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Skieller, Bjrk, and Linde-Hansen method

Laurel R. Leslie, DDS, MS,a Thomas E. Southard, DDS, MS,b Karin A. Southard, DDS, MS,c

John S. Casko, DDS, MS, PhD,d Jane R. Jakobsen, MS,e Elizabeth A. Tolley, PhD,f

Stephen L. Hillis, PhD,g Chris Carolan, MS,g and Mark Logue, MS,g

Iowa City, Iowa, and Memphis, Tenn.

The purpose of this investigation was to assess the method proposed by Skieller, Bjrk, and Linde-Hansen

in 1984 to predict mandibular growth rotation. Our sample consisted of 40 randomly selected, untreated,

adolescent subjects representative of the patient population generally encountered in orthodontic practice.

The four independent variables identified in the Skieller study as having the highest predictive value

(mandibular inclination, intermolar angle, shape of the lower border of the mandible, and inclination of the

symphysis) were identified on initial lateral cephalograms. The proposed regression equations were applied

and predicted mandibular rotations obtained. Final lateral cephalograms made 6 years after the initial profile

radiographs were superimposed and actual mandibular rotation recorded. The observed and predicted

rotations were compared and regression analyses performed to determine the amount of variability in

observed values accounted for by the four variables individually and in combination. Only 5.6% of the

variability in mandibular growth rotation could be accounted for using the four variables individually. Only 9%

of the variability could be accounted for with a combination of the variables. In addition, we performed a

Monte Carlo analysis, which mirrored the Skieller analysis but used random numbers instead of actual

cephalometric data, to determine if the Skieller results may simply have capitalized on chance. Using the

same forward stepwise selection procedure with a rejection level of P > .1, we found after 5000 simulations

that a mean of 84% and a median of 94% of mandibular growth rotation variability could be accounted for

using meaningless data in the Skieller analysis. This result was comparable to the Skieller value of 86%. In

conclusion, information derived from pretreatment lateral cephalograms using the Skieller, Bjrk, and LindeHansen method does not permit clinically useful predictions to be made in a general population relative to

the direction of future mandibular growth rotation. (Am J Orthod Dentofacial Orthop 1998;114:659-67)

growth markedly impact orthodontic therapy in growing patients. Traditionally, it has been demonstrated

that the mandible grows in a downward and forward

direction via posterior growth and anterior displacement.1-8 However, it has also been shown to rotate over

the course of growth.9-12 This rotational aspect of

mandibular growth can greatly influence the therapeutic result of orthodontic treatment. In fact, a backward

rotation of the mandible is quite often regarded as

aIn private practice, Longmont, Colo; former orthodontic resident at The University of Iowa.

bAssociate Professor, The University of Iowa.

cAssociate Professor, The University of Iowa.

dProfessor and Head, Department of Orthodontics, The University of Iowa.

eDepartment of Preventive and Community Dentistry, The University of Iowa.

fDepartment of Preventative Medicine, The University of Tennessee.

gDepartment of Statistics and Actuarial Science, The University of Iowa.

Reprint requests to: John S. Casko, DDS, MS, PhD, Department of Orthodontics, College of Dentistry, The University of Iowa, Iowa City, IA 52242

Copyright 1998 by the American Association of Orthodontists.

0889-5406/98/$5.00 + 0 8/1/89302

being particularly difficult to treat.10-14 Close observation is often required throughout the course of therapy

to deal with effects of the rotational pattern.

The ability of an orthodontist to predict future

mandibular growth rotation would greatly aid in diagnosis and treatment planning. Better therapeutic decisions could be made regarding timing and length of

treatment, appliance selection, extraction pattern, and

possible need for surgery. Therapy could truly be tailored to the individual with the possibility of optimal

results in a shorter period of time.

A number of techniques have been proposed to predict growth based on cephalometric landmarks,6,15-20

and a few of these specifically address rotational

growth of the mandible. Skieller, Bjrk and LindeHansen16 proposed a method for predicting future

mandibular growth rotation from an initial prepubertal

lateral cephalogram. Of a group of 100 children who

had been enrolled in an implant growth study, 21 subjects were selected retrospectively on the basis of a pattern of extreme backward or forward growth rotation.

659

660

Leslie et al

variables no. 2. (intermolar angle), no. 3 (shape of the

lower border of the mandible), and no. 4 (inclination of

the symphysis).

