{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T03:45:08Z","timestamp":1791690308419,"version":"4.3.4"},"reference-count":39,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Skeletal deep bite malocclusion (Angle Class II division 2) represents a common vertical skeletal discrepancy characterized by excessive anterior overbite and a hypodivergent craniofacial growth pattern. The contribution of cranial base morphology to mandibular growth direction during early development remains incompletely understood. Objective: To evaluate the relationship between cranial base morphology and maxillofacial growth patterns in children with skeletal deep bite, using a longitudinal cephalometric approach. Materials and Methods: This retrospective longitudinal cohort study included 96 prepubertal patients aged 7\u201310 years (54 with skeletal deep bite, 42 Angle Class I dentoalveolar controls). Skeletal deep bite was defined by overbite &gt; 4 mm and mandibular plane angle (FMA) &lt; 22\u00b0. A total of 298 standardized lateral cephalometric radiographs (2\u20134 per subject; mean follow-up 24 \u00b1 4 months) were analyzed. Twenty-two cephalometric parameters were assessed. Longitudinal changes were evaluated using repeated-measures analysis, and predictors of deep bite severity were identified using multiple linear regression. Results: Compared with controls, the deep bite group exhibited significantly reduced mandibular plane angle (18.5\u00b0 vs. 24.0\u00b0), smaller gonial angle (104.3\u00b0 vs. 111.0\u00b0), and decreased lower anterior facial height (86.3 mm vs. 92.0 mm; all p &lt; 0.001). Differences in cranial base morphology were modest, including reduced anterior cranial base length (58.6 mm vs. 60.0 mm; p = 0.031). Regression analysis identified gonial angle and lower anterior facial height as significant predictors (R2 = 0.58). Longitudinal analysis suggested early tendencies toward forward mandibular rotation and reduced vertical growth rate over the observation period. Conclusions: In prepubertal children, skeletal deep bite is associated with early tendencies toward reduced vertical facial development and forward mandibular rotation. Cranial base morphology appears to be associated with mandibular growth direction as a secondary modulatory factor rather than a primary determinant. Early identification of hypodivergent growth indicators may facilitate timely interceptive orthodontic strategies.<\/jats:p>","DOI":"10.3390\/diagnostics16101414","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T08:01:39Z","timestamp":1778140899000},"page":"1414","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cranial Base Morphology and Mandibular Growth in Skeletal Deep Bite: A Longitudinal Study in Prepubertal Children"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5193-4944","authenticated-orcid":false,"given":"Eugen Silviu","family":"Bud","sequence":"first","affiliation":[{"name":"Orthodontics Department, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"P\u0103curar","sequence":"additional","affiliation":[{"name":"Orthodontics Department, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2943-4745","authenticated-orcid":false,"given":"Cristina Ioana","family":"Bica","sequence":"additional","affiliation":[{"name":"Pedodontics Department, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5433-1137","authenticated-orcid":false,"given":"Sorana Maria","family":"Bucur","sequence":"additional","affiliation":[{"name":"Department of Dentistry, Faculty of Medicine, \u201cDimitrie Cantemir\u201d University of T\u00e2rgu Mure\u0219, 540545 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3883-0547","authenticated-orcid":false,"given":"Alexandru","family":"Vlasa","sequence":"additional","affiliation":[{"name":"Department of Periodontology and Oral-Dental Diagnosis, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 38 Gh. Marinescu Str., 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Be\u00e1ta","family":"Szab\u00f3","sequence":"additional","affiliation":[{"name":"Private Office, 14 Ion Heliade R\u0103dulescu Str., 540189 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anamaria","family":"Bud","sequence":"additional","affiliation":[{"name":"Pedodontics Department, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Watted, N., Lone, I.M., Zohud, O., Midlej, K., Proff, P., and Iraqi, F.A. (2023). Comprehensive Deciphering the Complexity of the Deep Bite: Insight from Animal Model to Human Subjects. J. Pers. Med., 13.","DOI":"10.3390\/jpm13101472"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"222","DOI":"10.53730\/ijhs.v5nS2.5659","article-title":"Deep bite: Its classification, etiology, clinical features, diagnosis & treatment modalities","volume":"5","author":"Jain","year":"2021","journal-title":"Int. J. Health Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100956","DOI":"10.1016\/j.ortho.2024.100956","article-title":"Orthodontic treatment of deep bite in mixed dentition and\/or early permanent dentition: What about stability?