A diagnostic and treatment planning checklist for vertical problems in orthodontic patients

Vertical discrepancies in orthodontics represent a complex and multifactorial diagnostic challenge. Traditional approaches often lack a consistent correlation between facial patterns, overbite, and occlusal vertical dimension, limiting a comprehensive treatment planning. This article proposes a diagnostic checklist structured around five key factors-lower anterior facial height, incisor display at rest, posterior dental height, overbite, and occlusal wear-to assess vertical problems across macro-, mini-, and microesthetic levels. The amount of incisor display at rest serves as the guiding parameter for planning vertical tooth movements and determining jaw positioning. Each diagnostic factor contributes uniquely to evaluating vertical proportions, esthetic balance, and functional occlusion. The checklist offers clinicians a hierarchical tool to decode clinical and cephalometric findings and translate them into individualized treatment strategies. Possible therapeutic options include anterior or posterior tooth intrusion or extrusion, restoration of worn teeth, and orthodontic or orthognathic repositioning of dental or skeletal structures. Three clinical cases-addressing deep bite, open bite, and occlusal wear-illustrate the application of the checklist. These examples underscore the critical role of incisor display in planning and executing movements that harmonize the face, smile, and occlusion.