ORIGINAL ARTICLE

Cephalometric characteristics of anterior open bite in a

southern Chinese population

Wai-Ming Tsang, BDS, MDS, FRACDS,a Lim-Kwong Cheung, PhD, FDS, FRACDS(OMS),b and
Nabil Samman, MRCS, FDSRCSb
Hong Kong

The cephalometric characteristics of skeletal anterior open bite (AOB) in a southern Chinese
population were evaluated in a group of 104 subjects with AOB and were compared with a control
group of 40 subjects without AOB. The anteroposterior jaw relationship in the AOB group was
Class I in 43%, Class II in 14%, and Class III in 43%. Cephalometric analysis of all subjects was
completed by using 24 skeletal and 12 dentoalveolar measurements. Sexually dimorphic variables
were identified and compared separately between groups with independent t tests. Two levels of
significance were used, P # 0.05 and P # 0.001. Sexual dimorphism of cephalometric variables
was present in both the test and the control groups, but affected more variables in the test group.
Significant findings in AOB were shorter anterior cranial base, upward and forward rotation of the
maxilla, increased gonial and mandibular plane angles, increased upper posterior dental height, and
increased lower anterior facial height. These findings generally coincided with those for white
subjects, however, there was no conclusive evidence in this study regarding the contribution of the
upper anterior facial height or the posterior facial height to the AOB deformity. (Am J Orthod
Dentofacial Orthop 1998;113:165-72.)

In the majority of cases, anterior open bite

(AOB) is a developmental abnormality caused by a
ropean descent except one study of North American
black subjects.10 There are no data yet on the
combination of dental and skeletal factors. These skeletal characteristics of AOB in the Chinese race.
patients exhibit a typical appearance with a long The aim of this study is to identify the cephalo-
ovoid face and increased lower facial third propor- metric features of AOB in a southern Chinese
tion.1-3 The alar base is often narrow and the lips are population and highlight the measurements that
incompetent with increased upper incisor exposure. characterize AOB when compared with a control
In profile, the nose is usually prominent but with group without AOB.
mild paranasal depression. The lower lip may be
everted or attempting to achieve lip competence by MATERIAL AND METHODS
straining the mentalis muscle. The chin is commonly The subjects in this study were chosen from more than
retruded with a high mandibular plane angle. These 800 patients who presented to the Department of Oral
classical facial features may alternatively be classi- and Maxillofacial Surgery, University of Hong Kong, for
fied as long-face syndrome with open bite.4 treatment of dentofacial deformity. The test group was
Many authors attempted to categorize the skel- comprised of 104 southern Chinese subjects with anterior
etal characteristics of AOB by cephalometric meth- open bite, 45 males and 59 females, with an age range of
ods.5-9 In contrast to the well-known soft tissue 14 to 35 years (mean 23 years). They were selected from
features, the skeletal features varied between stud- the pretreatment cephalometric radiographs where the
ies and were sometimes contradictory. The subject upper and lower incisors did not overlap vertically for at
sample of most studies were white subjects of Eu- least 1 mm when measured perpendicularly to the Frank-
fort horizontal plane. Of the 104 AOB subjects in the test
This study is based on part of the Dr. Tsang’s supervised master degree group, the jaw relationship in the horizontal plane was
dissertation awarded by the University of Hong Kong. Class I in 45 subjects (43%), Class II in 14 subjects (14%),
From the Department of Oral and Maxillofacial Surgery, University of
Hong Kong.
and Class III in 45 subjects (43%).
a
Postgraduate student. The control group was comprised of 40 normal sub-
b
Associate Professor. jects, 20 males and 20 females, with an age range of 16 to
Reprint requests to: Dr. N. Samman, Department of Oral and Maxillofa- 38 years (mean 24 years), who were clinically determined
cial Surgery, University of Hong Kong, Prince Philip Dental Hospital, 34
Hospital Rd., Hong Kong. E-mail: nsamman@hkucc.hku.hk
as having a normal profile and a Class I occlusion with 2
Copyright © 1998 by the American Association of Orthodontists. to 4 mm of overbite. The cephalometric radiographs of
0889-5406/98/$5.00 1 0 8/1/79615 the test and control groups in this study were traced

