ORIGINAL
RESEARCH
Prevalence of vertical
occlusion alterations
Prevalencia de las alteraciones de la oclusión
en sentido vertical
Katherin Dayana Chumo Rivero 1. Carlos Ernesto
Véliz Arauz 2. Karla Lissette Gruezo
Montesdeoca 3
1 Student, Universidad San Gregorio de Portoviejo. https://orcid.org/0009-0009-4736-6345
2 Faculty Member, Universidad San
Gregorio de Portoviejo. https://orcid.org/0009-0000-5190-055X
3 Faculty Member, Universidad San
Gregorio de Portoviejo. https://orcid.org/0000-0002-3042-1944
Received: 25/04/2026 Accepted: 28/06/2026
ABSTRACT
Objective: Identify the
prevalence of vertical occlusion alterations in patients treated at the
postgraduate orthodontics clinics of San Gregorio de Portoviejo University
during the year 2025. Materials and methods: An observational, descriptive,
cross-sectional prevalence study was conducted with a quantitative approach and
a non-experimental design. Three hundred and seventy-four medical records of
patients treated between January and December 2025 were reviewed, selected
using census sampling. The variables analyzed included the type of vertical
alteration, facial biotype, sex, age, and mandibular plane. Data were processed
using IBM SPSS Statistics with descriptive statistics and the chi-square test.
Results: 48.9% of patients did not present vertical malocclusions, while deep
bite was the most prevalent (41.4%), followed by open bite (9.6%). The
mesofacial biotype predominated in females (48.9%), while the dolichofacial
biotype predominated in males (44%). An increased mandibular plane was the most
frequent in all three vertical occlusion categories (46.2-48.7%). No
statistically significant association was found between facial biotype and
vertical occlusion type (p =0.652), nor between the mandibular plane and
vertical occlusion (p = 0.33). Conclusions: Deep bite was the most frequent
vertical malocclusion in the studied population. The mesofacial biotype
predominated in women and the dolichofacial biotype in men, while the
mandibular plane did not act as a determining factor in the type of vertical
occlusion.
Keywords: Dental
Occlusion; Orthodontics; Open Bite; Overbite.
RESUMEN
Objetivo: Identificar la prevalencia de las
alteraciones de la oclusión en sentido vertical en pacientes atendidos en las
clínicas de posgrado de ortodoncia de la Universidad San Gregorio de Portoviejo
durante el año 2025. Materiales y métodos: Se realizó un estudio observacional,
descriptivo, de prevalencia y corte transversal, con enfoque cuantitativo y
diseño no experimental. Se revisaron 374 historias clínicas de pacientes
atendidos entre enero y diciembre de 2025, seleccionadas mediante muestreo censal.
Las variables analizadas incluyeron el tipo de alteración vertical, el biotipo
facial, el sexo, la edad y el plano mandibular, procesando los datos en IBM
SPSS Statistics mediante estadística descriptiva y la
prueba de chi-cuadrado. Resultados: El 48,9% de los pacientes no presentó
alteraciones verticales, mientras que la mordida profunda fue la más prevalente
(41,4 %), seguida de la mordida abierta (9,6 %). El biotipo mesofacial
predominó en el sexo femenino (48 %), mientras que en el sexo masculino predominó
el dolicofacial (44 %). El plano mandibular aumentado fue el más frecuente en
las tres categorías de oclusión vertical (46,2-48,7 %). No se encontró
asociación estadísticamente significativa entre el biotipo facial y el tipo de
oclusión vertical (p = 0,652), ni entre el plano mandibular y la oclusión
vertical (p = 0,33). Conclusiones: La mordida profunda constituyó la alteración
vertical más frecuente en la población estudiada. Predominó el biotipo
mesofacial en mujeres y el dolicofacial en hombres, mientras que el plano
mandibular no actuó como factor determinante del tipo de oclusión vertical.
Palabras clave: Oclusión Dental; Ortodoncia;
Mordida Abierta; Sobremordida.
INTRODUCTION
According to the World Health Organization (WHO), malocclusions
represent one of the most common oral health problems worldwide1. In
a systematic review conducted in Saudi Arabia, the global prevalence of
vertical occlusal alterations was considerable; approximately 21.98% of
individuals were estimated to have deep overbite, while approximately 4.93%
presented with open bite, demonstrating that vertical discrepancies are not
marginal and highlighting their clinical and epidemiological importance2.
The presence of vertical alterations directly affects
essential functions such as mastication, speech, and occlusal stability, as
well as facial aesthetics, thereby affecting patients’ quality of life3,4.
