The general consensus among orthodontists today is that the dolicofacial, retrognathic patient can present one of the most challenging problems for conventional orthodontic therapy. It is often stated that many of these patients will have more mandibular opening rotation during orthodontic treatment than the mesofacial or brachyfacial patient. This opening rotation is compounded when the use of cervical traction and Class 11 mechanics are incorporated into the treatment plan. Because of the problems involved with the treatment of these types of patients, it has been suggested in the literature that there may be an ideal age to start orthodontic therapy that may alleviate some of the complications.
A sample of 38 dolicofacial, retrognathic cases were randomly selected from the files of Rocky Mountain Data Systems, Inc., and Doctors Ricketts and Bench. The cases were divided into three groups according to the age when treatment was initiated. Group I included thirteen cases in which treatment was started by the age of nine years, eleven months; Group II included twelve cases in which treatment was started sometime between the ages of ten years to eleven years, eleven months of age; Group III included thirteen cases in which treatment was started after the age of twelve years.
The measurements of facial axis, convexity, maxillary depth, facial depth, incisor overbite and lower anterior arch length discrepancy for each of the three groups were statistically compared for during treatment change and during retention change. This was done to determine if it is advantageous to initiate treatment at an early age (deciduous and mixed dentition) or wait until a later age (permanent dentition) for the dolicofacial, retrognathic patient and to demonstrate the biologic plasticity and/or resistance to mandibular opening rotation of different age groups and their rebound potential to treatment forces.
On the basis of the data obtained from this randomly selected sample the following conclusions have been set forth:
- Treat patients older (after age twelve years) if opening rotations of the mandible against high-pull headgear therapy is of primary concern (severe dolicofacial, retrognathic patients).
Treat patients younger (before age ten years) if maximum orthopedic convexity reduction and maxillary depth reduction are of primary concern.
Treat incisor openbite patients younger even though the patient has a vertical growth pattern. There is no greater tendency for incisor openbite relapse if there is an existing normal myofunctional envelope.
Incisor openbites tend to deepen with an increase in age and correct themselves. If the only reason for treating a patient is to close the incisor openbite, the clinician should probably hesitate in proceeding with his treatment plan until a later time, as the problem may be self-correcting.
Mandibular arch length discrepancy relapse is not a reason to avoid the early treatment of mild, dolicofacial, retrognathic facial patters. Indeed, the younger patients (Group I) showed less mandibular arch length discrepancy relapse.
James R. Wise
Lawrence W. Will
Gary G. Morikone
Logan L. Barnard
Master of Science (MS)
Year Degree Awarded
Date (Title Page)
Library of Congress/MESH Subject Headings
Loma Linda University Libraries
This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.
Clarke, George B. Jr., "The Treatment Timing of Dolicofacial, Retrognathic Facial Patterns" (1976). Loma Linda University Electronic Theses, Dissertations & Projects. 1270.
Loma Linda University Electronic Theses and Dissertations
Loma Linda University. Del E. Webb Memorial Library. University Archives