A THREE-DIMENS IONAI ANÃJ,YS T S OF ISOMETRIC B]TING

IN I-.,ONG AND SHORT FACIAI. TYPES

BY

LAUR.A REI IWASAK I

A thesis submitted to the Faculty of Graduate Studies

of the University of Manitoba
in partial fulf il-lrnent of the requirements
for the degree of
Master of Science

Department of Preventive Dental- Science

Winnipeg, ManitoÞa
June, 1987
tÇ)
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ISBN 0*3:15*37375*x
 A THREE - D II.fENS IONAL ANALYSIS OF ISOI,fETRIC BITING

IN LONG AND SHORT FACIAL TYPES

BY

LAURA REI II.JASAKI

A thesis submitted to the Faculty of Craduate Studies of

the University of Manitoba in partial fulfillment of the requirentents
of the degree of

¡IASTER OF SC IENCE

o 198 7

Pe¡mission has been grarìred ro the LIBRARy OF THE UNIVER-

SITY OF MANITOBA to lerìd or sell copies of rhis rhesis. to
the NATIONAL LIBRARY OF CANADA ro microfilnì rhis
tlesis and to lend or sell copies of rhe film, and UNIVERSITy
MICROFILMS to publish an absrracr of rhis thesis.

The author reserves other publicatioll rights, and neitlìer the

thesis nor extensive extracts from it may be printed or other-
wise reproduced without the autho¡'s written pernrission,
 TÀBIE OF CONTENTS

ÀBSTRÄCT ,.,....., iv
ÀCKNOWLEDGEIIÍEIi¡1IS . . ..... vi
LISTOFFIGURES viii
LIST OF TÀBLES ......... x

CEÀPTER 1 INTRODI]CTION .,... 1

CHÀPTER 2 LITERÀTURE REVIETI 7

I O\IERVIE¡T 'l
II FÀCIÀI TTPE PÄRÀI,ÍETERS 8
1. Mandibular P1ane .Ang1e 9
2.ffi 10
3. Mandibular Plane .Ang1e and Facial HeÍght
correGElõns ... 72
rrr orrrrsED FAcrAr, rrPrs 13
1. t4
and Function ... 16
Breat ng 16
Muscles 19
II.I. Þi +ô !r^r^ô 23
iv, Vertical Dimension aa

27
4. Mecfran-icaf .Analysis 33

CHÀPTER 3 I{ETHODS ÀND I,IATERTA],S ,,. .,,35

r OVERVIEW 35
TI DESCRIPTION OF THE üODEL 35
III DESCRTPTION OF THE SA}IPLES 44
1. Cl-inical- Sampl-e 46
2, Osteological Sampl-e RE
i. Photographic Records 57
ii. cephalonetric Records 67
3, Methods of Tracinq Records ..,... 69
@aphic Records 69
ii. Osteological Cephalometric Records. 73
iii, Cl-inical Cephalometric Records ... 75
IV ERROR CONSIDERÀTIONS ,,,., 76
l-.
83
V COI,IPÀRISON OF PHOTOGRÄPHIC À}¡D CEPIIÀIÐI{ETRTC
TECHNÏOUES 84

'I 1
crrÀPTER 4 RESIJLTS ,.. ,.,,. 87

r ÀNÀLYS IS OF FJIC IÀJ, TYPEBY CEPHÀTÐUETRICS ... 87

If ÄNÀLYS IS OF FÀCIÀI TÏPE BY fHE NUI,ÍERICÄL IíODEL
IÏÏ " ' ' 91
ÀNÀLYS IS OF FÀCIÄ]J TYPE BY ÀN]\TOI,ÍIC REI,ATTONSHIPS
REIÀTIVE TO OCCLUSÀI PI,ANE ,,,. 105

CIIÀPTER 5 DISCUSSION ,,, 111

I PROPORTIONÀL REI,ÀTIONSHIPS ..,. II2
rI RELEVÀNCE OF FINDINGS TO CLINICAL TREÄTMENT 119
rII PI,ANES OF REFERENCE . ., .. I23
IV RÀNGE OF VÀRIÀTION ,,,.., L27
V SEXT'.AT DIIÍORPHIS}Í ...,., T27

CIIÀPTER 6 CONCI,USIONS ÀND SUGGESTIONS FOR FIITÛRE WORK. 128

I coNcLusroNs .. ... . 128

II IüPROVE}ÍENTS TO THE CEPIIÀTO}ÍETRTC TECHNIQUE
FOR THREE-DIIIÍ ENSTONÀ¡ DÀTÀ COTLECTTON ........ 129
IÏT ESTÀBLISHIIIENT OF CRITICÀL PROPORTIONÀI
REI,ATIONSHIPS .. . 131
IV TURTHER DSVEIÐPI,fENT OF THE N{JIÍERICAL üODEL ÀS À
cl,rNrcÀï- Toor .... . 133

REFERENCES .,.. ].36

APPENDTX A ,.. .,,...150

ÀPPBNDTX B ,., ...,. 166

Ill
 .ABSIrRÀCT

The f acial- types exemplified by "long face syndrome"

(LFS, dolicofacial type) and "short face syndrome" (SFS,
brachyfacial type) individuaÌs are conventionally defined as
being very different--morphologically and functionally.
The pre-orthodontic treatment records of eight LFS and eight
SFS patients from the University of Manitoba Graduate
OrthodontÍc Clinic were selected for analysis and
comparison in terms of applied three-dimensiona I rnechanics.
The possible functional importance of facial type was
investigated for condj-tions of verticaL Ísometric biting, by
employing a three-dimensÍonal numerical model of the
masticatory system (Smith et aI., 1986).
Comnonly used cephalometric landnarks and reference
pJ-anes were employed for cephalometric measurements. These
measurenents confirmed clinically recognized dif ferences
between the two faciaL tl¡pes j-n terms of anatomic form, The
mechanical analysis was carried out for vertical- isometric
bi!ing, using the plane of occLusion as the pLane of
reference, Mechanical predictions pertaining to masticatory
function were thus derived for each Índivídual set of
morphological conditions. These predictions were compared
with respect to conventionally defined facial- tlæes.
For the given bit.ing conditÍons, the mechanics of
masticatory function predicted by the model for the two
faciaL type groups showed very Little difference. This was
surprisÍng, in 1Íght of the distinctÍon made between the two
f acial- types on the basis of cLÍnical evaluation and
jv
according to conventional" cephalometrÍc analyses based on
Frankfort horizontal plane (FH) and/or SeIla-Nasion plane
(SN). A closer analysis revealed that the three-dÍmen s iona L
geometric anatomic relationships for the sixteen pre-
orthodontic patients studied were not very different when
measured relative to the occ I usa I pJ.ane. It seens,
therefore, that the chewing apparatus demonstrates
complementary norphological relationships, perhaps the
resuLt of strong functional influences on inherent form.
The use of the weLl known cephalonetric reference
planes, FH and SN to impJ.y functionaL characteristics
associated with conventionally defined faciaL tl¡pes has been
shown to be inappropriate, In terms of the functional_
mechanics of the masticatory system, the occlusal plane is
suggested as a more relevant pl,ane of reference. That is¡
the geometric anatomic reJ.ationships important to the
function of the chewing apparatus can be better assessed
reLatÍve to the occLusal- plane, than to FH or SN. It
seems, furthermore/ that "abnormal,, dentofacial form as
determined relative to FH or SN, may not necessarily imply
"abnormal " mechanÍca1 function.
A technique for obtaÍning three-dirnens j_ona 1 geometric
anatomic data from standardized cephal-ometric radiographs
has been developed. A proposed future use of the numerical
model as a cl-inical, diagnostic tool for the assessment of
Èhe mechanics of masticatory function, is supported by this
thesis.
 ÀCIO'IOI{TEDGE}IENTS

I am indebted to all the people whose tirne, attentionf

and interests made thÍs thesis and the experience associated
wíth it, possibJ- e,
I am particu.Larl-y grateful to my advisor, Ken
Mcl,achIan, for his good counsel, his friendship, his
challenges, and his provisÍon of a "space" prevaded by a
sense of sincerity, honesty, and great qual-ity. I cannot
inagine this work without him.
My friends and assocíatesf Jeff Nickel and Peter
Trainor have been very important to me for their invoLvement
in my research, and their support and good company
throughout its various stages,
Denny Smith, who I have looked to as a teacher and a
confidant, is gratefuJ.J-y acknowledged. His investigative
work, which provided the basis for my thesis, and his
conscientious participatj-on as a member of my committee, has
been very much appreciated.
r woul-d like to thank Dr. Charles Dowse for his patient
efforts as my external- examÍner. The discussions wÍth him
about my thesis, and hís considerate suggestions regarding
it, were very heJ-pfu.I to me.
The data collection trip to the CleveÌand Museum of
Natural History was made possible by the financial
assistance of the Dean's MRC Fund. The Dean and his
com.rnittee are gratefully acknowledged for their support of
this segment of my research.
The enLhusiastic help and the warm hospi!aJ.ity of the
staff in the Physical Ànthropology Department, at the
CLeveland Museum of Natural History, made the colLecting of
my osteological- data an especial ly memorabJ.e experience, I
wish to thank Dr. Bruce Latimer for permitting me to use
the Hamman-Todd Col- lection and the f ine f aci l- ities at the
museum.

The cephaJ.ometric radiographs of the osteological

sample were obtained through the generosity and assistance
of Drs, O. Oyean and B.H. Broadbent and their staff at the
School of Dentistry, Case Western Reserve University. Their
contribution to this work is gratefully acknowledged,
I wish to thank Mr. Jerry Kostur, who drew the graphs
contained in my f igures.
I am very much indebted to Dr. .4,.T. Storeyr for the
opportunities and the inspiration he has provided for me in
my studies and my research. His interest and support has
vl
meant a great deal to me.

None of the good experiences that f have had wouLd have

been possibLe without the encouragement and the assistance
of my parents. I have relÍed upon them heavily, and they
have always been supportive. I am so grateful. Thank you,
Mom and Dad.
 IIST OF FIGI'RES

Figure !

CHÄPTER 3 IIÍETHODS ÀND I{ATERI.ALS

3.1 ORTHOGONÀ].,, ÀXES FOR SPATIÀ¡ RELATIONSHIPS .... 37

3,2 OCC],USÆ,, PLÄNE TN THE SAGTTT.A! VTEW . . . . 39

3.3 OCCLUS.AI VIEW OF MÀND I BUI,AR DENTÀI ARCH . . . . . . 41
3.4 GEOMETRICÀ], REL.A,T]ONSHIPS ......, 43

3.5 INFORMATION REOUIRED TO CÀICULATE STATIC

EourLrBRruM ... ..... 45

3.6 CLINICÄ¡ CTIARÀCTERISTICS ...,..., 48

3,7 LATERAL CEPHALOMETRIC TRå,CING .., 49

3. I CEPHÀTTOMETRTC ÃNArySrS MÀNIToBÀ II (1984) . . . . 50

3.9 LÀTERÃL CEPHÄLOMETRIC SUPERIMPOSITIONS ON SN 54

3.10 SAGITTAL PHOTOGRÀPH OF MÃNDIBLE ...,.... 61

3.11 SAGITTÀI, PHOTOGRÃPH OF SKULL WITH MÄNDIBLE .,, 61

3.12 COMPOSITE SAG]TTAI TRACING ,..... 61

3.13 FRONTÃI PHOTOGRÀPH OF MÀNDIBLE ... 62

3.14 FRONTÂI PHOTOGRÄPH OF SKULL I^¡ITH MANDIBLE ..,. 62

3.15 COMPOSITE FRONTÃJ.,, TRÀCING ....,,. 63

3,16 OCCLUS.AI, PHOTOGRÀPH OF MÀNDIBLE ........ 63

3.17 BASAI PHOTOGRÀPH OF SKULL ..,,... 63

3.18 PHOTOGRÀPHIC FRAMEWORK ... 65

CIIÀPTER 4 RESIILTS

4.1 RELATIONSHIP OF LAFH/TA3H (*.)

FOR THE CLINI CAI., SAMPLE T: ïT:i..1Ì:::"i¿
4.2 RELAT]ONSHIP OF I¡AFH,/TAFH (8) ro FHMPA (DEGREES)
FOR THE CLINICAI., SA}4PLE 90

vi i i
 4,3 MODEL PREDICTIONS: MUSCLE FORCE OR CONDYIÀR LOÀD
FOR POSITION OF ÀPPLIED BITE FORCE .,...,,.,,. 93
4,4 NUMERICÀL MODEL PREDICTIONS FOR THE LONG/STEEP
GROUP - VERT]CÀL BITING FORCE ,.......94
4,5 NUMERICÀI, MODEL PREDICTIONS FOR THE SHORT/FLAT
GROUP- VERTICÀL BITTNG FORCE ......... 95
4,6 RELATTONSHIP OF CONDYT.,AR LOAD (t OF BrTE FORCE)
TO rAFH/TÀFH (8) rOR THE CLTNTCÀL SAMPLE ,.... 98
4,7 RELÀTIONSHIP OF CONDYLÀR LOAÐ (tOFBITE FORCE)
TO SNMPA (DEGREES) FOR THE CLINICÀ! SÀMPLE .,, 99
4.8 RELÀTTONSHIP OF CONDYLÀR LOÀD (t OF BITE FORCE)
TO FHMPÀ (DEGREES) FOR THE CLTNTCAT SAr'fpLE .,. 100
4.9 REIÀTIONSHIP OF MÀSSETER MUSCLE FORCE (8 OF BITE
FORCE) TO TEMPORÀLIS MUSCLE FORCE (t OF BrrE FORCE)
FOR THE CLINTCÀI, SÀ.I,ÍPLE ... 102
4.10 REI,ATIONSHÌP OF MÀSSETER MUSCI,,E FORCE/TEMPORALIS
MUSCLE FORCE TO FHMPA (DEGREES) FOR THE CLINICÀL
SÀl"lPLE ....,.. 104

4.11 RELATTONSHTP OF CONDYT,AR LOAD (8 OF BITE FORCE) TO

ï:ï::i:Tï tïlillT:i:ïl lîi TT: :i1Ìlîi lÏi"io,
CHÀPTER 5 DISCUSSION

5.1a PREDICTIONS FROM THE MODEL FOR PATIENTS D.K, ÀND

D.M. 113
5.lb PREDICTIONS FROM THE MODEL FOR PÀTIENT D,M, - ÀRCH
LENGTH ]NCREÀSED (27t) .,, 113

5,2 I'IÀSSETER ÀND TEMPORÀLIS MUSCLE VECTOR ÀNGULÀTIONS

T0 occLUsAL PLANE (LATERAI.., VrEW) ,,.,. 118

5,3 RELÀTION OF CONDYLÀR LOÀD (t OF BrrE FORCE)rO

::i?i* T:i::i1T:T ::i:i: i:: T:: :::i::T :Tiiä
ÀPPENDIX À

À.1 DEGREE OF CRÀNTÀL BASE FLEXURE r62

]X
 LIST OF TÀBLES

Table 3

CHÄPTER 3 }IETHODS .AND }ÍATERIÀIS

3-1 THE UNIVERSITY OF MÀNITOBA CLINIC.AI SAI,IPLE

3-2 THE HÀMMÀN-TODD OSTEOLOG I C.AI SÀ.I\,f PLE 58

CIIAPTER 4 RESIILTS

4-1 COMPARTSON O!' THE LAFH/TAFH, SNMPA, AND FHMPÀ

VALUES FOR THE CLINIC.AT SÃ}ÍPLE GROUPS }.IITH
M.àN I TOBÀN CEPH.LLOMETRIC AN.AIYS ] S STAND.ARDS ,.,, 88
4 - 2 THE UNIVERSITY OF M.ANTTOBA CLINICÃT SAì.,f PLE CONDYLE
.AND MUSCLE FORCE MÀGNITUDES FOR VERTICÃT ]SOMETRIC
BITING AT THE CENTRAL .ANTERIOR POSIT]ON ... , ,.. 96
 CIIAPTER 1 INTRODUCTION

Form and function have been said to be reLated in both

evol-utionary and ontogenetic senses. ehysical differences
and simil-arities in the facial appearances of individual-s
and of groups, are commonJ-y acknowl-edged, The
categorízation of peopJ.e on the basis of facial appearance
has led to the description of distinct f aciai- types. By
extrapolation, these facial types have come to be associated
with rnore than just form.
Facial- types have, for instance, come to be associated
wÍth predictable personality traits. In the arts, this
association is often purposely exaggerated, and hence facial
appearances are used deliberateLy to help to imply physical
abiLities and to portray particular personality
characteristics. Consider Shakespeare,s Cassius versus
Falstaff for example, as an ii-lustration of this linking of
physical and mental traits (Brodie, 1946).
FaciaL morphology has also come to be associated with
biological function. In the cLinÍcaL sciences, the assumed
relationship between craniofacial form and nasticatory
function is f undarnental to many cÌinÍcal- treatment
ratíonales. The vaJ.idity of this assumption has not been
weJ- I tested and further work is needed to determine the

possibJ-e functional relevance of conventionally recognized

f acia L tlr¡>es .

Orthodontics and rel-ated fields, have for a long time

emphasized the diagnostic inportance of facial- tl¡pe in terms
of the assessment of curren! function. potential- growth and
development/ treatment requirements/ prognosis for
"successfuL" treatment, and retention of treatment resul_ts
for a given individuai-. The so-cal-Ied dolicofacial (long
face) and brachyfacÍal (short face) typès of people have
traditionally been seen as being distinctLy different in
terms of measurable physical features (Dorland, 1974). They
are examples of commonly used facial type cJ-assificatÍons.
Aside from the obvious differences in facial appearance
between these two groups, differences Ín growth and
development, general physÍque, posture, physío1ogy, and
personality have aLso been observed.
Peopl-e of one facial tlæe are belíeved to share conìmon

esthetic and functional "probIems." Strong belief that

Ínffuential rel-aLionships exist between form and function
have l-ed to the extrapolatÍon of dÍfferences in function
associated with these faciaf tlæes,
Different f acial- patterns have been recognized and
quantified by the measurement of standardized photographs or
radiographs. Since the advent of cephalometrics, in the
early 1930's, anaJ-ysis of standardized radiographs of the
head has figured prominently in orthodontics and related
fiefds. Cephal-onetrics has provided a means of describing
skeÌetal and dentaf morphological relationships not sèen or
not easily measured clinicaIly.
CephaJ-ometric standards commonJ-y used to distinguish
"long face syndrone" (LFS) or dolicofacial indivÍdual"s from
 "short face syndrone" (SFS) or brachyfacial individuals,
incl-ude facÍaL height measurenents, expressed as relative
proportíons of the total- anterior vertical- face height, and
mandíbul-ar plane inclinations expressed as an angJ.e measured
to some fixed reference plane such as Frankfort horizont,al
(FH) or Sel La-Nasion (SN),
Specific, conventional-fy employed, cephalometric
measurements based on FH or SN reference pl-anes, have been
used to identífy faciaL types, and furthermore, have been
correl-ated with certain functional paramelers. Strong
musculature and increased bÍting forces are attributed to
indivÍdual-s with short anterior face heights (AFH) and flat
mandibul-ar pfane angles (MPA), for example, In contrast,
those with long AFH and steep MPA are assumed to have
relatively weak musculature and decreased biting forces.
These relationships are based on experimentally determined
statisticaÌ correlations, and tend !o support cIínical
impressions, Cephalometric measurements of face height and
mandibul-ar plane inclination rel-ative to FH or SN have thus
come to impJ-y functional importance.
The consequence of the seÌection of reference pLanes to
cepha L ometric and soft tissue anaÌyses has been
acknowledged, The frame of reference rel-ative to which other
structures are measured, has a strong inf l-uence on the
interpretive descriplion of a given situation, There Ís
litt1e agreement on the selection of an "ideal-" reference
pJ-ane for cephalometric analysÍs. So many analyses have
employed FH or SN as reference planes, however, that these
planes have been largely accepted as standards of
orientation.
Other cephaLometric planes, rel-ative to which the
maxiLlary and rnandibular structures may be measured and
assessed, have been advocated. The BoLton plane, which
passes through the cranial base, and the PalataI plane,
which is the lÍne joining the anterÍor nasaL spÍne with the
posterior nasaL spine, for example, have been used Ín
cephalomet.ric assessments and for superimpos ition, None of
these planes have real-ized the same degree of popul-arity as
FH and SN, however.
The plane of occl-usion, or at l-east a Iine
approxÍmating such a plane, has al-so been referred to in the
l-iterature, but it has not seen extensíve use in diagnostic
analyses, The defínitions of occlusal- plane have been many
and varied, but t\^¡o are nost co¡nmon (Moyers, I979), A line
drav¡n to bisect the mid-occJ.usa] points of the first molars
and the incisal overlap of the central incisors has been
used. As an alternativef to be used when lhe central
incisors are missing or grossly malpositioned, a line
averaging the points of posterior occ l usa I contact,
involving t,he first permanent mol-ars and prinary molars or
the bícuspÍd regions, has also been advocated.
The plane of occlusion is particularl_y difficutt to
defineate precisely when the occlusion foll-ows a curve (the
Curve of Spee) rather than a plane Ín the lateral_ view, and
when the dentition Ís not completely intact. The functionat
reLevance of the occlusaf plane should be recognized,
however, The occl-usÍon as a particuLar site or boundary
pertinent to the study of cranÍofacial growth and
development, represents the composite effects of both
a.Lveolar bone and dental growth. The occlusal junction of
the teeth has been regarded as a "specialized kind of
movable articul-ation essential-ly comparabl-e to other bone-
to-bone junctions" (EnJ.ow et, a1,, 1971). It seems however,
that despite its conceivabLe functionaL reLevance to the
masticatory system. the occlusal pJ-ane has not been a very
popuJ-ar plane of reference because it does not fulfill the
standard criteria of accurate identification, or stabíLÍty
over time,
In investigating the suggested rei-ationships between
dentofaciaL form and function. a review of the pertinent
l-iterature will be presented to outline the commonly used
facÍal type cl-assifications and to provide some insÍght into
the background inffuences in devising these classifications.
Evidence for the functional imporlance of dentofaciaÌ form
with re spèct to the above menti oned LFS and SFS
cl-assifications wil-I also be ínvestigated. As we11,
examp I e s demon s tra ting the app 1i cat ion of these
classifications to orthodontics and related fields wil-I be
provided.
Physical anthropol-ogy, the theories of evoJ-ution, and
Lhe concepts of human growth and deve oprnent in reLation to
J.

facial morphology have had strong influences on the general

regard for facial type, These influences are discussed in
detail in Appendix A, and hence, their discussion herein
will be I:rief . The intentÍon of this study is to
investigate the morphological rel-ationships pertinent to
function. These will be compared with more traditional-
concepts of "normal" and "abnormaL " morphoJ_ogy in terms of
esthetics, and as applied to standards of facial type
assessment.
 CIIÀPTER 2 I,ITERÄTURE REVIEW

I OVERVIEW

Facial typing as ít pertains to the classification of

dentoskel-etal refationships is a wj.del-y used clinical tool
through which descriptions, diagnoses, treatment regimens,
and prognoses are made, To appreciate the origÍns of the
faciaL types that are currently employed in dentistry,
particuLarly in orthodontics and oral surgery, is to
appreciate the words of BrodÍe (1946):
Since man's earlÍest efforts to portray the human,
we find notice being taken of certain groupings of
characterístics,
The current regard for facial form in orthodontics and
dentistry wiLl- be discussed. For a better appreciation as
to how classifications of morphological- type have corne
about, readers are referred to Appendix A.
HÍstoricall-y, the study of human form and function has
been primarily based on visualJ.y perceÍved observations and
concomitant descriptive interpretations. These descriptive
interpretatj-ons have become formalized in the practíce of
orthodontics such that certain descriptive parameters are
accepted almost axiomatically.
The classification of human form has been an important
method of appraisal for centuries. A number of dÍfferent
classification systems used to distínguish human body buiJ.d
ha ve been based on anatomical and physiological
characteristics. Three extreme patterns of general human
body form have usually been differentiated¡ slender,
corpuLent, and stocky (Lindegârd, 1953). These general body
forms have been related to dêntofacÍa1 characteri stics. For
exampJ-e, índividuafs of extremely sturdy buil-d are said !o
have larger, broader heads (Lindegârd, 1953), as well as
Iarger tooth sizes, earlÍer tooth eruption, and better
response to orthodontic therapy due to better growth (BjOrk,
r95s ) .
Anthropo I ogj- sts have
long used craniometric t,echniques
in the eval-uation of human form (KeIso, 1970). Influenced
by these craniometric studies of anthropol-ogy/ orthodontists
and others have studied the patterns of assocÍation between
the head, the face, and the teeth, These associations have
been investigated in terms of evol-utionary changes as well
as ontogenetic changes in an attempt to better understand
the l-ink between dentofaciaf form and function (Downs, L938;
BjÖrk, 1951-).

