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28
Table 1. Summarization of patient demographic information and clinical
characteristics.
Variable
Class II
Class III
21
(42)
20
(40)
4(19.05)
17(80.95)
7(36.84)
13(68.42)
Age at the surgery (year)
29.35±9.58
28.08±11.20
0.83
CT data collection
Pre-surgery (day)
Post-surgery (year)
25.09±5.85
23.0±74.61
34.63±12.16
20.2±6.18
0.06
0.31
Overjet (mm)
6.36±2.98
-2.12±4.52
0.00**
Overbite (mm)
-1.49±5.30
-2.82±3.94
0.37
Cephalometric measurement
SNA (o)
Pre-surgery
Post-surgery
83.06±5.59
78.89±5.00
80.32±3.03
80.03±3.29
0.83
0.08
SNB (o)
Pre-surgery
73.99±5.42
82.07±5.73
0.42
Post-surgery
73.77±4.73
78.91±3.30
0.41
ANB (o)
Pre-surgery
Post-surgery
8.70±2.84
5.02±2.20
-2.55±3.67
1.55±2.68
0.00**
0.00**
Sn-Mp (o)
Pre-surgery
Post-surgery
48.75±9.33
50.16±8.70
39.36±10.14
39.8±10.74
0.00**
0.01**
Occ change (o)
Wits appraisal (mm)
-1.39±4.56
1.56±4.39
-0.88±7.81
-13.39±8.48
0.80
0.00**
Range of surgery
Maxillary (Le Fort I) (mm)a
Mandible (SSRO) (mm)b
-1.16±3.02
1.50±2.67
3.29±1.54
-5.32±3.61
0.00**
0.00**
Number of patients
(Total condyle)
Gender
Male (%)
Female (%)
p: significance. **p≤0.01, independent-samples T-test
Occ change: Change of occlusal plane between T1 and T0
a,b
Positive value means advancement, a negative value means setback surgery
29
p-value
Table 2. Condylar volume pre-surgery and post-surgery
Class II
Class III
Pre-surgery (mm3)
1563.97±517.42
2148.26±435.82
Post-surgery (mm3)
1521.19±513.02
2194.48±442.12
p-value
0.003**
0.003**
**p<0.01, paired samples- T-test. Data was presented as Mean ± SD
30
Table 3. Comparison of the absolute amount of condylar remodeling between class
II and class III skeletal malocclusions.
Medial
Anterior
-medial
Anterior
-lateral
Lateral
Superior
Posterior Posterior
-medial
-lateral
Class II
45.51
38.12
43.61
35.04
44.86
49.14
45.18
Class III
37.29
45.05
39.29
48.29
37.98
33.48
37.64
Z-score
-1.56
-1.32
-0.82
-2.52
-1.31
-2.31
-1.43
p-value
0.12
0.19
0.41
0.01**
0.19
0.00**
0.15
Mean rank
p: significance. **p≤0.01, Mann-Whitney U test
31
Table 4. Comparison of the absolute amount of glenoid fossa remodeling between
class II and class III patients.
Medial
Anterior
-medial
Anterior
-lateral
Lateral
Superior
Posterior Posterior
-medial
-lateral
Class III
36.03
37.15
41.55
39.24
36.73
37.25
37.25
Clas II
44.98
43.85
39.45
41.76
44.28
43.75
43.75
Z-score
-1.72
-1.29
-0.40
-0.49
-1.45
-1.88
-1.25
p-value
0.21
0.06
0.09
0.20
0.69
0.63
0.15
Mean rank
p: significance. Mann-Whitney U test
32
Table 5. Correlation between remodeling of the condyle and the change of condylar
rest position in three axes (Spearman’s correlation)
Medial
Anteriormedial
Anteriorlateral
Lateral
Superior
0.09
0.12
0.07
0.06
0.02
-0.26
-0.13
0.43
0.28
0.54
0.58
0.88
0.02*
0.23
0.18
0.25
0.26
0.08
-0.25
0.03
-0.02
0.10
0.02*
0.02*
0.47
0.02*
0.82
0.84
-0.12
-0.01
-0.14
0.16
0.06
-0.12
-0.02
0.27
0.91
0.22
0.16
0.61
0.29
0.83
r: Spearman’s correlation coefficient
p: significance. *p≤0.05
33
Posterior- Posteriormedial
lateral
Table 6. Factors related to the total condylar volume change
Spearman’s
correlation
Variables
