OP & Dento Skeletal Frames During Growth by Dr. Eliana Midori Tanaka
OP & Dento Skeletal Frames During Growth by Dr. Eliana Midori Tanaka
OP & Dento Skeletal Frames During Growth by Dr. Eliana Midori Tanaka
Introduction: Valuable information about growth and development in different types of occlusions and
skeletal frames can be obtained by analyzing longitudinal data, particularly the functional significance of the
occlusal plane; this information is important for understanding the etiology, diagnosis, and treatment of
malocclusion. The purpose of this study was to investigate the relationship between the cant of the occlusal
plane and mandibular position to establish a functional determinant in the development of different
dentoskeletal frames in longitudinal growth samples. Methods: Several measurements were analyzed and
compared in a total sample of 406 lateral cephalograms of 102 orthodontically untreated white patients taken
at different ages of the growing period from the Burlington Growth Centre, Toronto, Ontario, Canada.
Results: Regarding changes related to the cant of the occlusal plane, a progressive tendency was seen
through the years for consistency (significance and correlation) between maxillary posterior occlusal plane
inclination (FH-OP[P] and Mx-OP[P] angles) and mandibular position (SNB angle) reflected in the appearance
of a certain type of dentoskeletal frame (APDI and ANB angles). Statistically significant correlations (P
0.0000) were found between the angle of the Frankfort plane-maxillary posterior occlusal plane and the
anteroposterior dysplasia indicator, the maxillary posterior occlusal plane angle and the anteroposterior
dysplasia indicator, the maxillary posterior occlusal plane angle and the angle of the palatal plane-mandibular
plane, the angle of the Frankfort plane-maxillary posterior occlusal plane and the SNB angle, and the
maxillary posterior occlusal plane angle and the SNB angle. Conclusions: There is a possible relationship
between the inclination of the maxillary posterior occlusal plane and mandibular position, consistent with the
etiology of different dentoskeletal frames. Thus, a more comprehensive etiologic approach based on the
inclination of the maxillary posterior occlusal plane should be considered in the correction of malocclusion.
(Am J Orthod Dentofacial Orthop 2008;134:602.e1-602.e11)
C
raniofacial growth prediction is an ultimate treatment of malocclusions. It is still not completely
goal in craniofacial biology and is a major clear how abnormal growth occurs in the different
concern in orthodontics, because it is the key dentoskeletal frames, largely because the various fac-
point in the diagnosis, prevention, interception, and tors that seem to be involved (cranial base flexion,
eruption, vertical dimension, occlusal plane, intrinsic
From the Department of Craniofacial Growth and Developmental Dentistry,
Division of Orthodontics, Kanagawa Dental College, Yokosuka, Japan.
maxillary and mandibular growth, genetics, environ-
a
Orthodontist PhD and visiting research fellow. ment, and so on) and their interactions, particularly the
b
Professor, chairman, and research associate, Research Institute of Occlusion significance of the occlusal plane inclination as a
Medicine, Research Center of Brain and Oral Science.
Made possible with material from the Burlington Growth Centre, Faculty of
primary determinant in establishing the mandibular
Dentistry, University of Toronto, Toronto, Ontario, Canada, which was position, are not totally understood.
supported by funds provided by National Health Grant 605-7-299 (Canada) Many experiments and theories have addressed
(data collection); grant PR 33 (Province of Ontario) (duplicating); the Varsity
Fund (housing and collection). Research supported by a grant-in-aid for open
craniofacial growth-related dentoskeletal problems. It
research from the Japanese Ministry of Education, Culture, Sports, Science and has been stated many times in the literature that the
Technology; and a research grant from Dr. Young H. Kim and the Kim mandible moves forward the exact amount of the
Foundation of the MEAW (Multiloop Edgewise Arch Wire), Kenkyukai
(Japan).
