Influence of cranial base angle on craniofacial morphology in growing orthodontic patients: a retrospective cephalometric study

Background/objectives: This retrospective cephalometric study evaluated the association between cranial base flexure, measured by the NSAr angle, and sagittal and vertical craniofacial morphology in growing orthodontic patients. Methods: Forty patients aged 11-17 years who underwent orthodontic examination and pre-treatment lateral cephalometric radiography at the Orthodontics Department of the Policlinico of Bari were included after ethics committee approval (No. 2377/CEL, September 29, 2025) and written parental informed consent. Participants were classified according to NSAr values into Group A (>125◦), Group B (120◦-125◦), and Group C (<120◦). Eight angular and seven linear cephalometric parameters were measured using Delta-Dent software. Statistical analysis was performed with StataMP17, including normality testing, between-group comparisons, and Pearson or Spearman correlation analyses, with significance set at p < 0.05. Results: In the total sample, NSAr showed significant positive correlations with SN-GoGn (r = 0.35, p = 0.02) and NAPg (r = 0.31, p = 0.04), indicating that a wider cranial base angle was associated with greater mandibular plane inclination and increased facial convexity. A non-significant trend was observed for SNB (r = −0.28, p = 0.08), whereas no significant associations were found with the remaining parameters. NSAr explained approximately 12% of the variability in SN-GoGn, and sensitivity analysis confirmed the robustness of the findings. Conclusions: Cranial base angle was significantly associated with selected sagittal and vertical craniofacial parameters in growing orthodontic patients. NSAr assessment may provide useful adjunctive information for early diagnosis, growth prediction, and individualized orthodontic treatment planning.