Skip to main content

Geometric Influence of the Sagittal and Vertical Apical Base Relationship on the ANB Angle

Geometrischer Einfluss der sagittalen und vertikalen Kieferbasen auf den ANB-Winkel

Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie volume 70, Article number: 152 (2009) Cite this article

Abstract

Objective:

The objective of this study consisted in determining the variability of the ANB angle in relation to the position of the A- and B-points in the sagittal vertical plane.

Materials and Methods:

Using a theoretical model, we varied the position of the cephalometric points A and B in the sagittal vertical plane while its sagittal relationship was kept constant (Wits value = 0 mm). For this purpose, seven lines were erected perpendicular to the occlusal plane on a lateral cephalogram. The position of points A and B were determined on each of the vertical lines by calculating one anterior and one posterior angle in each case. In this way, the positions of all A- and B-points were clearly defined in the sagittal vertical plane.

Results:

The characteristic of the ANB angle in the sagittal vertical plane was graphically represented by determining both points A and B using two angles instead of one. This revealed that the ANB angle for the same sagittal base relationship was characterized by major variations depending on the position of the A- and B-points in relation to the anterior cranial base. The larger the SNA and SNB angles were, the larger the corresponding ANB angle. At the same time, the absolute value of ANB increased with the length of the vertical distance between the points A and B.

Conclusion:

The ANB angle is strongly influenced by geometric factors. Accurate diagnosis of the sagittal base relationship should thus take the individual character of the ANB angle into account.

Zusammenfassung

Ziel:

Das Ziel der Studie bestand darin, die Variabilität des ANB-Winkels in Abhängigkeit der Lage des A- und B-Punktes in der Sagittal-Vertikal-Ebene zu bestimmen.

Material und Methode:

Anhand eines theoretischen Modells wurde die Position der kephalometrischen Punkte A und B in der Sagittal-Vertikal-Ebene variiert, während ihre sagittale Relation konstant gehalten wurde (Wits-Wert = 0 mm). Hierfür wurden auf einem Fernröntgenseitenbild sieben Linien senkrecht zur Okklusionsebene konstruiert. Die Position der Punkte A und B wurde jeweils auf den senkrechten Linien bestimmt, indem jeweils ein anteriorer und ein posteriorer Winkel berechnet wurde. Auf diese Weise konnte die Lage der Punkte A und B in der Sagittal-Vertikal-Ebene eindeutig definiert werden.

Ergebnisse:

Die Eigenschaft des ANB-Winkels in der Sagittal-Vertikal-Ebene konnte graphisch dargestellt werden, in dem die Punkte A und B durch jeweils zwei statt durch einen Winkel berechnet wurden. Es zeigte sich, dass der ANB-Winkel für dieselbe sagittale Basenrelation in Abhängigkeit der Lage des A- und B-Punktes zur vorderen Schädelbasis große Variationen aufwies. Je größer der SNA- und SNB-Winkel waren, umso größer wurde der dazugehörige ANB-Winkel. Gleichzeitig vergrößerte sich der Betrag des ANB-Winkels mit zunehmendem vertikalen Abstand zwischen den Punkten A und B.

Schlussfolgerung:

Der ANB-Winkel wird in hohem Maße von geometrischen Faktoren beeinflusst. Für eine genaue Diagnose der sagittalen Basenrelation sollte aus diesem Grund die individuelle Natur des ANB-Winkels berücksichtigt werden.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. IDF Diabetes Atlas. 2003. URL: http://www.eatlas.idf.org/Prevalence

  2. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003;26Suppl 1:S5–S20.

  3. IDF Press Release: Diabetes epidemic out of control. 2006. URL: http://www.idf.org/home/index.cfm?unode=7F22F450-B1ED-43BB-A57C-B975D16A812D

  4. Ainamo J, Ainamo A. Risk assessment of recurrence of disease during supportive periodontal care. Epidemiological considerations. J Clin Periodontol 1996;23:232–239.

