CONTINUING EDUCATION

Comparison of the effects of passive posterior bite-blocks

with different construction bites on the craniofacial and
dentoalveolar structures
Hakan N. Iscan, DDS, PhDfl and Lale Sarisoy, DDS, PhD b
Ankara, Turkey

Posterior bite-blocks that are used in the early treatment of skeletal open bite, produce a forward
and upward mandibular rotation by transmitting the masticatory muscle forces to the buccal
dentoalveolar regions and preventing their vertical growth. Increasing the vertical dimension of the
face artificially causes skeletal adaptations to occur not only in the dentoalveolar region but also in
the other regions of the craniofacial complex. The effects of passive posterior bite-blocks,
constructed in two different heights, were investigated for two treatment groups, in comparison to
an untreated control group. Two treatment groups comprised of 25 growing patients, who had
skeletal open bite and skeletal/dental Class I or Class II malocclusions, and one control group
consisting of 14 growing patients were used. These groups were matched concerning their age,
sex, and vertical and sagittal skeletal cephalometric and dental characteristics. Passive posterior
bite-blocks of 5 and 10 mm heights were applied to the subjects of the treatment groups
respectively for 18 hours per day. Untreated control subjects were observed for 7 to 9 months. The
findings of this study revealed that the downward and backward mandibular rotation continued in
the control group, increasing the lower facial height significantly, whereas in the treatment groups,
the skeletal open bite was treated and the mandible rotated upward and forward. The increase of
the height of the posterior bite-blocks had a significant effect on the anterior mandibular rotation
and in the increase of the gonial angle. (Am J Orthod Dentofac Orthop 1997;112:171-8.)

S k e l e t a l open bite possesses characteris- approximately 3 to 4 mm beyond its resting position

