original article

J. Stomat. Occ. Med. (2009) 2: 114–121

DOI 10.1007/s12548-009-0022-z
Printed in Austria
© Springer-Verlag 2009

Importance of vertical dimension and cant of occlusal

plane in craniofacial development
J. I. Kim, S. Akimoto, H. Shinji, S. Sato

Department of Craniofacial Growth and Development Dentistry, Kanagawa Dental College, Japan

Received June 30, 2009; Accepted July 25, 2009

Purpose: In order to examine the relationship between the and malocclusion often develops during this period. The
vertical dimension change and the growth of the maxillo-facial skeletal form of the craniofacial complex at the beginning of
complex in the mixed dentition, we applied a denture frame occlusion development is often categorized as Class II because
analysis including the measures of vertical dental and skeletal the mandible is retruded. Generally, deciduous occlusion is
height, and maxillo-mandibular growth. characterized by the relationship of distal surfaces of the
Materials and methods: The materials used in this study deciduous second molars [3, 13]. In normal growth and
consisted of 225 pair of dental casts in occlusion and serial development, these distal surfaces line up vertically, and
lateral cephalograms of 25 children. We observed their occlu- dental professionals characterize this state as a “Flush Termi-
sion and growth in the initial stage (Stage 1), beginning of nal Plane”.
exchange of the buccal segment (Stage 2), end of exchange Mixed dentition begins when the permanent first molars
of the buccal segment (Stage 3), and final stage (completion erupt. Although normal molar contact in the permanent
of occlusion, Stage 4). dentition is designated as Class I in Angle’s classification, the
Results: Most of the dentition (58%) became Class I molar usual arrangement of the deciduous molars is categorized as
relation before Stage 2 and almost all of the Class II at Stage 2 an equivalent of a Class II relation. During the transition from
remained as Class II occlusion at the final occlusion (Stage 4), deciduous occlusion to the beginning stage of the mixed
indicating rarely available Lee way space for obtaining Class I dentition, the occlusal relationships of the molars change
molar relation. The skeletal Class II group showed a signifi- significantly. The alteration of occlusion in this stage is one
cantly higher eruption of the lower first molar in Stages 2 and 3, of the key points to obtain a proper occlusion in the future.
while Class III skeletal group showed a significantly higher A clear characterization of this dynamic process is, however,
eruption of upper first molars at Stage 4. There were significant lacking.
differences of posterior occlusal plane (POP) in different Previous research shows that, without therapeutic inter-
skeletal frames. vention, the children whose deciduous dentition is character-
Conclusion: The results suggested that the increase in ized by a Flush Terminal Plane will transition into Class I and
vertical dimension and inclination of the POP influence the Class II permanent dentitions with probabilities of 56% and
growth of the mandible in obtaining Class I molar relation and 44%, respectively [2]. For the children in whom the relation-
that improper vertical dimension and inclination of POP are ship of the first molars is Class II at initial occlusion, the
related to the development of skeletal malocclusions. corresponding probabilities are 70% and 30%, respectively [1].
Combining the previous research results, it can be estimated
Keywords: Vertical dimension, occlusal plane, skeletal that approximately 35–45% of the population will develop
frame, growth, lee way space Class II malocclusion in the permanent dentition. Much
research has shown that the retrognathic mandible rather
than the prognathic maxilla is the defining feature of Class II
Introduction
malocclusion [11, 16] and this group of malocclusions often
Considerable occlusal changes take place during the transi- leads to craniomandibular disorders [12, 25]. Class II maloc-
tion phase from deciduous dentition to permanent dentition, clusion presents a substantial risk to oral health, and we
therefore urge dental professionals to recognize the condition
in the earliest stage possible in order to implement early
This research is a part of Jeong Il Kim’s PhD Thesis in Kanagawa Dental
College. Results of this research were once published in the Kanagawa therapeutic interventions.
Shigaku, Volume 41, 2006 issue, in Japanese. Therefore this English Leeway space, the length difference between the decid-
translation issue is a secondary publication with copyright permission uous lateral segment and the permanent lateral segment, has
from Kanagawa Shigaku.
been described as an essential concept that allows for a normal
Correspondence: Sadao Sato DDS, PhD, Department of Craniofacial transition from the Flush Terminal Plane in the deciduous
Growth and Development Dentistry, Division of Orthodontics, Kanagawa
Dental College, 82 Inaokacho, Yokosuka 238-8580, Japan. dentition to a Class I relationship in the permanent dentition
E-mail: satos@kadcnet.ac.jp [14, 15]. The deciduous lateral segment is longer than the