    PubMed  Article  Google Scholar 

  5. Alikhani Z, Alikhani M, Boyd CM, et al. Advanced glycation end products enhance expression of pro-apoptotic genes and stimulate fibroblast apoptosis through cytoplasmic and mitochondrial pathways. J Biol Chem 2005;280:12087–12095.

    PubMed  Article  Google Scholar 

  6. Bensch L, Braem M, Van Acker K, et al. Orthodontic treatment considerations in patients with diabetes mellitus. Am J Orthod Dentofacial Orthop 2003;123:74–78.

    PubMed  Article  Google Scholar 

  7. Canalis E. Effect of insulinlike growth factor I on DNA and protein synthesis in cultured rat calvaria. J Clin Invest 1980;66:709–719.

    PubMed  Article  Google Scholar 

  8. Chaudhary SB, Liporace FA, Gandhi A, et al. Complications of ankle fracture in patients with diabetes. J Am Acad Orthop Surg 2008;16:159–170.

    PubMed  Google Scholar 

  9. Cheraskin E, Ringsdorf WM, Jr. Tissue tolerance to orthodontic banding. A study in carbohydrate metabolism. Angle Orthod 1982;52:118–128.

    PubMed  Google Scholar 

  10. Cozen L. Does diabetes delay fracture healing? Clin Orthop Relat Res 1972;82:134–140.

    PubMed  Article  Google Scholar 

  11. Daley TD, Wysocki GP, Mamandras AH. Orthodontic therapy in the patient treated with cyclosporine. Am J Orthod Dentofacial Orthop 1991;100:537–541.

    PubMed  Article  Google Scholar 

  12. Delatte ML, Von den Hoff JW, Nottet SJ, et al. Growth regulation of the rat mandibular condyle and femoral head by transforming growth factor-{beta}1, fibroblast growth factor-2 and insulin-like growth factor-I. Eur J Orthod 2005;27:17–26.

    PubMed  Article  Google Scholar 

  13. Devlin H, Garland H, Sloan P. Healing of tooth extraction sockets in experimental diabetes mellitus. J Oral Maxillofac Surg 1996;54:1087–1091.

    PubMed  Article  Google Scholar 

  14. Diedrich P. Grenzen der kieferorthopädischen Behandlung im parodontal geschädigten Gebiss. Dtsch Zahnarztl Z 1990;45:78–81.

    PubMed  Google Scholar 

  15. El-Bialy T, Aboul-Azm SF, El-Sakhawy M. Study of craniofacial morphology and skeletal maturation in juvenile diabetics (Type I). Am J Orthod Dentofacial Orthop 2000;118:189–195.

    PubMed  Article  Google Scholar 

  16. Emingil G, Darcan S, Keskinoglu A, et al. Localized aggressive periodontitis in a patient with type 1 diabetes mellitus: a case report. J Periodontol 2001;72:1265–1270.

    PubMed  Article  Google Scholar 

  17. Firatli E. The relationship between clinical periodontal status and insulin-dependent diabetes mellitus. Results after 5 years. J Periodontol 1997;68:136–140.

    PubMed  Google Scholar 

  18. Firatli E, Yilmaz O, Onan U. The relationship between clinical attachment loss and the duration of insulin-dependent diabetes mellitus (IDDM) in children and adolescents. J Clin Periodontol 1996;23:362–366.

    PubMed  Article  Google Scholar 

  19. Friedlander AH, Friedlander IK, Yueh R, et al. The prevalence of carotid atheromas seen on panoramic radiographs of patients with obstructive sleep apnea and their relation to risk factors for atherosclerosis. J Oral Maxillofac Surg 1999;57:516–521; discussion 521–2.

    PubMed  Article  Google Scholar 

  20. Gotz W, Duhr S, Jager A. Distribution of components of the insulinlike growth factor system in the temporomandibular joint of the aging mouse. Growth Dev Aging 2005;69:67–79.

