ORIGINAL ARTICLE

Novel method of 3-dimensional soft-tissue

analysis for Class III patients
 ,a Chung How Kau,b Stephen Richmond,c Maja Ovsenik,d and Natas
a Ihan Hrene
 ic
Marko Boz
Ljubljana, Slovenia, Houston, Tex, and Cardiff, United Kingdom
Introduction: The aim of this study was to evaluate 3-dimensional facial shells by incorporating a populationspecific average template with a group of Class III subjects preparing to have orthognathic surgery. Methods:
The Class III group included 14 male (MCIII) and 15 female (FCIII) subjects. We used 43 male and 44 female
Class I subjects to construct average male (AvM) and female (AvF) faces. Coordinates of 3 points on the facial
templates of groups MCIII and FCIII and the templates AvM and AvF were compared. MCIII-AvM and
FCIII-AvF superimpositions were evaluated for differences. Results: Vertical distances (sella to soft-tissue
pogonion) were statistically significantly higher for the AvM (9.1%) and MCIII (10.1%) than for the AvF and
FCIII, respectively (P \0.05). The distances of soft-tissue pogonion in the horizontal x-axis were positive in
80% of the FCIII group and 85.7% of the MCIII group. The Class III subjects differed from the average face
in the lower two thirds, but, in 50% (MCIII) and 60% (FCIII), they differed also in the upper facial third.
Conclusions: (1) The average and Class III Slovenian male morphologic face heights are statistically significantly higher than those of the female subjects. (2) The Slovenian Class III male and female subjects tend toward a left-sided chin deviation. (3) Differences between Class III patients and a normative data set were
determined. (Am J Orthod Dentofacial Orthop 2010;138:758-69)

hree-dimensional (3D) imaging in maxillofacial

surgery and orthodontics is a fast developing
field. Several noninvasive and radiographic
methods have been introduced in the last 20 years, and
they have proved valid and reliable compared with direct
anthropometry.1 The methods that render 3D imaging
possible are photogrammetry, laser acquisition systems,
structured light systems, video imaging, computerized
tomography, cone-beam computerized tomography,
magnetic resonance imaging, and ultrasound.2 Because
of ever improving techniques, the acquisition of 3D data
today is safe, affordable, and precise. The software
applications are also being reengineered to efficiently
handle and analyze these highly precise 3D data
formats.3
a

Resident and Fulbright scholar, Clinical Department of Maxillofacial and Oral

Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia.
Associate professor, University of Texas Health Science Center at Houston,
Houston, Tex.
c
Professor, Dental Health and Biological Sciences, Cardiff University, Cardiff,
United Kingdom.
d
Assistant professor and chair, Department of Orthodontics, Division of Stomatology, University Medical Center Ljubljana, Ljubljana, Slovenia.
e
Assistant professor, Clinical Department of Maxillofacial and Oral Surgery,
University Medical Center Ljubljana, Ljubljana, Slovenia.
The authors report no commercial, proprietary, or financial interest in the
products or companies described in this article.
Reprint requests to: Chung How Kau, University of Texas Health Science Center
at Houston, 6516 M. D. Anderson Blvd, Ste 371, Houston, TX 77030; e-mail,
chung.h.kau@uth.tmc.edu.
Submitted, November 2008; revised and accepted, January 2009.
0889-5406/$36.00
Copyright 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2009.01.033
b

