Effects of functional versus bisected occlusal planes

on the Wits appraisal

Todd A. Thayer, DDS
Lincoln, Neb.

Lateral cephalometric radiographs of 35 males between the ages of 11 years and 24 years, all of
whom had Class JI, Division 1 malocclusions, were traced and Wits appraisals were completed with
the use of two occlusal planes: the functional occlusal plane and the bisected occlusal plane. These
two values were then statistically related to two dental parameters (overjet and incisor anguiation
[1 to 1]) and one skeletal parameter (angle ANB) by means of the Pearson product-moment
correlation with a predetermined level of statistical significance at p < 0.05. The findings
demonstrated that Wits values for both occlusal planes were significantly correlated to both skeletal
and dentai parameters. Each Wits value also shared variance with the Wits value for the other
occlusal plane. Both Wits measures seem to vary to the same degree when compared to the other
measures, as demonstrated by the r values. From the results of this experiment, three conclusions
can be drawn: (i) either occlusal plane can be used in the calculation of the Wits appraisal to aid in
the diagnosis of the severity or degree of anteroposterior jaw disharmony, (2) the bisected occlusal
plane Wits appraisal value showed a higher relationship to dental measures than the functional
occlusal plane Wits appraisal value, and (3) the functional occlusal plane Wits value shared slightly
more variance with skeletal measures (i.e., angle ANB). (AM J ORTHoDENTOFACORTHOP
1990 ;97:422-6.)

I n 1975 Jacobson t introduced the Wits ap-
praisal as a diagnostic aid whereby the severity or de-
gree of anteroposterior jaw disharmony could be mea-
sured on a lateral cephalometric radiograph. This ap-
praisal relates point A and point B to the occlusal plane,
providing a measurement of the anteroposterior rela-
tionship of the jaws nearer the teeth than is provided
by the angle ANB.2
' Th e Wits appraisal was developed in an effort to
reduce inconsistencies found within angle ANB when
both the rotational effect of the jaws relative to cranial
reference planes and the anterioposterior spatial rela-
tiOnship of nasion relative to the jaws are considered.
The Wits appraisal uses a constructed occlusal plane,
wh.ich bisects the overlap of the mesiobuccal cusps of
the first permanent molars and the incisor overlap (Fig.
1). Perpendicular lines are drawn from points A and B
to this occlusal plane. From these points on the occlusal
plane, a measurement is made in millimeters. Positive
values occur when point A is anterior to point B, and
negative values occur when point B is anterior to point
From the University of Nebraska Medical Center College of Dentistry. De-
partment of Orthodontics, Lincoln, Neb.
811/13788
A. Mean values between - 2 mm and + 3 mm have
been reported?
In mixed-dentition patients with deep bite, the con-
structed occlusal plane may differ considerably from
the functional occlusal plane of the deciduous and per-
manent molars. Similarly, in mature dentitions, it may
be difficult to follow the plane of maximum intercus-
pation in patients with a steep curve of Spee.
Several investigators have reported on the premise
of relating the anteroposterior positioning of the jaws
by means of a parameter that avoids the use of cranial
landmarks. Hussels and Nanda 4 questioned the use of
a dental parameter (the occlusal plane) as a means of
comparing the relationships of the jaws. Other studies
by Bishara et al? and Rotberg et al. 6 were concerned
with the relationship of the Wits appraisal and angle
ANB. Bishara et al? investigated the longitudinal
changes in both the angle ANB and the Wits appraisal
and concluded that angle ANB changed with age
whereas no significant changes were demonstrated in
the Wits values. Rotberg et al. 6 attempted to predict
Wits values from angle ANB and found the correlations
were not statistically significant. The study, however,
raised questions concerning the relationship between
the occlusal plane and the Wits appraisal and the use