I I FACTÀI TY:PE PAR.A¡4ETERS

A number of measurenents and correl-ations have gained

particul-ar distinction and have found common use in
distinguishÍng and identifying facial- types. Observatíona1
studies (Wy1ie, 1945i Bal-l-ard, 1951)r supported by clinical
experience, have firmly established certain parameters as
usefuÌ clinical tooIs. These parameters are supposed to
provide important diagnostic clues to a more complete
pattern of typical characterÍ sti cs, and therapeutic cues in
Èerms of expected responses and achievabl-e t'reatnent
resuLts. The most commonly used paramelers wiII be
discussed ín the f ol- l-owing sections.

1, Mandibular Pl-ane .Anql-e

Form was at one time bel-ieved to be strictly inherent,
and proportional- relationships wêre expected to remain
unchanged from birth to maturity (Brodie, 1941). Angular
measures were therefore thought to be partícu1ar1y usef ul-
for the assessment of craniofacial morphology, Angular
measures contÍnue to be empì-oyed to assess and categorize
craniofacial f orrn.
Even before the general acceptance of cephalometrics,
measurement of the inclination of the mandibular pJ-ane
relative to other craniofacial structures had been advocated
for clinÍcal díagnosis (Sa I zmann, 19 4 5 ) , Some form of
mandibul-ar plane angulation measurement has been incl-uded in
most of the cÌassical and popular cephalometrÍc analyses
(MargoIis, 1947; Downs, l-948; St'einer, 1953; Tweed, 1953;
Coben, 1955; McNamara, 1984),
The two planes of reference most commonly used to
assess the inclination of the nandibular plane are the
Frankfort horizontal (FH) plane and SeIla-Nasion (SN) plane.
Both the Frankfort horizonta1-mandibuLar plane angle (FHMPA)
(Johnson, 1950)r and the Se l- L a-Nas ion-mandibu 1ar pJ.ane angle
(SNMPA) (Schudy, 1964; Droel and Isaacson, L972¡ Bishara and
Augspurger, 1975) have been advocated to identify "separate
and distinct" facial t)æes.
cenerally¡ clinÍca1 populations, divided into groups
according to their mandibuLar plane angles (MPA), have been
 studied in order to appraise dentofaciaL characteristics
associated with "high. and r'1ow" MPA, as compared to
"normal" MPA. Large MPA values have been found to be
positively correLated \Mith convex facial profiles where
both maxil-lae and mandibles tended to be in more retruded
positions (Schudy, L964¡ Bishara and Augspurger, 1975),
very small degrees of cranial- base flexure (Bíshara and
Augspurger, 1975), relativeJ.y superÍorly posÍtioned glenoid
fossae (Johnson, 1950; Droel and Isaacson, I972)t smaLL
ramal l-engths and large gonial angles (Johnson, 1950)¡
upright Lower incisors (Johnson, L950; B j-shara and
Augspurger, 1975), small- vertj-ca1 overbites (Johnson, 1950;
Schudy, 1,964), long vertical- face heights (Johnson, 1950;
Bishara and Àugspurgerf 1975), and poor facial esthetics
(Johnson, 1-950). SmaLl- MPA values, on the other hand, were
found to be associated with straight or concave facial
profiles, relatively more protrusive mandibles (Schudy,
1964; Bishara and Augspurger , I97 5) , g l enoid fossae
positioned inferiorly in the skull (Johnson, 1950; Droel- and
Isaacson, 1972), deep overbites (Johnson, L950). very
short vertical anteríor face heights (Schudy, 1964; Bishara
and Augspurger, 1975), and, depending on the individual
case, very poor facial esthetics (Johnson, 1950). High or
low val-ues of MPA appear to be assocÍated with predictable
dentofaciaL characteristics,

2, Facial Heiqht
Facial height has been regarded as an important

10
variable in distinguishing facial type, Studies regarding
facial balance have shown that increased f acial- height Ís
generally related to increased gonial angle and a poor
facial pattern (WyIie and Johnson, 1952), Ratios or
percentages of upper or Iower facial- heights to total facial
height are conmon cephalometric ¡neasurements (Wyl-ie, L944¡
Coben, 1"955; Goldsman, 1958; Schudy, L964; Weinberg and
Kronman, 1966; Beaton, 1973). The norms or standards of
these facial heíght measuxements have varied slightly fron
analysis to analysis, depending on the sample popul-ations
involved.
There has been much controversy regarding the constancy
of facÍaÌ height proportions. The work of Brodie (1.94L1
l-950, 1953) greatly affêcted the regard for growth and
development in cLinical orthodontícs during the 1940,s and
1950's (T\Meed, 1946¡ Wylie/ 1946; Downs, L952¡ Stoner,
1955), Brodie propounded the concept that the
"morphogenetic pattern" of the human head was established at
a very early age, and that once attained, this pattern did
not change, The percentage contributions of the faciaL
parts to total height were thus believed to remain the same,
regardless of age (Brodie, 1941; Hellman, 1932i Broadbent,
794I¡ Herzberg and HoLic, 1943; Wy1ie, L944i Tirk, 1948; and
Isaacson et al,, L977). Other investigators have contested
this belief, however (Williams, 1953; Meredith et a1.,
L958; Moore, 1959).

11
 3. Mandibufar Pfane Ã.nq.l- e and Facial- HeiqhL Correl-ations
A number of Ínvestigators have proposed that a
compensatory mechanism or balancing property functions
within the dentofacial complex to preserve a semblance of
overall harmony and proportion in the faciaf pattern (Tweed,
1954; Coben, 1955; GoIdsman, f959; Hasund and Ul-stein,
1970). Where one dimension shows an obvious discrepancy,
therefore, other dimensions are compensated in a predictable
manner. Significant correlations between facial dimensions
that display obvíous deviations from mean val-ues typically
characterize facial tlæes. It has often been suggested that
more than one parameter be used to describe facial type
(Coben, 1955; Opdebeeck and Bel-l-, J,978¡ Fields e! al,,
1984). The combination of parameters most conmonly used to
distinguish facía1 types is the MPA and lhe l- o\,¡er anterior
face height as a proportion of the total- facial height
(LAFH/TAFH).
Isaacson et qI. (1971) examined extreme variations in
facíaI growth in order to compare lhe morphological
differences manifest from these growth patterns. Increased
verticaL al-veolar growt,h and increased anterior dental
height were found in cases of high SNMPA, whil-e decreased
vertical al-veol-ar growth and increased anterior dental
height were found in cases of Low SNMPA, A tendency to
anterior open bite malocclusions in high SNMPA cases, was
therefore predicted, despite that fact that these patients
tend to show reLatively longer maxil- Ìary incisors. In
contrast, a tendency to deep-bite maloccl-usion in Iow MPA

L2
cases predicted. despite the fact t,hat these patients
\Mas

tend to show rel-ativeJ-y shorter maxil lary íncÍsors,

Characteristic dentoskefetal morphologies resuftant to
characteristic patterns of growth, have thus been
described,

III DEFINED FÀCIÃJ, TYPES

In orthodontics and orthognathic surgery especiaJ-Iy,

interest in craniofaciaJ- morphology has been fueled by
inlerests in form and function with respect to treatment.
The evolutionary course of man,s development from more
primitive life forms is believed to be the result of
adaptatíons of shape and structure to changes in function,
Many experimental studies on living animals and human
subjects have documented growth, deveJ.opment., physiological
functions, movements, and associated muscle activity, for
example, in rel-ation to anatomical form. This has been in
an attempt to establish a basis for the interpretation of
observed morphology in têrms of functional_ demands, The
rationa I es supporting the conventiona 1l-y accepted
cLassifications of facial form, and the functional
characteristics generally associated with these, are to be
found in the I iterature describing the theories of
craniofacial growth and deveJ.opment with respect to form and
function, From these theories come the bases for the
cl-inical- applications of facial type classifications in
terms of treatment for "abnormaL,' forn and ,,abnormal "
f unction. This l iterature r,.ri I1 now be explored,

13
 Characteri zation
The term "long face syndrorne" (LFS) has been used to
describe indÍvidual-s showing excessive anterior verticaL
facÍaL dÍmensions rel-ative to posterior facial dimensions
(SchendeÌ et al.¡ 1976; Radney and Jacobs, 198J-; Proffit and
FieLds, 1983; FieLds e! a!., 1-984). This so-cal-led
"slmdrome" is characterized primarÍIy by an excessÍve nose-
to-chin length (LAFH) and a steep mandibular plane ang1e.
Other characteristics which have been incl-uded in the
"syndrome" are: a narrow alar base and nostrí1s that are
smaIl and poorly developed; a poor upper lip-to-tooth
relationship with inordj-nate exposure of maxillary teeth and
gingiva upon smifing; a l-arge interLabial- gap; a short
ramus; a retruded mandible, a long, narrow, v-shaped
maxil- lary arch with a hÍgh palataL vault/ proclined upper
incisors, and a large distance between the maxilfary root
ap.ices and the nasal floor, Tendencies toward a skeletal
anterior open bite, an open mouth posture, and a vacant
facial expression have also been associat,ed with large LAFH
and steep MPA (Linder-Aronson and Backstrom, 1960; L.,inder-
Ä.ronson, 1970; Schendel et Êf ., 1976; Radney and Jacobs,
1981; Shaughnessy, L9B3). Àmong other terms used to
describe this f acial- type are! extreme cLockwise rotation
(Schende1 et a1. I I976), high angle type (Schudy, 1966),
adenoid facies (O'Ryan et qI., 1982), idiopathic long face
(Wi1J.mar, 7974), total- maxil-lary alveolar hyperplasia (Ha11
and Roddy, 1975)t and vertical maxilJ-ary excess (SchendeI et
aL., J"976).

t4
 The opposite condition of short LAFH and L o\..¡ MpA has
been termed "short face syndrome" (SFS) (BeLl-, I977),
IndÍviduals manifesting simíIar skeletal-, dental, and facial
features as a result of a l-ack of vertj-caÌ maxillary growth,
characteristic of the SFS (BeÌ1, 1977), have been described
under a number of different lerms, such as: hypodivergent
face (Schudy, 1965), Iow-angle type (Schudy, 1966), skeletaL
type deep-bite (Sassouni, 1969), idiopathÍc short face
(Wil1mar, L97 4) t vertical maxilJ-ary deficiency (Opdebeeck
and Bel-1, 1978), and extreme counterc l ockwi se rotation type
(Opdebeeck and BeIl, 1978). ClinicatIy, the typícaI SFS
presents wi!h an edentul-ous, overclosed appearance in a
short, square-shaped face; often wit,h a distinct chin
button, deep mentoJ.abial foId, and a tendency to skin-foLds
lateral to the oral- com¡nissures. The masseter muscLes are
generally weJ-J- developed, the vertical maxillary height is
smaÌ1, the interocclusal distance l-arge, and there is a
large overbÍte along with the short LAFH and l-ow MpA (Van
Sickels and Ivey, 1979),
Use of the tern "syndrome" has been justified by
Opdebeeck and Bell (1978) since, for a given facial type,
sÍmil-ar esthetic, cephaJ.ometrÍc, and occl-usal features are
consistent and thus can be grouped together. The generaL
terms LFS and SFS have been used to al low a Less restricted,
more complete description of the skeletal-, dentat, and
facial- characteristÍcs of a given tl¡pe and it,s variants,
The LFS and SFS individuals represent extreme

15
dyspJ-asias in terns of skeletal-, denta 1, and facial
structures, Surgical treatment to improve the hard and soft
tissue reLationships Ís often advocated Ín such cases (BelJ.,
J,977 i Van Sickel-s and Iveyt L979; Piecuch et aL., 1980;

Radney and Jacobs, 1981). It is felt to be indicated on the

basis of compromised esthetics and function due to extreme
rnorphologíca.l deviations from accepted human norms.

2. Theories Regarding Form and Funct.ion

i, Breathing and Posture
Mouth-breathíng due to impaired nasal respíration has
often been discussed as a major etiological factor ín cases
of LFS (Linder-Aronson, 1979i Yí9, l-981t O,Ryan et a1,¡
L982¡ Quinn, 1983). Although commonly observed and
frequently reiterated (Brash et e],, 1956), the causal
reLation between respiration, posture/ and deformities Ín
the dentofacial compl-ex have yet to be substantiated by
well-controJ.J.ed experíments carried out on human subjects.
Studies have shown respiration (Riski, 1984) and posture
(81íasson, 1975) to be highly variable within the same
individual. Methods of accurateJ.y assessing respiration
have so far not been avaiLabl-e for use in prospectivef
longitudinal, clinicaL studies (Vig, 198i.i O'Ryan et a1,,
I984i Warren, l-984). Al-though evidence from animal-
experiments (McNamara, 7977¡ Harvold, 1979i Tomer and
Harvold/ L982; Mill-er et a1., 1984i Ramadan/ 1984) would
seem to demonstrate support for sÍgnificant paraÌlels
between mouth-breat,hing in humans and IJFS, the validity of

16
 extrapolation to the human situation is questionable.
A rel-atÍonship between head posture and craniofacial
morphology was firs! suggested by Schwarz in L926 (Solow et
ê1,, 1984). He attributed the developrnent of Cl-ass II
malocclusions to the hyperextension of the head relatj-ve to
the cervical co.Lumn during sIeep. Since then, many
associations have been made between airway adequacy,
craniocervical posture, and craniofacial- morphology. It has
been postuLated that rnouth-breathers tend to Lip their heads
backwards in an attempt to increase their airway. Where
adenoidectomies have created a normal airway, a l_ess
extended head posture has been reported (Ricketts, 1968i
Linder-Aronson, l-974; Woodside and LÍnder-Aronson, 1979i
SoÌow and Greve, 1979). Furthermore, a radiographic study
done by SheLton and Bosma (f962\ on pharyngeat airway
patency showed this patency to be markedly increased in
radiographs taken with the head extended.
"Forward head posture," is known to have whole-body
ramifications. Ä chronology of events is associated with
this "abnormaf" postural position, which can affect ,'muscl-e
length/tension relationships and joint biornechanics,'
(Darnel- I, 1983). SoLow and Tallgren (I977), found that
subjecLs with J.arge craniocervical angulation tended to have
decreased facial prognathism, a large mandÍbu1ar plane
inclination, and a large LAFH. A hypothesis to account for
the association between head position, decreased nasal-
airway function, and craniofacial morphology has suggested a
chain of interactions invol ving:

I7
 1) change in airway adequacy
2) ar feedback
neuromuscu.l
3) change in craniocervical- angulation
4) passive stretching of thê soft-tissue l-ayer
covering the face and neck
5) morphologic change
6) change in airway adequacy.
-SoLow and Ta J- l gren (1977)
"Triggering factors" are also thought to be involved:
adenoÍd tissues, perennÍa1 al-l-ergic conditions; disturbances
in the visual-, propriocepLive. utricular, or semicircul-ar
canal systems; cervical spine anomalies; scar tissues; and
sutural growth disorders, condylar disorders, or a
discrepancy between the vertical components of condylar and
cervical vertebraJ- growth (Solow et al-., 1984),
Investigations to test the possible correl-ations between
nasal respiratory resistance and craniocervÍcaI angulations
have been carríed out (Solow and Greve, 1979¡ Línder-
Aronson, J.979; Weber et a1., 1981; SoJ-ow et al., 1984).
The effects of tongue and mandibular posture, on the
dentofacial morphology have been expLored for real and
simulated anterior open bite subjecls using EMG recordings
of the activity of the tongue¡ the jaw, and the orof acÍal-
musculature (Lowe, 1980). Although relationships have been
suggest.ed, the smal- I sampl-e sizes preclude any defÍnite
concl-usions from these studies. DaIy et aL (1982) found
that, a mechanical- bÍte-opening of eight mil-l-imeters caused
changes in head posture in theÍr cLinicaL subjects. These
were largely due to extensíon of the neck, and were índuced
withÍn one hour. The subjects t,ended to recover their

18
origína1 head poslure after removal of the bite-opening
device, Ieading to speculations that the response was
re.Iated to functional demands and influences. The
maintenance of a postlinguaJ- airway and/or occlusal sensory
perception and a subsequent motor response have been
suggested in this regard.
With the increasing prevalence of t.he surgical-
correction of craniofacial deformities, concern has been
raised over the effect of such surgery on nasal airway
resistance/ especÍalIy where vertical changes to the maxilla
are invol-ved. It is hoped that the suspected câuse-effect
relationshíp between nasaL airway and craniofacial
charcteristics, and the part played by posture, muscular
activity, and oral- habits wiII be Ínvestigated through the
study of the effects of orthognathic surgery. The current
l-iterature in thís area has described prelirninary research
onLy (Grandstaff and Mason, 1983t Turvey et a1., 1984¡
Guenthner et al., f 984).

ii. Muscles
Links between the neuromuscul-ar and skeletaL systems
are known to exist (HarvoId, 1979) however, the nature of
the relationshíp between form and function has yet, to be
determined. The question of whether a predetermined facial
form dictates muscle strength or whether muscle strength
det.ermines the facial form remains.
Experimental investigations have consistently sho\dn
type-specific muscl"e characteristics associated with the

L9
masticatory sys tens of LFS and SFS individual-s.
Correlations between the masticatory muscle
electromyographic (EMG) activity and facial and bite
morphology have been found in chil-dren (AhIgren, I967¡
Ahlgren et af. , 1,973¡ IngervaÌI and ThÍfander, 1974) and
adults (MdIler, f966). Sirnilar resul-ts have been obtained
from studies of isometric bite force in adults (Ringqvist,
1973). For the conditions of chewing, bitÍng, swaJ. lowing,
and posturaf rest position, these studíes have shown
íncreased masticatory muscle aclivity and increased bÍtÍng
force in individual-s with SFS characteristics (AhIgren,
I967¡ Md L ler, I966¡ Ringqvi st, 1973¡ Ingerva l L and
Thilander, L974¡ rngervaJ. 1, 1976). These individuafs
exhibited small- face height; parallelism between jaw bases,
occLusaL lÍne, and the mandibular border; and a smal1 gonial
angle,
MdlLer found that certain features of facial morphology
varied less within a group of persons with strong
masticatory muscles than with weak masticatory muscLes
(IngervaLl- and Helkimo, J.978). Strong muscl-es therefore
resuLted in faces with simil-ar morphological features,
whereas weak muscles, whj-ch were less able to infLuence
morphology, resulted in a wide range of variation in
individual f acia l- patterns.
Ingervall and Hefkino (1978) studied young adults with
complete/ natural dentitions, to measure bite force and to
examine then for signs and sl¡mptoms of functional problems
within their temporomand i bu Ì ar Joint systems. The sample

20
was represented by strong and weak bite force groups. No
significant difference with respect to signs and symptoms of
lemporomandibu l ar joint dysfunction (TMD) was found, except
the strong bite group as a whoLe showed increased tooth
abrasion. A link between bite force, tooth position, and
facial morphoÌogy has been pointed out by others as well
(RÍchards, 1985), Strong bite force r¡7a s presumed to imply
strong musc.Ie force, although muscle activity \,¡a s not
actuaL ly measured. A comparison of cepha].ometrÍc parameters
used to measure faciaL morphofogy supported the work of
MdlLer (Ingerval l- and Hel-kimo, 1978), in that a greater
uniformity in faciaL norphology was shown in those with
strong bites, Ingerval-I and Helkimo therefore concluded
that the effects of rnuscles contribute to the shape of the
face. The cranial base, on the other hand, seemed to be
governed by intrinsic factors, since it was found to be
variable in both strong and weak bite groups (supporting the
theoríes of van Limborgh, 1972), The essen!Ía1 morphologic
differences between the weak and strong bite groups were
thus: decreased facial height and decreased mandibular
plane inclinations Ín the strong bite group relative to the
weak bite group.
Investigations int.o vertical f acial- dysplasias with
rêspect to muscl-e morphoJ-ogy, rnuscJ_e activity, and muscle
mechanics, have been described. Finn and co-workers (1980)
obtained muscLe biopsies of the deep masseter f rorn three
L,FS and three SFS surgery patient,s, and from three nornaL

21
 cadavers/ for hÍstological examination. The type and
distribution of the component muscl-e fibres are general J-y
felt to be a ref l-ection of the function of the muscLe as a
whol-e. Signs of muscl-e fÍbre hypertrophy were found in
long-faced patients, while signs of muscle fibre atrophy
were found in short-faced patients compared to the controls.
This initial histological study has suggested that patiênts
with verticaf maxillary dysplasia have abnormaL jaw muscles.
EMG resul-ts of the muscle activity Ín LFS compared to
SFS patients have been quite consistent, in that hÍghêr EMc
activity of the muscl-es has been seen in short-faced
subjects (Md.lJ-er, 1966¡ AhIgren, L973¡ Ingervall- and
Thilander, 1974i lngervaJ-1, 1-976; Finn et gI., 1980). On
the basis that the force that a rnuscLe fiber can generate is
proportional to the cross-sectional area of the fiber, it
has been argued that short-faced patients must recruit more
muscLe fibres to generat.e the same bite force as long-faced
patients (Finn et aI.¡ 1980). A two-dimensional analysis of
the masticatory systen of short-faced patients compared !o
long-faced patients did not show J-arge differences in the
mechanicaJ- advantage between the two groups, however. FÍnn
et a1. concluded, therefore, that dÍfferences in muscle
morphology masked the relatively sma l- I mechanical

dÍfferences that might have existed,

The total muscle fibre cross-sectionaL area has been
assumed to be a measure of the maximaÌ isornetric strength of
a muscle. Cross-sectionaf areas of the nasticatory
muscLes have been investigated in cadaver materiaL by Weijs

22
and Hillen (1984a and 1985), Cross-sections taken from
computex tomograns taken at pre-defined 1eve1s in the muscle
were found t.o be proportional to the anatomically determined
totaL fibre cross-sectional- area. The relationships
belween the cross-sectional areas of the masticatory muscLes
and the dimensions of the face and cranium in clinical
subjects with "normal" occLusion have also been studied
(weijs and HiIlen, 1984b), In general, the breadths of the
skull-, face, and mandible were found to be strongly
correLated with the strength of the masticatory system.
The masseter and medial pterygoid muscles were found to be
large in individuals with brachycephalic skulÌs, short
faces, and small gonial angles. The cross-sectional areas
of the temporalis and l-ateral- pterygoid muscles, however,
showed no significant correl-ation with f acial- dirnensions,
This lack of correlatÍon between the cross-section of the
temporalis (the largest jaw muscl-e), and craniofaciaJ- form,
was surprisíng. Since the ternporalis varÍed fess in cross-
section than the other jaw muscLes and showed a re]-atÍvely
weak correlation with the total- jaw muscle cross-section, it
was suggested that the strength of the temporaralis muscle
may be a constant factor in the chewing system, and that the
rnasticatory strength is modulated by the masseter and medial_
pterygoid muscl-es (Wei js and HiJ. len, 1985).

rrr, BÌte .t'orce

The magnitude of the biting force has been presumed to
be related to muscle strength (lngervall and HeLkimo, L97Bi

¿5
Kawazoe et. aI.f 1979), In a study of bite force (simul-ating
that used in chewing) and finger force however, Helkimo and
IngervaII (1978) showed no correlation belween bite force
(or chewing force) and the general muscLe stÏength as
represented by finger force, This was in agreement \.{ith the
findings of Lindholm and Wennstrërn (l-970) who failed to show
statislical- ly sÍgnificant correl-ation between bite force and
general muscl-e force, body height, wêight, and skeLetal
dimensions,
It has been suggested that for a given individual, a
vertical dimension exists from which maximum masticatory
force may be developed (Boos, i.940; TuelIer, 1969), This
position Ís bel-ieved to be close to the mandÍbul-ar posturaJ.
rest position. Manns and associates (1979) investigated
these findings by recording masseter muscle EMG activity and
the bite force during isometric bitÍng at various vertÍcaI
dimensions Ín healthy adult subjects. An optimum vertical
dimension was found to exist, for these individual-s, bet\4reen
fifteen and twenty millimeters from occLusion. This
position, where the bite force was rnaximized and the EMG
activity of the masseter muscle was minimized, was
considerably larger than the conventionally accepted ranges
for rest position interoccfusal distance. It was
concl-uded that this represented a physiologÍca11y optimun
rnuscu.lar elongation of major efficiency for the masseter
muscle, and that individual differences in this position
probably corresponded to differences in craniofacial
 skeLetaI characterístics.
Invêstj.gations by Proffit, FieIds, and Nixon (1983a)
have demonstrated significant differences between occlusal_
forces in adults with normal vertical dentofacÍal
proportíons and those wÍth LFS vertical dyspLasias. At
maximum effort, the LFS individuals were shown to have about
half as much biting force as the normal- indÍviduaIs, The
I-.,FS subject,s al-so showed considerabl-y J.ess occl_usal- force

during simul-ated chewing, and were found to bring their

teeth together wÍth significantly less force during
swallowing than did the normaL group.
A sirniLar study was carried out by Proffit and Fiel-ds
(1983b) to investigate the occ.l-usal- forces ín normal and
LES chil-dren, They hoped to dÍscern the possible
etioJ.ogical significance of bite force in t,he LFS; that is,
whether lower occlusal- forces in LFS aduJ_ts cause the
development of long vertical facial proportionsf or whether
long verticaf facial proportions account for relatively
l-ower occlusal forces, The forces of dentaf occl_usion
measured during swaL Lowing, simulat,ed chewing, and hard
biting were found to be similar for boLh the long-face and
norma]- children. These forces were similar to those found
in long-face adul-ts, or about half of those found in normaL
adults. Proffit and Fields (1983b) thus concluded that
indivj-duals with LFS fail to gain a normal level of strength
in the muscles invoLved in biting.
The clinical- importance of facial type recognítion in
treatment invoJ.ving occlusal changes has been pointed out.