165
166 Tsang, Cheung, and Samman American Journal of Orthodontics and Dentofacial Orthopedics
February 1998

Fig. 2. Linear measurements of dentoalveolar land-

Fig. 1. Linear measurements of skeletal landmarks. marks.

manually. To minimize the error of the method, the were sexually dimorphic, and 10 of these at the level of
measurements were taken twice and the average reading P # 0.001. The nonsexually dimorphic variables with
recorded. Skeletal and dental landmarks used in the study significant difference between the test and control
are detailed in Appendix 1. groups totaled 24 measurements at P # 0.05 and 17 at
In total, 24 skeletal and 12 dentoalveolar features
P # 0.001 and are shown in Table VII. The sexually
were measured. The measurements adopted in this study
are illustrated in Figs. 1 to 4, and defined in Tables I to IV.
dimorphic variables with significant difference between
The cephalometric relations analyzed are shown in Table the test and control groups in male subjects totaled 5
V. Sexual dimorphism for the test and control groups was measurements at P # 0.05 and 2 at P # 0.001 (Table
investigated by independent t tests between the variables VIII). In female subjects, the equivalent findings were
of the male and female subjects in both groups. For the 4 and 2, respectively (Table IX). Tables VII, VIII, and
sexually dimorphic variables, male and female subjects of IX also include the absolute values of the cephalomet-
the test group were compared with male and female ric measurements. Table X highlights some measure-
subjects of control group, respectively. The nonsexually ments from AOB subjects in this study for comparison
dimorphic variables were pooled together in each group with results of other populations.
for comparison between the test and control groups. Two
levels of significance were used, P # 0.05 and P # 0.001. DISCUSSION
The Chinese are a mixture of five major and
RESULTS many small races, altogether forming more than one
Variables exhibiting sexual dimorphism for each fifth of the world’s population. Despite this large
level of significance are identified with an asterisk in population and variation in races, there are few
Table VI. In the control group, 12 cephalometric studies on the cephalometric norms of mainland
measurements exhibited significantly different val- Chinese,11 as the majority of studies are applied to
ues between male and female subjects at the level of overseas Chinese subjects.12-17 The facial profile of a
P # 0.05, but only 5 of these at P # 0.001. northern Chinese person can be very different from
In the test group of AOB subjects, 22 variables a southern Chinese person, and overseas Chinese
American Journal of Orthodontics and Dentofacial Orthopedics Tsang, Cheung, and Samman 167
Volume 113, No. 2

Fig. 3. Angular measurements of skeletal landmarks.

may be mixed with local races to form another

Fig. 4. Angular measurements of dentoalveolar land-
variation. Cephalometric norms for the southern marks.
Chinese population are thought to be useful for
providing orthodontic and surgical treatment both
for the local population and many overseas Chinese Table I. Linear measurements of skeletal landmarks
of Cantonese descent, however, only two studies are Name Code Definition
available: one on children of 12 years of age18 and
Anterior cranial base S-N The distance between sella and
the other on young adults.19 Although the control
nasion.
group of this study consists of only 40 patients with Posterior cranial base S-AR The distance between sella and
a normal facial profile and Class I occlusion, it articulare.
Lower posterior facial LPFH The distance between
nevertheless forms a valuable baseline for the local
height articulare and gonion.
population and is essential for comparison with a Posterior facial height PFH The distance between sella and
test group of dentofacial deformity. The values of gonion.
Upper posterior facial UPFH The distance between
the norms derived from this study were found highly
height ethmoidal registration point
compatible with those of Chan,19 and this forms a and posterior nasal spine.
stronger confirmation of the validity of this data as Anterior facial height AFH The distance between nasion
and menton.
representative of the craniofacial characteristics of
Upper anterior facial UAFH The distance between nasion
the southern Chinese population. One possible height and anterior nasal spine.
drawback is the combination of subjects with Class I, Lower anterior facial LAFH The distance between anterior
height nasal spine and menton.
II, and III jaw relationship within the AOB group;
Mandibular body GO-ME The distance between gonion
however, this is thought not to significantly affect the length and menton.
results as discussed later. Sella to posterior nasal S-PNS The distance between sella and
spine posterior nasal spine.
In statistical terms, this study is essentially a
comparison of two independent groups, each con-
sisting of multiple parametric variables, hence the
selection of multiple t tests that use the Bonferroni the large number of variables compared. The vari-
method. In addition to the traditional level of ables found to be significant at P , 0.001 should be
significance, P , 0.05, a higher level of confidence regarded of high importance to the aim of the study.
was necessary to avoid spurious results because of Because Bonferroni’s method is very conservative,
168 Tsang, Cheung, and Samman American Journal of Orthodontics and Dentofacial Orthopedics
February 1998

