o objetivo desse estudo foi realizar uma revisão sistemática sobre as características morfológicas da base do crânio (flexão, comprimento anterior e comprimento posterior) e o desenvolvimento concomitante da má oclusão, comparando as diferenças do dimorfismo, etnia e idade.

Métodos:

os artigos foram selecionados por meio de busca eletrônica nas bases de dados BBO, MEDLINE e LILACS, de 1966 a 2016. Uma avaliação qualitativa da metodologia dos artigos também foi executada.

Resultados:

ainda que a literatura seja abundante nesse assunto, somente 16 artigos foram selecionados para a presente revisão sistemática. O ângulo da base do crânio, por si só, não parece desempenhar papel significativo no desenvolvimento das más oclusões. De fato, o ângulo da base do crânio é relativamente estável dos 5 aos 15 anos.

Conclusões:

um ângulo mais obtuso na base do crânio, associado ou não a um comprimento maior, pode contribuir para o desenvolvimento da má oclusão de Classe II, divisão 1. Por outro lado, um ângulo mais agudo na base do crânio pode contribuir para um posicionamento mais anterior da mandíbula e para o desenvolvimento da má oclusão de Classe III.

Palavras-chave:
Má oclusão; Cefalometria; Crescimento; Base do crânio

Autoria

Kélei Cristina Mathias de Almeida

Universidade Estadual Paulista, Faculdade de Odontologia de Araraquara, Departamento de Ortodontia e Odontopediatria (Araraquara/SP, Brazil).Universidade Estadual PaulistaBrazilAraraquara, SP, BrazilUniversidade Estadual Paulista, Faculdade de Odontologia de Araraquara, Departamento de Ortodontia e Odontopediatria (Araraquara/SP, Brazil).

Taísa Boamorte Raveli

Camila Ivini Viana Vieira

Private practice (Araraquara/SP, Brazil).Private practice (Araraquara/SP, Brazil).BrazilAraraquara, SP, BrazilPrivate practice (Araraquara/SP, Brazil).

Ary dos Santos-Pinto

Dirceu Barnabé Raveli

Contact address: Dirceu Barnabé Raveli Rua Humaitá, 1680, Araraquara/SP - CEP: 14.801-903 E-mail: draveli@foar.unesp.br

Author contributions

Conception or design of the study: KCMA, TBR, CIVV, ASP. Data acquisition, analysis or interpretation: KCMA, TBR, CIVV, ASP, DBR. Writing the article: KCMA, TBR, CIVV, ASP, DBR. Critical revision of the article: KCMA, TBR, ASP, DBR. Final approval of the article: KCMA, TBR, ASP.

SCIMAGO INSTITUTIONS RANKINGS

Private practice (Araraquara/SP, Brazil).Private practice (Araraquara/SP, Brazil).BrazilAraraquara, SP, BrazilPrivate practice (Araraquara/SP, Brazil).

Tabelas

Tabelas (4)

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Table 1
Qualification of the methodology used by the articles selected for review.

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Table 2
Evaluation of methodological quality of the 16 articles selected for review.

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Table 3
Sample characteristics and objectives of the 16 articles selected for review.

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Table 4
Epitome of the articles selected for review.

Table 1 Qualification of the methodology used by the articles selected for review.

	2 points	1 points
Clearly formulated objective	(x) yes	( ) no
Study design	(x) yes	( ) no
Description of the sample selection	(x) yes	( ) no
Adequate sample size	(x) yes	( ) no
Control group	(x) yes	( ) no
Adequate measurement method	(x) yes	( ) no
Adequate statistical analysis	(x) yes	( ) no
Method error analysis	(x) yes	( ) no
Blind study	(x) yes	( ) no
Multiple comparison between Class I, II and III malocclusions	(x) yes	( ) no
Total		20 points

Table 2 Evaluation of methodological quality of the 16 articles selected for review.

