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The Wits Appraisal of Jaw Disharmony PDF
The Wits Appraisal of Jaw Disharmony PDF
Alex Jacobson was born in South Africa and completed his dental education there in 1941. He received an
MS degree in orthodontics from the University of Illinois in Chicago in 1953 and then returned to South Africa
to private practice. He was head of the orthodontic department at the University of Witwatersrand (known as
Wits, hence the name “Wits” analysis). He received an MDS degree in 1961 and a PhD in physical
anthropology in 1978 and was named chair of the orthodontic department at the University of Alabama at
Birmingham in 1976. He returned to private practice and part-time teaching again in 1989. He has written or
edited 3 textbooks and about 100 articles in refereed journals, and is editor of the Reviews and Abstracts
section of the Journal.
M
any analyses tend to be cumbersome and far when upper incisor teeth are moved. Since point A
too complex for routine clinical use. Numer- was originally defined, clinicians and investigators
ous measurements are employed which do have sought a better reference point but have some-
not differentiate between meaningful information and how continued to revert to the basic point first
inconsequential details. Others at the opposite end of described.17 From a practical standpoint, therefore,
the scale employ too few measurements to yield ade- point A must be regarded as the anterior limit of the
quate information for appraisal of the orthodontic maxillary denture base.
problem. An analysis of choice is one which employs Point B was described by Downs5 in 1948 as a
the least possible number of measurements to be point at the deepest curvature of the outline of the
adequate. symphysis of the chin. This point is located at the
The “Wits”* appraisal of jaw disharmony, however, junction of basal and alveolar bone. A deepening of
is not an analysis per se; rather, it is intended as a the body of the symphysis occurs with eruption of
diagnostic aid whereby the severity or degree of an- the teeth. The bony tissue that is alveolar in the
teroposterior jaw disharmony can be measured on a young is incorporated in the body and becomes
lateral cephalometric head film. basilar in the adult, so that point B moves horizon-
tally and vertically. Point B was referred to earlier by
Cranial and denture landmarks Björk1 as supramentale, the anthropometric term.11
Nasion is related functionally to the ectocranial This point which, like point A, is subject to mild
table of the calvaria, in which case growth may alter its change with lower incisor movement may be re-
vertical and horizontal position in space.15 However, garded as the anterior limit of the lower denture base.
for practical purposes, nasion may be conveniently In appraising the horizontal disharmony of the face,
regarded as the anteriormost point on the anterior the ANB angle (the difference between the SNA and
cranial base from which to relate the dentures. SNB angles) is the most commonly used measurement.
Point A is located at the deepest point on the The SNA reading, Steiner reports, is of little concern
contour of the maxilla between the anterior nasal because it merely shows whether the face protrudes or
spine and the alveolus. The anterior nasal spine is a retrudes below the skull.23-25 However, rather than
process, as is the alveolar process, and between these ignore or discount the relative relationship of the
two lies the most basic part of the denture base at the denture bases to cranial reference planes, this article
anterior limit. All bone in the anterior part of the endeavors to emphasize an awareness of this relation-
maxilla is thin and laminated and subject to change ship in the overall interpretation and assessment of
cephalometric analyses.
First published February 1975;67:125-38.
From the Department of Orthodontics, Dental School, University of the ANB angle as a measure of jaw dysplasia
Witwatersrand, Johannesburg, South Africa.
*Abbreviation for University of the Witwatersrand. The ANB angle in normal occlusions is generally
Am J Orthod Dentofacial Orthop 2003;124:470-9 2 degrees.18 Angles greater than this indicate tenden-
Copyright © 2003 by the American Association of Orthodontists.
0889-5406/2003/$30.00 ⫹ 0 cies toward Class II jaw disharmonies; smaller an-
doi:10.1067/S0889-5406(03)00540-7 gles (extending to negative readings) reflect Class III
470
American Journal of Orthodontics and Dentofacial Orthopedics Jacobson 471
Volume 124, Number 5
Fig 1. Lateral cephalometric head film tracing of a Class II malocclusion (A) and normal occlusion
(B), each having an ANB angle of 7 degrees.
Fig 2. Further example of a Class II malocclusion (A) and a normal occlusion (B) having identical
ANB angles readings (6 degrees).
anteroposterior jaw discrepancies. The foregoing is department of Conservative Dentistry as having the
an acceptable generality. However, there are numer- best occlusion in the school. Figure 2, A and B,
ous instances in which the contention does not shows a further example of a Class II malocclusion
obtain. Figure 1, A, for instance, shows a lateral and an excellent normal occlusion with identical
cephalometric head film tracing of a Class II maloc- ANB angle readings of 6 degrees. The anteroposte-
clusion. The ANB angle is 7 degrees, which is rior relationship of the jaws in these examples is not
regarded as being high and typical of a Class II jaw satisfactorily reflected by the ANB angle readings.
dysplasia. Figure 1, B, on the other hand, shows a These general variants, therefore, assume importance
lateral head film tracing of a patient with a perfectly when one endeavors to appraise degree of craniofa-
normal occlusion. Paradoxically, here too the ANB cial skeletal disharmony in orthodontics.
angle measures 7 degrees. The tracing in the latter Relating jaws to cranial reference planes presents
instance was that of the male student adjudged by the inherent inconsistencies because of variations in cranio-
472 Jacobson American Journal of Orthodontics and Dentofacial Orthopedics
November 2003
Fig 8. Perpendicular lines dropped from points A and B onto the occlusal plane. “Wits” reading
(enlarged in right-hand block) is measured form AO to BO.
