Facial Asymmetry Detected with 3D Methods in Orthodontics: A Systematic Review

Laura Pedersoli1, Domenico Dalessandri1, Ingrid Tonni1, Marino Bindi2, *, Gaetano Isola3, Bruno Oliva1, Luca Visconti1, Stefano Bonetti1
1 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, School of Dentistry, University of Brescia, Brescia, Italy
2 Dental Clinic, A.O.U. Maggiore della Carità di Novara, Novara, Italy
3 Department of General Surgery and Medical and Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy

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© 2022 Pedersoli et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Dental Clinic, A.O.U. Maggiore della Carità di Novara, Viale Piazza d’Armi n. 1 - 28100 Novara, Italy; Tel: +39 3213734948; Fax: +39 3213734843; E-mail:



Historically, the development of two-dimensional (2D) imaging techniquesforerun that of three-dimensional (3D) ones. Some 2D methods are still considered valid and effective to diagnose facial asymmetry but 3D techniques may provide more precise and accurate measurements.


The aim of this work is to analyze the accuracy and reliability of the imaging techniques available for the diagnosis of facial asymmetry in orthodontics and find the most reliable.


A search strategy was implemented using PubMed (National Library of Medicine, NCBI).


A total of 3201 papers were identified in electronic searches. 90 articles, available in full text, were included in the qualitative synthesis consisting of 8 reviews on the diagnosis of facial asymmetry, 22 in vivo and in vitro studies on 2D methods and 60 in vivo and in vitro studies on 3D methods to quantify the asymmetry.


2D techniques include X-ray techniques such as posterior-anterior cephalogram, which still represents the first level exam in the diagnosis of facial asymmetry. 3D techniques represent the second level exam in the diagnosis of facial asymmetry. The most current used techniques are CBCT, stereophotogrammetry, laser scanning, 3D optical sensors and contact digitization. The comparison between bilateral parameters (linear distances, angles, areas, volumes and contours) and the calculation of an asymmetry index represent the best choices for clinicians who use CBCT. The creation of a color-coded distance map seems to represent the most accurate, reliable and validated methods for clinicians who use stereophotogrammetry, laser scanning and 3D optical sensors.

Keywords: Facial asymmetry, Orthodontics, Diagnosis, 2D diagnosis, 3D diagnosis, Three-dimensional techniques.