ORIGINAL ARTICLE

Posterior tooth angulations in patients with

anterior open bite and normal occlusion
Guilherme Janson,a Vinicius Laranjeira,b Mayara Rizzo,b and Daniela Garibc
Bauru, S~ao Paulo, Brazil

Introduction: The aim of this study was to compare the posterior tooth angulations in patients with open-bite
malocclusion and normal occlusion. Methods: Lateral cephalometric headfilms of 45 untreated open-bite
subjects were compared with the lateral headfilms of 45 subjects with normal occlusion in the permanent
dentition. The groups were matched for age and sex distribution and compared with t tests. Results: The maxil-
lary and mandibular premolars were more mesially angulated in relation to the bisected occlusal plane, and the
first and second molars were significantly more distally angulated in the open-bite group in relation to the palatal
and mandibular planes. Conclusions: The maxillary and mandibular premolars were more mesially angulated
in relation to the bisected occlusal plane and therefore do not compensate for the divergence of the palatal and
mandibular planes as the molars do. (Am J Orthod Dentofacial Orthop 2016;150:71-7)

M
alocclusion is caused by an imbalance in the
complex interactions among the facial growth
pattern, causative local factors, and the lack of
a dentoalveolar compensation mechanism.1 In partic-
ular, anterior open-bite malocclusions associated with
a strong vertical component are the most challenging
to treat.2-6 Combinations in vertical dysplasia are
various, so that a patient with a long face can have a
deepbite, and a patient with a short face is not
excluded from developing an anterior open bite.7-9
The pioneer implant studies of Bj€ ork10 and Bj€ork and
11
Skieller showed the influence of the rotation of the
apical bases on the final tooth positions. Solow12
described in more detail the dentoalveolar compensatory
mechanism, and Kim4 stated that in skeletal open-bite
subjects the posterior teeth have a marked mesial angu-
lation when measured in relation to the bisected occlusal
From the Department of Orthodontics, Bauru Dental School, University of S~ao
Paulo, Bauru, S~ao Paulo, Brazil.
a
Professor and head.
b
Postgraduate student.
c
Associate professor.
All authors have completed and submitted the ICMJE Form for Disclosure of
Potential Conflicts of Interest, and none were reported.
Based on research by Vinicius Laranjeira in partial fulfillment of the requirements
for the degree of MSc in orthodontics at Bauru Dental School, University of S~ao
Paulo, Bauru, S~ao Paulo, Brazil.
Address correspondence to: Guilherme Janson, Department of Orthodontics,
Bauru Dental School, University of S~ao Paulo, Alameda Octavio Pinheiro Brisolla
9-75, Bauru, S~ao Paulo, 17012-901, Brazil; e-mail, jansong@travelnet.com.br.
Submitted, August 2015; revised and accepted, December 2015.
0889-5406/$36.00
Copyright Ó 2016 by the American Association of Orthodontists. All rights
reserved.
http://dx.doi.org/10.1016/j.ajodo.2015.12.016
plane (BOP), and a major treatment objective is to up-
right these teeth to facilitate bite closure. Since these re-
ports, there have been few specific studies evaluating
this dental feature, which is regarded as an anterior
open-bite characteristic.13,14 Much attention has been
given to the compensatory vertical dentoalveolar
development of the posterior and anterior teeth in
open-bite malocclusions and not to the posterior tooth
mesiodistal angulations.5,8,14-17
Therefore, the aim of this study was to test the null
hypothesis that there is no difference in posterior tooth
angulations in patients with open-bite malocclusion and
normal occlusion.
MATERIAL AND METHODS
This study was approved by the ethics in research
committee of Bauru Dental School, University of
S~ao Paulo, Brazil, with research protocol number
20303213.2.0000.5417.
The sample size calculation, considering an 80% test
power at a significance level of 5%, with a minimum
mean difference to be detected of 3 and a mean stan-
dard deviation of 5 , showed that 45 subjects in each
of the 2 groups were the minimum for providing reliable
results.13 The minimum mean difference to be detected
and the standard deviation of the maxillary first premo-
lar in relation to the bisected occlusal plane were based
on a previous study.13
The sample, consisting of lateral headfilms of 90 (43
male, 47 female) untreated subjects in the permanent
dentition, selected from the files of the Department of
71
72 Janson et al