25
Evidence for a relationship between facial types
distinguished by FMPA, patterns of tooth contact in
eccentric jaw movements (fateraL disclusion), and biting
forces has been presented (Dipietro, I977).

iv. Vertica i- Dimension

The effect of the maxillary and mandibul-ar denture
rel-ationships on facial heíght has been debated, primarily
in the prosthodontíc Iiterature. Rugh and Johnston (1984)
have provided a comprehensive summary of the controversy
surrounding the stabilíty of the vertical dimensj_on (the
facial- height as deterrnined by the teeth, their supporting
structure¿ and the jaw-posÍtioníng muscles) in the cl-inical
subject. The confusion fies in whether or not the vertical
dimension can be changed by restorations or orthodontic
therapies. It has genera 11y been felt that the
neuromuscul-ar system determines the optimun vertical_
dimension for the individual. This position is commonly
regarded as critical and rel-atively stable, If violated
beyond the range of tolerance of a given individual, the
general consensus is that a predictable sequence of events
occurs which is bel-ieved to be del-eterious to the
indj-vidual. The predicted results have included¡ muscle
hyperactÍvity, extrusion or intrusion of teeth, possible
loss of periodontal support/ and, in the edentul-ous patient,
dental- prostheses fail-ure (Rugh and Johnston, 1984).
With respect to the effects of orthodontic treatment on
the vertical dirnension, anterior face height and the

26
variations in its conponents, have been investigated for
individuals with deep-bite rnalocclusions (overbite greater
than five miI limeters ). Orthodontic treatment was
found not to sÍgnificant.ly al-ter the anterior facial
proportíons, in spite of successful correction of deep
overbite mal-occLusions, involving a signifÍcant change in
the dentaL components of facial height (Weinburg and
Kronman, 1966). Specufat.ions that the masticatory muscles
were responsibLe for maintaining facial proportions by
acting to maintain their resting Iength, and that the
decrease in overbite with treatment 1^/a s due to depression of
the mandibuÌar incisors, have thus been made.
The role of verticaL dimension discrepancies of lhe
jaws has figured prominently Ín the quest to understand
masticatory pain and dysfunction, Cases of SFS and LFS.
where surgicaJ. rearrangement of maxil- lary and mandibular
rel-ationships are carried out, may, in the future, heJ.p to
resolve the controversy regarding the sanctity of vertical
dimension.

3. Dysfunction as a Basis for Treatment of LFS and SFS

The mechanical, occlusal¡ and neuromuscular theories
pertaining to the functional- characteristics of SFS and LFS
affect the assessnent, treatment¡ and prognosis for
individual-s where external intervention to achieve
morphological changes is contempL a!ed.
Three basic views have prevailed. The mechanical view
pertains to anatomical positioning and the compromised
relationship of the condyle to the temporal fossa in cases
of changes to the vertical dimension. ',OvercLosure" is of
partícu1ar concern (Costenf 1,934; Harris, 1938). The
occl-usal view pertains to poor tooth-to-tooth reLationships
causing displacement of the mandible during function.
particularly in a posterior direction. This resul-ts in
compression of the highly vascular, densel-y innervated,
l-oose retrocondylar connective tissue (Thompson, 1951;
Hankey, 1954; Granger, 1958), The third view is the
neurophysiological vÍew, which pertains to muscuLar
dysfunction due to a.Itered proprioceptive feedback and
ínvolving higher centres of control- (Laskin, 1969).
The concept that a malocclusion may initÍate occlusaL
disharmonies leading to hyperactivity of the masticatory
musculature and temporomandibuf ar joint pain and dysfunction
(TMD), has long been held. Many surveys have been conducted
in an attempt to eval-uate the significance of Angle
cLassificatj-on malocclusions and/or skeletal- problems to the
prevalence of signs and symptoms of TMD (Egermark-Eriks son
et eI., 1983; Upton et a1., 1984; MohIin and Thilander,
l-984). This cl-assificatÍon system has notable limitations
(strictly speaking, it implies anleroposterior discrepancies
only), but Ít is used so commonl-y as a basis for diagnosis
and treatment, that evidence for a correlation of AngIe
classificatÍon "types" to TMD has been actively sought,
Cl-inicaf irnpression has suggested that .Ang l- e Class II
skeÌet.al and dental- patterns with vertical dysplasias show

¿at
 signs and symptoms of TMD nost frequently, Deep bítes,
charact.eristic of Ang1e Cl-ass ff, Division two maloccLusions
have been commonl-y reported ín cfinicaL TMD sampfe groups
(Perry¿ 1969; Mongini, I977¡ WiLl-iamson and Brandt, 1981) as
have skeletal- anterior open bite mal-occlusÍons (Perry, 1969;
Willíamson and Brandtf 1981; MohLin and Thilander, 1984;
ThÍIander, 1985),
CurrentLy, there is l-ittle agreement on the association
between abnormal- skeletal- and/or dentaL Tel-ationships and
temporomandibul-ar pain and dysfunction, including internal
joÍnt pathology and abnor¡nalities of muscl-e functÍon, What
constitutes "dysfunction" has been controversiaL and poorly
defined (Moyercs, 1985), The sample sel-ection of most studies
have therefore been based on poor criteria. Greene and
Marbach (1982) have suggested that any rel-ationships between
dental- mal-occLusion, abnormal facial norphology, and TMD
have been greatly exaggerated, Their criticaf analysis of
t'he epidemiological research in this area provides good
argument against the cLinical appl-ication of the informat.ion
gained from such studies.
Van Sickels and lvey (J.979) have presented a rationale
for the association of SFS wit,h myof acial- [sic] pain
dysfunction syndrome, Myofascial pain dysfunction syndrome
(MPD) is recognized as a multifactorial entí!y rel-ated to
the anatomy of thê temporomandibu 1ar joint, the muscfes of
mastication, the occlusion, and the personality of the
patient, It has been suggested that SFS represents an
anatomic variation which simulates the situation of

29
 overcl-osure due to l-oss of verticaL di-mension in the
prosthodontic patient (Van Sickels and Ivey, L979, Piecuch
et a1,, 1980). This so-ca1led overclosure, is purported to
cause the muscles to overcontract and result in muscle
fatigue, and furthermore, to result in posterosuperior
repositioning of the condyJ.es, leadÍng to joint noises and
al-t,ered mandibuÌar movèments. Treatment Lo address both
the MPD and the underj-ying anatonic varíation has been
advocated (Van Sickel-s and Ivey, L979¡ Piecuch et al-.¿
1980), Occ.Iusa.I splint !herapy in order to temporarily
attain a more normal- verticaL dimension, f oJ.J.owed by a
maxÍLLary osteotomy procedure to permanentÌy ímprove
function and esthetics, have been suggested in cases of SFS
(Van sÍckels and Ivey, 1979). Resolution of TMD probJ.ems in
a SFS patient, who underv¡ent orthognathic surgery to
establish more normal- skeletodenta.L rel-ationships, has been
documented (Piecuch et al-,, 1980). More substantial
evidence is needed, however. Treatment rationales such as
these require more thorough investigation before being
applied to the general SFS popuLat,ion, or !o the skel_etal
dysharmony population as a who.le,
A number of studies to investigate the prevalence of
TMD in skeletal disharmony groups or subgroups have been
carried out. Rotskoff has reported a forty-three percent
incidence of TMD sl¡mplons in a population of one hundred and
forty-one pre- orthognathii surgery patients (Upton et aLf
1984). Upton and associates found an incidence of

30
pretreatment TMD symptoms in orthognathic surgery patients
of fifty-three percent, but thi s was based on a
postreatmentf retrospective questionnaire, to which l-ess
than hal-f of their patients responded.
Wisth (1984) has Iooked at TMD signs and symptons in
patients with mandibul-ar prognathism, He reported a
signifÍcantLy greater incidence and severity of certain TMD
signs and sl¡mptoms in untreated prognathism patients than in
those v¡ho were treated surg j-ca1l-y ten years earlÍer, He

therefore suggested that surgical repositioning of the

mandible to a more normal- posÍtion may decrease TMD by
securing a nore normal pattern of mandibuLar functj-on,
There has been relatively l-itt1e published work
describing how maJor skeletal disharmonies such as those
seen in LFS and SFS refate to TMD. yet there is a strong
implication that in cases such as LFS and SFS, where
occlusal and facial- morphology deviate form the ,'normaL,' or
"ideaI," that correction in the form of dental and/or
surgical treatment is needed to not only improve esthetics¡
but to improve function and possibly avoid future functÍonal
problems (Kwon et aI./ 1984). In terms of functÍon,
"prophyl-actic" treatment is felt to be Justified even when
no pre-treatment signs or symptoms of any pathology or
mandibuLar dysfunction can be demonstrated (Greene and
Marbach, 1982).
Evidence from ot.her studies has shown the Íncidence of
the signs and symptoms of TMD in the general population to
be quite high (Rieder, t977¡ Helkimo, 1976:' Greene and

3r
Marbâch, L982). Às weJ. 1, emotional- and psychotogical
factors are known to be involved (Laskin, L969; Zarb and
Speck¡ f977). Yêmm (1979), has supported the argument that
TMD represents a centraJ.J-y deríved disturbance rather than a

result of f unct.ional dysharmony dÍctated primarily by

abnormal- morphoJ-ogy.
In a survey of the oral and maxiLl-of acial surgery
training programs at major universities and hospital-s in the
United States, Laskin and associates attempted to determine
$¡hat the experience of TMD in orthognathic surgical- patients
had been in the various centres (1986), Responses were
received from the staff of fifty-one of the one hundred and
sixteen programs, Representatives of the programs, in most
cases, reported fewer than twenty percent of their patÍents
as having symptons of TMD (mean, 148; median, 109). Two
respondents cl-airned to see such problems ín seventy-five
percent of their patienls, while five respondents reported
that no patients vrith synptoms of TMD were found in their
screened popuJ-ations, AccordÍng to the responses, the
majority of the potential- orthognathic surgery patiênts
being screened in these programs did not appear to exhibit
s]¡mptoms of TMD. Clearly, however, wide variation existed
in lhe reponses from the various centres, Laskin and
associates have suggested that these variat.j.ons reflect
differences in the criteria that clinicians use to diagnose
TMD/ as weLl as differences in their perceptions and
attitudes about the etiologic inportance of gross skeletal

32
dysharmonies in cases of TMD, Three major problems arise
from errors of improper classification (Laskin et aI.,
1986). Firstly, a mi sunderstanding can be created about how
common it j-s for TMD to develop in patients wÍth skeletal
dentofacial dysharmonies. SecondJ-y, a presumptive and
possibJ-y erroneous causal assocÍation has been made when a
patient with a major skeletal dysharmony has symptoms of
mandibul-ar pain and dysfunction. FÍna11y, !he need for
correction of these dysharmonies appears more imperative if
surgeons and orthodontists bel-ieve that patients with major
maf occl-usions either are at hÍgh risk of TMD or must have
ort.hognathic treatment in order to resolve sl¡mptoms that are
pTesent, Data !o support an assocíation between skeLetal
dysharmonies and TMD has so far been ínsufficient to be a
strong basis for cl-inical- treatment.

4, MechanicaL Ànalysis
Investigations into the mechanics of various
masticatory systems as dictated by morphology have been
attempted, O'Ryan and Epker (1984) have pointed out
variations in the temporonandibu l ar joint morphology between
Cl-ass I normal-, Class II open-bite, and CIass II deep-bite
variants, They have suggested that since such morphological
differences are predi ctab 1e, predi cti ons as to
temporomandibu l- ar joÍnt problems, particularly with respect
to joint loading should afso be possible,
Throckmorton and associates (L983) have presented the
resuLts of a modeL anaLysis demonstrating how seLeçted

33
differences in faciaL morphology shouLd affect the
mechanical- advantage of the mas!icatory muscl-es. The model
was used to evaluat.e differences in the mechanical advantage
betvreen patients with LFS and those with SFS. Al-though
Throckmorton and associates predicted that differences in
facial morphology between the two extrême facial types
resu.l-ted in significant differences in the mechanical-
advantage of theÍr muscles, their model analysis was
strictfy two-dimensionaI ExtrapoLation to the cl-inical
situation to predict the effects of orthognathic surgical
procedures or masticatory function/ therefore, is hÍghJ-y
guestionable,
Various other nodels of the masticatory system have
been proposed as welf (Barager and Osborn, 1984; Osborn and
Barager, 1985; Smith et al-., 1986i Meyer and FieÌds, 1986;
Hatcher et af ,, L986). but no three-dimensiona f analyses of
the mechanics of masticatory function with respect to
facial type have yet been reported.

34
 CIIAPTER 3 T,ÍETHODS .AND }IATERIATS

I OVERVIEW

IndÍvidual-s with gross morphological differences are

expected to function dif ferentJ-y, On this basis, an initial
evaLuation of isometric biling in two facial types was
undertaken. A numerical- model was empLoyed to comparè the
mechanical aspects of the masticatory systen as governed by
ana!omical rel-ationships inportant to static bÍte
situations, IndividuaLs were assessed clinically and
cephalornetrical ly, and selected to exemplify two very
different types of facial morphology. Each individual was
analyzed for comparÍson in terns of the mechanics of their
chewing apparatus and their functional anatomy, $/ith respect
to conventionaJ. ly defined facial types.

II DESCRIPTION OF THE MODEL

The numerj-caI model used for this study is an

iterative, three-dimensionaL model- of the mast,icatory
systen, simil-ar to that deveJ.oped by Mcf.,achtan and Snith
(Smith et sI., f986). Under normaJ- biting conditions the
mandibl-e is assumed to undergo negligible accel-erated
motj-on. It may therefore be regarded as a rigid body.
Sínce the gross anatomical- parameters, and hence, the
mechanical parameters for an isometric bite can be fully
defined, a numerical- soLution to describe the requirements
for static eguilibrium in a given system can be reached.
The Mcl,ach l- an- SmÍth nodel employs New-tonian principles to
predict nuscLe activity patterns and condylar load patterns

35
rel-ative to an applied bite force, The prenise that the
temporomandibu I ar joints should be ¡nÍnima11y loaded for any
given bite force consistent with mechanical equilibrium, is
the basis for this numerical model.
The term "loadingf ', as it pertains to the
temporomandibufar joint, has been defined in this model_ as a
force aÕting upon the condyle and imparting lo the condyle a
propens ity toward .l inear movenent (Smith, L 9I4 ) . ',Load,,'

for the purposes of this presentation wÍ11- be used

synonomously with the tern "f orce,' and thus wÍl- I have the
properties of nagnitude, dírectÍon, and point of
application, For any situatíon in which the condyles have a
propensity for rnovement, regardless of the dírection, the
temporomandíbu 1ar joints wil_ 1 be considered to be loaded,
Forces dÍrecting the condyle towards Íts articul_ar eminence
wiLl be regarded as appositional foads, Forces directing
the condyle away from its articufar eminence wi.L L be
regarded as dj.stracting I oads,
The spatial- reLationships of the particular chewing
apparatus to be represented in the model were measured
orthogonally relative to the plane of occlusion and the
intercondyLar axis (Figure 3,1). Thus, the relative
positions of the tooth row, condyles, and muscl-es invoLved
in biting are described by coordinates (xtytz) from an
origin at the centre of the inter-condylar axis. Thêse
numerical- data form the majot data set for the model_.
The "nâluraL" or "functional" occlusaf, plane, añ defined by

36
Fi gure 3. 1 ORTHOGONAL AXES FOR SPATIAL RELATIONSHIPS
Moyers (I979)t has been modified for use in the modeÌ,
Moyers defined the sagittal view occlusaL plane as being
represented by a fine averaging the posterior occfusal
contacts, usually involving the first permanent ¡nolars and
the primary molars or the bicuspids. For the mode1, the
occlusal- plane was a plane averaging the points of posterior
occl-usal contact from the dÍstobuccal cusp of the mandÍbuIar
second permanent molar (2n), anteriorly t,hrough the bicuspid
region, and crossing within the area between the incisal
edge and the incÍsal- one-quarter of the most anterj.or
mandibul-ar tooth (Fígure 3.2), The crÍteria for determiníng
occ.l-usaI plane were applied in the following order:
1) the point of contact at the distobuccal cusp of
the 2m
2) a point between the incisaL edge and the incisal
one-quarter of the central incisor; or the most
anterior mandibul-ar tooth invoLved in function
3) the best plane averaging the points of occlusal
contact between poínts L) and 2),
The x-z plane is paralLel to this occlusal p1ane, while the
x-y plane and y-z plane are perpendicular to this occlusal_
plane ,

In cases where all- the mandibular teeth are intact,

wel l-aIigned, and show minirnal curve of Spee (the curve to
the plane formed by the biting surfaces of the teeth), the
occlusal plane is quite easily determined by this
definítion. Cases \,rith mal-occlusions where the teeth are
grossly malpositioned and/or there Ís a significant curve of
Spee however,require a greater degree of operator judgement
and are subject to nore variabilÍty.
The z-coordinates cornpleting the three-dimensional

-) at
Figure 3.2 0CCLUSAL PLANE IN THE SAGITTAL VIE|I
 description of the tooth ro\,¡ are given by the positions of
!he cusp tip of the nandibular canine and the distobuccal_
cusp tip of the mandibular second permanent mol-ar, The
tooth row is thus approximated by two straight 1Íne segments
representing the rÍght and Left mandibuLar teeth from the
distobuccal cusp of the second permanent molar to the
canine, and by the arc of a circle representing the
mandibufar anteríor teeth (Figur.e 3,3).
The most anterosuperior point on the sagittal view
profile of the condy.le, and approximately mÍdway
mediolateraJ-ly, represents the temporomandibular
articuLation for the ríght and feft condyles (Figures 3,2
and 3,3). A line joiníng these two points has been defined
here as the intercondylar axis (z-axis in Figure 3.1).
The resul-tant force and the resultant moment acting on
the mandible are zero when static equilÍbrium is satisfied.
A bite force applied at a point on the tooth row must
therefore be resisted by the condyles and by the contraction
of muscl-es, Six muscles of mastÍcation that are invofved in
jaw closure are represented in the model_; these are the
right and left masseter nuscles, the right and l-ef t
temporalis muscles, and the right and left lateral pterygoid
muscl-es, The biting system has been simplified to
investigate verticaÌly applied biting loads, The mediaÌ
pterygoid muscl-es, which are thought to be important in
resisting mediol-at,eraI loads to the jaw, have therefore been
excl-uded,
The six nuscle vectors are determined from estimates

40
Figure 3.3 0CCLUSAL VIEII 0F MANDIBULAR DTNTAL ARCH
 of the muscl-e centroids correspondíng to muscl-e insertÍons
and origÍns, as determined by anatomic landmarks. For
isometric biting, because musc.l-e attachments are fixed to
bone, and because the forces created by rnuscles come abouL
only through contraction, these muscl-e vectors wiff be of a
se! direction and point of applica!Íon. The contraction
forces required to satisfy static equilibrium are thus
represented as síngle resultant vectors. The relatÍonship
betr,reen these muscle vectors, for a given biting situation,
wilJ- depend on the anatomical- rel-atÍonships of the origÍns
and insertions for an indivíduaf. Within an índivÍdua I
system, t'he muscLe vectors can be moved to accommodate
variatj-ons Ín function. ¡'or example, posterior biting with
the mandibLe in a retruded posÍtion, as weII as anterior
biting with the mandÍb1e in a protruded position, may be
investÍgated in the model (NickeJ-, L987).
The basic j-nformation required for the numerÍcal model
ana.lysis of a particular bitÍng situation Ís provided by the
geornetric anatonic data representing a given system, The
relative positions of the occlusal- pl-ane, the condylar
heads, and the muscle vectors of the masseter/ temporalis,
and the l-ateraL pterygoid musc.l-es, are measured from dentaL
and skeletal l-andmarks and hence are known (Figure 3.4).
The bite force, its point of application, and the direction
of its action on the mandibÌe are specified by the
investÍgator, and therefore are al-so known. Given the
condition that the forces acting on the condyles shouLd be
minimized, a two-step algorithm is employed to solve for the

42
SAGITTAL VIEI,I FRONTAL VIElll

POSITIONS OF:
* CONDYLE

O TOOTH
¡ MUSCLE ORIGIN
O MUSCLE INSERTION

3.4 GEOI4ETRICAL RELATIONSHI PS

unknowns: the muscle force magnitudes and the magnitudes
and directíons of Lhe forces on the condyles (Figure 3.5).
A computer program was devel-oped to conduct the iterative
caLcu.Lations required to reach a soLutj-on,
The muscl-e force magnitudes required to minÍmize
condyle force magnitudes for static eguilibrium in three-
dimensions, are thus determined by the numerical modeL when
a chosen bite force is applied at a specified point al-ong
the tooth row. Vert,icaJ- bite forces, whích have been
assigned an arbitrary magnitude of one hundred uníts have
been used, The predÍcted muscl-e force and condyJ.ar J-oad
magnitudes are expressed relative to this percent of bite
force. For a more detaiLed rnathematical description of this
numerical model- readers are referred to Smith,s work (1984).

IÏ I DESCRIPTION OF TEE SÌTI4PtES

Investigations regarding the functionaf morphology of

the human masticatory system have been carried out using the
described nodel- (smith et af ., 1986; Nickel, 1987), The
geometric anatomicaf reJ.ationships required for these
investigations have been obtained through direct (Srnith, et
â1., 1986 ) and indirect (NickeL , 1987 ) measurements of
human skel-etal material-. A method of deriving the required
anatomical data from living human subjects for use in the
model, ís seen as potential ly va.Iuabl-e to clinÍcal
investigations of the hu¡nan masticatory system,
A method empJ.oying the cephalometric radiographic
records comnonLy used by orthodontists for patient
ur

I f.,l Specified
E] Fixed anatom¡cally
T Unknown(iterativety acquired)

Figure 3.5 INFORMATION REOUIRED TO CALCULATE

STATIC EQUILIBRIUM
(i4odified frorn Smith (1984) with pennissÍon
, of the author)
eval-uation is proposed. The method has been tested on an
osteol-ogÍcal sample and applied to a clinical sample. The
clinicaL and osteological samples j-nvoIved, and a ¡nethod of
obtaÍning the desÍred three-dimensionaÌ measurenents from
radiographs, are described in the following sections,

]. CLinical Samp1e
Sixteen pre-orthodontic treatment patients from the
University of Manitoba Graduate Orthodontic CIinic were
chosen for invest,igation, The patients were North .tunerican
Caucasians. Their ages ranged from thirteen years and nine
months to t\,renty-six years and one month, \"¡ith a mean age of
L7 years and four months. There were equal nurnbers of maLes
and females. Al-l- the patients were in good general heafth
and were not known to be suffering from any chronic, and/or
debilitating disease or disorder.
By orthodontic standards, these patients demonstrated
maloccl-usions associated with some degree of gnathic,
skeletal- disharmony, In general, treatment of severe cases
of "abnormal-" skeletaL, dentofaciai- patterns is most ideaIJ.y
addressed t.hrough orthognathic surgery in conjunctíon with
orthodontic therapy. In fourteen of the sixteen cases used
in this study, orthodontics combined with orthognathic
surgery was the subsequent.Ly recommended treatment,
Form and functÍon have been assurned to be related, By
accepted orthodontic norms, it could be saíd that the
cÌinical sample showed skeletal- and dental ma l- f orrnations.
Despite their so-cal led "malf ormations', however,

46
 "malfunction" to an obvÍous, hea l th-compromi s ing extent was
not evident in these patients. This study was focussed upon
the consíderations of whether, and to whaL degree,
functional- compromÍses associated with the "abnormal,' form
demonstrated by the sampJ.e may have existed. The method
described was aimed at investigating the rel-ationship
between orthodontÍc cl-assif ication of "normal', and
"abnormal-" form, and the prÍmary function of the masticatory
systen as related to the plane of occlusion.
The patients in this study were sel_ected to represent
extremes in terms of facial type, The patients were judged
c1ÍnÍca1ly to demonstrate doficofacial or brachyfacial
characteristÍcs (Figure 3.6). The se clinical
cl-assÍfÍcations were verified cepha l ometrica I J-y by analysis
of tracings made from Iateral cephalometríc radiographs,
Figure 3.7 shows a typical Lateral- cephalometric tracing.
The Landnarks and reference pLanes pertinent to this method
are indÍcated, The relative facial heights and the
mandibular plane angles (MPA) for the seLected individuals
were quantified and compared to the normative ranges for
these paraneters given by the ManÍt.oba CephalometrÍc
Ä.naIysis (Figure 3,8). In terms of anterior facial height
proportions and rnandibular plane incl-inations rel-ative to
conventional- reference planes (FH and SN), lhese patients
* Th.
"Manitoba Anatysis" is a set of standard values for
comrnonly used cephaJ.ometric measurenents based on a sel-ected
sample of CLass I 'rnormal " skeLetal and dentaJ_ pattern
children of the city of Winnipeg, Manitoba, Canada (Beaton,
1973), These norns were felt to be appropriate for the
clinical sampJ-e group described in this thesis,
47
 LONG/STEEP FACIAL TYPE:
("Long Face Syndrome" )

SHORT/FLAT FACiAL TYPE :

( "Short Face Syndrome" )

Figure 3.6 CLIN I CAL CHARACTERISTICS

48
 I
I
I
TAFH

I
I
LAFH

Figure 3.7 LATERAL CEPHALOMETRIC TRACING

49
 CEPHALOMETR IC ANALYSIS
MANTTOBA ll (1984)

PAIIENl'S NAMÊ BISlHDATE

D.v Monrh Y.rt

PRE.'TNEATMÊNT
DAfI
OURIIIG fREAIMENI
POST'TREAIMEÑI
ACt POSI RE]TENTION
!ONG RA{GE REf€NTIOI¿
cooE

SKELEfAL PATTERN

sNg I .t

..!,t...r
56 26

¡ASO.

