This document discusses Steiner's acceptable compromises for compensating for sagittal discrepancies between the upper and lower jaws. It provides guidelines for adjusting the positions of the upper and lower incisors based on the ANB angle. A case example is used to illustrate how to predict changes to the ANB angle through growth or treatment and adjust incisor positions accordingly. The document also discusses individualizing treatment proposals based on factors like soft tissue function.

2. Position of the teeth
Compensates the basal discrepancies
Inadequate compensation
MALOCCLUSION
Most important compensation variation in
upper and lower incisor inclination which may
mask a sagittal discrepany
Position of incisors influence position of the lips

3. Position of the teeth
Steiner used the ANB angle as expression for
sagittal relation between the jaws
Position of the UI and LI should vary as ANB
varies

4. Steiner acceptable compromises
A 1° change in the ANB angle gives a change of 1mm
and 1° in UI‐NA, and 0.25mm and 1° for the LI‐NB

5. Steiner’s acceptable compromises
ANB
UI‐NA
(mm)
UI‐NA
(°)
LI‐NB LI‐NB
(°) (mm)

6. Steiner acceptable compromises
Indicate how it is possible to adjust the position of
the upper‐ and lower incisors to the size of the ANB
angle, and at the same time maintain a normal
overjet and overbite
Find the position of the incisors that best
compensates a basal sagittal discrepancy
Only indicated with positive ANB angles

7. Steiner’s acceptable compromises
Based on prediction of how the ANB angle can be
changed through growth and treatment
Best illustrated by a case:
ANB: 10°
UI‐NA: 6.5 mm
UI‐NA°: 27
LI‐NB°: 36
LI‐NB: 10 mm
Pg‐NB mm: 1.5

8. Steiner’s acceptable compromises
First: Evaluate the possibility of changing or reducing
the ANB angle
ANB: 10° (3.5 S.D. 2.0)
UI‐NA°: 27 (26.6 S.D. 5.5) UI‐NA: 6.5 mm (6.6 S.D. 2.4)
LI‐NB°: 36 (31.8 S.D. 5.5)
LI‐NB: 10 mm (8.6 S.D. 2.2)

9. Steiner’s acceptable compromises
Theoretically, the ff possibilities exist:
Prevention of the forward growth of the
maxilla, while the mandible is allowed to
grow forward
Distal movement of point A by extraoral
forces
Distal movement of point A by palatal
torquing of the incisor roots

10. Steiner’s acceptable compromises
The first two points must be related to the previous
evaluations of growth direction and growth amount
The possibilities for a reduction of the ANB angle is
generally greater in a patient with an anterior
mandibular growth rotation than in a patient with a
posterior mandibular growth rotation
Stage of growth treatment is started is important

11. Steiner’s acceptable compromises
To move point A distally by treatment:
the front teeth have to be translated distally
the apex areas may even need to be moved
more distally than the crowns
how: fixed appliances with rectangular
arches

12. Steiner’s acceptable compromises
By treatment only, ANB could be reduced by
2‐3 degrees
By treatment and favorable growth, ANB may
be reduced to half of the original value
In more unfavorable cases, you should add 1
or 2 degrees to the half value

13. Steiner’s acceptable compromises
In our case: it is possible to reduce ANB to 6 degrees
Use the Steiner acceptable compromises and find
which linear distance the upper and lower incisors
should have from the NA line and NB line when the
ANB is 6 degrees

14. Steiner’s acceptable compromises
This is then noted in the diagramme for ANB
prognosis, which then give the result:
6° [A]
0 mm [B]
5 mm [C]
ANB ‐ prognosis

15. Steiner’s acceptable compromises
Second: is to predict the development of the chin
Predict growth rotation of the mandible
Anterior growth rotation: increases chin
protrusion in relation to NB line
Posterior growth rotation: no change or reduction
in chin protrusion

16. Steiner’s acceptable compromises
In orthognathic faces: LI‐NB and Pg‐NB, often
the same
In retrognathic faces: incisors often positioned
2‐3mm more anteriorly than pogonion
In prognathic faces: incisors often positioned 2‐
3mm more posteriorly than pogonion

17. Steiner’s acceptable compromises
If we anticipate that Pg‐NB distance in our case
will increase from 1.5‐3mm, where should the
incisors be positioned?
Our case has an orthognathic face: LI‐NB=Pg‐NB
should be 1:1, then we get
3 mm [E]
3 mm [D]
Pogonion prognosis

18. Steiner’s acceptable compromises
Which distance for UI‐NA mm should be found together
with the LI‐NB = 3mm?
The difference between the UI and LI distance should be
the same irrespectable of whether it is evaluated in
relation to the size of the ANB angle or to the Pg‐NB
distance
6° [A] F = E – (C‐B)
0 mm [B] [F?] = 3 – (5‐0)
= 3 – 5
= ‐ 2
5 mm [C] 3 mm [E]
ANB prognosis 5 mm 3 mm [D]
Pogonion prognosis

19. Steiner’s acceptable compromises
If we use this value in diagram for the pogonion,
we get
‐2 mm [F?] F = E – (C‐B)
= 3 – (5‐0)
= 3 – 5
3 mm [E] = ‐ 2
3 mm [D]
Pogonion prognosis

20. Steiner’s acceptable compromises
We have now made 2 predictions for the incisor
position: 1) one based on the prognosis for
change of the ANB angle; 2) one based on the
change of the chin position
6° [A] ‐2 mm [F]
0 mm [B]
3 mm [E]
5 mm [C]
3 mm [D]
ANB prognosis 5 mm Pogonion prognosis

21. Steiner’s acceptable compromises
Both predictions are seldom similar so they have
to be worked together
Done by using the mean value of the 2
predictions
From the resulting millimeter values we once
again go into the Steiner acceptable compromises
and find the angular values for the incisor
inclination in relation to NA‐ and NB‐ lines that
corresponds to the actual mm values

22. Steiner’s acceptable compromises
We then get the following proposal:
6° [A]
0 mm [B] ‐2 mm [F] ‐1 mm [G]
[I] 17
[J] 25 4 mm [H]
5 mm [C] 3 mm [E]
5 mm 3 mm [D] 3 mm
proposal
G = B + F G = 0 + (‐2) H = C + E H = 5 + 3
2 2 2 2
= ‐ 1 = 4

23. Steiner’s acceptable compromises
We then get the following proposal:
6° [A]
0 mm [B] ‐2 mm [F] ‐1 mm [G]
[I] 17
[J] 25 4 mm [H]
5 mm [C] 3 mm [E]
5 mm 3 mm [D] 3 mm
proposal
G = B + F G = 0 + (‐2) H = C + E H = 5 + 3
2 2 2 2
= ‐ 1 = 4

24. Steiner’s acceptable compromises
This is an expression for the ideal treatment aim
Often need individual changes
‐1 mm [G]
[I] 17
[J] 25 4 mm [H]
3 mm
proposal

25. Steiner’s acceptable compromises
The soft tissue function may influence the
evaluation
A very active tongue function may make an
uprighting of the lower incisors difficult
Or a retrusion of the incisors will result in a
retruded and esthetically unpleasing mouth area
An individualization may also be necessary in
cases that are on the border between
extraction/non extraction treatment

26. Steiner’s acceptable compromises
Protrusion of the lower incisor may reduce the
need of space and case may turn out as a non‐
extraction case
The individualized proposal may therefore be:
6°
1 mm
17°
30° 3.25 mm
3 mm
Individualized proposal

27. Steiner’s acceptable compromises

28. END

29. Am J Orthod Dentofacial Orthop 1998:113:62‐72