{"paper_id":"46e6ea28-6c8c-4e45-b280-c5241dee37bf","body_text":"Antegonial Notch Depth and Mandibular Growth: A Longitudinal Multilevel Modelling Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Antegonial Notch Depth and Mandibular Growth: A Longitudinal Multilevel Modelling Approach Mohamad Rustom, Balazs J. Denes, Stavros Kiliaridis, Gregory S. Antonarakis This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7862123/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Introduction: The antegonial notch has been proposed as a morphological indicator of mandibular growth, yet its developmental trajectory and predictive value remain insufficiently explored. This study examined how the antegonial notch changes across growth and whether craniofacial morphology can predict its depth. Methods A longitudinal sample of 250 untreated individuals (42% female) was analysed at three ages: 7/8, 13/14, and 17/18. Antegonial notch depth was measured from lateral cephalograms. A mixed repeated-measures ANOVA tested the effects of age, sex, and Angle molar classification, while multilevel general linear regression evaluated whether skeletal morphology predicted antegonial notch depth. Results Antegonial notch depth changed significantly over time ( P < 0.001). Males consistently had deeper notches than females. Shallowing of the antegonial notch was generally seen in both sexes between ages 7 and 14 but deepened thereafter in males. Angle molar classification showed no significant influence on notch depth. Multilevel modelling revealed only the gonial angle as a significant predictor (B=–0.014, P = 0.044) to notch depth. Conclusion Antegonial notch depth undergoes modest sex-specific changes during adolescence and is minimally associated with craniofacial morphology, with only the neighbouring gonial process being a significant predictor possibly reflecting the view that antegonial notch depth primarily reflects localized bone remodelling. Antegonial notch mandibular growth cephalometry craniofacial development multilevel modelling orthodontics Figures Figure 1 Figure 2 Introduction Accurate prediction of mandibular growth could be an important element to orthodontic and orthognathic treatment planning, enabling timely and effective interventions in developing patients. One anatomical feature of interest is the antegonial notch (also known as the gonial notch, premasseteric notch, or groove for facial vessels), a concavity on the inferior border of the mandible, located anterior to the masseter and medial pterygoid attachments 1 – 3 . Its prominence can range from absent to deep, with mean depths around 2.0 ± 1.1 mm for orthodontically untreated individuals under the age of 18 in North America 4 , 5 . Mechanistic theories suggest notch formation results from differential muscular activity. Wolf’s law states that the bone remodels itself based on the load to reach an optimal shape 6 , 7 . Recent evidence further links antegonial notch dimensions with craniofacial morphology and masticatory muscle size, underscoring its potential as a musculoskeletal growth marker 7 . Hovell proposed that when condylar growth fails to lower the mandible, continued masseter and medial pterygoid activity promotes bone apposition on the gonial angle and notch development, while balanced mandibular and soft-tissue growth yields an absent notch 8 . It is important to note that the antegonial notch depth and presence seems to differ depending on ethnicity. Obamiyi et al showed that those with African, Asian and Hispanic ethnicities tend to present with an antegonial notch more often than the White group 9 . As for the depth, a study on a Japanese population showed that the mean depth was 3.1 mm ± 1.1 which was more than the North American group 10 , but this may also be dependent on age. Sex also seems to be of relevance with male presenting with a significantly deeper notch 5 , 11 . Such sexual dimorphism is consistent with broader mandibular shape variation between males and females reported in recent morphometric analyses 11 . Schütz et al conducted a retrospective analysis of the antegonial notch depth using a sample of growing children (n = 302) from North America 5 . The results showed that males have significantly deeper notches than females (1.2 mm difference). The depth of the notch in those with Class I occlusion was significantly higher than for those with Class II malocclusions. For those with a deep notch (which all happened to be male in the study), the changes occurred largely during or after the adolescent growth spurt between the ages of 13 and 18. Nonetheless, an important shortcoming of the Schütz et al (2022) study was that it does not make it clear that it takes into account the multilevel structure of the paired data – participants should be nested within time points – therefore, statistical tests and comparisons could be inaccurate due to the violation of the independence of observation assumption 12 . Despite these anatomical insights, evidence for clinical utility remains conflicting. Björk’s longitudinal implant studies indicated a correlation between notch depth and mandibular rotation direction—deep notches with vertical growth, shallow with horizontal 1 , 13 , 14 . Singer et al. and Lambrechts et al. similarly reported that deep notches correspond to increased vertical facial growth, increased facial height, and obtuse gonial angles 15 , 16 . On the other hand, however, Halazonetis et al. and Kolodziej et al. countered that notch depth shows weak or no predictive value for rotation or future facial growth 17 , 18 . Moreover, Kolodziej et al. in their longitudinal study of untreated normal subjects concluded that while a statistically significant relationship exists between notch depth and horizontal jaw growth, the correlation lacks clinical significance 18 . Thus, although the antegonial notch remains a promising anatomical marker, its relevance in routine growth prediction—especially in normative dental populations—remains unresolved, and longitudinal investigations in untreated cohorts are needed. Given the paucity of evidence, the factors associated with a deeper/shallower notch are still unclear in an untreated population. To address this gap, the present longitudinal study evaluated orthodontically untreated participants to: (1) to evaluate the development of the antegonial notch during normal growth in orthodontically-untreated subjects; and (2) to determine whether cephalometric craniofacial morphology can help predict the depth of the antegonial notch in growing subjects. These objectives could help clarify whether antegonial notch depth could constitute a reliable, clinically applicable marker for mandibular growth monitoring and prediction in general populations. Material and Methods Sample selection For this retrospective study, lateral cephalograms of 250 patients of which 42.4% (n = 106) were female, were collected from the American Association of Orthodontist Foundation (AAOF) Craniofacial Growth Legacy Collection website ( www.aaoflegacycollection.org ). Formal ethical approval and additional informed consent were not required, as the raw data (lateral cephalograms) are publicly accessible through the stated resource. The study was conducted in compliance with the Declaration of Helsinki. Records were taken from all nine growth studies available on the online database, including all three Angle dental classifications (Class I, Class II and Class III), where three lateral cephalometric radiographs were available at the ages of 7/8 years, 13/14 years and 17/18 (or > 17 years) for the same participant. The majority of participants had Class I (67.2%, n = 168) occlusion, while 29.6% (n = 74) had a Class II malocclusion, while only 3.2% (n = 8) were Class III. These three age groups represent preadolescent children, adolescents, and young adults 18 . The ethnicity for our sample was either White or African American. Evaluation of the development of the antegonial notch The lateral (right side) cephalograms were calibrated, traced and analysed by a single operator (M.R.), using Osirix software (OsiriX v3.9 Pixmeo SARL). The magnification criteria were provided on the AAOF legacy collection website for each growth study group in order to correctly calibrate all radiographs and accurately measure both linear and angular values on the radiographs. The antegonial notch depth was measured as the perpendicular distance between the deepest point on the mandibular body concavity and tangent to the lower body of the mandible (Fig. 1 ). In case of double contours, for example where the border of the right and left mandibular bodies did not coincide, points and planes were traced as a mean distance between right and left contours. This was measured on the lateral cephalometric radiograph at all three ages for each individual. A Mixed ANOVA was conducted using SPSS to examine changes in the dependent variable across three time