Fig 9. Repeat tracings of Fig 1 incorporating “Wits” reading. A, Class II malocclusion: ANB angle,
7 degrees; “Wits” reading, 10 mm. B, Normal occlusion: ANB angle, 7 degrees; “Wits” reading, 0
mm.
ANB angle, the “Wits” reading was only 2 mm and what appeared to be a favorable convergent type9 of
easily treatable. craniofacial skeletal pattern. The biggest problem in
Figure 14, A and B, shows similar tracings of Class correction of B was not the anteroposterior jaw dishar-
II malocclusions with ANB angle measurements of 7 mony (which, according to the “Wits” appraisal, was
degrees. The anteroposterior disharmony, according to minimal) but that of vertical dimension and its associ-
the “Wits” appraisal in A, was severe (9 mm), whereas ated orofacial muscular disharmonies.
that in B was minimal (1 mm). The anteroposterior jaw A 2 degree ANB angle, by conventional assessment
correction in A entailed considerable therapy in spite of of jaw disharmony, is normal. In Figure 15, the ANB
476 Jacobson American Journal of Orthodontics and Dentofacial Orthopedics
November 2003
Fig 10. Repeat tracings of Fig 2 incorporating “Wits” reading. A, Class II malocclusion: ANB angle,
6 degrees; “Wits” reading, 6 mm. B, Normal occlusion: ANB angle, 6 degrees; “Wits” reading, 0 mm.
Fig 11. Class III malocclusion tracings with approximately same ANB angle readings. A, Mild Class
III jaw disharmony: ANB angle, ⫺1.5 degree; “Wits” reading, ⫺1.5 mm. B, Severe Class III jaw
disharmony: ANB angle, 1.0 degree; “Wits” reading, ⫺12 mm.
Fig 12. Class II malocclusion tracings with identical ANB angles (9 degrees). A, “Wits” reading of
⫺8 mm reflects a severe Class III jaw disharmony. B, “Wits” reading of ⫺2.5 mm indicates a mild
Class III jaw disharmony.
Fig 14. Class II malocclusion tracings with identical ANB angle readings (7 degrees). A, “Wits”
appraisal (9 mm) indicating severe Class II jaw disharmony. B, “Wits” appraisal (1 mm) indicating
mild Class II jaw disharmony.
points A and B on the maxilla and mandible, respec- 8. Jacobson A. Orthodontics—mechanical or biologic objectives?
tively, onto the occlusal plane. The points of contact of Am J Orthod 1973;64:1-16.
9. Jacobson A, Evans WB, Preston CB, Sadowsky PL. Mandibular
the perpendiculars onto the occlusal plane are labeled
prognathism. Am J Orthod 1974;66:140-71.
AO and BO, respectively. 10. Margolis HI. A basic facial pattern and its application in clinical
In a sample of twenty-one male and twenty-five orthodontics, craniofacial skeletal analyses and dento-cranio-
female adults selected on the basis of excellence of facial orientation. Am J Orthod 1953;39:425-43.
occlusion, it was found, on the average, that in females 11. Martin R. Lehrbuch der Antropologie. Part II, ed. 2, Jena, 1928,
points AO and BO coincided and in males point BO Gustav Fischer.
12. McIver LW. Growth formulas in Class II treatment. Am J Orthod
was located 1 mm ahead of point AO.
1973;43:1-17.
In skeletal Class II jaw dysplasias, point BO would 13. Moore AW. In: Salzmann JA, editor. Roentgenographic cepha-
be positioned well behind point AO (positive reading), lometrics. Philadelphia: J. B. Lippincott; 1959. p. 85.
whereas in Class III skeletal jaw disharmonies, the 14. Moorrees CFA. Normal variation and its bearing on the use of
“Wits” reading would be negative, that is, with point cephalometric radiographs in orthodontic diagnosis. Am J
BO ahead of point AO. Orthod 1953;39:942.
15. Moss ML. In: Salzmann JA, editor. Roentgenographic cephalo-
The advantages of the “Wits” appraisal over that of
metrics. Philadelphia: J. B. Lippincott; 1961. p. 57.
the conventional ANB angle reading are illustrated and 16. Ricketts RM. The influence of orthodontic treatment on facial
discussed. growth and development. Angle Orthod 1060;30:103-33.
17. Ricketts RM. The keystone triad. Am J Orthod 1964;50:244-64,
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