ORIGINAL ARTICLE

Comparison of maxillary and mandibular

growth
Banafsheh K. Ochoa, DDS, MS,a and Ram S. Nanda, DDS, MS, PhDb
Oklahoma City, Okla

In this longitudinal study, serial lateral cephalometric radiographs were used to compare growth patterns of
the maxilla and mandible, with hand-wrist radiographs used to assess skeletal maturity. The sample
comprised 28 untreated subjects (15 female, 13 male) who were followed from ages 6 to 20 years. All
subjects had Class I malocclusions without anterior crossbites. Absolute values and incremental changes for
linear and angular cephalometric measurements were recorded and analyzed, and the relative growth-rate
formula was used to provide an accurate index of acceleration and deceleration of growth. The SNA angle
did not change significantly with age, but the SNB angle increased significantly in the male subjects. The ANB
angle decreased continuously until age 14. The palatal plane descended significantly from the horizontal
plane. The anterior and posterior nasal spines moved at about the same rate. The mandible grew in length
twice as much as the maxilla from ages 6 to 20. With growth, the facial profiles of the male subjects became
straighter as the chin became more prominent. The female subjects had less incremental growth and
duration of growth of the mandible, so that the profiles remained more convex. Overall, skeletal and
chronologic ages did not differ significantly, except at ages 10 and 16 in the female subjects. Individual
variability pointed to the need for assessing each patient’s pattern in the general guidelines of the group
pattern. (Am J Orthod Dentofacial Orthop 2004;125:148-59)

