RELATIONSHIP BETWEEN SAGITTAL POSITION OF LOWER INCISORS AND FACIAL PROFILE ESTHETICS WITH REFERENCE TO VERTICAL FACIAL DIVERGENCE
DOI:
https://doi.org/10.33279/jkcd.v15i02.905Keywords:
Cephalometry, Growth Patterns, Incisor Mandibular Plane Angle(IMPA), MalocclusionAbstract
Objectives: To compare the sagittal position of the lower incisors and facial profile esthetics among sagittal and vertical pattern.
Materials and Methods: This comparative study on 229 participants at deparment of Orthodontics, Armed Forcers Institute of Dentistry, Combined Military Hospital, Rawalpindi. Patients aged 20–30 years with no history of orthodontic treatment and a complete dentition up to the second permanent molars were included, while those with dental anomalies, craniofacial deformities, or a history of head and neck trauma or surgery were excluded. Pretreatment lateral cephalograms were obtained, and age and gender were recorded from patient files. Facial growth patterns were assessed using the SN-MP angle, facial profile convexity using Merrifield’s Z-angle, and lower incisor inclination using the IMPA. Student t-test and ANOVA were used to compare lower incisor inclination and facial profile among vertical and sagittal patterns.
Results: Males were 95 (41.5%). IMPA was significantly higher in the high-angle (100± 9.9) than in the low-angle group (94.8±15.320) (p = 0.004), while the Z angle was significantly lower in the high-angle (66.02±7.880) than in the low-angle group (72.07 ± 11.35) (p < 0.001). Signifi cant diff erences in IMPA and Z angle across skeletal classes (p < 0.001), with Class II showing the highest IMPA (108.68 ± 5.54) and lowest Z angle (64.59 ± 7.510), while Class III had the lowest IMPA (66.88 ± 6.630) and highest Z angle (90.12 ± 5.970).
Conclusion: High-angle participants had more proclined lower incisors and a retrusive profile, while Class II showed the most proclined incisors and flattest profile.
References
Derwich M, Minch L, Mitus-Kenig M, Zoltowska A, Pawlowska E. Personalized orthodontics: From the sagittal position of lower incisors to the facial profile esthetics. J Pers Med. 2021;11(8):692. doi:10.3390/jpm11080692.
Nicolay O, Almaidhan A. Orthodontics for esthetic dental treatment: Symbiotic efforts for optimal results. In: Raigrodski AJ, ed. Esthetic Oral Rehabilitation with Veneers. 1st ed. Cham, Switzerland: Springer; 2020:27-66. doi:10.1007/978-3-030-41091-9_2.
Reyneke JP, Ferretti C. Diagnosis and treatment planning for orthognathic surgery. Oral Maxillofac Surg. 2025 Sep 4:927-64. doi: 10.1002/9781119842958.ch7.1.
Liaw JJL, Park JH. Orthodontic considerations in hypodivergent craniofacial patterns. J World Fed Orthod. 2024;13(1):18-24. doi:10.1016/j.ejwf.2023.12.007
Plaza SP, Reimpell A, Silva J, Montoya D. Relationship between skeletal Class II and Class III malocclusions with vertical skeletal pattern. Dental Press J Orthod. 2019;24(4):63-72. doi:10.1590/2177-6709.24.4.063-072.oar.
Nazir DS, Mushtaq DM. Incisor Mandibular plane Angle (IMPA), Frankfort Mandibular Plane Angle (FMA) and Lower Incisor to A-pog distance, and their relation in Different Skeletal Classes. Int J Appl Res. 2020;6(12):309-14. doi: 10.22271/allresearch.2020. v6.i12e.8112.
Alhammadi MS, Halboub E, Fayed MS, Labib A, El-Saaidi C. Facial profile evaluation and prediction of skeletal Class II patients using photographic analysis. Head Face Med. 2023;19(1):10. doi:10.1186/s13005-023-00397-8.
Rongo R, Importuna MME, Pango Madariaga AC, Bucci R, D’Antò V, Valletta R. Evaluation of incisor position in a sample of orthodontic patients. Diagnostics. 2024;14(18):2062. doi:10.3390/diagnostics14182062.
Hashim HA, Hashim MH, Narasirmhan S. Ethnic differences in tweed’s facial triangle: a comparative study between sudanese and the major racial classes. Oral Health Dent Sci. 2024;8(6):1-6. doi:NA
Margolis HI. The axial inclination of the mandibular incisors. Am J Orthod Oral Surg. 1943;29(10):571-594. doi:10.1016/S0096-6347(43)90266-2.
Ariq R, Khan MT, Afaq A, Tariq S, Tariq Y, Khan SS. Malocclusion: Prevalence and Determinants among Adolescents of Karachi, Pakistan. Eur J Dent. 2024;18(1):143–153. doi:10.1055/s-0043-1761461.
Jacobson A, Jacobson RL. Radiographic cephalometry: From basics to 3-D imaging. Am J Orthod Dentofacial Orthop. 2006;130(2):256-259. doi:10.1016/j.ajodo.2007.02.038
Zhang X, Zheng J, Deng J. Three-dimensional evaluation of soft tissues in hyper divergent skeletal Class II females in Guangdong. BMC Med Imaging.2022;22:56. doi: 10.1186/s12880-022-00782-w.
Grippaudo C, Oliva B, Greco AL, Sferra S, Deli R. Relationship between vertical facial patterns and dental arch form in class II malocclusion. Prog Orthod. 2013;14:43. doi:10.1186/2196-1042-14-43.
Merrifield LL. The profile line is used to aid in critically evaluating facial esthetics. Am J Orthod. 1966;52(11):804-822. doi:10.1016/0002-9416(66)90250-8
Kang HK, Pangrazio-Kulbersh V, Kaczynski R, Munoz A. Treatment change comparisons between skeletal Class I and II white adolescents with three different vertical divergencies-Part 2: Holdaway difference. Am J Orthod Dentofacial Orthop. 2024;165(3):357-364. doi:10.1016/j.ajodo.2023.10.012.
Yan X, Ouyang Y, Tong H. Treatment of a severe skeletal Class II malocclusion through growth modification and fixed appliances: A case report. Australas Orthod J. 2023;39(2):83-95. doi:10.2478/aoj-2023-0027.
Guo YN, Cui SJ, Liu Y. Quantitative evaluation of vertical control in orthodontic camouflage treatment for skeletal class II with hyper divergent facial type. Head Face Med. 2024;20(1):31. doi:10.1186/s13005-024-00432-2.
Godt A, Müller A, Kalwitzki M, Göz G. Angles of facial convexity in different skeletal Classes. Eur J Orthod. 2007;29(6):648-653. doi:10.1093/ejo/cjm073.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Mehak Hassan, Umar Safia, Jan Abdullah , Binte Ali , Farhan Yahya Ahmed , Erum Amin

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes .
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.