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Landmark validation for a mandibular horizontal plane for analysing facial asymmetry: Mental foramen versus Gonion Cover

Landmark validation for a mandibular horizontal plane for analysing facial asymmetry: Mental foramen versus Gonion

Open Access
|Dec 2025

Figures & Tables

Figure 1.

A, Landmarks and reference planes. B, Mandibular measurements. Cg, crista galli; Dv, deviated side; FH, Frankfort horizontal; Go, gonion; LM, mandibular first molar; Me, menton; MF, mental foramen; NDv, non-deviated side; Op, opisthion; Or, orbitale; Po, porion.
A, Landmarks and reference planes. B, Mandibular measurements. Cg, crista galli; Dv, deviated side; FH, Frankfort horizontal; Go, gonion; LM, mandibular first molar; Me, menton; MF, mental foramen; NDv, non-deviated side; Op, opisthion; Or, orbitale; Po, porion.

Figure 2.

Workflow of the best-fit mirroring superimposition of the mandibular body and mandibular co-ordinate system. A, Three-dimensional CBCT image. B, Self-mirroring of the original mandibular body image (original, white; mirrored, blue). C, Best-fit superimposition of the original and mirrored body images (yellow area). D, Go and MF co-ordinates. E, Go line and MF line angulations relative to the x-axis. Dv, deviated side; Go, gonion; Me, menton; MF mental foramen; NDv non-deviated side.
Workflow of the best-fit mirroring superimposition of the mandibular body and mandibular co-ordinate system. A, Three-dimensional CBCT image. B, Self-mirroring of the original mandibular body image (original, white; mirrored, blue). C, Best-fit superimposition of the original and mirrored body images (yellow area). D, Go and MF co-ordinates. E, Go line and MF line angulations relative to the x-axis. Dv, deviated side; Go, gonion; Me, menton; MF mental foramen; NDv non-deviated side.

Figure 3.

Scattergrams of Go and MF positions on the XZ plane of the mandibular co-ordinate system. Dv, deviated side; Go, gonion; MF, mental foramen; NDv, non-deviated side.
Scattergrams of Go and MF positions on the XZ plane of the mandibular co-ordinate system. Dv, deviated side; Go, gonion; MF, mental foramen; NDv, non-deviated side.

Figure 4.

Box plots of the Go line and MF line angulations relative to the x-axis of the mandibular co-ordinate system. Go, gonion; MF, mental foramen; Δ Go–MF line, the difference of the Go line and MF line angulations. Significant differences between the lines at *P<0.05, ***P<0.001. Significant differences between the groups or between the asymmetry types at P<0.05.
Box plots of the Go line and MF line angulations relative to the x-axis of the mandibular co-ordinate system. Go, gonion; MF, mental foramen; Δ Go–MF line, the difference of the Go line and MF line angulations. Significant differences between the lines at *P<0.05, ***P<0.001. Significant differences between the groups or between the asymmetry types at P<0.05.

Figure 5.

Box plots of the Go line, MF line, and LM line angulations relative to the FH plane. Dv, deviated side; Go, gonion; FH, Frankfort horizontal; LM, mandibular first molar; MF, mental foramen; NDv, non-deviated side. Significant differences between the lines at **P<0.01. Significant differences between the groups or between the asymmetry types at †††P<0.001.
Box plots of the Go line, MF line, and LM line angulations relative to the FH plane. Dv, deviated side; Go, gonion; FH, Frankfort horizontal; LM, mandibular first molar; MF, mental foramen; NDv, non-deviated side. Significant differences between the lines at **P<0.01. Significant differences between the groups or between the asymmetry types at †††P<0.001.

Transverse cant of Go and MF lines relative to the x-axis on the mandibular coordinate system

Symmetry (n=30)Asymmetry (n=60)P-value (between the groups)Roll type (n=30)Non-roll type (n=30)P-value(between the types)
Go line angulation (°)–0.66±1.11–1.14±1.270.080–l.3l±1.36–0.97±1.l70.303
MF line angulation (°)–0.07±0.64–0.09±0.870.8930.17±0.78–0.35±0.890.019
Δ Go-MF line angulation (°)–0.59±1.30–1.05±1.6l0.175–1.48±1.61–0.62±1.520.036
P-value (between the line angulations)0.020*0.000*** 0.000***0.034*

