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    Bulletin of Kanagawa Dental College Vol. 30, No. 2, September, PP, 93-98, 2002 Morphological Characterization of Different Types of Class II Malocclusion Sae Kato, Woo-Nahm Chung, Jeong-li Kim and Sadao Sato Department of Orthoontcs,Kanagoroe Dental Calle Abstract ts important to understand the morphological features of malocclusion in order to recon struct a functional acelusion. The features of Class II malocclusions make them especially difficult to correct. We measured and compared the occlusal plane and various paramaters obtained from the ‘cephalogram of class Il malocclusions anc that of normal ogclusions. The abjaotive of this study has been to gain a better understanding of the morphological features of high- and low-angle Class Il malocclusion in order to establish a tramework for a better therapeutic approaen In cases of high-angle Class I! malocclusion, the mandible is small, retruded, rotated back ‘ward, and accompanied by @ steep posterior occlusal plane. The stegp posterior occlusal plane ie corrolated with @ short vertical neight of tho upper second molars, The mandible Is also sinall and vetruded in cases of low-angle type of Class Il malocclusions, bul with a flat anterior occlusal pian. The flat antorior occlusal plane divides tho occlusal olane into two ‘segments. These results demonstrate that tne skeletal features of the Clas II malocclusion are closely related to the deviation in the vertical aspect of the occlusion. We conclude that correcting the occlusal plane by controling the vertical dimension is extremely important in the treatment of Class Il malocelusions, Key words: Class 1 malocclusion, Occlusal plane, High-angle, low-angle Introduction Every phase of the orthodontic treatment of maloc- clusion depends on the relationship of the mandible to the cranium and on the functional movement of the mandible. Fffective techniques and methods are essen- tial in treating malocclusion, but they will succeed only if they harmonize with the morphological situation and functions of the craniomandibular system. These latter include static and dynamic control of the mandible and maintaining unhindered’ mandibular movement. Malocclusions become difficult to treat orthodontically when there are skeletal deviations re- lated to craniofacial growth. In an effort to resolve such skeletal problems, researchers have done experiments and presented theories about how the human face grows, and they have tried different methods for con- trolling facial growth. [tis clear that skeletal patterns are aggravated by orthodontic treatment, and this sug ‘Accepted for publication on May 27,2002 ‘Address for cormespondence: Sadao Sato, Depastment of Orthodontics, Kanapaws Dental Calege, inaekacho 89, Yokosaka ‘Kenagawa, 238-8500, Japan, gests that uncontrolled functional changes may affect facial growth. Observations of the relationship between occlusal deviation and facial growth have been reported. ‘MeNamara (1) showed that the temporomandibularjoint, is not an immutable structure, but rather is an articula- tion capable of functional adaptation. Structural adap- tations within the mandibular condyle, however, are related to the level of maturation of the individual. MoNamara and Carlson (2, 3) showed that significant adaptive responses take place in the mandibular condyle of the juvenile rhesus monkey ifthe functional position of the mandible is altered. Fushima ct al. (4) used P-A cephalograms to measured the vertical height of poste- rior teeth in subjects who had mandibular asymmetry, and he showed that the vertical height of posterior teeth, on the side toward which the mandible had shifted was lower than the contralateral dental height. These are additional findings that suggest that the degree of oc- clusal deviation is an important determinant of facial growth. Among the various types of malocchision, Class Il S. Kato et al Bull. Kanagawa Dent, Col, 30 (2002) malocchusions are among the hardest to treat. McNamara (6) and Moyers et ai (6) have suggested that the funda- mental problems in the balance of craniofacial skeletal structures in Class II malocclusion are due to mandibu- lar retrognathism rather than maxillary prognathism. ‘Their research led us to examine the relationship be- tween retrognathism of the mandible and the occlusal plane in different types of Class II malocclusion. The ‘purpose of this study was to obtain a better understand- ing of the morphological features of high-angle and low. angle types of Class I malocclusion. Materials and Methods ‘Twenty adults (10 males and 10 females) with nor- mal occlusion and no missing teeth were selected from the patient files of the Department of Orthodontics, Kanagawa Dental College, as normal-occlusion subjects Untreated high- and low-angle Class [1 malocclusion subjects were also selected from the file. The 20 adults in each group (10 males and 10 females) were all at the IVA dental stage, and each of them had a mandibular- plane angle that was either more than 35 degrees or less than 25 degrees. The lateral cephalograms of all the sub- jects were traced by one of the authors (SK). We cephalometrically measured the occlusal plane and the condylar axis (Cx) {for analyzing the inclination of the condyle) (Fig, 1), The measured quantities and defini- tions of skeletal and dental patterns are listed below. Definition of the occlusal plane 1, Anterior occlusal plane (AOP): line drawn from the incisal edge of the upper central incisor to the cusp tip of the upper first premolar. 