points (within-subjects factor: Time) and to assess the effects of two fixed between-subject factors: Sex and Angle classification of malocclusion. This method was selected to test for both main effects and interactions while accounting for repeated measurements within participants. Greenhouse-Geisser correction was applied where assumptions of sphericity were violated. A P -value of < 0.05 was considered statistically significant. Correlations between antegonial notch depth and craniofacial morphology Craniofacial morphology was determined using the lateral cephalometric radiographs, concentrating on variables representing the sagittal and vertical skeletal relationships as well as the gonial angle. Cephalometric landmarks and angular measurements used in this study are shown in Table 1 . Table 1 Cephalometric landmarks and angles measurements Landmark Definition S (Sella) Midpoint of the sella turcica N (Nasion) Junction of nasal and frontal bones at the naso-frontal suture ANS (Anterior Nasal Spine) Most anterior point on the sagittal plane of the bony hard palate on the mid-sagittal plane PNS (Posterior Nasal Spine) Most posterior point on the sagittal plane of the bony hard palate on the mid-sagittal plane A (Point A) Deepest point of the concavity of the anterior maxilla B (Point B) Deepest point of the concavity of the anterior mandible Ar (Articulare) Point of intersection of the inferior cranial base surface with the surface of the mandibular condyles Go (Gonion) The most posterior-inferior and lateral point at the angle of the mandible, located by bisecting the angle formed by the posterior ramus and the inferior border of the mandible. Me (Menton) The lowest midline point on the inferior border of the mandibular symphysis. From these landmarks, the following angular measurements were made: ANB angle; mandibular plane angle (SN-MeGo); intermaxillary angle (ANSPNS-MeGo); and the gonial angle (Ar-Go’-Me). Correlations between the depth of the antegonial notch and cephalometric angular variables were carried by using linear regression analysis. A P -value of < 0.05 was considered statistically significant. Error of the method To evaluate both systematic and random errors in localizing landmarks, 30 lateral cephalograms were randomly chosen (using the true random number generator - https://www.random.org ) and retraced by the same examiner. Systematic error was calculated using paired t-tests, revealing no significant systematic error (p > 0.05). Random error was assessed using Dahlberg’s formula, and the maximum error was found to be 0.3mm for linear and 1.1° for angular measurements. Results Repeated measures ANOVA showed that antegonial notch depth significantly fluctuated between the three time points measured ( P < 0.001) with a medium effect size (η p ²=0.09) according to Cohen 1988 19 . Post-hoc showed all time points differed significantly from one another. Descriptive statistics (Table 2 ) revealed that on average males exhibited deeper antegonial notches than females at all time points, with the greatest divergence observed at age 18, where males had a mean depth of 2.10 mm (SD = 1.10) compared to 1.39 mm (SD = 0.65) in females. Within time comparison for each sex subgroup, it could be noticed that the male group notch depth fluctuated dropping at 14 years of age then increasing at 18 years in contrast to the female group which consistently decreased at each time point (Fig. 2 ). Table 2 Findings of Mixed Repeated Measures ANOVA for the antegonial notch depth for the three time points across sex and occlusal class subgroups. Time Point Sex Angle Class Effects Male (n = 144) Female (n = 106) Class I (n = 168) Class II (n = 74) Class III (n = 8) P ES (η p ²) mean ± SD mean ± SD mean ± SD mean ± SD mean ± SD Time < 0.001 0.037 Time 1 (yr 7) 2.05 ± 0.78 1.96 ± 0.68 2.09 ± 0.78 1.82 ± 0.63 1.98 ± 0.66 Time × Sex 0.001 0.029 Time 2 (yr 14) 1.76 ± 0.86 1.57 ± 0.71 1.72 ± 0.83 1.58 ± 0.72 1.67 ± 1.01 Time × Class 0.448 0.007 Time 3 (yr 18) 2.10 ± 1.10 1.39 ± 0.65 1.88 ± 1.04 1.64 ± 0.86 1.57 ± 1.16 Time × Sex × Class 0.709 0.004 Per class comparison shows that antegonial notch depth fluctuated for Class I and II occlusions, decreasing at 14 years of age, then slightly increasing at Year 18 (Table 2 ). Class III, however, decreased consistently across the three time points. A mixed repeated measures ANOVA was conducted to evaluate changes in antegonial notch depth across three developmental time points (ages 7, 14, and 18 years) accounting for sex and class as fixed factors (Table 2 ). The analysis showed a significant main effect of time ( P < 0.001, partial η² = 0.037), indicating that antegonial notch depth varied significantly over time with a small effect size according to Cohen 1988 19 . The time and sex interaction were also statistically significant with a small effect size ( P = 0.001, partial η² = 0.029), suggesting that the pattern in notch depth across time differed meaningfully between males and females (Table 2 ). The time and molar Class interactions, and the time and molar class and sex interactions were not statistically significant ( P > 0.05). Multilevel General Linear Model for Different Craniofacial Morphologies as Predictors of Antegonial Notch Depth Interclass Correlation Coefficient (ICC) was 0.63 showing a clear need for multilevel modelling. The multilevel model (Table 3 ) shows that none of the studied craniofacial morphologies significantly predict antegonial notch depth except for the gonial angle (B=-0.014, P = 0.04), but with a small effect size (ES = 0.20). The intermaxillary angle (ANSPNS – ML) measurement also seems to be minimally significant (B=–0.0191, P = 0.064) with a small effect size (ES = 0.18). The model shows that the higher the gonial angle and the intermaxillary angle values were, the shallower the depth of the antegonial notch (negative correlation). Table 3 Multilevel general linear model of participants' antegonial notch depth as predicted by different craniofacial morphologies Effect Type Predictor B SE P ES Fixed Intercept 3.9627 Time –0.1240 0.0297 < 0.001 0.39 ANB 0.0165 0.0154 0.283 0.10 Mandibular plane angle 0.0091 0.0111 0.415 0.08 Intermaxillary angle –0.0191 0.0103 0.064 0.18 Gonial angle –0.0140 0.0069 0.044 0.20 Random Intercept 0.4086 Time 0.0663 Residual 0.1900 B: unstandardized regression estimate; SE: standard error; P: probability that the association or the difference is due to chance; ES: Effect size Discussion The present study aimed to assess the development of the antegonial notch during growth in orthodontically-untreated subjects and to determine whether cephalometric craniofacial morphology measures can predict the depth of the antegonial notch. In this longitudinal cohort of untreated individuals, antegonial notch depth showed statistically significant changes over time with a medium effect size. Males consistently exhibited deeper notches than females at all ages 11 . Both sexes showed a decrease in notch depth from ages 7–8 to 13–14, but thereafter males experienced an increase by age 17/18 while females continued a slight decline. Angle class (I, II, III) didn’t seem to have a significant main effect on antegonial notch development. Multilevel modelling showed that only the gonial angle (and marginally the intermaxillary angle) could significantly predict notch depth, with larger gonial angles associated with slightly shallower notches, although the clinical significance of this finding is questionable. The pronounced sex difference and timing of change hint at underlying mechanisms. Males not only had deeper notches on average, but their notches deepened after age 13/14, whereas females’ notches continued to flatten, as also suggested by other data 11 . This observation aligns with broader morphometric evidence that mandibular shape is highly sexually dimorphic beyond notch morphology, which is in line with previous results 11 . This pattern is consistent with muscle-driven remodelling suggested in the literature 6 , 20 , 21 . In puberty, boys typically experience a surge in masticatory muscle mass, which could stimulate bone apposition at the gonial angle and accentuate the notch 5 , 7 . Indeed, Schütz et al. interpreted their results with this in mind, suggesting that increased notch depth in males may be due to stronger masticatory forces and greater muscle mass (5). Our finding that notch depth correlated negatively with gonial angle (i.e. deeper notches in jaws that grew more horizontally) may reflect such muscular influences rather than a primary skeletal growth factor 7 . Clinically, these insights imply caution in using the antegonial notch depth to predict mandibular growth. Although statistically significant, the effects we observed are small to medium. Thus, antegonial notch depth is not a robust standalone marker for treatment timing or growth forecasts. It may instead serve as an indicator of individual mandibular morphology