A
n important objective of orthodontic treatment
during adolescence is to take advantage of
growth in patients with skeletal discrepancies.
Through effective management of the growing cranio-
facial complex, superior results can be achieved. There-
fore, orthodontists are generally interested in defining
the changes in the various components of the craniofa-
cial structures, especially in the maxilla and mandible.
In 1955, Björk1 used metallic implants in the right
side of each arch to analyze the growth mechanism of
individual human bones on the basis of comparison
with the external bone contours. Nanda and Ghosh2
studied longitudinal cephalometric radiographs from
the Denver Child Research Council and found that the
largest amount of growth occurred from ages 6 to 12
years in girls and 12 to 18 years in boys. Even in the
period of 18 to 24 years, a small amount of growth was
recorded in both sexes. There were relatively larger
changes in the male subjects when compared with the
female subjects.
From the University of Oklahoma College of Dentistry, Oklahoma City, Okla.
a
Graduate student.
b
Professor and chairman, Department of Orthodontics.
Reprint requests to: Dr Ram S. Nanda, University of Oklahoma College of
Dentistry, Department of Orthodontics, PO Box 26901, 1001 Stanton L. Young
Blvd, Oklahoma City, OK 73190; e-mail, ram-nanda@ouhsc.edu.
Submitted, August 2002; revised and accepted, March 2003.
0889-5406/$30.00
Copyright © 2004 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2003.03.008
148
Growth of the face is closely related to growth of
the body as a whole and therefore accelerates consid-
erably during adolescence.3-6 Maximal craniofacial
growth, although closely associated with stature, has
been shown to occur slightly later than maximal statural
growth.3,7
The clinical importance of evaluating skeletal mat-
uration has long been recognized in orthodontics. The
osseous changes seen in hand-wrist films are indicators
of more general skeletal changes. Most investigators
have found significant correlations between matura-
tional stages derived from hand-wrist radiographs and
changes in statural height. Since Greulich and Pyle8
presented an atlas of hand-wrist radiographs to deter-
mine state of maturity, many studies have shown a
close relationship between skeletal maturation and
facial maturation.
Investigations based on longitudinal cephalomet-
ric growth studies indicate that facial type might be
identified as early as age 5,9 and a tendency for a
Class II relationship can also be predicted.10 Growth
is a differential process, in which some parts enlarge
more or less than others and in many directions. In
this study, some measurements commonly used in
orthodontic diagnosis were used to focus on growth
changes in the maxilla and mandible. Hand-wrist
radiographs were used to relate these growth changes
to skeletal maturity.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 125, Number 2
Fig 1. Cephalometric planes. 1, S-N: plane passing
through sella and nasion; 2, horizontal plane: plane
passing through sella, 7° down from line connecting
sella and nasion; 3, N-Go: plane passing through nasion
and gonion; 4, palatal plane: plane passing through
posterior nasal spine and anterior nasal spine (ANS-
PNS); 5, S-Gn: plane passing through the sella and
gnathion; 6, Go-Gn (mandibular plane): plane passing
through gonion and gnathion.
MATERIAL AND METHODS
This study was conducted on serial lateral cephalo-
metric radiographs and hand-wrist radiographs taken
from a sample of 28 subjects (15 female, 13 male)
between the ages of 6 and 20 years. Records were
available for 10 female and 10 male subjects at age 20.
Four extreme cases were selected, and tracings were
superimposed on the sella-nasion line, holding sella
constant, to show profile changes during development.
The longitudinal data were derived from the records
of the Child Research Council, Denver, Colo. All
subjects were healthy, white, and born in Denver.
Radiographs were taken yearly as part of a compre-
hensive study of human growth that ended in the late
1960s. The original data and the radiographs were
made available to us, and the quality of the research
material was excellent. Waldo,11 McDowell,12 and
Nanda3 have previously described the Child Research
Council and the records.
The criteria for selecting the sample were no history
of orthodontic treatment and a Class I malocclusion
without anterior crossbites. Dental occlusion was iden-
tified from the cephalometric radiographs at age 18.
Skeletal development was assessed on hand-wrist
radiographs, according to the Pyle13 standard of refer-
Ochoa and Nanda 149
Fig 2. Cephalometric angles. 1, SNA (sella-nasion-
point A): angle formed by intersection of S-N line and
N-A line at N; 2, SNB (sella-nasion-point B): angle
formed by intersection of S-N line and N-B line at N; 3,
ANB (point A-nasion-point B): difference between an-
gles SNA and SNB; 4, Y axis: anterior inferior angle
formed by intersection of horizontal plane with S-Gn
line; 5, SN-GoGn (mandibular plane angle): angle
formed by intersection of S-N and Go-Gn; 6, upper
gonial angle: angle formed by intersection of line N-Go
and posterior border of ramus; 7, lower gonial angle:
angle formed by intersection of line N-Go and ventral
border of mandible; 8, total gonial angle: sum of upper
and lower gonial angles.
ence, which was prepared for the United States Na-
tional Health Examination Survey.
One examiner (B.O.) traced the radiographs with a