758

Three-dimensional imaging is now being used for various orthodontic and maxillofacial assessments: 3D
treatment planning, preorthodontic and postorthodontic
evaluations, preoperative and postoperative evaluations,
3D prefabricated archwires, research, distinction between
syndromes involving craniofacial deformities, and more.4-6
Soft-tissue prediction software has also been used
successfully in patients with skeletal Class III
malocclusion treated with bimaxillary surgery.7
Three-dimensional imaging with a laser scanning system has proven to be reliable, with accuracy within
0.85 mm.8 A study with a photogrammetric tool for
3D acquisition showed a lower system error: within
0.2 mm.9 On the other hand also, a recent study
showed that the 3D cone-beam computerized tomography measurements were statistically significantly
different from measurements performed on ex-vivo
skulls in two thirds of the measurements, but the
authors concluded that this statistical significance
was probably not clinically relevant.10
Despite the favoring trends in 3D imaging, 2-dimensional diagnostic methods are still the main tools (lateral
and frontal cephalograms, dental panoramic tomograms,
intraoral and extraoral photographs) in maxillofacial
surgery and orthodontics. This might be a direct result
of the lack of 3D evaluation tools to accompany newer
imaging modalities.
A Class III malocclusion is a common condition
that, along with Class I and Class II malocclusions,
has physical, psychological, and social effects on

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759

Class III female subgroup coordinates of Pog

(px, py, and pz) and subspinale (ax, ay, and az), with
S as the zero point (0, 0, 0)

Table I.

Subject/coordinate
1
2
3
4
5
6
7
8
9
10
11
12
12
14
15
Average*
Mean
AvF
Mean direction

Fig 1. An average facial template showing the locations

of sella (S), subspinale (A), and Pog (P).

quality of life.11 Class III patients most common features are retrusive maxilla, protrusive maxillary incisors, retrusive mandibular incisors, protrusive
mandible, and long lower facial height.12 Facial asymmetry is a 3D problem that often accompanies other facial deformities. Many analyses compare right and left
measurements with a constructed midline reference
plane for the estimation of asymmetries.13 This method,
however, has raised concerns, and new methods of
asymmetry evaluation are still emerging.14
The aim of this study was to evaluate 3D facial
shells by incorporating a population-specific average
template with a group of Class III subjects preparing
for orthognathic surgery. To date, 3D data of such nature
have not been used to determine differences between
Class III patients and a normative data set.
MATERIAL AND METHODS

Two groups from the University Medical Center in

Ljubljana, Slovenia, were included in the study. The
first group consisted of normal subjects (Class I) at
the Division of Stomatology, and the second group
consisted of Class III subjects who came for surgery
at the Department of Maxillofacial and Oral Surgery.
The inclusion criteria for the Class I group were (1)
white descent, (2) between 18 and 30 years of age, (3)
no adverse skeletal deviations (a basic orofacial

px
1.68
8.70
0.13
5.49
2.56
6.72
4.33
0.23
4.07
1.18
2.70
9.78
1.51
1.85
6.53
3.83
1.92
1.18
Left

py

pz

103.98
2.01
103.35 0.45
97.18
4.50
99.47
5.73
100.79
0.90
100.88
0.59
93.23 0.14
103.04
2.18
86.81
5.78
103.33
0.08
98.15 1.28
97.67 2.53
104.79 0.34
97.70 0.88
103.65 1.77
99.60
1.95
99.60
0.96
95.21 4.09
Down Forward

ax
0.89
1.24
0.81
0.44
1.24
0.90
0.31
2.22
0.59
0.64
0.76
0.71
2.35
1.64
1.37
1.07
0.58
1.54
Left

ay

az

51.15
3.64
56.14
0.98
50.74
4.80
48.94
4.03
54.17 2.04
48.47 1.07
52.03
0.44
54.04
3.17
50.24
2.24
59.73
0.34
48.49
0.76
51.64
1.39
59.80 0.49
52.89 0.57
56.87
0.28
53.02
1.75
53.02
1.19
55.05
2.83
Down Forward

*Represents the average value of the absolute values (distance from 0)

of the coordinates; Average female facial template.