    PubMed  Google Scholar 

  21. Gotz W, Kunert D, Zhang D, et al. Insulin-like growth factor system components in the periodontium during tooth root resorption and early repair processes in the rat. Eur J Oral Sci 2006;114:318–327.

    PubMed  Google Scholar 

  22. Grossi SG, Zambon JJ, Ho AW, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol 1994;65:260–267.

    PubMed  Google Scholar 

  23. Guggenheimer J, Moore PA, Rossie K, et al. Insulin-dependent diabetes mellitus and oral soft tissue pathologies. I. Prevalence and characteristics of non-candidal lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:563–569.

    PubMed  Article  Google Scholar 

  24. Harvey WK, Nakamoto T. The influence of a high-protein, low-carbohydrate diet on bone development in the fetuses of rat dams with streptozotocin-induced diabetes. Br J Nutr 1988;59:57–62.

    PubMed  Article  Google Scholar 

  25. Holtgrave EA, Donath K. Die Reaktion des Parodonts auf kieferorthopädische Kräfte bei diabetischer Stoffwechsellage. Fortschr Kieferorthop 1989;50:326–337.

    PubMed  Article  Google Scholar 

  26. Hugoson A, Thorstensson H, Falk H, et al. Periodontal conditions in insulin-dependent diabetics. J Clin Periodontol 1989;16:215–223.

    PubMed  Article  Google Scholar 

  27. Hurter P, Berger M, Kubel R, et al. Diabetesspezifische Veränderungen der Hand (cheiropathy) bei Kindern und Jugendlichen mit Insulinabhängigen Diabetes (Typ I). Monatsschr Kinderheilkd 1983;131:582–586.

    PubMed  Google Scholar 

  28. Jiamsripong P, Mookadam M, Honda T, et al. The metabolic syndrome and cardiovascular disease: Part I. Prev Cardiol 2008;11:155–161.

    PubMed  Article  Google Scholar 

  29. Kerner W, Brückel J, Böhm B, Definition, Klassifikation und Diagnostik des Diabetes mellitus. 2004 (URL: http://www.deutsche-diabetesgesellschaft.de/redaktion/mitteilungen/leitlinien/EBL_Klassifikation.pdf).

  30. Krishnan V, Davidovitch Z. The effect of drugs on orthodontic tooth movement. Orthod Craniofac Res 2006;9:163–171.

    PubMed  Google Scholar 

  31. Kumar BV, Padshetty NS, Bai KY, et al. Prevalence of Candida in the oral cavity of diabetic subjects. J Assoc Physicians India 2005;53:599–602.

    PubMed  Google Scholar 

  32. Lal S, Cheng B, Kaplan S, et al. Accelerated tooth eruption in children with diabetes mellitus. Pediatrics 2008;121:e1139–e1143.

    PubMed  Article  Google Scholar 

  33. Lalla E, Cheng B, Lal S, et al. Diabetes mellitus promotes periodontal destruction in children. J Clin Periodontol 2007;34:294–298.

    PubMed  Article  Google Scholar 

  34. Lam DK, Jan A, Sandor GK, et al. Prevention of infective endocarditis: revised guidelines from the American Heart Association and the implications for dentists. J Can Dent Assoc 2008;74:449–453.

    PubMed  Google Scholar 

  35. Locatto ME, Abranzon H, Caferra D, et al. Growth and development of bone mass in untreated alloxan diabetic rats. Effects of collagen glycosylation and parathyroid activity on bone turnover. Bone Miner 1993;23:129–144.

    PubMed  Article  Google Scholar 

  36. Marasa F. Crozat appliance treatment of buccal crossbite. J Clin Orthod 2003;37:329–334; quiz 314.

    PubMed  Google Scholar 

  37. McNair P, Christiansen C, Christensen MS, et al. Development of bone mineral loss in insulin-treated diabetes: a 1 1/2 years followup study in sixty patients. Eur J Clin Invest 1981;11:55–59.

