The Maxillo-mandibular discrepancies through soft-tissue references: validation on a novel anteroposterior measurement

Aim: Accurate assessment of maxillary mandibular sagittal discrepancy is fundamental for orthodontic diagnosis and facial proportion evaluation. This study aimed to introduce a novel mandibular discrepancy based on facial soft tissues and to validate its effectiveness by verifying its correlation with the established wits appraisal. Material and methods: the study included 300 Caucasian subjects (162 males, 138 females; aged 6-50 years) with Class I, II, or III malocclusions. Participants were divided into six age groups. Reclusion criteria included facial asymmetry, surgical needs, and previous orthodontic treatment. For each subject, CBCT images and facial scans were used to reconstruct 2 D lateral cephalograms. The analysis compared the conventional Wits appraisal with a “Soft tissue Wits appraisal”, obtained by projecting soft tissue point A and B onto the occlusal plane, Statistical analysis included linear correlation, Student’s for gender comparisons, chi-square tests for age groups, and ICC for operator agreement. Results and conclusions: the results demonstrated significant correlations (<0.001) between soft tissue and conventional Wits appraisals across all age groups, with correlation coefficients raging form 0.719 (adolescents) to 0.880 (adults). The age independent correlation coefficient was 0.817, and inter-examiner agreement reached 95%. No significant gender related differences were foud. In conclusion, the Soft Tissue Wits Appraisal proved to be a simple, reproducible, and reliable tool for the aesthetic diagnosi of maxillo mandibular sagittal relationships. This novel method effectively integrates skeletal assessment wit facial soft tissue analysis, enhancing the precision of orthodontic treatment planning and facial aesthetic evaluation.