\u2014A systematic review","volume":"23","author":"Zaoui","year":"2025","journal-title":"Int. Orthod."},{"key":"ref_4","first-page":"449","article-title":"Deep bite malocclusion: Exploration of the skeletal and dental factors","volume":"28","author":"Bhateja","year":"2016","journal-title":"J. Ayub Med. Coll. Abbottabad"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1053\/j.sodo.2017.07.003","article-title":"Heredity, genetics and orthodontics\u2014How much has this research really helped?","volume":"23","author":"Hartsfield","year":"2017","journal-title":"Semin. Orthod."},{"key":"ref_6","first-page":"e62666","article-title":"Evaluation of the best method for orthodontic correction of skeletal deep bites in growing patients: A systematic review","volume":"16","author":"Rasol","year":"2024","journal-title":"Cureus"},{"key":"ref_7","first-page":"e35381","article-title":"Investigating the effectiveness of low-level laser in reducing root resorption of the upper incisors during intrusion movement using mini-implants in adult patients with deep overbite: A randomized controlled clinical trial","volume":"15","author":"Nasser","year":"2023","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Funato, N. (2020). New insights into cranial synchondrosis development: A mini review. Front. Cell Dev. Biol., 8.","DOI":"10.3389\/fcell.2020.00706"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/s41413-025-00426-z","article-title":"RUNX2 is essential for maintaining synchondrosis chondrocytes and cranial base growth","volume":"13","author":"Hallett","year":"2025","journal-title":"Bone Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1590\/2177-6709.22.5.056-066.oar","article-title":"Influence of the cranial base flexion on Class I, II and III malocclusions: A systematic review","volume":"22","author":"Almeida","year":"2017","journal-title":"Dent. Press J. Orthod."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Al-Gumaei, W.S., Al-Attab, R., Al-Tayar, B., Al-Hadad, S.A., Alyafrusee, E.S., Al-Mashraqi, A.A., Alhashimi, N., Zheng, Y., and Alhammadi, M.S. (2022). Comparison of spheno-occipital synchondrosis maturation stages with three-dimensional assessment of mandibular growth. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02692-3"},{"key":"ref_12","first-page":"1","article-title":"Deep bite malocclusion: Exploration of the skeletal and dental factors","volume":"8","author":"Alaklany","year":"2023","journal-title":"Univ. J. Pharm. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1053\/j.sodo.2025.02.006","article-title":"Deep bite correction with clear aligners\u2014After 26 years where are we at?","volume":"32","author":"Blundell","year":"2025","journal-title":"Semin. Orthod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/ocr.12083","article-title":"Genetics of the dentofacial variation in human malocclusion","volume":"18","author":"Miller","year":"2015","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/0002-9416(69)90036-0","article-title":"Prediction of mandibular growth rotation","volume":"55","year":"1969","journal-title":"Am. J. Orthod."},{"key":"ref_16","first-page":"1","article-title":"Normal and abnormal growth of the mandible: A synthesis of longitudinal cephalometric implant studies over a period of 25 years","volume":"5","author":"Skieller","year":"1983","journal-title":"Eur. J. Orthod."},{"key":"ref_17","unstructured":"Enlow, D.H., and Hans, M.G. (1996). Essentials of Facial Growth, WB Saunders."},{"key":"ref_18","first-page":"e87864","article-title":"Predictability of a mandibular corpus length multivariate model integrating Bj\u00f6rk-Jarabak measurements and the cephalometric norm","volume":"17","year":"2025","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.identj.2024.12.023","article-title":"Long-term predictive modelling of the craniofacial complex using machine learning on 2D cephalometric radiographs","volume":"75","author":"Myers","year":"2025","journal-title":"Int. Dent. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1093\/ejo\/17.5.403","article-title":"Relationship between cranial base and maxillofacial morphology","volume":"17","author":"Kasai","year":"1995","journal-title":"Eur. J. Orthod."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Alhazmi, N., Almihbash, A., Alrusaini, S., Bin Jasser, S., Alghamdi, M.S., Alotaibi, Z., Alshamrani, A.M., and Albalawi, M. (2022). The association between cranial base and maxillomandibular sagittal and transverse relationship: A CBCT study. Appl. Sci., 12.","DOI":"10.3390\/app12189199"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"St\u0103ncioiu, A.-A., Vasica, F., Nagib, R., Popa, A., Motofelea, A.C., Hu\u0219anu, A.A., and Szuhanek, C.