examination was performed to exclude them), (4) normal body mass index of 18.5 to 25, and (5) no gross craniofacial anomalies.
The inclusion criteria for the Class III group were (1)
white descent, (2) normal body mass index of 18.5 to 25,
(3) diagnosed Class III condition that required combined
orthodontic and surgical treatment, and (4) no other
forms of pathology (eg, condylar hypolasia). The Class
III group was further divided into subgroups by sex.
The study was approved by the Slovenian National
Medical Ethics Committee. It was conducted according
to the principles of the Helsinki-Tokyo declaration.
Informed consent was obtained from all subjects.
The laser scanning system consisted of 2 highresolution Vivid VI900 3D cameras (Konica Minolta,
Tokyo, Japan) with a reported manufacturing accuracy
of 0.1 mm, operating as a stereo pair. Each camera emits
an eye-safe Class I laser, 690 nm at 30 mW, with an
object-to-scanner distance of 600 to 2500 mm and
a fast mode scan time of 0.3 seconds. The system uses
a one half frame transfer charged couple device and
can acquire 307,000 data points. The scanners output
data are 640 3 480 pixels for 3D and red, green, and
blue color data. The data were recorded on a desktop
workstation, and, for surface capture, a medium-range
lens (Konica Minolta) with a focal length of 14.5 mm
was used. The cameras were placed 1350 mm from the
subjects. The scanners were controlled with multi-scan

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Class III male subgroup coordinates of Pog

(px, py, and pz) and subspinale (ax, ay, and az), with
S as the zero point (0, 0, 0)

Table III.

Subject

Subject

Diff px

Diff py

Diff pz

Diff ax

Diff ay

Diff az

1
1.27 105.54
5.52 0.24 55.93
5.81
2
1.90 102.43 0.85
0.70 52.41 2.38
3
1.28 102.23 10.81
0.47 58.73
1.12
4
2.04 115.68 8.69
1.03 56.48 3.81
5
1.89 111.53
6.15
0.72 58.40
6.66
6
2.41 129.64
2.08
0.81 71.47
4.83
7
2.15 112.53 0.62
0.00 58.60 5.03
8
0.40 103.14 0.47
1.90 64.58 2.45
9
2.16 103.66
2.86
0.86 60.43 1.48
10
5.48 114.50 1.93
3.32 61.00
3.36
11
2.52 114.14
2.57
1.77 58.82
4.98
12
7.12 108.13
0.09
2.27 55.57
2.08
13
2.01 114.58 3.60
0.99 64.42
0.42
14
4.48 97.94 4.48
3.16 54.33 2.35
Average*
2.65 109.69
3.62
1.30 59.37
3.34
Mean
2.32 109.69
0.67
1.27 59.37
0.84
0.37 55.60
3.33
Value on AvM 0.83 103.96 5.49
Mean direction Left Down Forward Left Down Forward

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Average*
Mean
Direction

0.50
9.88
1.32
6.68
1.38
5.54
3.15
0.96
2.89
0.01
1.51
8.59
0.32
0.67
5.34
3.25
0.74
Left

8.77
8.14
1.97
4.26
5.57
5.67
1.99
7.83
8.40
8.11
2.94
2.46
9.58
2.48
8.44
5.77
4.39
Down

6.10
3.64
8.59
9.82
4.10
4.68
3.95
6.27
9.87
4.17
2.81
1.56
3.75
3.21
2.32
5.05
5.05
Forward

2.43
2.78
2.35
1.98
0.31
0.65
1.85
0.67
0.96
0.90
0.79
0.84
0.81
0.10
0.17
1.17
0.96
Right

3.89
1.09
4.31
6.11
0.88
6.58
3.02
1.00
4.81
4.69
6.56
3.41
4.76
2.16
1.82
10.90
2.03
Down

0.81
1.85
1.97
1.20
4.87
3.90
2.40
0.34
0.59
2.49
2.07
1.45
3.32
3.40
2.55
2.21
1.64
Back

*Represents the average value of the absolute values (distance from 0)

of the coordinates; Average male facial template.