variable light source. The cephalometric planes, angles,
and linear measurements used in this study are shown
in Figures 1, 2, and 3, respectively (the abbreviations
that follow are defined in the figure legends). Several
cephalometric measurements were selected to evaluate
maxillary and mandibular growth in relation to skeletal
maturity. The distance from ANS to PNS was measured
to depict horizontal growth of the maxilla. A horizontal
plane was drawn at S with a correction of 7° to the SN
line. The distances from points ANS and PNS to their
perpendicular intersection on the horizontal plane were
measured to depict vertical growth of the anterior and
posterior maxilla, respectively. For mandibular growth,
the linear measurement Ar-Pog was measured. To
compare maxillary and mandibular growth, 2 different
methods were applied. One method used the angles
SNA, SNB, and ANB. The other entailed drawing
perpendiculars to the palatal plane from points A, B,
150 Ochoa and Nanda
Fig 3. Cephalometric linear measurements. 1, ANS-
PNS (maxillary length): distance between points ANS
and PNS; 2, vertical to palatal plane at PNS and ANS:
first, lines are drawn from points ANS and PNS to their
perpendicular intersection on horizontal plane, then
distance in millimeters is measured from points of
intersections to respective points ANS or PNS; 3, A, B,
and pogonion (Pog) to palatal plane: lines are drawn
perpendicular to palatal plane from point A, point B, and
Pog, and differences in millimeters between points A, B,
and Pog projected onto palatal plane are measured; 4,
Ar-Pog (mandibular length): distance from articulare (Ar)
to Pog.
and Pog. The perpendicular distances in millimeters
between the points A-B and A-Pog on the palatal plane
were then measured.14
Absolute values and incremental changes for the
linear and angular cephalometric measurements were
recorded and analyzed. The relative growth rate formu-
la3,14,15 was used to provide an accurate index of
acceleration and deceleration of growth over specific
periods. This formula was used for each subject for all
cephalometric measurements. Means were then calcu-
lated for the male and female subjects. Growth changes
that occurred over varying periods were all converted to
annual rates by including elapsed time in the formula.
With this method, we could compare growth rates and
growth patterns.
The longitudinal data were categorized into 8 peri-
ods. The sample did not include longitudinal radio-
graphs at the same ages for all subjects. Therefore, for
statistical comparison, estimated ages 6, 8, 10, 12, 14,
16, 18, and 20 years were used as the 8 periods. In the
female and male samples, the paired t test did not show
American Journal of Orthodontics and Dentofacial Orthopedics
February 2004
any significant difference between estimated age and
mean chronologic age. The mean and standard devia-
tion were calculated for actual and skeletal ages at each
period for the female and male samples. The paired t
test was used to find statistically significant differences
between chronologic and skeletal ages.
The mean and standard deviation were calculated
for each cephalometric value at each period. Analysis
of variance was used to determine whether there was
any statistically significant difference between the pe-
riods. The Student-Newman-Keuls test was then per-
formed on the data to detect which periods were
significantly different. All statistical analyses were
done for the female and male samples separately and
for the combined sample.
RESULTS
The female sample was found to have a signifi-
cantly higher skeletal age at age 10 (P ⬍ .05) and a
significantly lower skeletal age at age 16 (P ⬍ .01). In
8 of the 15 girls, the bones on the hand-wrist radiograph
were not fused until age 8, and, in 1 subject, the bones
did not fuse until age 20.
Differences between skeletal and chronologic ages
in the male sample were not statistically significant at
any period, except at 20 years. Only 10 of the 13 men
had radiographs at age 20. Of these 10, 4 did not have
all the bones in their hand and wrist fused until age 20.
When we compared SNA measurements from ages
6 to 20 years in the female and male subjects separately
and combined, the change was not statistically signifi-
cant. For the total sample, the mean SNA angle was
81.44° ⫾ 2.76° at age 6 and 82.34° ⫾ 3.05° at age 20.
In the total sample, SNB angle was found to have
significant changes between various ages. There were
significant increases from ages 6 to 14, 8 to 16, and 12
to 18. The increase was not significant after age 16. The
female sample alone did not show a statistically signif-
icant change in SNB, whereas the male sample had
significant increases in SNB from ages 6 to 16, 12 to
18, and 14 to 20. Table I shows that in a 2-year period,
the peak relative increase in SNB was from ages 10 to
12 (0.5% per year, 0.79° per 2 years) in the female
subjects. In the male subjects, the greatest increases
were from ages 12 to 14 and 14 to 16 (0.78% and
0.74% per year, or 1.17° and 1.14° per 2 years,
respectively).
ANB angle showed a significant decrease during
growth. From ages 8 to 16 in both sexes combined,
there was a statistically significant decrease. In the
female subjects over a 2-year period, the greatest
relative decrease in ANB was between ages 12 and 14
(26.48% per year, or 0.98° per 2 years). In the male
American Journal of Orthodontics and Dentofacial Orthopedics Ochoa and Nanda 151
Volume 125, Number 2

