IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(1):46–52

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IP Indian Journal of Orthodontics and Dentofacial Research

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Original Research Article

Comparative analysis and co-relation of antero-posterior jaw dysplasia indicators
in angle’s Class I molar relation and normal overjet subjects of Central India – A
pilot study
Aayush Jaiswal1 , Mukesh Gupta1 , Himanshu Kanungo1 , Kratika Mishra 1, *

1 Dept. of Orthodontics and Dentofacial Orthopedics, Index Institute of Dental Sciences, Indore, Madhya Pradesh, India

ARTICLE INFO ABSTRACT

Article history: Aim: To assess and compare anteroposterior jaw dysplasia indicators i.e. (Wits-appraisal, ANB-angle,
Received 18-11-2022 β(Beta)-angle, W-angle, YEN-angle and π(Pi)-angle) in Angle’s Class I molar relation subjects with normal
Accepted 30-12-2022 overjet of central India.
Available online 15-03-2023 Materials and Methods: Sum of 40 lateral cephalograms were traced in line with the inclusion criteria
of Angle’s Class I molar relation subjects. Subjects had to be between the ages of 18 and 30 and have
a normal overjet and aligned arches. We measured and compared the Wits-appraisal, ANB-angle, (Beta)-
Keywords: angle, W-angle, YEN-angle and Pi-angle. The statistical package for social sciences (SPSS) 20.0 version
Anteroposterior jaw dysplasia was used to examine the data. We used descriptive statistics. The Spearman’s correlation coefficient was
Class I molar relation
used to evaluate the correlation between the variables. Statistics were judged as significant at a p-value of
ANBangle
0.05. 95% of the confidence interval was chosen.
Wits appraisal Results: The result showed descriptive statistical representation for the norms of Wits-appraisal, ANB-
Betaangle angle, Beta-angle, Yen-angle, W-angle, and Pi-angle for the Central India population. We found a high
Pi angle
correlation of ANB-angle with YEN-angle, ANB-angle and Pi linear, ANB-angle and W-angle, Beta-angle
Wangle
and W-angle, YEN-angle and W-angle and Pi-angle and Pi linear.
Yenangle Conclusion: Among the angles used for the comparative evaluation for the prediction of anteroposterior
jaw dysplasia, W-angle and YEN-angle had the utmost accuracy, whereas Beta-angle had the least.
Therefore, YEN-angle and W-angle are reliable in our practice in the prediction of anteroposterior jaw
dysplasia in the Central India population.

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1. Introduction relationship of the maxilla and the mandible in the sagittal

plane is the most crucial criteria employed in orthodontic
Broadbent introduced cephalometric in 1931. diagnosis as early as the 1900s, even before Angle created
Cephalometrics is regarded as a crucial tool for his classification of malocclusion. 1
evaluating jaw relationship in all spatial planes, including
anterior-posterior, vertical, and transverse. The Anterior
posterior plane has been one of the mainstays in the ANB-angle, Wits appraisal, YEN-angle, Beta-angle, Pi-
diagnosis, prognosis, treatment planning as well as angle, and W-angle are some geometric characteristics that
mid-treatment/post-treatment/retention evaluation. The have been defined and utilised successfully to aid the
physician in the diagnosis of sagittal jaw discrepancies.
* Corresponding author. Particular and unique reference lines, planes and points are
E-mail address: [email protected] (K. Mishra). employed for each of these attributes.

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 Jaiswal et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(1):46–52 47