OENIAL PAl'fERN

uì.sN

LI.N8

ù.tg

P.N8

utryEß8tfY oF MAHtfOà^
I SNMPÄ
2
FHMPÀ
(*From Beaton, 1973)

Figure 3.8

50
were generalJ.y seen as being beyond the accepted ranges of
"normal- " (TabJ-e 3,1-).
The use and rel-evance of the measurements of facial
height proportions and mandibular plane incLinatíon have
been referred to in Chapters I and 2. More specific
definitÍons are given ín the following paragraphs. AÌl_
descriptions are made in reference to a lateral_-view
cephal-ometric tracing.
Anterior facÍaL heÍght proportions were expressed by
the l- ower anterior face height (LAI'H) as a percentage of the
total- anterior face height (TAFH). The TAFH, as
conventíonally measured, was the distance between the points
Nasion (N, the junction.of the frontonasal suture with the
skeletal prof iJ.e outfine of the bridge of the nose) and
Menton (Me, the Lowest point on Èhe symphyseal- outl-ine of
the chin). The LAFH was measured between Me and Anterior
Nasa l- Spine (ANS ) .

The mandibular plane inclinations were measured by the

angle formed between the mandibular plane and the
conventional- reference planes SelIa-Nasion (SNMpA), and
Frankfort horizontal (FHMPA) . The mandibufar plane (Mp) v¡as
a Iine drawn tangential J-y to the posterior portion of the
Iower border of the mandible, and to t,he symphyseal curve
(through Me). SN pLane was drawn as a line joining N with
the centre of se1la turcica, the hypophyseal fossa in the
cranial base of the skuL l-. FH pl-ane was drawn from Orbitale
(Or, the lowest point of the bony orbit) to porÍon (po, the
top of the shadow of the cephal"ostat ear rod in the external

5L
 Tab].e 3-1 - THE IJNIVERSTTY OF MÀNITOBA CLINICÀL SÀ-I,ÍPLE*

PatÍent Sex Age I,AFH/TAFH SNMPA FHMPA

(years-months ) (t) (degrees
(deg-rees
) )

Long/Steep Group:
J, B. M 13-9 57.0 5.5
4 34.s
J,l^7. M 14-0 56.2 38.0 31.5
K.M. î 14-4 60.8 48,0 ¿1 C
P,A, F 15-l-0 58.9 37.0 34.0
D.K. M 17-3 57.8 38.5 37.5
ÞD F L'l -4 63.6 s6.0 53,5
J ,Z, M i_7-5 62.4 53.0 48.0
T.K. F 20-0 60.3 LL
^
36.5
Mean age of long/steep groups 16 years - 3 months

Short/Flat Group!
CF 15- 0 52.2 22.0
M 14.0
D,H. M 1.5-9 53.4 2 s.0 18,0
u,b. F 15-9 51.8 2t,5 12,0
T.W, F L7 -0 55.1 26,0 r_9.5
L, P, F 1B-8 54.8 17.0 L2.0
Þr\ M L9-2 56.6 23.0 r8.0
A,L, F 20-L 54.8 ¿¿.u l_ 1.5
D.M. M 26-7 53.8 23.0 16 .5

Mean age of short/flat group3 18 years - 5 months

OVERÀLL MEAN AGE OF CLINICAI SAMPLE: 17 years - 4 months

*Where:F=femafe M= male
LAFH = Lower anterior facÍa1 height
TAFH = Total- anterior facial height
SNMPÀ = Sell-a-Nasion - Mandibular pJ.ane angle
FHMP.A, = Frankfort horizontal - MandÍbuIar plane
ang 1e

52
auditory meatus), Since Or and Po are both bilateral
landmarks, the points representj-ng then r¡/ere averaged over
the rÍght and l-eft sides.
LAFH/TAFH, SNMPA| and FHMPA measurements clearly
separated the long LAFH/steep MPA (l-ong/steep) group from
the short LAFH/f l-at MPÀ (short/fIat) group, As weII,
superimpos itions of Lateral- cephal-omètric tracings on both
FH and SN planes demonstrated two distinctly different
f acial- types by normaL standards of assessment (Figure 3,9
shows superimpositions on SN) . This conventiona I
distinction between the two groups of people examined was
tested with respect to function, by investigating the
mechanical- potential of their respective masticatory
systems,
The geometric anatonical relationships between the
condy.lar heads, the origins and insertions of the mâsseter,
temporalis, and lateral pterygoid muscJ.es, and the tooth row
for each of the patients were obtained f ro¡n tracings of
standard orthodontic lateral and posteroanterior (PA)
cephalometric radiographs. These radiographs were part of
the initial records made at the University of Manitoba and
hence were avaÍLabLe for study. The derived geometries were
used in the model and the condyJ-ar load and musc.Ie activity
patlerns were caLcu.l-ated for each of the eight individuals
in the long/steep group and each of the eight individual-s in
the short/ f i-at group.
The cephalometric radiographs \,¡ere obtained in the OraI
DiagnosÍs/Radiology Clinic, Department of Stomatology,

53
LONG/STEEP GROUP: SHORT/FLAT GROUP:

f'-rl
íi I
¡i ' N

V,

Figure 3.9 LATERAL CEPHAL0METRIC SUPERII4POSITIONS 0N SN

 Faculty of Dentistry, University of Manítoba*. A Taylor**
cephaLostat was used in a Picker*** radiographic unit,
where the focaf spot-midsagittaL pLane distance was 152.4
centimeters¿ and the f i 1m-mÍdsagitta J. plane distance was 15
centimeters, As found in most rnodern cephalometric
radiographic units (Moyers | 1,979 ), the x-ray source was
fixed, so that after the f ateral- view was exposed, the
cephaLostat \,¡a s rotated ninety degrees and the patient was
repositioned for the PA exposure. The radiographs were made
using Kodak X-OMAT RP (Registered Trademark) fiLm with
regular speed screens. For the l-ateral cephalometric
views, the machine settings were L0 nA and 85 kvp for an
exposure of 7 /1,0 second. For the PA views, the machine
settings were 10 mA and 90 kvp for an exposure of one
second. An upright stance and forward gaze v¡ith the teeth
in full--occlusion and the lips relaxed, was the standard
positíon for aLl of the radiographs made of the patients
invo.l- ved in this study.

2. OsteologicaL Sampl-e
In order to determine whether the geometric
rel-ationships of the teeth, temporomandibu l- ar joints, and
the muscles of mastication could be accurately derived from
* Faculty of Dentistry,
780 Bannatyne Àvenue,
l'Tinnipeg, Manitoba , Canada R3 E 0W3
** N. TayLor Engineering Ltd.,
Parks tone-DorseL / England
*** Pi"k"r x-ray Engineering l-.,td,,
Winnipeg/ Manitoba

55
 cephalometric radiographs, data from a human osteological
sampJ.e were obtained, The sample consisted of ten human
skull-s selected from the Hamann-Todd (H-T) Osteological
ColLection. This unique coffection is housed in the
Department of Physical Anthropology, at the Cl-eveland Museum
of Natural History. * The Hamann-Todd Col lection
represents an exceptionally weJ. l--documented and catalogued
assembly of autopsied skel-etal remains, Relatively
complete records of over two thousand eight hundred
macerated cadavers, which were accumul-ated over the Latter
part of the nineteenth century and first haÌf of this
century/ are now stored in the nuseum, The acconpanying
autopsy and pathology reports have included as much detailed
information as possíbIe. Where available, records from
medical- and civic authorities have been included to assÍst
the accurate recording of each individuaf,s chronological
and maturatÍona1 age, sex, ethnicÍty, provenience, heaLth
historyr and cause of death, Heights and body weights of
the cadavers, as well as photographs in some cases, helped
to give further Índication of general body constitution.
Ten adul-t skul-Is with nandibl-es and relatively intact
natural- dentiÈions were selected. These specimens were
believed to be ín relatively good generaL heal-th at the time
of their deaths. Specimens v¿hose records showed evidence of
Long-standing chronic and/or osteologically degenerative
* Th" C1..r.l-and Museum of Natural- History,
Wade Oval I University Circle,
CleveIand, Ohio, U.S.A. 44L06

56
processes were not incLuded in the sample, The ten
specinens are described with respect t.o age, sex, ethnÍc
origin, and cause of deat.h, in the Table 3-2.
The photographic data col- l-ected from the skeletal
sample was used to test a cephalomêtric radiographic
technique for data coflection. This was accomplished by
comparing t.he anatomÍc measurements obtained from the skuffs
with the radiographic anatomic measurements obtained from
standardized cephalometric radiographs of the same skuLls.
The ten osteologic spec j-mens were also selected to
represent extrenes in terms of facial type, and could be
divided into two groups, wíth five skulLs showing long face
heÍghts and steep mandibul-ar pl-ane inclinations, and five
skulls showing short face heights and fLat mandibular plane
inclinations,

i. Photographic Records
Geometric anatomic data suitable for use in the model
was obtained from the skulls using a st,andardized
photographic technique developed by NickeÌ, Mcl..achlan and
Snith (NickeI I L987), This technÍque f acil-itated the
measurement of specific points relative to a defined
orthogona I axÍs sys tem, and provided a mean s of
transporting and storing the skel-etaI information as a
resource rnateria L ,

The three-dimens iona I relationships of each skuLl and

mandible have been recorded through a series of nine
photographs. The photographs were made in standardized

57
Table 3-2 - THE IIAMMÀN-TODD OSTEOLOGICÀL S.Aì,TPIE

Hamman -Todd Age Sex Ethni c i ty Cause of Death

Number (vears )

r0J.7 4 40* Ma 1e Caucasian Lobar Pneumonia

T0L71 39* MaLe Bl-ack Lobar Pneumonia
r0333 25* Ma 1e Bfack Hit by Traín
r0255 48 Mal-e Caucasian Gangrene of Foot
T0509 52* Ma 1e Caucasian Nephriti s
T0449 40* MaLe Caucasian Pneumonia
r0238 30 MaIe Caucasian Pul-monary T. B. * *
r0326 30 MaLe Black Lobar Pneumonia
r0484 30 MaLe Caucasian Pulmonary T, B. **
T0463 54 Ma 1e Caucasian Myocardia J.
In farct

* Estimated age at time of deaLh

** Tubercu l- os i s

5B
 views based on three anatomic pJ.anes: the sagittal, the
f ronta.l , and the basal planes.

In preparatÍon for photographing/ the selected skulls

were inspected carefully and the areas of the origins and
insertions of the three muscle pairs were outl-ined with
coloured Letraline (Registered Trademark) 1.59 mí1limeter,
matte-finish, drafting tape. The main portions of the
musc I es invol-ved in elevating the jaw to a centric,
isometric, bite position were considered, The areas of
muscl-e attachment were identified by the observed bony
scarring, guided by the anatomical- descript,ions of Sicher
and DuBruI (1975), On the basis of assumed gross
morphologic sl¡mmetry, only one side, the right or the l-eft,¡
was prepared and photographed. Inter-indi vidua I and intra-
individual variabílity was noled in the location and the
degree of bony scarring. The side in which the bony scarring
best del-ineated the outline of the nuscle attachment was
chosen in cases where a right-left difference existed. The
muscl-e attachments of the masseter¡ temporalis, and Lateral
pterygoid muscles, as used in this st,udy, are described in
the paragraphs to f ol- l-ov¡.
The action of the superficial portion of the masseter
muscle has been said to be involved during ísometric bÍting
fron a centred/ minima I 1y-opened, jaw position (Sicher and
DuBrul f 1975). General ly, t.he origin of the more
superficial portion of the masseter muscl-e, v¡as represented
in this study by an area running along the inferior border
and lateral cortex of the zygomatic arch (Figures 3.LL and

59
 3.17). This area has been defined as extending posteriorly
to the region of the zygomati cotempora 1 suture (Sícher and
DuBrul-, L975) and anteriorly on to the zygomaticomaxi 1 l ary
process, The insertion of the masseter muscl-e was marked Ín
the area of the angfe of the mandible extending anteriorly
towards the l-evel of the Lower second molar tooth, and on
the Lateral cortícaL surface of the inferior portion of the
ramus (Figure 3.10 ) .
The origin of the temporalis muscle was delineated
according to Sicher and DuBrul (1975), in that Ít fotlowed
the inferior ternporal Line and thereby extended over the
temporal, parietaì-, sphenoid (greater wing) and frontaL
bones on the f ateraJ- part of the skulJ. (Figure 3.11). The
insertion of the temporalis muscfe was outl-ined on the
medial and lateral cortical surfaces of the coronoid
process. The bony scarring of the insertion was seen to
extend anteriorly and inferior.Iy towards the posterior end
of the alveolar process of the nandiblef l-ateral and medial
to the retromolar fossa (Figures 3,10, 3,13, and 3.16).
The outl-ine of the origin of the l-ateral pterygoid
muscle included the regions occupied by the inferior and
superior heads of the muscle (Figure 3.17). Bony scarring
was observed on the l-ateraL cortical- surface of the l-ateral
pterygoid pLate of thê sphenoÍd bone, representing the
origin of the inferior head (Figure 3,17), The scarring
extended superiorly onto the ínfratemporaL surface of the
greater wing of the sphenoid, This area, medial to the

60
 infratemporal crest, whj-ch formed the roof of the temporal
fossa, represented the superÍor head, The insertion of the
lat.eral pterygoíd muscl-e was outlined by the muscfe scarring
evídent Ín the fovea of the condylar neck (Fígure 3.16),
The photographs were made with the prepared sku1ls
and/or mandÍbles positioned within a specíalIy constructed
framework (Figure 3.18). This framework had a set and
identifiable focal- pfane, located at the nost anterior Limít
of the framework with respect to the camera, This focaL
plane was narked by a metaf rod measuring 149 mil-Iímeters in
length, which was used as a guide to the posÍtíoning of the
specimens. The metaf rod was incLuded in the photographs¡
to one side of the specimen. Inclusion of this rod
permitted the obtained photographÍc images to be scaled to
stze. It also allowed perspective errors to be
calculated for measurements of coordinates located behind
the focal p I ane,
The specimens themsel-ves were supported by a dry,
Ìarge-particl-e medium (spIit yel lo\^¡ peas) in a metaL pan
attached to the f ra¡nework. The set-up allowed sliding of
the pan towards and a\,¡ay from the camera in the horizontal
pLane. The posítion of the pan within the framework could
thus be adjusted with respect to the f ocaJ- plane, For the
photographs made of the skuLl- with the nandibl-e, the
position of f ul-l--occlusaL articulation of the teeth was
approximated, judging from the occlusaL facets and patterns
of dentaÌ attri!Íon, and the mandibl-e was secured to the
skul-l- in that position with masking tape. Where support

64
from the masking t.ape alone would interfere with visibility
of important anatomicaL structures, manuaf support, was
provÍded by an assístant, For the photographs of the
mandible a.lone, a hofding device was used to suspend the jaw
bone above the support rnedium so that the entire mandibLe
was visib.Ie Ín the photograph.
Three sagittal pfane views of each specimen were
recorded. These showed the skulL alone, the mandibfe alone
(FÍgure 3.10), and the skuLL and the mandiblè together
(FÍgure 3.f1), The sagittal view photographs were made wÍth
the specimen adjusted to have the sagiltaJ- plane paraJ-leI to
the focal plane and the occ1usal. plane horizontal. For the
sagittal- views of the skufl aLone and with the mandible, the
position of the specimen was adjusted to have the parietal
eminence intersectÍng the focal pfane. For the sagittal- view
of the mandibl-e only, the ipsÍlateral condyle was positioned
to intersect the focaL plane,
Three frontal plane views were recorded. These showed
the skul-1 aIone, the mandibLe alone (Figure 3.13), and the
skull and the mandible together (Figure 3.14). The frontal
view photographs were made wÍth the specimen adjusted to
have the frontal plane parallel to the focal- plane and the
occlusal- plane horizontal-, In these views the most antêrior
portion of the specimen was positioned to intersect the
focal p I ane,
Two basaf aspect photographs of each specírnen were
made, one with the skull- alone (Figure 3.16) and the other
with the mandibl-e articul-ated. In these views, the occLusal

66
plane was positíoned paraLleL to the focal p1ane, and the
most proxirnal portions of the skull- and the nandibl-e in this
position, were set to intersect the focal plane,
Àn occLusal- view of the mandÍble (Figure 3,17)
completed the set of nine picturès made for each specÍmen.
The occlusal plane was oriented para11eJ. to the focal plane
for this photograph, and the most superior aspects of the
condyles, or in some casesf the coronoid processes, were
positioned to intersect the focal plane.
A Minolta (Registered Trademark) 35 millirneter, single
lens refLex camera was used on a fÍxed tripod, with the
camera l-ens-f ocaÌ pl_ane set at a distance of 100
centimeters, The camera was set at f-g, and the belLows at
position 9/ on the given scal-es, The Kodak (Registered
Trademark) EPY 135, ASA 50 film empJ_oyed was processed and
developed by a commercial photographic laboratory.

ii, Cephalometric Records

The same ten adult specimens used in the photographic
technique were radiographed in the standard orthodontic
lateraL and pA cephalornetric views. prior to x-ray
exposure, radio-opaque markers were affixedto the skulls,
These markers assisted the identification of the muscle
attachment centroids for lhe three rnuscle pairs on the
radiographs obtained. The centroid of a muscle attachment
has been defined, for the purposes of this study, as the
investigator's best approximation of the midpoint of the
muscle attachment, which would be intersected by a l-ine

67
demonstratíng the maín direction of muscl-e pull ín a
centríc, isometric bite posÍtion, This definition has taken
into consideration the muscle bul_k as wefl as attachment
area, It therefore was not a mathematical centroÍd
caLcul-aLed strictly from the two-dimensionaf outLine of the
muscl-e attachment,
SmalI pieces of l-ead foil were secured with transparent,
tape to the estimated centroid positions of the origins of
the masseter, temporalis, and f ateral- pterygoid muscJ.es, and
the insertion of the tenporalis muscle. To mark the
insertíons of the masseter and l-ateral- pterygoid muscles,
1.0 mill-imetêr diameter, dead-sof!, solder wíre, secured by
tape, was used to mark the approximate length of the maJor
extent of the area. With the radio-opaque markers in pIace,
the mandibl-e and craníaI portion of each specimen were
articuLated according to the dentition, as in the
photographic technique, and secured in this position with
masking tape,
The set-up used to obtain the cephalometric radiographs
of the osteol-ogical sample was provided by the School of
Dentistry, Case Western Reserve University.* The specimens
were transported from the museum to the Bol-ton-Brush Study
Roo¡n in the Department of Orthodontics at Case Westeïn
Reserve University, for radiographing. The Bol_ton-Brush
cephal-ometric x-ray unit utÍlizes two x-ray sources and two
fifm hol-ders so that the subject, or specímen in this case,

* Case Western Reserve University, Schoot of Dentistry,

2123 Abington Road, Cleveland, Ohio, U.S.A, 44L06

6B
did not need to be moved between the Laterat and pA
exposures. The cephalostat lherefore did not rotate. This
unit was rnodelled after that used for the origina I
Broadbent-BoLton cephalometric study, first described in
1931. An orbitale poÍnter helped to l_ocate Frankfort
horizontal plane in the specimen in order to more
accurately orient this plane paraLl-el to the f1oor, The ear
rods of lhe cephalostat were posÍtioned and secured in the
external audit.ory meati of the skuJ-I, with the nasion
Locator helping to provide additional support. The
specÍmens were thus suspended in the cephalostat and exposed
for both cephalonetric vÍews. The advantage of thÍs set-up
was that more precÍse three-dimensionaL interpretations
were possible than would be the case if the subject or skull
was repositioned for the second exposure.

3, Methods of Tracinq Records

i, Osteological Photographic Records
The standardized phot,ographÍc transparencies of the
selected Hanann-Todd specimens were projected onto a f l-at
surface, and the images were adjusted !o a reaL-Iife scale
for tracing, This was accomplished by adjusting the image
so that the projection of the metal reference was L49
nÍl limeters Iong, thus matching the actual measured length
of the rod, By superÍmposing the nine standardÍzed views,
"life-sized" tracings were made of the lateral and frontal
aspects of each specimen (Figures 3,12 and 3.J_5), The
desired three-di¡nensional geometric coordinates were

69
rneasured from these two composite tracings, the x-
coordinates and y-coordinates being obtained from the
LateraL aspêct tracing and the z-coordinates being obtained
from the f ronttaL aspect tracing. The coordinate axis system
was defined in this study, to be centred at the midpoint of
the inlercondylar axis, where the intercondylar axis was the
line perpendicular to the midsagittal pJ.ane of the specimen,
that intersected the most anteïosuperior, central point of
each of the condyles. The x-axis and the z-axis were
defined as lines 1yÍng in a horizontaJ- p1ane, paraJ. J.el to
the occl-usaI plane of the specirnen, running anteroposterio ly
and mediolaterally, respectively. The y-axis was therefore
defined as the vertical- axis, which ran superoinferiorly,
perpendicular to the occl-usa1 plane (FÍgure 3.2).
Ai-l- tracings were made in a systernatic fashion, In
order to minimize perspective errors, the view which showed
the area of interest closest to the f oca]. plane was used
whenever possible, to draw the area in the tracing. The
method employed to construct the composite IateraL and
frontal tracings from the photographic sLide series for a
given specimen, wiJ. l- now be outlÍned in detaiL.
The lateral aspect tracing was based mainly on lhe
sagittal views of the skul-1 and mandibl-e alone and together,
From the projection of the transparency of the lateral view
of the mandible, the occlusal pfane was estabLished in
relation to the condyle, the coronoid process, the ramus,
and the angle of the mandibl-e (Figure 3,10). The anterior
and posterior tooth positions (CA and 2m) were marked along

70
 the l-ine representing occlusal plane Ín the tracing. From
LhÍs Lateral- view of the mandible transparencyf the out.Iine
of the entire insertion of the masseter muscle and what
could be seen of the temporalis muscle originr ês
delÍneated by the drafting tape, were traced. The most
anterosuperior point on the profile of the condyle was
marked, and where visible, any portion of the markings of
Lhe l-ateraL pterygoÍd muscl-e insert.ion were al_so traced,
The tracing was then superimposed by the proJection of
the l-ateraf view skul1-with-mandibLe transparency (Figure
3.11). The occ1usal. plane was lined up as in the first
transparency of the mandible alone, and the best-fit of the
condyle, t,he coronoid process, the ramus and the angle of
the mandible was estabÌished, .Any differences seen in the
anteroposterior positioning of the teeth ref l ected
discrepancies due to perspective and/or technique errors,
The outlines of Lhe masseter muscle and temporalis muscle
origins were added to the tracing, as was any portion of the
lateral pterygoid muscle origin, visible through the
semilunar notch. Additional portions of the outlÍne of the
l-ateral- pterygoid muscl-e origín were obtained from the
superÍmposition of the l-ateral view of the skulf a1one.
Both basal views, and the frontal and occLusal views of
the mandibLe were studied carefully in order to apprecÍate
the extension of the muscle attachments not seen in the
l-ateral view projections. In particular, the origin of the
superÍor head of the lat.eraL pterygoid muscLe which

7L
 extended on to the roof of the infratemporal fossa, the
lateral extensÍon of the temporal j-s rnuscl-e insertÍon on thê
coronoid process, and the fovea area of the condylar neck,
were examined and taken into account, This aided the
sel-ection of muscle "centroids', for measurement from the
Ìateral view tracing. Muscle ,'centroÍdr" as used here, was
defined in the previous section. From the composite Lateral
vie\M tracing, the x-coordj_nates and the y-coordinates of the
condylar head, the tooth positions. and the origins and the
insertions of the three muscle pairs were derived.
The midplane of the f rontal_ aspect tracing was
established from the frontal_ sku l- L -with-mandibL e projection
by a best-fit fine through bil-ateral- cranial and mandibular
st.ructures (Figure 3.14). The teeth and some of the
midplane structures were t,raced for superimposition
purposes, The mediolateral positions of the temporaÌis and
masseter muscle origins were focated through the frontal
view as well as through the basal view of t,he skuIl al-one,
The insertions of the masseter and temporalis muscles were
also sketched in from this view, and then checked by
comparison with the frontal_ vÍew of the mandibLe al-one
(Figure 3,13). The basal view of the skul_ L-with-mandible
also helped to focate the nasseter muscl_e insertion.
The mediolateraL position of the distobuccal cusp of
the second mandibul-ar molar and the cusp tip of the
mandibular cuspid were marked. on the tracing. These were
derived from the frontal- view transparency projection of the
nandible alone/ or from the occl-usal- view of the mandÍble

17
(Figures 3,13 and 3.1-6). From these pro j ections, the
mediolateraJ. positions of the centre of the condyle and the
centroid of the lateraL pterygoid muscfe insertion were al-so
marked .