Table I. Mean values of SNB and relative growth between periods

Grouped Overall Female Incremental Female Male Incremental Male
age (y) n SNB (°) n RG (%) changes (°) SNB (°) n RG (%) Changes (°) SNB (°)

6 28 76.46 15 NA NA 76.39 13 NA NA 76.54

8 28 76.88 15 0.21 0.28 76.67 13 0.44 0.57 77.11
10 27 77.14 15 0.26 0.43 77.10 12 0.08 0.08 77.19
12 28 77.89 15 0.50 0.79 77.89 13 0.39 0.69 77.88
14 28 78.71 15 0.29 0.54 78.43 13 0.78 1.17 79.05
16 28 79.58 15 0.36 0.62 79.05 13 0.74 1.14 80.19
18 28 79.90 15 0.20 0.28 79.33 13 0.22 0.36 80.55
20 20 80.56 10 0.06 0.13 79.46 10 0.54 1.10 81.65

RG, Relative growth; % change per year from previous age group to age on same line. NA, not applicable.

Table II. Mean values of maxillary length and relative growth between periods
Estimated Overall Female Incremental Female Male Incremental Male
age (y) n (mm) n RG (%) changes (mm) (mm) n RG (%) changes (mm) (mm)

6 28 45.13 15 NA NA 44.33 13 NA NA 46.05

8 28 47.59 15 2.79 2.39 46.72 13 2.87 2.54 48.59
10 27 49.21 15 1.72 1.49 48.21 12 1.48 1.89 50.48
12 28 50.99 15 1.93 1.88 50.09 13 1.87 1.55 52.03
14 28 52.22 15 0.83 0.97 51.06 13 1.46 1.52 53.55
16 28 53.40 15 0.56 0.49 51.55 13 1.64 1.98 55.53
18 28 53.85 15 0.40 0.42 51.97 13 0.44 0.49 56.02
20 20 54.25 10 ⫺0.31 ⫺0.31 51.66 10 0.67 0.81 56.83

RG, Relative growth: % change per year from previous age to age on same line. NA, not applicable.

Table III. Mean values of mandibular length and relative growth between periods
Estimated Overall Female Incremental Female Male Incremental Male
age (y) n (mm) n RG (%) changes (mm) (mm) n RG (%) changes(mm) (mm)

6 28 85.44 15 NA NA 84.05 13 NA NA 87.04

8 28 90.18 15 2.32 3.83 87.88 13 3.14 5.78 92.82
10 27 94.08 15 2.10 3.59 91.47 12 2.32 4.53 97.35
12 28 98.48 15 2.27 4.24 95.71 13 2.16 4.31 101.66
14 28 102.95 15 2.26 4.85 100.56 13 2.01 4.06 105.72
16 28 106.79 15 0.89 1.71 102.27 13 3.01 6.29 112.01
18 28 108.29 15 0.46 0.84 103.11 13 1.26 2.27 114.28
20 20 109.38 10 0.33 0.58 103.69 10 0.48 0.66 114.94

RG, Relative growth: % change per year from previous age to age on same line. NA, not applicable.