Article	Clear objective	Study design	Description of the sample selection	Adequate sample size	Control group	Adequate measurement method	Adequate statistical analysis	Method error analysis	Blind study	Multiple comparison between Class I, II and III malocclusions	Score
Dhoptkar et al.¹⁹19 Dhoptkar A, Bhatia S, Rock P. An investigation into the relationship between the cranial base angle and malocclusion. Angle Orthodontist. 2002 Oct;72(5):456-63.	Yes	No	Yes	Yes	No	Yes	Yes	Yes	No	Yes	17
Wilhelm et al.¹⁵15 Wilhelm BM, Beck FM, Lidral AC, Vig KWL. A comparison of cranial base growth in Class I and Class II skeletal patterns. Am J Orthod Dentofacial Orthop. 2001 Apr;119(4):401-5.	Yes	Yes	Yes	Yes	No	Yes	Yes	No	No	No	16
Mouakeh²¹21 Mouakeh M. Cephalometric evaluation of craniofacial pattern of Syrian children with Class III malocclusion. Am J Orthod Dentofacial Orthop. 2001 June;119(6):640-9.	Yes	No	Yes	Yes	Yes	Yes	Yes	No	No	No	16
Alexander et al²²22 Alexander AEZ, McNamara JA, Franchi L, Baccetti T. Semi longitudinal cephalometric study of craniofacial growth in untreated Class III malocclusion. Am J Orthod Dentofacial Orthop. 2009 June;135(6):701-14.	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	No	No	17
Ishii et al.²³23 Ishii N, Deguchi T, Hunt N. Craniofacial morphology of Japanese girls with Class II division 1 malocclusion. J Orthod. 2001 Sept;28(3):211-5.	Yes	No	No	Yes	Yes	Yes	Yes	Yes	No	No	16
Polat, Kaya¹1 Polat OO, Kaya B. Changes in cranial base morphology in difference malocclusions. Orthod Craniofac Res. 2007 Nov;10(4):216-21.	Yes	No	Yes	Yes	No	Yes	Yes	Yes	No	Yes	17
Singh et al²⁴24 Singh GD, McNamara JA Jr, Lozanoff S. Morphometry of the cranial base in subjects with Class III malocclusion. J Dent Res. 1997 Feb;76(2):694-703.	Yes	No	Yes	Yes	Yes	Yes	Yes	No	No	No	16
Johannsdottir et al.²⁵25 Johannsdottir B, Thordarson A, Magnusson TE. Craniofacial morphology in 6-year-old Icelandic children. Eur J Orthod. 1999 June;21(3):283-90.	Yes	No	Yes	Yes	Yes	Yes	Yes	No	No	No	16
Rothstein, Yoon-Tarlie¹⁶16 Rothstein T, Yoon-Tarlie C. Dental and facial skeletal characteristics and growth of males and females with Class II, division 1 malocclusion between the ages of 10 and 14 (revisited)-Part I: characteristics of size form, and position. Am J Orthod Dentofacial Orthop. 2000 Mar;117(3):320-32.	Yes	No	Yes	Yes	Yes	Yes	Yes	No	No	No	16
Ishii et al.²⁶26 Ishii N, Deguchi T, Hunt NP. Morphological diferences in the craniofacial structure between Japanese and Caucasian girls with Class II division 1 malocclusion. Eur J Orthod. 2002 Feb;24(1):61-7.	Yes	No	Yes	Yes	Yes	Yes	Yes	No	No	No	16
Kappor et al.²⁷27 Kapoor S, Kapoor DN, Jaiswal JN. Cephalometric evaluation of Class II malocclusion in transitional dentition. J Indian Soc Pedo Dent. 2001 Dec;19(4):127-33.	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	No	No	17
Singh et al.²⁸28 Singh GD, McNamara JA Jr, Lozanoff S. Craniofacial heterogeneity of prepubertal Korean and European-American subjects with Class III malocclusions: procrustes, EDMA, and cephalometric analyses. Int J Adult Orthod Orthognath Surg. 1998 Jan;13(3):227-40.	Yes	No	No	Yes	No	Yes	Yes	No	No	No	14
Zeng et al.²⁹29 Zeng XL, Forsberg CM, Aronson SL. Craniofacial morphology in Chinese and Swedish children with Angle Class I and Class II occlusal relations. Australian Orthod J. 1998 Oct;15(3):168-76.	No	Yes	Yes	No	No	Yes	Yes	Yes	No	No	15
Lau, Hagg³⁰30 Lau JWP, Hagg U. Cephalometric morphology of Chinese with Class II division 1 malocclusion. Br Dental J. 1999 Feb;186(4):188-90.	No	No	No	Yes	Yes	No	No	No	No	No	12
Chang et al.³¹31 Chang HP, Hsieh SH, Tseng YC, Chou TM. Cranial-base morphology in children with Class III malocclusion. Kaohsiung J Med Sci. 2005 Apr;21(4):159-65.	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	No	18
Yoon, Chung³⁷37 Yoon SS, Chung CH. Comparison of craniofacial growth of untreated Class I and Class II girls from ages 9 to 18 years: a longitudinal study. Am J Orthod Dentofacial Orthop. 2015 Feb;147(2):190-6.	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	No	17

