original article

J. Stomat. Occ. Med. (2009) 2: 122–130

DOI 10.1007/s12548-009-0023-y
Printed in Austria
© Springer-Verlag 2009

Mandibular rotation and occlusal development

during facial growth
K.-M. Kim, K. Sasaguri, S. Akimoto, S. Sato

Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics, Kanagawa Dental College, Japan

Received June 30, 2009; Accepted July 25, 2009

Purpose: Mandibular growth rotation is an important phe- Introduction

nomenon in human facial growth. However, changes in the
With an understanding of how occlusion changes during
vertical height of the dentition, the inclination of the occlusal
growth and development, orthodontists, pedodontists, and
plane, and subsequent mandibular rotation during growth,
other dental professionals can in many cases prevent maloc-
are only poorly established. This study was designed to exam-
clusion, and they can initiate early therapeutic measures if
ine the inter-relation among occlusal plane rotation, mandib-
malocclusion does develop. Most changes take place during
ular growth rotation, and the establishment of tooth axis
the transition from deciduous to permanent dentition, an
during growth and development.
important period during which functional occlusion develops.
Materials and methods: The materials used consisted of
This is also the period during which occlusal and skeletal
351 lateral cephalograms from 39 children who belonged to a
malocclusion often develops. Occlusion development during
longitudinal growth study. We observed their growth changes
ontogenesis is a complex process, and the function of the
in the developmental stages from first molar eruption (Initial
masticatory organ is affected by a number of factors, including
stage) until the completion of permanent dentition (Final
mandibular growth rotation, the inclination of the teeth axes,
stage). We measured values regarding the posture of the lower
and the curves of occlusal surfaces. However, a comprehen-
face, including mandibular rotation, occlusal plane, and tooth
sive analytic description, based on clinical data, of how these
axis. The tangent law was applied for the sagittal organization
variables change during the transition from deciduous to
of the mandibular teeth by geometrical analyses.
permanent dentition has yet to be established.
Results: Results showed that mandibular growth rotation
Over a century ago, Spee FG [23] studied human occlusal
is associated with occlusal plane rotation, which is caused by
plane curves, and recognized the important role this curved
greater vertical height increase in the molars than in the
surface plays during the development of occlusion. The curve
anterior incisors. It was also shown that the mandibular
of Spee begins at the cusp tip of the canine, passes along the
incisors followed the tangent law, but the long axis of the
cusps of the molars, and ends at the frontal edge of the
posterior mandibular teeth exhibited almost the same angle,
condyle. The curve of Spee is functionally significant because
approximately 15 with the direction of the tangent. This tooth
this curvature makes it possible for occlusion to withstand
axis arrangement was very much dependent upon occlusal
vertical occlusal forces [5, 13, 14].
plane rotation and mandibular rotation during growth.
As teeth erupt, the long axis should ideally correspond to
Conclusion: The results of this cephalometric study
the occlusal contact of mandibular rotation; this is called the
could help dentists to determine a more suitable organization
tangent law [16]. Orthlieb [15] reported that mandibular in-
of occlusion in the sagittal plane, as required in orthodontics,
cisors follow this law, but there is a difference between the
prosthodontics, and implant dentistry.
closing axis and the long axis of teeth in the premolar and
Keywords: Occlusal plane, tangent law, mandibular rotation, molar region, showing that they do not follow the principle of
curve of Spee, growth the tangent law. On the other hand, Björk [1–3] proved in his
implant study that the mandible rotates forward during man-
dibular growth and development. When an implant is placed
as a marker in the stable part of either the mandible or the
This research is a part of Keun-Man Kim’s PhD Thesis in Kanagawa Dental
College. Results of this research were once published in the Kanagawa maxilla, it can be found that the mandible rotates as it
Shigaku, Volume 42, 2007 issue, in Japanese. Therefore this English grows and that the condyle grows perpendicularly in a
translation issue is a secondary publication with copyright permission slightly forward direction (Fig. 1). In addition, mandibular
from Kanagawa Shigaku.
growth rotation differs depending on individual growth and
Correspondence: Sadao Sato DDS, PhD, Department of Craniofacial development. This suggests that mandibular growth rotation
Growth and Development Dentistry, Division of Orthodontics, Kanagawa
Dental College, 82 Inaokacho, Yokosuka 238-8580, Japan. is strongly connected to one’s growth and how malocclusion
E-mail: satos@kadcnet.ac.jp develops.

