European Journal of Orthodontics 10 (1988) 177-179 © 1988 European Orthodontic Society

Mandibular rotations: concepts and terminology

Beni Solow* and William J. B. Houston**
* Institute of Orthodontics, Royal Dental College, Copenhagen, Denmark
** UMD5 of Guy's and 51. Thomas's Hospitals, London, England

SUMMARY The paper proposes a terminology for describing the growth rotation of the mandible.
Distinction is made between rotation (of a rigid body) and angular change (of a reference line).
The terms true rotation and apparent rotation of the mandible are defined, and the term angular
remodelling is introduced to describe the angular measure of the remodelling of the mandibular
border.

Introduction tive to the cranial base, and as 'morphogenetic

rotations', changes in the shape of the mandible.
The purpose of the present paper is to review
A new terminology for these concepts was

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the concept of mandibular growth rotations and
to propose the adoption of a terminology that introduced by Bjork and Skieller (1983) in which
rotation of invariant structures in the mandible
should dispel the confusion that has grown up
(implants or natural reference structures) relative
around this fundamental concept.
to the cranial base was termed 'total rotation'.
Rotation of the lower border of the mandible
Review of literature relative to the cranial base was 'matrix rotation',
Since Bjork (1955) drew attention to mandibu- and the change in the orientation of invariant
structures in the mandible relative to the lower
lar growth rotations as a feature of normal facial
border was 'intramatrix rotation'. Although this
growth, interest in their clinical relevance has
terminology is internally consistent, it has
gradually developed and the literature on this
given rise to confusion, the concept of intra-
topic is now quite extensive. The fact that
matrix rotation being frequently misunderstood.
the lower border of the mandible on average
Dibbets (1985) introduced the term 'counter-
becomes less steeply inclined with growth, had
balancing rotation' for what is essentially
been pointed out by Lande (1952) but it was
intramatrix rotation, with the implication that
only by the use of metallic implants that Bjork
the changes described by this term represent
(1955) was able to demonstrate the much greater
adjustments of the contribution of condylar
underlying mandibular rotation that was masked
growth to overall growth in the length of the
by periosteal remodelling at the lower border.
mandible. Rune et al. (1987) reviewed the terms
Bjork and Skieller (1972) demonstrated that
introduced by Bjork and Skieller (1983) and
dento-alveolar adaptation in response to man-
remarked that in the context of intramatrix
dibular growth rotation could result in occlusal
rotation Bjork and Skieller's 'interpretation of
change such as late lower incisor crowding.
the findings seems to have no relation to the
Bjork (1969) discussed different directions of
general concepts of craniofacial bone growth'.
rotation of the mandibular implant line and the
relations of these to mandibular form. 0degard
(1970) described as a rotation, the change in
Terminology
orientation that can occur between the implant
line and the lower border of the mandible. This In order to bring some order to the general
concept was elaborated by Lavergne and Gasson confusion of terms, it is necessary to distinguish
(1977) who described as 'positional rotations', between the general concept of angular change
changes in the orientation of the mandible rela- between two reference lines and the concept of
178
rotation which is a special case of angular
change.
Rotation
Semantically, it is convenient to use the term
rotation to describe the angular movement of
one rigid body relative to another. A wheel
may rotate with reference to its supporting
framework; a tooth may rotate as it is moved
through its supporting bone; and with growth,
bones that are displaced relative to one another
at intervening structures such as sutures or
joints, may also rotate relative to one another.
As pointed out by Rune et al. (1987) only
displacements that satisfy the concept of the
rigid body model should be termed rotations.
Angular change
When a single body changes in form due to
surface accretion and removal (as in a bone)
there may be changes in orientation between
reference lines within that body, but these should
be termed angular changes: they are not ro-
tations in the sense defined above. This is true
of the change in orientation of the mandibular
line relative to an implant line.
In order to solve the problems of terminology,
we propose that the terms introduced by Solow
and Siersbaek-Nielsen (1986) should be adopted
generally as they are unambiguous and semantic-
ally consistent. To describe the changes in
inclination of mandibular reference lines, the
following terms are thus suggested:
True rotation of the mandible
Definition: Rotation of the mandibular body as
represented by implants or stable trabecular
reference structures, relative to the anterior cran-
ial base.
This is the rotation originally described by
Bjork (1955) and subsequently called 'total ro-
tation' by Bjork and Skieller (1983). It is the
fundamental rotation that may occur in the
relationship between mandible and cranial base.
Apparent rotation of the mandible
Definition: The angular change of the mandibu-
lar line relative to the anterior cranial base.
This is the type of change reported by Lande
(1952) and which was called 'matrix rotation'
by Bjork and Skieller (1983). It is the angular
BENI SOLOW AND WILLIAM HOUSTON
change that is apparent from conventional
cephalometric analysis. It is the result of true
