European Journal of Orthodontics 11 (1989) 139-143 © 1989 European Orthodontic Society

Incisor edge-centroid relationships and overbite

depth
W. J. B. Houston
Department of Orthodontics, UMDS, Guy's Hospital, London

SUMMARY Interincisor angulation is commonly held to be a critical factor in determining

overbite depth, where there is incisor contact. In this study significant correlations between
these variables were found in Class II, division 2 malocclusions although interincisor angle
explained less than a third of the variance in overbite depth. It was found that the anteroposterior
relationship of the lower incisor edge to the upper incisor root centroid is more strongly related
to overbite depth and it is suggested that this is a useful factor to take into account in planning
treatment in Class II cases.

Introduction planning, as this would include the effects both

The factors generally accepted as influencing
overbite depth where incisor contact is achieved,
are the interincisor angle and the shape of the
palatal surface of the upper incisor crown.
Clearly, where incisor contact is not achieved,
either because of the size of overjet or because
there is an open bite, these dental factors are
not important in determining overbite depth.
Where the incisors do meet, it has been postu-
lated that they will continue to erupt until there
is a stable contact that balances the forces of
eruption of the teeth. The stability of the contact
depends on the angle between the lower incisor
axis and the slope of the relevant part of the
palatal surface of the upper incisors. This in
turn is related to the interincisor angle.
It is apparent, however, that other dental
facrorsmustbeimportantinfluences-on overbite - -than_with_overbites Jess_than_ 2_mm^Ballard
depth: an increased interincisor angle will usually (1948) remarked that the inclination of the lower"
be associated with a deep overbite where there
is a Class II skeletal pattern; but in a Class III incisors, and thus the interincisor angle, were
skeletal pattern with a similar interincisor angle, important in determining overbite depth. This
the overbite will be reduced (Fig. 1). In this
respect the skeletal pattern is important in its
influence on the anteroposterior incisor apical
relationship. Variations in the lower incisor
inclination may compensate for or exaggerate
the effects of the anteroposterior incisor apical
relationship. It seems therefore that some meas-
ure of the anteroposterior relationship between
the lower incisor edge and the upper incisor apex
might be of value in diagnosis and treatment
of the incisor apical relationships and the lower
incisor inclination. In practice, it is more con-
venient to locate the upper central incisor root
centroid (Fig. 2). The hypothesis investigated
here is that the anteroposterior relationship
between the lower incisor edge and the upper
incisor root centroid is an aetiological factor in
determining overbite depth. As such, it is of
relevance in planning tooth movements in Class
II cases to ensure that overbite reduction will be
stable.
Review of literature
Bjork (1947) found that in Swedish conscripts
when the overbite was greater than 2 mm the
interincisor angle was on average 5 degrees wider
incisor axis to the palatal surface of the upper
view has been supported by many authors since
that time, although there have been few scientific
investigations into the problem.
Popovich (1955) investigated the association
between interincisor angle and overbite depth
and in Class II, division 2 cases reported a
correlation of r = 0.73. In a study of 190 cases,
Backlund (1960) found a correlation of —0.57
between the inferior interincisor angle and over-
bite depth (the correlation was negative be-
140
Figure 1 A wide interincisor angle will usually be associated
with a deep overbite in a Class II case (a); but in a Class HI
case a similar interincisor angle may be associated with a
reduced overbite.
cause he measured the supplement of the angle
usually reported). There was a very similar
correlation (r = 0.52) between overbite depth
and interincisor angle in 100 cases where the
overbite before treatment exceeded 5 mm (Lud-
wig, 1967). Solow (1966) in his study of 100
young adults reported the correlation between
these variables to be 0.45. Simons and Joondeph
W. J. B. HOUSTON
Figure 2 The upper incisor root centroid is located at the
midpoint of the long axis of the root. The edge-centroid
relationship (a) is measured as the distance between the
perpendicular projections of these points on to the maxillary
plane. The distance is positive wherever the lower incisor
edge is in advance of the upper root centroid, and negative
otherwise.
(1973) found that in their series of 70 cases there
was an association between the interincisor angle
and overbite depth prior to treatment, but no
figures were given.
It is of interest that in Ludwig's cases at least
2 years post-retention, the correlation between
interincisor angle and overbite depth was only
0.31; and Simons and Joondeph (1973) stated
that in their cases at least 10 years post-retention,
there was no correlation between these variables.
However, Berg (1983) in his study of the stability
of deep overbite correction, stated that 'The fact
that the interincisor angle was less than 140
degrees after treatment was considered to be an
important factor in the amount of stability
achieved'.
Ballard (1948) had pointed out that the slope
of the palatal surface of the upper incisors could
be relevant to overbite depth. Backlund (1958)
investigated the angle between the lower incisor
axis and the slope of the different parts of the