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permanent lateral segment, and this difference is greater in the

lower jaw than in the upper jaw. Therefore, the mesial migra-
tion of lower first molars during the exchange of the lateral
segment produces Class I occlusion. However, if leeway space
is essential for this transition to proceed successfully, then for
those children with cusp-to-cusp occlusion (half Class II), a
Class I occlusion of the permanent dentition can be expected
by the end of the mixed dentition. As a result, these children
spend 4–5 years with Class II malocclusion during most of the
mixed dentition stage.
Clinically, there are many cases in which patients gain
Class I occlusion before the exchange of the lateral segment.
This leaves a question about Class II patients who have a 1.5 mm 1.5 mm
mixed dentition that does not change to Class I occlusion even
after the lateral-segment exchange period has passed. It is
important to know these factors for managing the early occlu-
sal form and for arriving at a proper diagnosis and treatment
plan. Fig. 1: Classification of dental occlusion. Class I occlusion is defined as
that in which mesiobuccal cusp of the upper first molar corresponds to
The changes in the vertical height of dentition and the the buccal groove of the lower first molar and mesial is less than 1.5 mm
occlusal plane during growth and development greatly and distal is also less than 1.5 mm. When the buccal groove of the lower
affect craniomandibular skeleton growth and development first molar was distal or mesial more than 1.5 mm, the classification was
categorized as Classes II and III, respectively
of skeletal malocclusion [17, 18]. When the vertical height of
dentition is not sufficient and when the occlusal plane main-
tains a steep inclination during growth and development,
the lower jaw is forced rearward and Class II occlusion Occlusal changes in molars from collected
develops. Excessive growth in vertical height of dentition dental-cast pairs
and a flat occlusal plane are factors that encourage a protru- Left and right sides of the dental casts were analyzed inde-
sive adaptation of the lower jaw, and Class III occlusion pendently and their occlusion classified as Class I, II, or III
develops. This observation suggests that, in addition to leeway according to Angle’s classification of molar intercuspation.
space, the vertical height of dentition plays an important role Class I occlusion is defined as that in which the mesiobuccal
during the change from Flush Terminal Plane to Class I cusp of the upper first molar corresponds to the buccal groove
occlusion. of the lower first molar and the mesio-distal variation is within
The present research examined the relationship be- 1.5 mm. When the buccal groove of the lower first molar is
tween occlusal changes and the growth of the craniofacial displaced distal or mesial more than 1.5 mm, the molar rela-
complex on the basis of longitudinal growth samples. Results tion is categorized as Class II and Class III, respectively (Fig. 1).
showed that the vertical height of dentition and occlusal
plane change during growth and development are closely
related to the growth of craniofacial components of the Classifying occlusal development stages
skeleton. The protrusive adaptation of the mandible mod- The occlusion development was divided into 4 stages:
ulates the process by which the occlusion transitions from
Class II mixed dentition to Class I permanent occlusion. Our Stage 1: the upper and lower first molars make first occlusal
findings, therefore, raise some questions about the leeway- contact
space hypothesis. Stage 2: lateral-segment exchange has begun
Stage 3: all teeth in the lateral segment from canine to 2nd
premolar have erupted
Materials and methods Stage 4: permanent dentition with 2nd molar fully erupted.
In this study, dental casts and cephalometric radiographs
collected during a 14-year period from 1960 and 1974 at the
Classifying growth patterns from the skeletal
Department of Craniofacial Growth and Development Den-
and occlusal form
tistry (Kanagawa Dental College) were used. Twenty-five
subjects were selected based on the following criteria; 1) a For judging the growth pattern of craniofacial complex, the
series of dental casts that clearly show the occlusion during the Antero-Posterior Dysplasia Indicator APDI [9, 10, 24] was
entire period covering the transition to permanent dentition, used. The APDI measures the facial-plane angle and the angle
2) no orthodontic or prosthetic treatment, and 3) no distur- which is the sum of the AB plane angle and FH-PP. It is the
bance of the dentition and occlusion by oral disease or trauma. index used for evaluating the anteroposterior character of the
Each subject had at least 9 pairs of upper and lower dental craniofacial complex. Skeletal Classes I, II, and III correspond
casts (at about 1-year intervals) and at least 9 cephalometric to APDI readings of 78–84 , <77 , and > 85 , respectively.
radiographs (also at about 1-year intervals). Each cephalo- The occlusal form based on the occlusal relationship of
metric radiograph was traced in the customary way and the molars was classified as follows: Class I, both sides are
lengths and angles were measured to analyze the relationships Class I; Class II, at least one side is Class II; Class III, at least one
of the craniofacial morphology. side is Class III.