Table I. Cephalometric variables

Maxillomandibular relationship ( )
SNA SN to NA angle
SNB SN to NB angle
ANB NA to NB angle
Growth pattern
SN.PP ( ) SN to the palatal plane angle
SN.GOGN ( ) SN to Go-Gn angle
PP.MP ( ) Angle between the palatal plane (ANS/PNS)
and the mandibular (Go/Gn) plane
FMA ( ) Frankfort horizontal to the mandibular
plane angle
Gonial Ar-Go to Go-Gn angle
angle ( )
LAFH (mm) Lower anterior face height: distance from
ANS to menton
Dental relationship (mm)
Overbite Distance between the maxillary and mandibular
incisor borders perpendicular to the functional
Fig 1. Overbite measurement was defined as the dis- occlusal plane
tance between the maxillary and mandibular incisor bor- Maxillary mesiodistal angulations ( )
ders, perpendicular to the functional occlusal plane. Mx4.BOP Long axis of the maxillary first premolar to the
BOP
Mx5.BOP Long axis of the maxillary second premolar to the
Orthodontics at Bauru Dental School, University of S~ao BOP
Paulo, Brazil, was divided into 2 groups, based on the Mx6.BOP Long axis of the maxillary first molar to the BOP
amount of overbite, regardless of cephalometric charac- Mx7.BOP Long axis of the maxillary second molar to the
BOP
teristics. All subjects had all permanent teeth up to the Mx4.PP Long axis of the maxillary first premolar to the
second molars. ANS-PNS angle
Group 1 (open bite) consisted of lateral headfilms ob- Mx5.PP Long axis of the maxillary second premolar to the
tained from 45 (20 male, 25 female) untreated subjects ANS-PNS angle
of Mediterranean ancestry, with a mean age of Mx6.PP Long axis of the maxillary first molar to the ANS-
PNS angle
13.95 years (range, 12-19.75 years); their open bites Mx7.PP Long axis of the maxillary second molar to the
ranged from 0.5 to 8.7 mm, with a mean of 2.68 mm. ANS-PNS angle
Twenty-four had Class II, 17 had Class I, and 4 had Class Mandibular mesiodistal angulations ( )
III malocclusions. Md4.BOP Long axis of the mandibular first premolar to the
Group 2 (normal occlusion) consisted of lateral head- BOP
Md5.BOP Long axis of the mandibular second premolar to
films obtained from 45 (23 male, 22 female) subjects the BOP
with a mean age of 13.83 years (range, 12-15.33 years), Md6.BOP Long axis of the mandibular first molar to the BOP
with overbites from 0.5 to 4.7 mm, with a mean of Md7.BOP Long axis of the mandibular second molar to the
3.04 mm and pleasant facial profiles, of Mediterranean BOP
ancestry. Md4.MP Long axis of the mandibular first premolar to the
mandibular plane (Go-Gn) angle
The cephalometric tracings and landmark identifica- Md5.MP Long axis of the mandibular second premolar to
tions were performed on acetate paper by 1 investigator the Go-Gn angle
(V.L.) and then digitized with a digitizer (DT-11; Hous- Md6.MP Long axis of the mandibular first molar to the
ton Instruments, Austin, Tex). Go-Gn angle
Overbite measurement was defined as the distance Md7.MP Long axis of the mandibular second molar to the
Go-Gn angle
between the maxillary and mandibular incisor borders Interdental angulations ( )
perpendicular to the functional occlusal plane (Fig 1). Mx4.Md4 Long axes of the maxillary and mandibular first
In total, 129 landmarks were identified, and 30 mea- premolars
surements were performed (Table I). Posterior tooth an- Mx5.Md5 Long axes of the maxillary and mandibular
gulations were measured in the maxillary and second premolars
Mx6.Md6 Long axes of the maxillary and mandibular first
mandibular arches and consisted of measuring the an- molars
gles between the premolars' (apex-cusp tip) and the Mx7.Md7 Long axes of the maxillary and mandibular
molars' long axes (furcation-center of the crown) to second molars

July 2016  Vol 150  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Janson et al 73

Fig 2. A, Maxillary and mandibular posterior tooth angulation measurements in relation to the BOP: 1,
Mx4.BOP; 2, Mx5.BOP; 3, Mx6.BOP; 4, Mx7.BOP; 5, Md4.BOP; 6, Md5.BOP; 7, Md6.BOP; 8,
Md7.BOP. B, Maxillary posterior tooth angulation measurements in relation to the palatal plane
(PP): 1, Mx4.PP; 2, Mx5.PP; 3, Mx6.PP; 4, Mx7.PP.

