Steep Mandibular Plane Angle Research Articles

Associations among temporomandibular disorder, headache, shoulder pain, craniofacial morphology, and premature contacts in female children and adolescents with malocclusion

ABSTRACT Purpose Orthodontic patients frequently exhibit signs and symptoms of temporomandibular disorder (TMD) in combination with symptoms around the stomatognathic region (i.e. headache). Although maxillofacial morphology and malocclusion have been widely investigated as risk factors for TMD and headache, their relationship remains unclear and functional factors have not been verified. This study investigated associations among TMD, headache, craniofacial morphology, and premature contacts in female children and adolescents with malocclusion. Materials and methods One hundred twenty female children and adolescents (mean age, 11.4 ± 2.5 years) who sought orthodontic treatment were randomly selected from a cohort of orthodontic patients. The patients were divided into three groups (no condition, at least one condition, ≥ 2 conditions: TMD, headache, and/or shoulder pain). Premature contacts were determined using the functional wax bite method; craniofacial morphology was analysed using lateral cephalometric radiographs. The χ2 test, Tukey test, and ordered logistic regression were used for statistical analysis. Results Patients with TMD and headache had a steep mandibular plane angle (odds ratio = 1.11), but there were no significant differences among groups in other craniofacial morphology parameters. Patients with premature contacts had a higher incidence of combined TMD and headache (odds ratio = 7.72). Premature contacts more strongly contributed to pathogenesis than did mandibular plane angle or age. Conclusion TMD and headache are associated with both craniofacial morphology and premature contacts.

Cephalometric norms in coastal Odisha children

To establish cephalometric norms (skeletal and dental) for Coastal Odisha population of India and to compare it with other Caucasian norms.The Lateral cephalograms of 60 children of 9-16 year age group with normal occlusion and pleasant profile were taken and cephalometric norms were established using Down’s, Steiner’s, Tweeds, Wits, Bjork, Jarabak, McNamara, Ricketts and Schwarz analysis.The study concluded that Overall dimension of cranial base, maxilla and mandible are smaller in Coastal Odia children than that of Caucasians. Odia children are having more proclined upper and lower incisors and smaller upper and lower dental height in anterior and posterior region, steeper mandibular plane angle, greater upper and lower lip prominence but lesser upper lip thickness and strain than Caucasian population.

Vertical Maxillary Excess Complicated with Mutilated Dentition Treated by an Interdisciplinary Approach

Vertical skeletal dysplasia can lead to excessive lower facial height and maxillary teeth elongation with gum exposure. Patients usually have long face, steep mandibular plane angle, usually with mandibular retrognathism. The clinical manifestations include narrow nose, narrow upper dental arch, excessive incisal display, a significant backward and downward rotated mandible as well as vertical maxillary excess (VME). Traditional classifications which mainly based on sagittal jaw relation is inadequate in describing the vertical skeletal discrepancy. The patient also suffered from multiple missing posterior teeth, that requires an interdisciplinary dental care. The main treatment objectives are to normalize overjet and overbite, improve chin projection, reduce the gummy smile, and establish satisfactory occlusion with stable posterior support. A three-pieces Le Fort I with a unilateral posterior segmental maxillary impaction was done to correct the over-erupted molars. In the mandible, sagittal split osteotomies with genioplasty were performed. An esthetic improvement and balanced oral function were both achieved after all teeth being restored. The benefit of this comprehensive approach among orthodontist, oral surgeon and prosthodontist to correct a severe dentofacial deformity were also discussed.

Screening of obstructive sleep apnea (OSA) risk in adolescent population and study of association with craniofacial and upper airway morphology