None of the subjects had received orthodontic treatment before or during the period of study. Metallic

implants had been placed in their mandibles, and jaw

growth was followed from childhood into early adulthood. Growth rotation was calculated on the basis of

the change in inclination of the implant line on radiographs. A 6-year observation period was selected,

with the initial lateral cephalogram made 3 years

before puberty and the final cephalogram made 3 years

after pubertal onset. Forty-four morphologic variables

were measured from each initial lateral cephalometric

radiograph and multivariate statistical methods were

used to identify which variables, alone or in combination, showed the highest predictive value for

mandibular growth rotation. The authors reported that a

combination of four variables accounted for 86% of the

variability observed. These included: mandibular inclination, intermolar angle, shape of the lower border of

the mandible, and inclination of the symphysis.

Regression equations were given based on these variables that could be applied to an initial prepubertal lateral cephalogram and were believed to predict future

mandibular growth rotation.

Limitations of this study are apparent. For instance,

the sample size was small relative to the large number

of measurements investigated. In order to provide some

December 1998

capitalizing on chance, a minimum of 5 to 10 subjects

are generally needed for each independent variable tested to predict an outcome variable.21 In other words, in

the Skieller et al study, 220 to 440 subjects in contrast

to 21 subjects would be needed to test the 44 independent variables. In addition, the authors themselves

pointed out the most serious limitation of the study; the

sample included extreme rotational patterns that may be

influential in determining the prediction equation. As a

consequence of having such a biased sample, the

applicability of the predictive variables to less extreme

rotational patterns could be questioned.

To address the latter concern, Lee et al22 tested this

predictive method with 25 subjects with metallic

implants with less extreme facial patterns than those in

the Skieller et al sample. Efforts were made to reproduce the procedures and statistical methods of the

Skieller study as closely as possible. Contrary to the

results reported by the Skieller et al study, the Lee et al

study found the combined predictive power of the four

independent variables to account for only 8% of the

variability observed in mandibular growth rotation.

A limitation in the Lee et al study was the inclusion

of treated subjects. It has been demonstrated that

orthodontic treatment affects mandibular rotation.10,23,24 Consequently, including treated subjects

could weaken the application of the Skieller et al predictive equation that was derived from a sample of

untreated individuals.

Because the Skieller, Bjrk, and Linde-Hansen

study is frequently quoted by orthodontists and even

considered a classic work,25 a need exists to examine

the four identified predictive variables with a large

sample of untreated subjects who present with facial

morphology more typically seen in an orthodontic

practice. The purpose of the present study is to assess

the ability of the Skieller, Bjrk, and Linde-Hansen

method in predicting the direction of mandibular

growth rotation using a sample of 40 untreated subjects

(10 subjects for each of the 4 identified variables) who

are more representative of a general patient population.

MATERIAL AND METHODS

from the Iowa Facial Growth Study, a longitudinal

study composed of 183 whites (92 males and 91

females), 97% of whom are of northwest European

ancestry. Records from a set of 40 subjects (20 males

and 20 females) who had not received orthodontic

treatment were randomly selected. A 6-year time interval had been established in the Skieller et al study.

Because accompanying developmental data pinpoint-

Volume 114, Number 6

Table I.

Variable description

Posterior facial height

Anterior facial height

Mandibular inclination determined by NSL

to mandibular line 1 (NSL -ML1)

Intermolar angle (MOLs-MOLi)

3

4

Inclination of the symphysis (CTL-NSL)

1a

661

Definition of variables

Variable number

1

Leslie et al

ing the onset of pubescence were not available, an initial age of 9 years was selected with the follow-up lateral cephalogram at age 15. All subjects in the Iowa

Facial Growth Study had lateral cephalograms made at

these ages. It was assumed that puberty would fall

within this time period. The initial profile headfilms

were traced and the following anatomic landmarks

identified (Fig 1):

Nasion (N): The most anterior point of the nasofrontal

suture.

Sella (S): The center of the cavity outlined by sella turcica.

Menton (Me): The most inferior point on the mandible at

the symphysis.

Articulare (Ar): The point of the intersection of the inferior surface of the cranial base and the averaged posterior

surfaces of the mandibular condyles.

Tangential gonion (tGo): Found by bisecting the angle

formed by a line tangent to the averaged inferior borders

of the mandible and a line through articulare tangent to

the averaged posterior borders of mandibular rami.

Each landmark was then verified by another investigator. The following lines were drawn using definitions established by the Skieller et al study (Fig 1 and

Table I):

Nasion-sella line (NSL).

Mandibular line 1 (ML1): The tangential line formed by

the lower border of the mandible.

