Vertical control as an important ingredient in the treatment of severe sagittal discrepancies

The control of vertical development, in particular in the maxillary molar region, has often been suggested as a method of implementing sagittal change in treatment of Class II skeletal discrepancies. A group of twenty-eight Italian children in the early mixed-dentitional stage, with increased overjet and distal molar relationship, were treated orthodontically with a combination of a removable maxillary splint and high-pull extraoral traction. While only slight dorsal repositioning of the maxilla could be observed, an effective retardation of the vertical maxillary development was recorded, as well as a pronounced forward displacement of the mandibular symphysis. Distal movement of the maxillary dentition contributed likewise to the elimination of overjet observed clinically. The center of mandibular rotation was evaluated for each patient and displayed a pronounced variation illustrating different responses to the same type of appliance by different patients. The clinical implications of the above findings are discussed, and the necessity for constant appraisal of results during treatment is stressed.