Diff, Difference.
*Represents the average of absolute differences.

software (Cebas Computer, Eppelheim, Germany), and

data coordinates were saved in a vivid file format. Information was transferred to a reverse modeling software
package, Rapidform 2006 (RF6) (INUS Technology,
Seoul, Korea), for analysis.
The images were acquired with the subjects in natural
head posture. NHP has proven to be clinically reproducible.15 The subjects sat on an adjustable chair and were
asked to look at an object located centrally between the
cameras. Adjustments to the height and angle were
made to achieve the NHP and appropriate positioning.
The subjects were asked to keep their facial musculature
as relaxed as possible and to remain as still as possible
during the scan. The image acquisition took approximately 10 seconds for every patient and was repeated if
any movement in the head position or mimics was noted.8
The images were analyzed by using the RF6 software.
Absolute mean shell deviations, standard deviations of
errors during shell-to-shell overlaps, maximum and minimum range maps, histogram plots, and color maps were
generated. The data were further processed before analysis
to obtain an image with preserved shape, surface, and volume by using custom-made macros for the RF6.16 Surface
defects were filled automatically or manually without loss
of raw data. The result was 1 composite shell per subject.
The construction of an average face was performed
by using a previously validated software subroutine
available in the RF6. The Class I group was divided by
sex. The results were an average male (AvM) shell and

Table IV. The difference of Pog (px, py, and pz) and
subspinale (ax, ay, and az) of the average male template
and the male Class III subjects

Table II.

px

py

pz

ax

ay

az

The difference of Pog (px, py, and pz) and

subspinale (ax, ay, and az) of the average female template and the female Class III subjects

Subject

Diff px Diff py

1
2
3
4
5
6
7
8
9
10
11
12
13
14
Average*
Mean
Mean direction

2.10
1.07
2.11
2.87
2.72
3.23
2.98
0.43
2.99
6.31
3.35
7.95
2.84
5.31
3.30
3.15
Left

Diff pz

1.57 11.02
1.54
4.64
1.74 16.31
11.71
3.19
7.57 11.65
25.68
7.58
8.57
4.87
0.83
5.02
0.30
8.35
10.54
3.57
10.18
8.06
4.16
5.58
10.62
1.89
6.02
1.02
7.22
6.62
5.73
6.17
Down Forward

Diff ax Diff ay Diff az

0.61
0.33
0.10
0.65
0.35
0.44
0.37
1.53
0.49
2.95
1.40
1.89
0.62
2.79
1.04
0.90
Left

0.33
3.19
3.13
0.88
2.80
15.87
2.99
8.98
4.83
5.40
3.21
0.03
8.81
1.28
4.41
3.77
Down

2.49
5.71
2.20
7.14
3.34
1.51
8.36
5.77
4.81
0.04
1.66
1.25
2.91
5.67
3.77
2.49
Back

Diff, Difference.
*Represents the average of absolute differences.

an average female (AvF) shell. The steps required to produce an average face have already been described and
are summarized as follows: (1) the images are
prealigned to determine the principal axes of rotation;
(2) manual corrections are made to positioning;
(3) best-fit alignment is done with the built-in algorithm

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Fig 2. Coordinates px (Pog) of the male and female Class III (MCIII and FCIII) patients compared with
the px of the average female (AvF) and male (AvM) patients.

in RF6; (4) the z-coordinates of the images are averaged

based on normals to a facial template; (5) the point cloud
is triangulated to obtain an average face; (6) defects
and unwanted areas are removed, and holes are filled;
(7) color texture is applied; and (8) shells are created
with 1 positive and 1 negative standard deviation.17
All images were oriented in the virtual space to have
a NHP before analysis. Sella (S), subspinale (A), and
soft-tissue pogonion (Pog) were chosen as described
before and shown in Figure 1.18 The surface shell was
translated in the 3D space so that S represented the
zero point (x, y, and z values were 0, 0, and 0). The values
of the other points coordinates therefore represented
distances from S in the chosen axis in millimeters, and
their corresponding positive or negative value sign (the
plus sign was omitted for positive values) indicated the
directions (ie, positive x, left; positive y, up; positive z,
to the front). The coordinates of points A and Pog
were summated in the following manner. (1) As absolute
values to demonstrate the absolute differenceie, distance from S not taking the direction into account; in
this way, by dividing the sum by the number of subjects,