In 1952, Riedel 2,3 introduced the ANB-angle. Using the measurement error, the same observer retraced 5
the Nasion as a point of reference, he measured the randomly selected cephalograms 1 week following the
difference between the SNA and SNB, or angle-ANB, as original assessment for each of the parameters.
a representation of the dental apical base relationship. The Identification & tracing of these following landmarks
lines that connect Nasion to points A and B cross to create were done
this angle. It indicates how the maxilla and mandible are
situated in relation to one another. 1. Nasion (N)
Jacobson made the Wits evaluation suggestion in 1975. 4 2. Midpoint of the sella (S)
It gauges how closely the mandible and maxilla are 3. Subspinale (A)
connected to one another in the sagittal or anteroposterior 4. Supramentale (B)
plane. Points B and A are separated by a linear AO-BO 5. Mandibular condylar axis (C)
distance that is perpendicularly projected on the occlusal 6. Centre of the anteriormaxilla (M)
plane. 7. Centre of the circle (G), i.e., at a tangent to the three
Baik and Ververidou invented the Beta-angle for the first inner surfaces of the symphysis of the mandible.
time in 2004. 5 Point B, Point A, and the condylar axis of the 8. G’ point: The G point perpendicularly projected onto
mandible are used as references to measure this angle that the true horizontal.
depicts the skeletal dysplasia in the sagittal direction (C). 9. M’ point: M point perpendicularly projected onto the
true horizontal.
The YEN-angle was introduced as a sagittal dysplasia
indication by Neela et al 6 in 2009. To calculate the YEN-
angle, reference points are utilised at locations M (the centre 2.1. Tracing of these following lines were done
of the pre maxilla), G (the midpoint at the mandibular 1. Plane of the occlusion (Functional).
symphysis), and S (the midway of the sella). 2. The N-B line: Segment joining Nasion and
Bhad et al 7 proposed the W-angle in 2013. True sagittal Supramentale points.
dysplasia is reflected, and growth rotations have no impact 3. The N-A line: Segment joining Nasion and subspinale
on it. Three skeleton landmarks—Points M, G, and S—are points
used as reference points in this angle. A line drawn at 90◦ 4. The A-B line: Segment joining subspinale and
from point M on the S-G line and the M-G line, the W-angle supramentale points.
is calculated. 5. The C-B line: Segment joining the midway of the
In 2012, Kumar S et al 8 introduced the Pi analysis. condyle(C) and supramentale point.
According to the authors, this angle wouldn’t be affected 6. The S-M line: Segment joining S and M points.
by how the jaws rotated. The genuine horizontal line that 7. A segment at right angle from subspinale: Segment
passes through Nasion, which is liable to vary with growth, from subspinale point at right angle to the C-B line.
serves as the reference for the (Pi)-angle. 8. The M-G Line: Segment joining M and G points.
Numerous research have been conducted to evaluate and 9. A segment at right angle from point M: Segment from
compare different anteroposterior jaw dysplasia markers point M at right angle to the S-G line.
in various classes and populations. However, inconsistent 10. The S-G Line: Segment joining S and G points.
outcomes and a lack of distinct clinical use indications were 11. True vertical (Tv): True vertical metallic scale line
found. created from radiography picture.
Thus, this study was planned to assess and compare 12. True horizontal (Th): Nasion is located along a line
anterior-posterior jaw dysplasia indicators i.e. Beta-angle, perpendicular to the real vertical.
Wits-appraisal, ANB-angle, W-angle, YEN-angle and 13. The G’-M line: Segment joining G’ and M points.
π(Pi)-angle in Angle’s Class I molar relation subjects 14. A segment at right angle from point M: Segment from
with normal overjet of Central India and to evaluate the point M at right angle to the true horizontal line.
correlation between anteroposterior dysplasia indicators. 15. The N-M’ Line: Segment joining N and M’ points.
16. A segment at right angle from point G: Segment from
2. Materials and Methods point G at right angle to the true horizontal line.
17. The N-G’ line: Segment joining N and G’ points.
A sum of 40 Angle’s Class I molar relation participants
with normal overjet and aligned arches between the 2.2. The six parameters were measured as follows
ages of 18 and 30 were chosen; those with history of
orthodontic treatment, congenital abnormalities, or obvious 2.2.1. ANB angle
asymmetries were excluded. A 0.5 mm lead pencil was We shall identify points A, B, and Nasion in order to create
used to hand trace each cephalogram onto a piece of 0.003- the ANB-angle. Two lines A-N and B-N are drawn. The
inch acetate paper while using the same lighting. The lead angle ANB is formed when the A-N line and the B-N line
investigator conducted each and every trace. To determine cross at Nasion. Angle ANB typically falls between 0◦ and
48 Jaiswal et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(1):46–52

4◦ ”. Class II is believed to be ANB > 4◦ , while class III is

skeletal ANB 0◦ . (Figure 1)