or muscle function. The absence of strong correlations with conventional cephalometric angles (ANB or the mandibular plane angle) suggests that notch depth is more a feature of local bone remodelling. This aligns with the view that antegonial notch should not be overinterpreted as a “growth potential” gauge 7 . Our results both align with and diverge from prior studies. Consistent with Schütz et al., we found that males have deeper notches than females and that most deepening occurs around puberty 5 , keeping in mind that part of the material between the two studies is common since it is derived from the AAOF Craniofacial Growth Legacy Collection. However, unlike Lambrechts et al. and Singer et al. 15,16 who proposed deep notches as markers of a hyperdivergent (backward-rotating) growth pattern, we observed the opposite tendency. In our sample, deeper notches were linked to smaller gonial angles (a more horizontal growth orientation). This agrees more closely with Kolodziej et al., who reported that antegonial notch depth is not a reliable indicator of growth direction 18 . For example, whereas Lambrechts et al. and Singer et al. found deep notches in vertical growers, Kolodziej et al. found no clinically useful correlation between notch depth and future mandibular growth. Similarly, Halazonetis and co-workers also noted only weak or nonsignificant relationships between notch depth and craniofacial angles 17 . In effect, our findings support the view that antegonial notch depth, at least in a healthy orthodontically-untreated population, has limited predictive value for overall craniofacial growth pattern. Notably, Schütz et al. reported only a fractional average difference (≈ 0.33 mm) between antegonial notches in individuals with Class I and II malocclusions, cautioning that this is about the same magnitude as the measurement error 5 . We observed the same: any differences notch depth between individuals with different Angle molar relationships were insignificant and within 0.5 mm. This suggests that sagittal occlusion (in orthodontically-untreated individuals) has minimal influence on notch depth during growth. The consistency between our results and those of Schütz et al. 5 particularly regarding sex differences and the timing of notch change – strengthens confidence in these findings despite the sample being derived from the same source (namely the AAOF). The present study has certain limitations. It was retrospective in nature, relying on historical growth-study radiographs with variable quality. Although we calibrated images, older film images can introduce noise. Our sample, drawn from predominantly White or African-American cohorts, limits generalization to other ethnic groups (notably, prior work reports deeper mean notches in Asian populations) 10 . The relatively small number of individuals with Class III malocclusions reduces power to detect differences in these individuals. Importantly, we used mixed (multilevel) modelling to account for repeated measures, addressing a key shortfall of past analyses which violated the assumption of independence of observation. Future studies could improve on this by using 3D imaging to capture notch morphology more fully, and by directly measuring muscle size or function 3 . Longitudinal research in larger, more diverse samples would clarify whether early antegonial notch characteristics have any predictive value for later mandibular or craniofacial growth or treatment outcomes. Conclusion Antegonial notch depth changes only modestly during normal growth, is consistently deeper in males, and is only weakly linked to sagittal or vertical skeletal characteristics. These findings might suggest that notch depth reflects localized bone remodelling (likely driven by musculature) rather than serving as a clear marker of overall mandibular growth direction. While our data do not support using notch depth in isolation for growth prediction, they contribute normative benchmarks and underscore the need to consider muscular and developmental factors when interpreting mandibular anatomy. Declarations Competing Interests The authors declare that they have no conflict of interest to disclose. Author contributions statement MR: Methodology; Validation; Formal analysis / Statistics; Writing – original draft; Writing – review & editing; Visualization. BD: Data curation; Formal analysis / Statistics; Writing – review & editing; Visualization. SK: Conceptualization; Methodology; Validation; Resources; Supervision; Project administration; Writing – review & editing. GA: Conceptualization; Methodology; Validation; Resources; Supervision; Project administration; Writing – review & editing. All authors reviewed the manuscript and approved the final version. Funding No funding was given to conduct or write the research paper. However, publications fees have been covered by the University of Geneva. Author Contribution MR: Methodology; Validation; Formal analysis / Statistics; Writing – original draft; Writing – review & editing; Visualization. BD: Data curation; Formal analysis / Statistics; Writing – review & editing; Visualization. SK: Conceptualization; Methodology; Validation; Resources; Supervision; Project administration; Writing – review & editing. GA: Conceptualization; Methodology; Validation; Resources; Supervision; Project administration; Writing – review & editing. All authors reviewed the manuscript and approved the final version. Acknowledgement The authors would like to thank Dr. Ghaith Alfakhry for providing comments on the statistical analysis. Data Availability All raw data are publicly available on the American Association of Orthodontist Foundation (AAOF) Craniofacial Growth Legacy Collection website ( [www.aaoflegacycollection.org](http:/www.aaoflegacycollection.org) ). References Björk A (1963) Variations in the Growth Pattern of the Human Mandible: Longitudinal Radiographic Study by the Implant Method. J Dent Res 42:400–411. https://doi.org:10.1177/00220345630420014701 Becker MH, Converse CP (1976) Antegonial notching of the mandible an often overlooked deformity. Radiology 121:149–151 Kitagawa N et al (2023) The notch of the mandible: what do different fields call it? Anat cell biology 56:308–312 Mączka G et al (2022) Morphology of the antegonial notch and its utility in the determination of sex on skeletal materials. J Anat 241:919–927 Schütz C, Denes BJ, Kiliaridis S, Antonarakis GS (2022) Mandibular antegonial notch depth in postpubertal individuals: a longitudinal cohort study. Clin experimental Dent Res 8:923–930 Kiliaridis S (1995) Masticatory muscle influence on craniofacial growth. Acta Odontol Scand 53:196–202 Tunis TS et al (2025) Association of antegonial notch size with craniofacial morphology and masticatory muscle dimensions. Sci Rep 15:23557 Hovell JH (1965) VARIATIONS IN MANDIBULAR FORM. Ann R Coll Surg Engl 37:1–18 Obamiyi S et al (2018) Radiographic Features Associated with Temporomandibular Joint Disorders among African, White, Chinese, Hispanic, and Indian Racial Groups. Niger J Clin Pract 21:1495–1500. https://doi.org:10.4103/njcp.njcp_63_18 Manabe A et al (2024) A cephalometric analysis of the antegonial notch in relation to the direction of mandibular growth. Sci Rep 14:23241 Chalazoniti A, Lattanzi W, Halazonetis DJ (2024) Shape variation and sex differences of the adult human mandible evaluated by geometric morphometrics. Sci Rep 14:8546 Field A (2017) Discovering statistics using IBM SPSS statistics (fifth edition) . 11sage Björk A (1969) Prediction of mandibular growth rotation. Am J Orthod 55:585–599. https://doi.org:10.1016/0002-9416(69)90036-0 Bjork A, Skieller V (1983) Normal and abnormal growth of the mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years. Eur J Orthod 5:1–46. https://doi.org:10.1093/ejo/5.1.1 Singer CP, Mamandras AH, Hunter WS (1987) The depth of the mandibular antegonial notch as an indicator of mandibular growth potential. Am J Orthod Dentofac Orthop 91:117–124. https://doi.org:10.1016/0889-5406(87)90468-9 Lambrechts AHD, Harris AMP, Rossouw PE, Stander I (1996) Dimensional changes of the craniofacial morphologies of groups with deep and shallow mandibular antegonial notching. TheAngle Orthod 66:265–272. https://doi.org:10.1043/0003-3219(1996)066%3C0265:Dditcm%3E2.3.Co;2 Halazonetis DJ, Shapiro E, Gheewalla RK (1991) Ernest Clark, R. Quantitative description of the shape of the mandible. Am J Orthod Dentofac Orthop 99:49–56. https://doi.org:10.1016/s0889-5406(05)81680-4 Kolodziej RP, Southard TE, Southard KA, Casko JS, Jakobsen JR (2002) Evaluation of antegonial notch depth for growth prediction. Am J Orthod Dentofac Orthop 121:357–363. https://doi.org:10.1067/mod.2002.121561 Cohen J (1988) Statistical power analysis for the behavioural sciences (2nd edition). Hillsdale, NJ: Erlbaum. Ingervall B, Helkimo E (1978) Masticatory muscle force and facial morphology in man. Arch Oral Biol 23:203–206 Pepicelli A, Woods M, Briggs C (2005) The mandibular muscles and their importance in orthodontics: a contemporary review. Am J Orthod Dentofac Orthop 128:774–780 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 05 Jan, 2026 Reviews received at journal 15 Dec, 2025 Reviewers agreed at journal 14 Dec, 2025 Reviews received at journal 28 Nov, 2025 Reviewers agreed at journal 08 Nov, 2025 Reviewers invited by journal 06 Nov, 2025 Editor assigned by journal 15 Oct, 2025 Submission checks completed at journal 15 Oct, 2025 First submitted to journal 14 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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20:26:51\",\"extension\":\"xml\",\"order_by\":6,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":69841,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"00922bee1332455caf8aa2d6a078c9da1structuring.