A knowLedge of the l-ateral aspect positions of the

muscl-e centroids aided the mediol-ateral_ location of
centroids of the masseter and temporalis rnuscle insertions
and origins in the f rontal- aspect. The mediol-ateral
position of the centroid of the Lateral pterygoid muscle
origÍn was derived from the basal vÍew of the skuff (Figure
3,17) superimposed along the midsagittal- pl-ane of Èhe
tracing,
The z-coordinates were measured from the frontal aspect
tracing as perpendicular distances from the nidsagittal
plane (Figure 3.15). The required data set describing the
geometrÍc anatomical rel-ations of the condyles, the teeth,
and the three muscle pairs was, in t.hÍs way, complete and
ready to be tested in the model-.

ii. Osteological Cephalometric Records

Sys tema ti c tracings, inc l uding convent j-onaI
cephalometric Iandmarks (as used in the Manitoba
Cephalometric Ä,naIysis, see Figure 3.8) were made from the
.lateral and PA radiographs of the Hamann-Todd specimens,
Both the rÍght and J-ef t radiographic images were d.rawn for
bilateral- structures, In the case of the condyles, the
right and left Lateral view images were averaged to mark the
most anterosuperior point on the radiographÍc profiLe of the
condyl-es,
From the lateral cephal-ometric radiographf the occlusal
plane was drawn Ín, The anterior and posterior tooth
positÍons (CA and 2n) were label.Ied al-ong the l_ine
representing the occlusal plane, The images of the radÍo-
opaque markers were also traced and their location with
respect to cephalometric Iandmarks and structures were
studied careful ly.
The centroids of the masseter and lateral pterygoíd
muscle insertionsf and the tempora.l is muscle origin and
insertion, were given by the centre of the metallic marker.
For the mâsseter and l-ateraL pterygoid muscLe origins, the
centroids were chosen by the investigator, guided by the
radio-opaque l-ines marking the extensions of these muscle
origíns. This was assisted by the experience gained from the
direct and indirect (via the photographic technique)
examinatÍon of osteological specimens. A point on the
radio-opaque marker just poslerÍor to the cephalometric
landmark, "Key Ridge," near its most inferior point, was
generally seJ.ected to represent the centroid of the masseter
muscl-e origin (Figure 3,7). Key ridge (KR), is a bilateraf
structure seen in the l-ateral víew, as the radiographÍc
image of the posterior edge of the frontal process of the
zygomatic bone. For the centroid of the Lateral pterygoÍd
muscle orígin, the approxinate centre of the radio-opaque
Iíne marking the muscle attachment was sel-ected,
A tracing was al-so rnade of the pA cephalonetric
radiograph, The position of the midplane was estabLished,

74
represented ín the tracing by a best-fit line through
midplane structures, and reflecting as closely as possible,
slmmetry of bifateral- structures. The skel-etal radiographÍc
Ímages were studied with respect t.o the positions of the
applied radio-opaque markers. The centres of the lead foil
imaqes were marked as the centroids to the muscle
attachments of the temporalis muscle and Lhe inserËions of
the masseter and fateral pterygoid muscles. The poínts
cho s en to denote the centroids of the origins of the
masseter and lateraÌ ptergoid muscl-es, in this view, were
the points of most convexÍty and concavity respectively,
aLong the lines marking the extension of these rnuscl-e
attachments.
The mediolateraf centre of the condyle and the
positions of the distobuccal cusp of the mandibuLar second
moLar and the cusp tip of the mandíbul_ar cuspid tooth on one
side, were also marked in the tracing, The geometric data
for use ín the model- couLd thus be derived from the
composite tracing of the cephalonetric radiographs in a
fashion of measurement similar to that used in the
photographic technÍque. The x-coordinates and y-coordinates
were mea s ured f rom the l-ateraL view tracings of
cephalometric radiographs and the z-coordinates were
measured from the PA view tracings of cephalometric
radiographs.

iii, CLinÍcaf Cephal-onetric Records

The tracings of the lateral and pA cephalomet,ric

75
radiographs of the clinical- subjects \¡zere made in a manner
ídentical- to the tracings made of cepha.lometric radiographs
of the osteoJ-ogical sample. There were of course, no
art.ifÍcial markers to índicate the centroids of the muscl_e
attachments in the clinicaf sample. The locating of the
centroids of the masseter/ tenporal-is/ and lateral- pterygoid
muscl-e attachments was done in a systematic and consistent
manner/ and was dependent upon knowledge of the anatomy,
particuLarly with respect to cephaJ"ometric radiologicaJ.
int,erpretation, and experience in tracíng.

IV ERROR CONSTDERÀ,TIONS

1. Photoqraphic TechnÍgue Errors

One of the main errors associated with the measurement
of a two-dimensional photographic representation of a three-
dimensionaL object was that of perspective. Correction for
such perspective errors addressed an elementat problem of
paralJ-ax, Investigations aimed at establishíng correction
factors for the described photographic technique have been
carried out by Nickel (1987), photographs mad.e of a
comp.l-ex, rectangular, three-dimensional object of known
dimensions were projected and traced, The projection was
scaled such that the front of the object, which was
positioned to intersect the focal p1ane, \,¡a s traced to
"l-ife-size," By comparing the traced dimensions of parts of
the object located behind the focal plane with the known
dimensions of those parts of the object¿ a correction factor
was ca l cuÌ ated,
 A perspectj-ve error equation based on this correction
factor was thus establ ished ¡
Ma = Mt (1 + D/1000)
where Ma=the corrected measurement or "actua.l-,'
measurement of the coordinate (xty, or z\i
Mt = the measurement of the coordinate obtained
from the tracing;
and D = the distance of the coordÍnate behind the
focal plane of the coordinate;
\^'here Ma, ML, and D are gÍven in milLimeters,

The vafue of 1000 in the denominator of the error factor

represents the set distance between t.he lens of the camera
and the focal pJ.ane, and is also expressed in mÍ11-imeter
units.
The distance D, behind the f ocal- plane was determined
from the photographic views and thus was subject to some
error in itself, but this error was of a relatively smal I
magnitude. Resolution of the error in the neasurement of
distance D, could be addressed through an iteratÍve approach
but, to a first approximatÍon of perspectÍve error, the
distance D as measured directly from the tracing, was
thought to suffice for the purpose of this study.
The corrected measurements of interest with respect to
the different photographic aspects were as follows: for the
lateral view photographic tracings, Ma(x) and Ma(y); for the
frontal vie\4' photographic tracings, Ma(y) and Ma(z); and for
the basal and occlusal photographic tracings, Ma(x) and
Ma(z), The view used was one which aÌ lowed a part.icular
tracing measurement Mt to be made, and where distance D was
smaflest, This helped to minimize the difference betr,reen Ma
and Mt due to perspective,
For any of the specimens photographed and measured by
the technique described, the J-argest relative error in any
measurement made directly from the tracing without regard
for perspective, was ten percent of the distance behind the
focal pJ.ane of the neasured part of the specimen. The
largest errors in measuring directly from the tracing
therefore occurred when the distance D was largest for the
view in which the coordinate to be measured was l_ocated as
cl-ose to the f oca.I pLane as possible. The specimen
associated with the l_argest perspective error was found to
be H-T Specimen #75. For this specimen, the measurement of
the z-coordinate of the origin of the temporal_is nuscle \^¡a s
associated with a D-value of 83 mil l-imeters in the view
showing the muscle origÍn as close to the focal plane as
possible, The dÍfference between Ma and Mt for this
coordinate was therefore 8.3 percent of the measured Mt,
The importance of perspective error considerations was
investigated by using the modeL. Al1 of the measured
coordinates for H-T Specimen #75 were corrected. for
perspective. The nodê1 was then run based on this
perspecti ve- corrected data to compare the resul_ts with those
based on the unaltered data, The specified biting
condÍtions for this perspective error investÍgation were: a
bite force of 100 units in magnitude, applied to the tooth
ro\^¡ in a vertical direction at four positions
anteroposterior.Iy, aÌong the right-hand hal-f of the tooth
row.

78
 The comparison of the corrected versus the unaltered
geometric descriptions of the H-T Specimen #75 as expressed
by the modeL, for the specified conditions, showed very
little difference between the predicted resuLts ín terms of
the magnitudes and directions of l-oads on the condyles, Any
difference in the condylar load magnitude or the muscLe
force magnítude was expressed as a percentage of the applied
bite force, The average difference in the resuLtant load on
either the r ight or l-ef t condyLes ov er the four
anteroposterior positions was 2.9 percent. The range of
differences for the resu.Ltant condylar loads was 0.8 percent
to 5,1" percent. Average val-ues for the differences between
Èhe x-axis components and y-axis components of lhe condylar
loads for the unaltered versus the corrected situations were
1,4 percent and 2.6 percent respectively. The maximum
difference between the two data sets, in their predicted
force rnagnitudes for the muscl-es and the condyles, was 5.4
percent of the applied bite force. This maximum difference
occurred in the predicted muscl-e force vaLue for the
masseter. The average difference in the direction of the
J-oad acting on the condyLe was 0.4 degrees, with a range of
0,1 degrees to 0.6 degrees. These differences ín the
predictions made by the model, represented thê maximum
amounts of error involved in calcuLating the magnÍtude and
direction of the minimum condylar loads and muscfe forces
required to attain these, when unal-tered measurements,
obtained directJ-y from the tracing were used. For the
purposes of this study, it was felt that the amount of error

79
 associated \ùith the predictions fTom the unal-tered
geometries was smaLl enough to permÍt the use of the traced
neasurements without perspêct i ve -correcti on,
There were other errors ínherent in the photographic
technÍque, These errors were associated primarily with the
set-up of the technique itself, and with the timÍtations of
the operator. In order to obtain the photographs as
desired, the positioning of the specÍmens within the
frarnework was velcy important in terms of proper orientatÍon,
The specimens were not perfectJ.y symmetrica.L, and hence some
degree of operator judgement was required in deternínÍng the
best position of the skul- l- and/or mandible for
photographing. Such errors, which occurred with the
obtaining of the photographs, tended to be unpredictabl_e,
fnformaL assessment of changes in dimension due to operator
judgement, Índicated that such errors would be smal l- when
compared with other errors.
Assuming therefore, that the effors associated with the
photographic transparencies were relativel_y sma11. attentÍon
was focussed toward lhe operator errors which were incurred
through the photographic technique, OperaLor-re I ated errors
occurred in the projectÍon of the photographic images, in
the l-ocating of the anatomical- landmarks, and in the tracing
and measuring of these l-andmarks, Errors in the proJection
of a photographic image woul-d largely have entaiLed
magnification and/or distortion errors. As long as the
distortion errors were kept to a minimum, projection errors
coufd be considered negligible, since any magnification or

80
 dimunition of the size of the specimen would not affect the
refative geometric refationships within it, and therefore
wouLd not affect the predÍctions of the model_, Errors in the
actual- tracing of the visible landmarks and anatomic parts,
and the measurement of selected points, were non-systematic
and rel-atively smal1. The largest operator error was
associated \^¡ith the establishment of occlusaL plane and
with the sel-ection of muscle centroids for the establishment
of representatÍve muscle vecLors. Repeated tracÍngs of one
specimen were carried out in order t'o characterizê the
operator error associated with the selection of data points
for measurement from the photographic tracings. An analysis
of the measurements for H-T SpecÍmen #75 was done in three
separate test trials, in which the described technique \,¿a s
applied by the same operator. In order to minimize the
infLuence of the operator,s memory, and encourage impartÍaJ.
and unbiased but systematic tracing, procedures were carried
out using the photographÍc transparency series for the
specimen in three different orientationss conventional-ly (as
photographed), rotated by 90 degrees, and where the mirror-
image projection was rotated by 180 degrees.
The indivídual measurenents from the three test triaLs
were compared, Relative neasurements of the condylar
position and the tooth row showed a maximum discrepancy of
5.5 miLlimeters overaLl (for the measurement of central
anterior position/ Ín this case)/ while the largest
discrepancy in the muscle vector angul-ation relative t,o the
occl-usal- plane, was 7 degrees (for the temporal_is ¡nuscle in

8r
the lateral view),
The measured geonetric data from each of these test
trials were entered into the computer and the model
predictions were obtained for cornparison. The conditions
were again specified to be l-00 units of biting force applied
verticaL ly, at four positions anteroposterior 1y, along the
right half of the tooth row. Äny difference in the condylar
load magnitude or the muscle force magnitude, was expressed
as a percentage of the applied bite force. The average of
the maximum differences in the resultant load on either the
right or left condyles over the four anteroposterior bite
positions for the three trials was 3.3 percent. The range
of these maximum dífferences was 2.8 percent to 3.7 percent.
The average values for the differences between the x-axis
components and the y-axis components of the condylar loads
for the three trials were 3.4 percent and 5.2 percent¡
respectively. The l-argest maximurn difference between the
three data sets for H-T Specimen #75, in the predÍcted force
magnitudes for the muscles and condyles/ was 6.2 percent of
the applied bite force. This largest maxirnum difference
occurred in the predicted rnuscl-e force vaLues for the
ipsilateral masseter. The average maximum difference in the
direction of the J-oad acting on the condyle was 5.6 degrees
with a range of 5.1 degrees to 6.1 degrees.
The operator-re l ated errors demonstrated through three
test-triaI tracings of H-T SpecÍmen #75 showed relativeJ.y
consistent neasurements, and hence relatively smal Ì
differences in the mode I predictions bâsed on these

B2
measurenents, The operator-related errors due to the
sel-ection of landmarks (and therefore the tracing and
measuring of these landmarks as well) was shown to be sma1l
but greater in a1l respects, than the errors due to direct
measurements without consideration of perspective effects.

2, Cephal-ometrÍc Technígue Errors

The 1ÍmítatÍons of, and errors associated with
conventj.onal cephalometric techníques and anal_yses have been
descrÍbed and discussed at length in the literature (Adams,
1940; Thurow, i.951; Hatton and Grainger, 1958; Bjork and
Solow, 1962; Richardson, 1966; Baurnrind and Frantz, J"97La
and 1971b; Mitgard et qI.t L974; Bergexsen, 1980; Stabrun
and Danielson, 1982; Ahlqvist et e!., l9B3; Tsao e! af .,
1983; Cohen, l-984). The probJ_ems are primariLy reLated to
the qua 1i ty of the radiographs obta ined and the
interpretation of these radiographs.
ïn terms of the radíographs used Ín this study, Lhose
obtained from the osteological sampl-e were of exceptionalty
high quaJ.ity, and because the head position did not change
for t,he Iateral and the PA views, these radiographs provided
a rel-atively accurate three - dimens iona I representation of
the sel-ected skulLs and mandibles.
The cl-Ínica1 cephalometric radiographs had additionaL
error considerations. For instance/ they were made in a
cephalostat which was rotated between vÍews for patient
repositioningf and which therefore were subject to
repositioning errors. In addition, the superimposition of

83
the soft tissues tended to complicate radíographic
interpretation compared to the osteotogic samp.Ie.
Undoubtedly, there were potentiaÌIy large errors involved in
using cIínical cephalometric radiographs to measure three-
dimensional anatomic relatÍonships, lrlhen employed with the
experience gained from a conscÍentious, prospective study of
an osteologic sample, these radiographs nonetheless offered
j-nf ormation useful- for the purposes of this study. The
future prospect of cephalometric radiographs being used to
obtain clinical- information pertinent to mechanical function
of the nastÍcatory system is supported by the work reported
herein.

V COUPÄRTSON OF PEOTOGRÃPHIC ÀND CEPHALOT{ETRIC TECHNTQUES

The geometric anatomic data describing a given

osteological specimen, as obtained by the photographic
technigue, was compared to the geometric anatomic dala
des cribing the same specirnen as obta i ned by the
cephaLometric technique. The individual- measurement.s of
anatomic relationships vTere expected to be quite different
for the two techniques, due largely to thê nagnifÍed image
obtained from cephalometric radiographs. However, whether
or not the same relative measurements collectively
characterizing a particul-ar masticatory system could be
derived through the two techniques needed to be established.
In order to do this. the nunerÍcaf modet was used. to compare
the cephaJ.ometric data set wÍth the photographic data set
for vertical bite forces of 100 units in magnitude, which

84
were applied at four anteroposterior positions along the
right half of the tooth row. The cephalometric data and the
photographic data for each of the ten H-T specimens were run
in the model- and the resul-ts from the two techniques weïe
compared for each specimen.
The average of the absolute difference between the
predicted minimum resultant condyJ.ar .Ioads for the ten H-T
specimens, over the four bite force positions, was 8,6
percent with a range of 1,6 percent to 21..5 percent. The
average of t,he absolute differences in the x-axis components
and the y-axis components of the resu.Itant condylar Ioads
was 10.7 percent, .ç,ríth a range of 3,4 percent to 19,3
percent, The average of the maximum differences in the
predicted masseter activity over the four bite force
positions was 12.9 percent, with a range of 4.7 percent to
31.9 percent; while for the t,enporalis muscle, it was 12,0
percent¡ with a range of 3.3 percent to 2L,6 percent. The
largest values in the aforementioned ranges occurred in
three specimens. The remaíning seven specimens showed
maximum differences between the predicted condylar loads and
muscl-e forces of a smalLer nagnitude. The average maximum
difference in the dÍrection of the x-axis and the y-axis
conponents of the resul-tant condylar Loads was 7.0 degrees,
wilh a range of 2,9 degrees to 14,4 degrees,
Tests were carried out in an attenpt to account for the
differences in the model predictions for the cephalometric
technique data versus the photographic technique data for
lhe sane specimen. It seemed from preliminary anaÌyses

85
 that Lhe mechanical predictions for the model- may be
particularly sensitive to differences in condyJ.ar heighL
rel-ative to the occlusal- plane, arch J_ength reLative to the
position of the condyle, and the l_ateral-view angulation of
the nasseter muscfe to the occLusa.I plane, For example,
changes were made to the photographic technÍque data for H-T
Specimen #66. Specifical ly, these changes entai 1ed
increasing the condylar height by ten nill-ineters
increasing arch length by five miÌ1Írneters, and making the
l-at,eral-view masseter muscfe vector-to-occIusaI plane
angulation more oblÍque by fifteen degrees. These changês
simuLated the measured values from the cephaJ.omet.ric
technigue for these parameters. The resul_tant predictions
from the photographic Lechnique data, when al_tered Ín this
wây, were very simifar to those obtained from the
cephal-ometric technigue data,
A more detailed investigation into the observed
differences Ín the model,s predictions for the anatomic data
from the two techniques will be required in the future. For
the purposes of the present sludy, the consistency
demonstrated between the resul-ts for the two technÍques for
the majority of the specimens in the osteol_ogical sample was
felt !o be satisfactory, partícularly in Ìigh! of the
acknowledged error considerations associated with the
individuaL techniques.

85
 CIIAPTER 4 RESTTLTS

I ANÀLYS I S OF FAC].A], TYPE BY CEPIIATOMETRICS

The anterior facÍa1 height and the relative incLÍnation
of the mandÍbular plane were the bases for the distinction
made between the two facíaI type groups in the cLinical
sarnple. The eight J-ong/steep cases and the eight short/fLat
cases were selected by cliníca1 judgement, a qualitative
assessment which was verí f i ed quantitativel_y by
cephalometric measurements. The clinicaL sample represented
two extremes in terms of facial type. For anterior facial
height proportions and MpA measurements, the long/steep and
short/fl-at groups generally f el-I outside the normaL-range
maxima and minima given for these features by the ManÍtoba
Cephalometric ÀnaJ-ysis standards (Tab1e 4-1),
In terms of L.A,FH / TAFH / SNMPA, and FHMPA values, the two
clinical sample groups were dist,inctly dÍfferent.
Student's t-test statistical- analyses confirmed this at a
958 Level of confidence. The l-ong/steep group not onty
showed larger LAFH/TAFH values, but they also showed larger
independent measures of TAFH. Mean TAI'H for the long/steep
group was equal to 137,4 millimeters + 11,3 miJ. lÍmeters,
whil-e for the short/flat group it was equal- to 117,0
miÌ fimeters + 5.8 mÍ11-imeters.
PLots of LAFH/TAFH versus SNMPA and FHMPA showed, in
both cases, the existence of a relativel-y strong l-inear
reLat,ionship between facial height proportÍons and MpA
(Figure 4.L and Figure 4,2), The IÍnear regressÍon
 TAbIE 4-]. COUPÃRISON OF THE I,AFH/T.AFH, SNMPÀ, AND FHI.IPA
VÄIUES FOR IIHE CTINICÄL S.AI.{PLE GROUPS }IITH
IÍANITOB.AN CEPHAtOttfETR I C .ANALYSIS ST.ANDÄRDS*

Mea s ured Manitoba Long/Steêp Short/Fl at

VãTue ometri c
Cepha I Group Group
Anafysis Standards
LAFH/TAFH (8)
Mean 56,57 59.6 54,1
Standard Deviation - +2,6 +1.6
Range 56.26 - 56.88 56.2 " - 63.6 51.8 - s6.6--

SNMPA (degrees )

Mean 32,0 45.6 22.4

Standard Deviation - +7,L 3.4
+
Range 26,5 - 37 ,5 38.0-- 56,0 r7.O-- 26.0

FHMPA (degrees )

Mean 25,3 39.6 r5.2

Standard Deviation - +7 ,6 +3,2
Range 2 0.6 - 30,0 3r..5-- 53.5 11.5-- 19.5

* Where: I¡AFH/TÀFH = the ratio of Lower Anlerior FaciaI

Height to Total Ä-nterior Facial Height
SNMPA = Se I l- a-Nas ion-Mandibu L ar pl-ane ÀngIe
FHMPÀ = Frankfort horizontal-Mandibular plane
Angl e

** The lowest LAFH/TAFH vaLue for the Long/Steep group and

the _ highest L,AFH/TAFH value for the Short,znfat Çroup
were found to be within the range of normal given by
Manitoban standards for faciaL height proportíòns. nor
these two patients, only their MpA values verified their
clinical categorizations when cornpared to Maniloban norms.

88
 R SQUARED = O-81

@
\o
v
LONG/STEEP GROUP
Femole
-v
Mole - y
SHORT/FLAT GROUP
Femole - tr
Mole - t
MANITOBA ANALYSIS NORMAL VALUES
Meon - ft
Ronge -N

40.0
SNMPA (Degrees)
 R SQUARED = 0.86
àQ

r 60.0
(o lr
o v
t-
I
l! LONG/STEEP GROUP
Femole
-v
J Mole - y
SHORT/FLAT GROUP

MANITOBA ANALYSIS NORMAL VALUES

Meon -ft
Ronge -N
o.o
o.o 10.o 20.o 30.0 40.o 50.0 60-o
FHMPA (Degrees)
coeffícient for LAFH/TATH versus SNMPA was 0,91, while for
LAFH/TAFH versus FHMpAT it was 0.86. The Manitoba
CephalonetrÍc Analysis ',normal-', rnean val-ues and ranges for
LAFH/TAFH| SNMPA, and FHMPÀ are Índicated in Figures 4.1 and
4,2, These vafues were not included in the Línear
regression analyses by which the R-sguared values and
straight,-line relationships characterized in the figures
were derived. It shouLd be noted however, that the
corresponding Manitoba Cephalometric Analysis mean values
and ranges fit very wel l with both the LAFH/TAFH versus
SNMPA (Figure 4.1) and LAFH/TAFH versus FHMPA (Figure 4.2)
pl-ots of the clinical sample data, The ManÍtoba
Cephalometric Analysis ,,normaL', measurements appeared t.o be
appropríate standards for comparing the sel-ected individuals
in the University of Manitoba cLinical- sample, This
supports the initiaL assumption made in thÍs regard (Chapter
3, IIt-1.),
Trends with respect to age or gender of the subject
were not expected for the given data (Tabte 3-1). The fack
of sexuaL dimorphism for the parameters tested is shown in
the Figures 4,1 and 4.2.

