Scand. / . Dent. Res.

1977: 85: 193-199

(K.ey words: growth; mandihle)

Direction arid intensity of

mandibular rotation in the sagittai
adjustment during growth
of the jaws
JEAN LAVERGNE AND NICOLE GASSON

Orthodontic Department, School of Dentistry, Bergen, Norway

ABSTRACT — A material of 22 patients with metallic implants in both jaws has been used to
study, longitudinally on lateral headplates, the relationship between the degree of mandibu-
lar rotation, the difference in amount of growth of both jaws, represented by the value (E),
and the sagittal intermaxillary relationship (G). It has been established that the variation
of sagittal mtermaxillary relationship and the variation of the degree of mandibular rota-
tion are two phenomena presenting a "balance mechanism" when related to the value (E).
The different combinations of these three variables during mandibular growth are proposed,
represented in diagrams. This study reveals that several possible mandibular responses cor-
respond to a single given initial condition.

(Accepted for publication 15 June 1976)

It has been established in an earlier study
(LAVERGNE & GASSON 1976) that the di-
rection and intensity of mandibular rota-
tion are closely related to the difference in
the rate of growth of the jaws. It has been
suggested that mandibular rotation plays
an important role in the intermaxillary
adaptation during growth.
This relationship between the differ-
ence in the amount of growth and the de-
gree of rotation was established without
taking into consideration the relative sa-
gittal movement of both jaws. Some devia-
tion in the relationship was also observed
and this could be either of marked inten-
sity but of limited duration (Fig. 1) or
relatively mild, but present during the
whole period of observation (Fig. 2). The
variation in the sagittal intermaxillary re-
lationship seems to play an important role
in these deviations.
To investigate this problem further, a
study of the relative position of both jaws
has been undertaken and has been ana-
lyzed in relation to the rotation and the
intensity of growth.
Material and metliods
The sample consisted of 22 patients (nine girls
and 13 boys) from the collection of patients
with metallic implants at the Orthodontic De-
partment, School of Dentistry, University of
Bergen. None of these patients exhibited patho-
logic conditions, but various types of malocclu-
194 LAVERGNE AND GASSON

Fig. 3. Age distribution of the sample.

Fig. I. Comparison between rotational diagram

(d°/NSL) and value (E). The curves exhibit a backward movement of the mandible relative
a local deviation at age II years (patient 10'). to the maxilla. (3) Tbe value E = XCAXs -
AXi) + 2:(AY2 - AYi) was used (LA-
VE»GNE & GASSON 1976) to represent the dif-
sion, treated and non-treated, were represented. ference of growth rate of both jaws. The sig-
The distribution of tbe sample is given in Fig.
3. Reference points and lines are shown in
Fig. 4.
The measurements made on each cephalo-
metric head-film were: (1) the degree of posi-
tional rotation of the mandible, i.e. the man-
dibular rotation measured relative to NSL and
expressed by d°/NSL (LAVERGNE & GASSON
1977). (2) The G-angle: this is measured be-
tween the vertical line connecting the most an-
terior implant in each jaw and the bisecting
line of ML-NL. The G-angle was chosen to
minimize the effect of the rotation in mea-
suring the variation of the intermaxillary rela-
tionship. A curve was constructed to show the
variation of tbe G-angle. The first value was
taken as the base and subsequent points "ivere
plotted in relation to this. A positive slope indi-
cates a forward movement and a negative slope