122 3/2009 Mandibular rotation and occlusal development during facial growth
Springer-Verlag J. Stomat. Occ. Med.
 original article

SN plane

Mandibular
rotation
Condylar growth
direction

Fig. 1: Mandibular growth rotation. Cranial registrated superimposition (S, SN plane) of cephalometric tracings of different ages showed that
maxillary and mandibular implant lines were rotated forward during growth. Superimposition registrated by implant lines showed that the growth
direction of condyle is vertical and forward [3]

Although much research [8, 9, 22] has been done on
mandibular growth rotation, there are no clear explanations
about the mechanism of development and the physiological
significance of mandibular growth rotation. Mandibular
growth rotation has been categorized as a potential growth
pattern and not recognized in relation to vertical dimension
and occlusal function. Many researchers have suggested that
vertical dimension and the inclination of the occlusal plane
are closely related to the growth pattern of skeletal Classes II
and III [18–21].
Human skeletal patterns are more variable than any other
animal, and in order to clinically apply the principles of the
curve of Spee, the tangent law, and mandibular rotation,
further study of individual growth and how occlusion com-
pletes during growth and development is necessary. The
present study examined how the curve of Spee, the tangent
law, and mandibular rotation are related to occlusion devel-
opment during ontogenesis under the hypothesis that man-
dibular rotation depends on the increase in vertical dimension
and is related to the tangent law. In addition, the relationship
between the occlusal plane and the long axis of teeth, skeletal
patterns, changes in the tangent law, and formation of the
curve of Spee were studied using annually collected longitu-
dinal growth samples.
3) 3rd Stage: After exchange of the lateral segment.
4) Final Stage: Completion of permanent occlusion.
Skeletal classification
The skeletal pattern of each individual was classified into
Classes I, II, or III based on the Antero-Posterior Dysplasia
Indicator (APDI), which was developed by Kim YH [10], on
completion of permanent occlusion. In the skeletal classifica-
tion, Class II corresponds to an APDI reading of <77 , Class I
between 78 and 84 , and Class III <85 .
Measuring the rotation of upper occlusal plane
and eruption of the incisors (Fig. 2)
To measure the rotation of the upper occlusal plane, the
lowest point of the Pterygopalatine Fossa (Ptm) and Frankfort
Plane (FH) were used as the reference plane. Two cephalo-
FH plane

Materials and methods Palatal plane (PP)

Cephalometric radiographs collected annually from 1960 to

1974 at the Department of Craniofacial Growth and Develop-
ment Dentistry, Kanagawa Dental College were used in this
study. A total of 351 cephalometric radiographs from 39
subjects were selected based on the following criteria: no
orthodontic or prosthetic treatment and no severe damage
to the occlusion during the period. All the cephalograms were
traced including upper and lower teeth and analyzed.
The development of occlusion was classified into four
stages:
1) Initial Stage: Completion of the eruption of the first molar.
2) 2nd Stage: Before exchange of the lateral segment.
Fig. 2: Measurements of the upper occlusal plane rotation and vertical
dental heights of the upper central incisor and first molar. Rotation of
the upper occlusal plane was determined by the angle measurement
between the occlusal plane at the initial stage (OP Initial) and the
occlusal plane at the final stage (OP Final). Increment of dental
height at incisor and first molar was calculated by subtraction of the
PP-1 or PP-6 at the initial stage from the PP-1 or PP-6 at the final stage,
respectively