tics such as backward rotation of the mandible,
increased anterior facial height, and obtuse gonial
angle. T M If the increase in development of the
vertical direction of the facial sutures or alveolar
processes exceeds the increase in the vertical growth
of the condyle, the mandible will rotate back-
w a r d . 12q4
The treatment strategy of the skeletal open bite
is based on the inhibition of the vertical develop-
ment or intrusion of the buccal dentoalveolar struc-
tures by means of various kinds of bite-blocks or
extraoral appliances, 4,5,~s-32 thus producing an up-
ward and forward rotation of the mandible into a
more horizontal growth direction, rather than verti-
cal. 5'9'12'17'22'23'25-27'32"38 This basic therapeutic ap-
proach is functional before growth has been com-
pleted and is surgical afterwards. 9,18,29,39-44
Passive acrylic posterior bite-blocks are func-
tional appliances, hinging the mandible open by
From the Orthodontic Department, Gazi University Faculty of Dentistry.
aprofessor.
bResearch assistant.
Reprint requests to: Professor Dr. Hakan N. Iscan, Gazi Universitesi, Dis
Hekimligi Fakultesi, Ortodonti Anabilim Dali, 06510 Emek-Ankara, Tur-
key.
Copyright © 1997 by the American Association of Orthodontists.
0889-5406/97/$5.00 + 0 8/1/73493
and maintaining pressure on the neuromuscular
system supporting the mandible. 17,18,25-27,32,45Spring-
loaded bite-blocks are activated from time to time,
and they supply additional force within the neuro-
muscular system, besides the forces of the mastica-
tory muscles that are exerted by the passive acrylic
posterior bite-blocks. 22,23,37,45,46 Magnetic bite-
blocks, which have first been introduced by Del-
linger, 2I provide continuous pressure on the occlusal
surfaces of the buccal teeth by means of the repel-
ling magnets.
Kiliaridis et al. 25 compared repelling magnets
with the passive acrylic bite-blocks. Both appliances
have provided intrusion of the posterior teeth with the
intrusive forces generated only by the masticatory
muscles or by the magnetic forces, respectively. 17,27
Posterior bite-blocks have the advantage in ap-
plying essentially vertical forces. Magnetic bite-
blocks, however, provide lateral shearing forces as
well as the vertical onesY To avoid the adverse
lateral vector, use of magnets with lower force
threshold has been proposed. 24,25
McNamara 27 has used bite-blocks of different
vertical heights on the rhesus monkeys. He con-
cluded that as the vertical dimension of the bite-
block is increased, the vertical growth at the head of
171
172 Iscan and Sarisoy
Fig. 1. A, Passive posterior bite-block of vertical height
5 mm. B, Passive posterior bite-block of vertical height
10 mm.
the condyle is decreased, and the direction of
growth of the mandibular condyle is oriented pos-
teriorly, while some localized bone resorption ap-
pears in the area of the gonial angle.
Woods and Nanda 31 have observed that both
magnetic and acrylic bite-block appliances provided
a depression of the buccal teeth, alteration in max-
illary displacement, and changes in mandibular
shape. Therefore they have suggested that these
effects could also be attributed to a muscular re-
sponse to the artificially increased vertical dimen-
sion, as well as to the presence of the repelling
magnets. However, they have found that the local-
ized bone resorption at the gonial angle had been
more marked in the magnetic bite-block group.
According to Sander and Weinreich, 47 to achieve
positive results in functional treatment of patients
who have vertical discrepancies, pressure should be
applied to the region behind the first molars. As a
result, enhanced autorotation of the mandible can
occur. They advocate that the vertical dimension of
the bite-blocks should be lOW. 46'47
Spring-loaded posterior bite-blocks, like mag-
netic counterparts, also provide intrusive forces on
American Journal of Orthodontics and Dentofacial Orthopedics
August 1997
Fig. 2. Intraoral view of passive posterior bite-block.
the buccal segments in treatment of skeletal open
bites, and have been shown to create forces in
different directions, with different strengths, affect-
ing the craniofacial and dentoalveolar struc-
turesY '31,33 In addition, the effects of the spring-
loaded posterior bite-blocks on the posterior
inclination of the mandibular ramus were signifi-
cantly different from those of the passive posterior
bite-blocks used with vertical chincapsY Some stud-
ies have shown that the use of spring-loaded and
magnetic bite-blocks increase the ramal inclination
and the gonial angle. 22'23'33'41
In a study comparing the effects of the magnetic
bite-blocks to those of the spring-loaded posterior
bite-blocks, Kuster and IngervalP 3 found that the
bite force and the activity of the masseter and the
anterior temporal muscles have increased during
various stages of the treatment, and showed that the
mandibular prognathism and the gonial angle have
increased by significantly different amounts.
In human studies2s'33'45 that investigated and
compared the effects of various kinds of bite-blocks,
the appliances used were quite different from each
other in their force generating capacities. Further
studies are still needed to determine to what degree
the changes in the craniofacial and the dentoalveo-
lar regions are related to the amount of limited
vertical opening of the mandible.
The purpose of the current study is to investigate
the effects of increasing masticatory muscle forces in
a limited range by means of the passive posterior
bite-blocks, constructed in two different heights, on
the craniofacial and the dentoalveolar regions and
to compare the direction and amount of variations.
MATERIAL AND METHODS
Sample Selection
This study consists of 25 open bite cases with Class I or
Class II, Division 1 malocclusions, which were selected
American Journal of Orthodontics and Dentofacial Orthopedics'
Volume 112, No. 2
X~.
LIE
Fig. 3. Cephalometric landmarks used in this study.
from the patients referred for orthodontic treatment to
the Department of Orthodontics of the Dental Faculty of
Gazi University. The following criteria were considered in
selection of the cases: Existence of an anterior open bite
with a skeletal component (amount of open bite varying
between -1.0 and -5.5 mm in our sample), sagittally Class
I or II skeletal type; fully erupted upper and lower
permanent incisors; no record of sucking habits within
recent years; and no need for tonsillectomy or adenoid-
ectomy on their examination by the otorhinolaryngologist.