posterior horizontal condylar growth, if no autorotation
Reprint requests to: Eliana Midori Tanaka, Department of Craniofacial Growth occurs.1-4 In addition, Schudy5 pointed out that the
and Developmental Dentistry, Research Institute of Occlusion Medicine, relationship between effective vertical condylar growth
Research Center of Brain and Oral Science, Division of Orthodontics, Kana-
gawa Dental College, 82 Inaoka-Cho, Yokosuka, Kanagawa 238-8580, Japan; (horizontal growth) and vertical growth of the molars,
e-mail, [email protected]. determines whether the mandible rotates backward or
Submitted, November 2007; revised and accepted, February 2008. forward, or whether it does not rotate. The occlusal
0889-5406/$34.00
Copyright 2008 by the American Association of Orthodontists. plane is the effect, not the cause, of anatomic relation-
doi:10.1016/j.ajodo.2008.02.017 ships attributing condylar growth (related to vertical
602.e1
602.e2 Tanaka and Sato American Journal of Orthodontics and Dentofacial Orthopedics
November 2008
Denture frame ()
FH-MP Angle formed by FH and MP
PP-MP Angle formed by PP and MP
OP-MP Angle formed by OP and MP
AB-MP Angle formed by AB and MP
Kim ()
APDI Sum of facial plane, AB plane angle,
and FH-PP angle
ODI Sum of AB-MP plane and FH-PP angle
Downs-Graber ()
SNA Angle formed by SN and NA planes
SNB Angle formed by SN and NB planes
ANB Angle between SNA and SNB planes
Occlusal plane ()
FH-OP(C) Angle between the FH plane and OP(C)
FH-OP(A) Angle between the FH plane and OP(A)
FH-OP(P) Angle between the FH plane and OP(P)
Mx-OP(C) Angle of OP(C) to the PP perpendicular
Mx-OP(A) Angle of OP(A) to the PP perpendicular
Mx-OP(P) Angle of OP(P) to the PP perpendicular
OP difference Angle between OP(A) and OP(P)
Fig 1. Reference landmarks and planes used for ceph-
(A P) alometric measurements.
cial growth can be influenced by occlusal changes. III.26 Because APDI reflects both skeletal and dentoal-
Thus, it is extremely important to obtain a better veolar characteristics that cannot be shown by single
understanding of the anatomic and physiologic modu- measurements and has proved to have the best diagnos-
lation of the occlusal plane during growth and devel- tic performance in determining anteroposterior discrep-
opment to determine the contributing factors and use an ancy of the skeletal pattern according to the receiver
adequate clinical approach to treat the various maloc- operating characteristic analysis,27 it was preferred over
clusions. the more commonly used ANB angle. Six age interval
The purpose of this study was to estimate the groups (3-4, 6-7, 8-10, 12-14, 16-17, and 18-20 years)
possible relationship between the cant of the occlusal were identified, and cephalometric data at these ages
plane and mandibular position to establish a functional were compared among the 3 dentoskeletal frames.
determinant in the development of different dentoskel-
etal frames in longitudinal growth samples of white Cephalometric analysis
subjects. All cephalograms were hand traced on acetate
paper, and their landmarks were digitized by the same
MATERIAL AND METHODS investigator (E.M.T.). After data collection, the cepha-
This study was performed at the Research Institute lometric tracings were scanned at high resolution and
of Occlusion Medicine and Research Center of Brain digitized by using computer software for digital anatom-
and Oral Science, Kanagawa Dental College, Yoko- ical markers and cephalometric analysis (CADIAS,
suka, Japan. GAMMA Dental Software for Windows, version 5.1.1.0
The total sample comprised 406 lateral cephalo- with SP10, Vienna, Austria). The analyzed variables of
grams of 102 subjects (46 female, 56 male), taken at the lateral cephalograms are shown in Table I.