BackgroundObstructive sleep apnea (OSA) is a common form of sleep-disordered breathing with high prevalence and associated co-morbidities. It still goes largely under-reported due to events occurring in sleep and difficulty in identifying predisposing factors. AimsTo perform questionnaire-based screening of OSA-risk in adolescents and study association of OSA-risk with craniofacial and upper airway morphology. Material and methodsModified STOP-BANG questionnaire was used for screening OSA-risk in adolescent orthodontic patients (10–19 years) in a government dental hospital in India. Patients were categorised into two groups: OSA-risk and non-risk, based on the questionnaire scores, and were subsequently evaluated for craniofacial and upper airway morphology, both on examination and on lateral cephalometric radiographs. ResultsDocumented a high prevalence of 14% for OSA-risk in adolescent orthodontic patients. The extra-oral and intra-oral parameters found significantly associated with OSA-risk were convex profile [Odd's ratio (OR) - 3.824], steep mandibular plane angle [MPA] (OR- 79.75), Type 3/4 faucial pillars (OR- 11.227), Class II molar relationship (OR - 4.518), ovoid upper arch form (OR - 13.750). In addition, the cephalometric parameters: ANB (p– 0.025), SN-MP (p– 0.007), BA-SN (p– 0.020), PNS-AD1 (p < 0.001), PNS-AD2 (p – 0.001) also showed highly significant association to OSA-risk. The ROC curves demonstrated high sensitivity and specificity for PNS-AD1 (60%,83.3%), PNS-AD2 (73.3%, 70%) and SN-MP (60%,70%), respectively for OSA-risk. ConclusionsThe study supported applicability of modified STOP-BANG questionnaire for OSA-risk in Indian adolescents. The parameters [extra-oral, intra-oral, cephalometric and upper airway (PNS-AD1, PNS-AD2, SN-MP)] significantly associated with OSA-risk, were identified.

The National Dental Practice-Based Research Network Adult Anterior Open Bite Study: Treatment recommendations and their association with patient and practitioner characteristics

This aim of this paper is to describe and identify the practitioner and patient characteristics that are associated with treatment recommendations for adult anterior open bite patients across the United States. Practitioners and patients were recruited within the framework of the National Dental Practice-Based Research Network. Practitioners were asked about their demographic characteristics and their treatment recommendations for these patients. The practitioners also reported on their patients' dentofacial characteristics and provided initial cephalometric scans and intraoral photographs. Patients were asked about their demographic characteristics, previous orthodontic treatment, and goals for treatment. Four main treatment groups were evaluated: aligners, fixed appliances, temporary anchorage devices (TADs), and orthognathic surgery. Extractions were also investigated. Predictive multivariable models were created comparing various categories of treatment as well as extraction/nonextraction decisions. Ninety-one practitioners (mostly orthodontists) and 347 patients were recruited from October 2015 to December 2016. Increased aligner recommendations were associated with white and Asian patients, the presence of tongue habits, and female practitioners. TADs were recommended more often in academic settings. Recommendations for orthognathic surgery were associated with demographic factors, such as availability of insurance coverage and practitioner race/ethnicity, and dentofacial characteristics, such as anteroposterior discrepancies, more severe open bites, and steeper mandibular plane angles. Extraction recommendations were largely associated with severe crowding and incisor proclination. Both doctorand patient demographic factors, as well as dentofacial characteristics, were significantly associated with treatment recommendations for adult anterior open bite patients.

Craniofacial morphology and growth in young patients with congenital or childhood onset myotonic dystrophy

This study investigated the craniofacial morphology of young individuals with congenital or childhood onset myotonic dystrophy type 1 (DM1) compared to healthy subjects. The study also followed growth changes in their facial morphology over a 5-year period. Lateral cephalograms of the 26 subjects (young patients with DM1 from west and south Sweden) were taken at baseline and after a 5-year period. These radiographs were compared with normal standards based on healthy individuals from the Michigan Growth Study, according to their age and sex, using paired t-tests (P < 0.05). On examination of initial radiographic measurements, patients with DM1 showed, in the sagittal plane, larger ANB and smaller SNPg angles. Analysis of the vertical plane showed the mandibular plane angle (ML-NSL) and the intermaxillary angle (ML-NL) to be larger. During the 5-year follow-up period, the intermaxillary angle (ML-NL) remained the same in the group with DM1 whereas this angle decreased in healthy individuals. For ethical reasons, historical cephalometric norms were used to compare the growth and the craniofacial morphology of patients with DM1. Young patients with DM1 had already from the beginning a more retrognathic profile and hyperdivergent skeletal aberration with a steep mandibular plane and large intermaxillary angle when compared with healthy individuals. The intermaxillary angle did not decrease during the observation period, contrary to what was observed in healthy individuals.

Evaluation of Mandibular Condylar Changes in Patients Following Orthognathic Surgery: A Retrospective Study.

