Professional Documents
Culture Documents
Luterul cephalometric rudiogruphs wew taken of twenty-jitre hogs und r~\‘c’trt~:/7tx~ girls
hetrc,een the U~CJSof 10 und 14. Euc,h subject hud either a Clus~ I or C’ltr.\.\ !I
mulocclwion. u good gro,cath puttrrn, und un ANB rungr qf I to 8 &~I.cc~.~. TheWits
uppruisal for these patients runged from -4 to 9 mm. Ten patients htrd t, nc,qutivc
Wits value, runging from -0.5 to -4 mm. und an ANB runge of I to 4 tlcgrec~.\. Fort?
putients hud II positive Wits vuiuc, ranging jiwm 0.5 to 9 mm., und (III AN6 ra~r,yc’of
I .5 to 8 degrees. TMlelve ($ the putients with a positiw Wits vulue had the .sunw AN6
runge as those \rYth negative Wits vulurs. The Peurson produc,t moment c~orrclution
weficient KU.Sperformed on both the neRatiw and positir’r Wits group”. ;lio
stutisticully .sign$cant correlation wus jtiund between ANB vulues and the Wits vu1ue.c
for the negutive Wits group (r = 0.08. t = 27, df = 8). A .stutisticwll~ ~sign~fic~unt
‘correlation M’USfour~d for the positive Wits group (r = 0.62, t = 3.87, cf = 38.
p < 0.001). Using the sunw stutistics. IloM~e~~er,a less stutisticull~~ signjfiwnt
correlation MYISdetermined,for thr group with u positiw Wits vulu~ und un ANB value
greater than 4 degrees (r = 0.53, t = .Z.l2. cif = 26, p < 0.005). No c~linicull~
.siq$cunt relutionships tt’ere ,ji)und j?w unp of the groups of putier1t.s .studicd.
H istorically, orthodontists have related both the maxilla and the mandible to
reference points in the cranial base of the skull to determine if there are any disharmonies
in growth between them. l6 The measurement most commonly used to detect jaw dishar-
monies is the ANB angle.” It has long been recognized that nasion is, indeed, not a
“fixed” point and, therefore, any changes in its position will, in turn, affect the amount of
discrepancy that exists between the jaws as measured by the ANB angle. Any “rotation”
of the jaws by either growth or treatment can also change the ANB reading.”
In order to obviate these inherent inconsistencies, the “Wits” appraisal,” which
relates points A and B to the occlusal plane, was devised. This analysis does not use
cranial or extracranial landmarks, and this should, theoretically, give a more accurate
picture of any anteroposterior skeletal disharmonies existing between the maxilla and the
mandible. I2
The purpose of this article is to correlate the “Wits” appraisal with ANB differences
on a group of patients to see how accurately one can predict the “Wits, ” given the latter.
IANB4'
WITS -&m
extracranial reference point, clockwise or counterclockwise rotation of the jaws does not
affect the over-all assessmentof the severity of jaw disharmony. l3 Sperrylg points out that
this is important in differentiating between patients who can be treated orthodontically and
those patients who are surgical candidates. It is also important to remember, however, that
the tilting of the occlusal plane during treatment mechanics or growth can change a Class
II to a Class I.
WITS+5mm
ANB-The angle formed by the intersection of lines extending from point A and point
B of nasion.
Occlusal plane-A line joining the distobuccal cusp of the upper first molar (or last
molar in occlusion) to a point midway between the incisal tips of the maxillary and
mandibular central incisors (same as used in “Wits” appraisal).
Gn-Gnathion, midpoint between pogonion and menton at the curvature of the
symphysis.
Go-Gonion, the most anterior, inferior point in the bony chin.
Mandibular plane-A line connecting the points gonion and gnathion.
OM angle-The angle formed by the intersection of the occlusal plane and the man-
dibular plane.
“Wits” appraisal-The distance between points A0 and BO which are the points of
contact of a perpendicular drawn from points A and B onto the occlusal plane.