Fig. 4: YEN-Angle

Fig. 1: ANB-angle

Fig. 5: W-angle

Fig. 2: Wits appraisal

Fig. 3: Beta-angle Fig. 6: Pi-angle and Pi linear

 Jaiswal et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(1):46–52 49

2.2.2. Wits appraisal Spearman’s correlation coefficient was used to evaluate the
The AO-BO distance, sometimes referred to as the Wits correlation between the variables. Statistical significance
assessment, Points A and B are projected at right angle to was defined as a p-value of 0.05 or below. 95% of the
the occlusal plane. The normal value in women is 0 mm, confidence interval was chosen.
whereas in men it is -1 mm. Point AO was placed ahead
point BO in skeletal class II, while in class III, point AO is 3. Result
far behind of point BO. (Figure 2)
Table 1 shows the descriptive statistical representation for
2.2.3. β(Beta)- angle the norms for all the parameters for the sample of 40
subjects of the Central India population.
To draw Beta-angle, points Subspinale(A),
Supramentale(B), and C (the mandibular condylar axis) The six anteroposterior jaw dysplasia indicators are all
will be used. A-B, C-B, and a segment from point A that included in Table 2 along with their Spearman’s correlation
is at right angle to the C-B segment are the three lines that coefficients for the whole sample. As can be seen, we
will be drawn. The beta-angle is the intersection of the A-B found a significant correlation of ANB-angle with YEN-
line and the 90◦ segment. Beta-angles between 27◦ and 35◦ angle, Pi linear and W-angle. Furthermore of W-angle with
can be categorised as class I skeletal patterns. Class II and YEN-angle and Beta-angle. Pi-angle and Pi linear had a
class III skeletal patterns are indicated by angles between significant correlation as well.
27◦ and 35◦ , respectively. (Figure 3)
4. Discussion
2.2.4. YEN-angle ANB-angle is considered a pioneer in measuring
Points S, M, and G will be found in order to create the anteroposterior jaw dysplasia to date. Age of the patient,
YEN-angle. S-M and M-G will be the two lines we draw. poor repeatability of landmarks, rotation of the jaw, changes
Calculating the ‘YEN-angle’ between both the lines at point in reference planes caused by growth, and changes brought
M. Skeletal class I is defined as YEN-angles between 117 on by orthodontic treatment are all variables that have an
and 123◦ , skeletal class II as YEN-angles below 117◦ , and impact on all other anterior-posterior criteria that have been
skeletal class III as YEN-angles above 123◦ . (Figure 4) presented throughout the years (Ishikawa et al., 2000). The
typical ANB-angle range, according to Riedel (1952), is
2.2.5. W-angle 0◦ to 4◦ . The ANB-angle range, according to Polina et
The points S, M, and G will be chosen in order to form al 9 (2015), is 0◦ to 4.5◦ in Andhra population. However, in
the W-angle. M-G, S-M, S-G, and a segment from M point our study, the range of ANB-angle is 0.0◦ to 10.0◦ .
that is at 90◦ to the S-G segment are the four lines that By employing wits evaluation, one may determine the
will be drawn. The W-angle is the angle formed by the ‘M- degree or severity of the anteroposterior skeletal disharmony
G’ line and the segment at right angle from point ‘M’ to of the jaws. There are no cranial landmarks involved. For
the ‘S-G’ segment. W-angles with a 51◦ to 56◦ angle are females, the value is 0mm, while for males it is -1mm,
categorised as class I skeletal patterns. A skeletal class II according to Jacobson (1975). The range of Wits, according
connection is a W-angle of less than 56 degrees. Skeletal to Polina et al 9 (2015), is -3mm to 2.5mm in Andhra
class III relationships are those with W-angles greater than population. However, the range of wits evaluation in our
56◦ . (Figure 5) study is 0.0 mm to 8.0mm.
Rotations of the jaw do not impact beta-angle, and it
2.2.6. π(Pi)-angle does not employ a functional plane (Baik and Ververidou,
It was created by drawing a segment at right angle from G 2004). However, it makes use of points A and B, which are
point to the real horizontal line’s intersection at G’, then prone to alter with development and orthodontic treatment
creating another segment from G’ to M point. The angle (Richardson 1982; Frank, 1983; Rushton et al., 1991). On
GG’M, often known as the Pi-angle, is created by joining mouth-closed lateral head films, the point condylion(C) is
the points G’G and G’M. Additionally, a virtual line will be not very reproducible (Adenwalla et al., 1988; Moore et al.,
created from the M point to cross the real horizontal line 1989; Ghafari et al., 1998). Class I skeletal patterns can be
at M’. The Pi linear was assumed to represent the distance categorised as beta-angles between 27◦ and 35◦ . The range
between points G’ and M’. (Figure 6) of Beta-angle, according to Polina et al 9 (2015), is 27◦ to
The SPSS (Statistical Package for Social Sciences) 20.0 37◦ in Andhra population. However, the range of Beta-angle
version was used to examine the data once they had in our study is 19.0◦ to 43◦ .
been collected. The Kolmogorov-Smirnov test was used to Points S, M, and G will be found in order to create
determine the probability distribution of the data; a p value the YEN-angle. Skeletal class I is defined as YEN-angles
of less than.05 showed that the data were not normally between 117◦ and 123◦ (Neela et al). According to studies,
distributed. The use of descriptive statistics was used. The the sella turcica undergoes constant remodelling from
50 Jaiswal et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(1):46–52