Mandibular line 2 (ML2): The line formed tangent to the

lower gonial border and passing through menton.

Molar long axis (MOL) inferior (i) and superior (s).

Chin Tangent Line (CTL).

these landmarks and lines: mandibular inclination (Figs

2 and 3), intermolar angle (MOLs to MOLi, Fig 1),

shape of the lower border of the mandible (ML1 to

ML2, Fig 1), and inclination of the symphysis (NSL to

CTL, Fig 1). Two measurements were made for the

independent variable mandibular inclination (Figs 2

and 3), both of which had been designated by Skieller

et al as having high levels of predictability. Angular

Method of measurement

s-tgo distance

100 (Fig 2)

n-me distance

Angle between SN line and

mandibular line 1 (Fig 3)

Angle between the maxillary first molar long

axis and the mandibular first molar long

axis (Fig 1)

Angle between the two mandibular lines (Fig 1)

Angle between chin tangent line and SN line

(Fig 1)

measurements were made to within 0.5 mm. All measurements were repeated by another investigator and

any discrepancies between the independent sets of

measurements were re-measured by the principal

author to the prescribed limits. The Skieller et al

regression equations (Tables II and III) were used to

obtain the predicted mandibular growth rotation using

the four variables of interest. Thus, the initial calculations were done in a prospective manner with no prior

knowledge of the actual rotational outcome.

Next, the final (postpubescent) lateral cephalograms were traced and superimposed on the initial lateral cephalogram. There are many superimposition

techniques that can be used by the clinical orthodontist,

but there is no one best technique. In this study we

elected to superimpose by registering on sella and orienting along NSLa technique used by many clinicians. Actual mandibular rotation was then determined

as the change in mandibular line 2 (ML2) from the initial to final cephalogram. Again, rotational measurements were made by two independent investigators and

discrepancies resolved by the principal author. Forward

rotation (counterclockwise) was designated as negative

(-) and backward rotation (clockwise) was designated

as positive (+).

Statistical analysis was performed using the SAS

statistical software package (SAS Institute Inc,). The

regression equations given by the Skieller et al study

(Tables II and III) were used to calculate the predicted

mandibular rotation with the measurements obtained

for the independent variables. Two measurements were

made for the independent variable mandibular inclination (1 and 1a) and the appropriate regression equation

was used in each instance. Univariate and stepwise

regression analyses were used to evaluate the predictive value of the proposed method as it related to the

sample chosen for this study.

In cases where the number of subjects is small rel-

662

Leslie et al

December 1998

n-Me

Table II.

75.6 -

R2 =

0.59

(variable 1)

0.32

(variable 2)

0.98

(variable 3)

0.15

(variable 4)

predicted rotation

0.8612

+

=

ative to the pool of possible predictor variables, the forward stepwise selection procedure is unreliable in the

sense that the R-squared statistic will be quite high,

even when the independent variables have no predictive power whatsoever.

To illustrate this point, we performed a Monte

Carlo study that mirrored the number of subjects and

number of possible predictor variables in the Skieller

et al study; however, all the variables were unrelated.

For each simulation, 945 random numbers were generated from a normal distribution and then randomly

grouped into 45 columns with 21 random numbers per

column. The first column of 21 numbers was taken to

be the response variable and the remaining 44 columns

to be the candidate predictor variables. For each simulation a forward stepwise selection procedure was performed and the following quantities were recorded: (1)

Fig 3. Independent variable no. 1a. Mandibular inclination determined by the angle NSL-ML1.

Table III.

18.3 +

R2 =

0.44

(variable 1a)

0.29

(variable 2)

0.94

(variable 3)

0.14

(variable 4)

predicted rotation

0.8201

+

=

variable and the response and the corresponding Pvalue; and (2) the overall R-squared value and the

number of predictors allowed into the model that

resulted from a forward stepwise selection procedure

with a .1 P-value threshold entry criterion (as in the

Skieller et al article). This procedure was repeated

5000 times.

RESULTS

al, and present studies are shown in Table IV. The differences in respective sample size (21, 25, and 40 subjects) should be noted. The inclusion of 40 untreated

subjects in the present study provided 10 subjects for

each of the 4 independent variables investigated. Also,

both Skieller et al and the present study used untreated

samples, whereas Lee et al used a mixture of treated

and untreated subjects.

Leslie et al

Volume 114, Number 6

Table IV.

Sex distribution

Males

Females

Baseline age

Treatment status

Population characteristics

Table V.