In Latin America, deleterious oral habits have been associated with a higher
prevalence of Class II and Class III malocclusions, particularly among females5.
In countries in the region such as Mexico, significant
percentages of anterior open bite have been reported, reaching 35.1%, together
with a vertical overbite of 11.5%6. In Ecuador, although studies
have not focused exclusively on vertical alterations, high rates of skeletal
Class II and Class III malocclusions have been identified in the province of
Azuay, which could suggest underlying vertical discrepancies7.
The Universidad San Gregorio de Portoviejo (USGP), a
private higher education institution located in the city of Portoviejo, capital
of the province of Manabí, has a School of Dentistry with postgraduate
orthodontic clinics where a large population of patients with various oral
conditions is treated. Understanding the distribution of vertical alterations
is essential for strengthening clinical practice, designing care protocols, and
improving the quality of the services provided5. Therefore, the
following research question was proposed: What is the prevalence of vertical
occlusal alterations among patients treated at the postgraduate orthodontic
clinics of the Universidad San Gregorio de Portoviejo during 2025?
This study aims to generate updated data on the
distribution of vertical alterations among the population treated at the USGP
postgraduate orthodontic clinics. This will make it possible to determine the
prevalence of this condition, guide clinical decision-making, and strengthen
the quality of dental services provided in the university and provincial
context. Accordingly, the general objective of this study was to identify the
prevalence of vertical occlusal alterations among patients treated at the postgraduate
orthodontic clinics of the Universidad San Gregorio de Portoviejo during 2025.
The specific objectives were to quantify the types of vertical malocclusions
documented in the clinical records, characterize facial biotypes according to
the patient’s sex, and describe vertical occlusal alterations and mandibular
plane abnormalities.
MATERIALS AND METHODS
An observational, descriptive, prevalence-based,
cross-sectional study was conducted using a quantitative approach and a
non-experimental design. Additionally, the chi-square test was applied for
exploratory purposes, with a significance level of 0.05. The information was
analyzed at a single point in time corresponding to the period from January to
December 2025. No intervention was performed on the patients or on the
variables studied; the analysis was limited to the review of existing clinical
records.
The study was conducted in the postgraduate
Orthodontics clinics of the Universidad San Gregorio de Portoviejo. The initial
population consisted of 476 clinical records (CRs) of patients treated during
the aforementioned period. For sample selection, clinical records were included
if they contained informed consent signed at the beginning of clinical care and
complete records of the variables required for the study analysis. Clinical
records that were incomplete, did not clearly or legibly document the variables
of interest, lacked informed consent, or contained inconsistent information
that prevented proper interpretation were excluded. Ultimately, a sample of 374
clinical records was obtained.
The data collection technique consisted of reviewing
clinical records, and the instrument was a data collection form specifically
designed for this study. The form recorded sociodemographic variables, such as
sex and age, as well as clinical variables related to vertical occlusion,
including the type of vertical alteration (open bite, deep bite, or no
alteration), facial biotype, and mandibular plane. Data collection was
performed systematically by reviewing each included clinical record and
recording the corresponding information on the data collection form.
The collected information was organized and analyzed
using descriptive statistics, including absolute frequencies and percentages.
IBM SPSS Statistics version 31 was used for the analysis, and the results were
presented in statistical tables, allowing the prevalence of vertical occlusal
alterations in the study population and their distribution according to the
variables analyzed to be determined. Valid cases were used for each variable
because some clinical records did not contain all the data required for
analysis.
This study was conducted in accordance with the
ethical principles established in the Declaration of Helsinki. As this was a
documentary study based on the review of dental clinical records, prior institutional
authorization was obtained from the Coordination of the School of Dentistry,
which is responsible for the custody and protection of patients’ clinical
information. The information analyzed corresponded to clinical records
previously generated during dental care, which already included institutional
informed consent signed by the patient authorizing the use of their data for
academic and healthcare purposes. In the case of minors, the minor’s assent and
the legal guardian’s consent were additionally obtained. Due to the documentary
nature of the study and the use of previously recorded information,
participants were not exposed to physical, psychological, or social risks
resulting from the research.
For the analysis by age groups, the classification
established by the Ministry of Public Health of Ecuador was used, which defines
childhood as the period from 0 to 9 years, adolescence from 10 to 19 years, and
adulthood from 20 to 64 years8. For the analysis by sex, the
biological classification established by the World Health Organization (WHO)
was used, which defines sex as the biological characteristics that define human
beings as male or female, noting that although these sets of biological
characteristics are not mutually exclusive, they tend to differentiate human
beings into these two categories9.