subjects, the maximum decrease was between ages 18
and 20 (19.84% per year, or 0.24° per 2 years).
When we evaluated the female and male samples
separately, the decrease in SN to GoGn was significant
only from ages 6 to 20 in either sex. The SN-GoGn
angle was 33.99° ⫾ 2.87° at age 6 and 29.46° ⫾ 4.19°
at age 20 in the female subjects; for male subjects, the
angle was 34.17° ⫾ 4.98° at age 6 and 27.52° ⫾ 5.87°
at age 20.
When we compared Y axis measurements from
ages 6 to 20 in both sexes combined or alone, there was
no statistically significant change. At age 6, the angle
was 60.99° ⫾ 2.74° and 60.89° ⫾ 2.83° in the female
and male subjects, respectively. Similarly, at age 20,
the angle was 59.85° ⫾ 2.81° and 58.41° ⫾ 2.94° in the
female and male subjects, respectively.
There were significant increases in the vertical
movement of the ANS point from ages 6 to 8, 8 to 10,
10 to 12, and 12 to 14 with both sexes combined and in
the male sample alone. The statistical findings in the
female sample differed in that, after age 8, the signifi-
cant increase was over 4 years instead of 2. After age
14, there was no significant increase. When we looked
at 2-year intervals, the female sample had an increase in
152 Ochoa and Nanda
the vertical measurement at point ANS to the horizontal
plane from ages 6 to 8, 8 to 10, and 10 to 12 (3.51%,
3.25%, and 2.77% per year, or 2.39, 2.16, and 2.13 mm
per 2 years, respectively). In the male subjects, the
greatest increase was from ages 6 to 8 (4.44% per year,
or 3.24 mm per 2 years). The increases in this mea-
surement from ages 8 to 10, 10 to 12, and 12 to 14 were
nearly the same at each 2-year interval (ie, 2.66%,
2.44%, and 2.07% per year, or 1.94, 2.18, and 1.74 mm
per 2 years, respectively).
The increase in the vertical movement of point PNS
from ages 6 to 8, 8 to 10, 10 to 12, 12 to 14, and 14 to
16 for both sexes combined and the male sample alone
was also significant. Again, there was a slight differ-
ence in the female sample, which showed no significant
increase from ages 12 to 14. After age 16, there was no
significant increase in individual groups or the overall
sample.
The vertical increase at point PNS from the hori-
zontal plane was similar to that of ANS. In the female
subjects, the increases from ages 6 to 8, 8 to 10, and 10
to 12 (3.14%, 2.61%, and 2.20% per year, or 2.18, 1.71,
and 1.69 mm per 2 years, respectively) were compara-
ble. In the male subjects, the greatest increase was from
ages 6 to 8 (4.10% per year, or 2.93 mm per 2 years).
Increases from ages 8 to 10, 10 to 12, 12 to 14, and 14
to 16 were similar at 2.87%, 1.98%, 2.55%, and 2.32%
per year, or 2.11, 1.69, 2.08, and 2.09 mm per 2 years,
respectively.
There were statistically significant increases in
maxillary length from ages 6 to 8, 8 to 10, and 10 to 12
in the combined sample, with stability after the age of
14. Whereas the female sample showed statistically
significant increases from ages 6 to 8 and 8 to 12, with
stability in growth after age 12, the male sample
changed significantly from ages 6 to 8, 8 to 12, 12 to
16, and 14 to 20. As shown in Table II, in the female
and male subjects, the greatest relative increase in
maxillary length was from ages 6 to 8 (2.79% and
2.87% per year, or 2.39 and 2.54 mm per 2 years,
respectively.
Mandibular length increased significantly from
ages 6 to 8, 8 to 10, 10 to 12, 12 to 14, and 14 to 16 in