J. Stomat. Occ. Med.
Springer-Verlag Mandibular rotation and occlusal development during facial growth 3/2009 123
 original article
Fig. 3: Measurements of mandibular rotation and lower occlusal plane
rotation. Superimposed cephalometric tracings of initial stage and final
stage registrated according to Björk’s method. Rotation of the mandible
was determined by the measurement of the angle between the
SN plane at the initial stage and the SN plane at the final stage. Lower
occlusal plane rotation was determined by the angle measurement
between the occlusal plane at the initial stage (OP Initial) and the occlusal
plane at the final stage (OP Final)
metric tracings of the initial stage and the final stage were
superimposed with the FH plane registrated at Ptm, and then
the angle consisting of the occlusal plane from the initial stage
and the final stage was measured. In addition, the amount of
Fig. 4: Measurements of lower long axis of the tooth to the closing axis. Closing axes were drawn from the center of the condyle to the cusp of
each tooth. Angles between the closing axis and long axis of the tooth are formed
124 3/2009 Mandibular rotation and occlusal development during facial growth
vertical growth of the upper first molars and central incisors
was measured.
Mandible and lower occlusal plane rotation
during growth and development (Fig. 3)
Rotation of the mandibular plane and the lower occlusal
plane was determined by cephalometric tracing of the initial
and final stages of growth, according to the methods of Björk
[1–3]. Based on a metal-implant study, Björk reported that
the most stable parts of the mandible were 1) the anterior tip
of the chin; 2) the inner cortical structure at the inferior
border of the symphysis; 3) trabecular structures related to
the mandibular canal; and 4) the lower contour of a molar
germ from the time mineralization of the crown is visible
until the roots begin to form. Two tracings were superim-
posed by Björk’s method; the rotation of the mandible could
then be measured as an angular change of the SN plane from
the initial stage to the final stage. The angular difference
between the initial and final occlusal planes was also
measured.
Transition of lower tooth axis and mandibular growth
The change of the lower tooth axis was measured according to
Orthlieb’s method [15]. After establishing the center point of
the condylar head (Fig. 4), the angle of the line from the center
point of the condyle to the cusp of each tooth (closing axis) and
its corresponding axis was measured. In addition, the angle
between the lines from the edge of the lower incisors to the
disto-buccal cusp of the lower first molar as the occlusal plane
(OP) and the closing axis (CA) was measured (CA-OP). Dis-
tance to plane of occlusion (DPO), the perpendicular line from
the center of the condyle drawn to the lower occlusal plane,
was also measured. The amount of occlusal plane rotation

Springer-Verlag J. Stomat. Occ. Med.

Fig. 5: Measurements of DPO, DPO real, and alteration of the tooth axis
of the lower central incisor and first molar. Superimposed cephalometric
tracings at the initial stage and final stage according to Björk’s method
Fig. 6: Measurements of curve of Spee and Spee ideal. Curve of Spee
was drawn connecting the cusp tips of buccal segments of the teeth.
Spee ideal was determined by a three-point connection of the cusp tip of
the lower canine or first premolar, central occlusal point of lower first
molar and frontal part of the condyle. The radii of the curves were
calculated in millimeters
during growth and development was measured as the angle
between the OP initial and the OP final (Fig. 5). The actual
increment of DPO during growth and development was mea-
sured as the vertical distance from final condyle to the initial
occlusal plane (DPO real).
Measuring the curve of Spee (Fig. 6)
The curve of Spee was measured as the radius of the curve
constructed connecting the cusp of the lower canine or cusp of
first premolar to cusp of second molar. Spee ideal was deter-
mined as the radius of the circle made by connecting three
points with the lower canine or the cusp of the first premolar,
J. Stomat. Occ. Med.
Springer-Verlag Mandibular rotation and occlusal development during facial growth
original article
the disto-buccal cusp of the first molar, and the front edge of
the condyle.
Statistical analysis
Statistical significance of differences between three craniofa-
cial classes and the inclination of the long axis was analyzed
with SPSS and Kruskal–Wallis ANOVA. Statistical significance
was determined at the level of rejecting the null hypothesis
at 5%.
Results
Alterations in craniofacial pattern, DPO and CA-OP
during growth and development
In this study, the skeletal pattern was classified into Classes
I, II, and III based on the APDI. The figure from APDI
showed significant difference between Classes II and III at
the age of 6. However, similar figures were seen with APDI,
which became clearer among the classes (Tab. 1). On the
other hand, FH-MP in Classes I and III was slightly de-
creased, but there was no change in Class II. For DPO and
CA-OP, the same pattern of increase by age was observed in
the three classes, with no significant differences between
classes (Tab. 2).
Rotation of mandible and occlusal plane and changes
in DPO real during growth
Mean rotation of the mandible during craniofacial growth for
Class I was 10.2 . The value for Class II was lower, 8.4 , while
the value for Class III was higher, 13.1 . However, these
differences were not statistically significant (Tab 3).
The rotation of the upper occlusal plane for Class I was
4.1 and 4.2 in the lower occlusal plane. The rotations were
less for Class II and more in Class III. However, these differ-
ences were not statistically significant. The growth amount
from occlusal plane to condyle (DPO real) was 46.9 mm for
Class I and 48.3 mm for Class II with no significant difference.
However, DPO real for Class III was 54.5 mm. This difference
was statistically significant.
The curve of Spee
The radius of the curvature was between 94 mm to 109 mm.
Although there were wide ranges, there were no significant
differences between skeletal patterns (Tab. 1). Spee ideal was
77 mm to 82 mm; there were no significant differences among
skeletal patterns (Tab. 3).
Changes in the inclination of tooth axis and vertical
dimension
Mean inclination of the anterior teeth labially during
growth was 11.2 in Class I, 17.0 in Class II, and 9.4 in
Class III. However, there was no significant difference
among classes (Tab. 4). Inclination of the lower first molar
was within 4 to 7 . There were no significant differences
among Classes I, II, and III. The changes in vertical dimen-
3/2009 125
 original article