palatal surface of the upper central incisors
and in a subsequent paper (Backlund, 1960)
suggested that the angle between the lingual line,
from the incisor edge to the amelo-cemental
OVERBITE DEPTH
junction, and the lower incisor axis was a rel-
evant factor in overbite depth in Class II, division
2 cases.
Subjects and methods
Lateral skull radiographs were taken in sequence
from files of the Royal Dental Hospital of
London, until 50 in each of the incisor Classes
I, II, division 1 and division 2 had been obtained.
The only criteria for selection were that the
patient had either a late mixed or permanent
dentition and that they belonged unequivocally
to one of these groups, with complete overbites.
Subsequently a few radiographs were rejected
because of inadequate quality.
The radiographs were digitized directly under
optimal conditions on a back-illuminated digit-
izer on-line to a computer (Houston, 1979). The
landmarks are the anterior and posterior nasal
spines, the apices and edges of the upper and
lower incisors, and the upper incisor root cen-
troid. They were digitized twice in sequence,
points in disagreement by more than 2 mm being
redigitized. The wide error limit was chosen
to reject outliers without distorting the error
distribution. Method error was calculated from
the difference between variables calculated from
the two digitizations. The immediate replication
only slightly underestimates the true method
error (Houston, 1982). The statistical analysis
was undertaken on measurements averaged from
the two digitizations.
Results
The reproducibility of the measurements was
within generally accepted limits. The descriptive
statistics (Table~ 1) follow~the pattern that was-
expected. Overbite depth was greatest on average
in the Class II, division 2 group with its varia-
bility, represented by the standard deviation,
Table 1 Descriptive statistics
Class 1
n = 50
X s.d.
Overbite depth (mm) 3.0 1.5
Intercisor angle (degs) 132.9 7.8
Edge centroid (mm) 2.6 2.0
141
being similar to that in the other groups. The
interincisor angle in Class I falls between that
for the two Class II groups. In Class II, division
1 the interincisor angle is reduced because the
upper incisors are proclined; and it is large in
the Class II, division 2 cases because the upper
central incisors are retroclined.
The edge-centroid relationship in the Class I
cases averages 2.6 mm with a standard deviation
of 2.0 mm: in the majority of these cases the
lower incisor edge lies in advance of the upper
root centroid. In the Class II cases, the lower
incisor edge is palatal to the upper incisor root
centroid, the discrepancy being more severe in
the Class II, division 2 cases.
Correlations between the measurements inves-
tigated here are reported in Table 2. The only
significant correlation between overbite depth
and interincisor angle is in the Class II, division
2 cases where it is 0.53. This indicates that 28
percent of the variance in overbite depth in
these cases can be explained by variance in the
interincisor angle (r = 0.53, r2 = 0.28).
The correlations for overbite depth with the
edge centroid relationship are higher than with
the interincisor angle. The correlation is again
strongest for the Class II, division 2 cases (r =
— 0.78, r2 = 0.61). These correlation coefficients
are negative because the farther behind the upper
root centroid the lower incisor edge lies, the
smaller (or more negative) the measurement. In
order to determine whether the interincisor angle
in Class II, division 2 cases (the only group in
which this variable was significantly related to
Table 2 Correlations with overbite depth.
Class II Class II
Class I div 1 div 2
Interincisor angle 0.17 0.17 0.53
Edge centroid relation -0.59 -0.24 -0.78
Class II Class II div 2
n = 46 n =42
X s.d. X s.d.
6.42 2.8 8.9 2.8
113.0 10.6 157.0 10.9
-1.6 2.0 -3.5 2.3
142
overbite depth) still explains some of the vari-
ation in overbite depth after the edge centroid
relationship is taken into account, the partial
correlation coefficient between overbite depth
and inter-incisor angle was calculated. This
coefficient was virtually zero ( — 0.01) and indi-
cates that the interincisor angle is not related to
overbite depth once the edge centroid relation-
ship has been taken into account.
Discussion
The values for the interincisor angle in the
different classes of malocclusion are in general
agreement with previous reports. It is note-
worthy that the correlation between overbite
depth and interincisor angle in the Class II,
division 2 group (r = 0.53) is in such close
agreement with the value of 0.52 reported by
Ludwig (1967) in 100 cases with overbite greater
than 5 mm; and the value of —0.57 of Backlund
(1960). The incisor classification of the cases
studied by these authors is not clear, although
both must have included a substantial pro-
portion of rather severe Class II cases. In a study
of Popovich (1955) the correlation reported
between interincisor angle and overbite was
remarkably high in the Class II, division 2 cases
(r = 0.73). It is possible that this is due to
some peculiarity in the sampling, because the
correlation between overbite depth and anterior
facial height are also very high. In the present
study it was found that the edge centroid re-
lationship explains significantly more of the
variance in overbite than does the interincisor
angle. Indeed, once this has been allowed for,
the interincisor angle adds nothing to the expla-
nation of overbite depth. The edge-centroid
relationship is most important in overbite depth
in Class II, division 2 cases but even here, it
explains only about 60 percent of the variance