different age periods (range, 3-20 years) from the The variables related to skeletal morphology were
representative population of the Burlington Growth analyzed by using the Downs-Graber analysis (SNA,
Centre, University of Toronto, Ontario, Canada; their SNB, and ANB angles),28,29 the Kim analysis (anterior
predominant racial origin was white, and the major dysplasia indicator [APDI] and overbite deep indicator
ethnic background was Anglo-Saxon. [ODI]),26,30 and Satos denture-frame analysis.31
Orthodontic records from the data bank of the Briefly, the denture frame consists of 5 planes: Frank-
Burlington Growth Centre were initially selected based fort horizontal (FH), palatal plane (PP), mandibular
on the availability of lateral cephalograms under the plane (MP), maxillary occlusal plane (OP), and AB
following inclusion criteria: natural growth, orthodon- plane (AB), and the angles formed by these planes were
tically untreated, no congenitally missing teeth (except measured (Fig 1). In this study, additional measure-
for the third molars), no extracted teeth, and sequential ments regarding the occlusal plane were made, namely,
records with at least 3 cephalograms including 1 at the FH-OP(C), FH-OP(A), FH-OP(P), Mx-OP(C), Mx-
beginning and 1 at the end of the growing period. In OP(A), and Mx-OP(P), to examine the relationship
addition to these inclusion criteria, the final sample was between the measurements regarding the skeletal frame
classified according to the dentoskeletal frame into and the occlusal plane configurations (Fig 2).
Class I, Class II, and Class III, based solely on the The FH plane was determined by using anatomic
anteroposterior dysplasia indicator (APDI), the follow- porion and orbitale as reference points,32 and the OPs
ing criteria: Class II 81.37 3.79 (Class I) Class were defined as follows.
602.e4 Tanaka and Sato American Journal of Orthodontics and Dentofacial Orthopedics
November 2008
Table II. Descriptive statistics and comparisons in different skeletal occlusion types at subsequent age periods for
white subjects*
3-4 years 6-7 years
I vs I vs II vs I vs I vs II vs
Class I (n 15) II (n 4) III (n 9) II III III I (n 29) II (n 16) III (n 19) II III III
Denture frame ()
FH-MP 27.1 3.5 24.8 4.5 28.4 4.9 NS NS NS 23.7 4.1 23.8 3.6 26.0 4.3 NS NS NS
PP-MP 30.1 3.7 30.2 5.4 29.7 4.3 NS NS NS 27.4 3.6 28.1 4.3 28.9 5.1 NS NS NS
OP-MP NA NA NA NA NA NA 12.5 3.1 11.0 2.5 17.9 14.6 NS NS NS
AB-MP 73.6 4.1 76.8 7.1 72.0 4.9 NS NS NS 76.5 4.3 76.7 5.3 72.2 5.1 NS
Kim ()
APDI 76.3 3.1 73.1 2.0 78.4 4.4 NS NS NS 76.1 4.0 75.3 3.9 78.9 3.9 NS NS
ODI 70.7 5.4 71.3 8.0 70.8 5.2 NS NS NS 72.7 4.9 72.4 7.3 69.3 6.7 NS NS NS
Steiner ()
SNA 80.1 4.2 79.6 5.0 81.4 3.8 NS NS NS 80.7 3.4 80.7 3.5 81.0 3.9 NS NS NS
SNB 75.7 3.8 74.3 4.1 76.7 2.4 NS NS NS 76.2 3.1 75.9 3.7 76.8 2.9 NS NS NS
ANB 4.4 1.4 5.3 1.6 4.7 2.2 NS NS NS 4.4 1.7 4.8 1.3 4.2 1.8 NS NS NS
Occlusal plane ()
FH-OP(C) 12.9 3.6 10.5 2.8 14.5 2.2 NS NS NS 10.5 3.9 9.7 4.8 11.3 3.4 NS NS NS
FH-OP(A) NA NA NA NA NA NA 6.1 5.7 8.1 2.7 8.5 5.1 NS NS NS
FH-OP(P) NA NA NA NA NA NA 12.6 2.8 17.0 4.3 14.4 7.2 NS NS NS
Mx-OP(C) 74.2 4.0 74.0 1.9 74.3 3.6 NS NS NS 75.7 2.6 75.9 3.9 75.8 3.9 NS NS NS
Mx-OP(A) NA NA NA NA NA NA 78.5 5.2 78.1 1.0 76.9 6.8 NS NS NS
Mx-OP(P) NA NA NA NA NA NA 72.0 3.2 69.3 4.4 71.0 7.0 NS NS NS
OP difference NA NA NA NA NA NA 6.4 6.9 8.8 4.9 5.9 5.5 NS NS NS
(A P)
1. OPs in the permanent dentition. ous molar to the midpoint of the maxillary first
OP(C): maxillary OP conventional, a line drawn permanent molar at the occlusal surface.
