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470
Jacobson 471
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).
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Fig 3. Lateral cephalometric head film tracing of average normal occlusion with ANB angle of 2 degrees.
Fig 4. Diagrammatic representation of lateral cephalometric head film tracing with nasion and points A and B
identified.
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The Wits appraisal of jaw disharmony is a measure of the extent to which the jaws are related to each
other anteroposteriorly. The method of assessing the
degree or extent of the jaw disharmony entails drawing
perpendiculars on a lateral cephalometric head film
tracing from points A and B on the maxilla and
mandible, respectively, onto the occlusal plane which is
drawn through the region of maximum cuspal interdigitation. The points of contact on the occlusal plane from
points A and B are labeled AO and BO, respectively
(Fig 8).
In a sample series of twenty-one adult males selected on the basis of excellence of occlusion, it was
found that point BO was approximately 1 mm ahead of
point AO. The calculated mean reading was 1.17, S.D.
1.9 (range, 2 to 4 mm). In twenty-five adult females
selected on the same basis, points AO and BO generally
coincided. The calculated mean reading was 0.10
mm, SD 1.77 (range, 4.5 to 1.5).
In sum, therefore, the average jaw relationship
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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.
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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.
Discussion
Jacobson 477
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 13. The ANB angle measures 10 degrees. By conventional assessment, this is a severe Class II jaw
disharmony. According to Wits appraisal (2 mm), the
malocclusion is that of a mild Class II skeletal pattern.
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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.
Fig 15. Cephalometric tracing of a Class III malocclusion with ANB angle of 2 degrees. According to conventional assessment, this would appear to be an
average normal occlusion. Wits reading of 4.5 mm
suggests a definite Class III skeletal disharmony.
Summary
points A and B on the maxilla and mandible, respectively, onto the occlusal plane. The points of contact of
the perpendiculars onto the occlusal plane are labeled
AO and BO, respectively.
In a sample of twenty-one male and twenty-five
female adults selected on the basis of excellence of
occlusion, it was found, on the average, that in females
points AO and BO coincided and in males point BO
was located 1 mm ahead of point AO.
In skeletal Class II jaw dysplasias, point BO would
be positioned well behind point AO (positive reading),
whereas in Class III skeletal jaw disharmonies, the
Wits reading would be negative, that is, with point
BO ahead of point AO.
The advantages of the Wits appraisal over that of
the conventional ANB angle reading are illustrated and
discussed.
REFERENCES
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2. Broadbent BH. The face of the normal child. Angle Orthod
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3. Coben SE. The investigation of facial skeletal variants; a serial
cephalometric roentgenographic analysis of craniofacial form
and growth. Am J Orthod 1955;41:407-34.
4. De Coster L. A new line of reference for the study of lateral and
facial teleradiographs. Am J Orthod 1953;39:304.
5. Downs WB. Variations in facial relationship; their significance in
treatment and prognosis. Am J Orthod 1948;29:8-29.
6. Enlow DH, Takayuki K, Lewis AB. Intrinsic craniofacial compensations. Angle Orthod 1971;41:271-85.
7. Isaacson JR, Isaacson RJ, Speidel TM, Worms FW. Extreme
variation in vertical facial growth and associated skeletal and
dental relations. Angle Orthod 1971;41:219-29.
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