This classification was used in the present study
because the data were obtained from institutional clinical records, in which
sex is recorded according to this biological categorization. Although greater
diversity in terms of gender identity is currently recognized, the sex variable
recorded in clinical records is based on biological and morphological criteria,
which are relevant to the analysis of facial biotype and occlusal alterations,
as these are directly related to differentiated craniofacial growth patterns
between males and females.
Confidentiality and anonymity of the collected
information were ensured at all times through the use of alphanumeric codes,
avoiding the use of information that could identify patients. Likewise, the
study was approved by the Research Ethics Committee for Human Subjects (CEISH)
of the Universidad San Gregorio de Portoviejo (CEISH-USGP-OBS-ODO-2026-026).
RESULTS
A total of 374 clinical records of patients treated at
the postgraduate Orthodontics clinics of the Universidad San Gregorio de
Portoviejo during 2025 were analyzed, with the purpose of determining the
prevalence of vertical occlusal alterations and their distribution according to
different clinical and sociodemographic characteristics.
The sample consisted of 374 patients. Of these, 215
(57.5%) were female and 159 (42.5%) were male (Table 1).
Table 1. Distribution of facial biotype according to
sex
|
Sex |
Brachyfacial |
Mesofacial |
Dolichofacial |
Total |
|
Male |
29 (18%) |
60 (38%) |
70 (44%) |
159 (43%) |
|
Female |
39 (18%) |
103 (48%) |
73 (34%) |
215 (57%) |
|
Total |
68 (18%) |
163 (44%) |
143 (38%) |
374 (100%) |
Pearson’s chi-square test: χ² = 4.595; df = 2; p = 0.101
Source: Data collected from clinical records. Authors’
own elaboration.
Regarding facial biotype according to sex, among the
215 female patients, 48% presented with a mesofacial biotype, making it the
most frequent biotype in this group. In contrast, among the 159 male patients
studied, the dolichofacial biotype predominated, accounting for 44%. The
chi-square test showed no statistically significant association between sex and
facial biotype (Table 1).
Table 2. Distribution of facial biotype according to
age
|
|
|
Facial Biotype |
|
||
|
|
Brachyfacial |
Mesofacial |
Dolichofacial |
Total |
|
|
Age group |
Childhood |
1 (7%) |
9 (64%) |
4 (29%) |
14 (3.7%) |
|
Adolescence |
33 (17%) |
80 (42%) |
77 (41%) |
190 (50.8%) |
|
|
Adults |
34 (20%) |
74 (44%) |
62 (36%) |
170 (45.5%) |
|
|
|
Total |
68 (18%) |
163 (44%) |
143 (38%) |
374 (100%) |
Pearson’s chi-square test: χ²
= 3.530; df = 4; p = 0.473
Source: Data collected from clinical records. Authors’
own elaboration.
Regarding the distribution by age group, Table 2 shows
that the adolescent group was the largest (50.8%), followed by adults (45.5%)
and children (3.7%). The mesofacial biotype predominated across all three age
groups, with no statistically significant association between age and facial
biotype (χ²
= 3.530; p = 0.473).
Table 3. Distribution of vertical occlusion according
to facial biotype
|
|
|
Facial Biotype |
|
||
|
|
Brachyfacial |
Mesofacial |
Dolichofacial |
Total |
|
|
Classification of vertical occlusion |
Open bite |
4 (11%) |
17 (47%) |
15 (42%) |
36 (10%) |
|
Deep bite |
31 (20%) |
70 (45%) |
54 (35%) |
155 (41%) |
|
|
No alteration |
33 (18%) |
76 (42%) |
74 (40%) |
183 (49%) |
|
|
|
Total |
68 (18%) |
163 (44%) |
143 (38%) |
374 (100%) |
Pearson’s chi-square test: χ² = 2.459; df = 4; p = 0.652
Source: Data collected from clinical records. Authors’
own elaboration.
The results presented in Table 3 show that 49% of patients
did not present vertical alterations, 41% presented with deep bite, and 10%
with open bite. The mesofacial biotype predominated across all three
categories, with no statistically significant association between facial
biotype and vertical occlusion (χ² = 2.459; p = 0.652).
