The vertical dimension: the "low-angle" patient

The patient who has a diminished anterior facial height and excess posterior facial height must be treated with a "different" diagnosis and treatment plan. The mandibular incisors must be left in their pretreatment positions--or facial balance will be compromised. They must not be proclined to eliminate crowding or to level a curve of Spee. The three most common diagnostic "schemes" for these patients are: (1) third molar extraction; (2) maxillary first premolar and mandibular third molar extraction; and (3) maxillary first premolar and mandibular second premolar extraction. This article will attempt to explain why certain diagnostic decisions are made. Case reports are used to illustrate the three most common treatment plans.