(r = -0.78, r2 = 0.61). Clearly other factors are
still of relevance and these must include the
slope of the palatal surface of the upper incisor
at the contact with the lower incisor edge, and
possibly anterior face height and the eruptive
potential of the incisor teeth. It is also possible
that the direction of facial growth and thus the
direction of eruption of the incisors is important.
The tracings published by Bjork and Skieller
(1972) show that the incisors do not necessarily
erupt along their long axes but may drift oc-
W . J. B. HOUSTON
clusally with resorption occurring along the
lingual surface of the socket wall.
Investigation of the factors associated with
overbite depth is of relevance not only in deter-
mining aetiology but in defining the tooth move-
ments that are required to ensure stability
following orthodontic treatment. The low or
absent correlations between overbite depth post-
retention and interincisor angulation found by
Ludwig (1967) and by Simons and Joondeph
(1973) respectively, may be attributable to a
number of factors, although their results are not
reported in sufficient detail to allow further
analysis. It should be noted that these papers
dealt with overbite depth following retention,
not the change in overbite depth that following
treatment. It was found in this study that in
Class I cases, the relation between overbite and
interincisor angulation is low: where the lower
incisor edges occlude on the cingulum plateau
of the upper incisors, variations in overbite are
liable to reflect crown length and overjet rather
than the interincisor inclination directly. The
majority of treated cases should have an ideal
incisor relationship and few will exhibit a relapse
in overbite depth. Thus the distribution of over-
bite depth (or its post-treatment change) is likely
to be markedly skewed: this can make the use
of parametric correlation coefficients misleading.
The only effective way of investigating this
problem would be to obtain records of cases
displaying a range of post-treatment change
in overbite depth, from complete stability to
extensive relapse, and to relate these changes to
the interincisor angle and other factors such as
overjet stability. To obtain a sufficient number
of relapsing cases would be difficult. The stronger
association found in this study between overbite
depth and the edge centroid relationship indi-
cates that it might be more closely related to
overbite stability, although to demonstrate this
would again require extensive post-treatment
records. However, on the basis of the present
results, it does seem to be appropriate to take
account of this relationship in planning treat-
ment.
The edge centroid relationship offers a particu-
larly simple method of evaluating the tooth
movements that are required for stable overbite
reduction in Class II cases. Where the lower
incisor edges already lie in advance of the root
centroid by 1 -3 mm, as in some Class II, division
1 cases, simple tipping of the upper incisors to
OVERBITE DEPTH
reduce the overjet should result in an overbite
that is stable. On the other hand, where the
lower incisor edge lies behind the upper root
centroid, reasonable assurance of the stability
of overbite reduction depends on a correction
of this relationship. A clinical decision has to be
made whether this should be done by lower
incisor advancement or by palatal root torque
of the upper incisors. If the lower incisors
are brought forward by favourable mandibular
growth, then prospects for stability are good
but prediction of these favourable changes is
unreliable. Except where they have been pre-
vented from coming forward to a position of
muscle balance by a habit or by the occlusion
with the upper arch during favourable facial
growth, the prospects for stability of lower
incisor proclination are poor (Mills, 1968:
Simons and Joondeph, 1973).
Apical torque of upper incisors is technically
demanding and is limited by the thickness of the
alveolar process. Often a combination of these
changes is required, the exact balance depending
on the clinical assessment of the individual case.
The amount of correction that is required for
overbite stability depends on the circumstances.
In adults where the overbite is reduced by
intrusion of the incisors, or in the child where
growth in lower face height will exceed the
amount of overbite reduction required, the inci-
sors contact needs to resist only the eruptive
force of the teeth. In these circumstances the
overbite may well be stable when the upper
incisor root centroid lies only slightly behind the
lower incisor edge, although further correction
may be desirable. On the other hand, if overbite
reduction in an adult has been achieved by
extrusion of the buccal teeth and an increase in
lower face height, this may reduce slowly over-
a period of years. This will be accompanied by
intrusion of the buccal teeth, but unless the
incisor contact is really secure, the incisors will
tend to slide past one another, rather than
intrude. The same considerations apply to the
younger patient where residual facial growth is
less than the amount of overbite reduction that
has been obtained by buccal segment extrusion.
143
A secure overbite may be difficult to obtain in
these cases, but for the maximal chances of
stability, the upper root centroid should be at
least 2 mm behind the lower incisor edge.
Address for correspondence
Professor W. J. B. Houston
Department of Orthodontics and Children's
Dentistry
United Medical and Dental Schools of Guy's
and St. Thomas's Hospitals
Guy's Tower
London Bridge SE1 9RT
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