Table II. Linear measurements of dentoalveolar landmarks Table III. Angular measurements of skeletal landmarks

Name Code Definition No. code Definition

Upper posterior dental U6-PP Perpendicular distance between 1. SNA The angle between the sella-nasion line and the
height (UPDH) mesiobuccal cusp tip of nasion-point A line.
maxillary first molar to the 2. SNB The angle between the sella-nasion line and the
palatal plane. nasion point B line.
Upper anterior dental U1E-PP Perpendicular distance between 3. N-S-AR The angle between the nasion-sella line and the sella-
height (UADH) upper central incisal edge articulare line.
and the palatal plane. 4. SN-MP The angle between the sella-nasion line and the
Lower posterior dental L6-MP Perpendicular distance between mandibular plane.
height (LPDH) the mesiobuccal cusp tip of 5. SN-FH The angle between the sella-nasion line and the
mandibular first molar to the Frankfort horizontal line.
mandibular plane. 6. FH-FOP The angle between the Frankfort horizontal and the
Lower anterior dental L1E-MP Perpendicular distance between functional occlusal plane.
height (LADH) lower central incisal edge 7. FH-PP The angle between the Frankfort horizontal plane
and the mandibular plane. and the palatal plane.
Overjet OJ Distance between the tip of the 8. S-AR-GO The angle between the sella-articulare line and the
lower central incisor to the articulare-gonion line.
upper central incisal edge 9. GOA The angle formed by the mandibular plane and a
along a line parallel to the tangent to the posterior border of ramus through
Frankfort horizontal. articulare.
Overbite OB Distance between the tip of the 10. UGOA The angle between the tangent to the posterior
lower central incisor to the border of ramus through articulare and the line
upper central incisal edge joining nasion and gonion.
along a line perpendicular to 11. LGOA The angle between the mandibular plane and the line
Frankfort horizontal. joining nasion and gonion.
Upper first molar to sella U6-SV Distance between the 12. FH-MNOP The angle between the Frankfort horizontal and the
in vertical plane mesiobuccal cusp tip of mandibular occlusal plane.
maxillary first molar to sella 13. FH-MXOP The angle between the Frankfort horizontal and the
along a line perpendicular to maxillary occlusal plane.
SN. 14. SN-PP The angle between the sella-nasion line and the
Upper first molar to sella U6-SH Distance between the palatal plane.
in horizontal plane mesiobuccal cusp tip of
maxillary first molar to sella
along a line parallel to SN.
Table IV. Angular measurements of dentoalveolar landmarks