422
Volume 97 Effects of functional vs bisected occlusal planes on Wits appraisal
Number 5
Fig. 1. Bisected occlusal plane (BI) drawn bisecting overlap of distobuccal cusps of first permanent
molars and incisors.
of a dental parameter to differentiate the degree or se-
verity of anteroposterior jaw disharmonies. The purpose
of this study is to investigate the effects of the functional
versus the bisected occlusal planes on the Wits appraisal
in an adolescent and young adult population. With the
comparison of these two occlusal planes to skeletal and
dental parameters, possibly a standard occlusal plane
can be defined for use in the calculation of the Wits
appraisal.
MATERIALS AND METHODS
Thirty-five pretreatment lateral cephalometric ra-
diographs of male subjects between the ages of 11 years
and 24 years were selected on the basis of exhibiting
Class II, Division 1 malocclusions with complete adult
dentitions, except third molars. No subject had under-
gone orthodontic therapy. All the radiographs were
taken at the University of Nebraska Orthodontic Clinic.
Each radiograph was traced. The following list includes
the cephalometric landmarks and planes used in this
study:
Nasion (N)
Point A
423
Bisected
Occlusal Plane (Bl}
Point B
Angle ANB
Upper incisor to lower incisor (1 to T)
Overjet (OJ)
Bisected occlusal plane (BI) bisecting the overlap
of the distobuccal cusps of the first permanent
molars and incisor overlap (Fig. 1).
Functional occlusal plane (FOP) following the mo-
lars and premolars (Fig. 2).
Lower incisor occlusal plane (LI) bisecting the over-
lap of distobuccal cusps of the first permanent
molars to the tip of the lower central incisor
(Fig. 3).
Lengths were measured to the nearest 0.01 mm and
angles to the nearest 0.5 °. Statistical analysis was ac-
complished by means of descriptive statistics and a
Pearson product-moment correlation with a predeter-
mined level of statistical significance at the 0.05 level.
The experiment design included three occlusal
planes: the bisected occlusal plane (BI), the functional
occlusal plane (FOP), and the occlusal plane drawn
from the overlap of the distobuccal cusps of the first
permanent molars to the tip of the lower incisor (LI).
424 Thayer Am. J. Orthod. Dentofac. Orthop.
May 1990

Fig. 2. Functional occlusal plane (FOP) drawn along molars and premolars.

B,O
Plane ILI~

Fig. 3. Lower incisor occlusel plane (LI) drawn from bisection of distobuccal cusps of first permanent
molars to tip of ower incisor.
 Volume 97 Effects of functional vs bisected occlusal planes on Wits appraisal 425
Number 5

The LI occlusal plane was used as a means of reference Table I. Cephalometric measurements
when an attempt was made to locate the midpoint of
the incisor overlap. Locating the tip of LI on a lat-
Wrio_,e Meo,, I SO 1 ..... IN
eral cephalometric radiograph was accomplished with F O P Wits 0.0 2.8 - 5 . 5 mm 5.0 mm 35
greater accuracy than was bisecting the incisor overlap, BI Wits 4,1 3.0 - 2 . 0 mm 9.5 mm 35
LI Wits 7.3 3.3 1.0 mrn 15.0 mm 35
because only one point had to be located rather than
1 to T 126.9 10.2 to3.0 ° 151.5 ° 35
the bisection of two points. Wits appraisals were then oJ 8.3 3.5 3.0 mm 17.0 mm 35
measured on all three occlusal planes. The Pearson SNA 80.8 4.0 73.5 ° 94.0 ° 35
product-moment correlation indicated that BI and LI SNB 75.6 3.8 69.5 ° 88.0 ° 35
were very highly correlated (r = 0.945). This finding ANB 5.2 2.0 1.0 ° 9.00 35