Table 1: Description of different variables

Variables ANB WITS BETA Yen- angle PI angle PI Linear W angle
angle appraisal angle
Mean 3.7o 2.55 mm 29.25o 116.35o 3.55o 4.2 mm 52.95o
Std. Deviation 2.77394o 1.84890 mm 5.59958o 25.38809o 2.43818o 2.85804 mm 3.85903o
Range 0.0o 0.0-8.0 mm 19.0- 112.0o -133.0o 1.0o -10.0o 1.00-12.0 mm 44.0o -59.0o
-10.0o 43.0o
Median 3.0o 2.5 mm 28.0o 122.5o 3.0o 3.5 mm 53.0o
Inter-quartile 1.25o 1.0-3.0 mm 26.0o 116.25o 2.0o -4.75o 2.0-5.75 mm 51.0o -56.0o
range -5.0o -32.75o -124.75o

Table 2: Correlation between different variables

Variables Spearman’s correlation coefficient P value
ANB angle & WITS appraisal .359 >.05 (NS)
ANB angle & BETA angle -.570 <.05 (S)
ANB angle & SMG (Yen) angle -.677 <.001 (HS)
ANB angle & PI angle .591 <.05 (S)
ANB angle & PI Linear .716 <.001 (HS)
ANB angle & W angle -.768 <.001 (HS)
BETA angle & Wits appraisal -.424 >.05 (NS)
Yen-angle & Wits appraisal -.099 >.05 (NS)
WITS appraisal & PI angle .263 >.05 (NS)
WITS appraisal & PI Linear .141 >.05 (NS)
WITS appraisal & W angle -.177 >.05 (NS)
BETA angle & SMG (Yen) angle .626 <.05 (S)
BETA angle & PI angle -.032 >.05 (NS)
BETA angle & PI Linear -.116 >.05 (NS)
BETA angle & W angle .696 <.001 (HS)
SMG (Yen) angle & PI angle -.232 >.05 (NS)
SMG (Yen) angle & PI Linear -.312 >.05 (NS)
SMG (Yen) angle & W angle .744 <.001 (HS)
PI angle & PI Linear .856 <.001 (HS)
PI angle & W angle -.460 <.05 (S)
PI Linear & W angle -.567 <.05 (S)
S- Significant, HS- Highly significant, NS- Non-significant