Tab. 1: Longitudinal alterations in mandibular plane angle (FH-MP) and antero-posterior displasia
indicator (APDI) according to age
Age FH-MP APDI
(year)
Class I Class II Class III Class I Class II Class III
6 30.6  3.8 30.3  4.0 30.4  3.3 78.9  2.9 75.3  1.8# 80.4  4.3#
#{ #{
7 29.9  2.9 32.4  5.5 30.5  3.8 78.9  2.0 75.6  3.4 82.9  4.4#{
8 29.9  3.4 31.2  5.5 29.5  4.5 79.6  3.0#{ 75.6  2.2#{ 83.7  4.0#{
9 29.7  3.8 31.2  5.0 29.5  4.1 80.6  2.8#{ 74.0  2.8#{ 84.3  3.2#{
10 29.3  3.7 31.1  5.1 28.8  4.5 80.2  2.4#{ 75.4  2.4#{ 84.0  3.8#{
11 28.7  4.1 31.1  5.5 28.5  4.8 80.3  2.8#{ 75.6  2.3#{ 85.8  3.8#{
#{ #{
12 28.7  4.0 30.5  6.3 28.0  4.2 80.4  2.1 75.5  2.3 86.9  3.5#{
13 27.8  3.8 31.7  7.1 28.6  4.4 80.9  2.3#{ 75.0  3.0#{ 87.2  3.4#{
14 28.0  4.8 31.0  6.6 26.9  4.4 80.8  1.8#{ 75.6  1.1#{ 87.8  3.7#{

Significantly different between Class I and Class III at P < 0.05.
#
Significantly different between Class II and Class III at P < 0.05.
{
Significantly different between Class I and Class II at P < 0.05.

Tab. 2: Longitudinal alterations in parameters regarding DPO and occlusal plane to the closing axis
(CA-OP) according to age
Age DPO CA-OP
(year)
Class I Class II Class III Class I Class II Class III
6 23.6  4.0 23.0  4.1 23.4  3.9 16.1  2.3 17.0  2.8 17.0  2.0
7 25.0  3.3 22.3  3.5 25.5  4.2 17.5  2.1 16.1  2.3 18.1  2.9
8 26.3  4.2 25.2  5.6 27.2  4.8 18.1  2.4 17.3  3.2 18.5  2.9
9 28.5  4.4 27.9  4.9 29.5  4.7 18.9  2.7 18.6  2.9 19.4  2.9
10 30.8  4.4 29.6  5.0 32.6  4.6 19.8  2.6 19.4  3.0 21.1  2.6
11 32.6  5.3 31.4  4.7 34.2  4.5 20.7  3.3 19.9  2.3 21.5  2.3
12 34.5  4.5 33.5  6.1 37.4  5.1 21.1  2.9 20.9  3.0 22.2  3.0
13 35.3  4.8 34.8  5.4 38.6  5.8 21.5  3.4 21.4  2.7 22.7  3.0
14 36.7  5.7 35.0  5.5 39.6  5.9 22.1  3.1 21.4  2.4 23.5  2.8