average distances of points A and Pog from S (zero) for

the male and female Class III groups were calculated.
(2) With their positive and negative values and divided
by the number of subjects to give the mean value of
the coordinate, showing also the direction. The differences of the A and Pog coordinates of the template
AvM and group MCIII (AvM MCIII) and the differences of the template AvF and group FCIII (AvF FCIII)
were also summated and divided in these 2 ways to give
the average distances regarding the average face and the
means showing also the direction of the points in the
Class III groups compared with the average facial
templates (AvM and AvF). Means of the coordinates
and means of their differences (AvM MCIII and
AvF FCIII) were compared and tested for significant differences between the sexes. The differences (AvM MCIII,
AvF FCIII) of coordinates of points A (ax) and Pog (px)
were also compared for significant differences.
Superimpositions of the shells from the Class III
group were performed with the AvM and AvF shells
by using a previously described technique.19 The morphologic differences between the shells were depicted.

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Fig 3. Coordinates py (Pog) of the male and female Class III (MCIII and FCIII) patients compared with
the py of the average female (AvF) and male (AvM) patients.

The process of comparing the facial average shells

involved a manual alignment of the 5 points on the facial
scans (4 points at the outer and inner canthus of the eyes
and 1 point on the nasal tip) followed by fine alignment
performed automatically by the RF6.19 Color histogram
and surface areas and shapes were the parameters used in
the study. The color histogram indicates the difference
between the average facial shells: the blue areas show
negative values, and the red areas show positive values.
Surface areas and shapes were automatically generated
by the RF6. These shapes were obtained when a previous
tolerance of 0.85 mm was applied to the paired surface
shell studies.8 The areas corresponding to 0.85 mm
were deemed to be similar between the 2 shells, whereas
the shapes above this tolerance represented differences
and were shown as surface shapes and color deviations.
The percentage of the areas corresponding to the
tolerance of 0.85 mm was calculated by the RF6 and
represented the similarity of 2 shells.
Statistical analysis

The data were tested for significant differences

by using the independent-samples 2-tailed Student

t test in SPSS for Windows (version 11.0.0, SPSS,

Chicago, Ill).
RESULTS

One hundred sixteen subjects were included in this

study; 43 male and 44 female subjects constituted the
normal group that made up the average templates, and
14 male and 15 female subjects constituted the Class
III group.
Coordinates of the points Pog (px, py, and pz) and A
(ax, ay, and az) with the average distance from S
(average of the absolute values) for the groups FCIII
and MCIII as well as for the AvM and AvF facial templates are presented in Tables I and II, respectively.
Their mean values and corresponding directions are
also shown. Tables III and IV show the differences
between the coordinates Pog and A chosen on the
AvF and AvM templates and the coordinates of Pog
and A chosen on the subjects of groups FCIII and
MCIII, respectively. The values of the coordinates of
points A and Pog of FCIII and MCIII and values of
the A and Pog coordinates of the average facial
templates (AvF and AvM) are also presented in

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Fig 4. Coordinates pz (Pog) of the male and female Class III (MCIII and FCIII) patients compared with
the pz of the average female (AvF) and male (AvM) patients.

