18A Readers’ forum
February 2004
Reappraising “Wits”
The article “The ‘Wits’ appraisal of jaw harmony” (Am J
Orthod Dentofacial Orthop 2003;124:470-9) hardly justifies
being called a classic. It was neither an original contribution
nor a reliable means of appraising sagittal jaw discrepancy.
The “Wits” appraisal can be traced to Jenkins,1 who in
1955 used the functional occlusal plane to assess anteropos-
terior maxillary and mandibular relationships by perpendicu-
lar intersects from points A and B. Harvold2,3 evaluated
sagittal changes with activator treatment by measuring pro-
jections on the functional occlusal plane from points A and B.
He stated that during growth it might not provide an accurate
appraisal due mainly to the changes in the cant of the
functional occlusal plane; this has been confirmed by Sher-
man et al.4 Chinappi et al5 used this appraisal as a part of their
quadrilateral analysis.
On the surface, the “Wits” appraisal might appear to be a
simple measurement. However, it is affected by close inter-
action of sagittal as well as vertical growth of the maxilla and
mandible, and by the cant of the occlusal plane.4 The
functional occlusal plane changes with growth; the posterior
part drops down.6 These changes are more evident in growth
patterns where the mandible grows more than the maxilla.7
Harvold3 argued that, from ages 6 to 9 years, the anterior
growth of the mandible could bring B point anteriorly in
reference to A point on the functional occlusal plane, but as
the cant of the occlusal plane changes with growth, B point
might become even more posterior than before. In a longitu-
dinal growth study, Sherman et al4 fully elaborated on and
presented the changes in “Wits” appraisal with growth.
We have proposed using the palatal or the maxillary
plane for evaluating the perpendicular projection from points
American Journal of Orthodontics and Dentofacial Orthopedics
A and B, even though there are vertical and geometric effects
because it is closer to A point than B point.8 The palatal plane
is more stable during growth and is not usually affected by
orthodontic treatment. We also believe that, in any sagittal
evaluation of the maxilla and the mandible, the position of
pogonion and the shape of the symphysis must be included. B
point hardly ever represents the anteroposterior relationship
of the mandible or the facial balance and harmony.
Ram S. Nanda, DDS, MS, PhD
Endowed Chair and Professor
Department of Orthodontics
University of Oklahoma, Oklahoma City
0889-5406/$30.00
doi:10.1016/j.ajodo.2003.12.012
REFERENCES
1. Jenkins DH. Analysis of orthodontic deformity employing lateral
cephalometric radiography. Am J Orthod 1955;41:442-52.
2. Harvold EP. Some biologic aspects of orthodontic treatment in the
transitional dentition. Am J Orthod 1963;49:1-14.
3. Harvold EP. The role of function in the etiology and treatment of
malocclusion. Am J Orthod 1968;54:883-98.
4. Sherman SL, Woods M, Nanda RS. The longitudinal effects of
growth on the Wits appraisal. Am J Orthod Dentofacial Orthop
1988;93:429-36.
5. Chinappi AS, DiPaolo RJ, Langley JS. A quadrilateral analysis of
lower face skeletal patterns. Am J Orthod 1970;58:341-50.
6. Nanda RS. Determinant growth changes in the occlusal plane.
Orthod Fr 1988;59:891-913.
7. Kim YE, Nanda RS, Sinha PK. Transition of molar relationship in
different skeletal growth patterns. Am J Orthod Dentofacial
Orthop 2002;121:280-90.
8. Nanda RS, Merrill RM. Cephalometric assessment of sagittal
relationship between maxilla and mandible. Am J Orthod Dento-
facial Orthop 1994;105:328-44.