Multidimensional patterns of malocclusion in treatment-seeking Turkish orthodontic patients

Malocclusion is a common craniofacial disorder with significant functional and aesthetic implications. Although sagittal, vertical, and transverse discrepancies frequently coexist, most prevalence studies evaluate these traits separately. This study aimed to analyze the prevalence and multidimensional interactions of sagittal, vertical, and transverse malocclusions in a large Turkish treatment-seeking orthodontic cohort using artificial intelligence-assisted overbite measurements for standardized vertical assessment. A retrospective cross-sectional analysis was performed on standardized intraoral photographs and cephalometric radiographs of 2624 treatment-seeking orthodontic patients (1125 males and 1499 females) treated at a tertiary referral university clinic between 2007 and 2020. Sagittal malocclusions were classified according to Angle’s classification (class I, II, and III). Transverse relationships were defined by the presence or absence of posterior crossbite, while vertical subgroups were established using artificial intelligence-assisted overbite measurements for standardized vertical assessment. Chi-square tests with Bonferroni-adjusted pairwise comparisons and multinomial logistic regression were performed. Class II malocclusion was the most prevalent sagittal malocclusion (49.1%), followed by class I (33.0%) and class III (17.9%). Normal transverse relationships predominated in class I (54.3%) and class II (66.9%), whereas more than half of class III individuals exhibited posterior crossbite (57.9%). In class I and II, posterior crossbite was seen more frequently in open bite cases and was least common in deep bite cases. In class III, posterior crossbite prevalence remained high across all vertical subgroups, regardless of overbite pattern. Multinomial logistic regression showed that deep bite had the strongest independent association with class II malocclusion, whereas bilateral posterior crossbite had the strongest independent association with class III malocclusion. The prevalence of orthodontic malocclusions should be evaluated using a multidimensional approach that considers the coexistence of sagittal, vertical, and transverse discrepancies rather than assessing each occlusal dimension independently. The strong association between class III malocclusion and posterior crossbite, together with the vertical–transverse interactions observed in class I and II, highlights the importance of comprehensive multidimensional orthodontic assessment and individualized treatment planning. Recognizing these multidimensional patterns may facilitate comprehensive clinical assessment and guide future epidemiological research.