Table 3 Sample characteristics and objectives of the 16 articles selected for review.

Article	Type of study (T or L)	n	Control group	Malocclusion	Sex %	Ethnicity	Age	Objective
Dhoptkar et al.¹⁹19 Dhoptkar A, Bhatia S, Rock P. An investigation into the relationship between the cranial base angle and malocclusion. Angle Orthodontist. 2002 Oct;72(5):456-63. (2002)	Transversal	200	No	50 with Class I 50 with Class II div 1 50 with Class II div 2 50 with Class III	50%	Caucasian	Class I: 10.4 yrs Class II div 1: 10.1yrs Class II div 2: 11.1yrs Class III: 10.2 yrs	To compare the skull base flexion to type of malocclusion as follows: Class I to Class II div 1 to Class II div 2 and Class I to Class III
Wilhelm et al.¹⁵15 Wilhelm BM, Beck FM, Lidral AC, Vig KWL. A comparison of cranial base growth in Class I and Class II skeletal patterns. Am J Orthod Dentofacial Orthop. 2001 Apr;119(4):401-5. (2001)	Longitudinal	43	No	22 with Class I 21 with Class II	50%	European	1 month 2 yrs and 14 yrs old	To compare the longitudinal growth of the skull base (size and shape) to Class I and Class II malocclusions)
Mouakeh²¹21 Mouakeh M. Cephalometric evaluation of craniofacial pattern of Syrian children with Class III malocclusion. Am J Orthod Dentofacial Orthop. 2001 June;119(6):640-9. (2001)	Transversal	138	Yes; Paired by age, sex and ethnicity	69 with Class III 69 with Class I (control)	66.6% female	Syrian	5 - 12 yrs old Mean 8.4 ± 2 yrs old	To identify morphological characteristics of the craniofacial complex in Syrian patients with Class III malocclusion and compare them to controls
Alexander et al.²²22 Alexander AEZ, McNamara JA, Franchi L, Baccetti T. Semi longitudinal cephalometric study of craniofacial growth in untreated Class III malocclusion. Am J Orthod Dentofacial Orthop. 2009 June;135(6):701-14. (2009)	Longitudinal	103	No	103 with Class III	55 females 48 males	Caucasian	6-7; 7-8; 8-9; 10-11; 11-12; 12-13 13-14; 15-16; 16-17; 17-18 yrs old	To investigate changes in the craniofacial growth in untreated individuals with Class III malocclusion
Ishii et al.²³23 Ishii N, Deguchi T, Hunt N. Craniofacial morphology of Japanese girls with Class II division 1 malocclusion. J Orthod. 2001 Sept;28(3):211-5. (2001)	Transversal	279	Yes	190 with Class II div 1 89 with Class I (control)	100% females	Japanese	3 groups: Mixed dentition, Delayed mixed dentition, Young permanent dentition	To compare the craniofacial characteristics of Japanese females with Class II division to those of controls
Polat, Kaya¹1 Polat OO, Kaya B. Changes in cranial base morphology in difference malocclusions. Orthod Craniofac Res. 2007 Nov;10(4):216-21. (2007)	Transversal	75	No	25 with Class I 25 with Class II 25 with Class III	CIass I: 13 F, 11 M Class II: 14 F, 11 M Class III: 13 M, 12 F	Not specified (patients treated at the Baskent University in Ankara, Turkey	15.74 yrs ± 4.28	To evaluate the difference in the skull base flexion between dental and skeletal Class I, Class II, and Class III malocclusions
Singh et al.²⁴24 Singh GD, McNamara JA Jr, Lozanoff S. Morphometry of the cranial base in subjects with Class III malocclusion. J Dent Res. 1997 Feb;76(2):694-703. (1997)	Transversal	142	Yes	73 with Class III 69 with Class I (control)	Approximately the same number of males and females	European/American	7 groups of 5 to 11 yrs	To differentiate the skull base between individuals with Class I malocclusion and those with Class III malocclusions
Johannsdottir et al.²⁵25 Johannsdottir B, Thordarson A, Magnusson TE. Craniofacial morphology in 6-year-old Icelandic children. Eur J Orthod. 1999 June;21(3):283-90. (1999)	Transversal	563	Yes	200 with Class I 363 with Class II	184 males 179 females	Icelanders	5 yrs 7 mo to 7 yrs 8 mo Mean of 6 yrs 7 mo	To describe the craniofacial characteristics of Icelander children aged 6 years old with Class II malocclusion and compared them to Class II malocclusion