both sexes combined and the male sample alone. After
age 16, there were no significant increases. In the
female sample, the only difference was that the growth
of the mandible was stable after age 14 instead of age
16. As shown in Table III, in the female subjects, the
relative rate of increase in mandibular length was
considerable from ages 6 to 8, 8 to 10, 10 to 12, and 12
to 14 (2.32%, 2.10%, 2.27% and 2.26% per year, or
3.83, 3.59, 4.24, and 4.85 mm per 2 years, respec-
tively), with the peak increase from ages 10 to 12. In
American Journal of Orthodontics and Dentofacial Orthopedics
February 2004
the male subjects, the greatest relative increase was
from ages 6 to 8 and again from ages 14 to 16 (3.14%
and 3.01% per year, or 5.78 and 4.53 mm per 2 years,
respectively).
There were statistically significant decreases in the
distance from A-point to B-point on the palatal plane
between ages 6 to 10, 8 to 14, and 12 to 18. In the
female sample, the greatest relative decrease from
points A to B on the palatal plane was from ages 12 to
14 (15.06% per year, or 1.36 mm per 2 years), whereas
in the male sample, the greatest decrease was from ages
16 to 18 (21.77% per year, or 1.01 mm per 2 years).
Ages 14 to 16 and ages 18 to 20 also had comparable
decreases (16.47% and 17.83%, or 0.68 and 0.60 mm
per 2 years, respectively).
The distance from A-point to Pog on the palatal
plane also decreased significantly between various
ages. The female sample had significance from ages 6
to 8, 8 to 14, and 12 to 16. The male sample showed
significance from ages 6 to 12, 8 to 14, and 10 to 16.
The female sample showed a gradual decrease from
A-point to Pog on the palatal plane, with the peak
relative decrease from ages 6 to 8 (17.96% per year, or
2.33 mm per 2 years) and the second greatest decrease
from ages 16 to 18 (15.00% per year, or 0.36 mm per
2 years). The relative percentage of decrease in the
male sample was much higher after age 14, with the
maximum relative decrease from ages 16 to 18 (33.62%
per year, or 0.86 mm per 2 years).
There was no statistically significant change with
age in the lower gonial angle in the female or male
subjects, or the combined sample. However, the upper
gonial angle decreased significantly from ages 6 to 10,
8 to 14, and 12 to 16 in the combined sample. Likewise,
the total gonial angle decreased significantly from ages
6 to 12, 8 to 16, and 12 to 20.
The growth curves showed that individual variation
occurred in both sexes. Some subjects in this study
displayed extreme variations. For example, female
subject number 5 (Figs 4 and 5) had Class III skeletal
tendencies, with relatively high SNA and SNB angles.
From the ages of 12 to 16, the ANB angle became
negative. Distances from A to B and A to Pog on the
palatal plane were also relatively low, but they had
gradual decreases. The subject had an average profile
during childhood and then grew to have a strong chin
and straighter profile. It was evident on examination of
the growth curves of maxillary and mandibular length
that the mandible grew consistently from ages 6 to 18,
whereas the maxilla showed growth spurts only from
ages 10 to 12 and 14 to 16. The palatal plane main-
tained a nearly parallel relationship to the horizontal
plane. In addition, the relatively lower Y axis and
American Journal of Orthodontics and Dentofacial Orthopedics Ochoa and Nanda 153
Volume 125, Number 2