Tab. 3: Total changes in parameters regarding Tab. 4: Total changes in parameters regarding
mandibular rotation, occlusal plane rotation and tooth axis and vertical dental height
compensating curve of Spee
Class I Class II Class III
Class I Class II Class III (n = 19) (n = 9) (n = 11)
(n = 19) (n = 9) (n = 11)
L1 Inclination (degree) 11.2  6.8 17.0  9.5 9.4  5.3
Mand Rotation (degree) 10.2  4.1 8.4  4.3 13.1  2.6
L6 Inclination (degree) 4.3  7.9 6.3  9.7 6.4  5.3
UOP Rotation (degree) 4.1  3.0 2.9  2.8 5.5  3.1
L1 VD (mm) 4.8  2.1 5.6  2.0 6.5  2.0
LOP Rotation (degree) 4.2  2.4 4.9  4.2 6.4  4.0 
L6 VD (mm) 6.9  2.6 8.3  1.9 9.1  2.4
DPO real (mm) 46.9  8.5 48.3  8.1 54.5  7.4
U1 VD (mm) 3.5  2.2 3.0  2.0 3.1  3.0
Spee (radius, mm) 97.8  20.5 94.4  27.9 108.5  37.9
U6 VD (mm) 9.0  2.8 6.8  1.2# 12.5  3.2#
Spee ideal (mm) 78.1  7.4 77.2  6.9 81.7  15.4

Significantly different between Class I and Class III at P < 0.05.

Significantly different between Class I and Class III at P < 0.05. #
Significantly different between Class I and Class III at P < 0.05.

126 3/2009 Mandibular rotation and occlusal development during facial growth
Springer-Verlag J. Stomat. Occ. Med.
 original article

Tab. 5: Longitudinal alteration of the angle Class II and increase in Class III. The change was more
between the tooth long axis of the lower central significant in growth and development (Tab. 5).
incisor and the closing axis according to age
in the different skeletal classes Average changes in lower premolar axis against
Age Central the closing axis
(year) The change ranged from 100 to 106 in skeletal Class I, and
Class I Class II Class III
(n = 19) (n = 9) (n = 11) there were no significant annual changes. However, there
were fewer changes in Class II and more changes in Class III
6 86.0  4.1 88.7  3.7 86.6  6.0 compared with Class I (Tab. 6).
7 85.8  5.8 83.0  4.5 89.0  4.0
8 84.2  5.7 82.3  3.5 87.1  4.0 Average changes in lower molar and closing axis
9 84.4  5.6 81.3  4.2# 87.4  3.0# The change ranged from 105 and 110 in skeletal Class I, and
10 84.5  5.1 82.4  4.6 #
87.7  3.0 # there were no significant annual changes. However, there
were fewer changes in Class II and more changes in Class III
11 84.6  4.9 82.1  4.5 #
87.9  2.6#
than Class I (Tab. 7).
12 84.1  4.2 81.3  3.8# 87.3  3.3#
13 84.4  3.7 81.1  4.2# 90.1  4.7#
14 84.6  4.1 
81.6  4.3 #
90.5  3.6#
Discussion
 The present results showed that the vertical-dimension in-
Significantly different between Class I and Class III at P < 0.05.
#
Significantly different between Class II and Class III at P < 0.05.
crease in the molar region was greater than that in the
anterior-tooth area and that extensive rotation of the maxilla-
mandible occlusal plane occurred. In addition, the growth in
maxillary and mandibular occlusal plane was closely related to
sion were more in the molar region than in the anterior
the increase in vertical dimension and rotation of the occlusal
region during growth. There were significant differences in
plane. Additionally, it was found that inclination of the tooth
the lower first molar between Classes I and II and in the
axis of the lower dentition did not significantly change during
upper molar between Classes II and III.
growth and development and the angle of the lower closing
axis and tooth long axis was generally the same with no
Average changes in the angle of lower anterior tooth significant changes. This means that the tangent law depends
axis against the closing axis on the harmonization of the rotation of the occlusal plane with
The angle in lower anterior tooth against closing axis was the mandible. Figure 7 shows the average changes in occlu-
85 in skeletal Class I and there were no significant annual sion related to the maxilla and the mandible during growth
changes. However, there was a tendency for decrease in and development.