Figures 2 to 7. Coordinates py and ay of the groups

MCIII and FCIII were statistically significantly
different (P \0.05). The other coordinates did not
show statistical significance.
The average distances of Pog from S in the vertical
dimension (ie, y-axis) were 109.69 mm (103.96 on
AvM) for the MCIII subjects and 99.60 mm for the
FCIII subjects (95.21 on AvF). The distance differences
were 10.09 mm between MCIII and FCIII and 8.75 mm
between AvM and AvF.
The subtractions of the female ax and ay coordinates
(AvF FCIII) were statistically significantly (P \0.05)
different from the subtractions of the male ax and ay
coordinates (AvM MCIII).
Differences of the px were statistically significantly
higher than differences of the ax (P \0.05).
In the template analysis, the results of differences
between the average faces (AvM and AvF) and Class
III patients (MCIII and FCIII) are shown with color
histograms in Table V. The similarities to the average
face ranged from 21.30% to 46.07% among the MCIII
subjects and from 23.71% to 52.02% among the FCIII
subjects. The average percentages of similarity were

38.34% for FCIII to AvF and 32.85% for MCIII to

AvM. The differences were mainly in the lower facial
two thirds. However, in 50% (MCIII) to 60% (FCIII),
there were also differences in the upper facial third.
Figure 8 shows a face with a protruded mandible, with
the upper two thirds mostly within the accepted
0.85-mm tolerance when superimposed on the corresponding average face. Asymmetry can also easily be
noted from the image. Figure 9 shows a subject with
mandibular prognathism and maxillary retrognathism,
whereas the upper facial third is mostly within the
accepted 0.85-mm tolerance when superimposed on
the corresponding average face. Figure 10 shows a subject whose mandible is protruded and whose maxilla is
retruded, and there is also a significant difference from
the average face in the upper third of the face: the area
around the eyes and forehead.
DISCUSSION

Three-dimensional imaging is a fast developing

field of medical diagnostics. It was shown that 3D imaging with laser scanning devices can be used reliably

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Fig 5. Coordinates ax (point A) of the male and female Class III (MCIII and FCIII) patients compared
with the ax of the average female (AvF) and male (AvM) patients.

and with great accuracy.20,21 A 3D average face has

been used in several studies: to distinguish people
with Noonans syndrome,4 to compare different
groups of orthodontic patients (postextraction to nonextraction groups),22 to distinguish growth changes
among children,23 and to compare distinct geographically remote white populations (Slovenian and
Welsh).24
In our study, the 3D data were obtained with a noninvasive laser scanning device. A previously described
method of averaging faces was used.17 Differences and
asymmetry of Class III patients and their comparisons
to average female and male facial templates of their population were noted. To our knowledge, previous studies
have not used an average face for the objective of linear
measurement.
Symmetry and averageness were considered in this
study, since they play important roles in a faces
attractiveness, although extraordinary beauty probably
depends on the addition of special characteristics
(child-like and mature characteristics and expressiveness) for the females, whereas male attractiveness is
more controversial, depending on the great influence

of the menstrual cycle and the environment on female

observers. The ideal of beauty is also subject to fluctuations in fashion.25
Our findings show that the male and female faces of
Class III patients in Slovenia are statistically significantly different in the vertical (y) direction. This agrees
with a recent international anthropometric study where
the mean morphologic face height was determined as
the distance from nasion to gonion. Thirty male and
30 female subjects from Slovenia were included, and,
for the males, the mean morphologic face height
was 7.1% higher than for the females (116.6 mm vs
108.8 mm).26 In our study, the morphologic face height
was estimated as the distance between S and Pog in
the y-axis. On the AvM facial template, the Pog distance in the y-axis was 9.1% higher than on the AvF,
and, in the MCIII group, it was 10.1% higher than in
the FCIII.
Asymmetry makes the human face less attractive,
and its objective estimate is therefore important.25 In
FCIII, the deviation of Pog to the left or right was on
average 3.8 mm (2.65 mm in MCIII), whereas on the
AvF template it was 1.18 mm (0.83 mm on AvM).

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Fig 6. Coordinates ay (point A) of the male and female Class III (MCIII and FCIII) patients compared
with the ay of the average female (AvF) and male (AvM) patients.