TI ÄNAI,YS I S OF FÀCIÀT TYPE BY THE ¡IT]T{ERTC.AT }TODEL

The numericaf modeLpredictÍons for the muscle activÍty

patterns and minimal condyLar Ioad for each of the
indivíduaIs in the clinical sample were assessed for
vertical isometric biting forces. These bÍting forces were
âssigned a magnitude of one hundred unitsf and were applied

91
 at four anteroposterÍor posÍtions along the rÍght side of
the given mandibular tooth row. The results obtained from
the model can be represented in the form of comprehensive
three-dÍmensiona I pLots. Figure 4.3 provides a J_abelled key
to the infornation available from such pl-ots/ whÍIe Figures
4.4 and 4.5 show the pfotted results for the descrÍbed
vertÍcal- biting conditÍons at four anteroposterior biting
positions, Each horizontal row seen in the figures
represents the model.s predictions for an individuaf
patient. Along each row, the muscle activities for t,he Left
and right masseter (ML, MR), lateral_ pterygoid (LPTL, LPTR),
and temporalis (TL.TR) muscles at the four bit.ing
positions, and the resultant minimaÌ left and right condyJ.ar
loads (CLf CR) at the four positions, are dispJ.ayed as a
set, The results for the eight Long/steep facial type
patÍents are shown in FÍgure 4.4, while the resul_ts for the
eight short/flat facial type patients are shown in Figure
4.5. A1 Ì forces and loads are expressed as a percentage of
the applied vertical bitÍng force, t,he magnitude of whÍch is
shown by the length of the verticaL axis on the left of each
pl-ot .

More specif j-c, numerical- data is presented in the

following table (TabIe 4-2), ThÍs is the data corresponding
to the most anterior bite force position onIy, It
represents just a portion of lhe data provided by t.he modeI,
but exemplifies t'he type of information avaÍlab1e,
References to the results shown in Tabl-e 4-2 will be made in
the ensuing paragraphs.

92
 Figure 4.3 l,lODEL PREDICTIONS: I4USCLE F0RCE 0R CONDYLAR LOAD
FOR POSITION OF APPLIED BITE FORCE

100.

FORCE OR LOAD

OF BITE FORCE)

ov= o

(o

(POSTERiOR) (ANTERIOR)

BITE FORCE POSITION

whereX=M- Masseter muscìe force

LPT - Lateral pterygoid muscle force
T- Temporaì i s muscle force
c- Condylar I oad
L = Left side
R = R.ight side
* - Height of condyie
2m - l4andibular second molar posit.ion
CA - Central anterior position
0 - Anqle of bite force from verticaì
v-
 FìguTe 4.4 NUI4ERICAL MODEL PREDICTIONS FOR THE LONG/STTEP GROUP . VERTICAL BITING FORCE
(See Figure 4.3 for key)
PATI ENT

;l@lÚlHlHlslrylels
,, lÐlÐlHlHlslrylele
KM lØlWlHlHlHlryls.g,
\o

P.A. lglÐlHlHlrylrylsls
D. K. lÐlWlHlHlslrylsls
8.P. lÐlWlHlHlE'lrylsle
rz lÐlÚlHlHlglrylsls
TK. l&lÚlHlHlslrylslg
ML MR LPTL LPTR TL TR CL CR
 Figure 4.5 NUMERICAL MODEL PREDICTIONS FOR THE SH0RT/FLAT GROUP - VERTICAL BITING F0RCE
(See Figure 4.3 for key)
PATI ENT

; 14' lW Ls lb' lÐ' lÐ' lfl lg

D.H. 14' lÐ' lH lb' @ lÆ' lg lÆ'
\o
c.s. l4' W' lH lH lry lry lg lg
(n

r,{.
l@lÚlHlrylslrylsle
LP lglÚlHlHlslwlels

PD l&lÚIHlHlslrylsls

AL l&lÚlHlHlrylrylslg
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 Tab1e 4-2 THE UNÌVERSITY OF UÃNTTOBA CLINICAL SÃI,f PI,E:
CONDYI.E ÀND UUSCLE FORCE üAGN]TI]DES FOR
\rERTIC.AT TSOIiÍETRIC BITING ÀT THE CENTRÀL
ANTERIOR POSITION*
Papient CondyLar Masseter Lateral Temporafis Masseter/
(Sex) I.,oad Muscl_e pteryqoíd Muscl_e Tempora l- Í s
Force(?) Force(8) Force (?)
Mus c 1e
Forcã- RãETo
Lonq/Steep Group ¡
J,B. (M) 51,3 79.0 0.00 39.4 2 .00
J. w, (M) 52 ,6 84.3 0.00 33.2 2 .54
K.M. (F) 60.8 r05.1 0.00 14 ,2 8.40
P,4. (F) 55,6 0.00 46.l" r-.63
D.K, (M) 56.2 89,2 0.00 2s .6 3.48
B.P. (F) 48.5 80.8 0.00 31.4
J, z. (M) 52 .9 89.6 0.00 20 .5 4 .37
r. K. (r) 55.3 87. B 0.00 24 .5 3.58

Mean va l- ues ¡
54,2 I6.4 0.00 29.3 3.69
Ranges:
(48.5-60.8) (7s.2-10s.1) (L4.2-46.t) (1,63*8,40 )

Short/FLat Group3
s.E. (M) 49 .8 0.00 41.8 r.78
D. H, (M) 44 ,6 73.2 0,00 36.8 1.99
c,s. (F) 54 .4 84.6 0.00 36,2 't )À
r.w. (F) 45 .7 78.0 0.00 2s .6 3.05
L.P, (F) 47 .0 69. B 0,00 39.1 L,78
P.D. (M) 50.6 83 .2 0.00 ¿6,r+ 2 1t
A.L, (F) ÃÃ c UJ, U 0.00 40.3 2 ,06
D. M, (M) 44 .0 71.0 0.00 28.2 2 ,52

Mean vaLues:
49.0 77,r 0.00 34.3 2.4 6
Ranges !
(44.0-s5.s) (6e.8-84.6) - (26,4-4L.8) (1.78-3.34)

OveraJ- L means :
51.6 81.8 0.00 31.8 3.08
Overa I l- ranges :
(44.6-60.8) (69.8-10s.1) - (L4.2-46.r) (1.63-8.40)

Forces are expressed as a percentage of the applied bÍte

force and represent right/left averaged vaLues.

96
 A quantitative, comparative anaLysis of the predicted
condylar load for vertical- isometric biting at the centraL
anterior position/ demonstrated relatively Iit!Ie dif ference
belween the two groups. The centraf anterÍor position was
chosen in order to sÍnplify the comparative analysis, The
magnitude of the loading of the condyles was maxÍmal_ at this
position for any given case (Snith et, aI, L986), and, since
the applied bite force was central- for this situation, the
required muscl-e activity and resul-tant foads on the condyles
were expected to be symmetrical (the same for right and left
sides). The mean condyl-ar load for the long/steep group
(54,22) was somewhat higher than the rnean condylar l-oad for
the short/ffat group (49.08) at this posit.ion, but this
difference was not statisticall-y significant for the
clinical popu l ation investigated to a 95t IeveL of
confidence, The numerical mechanical anaJ-ysis of the
masticatory systems of the clinical- sample wil_1 be explored
in more detail for this biting position.
CondyJ. ar f oad at the central anterior position¡
expressed as a percentage of the appJ.ied bite force, showed
no strong correlation to facial height proportÍons/ or MpA
for the individuafs invoLved (!'igurês 4,6t 4,2, and 4.9),
The Iinear regression coefficients for the plots of the
condylar foad versus the LAFH/TÀFH, the condylar Ioad
versus SNMPA, and the condylar l_oad versus FHMPA, for this
s amp 1e, were nearl-y zero (0,06/ 0,L7, and 0,15,
respectively), indicating poor linear dependence of the
predicted condyJ.ar l-oads and the parameters characterizing

97
FiguTe 4.6 RELATIONSHIP OF CONDYLAR LOAD (% OF BITE FORCE) TO LAFH/TAFH (U) FOR THT CLINICAL SAMPLE*

70.o

R SQUARED = 0.06
3 oo.o
o
lJ-
o tr

:o so.o
o
g It tr
o
4o.o
ó
J LONG/STEEP GROUP
cr Femole-v
Mole - v
# so.o
o SHORT/FLAT GROUP
z Femole
-O
o
() Mole - ¡
20.o

o.oL_.,
o.o 50.0 55.0 60.0 65.O
LAFH/TAFH (%)
+
For vertlcal bltlng at tho central Êntorlor Þosltlon.
 Figure 4.7 RELATIONSHIP 0F CONDYLAR LOAD (% 0F BITE FORCE) T0 SNMPA (DEGREES) FOR THE CLINICAL SAMPLE*

(1) R SQUARED = 0.17

()
.:]
o
IL
o
.=
d¡
o
a o
\o
¡l
(o o .."]
o
J
(r LONG/STEEP GROUP
Femole
-v
J Mole - V
o -.1 SHORT/FLAT GROUP
z
o Femole
-o
o Mole - I

,.1_,o-o 15.0 25.O 35.O 45.0 55.0

SNMPA (Degrees)
+For vertlcal bit¡ng at th6 central
ant€rlor posltlon.
FÍgUTC 4.8 RELATIONSHIP OF CONDYLAR LOAD (% OF BITE FORCE) TO FHMPA (DEGREES) FOR THE CLINICAL SAMPLE*

R SQUARED = O.15
o
C)
o
u-
o t vvv
dt
50.o
o
a
Õ
¡ro
40.o
o
J
fr LONG/STEEP GROUP
J Femole-v
30.o Mole - y
zo SHORT/FLAT GROUP
o Femole
-O
o Mole - I

o.o#
o.o 10-o 20.o 30.o 40.o 50.o 60_o

FHMPA (Degrees)
*For
vørtlcal blt¡ng at the contral antorior poa¡t¡on.
facial type,
The muscle activity
patterns required to satisfy static
equilibrium and minimize the l-oad on the condyles were al-so
analyzed for vertical isometric bÍtÍng. In the survey shown
in Figures 4.4 and 4.5, overall l-ateral pterygoid muscle
inactivity was predicted by t,he mode1. The predicted
masseter and temporaLÍs rnuscLe forces, on the other hand,
showed some degree of activity at a1l_ four of thê bite force
posÍtions surveyed, The observed masseter-temporalis
muscle force patterns, with respect to bite force position,
were ínvestigated more cl-osely. The model predictions for
the situation of verticaÌ biting at the central- anterior
position (Table 4-2) were anaJ_yzed. The nasseter muscle
force versus the Lemporal_ is muscle force for lhe clinical
sampJ.e showed an inverse relationship of a l-inear nature for
this situation (Figure 4.9). This was a rel-atively weak,
but notabfe inverse rel_ationship, wÍth R-squared equal to
0.51.
The relative activity of the masseter and temporalis
muscles was further expJ.ored. The ratio of masseter muscLe
force to temporaLis muscl-e force (M/T) was used to represent
the reLatÍve activity of these two muscles. Whether or not
the M/T showed a rel-ationship to facial- type was therefore
investigated by pl-otting M/T at. the centraL anterÍor
posilion versus both facíaI height proportions and MpA for
al-l- the individuals in the cl-inical sanple, These ptots
faifed to show any strong relationship between the muscle
activity patterns and paxameters used to distinguish faciaL

101
FiguTe 4.9 RELATIONSHIP OF MASSETER MUSCLE FORCE (% OF BITE FORCE) TO TEMPORALIS MUSCLE
FORCE (% OF BITE FORCE) FOR THE CLINICAL SAMPLE*

110.0
(l)
o
o
II
(l) 100.0 R SQUARED = O.5'!
.:
d¡
o
a 90.0
UJ
o
c
o
l! 80.0
ul
J [-ONG / STEEP GROUP
o
U) Femole
f,
-v
70.o Mole - v
fr SHORT/FLAÏ GROUP
t¡J Femole - o
t-
IU Mole - I
U) 60.o
(t)

o.o
o.o 10.o 20.0 30.o 40.0
TEMPORALIS MUSCLE FORCE (% of Bite Force)
*
For verticel bltlng at the contral enterbr poalt¡on.
type (Figure 4,10 shows a representative plot), The
correl-ation coefficients for M/T vêrsus LAFH/T.A,FH, M/T
versus SNMPA, and M/T versus FHMPA were 0.28, 0,26, and
0.25 t respectivel-y.
Compared to the rest of the sample, one indÍvidual_ in
the long/steep group, patient K.M,, generally showed very
high condy.Iar l-oads and masseter muscLe forces, with Iow
temporalis musc.l-e forces predicted for aIl_ biting positions
surveyed. These were particularly extreme at the central
anterior posÍtÍon, The effects of this ,,extreme,' data on the
l-inear regression equations cal-culated for the sample were
tested. The data associated \,¡ith patient K.M. was excJ.uded,
and the linear regression equations were recalculated,
For the plot of the relationship between masseter
muscle force and temporalis muscl_e force for the sample,
when the data point representíng patíent K.M, was excluded,
the linear regression coefficient decreased somewhat, from
R-squared equal to 0,51 to R-sguared egual to 0.32, AIso,
for the plots of condylar load versus MpA, analyses showed
that the Ìinear refationships were made worse when patient
K,M, was excLuded from the sample. For the plot of condylar
l-oad versus SNMPA, for exampJ.e, the R-squared value changed
from 0.17 Lo 0,10 when thÍs patient was excl-uded. The
extreme model prediction val-ues for the patient K.M.
therefore, dÍd not appear to be masking stronger l-inear
reLationshÍps between mechanicaf analysis predictions and
conventional- facial- type parameters. fn addit,ion/ they were
not rnisleading in terms of possible masseter-temporalis

103
 Figure 4.10 RELAÏIoNSHIP 0F MASSETER MUSCLE FoRCE/TEMPoRALIS MUSCLE FoRCE T0 FHMPA (DEGREES)
IU FOR lHE CLINICAL SAMPLE*
o
E
o
ll-
l¡J
J R SOUARED - O.25
o
ct)
:)
(t) LONG/STEEP GROUP
Femole
-v
=
fr Mole - y
o
o- SHORT/FLAT GROUP
Femole
-O
u,t
t- Mole - I
t¡J
o
fr
o
l!
IJ
J
o
U)
)
=
(r
ul
t-
IIJ
ct)
g,
o.o 10.0 30.o 40.o 50.o 60.o
FHMPA (Degrees)
* For vertlcal bltlng at tho contral ânterlor porltlon.
muscl-e associations for t'he sampl_e group,
A separaLe analysis of the nasseter muscle force versus
tenporaLis muscl-e force relationship of the eight
individuals representing the Long/steep group onIy, showed. a
much stronger l-Ínear reÌationship (R-squared equal to 0.85)
than the anaJ.ysis of this rel-ationship for the overaLl
sampl-e. Exclusion of the data point. associated with patient
K.M. in this situation, Írnproved the inverse relationship
between masseter and temporal-is muscLe forces foï the
long/steep group (R squared equal to 0.91). A much stronger
masseter-temporaJ-is muscl_e force relatíonship withÍn the
Iong/steep group was thus evÍdent. pl_ols of M/T versus the
cephaÌometric parameters of facial height proportions or MpA
did not show strong links within this group. R-sguared
vaLues v¿ere very Iow, including and excluding patient K.M.
The model predictions for the clinical sample
investigated did not support strong f acial- type-specifÍc
characteristícs in terms of condylar Load and muscLe force
patterns for vertical isometric bitíng, In addition, no
obvious sexuaf dimorphisrn was demonstrated in any of thè
parameters investigated (Figures 4.6, 4,7, 4,8, 4.9, and
4.10), As was found for the measures used to characterize
facial type, the predicted condyJ-ar Load and muscl_e force
magnitudes did not show trends related to gender.

TII ÀNAIYSIS OT FÀCTÀI TYPE BY ÃNÀTOMIC REI.ATIONSHIPS

REI,ÀTIVE TO OCCLUSÄT PLÀNE
As mentioned Ín Chapter 3¡ section Vf tests using the
mode] have shown notabLe sensitivities to certain

r05
anatonical- parameters, Tn particu j_ar/ the mechanics of
the masticatory anatomy are affected byt arch Iength
relative to the posÍtÍon of the condyles, cond.ylar height
measured perpendicuLar to the occlusal- plane, and the
l-a!era.l-vÍew angulation of the masseter nuscle to the
occfusal pÌane. The modef predictions did not vary widely
between the Long/steep and short/f l-at groups. It might
therefore be expected that the aforementioned parameters
aÌso did not vary much between the faciaf type groups,
despite their wide differences with respect to comnon].y used
cephalometric measurement.s,
The relative anatomical geometric measurements and
proportions of the two sample groups were therefore
investigated relative to occlusal_ plane, AtI of the
individual-s showed a remarkable degree of siniLarity Ín
terms of their functional masticatory anatomy when measured.
in this way. The parameters of arch length, condylar
height, and l-ateraL-view masseter angul_ations wil l- be the
focus of this section, but simil-ar consistencies in other
anatomic refationships, relative to occlusal plane, were
al-so observed.
Larger predicted condylar loads for a defined bite
force as it is applied at more and more anterior positions
along a given tooth row have been reported (Smith et. al-,
1986). Sensitivity tests Ín which arch J.ength was extended
also supported thÍs, The effect of variations in aïch
length as demonstrated within the clinica j. sample was

106
expl-ored by plotting the relalionship between condylar l_oad
at the central- anterior position versus the arch length
(Figure 4.11), For the sample group, the condylar load
magnitude was not strongly reLated to the anteroposterior
distance from the condyles at which the biting force was
applied (R-squared, J-ess than 0.0L).
A closer l-ook at arch length measured relative to the
condylar position for the cfinical sampJ_e showed that it
did not provide a strong basis for distinguishÍng between
the two facial tlæes, The Lack of anatomical- distinction
supported the l-ack of functional mechanical distinction
predicted between the two groups, The mean vaLue for arch
l-ength for the long/steep group was 90.1 mil limeters, with a
range of 82,4 Lo 104,5 nilLimeters. For the short/fIat
group, mean arch length was 84,3 miLlimeters with a range of
7 6 ,0 to 9 0.5 ¡ni l .l imeters, Al though the l ong/ s t.eep group
showed a tendency towards slightly l_arger arch J_ength
val"ues, a Student,s t-test anaJ.ysis showed no significant
difference between these two groups in terms of arch Iength,
to a 958 leveÌ of confidence.
Sensítivity tests in the modeL have also shown condylar
height measured perpendicul-ar to occlusaL plane to be an
important parameter with respect to mechanical function
(Chapter 3, section V). However, the model predíctions for
the clinical sampLe groups did not imply strong correlations
Èo condylar height, over the range of condylar height
variations demonstrated by the sample.
Further anaJ-ysis of the condylar height measurements of

107
 Figure 4. 11 RELATIONSHIP OF CONDYLAR LOAD (% OF BITE FORCE) TO ARCH LENGTH (MILLIMETERS)
FOR THE CLINICAL SAMPLE*
80.o

(¡) R SQUARED < O.O1

o
o
lJ-
o V
Í
d¡
o
a
o
@ o
o
J
fr LONG/STEEP GROUP
Femole
-v
J
Mole - v
zo SHORT/FLAT GROUP
o Femole
-O
o Mole - ¡

o.o
o.o 70.0 80.O 90.O
ARCH LENGTH (Mill¡meters)
* For vertical b¡t¡ng at the central antor¡or poe¡tion.
the two f acial- types did not show this measurement to be
closely associated with facial type. The mean condylar
heights and ranges for the long/steep and the short/flat
groups were 37.8 millÍmeters, wíth a range of.27,5 to 50.0
miLlimeters, and 38.7 nill-imeters, wíth a range of 33,5 to
43.5 milfimeters. The facial type groups were not
significantly different in terms of condylar height to a 958
confidence l-eve1.
The lat.eral-view masseter muscle vect,or anguJ.ation
relatíve to the occfusal- pJ.ane was afso measured for aIl the
indÍviduals in the cl-inical sample. This angl-e tended to be
higher for the individuals in the i-ong/steep group, t,han for
the índividuafs in the short/fIat group, but this difference
was not found to be significant to a 958 confidence l-evel.
The average va.l-ue of the masseter muscle vector to occlusal
plane angJ.e in the l-ateral view, was 57,0 degrees, with a
range of 52.0 to 73.9 degrees for the Iong/steep group, and
52.7 degrees, with a range of 43,5 t,o 59,0 degrees for the
short/fIat group, Linear regression anaJ.ysis showed that
the condylar loads predícted by the model for the clinical_
sample did not appear to be closely related to the
measurement of this angle for the sixteen indíviduals
investigated (R-squared equal_ to 0.20), pot,entiaL for
relatively large errors in this angular measurement is
acknowledged. Error considerations have been discussed in
Chapter 3,

An investigation of the anatomical relationships of

sixteen pre-orthodontic patients has shown that, when

r.0 9
assessed re.Iative to occl-usaJ. p1ane, their masticatory
systems exhibit remarkably simil-ar patterns of muscl-e
functÍon and condyle loading as determined by the numerical
mode.L, In addition, theÍr component anatomical structures
exhibit striking similarities. This Ís in contrast to the
distinct differences in the anatomical rel_ationships of
these individuals when interpreted relative to conventÍona1
cephaLometric reference planes such as SN and FH.
Cephalometric analysis woufd divide the cl-inÍcaJ- sample Ínto
two groups, representing two very different f acial- types.
-A,n anatomical analysis relative to occLusal plane, and a
mechanicaÌ analysis using a numerical model based on
occlusaf pl-ane, do not support this categorization. The
implication that marked rnorphological and mechanical
differences exist between the long/steep and short/fIat
facial- types has not been borne out by analyses relative to
a functionaJ-ly relevant reference pJ_ane,

110
 CIIÀPTER 5 DISCUSS TON

It Ís often assumed that cranÍofaciaL f orrn is rel-ated

to masticatory function, and hence, individuals showing
extremely different dentoskeletal morphology might be
expected to exhibit differences in terms of their functional_
mechanics, Sixteen pre-orthodontic patients from the
University of Manítoba craduate Orthodontic C1ínic, have
been studied in order to investÍgate possible relationships
between form and function with respect to the chewing
apparatus. These pat,Íents cl-inica1ly and cephalometrical ly
typified two distinct classes of facial form. That is, they
were generally consístent with the classical- definitions of
" long-face syndrome " and ,,short,-f ace syndrome.,,
Specif icall-y/ they v¡ere sel-ected to represent extremes in
terms of facial proportions and MpA, The two extreme groups
were therefore designated as "long/steep" and ,,short/f 1at,"
in reference to their respective anterior facial height
proportions and mandibuLar plane inclinations. This
distinction between the two facÍa1 types was verified by
cepha]ometrÍc analysis using conventional measures and
reference planes (TabIe 4-1).
The mechanicaÌ aspects of the masticatory systems of
these individuals, presumed to represent two dÍstÍnctly
different dentoskel-etaI forms, were analyzed using a three-
dirnensional numericaf nodel. In terms of their predicted
mechanical- function however, the resuLts did not show a
marked dlstinction that would support the facial type

l_ 1L
cfassÍfications used ( FÍgure 4,4 and 4.5). Further
comparison reveaLed that, relative to occl-usaf plane, the
geometric anatomic data representing an indÍvidual-,s basic
masticatory system \^¿a s not markedly different in terms of
facial type, The differences in the functíonaI masticatory
anatomical- relationships expected between the two
conventionally recognized faciat types were not found.

