Tweeds

Analysis

TWEEDS ANALYSIS

Late in 1934, Charles H. Tweed, began an analysis of his practice, due to

his inability to create balance and harmony of face in a few of his patients the
evaluated dental casts, photographs and x-rays films of all the patients treated by
him.

The photographs were classified into 2 groups (i) those with balance and
harmony of facial proportions and (ii) those who lacked these qualities.

In virtually every instance, those patients processing balance and harmony

of facial proportions had mandibular incisors that were upright over the basal
bone.

The patients who lacked these qualities of facial proportion had too
prominent teeth and mandibular incisor, were not upright over the basal bone. It
was noted that the lack of harmony in facial contour was in direct proportion to the
extend to which the denture has been displaced medially into protrusion.

The four orthodontic objectives, which he considered was

1. The best balance and harmony of facial lines
2. Stability of dentures after treatment.
3. Healthy mouth tissues
_____________________________________________________________________
93
 Tweeds
Analysis
4. As efficient chewing mechanism.

He compared the casts and photographs of people with normal occlusions,

who never had an orthodontic treatment. Facial harmony and balance of these
individuals were studied. The relationship of teeth to basal bone and variation in
inclination of mandibular incisor teeth to the body of mandible that is the long axis
of the body of mandible. The inclinations of the mandibular incisors when related
to the lower border of the mandible are approximately 85° or -5°.

H.I. Morgolis suggested taking the mandibular border as the better plane to
use in describing the inclinations of mandibular incisors in relation to the body of
the mandible. The inclinations of the mandibular incisors in non-orthodontic
normal persons were 90° or 0°, when related to the lower border.

The variation in inclination of the mandibular incisors in this group of non-

orthodontic normals is approximately 10°. He concluded that, to attain facial
esthetics and dentures similar to those found in non orthodontic normal position
the mandibular incisors within the normal range of -5° to +5°.

Concept of Normal
The term normal, is the balance and harmony of proportions generally
accepted as the most pleasing to human face. He found that the normal occlusion
and the ultimate in balance and harmony f facial esthetics are most closely related.

He made studies by treating, 13 year old boys, presenting a discrepancy

between size of teeth and size of basal bone. One was first related by retention of
all teeth, and the other one after the removal of four I premolars. Balance and
harmony of face was noted in the extraction case.

By doubling the number, he conducted the experiment. They are treated by

the retention of all teeth. The treatment was failure and re-treatment was done
after removal of first premolars.

_____________________________________________________________________
94
 Tweeds
Analysis

The analysis showed only 20% of patients of non-extraction case had been
successfully treated.

He concluded that the normal range of inclinations, of mandibular incisors,

when related to the mandibular plane was 90° + 5°. The first angle of the
diagnostic facial triangle IMPA was finally established after clinical research
covering a period of approximately 12 years.. Dr. Tweed established prognosis on
the treatment result, based on the configuration of the triangle. Depending on the
diagnostic triangle two subjects involving malocclusions in both mixed and
permanent dentition can be obtained. ie., 1) Anchorage preparations and
2) Facial growth trends.

Tweeds triangle is formed by:

1. Frankfort horizontal plane.
2. The mandibular plane.
3. The long axis of lower incisor.

THE DIAGNOSTIC TRIANGLE – TWEEDS

The Frankfort mandibular plane angle

He began to wonder whether or not this discrepancy in face form, could

have any bearing on why he could not make his “unfavourables” beautiful like his
favourables. This led to the second phase of his visual clinical investigations,
which concerned the Frankfort mandibular plane angle.