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Cephalometric measurements related to craniofacial 3. Measurement of occlusal planes

complex and vertical dimension (Fig. 2) Three different occlusal planes were examined in this study.
The Gnathological Occlusal Plane (GOP) is the plane from the
1. Measurement of vertical dimension edge of the central incisor to the distal buccal cusp of the first
The change of vertical dimension was measured from the mandibular molar. The Anterior Occlusal Plane (AOP) is the
perpendicular height change of the occlusion, which was the plane from the edge of the central incisor to the buccal cusp of
length of the perpendicular line from the center of the mesio- the maxillary second premolar. The Posterior Occlusal Plane
distal width diameter of the upper first molar to the palatal (POP) is the plane from the buccal cusp of the maxillary
plane (PP) and the center of the mesial-distal width diame- second premolar to the cusp of the maxillary first molar.
ter of the lower molar to the mandibular plane (MP). In However, in the case of mixed dentition, the upper second
addition, to quantify the change in skeletal vertical dimension, deciduous molar was substituted for the upper second pre-
the distance from sella turcica (S) to the PP was measured. molar. The angle of each of these occlusal planes was mea-
sured with the FH plane as a reference.
2. Forward growth of maxilla and mandible
The changes in the anteroposterior growth of maxilla and 4. Interrelationship between vertical-height change
mandible were examined by drawing a perpendicular line and mandibular growth
from the lowest point of the fossa pterygopalatina (Ptm) to the The changes in vertical dimension and increment of mandib-
PP and then measuring the distance from there to the most ular forward growth were calculated at each craniofacial
anterior point of the maxilla (A) and to the most anterior point growth stage, to identify any correlation between these
of the mandible (B). variables.

Statistical analysis
Statistical significance of differences between the three classes
of growth changes in the occlusal plane as a function of
craniofacial complex type and occlusal type were tested using
Kruskal–Wallis ANOVA (SPSS, version 18) and the level of
rejecting the null hypothesis was set at 5%. In addition, the
correlation between the increase in vertical dimension and
forward growth of the mandible was assessed by Pearson’s
correlation analysis. The significance of correlation was as-
sessed within 1% level.

Results
Alterations of occlusal relationships of molars
Observation of first-molar occlusion during craniofacial
growth and development in each growth stage showed that
in Stage 1, 46% were in Class II, 52% in Class I, and 2% in
Class III (Fig. 3). In Stage 4, 38% were in Class II, 30% in Class I,
and 32% in Class III.
It was examined how the initial occlusion subsequently
Fig. 2: Cephalometric analysis of the craniofacial morphology, vertical changed (Fig. 3). Many cases of Class I occlusion changed to
dimension, and occlusal planes Class III, then 19% changed to Class II (5 sides), 39% to Class I

Fig. 3: Alterations of molar relation in different stages of occlusion development. Fifty-two percent of the cast sides showed Class I molar relation at
Stage 1 of dental development. Final occlusion (Stage 4) distributed into almost an equal balance of Class I, Class II, Class III, while the Class II molar
relation was predominant. Fate of Class I occlusion at Stage 1 showed that one-fifth of Class I became Class II, while 42% of Class I changed to Class III.
Conclusively, 38% of Class I remained as Class I at Stage 4. Fate of 23% of Class II molar occlusion showed that about one-third of the sides
were Class I occlusion, but majority of Class II occlusion did not change their molar relation even through the period of buccal segment exchange
(Stages 2 and 3), suggesting that the Lee way space does not contribute much to the attainment of Class I molar occlusion

