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Osmond G. Jones*
Washington, D.C.
The piirpose of this research project was,to investigate a group of 32 North American black patients
witti anterior opeti bite a,nd compare them to th& Noti, American black norms established by
Altemus and Drummond2 and to white populatiqn norms Mablished by Steiner.3 In addition, values
weke establitihed for blaCk patients bq use of ,the overbite depth indicator of Kim. The method
involved the tracing of Ia~eral e&ptialdmetric radiugraphs of 32 patients with anterior open bite using
the analyses of Ttieed,*,Steiner,3 and Kim. The resulting angles were added and the means and
standard deviations calculated. 0r1 the basis. of the criteria us&d for this study, the significant findings
were as follows: (1) the maxilla was normally positioned to the cranial base; (2) the upper and lower
incisors w&e procumberit with an acute interi,ncisal reltitionship; (3) the mandibular position tended
to be retrllsive to the cranial base; (4) the lower facial height was greater and the mandibular plane
angle (GoGn-SN) was smaller than white population standards; and (5) the overbite depth indicator
of Kim4 was smaller for this group than for the white population studied. (AM J ORTHOD DENTOFAC
ORTHOP
1$89;95:289-96.)
*Assistant Professor,
Orthodontics.
Howard
University
College of Dentistry,
Department
METHOD
This research involved the use of lateral cephalometric radiographs of 32 black patients, aged 8 to 39
years, with clinically diagnosed anterior open bite. The
group was divided into 25 female and seven male subjects. Tracings were made of x-ray films and landmarks
were identified by use of the analyses of Steiner,3
Tweed, and Kima (Figs. 1 through 3). The occlusal
planes (Fig. i) and the A-B plane (Fig. 3) were drawn.
Total facial height and lower facial height were measured according to Richardson, and Nahoum69 (Fig.
2), ahd the relevant angles for the Steiner and Tweed
analyses were recorded. The sample was divided further
into skeletal and dental groups by arbitrarily usihg
GoGn-SN angle of 32.5 as a division. Anterior skeletal
open bites were classified above this division.
Tracings were done with a hard pencil on 0.003
matte acetate tracing paper and measurements were obtained using cephalometric tracing equipment. * The
data were presented in tabular form and the mean,
range, and standard deviation were calculated.
RESULTS
of
*Unitek
Corporation.
Monrovia,
Calif.
289
290
Am. J. Orthod.
Jones
Dentofac. Orthop.
April 1989
KEY
S N a
SN=
60.
Gn=
A =
nidpoint
oi Pituitary
Foisa
Naiion
Cranial
base
plane
Gonion
Gnathion
Point
of greatest
convexity
the
anterior
of thr
maxilla
B = Point
of greatest
convexity
the
anterior
of the
mandible
on
on
the white open bite cases (Table III), it was seen that
both racial groups had $NA values similar to their respective notis. However, SNBs and interincisal angles
were smaller and GoGn-SN values were larger than
normal. The white data had larger GoGn-SN values.
Table IV shows that the mean open bite FMA angle
was smaller for the black subjects than that for white
subjects.
Both open bite racial groups had increased lower
facial height, but overall black subjects had the larger
value. The overbite depth indicator (ODI) was lower
for black subjects than for white subjects (Table V).
The sample was divided into two groups fo; the
iteine? analysis (Table VI). Group I (skeletal open bite)
had GoGn-SN angle above 32.5 and group II (dental
open bite) had a GoGil-SN angle below this point.
There were differences between the groups. The
skeletal type showed no maxillary protrusion (SNA,
85 = norm). The mandible @ND, 74.9) displayed
downward and backward rotation or retrusion. Ttie skeletal group also had maxillary incisal procumbency
(&NA, 25.5), but this was less than the dental group
(I-NA, 27;3). The dental types exhibited maxillary and
Volume 95
Number
Cephdometric
open bite
291
KEY
ANS= Anterior
nasal
spine
PNS= Posterior
nasal
spine
ANS-PNS
= Palatal
plane
Ii
- Nanton
N-N=
Total
facial
height
N-ANSUpper
f&J81
height
ANSM=
Lower
facial
height
LA = Long
axis
6f the
lower
Incisor
Frankfurt
Plrne
= Llna
irola
the
upper
border
of the
external
auditory
nertus
to the
lower
border
ofthe
orbit
Mandibular
Pi@no
= Line
tangential
tti the
lower
border
of the
mandible
Table
SNA
SNB
ANB
SND
LNA
A-NA
LT
T-NB
T-NB
GoGn-SN
Mean
SD (2)
Mean
SD (2)
85.50
81.00
4.50
77.00
23.00
7.00 mm
119.00
34.00
10.00 mm
32.50
85.70
79.00Q
5.72
78.60
26.03
8.25 mm
111.10
37.90
ll.OOmm
35.60
4.79
4.78
3.57
5.31
7.50
2.97
11.57
7.82
3.36
5.72
mandibular protrusion (SNA, 87; SNB, 83, respectively) and had a greater procumbency than the norm
for the maxillary incisors (A-NA, 27.3).