Definitions of landmarks, reference planes, and measurements

LandmarkDefinition
CgThe most superior point on the crista galli
OpThe middle point of the posterior border of the foramen magnum
OrThe most inferior point of the lower orbital margin
PoThe most superior point of the external auditory meatus
MeThe most inferior point on the symphyseal outline
GoThe most inferior point of gonial angle on the lateral view
MFThe most inferior point of the mental foramen
PMThe point where the curvature changes from concave to convex on the most anterior symphyseal border
CdThe most superior point of the condyle head
LMThe central fossa of the mandibular first molar
LI_midThe midpoint between the mandibular central incisor edges of both sides
Reference planeDefinition
  Frankfort horizontal (FH) planeThe plane passing by bilateral Po and right Or
  Midsagittal planeThe plane passing by Cg and Op, perpendicular to FH plane
MeasurementDefinition
Skeletal
  Menton deviationThe distance between menton and midsagittal plane
  Body lengthThe distance between menton and Go
  Ramus heightThe distance between Go and Cd
  Ramus inclinationThe angle between the ramus axial line (Cd-Go) and midsagittal plane
Landmark line angulation
  Line angulation relative to the x-axis of the mandibular coordinate system
    Go line to the x-axisThe angle between the Go line (right-left Go) and the x-axis
    MF line to the x-axisThe angle between the MF line (right-left MF) and the x-axis
  Line angulation relative to the FH plane
    Go line to the FH planeThe angle between the Go line (right-left Go) and FH plane
    MF line to the FH planeThe angle between the MF line (right-left MF) and FH plane
    LM line to the FH planeThe angle between the LM line (right-left LM) and FH plane

Bilateral difference in landmark position using the coordinate component on the mandibular coordinate system

SymmetryAsymmetryRoll typeNon-roll type
ΔNDv-DvGoMFP-valueGoMFP-valueGoMFP-valueGoMFP-value
x-componeni–0.25±1.77–0.12±1.100.7410.53±2.490.38±1.320.6770.48±2.40–0.01±1.390.3400.58±2.610.76±1.150.726
y-component0.29±2.660.06±1.030.6572.69±3.100.54±1.300.000§§§1.95±2.130.41±1.300.002§§3.43±3.720.67±1.290.000§§§
z-componeni1.13±1.860.06±0.570.005§§1.95±2.140.08±0.760.000§§§2.30±2.36–0.15±0.660.000§§§1.60±1.870.31±0.790.001§§

Three-dimensional skeletal measurements in the symmetry and asymmetry groups and the roll and non-roll types

Symmetry groupAsymmetry groupRoll typeNon-roll type
DvNDvP-valueDvNDvP-valueDvNDvP-valueDvNDvP-value
Me deviation (mm)1.06±0.53†††7.90±3.238.15±3.747.65±2.66
Body length (mm)82.56±4.0682.49±4.280.86581.72±4.6885.21±5.010.000***81.57±5.1084.71±5.240.000***81.87±4.2985.72±4.810.000***
Ramus height (mm)70.99±4.4871.44±4.910.17868.74±6.0371.52±5.420.000***66.31±5.76††72.17±5.810.000***71.17±5.3570.87±5.010.247
Ramus inclination (°)11.46±3.68††12.14±3.290.0748.20±5.5112.70±4.480.000***7.67±5.1611.94±3.980.001 **8.73±5.8813.47±4.880.000***

Sample distribution (age and sex) and cephalometric measurements

Symmetry (n=30)Asymmetry (n=60)P-valueRoll type (n=30)Non-roll type (n=30)P-value
Sex 0.077 0.371
  Male (n)1745 2421
  Female (n)1315 69
Age (y)*21.34±2.4222.31±3.710.20021.02±2.1421.66±2.670.308
Cephalometric measurement*
  SNA (°)82.57±3.4181.72±2.910.21981.36±2.9982.08±2.820.344
  SNB (°)85.67±3.3984.24±3.170.05283.58±3.2384.91±3.010.104
  ANB (°)–3.10±2.33–2.52±2.040.230–2.21±1.62–2.83±2.370.247
  FMA (°)25.02±1.4525.70±5.490.36825.88±4.6625.52±6.290.804

Transverse cant of Go, MF, and LM lines relative to the Frankfort horizontal plane

SymmetryAsymmetryP-value (between the groups)RollNon-rollP-value (between the types)
LM line angulation (°)0.44±1.49A2.08±2.09AB0.000†††2.77±2.34A1.40±l.57 B0.000†††
Go line angulation (°)–0.00±1.10A1.35±2.04A0.000†††2.80±l.56 A–0.ll±1.27 A0.000†††
MF line angulation (°)0.31±1.l9 A2.70±2.90 B0.000†††4.60±2.46 B0.79±l.88 AB0.000†††
DOI: https://doi.org/10.2478/aoj-2025-0029 | Journal eISSN: 2207-7480 | Journal ISSN: 2207-7472
Language: English
Page range: 380 - 391
Submitted on: Jun 1, 2025
Accepted on: Jul 1, 2025
Published on: Dec 16, 2025
Published by: Australian Society of Orthodontists Inc.
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2025 Ho-Jin Kim, Hyung-Kyu Noh, Hyo-Sang Park, published by Australian Society of Orthodontists Inc.
This work is licensed under the Creative Commons Attribution 4.0 License.