ï Proportiona I Rel-ationships
No single parameter is expected to account for the
observed differences or sÍmilarities in the predicted
mechaníca1 function of thê individuals investigated and
described herein, Sensitivity tests in the numericaL model
have shown that significant changes to certain anatomÍcal
parameters can cause noteworthy changes in the predictions
obtained from the model (see Chapter 3, section V). The
indivídual-s in the sample showing the Largest and smallest
measurements for a given parameter generally did not
demonstrate large differences in theÍr predicted functÍonal-
mechanics, however. Consider the l-argest and smal_Iest
measurements of arch length for example, which were shown by
patients D,K. and D.¡4,. The arch J.engths, measured from the
condyle to the CA position along the occl-usal p1ane, were
104.5 millimeters and 76,0 millimeters, respectively, for
these t\^ro patients, representing a reJ.ative difference of
approximately twenty-seven percent, The predictions from
the model for the tv¡o patients were not markedly different
(Figure 5.1a) compared to lhe difference in the predictions
PATI EN T

D.K.
l@WlHlHlglrylÐls
D .l{. l4lWZrlHlslrylele
ML MR LPTL LPT
LPTRÞ Tl
TL TÞ .r -Þ

". l4' l4' 2--r, 2=r |tu, lry 14, @

 from the model- shown for patient D.M. in a test sÍtuation
where the arch length for this indivÍdual- was Íncreased by
fwenty-seven percent (Figure 5.1_b), Conpensatory
rel-ationships in other parameters are thought to be
responsible. The similarities in the predictions of the
model for the sampl_e group are befieved to be a reflection
of compensatory refationships bet.ween the functionafLy
relevant/ anatomical- components of the masticalory system,
existent in these peopl_ e.
For the vertical isometric bite situation, investigated
at four anteroposterior bite force positions, the modet
predicted a general shut do\^¡n of the LateraL pterygoid
musc.Le (FÍgures 4.4 and 4.5). This was in agreement with
the findings of Smith and co-workers (19g6), and was thought
to be associated with a rel-atively stable biting conditìon.
The masseter and temporaLis muscles, on the other hand,
showed some degree of activity for the conditions surveyedf
at all four bite force positions, The general_ form of the
predicted masseter and temporalis muscLe force patterns
showed surprising consistency for the cÌÍnical- sampLe group
as a whol-e. The predicted force patterns for the masseter
¡nuscle or the temporalís muscl-e did not Índependently
support a distinction between faciaL types. GeneraJ- trends
bet\,reen the masseter and the tenporal_is muscl_e force changes
with anteroposterior changes to bite force position, were
apparent however, These trends suggested an association
between the masseter muscle and ternporalis muscle forces
reguired to minimize the resultant condyl-ar l_oads at a given

114
position. (R-squared for the relatÍonship was found to be
0, sl, )

The rel-atíonship bet'ween thê masse!er and the

temporalÍs musc.Ie forces r¡¡a s further tested by investigating
the M/T ratio versus facial- type parameters. (See Chapter 4,
section II ) A dÍstinction between the clinically and
cepha I ometrica I ly determined facial type groups on the basis

of I4/T vafues for the sample, did not support a functional

distinction between individual-s regarded as morphologically
distinct.
Through modeL sensitivity testing, it is known that
changes to the arch length along occl-usal_ p1ane, the
condylar heightf or the lateral--view masseter muscLe vector-
to-occl-usal pJ.ane ang1e, affect the predicted condyl_ar
l-oads and muscle force pat.terns for a given biting
condition, For exampl-e, changes to the central- anterior
and/or second molar position in the range of five
mil- limeters or more¿ wíth al-l other parameters remaining
unchanged, resulted in changes to the mechanical model
predictions. SimilarÌy, mechanicaf differences predicted by
the model were associated wÍth condylar height changes in
the range of ten mif limeters, and with lateral--view masseter
muscl-e vector-to-occ L usa L pl-ane angle changes in the range
of fifteen degrees.
The model predictions for the clinical sample were
surveyed. It was expected that any substantial mechanical
differences night be accounted for by individual or group-
 specific differences in one or more of the aforementioned
anatomÍcaI parameters, The numerical model predictions for
the clinical sampl-e were found to be very similar however,
This was somewhat surprising, so a cl_oser Ínvestigation of
the range of anatomical- paraneter variations for the samp.Ie
was carried out, This showed that the true variation in the
relative geometry within the total sample was, in fact/ very
smal-.L. For example, t,he distance from the central anterior
position to the second molar position along the occlusaL
pJ-ane in the sagittal- vÍew, was very consistent for the
sample, having an overall mean equaJ. to 43.4 millirneters,
with a standard deviation o1. + 2,9 mil-limeters, There was
no statistical. Iy significant faciaL type-specific difference
in arch Length t,o a 958 leve1 of confidence, Within an
individuaL system, the retationships between tooth row,
condyLar position, and muscl-e vector angulations, appeared
to be compLementary in that simil-ar proportions for the
entire sample group were demonstrabl-e (See Appendix B for a
table containing this data ) .
The simifarities in the geometric anatonical
refationships of the sample were further shown by the fact
that proportions of arch Length to condylar heíght and
intercondylar distance were remarkabJ-y consistent, The
overaff mean of the rel-ationshÍp between (condytar
height ) (intercondyL ar distance)/(arch length) was equal to
1,2 "míIlimeters,,, with a standard deviation of + 0.2
"mil-limeters;" and no statistically significant facial type-
specific difference, to a 95? confidence leveJ_. A simil_ar

116
degree of consÍstency was seen in the angular measurements
studied, though, as dÍscussed in Chapter 3, a relatively
large potentÍal error, which was in part, inherent in the
operator, was recognized in these muscl_e vector-as sociated
angles. Nonetheless, the range of values for the angle
formed between the Lines of direction of the masseter muscle
vector and the temporaJ.Ís muscle vector in the lateral view,
was found to be quÍte smal-f . The overal- 1 sample mean for
the angle formed by these l-ines was equaJ. to 65.8 degrees,
with a standard deviation of + 4.5 degrees. Students. t-
test statisticaJ- anaJ-ysis showed no significant difference
between the two facial type groups for this angle to a
confÍdence leveI of 958. Masseter and temporalis muscle
vector angulations relative to occlusal- plane in the l-ateral
view therefore showed a complernentary relationshÍp, Where
nasseter muscle vector angulation to occl-usaI plane tended
to be more oblÍque, the tenporalis muscLe vector angulation
to occl-usa1 plane tended to be reJ.atively uprÍght, and vice
versa. Figure 5.2 shows these angles relative to occlusal
p1ane.
It seems that proportional refationships important to
mechanical function, exist between the anatomíc parts of the
mastÍcatory system. Differences in these proportional
relationships may be responsible for the differences ín the
model predictions for individual masticatory systems. The
initial investigations carried out for the clinical sample,
using the numericaL model support this. For example, an
 -
\/ \,1 v \/ \/ \/ \/ \/
LONG/STEEP GR0UP: (Patient Degrees)

Patíent: JB Jl,l Ki,l PA DK BP JZ TK

Degrees: 69.0 68.0 68.0 66 .0 63.0 77.0 62,0 61.0

SHORT/FLAT GRoUP: (Patjent - Degrees)

v \/ \,2 \/ \z \/ \,2 \/
Pâtient: SE DH CS Tì,1 LP PD AL Di4
Degrees: 68,0 69.0 67 .O 62.0 71,0 62,0 68,5 55,0

Fi gure 5.2 MASSETER AND TEMPORALIS MUSCLI VECTOR ANGULATIONS TO

OCCLUSAL PLANE (LATERAL VIEI,I)
anal-ysis of condyl_ar Load versus t.he ratio of condyJ.ar
height to arch tength (Fígure 5,3), suggests that a
refationship rnay exist (R-squared equal to 0,43), Further
investígations to f u1J.y define the anatomic proportional
changes responsible for significant effects on the mechanics
of masticatory function, are feft to future work.

II Relevance of Findings to Clinical TreatmenË

By normal orthodontic standards the cl_inical sample
studied demonstrated a moderate to severe degree of
dentoskeÌetaI maLformation. Dêspite this relative
"abnormaLity¿" none of these malformations could be said to
be 1Ífe-threatening. Al- I of lhe patients were, in fact,
found to be in good general_ health. It has been implied
that form and functÍon are cLosely reLated, Severef
compromising effecls of the ,'abnormal', form demonstïated by
the clinical sample on the essential functions of
mastication, speech, deglutition, and perhaps social
behaviour, were not evident. ft seems that the question
regardÍng the relatÍonshj-p between "abnormal', form and
"abnormal- " function has not been adequately defined, This
study has focused on a Limited aspect of this relationship,
Evi-dence for the exi s ten ce of consistent or
complementary functionaÌ, anatomical relationships in
persons outwardl-y exhibíting very different dentoskel-etaL
form, sheds interesting light on the debate over the
rel-ationships between anatomical form and masticatory
function, Conventional thÍnking with respect to differences

119
 Figure 5.3 RELATIONSHIP OF CONDYLAR LOAD (% OF BITE FORCE) TO CONDYLAR HEIGHT/ARCH LENGTH
FOR THE CLINICAL SAI'IPLE*

70_o

R SQUARED = O.43
(¡)
o
o 60.0
¡!
o)
.=
fD
o 50.0
a
o
o 40.o
J LONG/STEEP GROUP
G Femole -v
Mole - i7
J
30-o SHORT/FLAT GROUP
zo Femole
-o
o
() Mole - ¡

o.o o.25 0.35 0.45

CONDYLAR HEIGHT/ARCH LENGTH
* For vertlcal bltlng at the central entorlor porltlon.
 in dentofacial morphology has presumed concomitant
differences in mastÍcatory function. CIinically and
cephal-ometrical J.y judged extremes in facial type, were
demonstrated by the eight long/steep group patients and
eight shorL/fIaL group patients studied here, These two
types of indivÍduaIs are traditionaLLy considered to be
"abnormal- " and to denonstrate undesirable dentofacial
patterns. Many patients classÍfied as exhibiting " Iong-face
syndrome" or "short-face syndrome', undergo major orthodontic
and/or orthognathic surgical treatment. This was
subsequently the case for fourteen of the sixteen patients
included Ín this study, Such treatment is advocated in
order to address major dentoskefetal ,'dis crepancies. " It is
intended to harmonize the dentoskel-etal- relations by naking
them approximate nore 'rnormal-', or average relations, The
object.ives of this treatment are to not only correct
esthetíc probl-ems by nakíng the patient look more "noïmal',
or average, but supposedly to correct functional problerns as
wel-l-.
The mechanical analysis of the masticatory function of
lhe sixteen individual-s seLected, did not support their
clinÍcal and cephalometric categorization, General
simil-arities were noted between aI1 individuals studied, in
terms of the functional anatornic components of the
masticatory systems when compared rei-ative !o occlusal
pLane, This would suggest that the hunan system, in its
development, compensates weIl, in the mix of anatomical_
strucLures necessary to maintain function adequate for

L2l
 survÍval. Exampfes of the effects of function on form are
pLent.if uL. Consider the effect of a proJ.onged digit-
sucking habit on the dentoskel-etaf rel-ationshÍps, for
example. Masticatory functíon is expected to sirniJ.arly
influence the growth and devefopment of the component parts
involved in masticatÍon. As a result, compensatory
reLatj-onships between the components important to
mastication, Leffect the inf l-uencè of functional demands on
the underlying genetic predisposition for form,
Some of the higher condylar loads predÍcted for the
sampLe occurred for bite forces applied at the central
anterior position ín the five long/steep group patÍents who
clinically demonstrated anterÍor open bite malocclusÍons
(Patients J.w.f D,K., 8,p., J.2., and T,K. in Table 4-2),
It may be hypothesized that the development of an anterior
open bite refLects a compensation to discourage incisor
biting, in individual"s where relativeJ.y high J.oads on the
condyLes would resul-t, In the future, this could be f urt.her
explored using the nurnerica l- model-.
The existence of compensatory relatÍonships rnay also
help to explain orthodontic relapse subsequent to treatment
to "improve" form. Such improvements/ as they are regarded./
generally mean changes in form t,o meet conventional
orthodontic concepts of ídeal occl-usion and facÍat balance.
These ideaLs are J.argeIy based on derived systems of
reference, Changes in form to meet these concepts may not
comply r{ith the functionaL demands of the dentoskelelal

r22
unit, A!ùareness of this is a lreatnent imperative.
Proportional- relatÍonships between the functional anatomic
components of the masticatory system are evident through
this work. Changes in for¡n whÍch violate these functionaL
rel-ationships may compromise and/or damage the underlyíng
heal-lh of the chewing apparatus. The use of orthodontic and
orthognathÍc surgÍcal procedures to make gross changes to
the dentoskeletal reLations in order to ,,improve"
denLoskeLetal and facial harmony and bal_ance/ is put j-nto a
new perspective by the results presented in this thesis,

TfI Planes of Reference

The findings from this investigation cal"l Ínto questÍon
the use of conventionally derived planes of reference. It
seems that popular reference pl-anes such as SN and FH/ may
not be universaJ. 1y appropriate to the assessment of
dentoskelelal- and facial_ form, In terms of the functional_
mechanical anaJ-ysis of the components of the dentoskeletal
system involved in isometric biting at Ieast, the use of
such traditional planes of reference is in fact misleading,
The two groups of eight indÍviduaIs, represented two
distinctly different morphotogical types, the "Iong-face
syndrome " or do L icofacia l type, and the ,' short-f ace
syndrome" or brachyfacial type, According to both clinical
judgement and cephalometric measurements (LAFH/TÀFH/ SNMPA,

and FHMPA), the two groups demonstrated extreme differences

in dentoskeletal_ and facial form.
Through a functLonal analysis of the ¡nechanics of the
anat,omic components invol-ved in vertj.caf isometric biting,
the mastícatory systems of the c1ÍnÍcal sample were not
found to be extremely different. ThÍs functíona1 analysis
dÍd not support the dÍvision of the clinical_ sample Ínto two
distinct faciaL type groups. Despite the given dentofacial
form as assessed clinÍcally and as interpreted relative to
SN or FH reference planes, it seems that the functional
reLationships within an indívidual system were such that
adequate mechanical functÍon coul-d be possible. The
reciprocal Ínfluences of form on function and function on
form, may thus dÍrect the growth and development of the
masticatory apparatus in a manner that would optimize the
mechanical- reLationships required for essential functÍons,
wi thin the genetÍ c dictates governi ng form, The
characteristic dentoskeletal patterns observed in certaj-n
f acj-al- types thus may demonstrate important compensatory
relationships. These rel_ationships may have devetoped
through the inf l-uence of functional demands imposed on a
bas ic, inheri ted morpho l ogi ca 1 pa ttern. These
reLationships, which are Ímportant to the mechanical aspects
of function should not be expected to have direc! or special
relevance to such pLanes of reference as SN or FH,
In the anaJ.ysis of the functional- reÌa!ionships of a
given masticatory systen for any morphological "f acj.a1
type," important information is to be gained through the use
of a pJ.ane of reference which Ís relevant to the function of
that system. The occlusal- plane for exarnple, should have
more functionaL reLevance to the chewing apparatus than FH

124
 or SN, If the reciprocal influences of form and function
are to be recognized and respected in the treatment of
dentofacial disharmony or "abnormalitÍes,', functional as
wel.I as morphological relationshÍps must be appropriately
assessed and addressed in all phases of treatment. This
thesis contends that the SN and FH planes of reference are
not appropriate to the assessnent of the functional occlusal
relationships which characterize a given system,
Dentofacial form that is judged to be ,'abnormal, " may
constitute a real and val-id concern from a number of
perspectives, Orthodontic standards regarding,,normaI,' and
"abnornal" dentofacial form are l-inked to societal standards
and personal- tastes. Facial- form and esthetics are known to
influence sociaL behaviour and interactions (Macgregor,
1970; Lansdown, 198J-; Kiyak et CI., 1986), In alnost aII
forms of communícation rnedia, the association of facial form
with personality and behavioural characteristics finds
prominent, use. As welI, there are strong functional
impJ-ications associated with facial_ form and esthetics from
the personal, societal., and dental standpoints,
Achieving more ,'normaL,, dentofacial refationships, is
generalJ-y the primary goaJ- for those indÍviduaLs exhíbitÍng
"abnormal- " dentofacial form, who seek treatment and/or for
whom treatment Ís advocaLed. Because of the suspected close

rel-ationship bet\,¡een form and function, those patÍents with

"abnormal" form are often assurned to function "abnormal-fy"
as wefl. It is felt lhat by attaining more "normal" " forn,
Ímprovements to functÍon wiIl tend to follow. In cases
where rna jor morphoJ.ogic changes are to be made through
orthodontics, with or without orthognathic surgeryf it seems
imperative that functionaL considerations as well as
esthetic considerations be addressed, The study of the
functional aspects of an Índividual masticatory systen
shou]-d be a separate and conscientious effort, fts purpose
shoui.d be to achieve functional_ Ímprovements through
treatment, or at l-east to ensure that function is not
cornpromised by treatment to improve the dentofacial
esthetics. Both the pre-treatment and the potential post-
treatment situation with respect to function, must be
carefuL ly as sessed.
The numerical model provÍdes one means of evaluating
the mechanicaL aspects of functÍon for conditions of
ísometric biting, using a functionally relevant reference
p1ane, This Ís in contrast to the more traditionaL
assessments of dentofacial_ form which are made relative to
FH, SN¡ and other reference planes. This model provides an
opportunity to evaluate form with respect to function usíng
occlusal- plane as the reference pJ-ane. CritÍcism regarding
the difficulty in defining, and the error associated with
locating occfusal plane (as discussed in Chapters J_ and 3)
has been commonly voiced. DespiLe thÍs however, the
occlusal pJ.ane seems a far superior reference from which to
assess the mechanics of the functional- masticatory ability
existÍng, and conseguent to changes in forn.
 Mange of Variation
For the sample overal-1, the ranges of variation were
not outstanding for t,he various anatomical_ parameters
measured relative to occl-usal pIane. It Ís worth noting
however, that for alL paranêters, the ranges of variation
observed for the long/steep group were greater than the
ranges of variation observed for the short/f l-at group. This
is in agreement with the literature, which purports that
certain features of facial morphology vary less in persons
of the short/flat facial type due to the relatively stronger
muscufature found in these people (IngervaLl and HeJ.kimo,
1978). It is therefore implied that brachyfacial types
demonstrate a greater effect of function on form.

V Sexual DÌmorphisn
As mentioned in Chapter 4, sexuaJ_ dimorphism was not
demonstrated in any of the parameters quantified by
cephal-ometric rneasurements or by geornetric relationships
relative to occlusaL pl-ane, Since t,he geometric relations
were not gender-specific, it foLLowed that the model
predictions were not gender-specific either. It seems that,
despite the differences in gross size of anatonicaL parts,
and muscufar strength generalLy associated with gender, the
proportÍonaJ. relationships of the dentofaciaf systems
studied did not show trends associated with gender.

1.27
 CTIÄPTER 6 CONCLUSIONS ÀND SUGGESTIONS FOR FUTURE WORK

I Concfusions
The functional importance of conventional_ facial typíng
has been investigated. The rnechanics of the human
masticatory systems characterizing two very different facial
types were analyzed using a three-dinensional numerical
modeL, The geometric anatomic rel-ationshÍps relevant to
isometric biting in eight dolicofacial (LFS) patients and
eight brachyfaciaJ- (SFS) patients were thus conpared. As a
result of this work,, the f ol J-owing conclusions have been
made 3

1. The conventionally defined facial types investigated

were found to be surprisíngly simiLar in terms of
predÍcted functional- mechanics for the isometric bite
situation. Furthermore, Ín terms of the geometric
anatomic reLationships representing their masticatory
systems,the two facial types \^¡ere found to be very
s imi lar .

The Frankfort horizonta 1 and the Sel1a-Nasion

reference p anes , commonly used to distinguish f acÍa l-
J-
types, do not have direct relevance to masticatory
function.

3, The occLusal plane is a reference pLane better suited

to a functionaJ- analysis of the chewing apparatus,

4. Three-dimensional data representing the geometric

anatomicaf re l ationships of the masticatory system,
can be obtained for mechanical analysis f rorn
c l inica l- subjects,
 II lmprovements to the Cephalornetric Technique for
Three-Di-mensional- Data Collection
The conventional applica!Íons of cephalometric
radíography to orthodontics have been generally discussed in
Chapter 1, Presentl-y, most commonl_y used cephal_ometric
analyses are based almost exclusi_veIy on lateral
cephalometric radiographs. One of the important uses of the
cêphalometríc technigue as it l^ras first advocated by
Broadbent (1931) however, was to obtain t,hreê-dimensional
measurements of dentoskel_etaI rel-ationships fron
standardized radiographs taken from both l_ateral- and
posteroanterior views. ReIiabfe, three-dimensional,
anat.omical- measurements made of c1Ínicaf subjects would be
extremely desirable for mechanical analysÍs using the
Mclachlan-Smith numerical- modeL. This has been attempted,
Some of the errors and problems associated with the use of
conventional cephalometric radiographs to obtaÍn the desired
three-dimensíonaI geometric anatomic data for use in the
model, have been dÍscussed in Chapter 3¡ section IV-2,
Additional- suggestÍons for improvements to the radiographic
method are now offered.
The numericaL rnodeL shows that the mechanics of the
masticatory syslem are sensitive to changes in certain
parameters. In particular, the model predictions are
affected by changes Ín arch length, condylar height, and the
l-ateral-view masseter muscle vector-to-occ usa I plane angIe.
J-

With these sensitivities in mind, in the future, steps may

be taken to minimize the measurement errors associated wit,h

I29
these parameters,
The future investigator could benefit greatl-y by having
the opportunÍty to examine the subject cfinical-ly, prior to
x-ray exposure for the cephalometric radiographs. Radio-
opague markers could be temporarily attached to the teeth in
a manner that did not interfere with the occlusion or lip
posture. These markers wouLd help to more accurateÌy focate
the positions of the teeth, and thus improve the rêf iabil_ity
of the arch Iength measurements and locatÍon of the occl_usal
p.lane. Direct measurement of relative tooth positions Ín
the mouth or f rorn accurate study modeLs could be an
additional help to verify relative tooth positions measured
radiographica11y ,

Through the clinical examination, the investigator

could also determÍne the approximate height of the
condyles. Pal-pation in the area l-ateral to the condyle,
whi l-e the subject moved the jaw through a Limited range of
opening and cJ-osing, and side-to-side movements, would help
to locate the area of the face external_ to the condyle.
This area could then be marked temporariJ.y with a radio-
opaque narker, and Iater used as a guide to the location of
the condylar head on the radiograph.
The superficial masseter muscl-e and perhaps the
tenporalis muscle also, could be palpated during the
cl-inical examination. The focation of the musc.Le centroids
and the directíon of muscle pull for the isometric bite
situation couLd thus be clinically assessed. Radio-opaque

130
markers attached to the skÍn couLd serve adjunctively as
guides to the Location of muscle centroids and the
direction of muscle puJ. 1.
The radio-opaque imaging parameters usêd to obtain the
cephalonetric radiographs could be improved in future.
These parameters could be adjusted more specifically for the
improved visibility of the anatomical part of ínterest. The
condy.l-es, for exampl-e, are not always clearly seen in
cl-ÍnÍcal cephaJ.ometric radiographs. Such improvements to
the radiographic image definition can be achieved wit,h very
smal- I changes in the radiation exposure to the subject

(Hatcher, 1987).
A f inal- suggestíon with respect to further improvements
to the cephalometric technique, regards additional testing
to better verify the accuracy of this technique,
Osteological- specimens should be radiographed with and
without radio-opaque markers for tracing by the sane
operator, The accuracy of the measurements determined fron
the unmarked specimens compared to the marked specimens
would give a further indication as to the degree of accuracy
expected for this aspect of the technique. Appropriate
steps should of course be taken to avoid operator bias in
such tracÍngs. This coutd be accomplished by having the
operator trace a number of unidentifíed, inarked and unmarked
radiographs, not alJ- of which would be matched pairs.

III Establishment of Critical proportional Re1atíonships

The resul-ts of prelirninary studies with the numerical

131
modeÌ have suggested that the mechanics of the masticatory
system may be morê sensitÍve to variations in certain
anatomÍc reLatíons and proportions than others. The
relationships believed to be critÍcaI, such as that of arch
length to condyJ-ar height and intercondyl-ar widthf and the
lateraL-view angul-ation of the masseter muscle to occlusal
pl-ane, should be more fully tested in the nodeL. The exact
naturê and rnagnitude of these critical- reLations and
proportions should be determined in the future,
The resuÌts reported in this thesis coul-d serve as a
guide to such future work. Cl-ues as to the anatomical
rel-ationships nost important to the nodel may be found by
examining and comparing the results of the anatomical_ versus
the modef anaJ.yses for the individual-s in the clinical
sample. For instance, out of the entire clinícaL sampLe,
the predicted condylar Load was the highest for patient K.M.
for the condítions surveyed, for all bite force positions
except the most posterior. Linear regression analyses
indicated that the predictions pertaining to patient K.M.
belonged with those of the group assessed, but represented
the extreme within this group. fnvestigation Ínto how
patient K,M. differed from the rest of the clinÍcal_ sampJ"e
in terms of anatomÍc parameters and proportions should
firstly be performed, These differences coul-d then be
tested in the model to see which might account for lhe
predictions of higher condylar loads,
Às weJ"1, t,he effecls of breadth parameters on the

t32
mechanics of the masticatory system for the conditions of
non-vertical bÍting, should be expJ.ored with respect to
f acial- types. The widths of the face, jaws, and dental

arches are alf features characterized by definitions of

facial type. The focus of orthodontic treatment and
diagnosis, however, especÍally as it pertains to the use of
cephalometrics, has J.argeIy ernphasized dentoskeletal-
characteristics eval-uated in the lateraf vier,r. Breadth
considerations j-n the anatomic components of the masticatory
system were not emphasízed in this study since the biting
conditions investigated were restricted to vertical bíting
forces applied at a centred, anterior position in the dental
arch .

