Prevalence of mandibular asymmetry in different skeletal sagittal patterns

Angle Orthod. 2022 Jan 1;92(1):118-126. doi: 10.2319/040921-292.1.


Objectives: To analyze the prevalence of mandibular asymmetry in skeletal sagittal malocclusions.

Materials and methods: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Two independent investigators selected the eligible studies, and assessed risk of bias and certainty of evidence (GRADE). One reviewer independently extracted the data and the second reviewer checked this information. Any disagreement between the reviewers in each phase was resolved by discussion between them and/or involved a third reviewer for final decision.

Results: Electronic search identified 5,132 studies, and 5 observational studies were included. Risk of bias was low in two studies, moderate in one, and high in two. The studies showed high heterogeneity. Mandibular asymmetry ranged from 17.43% to 72.95% in overall samples. Horizontal chin deviation showed a prevalence of 17.66% to 55.6% asymmetry in Class I malocclusions, and 68.98% in vertical asymmetry index. In Class II patients, prevalence of mandibular asymmetry varied from 10% to 25.5% in horizontal chin deviation, and 71.7% in vertical asymmetry index. The Class III sample showed a prevalence of mandibular asymmetry ranging from 22.93% to 78% in horizontal chin deviation and 80.4% in vertical asymmetry index. Patients seeking orthodontic or orthognathic surgery treatment showed greater prevalence of mandibular asymmetry.

Conclusions: Skeletal Class III malocclusion showed the greatest prevalence of mandibular asymmetry. Mandibular vertical asymmetry showed a marked prevalence in all malocclusions. However, conclusions should be interpreted with caution due to use of convenience samples and low-quality study outcomes.

Keywords: Angle's malocclusion classification; Asymmetry; Mandible; Prevalence; Systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Cephalometry
  • Facial Asymmetry / epidemiology
  • Humans
  • Malocclusion, Angle Class II*
  • Malocclusion, Angle Class III* / epidemiology
  • Mandible
  • Orthognathic Surgical Procedures*
  • Prevalence