Background:Condylar resorption as a cause of relapse after orthognathic surgery is well known. Several authors have presented evidence of the relation between orthognathic surgery and condylar remodeling and resorption. This study was done to appraise the condylar changes along with the form and function following orthognathic surgery, as well as to assess what factors may have contributed to the problems.Methodology:A diagnosis of progressive condylar resorption (PCR) was made by comparison of preoperative and postoperative radiographs (cephalometric radiograms), as well as clinical evaluations. The radiographs were taken for each patient preoperatively and postoperatively, which include immediately after osteotomy, at 6 months and 24 months. Additional radiographs were taken when required. Then, preoperative and postoperative tracings were compared at 24 months postoperatively.Results and Conclusion:It can be concluded from this study that females of relative low age (<18 years) appeared to be a high-risk factor for the occurrence of condylar alteration including PCR. A steep mandibular plane angle, the low facial height ratio (post/ant), and magnitude of surgery were also significantly related to the occurrence of condylar alteration, but the multivariance regression showed that these parameters had only limited value.

A pediatric case of anesthesia mumps after general anesthesia

Sir/Madam, We would like to report an 8-year-old child with swelling of the right parotid gland after general anesthesia. He weighed 18 kg and underwent adenoidectomy and bilateral tympanostomy tube insertion operation. Preoperatively, he was normal and he also had no other medical problem. Anesthesia induction was performed with 2 mg/kg of propofol, 1 mcg/kg of fentanyl, and 0.5 mg/kg of rocuronium. After endotracheal intubation, maintenance of anesthesia was achieved with sevoflurane (2-3 vol%) in 50% O2 and 50% air. The surgical procedure lasted for 35 min. The patient was extubated without any problems at the end of the surgery. After the extubation period, we noticed a painless swelling on the right parotid gland extending the angle of the mandible [Figures ​[Figures11 and ​and2].2]. There was no sign of inflammation. The right parotid gland swelling disappeared in the next 24 h without any sequelae. Figure 1 Adenoid face of patient and swelling of right parotid gland Figure 2 Swelling of right parotid gland Acute transient swelling of the parotid gland related to anesthesia, defined as “anesthesia mumps,” is a rare complication. It is a benign and noninfectious complication.[1] This usually occurs immediately after surgery and resolves spontaneously over a period of a few hours to a few days without any known sequelae.[2] It was more rarely seen in the pediatric population compared to adults. Although the exact mechanism of anesthesia mumps is not fully explained, different explanations have been suggested including obstruction of Wharton or Stensen ducts from patient positioning and endotracheal tube placement, positive pressure ventilation during and increased pressure in the oral cavity, and thickened oral secretions secondary to salivary stasis.[3] We thought that the clinical picture in our case may have resulted from intraoral pressure increase by mask ventilation or from obstruction of ducts due to head positioning during bilateral tympanostomy tube insertion. Our patient had an adenoid face (a narrow upper dental arch, increased anterior face height, a steep mandibular plane angle, and a retrognathic mandible). Manual ventilation on mask was not comfortable due to poorly fitting mask during the induction. Also, the patient had a relative microgratia. On the other hand, tympanostomy tube insertion was made when the head rotated to the left side and right side. Anesthesia mumps usually resolves spontaneously over a period without any treatment. In some cases, hydration and warm compresses may be helpful in relieving the symptoms.[2,4] In our case, we managed the swelling conservatively by the advice of otolaryngology clinic. The swelling decreased and resolved completely in 24 h. Additionally, there was no radiologic image for this patient. The swelling of the parotid gland resolved gradually and also, the otolaryngologists did not anticipate any other pathology due to signs of swelling. We did not want to perform an x-ray examination of this child patient for benign swelling. In conclusion, anesthesia mumps may occur immediately after general anesthesia in pediatric patients and they fully recover. Also, we hope that the reporting of such pediatric cases would increase the awareness among anesthesiologists regarding this benign complication.

Orofacial findings associated with obstructive sleep apnea in a group of Saudi Children.

Objectives:To evaluate orofacial and occlusion findings associated with obstructive sleep apnea (OSA) in a group of Saudi children.Methods:The sample consisted of 30 OSA patients, and 30 age and gender matched, healthy control. The following facial and occlusal features were evaluated: frontal view, facial profile, mandibular angle, tongue size, dental midline to facial midline, upper to lower dental midline, overjet, overbite, anterior open bite, cross bite, scissors bite, palatal vault, maxillary and mandibular arch crowding and spacing, molar and canine relationship.Results:Participants age ranged from 3 to 8 years. Study group had steeper mandibular angle, deeper palatal vault, and less spaced upper and lower arches. There was no statistically significant difference between the two examined groups regarding facial morphology, facial profile, midline, anterior openbite, tongue size, posterior crossbite, overjet or molar relationship.Conclusion:OSA children have a relatively different orofacial morphology compared with control children. OSA subjects had deeper palatal vault, steeper mandibular plane angle and less spaced upper and lower arches compared to control.