Tab. 6: Longitudinal alteration of the angle between the long axis of the lower premolar and the closing
axis according to age in the different skeletal classes
Age Premolar
(year)
Class I (n = 19) Class II (n = 9) Class III (n = 11)
P1 P2 P1 P2 P1 P2
6 – – – – – –
7 – – – – – –
8 – – – – – –
9 100.7  2.3 106.0  1.4 104.0  0.0 105.5  3.5 107.5  0.7 110.0  1.4
10 106.1  7.5 107.9  5.6 107.7  3.2 107.3  3.8 107.3  4.6 109.6  5.0
11 106.1  4.1 107.5  4.9 102.6  4.9 104.3  5.6
#
107.1  3.9 111.5  4.1#
12 104.2  5.6 106.2  4.7 101.7  6.0 106.1  6.4 106.8  5.0 108.3  5.6
13 104.0  4.1 106.2  3.7 100.8  6.7
#
104.5  7.8 107.9  4.3#
110.4  5.7
14 103.9  4.9 106.5  4.6 101.7  5.6 104.6  6.7 107.1  6.3 110.8  6.8

Significantly different between Class I and Class III at P < 0.05.
#
Significantly different between Class II and Class III at P < 0.05.

J. Stomat. Occ. Med.
Springer-Verlag Mandibular rotation and occlusal development during facial growth 3/2009 127
 original article

Tab. 7: Longitudinal alteration of the angle between the long axis of the lower molar and the closing axis
according to age in the different skeletal classes
Age Molar
(year)
Class I (n = 19) Class II (n = 9) Class III (n = 11)
M1 M2 M1 M2 M1 M2
6 106.6  5.5 – 106.3  8.9 – 108.1  7.8 –
7 105.7  6.3 – 106.1  9.8 – 109.3  5.5 –
8 106.1  3.6 – 104.6  8.8 – 110.7  6.0 –
9 105.7  5.9 – 105.6  7.6 – 110.3  5.7 –
10 106.3  7.1 105.3  9.3 104.0  6.8# – 113.0  5.1# 109.5  7.0
 #
11 106.8  4.9 104.3  5.3 104.9  7.9#
107.6  6.2 113.7  5.2 113.0  9.0
12 108.5  5.6 104.6  6.2 105.4  8.8 107.0  7.7 113.7  7.3 109.2  6.4
13 108.1  4.8 105.7  7.2 105.6  8.5#
104.0  8.9 113.6  5.7#
111.9  7.1
14 108.9  3.8 107.3  6.1 107.3  9.3# 105.4  7.9 114.2  5.9# 113.8  9.6

Significantly different between Class I and Class III at P < 0.05.
#
Significantly different between Class II and Class III at P < 0.05.

Björk’s studies [1–3] with a metal implant as the marker
for growth clearly showed rotation in mandibular growth and
the direction of growth in the condyle. Later, many researchers
studied the mechanism of mandibular growth rotation and
mandible growth; however, there was no clear explanation. It
was believed that mandibular growth is dependent on the
intrinsic growth capacity, and the relation to the increase of
vertical dimension of occlusion and changes in occlusal plane
was ignored. As shown in this research, occlusal vertical
dimension between the ages of 6 and 14 changed more in
molars than in anterior teeth. The occlusal plane rotated by
4.1 in the upper jaw and 4.2 in the lower jaw. This condition
would result in anterior open bite; however, the lower jaw
rotated forward by 10.2 to adapt to this change. In addition,
Fig. 7: Schematic representation of the average changes of parameters
regarding the occlusion system according to age. Upper and lower
occlusal plane changes contributed to the increase in the posterior
dental vertical height and induced mandibular growth rotation. These
changes maintained the tooth axis to the closing axis during growth and
development
the rotation of the occlusal plane caused mesial inclination of
the tooth axis of between 9 and 17 in the anterior teeth and 4
and 7 in the molar region in the mandible.
Under the conventional concept of craniofacial growth,
the growth of the mandible and condyle was believed to be
hereditary and changes in the occlusion system secondary [4].
However, in a craniofacial growth study performed in the
1970s, mandibular growth showed great ability to adapt and
growth of the mandible and condyle were secondary adaptive
reactions [6, 11, 12, 17]. The results of the present study
suggest a high probability that changes in occlusal vertical
dimension and rotation of occlusal plane lead to the adapta-
tion reaction of the mandibular rotation, which is followed by
condylar growth. Therefore, condylar growth occurs almost
vertically upward, as Björk showed more than half century
ago. The maxillary and mandibular occlusal planes each rotate
approximately 4 (total approximately 8 ) in accordance with
the increase of the vertical dimension of the posterior molar
regions. This change leads to an open bite in the anterior teeth,
and the mandible rotates around 10 in order to adjust the
occlusion.
Page [16] introduced the concept of the tangent law as an
important element to understand the function of occlusion.
This concept was established by observing the relation of the
occlusal plane to the incisors and tooth axis in carnivores. In
carnivores, all axes lie vertically against the closing axis, and
this is a stable occlusion from the viewpoint of biomechanics.
In herbivores, Orthlieb [15] pointed out that the distance
between the occlusal plane and condyle is larger, and these
animals have a strong curve of Spee. The same principles were
seen among human beings, and the curve of Spee was corre-
lated with DPO (bigger DPO leads to a bigger curve of Spee).
According to this theory, the molar axes incline mesially in
sequence and form the curve of Spee. Orthlieb [15] called the
inclination of lower posterior dentition the differential angle
and reported that this angle becomes smaller toward the
molars.