    PubMed  Article  Google Scholar 

  38. Mealey B. Diabetes and periodontal diseases. J Periodontol 1999;70:935–949.

    PubMed  Article  Google Scholar 

  39. Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc 2006;137Suppl:26S–31S.

    PubMed  Google Scholar 

  40. Monnier VM, Glomb M, Elgawish A, et al. The mechanism of collagen cross-linking in diabetes: a puzzle nearing resolution. Diabetes 1996;45Suppl 3:S67–S72.

    PubMed  Google Scholar 

  41. Morrison WB, Ledermann HP, Schweitzer ME. MR imaging of the diabetic foot. Magn Reson Imaging Clin N Am 2001;9:603–613, xi.

    PubMed  Google Scholar 

  42. Nah SS, Choi IY, Yoo B, et al. Advanced glycation end products increases matrix metalloproteinase-1, -3, and -13, and TNF-alpha in human osteoarthritic chondrocytes. FEBS Lett 2007;581:1928–1932.

    PubMed  Article  Google Scholar 

  43. Nelson RG, Shlossman M, Budding LM, et al. Periodontal disease and NIDDM in Pima Indians. Diabetes Care 1990;13:836–840.

    PubMed  Article  Google Scholar 

  44. Nevins ML, Karimbux NY, Weber HP, et al. Wound healing around endosseous implants in experimental diabetes. Int J Oral Maxillofac Implants 1998;13:620–629.

    PubMed  Google Scholar 

  45. Oh TJ, Eber R, Wang HL. Periodontal diseases in the child and adolescent. J Clin Periodontol 2002;29:400–410.

    PubMed  Article  Google Scholar 

  46. Pastan RS, Cohen AS. The rheumatologic manifestations of diabetes mellitus. Med Clin North Am 1978;62:829–839.

    PubMed  Google Scholar 

  47. Pithon MM, Ruellas CV, Ruellas AC. Orthodontic treatment of a patient with type 1 diabetes mellitus. J Clin Orthod 2005;39:435–439.

    PubMed  Google Scholar 

  48. Rees TD. Periodontal management of the patient with diabetes mellitus. Periodontol 2000;23:63–72.

    Article  Google Scholar 

  49. Roe TF, Mora S, Costin G, et al. Vertebral bone density in insulindependent diabetic children. Metabolism 1991;40:967–971.

    PubMed  Article  Google Scholar 

  50. Rohlfing CL, Wiedmeyer HM, Little RR, et al. Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care 2002;25:275–278.

    PubMed  Article  Google Scholar 

  51. Rosenbloom AL, Silverstein JH, Lezotte DC, et al. Limited joint mobility in diabetes mellitus of childhood: natural history and relationship to growth impairment. J Pediatr 1982;101:874–878.

    PubMed  Article  Google Scholar 

  52. Salvi GE, Kandylaki M, Troendle A, et al. Experimental gingivitis in type 1 diabetics: a controlled clinical and microbiological study. J Clin Periodontol 2005;32:310–316.

    PubMed  Article  Google Scholar 

  53. Santiago JV, McAlister WH, Ratzan SK, et al. Decreased cortical thickness & osteopenia in children with diabetes mellitus. J Clin Endocrinol Metab 1977;45:845–848.

    PubMed  Article  Google Scholar 

  54. Sastrowijoto SH, Hillemans P, van Steenbergen TJ, et al. Periodontal condition and microbiology of healthy and diseased periodontal pockets in type 1 diabetes mellitus patients. J Clin Periodontol 1989;16:316–322.

    PubMed  Article  Google Scholar 

  55. Sbordone L, Ramaglia L, Barone A, et al. Periodontal status and selected cultivable anaerobic microflora of insulin-dependent juvenile diabetics. J Periodontol 1995;66:452–461.

    PubMed  Google Scholar 

  56. Schmidt AM, Weidman E, Lalla E, et al. Advanced glycation endproducts (AGEs) induce oxidant stress in the gingiva: a potential mechanism underlying accelerated periodontal disease associated with diabetes. J Periodontal Res 1996;31:508–515.