Rothstein, Yoon-Tarlie¹⁶16 Rothstein T, Yoon-Tarlie C. Dental and facial skeletal characteristics and growth of males and females with Class II, division 1 malocclusion between the ages of 10 and 14 (revisited)-Part I: characteristics of size form, and position. Am J Orthod Dentofacial Orthop. 2000 Mar;117(3):320-32. (2000)	Transversal	613	Yes	278 with normal occlusion 335 with Class II div 1	T1: 47 F and 48 M T2: 47 F and 43 M	Caucasian	3 groups of subjects aged 10, 12 and 14 yrs old ± 6 years	To investigate whether Class II malocclusion is characterized by a poorly developed mandible or by its retropositioning
Ishii et al.²⁶26 Ishii N, Deguchi T, Hunt NP. Morphological diferences in the craniofacial structure between Japanese and Caucasian girls with Class II division 1 malocclusion. Eur J Orthod. 2002 Feb;24(1):61-7. (2002)	Transversal	124	No	Class II div 1 in Japanese females Classe II div 1 in Caucasian females	100% females	49 Japanese and 75 Caucasian females	Japanese: 11 yrs 8 mo British: 11 yrs 11 mo	To help define the craniofacial morphology of the Japanese with Class II malocclusion div 1 and to compare them with Caucasian individuals with the same malocclusion; and to elucidate craniofacial differences between ethnic groups
Kapoor et al.²⁷27 Kapoor S, Kapoor DN, Jaiswal JN. Cephalometric evaluation of Class II malocclusion in transitional dentition. J Indian Soc Pedo Dent. 2001 Dec;19(4):127-33. (2001)	Transversal	100	Yes	50 with Class II 50 with normal occlusion	50%	Indian	9 to 12 yrs old 10.64 yrs old, males 9.8 yrs old, females	To understand and differentiate the skeletal-dental morphology of children with straight terminal plane and those with Class II pattern
Singh et al.²⁸28 Singh GD, McNamara JA Jr, Lozanoff S. Craniofacial heterogeneity of prepubertal Korean and European-American subjects with Class III malocclusions: procrustes, EDMA, and cephalometric analyses. Int J Adult Orthod Orthognath Surg. 1998 Jan;13(3):227-40. (1998)	Transversal	141	No	72 with Class III, European/American 69 with Class III, Korean	50%	European/American Korean	5 to 11 yrs old	To compare Korean and European/American subjects with Class III malocclusion and provide data on ethnic diversity in individuals with Class III malocclusion
Zeng et al.²⁹29 Zeng XL, Forsberg CM, Aronson SL. Craniofacial morphology in Chinese and Swedish children with Angle Class I and Class II occlusal relations. Australian Orthod J. 1998 Oct;15(3):168-76. (1998)	Transversal	160	No	40 with Class I Chinese; 40 with Class II Chinese (ch) 40 with Class I Swedish 40 with Class II Swedish (sw)	50%	Chinese Swedish	8 to 10 yrs old 9.1 ± 0.9 males (M) ch Class II 9 ± 0.8 females (F) ch Class II 9.4 ± 0.8 M/F ch Class I 9.3±0.9 M sw Class I 9.3 ± 0.8 F sw Class I 8.7±0.8 M sw Class II 8.9±1.0 F sw Class II	To assess craniofacial structures in two ethnic groups and two malocclusions by comparing Chinese and Swedish individuals with Class I and Class II malocclusions
Lau e Hagg³⁰30 Lau JWP, Hagg U. Cephalometric morphology of Chinese with Class II division 1 malocclusion. Br Dental J. 1999 Feb;186(4):188-90. (1999)	Transversal	416	No	105 Chinese with Class II div 1 107 Caucasians with Class II div 1 204 Chinese with normal occlusion	Approx. 50%	Chinese Caucasians	10 to 15 yrs old 11 to 13 yrs old 12 yrs old	To assess the craniofacial pattern of Chinese and Caucasian individuals with Class II div 1 malocclusion and those with normal occlusion; Chinese with Class II x Chinese with normal occlusion; Chinese with Class II div 1 x Caucasians with Class II div 1
Chang et al.³¹31 Chang HP, Hsieh SH, Tseng YC, Chou TM. Cranial-base morphology in children with Class III malocclusion. Kaohsiung J Med Sci. 2005 Apr;21(4):159-65. (2005)	Transversal	200	Yes	100 with Class III 100 with normal occlusion (control)	50%	No specification (radiographs from the Kaohsiung University, Taiwan)	9.4 to 11.5 yrs old	To compare morphological characteristics of the skull base in children with malocclusion Class III with normal children and provide database for subsequent Class III studies
Yoon, Chung³⁷37 Yoon SS, Chung CH. Comparison of craniofacial growth of untreated Class I and Class II girls from ages 9 to 18 years: a longitudinal study. Am J Orthod Dentofacial Orthop. 2015 Feb;147(2):190-6. (2015)	Longitudinal	46	Yes	25 with Class I 21 with Class II	100% females	Caucasian	ages 9, 14, and 18	To investigate and compare the craniofacial growth of untreated Class I and Class II girls from ages 9 to 18 years

