British Journal of Orthodontics

ISSN: 0301-228X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/yjor19

The Eastman Standard Incisor Angulations: are

they still appropriate?

M. J. MacAllister & W. P. Rock

To cite this article: M. J. MacAllister & W. P. Rock (1992) The Eastman Standard Incisor
Angulations: are they still appropriate?, British Journal of Orthodontics, 19:1, 55-58, DOI: 10.1179/
bjo.19.1.55

To link to this article: http://dx.doi.org/10.1179/bjo.19.1.55

Published online: 21 Jun 2016.

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 British Journal of Orthodontks/Vol. 19/1992/55-58

The Eastman Standard Incisor Angulations:

are they still appropriate?
M. J. MACALLISTER, B.D.S.
Department of Orthodontics, Queens University of Belfast, Northern Ireland
W. P. RocK,* D.D.S., F.D.S., D.ORTH., R.C.S.
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Orthodontic Unit, University of Birmingham Dental School, St Chads Queensway, Birmingham B4 6NN
Received for publication February 1991

Abstract. The Eastman Standard values for cephalometry were first described almost 40 years ago and their
derivation is not clear. The present study examines the rationale for the Standard and considers the way it was
originally described. Based on a sample of 30 cases of Class I occlusions with normally related skeletal bases
the mean incisor angulations were found to be exactly on the Eastman Standard, which, therefore, still remains
appropriate as a basis for assessment and treatment planning in orthodontics.
Index words: Cephalometry, Treatment Planning

Introduction 'normal' angular relationship to the supporting

bones. It therefore followed that, if the upper and
Cephalometric radiology is now an essential part of lower incisor inclinations were rectified to the
orthodontic diagnosis and various methods have Frankfort and mandibular planes, respectively, the
been devised for the analysis and interpretation of apical base relationship must correspond with
films (Brown, 1981 ). Some methods, such as the the incisor relationship produced. This method
Wits analysis (Jacobsen, 1975) rely upon simple became known as the Conversion Tracing. From
linear measurements, whilst others such as the 1952 onwards use of the Frankfort plane was
Bjork analysis (Bjork, 1954) are very complex. discontinued and it was replaced by them ore reliable
In the United Kingdom much of the early work maxillary plane, following a lecture given in Lau-
with lateral skull radiographs was carried out by sanne by Professor A.M. Schwartz (Ballard, 1990).
Professor Clifford Ballard, firstly at the Royal In essence the method involved removing the
Dental Hospital and from 1948 onwards at the effects of soft tissue action on the teeth and
Eastman Dental Hospital in London. Ballard began visualising a new incisor relationship with the teeth
by studying the relationship of the soft tissues to the in their skeletally 'normal' positions. Both Ballard
teeth; on films produced in an ENT Department. and Hovell were careful to point out that the word
When he joined the Eastman Dental Hospital in 'normal' was not an absolute definition, but was
1948 a system for proper cephalometric recording used to describe a range of incisal relationships that
of orthodontic cases was gradually developed and were variations about the ideal. At first Ballard used
Ballard (1948) outlined a method for assessment of the figures produced by Bjork (1947) as norms, but
the antero-posterior relationship of the incisor soon he began to collect material from the London
apical bases that was derived from an understand- population amongst whom he worked. Lateral skull
ing of average incisor inclinations. The upper radiographs were obtained for three groups of
incisors were related to the Frankfort plane (Tweed, patients who attended the Childrens and Conserva-
1944) and the lower incisors to the mandibular tion Departments of the Eastman Dental Hospital
plane (Margolis, 1943). for routine dental treatment. The patients in each
Five years later the method devised by Ballard group were aged 8-9 years, 13-14 years, and adults,
was more fully elucidated in two linked papers respectively. Ballard (1990) recalls that there were
(Hovell, 1953; Ballard, 1953). Hovell described how 60 patients in each group, although elsewhere
in a 'normal' skeletal pattern the teeth had a definite cephalometric values are described on the basis of a

*To whom correspondence should be addressed.

030 I-228X/92,002000102.00 II) 1992 British Society for the Study of Orthodontics
 56 M. J. MacAllister and W. P. Rock BJO Vol. 19 No. I

TABLE I Median lateral skull parameters

Author SNA SNB ANB UI/MX LI/MN MM UI/LI

Bjork ( 1947) 82 78 4 110 91 28

Ballard (1956) 81 77·5 3·5 109 92·5 28 130·5
Mills (1970) 109 92·5 28 130·5
Eastman Standard (Mills, 1982) 81 78 3 109 93 27 131

