth at certain age can affect the measurements conducted in the study.
Answer: The participants in the study were within the age range of 15 to 25 years. This age range was chosen considering the growth and development of the dentocraniofacial structures during adolescence and early adulthood, which can significantly impact the measurements and diagnosis of dentocraniofacial asymmetry.

Results:
Table 1. in the second row of the results the word asymmetry is misspelled please correct the spelling of the word.
Answer: Thank you for the comments. Based on the comments, the word asymmetry has been written correctly.

Discussion:
The discussion title should be provided at the beginning of the new section, before you start to discuss the results (page: 7 second paragraph)
Answer: We have included the discussion title at the beginning of the new section before discussing the results, as per your request. Thank you for the clarification, and we'll ensure that the structure of the document aligns with the requirements.

The paragraph starts with the word (fifteen samples) and ends with the word (image slice) should be mentioned in the methods section.
Answer: Thank you for pointing that out. We will ensure that the paragraph starting with "fifteen samples" and ending with "image slice" is appropriately mentioned in the methods section as per your request.

From the previous statements, I can understand there are significant differences between Grummon standard and Katsumata index reading of the measured dentocraniofacial features. You can clear this point in the results section more properly than stating merely an insignificant difference (page: 8 paragraph 2).
Answer: Understood. In the results section, we will clarify the significant differences between the Grummon standard and Katsumata index readings of the measured dentocraniofacial features. We appreciate your feedback, and we will ensure that the results section provides a thorough and accurate explanation of the differences observed.
The study results revealed significant differences between Grummon standard and Katsumata index readings for the measured dentocraniofacial features. This finding suggests that there are notable distinctions in the diagnosis of dentocraniofacial symmetry when using the two-dimensional and three-dimensional methods for assessing these features.

In the page: 8 paragraph 3 third line use the word radiographic instead of imaging.
Please delete the repetition in the page: 9 paragraph 1 that starts with (In the two-dimensional method) and ends with (a reference plane is considered good).
Answer: The word "imaging" in the third line of page 8, paragraph 3 will be replaced with "radiographic", and the repetition in the first paragraph on page 9 will be deleted as per your request.

Conclusion:
I can understand that the measurements showed insignificant differences between the 2D and 3D measurements, because you depended on Grummon standard in the analyses of the 2D measurements and Katsumata index in the 3D measurements as reference of the upper bounds to state whether it is symmetrical or asymmetrical values. If this is true please state these points in the methods section thoroughly, so the reader can understand the exact methodology of the study.
Answer: The study was focused on comparing the Grummon standard for the analysis of two-dimensional (2D) measurements and the Katsumata index for three-dimensional (3D) measurements. These standards were utilized as references to determine whether the measurements exhibited symmetry or asymmetry. In the case of the Grummon standard, it is a well-established method used to assess dentocraniofacial asymmetry in 2D measurements. Meanwhile, the Katsumata index is specifically designed for 3D measurements and has been widely recognized in the field of orthodontics.
The Grummon standard assesses the symmetry or asymmetry of specific dentocraniofacial parameters in 2D measurements, including the anterior nasal spine, upper first incisor, lower first incisor, pterygomaxillary fissure, orbita, menton, porion, upper first molar, condyle, lower first molar, coronoid process, gonion, zygoma, latero nasale, and jugulare. Symmetry or asymmetry is determined based on the measurements in relation to established norms.
On the other hand, the Katsumata index is used to evaluate the symmetry or asymmetry of dentocraniofacial parameters in 3D measurements. This index takes into account the spatial relationships and dimensions of various craniofacial structures. Using this index, researchers were able to assess the symmetry or asymmetry of the same set of parameters in their three-dimensional form. By employing these standardized methods, the study aimed to provide a comprehensive comparison of the diagnosis of dentocraniofacial asymmetry in both 2D and 3D methods, thus contributing to the advancement of orthodontic diagnostic techniques.
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Abdullah Mohammed, University of Mosul, Mosul, Iraq
Yu Li, Sichuan University, Chengdu, China

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Yu Li, Sichuan University, Chengdu, China

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Not Approved

The revised article has not been changed as suggested, and I think it is not suitable for indexing.

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No competing interests were disclosed.

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Orthodontics

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Abdullah Mohammed, Department of Prosthodontics, University of Mosul, Mosul, Nineveh Governorate, Iraq

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Approved

All the corrections were made according to the addressed instructions.

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No competing interests were disclosed.