from the incisal edge of the maxillary central 3. OP in the deciduous dentition.
incisor to the midpoint of the maxillary first molar OP(C): maxillary OP conventional, a line drawn
at the occlusal surface. from the incisal edge of the maxillary central
OP(A): maxillary OP anterior, a line drawn from deciduous incisor to the distobuccal cusp tip of the
the incisal edge of the maxillary central incisor to maxillary second deciduous molar.
the cusp tip of the maxillary second premolar.
OP(P): maxillary OP posterior, a line drawn from Statistical analysis
the cusp tip of the maxillary second premolar to the Statistical analyses were performed with the SPSS
midpoint of the maxillary second molar or third molar program for Windows program (version 13.0J, SPSS
(if it has erupted) at the occlusal surface. Japan, Tokyo, Japan). In addition to standard descrip-
2. OPs in mixed the dentition. tive statistical calculations (means and standard devia-
OP(C): maxillary OP conventional, a line drawn tions), the ANOVA test was used to evaluate differ-
from the incisal edge of the maxillary central ences among the 3 groups. When ANOVA yielded
permanent incisor to the midpoint of the maxillary significant results indicating that at least 1 group was
first permanent molar at the occlusal surface. significantly different from the others, post-hoc analy-
OP(A): maxillary OP anterior, a line drawn from ses (Tukey, Bonferroni, Scheff tests) were also per-
the incisal edge of the maxillary central permanent formed for multiple group comparisons to determine
incisor to the cusp tips of the maxillary second which group significantly differed. The statistically
deciduous molar. significant levels were predetermined at P 0.05, P
OP(P): maxillary OP posterior, a line drawn 0.01, and P 0.001. Additionally, to report intra-
from the cusp tips of the maxillary second decidu- group longitudinal changes in OP inclination, the Stu-
American Journal of Orthodontics and Dentofacial Orthopedics Tanaka and Sato 602.e5
Volume 134, Number 5
I vs I vs II vs I vs I vs II vs
Class I (n 34) II (n 32) III (n 20) II III III I (n 39) II (n 27) III (n 22) II III III
Denture frame ()
FH-MP 22.8 3.8 23.6 4.9 24.8 4.5 NS NS NS 22.3 4.2 23.3 4.8 24.1 5.4 NS NS NS
PP-MP 26.1 3.9 27.6 4.9 27.5 6.1 NS NS NS 25.2 4.4 25.7 3.9 26.3 5.5 NS NS NS
OP-MP 11.6 3.1 12.7 4.9 13.4 4.6 NS NS NS 12.5 3.3 11.0 2.5 13.9 5.0 NS NS NS
AB-MP 75.6 4.3 76.8 7.1 70.9 5.9 NS
75.2 4.5 76.7 5.3 69.3 6.8 NS
Kim ()
APDI 78.0 3.8 74.1 3.6 81.6 3.9 NS
74.1 3.6 76.2 4.5 84.4 4.6
Steiner ()
SNA 80.3 4.0 79.5 4.4 81.7 4.3 NS NS NS 80.6 4.0 80.4 4.0 81.3 4.1 NS NS NS
SNB 76.9 3.4 74.7 3.5 78.8 3.3
NS
77.5 3.0 75.9 3.7 79.4 3.0 NS NS
Occlusal plane ()
FH-OP(C) 11.6 4.4 10.4 4.7 11.1 2.6 NS NS NS 9.8 4.1 11.5 4.5 10.2 2.9 NS NS NS
FH-OP(A) 10.9 5.5 8.6 6.2 9.8 3.2 NS NS NS 9.0 5.2 10.4 5.0 10.1 3.2 NS NS NS