No/Code Definition
the chance of a false positive result is further
1. U1-SN The angle between the sella-nasion line and the long axis of
minimized.
the upper incisor.
This study highlights differences in the facial 2. U1-PP The angle between the palatal plane and the long axis of
skeleton between male and female subjects of the the upper incisor.
3. I-I The angle between the long axis of upper and lower
study population. This was confirmed in the control
incisors.
group by five highly significant (P , 0.001) and 4. L1-MP The angle between the mandibular plane and the long axis
another seven significant (P , 0.05) variables (Table of the lower incisor.
VI). All these variables were linear measurements
of the craniofacial structures. This was consistent
with the findings of Cooke and Wei18 who also noted population are presented in Table X, along with the
that angular measurements were similar between findings on AOB in white subjects and North Amer-
sexes, whereas several linear measurements had ican black subjects for the purpose of comparison.
greater readings in male subjects. For the test group It will be noted that in relation to the norms of
of AOB subjects, a total of 10 variables were highly the equivalent population, the SNA angle value in
significantly different between sexes, 4 of these in the Chinese subjects decreased in the AOB and the
common with the control group. At the normal SNB angle remained similar to the control, but in
significant level, an additional 12 variables were white subjects, the SNA angle remained similar to
noted to differ between the sexes. This suggests that controls and the SNB angle decreased because of
sexual dimorphism may be exaggerated by dentofa- backward and downward rotation of the mandible.
cial deformity, particularly in skeletal anterior open In the black population, the SNA and SNB angles in
bite. AOB were similar to the nonAOB norms. In the
Some of the significant cephalometric character- southern Chinese subjects, the high incidence of
istics of skeletal AOB in this southern Chinese study Class III malocclusion19 and the shorter maxillary
American Journal of Orthodontics and Dentofacial Orthopedics Tsang, Cheung, and Samman 169
Volume 113, No. 2

Table V. Cephalometric relations Table VII. Nonsexually dimorphic variables with significant
difference between test and control groups
Cranial base Maxillary Mandibular Vertical facial Dentoalveolar
relations relations relations relations relations Variable Test mean Control mean P # 0.05 P # 0.001

S-N SNA SNB AFH FH-FOP U6-SH NSAR 12.80 123.85 * *

S-AR SN-PP SN-MP UAFH FH-MXOP U6-SV SNFH 7.90 6.85 *
SN-FH FH-PP GO-ME LAFH FH-MNOP U1E-PP SNA 81.13 83.47 * *
N-S-AR S-PNS S-AR-GO PFH U1-PP LIE-MP FHPP 1.73 2.80 *
AR-GO-ME LPFH U1-SN U6-PP SNMP 41.39 31.4 * *
AR-GO-N UPFH L1-MP L6-MP LGOA 83.83 73.05 * *
N-GO-ME OB GOA 128.28 117.23 * *
OJ U1PP 119.68 116.59 *
U1SN 110.44 107.24 *
L1MP 89.45 97.98 * *
Table VI. Sexually dimorphic variables in test and U6SV 81.60 78.54 *
control groups FHFOP 11.62 8.26 * *
FHMNOP 15.15 8.26 * *
Control group Test group U6PP 28.39 26.35 * *
OB 24.00 3.13 * *
Variable P # 0.05 P # 0.001 P # 0.05 P # 0.001 OJ 1.32 2.73 *
PPMP 31.90 21.96 * *
SN * * * * I-I 118.38 122.45 *
SAR * * * * PFH/AFH 0.62 0.68 * *
SPNS * * * * UAFHR 0.43 0.45 * *
GOME * * * LAFHR 0.58 0.56 * *
L6MP * * ANB 1.15 3.36 * *
AFH * * * * SPA 402.27 392.33 * *
UAFH * * * UGO/LGO 0.53 0.61 * *
LAFH * *
PFH * * * UAFHR 5 Ratio of UAFH to AFH.
UPFH * * * LAFHR 5 Ratio of LAFH to AFH.
LPFH * * * SPA 5 GOA 1 S.AR.GO 1 N.S.AR.
L1EMP * * *
SNFH *
SNPP * Table VIII. Sexually dimorphic variables with significant
SNMP * difference between test and control groups in male subjects
SNB *
U6SH * Male
U6SV * *
U6PP * Variable Mean AOB Mean control P # 0.05 P # 0.001
OJ *
PFH/AFH * SN 70.44 72.45 *
ANB * SAR 36.47 39.08 *
AFH 141.12 132.39 * *
LAFH 82.36 74.19 * *
UPFH 53.77 51.67 *
length,18 as well as the more vertical growth direc-
tion of the face,18 all suggest that AOB is often likely
to occur together with a Class III jaw relationship. Table IX. Sexually dimorphic variables with significant
difference between test and control groups in female subjects
This may explain the differences previously men-
tioned. The Chinese subjects also had the most Female
hyperdivergent skeletal pattern as noted by the
Variable Mean AOB Mean control P # 0.05 P # 0.001
SNMP value, whereas the black subjects had the
greatest amount of incisor procumbency. The find- SAR 33.45 35.64 *
ings are further discussed under the following head- AFH 133.33 125.45 * *
LAFH 77.98 70.77 * *
ings: cranial base, maxillary, mandibular, dentoalve- PFH 80.72 84.78 *
olar, occlusal, and vertical relationships.

