Evaluation of differential growth and orthodontic treatment outcome by regional cephalometric superpositions

Cephalometric superimposition on cranial base is the accepted method for evaluating mandibular displacement during orthodontic treatment and/or growth. However, assessing mandibular position relative to the maxillary base may yield different information. The aim of this study was to evaluate the effects of regional superpositions (cranial versus maxillary) on interpreting mandibular displacement. Both methods were applied to pre- and posttreatment cephalograms of 22 growing children (12 female, 10 male) treated for Class II Division 1 malocclusion. Differences in linear and angular measurements of three mandibular landmarks (pogonion, gnathion, menton) between cranial and maxillary superpositions were statistically significant (p = 0.0001). Vertical displacement of these landmarks contributed significantly to the differences (p = 0.0001). The contribution of horizontal displacement was not statistically significant. The results support the proposition that, in growing children, posttreatment displacement of mandibular skeletal and dental components should be assessed by both maxillary and cranial base superimpositions. The maxilla is subject to rotational and translational changes during growth that may affect the position of the mandible relative to the maxilla in a way inconsistent with the mandibular displacement perceived upon cranial superposition. Since occlusion is directly associated with the positions of the maxillary and mandibular basal bones, the positions of these bones relative to each other is critical in assessing occlusal changes in individual patients.