Role of mandibular displacement and airway size in improving breathing after rapid maxillary expansion

BackgroundOral breathing and maxillary deficiency are often associated with steep mandibular plane angle, and retrognathic mandible compared with the faces of healthy controls. Some studies suggested that after rapid maxillary expansion, improvement in nasal breathing and repositioning of mandible with transitory increasing of facial height and, in some cases, spontaneous forward repositioning might occur. The abovementioned mandibular effects could contribute to enlarge oropharynx volume with repositioning of tongue and soft palate with an improvement of upper airway volume after treatment. The aim of this study was to investigate by cone beam computed tomography the role of oropharyngeal volume and mandibular position changes after rapid maxillary expansion in patients showing improved breathing pattern confirmed by polysomnography exam.MethodsThe final sample of this retrospective study comprised 14 Caucasian patients (mean age 7.6 years) who undergone rapid maxillary expansion with Haas-type expander banded on second deciduous upper molars. Cone beam computed tomography scans and polysomnography exams were collected before placing the appliance (T0) and after 12 months (T1). Mandibular landmarks localization and airway semiautomatic segmentation on cone beam computed tomography scans allowed airway volume computing and measurements.ResultsNo significant differences were found between oropharyngeal airway changes and mandibular displacement after rapid maxillary expansion in growing patients.ConclusionsThe suggested improvement in upper airway and breathing after rapid maxillary expansion should be further related to different compartments of airway such as rhinopharynx and nasal cavity.

Evaluations of Sagittal and Vertical Changes Induced by Surgically Assisted Rapid Palatal Expansion

Class II, anterior open bite and/or a steep mandibular plane angle are frequently considered a contraindication to the use of surgically assisted rapid palatal expansion (SARPE). Nevertheless, few studies have investigated the maxillary and mandibular effects after SARPE on the sagittal and vertical planes, with dissimilar results and small samples of patients.The aim of the current study was to evaluate the sagittal and vertical effects after SARPE. Twenty-one consecutive adult patients (7 males, 14 females; mean age, 25.6 ± 6.3 years) who required SARPE were included in this study. All patients were subjected to subtotal LeFort I osteotomy with pterygomaxillary disjunction. Lateral cephalometric radiographs were taken during the preoperative assessment (T0) and 6 months after the end of the expansion (T1). Cephalometric measurements were realized at T0 and T1 for all the patients. Independent-sample t test and analysis of variance were used. Statistically significant changes were observed only in upper incisor^NA (P = 0.04). No skeletal sagittal or vertical variation was found after SARPE. Class II, anterior open bite and/or a steep mandibular plane angle cannot be considered an outright contraindication to its use. Upper incisor palatal inclination could result after SARPE.

Poster 41: Stability of Anterior Open Bite Correction in Class III Patients Using Bimaxillary Surgery Involving Intraoral Vertical Ramus Osteotomy