Fig 3. A, Mandibular posterior teeth angulation measurements in relation to the mandibular plane
(MP): 1, Md4.MP; 2, Md5.MP; 3, Md6.MP; 4, Md7.MP. B, Intermolar and interpremolar angulation mea-
surements: 1, Mx4.Md4; 2, Mx5.Md5; 3, Mx6.Md6; 4, Mx7.Md7.

the BOP (Fig 2, A) and to the palatal plane (ANS-PNS) the maxillary occlusal plane (from the distal buccal
(Fig 2, B) and the mandibular plane (Fig 3, A). The inter- cusp of the maxillary second molar to the incisal edge
premolar and intermolar angulations were measured as of the most extruded maxillary central incisor) and the
well (Fig 3, B). The BOP was obtained by bisection of mandibular occlusal plane (from the distal buccal cusp

American Journal of Orthodontics and Dentofacial Orthopedics July 2016  Vol 150  Issue 1
74 Janson et al

Table II. Intergroup comparison for age (t test) Table IV. Intergroup comparison of all variables
(t tests)
Group 1, open bite Group 2, normal occlusion
(n 5 45) (n 5 45) Group 1, open Group 2, normal
bite (n 5 45) occlusion (n 5 45)
Variable Mean SD Mean SD P
Age (y) 13.95 1.89 13.83 0.95 0.700 Variable Mean SD Mean SD P
Maxillomandibular relationship ( )
SNA 81.88 6.09 81.76 3.65 0.911
SNB 77.16 5.17 79.32 3.01 0.017*
Table III. Sex distribution in the groups (chi-square ANB 4.71 2.90 2.44 1.92 0.000*
test) Growth pattern
SN.PP ( ) 6.58 3.62 8.40 3.03 0.001*
Sex SN.GoGn ( ) 39.52 6.64 32.38 4.72 0.000*
Group Boys Girls Total PP.MP ( ) 32.93 5.45 23.98 4.58 0.000*
FMA ( ) 33.68 5.15 28.32 4.61 0.000*
Group 1, open bite 20 25 45
Gonial angle ( ) 129.26 5.57 125.84 6.74 0.010*
Group 2, normal occlusion 23 22 45
LAFH (mm) 71.54 5.57 63.94 4.58 0.000*
Total 43 47 90
Dental relationship (mm)
Chi-square 5 0.04; degrees of freedom 5 1; P 5 0.833. Overbite 2.68 2.05 3.04 1.10 0.000*
Maxillary mesiodistal angulations ( )
of the mandibular second molar to the incisal edge of the Mx4.BOP 75.47 5.04 79.23 4.34 0.000*
Mx5.BOP 83.95 3.89 86.56 3.69 0.001*
most extruded mandibular central incisor).4
Mx6.BOP 90.78 4.72 89.94 4.28 0.378
These data were stored in a computer and analyzed Mx7.BOP 99.57 6.16 96.80 5.75 0.030*
with Dentofacial Planner software (version 7.0; Dentofa- Mx4.PP 94.94 5.33 94.25 5.20 0.538
cial Software, Toronto, Ontario, Canada), which cor- Mx5.PP 86.47 5.09 86.94 4.73 0.653
rected the image magnification factors of the x-rays. Mx6.PP 79.64 5.62 83.55 4.49 0.000*
Mx7.PP 70.84 7.38 76.69 5.54 0.000*
The lateral headfilms obtained in the open-bite
Mandibular mesiodistal angulations ( )
group were taken with various x-ray machines, which Md4.BOP 76.65 5.74 82.95 4.21 0.000*
produced different magnification factors of the images, Md5.BOP 78.46 5.43 84.05 4.11 0.000*
ranging from 6% to 10.94%. All lateral cephalograms in Md6.BOP 81.37 4.82 82.22 4.20 0.377
the normal occlusion group were taken with the same x- Md7.BOP 76.56 5.29 78.07 5.18 0.174
Md4.MP 79.99 5.77 79.56 5.14 0.712
ray machine, which had a magnification factor of 6%.
Md5.MP 78.18 4.97 78.47 5.19 0.786
To evaluate the intraexaminer errors, 14 radiographs Md6.MP 75.27 5.41 80.30 4.23 0.000*
were randomly selected, traced, digitized, and measured Md7.MP 80.08 5.74 84.45 4.48 0.000*
again by the same operator (V.L.) after a 30-day interval. Interdental angulations ( )
The random errors were Mx4.Md4 152.13 6.93 162.20 6.21 0.000*
P calculated according to Dahl- Mx5.Md5 162.40 6.66 170.61 5.10 0.000*
berg's formula (Se2 5 d2/2n),18 where Se2 is the error
Mx6.Md6 171.97 5.31 172.08 3.81 0.914
variance and d is the difference between 2 determina- Mx7.Md7 175.96 7.00 174.88 4.21 0.376
tions of the same variable, and the systematic errors
*Statistically significant at P \0.05.
were calculated with dependent t tests, at P \0.05.19-21