MaxSurgery
0.16
0.15
MandSurgery
-0.27
Wits
Binary Logistic Regression
Exp(B)
Correct prediction (%)
0.02*
0.15
0.01**
1.17
66.70
-0.37
0.00**
0.08
0.00**
1.09
71.80
Overjet
-0.38
0.00**
0.17
0.00**
1.19
68.80
Overbite
0.11
0.33
Occ change
0.04
0.72
ANB
-0.47
0.00**
0.18
0.00**
1.19
69.20
r: Spearman’s correlation coefficient
p: significance. **p≤0.01, *p≤0.05
B: regression coefficient. Exp(B): The odds ratio of the condylar volume reduction
Occ change: Change of occlusal plane angle between T1 and T0
MaxSurgery: Range of maxillary surgery
MandSurgery: Range of mandibular surgery
34
Table 7. Factor related to the remodeling in different regions of interest of the condyle (Spearman’s correlation)
AnteriorMedial
Anterior-lateral
Lateral
medial
MaxSurgery
0.13
0.24
MandSurgery
-0.23
Wits
0.16
0.17
0.33
0.00**
0.10
0.05*
-0.36
0.00**
-0.54
0.00**
-0.25
0.03
-0.33
0.00**
-0.47
Occ change
0.01
0.90
0.19
0.09
Overjet
-0.26
0.02*
-0.33
Overbite
0.02
0.88
ANB
-0.31
0.01**
Posterior-
Posterior-
medial
lateral
Superior
0.39
-0.11
0.36
0.14
0.22
0.07
0.52
-0.08
0.47
0.03
0.77
0.10
0.38
0.14
0.21
0.00**
0.34
0.02
0.02
0.88
0.02
0.84
0.03
0.78
0.09
0.43
-0.03
0.80
-0.10
0.36
-0.14
0.22
-0.05
0.66
0.00**
-0.44
0.00**
-0.15
0.19
0.09
0.45
-0.05
0.68
0.01
0.95
0.08
0.49
-0.16
0.15
0.19
0.09
0.06
0.61
0.05
0.67
0.26
0.02*
-0.33
0.00**
-0.46
0.00**
-0.28
0.01**
0.08
0.48
-0.09
0.45
-0.07
0.56
r: Spearman’s correlation coefficient, p: significance. *p≤0.05, **p≤0.01. Occ change: Change of occlusal plane angle between T1 and
T0. MaxSurgery: Range of maxillary surgery. MandSurgery: Range of mandibular surgery
35
Table 8. Factor related to the remodeling in different regions of interest of the glenoid fossa (Spearman’s correlation)
Anterior-
Anterior-
Medial
Lateral
medial
lateral
MaxSurgery
-0.06
0.60
-0.05
0.65
-0.02
0.87
-0.04 0.72
MandSurgery
0.16
0.17
0.07
0.55
-0.08
Wits
0.12
0.31
0.10
0.41
Occ change
-0.05
0.68
0.02
Overjet
0.12
0.29
Overbite
0.23
ANB
-0.10
Posterior-
Posterior-
medial
lateral
Superior
0.12
0.30
-0.01
0.95
-0.07
0.57
0.49
-0.25 0.03 -0.19
0.10
0.06
0.59
-0.12
0.30
-0.02
0.88
-0.15 0.21 -0.13
0.27
0.08
0.51
-0.10
0.42
0.88
-0.06
0.62
-0.03 0.79
0.00
0.97
-0.05
0.68
0.00
0.98
0.14
0.24
0.07
0.54
-0.03 0.79 -0.11
0.35
0.05
0.68
-0.06
0.61
0.04*
0.26
0.02*
0.22
0.05*
0.12
0.12
0.22
0.06
0.14
0.21
0.37
-0.05
0.67
-0.04
0.72
-0.10 0.40 -0.24 0.04*
-0.09
0.45
-0.18
0.11
0.31
0.18
r:Spearman’s correlation coefficient, p: significance. *p≤0.05. Occ change: Change of occlusal plane angle between T1 and T0.
MaxSurgery: Range of maxillary surgery, MandSurgery: Range of mandibular surgery
36
Supplementary table 1. Correlation between condylar rest position and glenoid fossa
remodeling (Spearman’s correlation)
Medial
Anterior- Anteriormedial
lateral
Lateral
Superior
Posterior
-medial
Posterior
-lateral
-0.02
-0.02
-0.01
-0.03
-0.01
0.17
0.09
0.84
0.85
0.95
0.78
0.90
0.13
0.44
0.01
-0.07
-0.10
-0.07
0.06
-0.08
-0.02
0.94
0.55
0.38
0.53
0.57
0.50
0.87
-0.03
-0.12
-0.19
-0.06
-0.17
-0.04
-0.13
0.83
0.30
0.10
0.62
0.13
0.75
0.26
r: Spearman’s correlation coefficient
p: significance.