Lateral cephalograms were taken during the first visit for
preassessment of the skeletal characteristics, and those
having a mandibular plane angle (SN/GoGn) of 37 ° or
more 48 and an ANB angle between 2° and 8°, were se-
lected.
Treatment Groups
The subjects who were selected according to the
criteria mentioned were split into two groups, matched for
age, sex, amount of open bite, and sagittal and vertical
skeletal classifications, according to the ANB and SN/
G o G n angles, respectively.
The first treatment group consisted of 9 girls and 4
boys, making a total of 13 patients whose ages ranged
from 8.9 to 13.5 years at the beginning of the study.
According to their hand-wrist radiographs, ~:heir skeletal
ages ranged between 8.2 and 12.8 years.
The second treatment group consisted of 9 girls and 3
boys, making a total of 12 patients, with an age range from
[scan and Sarisoy 173
Fig. 4. Angular measurements used in this study.
8.7 to 14.5 years at the beginning of the study and skeletal
age range between 8.3 and 14.6 years.
During the treatment period, passive acrylic posterior
bite-blocks of 5 and 10 mm vertical height (Fig. 1, A and
B) were inserted in the first and second treatment groups,
respectively. The bite-blocks were used for 18 hours per
day by the treatment subjects in both groups (Fig. 2).
The subjects were checked every 3 weeks and no
extractions of deciduous or permanent teeth were per-
formed to reduce crowding during the treatment period.
When an overbite of 1 to 1.5 mm was achieved, the
decision to end of the treatment was made and the
posttreatment records were taken. In some cases (three in
the first, four in the second treatment groups), although
evident improvement in the anterior open bite was ob-
served during the treatment period, an overbite relation
could not be achieved. In such cases, the treatment period
was ended after two 3-week visits when no improvement
was observed. Treatment time was between 4 to 10
months for the first treatment group and 4 to 13 months
for the second g r o u p .
Control Group
Longitudinal records of 11 girls and 3 boys, with Class
I or Class II, Division 1 malocclusions were used as
controls in this study. The control subjects were closely
matched for age, sex, amount of open bite (varying
between -0.5 and -3.5 ram), and sagittal and the vertical
classifications, according to the ANB and SN/GoGn an-
gles, respectively, and to the Angle classification of the
subjects in each treatment group. The ages of the control
subjects ranged from 8.9 to 13.3 years at the beginning of
the control period, and their skeletal age range between
8.2 and 12.5 years, as indicated by the hand-wrist radio-
graphs. The observation period ranged from 7 to 9
months.
174 Iscan and Sarisoy
Fig. 5. Linear measurements used in this study.
The current study was made on 78 lateral cephalo-
grams and hand-wrist radiographs that were taken before
and at the end of the treatment or observation period.
With the landmarks indicated in Fig. 3, 11 angular
(Fig. 4) and 11 linear (Fig. 5) measurements were assessed
on the lateral cephalograms. All the cephalometric mea-
surements were made by one author up to 0.5° or milli-
meters.
The comparison of the mean values for the beginning
and end of the study in each group (intragroup compari-
sons) were made with a paired t test. The comparison of
those mean values between the groups (intergroup com-
parisons) and the comparison~between the three groups
regarding the mean changes of each within the study
period were analyzed statistically with the Duncan's test.
RESULTS
To analyze the potential error of the method
during cephalometric tracing and measurements, 20
of the 78 lateral cephalometric radiographs were
selected randomly and both the tracings and the
measurements were repeated with an interval of at
least 15 days. With the use of two values for each
measurement, repeatability coefficients were calcu-
lated with the analysis of variance. The coefficients
were found to be very close to 1.00.
American Journal of' Orthodontics and Dentofacial Orthopedics
August 1997
Dentoalveolar Changes
At the end of the treatment, overbite was
achieved except in three cases in the first treatment
group and four cases in the second treatment group,
but evident improvement in open bite was obtained
in all the cases. Although there were no significant
differences in overbite between the three groups at
the beginning of the study period, significant differ-
ences were observed between the control group and
each of the treatment groups at the end of the study
period (Tables I, II, and III).
The upper-lower anterior/posterior dentoalveo-
lar heights did not show significant differences
among the groups. Intrusion of the lower first molar
was observed in both of the treatment groups.
Extrusion of the lower incisors in the treatment
groups was twice that of the control group (Table
III).
Morphologic Changes in the Mandible
During the study period, the SNB angle in-
creased, especially in the second treatment (larger
bite-block opening) group, and showed significant
differences among all the groups (Table III).
The decrease in the lower face height angle
(ANS - Xi/Xi - Pg) was more evident in the second
treatment group. Thus the only significant difference
for the change in this angle was found between the
second 10 mm vertical increase treatment group and
the control group (Table III).
The mandibular plane angle (SN/Go-Gn) de-
creased in both the treatment groups, with more
pronounced effect in the second group during the
study period, whereas it increased in the control
group. Significant difference was found only be-
tween the second treatment group and the control
group (Table III).
Although the gonial angle increased in both of
the treatment groups, the only statistically signifi-
cant change was observed only in the second treat-
ment group. The mean increase in the gonial and
the upper gonial angles was found to be significant
in both of the treatment groups. Significant differ-
ences with regard to the increase in these angles
were found between the two treatment groups and
between the control group and the second treatment
group (Table III).
The ramal inclination angle (SN/Go-Ar) de-
creased in both of the treatment groups. However,
the only significant difference for the change of this
angle was found between the second treatment
group and the control group (Table III).
American Journal of Orthodontics and Dentofacial Orthopedics lscan and Sarisoy 1 75
Volume 112, No. 2