mandibular rotation and remodelling at the
lower border of the mandible.
Furthermore, we suggest the introduction of
the following term:
Angular remodelling of the mandibular border
Definition: The angular change of the mandibu-
lar line when the mandible is registered on
implants or stable trabecular structures.
This is a measure of the amount of remodelling
that occurs at the mandibular border. It is a
descriptive term with no aetiological conno-
tations. From an aetiological point of view it
seems logical to assume that this remodelling
occurs, for instance, when the true rotation of
the mandible forces the gonial region against the
pterygo-masseteric muscular sling, a mechanism
which probably led Bjork and Skieller (1983) to
suggest the term 'intramatrix rotation'. Never-
theless, it seems appropriate to make the ter-
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minological distinction between the measure of
the amount of remodelling that occurs at the
mandibular border, and the rotational process
that probably causes it.
From the studies of Bjork and Skieller (1972)
and Lavergne and Gasson (1976) it is seen that
the angular remodelling of the lower mandibular
border amounts to about 50 per cent of the true
mandibular rotation, indicating a 50 per cent
efficiency of a counter-remodelling process.
For the posterior mandibular border, on the
other hand, the data presented by Bjork and
Skieller (1972) show that the average angular
remodelling (5°) was almost as large as the
average true rotation (- 6°) over the six-year
period of observation. For this border, the
efficiency of the counter-remodelling process
caused by the 'soft tissue matrix' was thus over
80 per cent, with the consequence that the
average apparent rotation of the ramus line, RL,
was only _1°. It follows from these observations
that if the terminology of 'intra-matrix rotation'
were accepted, the term would be inconsistent
as a description of the rotation of a mandibular
'central body' against an enveloping 'soft tissue
matrix': with a true rotation of, say, 6°, the
'intra-matrix rotation' could not at the same
time be 3° (when assessed against ML) and 5°
(when assessed against RL).
As is evident from the above, the term angular
remodelling can be applied to the lower as well
MANDIBULAR ROT ATrONS
as the posterior mandibular border. The term
angular remodelling can also be applied to the
remodelling of the hard palate. It was shown by
Bjork and Skieller (1977) that when the maxilla
rotates forward during growth, there is a coun-
ter-remodelling of the nasal and palatal surfaces
of the hard palate, so that the apparent rotation
of the palatal plane is much less than the
true rotation of the maxilla. The term 'angular
remodelling of the maxilla' can thus be defined
as the angular change in the palatal plane when
the maxilla is registered on implants or stable
natural structures.
Clinically, it is frequently useful to discuss
changes in the inclination of the occlusal plane
with growth or treatment. Since the occlusal
plane does not represent a rigid body we suggest
the use of the terminology 'angular change of
the occlusal plane' relative to the cranial base
or relative to the maxilla or the mandible, as
required, to describe occlusal plane changes.
The current sign convention is that rotation
and angular changes are designated negative or
'forward' when the changes are counterclock-
wise, facing right (or clockwise, facing left). The
change is designated positive or 'backward'
when the change is clockwise, facing right (or
counterclockwise, facing left).
Much of the confusion that is apparent when
mandibular growth rotations are discussed, has
developed because of a failure to distinguish
angular change from rotation, and because of
the varied terms that have been applied to
these concepts. It is hoped that adoption of
the terminology proposed in this paper will
remove the mystery that has shrouded this basic
concept.
179
Address for correspondence
Professor B Solow
Institute of Orthodontics
20, Nerre AIle
DK-2200 Copenhagen N
Denmark
References
Bjork A 1955 Facial growth in man, studied with the aid of
metallic implants. Acta Odontologica Scandinavica 13:
9-34
Bjork A 1969 Prediction of mandibular growth rotation.
American Journal of Orthodontics 55: 585-599
Bjork A, Skieller V 1972 Facial development and tooth
eruption. An implant study at the age of puberty. Amer-
ican Journal of Orthodontics 62: 339-383
Bjork A, Skieller V 1977 Growth of the maxilla in three
dimensions as revealed radiographically by the implant
method. British Journal of Orthodontics 4: 53-64
Bjork A, Skieller V 1983 Normal and abnormal growth of
the mandible. A synthesis of longitudinal cephalometric
implant studies over a period of 25 years. European
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Journal of Orthodontics 5: 1-46
Dibbets J M H 1985 The puzzle of growth rotations.
American Journal of Orthodontics 87: 473-480
Lande M J 1952 Growth behaviour of the human facial
profile as revealed by serial cephalometric roentgenology.
Angle Orthodontist 22: 78-90
Lavergne J, Gasson N 1976 A metal implant study of
mandibular rotation. Angle Orthodontist 46: 146-150
Lavergne J, Gasson N 1977 Operational definitions of
mandibular morphogenetic and positional rotations.
Scandinavian Journal of Dental Research 85: 185-192
0degard J 1970 Mandibular rotation studied with the aid
of metallic implants. American Journal of Orthodontics
58: 448-454
Rune B, Sarnas K-V, Selvik G 1987 Growth rotations-a
puzzle? European Journal of Orthodontics 9: 237-239
Solow B, Siersbrek-Nielsen S 1986 Growth changes in head
posture related to craniofacial development. American
Journal of Orthodontics 89: 132-140