FH-OP(P) 12.9 3.5 14.4 3.3 13.0 2.9 NS NS NS 12.6 3.5 15.9 4.5 11.5 4.2
NS
Mx-OP(C) 75.0 3.8 75.6 3.7 76.2 2.6 NS NS NS 77.3 3.4 76.1 3.5 77.7 3.1 NS NS NS
Mx-OP(A) 75.7 4.9 77.4 5.1 77.2 3.0 NS NS NS 78.1 4.3 77.2 4.0 77.8 3.3 NS NS NS
Mx-OP(P) 73.6 2.9 71.5 3.7 74.0 3.9
NS
74.5 4.4 71.8 3.9 76.4 5.0
NS
dent t test was used to compare the change of the OPs the statistical comparisons of the 3 dentoskeletal frame
in each group (Class I, Class II, and Class III) over time groups at each age interval are shown in Table II.
at the different age intervals (P 0.05). Pearson prod- There were no significant differences among the 3
uct moment correlation coefficients were calculated to groups in the measurements related to the denture-
estimate the relationship between the OP and the frame analysis, although there was a notable tendency
dentoskeletal configurations. for FH-MP and PP-MP to decrease through the years.
Data analysis was performed in the total sample, The values for OP-MP became close to normal (aver-
and no classification was made according to sex, age, 12.1) after the growing period in all groups when
because there was no significant differences in vari- the OP(C) was considered. The AB-MP angle started to
ables related to the OP between the sexes. show significance from 6 to 7 years; it was significantly
To assess the cephalometric method error, dupli- higher in Class I vs Class III and Class II vs Class III
cate tracings and measurements of 30 randomly from 8 to 14 years, and more significantly different in
selected lateral cephalograms were made by the same Class I vs Class II and Class II vs Class III from 16 to
investigator (E.M.T.) after 20 days. Dahlbergs cal- 20 years. This might indicate the different mechanisms
culation33 and Houstons coefficient of reliability34 of anteroposterior mandibular adaptation.
were used to determine sufficient reliability and The ODI (mean SD, 74.50 6.07)30 did not
measurement accuracy. Random errors ranged from have statistical significance in the 3 to 7 age groups, but
0.15 to 0.65 for the angular measurements, and it did change significantly in the 8 to 18 age groups,
Houstons reliability ranged from 0.87 to 0.99. No showing no statistical significance and reaching normal
systematic errors were detected at the 10% level of values for overbite among the 3 groups at the end of the
significance. growing period. As we expected, the APDI was not
significant at earlier stages, but it became significantly
RESULTS higher with growth and development in the 3 dentoskel-
Of the total sample of 102 subjects, 42 were etal groups. Similar behavior was observed for the
classified as Class I (41%), 38 as Class II (37%), and 22 ANB angle, but no significant difference was found
as Class III (22%) based on the APDI.26 The results and between Class I and Class III.