Table I, Comparison of the mean values between the groups at the beginning of the study

Bite-block 5 mm Bite-block 10 mm Control group

(T1) n = 13 (T2) n = 12 (C) n = 14 Comparison

Measurements X Sx Sd X [ Sx Sd X Sx Sd T1- T2 TIC [ __

T2-C

1. N-S-At 126.7 1.4l 5.07 125.9 1.52 5.27 127.7 1.32 4.93
2. SNA 78.6 0.84 3.03 78.0 1.02 3.52 78.4 0.87 3.24
3. SN/ANS-PNS 7.5 0.74 2.67 8.7 0.78 2.68 10.3 0.78 2.93
4. ANB 5.3 0.43 1.55 5.2 0.29 1.01 4.7 0.46 1.72
5. ANS-Xi/Xi-Pg 55.8 1.34 4.83 55.8 0.87 3.01 53.9 1.22 4.58
6. SNB 73.3 0.65 2.33 72.8 1.14 3.93 73.7 1.00 3.75
7. Co-Pg 103.4 1.57 5.65 103.1 1.25 4.34 101.1 1.71 6.40
8. SN/Go-Gn 41.5 1.03 3.71 42.7 0.95 3.31 41.4 1.09 4.09
9. Ar-Go-M 133.4 0.96 3.47 135.9 1.70 5.90 131.4 0.77 2.90
10. Ar-Go-N 51.8 0.88 3.16 52.8 1.08 3.73 50.0 0.35 1.32
11. N-Go-M 81.6 1.04 3.74 83.2 0.95 3.28 81,4 0.83 3.12
12. SN/Go-Ar 91.I 0.96 3.47 89.8 1.21 4.20 92.8 0.78 2.93
13. N-ANS 49.7 0.9l 3.29 50.0 0.85 2.95 51.1 1.00 3.76
14. ANS-M 69.3 1.0l 3.64 68.7 1.19 4.11 66.9 1.42 5.30
15. N-M 119.0 1.66 6.00 118.6 1.77 6.12 118.0 2.20 8.21
16. S-Go 69.9 1.22 4.42 68.8 1.30 4.52 69.7 1,23 4.60
17. Overbite -2.3 0.33 1.18 -2.6 0.49 1.68 1.6 0.25 0.93
18. Overjet 3.8 0.54 1.96 4.3 0.62 2.15 2.4 0.43 1.61
19. UIEA_ANS-PNS 29.0 0.53 1.92 28.6 0.55 1.91 28.2 0.86 3.21
20. LIE±Go-Gn 38.1 0.82 2.95 37.8 0.64 2.22 36.8 0.70 2.63
21. UMCLANS-PNS 22.2 0.57 2.04 22.3 0.52 1.79 22.1 0.71 2.64
22. LMC±Oo-Gn 29.5 0.63 2.29 29.5 0.69 2.39 29.1 0.61 2.28
23. Chronological age 10.4 0.33 1.20 10.9 0.53 1.85 10,6 0.37 1.40
24. Skeletal age 9.8 0.35 1.28 10.0 0.53 1.85 9.6 0.37 1.38

*P < 0.05.

