Malocclusion Case Examples

Measuring the Direction of Facial Growth.

Various authors have suggested the use of different planes to assess the growth direction but I recommend the use of two sequential X-rays superimposed along the ‘SN’ plane at ‘S’ or along the Frankfort Horizontal at the Porion. Alternatively using photographs superimposed on the Tragus along the line from there to the furthest point on the nose. It does not matter much which of these plains are used provided the ‘before’ and ‘after’ superimpositions are along the same lines. The direction of growth is then measured by marking Gnathion or Pogonion on both tracings and drawing a line through them extending to the plain used for the superimposition. 

In geometric terms anything less than 45° would be horizontal and anything over would be vertical. 35° to 40° would appear to be close to the functional and aesthetic ideal but there are many nice looking faces and straight teeth associated with angles as high as 50°. Research is difficult on this point as few serial records of outstandingly good looking people are available. However for most severe malocclusions the angle will be over 80°. Some character-full faces are found with high angles but as the growth direction increases there is less and less room available for the teeth. The following two clinical cases confirm the importance of diagnosing maxillary position correctly and the effect of different treatments on the growth direction. 

Slight upper spacing and no lower crowding

Figure III/13: Overjet of 11mm. Slight upper spacing and no lower crowding. Note the curvature of the cervical soine and flattened cheeks, to me this suggests vertical growth.

Case Example 1

Case Example 2