Table 4. Distribution of vertical occlusion according
to the mandibular plane
|
|
|
Mandibular plane |
|
|||
|
|
Measure |
Increased |
Decreased |
Normal |
Total |
|
|
Vertical
occlusion |
Open bite |
n |
14 |
3 |
12 |
29 |
|
% |
48.3% |
10.3% |
41.4% |
|||
|
Deep bite |
n |
67 |
11 |
67 |
145 |
|
|
% |
46.2% |
7.6% |
46.2% |
|||
|
No alteration |
n |
74 |
12 |
66 |
152 |
|
|
% |
48.7% |
7.9% |
43.4% |
|||
|
|
Total |
n |
155 |
26 |
145 |
326 |
|
|
% |
47.5% |
8.0% |
44.5% |
100% |
|
Pearson’s chi-square test: χ² = 13.728; df = 6; p = 0.33
Source: Data collected from clinical records. Authors’
own elaboration.
Regarding the relationship between the mandibular
plane and the classification of vertical occlusion, the analysis was conducted
on 326 clinical records, as no data regarding the mandibular plane were
recorded in the remaining 48 records. Table 4 shows that the increased
mandibular plane was predominant (47.5%), both in patients with open bite
(48.3%) and deep bite (46.2%), as well as in those without vertical alterations
(48.7%), with no statistically significant association (χ²
= 13.728; p = 0.33).
DISCUSSION
After analyzing the 374 clinical records of patients
treated at the postgraduate Orthodontics clinics of the Universidad San
Gregorio de Portoviejo during 2025, the findings obtained allow for discussion
of the prevalence of vertical occlusal alterations and their distribution
according to the clinical and sociodemographic characteristics of the study
population.
The vertical dimension is an essential component of
the muscular, functional, and esthetic stability of the maxillofacial complex.
Its proper maintenance enables efficient mastication, contributes to
neuromuscular balance, and ensures a harmonious facial appearance. However,
when this dimension is altered, problems such as reduced masticatory
efficiency, orofacial pain, changes in mandibular posture, and esthetic
alterations may occur10. Vertical malocclusions are identified by
measuring overbite, which determines the degree of vertical overlap between the
upper and lower incisors; this category includes open bite and deep overbite2.
Deep bite is defined as excessive vertical overlap
between the upper and lower incisors that exceeds the physiological overbite of
2 to 3 mm. This condition is one of the most common malocclusions in both
children and adults and may manifest with functional problems such as
difficulty chewing, altered phonation, tooth wear, and, in some cases,
musculoskeletal pain11.
Open bite, on the other hand, is characterized by a
lack of vertical contact between the upper and lower teeth when the patient
attempts to occlude12. It can be classified as anterior, posterior,
or complete open bite. The anterior form is the most common and can be further
subdivided into dental and skeletal open bite. Dental open bite is primarily
associated with persistent oral habits, whereas skeletal open bite is related
to excessive posterior facial growth, which increases facial height and
interferes with anterior occlusal closure13.
Cephalometry provides angular and linear measurements
that help identify facial growth patterns and mandibular rotations and is
essential for determining whether an occlusal alteration is of dentoalveolar or
skeletal origin. Parameters such as lower anterior facial height, the
mandibular plane angle, and the Ricketts VERT index provide a comprehensive
view of the vertical behavior of the craniofacial complex, making it possible
to understand why certain patients develop open bite or deep bite14.
Facial biotypes, in turn, represent morphological
patterns that directly influence the way each individual develops their
occlusion15. The mesofacial biotype is characterized by balanced facial
proportions, moderate masticatory muscle tone, and a harmonious relationship
between anterior and posterior facial height, which is generally associated
with greater occlusal stability14. The dolichofacial biotype is
characterized by an elongated face, increased anterior facial height, downward
and backward mandibular rotation, and weak masticatory musculature. These
characteristics favor anterior separation between the teeth and increase the
predisposition to open bite patterns14,15. In contrast, the
brachyfacial biotype presents a short face with greater masticatory muscle
tone, anterior mandibular rotation, and reduced lower facial height. These
conditions are clinically associated with the development of deep bites14,16.
In the present study, nearly half of the patients
presented with the mesofacial biotype, which was the most predominant in both
open bite and deep bite cases, followed by the dolichofacial biotype and, to a
lesser extent, the brachyfacial biotype. When the distribution of facial
biotypes was analyzed according to sex and age, the mesofacial biotype
predominated among females, whereas the dolichofacial biotype predominated
among males. These findings differ from those reported by Chacha et al.17
in a study conducted at the Universidad de Guayaquil, in which a predominance
of the mesofacial biotype was identified in both males and females, suggesting
that this biotype represents the most common facial pattern regardless of sex17.