663

Skieller et al

Lee et al

Present study

21

25

40

12

9

11.3 1.00

Untreated

Extreme growth patterns

11

14

8.5 0.0

Mixed

Less extreme

20

20

9.0 0.0

Untreated

Less extreme

Skieller et al

Lee et al

Present study

63.6 6.4

63.4 2.8

63.5 4.1

35.9 8.2

35.3 4.3

36.2 5.3

173.6 5.6

177.7 3.5

173.3 4.2

2.4 1.8

1.1 0.9

1.4 0.9

87.4 12.2

98.7 7.4

83.6 8.4

Independent variables

1

Post face height

Ant face height

1a

(NSL - ML1)

2

(Intermolar angle)

3

(ML1 - ML2)

4

(CTL - NSL)

The means and standard deviations for the independent variables for each investigation are listed in Table

V. The means appear to be remarkably similar with the

exception of variable no. 4 (CTL-NSL). The standard

deviations are much greater in the Skieller et al sample

than either the Lee et al or the current sample. This is

consistent with the Skieller et al selection of a group of

subjects with extreme growth rotation. A comparison

of the ranges for the independent variables in the

Skieller et al study and the present study are shown in

Table VI. These data were not published for the Lee et

al study. Again, the disparity is indicative of the selection of a specific sample of extreme rotators by

Skieller.

The means, standard deviations, and ranges for the

dependent variable (mandibular rotation) in each of the

investigations, when available, are presented in Table

VII. It was found that both Skieller et al and Lee et al

had observed mandibular rotations greater than what

was recorded for this study; the Skieller et al measurements were the largest.

The means, standard deviations, and ranges for the

expected mandibular rotation are listed in Table VIII

(variables 1, 2, 3, and 4) and Table IX (variables 1a,

2, 3, and 4). The means, standard deviations, and

ranges of the differences between the predicted and

the actual observed mandibular rotations are also presented. As can be seen, the difference between the

rotation of the mandible is quite large with either

regression equation.

The results of simple linear regression analyses are

shown in Table X. The amount of variability accounted

for by each of the independent variables is much lower

in the current study than that found by the Skieller et al

study. For example, variable no. 1 (mandibular inclination) had the highest predictive value found in the

Skieller et al research. It accounted for 62% of the variability observed. The best value obtained in the current

investigation was for variable no. 2, which accounted

for only 5.58% of the variability observed.

The results of stepwise multiple regression analyses

to determine the combined predictability of all four

variables are shown in Table XI (variables 1, 2, 3, and

4) and Table XII (variables 1a, 2, 3, and 4). The order

in which the variables entered each analysis is also

given. In this procedure the goal was to find how much

of the variability could be explained when all four

independent variables were used in combination. The

variables are selected in the order of their ability to

explain additional variance. Using independent variables no. 1, 2, 3, and 4 (Table XI), Skieller et al

obtained a combined predictive ability of 86%. In contrast, the current investigation was only able to account

for a total of 7% of the observed rotation using those

four variables; Lee et al could account for only 8%. In

664

Leslie et al

Table VI.

December 1998

Skieller et al

Independent variables

1

Post face height

Ant face height

1a

NSL-ML1

2

Intermolar angle

3

ML1 - ML2

4

CTL - SNL

Table VII.

Present study

Minimum

Maximum

Minimum

Maximum

54.4

76.8

57.1

74.0

19.0

52.5

23.3

45.0

159.8

180.1

163.0

181.5

0.0

5.5

0.0

4.5

65.0

116.0

65.5

104.5

Dependent variable

Skieller et al

Lee et al

Present study

Range: Minimum

Maximum

6.0 4.5

+5.3

16.4

4.9 3.0

NA

NA

1.9 2.1

+3.3

5.8

for the present study compared with the other studies.

On the second stepwise multiple regression analysis

(Table XII), with the use of independent variables 1a,

2, 3, and 4, the combined predictive ability found by

the Skieller et al study was 82%. The current research

obtained only a 9% predictability for those variables.

Lee et al did not present comparable results for this

analysis.

Results of the Monte Carlo study with random

numbers instead of cephalometric measurements

showed that the empirical distribution of the largest

squared correlation between the response and any of

the 44 independent variables had a minimum value of

0.10130 and a maximum value of 0.64688. The mean

and standard deviation were 0.28048 and 0.08151,

respectively. For approximately 90% of the simulations, there was at least one variable that was significantly correlated with the response at the 0.05 level significance level.