37
FIGURES LEGEND
Figure 1. The head orientation process
The head re-orientation process. The Frankfort horizontal plane goes through the superior
border of the opening of the bony external auditory meatus and the lowest point on the
margin of the right orbit. This plane was reoriented to coincide with the horizontal plane
of the 3D slicer (red). The posterior margin of the right external auditory meatus was
reoriented to match the coronal plane (green). The facial midline was adjusted to coincide
with the sagittal plane (yellow). A, B, Before re-orientation-Anterior view and Lateral
view respectively; C, D After re-orientation-Anterior and Lateral view respectively.
Coordinates: R(red): Right-Left axis; A(green): Anterior-Posterior axis; S(blue): SuperiorInferior axis.
Figure 2. Condylar volume measurement
The shape correspondence process generated pre-surgery (T0) and post-surgery (T1)
models with the corresponding points on the surface (A, B). The accuracy of the
correspondence was verified by Shape Population Viewer Tool. The same color indicates
the corresponding regions of T0 and T1 models (C). Pre-operative model (yellow) and
post-operative model (red) were superimposed using the Procrustes alignment method (D,
E). The vertical (green) and horizontal (red) cutting planes which go through the lowest
point of the sigmoid notch were defined to separate the condylar head from the rest of the
38
mandible (F). The volume of the condylar head was recorded (G).
Coordinates: R(red): Right-Left axis; A(green): Anterior-Posterior axis; S(blue): SuperiorInferior axis.
Figure 3. Regions of interest of condyle
Regions of interest (ROI) used for quantifying the remodeling in different regions of the
condyle. (Right condyle)
Coordinates: R(red): Right-Left axis; A(green): Anterior-Posterior axis; S(blue): SuperiorInferior axis.
Figure 4. Regions of interest of glenoid fossa
Regions of interest (ROI) used for quantifying the remodeling in different regions of the
glenoid fossa. (Right glenoid fossa)
Coordinates: R(red): Right-Left axis; A(green): Anterior-Posterior axis; S(blue): SuperiorInferior axis.
Figure 5. Measurement the change of condylar head position
The change of condylar rest position was the distance between the highest point of T0
and T1 models propagated to three axis X, Y, Z. The X-axis: medial-lateral movement,
the Y-axis: antero-posterior movement, the Z-axis: vertical movement.
Figure 6. Quantification of condylar remodeling in regions of interest
Quantification of condylar remodeling in regions of interest. A positive value means new
39
bone formation. A negative value indicates bone resorption.
Figure 7. Quantification of glenoid fossa remodeling in regions of interest
Quantification of glenoid remodeling in regions of interest. A positive value means new
bone formation. A negative value indicates bone resorption.
Figure 8. Condylar positional change
Measurement of condylar positional change when mandibular at rest in class II and class
III skeletal malocclusions. X-medial-lateral movement, the Y-antero-posterior movement,
Z-superior-inferior movement. A positive value means the condyle moves anteriorly,
laterally and superiorly.
Supplementary Figure 1. Identifying the center of ROI of the condyle
1, Marking the center points in the ITK-SNAP
This figure Illustrates the process of identifying the center of ROI of the condyle (right
side) in ITK-Snap software. The pre-labelled landmark is signified in dark blue color. A,
Scroll the computer mouse in the axial plane along the height of the condyle until the last
radiopaque image of the condylar head can be seen. Label this point as the top of the
condyle (center of the superior region). B, Scroll the computer mouse in the sagittal plane
40
along the medial-lateral width of the condyle until the last radiopaque image of the
condylar head can be seen on the lateral side. This point is labelled as the lateral pole of
the condyle (center of the lateral region). C, Similar to B until the last radiopaque image
of the condylar head can be seen on the medial pole, label this point as the center of the
medial region. D, The middle point between the top of the condyle and the axial plane
going through the lowest point of the sigmoid notch is marked as point A. In the axial
plane, draw the horizontal line which cut the posterior-lateral and posterior-medial margin
of the condyle at points B and C respectively. E, The intersection between the sagittal
plane which goes through the center point of points A and B and the anterior margin of
the condyle is labelled as the center of the anterior-lateral region, the intersection with the
posterior-lateral margin is labelled as the center of the posterior-lateral region. F,
Similarly, the intersection between the sagittal plane which goes through the center point
of points A and C and the anterior margin of the condyle is labelled as the center of the
anterior-medial region. The intersection with the posterior-medial margin is labelled as
the center of the posterior-medial region. G, Center of anterior-lateral and anterior-medial
regions on a 3D model. H, Center of posterior-lateral and posterior-medial regions on a
3D model.
