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Three-dimensional phenotype characteristics of skeletal class III malocclusion in adult Chinese: a principal component analysis–based cluster analysis

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Abstract

Background

Skeletal class III malocclusion has a diverse and complicated aetiology involving environmental and genetic factors. It is critical to correctly classify and define this malocclusion to be diagnosed and treated on a clinically sound basis. Thus, this study aimed to provide reliable and detailed measurements in a large ethnically homogeneous sample of Chinese adults to generate an adequate phenotypic clustering model to identify and describe the skeletal variation present in skeletal class III malocclusion.

Materials and methods

This is a retrospective cross-sectional study in which 500 pre-treatments cone-beam computed tomography (CBCT) scans of patients with skeletal class III malocclusion (250 males and 250 females) were selected following specific selection criteria. Seventy-six linear, angular, and ratios measurements were three-dimensionally analysed using InVivo 6.0.3 software. These measurements were categorised into 47 skeletal, 18 dentoalveolar, and 11 soft tissue variables. Multivariate reduction methods: principal component analyses and cluster analyses were used to present the most common phenotypic groupings of skeletal class III malocclusion in Han ethnic group of Chinese adults.

Results

The principal component analysis revealed eight principal components accounted for 72.9% of the overall variation of the data produced from the seventy-six variables. The first four principal components accounted for 53.37% of the total variations. They explained the most variation in data and consisted mainly of anteroposterior and vertical skeletal relationships. The cluster analysis identified four phenotypes of skeletal class III malocclusion: C1, 34%; C2, 11.4%; C3, 26.4%; and C4, 28.2%.

Conclusion

Based on three-dimensional analyses, four skeletal class III malocclusion distinct phenotypic variations were defined in a large sample of the adult Chinese population, showing the occurrence of phenotypic variation between identified clusters in the same ethnic group. These findings might serve as a foundation for accurate diagnosis and treatment planning of each cluster and future genetic studies to determine the causative gene(s) of each cluster.

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Data availability

All datasets analysed during the current study are not publicly available due to the confidentiality of the data extracted, but it will be available upon direct request from the corresponding author.

Abbreviations

CBCT:

Cone-beam computed tomography

3D:

Three-dimensional

PCA:

Principal component analysis

PCs:

Principal components

CA:

Cluster analysis

ICC:

Intra-class correlation coefficient

rTEM and TEM:

Relative and absolute technical error of the measurements

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Funding

This work was supported by the project of the National Natural Science Foundation of Gansu Province, China (No. 20JR5RA264).

Author information

Authors and Affiliations

  1. Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China

    Lina Hassan Alshoaibi, Barakat Al-Tayar & Xiaoli An

  2. Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, China

    Mohammed Muneer Alareqi

  3. Department of Orthodontics, School & Hospital of Stomatology, China Medical University, Shenyang, China

    Majedh Abdo Ali Al-Somairi

  4. Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen

    Majedh Abdo Ali Al-Somairi & Maged Sultan Alhammadi

  5. Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar

    Abeer A. Almashraqi

  6. Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia

    Maged Sultan Alhammadi

Authors
  1. Lina Hassan Alshoaibi
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  2. Mohammed Muneer Alareqi
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  4. Barakat Al-Tayar
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  5. Abeer A. Almashraqi
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  6. Xiaoli An
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  7. Maged Sultan Alhammadi
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Contributions

L.H.A collected, analysed, interpreted the data, contributed to the drafting of the article, and critical revision of the article, M.M.A carried out the statistical analyses and interpretation of the data; M.S.A and M.A.A substantially contributed to conception and design of the work and critical revision of the manuscript for important intellectual content; B.A and A.A.A contributed to grammatical and critically commented on the article; and X.L.A contributed to critical revision of the article, supervision, and funding acquisition. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaoli An.

Ethics declarations

Ethics approval and consent to participate

The ethical committee of clinical scientific research of the school of stomatology of Lanzhou University approved this study (No.: LZUKQ-2019–043). Moreover, all patients agreed to the use of their data and signed an informed consent form.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Alshoaibi, L.H., Alareqi, M.M., Al-Somairi, M.A.A. et al. Three-dimensional phenotype characteristics of skeletal class III malocclusion in adult Chinese: a principal component analysis–based cluster analysis. Clin Oral Invest 27, 4173–4189 (2023). https://doi.org/10.1007/s00784-023-05033-y

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