Table 4 Epitome of the articles selected for review.

Article	Flexion (NSBa or NSAr)	Anterior length (N-S)	Posterior length (S-Ba or S-Ar)	Conclusion
Dhopatkar et al.¹⁹19 Dhoptkar A, Bhatia S, Rock P. An investigation into the relationship between the cranial base angle and malocclusion. Angle Orthodontist. 2002 Oct;72(5):456-63. (2002)	NSBa: non-significant / NSAr: more significant for Class II div 1 malocclusion than for Class I malocclusion. No difference was observed in the latter	N-S: greater for Class II div 1 and 2 than in Class I malocclusion Class I and Class II malocclusions no significant	S-Ba: greater in Class II div 1 and 2; than in Class I Class I and Class III malocclusions no significant S-Ar was not studied	The skull base angle itself has no key influence on the development of malocclusions
Wilhelm et al.¹⁵15 Wilhelm BM, Beck FM, Lidral AC, Vig KWL. A comparison of cranial base growth in Class I and Class II skeletal patterns. Am J Orthod Dentofacial Orthop. 2001 Apr;119(4):401-5. (2001)	NSBa: not so obtuse in patients with Class II malocclusion, flexion decreases from 1 month to 2 years and 14 years. NSAr was not studied	N-S: no difference was found between Class I and Class II malocclusions	S-Ba: no difference between malocclusions S-Ar was not used	Growth in skull base is similar to that in Class I and Class II malocclusions
Mouakeh²¹21 Mouakeh M. Cephalometric evaluation of craniofacial pattern of Syrian children with Class III malocclusion. Am J Orthod Dentofacial Orthop. 2001 June;119(6):640-9. (2001)	NSBa was not studied; NSAr was smaller in Class III than in normal occlusion	N-S smaller in Class III than in normal occlusion	S-Ba was not studied S-Ar smaller in Class III than in normal occlusion	Flexion, anterior and posterior lengths are significantly smaller in Class III malocclusions
Alexander et al.²²22 Alexander AEZ, McNamara JA, Franchi L, Baccetti T. Semi longitudinal cephalometric study of craniofacial growth in untreated Class III malocclusion. Am J Orthod Dentofacial Orthop. 2009 June;135(6):701-14. (2009)	No measurement proposed was used	N-S increased yearly in all age groups studied, 1 mm in boys and less than 1 mm in girls	S-Ba not studied S-Ar not studied	No measurement proposed was used
Ishii et al.²³23 Ishii N, Deguchi T, Hunt N. Craniofacial morphology of Japanese girls with Class II division 1 malocclusion. J Orthod. 2001 Sept;28(3):211-5. (2001)	NSBa was not studied NSAr: not significant between age groups for Class II div 1 malocclusion Not evaluated for Class I malocclusion.	N-S smaller in Japanese young permanent dentition with Class II div I malocclusion than in those with normal occlusion	S-Ba not studied S-Ar: not significant between age groups for Class I div 1 malocclusion Not evaluated between Class II div 1 malocclusion and Class I malocclusion	Class II div 1 malocclusion had an increase in facial angle in association with a shortened mandibular ramus, compared to Class I malocclusion
Polat, Kaya¹1 Polat OO, Kaya B. Changes in cranial base morphology in difference malocclusions. Orthod Craniofac Res. 2007 Nov;10(4):216-21. (2007)	NSBa not significant NSAr not significant	N-S not significant	SBa not different S-Ar not significant	No difference was found in angle and dimensions of the skull base for Class I, II and III malocclusions