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7862123/v1/6860bc74834654a1df4005a1.xml\"},{\"id\":96216266,\"identity\":\"b1859eee-8ffb-4058-a2f6-0ec1824a7571\",\"added_by\":\"auto\",\"created_at\":\"2025-11-18 20:26:51\",\"extension\":\"html\",\"order_by\":7,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":77639,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7862123/v1/19ae7ce2dac3588ca40d39d5.html\"},{\"id\":96253240,\"identity\":\"f3fc1ee0-702b-4d0c-a061-a75a51784941\",\"added_by\":\"auto\",\"created_at\":\"2025-11-19 07:42:11\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":56355,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAntegonial notch depth measured as the perpendicular distance between point D (deepest point of the concavity) and point C on the tangent to the lower border of the mandible (A to B).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7862123/v1/42851726c3c5acb91cdd7264.png\"},{\"id\":96216258,\"identity\":\"156bd2be-e452-48a6-91f5-6f1f5bb1399f\",\"added_by\":\"auto\",\"created_at\":\"2025-11-18 20:26:51\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":16224,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eA comparison of antegonial notch development between male and female participants across three different time points (7, 14, and 18 years of age), showing means (bullets) and standard deviations (whiskers).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7862123/v1/fecd4c7e7088dc58cca15c4f.png\"},{\"id\":96257110,\"identity\":\"f01dfc6c-9135-496c-b44d-38d5caaf7e30\",\"added_by\":\"auto\",\"created_at\":\"2025-11-19 07:51:33\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":775584,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7862123/v1/cc7c80b3-dacc-4ab8-b510-f03f35c26453.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Antegonial Notch Depth and Mandibular Growth: A Longitudinal Multilevel Modelling Approach\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eAccurate prediction of mandibular growth could be an important element to orthodontic and orthognathic treatment planning, enabling timely and effective interventions in developing patients. One anatomical feature of interest is the antegonial notch (also known as the gonial notch, premasseteric notch, or groove for facial vessels), a concavity on the inferior border of the mandible, located anterior to the masseter and medial pterygoid attachments \\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e. Its prominence can range from absent to deep, with mean depths around 2.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.1 mm for orthodontically untreated individuals under the age of 18 in North America \\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eMechanistic theories suggest notch formation results from differential muscular activity. Wolf\\u0026rsquo;s law states that the bone remodels itself based on the load to reach an optimal shape \\u003csup\\u003e\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e. Recent evidence further links antegonial notch dimensions with craniofacial morphology and masticatory muscle size, underscoring its potential as a musculoskeletal growth marker \\u003csup\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e. Hovell proposed that when condylar growth fails to lower the mandible, continued masseter and medial pterygoid activity promotes bone apposition on the gonial angle and notch development, while balanced mandibular and soft-tissue growth yields an absent notch \\u003csup\\u003e\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eIt is important to note that the antegonial notch depth and presence seems to differ depending on ethnicity. Obamiyi et al showed that those with African, Asian and Hispanic ethnicities tend to present with an antegonial notch more often than the White group \\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u003c/sup\\u003e. As for the depth, a study on a Japanese population showed that the mean depth was 3.1 mm\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.1 which was more than the North American group \\u003csup\\u003e\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e, but this may also be dependent on age. Sex also seems to be of relevance with male presenting with a significantly deeper notch \\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/sup\\u003e. Such sexual dimorphism is consistent with broader mandibular shape variation between males and females reported in recent morphometric analyses \\u003csup\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eSch\\u0026uuml;tz et al conducted a retrospective analysis of the antegonial notch depth using a sample of growing children (n\\u0026thinsp;=\\u0026thinsp;302) from North America \\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e. The results showed that males have significantly deeper notches than females (1.2 mm difference). The depth of the notch in those with Class I occlusion was significantly higher than for those with Class II malocclusions. For those with a deep notch (which all happened to be male in the study), the changes occurred largely during or after the adolescent growth spurt between the ages of 13 and 18. Nonetheless, an important shortcoming of the Sch\\u0026uuml;tz et al (2022) study was that it does not make it clear that it takes into account the multilevel structure of the paired data \\u0026ndash; participants should be nested within time points \\u0026ndash; therefore, statistical tests and comparisons could be inaccurate due to the violation of the independence of observation assumption \\u003csup\\u003e\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eDespite these anatomical insights, evidence for clinical utility remains conflicting. Bj\\u0026ouml;rk\\u0026rsquo;s longitudinal implant studies indicated a correlation between notch depth and mandibular rotation direction\\u0026mdash;deep notches with vertical growth, shallow with horizontal \\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e\\u003c/sup\\u003e. Singer et al. and Lambrechts et al. similarly reported that deep notches correspond to increased vertical facial growth, increased facial height, and obtuse gonial angles \\u003csup\\u003e\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u003c/sup\\u003e. On the other hand, however, Halazonetis et al. and Kolodziej et al. countered that notch depth shows weak or no predictive value for rotation or future facial growth \\u003csup\\u003e\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u003c/sup\\u003e. Moreover, Kolodziej et al. in their longitudinal study of untreated normal subjects concluded that while a statistically significant relationship exists between notch depth and horizontal jaw growth, the correlation lacks clinical significance \\u003csup\\u003e\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eThus, although the antegonial notch remains a promising anatomical marker, its relevance in routine growth prediction\\u0026mdash;especially in normative dental populations\\u0026mdash;remains unresolved, and longitudinal investigations in untreated cohorts are needed. Given the paucity of evidence, the factors associated with a deeper/shallower notch are still unclear in an untreated population. To address this gap, the present longitudinal study evaluated orthodontically untreated participants to: (1) to evaluate the development of the antegonial notch during normal growth in orthodontically-untreated subjects; and (2) to determine whether cephalometric craniofacial morphology can help predict the depth of the antegonial notch in growing subjects. These objectives could help clarify whether antegonial notch depth could constitute a reliable, clinically applicable marker for mandibular growth monitoring and prediction in general populations.