Journal of Oral Rehabilitation, 1982, Volume 9, pages 301-306

The size of the Balkwill angle and the height

of the Bon will triangle

E. OHM and J. SILNFSS Department of Prosthodontics, School of Dentistry

University of Bergen, Norway

Summary
The Balkwill angle and the height of the Bonwill triangle were measured on cephalo-
grams of 128 adult females and males who had all their natural teeth. The size of the
Balkwill angle was dependent on the choice of the condylar reference point, whereas
the height of the Bonwill triangle was not. When analysed by sex, it was found that the
Balkwill angle was larger in males than in females. Likewise, the height of the Bonwill
triangle was larger in males.

Introduction
The Bonwill triangle (Bonwill, 1885) is the triangle formed by lines drawn between
mandibular incisors, right and left mandibular condyles. The baseline is made up
either by a line between points on the articulating surfaces of the condyle heads or by a
line between points located centrally within the condylar head (Figs 1 & 2). The vertical
cc

Fig. 1. Schematic drawing demonstrating the relation between the Bonwill triangle and the plane of
occlusion. Bo, the height of Bonwill triangle; cc, the centre of condyle heads; mo, the disto-buccal
cusp of second molars; ii, the incisal point.
Correspondence: Professor J. Silness, Department of Prosthodontics, School of Dentistry, University
of Bergen, Arstadv. 17, 5000 Bergen, Norway.
0305-182X/82/0700-0301 $02.00 ©1982 Blackwell Scientific Publications
301
302 E. Ohm and J. Silness

cd

Fig. 2. Schematic drawing demonstrating the difference between Ba 1 and Ba 2 and between Bo 1 and
Bo 2. Ba 1, Balkwill angle 1; Ba 2, Balkwill angle 2; Bo 1, Bonwill height 1; Bo 2, Bonwill height 2;
cd, tangential point on the articulating surface of condyle heads; cc, the centre of condyle heads;
mo, the disto-buccal cusp of second molars; ii, the incisal point.

from the incision to the baseline is the height of the triangle. The Balkwill angle
(Balkwill, 1866) is the angle formed by the imaginary plane of the Bonwill triangle
and the imaginary plane (the occlusal plane) described by the incisors and the disto-
buccal cusps of the mandibular second molars.
The Bonwill triangle, the height of the triangle and the Balkwill angle have been
used in attempts to construct dental articulators capable of reproducing mandibular
movements.
Bonwill (1885) measured craniometrically the triangle named after him and found
that it was equilateral with a side length of 4 in (101-6 mm) on the average. The height
of the triangle would then be 87-98 mm. Lundstrom (1946) measured the height of
Bonwill's triangle on cephalograms and found the mean size to be 97-4 mm.
Balkwill (1866) measured craniometrically the angle named after him in a few
mandibles and found a mean value of 26°. Bergstrom (1950) measured the Balkwill
angle in profile X-rays of crania and found an average value of 18°.
In general, later workers have accepted that the height of the Bonwill triangle is
87-98 mm. Likewise it has been accepted that the mean size of the Balkwill angle is
26°.
The present paper deals with the size of the height of Bonwill triangle and the size
of the Balkwill angle as determined by cephalometric methods.

Material and methods

The sample consisted of 128 adults living in the western part of Norway (Table 1). The
participants all had their natural teeth, except for third molars. Open-mouth cephalo-
grams were taken in a Harvold-Evald cephalostat (Brodr. Muller Vollerup/als,
Denmark). The distance from focus to film was 170 cm, and the distance from the
film to the midsagittal plane was 15 cm. The linear enlargement of this arrangement
was 9-68 % in the midsagittal plane. Exposure time was standardized at 0-5 s. 80 kV
and 20 mA.
 Balkwill angle and Bonwill triangle 303

Table 1. Distribution of partici-

pants on sex and age

Age
Sex n X SE.