602.e6 Tanaka and Sato American Journal of Orthodontics and Dentofacial Orthopedics
November 2008
I vs I vs II vs I vs I vs II vs
Class I (n 31) II (n 29) III (n 16) II III III I (n 33) II (n 12) III (n 12) II III III
Denture frame ()
FH-MP 21.2 4.8 21.8 5.9 21.5 4.5 NS NS NS 20.2 3.9 19.4 7.2 18.8 3.7 NS NS NS
PP-MP 23.5 4.6 24.3 5.2 22.4 5.6 NS NS NS 22.3 4.1 22.5 6.8 19.5 6.3 NS NS NS
OP-MP 13.2 4.1 13.1 4.4 13.4 4.2 NS NS NS 12.2 4.0 12.3 6.2 12.0 4.0 NS NS NS
AB-MP 74.4 5.6 79.5 7.2 70.2 6.7
NS
75.3 4.6 81.8 8.2 72.6 5.9
NS
Kim ()
APDI 82.1 2.9 76.2 4.4 87.3 3.6
82.4 2.2 75.7 2.1 87.9 1.3
Occlusal plane ()
FH-OP(C) 7.9 3.8 9.1 4.2 7.9 2.7 NS NS NS 8.0 3.5 8.3 4.9 7.0 2.6 NS NS NS
FH-OP(A) 7.5 4.6 8.3 5.7 7.7 3.1 NS NS NS 7.7 4.2 8.2 6.6 7.2 2.6 NS NS NS
FH-OP(P) 11.7 2.8 14.6 3.8 10.8 2.7
NS
11.3 2.7 13.8 3.3 8.7 2.9
OP difference 4.2 4.6 5.4 5.1 3.1 2.4 NS NS NS 3.6 4.3 5.6 7.0 1.5 3.5 NS NS NS
(A P)
SNA angle was significant in Class I vs Class III but remains constant in a normal value during the growing
and Class II vs Class III, but only from 16 years period while the mandible is adapting to obtain a Class I
onward. The SNB values were significantly different position. In the Class II group, the OP(P) did not differ
among the Class I, Class II, and Class III groups, significantly; it maintained an inclined (steep) plane from
almost from the beginning of the growing period. the beginning (17.0) to the end (13.8) of the growing
Measurements derived from the OP(C) and the period (P 0.05). But the Class III group showed a
OP(A) did not show a statistically significant differ- significant change over time for the OP(P) from the
ence between any pairs in the groups. However, beginning (14.4) to the end (8.7) of the growing period,
measurements related to the maxillary posterior oc- more specifically between 16 and 20 years (P 0.05),
clusal plane, or more exactly, FH-OP(P) and Mx- with marked flattening decreasing from 10.8 to 8.7.
OP(P), showed a progressive tendency to increase Statistically significant correlations were found be-
during the growing period, reaching statistical sig- tween FH-OP(P) and APDI (r 0.505, P 0.000);
nificance at 12 to 14 years and 8 to 10 years, Mx-OP(P) and APDI (r 0.548921, P 0.000);
respectively. This was especially observed in Class I Mx-OP(P) and PP-MP (r 0.50345, P 0.000),
vs Class II and Class II vs Class III, but statistical FH-OP(P) and SNB (r 0.50419, P 0.000); and
significance was also reached for Class I vs Class III Mx-OP(P) and SNB angle (r 0.4083, P 0.000).
after the growing period (Figs 3 and 4). The Class II These results indicate a progressive tendency
group had steep posterior occlusal planes and the through the years for consistency (significance and
Class III group had flat posterior occlusal planes in correlation) between the OP(P) inclination (FH-OP[P],
the maxilla. Notably, these changes were also evi- Mx-OP[P]) and mandibular position (SNB) reflected in
dent when analyzing the longitudinal behavior of this the appearance of a certain type of dentoskeletal frame
parameter in each group. For the Class I group, there (APDI, ANB).
was no significant difference over time for the cant of
the OP(P) from the beginning (12.6) to the end DISCUSSION
(11.3) of the growing period (P 0.05). This might Many longitudinal growth studies have investigated
explain why the cant of the OP has a tendency to decrease the changes in the skeletal pattern with age.35-43 There
American Journal of Orthodontics and Dentofacial Orthopedics Tanaka and Sato 602.e7
Volume 134, Number 5
Fig 3. Schematic representation of the average changes and comparison of the FH-OP(P) in the
different dentoskeletal frames (Class I, Class II, and Class III) during the growing period (6-20 years).
