Prediction of mandibular growth rotation: assessment of the Skieller, Björk, and Linde-Hansen method

The purpose of this investigation was to assess the method proposed by Skieller, Björk, and Linde-Hansen in 1984 to predict mandibular growth rotation. Our sample consisted of 40 randomly selected, untreated, adolescent subjects representative of the patient population generally encountered in orthodontic practice. The four independent variables identified in the Skieller study as having the highest predictive value (mandibular inclination, intermolar angle, shape of the lower border of the mandible, and inclination of the symphysis) were identified on initial lateral cephalograms. The proposed regression equations were applied and predicted mandibular rotations obtained. Final lateral cephalograms made 6 years after the initial profile radiographs were superimposed and actual mandibular rotation recorded. The observed and predicted rotations were compared and regression analyses performed to determine the amount of variability in observed values accounted for by the four variables individually and in combination. Only 5.6% of the variability in mandibular growth rotation could be accounted for using the four variables individually. Only 9% of the variability could be accounted for with a combination of the variables. In addition, we performed a Monte Carlo analysis, which mirrored the Skieller analysis but used random numbers instead of actual cephalometric data, to determine if the Skieller results may simply have capitalized on chance. Using the same forward stepwise selection procedure with a rejection level of P >.1, we found after 5000 simulations that a mean of 84% and a median of 94% of mandibular growth rotation variability could be accounted for using meaningless data in the Skieller analysis. This result was comparable to the Skieller value of 86%. In conclusion, information derived from pretreatment lateral cephalograms using the Skieller, Björk, and Linde-Hansen method does not permit clinically useful predictions to be made in a general population relative to the direction of future mandibular growth rotation.