Singh et al.²⁴24 Singh GD, McNamara JA Jr, Lozanoff S. Morphometry of the cranial base in subjects with Class III malocclusion. J Dent Res. 1997 Feb;76(2):694-703. (1997)	NSBa was more acute in Class III at 8 to 9 yrs old NSAr was not different between Class I and Class III malocclusions at 5-11 yrs old despite tending to be acute	N-S smaller in Class III than Class I malocclusions at 8 and 9 yrs old	S-Ba: no difference between age groups S-Ar not studied	Skull base angle tending to be more acute in Class III malocclusion than in normal occlusion
Johannsdottir et al.²⁵25 Johannsdottir B, Thordarson A, Magnusson TE. Craniofacial morphology in 6-year-old Icelandic children. Eur J Orthod. 1999 June;21(3):283-90. (1999)	NSBa not significant between men and women, being more obtuse in Class II than in Class I malocclusions NSAr not significant between men and women, being more obtuse in Class II than in Class I malocclusions	N-S was greater in Class II than in Class I malocclusion, dimorphism; SN smaller in women; SN was significant	S-Ba and S-Ar smaller in women	Dimorphism was found at the skull base at 6 yrs old in Class II malocclusion
Rothstein, Yoon-Tarlie¹⁶16 Rothstein T, Yoon-Tarlie C. Dental and facial skeletal characteristics and growth of males and females with Class II, division 1 malocclusion between the ages of 10 and 14 (revisited)-Part I: characteristics of size form, and position. Am J Orthod Dentofacial Orthop. 2000 Mar;117(3):320-32. (2000)	NSBa greater in Class II div 1 malocclusion for girls at 10, 12, 14 yrs old (no difference); and boys at 10, 12, 14 yrs old. NSAr not studied	N-S was significantly greater in Class II div 1 malocclusions for girls at 10, 12, 14 yrs old and for boys at 14 yrs old compared to Caucasians with normal occlusion	S-Ba: no significant difference found in girls Significant difference was found in boys at 10 and 12 yrs old only S-Ar not studied	Anterior base is more protrusive in Class II malocclusions, with length being excessive at the skull base, maxillary and frontal sinuses increased (may contribute to Class II malocclusion increase) Skull base flexion does not contribute to the retruded positioning of the mandible
Ishii et al.²⁶26 Ishii N, Deguchi T, Hunt NP. Morphological diferences in the craniofacial structure between Japanese and Caucasian girls with Class II division 1 malocclusion. Eur J Orthod. 2002 Feb;24(1):61-7. (2002)	NSBa not studied NSAr smaller in Japanese than in Caucasian women despite the lack of significant difference	N-S was significantly smaller in Japanese than in Caucasian women with Class II div 1 malocclusions	S-Ba not studied S-Ar: no significant difference	Caucasian women have a more significantly longer anterior skull base
Kapoor et al.²⁷27 Kapoor S, Kapoor DN, Jaiswal JN. Cephalometric evaluation of Class II malocclusion in transitional dentition. J Indian Soc Pedo Dent. 2001 Dec;19(4):127-33. (2001)	NSBa not studied NSAr: no significant gender difference was found despite being smaller in women. More acute for distal malocclusions	N-S not studied	S-Ba not studied S-Ar not studied	NSAr is one of the factors indicating a Class II pattern in association with a distal mandibular positioning and skull base rotation