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(10 sides), and 42% changed to Class III (11 sides). In the cases in Class II. The increase at B point was significantly more in the
which were Class II in the initial stage, most of them remained third and final stages in Classes II and III than in Class I.
Class II until the final stage (Stage 4). In the final stage, 61% However, there were no significant differences in the growth of
maintained Class II (14 sides), 22% changed to Class I (5 sides), point A at any stage.
and 17% to Class III (4 sides). The cases which showed
occlusion change from Class II to Class I (8 sides) indicated Vertical dimension increase in the skeletal group
that Class I occlusion was gained before the transition of
deciduous teeth to permanent teeth in the buccal segment S-PP shows the perpendicular height of the maxilla. In the
(Stage 2), suggesting that leeway space was not necessary to dental classification, it did not show any significant difference
establish Class I occlusion. at any stage. In the skeletal classification, there were signifi-
The case which had Class III (1 side) in the initial stage cant changes between Class II group and Class III group before
remained as Class III until Stage 4. the lateral-segment exchange (Stage 2) but not in any other
growth stage. The total vertical dimension (VD) of the upper
and lower first molars and S-PP was not significantly different
Alterations of vertical dimension in dental and skeletal
at any stage in either the occlusal or skeletal classification.
groups
There were no significant changes in the perpendicular Alterations in the occlusal plane (Fig. 6)
growth of upper and lower molars between dental Classes I,
II, and III groups in any growth stage (Fig. 4). On the other In this study, the average changes in the different occlusal
hand, comparing skeletal groups, Class III group in the final planes, AOP, POP, and GOP were analyzed. There was no
stage showed a significant difference in the growth of the significant difference in either AOP or GOP in the dental group
upper first molar, and Class II group in Stages 2 and 3 had or in the skeletal group. In POP, there were no significant
significant growth changes of lower first molars. differences among skeletal Classes I, II, and III at either Stage 1
or 2. However, in the last two stages, there were less significant
changes in the Class III group and more differences in Class II
Anteroposterior growth of maxilla and mandible
group at Stage 4.
Points A and B provided a reference to measure the antero-
posterior growth of the maxilla and the mandible, respectively.
Relationship between increase of vertical dimension
In the dental classification groups, there was no significant
and the forward growth of the mandible
difference in the growth of maxilla and mandible in any class
at any time (Fig. 5). In contrast, there were differences among We calculated correlation coefficients to quantify the relation-
skeletal groups. In the last two developmental stages (Stages 3 ship between three vertical-dimension variables and the for-
and 4), the distance to point B increased more in Class III than ward growth of the mandible (defined as the forward

15.0 15.0
Dental Class I (U6) Skeletal Class I (U6)
Dental Class II Skeletal Class II
Dental Class III Skeletal Class III
10.0 10.0
Increment of dental vertical height (mm)

5.0 5.0

0 0
15.0 15.0
Dental Class I (L6) Skeletal Class I (L6)
Dental Class II Skeletal Class II
Dental Class III Skeletal Class III
10.0 10.0

5.0 5.0

0 0
Stage 1 Stage 2 Stage 3 Stage 4 Stage 1 Stage 2 Stage 3 Stage 4

Fig. 4: Alteration of vertical height of upper and lower 1st molars. In dental classification, there was no significant difference with the increment of
dental height. In the skeletal classification groups, Class II skeletal group showed a significantly higher eruption of lower first molar in Stages 2 and 3,
while the Class III skeletal group showed a significantly higher eruption of the upper first molar in Stage 4

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15.0 15.0
Dental Class I (A) Skeletal Class I (A)
Dental Class II Skeletal Class II
Growth of point A (mm)

Dental Class III Skeletal Class III

10.0 10.0

5.0 5.0

0 0

15.0 15.0
Dental Class I (B) Skeletal Class I (B)
Dental Class II Skeletal Class II
Growth of point B (mm)

Dental Class III Skeletal Class III

10.0 10.0

5.0 5.0

0 0
Stage 1 Stage 2 Stage 3 Stage 4 Stage 1 Stage 2 Stage 3 Stage 4
Fig. 5: Alteration of forward growth of the maxilla (A) and the mandible (B). In groups of dental classification, there was no significant difference in
the forward growth of maxilla and mandible. In the groups of skeletal classification, Class II skeletal group showed significant difference in mandibular
growth (B), while maxillary growth was not significantly different

POP POP
30.0 30.0
Dental Class I Skeletal Class I
Dental Class II Skeletal Class II
Dental Class III Skeletal Class III
25.0 25.0
Posterior occlusal plane (Degree)

