The vertical dimension: the high-angle problem

When the patient who has excessive anterior facial height desires treatment for the correction of a malocclusion, the dimension of the dentition should be respected. The clinician must adhere to the anterior, posterior, vertical, and lateral limits of each patient's dentition--providing the musculature is normal--when the treatment plan is formulated. The goals of esthetics, health and function, stability, and treatment in harmony with growth are as valid for the high-angle patient as they are for a patient with a more normal vertical dimension. The diagnostic decisions made for the high-angle patient should be predicated on nonexpansion of the mandibular arch. Mandibular incisors must be overly upright. In addition, a decision on the mandibular third molars must be made prior to anchorage preparation-because their relationship to the mandibular second molars is critical if anchorage is to be properly prepared. A discussion of these topics as well as an illustrative case report are presented in this article.