Three-Dimensional Evaluation of Steiner Analysis and Witt’s Appraisal in The Assessment of Sagittal Skeletal Pattern in a Selected Group of Yemeni Adults

Background and Purpose: Precise quantification of the sagittal skeletal relationships between the maxilla and mandible is essential to orthodontic diagnosis and treatment planning. This study aimed to comprehensively evaluate the concordance between WITS appraisal and Steiner analysis across distinct sagittal skeletal patterns (SSPs) and to assess potential sexual dimorphism in these measurements in a Yemeni population utilizing cone-beam computed tomography (CBCT) imaging. Materials and Methods: This retrospective cross-sectional study analyzed 120 CBCT scans from a Yemeni population (60 males, 60 females; mean age: 23.39 ± 4.0 years), stratified into three sagittal skeletal pattern groups (n=40 each): Class I, Class II, and Class III, based on the ANB angle. Raw DICOM data were imported into CS 3D Imaging software, where images were oriented to the Frankfort Horizontal plane for three-dimensional reconstruction and segmentation. Cephalometric analysis was performed on standardized sagittal reconstructions to measure the ANB angle and WITS appraisal. These measurements were derived from established skeletal landmarks (including Nasion, Point A, and Point B) and reference planes (specifically the Sella-Nasion plane and the functional Occlusal Plane). Statistical analysis was performed using SPSS, including intergroup comparisons, gender-based comparisons, and Pearson correlation analysis. The level of statistical significance was set at p < 0.05. Results: Statistically significant differences in both ANB angle and WITS appraisal were demonstrated among the three sagittal skeletal patterns (p < 0.001), with Class II subjects demonstrating the highest mean values. No statistically significant sexual dimorphism was detected in either measurement within any skeletal class. A significant positive correlation between WITS appraisal and ANB angle was identified in Class II (r = 0.517) and Class III (r = 0.636) skeletal patterns; conversely, no statistically significant correlation was observed in Class I (r = 0.023). Conclusion: While WITS appraisal and ANB angle demonstrate a significant positive association overall, each measurement provides complementary diagnostic information and should be interpreted in conjunction rather than applied interchangeably when evaluating sagittal jaw discrepancies, particularly in borderline skeletal relationships.