random selection of 250 cases (Ballard 1956). The upper incisor apex (UIA)
precise number is unimportant since the values upper incisor tip (UIT)
produced agreed closely with those Bjork (1947). lower incisor tip (LIT)
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The values first published by Ballard in 1956, lower incisor apex (LIA)
rounded to whole numbers, became known as B point (B)
Eastman Standard values (Mills, 1982; Table 1). pogonion (Po)
The present study was set up in order to test menton (M)
whether or not the Eastman Standard values for gonion (G)
incisor angulations would be found for a European mesiobuccal cusp of upper first molar
population 40 years after they were first described. mesiobuccal cusp of lower first molar
Although the values are widely accepted and used in
The digitizing sequence was followed twice for
orthodontic diagnosis they have not been con- each radiograph and the computer only accepted a
firmed by a scientific study since the time of Ballard.
point if the identifications were within 0·5 mm on
the two occasions. If the second digitization of a
Materials and Methods point differed from the first by more than 0·5 mm
the whole sequence had to be repeated before the
The study was based upon measurement of 30 computer would accept the information.
cephalometric radiographs stored at the University Three of the original 30 films had SNA outside
of Birmingham Dental School. These films were the chosen range when this was checked by accurate
selected from amongst the pre-treatment records of digitization. The files were then searched again until
patients referred to the Orthodontic Department suitable cephalograms were found to restore the
for advice. The criteria for preliminary inclusion in
sample size to 30.
the study were that the patient was Caucasian, that After digitizing was complete the following
the overbite and overjet were normal and that
values were calculated by the computer for each
angles SNA and SNB were within 1o of Eastman
radiograph:
Standard values when measured using an adjustable
protractor. angle SNA
Before the study proper a reproducibility exercise angle SNB
was undertaken in which the following points were angle ANB
digitized ten times using a digitizer pad linked to a upper incisor axis-maxillary plane angle (IU-MX)
computer. lower incisor axis-mandibular plane angle (LI-
MN)
Anterior nasal spine
maxillary-mandibular plane angle (MM)
Posterior nasal spine
Inter-incisal angle (UI/LI)
Gonion
Menton
The values produced were used to check the Results
accuracy of the operator (MM) in identifying
The study group of 30 radiographs was obtained
cephalometric points.
only after examining some 700 films.
During the inain study the following points were
The 10 repeat digitizations for MM angle pro-
recorded:
duced a mean value of 26·88° with a maximum of
sella (S) 27·33° and a minimum of 26·40°. The standard
nasion (N) deviation was 0·37°.
A point (A) The means and standard deviations calculated
anterior nasal spine (ANS) for seven parameters relevant to the Eastman
posterior nasal spine (PNS) Standard are shown as Table 2. Lower incisors were
 BJO February /992 Eastman Standard Cephalometric Values 57

TABLE 2 Results of the present study line (Williams, 1969), is now widely used as a
landmark for correct lower incisor position at the
Eastman end of treatment, although opinions differ as to the
Parameter Mean(") S.D.e) Standard son precise relationship that the lower incisors should
SNA 81·28 0·88 81 3 have to the line (Ricketts, 1964, 1981; Williams,
SNB 78·36 1·11 78 3 1969).
ANB 2-93 0·59 3 2 The A-Po line was not used when Ballard
UI/MX 108·27 6·24 109 6
LI/MN 91·23 5·42 93 6 published his work and the relationship of lower
UI/LI 133-97 10·40 131 6 incisors to A-Po does not form part of the Eastman
MM 26·54 5·25 27 4 Standard. Had Ballard been writing today it prob-
ably would. In the present study lower incisors were
found to be on average 0·86 mm (S.D. 2·6 mm)
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behind A-Po. This is somewhat further back than

found to be 0·86 mm (S.D. 2·6 mm) behind the recommended in the three reports above. Ballard
A-Po line. (1990) remains convinced that long-term lower
incisor stability can be expected only if those teeth
Discussion are left at their naturally determined angulation and
antero-posterior position. His views still demand
The radiographs for the present study were selected close consideration.
from a much larger number, on the basis of having It is apparent from a study of the literature that
normal values for the relationship of the jaws to the the development of the Eastman Standard, and the
cranial base and to each other (Downs, 1948). conversion tracings that were derived from it, was a
Downs' method involves measurement of angles gradual process and there is no single account of the
SNA and SNB, the first published values for which whole method. The present paper has attempted to
were 80·79° and 78·0r, as calculated by a postgra- clarify the situation and to re-establish the appro-
duate student at Northwestern University (Ballard, priateness of the values.
1951). Rounded up to whole numbers the values
agree with those of the Eastman Standard.
According to Ballard (1953) a normal incisor Acknowledgements
relationship is established by vertical development The authors are very grateful to Professor Clifford
of the dento-alveolar structures from a normal base Ballard for his encouragement and help, and Angie
relationship by normal action of the lips and Tabbiner for preparing the manuscript.
tongue. Both Ballard and Mills held similar and
decided views upon the correct positioning of
incisors, particularly with respect to stability of the References
lower labial segment (Ballard, 1951; Mills, 1968). Ballard, C. F. (1948)
Results of the present study support the concept Some bases for aetiology and diagnosis in orthodontics, Dental
that incisor angulations are determined by a combi- Record, 68, 133-145.
nation of skeletal and soft tissue effects since, for a Ballard, C. F. (1951)
sample selected according to standard values for Recent work in North America as it affects orthodontic diagnosis
SNA and SNB, the angulations of both upper and and treatment,
Dental Record, 71, 85-97.
lower incisors were remarkably close to their stan-
Ballard, C. F. (1953)
dard values.
The significance of soft tissue morphology in diagnosis, prog-
As regards the antero-posterior position of lower nosis and treatment planning,
incisors, Mills ( 1968) used angle SNI to assess the Transactions of the European Orthodontic Society, 1953, 143-
amount of permanent change produced in four 175.
groups of children following no treatment or lower Ballard, C. F. (1956)
first premolar extractions only and after active Morphology and treatment of Class II division 2 occlusions,
proclination or retroclination. No appreciable Transactions of the European Orthodontic Society, 1956, 44-55.
change in lower incisor position was found for any Ballard, C. F. (1990)
Personal communications
group three years out of retention.
The findings of Mills were based upon simple Bjork, A. (1947)
The face in profile,
proclination or retroclination. Today there is much Berlingska Boktryckeriet, Lund.
more emphasis on the use of fixed appliances that Bjork, A. (1954)
can, within limits, determine incisor inclinations at Cephalometric X-Ray investigation in dentistry,
the end of treatment. The A-Po line, or diagnostic International Dental Journal, 4, 718-744.
 58 M. J. MacAllister and W. P. Rock BJO Vol. /9 No. I

Brown, M. (1981) Mills, J. R. E. (1970)

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