Cranial Base Relationship (SAR) in both sexes and the anterior cranial base (SN)
The cranial base angle (NSAR) is smaller in AOB in male subjects were significantly shorter in AOB
deformity, and the anterior cranial base to Frankfurt when compared with normal subjects. These findings
horizontal (SNFH) angle is greater, thus indicating a confirm those of Subtelny and Sakuda20 and Richard-
steeper inclination of the anterior cranial base of AOB son21 highlighting that AOB is of skeletal origin and
subjects. The length of the posterior cranial base that the abnormality is reflected in the cranial base.
170 Tsang, Cheung, and Samman American Journal of Orthodontics and Dentofacial Orthopedics
February 1998

Table X. Cephalometric characteristics of skeletal AOB

Chinese Black White

AOB AOB AOB

Mean SD Norm SD Mean SD Norm SD Mean SD Norm SD

SNA 81.1 4.15 83.5 3.06 85.7 4.79 84.7 4.4 79.3 3.24 80.79 3.85
SNB 79.9 6.28 80.1 2.80 79.0 4.78 79.2 4.2 75.8 3.21 78.02 3.06
ANB 1.15 3.12 3.36 1.91 5.72 3.57 5.5 3.1 4.20 2.88 2.77 2.33
I-I 118.4 14.9 122.5 8.04 111.1 11.6 113.8 6.9 120.7 10.5 130.4 7.24
SNMP 41.4 7.47 31.4 4.09 35.6 5.72 38.2 4.7 38.6 7.19 32.27 4.67
UAFHR 0.427 0.02 0.45 0.01 0.409 0.036 — — 0.428 — — —

Chinese AOB 5 Current study; Chinese norm 5 current study.

Black AOB 5 Jones10; Black norm 5 Drummond.32
White AOB 5 Hapak25; White norm 5 Riedel.33

Maxillary Relationship Occlusal Relationship

The SNA angle was significantly smaller in the The ANB angle was significantly smaller in AOB
AOB subjects, indicating a more retrusive maxilla in subjects when compared with the control group.
the anteroposterior plane. The palatal plane in This relative relation between the maxilla and the
relation to the Frankfort horizontal (FHPP) was mandible is probably influenced by the higher pro-
also significantly smaller, indicating a tendency to portion of skeletal Class III subjects in the test
upward and forward rotation in the AOB. This group. Similarly, the overjet and interincisal angle
phenomenon was also noted in white subjects22-24 were significantly smaller in the AOB than in the
with similar findings, in that the palatal plane was normal occlusion.
flatter and the anterior nasal spine was located In regard to the incisal angulation of the maxil-
physically more superiorly. lary and mandibular teeth, the lower incisor to
mandibular plane (L1MP) angle was significantly
Mandibular Relationship smaller, whereas the upper incisor to palatal plane
Three angular measurements were significantly (U1PP) and to cranial base (U1SN) were both
larger in the AOB subjects: the mandibular plane to significantly larger in the AOB. These values suggest
anterior cranial base angle (SNMP), the gonial that the incisor angulation in the AOB compensates
angle (GOA), and the lower gonial angle (LGOA). for the Class III occlusal relationship.
These are consistent with the findings for white
subjects of Sassouni and Nanda22 and Hapak,25 Vertical Facial Height
indicating a downward growth of the mandible as a For the sexually dimorphic variables, both the
key factor in the formation of the AOB. With the total and the lower anterior facial height (AFH and
combination of an upward and forward rotated LAFH) were significantly longer in the AOB group
maxilla and a downward and backward rotated than in the control group for both male and female
mandible, it was not surprising to find that the subjects. The increase in the LAFH in the AOB
palatal plane to mandibular plane angle (PPMP) correlates well with most reports.21,22,25,28 However,
was significantly larger in the AOB subjects. the upper anterior facial height was found not to be
a significant factor. This indicates that the increase
Dentoalveolar Relationship in the AFH is a result of the elongated lower face.
The upper posterior dental height (U6PP) was The total posterior facial height (PFH) was
significantly greater in AOB subjects, suggesting significantly smaller only in female subjects, and the
excessive growth of the dentoalveolus mainly in the upper posterior facial height (UPFH) smaller only
posterior maxilla. Another possible contributing fac- in male subjects with AOB. Therefore, in contrast to
tor to the AOB may be an overeruption of the the AFH, there is less conclusive evidence in this
mandibular molar teeth, reflected as an increased study of a significantly smaller PFH in AOB subjects
posterior mandibular dentoalveolar height.26 How- compared with normal subjects. Although a shorter
ever, the current study and the findings of Subtelny PFH was noted in some reports,6,22,27-29 Ellis et al.26
and Sakuda20 do not support this finding, and some found no significant difference in PFH and ramus
even reported a decreased posterior dentoalveolar height between AOB and normal subjects.
height.22,27 The inclusion of all AOB subjects in one group
American Journal of Orthodontics and Dentofacial Orthopedics Tsang, Cheung, and Samman 171
Volume 113, No. 2