Facial Height Changes anterior dentoalveolar region. This finding is also

The lower facial height decreased in both of the
treatment groups, whereas it increased in the con-
trol group. The total facial height increased in
limited ranges in the treatment groups, due to the
increase in the upper facial height. The ,changes in
the total and lower anterior facial height were found
to be significant between each of the treatment
groups and the control group (Table III).
DISCUSSION
It has been emphasized that increasing the ver-
tical dimension of the face artificially results in
skeletal adaptations, which are not limited to the
dentoalveolar region but occurs throughout the
craniofacial complex. 27 These are not limited to a
single region and differ especially according to the
vertical dimension of the construction b i t e . 17'27,49
This study was planned to examine the effects of
increasing the vertical dimension of passive poste-
rior bite-blocks on the craniofacial complex.
During the study period, evident improvement in
open bite was obtained in both of the treatment
groups. Significant increase in overbite was observed
as a result of the upward-forward rotation of the
mandible and the vertical development of the lower
supported by different studies. 19,23,26,33
As a finding of this study, the SNB angle in-
creased in both of the treatment groups, but by
larger amounts in the second treatment group where
posterior bite-blocks of 10 mm vertical dimension
were used. The differences between the mean
changes of the three groups were found to be
statistically significant. Different studies support this
finding. Altuna and Woodside 17 claim that passive
posterior bite-blocks cause the mandible to develop
in a more horizontal direction. These findings are
also in agreement with the result of the studies
about spring-loaded bite-blocks of Iscan and
Akkaya 22 and Iscan et al. 23 and with a study where
passive posterior bite-blocks were used along with
vertical chincaps. 26
Kuster and IngervalP 3 have compared the effects
of spring-loaded and magnetic bite-blocks, and have
observed that development of the mandible in the
sagittal direction was more in the group treated with
magnetic bite-blocks. They believe this was due to
the increased forces executed by the magnets.
The decrease in the lower face height angte
(ANS-Xi/Xi-Pg) was especially evident in the sec-
ond treatment group, and the difference between
 176 l s c a n a n d Sarisoy American Journal o f Orthodontics and Dentofacial Orthopedics
August 1997

Table II. Comparison of the mean values between the groups at the end of the study

Bite-block 5 m m Bite-block 10 mm Control group

(T1) n = 13 (T2) n = 12 (C) n = 14 Compa~on

Measurements X Sx Sd X Sx Sd X Sx Sd T1- T2 ~-C T2-C

1. N-S-Ar 126.4 1.38 4.99 126.5 1.56 5.42 128.7 1.43 5.34
2. SNA 79.0 0.79 2.85 78.7 1.16 4.02 78.4 0.88 3.28
3. SN/ANS-PNS 7.1 0.77 2.78 8.5 0.82 2.86 10.3 1.06 3.96
4. ANB 4.8 0.40 1.45 4.5 0.39 1.35 4.6 0.43 1.60
5. ANS-Xi/Xi-Pg 54.4 1.19 4.30 53.6 0.90 3.11 53.4 0.96 3.60
6. SNB 74.1 0.62 2,22 74.2 1.25 4.32 73.8 1.00 3.75
7. Co-Pg 104.6 1.79 6.47 104.8 1.36 4.72 103.5 1.76 6.57
8. SN/Go-Gn 40.8 1.06 3.81 41.5 0.98 3.39 41.5 1.12 4.20
*@
9. Ar-Go-M 133.9 1.00 3.59 137.8 1.87 6.48 131.4 0.92 3.46 *
@@
10. Ar-Go-N 52.7 0.84 3.02 54.8 1.13 3.90 49.9 0.48 1.80
11. N-Go-M 81.2 1.14 4.11 83.0 1.09 3.79 81.5 0.78 2.91
12. SN/Go-Ar 89.8 1.00 3.59 87.0 1.45 5.02 93.0 0.82 3.06
13. N-ANS 50.4 0.76 2.73 50.9 0.98 3.40 52.1 1.14 4.25
14. ANS-M 68.9 1.13 4.06 68.0 1.34 4.65 68.0 1.45 5.43
15. N-M 119.3 1.60 5.78 118.9 2.02 7.00 120.2 2.30 8.60
16. S-Go 70.4 1.34 4.85 69.5 1.39 4.81 71,1 1.44 5.38
#:~ @@
17. Overbite 0.4 0.25 0.90 0.1 0.30 1.03 -1.4 0.31 1.16
18. Overjet 4.5 0.53 1.90 4.7 0.72 2.48 2.5 0.46 1.72
19. UIELANS-PNS 29.3 0.57 2.06 28.7 0.69 2.40 28.9 0.88 3.29
20. L I E L G o - G n 39.2 0.83 3.00 38.9 0.66 2.29 37.5 0.70 2.62
21. U M C L A N S - P N S 22.5 0.58 2.11 22.5 0.41 1.43 22.9 0.86 3.23
22. L M C L G o - G n 29.0 0.62 2.22 28.8 0.81 2.79 29.3 0.61 2.29
23. Chronological age 11.1 0.34 1.21 11.6 0.55 1.91 11.3 0.37 1.40
24. Skeletal age 10.3 0.38 1.37 10.6 0.55 1.91 10.3 0.35 1.32

