This study investigates the influence of vertical facial growth patterns on the morphology of the zygomatic buttress (ZB) donor site and its implications for preoperative planning in bone grafting.

A total of 100 adult Cone beam computed tomography (CBCT) scans were analyzed and categorized into hypodivergent, normodivergent, and hyperdivergent groups based on SN-GoGn angles. Three-dimensional ZB models were created using semi-automatic segmentation, with key parameters—volume, surface area, thickness, and anteroposterior protrusion—measured using stable anatomical landmarks. Statistical analyses included descriptive statistics, one-way analysis of variance (ANOVA), Tukey's post-hoc tests, and Kruskal-Wallis H tests where necessary. A p-value < 0.05 was considered statistically significant.

ZB morphology varied significantly across facial growth types. Hypodivergent faces exhibited the highest bone volume (533.25 ± 129.58 mm³), surface area (560.70 ± 99.76 mm²), total thickness (4.68 ± 1.91 mm), and bulge thickness (9.75 ± 2.51 mm). Normodivergent faces showed intermediate values for bone volume (394.39 ± 141.62 mm³), surface area (504.27 ± 108.54 mm²), and thickness (2.79 ± 1.05 mm total, 5.42 ± 2.45 mm bulge). Hyperdivergent faces had the lowest bone volume (259.00 ± 86.28 mm³), surface area (422.64 ± 95.59 mm²), total thickness (1.70 ± 0.49 mm), and bulge thickness (3.57 ± 1.66 mm). Anteroposterior protrusion also differed significantly, with hypodivergent faces showing the largest protrusion (21.56 ± 3.24 mm).

The ZB is a reliable donor site with morphology influenced by facial growth patterns. Preoperative radiographic assessment facilitates optimized surgical planning and tailored grafting strategies.