Singh et al.²⁸28 Singh GD, McNamara JA Jr, Lozanoff S. Craniofacial heterogeneity of prepubertal Korean and European-American subjects with Class III malocclusions: procrustes, EDMA, and cephalometric analyses. Int J Adult Orthod Orthognath Surg. 1998 Jan;13(3):227-40. (1998)	NSBa and NSAr are more acute in European/American individuals than in Korean ones with Class III malocclusion	N-S greater in European/American individuals	S-Ba and S-Ar greater in European/American individuals	For European/American individuals with Class III malocclusions, the craniofacial morphology is affected by an orthocephalization of the skull base, exacerbated by prominent mandible and symphysis morphology
Zeng et al.²⁹29 Zeng XL, Forsberg CM, Aronson SL. Craniofacial morphology in Chinese and Swedish children with Angle Class I and Class II occlusal relations. Australian Orthod J. 1998 Oct;15(3):168-76. (1998)	NSBa: no significant difference was found between Swedish and Chinese individuals with Class I and Class II malocclusions NSAr not studied.	N-S greater in Chinese individuals with Class II malocclusions than in Swedish ones, despite being smaller in Chinese individuals with Class I malocclusion, compared to the Swedish ones S-Ar not studied	S-Ba greater in Chinese individuals with Class II malocclusions than in Swedish ones No significant difference was found in Class I malocclusion regarding both ethnic groups S-Ar not studied	Anterior and posterior lengths of the skull base were greater in Chinese than in Swedish individuals
Lau, Hagg³⁰30 Lau JWP, Hagg U. Cephalometric morphology of Chinese with Class II division 1 malocclusion. Br Dental J. 1999 Feb;186(4):188-90. (1999)	NSBa not studied NSAr: no significant gender difference in Chinese individuals with Class II div 1; however, this angle was smaller when Class II div 1 malocclusion was compared to normal occlusion	S-N not studied	S-Ba not studied S-Ar not studied	No dimorphism was found between Chinese individuals with Class II div 1 malocclusion Skull base angle is more acute in Chinese individuals with Class II div 1 malocclusion than in those with normal occlusion
Chang et al.³¹31 Chang HP, Hsieh SH, Tseng YC, Chou TM. Cranial-base morphology in children with Class III malocclusion. Kaohsiung J Med Sci. 2005 Apr;21(4):159-65. (2005)	NSBa not significant NSAr: more acute in Chinese individuals with Class III malocclusion	N-S smaller in Class III malocclusion than in normal occlusion	S-Ba smaller in Class III malocclusion, but with no significant difference S-Ar smaller in Class III malocclusion than in normal occlusion	The decreased flexion and length in Class III malocclusion may be related to the aetiology of this type of malocclusion
Yoon, Chung³⁷37 Yoon SS, Chung CH. Comparison of craniofacial growth of untreated Class I and Class II girls from ages 9 to 18 years: a longitudinal study. Am J Orthod Dentofacial Orthop. 2015 Feb;147(2):190-6. (2015)	NSAr ( Saddle angle) not significant	N-S not significant	S-Ba not studied S-Ar not studied	In general, the Class I and Class II groups showed similar skeletal growth

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[1] Contact address: Dirceu Barnabé Raveli Rua Humaitá, 1680, Araraquara/SP - CEP: 14.801-903 E-mail: draveli@foar.unesp.br