Accuracy of ANB, Beta, YEN and W Angles as Anteroposterior Discrepancy Indicators in a Sample of Yemeni Adults

Abstract

This cross-sectional observational study aimed to evaluate and compare the diagnostic accuracy of four commonly used cephalometric parameters—ANB, Beta, YEN, and W angles—as indicators of anteroposterior skeletal discrepancy in a sample of Yemeni adults. It was conducted at the Faculty of Dentistry, University of Science and Technology, Yemen, during 2025. One hundred standardized lateral cephalometric radiographs of Yemeni adults aged ≥ 18 years were selected, equally distributed between skeletal Class II and Class III patterns and balanced by gender. Skeletal classification was initially assessed using the two-finger method. Semi-digital tracing and angular measurements were performed using Dolphin Imaging software v11.9. Intra-and inter-examiner reliability were assessed using intraclass correlation coefficients. Statistical analyses included descriptive statistics, independent t-tests, Pearson’s correlation, receiver operating characteristic (ROC) curve analysis, and evaluation of sensitivity, specificity, and predictive accuracy. All measurements demonstrated excellent reliability (ICC = 0.930 –0.996). The results revealed strong correlations were found among the parameters, with ANB showing significant negative correlations with YEN, Beta, and W angles, while the latter three demonstrated strong positive intercorrelations. Diagnostic performance analysis revealed perfect predictive accuracy for ANB, Beta, and W angles, each achieving 100% sensitivity, specificity, and area under the curve (AUC = 1.000). The YEN angle showed slightly lower performance, with an overall accuracy of 83% (AUC = 0.830), and reduced sensitivity, particularly among females. In conclusion, all evaluated cephalometric parameters effectively identified sagittal discrepancies. Beta, W, and ANB angles demonstrated superior diagnostic accuracy and consistency, supporting the use of these angles as robust, gender-independent indicators for distinguishing skeletal Class II and Class III relationships in Yemeni adults, while YEN may serve as an adjunctive measure rather than a primary diagnostic tool.