Transverse dimension

To assess this dimension, look at the patient head-on and assess whether there is any asym-

Fig. 7 Anterior open bites are often associated with an increase in lower anterior face height

Fig. 7 Anterior open bites are often associated with an increase in lower anterior face height

Fig. 8 A centre line shift where the lower centre line is to the left

metry in the facial mid-line. If there appears to be any mandibular asymmetry this may be reflected in the position of the teeth as shown in Fig. 8. If there is asymmetry it is important to distinguish between false and true asymmetry. A false asymmetry arises when occlusal interferences force the patient to displace the mandible laterally producing a cross-bite in the anterior or buccal region. If the displacement is eliminated then the mandible will return to a centric position. A true asymmetry arises as a consequence of unequal facial growth on the left or right side of the jaws. In these cases elimination of any occlusal cross-bites (which can be very difficult) is unlikely to improve the facial asymmetry.

Fig. 9 Teeth are in soft tissue balance between the tongue and the lips

Fig. 10 These diagrams show how partial reduction of the overjet does not allow the lip to cover the upper incisors. The upper incisors are then quite likely to return to their pre-treatment position

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