A second operator traced the cephalometric films, and the landmarks were determined
by averaging the distance between his interpretation and that of the first operator where a
discrepancy existed.
The measurements were compiled. Interrelationships were determined according to
the Pearson product moment correlation coefficients and regression analysis.
Findings
The fifty patients selected for this study had an ANB range of 1 to 8 degrees; an OM
r.ange of 8 to 20 degrees, with a mean of 15.7 degrees; and a “Wits” range of -4 to 9
Table II. Statistical summary for negative \amplcs
N = 10
;;i ANB = 2.75
U Wits = 1.35
S- ANB == 1.14
S Wits = 1.02
S; ANB = 0.13
S; Wits = 0. I I
r = 0.08; t = 0.23; df = 8 not significant
Table IV. Statistical summary for positive samples limited to 4.5 degress or more
N = 28
ZANB = 6.18
Y Wits = 4.41
S+ ANB = I.19
S+ Wits = 2.37
S; ANB = 0.05
g Wits = 0.19
r = 0.53; t = 3.12; df = 26; P < 0.005 significant
rp = 28
I - r* = Error = 72%
mm. (Table I). Ten of these patients had a negative “Wits” value of -0.5 mm. to -4
mm., with an ANB value of 1 to 4 degrees (Fig. 1). Forty patients had positive “Wits”
values of 0.5 to 9 mm., with ANB values ranging from 1.5 to 8 degrees (Fig. 2). Both of
these groups had similar age and OM angle distributions. The group of forty patients with
positive “Wits” values can, in turn, be subdivided into two groups. The first group,
consisting of twelve patients, had positive “Wits” values but the same ANB range,
namely, 1.5 to 4 degrees, as the group of ten patients with negative “Wits” values. The
second group, comprising twenty-eight patients, also had positive “Wits” values but an
ANB range of 4.5 to 8 degrees, which was higher than the ANB range of the patients with
negative “Wits” values.
The Pearson product moment correlation coefficient was performed on negative and
positive “Wits” groups separately. No relationship was found for negative “Wits”
Volume 17
Number 6 Predicting “Wits” appraisal from ANB angle 641
Discussion
The ANB angle, although a most widely used means of evaluating anteroposterior
apical base discrepancies, is subject to great variation, depending on the anteroposterior
and vertical position of nasion. If the points A and B remain constant on the same vertical
line, there is a 2.5 degree change in the ANB angle for every 5 mm. of displacement of N
in an anteroposterior direction. When points A and B remain fixed in the normal positional
relationship established by the Bjork analysis, 3 theoretically the ANB angle is decreased
by 0.5 degree for each 5 mm. vertical displacement of N in an upward direction. There is a
1 degree increase in the ANB angle for each 5 mm. of vertical displacement of N in a
downward direction.2
Similarly, any tipping of the jaws from treatment will also affect the ANB reading. A
counterclockwise rotation, as evidenced by an upward tipping of ANS and a low mandibu-
lar plane angle, will lessen the ANB value. Conversely, a clockwise rotation of the jaws,
resulting in a downward tipping of ANS and a high mandibular plane angle, will increase
the ANB angle.r3
The “Wits” appraisal also measures apical base discrepancies, but it does so by
relating points A and B to the occlusal plane, thus eliminating cranial landmarks and some
geometric inconsistencies just described. There are, however, certain shortcomings to the
“Wits” analysis. Changes in the occlusal plane during treatment, such as intrusion of
incisors or extrusion of molars, will alter the “Wits” value and perhaps change a Class II
malocclusion into a Class I. Since both the ANB angle and the “Wits” appraisal are used
to evaluate the same parameters, there should theoretically be a strong correlation between
the two.
In our study, we found that with a positive ANB angle of 4 degrees or less, the
“Wits” value could be either positive or negative and that there is no correlation between
the ANB and “Wits” measurements if the latter is negative. Therefore, in order to use a
regression equation to predict the value of the “Wits” appraisal when the ANB is between
1 and 4 degrees, we must first know whether the “Wits” value is positive or negative.