Fig 4. Cephalometric superimposition of female subject #5, with Class III skeletal tendencies. Black
line, chronologic age (CA) ⫽ 5 years 9 months; blue line, CA ⫽ 11 years 9 months; red line, CA ⫽
17 years. Subject had an average profile during childhood and then grew to have strong chin and
straighter profile. Relatively low Y axis and mandibular plane correlate with horizontal growth pattern
or prognathic facial profile.

Fig 5. Growth curves for female subject #5. Mx, maxilla; Md, mandible.
154 Ochoa and Nanda American Journal of Orthodontics and Dentofacial Orthopedics
February 2004

Fig 6. Cephalometric superimposition of female subject #6, with Class II skeletal tendencies. Black
line, chronologic age (CA) ⫽ 5 years 9 months; blue line, CA ⫽ 11 years 9 months; red line, CA ⫽
17 years. Subject had retrognathic facial profile throughout growth. Y axis increased slightly as
subject aged, indicating vertical growth pattern.

Fig 7. Growth curves for female subject #6. Mx, maxilla; Md, mandible.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 125, Number 2
mandibular plane also show that this patient was a
horizontal grower or had a prognathic facial profile.
Female subject number 6 (Figs 6 and 7) seemed to
be quite different from number 5, in that her cephalo-
metric superimpositions displayed a continuous retrog-
nathic facial profile throughout growth. Angles SNA,
SNB, and ANB did not change greatly during develop-
ment. Maxillary and mandibular length increased
steadily, with the mandible not increasing in length to
the same extent as in female number 5. When we
compared female subjects 5 and 6, the linear measure-
ment from A to B on the palatal plane for number 5
decreased by 3.8 mm, so that it measured 0 mm at age
17 years; this measurement for female subject number
6 decreased 1.4 mm. The A to Pog measurement also
showed the same but more pronounced change (ie, it
decreased in 5 by 10.5 mm and in 6 by only 3.4 mm).
The Y axis in number 6 increased slightly as the patient
developed, indicating vertical growth. ANS grew ver-
tically more than PNS throughout growth, indicating
that the palatal plane tipped down anteriorly. All of
these changes related to a more convex profile and
vertical growth pattern for female subject number 6.
More male subjects in this study had a straighter
profile with a stronger pogonion, like that seen in male
subject number 1 (Figs 8 and 9). The curves for angles
SNA and SNB had the common convex profile in
childhood and then a straighter profile during adult-
hood. Angle ANB was 7.5° at age 5 years but decreased
to 0.5° at 18 years. The mandibular length showed a
steady growth, with a total increase of 30 mm, com-
pared with a maxillary growth of only 13 mm. Because
of the greater mandibular growth, the measurement
from A to B decreased from 6 to 0 mm and from A to
Pog from 5.5 to 1.7 mm.
A relatively extreme retrognathic profile was ob-
served in male subject number 7 (Figs 10 and 11).
Angle ANB increased from 5.5° to 7.5° with growth.
Distances from A to B and A to Pog on the palatal plane
seemed to follow the same relative straight-line pattern
during development. The A-to-B measurement did not
change from 5.75 to 20 years. The distance from A to
Pog decreased by 3 mm. As a result, this subject had a
Class II pattern.
DISCUSSION
The skeletal maturity evaluated from hand-wrist
radiographs for both the male and female subjects was
delayed compared with current maturity standards. The
material used in this study was collected between 1940
and 1970. It is possible that the pattern observed in the
Denver growth study sample was due to secular growth
trends in every decade up to the 1980s.
Ochoa and Nanda 155
Differences in the growth spurt between the sexes
should predict that the female subjects would show
pubertal growth 2 years earlier than the male subjects.
The female subjects tended to have the greatest skeletal
changes between the ages of 10 and 14. At age 10, the
skeletal age of the female sample was 6 months behind
chronologic age. The male sample had the greatest
changes from ages 12 to 16 and even up to age 18 with
mandibular measurements.
The growth pattern for the male sample made the
facial profiles straighter as they grew older. The female
sample, however, had less incremental growth and
duration of growth of the mandible, so that their
profiles remained more convex when compared with
the male sample. Examination of growth curves indi-
cated that individual variation was common in both
sexes, although a general trend in the growth pattern
was noticed.
This investigation included both linear and angular
measurements from the cephalometric radiographs.
With growth, the behavior of the linear and angular
measurements was different in that the angular mea-
surements did not show as much change. This was
because all angles have 3 points, and each point has 2
degrees of freedom for error. Also, all 3 points move
during growth.
The average SNA angle did not show significant
change during growth, a finding that was first reported
by Nanda.16 The data in this study indicated that
sagittal growth at nasion is approximate to the move-
ment of A-point on the maxilla. Other authors have,
however, found conflicting evidence with regard to the
changes in SNA angle. Jamison et al17 reported signif-
icant changes in SNA from ages 8 to 17, although the
increase was clinically insignificant.
The angle between the horizontal plane (7° to SN)
and the mandibular plane was found to decrease during
growth at a continuous rate. The peak decrease in the
mandibular plane angle occurred earlier in the female
group, from ages 6 to 8, than in the male group, which
experienced it from ages 12 to 14. It has been
shown14,16 that posterior vertical height of the mandible
grows more and for a longer period than does anterior
facial height. Therefore, more vertical growth posteri-
orly resulted in flattening of the mandibular plane.
The average value of the Y axis did not change
significantly with age. The male and female samples
showed less than 1° of difference at all ages. Therefore,
the line from sella to gnathion is a helpful foundation to
predict future horizontal or vertical growth of the
mandible.
Both anterior and posterior points of the palate
moved vertically down from the horizontal plane at
156 Ochoa and Nanda American Journal of Orthodontics and Dentofacial Orthopedics
February 2004

Fig 8. Cephalometric superimposition of male subject #1. Black line, chronologic age (CA) ⫽ 5
years 3 months; blue line, CA ⫽ 11 years 9 months; red line, CA ⫽ 18 years. Like this subject, most
men in study had straighter profiles with stronger pogonion. SNA and SNB curves display convex
profile common in childhood, becoming straighter during adulthood. Mandibular length increased
steadily, whereas maxilla had interrupted periods of growth (see Fig 9).

Fig 9. Growth curves for male subject #1. Mx, maxilla; Md, mandible.
American Journal of Orthodontics and Dentofacial Orthopedics Ochoa and Nanda 157
Volume 125, Number 2

Fig 10. Cephalometric superimposition of male subject #7, with Class II skeletal tendencies. Black
line, chronologic age (CA) ⫽ 5 years 9 months; blue line, CA ⫽ 11 years 9 months; red line, CA ⫽
20 years 4 months. Relatively extreme retrognathic profile. Like female subject #6, ANB did not
change much with growth. Note that soft tissue is much thicker for this subject compared with male
subject #1.