There is currently limited data on the use of intraoral vertical ramus osteotomy (IVRO) in the surgical treatment of anterior open bite and class three malocclusion. The purpose of this study is to investigate the stability of Le Fort I osteotomy with IVRO in the correction of anterior open bite with concomitant class III malocclusion. Chart reviews of patients who underwent surgical correction of anterior open bite with class three malocclusion were obtained from the years 2004-2009. Preoperative, postoperative, and 1 year postoperative lateral cephalograms were obtained. Anterior open bite was measured clinically from the edge of the maxillary central incisor to the edge of the mandibular central incisor along its axis. Angular measurements were used to evaluate jaw movement in the horizontal and vertical directions. Anterior-posterior movement of the jaws was determined by changes in the SNA and SNB angles. Vertical movements of the maxilla were calculated from changes in the Maxillary Occlusal Plane (MOP) and Palatal Plane (PP) angles to SN. Mandibular vertical movement was based on changes in the mandibular plane (MP) angle to SN. Dental compensation was determined by changes in MOP and MP angles. All cephalograms were traced and measured digitally with Dolphin© software. Statistical analysis was performed with the SAS procedure PROC MIXED (SAS/STAT software, SAS institute Inc., Cary, NC, USA). The accuracy of landmark identification, superimposition, and measurements were confirmed by retracing all cephalograms 7 days later by the same investigator. Sixty patient records were identified with 27 meeting the inclusion criteria. Six patients failed to have positive incisal overlap at 1 year postoperative (23%). Comparing preoperative data between the 2 groups, patients in the relapse group had a more significant open bite (OB −6.07 mm vs. −3.48 mm, p<0.05), overjet (−2.14 mm vs. −0.79 mm, p<0.05), maxillary posterior vertical excess (SN-PP: 0.75° vs. 3.74°, p<0.05), and a steeper mandibular plane angle (SN-MP: 41.98° vs. 36.35°, p<0.05). Surgically, the relapse group also had more maxillary clockwise movement compared to the non-relapse group (SN-PP +5.72° vs. +3.39°, p<0.05), but less mandibular counterclockwise movement (SN-MP −0.93° vs. −2.46°, p<0.05). When separating patients based on the severity of their preoperative open bite: no patients failed in the mild group (1–3 mm open bite; 0/9, 0%), 3 patients failed in the moderate group (3–6 mm open bite; 3/13, 23%), and 3 patients failed in the severe group (>6 mm open bite; 3/5, 60%). IVRO, when performed with maxillary Le Fort I osteotomy, has a success rate (78% positive incisal overlap at 1 year post operative) that is comparable to other surgical techniques when treating patients with anterior open bite and concomitant class III malocclusion. Patients likely to relapse have a severe preoperative open bite, a high preoperative mandibular plane angle, or inadequate mandibular counterclockwise movement during surgery. This study provides an evidence-based alternative to current techniques.

Two-phase treatment of skeletal Class II malocclusion with the combination of the Twin-block appliance and high-pull headgear

The patient was a boy with a Class II skeletal and dental relationship, a large overjet, an impinging overbite, and a steep mandibular plane angle. Treatment started with the Twin-block appliance combined with high-pull headgear to promote growth of the mandible, restrain the maxilla in the anteroposterior and vertical planes, and improve his profile. This was followed by extraction of the maxillary second premolars and the mandibular first premolars. Then fixed appliances were used to align and level the dentition. Pretreatment and posttreatment records are shown, and the treatment results are stable 2 years after debonding.

Comparative cephalometric study of Class I malocclusion in Egyptian and Japanese adult females

Orthodontic diagnosis is the key factor for conducting a successful orthodontic treatment. It typically includes comparing a patient's cephalometric measurements to standard values. However, lateral cephalometric norms, may be specific to an ethnic group and cannot always be applied to other ethnic types. Thus the purpose of this study was to compare the cephalometric features of Class I malocclusion in Egyptian and Japanese adult females inorder to understand the ethnic differences between these two groups. The lateral cephalograms of 50 Egyptian adult females and 50 Japanese adult females were traced and digitized by one investigator. Seventeen angular measurements and thirteen linear measurements of facial form were computed. A comparison of the vertical dimensions showed that, the Japanese had a significantly steeper mandibular plane angle. Also, Japanese females had a significantly larger lower face height together with increased distances of the posterior teeth to the mandibular plane. For the soft tissue dimensions, the Japanese subjects had a significantly less prominent nose, protruded lip positions, and a more retruded chin compared with Egyptians. These characteristic skeletal and soft tissue different features should be taken into consideration when formulating an orthodontic treatment plan for patients of varying ethnic backgrounds to optimize the final results.

Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

Average craniofacial development from 6 to 35 years of age in a mixed group of patients with juvenile idiopathic arthritis

Objective. To investigate long term the average changes in craniofacial morphology in a group of Norwegian juvenile idiopathic arthritis (JIA) patients with mixed diagnosis from 6 to 35 years of age. A matched group of healthy individuals was included as controls. Material and Methods. Craniofacial development in 38 females and 16 males with JIA was followed on lateral cephalograms from childhood for 23–31 years. The patients were compared with the healthy individuals at the ages of 6, 9, 12, and 35 years. Results. At 6 and 9 years of age, the average craniofacial morphology in the JIA patients was similar to that of the control subjects. At 12 years of age, significant craniofacial morphological differences between the JIA and the control subjects appeared. These included a steeper mandibular plane angle and a more retrognathic position of the mandible. The length of the mandible (ar-gn), the height of the ramus (ar-tgo), and the length of the corpus (tgo-gn) were significantly smaller in the JIA patients. The average growth direction of the chin was more downward in the JIA patients. A smaller posterior facial height and a higher ratio between the anterior and posterior facial heights were also observed. The differences in craniofacial morphology between the patients and the control group were more pronounced at 35 years of age than at earlier ages. Conclusion. The typical craniofacial morphological pattern in JIA patients was established between 9 and 12 years of age. From the age of 12 until the age of 35, this morphological pattern remained relatively stable, in contrast to the pattern in the healthy control subjects.

Dental and Craniofacial Characteristics in a Patient with Leprechaunism Treated with Insulin-Like Growth Factor-I

Leprechaunism is an autosomal recessive disease characterized by elfin-like faces, loss of glucose homeostasis, and severe insulin resistance. This disease is caused by inherited defects of the insulin receptor and is lethal early in life. Perhaps for this reason, the teeth and craniofacial features of patients with leprechaunism have never been reported. In the present case, the patient had been diagnosed with leprechaunism with mutation in the insulin receptor gene and had treatment with recombinant human insulin-like growth factor I (IGF-I) starting at the age of 1 year 7 months. It is of interest that all of his teeth were extremely large and subsequently showed severe crowding in the dental arches. He also showed a large tongue with an anterior open bite. He had a convex facial profile with a remarkably steep mandibular plane angle and large gonial angle. This is the first report of the characteristic phenotypes of the teeth and craniofacial morphology of a patient with leprechaunism treated with IGF-I. In addition, the possible association between these features and long-term IGF-I treatment is discussed.

Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

The effect of mode of breathing on craniofacial growth--revisited

It has been maintained that because of large adenoids, nasal breathing is obstructed leading to mouth breathing and an 'adenoid face', characterized by an incompetent lip seal, a narrow upper dental arch, increased anterior face height, a steep mandibular plane angle, and a retrognathic mandible. This development has been explained as occurring by changes in head and tongue position and muscular balance. After adenoidectomy and change in head and tongue position, accelerated mandibular growth and closure of the mandibular plane angle have been reported. Children with obstructive sleep apnoea (OSA) have similar craniofacial characteristics as those with large adenoids and tonsils, and the first treatment of choice of OSA children is removal of adenoids and tonsils. It is probable that some children with an adenoid face would nowadays be diagnosed as having OSA. These children also have abnormal nocturnal growth hormone (GH) secretion and somatic growth impairment, which is normalized following adenotonsillectomy. It is hypothesized that decreased mandibular growth in adenoid face children is due to abnormal secretion of GH and its mediators. After normalization of hormonal status, ramus growth is enhanced by more intensive endochondral bone formation in the condylar cartilage and/or by appositional bone growth in the lower border of the mandible. This would, in part, explain the noted acceleration in the growth of the mandible and alteration in its growth direction, following the change in the mode of breathing after adenotonsillectomy.

Cephalometric norms for saudi adults living in the western region of Saudi Arabia.

European-American norms are still used in the orthodontic treatment of Saudi patients, despite the different ethnic backgrounds of Saudis. The aims of this study were to evaluate the cephalometric features of a Saudi population and to establish cephalometric norms for Saudis living in the western region of Saudi Arabia. Seventy lateral cephalometric radiographs of Saudis (32 females and 38 males; aged 18-28 years) with acceptable profiles and Class I dental relationships were traced and analyzed. The mean value, standard deviation, and range of 16 angular and linear variables were calculated. The resulting norms for Saudis were compared with European-American norms using an independent t-test. Male and female groups were also compared using the t-test. Saudis tend to have an increased ANB angle because of retrognathic mandibles and bimaxillary protrusion as compared with European-Americans. Males tend to have more prognathic mandibles than females as indicated by the statistically significant increase in facial angle (P < .05) and SNB angle (P < .05). Although the anterior lower face height was similar in males and females, males tend to have a steeper mandibular plane angle when related to the anterior cranial base than females (P < .05). Saudis have distinct cephalometric features, which should be used as a reference in treating Saudi orthodontic patients.