2. Posterior acclusal plane (POP: a line drawn from the cusp tip of the upper first premolar to the mid- point of the upper first molar at the occlusal sur face. Measuronents related to the occlusal plane and the condylar axis 1. AOP angle (AOP-FEH): the anterior angle between the anterior occlusal plane and the FH plane. 2. POP angle (POP-FH}: the anterior angle between the posterior occlusal plane and the FH plane. 3, OPdiff: the angular difference between AOP-FH and POP-FH. 4. Ox: the angle between a line drawn from the condylion to the midpoint of the Na-Ba line through the condyle and the Xi-Pm line. ‘Measterements related to skeletal pattern 1. Mandibular plane angle (MP-FF): the angle be- tween the mandibular plane and the FH plane. 2. Lower facial height (LFH): the angle between the ANS-Xiline and the Xi-Pm line (corpus axis}. 1 FHLMP 2LPH 3 Ex 4G0a scor. 6x TODI-AR-MP)HFH-PP) SAPDIM(FPA}*(ABA)+(FH-PP) Fig. 1: Angular measurements ofthe occlusal plane and ower {ace skeletal frame. AOP: anterior occlusal plane, POP: pos- terlar occlusal plane, OPdif: occlusal plane difference, FFA: facial plane angle, ABA: AB plane angle, MP: mandibular plane angle, PP: palatal plane angle, LFH: lower facial height, Fx: facial axis, OA: gonial angle, COL: Condslar length, Cr: Condiylar axis, ODI: overbite dapth indicator (AB-MP +FH- PP), APDI: anteroposterior dislasia indicator (FPA+ABASFH- PP} 3. Facial axis (Bx): the angle between the facial axis, and the Ba-Na line. 4, Gonial angle (GOA): the angle between the poste- rior borderline of the ramus and the mandibular plane 5. Corpus length (COL}: the distance from the Xi point to the Pm point. 6. Over bite Depth Indicator (ODI) the angle between the AB plane and the mandibular plane plus the angle between the palatal plane and the FH plane, A positive value is given when the palatal plane increases downward and forward in relation to the FH plane. ", Anteroposterior Dysplasia Indicator (APDD): the angle between the facial plane and the FH plane pplus the angle between the AB plane and the facial plane plus the angle between the palatal plane and ‘the FH plane Measurements related to dental vertical height In order to establish the vertical position of maxil- lary dentition, the perpendicular distance between the palatal plane and (1) the incisal edge or cusp tips of inei- sors, canines, and premolars ar (2) the midpoint of buc- ‘Morphological Characterization of Class IT Malocclusion Fig. 2: Measurements of the upper and lower dental vertical height. cal cusps of molars was carefully measured. From these data we produced lateral cephalograms (Fig, 2).To char acterize the lower dentition, we measured the perpen- dicular distance between the mandibular plane (MP) and, (@) the incisal edge or cusp tips of incisors, canines, and premolars, (2) the mesial and distal buccal cusps of first, ‘molars, and (3) the midpoint of second molars. Statistical analysis Por each of these variables, we compared the three groups {normal occlusion, high-angle Class II malocclu- sion, and low-angle Class II malocclusion) with the Kruskal-Wallis test and the Post-hoe test. Because the results of these two tests were virtually identical for all variables; we show here only tables stimmarizing the results of the Post-hoc test. Results Skeletal character in the higit-angle class II group (Table 1) In the high-angle Class Il group, we found Fx to be significantly smaller than in either the normal group or the low-angle Class II group (P<0.001) (Table 1), while LEH and GOA were significantly larger than those of the other groups (P<0.001). COL was significantly smaller than that of the normal group (P<0.001) and that of the low-angle Class Il group (P<0.05). APDI was sig- nificantly smaller than in the normal group (P<0.001), ‘and ODI was significantly smaller than in the low-angle ‘Class II group (P<0.001). The inclination of the condyle (Table 1) to Cx was significantly smaller than it was in the normal group and in the low-angle Class II group {p<0.001), showing that Cx in high-angle Class Il groups inclines upward toward the rear. Skeletal character of the low-angle class TI group (Table 1) In the low-angle ClassII group, LFH, GOA, and APDI ‘were found to be significantly smaller than those of the normal group (P<0.001) (Table 1). Fx and ODI were sig~ nificantly larger than the same measures in the normal group (P20.01) and in the high-angle Class I group (P 0,001), COL was significantly smaller than that of the normal group (P<0.06), indicating that small, retruded mandibles are characteristic of the high-angle Class II group as well as the low-angle Class Il group. Cx was significantly larger than that of the normal group (P<0,001). These measures show that the condylar axis in the low-angle Class I group inclines upward from back to front, Dental pattern (Tables 2 and 3) ‘The POP-FH in the high-angle Class II group was found to be significantly larger than that in the normal group (P<0.001) (Table 2}. AOP-FH in the low-angle Class Il group was significantly smaller than that in the normal group (P<0.05). In addition, both AOP-FH and Table 1: Measurements of Mandibular Morphology and Occlusal planes in normal and Class Il Skeletal Frames CHiNowmal C1 High angle lil Low angle Postios tet Mean SD Mean SDMean—SD__CIIee CIMTFigh CIT vs CIT Low CHIHigh vs CIT Low MP Bk A 38 “ * GH 5338 BT 27 “ ~ Be aa 32 7868 28 ” * “ opr m5 3B mB 64 - APL «R638 BB 4D 3 ” a col m8 3 Baa a oo " . GOA mz 37 15 58 ” o ~ cx MA BS 21988 83 « z = Posthoc test: significant difference, p

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