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Skeletal discrepancies. Part 2: assessment, aetiology and management of high angle cases

From Volume 16, Issue 3, July 2023 | Pages 130-134


Kyle Durman


Post-CCST Trainee in Orthodontics, Royal Devon and Exeter Hospital

Articles by Kyle Durman

Hannah Batsford


Specialty Registrar in Orthodontics, Bristol Dental Hospital

Articles by Hannah Batsford

Peter Fowler

BDS, MSc, PhD, MOrth RCS, FRACDS(Orth)

Consultant, Senior Lecturer, Graduate Program Director, Bristol Dental Hospital

Articles by Peter Fowler


This is the second article in a three-part series considering skeletal discrepancies in the vertical and transverse dimensions. Discrepancies in the vertical dimension are a relatively common finding, presenting challenges for the orthodontist in terms of treatment planning, management and relapse.

CPD/Clinical Relevance: This article aims to increase awareness of the aetiology and management of patients presenting with increased Frankfort/maxillary mandibular planes angle and anterior lower face height, commonly described as ‘high angle’.


The vertical dimension is one of the three spatial planes used to assess orthodontic hard and soft tissue relationships. It is important to be able to assess the vertical dimension, understand the aetiology of the malocclusion and be able to manage patients with an increased Frankfort/maxillary mandibular planes angle (F/MMPA) and anterior lower face height (ALFH).

The definition of ‘high angle’ in orthodontics is an increased F/MMPA more than one standard deviation above average (FMPA >32°).1 A high angle is associated with increased vertical facial proportions, with backward growth rotations of the mandible. Other terms used to describe a high angle include hyperdivergent, dolichofacial and long or adenoid face. Although these terms all refer to similar clinical features, the assortment of interchangeable terms indicate variations in facial morphology and possible aetiological features.

The prevalence of patients with a ‘long face’ is approximately 22%, and increased vertical proportions occur predominately in the lower third of the face, rather than the middle third of the face.2,3

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