*P < 0.05; **P < 0.01.

the changes of the second treatment group and the
control group was statistically significant.
Mandibular plane angle (SN/Go-Gn) decreased
in both the treatment groups, but by greater amount
in the second treatment group, showing a statisti-
cally significant difference versus the control group
when the changes in this angle were considered. The
decrease in this angle by the use of different kinds of
posterior bite-blocks have been shown by many
s t u d i e s . 1 9 , 2 2 , 2 3 , 24
The decrease in the lower facial height angle and
in the mandibular plane angle shows that the man-
dible rotated upward and forward, and this finding
was more evident in the second treatment group
where the forces were higher. The change in the
lower anterior facial height is also in accordance
with these findings.
In our study, there was a decrease in the lower
posterior dentoalveolar height in the treatment
groups, as noted by Dellinger, 21 where an increase in
the control group was noticed.
Woods and Nanda 31 stressed that the intrusion
of the buccal teeth with both magnetic and acrylic
posterior bite-blocks could be attributed as much
to the muscular response to the artificially in-
creased vertical dimension as to the presence of
magnets.
The angle of ramal inclination seemed to be
unchanged in the control group during the study
period, whereas it decreased in the treatment
groups. The decrease in this angle in the treatment
groups may be interpreted as an indication of an
effort for an upward and forward rotation of the
mandible, being more evident in the second treat-
ment group. This corroborates similar results, where
spring-loaded bite-blocks were used. 22'23
The increase in the gonial angle (Ar-Go-M),
being more in the second treatment group has
revealed a statistically significant difference between
the two treatment groups and also between the
second treatment group and the control group. This
result has been shown by other studies as well. 22'23'33
The increase in the gonial angle being greater in the
second treatment group also may have been a
muscular response to the artificially increased verti-
cal dimension, as stated by Mc Namara 27 and Woods
and Nanda. 31 Sander and Weinreich 47 also support
this claim. The increase in the gonial angle seems to
be due to the increase in the upper gonial angle
(Ar-Go-N) in our study, and this increase was more
pronounced in the second treatment group. There-
fore the possible alteration in the gonial angle
should continue to be observed in the postretention
period.
American Journal of Orthodontics and Dentofacial Orthopedics Iscan and Satisoy "177
Volume 112, No. 2

Table III. The changes occured in each group during the study period and the comparison of the changes ,etween the groups
Bite-block 5 mm Bite-block 10 mm Control group
(T1) n = 13 (T2) n = 12 (C) n = 14 Comparison
t