Fig 11. Growth curves for male subject #7. Mx, maxilla; Md, mandible.
158 Ochoa and Nanda
about the same rate—10 mm—from ages 6 to 20 years.
There was not a significant tip in the palatal plane in the
sample as a whole or when separated by sex. Nanda and
Merrill14 reported similar findings.
The maxillary length increased significantly every 2
years from ages 6 to 12 years. For the male subjects,
maxillary length increased significantly from ages 14 to
20. This is consistent with data from Nanda and
Ghosh,2 who found that most growth in the maxilla
occurred from ages 6 to 12 in the female subjects and
ages 12 to 18 in the male subjects. Also comparable
was the finding that, on average, the maxilla grew 7.33
mm in the female subjects and 10.78 mm in the male
subjects. The mandibular length also increased signif-
icantly every 2 years up to age 16. These data showed
that the mandible continued to rapidly lengthen 2 years
after the maxilla had decelerated in growth. The sagittal
growth in the mandible ranged from 24 to 33.5 mm in
this sample.
The female sample demonstrated a relative slowing
in growth after age 12 in maxillary length and after age
14 in mandibular length, whereas the male sample
continued to grow significantly until age 16. On the
whole, the male sample displayed greater relative
increases and longer duration of growth in the maxilla
and the mandible. Compared with the maxilla, the
mandible grew more than twice as much in length
between ages 6 and 20. The average increments during
this period were 19.64 mm and 27.90 mm in the female
and the male subjects, respectively.
From the measurements examined individually
for the total sample of 28 subjects, regardless of sex,
angle ANB was not predictive of a skeletal Class II
relationship. The reduction in angle ANB ranged
from 7° to 2° between the ages of 5 and 20. Variation
in changes to angle ANB could not be related to the
amount of sagittal growth in the maxilla or the
mandible. However, a more consistent pattern
emerged in determining a Class II pattern based on
measurements A to B and A to Pog on the palatal
plane. Hussells and Nanda18,19 have shown that angle
ANB depends on other factors, and, to use it reliably,
a correction factor has to be included. Also, Nanda
and Merrill,14 after comparing the palatal plane to
other methods of assessing anteroposterior dysplasia,
concluded that the palatal plane is a reliable refer-
ence plane because of its stability during growth.
Chung and Wong20 conducted a longitudinal study
on Class II subjects selected on the basis of a large
angle ANB. They reported considerable individual
variability. Karlsen21 reported from his longitudinal
studies that, based on changes in angle MP-SN,
forward and backward mandibular rotation could not
American Journal of Orthodontics and Dentofacial Orthopedics
February 2004
be identified. The study of Klocke et al10 has,
however, shown that the indicators of unfavorable
Class II growth might be related to the mandible and
vertical parameters. They found that unfavorable
Class II growth changes were associated with a
tendency for increased gonial angle and a signifi-
cantly increased lower gonial angle. Equally convinc-
ing were the studies conducted by Baccetti et al,22 who
found that most early Class II skeletal signs were the
result of mandibular position and dimensions.
Most longitudinal growth studies provide means
and standard deviations of measurements on the basis
of a total sample. Although these data provide useful
information on the general group trends, they fail to
emphasize that the general trends cannot be reasonably
applied to the growth behavior of each person and the
measurements of his or her craniofacial structures. The
variation is too large to be easily summarized by group
statistics.
CONCLUSIONS
1. SNA angle did not change significantly from ages 6
to 20. SNB angle increased significantly in the male
subjects throughout life. ANB angle decreased con-
tinuously until age 14. This decrease was variable
and could not predict the degree of change on an
individual basis.
2. SN to GoGn decreased significantly until age 14.
3. The changes in the angulation of the palatal plane
were minimal.
4. None of the parameters used in this study was
predictive of a skeletal Class II relationship, because
of the individual variation in growth.
5. The mandible grew in length twice as much as the
maxilla from ages 6 to 20.
6. The male sample overall developed 2 years longer
than the female sample and also grew relatively
more. With growth, the facial profile became
straighter by increased prominence of the chin in the
male sample. The female sample had less incremen-
tal growth and duration of growth of the mandible,
so that the profiles remained more convex when
compared with the male sample.
7. Overall, skeletal and chronologic ages did not differ
significantly, except for ages 10 and 16 in the female
subjects.
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