indicates these variables are different measurements of

the same phenomenon, thus concluding that there was
relatively little error in bisecting incisor overlap al-
though, clinically, there appeared to be some difficulty
in doing so.
From this point on, only the functional occlusal
plane and the bisected occlusal plane were used for
comparison purposes in this study. Two dental param-
eters (overjet and incisor angulation [1 to i"]) and one
skeletal parameter (angle ANB) were then compared
with each of these occlusal planes' Wits appraisal val-
ues by means of the Pearson product-moment corre-
lation.
RESULTS
The results of the measurements and statistical anal-
yses are presented in Table I. The Pearson product-
moment correlations, among previously selected vari-
ables used in this study, are listed in Table II. The FOP
Wits value was correlated to the BI Wits value and an
r value of 0.940 and p = 0.000. Seventy percent of
the variation in one measure is explained by variation
in the other measure.
Correlations between both the FOP Wits and the
BI Wits values to the skeletal parameter (angle ANB)
yielded r values of 0.763 for ANB-FOP Wits, and 0.685
for ANB-BI Wits. These values show a significant cor-
relation between both occlusal plane Wits values and
angle ANB.
Dental parameters, 1 to T and overjet (OJ), were
then correlated to each Wits value and r values were
as follows; OJ-FOP Wits r = 0.574, OJ-BI Wits r =
0.647, 1 to T-FOP Wits r = 0.342, and_l to T-BI Wits
r = 0.452.
DISCUSSION
The study was undertaken to demonstrate the re-
lationship between occlusal planes used with the Wits
appraisal. Through statistical analysis with the Pearson
product-moment correlation, it has been shown that
when the bisected occlusal plane and the functional
occlusal plane are related to both skeletal and dental
Table II. Correlations among previously
selected variables
Variables [ r values
BI Wits-LI Wits 0.945
FOP Wits-BI Wits 0.840
ANB-FOP Wits 0,763
ANB-BI Wits 0.685
OJ-FOP Wits 0.574
OJ-BI Wits 0.674
1 to T-FOP Wits -0.342
1 to 1-BI Wits -0.452
parameters, a statistically significant relationship exists.
The FOP Wits is more highly correlated to angle ANB
than is BI Wits as demonstrated by the r values. Both
FOP Wits and BI Wits are significantly correlated to
overjet, although the BI Wits is more highly correlated.
BI Wits is also more highly correlated to _1 to 1- than
FOP Wits, even though both are significantly corre-
lated. The BI Wits value shows a higher relationship
to the dental measures than the FOP Wits value. FOP
Wits shares slightly more variance with skeletal mea-
sures (i.e., angle ANB). Both the FOP Wits and the
BI Wits share variance.
SUMMARY AND CONCLUSIONS
Lateral cephalometric radiographs of 35 males be-
tween the ages of 11 years and 24 years were traced
and Wits appraisals were completed using two occlusal
planes: the functional occlusal plane and the bisected
occlusal plane. These two values were then analyzed
statistically to two dental parameters (overjet and in-
cisor angulation [_1 to "[-]) and one skeletal parameter
(angle ANB) with use of the Pearson product-moment
correlation. The statistical analysis demonstrated that
Wits values for both occlusal planes were significantly
correlated to both skeletal and dental parameters. Each
426 Thayer Am. J. Orthod. Dentofac. Orthop.
May 1990

Wits value also shared variance with the other Wits I thank Drs. Robert Moore and L. C. Erickson for their
value. Both Wits measures seem to vary to the same guidance and support during the researching and writing of
degree when compared to other measures. this article. A special thank you is also extended to Dr. Linda
From the results o f this experiment, three conclu- DuBois for her help with the statistical analyses and inter-
sions can be made: (1) either occlusal plane can be used pretations.
in the calculation of the Wits appraisal to aid in the
diagnosis of the severity or degree of anteroposterior REFERENCES
l. Iacobson A. The "Wits" appraisal of jaw disharmony. AM J OR-
jaw disharmony, (2) the bisected occlusal plane Wits T H O D 1975;67:125-38.
value showed a higher relationship to dental measures 2. ReidelRA. An analysis ofdentofacialrelationships. AMJORTHOD
than the functional occlusal plane Wits value, and (3) 1957;43:103-19.
the functional occlusal plane Wits value shared slightly 3. Jacobson A. Application of the "Wits" appraisal. AM J ORTHOD
more variance with skeletal measures (i.e., angle 1976;70:179-89.
4. Hussels W, Nanda R. Analysis of factors affecting angle ANB.
ANB). AM J ORTHOD1984;85:411-23.
With these conclusions in mind, the application of 5. Bishara SE, Fahl JA, Peterson LC. Longitudinal changes in the
the Wits appraisal as a diagnostic aid in determining ANB angle and Wits appraisal: clinical implications. AN J OR-
the degree or severity of anteroposterior jaw disharmony THOD1983;84:133-9.
must remain consistent in the use o f its reference points. 6. Rotberg S, Fried N, Kane J, Shapiro E. Predicting the "Wits"
appraisal from the ANB angle. AM J ORTHOD1980;77:636-42.
Point A and point B are determined by their position
on a lateral cephalometric radiograph. Variability enters Reprint reqttests to:
the calculation of the Wits appraisal when different Dr. Todd A. Thayer
occlusal planes are used as reference planes. To remain UNMC College of Dentistry
Department of Orthodontics
consistent, the same occlusal plane, whether it is the 40th and Holdridge
bisected occlusal plane or the functional occlusal plane, Lincoln, NE 68583-0740
throughout the diagnosis and treatment o f the ortho-
dontic patient.

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