I 59
69
29' 8
31 •7
0-72
0-61

The reference points and lines are hsted in Table 2 and shown in Figs 1 & 2. The
variables used in the investigation are given in Table 3 and demonstrated in the figures.
The measurements were taken on the cephaiometric plates. The linear measure-
ments were recorded by means of a caliper square and recorded to the nearest 0-5 mm.
The angular measurements were taken by a protractor to the nearest 0-5°. The reference
points and lines were marked delicately with a soft pencil on the radiographs. After
the first series of measurements the markings were carefully removed by means of

Table 2. Reference points and lines used

ii The incisal point; the midpoint of the incisal edge of the most prominent mandibular
central incisor, projected on the midsagittal plane,
cd A point on the articulating surface of the condylar head as determined by the tangent from
the incisal point.
cc The condylar centre defined as the point equidistant from the anterior, posterior and
superior borders of the condyle head drawn freehand.
mo Molarion, the disto-buccal cusp of the second mandibular molars,
ii-cd The line through the incisal point (ii) and the point on the articulating surface (cd).
ii-cc The line through the incisal point (ii) and the condylar centre (cc).
ii-mo The line through the incisal point (ii) and the disto-buccal cusp of the second mandibular
molars.

Table 3. Variables used in the study

Angular variables
cd-ii-mo Balkwill angle 1 (Ba 1)
cc-ii-mo Balkwill angle 2 (Ba 2)
Linear variables
ii-cd Bonwill height 1 (Bo 1)
ii-cc Bonwill height 2 (Bo 2)

india-rubber. After a time lapse of more than 1 month new reference points and Hnes
were constructed and a second series of measurements carried out. Two measure-
ments of each of the variables were taken and the mean of the duplicate measurements
were utilized in the statistical analyses. This was done because it was occasionally
difficult to locate the reference points, particularly the condylar reference points.
Using the mean of two separate measurements will reduce the error of measurement.
The method error was calculated according to the formula:
304 E. Ohm and J. Silness

The customary statistical parameters were used. The distribution of the variables
was tested for skewness by y/bi based on the third moment of the distribution and
for kurtosis by 62 based on the fourth moment of the distribution. The statistical
calculations were performed with the aid of the electronic computer IBM-360/50. The
values of the measurements made on the films were used directly in the statistical
analyses without correcting for the X-ray enlargement of the linear variables.

Results and discussion

Error of measurements
The measurement error for the various angular and linear variables for both sexes is
presented in Table 4. For angular measurements the error varied between 0-58° and
0-97°. For linear variables the corresponding minimum and maximum values were

Table 4. Statistical distribution of the variables*

Range Mean Method

Skewness Kurtosis error /-test
Variable Sex n Min Max X SE5 bi 62 Si value

Ba 1 ? 59 14-75 29-25 23-37 0-332 -0-680t 4-41 0-58 1-2533

Ba2 ? 59 12-00 26-50 20-26 0-331 -0-7221 4-34 0-64 1-2474
Bo 1 ? 59 82-50 108-00 96-47t 0-628 -0-145 3--48 1-69 0-4070
Bo 2 ? 59 83-00 106-00 96 -20t 0-653 -0-016 2--74 1-03 0-1633
Ba 1 <S 69 16-75 31-00 24-59 0-335 -0-244 3--20 0-88 0-1937
Ba 2 14-25 28-00 21-55 0-325 -0-041 3--29 0-97 0-1219
Bo 1 87-50 116-50 102-15t 0-626 -0-111 3--45 1-17 0-9695
Bo 2 90-00 116-00 102-44t 0-607 0-077 3-31 1-46 0-2554

* Angular variables in degrees; linear variables in millimetres.

t Values not corrected for X-ray enlargement.
t Significant at the 5 % level. Remaining \/bi, bz, and ^values not significant.

1-03 and 1-69 mm. Both the angular and linear errors of measurement are relatively
low. Part of this is probably due to the fact that the mean of two separate measurements
were used in the statistical analyses. The possibility of systematic errors between the
first and second series of measurements was analysed by the Mest.
No significant differences between the two series were found (Table 4). It may be
concluded., therefore, that the determination of the method error was not influenced by
systematic errors.

Distribution of variables
The statistical distribution of the variables is shown in Table 4. In women the distri-
bution of angular variables showed a significant negative skewness {\/bi) at the 5 %
level, whereas in men the distribution was not significantly skewed. In women as well
as in men the distribution of the linear variables showed no significant skewness. The
distribution of the angular variables was significantly leptokurtotic in women
(P<0-05), but not in men. The results of the calculation of the measure of kurtosis
 Balkwill angle and Bonwill triangle 305

revealed that the linear variables did not depart significantly from normality. This was
so for women as well as for men.

Size of the Bonwill height .

The mean size of the various heights of the Bonwill triangle as measured on the
cephalograms is listed in Table 4. In women the small difference between the Bo 1 and
Bo 2 was not statistically significant. This was the case also for men. Comparison
between the sexes revealed that in men Bo 1 as well as Bo 2 was significantly larger than
in women ( f < 0-001). The true size of the Bonwill heights after correction for the
radiographic enlargement of 9-68 % is shown in Table 5.