Patients were placed in had holder with their head oriented on FH plane.
He studied Indian skulls, by placing them in Head holder. He concluded that the
normal variation of FMA was 16° - 35° with average or norm for the angle of 25°.
More extraction of teeth was necessary in patients with an FMA ranged upward

_____________________________________________________________________
95
 Tweeds
Analysis
from 30°. He further concluded that, when FMA ranges upwards from 35° and
becomes so steep, that it is a physical impossibility to fully compensate the
inclination of the mandibular incisor, prognosis is not good. The result of this
clinical research was the establishment of the norm for the FMA as 25° and the
normal variation of that angle as 16° to 35°. Thus was norm the IInd angle of
diagnostic facial a triangle is 180°. If the norm for IMPA is established at 90° and
the norm for FMA at 25°, the 3rd angle FMIA must be 65°.

Tweed Analysis makes use of 3 planes that form a diagnostic triangle. The
planes used are
1. F-H plane 2. Mandibular plane. 3. Long axis of lower incisor.

FH Plane
This plane connects the lowest point of orbit in orbitale and the superior
point of the external auditor meatus is portion.

Mandibular plane
This is the target drawn to the lower border of the mandible. The angles
formed by these planes are

The three angles thus formed are:

1. Frankfort – Mandibular plane angle.
2. Lower incisor to mandibular plane (IMPA) angle.
3. Lower incisor to Frankfort horizontal (FMIA) angle.

1. Frankfort mandibular plane angle (FMPA)

It is the angle formed by the intersection of Frankfort horizontal plane with
the mandibular plane. The mean value is 25°.

2. Incisor mandibular plane angle

_____________________________________________________________________
96
 Tweeds
Analysis
It is the angle formed by the intersection of long axis of lower incisor with
mandibular plane it indicates the relative inclination of the incisor teeth. The
mean value is 90°.

3. Frankfort mandibular incisor angle (FMIA)

It is the angle formed by the intersection of the lower incisor with the FH
plane. The mean value is 65°.

The basis is the FMA angle, as the following norms and prognoses
indicate:
1. FMA 16° to 28°: prognosis good
At 16° IMPA should be 90° + 5° = 95°
At 22° IMPA should be 90°
At 28° IMPA should be 90° - 5° = 85°.

Approximately 60 of malocclusions have FMA between 16° and 28°.

2. FMA from 28° to 35° prognosis fair at 28°, IMPA should be 90° - 5° = 85°,
extractions necessary in majority of case, at 35°, IMPA should be 80° to 85°.

3. FMA above 35°: Prognosis bad, extractions frequently complicates problem.

Tweed stressed the importance of the FMIA angle recommending that it be
maintained at 65° to 70°.

4. IMPA – Normal value is 90°

5. ANB – Normal value is –5° to 2°.

Importance
The Tweed analysis is primarily for clinical treatment planning by
establishing a position the lower incisor should occupy, with provisions made for

_____________________________________________________________________
97
 Tweeds
Analysis
variations in mandibular incisor positions and the upper incisor are placed
according to the lower incisor.

_____________________________________________________________________
98
 Tweeds
Analysis

TWEED’S ANALYSIS

Angles Normal Patient value Inference

1) FMA 21 – 29° 270 Average growth
pattern
0
2) IMPA 90° 104 Proclined lower
incisors
3) FMIA 65° 490 Proclined lower
incisors

References:

1. Tweed CH: The Frankfort –Mandibular plane angle in orthodontic

diagnosis, classification, treatment planning and prognosis. Am J Orthod
Oral Surg 1946;32:175-230.
2. Tweed CH: The Frankfort-mandibular incisors angle (FMIA) in
orthodontic diagnosis, treatment planning and prognosis. Angle Orthod
1954;24:121-169.
3. Kesling. D.H. The diagnostic setup with consideration of the third
dimension 1956;42:741-745.
4. Merrifield LL Vaden JL Klontz aH. Differential diagnostic analysis
system Am J Orthod Dentofac Orthopd 1994; 106:641-648.
5. Riolo ML, Moyers RE, McNamara JA, Hunter WS. An atlas arbor: Center
for Human Growth and Development. University of Michigan 1974.

0023.jpg

_____________________________________________________________________
99