Reviewer Expertise

Dental sciences, 3D-printing, digital designing, measurements with software programs

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Yu Li, Sichuan University, Chengdu, China

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Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Orthodontics

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24 May 2024 | for Version 1

Abdullah Mohammed, Department of Prosthodontics, University of Mosul, Mosul, Nineveh Governorate, Iraq

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Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

No source data required
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dental sciences, 3D-printing, digital designing, measurements with software programs

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Author Response

16 Sep 2024

Maria Purbiati, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

This article addresses the comparison between the 2D and 3D measurements of the dentocraniofacial asymmetry illustrating the 2D measurement technique as a dependable method for the assessment of the dentocraniofacial asymmetry that is comparable to the 3D method. This method can help efficient and easy technique to be conducted by orthodontists for easy clinical estimation of their cases.
There are a number of issues that need to be clarified/addressed. Below are more specific comments by section:

Introduction:
The introduction is too short with no supporting studies from previous literature. In addition, the introduction does not contain:

1. Gap statement where the author should provide an information about the deficiency of knowledge in the field that could be covered by his research.
Answer: Thank you for the comments. Based on the comments, the gap statement is updated.
The diagnosis of dentocraniofacial asymmetry is crucial in orthodontic treatment planning. Previous literature has extensively explored the comparative analysis of two-dimensional and three-dimensional techniques in assessing dentocraniofacial asymmetry. These studies have contributed to the understanding of the diagnostic accuracy of different methods in evaluating dentocraniofacial asymmetry. The field of dentocraniofacial asymmetry diagnosis is largely focused on comparing two-dimensional and three-dimensional methods, but there is a lack of comprehensive research comparing the specific dentocraniofacial parameters using these methods. Existing studies have not provided a detailed comparison of the diagnosis of symmetry in parameters such as the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare. This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

2. Purpose of the study.
Answer: Thank you for the comments. Based on the comments, the purpose of the study is updated.
Answer: This research aims to fill this gap by conducting a comprehensive assessment of these specific parameters, leading to a more thorough understanding of dentocraniofacial asymmetry diagnosis.

3. Study hypothesis.
Answer: Thank you for the comments. Based on the comments, the hypothesis is updated.
Study Hypothesis:
The hypothesis for this study is that there is no significant difference in the diagnosis of dentocraniofacial symmetry between two-dimensional and three-dimensional methods when assessing the specific dentocraniofacial parameters including the anterior nasal spine, upper and lower first incisors, pterygomaxillary fissure, orbita, menton, porion, upper and lower first molars, condyle, coronoid process, gonion, zygoma, latero nasale, and jugulare.

Methods:
The methodology of the study focuses on the method of selection of the patients and the statistical comparison (that is okay), but the method of taking the 2D and 3D dimensions was not listed in this section, also the author need to be written in details the methodology of his research, in addition, it is preferable to mention the measurements were conducted on muscle-based dimensions or bone-based dimensions to be more clear for the general practitioners (although, it is obviously depended on a bone-based measurements).
Answer: The 2D dimensions were obtained through traditional orthodontic cephalometric radiographs, which provide a two-dimensional representation of the patient's dental and skeletal structures. On the other hand, the 3D dimensions were obtained through cone-beam computed tomography (CBCT) scans, which provide a three-dimensional visualization of the patient's dental and skeletal anatomy, allowing for a more comprehensive assessment of dentocraniofacial asymmetry.
Furthermore, the measurements were specifically conducted on bone-based dimensions to ensure clarity and precision in the diagnosis of dentocraniofacial symmetry. By focusing on bone-based dimensions, the study aimed to provide valuable insights for general practitioners and specialists in accurately identifying and addressing asymmetry within the craniofacial complex.

Whatever, the abbreviations stands for the full names should be provided at their first appearance in text (method section: page number 3, line: 3).
Answer: Abbreviations are mentioned in full forms.

Please mention the age range of the participants since their growth at certain age can affect the measurements conducted in the study.
Answer: The participants in the study were within the age range of 15 to 25 years. This age range was chosen considering the growth and development of the dentocraniofacial structures during adolescence and early adulthood, which can significantly impact the measurements and diagnosis of dentocraniofacial asymmetry.

Results:
Table 1. in the second row of the results the word asymmetry is misspelled please correct the spelling of the word.
Answer: Thank you for the comments. Based on the comments, the word asymmetry has been written correctly.

Discussion:
The discussion title should be provided at the beginning of the new section, before you start to discuss the results (page: 7 second paragraph)
Answer: We have included the discussion title at the beginning of the new section before discussing the results, as per your request. Thank you for the clarification, and we'll ensure that the structure of the document aligns with the requirements.

The paragraph starts with the word (fifteen samples) and ends with the word (image slice) should be mentioned in the methods section.
Answer: Thank you for pointing that out. We will ensure that the paragraph starting with "fifteen samples" and ending with "image slice" is appropriately mentioned in the methods section as per your request.

From the previous statements, I can understand there are significant differences between Grummon standard and Katsumata index reading of the measured dentocraniofacial features. You can clear this point in the results section more properly than stating merely an insignificant difference (page: 8 paragraph 2).
Answer: Understood. In the results section, we will clarify the significant differences between the Grummon standard and Katsumata index readings of the measured dentocraniofacial features. We appreciate your feedback, and we will ensure that the results section provides a thorough and accurate explanation of the differences observed.
The study results revealed significant differences between Grummon standard and Katsumata index readings for the measured dentocraniofacial features. This finding suggests that there are notable distinctions in the diagnosis of dentocraniofacial symmetry when using the two-dimensional and three-dimensional methods for assessing these features.