Table 5. Size of the Bonwill heights after correction for

radiographic enlargement (9 - 68 %)

?
X < X SEx
Bo 1 (mm) 87 -95 0- 573 93- 13 0 -570
Bo 2 (mm) 87 -70 0- 595 93- 39 0 -554

In the present study two alternative heights of Bonwill triangle were measured.
The constructional difference between the heights (Bo 1, Bo 2) was related to the choice
of the condylar reference point. The change of condylar reference point from the
articulating surface to the centre of the condyle point did not, however, infiuence
significantly the size of the height, neither in women nor in men. In women the correc-
ted alternative average sizes were 87-95 and 87-70 mm. In men the corresponding
values were 93-13 and 93-39 mm. Thus, the difference between the sexes was somewhat
more than 5 mm. The size generally accepted (87-98 mm) approximated the value
found for women, but not the one found for men.

Size of the Balkwill angle

The average size of the various Balkwill angles is listed in Table 4. In women Ba 1
showed an average of 23-37° and Ba 2 averaged 20-26°. The difference of 3-11° was
statistically significant (P<0-001). In men Ba 1 showed a mean value of 24-59°. The
corresponding value for Ba 2 was 21-55°. The difference of 3-04° was statistically
significant (/"< 0-001). Comparison between the sexes showed that Ba 1 was on the
average 1-22° larger in men. This difference was statistically significant (P<0-01).
Likewise, Ba2 was on the average 1-29° larger in males. This difference was statistically
significant (P<0-01). The constructional difference between the alternative Balkwill
angles (Ba 1, Ba 2) was related to the condylar reference points in the same way as
was the Bonwill height. The results of the study showed that in both sexes the
choice of condylar reference point had a significant influence on the size of the angle.
A shift of reference point from the articulating surface (cd) to the centre of the con-
dyle (cc) in both sexes reduced the size of the Balkwill angle by approximately 3°.
Balkwill (1866) used the articulating surface of the condyle heads as reference point
and gave a mean value of 26°, whereas Bergstrom (1950) based his measurements on
306 E . Ohjn and J . S i l n e s s - ^ : :

the centre of the condyle heads and found an average value of 18°. Possible sex
differences were not reported or discussed by these authors.

Correlation between the Balkwill angle and the Bonwill height - .-

The results of the calculation of the coefficients of correlation (Table 6) showed that
the values of r were low indicating that the size of the Balkwill angle bears little or
practically no relation to the size of the Bonwill height and vice versa. Bergstrom
Table 6. Correlation coefficients and their /-values

Ba 1 vs Bo 1 Ba 2 vs Bo 2

n r t
? 59 -0-17 -1-30 -0-12 -0-91
3 69 -0-08 -0-65 0-03 0-24

P<005, / = 2-00for d.f. 60 and /=1-99 for d.f. 70.

(1950) constructed on paper lower jaws with variable sizes. In his drawings, increased
sizes of the angle were accompanied by increased sizes of the height of the Bonwill
triangle. Such a procedure would be permissible if a positive, significant correlation
between the two variables existed. The data presented here suggest that this is not the
case.

Conclusions
In consideration of the results of the cephalometric measurements and the statistical
analyses of the results, the following conclusions were drawn:
(1) The average size of the Balkwill angle and the average size of the height of the
Bonwill triangle were larger in males than in females.
(2) The average size of the Balkwill angle was dependent on the choice of the
condylar reference point. On the average, the choice of articulating surface (cd) gave
an approximately 3° larger angle than the choice of a central condylar reference
point (cc).
(3) The average size of the height of the Bonwill triangle was independent of the
choice of condylar reference points (cd, cc).
(4) The size of the Balkwill angle bears little or no relation to the size of the height
of Bonwill triangle.

References
BALKWILL, F . H .(1866) On the best form and arrangement of artificial teeth for mastication. Trans-
actions of Great Britain Odontological Society, 5, 133.
BERGSTROM, G . (1950) Reproduction of dental articulation by means of articulators. Acta odontologica
scandinavica, 9, Suppl. 4.
BONWILL, W.G.A. (1885) Geometrical and mechanical laws of articulation. Transactions of
Pennsylvania Odontological Society, 119.
LuNDSTROM, A. (1946) Kakarnas storlek. Svensk Tandldkare Tidskrift, 39, 391.

Manuscript accepted 24 April 1980