Fig. 4. Reference points and lines. A', intersec-

I to P. Y2, distance from Bi to NSL measured on
Fig. 2. Comparison between rotational diagram
(d°/NSL) and value (E) (patient 2). Here
the two curves exhibit similar shape.
tion of NL with NA line. Bi, mid-point of man-
dible on the bisecting line of gonial angle. P,
point of anterior part of symphysis tangent to a
perpendicular to ML. XI, length from A' to
PNS (posterior nasal spine). Yl, distance from
occlusal plane to NSL measured on a line tan-
gent to posterior wall of fossa pterygopalatina
and perpendicular to NSL. X^, length from Bi
a perpendicular line to NSL. A.I.L., anterior
implant line passing through the most anterior
implant in each jaw.
 MANDIBULAR ROTATION AND ADJUSTMENT 195

nificance of the variation of this value in rela-

tion to the variation of the degree of rotation
has been studied in previous papers (LA-
VERONE & GASSON 1976) in which a strong
correlation was established between both nn
curves. The term "expected rotation" is used in Fig. 5. Distribution of the variation of the G-
the discussion of the curves. The basic curve, angle.
expressing the "expected rotation", follows the
main direction of the d°/NSL curve, and is
further defined with the same shape as the E relation at the 0.01 level in two individ-
curve. In the previous papers the Spearman uals and at the 0.05 level in eight indi-
rank correlation test was used to check the re- viduals.
lationship between the curves^ but this test only
gives a basis for rough comparison of the curve The mean annual variation of the G-
shaipe. In the present investigation a detailed angle was found to be +0.37 for the
study of the slope of each annual segment of whole sample, indicating a tendency to a
the curves was undertaken. This results in a weak relative forward movement of the
division of the sample into three distinct
groups: Group 1 consisted of the cases where mandible (Fig. 5).
all the corresponding annual segments of curves An increase was found in the G-angle
(E) and d7NSL exhibit the same sign of in 18 cases and a decrease in two cases,
slope. That is to say, the curves have the same indicating a forward shift and a backward
slope shape, with or without the same general
direction (Fig. 2); Group 2 in which the two shift of the mandible respectively in rela-
curves exhibit the same variation but with tion to the maxilla. In two cases no shift
some "local deviations". The two curves ex- was detected.
hibit opposite signs of slope for 1 or 2 years
(Fig. 1); Group 3 in which the local devia-
tions are frequent and the two curves are com-
pletely different.
All the measurements were made by each of
the authors independently and the mean "^vas
used. When the difference between the two
measurements was more than 1" or 1 mm, a
third measurement was made and the mean
value between the two closest measurements
was used.
As this investigation is only a description of
some phenomena, no difference has been made
between treated and non-treated patients.

Results

For the total sample the Spearman rank

test indicates correlation between the
curves (E) and d°/NSL at the 0.01 level / ^
in 12 cases, at the 0.05 level in 10 cases,
and showed no correlation at all in two
cases.
Group 1 contains 10 individuals show-
ing a correlation at the 0.01 level and two
Figs. 6^ 7. Sagittal inter-jaws relationship (pa-
at the 0.05 level In Group 2 the Spear- tients 2 and 10). Thin line indicates the mean
man rank test indicates a significant cor- cuive (smoothed curve).
196 LAVERGNE AND GASSON

Observation of the curves representing ANTERIOR ROTATION

the variation of the G-angle revealed two

different patterns: smaU variations around
the mean curve (Fig. 6) and marked va-
riations away from the mean curve
(Fig. 7). d'/MSL

