Morphological decoupling-based skeletal classification for clinical assessment of malocclusion

Malocclusion skeletal grading is a fundamental task in orthodontics, critical for diagnosis and treatment planning. Traditionally, cone-beam computed tomography (CBCT) is used for visual measurement, and the reconstructed lateral cephalograms are handed over to expert dentists for diagnosis. However, manual review is time-consuming, labor-intensive, and subject to inter-operator variability. Therefore, an automatic CBCT-based system is needed for reliable malocclusion skeletal grading. In this case, we develop TeethGNN, a novel graph-based framework designed to combine CBCT image features with morphological information for accurate and efficient malocclusion grading. TeethGNN utilizes a decoupled learnable decoder to directly predict key morphological indicators from CBCT images, eliminating the need for manual measurements. These morphological features are then fused with image features using a graph neural network (GNN), which effectively models the relationships between the modalities. To further enhance robustness and calibration, we introduce a collaborative calibration strategy. This strategy combines multi-scale graph adversarial perturbation for explicit calibration and nonlinear topological graph calibration for implicit confidence adjustment. Extensive experiments and ablation studies on our collected clinical dataset demonstrate that our malocclusion measurement system achieves 77.08% in accuracy and 89.61% in AUC, outperforming the compared state-of-the-art methods. These results validate the effectiveness of graph-based multimodal fusion and collaborative calibration in improving malocclusion grading performance. Our system shows strong potential for advancing computer-aided orthodontic diagnosis, providing an accurate and reliable solution for vision-based clinical measurement and diagnosis.