Correlation between Occlusal Plane Angle, Balkwill Angle, and Temporomandibular Joint Morphology

doi:10.13701/j.cnki.kqyxyj.2025.11.005

Abstract

Abstract: Objective: To investigate the correlation between occlusal plane angles, Balkwill angle, and temporomandibular joint (TMJ) morphology in skeletal Class Ⅱ malocclusion patients with different vertical skeletal patterns. Methods: Skeletal Class Ⅱ malocclusion patients were divided into hypodivergent, normodivergent, and hyperdivergent subgroups (35 patients each) based on FH-MP angle, with 35 skeletal Class Ⅰ normodivergent adult patients as the control group. The Invivo Dental 5 software was employed to acquire the data of Balkwill angle, posterior occlusal plane angle (FH-POP), mandibular occlusal plane angle (FH-MOP), DPO (vertical distance from condylar center to the MOP), and the TMJ measurement items. Results: Skeletal Class Ⅱ patients with hyperdivergent type exhibited steeper FH-POP and FH-MOP, smaller Balkwill angle and DPO, shorter mediolateral and anteroposterior condylar diameters, smaller condylar inclination angle, and narrower anterior and superior joint spaces, while hypodivergent group showed opposite trends. DPO, MOP, and Balkwill angle were correlated with TMJ morphology. Conclusion: There was little difference in the TMJ morphology of normodivergent patients between the different sagittal patterns. While significant differences were found in the TMJ morphology among different vertical skeletal patterns. The results indicated that the DPO had a significant impact on TMJ morphology, followed by MOP angle, and finally Balkwill angle in skeletal Class Ⅱ hyperdivergent and hypodivergent group.

Key words: occlusal plane, Balkwill angle, temporomandibular joint, skeletal class Ⅱ malocclusion, cone-beam computed tomography

SHAN Xuelong, LI Ang, MENG Jian, ZHANG Jing. Correlation between Occlusal Plane Angle, Balkwill Angle, and Temporomandibular Joint Morphology[J]. Journal of Oral Science Research, 2025, 41(11): 952-958.