20.0 20.0

15.0 15.0

10.0 10.0

0 0
Stage 1 Stage 2 Stage 3 Stage 4 Stage 1 Stage 2 Stage 3 Stage 4
Fig. 6: Alteration of posterior occlusal plane inclination. There were significant differences of posterior occlusal plane in different skeletal frames,
steeper posterior occlusal plane in Class II skeletal and flat posterior occlusal plane in Class III skeletal frame, while there were no significant differences
in AOP and GOP

movement of point B). The three variables were the VDI of Discussion
the upper molars plus S-PP, the VDI of lower first molars, and
total VDI. There were significant correlations between the How the occlusion affects craniofacial growth is a subject of
variables and the mandibular forward growth (Fig. 7). The fundamental interest to researchers in the fields of pedodon-
correlation coefficients were 0.449, 0.267, and 0.503, respec- tics and orthodontics. In particular, the influence of occlusion
tively. on the growth of the mandible is an essential element by which

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complex using a data set of longitudinal growth samples from

R = 0.449 ethnic Japanese subjects.
6.0 P < 0.001 Our research showed that 52% of ethnic Japanese develop
Class I occlusion at Stage 1 when the first molar erupts, 46%
U6-VD increment (mm)

develop Class II, and 2% develop Class III. At an early stage of

4.0 mixed dentition, many sides were changed to Class I occlu-
sion. Then in Stage 4, 30% became Class I, 38% became Class II,
and 32% became Class III dental occlusion (Fig. 3). From
2.0 these results, it is not enough to simply observe the mixed
dentition and manage the anteroposterior skeletal changes
that take place during growth and development. In addition
0.0 to these, vertical dimension and the occlusal plane must be
taken into consideration to understand facial growth. This
means that it is important to understand the mechanism of
–4.0 –2.0 0.0 2.0 4.0 6.0 8.0 10.0 dynamic changes as the occlusion changes from deciduous
Point B increment (mm) to mixed dentition.
Since the proposal of Moyers [13], clinicians generally
10.0 use the terminal plane as the physical reference to charac-
R = 0.267
terize the pattern of deciduous dentition. During normal
P = 0.020
8.0
growth, a flush terminal plane is most often seen, the sec-
ond-most common being the distal-step type, followed by the
L6-VD increment (mm)

mesial-step type. However, a flush terminal plane will be-

6.0
come Class II malocclusion at the initial stage of occlusion
(Stage 1) when the first molar erupts. In fact, Johannsdottir
4.0
et al. [7] described the occlusal changes in children in Ice-
land, who were followed from age 6 to adulthood. Among
2.0 them, 67% of the males and 64% of the females developed
Class I occlusion at 6 years of age. The percentages of males
0.0 and females who developed Class II occlusion were 27% and
31%, respectively.
–2.0 Previous research [2] has also shown that at the initial
–4.0 –2.0 0.0 2.0 4.0 6.0 8.0 10.0
stage of occlusion, when the first molars erupt, 61.6% of
subjects develop Class I occlusion and 34.3% develop Class II.
Point B increment (mm)
Especially in the group that developed a flush terminal
20.0 plane, 56% became Class I and 44% Class II. These findings
R = 0.503 show that it is important to understand the process how the
P < 0.001 occlusal relation changes during the transition stage of the
15.0
Total VD increment (mm)

deciduous to mixed dentition. At the same time, this raises

the question about how the flush terminal plane changes to
10.0 Class I, and Class II occlusion at Stage 1 changes to Class I.
Nance HN pointed out that Leeway space can explain the
mechanism how the deciduous molar’s flush terminal plane
5.0
changes to Class I molar occlusion. The mesial migration of
the first molar during the exchange period of the buccal
0.0 segment accounts for the development of Class I occlusion.
However, there remains a problem with this hypothesis.
If leeway space is the only critical factor that allows a smooth
–5.0
transition from deciduous dentition to Class I permanent
–4.0 –2.0 0.0 2.0 4.0 6.0 8.0 10.0 dentition, then, during normal growth and development, one
Point B increment (mm) may not obtain Class I occlusion until after the lateral-segment
exchange period, meaning that most of the mixed-dentition
Fig. 7: Correlation among the vertical dimension and mandibular
growth. There was strong correlation between the increment of upper period passes in a state of Class II malocclusion. However,
1st molar and the mandibular forward growth (B) with a correlation many clinical cases which showed Class II occlusion in the
coefficient of 0.449, significant at P > 0.000 level. There was strong initial occlusion stage developed Class I occlusion before the
correlation between the increment of total vertical dimension and the
mandibular forward growth (B) with 0.503 of correlation coefficient,
exchange of the lateral segment. The present result shows that
significant at P > 0.000 level 52% already transitioned to Class I occlusion when the first
molars erupt. In addition, approximately 35% of Class II at
we may understand how to control the facial growth and, more Stage 1 transitioned to Class I occlusion before the lateral-
importantly, to prevent malocclusion. In this study, we exam- segment exchange. It is important to determine how these
ined the relationship between the occlusal plane, the vertical individuals transition to Class I occlusion and to determine
dimension of the occlusion, and changes of the craniofacial why some individuals who have Class II occlusion at the