Patients with skeletal open bite exhibited a greater
lower incisor procumbency (T-NB, 38.5) than those
292 Jones
Orthop.
April
KEY
A-B
c!DI
Plane
from
= The
1.
2.
1989
a,
d.
= Line
Joining
points
A (L B
Steiners
analysis
sti.
of the
angie formed by8
The Hondibular
&d
A&B Planer
The Fr.arikfUrt
and Pdlat?l
Planes
Table
II. Comparison of normal and open bite data by use of Tweeds analysis
Black
FMA
IMPA
FMIA
norm (Drummomf)
Black
Mean
SD (2)
Mean
;0.6&
100.00
49.40
4.70
5.00
5.70
31.56
99.50
49.20
analyses indicated that Fh4A angle was larger for patients with skeletal open bite and the IMPA angle was
larger for patients with dental open bite (Table VII).
(This implied that the skeletal group showed downward
and backward rotation of the mandible.) The dental
group generally had significantly lowerincisal procumbency. Upper facial heights were lower for skeletal open
bite cases than for the dental cases.
For Kims overbite depth indicator,4 the skeletal
group had a smaller ODI than the dental group. Both
groups were below the white norm of 74.50.
Dl!$ZUSSlON
study)
SD(*)
6.67
7.90
9.70
Volume 9s
Number
Cephnlometric
study
of black
patients
with
anterior
open
bite
293
Table III. Comparison of black and white open bite data by use of Steiners analysis
Black
SNA
SNB
ANB
AT
GoGn-\SN
study)
Mean
SD (?I
Mean
85.65
79.90
5.72
111.10
35.60
4.79
4.78
3.57
11.57
5.72
80. IO
75.90
4.20
120.00
38.56
SD (*i
3.23
3.79
2.88
10.49
7.19
___*Other
data unavailable.
Table IV. Comparison of black and white open bite data by use of Tweeds analysis
Black
FMA
IMPA
FMIA
study)
Mean
SD (2)
Mean
31.56
99.50
49.20
6.67
7.90
9.70
33.40
SD (2)
Unavailable
Unavailable
Table V. Comparison of black and white data: Overbite depth indicator (ODI) and upper facial height/total
facial height (IJFH/TFH) by use of Kims analysis
Black
ODI
UFHiTFH
*Norm
UFHITFH
unavailable
study)
White
Mean
SD (2)
Mean
66.14
40.90%
6.78
3.58
14.50
42.80%
for black
data
SD (?)
6.07 norm (Kim4)
Open bite (Hapal?)*
subjects.
values for the dental open bites, the mean value for
SND angle would be elevated because the skeletal relationships were closer to the norm.
The values for the relationship of the upper incisor
to the maxillary I-NA angle and millimeter measurement indicated that the upper incisors were noticeably
more procumbent in open bite cases. This was reported
in previous studies such as the one by Hapak13 in 1964.
The diminished interincisal angle also indicated that the
incisors were more procumbent. The angle made by
the lower incisor and the mandible (T-NB) showed a
marked procumbency of the lower incisors.
The mandibular plane angle (GoGn-SN) showed an
increase above t.he normal mean. Mizrahi,14 Hellman,
Nahoum,6- and others. indicated in their studies that
the mandibular plane angle increased in open bite cases.
Table II shows the findings of the present study for
the TweedI analysis. The results were unexpected.
294 Jones
Orrhop.