IV FuÌther Development of the Numerical l{ode1 as a Clinical

Tool
Steps to further deveJ.op the numerj-ca1 model as a
clinical tool are already underway, preJ_iminary EMc
experiments have been carried out with regards to validat.ion
of the nodel- (McLachJ.an, 1987). As we1.l , work towards
modifications to accommodate motion studies are currentl-y
being undertaken,
It is expected that verification and devel-opment of the
model through objective clinical testing, based on sound
theoreticaJ. hypotheses, will substantially enhance the
fundamental understanding of the mechanics of the
masticatory system, Functionaf considerations wíth respect
to the chewing apparatus could thus be more conscientiously
addressed in the development of cl_inical treatment plans for

133
orthodonticf orthognathic surgical, prosthodontic, and
temporomandibular joint dysfunctÍon cases.
The verified model- will provide a means for an e priorÍ
evaluatÍon of any treatment, which resuLts in al-teratj-ons to
the occlusaì- plane, It wiLl, therefore, be significant Ín
particular to the plannÍng and eval_uation of orthodontic,
orthognathic surgical, and prosthodontic procedures. The
abÍlity to eval-uatê the effects of changes to the occlusal
pLane on the mechanics of the masticatory systemf should
aflow a nore prevention oriented approach to trealment,
paying due regard to the possible long term effects of the
treatment on temporomandibuL ar Joint integrity, occlusion,
and esthetÍcs.
The numerica.L mode.I could/ j_n future, also serve as a
useful research tool for clinical_ investigation into
temporomandibu l ar joint function. Approporiate treatment
may be morê accurately apptied, as a result, to diagnosed
cases of temporomandibul ar joint dysfunction. For exarnple,
the mechanical- effects of occlusal splint therapy could be
ascertained. That is, knowledge gained from the model as to
the pattern of muscfe accommodation to occl-usal- splints,
would enhance the understanding of the effects of mandibular
repositÍoning splints in cornparison to rel_axation splints.
It is hoped that objectives for occl-usaI f unct,ion,
optimally suited to the faciaf form of each patient, will be
ul-timately identified through future research. The goa1,
more specificalJ.y, is to achieve an improved understanding

t34
of the relationships between skeletal rnorphology, the
muscl-es of nastication, and patterns of functional tooth
contact, In this way, the numerical_ model could not only
provide an improved theoretical basis for the planning,
delivery, and evaluation of ctinical dent,al- care, but also
could establish a means of objective testing of clinical
procedures.

135
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L46
Snith D.M., Mcl,achlan K.R.¡ Mccal1 W.D, (1986) À numerical
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So1ow, B.; Siersbaek-Niel-sen, S.; Greve, E. (1994) Airway
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Am. J. Orthod. 862214-223.
SoJ-ow, B.; TaJ. Lgren, A. (1,977) Dentoalveolar morphology
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Stabrun A.E.; DanieJ-son, K. (1982) precÍsíon in

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1"47
Tirk, T.M. (f948) A study of the growth of the head by
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148
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r-49
 .A.PPENDTX .4,

In the interests of clarity and brevity, Chapters L and

2 of this thesis (Introduction and L.,iterature Reviev¡), are
restrÍcted t.o topics directly rel-ated to concepts of faciaf
form and masticatory function. However, the application of
craniometric techniques to clinical orthodontics and
dentistry, has its origins in a complex of disciplines
re.Iated to human form. The purpose of the following
appendix is to provide more details as to how
classifications of facÍal type have come about.
The unique features of human form have tong been of
interest. Historicall-y/ attention to human form has
focussed primarily on visually observed morphoJ.ogical
simÍlarities and dífferences. This approach has Ied to the
description of distinct morphological- patterns, Repeated
reference to such distinctions and the weaLth of evÍdence
presumed to support them, has resulted in more formal-
categorÍzations of body types and facial types. The
resu l tant systems of classification and as sociated
termÍnoLogy have been adopted for cl-inicaJ. use, and further
deveJ-oped through this appl ication.
Part I of this review illuslrates the significance of
the historical development of human observations to the
theories pertainíng to human form and function, part II
deaLs with the establ-ishment of the currently accepted
facial tl¡pe classifications in orthodontics and dentistry.

150
I CI,]\SSIrICÀTION OF HUMAN TOru,{
l. Body Types
The classificatÍon of human form has been an important
method of appraisaL for centuries. Cl-assífications have
been applied for the purposes of identification,
communication, correlation, and prediction, Throughout
history, human physigue has been tínked to personality
patterns, susceptibility to disease, and physiotogicaì.
constitution (Lindegâ-rd, 1953). physical characteristics
impart a very strong bias in the assessment of personal
qualities and abitity (Tweed, 1953; Macgregor, I970¡
Willmar, J"974¡ Stricker et sI.t 1979; Lansdown, L98l_).
Strong implications that the "disease fÍts the patíentr',
have thus prevailed throughout the nedicaL and dental_
literature (Draper, 1935 ).
General human body form is often acknowledged Ín
orthodontics as part of the diagnostíc evaluation of a
patient, å, nunber of different cl-assification systems used
t,o distinguish human body buil-ds have been based on
anatomical and physiological characteristics. Three
extreme variants of general human body form have usually
been differentiated: sl-ender, corpul-ent, and stocky
(Lindegärd, 1953). One commonly used cfassificatíon system
comes from the work of Shel-don and assocíates (1940). In
thÍs system¿ the body has been assessed for type of
deve.I opment as fo f L ows:
Ectomorphy - a physique characterized by linearity
and deLicacy of structure with presence
of quantitatively ectodermal ly derived

l- 51
 tissues: the nervous !issue t]æe.
Endomorphy - a physíque with quantitativel_y endoder-
maIly derived tissues! soft roundness,
and a tendency to obesity,
Mesomorphy - a physique characterized by quantita-
tively mesodermally derived tissues !
well-developed bones, muscJ.es and con-
nective tissues.

2, CraniofaciaL Features Rêlated to Body Type

The rel-ationship between the shape of the human body
and the shape of the head and face has long been a mattêr of
interest and conjecture (BjOrk, 1955t Salzmann, 1966).
Formal investigatÍon of the observed associatÍon between
body build and the shape of the skufl and dentof acial_
structures, has been atte¡npted in hopes of dernonstrating
orthodontic prognosticative value Ín the assessment of body
build. Most of these studies have involved the making of
large numbers of measurements of various body parts, and
subsequently looking for correlations between these
measurements. Certain dentofaciaf characteristic have been
linked to sturdiness of the skuIJ., for example. Individuals
of extrernely sturdy buil-d are said to have larger, broader
heads (Lindegâ-rd. 1953)/ as well as larger tooth sizes,
earlj-er tooth eruption, and better response to orthodontic
therapy due to better growth (Björk, 1955).

3. Craniometry
HistoricaL ly, the recognition of head shapes has aided
the study of species evolution and of ethnicity in man,
Craniometry involves the int,egxat.ion of observations and

L52
measurements in the analysis of cranial- form. Various
prehistoric and modern peoples have been distÍnguished using
the cephal-ic index (Kraus et al-., 1959), the ratÍo of the
maximum breadth to the maximum height of the cranium. Human
averages range from seventy to ninety percent (Kelso/ 1970).
A low cephal-Íc index implies a rel-atively 1ong, narrow head,
a condition defined as dolicocephalia, where the cephalic
index eguals 75.9 percent or less (DorIand, I974), A high
cephalic index on the other hand, irnplies a short, broad
head, defined as brachycephalia, where the cephalic index
is 81,0 percent or over (Dor1and, I974).
Certain popul ations exhibit consistent cepha 1i c
indices. Whether or not brachycephal-Íc or dolicocephalic
characteristics are ínherited traits hordever, is not easy to
determine (Kraus et al-. 1-959).

r I F.A,CTÀI }IORPHOLOGY IN ORTHODONTICS

EarIv Observations of FacíaÌ MorphoÌoqy

L.
InfÌuenced by the cranÍometric studies of anthropology,
orthodontists and others have studied the patterns of
associatj-on between the head, the face, and the teeth. The
resul-ts of many investigations have consistentl-y shown
large variations within the populations evaLuated. Despite
thisf the estabÌishment of a range of normal variat.ion for
human dentofacial- relationships has been actively pursued.
An understanding of I'normaf r¡ has been assumed to be of value
to the diagnosis, treatment planning, and treatment
prognosis of craniofacial and dental discrepancies,

153
 The changes in the teeth, from the anthropoids to
modern man, show progressive refinement, The contemporary
human races are supposed to reffect this trend as weIl, from
the "primiLive" .Australian aboriginal peoples, to the "nost
refined" European peoples (Downs, 1938). The concept of
"domestication" affecting the facÍal skel-eton and dentitions
of man was thus put forth (Downs, J.938; Björk/ 1951), and
was thought to be demonstrable ontogenetica 1 J-y in animals,
as wel- l- as in t.he evolution of ¡nan f rom ',primitive', to more
"cÍvi1ized" modes of L ife.
Various factors are bel-Íeved to govern the growth and
development of the denture, and hence aLso influence facial-
grov,¡th. Downs (1938) suggested a relationship between form
and functÍon, such that denture and f acial- forms were
related to the stimul-ation of tissues by forces delivered
through the teeth. He proposed that in ',norma1 occlusionr,'
a "c1ose and consistent correl-ation between arch form, tooth
form, and facial forn and cephaJ-ic index', should exist, On
the other hand, optimum correlations were possible only if
the occlusion was norma]- / because onLy then, when the teeth
were in a "correct" relationship, being used in ,,correct,"
functÍoning movements, could stimulation be completely
ef ficient.

A number of dentofaciaf correlations to cephalic index

supported Downs' beLiefs, For instance, dolicocephalic
people with a J.ow cephaJ-ic index, tend to possess tapering
tooth and arch forms, whil-e brachycephaJ.ic people, with a
high cephalic index, tend to possess square tooth and arch

154
forrns. Downs suggested that the inclined ptanes of the
teeth were the dominating guides during the chewing stroke,
The tendency towards more tapered teeth, and therefore more
sharply inc.Iined pl-anes/ in the dolicocephalic ÍndividuaL
would necessitate a more vertical- chewing stroke than the
brachycephalic individual. DeJ- Ívery of such vertical

stresses to the bone by the teeth, would increase

stimulation of vertical growth and decrease stimul-ation of
Lateral- growth. Conversely, more square-type teeth would
encourage the maximal width developmen! of Lhe face and the
denture .

Downs (1938) aLso pointed out that the relative

positions of the muscLe origins and their direction of pu11
were normafly closely correlated to cephal-ic index, and were
another factor in determining arch form, The "sensitivity
of the craniofacial complex', to changes in functíon was
emphasÍzed. How such funct.ional- influences, governed
primarily by diet, affect the skeleton has been shown in the
Eskimo (Downs, 1938; HyIander, 1972).
It ís commonly accepted that muscle traction exerts a
considerable inf l-uence on bony structures. In thê early
evoLutionary stages, it is bel-ieved that huge muscle forces
were acting on the cranial- bones. causing massive
excre s c en ce s at their insertions. The observed
morphoJ.ogical differences are at Least partly attributed to
the functional reguirements governed by the diet (Davis,
J-964; Hiiemåe, 1967; DuBruJ. I L972 and 1.979; Noble, 1979;

155
FunakoshÍ, I980). Bony vestÍges resu.ItÍng from muscle
activity have been identified as being present in recent
human skul-1s, especially Ín the nuchal, temporal, and gonia]
regions (Jensen and PaLIing, 1954). ALthough general ly much
reduced in modern man, theÍr reLative prominence is bel-ieved
to reflect Índividual diet and function, hence, they have
been used by researchers to gain an impression of the amount
of ¡nusc.Ie mass which the individual possessed.

2. Theories of EvolutÍon and Growth of the Human Face

EvolutÍonary changes are believed to ref l-ect changes in
function and environnent, The theories of evol-ution and
growth have thus been expected to hel-p in the understandíng
of modern human craniofacial- form,
Since the time of our earliest human ancestor/ the
dentofacial complex has undergone a reduction in size. An
inverse relation between the size of the braín and the size
of the jaws has been postulated (DuBruI and Laskin, J-961).
Tt seems tha! the evoJ-utionary trend of the mandible in
particular, has resulted in its narrowing and ,'weakening,,
(Schumacher | 7972). The gonial angle (where the ramus and
body of the mandible meet) has decreased overal- l- from an
approximately fLat plane in the early repti 1e s to
approximately a right angle in the anthropoids, This has
been interpreted by some (Jensen and paLling, 1954; Noble,
L973) as the effect of an int,ensif ication and
differentiation of the chewing function, Conversel-y, the
relative increase of the angJ.e in the transition from
 anthropoids to man has been explained as a result of a
decrease in muscl-e mass. i^lith bipedaL Locomotion, the
f orel-imbs were freed to devel-op into major feeding
accessories, which greatl-y al-tered the feeding mechanics of
the jaws (DuBruL, I97 2),
The gonial angle may reflect f unctÍonal- demands in
ontogenetic as well as evolutionary senses. Consider it,s
changes with age. The gonial angle at birth is relatively
obtuse, but it shows a significant decrease with age to
adulthood, and general.J.y, an Íncrease in otd age (Hel-lman,
J-927; Jensen and Pal1ing, 1954). This has been attributed
to growth changes assocÍated with the development and
eruption of the dentition early in Iife, and degenerative
changes associatèd with the break-down or loss of the
dentition l-ater on in l-if e. Between birth and two years of
age, the gonial angle is thought to be greatty affected by
functionaf requirements for feeding (Jensen and palling,
1954). The gonial angle increase, l-ate in J-if e, has been
attributed to the effect, of increased masseter muscle pul-l-/
necessitated by the l-oss of the teeth (He11rnan, i.929).
The charactêri zation of facial types often incl-udes the
gonial- angle because of its apparent relationship to skul1
shape. Kieffer found that the gonial angle was
considerably larger in brachycephalic Germans than in
dolicocephalic Itafians and Negroes (Jensen and pai. 1Íng
1954), Many have reported simiLar evidence of a relationship
between facial height, mandibular ramal height, and gonial
angle (Hel1manf L927¡ Draper, J.935; Cleaver 1937; and

r57
Shel-don et al./ 1940), Hrdl-i8ka (1940) however, did not
find any correl-ation between skull type and gonial- angle.
The work of nany Ínvestigators has focussed primarily
on the mandíble with regard to its shape and rel_ative
position (HeLl-nan, 1927; Sicher, !947 i Downs, 1948). Some
have regarded growth of the mandible, especially the
condylar cartilage, as thê main determinant in the
deveJ-opment of the whoLe face (Sicher, L947 ). It has been
suggested that in an individuaÌ of the stocky type,
cartilaginous growth is sJ-ow, and a short but heavy ramus
with a small gonial angle results. The entire facíaL
heÍght is secondarily reduced and the face is thus wide and
short. In the ta11, slender, long-limbed type of person,
the opposite is predicted¡ such that the mandibuLar
characteristics of a J-ong and narrow ramus with an obtuse
gonial angle result, the facial- height is increased, and the
resultant face is narrow and long (Sicher, l-947),
The theories of the evoLution of man have been the
bases for many attempts to explain facial form and the
relative positions of the mandibLe andthe maxi.l- Ìa. The
evolution of the present hominid head form is said to be due
to three main influences acting on the "basic mammal-Ían
arrangement" (DuBruI t 1972 and 1979)3 changes in feeding
mechanics (as previously mentÍoned), plus a larger brain,
and erect bipedaJ. ism.
The enlargement of the cerebrum and the forward
vauLtÍng of the frontal part of the brain case/ has resulted

158
 in an overall shortening of the depth of the face and an
overall- increase in the height of the face (Enlow and
McNamara, 1973). Thê jaws, which Ín most rnammalian groups
1ie chief l-y in front of the eyes, appear to have swung
downward and backward, so that ín the prirnates they are
mostl-y behind and beneath the eyes (Jensen and Pal1ing,
1954; Enlow and McNamara, 1973), In hominids, the jaws are
even Iess promÍnentf and the profile becomes progressively
st,raíghter ín modern man (Björk, 1951-).
Perhaps the most profound influence on the development
of human form has been related to the shift to a vertical,
gait (Jensen and PaIling, L954; Uohl, 1984). This shift in
overal-I posture, demanded a reorganization of all of lhe
muscì-es, and a radical repositioning of the visceral cranium
rel-ative to the neurocranium. A severe bending of the
elongate primitive skull near ils middle, between visceral
and neura.I components, thus occurred (DuBrul , L972), The
craniofaciaL renovations may be summarized, according to
DuBruI (1972 and 1979), as follows:
1) vaulting of the dorsum
2) buckJ.ing up of the craniaL base at sel-l-a turcica
3) downward and forward positÍoning of the nuchal plane
4) forward shift of the foramen magnum and occipítal
condyl e s
5) extreme retrusion of the snoutf with shrinking and
crowding of the jaws
6) deepening of the mandible and outward f J-aring of its
entire fower border.
Attempts have been made to test the theories of
evoLution by simulating the adaptational- influences
experimental ly, DuBrul- and Laskin, in 196L, reported on
their investigations into the preadaptive potentials of the

159
mamma.Iian skull-. By surgically removing the spheno-
occipitaJ- synchondrosis of the cranial- base in rats, they
produced a curvature to the cranial- structures, These were
Ídentical !o some of the classical changes in the skul-l
thought to represent adaptatÍons to an upright posture,
Fanghänef (1972) investigatêd the infÌuence of statics upon
the postnatal developrnent of the skuIl and orofacial- systên
in rats, By surgical- amputation of the front extremíties at
the shoulder, the gro\^¡th adaptations to bipedal posture and
locomotion were studied. Fanghånel reported evidence of a
trend towards "brachycephaLization/" particufarly in the
dimensions of the skuLl- characterizing l-ength.

3.The Establ-ishnent of Criteria for Facial- T¡¡pe

ClassÍfication
tt."at"".a tn the previous sectionf the bending or
""
flexure of the cranial base is a distinguishing feature of
the hominid skul-1. The degree of this f l-exure has been
studied with respect to f acial- morphology (En1ow and
McNanara I L973), and may be linked to other facial
characteristÍcs. In the dolicocephalic type, the craniaf
base is comparatively horizontaL or "openr,' representing
rel-atÍvely litt1e f L exure. In contrast, in the
brachycephal-Íc tl¡pe, the floor of the craniaf base is said
to be more upright or "cLosed," representing a relatively
greater degree of f l-exure. The posi!ions of the
nasomaxil- lary complex and the nandible are thought to be
linked to lhe degree of bending in the cranial floor (Figure

160
À.1). In the dolicocephalic type, the nasomaxillary complex
is Iocated more anteriorly and inferiorly, and the mandibl-e
is more retruded, while in the brachycephalic type, the
nasornaxil lary cornplex is Iocated more posteriorly and
superiorly, and the mandibl-e is more protruded. Simitar
associations between cranial base, f acial-, and dental
relationships have been supported by a number of
investigators (Björk 1951 and 1955; Renfroe, 1948; Moss,
1955; Coben, 1955; Hopkin et a1,, 1968¡ Bishara and
Augspurger, 197 5),
CorreLations between dental and faciaL characteri sti-cs
are widely used as diagnostÍc tools in orthodontics. The
"Tweed Triangfe" (Tweed/ 1954) for example, is a nethod of
assessing dentofaciaL relations as seen in a lateral
cephaLometric radiograph, Such correLations have gained a
sense of irnportance through their frequent use and
widespread app.I ication.
The Tweed Triangle is formed by the Frankfort
horizontal and mandibular planes, and a l-ine passing through
the J-ong axis of the Lower incisor tooth, Certain angular
relationships were found to exist between these planes in
cases of "norma1" occLusion and ',esthetic" facial form, FoÍ
a given Frankfort horizontaL-mandibuLar pÌane angle, a
certain dental- pattern woul-d thus be required to maintain
good f acial- form, Some degree of variation could be
accommodated through compensations in the dentition or
mandibuLar plane inclination (T\,reed, 1-946 and 1-953).
Other commonly used dentofacial correLations concerning

1.6 1
 #Ër\ll

Figure À.i DEGREE OF CRANIAL BASE FLEXURE

L62
vert.ical proportions have been noted (Wylie, 1945¡ Ballard,
1957), These observational studies have been supported by
cl-inical experience, and have firmly establ-ished certain
paramelers as usef ul- cLinical- tool-s, These parameters are
supposed to provide important diagnostic clues to a more
conplête pattern of typical characteristics, and
therapeutic cues j.n terms of expected responses and
achievable lreatment results,

Growth and Development

Many attempts have been made to discern patterns of
faciaL growth and deveLopment in order to rationalize and
predÍct facial types, A great deal of attention has been
paíd to interpreting the effects of mandibular growth on the
development of the face. In what is now considered classic
v¡ork, Björk (1969) used implants and serial radiographs to
study growth changes in chil-dren, He concl-uded that two
types of rotational mandíbufar growth, forward and backward,
coul-d take place. Mahy others have supported this concept
and have described mandibul-ar growlh variations in terms of
forward and backward rotations (Schudy, J.965; Isaacson et
a1., 1971i Tsaacson et ÊI., I97 7 ).
The importance of facial typing accordÍng to growth
patterns and faciaL morphologies has been emphasized in
orthodontics. Presumabl-y, this Ís because orthodontic
probJ-ems could be better deaft wi th through an
identification and understanding of the specifÍc patterns of
growt,h responsible for them.

163
 The terns countercl-ockwise rotatíon and cl-ockwise
rotation have been applied Ín describing faciaL types
(Schudy, 1965). These terms are based on the convent.ionaL
lateral view of the head (norma Iêteral!s), where the
prof il-e faces to the viewer's right. Rotation of the
mandibLe is thought to result from inharmonious vertical and
anteroposterÍor (horizontal) growth of the component parts
of the mandible, The point of rotation of thê mandibLe is
thought to be located at the most distal- mandibul-ar molar
in occ.l"usal contact (Schudy, 1965).
A clockwise rotation of the mandible, is observed when
reLatively more vertical growth in the mol"ar areas than in
t,he condyles has occurred. In extreme cases/ lhis resuLts
in an open bite. A countercfockwise rotation of the
mandible is observed when more condylar growth than verlical-
growth at the molars has occurred. If extreme, a deep or
cLosed bite is the result. Rational-es have been sought to
explain why these extrernely different patterns of nandibul-ar
growth come about. Relationships reflecting compensatory
growth are found between the gonial angle, MPA| and the
angle formed by the occlusal- plane and mandibular plane
(OMÀ), Cases of severe vertical dysplasia, where SNMPA and
OMA are very large, are often accompanied by a severe open

bj-te, a tongue thrust, and mental-Ís muscle strain. It has

been suggested that an ímbalance between condylar growth and
verticaL mol-ar grow-th, results in a large SNMPA/ and a large
gonial angle (Schudy, 1966). The chin point is thus forced
away from the tip of the nose/ putting a functional strain

L64
upon the integumental tissues and the tongue, This
"maffunction" of the soft tÍssues call-s for a compensatory
vertical- growth of the mandibuLar anterior alveol-ar process
in an attempt to rel,ievê the strain. The changes observed
have been ínterpreted as occ.IusaI plane compensations for
"inharmonies of growth" (Schudy, 1965).
Many explanations for the observed patterns of facial-
growth have been descríbed and applied, Those based on
longitudínal data rather than cros s - sectiona.l- data, are felt
to be far superior for the eval-uation of trends in facial
growth (Popovich and Thompson, L977; Bishara and Jakobsen,
198s ) .

165
 ÀPPENDIX B

TABULATED DATA FROM THE CIJINICATJ SÀMPI-,E: COMPARTSON OF

MEASURED .ANATOMTC.A-I, RELATIONSHIPS

Patient Condyle-cA 2n-CA Condyl-e-OP Condyl-e L-R M-T

xxyzġql-e
("*.) (Í,m-.) (r*.) ("*.) (degreeÐ
Long/Steep:
J. B. 88. s 49.s 36.s 50.0 69.0
J,W, 92 .5 46.s 39.0 s0.0 68.0
K.M. 92 .0 44.5 27 .5 44 .0 68.0
P.A. 8s.0 40.5 36.0 42 .5 66.0
D. K. r04. s 45.0 45.0 54.0 63.0
B.P. 84.0 44,0 s0.0 54.0 77.0
J .2. 92 .0 40.0 3s.0 5r.5 62 .0
T. K. 82.s 40.5 33.0 48,0 61,0

Short/Fl-at:
s, E. 86 .5 44 .5 41.5 52 .5 68.0
D,H, 90.5 4L .5 39 .0 52.0 69.0
c. s. 80. 0 45.5 37.0 s6.0 67 .0
T.W. 80 . 5 40.0 37.0 53.0 62.0
L.P. 85.0 4s.0 38.5 49.0 71.0
P.D. 89.0 41.5 43.5 56.0 62 .0
A.r,. 86.5 46 .5 33.5 51.5 68.5
D.M. 76.0 40.0 39 . s 52 .0 55.0

Where: Condyl-e-CA = distance along x-axis from height

of condyle to central anterior
ition
pos

2m-CA = distance along x-axis from second mol-ar

tooth to central- anterior position
Condyl-e-OP = height along y-axis of condyle to
occlusal plane
Condyle L-R = intercondylar distance (z-axis)
M-T Angle = angle between masseter and lemporal"is
muscle vectors in the lateral view

1.6 6