Statistical significance was reached at 12-14 years among the 3 classes.
Fig 4. Schematic representation of the average changes and comparison of the Mx-OP(P) in the
different dentoskeletal frames (Class I, Class II, and Class III) during the growing period (6-20 years).
Statistical significance was reached at 8-10 years among the 3 classes.
602.e8 Tanaka and Sato American Journal of Orthodontics and Dentofacial Orthopedics
November 2008
Fig 6. Correlation between the OP(P), measured by the FH-OP(P), and A, anteroposterior
maxillomandibular relationship (APDI); B, mandibular position (SNB).
It was postulated that the position of the OP in the 3 groups at the end of the growing period. This leads us
denture frame can be greatly influenced by a tooth-to- to consider the extraordinary functional capacity of the
denture base discrepancy posterior to the first molar mandible to adapt to the maxillary occlusal surfaces to
(posterior discrepancy) due to the squeezing out achieve function (optimum and maximum occlusal
effect that causes overeruption of the maxillary and relationship) in this study sample.
mandibular posterior teeth. Consequently, a less steep The correlation analysis also showed a relationship
OP develops and adversely affects the vertical dimen- between the magnitude of OP(P) inclination and man-
sion (elongation) of the dentition; this interferes with dibular position. The smaller the OP(P) angle measured
the functional occlusion and induces malpositioning of by the FH-OP(P), the more forward the mandibular
the mandible followed by abnormal mandibular condy- position in congruence with the dentoskeletal type, and
lar growth in the developing skeletal Class III maloc- vice versa, as indicated by the SNB and APDI angles
clusion.49 Based on our findings, posterior discrepancy, (Fig 6). However, it is difficult to establish a cause-
in addition to the eruption force of the third molars and-effect relationship from these results, since other
(from 17-21 years)48 at the end of the growing period, factors could also be involved (eg, condylar growth)
should be considered a probable causative factor for the and should be evaluated with our outcomes. But it
abrupt flattening of the OP in Class III development, would be reasonable to assume, from these longitudinal
because this condition was seen in most patients (19 of growth findings, that any change in the inclination of
22; 86%) of our Class III sample, caused mainly by a the OP would alter the mandibular position relative to
discrepancy in both maxillary and mandibular molars the maxillary occlusal surfaces as well as the condylar
(63%) or only in the maxillary molars (32%). In adaptive response to it. This, in turn, might influence
comparison, Class I and Class II groups had a lower the skeletal pattern and type of malocclusion.
prevalence of posterior discrepancy; 43% (18 of 42 Nevertheless, our data suggest a link between the
patients) and 57% (22 of 38 patients), respectively, due cant of the OP and the development of dentoskeletal
mainly to the discrepancy in the mandibular molars frames caused by mandibular retrognathism or progn-
(61% and 50%) or in both jaws (33% and 41%). athism. This relationship was especially observed in
As for the ODI,30 the statistical significance ob- Class II subjects, in whom a steep OP was associated
served in the 8 to 17 age intervals might represent the with decreased mandibular prognathism, and Class III
different skeletal adaptations to the changes in the subjects, in whom a flat OP was associated with
occlusal configuration during growth. Noteworthy is increased mandibular prognathism than that in the
the observation that, when there was statistical signif- Class I subjects.
icance, higher values in Class II indicated a tendency It is likely that the inclination of the maxillary
for a deep bite; lower values in Class III denoted a posterior occlusal plane (OP[P]) during growth and
tendency for open bite. However, no statistical signif- development is a factor corroborating with the contin-
icance and normal values for the ODI were found in the uous adaptive capacity of the mandible.
602.e10 Tanaka and Sato American Journal of Orthodontics and Dentofacial Orthopedics
November 2008
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