# An Evaluation of the Ramus Mandibular Asymmetry on the Panoramic Radiography
## 4 Discussion  
In order to evaluate mandibular posterior vertical asymmetry, the analysis of the panoramic radiography proved to be an efficient conventional method for the radiological film capturing temporomandibular joints, the ramus of the mandible, the body of the mandible and dental structures [42]. Although its reliability and validity are still in question due to the magnifying distortion effect, most authors have demonstrated that changes in the head position do not significantly affect the results of the vertical measurements [31; 32; 43]. It is considered that the asymmetry caused by the incorrect head position has a value below 6%, and a difference in growth recorded between the conde and the right and left ramus higher than 6% already indicates the presence of vertical mandibular asymmetry [31; 32]. In the specialized literature, in some studies of mandibular asymmetry, sexual dimorphism was not taken into account due to the limited size of the studied groups [44; 45], and in other studies, these differences were investigated, but no statistically significant results were recorded [37; 46; 47; 48]. This study aimed to evaluate the asymmetry of the mandibular vertical ramus in two groups of patients, females and males, with mixed and permanent dentition with different types of malocclusions in the sagittal and transverse planes. From the collected results, in the group of 214 patients, a percentage higher than 3% of conde asymmetry was observed, with the percentage of males being higher than that of females, and with statistically significant differences. In the types of malocclusions studied, the greatest changes were highlighted when calculating the asymmetry index of the conde in the unilateral posterior crossbite, which was higher in males than in females, with a statistically significant difference. Regarding the asymmetry indices of the ramus and the conde-plus-ramus, homogeneity was recorded within the studied groups, with no notable differences between the group of females and males. In females, greater asymmetry of the conde \begin{table}
\begin{tabular}{c c c c c c|c} \hline \multirow{2}{*}{**Type of Occlusion**} & \multicolumn{2}{c}{**Male**} & \multicolumn{2}{c|}{**Female**} & \multirow{2}{*}{**\(p\)-Value**} & \multirow{2}{*}{**Mann-Whitney U Test**} \\ \cline{2-2} \cline{4-6}  & **Mean (\%)** & **SD (\%)** & **Mean (\%)** & **SD (\%)** & \\ \hline \hline
**I** & 2.0 & 1.9 & 2.1 & 1.1 & 0.8398 & 0.546631 \\
**I/1** & 2.2 & 1.9 & 2.1 & 1.7 & 0.8027 & 0.919097 \\
**II/2** & 1.8 & 1.6 & 2.0 & 1.3 & 0.6411 & 0.410383 \\
**III** & 2.4 & 2.0 & 3.0 & 1.3 & 0.4118 & 0.195488 \\
**UPC** & 2.3 & 1.6 & 2.4 & 2.1 & 0.8410 & 0.796219 \\ \hline \end{tabular}
\end{table} 
Table 4: Conde-plus-ramus asymmetry index (MAI) according to gender and different occlusion types. \begin{table}
\begin{tabular}{c c c c c c c} \hline \multirow{2}{*}{**Type of Occlusion**} & \multicolumn{2}{c}{**Male**} & \multicolumn{2}{c|}{**Female**} & \multirow{2}{*}{**\(p\)-Value**} & \multirow{2}{*}{**Mann-Whitney U Test**} \\ \cline{2-2} \cline{4-6}  & **Mean (\%)** & **SD (\%)** & **Mean (\%)** & **SD (\%)** & \\ \hline
**I** & 3.0 & 1.9 & 1.9 & 0.8 & 0.1361 & 0.210261 \\
**I/1** & 2.8 & 2.7 & 2.3 & 1.8 & 0.5142 & 0.832379 \\
**I/2** & 2.3 & 1.8 & 2.1 & 1.2 & 0.5773 & 0.950579 \\
**II** & 2.4 & 2.0 & 3.0 & 1.7 & 0.3453 & 0.151181 \\
**UPC** & 3.0 & 1.8 & 2.4 & 2.1 & 0.3839 & 0.281809 \\ \hline \end{tabular}
\end{table} 
Table 3: Ramus asymmetry index (RAI) according to gender and different occlusion types. could be appreciated in Angle Class II/1 and of the ramus and condyle-plus-ramus in Angle Class III. In males, the percentage of asymmetry in the condyle was more noticeable in Class Angle I, of the ramus in Class I and unilateral posterior crossbite, and of the condyle-plus-ramus in Angle Class III. [PERSON] et al. evaluated the condylar and mandibular ramus asymmetry for a group of patients (mean age 14.53 years) with Angle Class I and II malocclusions in order to identify possible differences between males and females.