The Skieller et al forward stepwise selection procedure used a rejection level of P > .1, and at this level

four variables entered their prediction model. In our

simulations that allowed exactly four predictor variables into the model (there were 393 cases), the overall

R-squared statistic ranged from 0.52473 to 0.86722,

with a median value of 0.67646.

In our simulations that did not restrict the number of

variables entering the model, but instead used the

Skieller et al rejection level of P > .1, the empirical distribution of the overall R-squared statistic for the forward stepwise selection procedure had a mean of

0.84328, a median value of 0.94741, and a standard

deviation of 0.21533. In approximately 20% of the simulations, the R-squared value was exactly 1. This happened whenever the procedure chose 20 variables to be

in the model. (For mathematical reasons, the overall Rsquared statistic will be 1 for any subset of 20 variables

selected from the 44 independent variables.)

DISCUSSION

patients may depend heavily on the amount and direction of jaw growth. Lateral cephalometric radiographs

are indispensable tools in orthodontic diagnosis,

treatment planning, and quantifying dentofacial

changes over time. Attempts, such as that made by

Skieller and co-workers, to apply measurements

made from these films in predicting jaw growth are

necessary and commendable.

Difficulties can arise in the interpretation of these

studies. In our eagerness to find help in predicting jaw

growth, practicing orthodontists sometimes accept

findings from preliminary studies as infallible. The

four variables isolated from the Skieller study are often

referred to in orthodontic seminars to explain why a

patient grew in a given direction.

It should be kept in mind, as noted previously, that

Leslie et al

Volume 114, Number 6

Predicted mandibular rotation with regression equation for independent variables 1, 2, 3, and 4

Table VIII.

Predicted mandibular rotation with regression equation for independent variables 1a, 2, 3, and 4

Table IX.

Range

Mean standard deviation

Predicted rotation

Difference from

observed rotation

6.71 2.57

4.76 2.94

Minimum

0.79

0.00

Maximum

12.99

11.41

the Skieller et al study sample was purposefully composed of extreme patterns of growth rotation. The

authors themselves pointed out this most serious limitation of their study. The Lee et al study selected a

sample to mirror the means recorded for the Skieller

et al independent variables but with less extreme patterns of growth rotation. As would be true of a typical

orthodontic practice, no predetermined rotational pattern was used in the random selection of the present

sample.

The baseline age of the sample from the present

study and from the Lee et al study differ from the baseline age of the Skieller et al study as exact data were

not available on the onset of puberty. Therefore, a

starting age of 9 years was chosen in an attempt to

incorporate puberty in the 6-year time frame set up by

Dr Skeiller. Certainly, clinical orthodontists would

only be able to make a best guess, based on the available information, as to the onset of puberty in their

patients. With further inquiry, actual pubertal onset

could be determined, but by then the growth spurt may

be well underway.

It is remarkable to note how similar the means for

the independent variables are for the three samples

(Table V), considering that there was no preconceived

selection on the part of the current study. The standard

deviations are quite different, which is reflective of the

differences in extremes between the samples selected.

The observed mandibular rotations (Tables VIII and

IX) are significantly different. This not only represents

the selection for extreme rotational patterns on the part

of Skieller et al, but also the absence of implants as reference points in the current study. As noted by Bjrk,6

half of the actual mandibular rotation that occurs is

masked by remodeling of the lower border of the

mandible. The mean rotation recorded using the

mandibular plane angle is consistent with Bjrks11

statement that, ...the mandible on the average rotates

forward a little during adolescence, and its inclination

thus decreases. Even though the absence of implants

may be viewed as a technical limitation of the present

study, our purpose was to assess the Skieller et al

method as applied to clinical practice where implants

665

Range

Mean standard deviation

Predicted rotation

Difference from

observed rotation

5.64 2.21

3.70 2.57

Minimum

0.57

0.20

Maximum

9.89

10.22

In contrast to the Skieller et al study, our results

demonstrate only minimal ability for any of the four

individual independent variables to predict mandibular

growth rotation. We found that the variable with the

highest predictive value was intermolar angle. This is

interesting considering the difficulty experienced by

most orthodontists in tracing molars on lateral cephalometric radiographs and on the questionable value of

this variable found in current cephalometric landmark

reliablity research.26 The Lee et al study was unable to

find significance at the P < .15 level for any of the four

independent variables.