Measurements l X I Sx Sd,. X Sx t Sd T1-T2 TI-C I T2-C

1. N-S-Ar -0.31 0.24 0.88 0.58 0.53 1.83 1.00 0.66 2.47
2. SNA 0.35 0.24 0.85 0.67?? 0.20 0.69 0.04 0.19 0.69
3. SN/ANS-PNS -0.35 0.33 1.18 -0.17 0.23 0.81 0.04 0.46 1.70
4. ANB -0.50? 0.21 0.76 -0.71 0.33 1.14 -0.07 0.17 0.65
,g
5. ANS-Xi/Xi-Pg - 1.3977 0.39 1.a0 -2.17Ti't 0.44 1.53 -0.46 0.46 1.70
@go ~ @:g
6. SNB 0.85?? 0.24 0.88 1.4277 0.35 1.20 0.04 0.22 0.82
7. Co-Pg 1.277 0.52 1.87 1.637 0.60 2.09 2.39t?? 0.50 1.87
$
8. SN/Go-Gn -0.77? 0.32 1.17 -1.2177 0.35 1.22 0.07 0.26 0.98
9. Ar-Go-M 0.50 0.36 1.2.1 1.8377 0.59 2.04 0.07 0.36 1.34
10. Ar-Go-N 0.89? 0.31 1.12 2.04?? 0.48 1.64 -0.1l 0.32 1.21
11. N-Go-M -0.39 0.21 0.77 -0.21 0.25 0.87 0.18 0.18 0.67
12. SN/Go-Ar -1.317 0.44 1.60 - 2.79T~" 0.80 2.77 0.21 0.41 1.53
13. N-ANS 0.73? 0.32 1.15 0.96t'~'i" 0.19 0.66 1.077 0.44 1.65
14. ANS-M -0.42 0.38 1.35 -0.67 0.46 1.59 1.14t 0.40 1.49
#~- gag
15. N-M 0.31 0.41 1.48 0.29 0.52 1.79 2.21777 0.24 0.91
16. S-Go 0.46 0.36 1.28 0.75 0.46 1.59 1.36777 0.28 1.06
17. Overbite 2.73]'?? 0.33 1.20 2.54??? 0.30 1.05 0.27 0.15 0.54
18. Overjet 0.73? 0.27 0.98 0.42 0.46 1.61 0.04 0.11 0.41
19. UIE±ANS-PNS 0.317 0.13 0.48 0.04 0.26 0.89 0.64? 0.29 1.10
20. L I E ± Go-Gn 1.12777 0.21 0.74 1.08777 0.19 0.67 0.64??? 0.10 0.36
21. UMCzANS-PNS 0.35 0.23 0.83 0.21 0.29 0.99 0.86?? 0.28 1.03
22. L M C ± Go-Gn -0.50 0.23 0,8.4 -0.79? 0.26 0.89 0.18 0.23 0.87
23. Chronological age 0.62??? 0.05 0.18 0.68??? 0,07 0.23 0.69??? 0.01 0.05
24. Skeletal age 0.47T~t 0.07 0.26 0.59??? 0.09 0.31 0.71Ti-? 0.06 0.21

*P < 0.05; **P < 0.01.

?P < 0.05; t t P < 0.01; t ? t P < 0.001.

CONCLUSIONS Faculty of Agriculture of Ankara University for their help

1. Passive posterior bite-blocks with ~ o different
construction bites were both found to be effective
in treatment of skeletal open bite and in producing
overbite.
2. Increasing the height of the posterior bite-block was
not significantly more effective during the experimen-
tal treatment time for overbite production.
3. Both treatment methods of vertical height groups
(5 and 10 mm) were effective in controlling the
increase of the vertical facial dimensions.
4. The growth of the mandible in the sagittal direction
was increased by increasing the height of the
posterior bite-block.
5. Although significant difference was not found con-
sidering the upward-forward rotation of the man-
dible with posterior bite-blocks of different con-
struction bites, the change in the rotation of the
mandible was more evident by increasing the ap-
pliance height.
6. Increasing the height of the posterior bite-blocks
results in an increase in the gonial angle. The
effects of this change need to be examined in the
postretention period.
We thank Prof. Dr. F. Gurbuz and Associate Professor
E. Baspnar from Department of Biometry and Genetics,
in statistical procedures.
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