Skeletal malocclusion and surgical-level skeletal discrepancies: a retrospective cephalometric study using Steiner and McNamara analyses

Abstract

To assess skeletal malocclusion patterns and surgical-level skeletal discrepancies using Steiner and McNamara cephalometric analyses. This retrospective cross-sectional radiographic study was conducted at the Faculty of Dentistry, Sana’a University, and included 353 randomly selected digital lateral cephalometric radiographs (LCR) of patients aged 18–50 years obtained from a major dental radiology center in Sana’a city. Landmark identification, cephalometric tracing, and analysis were performed digitally using OnyxCeph³™ software. Skeletal classification and surgical-level discrepancies were assessed using Steiner and McNamara cephalometric analyses based on established diagnostic thresholds. Statistical analysis was conducted using the Statistical Package for the Social Sciences, including chi-square, Mann–Whitney U, and Kruskal–Wallis tests, with the significance level set at p < 0.05. Class II malocclusion was the most prevalent pattern (45.9%), followed by Class I (27.5%) and Class III (26.6%). Significant associations were found between skeletal class and gender ( p = 0.000), with females predominating in Class II (48.8% vs. males: 39.4%), whereas males led in Class III (42.2% vs. females: 19.75). The overall proportion of patients exhibiting surgical-level skeletal discrepancies was higher when assessed using McNamara analysis (43.9%) than with Steiner analysis (27.2%), and females exhibited a higher objective cephalometric indication for surgery in both frameworks. The highest frequencies were observed for SN–GoGn (44.8%), Pn–Pog (63.2%), and Max–Man (69.7%). In this adult sample from Sana’a, ANB-defined Class II was the most frequent skeletal pattern, with a considerable proportion of patients presenting with surgical-level skeletal discrepancies. McNamara’s analysis identified a higher proportion of individuals exceeding the selected cephalometric thresholds than Steiner’s analysis.