Statistical analyses
To assess normal distribution of the data in the sam-
ple, Kolmogorov-Smirnov tests were performed.22,23 All
variables had a normal distribution in both groups.
We used t tests to evaluate the groups' comparability
regarding age, and the chi-square test was used to
compare the groups regarding sex distribution.
Intergroup comparisons of all variables were per-
formed with t tests.
The results were considered significant at P \0.05.
All statistical analyses were performed with Statistica
software (Statistica for Windows, version 10.0; StatSoft,
Tulsa, Okla).
RESULTS
No systematic errors were found, and the random er-
rors were within acceptable limits, varying from 0.47
(ANB) to 3.99 (Mx7.BOP).20
The 2 groups where comparable regarding age and
sex distribution (Tables II and III).
The open-bite group showed significantly more re-
truded mandibles, greater Class II skeletal relationships,
and more upward inclinations of the palatal plane
than did the normal occlusion group (Table IV). There
were also significantly more accentuated vertical growth
patterns and smaller overbites in the open-bite group.
The maxillary first and second premolars in the open-
bite group had significantly greater mesial angulations,

July 2016  Vol 150  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Janson et al
when measured in relation to the BOP, than did those in
the normal occlusion group (Table IV). The open-bite
maxillary first molars had significantly greater distal an-
gulations in relation to the palatal plane, and the
second molars had significantly greater distal angula-
tions in relation to both planes than did those in the
normal occlusion group (Table IV).
The open-bite mandibular first and second premolars
showed significantly greater mesial angulations in rela-
tion to the BOP than did those in the normal occlusion
group. The open-bite mandibular first and
second molars had significantly greater distal angula-
tions in relation to the mandibular plane than did those
in the normal occlusion group (Table IV).
The open-bite group's interdental angulations be-
tween the maxillary and mandibular first and second
premolars were significantly smaller than those in the
normal occlusion group (Table IV).
DISCUSSION
Open-bite characteristics have been studied for more
than 50 years.24 However, the difficulty in understand-
ing all components involved in this malocclusion makes
it difficult to treat. In the beginning of modern ortho-
dontics, many orthodontists refused to treat apertogna-
thia (Greek-Latin word meaning open bite
[apertus 1 gnathos]). Although our specialty has
evolved over the last century, and much knowledge
about this vertical malocclusion has been acquired,
some issues still remain controversial, such as the skel-
etal and dentoalveolar components of this vertical
disharmony.
Because most patients in the open-bite group had
Class II malocclusions, this group showed significantly
greater mandibular retrusion and Class II anteroposterior
relationship than did the normal occlusion group
(Table IV).
No effort was made to select patients with predomi-
nantly skeletal open bites. Those with an open bite
greater than 0.5 mm were selected. Therefore, it would
not be expected to find severe cephalometric skeletal
characteristics.2,25,26 Nevertheless, all the growth
pattern variables showed that the open-bite group was
significantly more vertical than the normal occlusion
group (Table IV). Consequently, it can be assumed that
reasonable skeletal vertical components were present,
as expected.3,27,28 Therefore, the results would be
more applicable to moderate open-bite malocclusions,
with a mean open bite of 2.68 mm.
The open-bite maxillary and mandibular premolars
had significantly greater mesial angulations than did
the normal occlusion premolars when measured in rela-
tion to the BOP, confirming previous observations.4,13,29
American Journal of Orthodontics and Dentofacial Orthopedics
75
However, in relation to the palatal plane, their
angulations were similar to those in the normal
occlusion group. This means that the decreased
angulation observed in relation to the BOP is
consequent to the greater divergence of the palatal
and mandibular planes in open-bite patients, who
have a more accentuated vertical growth pattern. In