-A. (2024). Cephalometric Evaluation of Facial Height Ratios and Growth Patterns: A Retrospective Cohort Study. Appl. Sci., 14.","DOI":"10.20944\/preprints202409.1465.v1"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zakhar, G., Hazime, S., Eckert, G., Wong, A., Badirli, S., and Turkkahraman, H. (2023). Prediction of Pubertal Mandibular Growth in Males with Class II Malocclusion by Utilizing Machine Learning. Diagnostics, 13.","DOI":"10.20944\/preprints202307.0164.v1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S0002-9416(84)90028-9","article-title":"Prediction of mandibular growth rotation evaluated from a longitudinal implant sample","volume":"86","author":"Skieller","year":"1984","journal-title":"Am. J. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S0889-5406(05)81602-6","article-title":"Growth patterns in subjects with long and short faces","volume":"98","author":"Nanda","year":"1990","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ajodo.2011.04.015","article-title":"Longitudinal growth changes in subjects with deepbite","volume":"140","author":"Baccetti","year":"2011","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lone, I.M., Zohud, O., Midlej, K., Proff, P., Watted, N., and Iraqi, F.A. (2023). Skeletal class II malocclusion: From clinical treatment strategies to the roadmap in identifying the genetic bases of development in humans with the support of the Collaborative Cross mouse population. J. Clin. Med., 12.","DOI":"10.3390\/jcm12155148"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"755","DOI":"10.2319\/100113-719.1","article-title":"Mandibular growth comparisons of Class I and Class II division 1 skeletofacial patterns","volume":"84","author":"Jacob","year":"2014","journal-title":"Angle Orthod."},{"key":"ref_29","first-page":"39","article-title":"Changes in cranial base morphology in Class I and Class II division 1 malocclusions","volume":"5","author":"Agarwal","year":"2013","journal-title":"J. Int. Oral Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ejwf.2023.12.004","article-title":"Biomechanical and clinical considerations in deep bite treatment using temporary skeletal anchorage devices","volume":"13","author":"Kim","year":"2024","journal-title":"J. World Fed. Orthod."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2319\/042823-310.1","article-title":"The effect of vertical skeletal proportions on overbite changes in untreated adolescents: A longitudinal evaluation","volume":"94","author":"Ferrillo","year":"2024","journal-title":"Angle Orthod."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Dinu, S., Igna, A., Petrescu, E.L., Braila, E.B., Dinu, D.C., Horhat, R.M., Mihai, C., Traila, I.A., Nica, D.F., and Popa, M. (2025). Timing of orthodontic intervention for pediatric class II malocclusion: A systematic review on early vs. late treatment outcomes. Children, 12.","DOI":"10.3390\/children12111533"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"69","DOI":"10.22514\/jocpd.2024.105","article-title":"Mandibular response after rapid maxillary expansion in mixed dentition children with different vertical growth patterns: A retrospective study","volume":"48","author":"Yang","year":"2024","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4773","DOI":"10.1007\/s00784-023-05105-z","article-title":"Effects of fixed functional orthodontic treatment in hypodivergent and hyperdivergent class II patients\u2014A retrospective cephalometric investigation","volume":"27","author":"Hourfar","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_35","first-page":"e38893","article-title":"Changes in the vertical dimension after orthodontic treatment in response to different premolar extraction patterns","volume":"15","author":"Burashed","year":"2023","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"244","DOI":"10.5005\/jp-journals-10024-3503","article-title":"Comparative evaluation of cranial base length and flexure on facial parameters in hypodivergent, normodivergent and hyperdivergent patients: A retrospective cephalometric study","volume":"24","author":"Anitha","year":"2023","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1093\/ejo\/cjab082","article-title":"Reliability of cephalometric superimposition for the assessment of craniofacial changes: A systematic review","volume":"44","author":"Graf","year":"2022","journal-title":"Eur. J. Orthod."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ceratti, C., Maspero, C., Consonni, D., Caprioglio, A., Connelly, S.T., Inchingolo, F., and Tartaglia, G.M. (2022). Cone-Beam Computed Tomographic Assessment of the Mandibular Condylar Volume in Different Skeletal Patterns: A Retrospective Study in Adult Patients. Bioengineering, 9.","DOI":"10.3390\/bioengineering9030102"},{"key":"ref_39","first-page":"e77021","article-title":"Evaluation of the Relationship Between Facial Measurements and Esthetic Evaluation of the Face in Patients With a Vertical Growth Pattern","volume":"17","author":"Albitar","year":"2025","journal-title":"Cureus"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1414\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T08:30:10Z","timestamp":1778142610000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":39,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16101414"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16101414","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]}}}