Digital evaluation of the zygomatic buttress intra-oral donor site dimensions in different vertical facial growth types

Abstract

Purpose

This study investigates the influence of vertical facial growth patterns on the morphology of the zygomatic buttress (ZB) donor site and its implications for preoperative planning in bone grafting.

Materials and methods

A total of 100 adult Cone beam computed tomography (CBCT) scans were analyzed and categorized into hypodivergent, normodivergent, and hyperdivergent groups based on SN-GoGn angles. Three-dimensional ZB models were created using semi-automatic segmentation, with key parameters—volume, surface area, thickness, and anteroposterior protrusion—measured using stable anatomical landmarks. Statistical analyses included descriptive statistics, one-way analysis of variance (ANOVA), Tukey's post-hoc tests, and Kruskal-Wallis H tests where necessary. A p-value < 0.05 was considered statistically significant.

Results

ZB morphology varied significantly across facial growth types. Hypodivergent faces exhibited the highest bone volume (533.25 ± 129.58 mm³), surface area (560.70 ± 99.76 mm²), total thickness (4.68 ± 1.91 mm), and bulge thickness (9.75 ± 2.51 mm). Normodivergent faces showed intermediate values for bone volume (394.39 ± 141.62 mm³), surface area (504.27 ± 108.54 mm²), and thickness (2.79 ± 1.05 mm total, 5.42 ± 2.45 mm bulge). Hyperdivergent faces had the lowest bone volume (259.00 ± 86.28 mm³), surface area (422.64 ± 95.59 mm²), total thickness (1.70 ± 0.49 mm), and bulge thickness (3.57 ± 1.66 mm). Anteroposterior protrusion also differed significantly, with hypodivergent faces showing the largest protrusion (21.56 ± 3.24 mm).

Conclusion

The ZB is a reliable donor site with morphology influenced by facial growth patterns. Preoperative radiographic assessment facilitates optimized surgical planning and tailored grafting strategies.