\\u003c/p\\u003e\"},{\"header\":\"Material and Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSample selection\\u003c/h2\\u003e\\u003cp\\u003eFor this retrospective study, lateral cephalograms of 250 patients of which 42.4% (n\\u0026thinsp;=\\u0026thinsp;106) were female, were collected from the American Association of Orthodontist Foundation (AAOF) Craniofacial Growth Legacy Collection website (\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ewww.aaoflegacycollection.org\\u003c/a\\u003e\\u003c/span\\u003e\\u003cspan address=\\\"http://www.aaoflegacycollection.org\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e). Formal ethical approval and additional informed consent were not required, as the raw data (lateral cephalograms) are publicly accessible through the stated resource. The study was conducted in compliance with the Declaration of Helsinki. Records were taken from all nine growth studies available on the online database, including all three Angle dental classifications (Class I, Class II and Class III), where three lateral cephalometric radiographs were available at the ages of 7/8 years, 13/14 years and 17/18 (or \\u0026gt;\\u0026thinsp;17 years) for the same participant. The majority of participants had Class I (67.2%, n\\u0026thinsp;=\\u0026thinsp;168) occlusion, while 29.6% (n\\u0026thinsp;=\\u0026thinsp;74) had a Class II malocclusion, while only 3.2% (n\\u0026thinsp;=\\u0026thinsp;8) were Class III. These three age groups represent preadolescent children, adolescents, and young adults \\u003csup\\u003e\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u003c/sup\\u003e. The ethnicity for our sample was either White or African American.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eEvaluation of the development of the antegonial notch\\u003c/h3\\u003e\\n\\u003cp\\u003eThe lateral (right side) cephalograms were calibrated, traced and analysed by a single operator (M.R.), using Osirix software (OsiriX v3.9 Pixmeo SARL). The magnification criteria were provided on the AAOF legacy collection website for each growth study group in order to correctly calibrate all radiographs and accurately measure both linear and angular values on the radiographs. The antegonial notch depth was measured as the perpendicular distance between the deepest point on the mandibular body concavity and tangent to the lower body of the mandible (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). In case of double contours, for example where the border of the right and left mandibular bodies did not coincide, points and planes were traced as a mean distance between right and left contours. This was measured on the lateral cephalometric radiograph at all three ages for each individual. A Mixed ANOVA was conducted using SPSS to examine changes in the dependent variable across three time points (within-subjects factor: Time) and to assess the effects of two fixed between-subject factors: Sex and Angle classification of malocclusion. This method was selected to test for both main effects and interactions while accounting for repeated measurements within participants. Greenhouse-Geisser correction was applied where assumptions of sphericity were violated. A \\u003cem\\u003eP\\u003c/em\\u003e-value of \\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003ch3\\u003eCorrelations between antegonial notch depth and craniofacial morphology\\u003c/h3\\u003e\\n\\u003cp\\u003eCraniofacial morphology was determined using the lateral cephalometric radiographs, concentrating on variables representing the sagittal and vertical skeletal relationships as well as the gonial angle. Cephalometric landmarks and angular measurements used in this study are shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eCephalometric landmarks and angles measurements\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLandmark\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinition\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eS (Sella)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMidpoint of the sella turcica\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN (Nasion)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eJunction of nasal and frontal bones at the naso-frontal suture\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eANS (Anterior Nasal Spine)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMost anterior point on the sagittal plane of the bony hard palate on the mid-sagittal plane\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePNS (Posterior Nasal Spine)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMost posterior point on the sagittal plane of the bony hard palate on the mid-sagittal plane\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eA (Point A)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDeepest point of the concavity of the anterior maxilla\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eB (Point B)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDeepest point of the concavity of the anterior mandible\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAr (Articulare)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePoint of intersection of the inferior cranial base surface with the surface of the mandibular condyles\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGo (Gonion)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eThe most posterior-inferior and lateral point at the angle of the mandible, located by bisecting the angle formed by the posterior ramus and the inferior border of the mandible.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMe (Menton)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eThe lowest midline point on the inferior border of the mandibular symphysis.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eFrom these landmarks, the following angular measurements were made: ANB angle; mandibular plane angle (SN-MeGo); intermaxillary angle (ANSPNS-MeGo); and the gonial angle (Ar-Go\\u0026rsquo;-Me).\\u003c/p\\u003e\\u003cp\\u003eCorrelations between the depth of the antegonial notch and cephalometric angular variables were carried by using linear regression analysis. A \\u003cem\\u003eP\\u003c/em\\u003e-value of \\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e\\n\\u003ch3\\u003eError of the method\\u003c/h3\\u003e\\n\\u003cp\\u003eTo evaluate both systematic and random errors in localizing landmarks, 30 lateral cephalograms were randomly chosen (using the true random number generator - \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.random.org\\u003c/span\\u003e\\u003cspan address=\\\"https://www.random.org\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e) and retraced by the same examiner. Systematic error was calculated using paired t-tests, revealing no significant systematic error (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). Random error was assessed using Dahlberg\\u0026rsquo;s formula, and the maximum error was found to be 0.3mm for linear and 1.1\\u0026deg; for angular measurements.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eRepeated measures ANOVA showed that antegonial notch depth significantly fluctuated between the three time points measured (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) with a medium effect size (η\\u003csub\\u003ep\\u003c/sub\\u003e\\u0026sup2;=0.09) according to Cohen 1988 \\u003csup\\u003e19\\u003c/sup\\u003e. Post-hoc showed all time points differed significantly from one another.\\u003c/p\\u003e\\u003cp\\u003eDescriptive statistics (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e) revealed that on average males exhibited deeper antegonial notches than females at all time points, with the greatest divergence observed at age 18, where males had a mean depth of 2.10 mm (SD\\u0026thinsp;=\\u0026thinsp;1.10) compared to 1.39 mm (SD\\u0026thinsp;=\\u0026thinsp;0.65) in females. Within time comparison for each sex subgroup, it could be noticed that the male group notch depth fluctuated dropping at 14 years of age then increasing at 18 years in contrast to the female group which consistently decreased at each time point (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eFindings of Mixed Repeated Measures ANOVA for the antegonial notch depth for the three time points across sex and occlusal class subgroups.