April 1989
Table VI. Comparison of group I skeletal and group II dental data by use of Steiners analysis
Skeletal
Mean
SNA
SNB
ANB
SND
I-NA
A-NA
1T
T-NB
T-NB
GoGn-SN
Dental
SD ()
85.00
78.70
6.30
74.90
25.50
7.90 mm
110.80
38.50
11.80 mm
38.30
4.10
3.96
3.10
4.72
7.60
2.80
10.37
7.70
3.26
3.79
II
Mean
SD (2)
87.30
83.00
5.60
79.30
27.30
9.20 mm
112.20
36.10
9.00 mm
28.70
3.50
3.00
2.29
3.30
7.60
3.50
14.90
9.19
2.69
3.57
Table VIIA. Comparison of group I skeletal and group II dental data by use of Tweeds analysis and
Kims ODI
Group I open bite
(present study)
Tweeds analysis
FMA
IMPA
FMIA
Kims overbite depth indicator
ODI
Mean
SD (2)
Mean
SD (2)
33.30
99.10
47.71
5.50
7.20
9.10
27.50
100.60
53.00
7.70
9.78
10.60
65.50
6.60
67.80
7.20
(ODI)
UFIWTFH
40.40%
3.90
42.20%
2.20
isons with the Tweed analysis (Table IV) and a statistical comparison was not possible because of incomplete data.
Table V indicates that the black open bite patients
had longer, lower faces than the white patients. This
was an expected finding since studies on normal patients
by Altemus already has displayed this trend.
The black patient sample evaluated in this study
showed the following:
1. Upper facial height to total facial height40.9 -+ 3.58
2. Kims overbite
Volume 95
Number 4
Cephalometric
open bite
295
296 Jones
4. Kim YH. Overbite
depth indicator
with particular
reference to
anterior open-bite.
AM J ORTHOD 1974;65:586-611.
5. Hellman M. Open-bite.
INT J ORTHOD 1931;17:421.
6. Nahoum H. Vertical proportions
and the palatal plane in anterior
open-bite.
AM J ORTHOD 1971;59:273-82.
7. Nahoum
H. Varieties
of anterior
open-bite.
AM J ORTHOD
1972;61:486-92.
8. Nahoum
H. Anterior
open-bite:
a cephalometric
analysis and
suggested treatment procedures.
AM J ORTHOD 1975;67:513-21.
9. Nahoum H. Vertical proportions:
a guide for prognosis and treatment in anterior open-bite.
AM J ORTHOD 1975;72:128-46.
10. Richardson
A. Skeletal factors in anterior open-bite
and deep
overbite.
AM J ORTHOD 1969;56:114-27.
11. Richardson
A. Dento-alveolar
factors in anterior open bite and
deep overbite.
Dent Pratt 1970;21:53-7.
12. Tweed CH. The Frankfort-mandibular
plane angle in orthodontic
diagnosis, classification,
treatment planning, and prognosis.
AM
J ORTHOD ORAL SURG 1946;32:175-230.
13. Hapak FM. Cephalometric
appraisal of the open bite case. Angle
Orthod 1964;34:65-73.
14. Mizrahi E. A review of anterior open bite. Br J Orthod 1978;s:
21-7.
15. Schudy FF. The control of vertical overbite
in clincial orthodontics. Angle Orthod 1968;38:19-39.
16. Atherton JD. The influence of the face height upon the incisor
occlusion
and lip posture. Dent Pratt 1965;15:227-31.
17. Baume L. Uniform
methods for the epidemiologic
assessment
of malocclusion.
AM J ORTHOD 1974;66:251-72.
18. Bjork A. The face in profile. Lund, Sweden: Berlingska
Boktryckeriet,
1947.
19. De Coster L. Open-bite.
INT J ORTHOD 1936;22:912-38.
20. Gershater MM. The proper perspective
of open bite. Angle Orthod 1972;42:263-72.
2 1. Helm S. Malocclusion
in Danish children with adolescent dentition: an epidemiologic
study. AM J ORTHOD 1968;54:352-66.
22. Johnson EL. The Frankfort-mandibular
plane angle and the facial
pattern. AM J ORTHOD 1950;36:516-33.
23. Kandil E, Fahmy MS. Open bite and thumb sucking.
J Med
Liban 1974;27:219-22.
24. Lemer HI. Thumbsucking
and dental occlusion.
AM J ORTHOD
1955;41:640.
Orthop.
April
1989
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