Finally, in tabulating the combined predictability of

the four variables with regard to mandibular growth

rotation, not only was the level of variability predicted

significantly lower in the present study, but the variables entered the equation in different orders. Regardless of the measurement used to determine mandibular

inclination, a maximum of only 9% predictability was

achieved. These results with untreated subjects support

the results of the Lee et al study, which included treated subjects.

Because of the small sample size of the Skieller et al

study relative to the number of variables tested, there is

a lack of assurance that the multiple regression analysis

results were not simply based on a few extreme and

highly influential observations. Ideally, the Skieller et al

study should be redone prospectively with 220 to 440

subjects if all 44 measurements are to be tested. The

present study was specifically designed to address this

problem. Four independent variables were tested on a

sample of 40 randomly selected subjects.

In our Monte Carlo study, we mirrored the Skieller

et al study but used random numbers instead of actual

cephalometric data. In other words, the Skieller et al

analysis was run repeatedly with meaningless data to

see if the Skieller et al results could have capitalized on

chance. Using the Skieller et al rejection level of P > .1,

we found that a mean of 84% and a median of 94% of

mandibular growth rotation variability could be

explained using meaningless data. This compares favorably with the Skieller et al value of 86%. From these

666

Leslie et al

Table X.

December 1998

Skieller et al

Independent variables

1

Post face height

ant face height

1a

(NSL - ML1)

2

(Intermolar angle)

3

(ML1 - ML2)

4

(CTL - ML1)

Present study

R2

Level of significance

R2

Level of significance

0.62

P < .001

0.0075

P < .59

0.61

P < .001

0.0192

P < .39

0.39

P < .005

0.0558

P < .14

0.27

P < .025

0.0012

P < .83

0.38

P < .005

0.0007

P < .87

Table XI.

Skieller et al

Lee et al

Present study

Independent variable

R2

Independent variable

R2

Independent variable

R2

1

2

3

4

0.62

0.76

0.81

0.86

1

2

3

4

0.05

0.08

0.08

0.08

2

4

1

3

0.06

0.06

0.07

0.07

Variables are listed in order of entry and R2 are cumulative for all variables included in the model.

Table XII.

Skeiller et al

Present study

Independent variable

R2

Independent Variable

R2

1a

2

3

4

0.61

NS

NS

0.82

2

1a

4

3

0.06

0.07

0.09

0.09

Variables are listed in order of entry and R2 are cumulative for all variables included in the model.

only be viewed as an exploratory technique when the

number of independent variables is larger than the number of observations, because it is easy to obtain a model

with a high R-squared value even when none of the

independent variables is related to the response variable. In this situation stepwise regression will have a

strong tendency to over fit models, adding variables

with no predictive power. Therefore, the Skieller et al

study should simply be considered exploratory.

The results of this study indicate that the information extracted from a pretreatment lateral cephalogram with the use of this method is inadequate to

permit clinically useful predictions to be made relative to the magnitude or direction of future mandibular growth rotation.

We thank Dr Brent Bankhead, former student at the

University of Iowa College of Dentistry, for his support

during this project.

CONCLUSION

accurately predict the future mandibular growth

rotation of untreated persons from a general popula-

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9. Brodie AG. Facial patterns: a theme on variation. Angle Orthod 1946;16:75-87.

10. Schudy FF. The rotation of the mandible resulting from growth: its implications in

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11. Bjrk A. Prediction of mandibular growth rotation. Am J Orthod 1969;55:585-99.

12. Bjrk A, Skieller V. Facial development and tooth eruption: an implant study at the age

of puberty. Am J Orthod 1972;62:339-83.

13. Schudy FF. Vertical growth versus anteroposterior growth as related to function and

treatment. Angle Orthod 1964;34:75-93.

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667

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as an indicator of mandibular growth potential. Am J Orthod 1987;91:117-24.

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Bound volumes of the American Journal of Orthodontics and Dentofacial Orthopedics

are available to subscribers (only) for the 1998 issues from the Publisher, at a cost of $87.00

($104.86 Canada and $98.00 international) for Vol. 113 (January-June) and Vol. 114 (JulyDecember). Shipping charges are included. Each bound volume contains a subject and author

index and all advertising is removed. Copies are shipped within 60 days after publication of

the last issue of the volume. The binding is durable buckram with the journal name, volume

number, and year stamped in gold on the spine. Payment must accompany all orders. Contact

Mosby, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 631463318, USA; telephone (314)453-4351 or (800)325-4177.

Subscriptions must be in force to qualify. Bound volumes are not available in place

of a regular Journal subscription.

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