Furthermore. when both the ANB and “Wits” values are positive, we can predict the
“Wits” measurement, given the ANB angle, with only a 38 percent accuracy. The
‘clinical uselessnessof these relationships should be obvious.
It is interesting to note that, in our sample, when the ANB angle was greater than 4
degrees, the “Wits” values were all positive. The accuracy of predicting the “Wits”
-from the ANB angle was 28 percent, however, which was less than in the sample as a
,whole (ANB, 1 to 8 degrees).
Further studies are indicated, perhaps with larger sample sizes, to determine if the lack
of a clinically significant correlation between ANB and “Wits” values is indeed due to the
variability of the ANB measurement as a parameter of apical base discrepancy or the
“Wits” analysis. The effect of the cant of the occlusal plane on the “Wits” appraisal
should also be studied.‘*
642 Rothcq et id.
REFERENCES
I. Baber. W. E., and Meredith, H. V.: Childhood change in depth and height of the face, with special
reference to Downs’ A point, AM. J. ORTHOD. 51: 913, 1965.
2. Binder, R. C.: The geometry of cephalometrics, J. Clin. Orthod. 13: 258, 1979.
3. Bjork, A.: The face in profile, Sven. Tandlak. Tidskr. 40: 5 B, 1947.
4. Buchnin, Irving D.: An appraisal of the effect of the edgewise arch appliance in modifying the dentofacial
profile, AM. J. ORTHOD. 43: 801-818, 1957.
5. Downs, W. B.: Variations in facial relationship: Their significanoe in treatment and prognosis, AM. J.
ORTHOD. 34: 812-840, 1948.
6. Dreyer, C. J., and Joffe, B. M.: A concept of cephalometric interpretation, Angle Orthod. 33: 123, 1963.
7. Enlow, Donald H.: A morphogenetic analysis of facial growth, AM. J. ORTHOD. 52: 283, 1966.
8. Freeman, R. S.: A radiographic method of analysis of the relation of the structures of the lower face to each
other and to the occlusal plane of the teeth, M. S. D. thesis, Northwestern University Dental School, 1950.
9. Graber, T. M.: Roentgenographic cephalometric workshop, AM. J. ORTHOD. 44: 928, 1958.
10. Hatton, M. E., and Grainger, R. M.: Reliability of measurements from cephalograms at the Burlington
Orthodontic Research Center, J. Dent. Res. 37: 853.859, 1958.
11. Holdaway, Reed A.: Changes in relationship of points A and B during orthodontic treatment. AM. I.
ORTHOD. 42: 176, 1956.
12. Jacobson, A.: The “Wits” appraisal of jaw disharmony, AM. J. ORTHOD. 67: 125-138. 1975.
13. Jacobson, A.: Application of the “Wits” appraisal, AM. J. ORTHOD. 70: 179-189, 1976.
14. Jacobson, A.: The proportionate template as a diagnostic aid, AM. J. ORTHOD. 75: 156. 1979.
15. Moore, Alton W.: Observations on facial growth and itsclinical significance, AM. J. ORTHOD. 45: 399-423,
1959.
16. Riedel, Richard A.: The relation of maxillary structures to cranium in malocclusion and in normal occlu-
sion, Angle Orthod. 22: 140-145, 1952.
17. Salzmann, J. A.: The Research Workshop on Cephalometrics, AM. J. ORTHOD. 46: 834, 1960.
18. Schudy, F. F.: Cant of the occlusal plane and axial inclination of teeth, Angle Orthod. 33: 69, 1963.
19. Sperry, T. P.: Differential treatment planning for mandibular prognathism, AM. J. ORTHOD. 71: 531, 1977.
20. Taylor, C. M.: Changes in the relationship of nasion, point A, and point B and the effect upon ANB, AM. J.
ORTHOD. 56: 143, 1969.
21. Sassouni, V., and Sotereanos, G. C.: Diagnosis and treatment of dentofacial abnormalities, Springfield,
Ill., 1974, Charles C Thomas Publisher.
83 speen St