the open-bite group, the palatal plane had significantly
smaller angles in relation to the cranial base (SN.PP); this
demonstrates a counterclockwise rotation that was not
compensated for by the premolar angulations.
The open-bite maxillary first molars had similar an-
gulations, and the second molars were more distally an-
gulated in relation to the normal occlusion group
regarding the BOP; this contradicts previous specula-
tions.4,13,29 Additionally, regarding the palatal plane,
both molars were significantly more distally angulated
in the open-bite group. Probably, this is because of their
distally angulated eruption path.30 It could be also
because the open-bite group had more divergent palatal
and mandibular planes (PP.MP), and consequently the
molars must have a greater distal angulation to
occlude10; this is considered a dentoalveolar compensa-
tion.13 These different premolar and molar angulations
may explain why an anterior open bite, in moderate to
severe cases, sometimes involves the premolars as well.
Their angulation in relation to the BOP usually does
not compensate for the palatal and mandibular planes'
divergence.10 The angulations of the normal occlusion
group were similar to those in a previous study in pa-
tients with balanced growth patterns.13
The mandibular first and second premolars in the
open-bite group had a similar behavior as the maxillary
premolars: they had significantly greater mesial angula-
tions than the normal occlusion premolars in relation to
the BOP, confirming previous speculations,4,13 but in
relation to the mandibular plane, their angulations
were similar to those in the normal occlusion group.
Again, the decreased angulations observed in relation
to the BOP are consequent to the greater divergence of
the palatal and mandibular planes in open-bite patients,
who have a more accentuated vertical growth
pattern.10,16,27,31
The mandibular first and second molars in the open-
bite group had similar angulations to those in the normal
occlusion group in relation to the BOP, also contradict-
ing previous speculations.4,13 Additionally, regarding
the mandibular plane, both molars were significantly
more distally angulated in the open-bite group, suggest-
ing a dentoalveolar compensation for the more accentu-
ated vertical growth pattern of this group.11,32 This
dentoalveolar compensation tends to occur in patients
with vertical growth during the early eruption stages.32
July 2016  Vol 150  Issue 1
76
The interdental angulations of the first and second
premolars also confirm their lack of dentoalveolar
compensation for the palatal and mandibular planes'
divergence (PP.MP) because they demonstrated smaller
interpremolar angles in the open-bite group than in
the normal occlusion group (Table IV). The premolar an-
gulations were not compensated for, and as the palatal
and mandibular planes' divergence increases, the smaller
the interpremolar angles will be.10 On the other hand,
because the molars had a dental compensation by a
greater distal angulation in relation to the palatal and
mandibular planes, the intermolar angles were similar
to those in the normal occlusion group.
These results demonstrated that only the premolars
have a greater mesial inclination in relation to the
BOP, therefore partially confirming the previous specu-
lations of Kim4 and Kim et al.33 However, although these
patients had a greater vertical component than did the
normal occlusion group, they cannot be considered to
have actual skeletal open bites, as mentioned by Kim.
Consequently, further studies in patients with predomi-
nantly skeletal open bites should be conducted to eval-
uate whether the molars also demonstrate a greater
mesial angulation in relation to a normal occlusion.
It has been shown that those with Class II malocclu-
sions usually have a greater distal angulation of the pos-
terior teeth than subjects with normal occlusion.34
Because 53.33% of the open-bite patients had Class II
malocclusions, this demonstrates that the divergent ver-
tical pattern overcame the influence of the anteroposte-
rior malocclusion discrepancy, mesially angulating the
premolars, despite their distal angulation tendency.
This fact corroborates other studies that demonstrated
the greater influence of a vertical growth pattern over
the anteroposterior discrepancy in terms of dentoalveo-
