Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern

Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures.

This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern.

A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV).

A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00).

The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.