128 3/2009 Mandibular rotation and occlusal development during facial growth
Springer-Verlag J. Stomat. Occ. Med.

85
15
15
15
15
Fig. 8: Average values of differential angles in the lower posterior
dentition. Tooth long axis of the lower incisor followed the tangent law.
However, tooth axis of the posterior segment was approximately 15
more upright than those explained by the tangent law. This tooth axis
angle generates a horizontal strength component with a tendency to
move teeth forward and tighten proximal contacts
In the present study, the angle from the closing axis to the
anterior tooth of Class I was around 85 and within 104 and
108 in premolars and molars. The angle in Class I was around
15 (differential angle values expressed minus 90 from our
measurement, according to Orthlieb [15]) and nearly the same
figures were maintained from the 1st premolar through 2nd
molar (Fig. 8). This figure remained the same during growth
and development. It can be speculated that the reason that
molar axes are adjusted to around 15 more than shown in the
tangent law is because mandibular rotation occurs with the
increase in posterior vertical dimension followed by occlusal
plane rotation (Fig. 7). In addition, the angle of the anterior
tooth axis is smaller in Class II and wider in Class III. This could
be the result of dento-alveolar compensation to the skeletal
discrepancy. Although there is some difference because of this
compensation, lower anterior tooth axes observed in the
present study basically followed Page’s tangent law.
The radius of the curve of Spee was smaller in Class II than
Class I, and longer in Class III; however, these differences were
not significant. DPO difference during growth and develop-
ment was less in Class II and more in Class III; however, again,
these differences were not significant.
From these results, it can be concluded that during lower
facial growth, the occlusal vertical dimension and occlusal
plane change. When the vertical dimension rises in the molar
region, the mandible will adapt to this change by anterior
rotation. During these processes, the inclination of the tooth
axis to the closing axis (differential angle) is maintained. As a
result, in completed occlusion development, the anterior
tooth axis tends to follow the tangent law. However, molars
tend to adjust by 15 against the tangent law described. This is
the result of the rotation of the occlusal planes and anterior
rotation of the mandible.
The reconstruction of dental occlusion is fundamental in
dentistry. It can be altered by orthodontic treatment, occlusal
management during growth, prosthetic treatment, or implant
J. Stomat. Occ. Med.
Springer-Verlag Mandibular rotation and occlusal development during facial growth
original article
therapy. However, guidelines for building functional occlu-
sion are poorly established. We believe that our knowledge of
the natural adaptation of the occlusion system during growth
will help to establish guidelines for daily clinical practice.
Take-home message
When the vertical dimension rises in the molar region during
lower facial growth, the mandible will adapt by anterior
rotation. During these processes, the inclination of the tooth
axis to the closing axis is maintained. As a result, in completed
occlusion development, the anterior tooth axis tends to follow
the tangent law. However, molars tend to adjust by 15 against
the tangent law. This is the result of the rotation of the occlusal
planes and anterior rotation of the mandible.
Conflict of interest
The authors declare that there is no conflict of interest.
Acknowledgments
This work was performed at the Research Institute of Occlu-
sion Medicine and Research Center of Brain and Oral Science,