    PubMed  Article  Google Scholar 

  57. Seymour GJ, Ford PJ, Cullinan MP, et al. Relationship between periodontal infections and systemic disease. Clin Microbiol Infect 2007;13Suppl 4:3–10.

    PubMed  Article  Google Scholar 

  58. Shah AA, Sandler J. Limiting factors in orthodontic treatment: 2. The biological limitations of orthodontic treatment. Dent Update 2006;33:100–102, 105–6, 108–10.

    PubMed  Google Scholar 

  59. Singer LD. Dentistry’s role in the diagnosis and treatment of obstructive sleep apnea. Dent Today 2 2007;26:124, 126–7; quiz 127, 123.

    Google Scholar 

  60. Soell M, Hassan M, Miliauskaite A, et al. The oral cavity of elderly patients in diabetes. Diabetes Metab 2007;33 Suppl 1:S10–S18.

    Article  Google Scholar 

  61. Soysa NS, Samaranayake LP, Ellepola AN Diabetes mellitus as a contributory factor in oral candidosis. Diabet Med 2006;23:455–459.

    PubMed  Article  Google Scholar 

  62. Stewart JE, Wager KA, Friedlander AH, et al. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol 2001;28:306–310.

    PubMed  Article  Google Scholar 

  63. Tager BN. Endocrine problems in orthodontics; the concept of a relative metabolic insufficiency in bone due to rapid skeletal growth and slow sexual maturation. Am J Orthod 1951;37:867–875.

    PubMed  Article  Google Scholar 

  64. Tillil H, Nick O, Kobberling J. Moderne Diagnostik und Klassifikation des Diabetes mellitus. Z Arztl Fortbild Qualitatssich 1998;92:456–466.

    PubMed  Google Scholar 

  65. Tyrovola JB, Spyropoulos MN. Effects of drugs and systemic factors on orthodontic treatment. Quintessence Int 2001;32:365–371.

    PubMed  Google Scholar 

  66. van Venrooy JR, Proffit WR. Orthodontic care for medically compromised patients: possibilities and limitations. J Am Dent Assoc 1985;111:262–266.

    PubMed  Google Scholar 

  67. Weber W, Heik M, Bibergeil H. Ossifikation des Karpalknochens in diabetisch erkrankten Kindern und Jugendlichen. Dtsch Z Verdau Stoffwechselkr 1969;29:133–140.

    PubMed  Google Scholar 

  68. Zieman SJ, Kass DA. Advanced glycation endproduct crosslinking in the cardiovascular system: potential therapeutic target for cardiovascular disease. Drugs 2004;64:459–470.

    PubMed  Article  Google Scholar 

  69. Ziskin D E, Siegel E H, Loughlin W C. Diabetes in relation to certain oral and systemic problems. J Dent Res 1944;23:317–331.

    Google Scholar 

Download references

Author information

Affiliations

  1. Department of Orthodontics, Georg August University, Göttingen, Germany

    Reza Sadat-Khonsari, Henning Dathe, Michael Knösel, Wolfram Hahn & Dietmar Kubein-Meesenburg

  2. Private Orthodontic Practice, Hannover, Germany

    Oskar Bauss

  3. Abteilung für Kieferorthopädie, Zentrum Zahn-, Mund- und Kieferheilkunde, Universitätsklinikum Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Reza Sadat-Khonsari

Authors
  1. Reza Sadat-Khonsari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henning Dathe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Knösel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolfram Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dietmar Kubein-Meesenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Oskar Bauss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reza Sadat-Khonsari.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sadat-Khonsari, R., Dathe, H., Knösel, M. et al. Geometric Influence of the Sagittal and Vertical Apical Base Relationship on the ANB Angle. J Orofac Orthop 70, 152 (2009). https://doi.org/10.1007/s00056-009-8809-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00056-009-8809-5

Key Words:

  • ANB angle
  • Sagittal jaw relationship

Schlüsselwörter:

  • ANB-Winkel
  • Sagittale Kieferrelation