(45 subjects with Class I horizontal jaw relationship, 4. Schendel SA, Eisenfeld J, Bell WH. The long-face syndrome: vertical maxillary
excess. Am J Orthod 1976;70:398-408.
14 subjects with Class II, and 45 subjects with Class 5. Jarabak JR. Open bite skeletal morphology. Fortschr Kieferorthop 1983;44:
III), whereas the control group comprised only Class 122-33.
6. Cangialosi TJ. Skeletal morphologic features of anterior open-bite. Am J Orthod
I jaw relationship, may be open to criticism. How- 1984;85:28-36.
ever, many previous studies have adopted this ap- 7. Ellis E, McNamara JA. Components of adult Class III open bite malocclusion.
Am J Orthod 1984;42:277-90.
proach.6,10,25,30 In a part of this study to be published 8. Nanda SK. Patterns of vertical growth in the face. Am J Orthod Dentofac Orthop
elsewhere,31 we specifically analyzed the horizontal 1988;93:103-16.
9. Denison TF, Kokich VG, Shapiro PA. Stability of maxillary surgery in open bite
jaw relationship in relation to the severity of the versus non-open bite malocclusions. Angle Orthod 1989;59:5-10.
AOB in the vertical plane. We found that the 10. Jones OG. A cephalometric study of 32 North American black patients with
anterior open bite. Am J Orthod Dentofac Orthop 1989;95:289-96.
median of the vertical measurement of the AOB in 11. Fu MK, Mao ST. A roentgenographic cephalometric study of 144 Chinese with
each of the Class I, Class II and Class III AOB normal occlusion. Chung Hua I Hsueh Chih 1975;12:865-7.
12. Cotton WN, Tatano WS, Wong WMW. The Down’s analysis applied to three other
subjects clustered around the overall mean of 4 mm, ethnic groups. Angle Orthod 1951;21:213-20.
and concluded that the horizontal jaw relationship 13. Hong YC. The roentgenographic cephalometric analysis of the basic dento-facial
pattern of Chinese. Formosan Med Ass 1960;59:144-61.
did not correlate with severity of the AOB. 14. Wei SHY. Craniofacial variation in a group of Chinese students—a roentgeno-
graphic cephalometric study in three dimensions. [Thesis.] Adelaide, Australia:
CONCLUSION University of Adelaide; 1965.
15. Hogeboom FE. Cephalometric study of Chinese-American children. S Calif St
On the basis of a thorough cephalometric analysis of Dent Assoc 1970;38:122-5.
104 subjects with AOB and 40 subjects without AOB in a 16. Foo GC, Woon KC. Some cephalometric norms in the young adult Malaysian
Chinese males with harmonious facial appearances. Dent J Malaysia Singapore
southern Chinese population sample, the following can be 1983;6:113-6.
stated: 17. Foo GC. A cephalometric study of the Chinese in profile. Aust Orthod J
1986;9:285-8.
1. Sexual dimorphism of cephalometric measure- 18. Cooke MS, Wei SHY. Cephalometric standards for the southern Chinese. Eur
ments was more marked in the AOB group. J Orthod 1988;10:264-72.
19. Chan GKH. A cephalometric appraisal of the Chinese (Cantonese). Am J Orthod
2. The most significant findings in AOB compared 1972;61:279-85.
with nonAOB were a shorter SN, upward and 20. Subtelny JD, Sakuda M. Open-bite: diagnosis and treatment. Am J Orthod
forward rotation of the maxilla, increased GOA 1964;50:337-56.
21. Richardson A. Skeletal factors in anterior open-bite and deep over-bite. Am J
and mandibular plane angles, increased U6PP, and Orthod 1969;56:114-27.
increased LAFH. 22. Sassouni V, Nanda S. Analysis of dentofacial vertical proportions. Am J Orthod
1964;50:801-23.
The findings are essentially in agreement with pub- 23. Nahoum H. Vertical proportions: a guide for prognosis and treatment in anterior
open bite. Am J Orthod 1977;72:128-46.
lished analyses of AOB in white subjects. It would be
24. Lopez-Gavito G, Little RM, Joondeph DR. Anterior open-bite malocclusion:
useful in this study to compare only the subgroup of AOB longitudinal 10-year post-retention evaluation of orthodontically treated patients.
with Class I jaw relationship with the control group to Am J Orthod 1985;87:175-86.
25. Hapak FM. Cephalometric appraisal of the open-bite case. Angle Orthod 1964;
eliminate possible confounding factors, however, on the
34:65-72.
basis of our data to be published separately, this is not 26. Ellis E, McNamara JA, Lawrence TM. Components of adult Class II open bite
expected to significantly affect the results. malocclusion. J Oral Maxillofac Surg 1985;43:92-105.
27. Nahoum HI, Horowitz SL, Benedicto EA. Varieties of anterior open-bite. Am J
The expert advice on statistical analysis of Dr. Philip Orthod 1972;61:486-92.
28. Frost DE, Fonseca RJ, Turvery TA, Hall DJ. Cephalometric diagnosis
Yu, Department of Statistics, and Dr. May Wong, Depart- and surgical-orthodontic correction of apertognathia. Am J Orthod 1980;78:
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172 Tsang, Cheung, and Samman American Journal of Orthodontics and Dentofacial Orthopedics
February 1998