Kanagawa Dental College, and supported by a grant-in-aid for
Open Research from the Japanese Ministry of Education,
Culture, Sports, Science and Technology.
References
[1] Björk A. Facial growth in man, studied with the aid of metallic
implants. Acta Odontol Scand 1954;13:9–34.
[2] Björk A. Prediction of mandibular growth rotation. Am J Orthodont
1969;55:585–99.
[3] Björk A, Skieller V. Facial development and tooth eruption. An
implant study at the age of puberty. Am J Orthodnt 1972;62:339–83.
[4] Carlson DS. Craniofacial biology as normal science. In: Johnston LE
(ed.) Vistus in Orthodontics, Philadelphia, PA: Lea & Feviger,
1985;12–37.
[5] Dawson PR. Evaluation, diagnosis, and treatment of occlusal
problems, 2nd edn, St Louis: CV Mosby, 1989;85–91, 365–81.
[6] Elgoyhen JC, Moyers RE, McNamara JA Jr, Rido ML. Craniofacial
adaptation to protrusive function in young Muscus monkeys. Am J
Orthod 1972;62:469–80.
[7] Fushima K, Kitamura Y, Mita H, Sato S, Suzuki Y, Kim YH.
Significance of the cant of occlusal plane in Class II division 1
malocclusion. Eur J Orthodont 1996;18:27–40.
[8] Karisen AT. Craniofacial growth differences between low and high
MP-SN angle males: a longitudinal study. Angle Orthod
1995;65:341–50.
[9] Karisen AT. Association between facial height development and
mandibular growth rotation in low and high MP-SN angle faces:
A longitudinal study. Angle Orthod 1997;67:103–10.
[10] Kim YH. Anterior open bite and its treatment with multiloop
edgewise arch wire. Angle Orthod 1987;57:290–321.
[11] McNamara JA Jr. An experimental study of increased vertical
dimension in the growing face. Am J Orthod 1977;71:382–95.
[12] McNamara JA Jr, Graber LW. Mandibular growth in the rhesus
monkey (Macaca mulatta). Am J Phys Anthropol 1975;42:15–24.
[13] Orthlieb JD, Slavicek R. Geometrische: interpretation der Spee kurve.
(Geometrical interpretation of the curve of Spee.) Zeitschrififur
Stomatologie 1985;82:1–18.
[14] Orthlieb JD. Interet de la courbe de Spee dans la recherche d’un plan
d’occluosion en prothese fixee. (Interest of the curve of Spee in the
construction of the occlusal plane in fixed prosthodontics.) Aix-
Marseille: These de doctorat en Sciences Odontologiques, Mars.
1983.
3/2009 129
 original article
[15] Orthlieb JD. The curve of Spee: Understanding the sagittal
organization of mandibular teeth. J Craniomand. Pract
1997;15:333–40.
[16] Page HL. The occlusal curve. Dental Digest 1952;19–21.
[17] Petrovic A. Mechanisms and regulation of mandibular condylar
growth. Acta Morphol Nee’l Scand 1972;10:25–34.
[18] Sato S, Suzuki N, Suzuki Y. Longitudinal study of the cant of the
occlusal plane and the denture frame in cases with congenitally
missing third molars – Further evidence for the posterior
discrepancy. J Jpn Orthod Soc 1988;47:517–25.
[19] Sato S, Takamoto K, Suzuki Y. Posterior discrepancy and
development of skeletal Class III malocclusion. Orthodontic
Review 1988;Nov–Dec:16–29.
130 3/2009 Mandibular rotation and occlusal development during facial growth
[20] Sato S. Case report: developmental characterization of skeletal
Class III malocclusion. Angle Orthodont 1994;64:105–12.
[21] Sato S, Lim CD, Miyagawa Y, Kim H, Akimoto S, Kim HY. The
development of open bite as a result of posterior discrepancy and
its treatment approach using multiloop edgewise arch wire. The
International Journal of the MEAW Technic and Research
Foundation. 1999;5:5–16.
[22] Schmuth GPF, Madre D. Prediction of growth rotation of the
lower jaw and the modification of overbite. Eur J Orthod
1979;1:155–68.
[23] Spee FG. Die versdiiebimgsbahn des Gnteridefara am schadel.
Orientation of the mandibular path related to the skull. Arch Anal
U Physiol 1890;16:285–94.

Springer-Verlag J. Stomat. Occ. Med.