lar compensation.9,35 Nevertheless, as mentioned above,
because the open bites were not predominantly skeletal,
the vertical component was not strong enough to affect
the molars.
Many authors have considered that primarily the
mandibular components are associated with open-bite
malocclusions.2,3,9,10,24-27,31,36-42 However, in this
study, we demonstrated that at least the maxillary
premolars also play a role in open-bite characteristics,
as had been previously suggested.4,13
The results of this study show that usually the maxil-
lary and mandibular premolars do not compensate for
the palatal and mandibular planes' divergence when
their angulation is measured in relation to the BOP.
Therefore, the orthodontic mechanics must be directed
to compensate for this divergence. It can be performed
with tip-back bends incorporated into the archwire,
such as in the multiloop edgewise archwire technique,4
July 2016  Vol 150  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Janson et al
or it can be obtained by mesially angulating the acces-
sories of the posterior teeth.43 Evidently, the use of ver-
tical anterior intermaxillary elastics is mandatory
because they are the actual accessories that will deliver
the required force to distally angulate the posterior
teeth.4,44,45 Sometimes, in more accentuated open-bite
patients, the same procedure can be undertaken with
the molars, despite their significantly greater distal an-
gulations in relation to a normal occlusion. This is prob-
ably because in more severe open-bite patients, even the
molars cannot compensate for the palatal and mandib-
ular planes' divergence.
CONCLUSIONS
The null hypothesis was rejected because of the
following.
1. The maxillary and mandibular first and second pre-
molars in the open-bite group had significantly
greater mesial angulations in relation to the BOP
than did those in the normal occlusion group.
2. The maxillary second molars in the open-bite group
had significantly greater distal angulations in rela-
tion to the BOP than did those in the normal occlu-
sion group.
3. The maxillary and mandibular first and
second molars in the open-bite group had signifi-
cantly greater distal angulations in relation to the
palatal and mandibular planes than did those in
the normal occlusion group.
REFERENCES
1. Mossey P. The heritability of malocclusion: part 1—genetics, prin-
ciples and terminology. J Orthod 1999;26:103-13.
2. Arvystas MG. Treatment of anterior skeletal open-bite deformity.
Am J Orthod 1977;72:147-64.
3. Schudy FF. Vertical growth versus anteroposterior growth as
related to function and treatment. Angle Orthod 1964;34:
75-93.
4. Kim YH. Anterior openbite and its treatment with multiloop edge-
wise archwire. Angle Orthod 1987;57:290-321.
5. Deguchi T, Kurosaka H, Oikawa H, Kuroda S, Takahashi I,
Yamashiro T, et al. Comparison of orthodontic treatment out-
comes in adults with skeletal open bite between conventional
edgewise treatment and implant-anchored orthodontics. Am J Or-
thod Dentofacial Orthop 2011;139(Suppl):S60-8.
6. Kuroda S, Sakai Y, Tamamura N, Deguchi T, Takano-Yamamoto T.
Treatment of severe anterior open bite with skeletal anchorage in
adults: comparison with orthognathic surgery outcomes. Am J Or-
thod Dentofacial Orthop 2007;132:599-605.
7. Nielsen IL. Vertical malocclusions: etiology, development, diag-
nosis and some aspects of treatment. Angle Orthod 1991;61:
247-60.
8. Schendel SA, Eisenfeld J, Bell WH, Epker BN, Mishelevich DJ. The
long face syndrome: vertical maxillary excess. Am J Orthod 1976;
70:398-408.
Janson et al
9. Kim YH. Overbite depth indicator with particular reference to ante-
rior open-bite. Am J Orthod 1974;65:586-611.
10. Bj€ork A. Prediction of mandibular growth rotation. Am J Orthod
1969;55:585-99.
11. Bj€ork A, Skieller V. Facial development and tooth eruption. An
implant study at the age of puberty. Am J Orthod 1972;62:339-83.
12. Solow B. The dentoalveolar compensatory mechanism: back-
ground and clinical implications. J Orthod 1980;7:145-61.
13. Chang YI, Moon SC. Cephalometric evaluation of the anterior open
bite treatment. Am J Orthod Dentofacial Orthop 1999;115:29-38.
14. Chang JZ, Chang WC, Chen KH, Chen YJ, Chen YJ, Lai EHH, et al.
How to achieve proper overbite—lessons from natural dentoalveo-
lar compensation. J Dent 2013;8:341-7.
