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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
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
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
Steiner’s acceptable compromises
           ANB

           UI‐NA
           (mm)
  UI‐NA
    (°)



  LI‐NB     LI‐NB
     (°)    (mm)
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
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
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)
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Steiner’s acceptable compromises
END
Am J Orthod Dentofacial Orthop 1998:113:62‐72

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