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JCO-Online Copyright 2012 Cephalometric Evaluation of Skeletal Open- and Deep-Bite Tendencies
VOLUME 26 : NUMBER 06 : PAGES (338-343) 1992 ANTHONY D. VIAZIS, DDS, MS
The influence of mandibular growth rotation in the development of deep or open bites before, during, or after orthodontic intervention has been the subject of extensive investigations over the past 40 years. 1-19 A number of diagnoses have attempted to predict abnormal rotational patterns in the growth and development of the facial skeleton, especially the mandible. 4,5,7,14-16,18 Although it has been well documented that the morphology of natural reference structures is accurate and effective as a basis for cephalometric research, 5,17 Baumrind and colleagues have shown that there is no measurement or set of measurements that can be used to predict growth rotation, even by experienced clinicians. 16 However, this does not mean an orthodontist cannot use some cephalometric measurements to assess an individual patient's facial growth. This article presents 10 such measurements (Table 1) that can indicate a rotational pattern tendency, thus increasing the likelihood of accurate growth prediction in a particular case. Some of these measurements are based on a sample of 15 male and 15 female patients who had Class I dental and skeletal relationships, orthognathic profiles, and good facial esthetics. 20 The Michigan growth studies were also used for some of the standards.8
Discussion
No cephalometric analysis is perfect. The clinician must rely on direct observation and experience, as well as on tools such as measurements and ratios, to achieve a correct diagnosis. The distinction between open- and deep-bite tendencies, especially in borderline cases, is important not only for the initial diagnosis, but also for planning treatment mechanics (Table 2). In borderline cases--those with slight increments of growth in one direction or another--the treatment can become complicated and the case difficult to finish. Not all the measurements presented here will be of equal value in every case, but a majority of them will usually give a good indication of a patient's growth tendency. The following two cases demonstrate the thinking process used with these measurements in evaluating and predicting growth rotation. These cases were not treated orthodontically, and therefore the changes shown are attributable solely to growth.
Case Reports
Case 1 shows a 12-year-old male who presented with a 1mm open bite (Fig. 1A). It is obvious that successful treatment of such a patient would depend greatly on controlling his open-bite tendency, especially during the pubertal growth spurt. Six of his 10 measurements were more than 1 SD from the means, indicating a backward growth rotational pattern--in other words, a strong open-bite tendency (Table 3). In fact, three years later the patient exhibited significant vertical growth that decreased his overbite by 4mm (Fig. 1B). This patient was treated surgically. Case 2 is a 10-year-old male who presented with a 1mm overbite (Fig. 2A). In his cephalometric evaluation, three of the 10 measurements indicated backward growth rotation and two indicated a forward growth pattern. The rest were close to the mean values (Table 4). The diagnosis was that the patient would continue to grow in the same manner, and that orthodontic mechanotherapy should limit extrusive side effects as much as possible. Five years later, without treatment, the patient demonstrated a similar occlusal relationship, with an overbite of 0mm (Fig. 2B). In both of these cases, clinical judgment, combined with a realistic evaluation of the cephalometric measurements, allowed a proper understanding of the individual patient's growth tendencies.
Figures
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Fig. 1 A. 12-year-old male with 1mm open bite. B. Significant vertical growth resulted in 3mm anterior open bite three years later.
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Fig. 2 A. 10-year-old male with 1mm overbite. B. Five years later, overbite is about the same.
Tables
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Fig. 1
Fig. 2
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Fig. 4
References
1. Bjork, A.: The face in profile: An anthropological x-ray investigation on Swedish children and conscripts, Svensk Tandlakare Tidskrift 40, Copenhagen, 1947. 2. Ricketts, R.M.: Planning treatment on the basis of the facial pattern and an estimate of its growth, Angle Orthod. 27:14-37, 1957. 3. Ricketts, R.M.: The influence of orthodontic treatment on facial growth and development, Angle Orthod. 30:103-133, 1960. 4. Schudy, F.F.: The rotation of the mandible resulting from growth: Its implications in orthodontic treatment, Angle Orthod. 35:36-50, 1965. 5. Bjork, A.: Prediction of mandibular growth rotation, Am. J. Orthod. 55:585-599, 1969. 6. Odegaard, J.: Growth of the mandible studied with the aid of metal implant, Am. J. Orthod. 57:145-157, 1970. 7. Jarabak, J.R. and Fizzell, F.A.: Technique and Treatment with Light Wire Edgewise Appliances, 2nd ed., C.V. Mosby Co., St. Louis, 1972. 8. Riolo, M.L.; Moyers, R.E.; McNamara, J.A.; and Hunter, W.S.: An Atlas of Craniofacial Growth, Monograph No. 2, Craniofacial Growth Series, Center for Human Growth and Development, University of Michigan, Ann Arbor, 1974. 9. Lavergne, J. and Gasson, N.: A metal implant study of mandibular rotation, Angle Orthod. 46:144-150, 1976. 10. Isaacson, R.; Zapfel, R.; Worms, F.; and Erdman, A.: Effects of rotational jaw growth on the occlusion and profile, Am. J. Orthod. 72:276-286, 1977. 11. Isaacson, R.; Zapfel, R.; Worms, F.; Bevis, R.; and Speidel, T.: Some effects of mandibular growth on the dental occlusion and profile, Angle Orthod. 47:97-106, 1977. 12. Ricketts, R.M.: Perspectives in clinical application of cephalometrics, Angle Orthod. 51:115-150, 1981. 13. Lavergne, J. and Gasson, N.: Analysis and classification of the rotational growth pattern without implants, Br. J. Orthod. 9:51-56, 1982. 14. Lavergne, J.: Morphogenetic classification of malocclusion as a basis for growth prediction and treatment planning, Br. J. Orthod. 9:132-145, 1982. 15. Skieller, V.; Bjork, A.; and Linde-Hansen, T.: Prediction of mandibular growth rotation evaluated from a longitudinal implant sample, Am. J. Orthod. 86:359-370, 1984. 16. Baumrind, S.; Korn, E.L.; and West, E.E.: Prediction of mandibular rotation: An empirical test of clinician performance, Am. J. Orthod. 86:371-385, 1984. 17. Buschang, P.H.; LaPalme, L.; Tanguay, R.; and Demirjian, A.: The technical reliability of superimposition on cranial base and mandibular structures, Eur. J. Orthod. 8:152-156, 1986. 18. Solow, B. and Houston, W.J.B.: Mandibular rotations: Concepts and terminology, Eur. J. Orthod. 10:177-179, 1988. 19. Nielsen, I.L.: Maxillary superimposition: A comparison of three methods for cephalometric evaluation of growth and treatment change, Am. J. Orthod. 65:422-431, 1989. 20. Viazis, A.D.: The Cranial Base Triangle, J. Clin. Orthod. 25:565-570, 1991.
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