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"9\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003eTime Point\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eSex\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c6\\\" namest=\\\"c4\\\"\\u003e\\u003cp\\u003eAngle Class\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003eEffects\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMale\\u003c/b\\u003e (n\\u0026thinsp;=\\u0026thinsp;144)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eFemale\\u003c/b\\u003e (n\\u0026thinsp;=\\u0026thinsp;106)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eClass I (n\\u0026thinsp;=\\u0026thinsp;168)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eClass II (n\\u0026thinsp;=\\u0026thinsp;74)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eClass III (n\\u0026thinsp;=\\u0026thinsp;8)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003eES (η\\u003csub\\u003ep\\u003c/sub\\u003e\\u0026sup2;)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eTime\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.037\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime 1 (yr 7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.96\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.68\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.09\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.63\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.98\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.66\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eTime \\u0026times; Sex\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.029\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime 2 (yr 14)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.76\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.86\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.72\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.83\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.72\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eTime \\u0026times; Class\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.448\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.007\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime 3 (yr 18)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.10\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.65\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.88\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.04\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.64\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.86\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eTime \\u0026times; Sex \\u0026times; Class\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.709\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.004\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003ePer class comparison shows that antegonial notch depth fluctuated for Class I and II occlusions, decreasing at 14 years of age, then slightly increasing at Year 18 (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Class III, however, decreased consistently across the three time points.\\u003c/p\\u003e\\u003cp\\u003eA mixed repeated measures ANOVA was conducted to evaluate changes in antegonial notch depth across three developmental time points (ages 7, 14, and 18 years) accounting for sex and class as fixed factors (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). The analysis showed a significant main effect of time (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, partial η\\u0026sup2; = 0.037), indicating that antegonial notch depth varied significantly over time with a small effect size according to Cohen 1988 \\u003csup\\u003e19\\u003c/sup\\u003e. The time and sex interaction were also statistically significant with a small effect size (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.001, partial η\\u0026sup2; = 0.029), suggesting that the pattern in notch depth across time differed meaningfully between males and females (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). The time and molar Class interactions, and the time and molar class and sex interactions were not statistically significant (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eMultilevel General Linear Model for Different Craniofacial Morphologies as Predictors of Antegonial Notch Depth\\u003c/h2\\u003e\\u003cp\\u003eInterclass Correlation Coefficient (ICC) was 0.63 showing a clear need for multilevel modelling. The multilevel model (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e) shows that none of the studied craniofacial morphologies significantly predict antegonial notch depth except for the gonial angle (B=-0.014, P\\u0026thinsp;=\\u0026thinsp;0.04), but with a small effect size (ES\\u0026thinsp;=\\u0026thinsp;0.20). The intermaxillary angle (ANSPNS \\u0026ndash; ML) measurement also seems to be minimally significant (B=\\u0026ndash;0.0191, P\\u0026thinsp;=\\u0026thinsp;0.064) with a small effect size (ES\\u0026thinsp;=\\u0026thinsp;0.18). The model shows that the higher the gonial angle and the intermaxillary angle values were, the shallower the depth of the antegonial notch (negative correlation).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eMultilevel general linear model of participants' antegonial notch depth as predicted by different craniofacial morphologies\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEffect Type\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePredictor\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eB\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSE\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eP\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eES\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFixed\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIntercept\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.9627\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eTime\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026ndash;0.1240\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.0297\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.39\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eANB\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0165\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.0154\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.283\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMandibular plane angle\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0091\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.0111\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.415\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.08\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIntermaxillary angle\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026ndash;0.0191\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.0103\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.064\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.18\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGonial angle\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026ndash;0.0140\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.0069\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.044\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRandom\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIntercept\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.4086\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eTime\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0663\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eResidual\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1900\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003eB: unstandardized regression estimate; SE: standard error; P: probability that the association or the difference is due to chance; ES: Effect size\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe present study aimed to assess the development of the antegonial notch during growth in orthodontically-untreated subjects and to determine whether cephalometric craniofacial morphology measures can predict the depth of the antegonial notch. In this longitudinal cohort of untreated individuals, antegonial notch depth showed statistically significant changes over time with a medium effect size. Males consistently exhibited deeper notches than females at all ages \\u003csup\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/sup\\u003e. Both sexes showed a decrease in notch depth from ages 7\\u0026ndash;8 to 13\\u0026ndash;14, but thereafter males experienced an increase by age 17/18 while females continued a slight decline. Angle class (I, II, III) didn\\u0026rsquo;t seem to have a significant main effect on antegonial notch development. Multilevel modelling showed that only the gonial angle (and marginally the intermaxillary angle) could significantly predict notch depth, with larger gonial angles associated with slightly shallower notches, although the clinical significance of this finding is questionable.