However, in the present study, males showed a tendency toward the dolichofacial
biotype.
Regarding age groups, the mesofacial biotype remained
predominant in all three groups analyzed. The difference between the mesofacial
and dolichofacial biotypes was narrower in the adolescent group than in the
other groups, suggesting a more balanced distribution between these two
biotypes at younger ages. This finding is consistent with a study conducted in
Peru18, which analyzed the prevalence of facial biotypes using
Ricketts cephalometric analysis and likewise found that the mesofacial biotype
was predominant across all age groups analyzed.
Regarding the classification of vertical occlusion,
nearly half of the patients did not present vertical alterations. Among the
identified alterations, deep bite was the most prevalent, followed to a lesser
extent by open bite. These findings are partially consistent with those
reported by Sánchez and Yañez19 in Peruvian university students, in
whom deep bite was also the most frequent alteration. However, it should be
noted that these were different populations: whereas the present study included
patients who attended the clinic because they required orthodontic treatment,
the Peruvian sample consisted of a general population not selected based on
treatment need, which may have influenced the differences in magnitude between
the two findings.
When examining the relationship between the type of
vertical occlusion and facial biotype in greater depth, the mesofacial biotype
was found to be the most frequent in all three groups analyzed, which can be
explained by its predominance in the overall sample. Specifically, in cases of
deep bite, although mesofacial patients accounted for the largest number of
cases, it should be noted that the literature associates this alteration with
the brachyfacial biotype, whose reduced lower facial height and greater
masticatory muscle strength favor its development19.
The dolichofacial biotype, in turn, represented the
second most frequent category among open bite cases, a finding that is
consistent with the description provided by Faria Vera et al.20, who
reported that open bites tend to occur more frequently in patients with
long-face characteristics associated with excessive growth and increased total
facial height, conditions characteristic of the dolichofacial biotype.
Regarding the relationship between the mandibular
plane and the classification of vertical occlusion, the increased mandibular
plane was predominant in the sample, both among patients with open bite and
among those with deep bite and those without vertical alterations. However, it
is noteworthy that the increased mandibular plane also predominated among
patients with deep bite, which differs from what would be theoretically
expected, as the literature indicates that a decreased mandibular plane is
associated with hyperdivergent patterns and a tendency toward deep bite11.
This distribution could be explained by the overall predominance of an
increased mandibular plane in the total sample, which influenced its occurrence
across all vertical occlusion categories.
CONCLUSIONS
In the study sample, females predominated (57%), and
the adolescent group was the largest (50.8%) among the three age groups
analyzed. Deep bite was the most frequent vertical alteration (41%), followed
by open bite (10%), while 49% of patients did not present vertical alterations.
The mesofacial biotype predominated among females
(48%), whereas the dolichofacial biotype predominated among males (44%). This
indicates a differentiated distribution according to sex, although no
statistically significant association was found (p = 0.101).
The increased mandibular plane was the most frequent
finding across all categories of vertical occlusion. However, no statistically
significant association was observed between the mandibular plane and the type
of alteration (p = 0.33), suggesting that, in this population, the mandibular
plane did not act as a determining factor for vertical malocclusions.
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DECLARATION OF CONTRIBUTIONS
Conceptualization and design: Katherin Chumo, Carlos Véliz, and Karla Gruezo; Literature review: Katherin Chumo
and Carlos Véliz; Methodology and validation:
Katherin Chumo and Karla Gruezo;
Formal analysis: Katherin Chumo and Carlos Véliz; Investigation and data collection: Katherin Chumo; Resources: Universidad San Gregorio de Portoviejo;
Data analysis and interpretation: Katherin Chumo,
Carlos Véliz, and Karla Gruezo;
Writing—original draft preparation: Katherin Chumo;
Writing—review and editing: Carlos Véliz and Karla Gruezo; Supervision: Carlos Véliz
and Karla Gruezo; Project administration: Katherin Chumo; Funding acquisition: Not applicable.
CONFLICTS OF INTEREST
The authors declare that
there were no conflicts of interest during the conduct of the research. The
manuscript was submitted exclusively to the Scientific Journal “Especialidades Odontológicas UG”
for review and publication.
FUNDING
The authors declare that the research was conducted
using their own funds.
COPYRIGHT
Chumo Rivero KD. Véliz
Arauz CE. Gruezo Montesdeoca KL. Prevalence of vertical
occlusion alterations. Revista
Científica Especialidades Odontológicas UG. 2026:9(2):36-42