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Fig. 8: Possible mechanisms to develop different malocclusions. The results of this study suggest that the increase of vertical dimension and
inclination of the posterior occlusal plane contribute to the mandibular growth and to obtaining Class I molar relation rather than Lee way space and that
improper vertical dimensions and inclination of posterior occlusal plane are related to the development of skeletal malocclusions

beginning of the mixed dentition do not transition to Class I created. This brings the question about the leeway-space
even after the lateral-segment exchange period. In fact, there is hypothesis by Nance which simply explains that Class I
only a low probability that the ones who are Class II at Stage 2 occlusion develops as a consequence of the anterior–posterior
will transition to Class I by the exchange of the lateral-seg- movement of the first molar.
ment. Most of the Class II occlusion cases in Stage 2 will Hwang et al. [5, 6] reported that there is a significant
remain as Class II in the permanent dentition (Stage 4). This relationship between the inclination of the posterior occlusal
suggests that other important mechanisms exist besides lee- plane and anteroposterior position of the mandible, in which
way space and it is important to manage the occlusion at an the inclination of posterior occlusal plane was closely related
early stage of mixed dentition. with the anteroposterior relationship of the mandible. In
Different skeletal classes, Classes I, II, and III classified addition, Sato [18] reported cases that had an occlusal plane
based on the APDI, showed vertical changes in the upper and of skeletal Class III malocclusion which became flatter by
lower first molars POP. The amount of the eruption of the growth and development, indicating that mandibular protru-
upper first molars after the lateral-segment exchange period sive adaptation is important in the developmental processes of
was significantly more in Class III than in other classes, and the skeletal Class III malocclusion. Kato et al. [8] and Fushima
eruption of the lower first molars before and after lateral- et al. [4] later examined the vertical dimension and inclination
segment exchange in Class II was significantly more than for of occlusal plane of Class II malocclusion cases; the molar’s
other classes (Fig. 4). At the same time, the posterior occlusal vertical dimension was significantly lower and the occlusal
plane in Class III became gradually flatter during craniofacial plane was steeper. In addition, the series of research papers
growth. However, in Class II it became steeper. By combining done by our research group [19–22] showed that vertical
these, eruption of the upper molars resulted in a flat POP. dimension and occlusal plane changes during growth and
Following this, the mandible adjusted itself by protrusive development and adaptation of the mandible toward it are
rotation and consequently developed Class III. Eruption of important elements of craniofacial skeletal growth and the
the lower molars made the occlusal plane steeper, because of cause of developing malocclusions. In addition, it suggests
posterior rotation of the mandible, and then Class II occlusion that the retrognathic mandible such as in Class II malocclu-
develops. It is suggested that the type of occlusion one sion is the result of secondary adaptation of the mandible [23].
develops strongly depends on the vertical dimension and From these reports and the findings of the present study,
occlusal plane changes that take place during growth and it is clear that Classes II and III malocclusions are related to
development. occlusal vertical dimension and inclination of the occlusal
We studied the relationship between the growth of the plane, especially that of posterior part (Fig. 8) [8]. In addition,
vertical dimension of maxilla and mandible and the antero- as shown in this research, these changes start at a considerably
posterior growth of the mandible. As a result, the sum of VDI, early stage of the growth and development. It can be conclud-
vertical increment of maxillary and mandibular first molars, ed that it is important to clinically observe the changes of
and cranial base to palatal plane distance was significantly occlusion and vertical dimension to avoid malocclusion at the
related to the forward growth of the mandible (point B) time when the first molars erupt.
(Fig. 7). This shows that alterations in the vertical dimension
of dentition are closely related to the growth of the mandible
Conclusions
and for establishing Class I occlusion. It is necessary that the
mandible must protrusively adapt after the vertical dimension Results of the present study regarding craniofacial mea-
increases, otherwise an anterior open bite malocclusion is surements including vertical dimension and occlusal plane

120 3/2009 Importance of vertical dimension and cant of occlusal plane
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