Appendix I. Definitions of cephalometric landmarks used

Name Code Definition

Menton ME The most inferior point on the symphyseal outline.

Point B B The point most posterior to a line from crest of
alveolus (Infradentale) to Pogonion on the
anterior surface of the symphyseal outline.
Lower incisal edge LIE The incisal tip of mandibular central incisor.
Upper incisal edge UIE The incisal tip of maxillary central incisor.
Point A A The most posterior point on the curve of the
maxilla between the anterior nasal spine and
crest of labial alveolus (supradentale).
Anterior nasal spine ANS The tip of the median, sharp bony process of the
maxilla.
Upper incisal apex UIA The root tip of the maxillary central incisor.
Lower incisal apex LIA The root tip of the mandibular central incisor.
Upper molar cusp tip UMT The mesial buccal cusp tip of maxillary first molar.
Lower molar cusp tip LMT The mesial buccal cusp tip of the mandibular first
molar.
Gonion GO A constructed point found by the intersection of a
line tangent to the posterior border of ramus
through articulare and a line tangent to the
most inferior point at the bony contour of the
mandibular angle.
Articulare AR The point of intersection of the inferior cranial
base surface and the averaged posterior surfaces
of the mandibular condyles.
Sella turcica S The center of the pituitary fossa of the sphenoid
bone determined by inspection.
Ethmoid registration point ERP Intersection of the sphenoidal plane with the
averaged greater sphenoid wings.
Nasion N The most anterior point of the frontonasal suture.
Orbitale OR The lowest point on the average of the right and
left borders of the bony orbit.
Posterior nasal spine PNS The most posterior point at the sagittal plane on
the bony hard palate.
Porion PO The midpoint of the line connecting the most
superior point of the external auditory canal on
both sides.