ORIGINAL ARTICLE Dentofacial features of children with distal occlusions, large overjets, and deepbites in the early mixed dentition Katri Keski-Nisula, a Leo Keski-Nisula, b Päivi Mäkelä, c Tapani Mäki-Torkko, d and Juha Varrela e Vaasa, Tampere, Jalasjärvi, Kurikka, and Turku, Finland Introduction: The aim of this investigation was to analyze craniofacial morphology in children with distal bites, large overjets, and deepbites in the early mixed dentition. Methods: The sample comprised 486 Finnish children who are participating in an ongoing clinical trial. Cephalograms were obtained at the deciduous-mixed dentition interphase for the baseline of the trial. The mean age of the children was 5.1 years (SD, 2.6; range, 4.0-7.8 years). Results: Subjects with bilateral distal steps of 1 mm compared with normal had long midfaces (P .05), short and retrusive mandibles (P .05), small maxillomandibular differentials (P .001), convex proﬁles (P .01), retrusive mandibular incisors (P .01), and large interincisal angles (P .001). Children with overjets of 4 mm had retrusive mandibles (P .001), long maxillae and midfaces (P .001), small maxillomandibular differentials (P .001), convex proﬁles (P .001), and protrusive maxillary and retrusive mandibular incisors (P .001). Children with deepbites (overbites of 4 mm) had short and retrusive mandibles (P .05), long midfaces (P .001) and maxillae (P .05), small maxillomandibular differentials (P .001), convex proﬁles (P .01), retrusive mandibular incisors (P .001), and large interincisal angles (P .001). No differences were found in the length of anterior cranial base, the position of maxilla relative to cranial base, lower facial height, and facial axis angle between any malocclusion group and normal children. All correlations between the occlusal and skeletal characteristics were low, suggesting only weak associa- tions at this stage of development. Conclusions: These results indicate that the early dentofacial features of children with distal occlusions, large overjets, and deepbites differ from normal values. However, the skeletal patterns of these 3 malocclusion types showed considerable similarities, with long but neutrally positioned maxillae, retrusive mandibles, small maxillomandibular differences, convex proﬁles, retrusive mandibular incisors, and large interincisal angles, but normal growth directions and lower facial heights as common features. (Am J Orthod Dentofacial Orthop 2006;130:292-9) I n younger children, both the occlusal and the skeletal signs of malocclusion are usually less obvious than in adolescents. Consequently, a diag- nosis of a malocclusion in the deciduous or early mixed dentition cannot be based on the same criteria as in the permanent dentition. When considering orthodontic treatment in the early stages of occlusal development, it is essential to predict how the developmental changes of the dentition will affect the occlusion, with and without intervention. Moreover, it is important to esti- mate the amount and the direction of facial growth and its inﬂuence on the development of occlusion. Longi- tudinal studies indicated that, in most patients, a diag- nosis of the malocclusion and a fairly consistent pre- diction of the development of the permanent occlusion can be based on features of the deciduous dentition, including distal step, 1-5 crowding or missing diaste- mas, 6,7 excess overjet and overbite, 8-11 and posterior crossbite. 12,13 However, early skeletal development and the interrelationship between occlusion and skeletal morphology in the deciduous and early mixed dentition are less well understood. Moyers and Wainright, 14 for example, who studied occlusal and skeletal develop- ment longitudinally from 4 to 16 years of age, found little evidence to support the assumption that cranio- facial morphology and facial growth are important determinants of occlusal development, at least in the younger age groups. a Chief orthodontist, Vaasa Central Hospital, Vaasa, Finland. b Assistant professor of radiology, Tampere University Hospital, Tampere, Finland. c General practitioner, Jalasjärvi Health Center, Jalasjärvi, Finland. d General practitioner, Kurikka Health Center, Kurikka, Finland. e Professor and chair, Department of Oral Development and Orthodontics; director, Postgraduate School of Oral Health Sciences; vice dean, Institute of Dentistry; University of Turku, Turku, Finland. Supported by the Finnish Dental Society Apollonia, the Medical Research Fund of Turku University Central Hospital, the Medical Research Fund of Vaasa Hospital District, and Plandent Oyj. Reprint requests to: Dr Juha Varrela, Department of Oral Development and Orthodontics, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, FIN-20520 Turku, Finland; e-mail, juha.varrela@utu.ﬁ. Submitted, October 2004; revised and accepted, January 2005. 0889-5406/$32.00 Copyright © 2006 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2005.01.025 292