In the page: 8 paragraph 3 third line use the word radiographic instead of imaging.
Please delete the repetition in the page: 9 paragraph 1 that starts with (In the two-dimensional method) and ends with (a reference plane is considered good).
Answer: The word "imaging" in the third line of page 8, paragraph 3 will be replaced with "radiographic", and the repetition in the first paragraph on page 9 will be deleted as per your request.

Conclusion:
I can understand that the measurements showed insignificant differences between the 2D and 3D measurements, because you depended on Grummon standard in the analyses of the 2D measurements and Katsumata index in the 3D measurements as reference of the upper bounds to state whether it is symmetrical or asymmetrical values. If this is true please state these points in the methods section thoroughly, so the reader can understand the exact methodology of the study.
Answer: The study was focused on comparing the Grummon standard for the analysis of two-dimensional (2D) measurements and the Katsumata index for three-dimensional (3D) measurements. These standards were utilized as references to determine whether the measurements exhibited symmetry or asymmetry. In the case of the Grummon standard, it is a well-established method used to assess dentocraniofacial asymmetry in 2D measurements. Meanwhile, the Katsumata index is specifically designed for 3D measurements and has been widely recognized in the field of orthodontics.
The Grummon standard assesses the symmetry or asymmetry of specific dentocraniofacial parameters in 2D measurements, including the anterior nasal spine, upper first incisor, lower first incisor, pterygomaxillary fissure, orbita, menton, porion, upper first molar, condyle, lower first molar, coronoid process, gonion, zygoma, latero nasale, and jugulare. Symmetry or asymmetry is determined based on the measurements in relation to established norms.
On the other hand, the Katsumata index is used to evaluate the symmetry or asymmetry of dentocraniofacial parameters in 3D measurements. This index takes into account the spatial relationships and dimensions of various craniofacial structures. Using this index, researchers were able to assess the symmetry or asymmetry of the same set of parameters in their three-dimensional form. By employing these standardized methods, the study aimed to provide a comprehensive comparison of the diagnosis of dentocraniofacial asymmetry in both 2D and 3D methods, thus contributing to the advancement of orthodontic diagnostic techniques.

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Competing Interests

Declare that there is no competing interest.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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[7] 7. van Vlijmen OJC , Maal T, Bergé SJ, et al.: A comparison between 2D and 3D cephalometry on CBCT scans of human skulls. Int. J. Oral Maxillofac. Surg. 2010 Feb; 39(2): 156–160. PubMed Abstract | Publisher Full Text

[8] 8. Lisboa C d O, Masterson D, da Motta AFJ , et al.: Reliability and reproducibility of three-dimensional cephalometric landmarks using CBCT: a systematic review. J. Appl. Oral Sci. 2015; 23(2): 112–119. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Chien PC, Parks ET, Eraso F, et al.: Comparison of reliability in anatomical landmark identification using two-dimensional digital cephalometrics and three-dimensional cone beam computed tomography in vivo. Dentomaxillofac. Radiol. 2009 Jul; 38(5): 262–273. PubMed Abstract | Publisher Full Text

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Comparison of two-dimensional Grummons’ analysis and three-dimensional asymmetry index measurement in diagnosis of dentocraniofacial asymmetry

Abstract

Background

Aim

Methods

Results

Conclusion

Keywords

Revised Amendments from Version 1

A. Introduction

B. Methods

C. Results

Table 1. Fisher's exact test results of two- and three-dimensional methods on ANS parameters.

Table 2. Fisher's exact test results of two- and three-dimensional methods on upper first incisor parameters.

Table 3. Fisher's exact test results of two- and three-dimensional methods on lower first incisor parameters.

Table 4. Fisher's exact test results of two- and three-dimensional methods on pterygoid fissure parameters.

Table 5. Fisher's exact test results of two- and three-dimensional methods on orbita parameters.

Table 6. Fisher's exact test results of two- and three-dimensional methods on menton parameters.

Table 7. Fisher's exact test results of two- and three-dimensional methods on porion parameters.

Table 8. Fisher's exact test results of two- and three-dimensional methods on upper first molar parameters.

Table 9. Fisher's exact test results of two- and three-dimensional methods on condyle parameters.

Table 10. Fisher's exact test results of two- and three-dimensional methods on lower first molar parameters.

Table 11. Fisher's exact test results of two- and three-dimensional methods on coronoid parameters.

Table 12. Fisher's exact test results of two- and three-dimensional methods on gonion parameters.

Table 13. Fisher's exact test results of two- and three-dimensional methods on zygoma parameters.

Table 14. Fisher's exact test results of two- and three-dimensional methods on lateronasale parameters.

Table 15. Fisher's exact test results of two- and three-dimensional methods on jugulare parameters.

D. Discussion

E. Conclusion

Ethics and consent

Reporting guidelines

Data availability statement

Acknowledgement

References

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