puberty forward. As a result, its midpoint’s location shifts. It (Bhad et al). The range of W-angle is 53◦ to 59◦ in South
is not a stable point as a result. True basal dysplasia may be Indian population, according to Gupta et al. 11 However, the
concealed by any jaw rotations brought on by development range of the W-angle in our study is from 44.0◦ to 59.0◦ .
or orthodontic therapy. The range of YEN-angle, according Table 1 shows the descriptive statistical representation
to Polina et al 9 (2015), is 120◦ to127◦ in Andhra population. for the norms for all the parameters for the sample of 40
However, the YEN-angle range in our study is from 112◦ to subjects of the Central India population.
133◦ . The six anteroposterior jaw dysplasia indicators are all
The pi analysis, a novel technique for evaluating the included in Table 2 along with their Spearman’s correlation
anteroposterior jaw relationship, is proposed. In skeletal coefficients for the whole sample. (Graphs 1, 2, 3, 4, 5 and 6)
class I pattern, the mean value for the Pi-angle is 3.40±2.04
degrees, and for the Pi-linear, the value is 3.40±2.20 5. Conclusion
mm, according to Kumar S et al. The range of Pi- The following conclusions can be drawn from the study:
angle and Pi linear according to Sanjeliwala et al 10 ANB-angle had a significant correlation with YEN-angle,
(2019) are 2.28◦ ±0.81◦ and 3.03±0.74vmm, respectively in Pi-linear, and W-angle. W-angle had a significant correlation
Ahmedabad population. In contrast, the ranges for Pi-angle with Beta-angle and YEN-angle. Pi-angle had a significant
and Pi-linear in our study are respectively 1.0◦ to 10.0◦ and correlation with Pi-linear. Among the angles used for the
1.00 mm to 12.0 mm. comparative evaluation for the prediction of anteroposterior
S, M, and G are used in the W-angle. W-angles with a jaw dysplasia, YEN-angle and W-angle had the highest
51◦ to 56◦ angle are categorised as class I skeletal patterns accuracy, whereas Beta-angle had the least. Therefore,
 Jaiswal et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(1):46–52 51

Graph 1: Correlation between YEN-angle & ANB-angle

Graph 4: Correlation between W-angle and BETA-angle

Graph 2: Correlation between ANB-angle & Pi-linear Graph 5: Correlation between YEN-angle & W-angle

Graph 3: Correlation between W-angle & ANB-angle Graph 6: Correlation between Pi-angle & Pi-linear
52 Jaiswal et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(1):46–52

according to our study, YEN-angle and W-angle are reliable 6. Neela PK, Mascarenhas R, Husain A. A new sagittal dysplasia
in our practice in the prediction of anteroposterior jaw indicator: the YEN angle. World J Orthod. 2009;10(2):147–51.
7. Bhad WA, Nayak S, Doshi UH. A new approach to assessing sagittal
dysplasia in the Central India population. dysplasia: the W angle. Eur J Orthod. 2013;35(1):66–70.
For the diagnosis of anteroposterior jaw dysplasia 8. Kumar S, Valiathan A, Gautam P, Chakravarthy K, Jayaswal P. An
in Central Indian population, we recommend the use evaluation of the Pi analysis in the assessment of anteroposterior jaw
of the values of our study, as it has been found to relationship. J Orthod. 2012;39(4):262–9.
9. Polina VS, Prakash AS, Paturi S, Mummidi B, Varma PK, Kumar
have different values and Standard Deviation not only BS. Establishment of cephalometric norms for four sagittal skeletal
in International population groups but also in Indian discrepancy indicators in Andhra population. J Dr NTR Univ Health
sub-contiental population. Further studies involving larger Sci. 2015;4(3):165–9. doi:10.4103/2277-8632.165404.
multi-centric sample size and with gender segregation of 10. Sanjeliwala A, Mehta F, Patel R, Bhattacharya A, Parekh H, Trivedi
R, et al. An Assessment and Comparison of Pi Analysis with Other
subjects will be needed to provide better floating norms for Sagittal Discrepancy Indicators. IOSR J Dent Med Sci. 2019;18(8):76–
this population. 82. doi:10.9790/0853-1808067682.
11. Gupta AK, Kumar A, Ashraf K, Hussain K, Kumar A, Kulshrestha
R, et al. Establishment of cephalometric norms of Yen, W and Beta
6. Conflict of Interest angle with assessment of sagittal jaw relationship in Eastern Indian
population. Indian J Orthod Dentofacial Res. 2019;5(2):63–6.
None.

7. Source of Funding Author biography

None.
Aayush Jaiswal, Post Graduate Student

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