\\u003c/p\\u003e\\u003cp\\u003eThe pronounced sex difference and timing of change hint at underlying mechanisms. Males not only had deeper notches on average, but their notches deepened after age 13/14, whereas females\\u0026rsquo; notches continued to flatten, as also suggested by other data \\u003csup\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/sup\\u003e. This observation aligns with broader morphometric evidence that mandibular shape is highly sexually dimorphic beyond notch morphology, which is in line with previous results \\u003csup\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/sup\\u003e. This pattern is consistent with muscle-driven remodelling suggested in the literature \\u003csup\\u003e\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e\\u003c/sup\\u003e. In puberty, boys typically experience a surge in masticatory muscle mass, which could stimulate bone apposition at the gonial angle and accentuate the notch \\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e. Indeed, Sch\\u0026uuml;tz et al. interpreted their results with this in mind, suggesting that increased notch depth in males may be due to stronger masticatory forces and greater muscle mass (5). Our finding that notch depth correlated negatively with gonial angle (i.e. deeper notches in jaws that grew more horizontally) may reflect such muscular influences rather than a primary skeletal growth factor \\u003csup\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eClinically, these insights imply caution in using the antegonial notch depth to predict mandibular growth. Although statistically significant, the effects we observed are small to medium. Thus, antegonial notch depth is not a robust standalone marker for treatment timing or growth forecasts. It may instead serve as an indicator of individual mandibular morphology or muscle function. The absence of strong correlations with conventional cephalometric angles (ANB or the mandibular plane angle) suggests that notch depth is more a feature of local bone remodelling. This aligns with the view that antegonial notch should not be overinterpreted as a \\u0026ldquo;growth potential\\u0026rdquo; gauge \\u003csup\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eOur results both align with and diverge from prior studies. Consistent with Sch\\u0026uuml;tz et al., we found that males have deeper notches than females and that most deepening occurs around puberty \\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e, keeping in mind that part of the material between the two studies is common since it is derived from the AAOF Craniofacial Growth Legacy Collection. However, unlike Lambrechts et al. and Singer et al. \\u003csup\\u003e15,16\\u003c/sup\\u003e who proposed deep notches as markers of a hyperdivergent (backward-rotating) growth pattern, we observed the opposite tendency. In our sample, deeper notches were linked to smaller gonial angles (a more horizontal growth orientation). This agrees more closely with Kolodziej et al., who reported that antegonial notch depth is not a reliable indicator of growth direction \\u003csup\\u003e\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u003c/sup\\u003e. For example, whereas Lambrechts et al. and Singer et al. found deep notches in vertical growers, Kolodziej et al. found no clinically useful correlation between notch depth and future mandibular growth. Similarly, Halazonetis and co-workers also noted only weak or nonsignificant relationships between notch depth and craniofacial angles \\u003csup\\u003e\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e\\u003c/sup\\u003e. In effect, our findings support the view that antegonial notch depth, at least in a healthy orthodontically-untreated population, has limited predictive value for overall craniofacial growth pattern.\\u003c/p\\u003e\\u003cp\\u003eNotably, Sch\\u0026uuml;tz et al. reported only a fractional average difference (\\u0026asymp;\\u0026thinsp;0.33 mm) between antegonial notches in individuals with Class I and II malocclusions, cautioning that this is about the same magnitude as the measurement error \\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e. We observed the same: any differences notch depth between individuals with different Angle molar relationships were insignificant and within 0.5 mm. This suggests that sagittal occlusion (in orthodontically-untreated individuals) has minimal influence on notch depth during growth. The consistency between our results and those of Sch\\u0026uuml;tz et al. \\u003csup\\u003e5\\u003c/sup\\u003e particularly regarding sex differences and the timing of notch change \\u0026ndash; strengthens confidence in these findings despite the sample being derived from the same source (namely the AAOF).\\u003c/p\\u003e\\u003cp\\u003eThe present study has certain limitations. It was retrospective in nature, relying on historical growth-study radiographs with variable quality. Although we calibrated images, older film images can introduce noise. Our sample, drawn from predominantly White or African-American cohorts, limits generalization to other ethnic groups (notably, prior work reports deeper mean notches in Asian populations) \\u003csup\\u003e\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e. The relatively small number of individuals with Class III malocclusions reduces power to detect differences in these individuals. Importantly, we used mixed (multilevel) modelling to account for repeated measures, addressing a key shortfall of past analyses which violated the assumption of independence of observation. Future studies could improve on this by using 3D imaging to capture notch morphology more fully, and by directly measuring muscle size or function \\u003csup\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e. Longitudinal research in larger, more diverse samples would clarify whether early antegonial notch characteristics have any predictive value for later mandibular or craniofacial growth or treatment outcomes.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eAntegonial notch depth changes only modestly during normal growth, is consistently deeper in males, and is only weakly linked to sagittal or vertical skeletal characteristics. These findings might suggest that notch depth reflects localized bone remodelling (likely driven by musculature) rather than serving as a clear marker of overall mandibular growth direction. While our data do not support using notch depth in isolation for growth prediction, they contribute normative benchmarks and underscore the need to consider muscular and developmental factors when interpreting mandibular anatomy.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003ch2\\u003eCompeting Interests\\u003c/h2\\u003e\\u003cp\\u003eThe authors declare that they have no conflict of interest to disclose.\\u003c/p\\u003e\\u003ch2\\u003eAuthor contributions statement\\u003c/h2\\u003e\\u003cp\\u003eMR: Methodology; Validation; Formal analysis / Statistics; Writing \\u0026ndash; original draft; Writing \\u0026ndash; review \\u0026amp; editing; Visualization. BD: Data curation; Formal analysis / Statistics; Writing \\u0026ndash; review \\u0026amp; editing; Visualization. SK: Conceptualization; Methodology; Validation; Resources; Supervision; Project administration; Writing \\u0026ndash; review \\u0026amp; editing. GA: Conceptualization; Methodology; Validation; Resources; Supervision; Project administration; Writing \\u0026ndash; review \\u0026amp; editing. All authors reviewed the manuscript and approved the final version.\\u003c/p\\u003e\\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e\\u003cp\\u003eNo funding was given to conduct or write the research paper. However, publications fees have been covered by the University of Geneva.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eMR: Methodology; Validation; Formal analysis / Statistics; Writing \\u0026ndash; original draft; Writing \\u0026ndash; review \\u0026amp; editing; Visualization. BD: Data curation; Formal analysis / Statistics; Writing \\u0026ndash; review \\u0026amp; editing; Visualization. SK: Conceptualization; Methodology; Validation; Resources; Supervision; Project administration; Writing \\u0026ndash; review \\u0026amp; editing. GA: Conceptualization; Methodology; Validation; Resources; Supervision; Project administration; Writing \\u0026ndash; review\\u0026nbsp;\\u0026amp;\\u0026nbsp;editing. All authors reviewed the manuscript and approved the final version.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\u003cp\\u003eThe authors would like to thank Dr. Ghaith Alfakhry for providing comments on the statistical analysis.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eAll raw data are publicly available on the American Association of Orthodontist Foundation (AAOF) Craniofacial Growth Legacy Collection website ( [www.aaoflegacycollection.org](http:/www.aaoflegacycollection.org) ).\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBj\\u0026ouml;rk A (1963) Variations in the Growth Pattern of the Human Mandible: Longitudinal Radiographic Study by the Implant Method. J Dent Res 42:400\\u0026ndash;411. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1177/00220345630420014701\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1177/00220345630420014701\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBecker MH, Converse CP (1976) Antegonial notching of the mandible an often overlooked deformity. Radiology 121:149\\u0026ndash;151\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKitagawa N et al (2023) The notch of the mandible: what do different fields call it? Anat cell biology 56:308\\u0026ndash;312\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMączka G et al (2022) Morphology of the antegonial notch and its utility in the determination of sex on skeletal materials. J Anat 241:919\\u0026ndash;927\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSch\\u0026uuml;tz C, Denes BJ, Kiliaridis S, Antonarakis GS (2022) Mandibular antegonial notch depth in postpubertal individuals: a longitudinal cohort study. Clin experimental Dent Res 8:923\\u0026ndash;930\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKiliaridis S (1995) Masticatory muscle influence on craniofacial growth. Acta Odontol Scand 53:196\\u0026ndash;202\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eTunis TS et al (2025) Association of antegonial notch size with craniofacial morphology and masticatory muscle dimensions. Sci Rep 15:23557\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHovell JH (1965) VARIATIONS IN MANDIBULAR FORM. Ann R Coll Surg Engl 37:1\\u0026ndash;18\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eObamiyi S et al (2018) Radiographic Features Associated with Temporomandibular Joint Disorders among African, White, Chinese, Hispanic, and Indian Racial Groups. Niger J Clin Pract 21:1495\\u0026ndash;1500. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.4103/njcp.njcp_63_18\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.4103/njcp.njcp_63_18\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eManabe A et al (2024) A cephalometric analysis of the antegonial notch in relation to the direction of mandibular growth. Sci Rep 14:23241\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eChalazoniti A, Lattanzi W, Halazonetis DJ (2024) Shape variation and sex differences of the adult human mandible evaluated by geometric morphometrics. Sci Rep 14:8546\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eField A (2017) \\u003cem\\u003eDiscovering statistics using IBM SPSS statistics (fifth edition)\\u003c/em\\u003e. 11sage\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBj\\u0026ouml;rk A (1969) Prediction of mandibular growth rotation. Am J Orthod 55:585\\u0026ndash;599. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1016/0002-9416(69)90036-0\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1016/0002-9416(69)90036-0\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBjork A, Skieller V (1983) Normal and abnormal growth of the mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years. Eur J Orthod 5:1\\u0026ndash;46. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1093/ejo/5.1.1\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1093/ejo/5.1.1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSinger CP, Mamandras AH, Hunter WS (1987) The depth of the mandibular antegonial notch as an indicator of mandibular growth potential. Am J Orthod Dentofac Orthop 91:117\\u0026ndash;124. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1016/0889-5406(87)90468-9\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1016/0889-5406(87)90468-9\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLambrechts AHD, Harris AMP, Rossouw PE, Stander I (1996) Dimensional changes of the craniofacial morphologies of groups with deep and shallow mandibular antegonial notching. TheAngle Orthod 66:265\\u0026ndash;272. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1043/0003-3219(1996)066%3C0265:Dditcm%3E2.3.Co;2\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1043/0003-3219(1996)066%3C0265:Dditcm%3E2.3.Co;2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHalazonetis DJ, Shapiro E, Gheewalla RK (1991) Ernest Clark, R. Quantitative description of the shape of the mandible. 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Am J Orthod Dentofac Orthop 121:357\\u0026ndash;363. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1067/mod.2002.121561\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1067/mod.2002.121561\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCohen J (1988) \\u003cem\\u003eStatistical power analysis for the behavioural sciences (2nd edition). Hillsdale, NJ: Erlbaum.\\u003c/em\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eIngervall B, Helkimo E (1978) Masticatory muscle force and facial morphology in man. Arch Oral Biol 23:203\\u0026ndash;206\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePepicelli A, Woods M, Briggs C (2005) The mandibular muscles and their importance in orthodontics: a contemporary review. Am J Orthod Dentofac Orthop 128:774\\u0026ndash;780\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"clinical-oral-investigations\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"cloi\",\"sideBox\":\"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)\",\"snPcode\":\"784\",\"submissionUrl\":\"https://submission.nature.com/new-submission/784/3\",\"title\":\"Clinical Oral Investigations\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"Antegonial notch, mandibular growth, cephalometry, craniofacial development, multilevel modelling, orthodontics\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7862123/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7862123/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cb\\u003eIntroduction:\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe antegonial notch has been proposed as a morphological indicator of mandibular growth, yet its developmental trajectory and predictive value remain insufficiently explored. This study examined how the antegonial notch changes across growth and whether craniofacial morphology can predict its depth.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eMethods\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eA longitudinal sample of 250 untreated individuals (42% female) was analysed at three ages: 7/8, 13/14, and 17/18. Antegonial notch depth was measured from lateral cephalograms. A mixed repeated-measures ANOVA tested the effects of age, sex, and Angle molar classification, while multilevel general linear regression evaluated whether skeletal morphology predicted antegonial notch depth.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eResults\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eAntegonial notch depth changed significantly over time (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Males consistently had deeper notches than females. Shallowing of the antegonial notch was generally seen in both sexes between ages 7 and 14 but deepened thereafter in males. Angle molar classification showed no significant influence on notch depth. Multilevel modelling revealed only the gonial angle as a significant predictor (B=\\u0026ndash;0.014, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.044) to notch depth.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eConclusion\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eAntegonial notch depth undergoes modest sex-specific changes during adolescence and is minimally associated with craniofacial morphology, with only the neighbouring gonial process being a significant predictor possibly reflecting the view that antegonial notch depth primarily reflects localized bone remodelling.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Antegonial Notch Depth and Mandibular Growth: A Longitudinal Multilevel Modelling Approach\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-11-18 20:26:46\",\"doi\":\"10.21203/rs.3.rs-7862123/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-01-05T09:19:34+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-15T19:48:59+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"265542106165158355470638298119661756016\",\"date\":\"2025-12-14T13:25:59+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-28T12:09:14+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"214529237625234806339482516223272289241\",\"date\":\"2025-11-08T14:11:35+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-06T07:34:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-10-15T05:48:33+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-10-15T05:48:20+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Clinical Oral Investigations\",\"date\":\"2025-10-14T22:08:55+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"clinical-oral-investigations\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"cloi\",\"sideBox\":\"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)\",\"snPcode\":\"784\",\"submissionUrl\":\"https://submission.nature.com/new-submission/784/3\",\"title\":\"Clinical Oral Investigations\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"38a7fa9c-035f-4fb9-b05f-6a0a35aab3b2\",\"owner\":[],\"postedDate\":\"November 18th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"in-revision\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-15T07:54:48+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-11-18 20:26:46\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7862123\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7862123\",\"identity\":\"rs-7862123\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}