Study of the pattern of variation of the

G-angle in each of the three groups (1,
2, 3) showed; in Group 1 with 12 indi-
viduals the sagittal relationship remains
constant or shows a weak variation
around the mean curve. In Group 2 with
eight individuals, the local anomalies he-
tween the curves seem to correspond with
certain changes io the G-angle. The dif-
ference between the measured rotation
and the expected rotation (given by E)
corresponds to the intensity of variation
of the G-angle. The larger the difference
between the expected and measured rota.-
tion, the larger the variation of the G-
angle. In Group 3 with two individuals,
the variation of the G-angle cannot he
classified.
Discussion
The results show that in Group 1, in
which the variation of the sagittal inter-
maxillary relationship is smooth (G
curve), the curves (E) and d°/NSL are
directly proportional and well correlated.
In Group 2 it can be seen that when the
G-angle increases, corresponding to a for-
ward shift of the mandible relative to the
maxilla, the degree of mandibular rota-
jANttUALAMOUMlj
Fig. S. Construction of the diagrams 9—11. Dif-
ference between annual amount of maxillary
and mandibular growth is given by value (E),
degrees of mandibular rotation by d°/NSL and
tbe sagittal relative movement of the jaws by
G-angle.
earlier studies (LAVERGNE & GASSON
1976), it was suggested that the mandibu-
lar rotation could be part of the process
of mandibular adaptation to the maxilla.
Anterior mandibular rotation was consi-
dered to be part of a process of "dissi-
pating" excess of mandibular growth re-
lative tO' the maxilla. The present investi-
gation shows that another way to use this
excess could be forward movement of the
mandible relative to the maxilla. The dif-
ferent possible combinations between the
degree of rotation, the G-angle and (E)
AMTEFtlOfl ROTflllOW

tion is less than would be expected from

the curve (E). Conversely, a backvirard
shift of the mandihle (a reducing G-
angle) is associated with a higher degree
of rotation than expected. Group 3 con-
tained individuals whose curves showed
no correlation.
It seems that there is some "balance"
between the sagittal movenaent of the Fig. 9. Alternative of mandibular response: the
mandihle and its degree of rotation. In mandible is growing more than the maxilla.
 MANDIBULAR ROTATION AND ADJUSTMENT
Fig. 10. Alternative of mandibular response:
the amount of growth is the same in the man-
dible and in the maxilla.
are shown in Figs. 8—11 and the corre-
sponding diagrams are shown in Figs.
12-14.
If the mandible has a stronger growth
than the maxilla (Fig. 9), on the basis of
the previous findings it can be said that
this aiBount of mandibular growth is used
(1) to compensate for maxillary growth
without changing the sagittal intermaxil-
lary relationship; (2) in anterior mandib-
ular rotation; and (3) in sagittal for-
ward movement of the mandible relative
to the maxilla.
To the initial condition, several re-
sponses are possible: (A) the excess
of mandibular growth is "dissipated"
through the anterior rotation and the sa-
gittal movement of the mandible, (B) the
Fig. 11. Alternative of mandibular response:
the mandible is growing less than the maxilla.
197
Fig. 12. Illustration of Fig. 9.
excess of mandibular growth is complete-
ly "dissipated" by anterior rotation, (G)
the excess of mandibular growth is
com:pletely "dissipated" through sagittal
movement of the mandible, (D) the ex-
cess of growth is completely "dissipated"
through the forward movement of the
mandible and an extra elongation from
the posterior rotation is used to^ increase
this forward movement, and (E) the man-
dible does not completely follow the max-
illa. This increased excess of growth is
"dissipated" through a high degree of
mandibular rotation.
If the amounts of mandibular and max-
illary growth are equal (Fig. 10), the
following responses are possible: (A) the
mandible follows the maxilla; there is no
d/NSL
'AGE is 19 II 12 : 17
PAT. 20 19 30
Fig. 13. Illustration of Fig. 10.
198 LAVERGNE AND GASSON

* i B ' c : D lowing the cybernetic theory of condylar

I ^^^^^ • : and mandibular growth (PETROVIC, G A S -
1 . "'^x^ : . i SON & SCHLIENGER 1974, PETROVIO 1974,,
I : ^'~ ' ~'"~- • • G A S S O N , STUTZMANN & PETROVIG 1975,
I lEi \ • i ' : PETROVIC & G A S S O N 1975) the rotation
I \ . ^^ is the last term of a sequence, of which
I A ^ ~ ^^"^ *^^ first cause is represented by variation
j GANQUE : : : ' o f the level of somatotropic hormone: ,a
j • : diminution of the level of this hormone
,.l ~~-~,, ; __ ; '•""--.,_ results in slowing d o w n of longitudinal
—I '' , 1 : growth, relatively more marked in the
AGE 13 14 : 15 t6 : B 9 ' i,0 II

