A ROENTGENOGRAPHIC CEPHALOMETRIC STUDY ON THE RELIABILITY OF ANGLE ANB PAVAN K, CHANDRA B.D.S. (UNIVERSITY OF LUCKNOW) A Thesis submitted in partial requirement for the degree of Master of Dental Science Department of Preventive Dentistry Faculty of Dentistry iversity of Sydney 1978ACKNOWLEDGEMENTS I wish to acknowledge the valuable advice and guidance of ny supervisor, Associate Professor K. Godfrey (Department of Preventive Dentistry, University of Sydney); the advice on statistical procedures from Associate Professor P. Barnard (Department of Preventive Dentistry, University of Sydney). I would like to thank the Audio-Visual Department at the United Dental Hospital for their help with a number of illustrations. Finally I owe a special debt of thanks to Mr. Rajasekaran Kanniah (Ph.D, student, Department of Agriculture Science) for his friendly advice and Mrs. Wendy Mack, who spent many hours of her precious time in deciphering my handwriting and preparing the final draft. Pavan K, Chandra B.D.S. October 1978PAGE INTRODUCTION ... 1 REVIEW OF LITERATURE ........... 3 A. INTRODUCTION TO CEPHALOMETRICS ...... eee aS) B. METHODS OF DIAGNOSIS ........0cssseeeeeeeeeeesnseesees 6 1. Anthropometric Method ........s0esee0e 6 2. Cast or Model Analysis ... successes 7) 3. Photography .....sseseeeeeeseees 9 4, Roentgenographic Cephalometric Method ae 9 (a) Craniofacial Analysis .......... + 10 (b) Dento alveolar Analysis ... . THE EFFECT OF RACE AND ETHNIC BACKGROUND ON CRANIOFACIAL MEASUREMENTS See eee eee 23 D. ‘THE EFFECT OF SEX AND AGE ON CRANIOFACIAL MEASUREMENTS 6... .es sess eeeeeee cee 28 E, ROLE OF ANGLE ANB AND CRANIOFACIAL MEASUREMENTS IN CLASSIFICATION OF MALOCCLUSION AND TREATMENT [73343409 poapooodoanocso000 7 peeeer 30 F, PROBLEMS OF ANB ANGLE IN DIAGNOSIS AND METHODS OF OVERCOMING THEM ....... See eee eee eae. G. LANDMARKS, CEPHALOMETRIC PLANES, ANGLES AND LINEAR MEASUREMENTS 42 1. Definition of Landmarks, Cephalometric Planes, Angles and Linear Measurements used .....e.es0025 42 Validation of Landmarks and Cephalometric Planes . 47H, RELIABILITY OF CEPHALOMETRIC TECHNIQUE ......sseeesee5 MATERIAL AND METHOD ... AIMS OF THE STUDY MATERIAL... METHOD ....... TRACING MATERIALS AND METHODS ..3..essseeeeseeereeeeee RESULTS ...s.eeeee DISCUSSION .. SUMMARY AND CONCLUSIONS ABBREVIATIONS .. BIBLIOGRAPHY SESE theses e erence etter setts eee ttre eet PAGE 53 59 59 60 61 66 68 101 108 113 117Fig Fig Fig Fig Fig Fig Fig 1: LIST OF ILLUSTRATIONS The effect on angle ANB produced by backward or forward movement of nasion (represented by a short or long anterior cranial base) (Jacobson 1976) sesseeeeeuees The effect on angle ANB produced by rotation of* the jaws which accompany growth (Jacobson 1975) ...... Wits appraisal (Jacobson 1975) .......e.00+ Methods of drawing occlusal plane (Jacobson 1976) .... 5 and Fig 6: Illustrations which Ferrazzini (1976) gives to explain his method 7 and Fig 9: Two cases each with same angle ANB but 8: different linear distances between the apical base (Taylor 1969; Beatty 1975) . A-B distance; method of measuring the saggital discrepancy between the upper and lower jaws (Stoner et al 1956) .. 10 and Fig 11: Cephalometric landmarks, angles, planes and linear measurements used in this study ... PAGE 18 19 20 an 34 36 37 40 39 44 46Fig Fig Fig Fig Fig Fig a2: 14: 15: 16: Ws 18: 19: ‘Types of mandibular plane .......eseeeeeee A case from the present study, illustrating the method used, (See text) .. Scatter diagram - AD' measurement (X) vs angle ANB (X) at NA distance S6-60 mm ..... Scatter diagram - AD' measurement (X) vs angle ANB (Y) at NA distance 61-65 m .,...... Linear regression between angle ANB and antero- posterior distance between the jaws AD' at (NA = 56-60 mm and Mand pl 8 3245) .... Linear regression between angle ANB and antero- posterior distance between jaws AD’ at (NA = S6- 60 mm and Mand pl R above or below 32 +5) .. Linear regression between angle ANB and antero- posterior distance between jaws AD! at (Mand pl & 3225)... Linear regression between angle ANB and antero- posterior distance between jaws AD! at (Mand pl & above or below 3245) ...ssee 62 76 77 