References

[1] Kurusu A, Horiuchi M, Soma K. Relationship between occlusal force and mandibular condyle morphology[J]. Angle Orthod, 2009, 79(6):1063-1069.
[2] Ueki K, Nakagawa K, Takatsuka S, et al. Comparison of the stress direction on the TMJ in patients with class Ⅰ, Ⅱ, and Ⅲ skeletal relationships[J]. Orthod Craniofac Res, 2008,11(1):43-50.
[3] Fushima K. Significance of the cant of the posterior occlusal plane in Class Ⅱ division 1 malocclusions[J]. Eur J Orthod, 1996, 18(1):27-40.
[4] Hu H, Lin W, Wu J, et al. Research on the correlation between the size of condyle and occlusion plane in skeletal Class Ⅱ malocclusions[J]. Clin Exp Dent Res, 2022, 8(6):1547-1554.
[5] Zheng J, Zhang Y, Wu Q, et al. Three-dimensional spatial analysis of the temporomandibular joint in adult patients with Class Ⅱ division 2 malocclusion before and after orthodontic treatment: a retrospective study[J]. BMC Oral Health, 2023, 23(1):477.
[6] Casazza E, Orthlieb JD, Giraudeau A, et al. Balkwill's angle, occlusal plane, mandibular shape, and curve of Spee[J]. Cranio, 2024, 42(5):583-591.
[7] Ma Q, Bimal P, Mei L, et al. Temporomandibular condylar morphology in diverse maxillary-mandibular skeletal patterns[J]. J Am Dent Assoc, 2018, 149(7):589-598.
[8] Li X, Shan X, Zhang S, et al. The correlation analysis between incisal guidance angle and occlusal plane angles and temporomandibular joint morphology[J]. Clin Oral Investig, 2024, 28(8):455.
[9] Creekmore TD. Changes in occlusion related to the cant of the occlusal plane[J]. Am J Orthod Dentofacial Orthop, 1997, 112(5):17A-20A.
[10] Li J, Kau CH, Wang M. Changes of occlusal plane inclination after orthodontic treatment in different dentoskeletal frames[J]. Prog Orthod, 2014, 15(1):41.
[11] Shetty S, Zargar NM, Shenoy K, et al. Position of occlusal plane in dentate patients with reference to the ala-tragal line using a custom-made occlusal plane analyzer[J]. J Prosthodont, 2015, 24(6):469-474.
[12] Li Y, Zhou W, Wu Y, et al. The relation between incisal guidance angle and the growth and development of temporomandibular joint: a multi-cross-sectional retrospective study[J]. BMC Oral Health, 2021, 21(1):380.
[13] Tanaka EM, Sato S. Longitudinal alteration of the occlusal plane and development of different dentoskeletal frames during growth[J]. Am J Orthod Dentofacial Orthop, 2008, 134(5):601.e1-11.
[14] Jeon YJ, Kim YH, Son WS, et al. Correction of a canted occlusal plane with miniscrews in a patient with facial asymmetry[J]. Am J Orthod Dentofacial Orthop, 2006, 130(2):244-252.
[15] Kattadiyil MT, Goodacre CJ, Naylor WP, et al. Esthetic smile preferences and the orientation of the maxillary occlusal plane[J]. J Prosthet Dent, 2012, 108(6):354-361.
[16] Rubio-Bueno P, Landete P, Ardanza B, et al. Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key?[J]. Int J Oral Maxillofac Surg, 2017, 46(11):1363-1371.
[17] Slavicek R. Die funktionellen Determinanten des Kauorgans[Functional determinants of the masticatory system][J]. Zahnarzt, 1985, 29(10):663-664, 667-670, 673-674.
[18] Ricketts RM. The value of cephalometrics and computerized technology[J]. Angle Orthod, 1972, 42(3):179-199.
[19] W B. Geometric and mechanical laws of articulation. Anatomical articulation[M]. Philadelphia: Trans Odont Soc Penn, 1885.
[20] Ohm E, Silness J. The size of the Balkwill angle and the height of the Bonwill triangle[J]. J Oral Rehabil, 1982, 9(4):301-306.
[21] Fukoe H, Basili C, Slavicek R, et al. Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition[J]. International Journal of Stomatology & Occlusion Medicine, 2012, 5(3):119-129.
[22] Maggetti I, Bindl A, Mehl A. A three-dimensional morphometric study on the position of temporomandibular joints[J]. Int J Comput Dent, 2015, 18(4):319-331.
[23] Shen Y, Wu C, Hsu J, et al. Assessments of Bonwill Triangle from CT Data Base in Taiwan[M]. 2010.
[24] Noh KJ, Baik H, Han S, et al. Differences in mandibular condyle and glenoid fossa morphology in relation to vertical and sagittal skeletal patterns: A cone-beam computed tomography study[J]. Korean J Orthod, 2021, 51(2):126-134.
[25] Zhou J, Yang H, Li Q, et al. Comparison of temporomandibular joints in relation to ages and vertical facial ypes in skeletal class Ⅱ female patients: a multiple-cross-sectional study[J]. BMC Oral Health, 2024,24(1):467.
[26] Loiola MEA, Fuziy A, Higa RH, et al. In vivo three-dimensional cephalometric landmarks using CBCT for assessment of condylar volume and surface in individuals with Class Ⅰ, Ⅱ, and Ⅲ malocclusions[J]. Cranio, 2023, 41(4):348-353.
[27] Ceratti C, Maspero C, Consonni D, et al. Cone-beam computed tomographic assessment of the mandibular condylar volume in different skeletal patterns: a retrospective study in adult patients[J]. Bioengineering (Basel), 2022, 9(3):102.