w- - 30 • ai • 15 IS mandible than in the maxilla. T h e "con-

Fig. 14. Illustration of Fig. 11. frontation operation." betweeti the posi-
tions of both dental arches then gives rise
to "correcting signals" resulting in an in-
rotation and no changes in the intermax- crease of activity of the lateral pter)'goid
illary relationship. (B) The mandible foi- muscle which promotes not only an in-
lows the maxilla and an extra elongation crease in the number of cell divisions in
from the posterior rotation allows a rela- the condylar cartilage, but also their pre-
tive forward movement of the mandible. ferential localization in the posterior zone
(G) The mandible does not completely of that cartilage. Moreover, the apposi-
follow the maxilla. The excess of growth tional growth at the level of the posterior
is "dissipated" through anterior rotation. edge of the ramus becomes more impor-
If the amount of growth in the man- tant in the superior part. This corresponds
dible is less than in the maxilla (Fig. 11) on a macroscopic level to a posterior di-
the following responses of the mandible rection of the condylar growth and to an
are possible: (A) the mandible does not opening of the gonial angle. The "cor-
follow the majcilla, there is no rotation recting signals" induce an increased ac-
and a backward shift of the mandible. tivity of the masseter and the internal pte-
(B), (G), (D), The mandible tries to foi- rygoid muscles, the posterior part of the
low the maxilla by extra elongation re- lower border of the mandible presents a
suiting from posterior rotation. greater appositional growth rate, resulting
The results derived from this and from in the formation of an antegonial notch.
previous studies confirm BJ5RK'S investi- At the same time a decreased periosteal
gations (BJORK 1955, 1969; BJORK & growth appears, resulting in less apposi-
SKIELLER 1972) and, taken together, raise tion at the level of the symphysis and the
the question of the biologic significance of anterior part of the lower mandibular
rotational growth of the mandible. It seems border. All these signs, visible on a cepha-
reasooable to believe that the phenomena logram, have been described and asso-
observed here at the macroscopic level are ciated with the posterior rotation by
reflecting the phenomena observed by BJORK (1969).
others at a microscopic level. From ani- Gonversely, an increased level of soma-
mal experiments, it appears that rotation totropic hormone results in an increased
is possible through the special characteris- maodibular growth relative to the maxil-
tics of the control mechanism of the con- la. Then the "correcting signals" reduce
dylar and mandibular growth rates. Foi- the activity of the lateral pterygoid mus-
 MANDIBULAR ROTATION AND ADJUSTMENT
cle. The cell divisions occur in the upper
part of the condylar cartilage and the
periostic growth is increased. On the ce-
phalogram the condyle looks more up-
righted, the gooial angle is smaller and
the symphysis corticalis and the lower an-
terior part of the corpus are relatively
thicker. These signs have been associated
with the anterior rotation by BJORK
(1969).
This investigation leads also to the fol-
lowing considerations: current growth pre-
diction methods are of most value when
the individual exhibits normal regulatory
mechanisms. As the working of some ele-
ments of this system of regulation devi-
ates from the normal, these methods be-
come less and less satisfactory because to
one initial situation there is not one, but
several possible final states. In other
words, a satisfactory approach to cranio-
facial growth prediction cannot be con-
sidered without a better knowledge and
understanding of the control mechanisms
of mandibular and maxillar)' growth
which win provide a basis from which the
appropriate cause of the anomaly can be
measured.
Acknowledgments — The authors wish to thank
Professor A. HASUND, Orthodontic Department,
Dental School, University of Bergen, for his
help and encouragement during their work.
This study has been supported by grants from
the Norwegian Research Council (Norges al-
menvitenskapelige Forskningsrad) No. 51.73.0.
Address:
Orthodontic Department
School of Dentistry
University of Bergen
Arstadvei 17
N-5000 Bergen
Norway
199
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