This could lead to a conclusion that Class III patients are

more likely to have a deviation of the chin than the
Class I population. Differences of the px were statistically significantly higher than differences of the ax,
meaning that the mandible deviates in the x-axis more
than the maxilla. It has been previously shown that
asymmetry among Class III patients is seen frequently
and not by chance and is more pronounced in the
mandible than in the maxilla.27
The px values were positive in 12 of 15 (80.0%) subjects of the FCIII group and in 12 of 14 (85.7%) subjects
in the MCIII group. A positive px value means left-sided
chin deviation; this also agrees with previous studies27
and probably is a consequence of prenatal (genetic
and teratogenic) factors.28,29
The subtraction of the ax (AvM MCIII) that was
significantly different from the subtraction of the ax
(AvF FCIII) leads us to conclude that Class III
men have a maxilla deviated more to the left, whereas
the women tend to have a maxilla deviated more to the
right. Considering the small dimensions of these
means of deviations (10.96 mm and 0.90 mm), it

is also possible that these can be ascribed to technical

errors.
The similarity of the Class III patients and the
average facial templates was low (FCIII similarity,
38.3%; MCIII similarity, 32.8%). To our knowledge,
no previous studies have used 3D digital data to
show this.
The data of this study also suggest that the upper facial third might be of importance for the final result of
orthognathic surgery. The upper facial third was different from the average face in 9 of 15 (60%) FCIII and in 7
of 14 (50%) MCIII patients. Since the upper third is not
surgically corrected, these patients might have a disadvantage when compared with those whose upper third is
more similar to the average face.
This study included average faces built only from
our small database; larger studies are needed and
ongoing. Further 3D imaging studies will help to create 3D norms that will eventually replace the traditional 2-dimensional cephalometric norms and lead
to better surgical and orthodontic corrections of facial
irregularities.

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American Journal of Orthodontics and Dentofacial Orthopedics

December 2010

Fig 7. Coordinates az (point A) of the male and female Class III (MCIII and FCIII) patients compared
with the az of the average female (AvF) and male (AvM) patients.

Percentages of similarity between the average

face templates and Class III patients calculated with
color histograms
Table V.

Female subject
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Average

Similarity (%)*

Male subject

Similarity (%)*

30.83
47.69
27.18
52.02
26.66
49.05
52.64
28.72
38.46
34.42
41.81
39.26
34.81
23.71
47.84
38.34

1
2
3
4
5
6
7
8
9
10
11
12
13
14

27.15
39.59
36.10
34.29
38.78
21.43
32.47
34.44
21.30
25.93
35.98
35.85
30.56
46.07
32.85

*Tolerance 5 0.85 mm (values less than this are deemed similar).

CONCLUSIONS

The following can be concluded from this novel

method of 3D analysis.
1.

2.

3.
4.

Facial morphologic differences between Angle

Class III patients and average Slovenian male and
female faces were noted by using commercially
available laser scanning system and software.
The average and Class III Slovenian male morphologic face height is statistically significantly higher
than female.
The Slovenian Class III males and females tend to
have a left-sided chin deviation.
Differences between Class III patients and a normative data set were determined (FCIII similarity,
38.3%; MCIII similarity, 32.8%).

Marko Bozic thanks the Fulbright Commision for

the scholarship that enabled him to work at the University of Texas Health Science Center at Houston and the
Slovenian Research Agency.

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 138, Number 6

Bozic et al

Fig 8. A Slovenian female Class III face superimposed on an average Slovenian female face showing
a protruded mandible, with the upper two thirds mostly within the accepted 0.85-mm tolerance. Note
the asymmetry of the mandible.

Fig 9. A Slovenian male Class III face superimposed on an average Slovenian male face showing
mandibular prognathism and maxillary retrognathism, with the upper facial third mostly within the
accepted 0.85-mm tolerance.

767

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Bozic et al

American Journal of Orthodontics and Dentofacial Orthopedics

December 2010

Fig 10. A Slovenian female Class III face superimposed on an average Slovenian female face where
the mandible is protruded, the maxilla is retruded, and there is also a significant difference from the
average face in the upper third: the area around the eyes and forehead.

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