Background: Accurate diagnosis in all three planes of space is essential for developing an appropriate treatment plan. Several cephalometric indicators are used to evaluate sagittal skeletal malocclusions, yet their diagnostic performance is influenced by factors such as mandibular growth pattern.
Purpose: This study aimed to assess how mandibular growth patterns affected the diagnostic accuracy of four sagittal dysplasia indicators: Beta angle, YEN angle, W angle, and Pi angle.
Materials and Method: A retrospective cross-sectional study was conducted using 120 pretreatment lateral cephalograms, evenly distributed based on mandibular growth patterns (mandibular plane angle and facial axis angle). The sagittal malocclusion was diagnosed using A point–Nasion–B point angle, Wits appraisal, molar relation, and patient profile, and compared with the four cephalometric indicators to evaluate their diagnostic performance. Data were analyzed using one-way analysis of variance (ANOVA), Kappa statistics, and intra-class correlation coefficient (ICC), with statistical significance set at p Value < 0.05.
Results: Mandibular growth pattern significantly influenced the performance of sagittal dysplasia indicators. In the normodivergent group, Pi angle was most reliable for class II, while Beta angle was most accurate for class I and class III cases. In the hypodivergent group, Beta angle was the most reliable for all sagittal malocclusion classes. In the hyperdivergent group, YEN and W angles were most accurate for class I cases, and Pi angle for class II. Class III cases were not assessed in the hyperdivergent group.
Conclusion: Mandibular growth pattern has a significant impact on the diagnostic performance of sagittal dysplasia indicators. Consideration of growth pattern alongside sagittal diagnosis may enhance diagnostic accuracy. A hierarchy chart is proposed to aid in selecting the most appropriate sagittal dysplasia indicator based on mandibular growth pattern.