80 81 85 86Fig 20: Scatter diagram - Wits appraisal (Xx) vs angle ANB (Y) seeee Fig 21, Fig 22 and Fig 23: Linear regression between ANB and Wits appraisal, (whole sample, Fig 21; Mand pl 8 32 + 5, Fig 22; and Mend pl X above or below 32 * S, Fig 23) 90 91 92LIST OF TABLES Table 1 and Table 2: Experimental error in the present study in Group II and Group I respectively . Table 3 and Table 4: Comparison of coefficient of varia- Table 5: Table 6: Table 7: Table 8: Table 9: Table 10: tion and relative validity of measurement for superiority in diagnosis between angle AXD method and angle ANB method in Group II and Group I respectively . Linear horizontal antero-posterior distance between the jaws AD', under different vertical NA distances in Group I subjects ..... Coefficient of correlation between angle ANB and antero-posterior distance between jaws AD', under conditions controlled by mandibular plane angle and, at a constant NA distance of 56-60 mm ..........00e at a constant NA distance of 61-65 mm ...... at NA distance that is not constant ........65 Coefficient of correlation between angle ANB and Wits appraisal . A detailed tabulation of Angle Class, designated for each case by five orthodontists .....+...++ PAGE 69 74 78 82 83 88 94Table 11: Table 12: Table 13: Norms for classifying the sixteen cases in Group II by the various methods .. A detailed tabulation for comparison of the various diagnostic methods with the standard obtained by the five orthodontists .... Relative percentage reliability of the various diagnostic methods used .......seeeeeeee PAGE 95-7 98 99INTRODUCTION Advancement in scientific technology in other fields of med- icine and allied sciences have led to different methods of ‘apprais- ing the craniofacial morphology in orthodontics. These different approaches have followed a sequence according to Krogman (1957) from artistic appraisal to craniometrics, cephalometrics, photography, facial and dental casts, roentgenographic cephalometry, laminagraphy, pantomography and xeroradiography. With the passage of time, as new techniques for assessing craniofacial morphology came into being, older techniques were either incorporated in them, or were discarded. Since the advent of roentgenographic cephalometry by Broadbent in 1931, many methods have developed in assessing the craniofacial morphology in orthodontic diagnosis, prognosis and treatment planning e.g. (Wylie 1947), (Downs 1948), (North western analysis 1948), (Riedel 1952), (Sassouni 1955), etc. These methods have tried to assess the cranio-maxillo-facial.. complex in different ways in saggital plane dimensions. One of the most popular methods to assess the anteroposterior (saggital) relations of the craniofacial complex has been the angle ANB method (Riedel 1952). Although this method had been considered the best, during the early fifties, lately it has been criticized for deficiencies of information. Taylor in 1969 and later Beatty (1975), Jacobson (1975, 1976) have pointed out the geometric problems which the angle ANB method faces in the saggital assessment of craniofacial complex. They, ~ together with Panagiotidis and Witt (1976) and Ferrazzini (1976),developed some methods of overcoming these problems. Some of these writers (Jacobson (1975, 1976), Panagiotidis and Witt (1976)) claimed superiority of their methods over the existing one (angle ANB) . In doing so, Jacobson especially did not give sufficient reasons experimentally or otherwise for claiming this superiority. This prompted me to carry out this study. In this study an attempt was made to: Apply these newer approaches (Taylor 1969, Beatty 1975) and develop similar but "alternative" methods of assessment of craniofacial complex and compare with angle ANB method: To compare angle ANB method with Wits appraisal and assess the effect of mandibular plane angle on this correlation. To compare the existing methods: Steiner's (1953) angle ANB, Panagiotidis and Witt (1976) individualized ANB, Jacobson (1976) Wits appraisal and the one derived from this study and to compare it with a standard to obtain the percentage reliability of the existing and derived methods.