15. Janson GR, Metaxas A, Woodside DG. Variation in maxillary and
mandibular molar and incisor vertical dimension in 12-year-old
subjects with excess, normal, and short lower anterior face height.
Am J Orthod Dentofacial Orthop 1994;106:409-18.
16. Betzenberger D, Ruf S, Pancherz H. The compensatory mecha-
nism in high-angle malocclusions: a comparison of subjects in
the mixed and permanent dentition. Angle Orthod 1999;69:
27-32.
17. Baek MS, Choi YJ, Yu HS, Lee KJ, Kwak J, Park YC. Long-term sta-
bility of anterior open-bite treatment by intrusion of maxillary
posterior teeth. Am J Orthod Dentofacial Orthop 2010;138:
396.e1-9.
18. Dahlberg G. Statistical methods for medical and biological stu-
dents. New York: Interscience Publications; 1940.
19. Houston WJ. The analysis of errors in orthodontic measurements.
Am J Orthod 1983;83:382-90.
20. Baumrind S, Frantz RC. The reliability of head film measurements:
2. Conventional angular and linear measures. Am J Orthod 1971;
60:505-17.
21. Richardson A. A comparison of traditional and computerized
methods of cephalometric analysis. Eur J Orthod 1981;3:15-20.
22. Sheats RD, Pankratz VS. Understanding distributions and data
types. Semin Orthod 2002;8:62-6.
23. Phillips C. Sample size and power: what is enough? Semin Orthod
2002;8:67-76.
24. Subtelny JD, Sakuda M. Open-bite: diagnosis and treatment. Am J
Orthod 1964;50:337-58.
25. Isaacson JR, Isaacson RJ, Speidel MT, Worms FW. Extreme varia-
tion in vertical facial growth and associated variation in skeletal
and dental relations. Angle Orthod 1971;41:219-29.
26. Nahoum H. Vertical proportions and the palatal plane in anterior
open-bite. Am J Orthod 1971;59:273-82.
27. Ellis E III, McNamara JA Jr, Lawrence TM. Components of adult
Class II open-bite malocclusion. Int J Oral Maxillofac Surg 1985;
43:92-105.
American Journal of Orthodontics and Dentofacial Orthopedics
77
28. Cangialosi TJ. Skeletal morphologic features of anterior open bite.
Am J Orthod 1984;85:28-36.
29. Sato S. Alteration of occlusal plane due to posterior discrep-
ancy related to development of malocclusion—introduction to
denture frame analysis. Bull Kanagawa Dent Coll 1987;15:
115-23.
30. Brodie AG. On the growth of the jaws and the eruption of the teeth.
Angle Orthod 1942;12:109-23.
31. Schudy FF. The rotation of the mandible resulting from growth: its
implications in orthodontic treatment. Angle Orthod 1965;35:
36-50.
32. Iseri H, Solow B. Continued eruption of maxillary incisors and first
molars in girls from 9 to 25 years, studied by the implant method.
Eur J Orthod 1996;18:245-56.
33. Kim YH, Han UK, Lim DD, Serraon ML. Stability of anterior open-
bite correction with multiloop edgewise archwire therapy: a ceph-
alometric follow-up study. Am J Orthod Dentofacial Orthop 2000;
118:43-54.
34. Chio BT, Yang WS. A roentgenocephalometric study on mesiodistal
axial inclination of posterior teeth. Korean J Orthod 1984;14:
151-60.
35. Kim YH, Vietas JJ. Anteroposterior dysplasia indicator: an adjunct
to cephalometric differential diagnosis. Am J Orthod 1978;73:
619-33.
36. Frost DE, Fonseca RJ, Turvey TA, Hall DJ. Cephalometric diagnosis
and surgical-orthodontic correction of apertognathia. Am J
Orthod 1980;78:657-69.
37. Sassouni V, Nanda S. Analysis of dentofacial vertical proportions.
Am J Orthod 1964;50:801-23.
38. Nahoum HI, Horowitz SL, Benedicto EA. Varieties of anterior
open-bite. Am J Orthod 1972;61:486-92.
39. Enunlu N. Palatal and mandibular plane variations in open bite
cases with varying aetiology. Trans Eur Orthod Soc 1974;165-71.
40. Lowe AA. Correlations between orofacial muscle activity and
craniofacial morphology in a sample of control and anterior
open-bite subjects. Am J Orthod 1980;78:89-98.
41. Hapak FM. Cephalometric appraisal of the open bite case. Angle
Orthod 1964;34:65-72.
42. Sassouni V. A classification of skeletal facial types. Am J Orthod
1969;55:109-23.
43. Janson G, Valarelli F. Open-bite malocclusion: treatment and sta-
bility. Hoboken, NJ: John Wiley & Sons; 2013.
44. Enacar A, Ugur T, Toroglu S. A method for correction of open bite.
J Clin Orthod 1996;30:43-8.
45. Kucukkeles N, Acar A, Demirkaya AA, Evrenol B, Enacar A. Ceph-
alometric evaluation of open bite treatment with NiTi arch wires
and anterior elastics. Am J Orthod Dentofacial Orthop 1999;116:
555-62.
July 2016  Vol 150  Issue 1