2, Superimposing the point-marked model and color-mapped model
41
The schematic diagram illustrates the color-mapped model (yellow model) merged with
the point-marked model (Red model, marked points are denoted in dark blue color) to
identify the center of the regions of interest in the condyle.
Coordinates: R(red): Right-Left axis; A(green): Anterior-Posterior axis; S(blue): SuperiorInferior axis.
Supplementary Figure 2. Identifying the center of ROI of the glenoid fossa
1, Marking the center points in the ITK-SNAP
This figure Illustrates the process of identifying the center of ROI of the glenoid fossa
(right side) in ITK-Snap software. The pre-labelled landmark is signified in dark blue
color. Firstly, the axial plane going through the lowest point of the articular tubercle is
used to determine the lower border of the glenoid fossa. A, Scroll the computer mouse
along the height of the glenoid fossa until the first radiopaque image can be seen. This is
marked as the highest point of the glenoid fossa. In the corresponding coronal plane,
identify the center point between the highest point of the glenoid fossa and the axial plane
going through the lateral border of the glenoid fossa (point A). The center point between
the highest point of the glenoid fossa and the axial plane going through the medial border
of the glenoid fossa is marked as point B. The center point between the lowest point of
the lateral border and the sagittal plane going through the highest point of the glenoid
42
fossa is marked as point C. The center point between the lowest point of the medial border
and the sagittal plane going through the highest point of the glenoid fossa is marked as
point D. B, The axial plane going through point A intersects with the lateral surface of the
glenoid fossa at the center of the lateral region. The axial plane going through point B
intersects with the medial surface of the glenoid fossa at the center of the medial region.
C, The intersection of an axial plane going through point A, the sagittal plane going
through point C and the anterior surface of the glenoid fossa is labelled as the center of
anterior-lateral region, and the intersection with the posterior surface of the glenoid fossa
is labelled as center of posterior-lateral region. D, The intersection of an axial plane going
through point A, the sagittal plane going through point D and the anterior surface of the
glenoid fossa is labelled as the center of the anterior-medial region, and the intersection
with the posterior surface of the glenoid fossa is labelled as center of posterior-medial
region.
2, Superimposing the point-marked model and color-mapped model
The schematic diagram illustrates the color-mapped model (yellow model) merged with
the point-marked model (Red model, marked points are denoted in dark blue color) to
identify the center of the regions of interest in the condyle.
Coordinates: R(red): Right-Left axis; A(green): Anterior-Posterior axis; S(blue): Superior43
Inferior axis.
44
45
Figure 2. Condylar volume measurement
1. Generating the corresponding models of T0 and T1
Point to point
corresponding
T0 model
T1 model
Same color regions: corresponding regions
2. Defining the borderline to measure condylar volume
Before alignment
Pre-surgery model
After alignment
Define cutting plane
Post-surgery model
46
Condylar head
Figure 3. Regions of interest of condyle
Lateral
Anterior-lateral
Medial
Superior
Anterior-medial
Posterior-medial
Posterior-lateral
47
Figure 4. Regions of interest of glenoid fossa
Lateral
Anterior-lateral
Medial
Superior
Posterior-lateral
Anterior-medial
Posterior-medial
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Figure 5. Measurement the change of condylar head position
T0
T1
Pre-marked landmark
49
Figure 6: Quantification of condylar remodeling in regions of interest
mm
Amount of condylar remodeling
Regions of interest of condyle
Class II
Class III
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mm
Figure 8. Condylar positional change
Amount of condylar positional change
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Supplementary Figure 1. Identifying the center of ROI of the
condyle
1. Mark the center points in the ITK-SNAP
2. Superimpose the point-marked model and color-mapped
model
Point-marked model
Color-mapped model
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Supplementary Figure 2. Identifying the center of ROI of the
glenoid fossa
1. Mark the center points in the ITK-SNAP
2. Superimpose the point-marked model and color-mapped
model
Point-marked model
Color-mapped model
54
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