CEPHALOMETRY 1

8/17/2019 CEPHALOMETRY 1

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“Cephalometrics is the languagein which the poetry oforthodontic diagnosis and

treatment planning is written”

-Cecil Steiner



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Contents

History and introduction Twenty centuries of cephalometry Cephalometric landmarks

Cephalometric technique Tracing technique Analyses and interpretations

References



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History

Historically human form had beenstudied for many reasons

To aid humanity’s self portrayal insculpture drawing and painting

To test the relation of physique tohealth temperament and beha!ioraltraits"



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canon



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#ndian iconometry studied e$tensi!ely by

Ruelius was transmitted through sanskritliterature" The face height was used as themodule of both %ariputra andAlekhyalaksana proportional systems which

closely reflected the natural relations ofparts of the body to each other" #n thissystem units were shown in angula"

& angula ' (mm



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Introduction

Anthropologists and anatomists)*ryskull)Craniometry)Cephalometry

*isco!ery of +)rays by Roentgen in&(,-

.roadbent of /%A and Hofrath of

0ermany) standardi1ed cephalometrictechnique



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Cephalometrics includemeasurementsdescription andappraisal of the morphologicalconfiguration and growth changes in

the skull by ascertaining thedimension of linesangles and planesbetween anthropometric landmarks

established by physicalanthropologists and points selectedby orthodontists"



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Cephalometry has influencedorthodontic in 3 major areas

#n morphological analysis#n growth analysis#n superimposition



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The lateral cephalometricradiographicitself is the product of atwo dimensional image of the skull inlateral !iew enabling the relationshipbetween teethbonesoft tissue andempty spaces to be scrutini1ed both

hori1ontally and !ertically"



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Uses of cephalograms

&" Helps in orthodontic diagnosis by enabling thestudy of skeletal dental and soft tissuestructures of the cranio facial region"

2" Helps in classification of skeletal and dentalabnormalities

3" Helps in planning treatment4" Helps in e!aluation of treatment results

-" Helps in predicting the growth related changesand changes associated with surgical treatment

5" 6aluable aid in research work of the craniofacialregion"



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Cephalometric technique

7atient is positioned within the cephalostatusing ad8ustable bilateral ear rods placed

within 9A: in standing position"The midsagittal plane of patient is !ertical

and perpendicular to $)ray beam andparallel to film plane"

The ;H plane is oriented parallel to floor"



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An ($&<inch film cassette equipped with appropriatefilm and intensifying screen is placed hori1ontally

or !ertically in the cassette holder"=nce properly positioned the patient should beinstructed to close to centric and swallow holdingthe body of the tongue in posterior area of softpalate" This reduces the radiolucent band

representing the pharyngeal air spacesuperimposed across the angle of mandible"A distance of &-cms from the midsagittal plane to

the film cassette is used"

*istance from patient to source is -ft"The k!p is ad8usted >< and abo!e with e$posure timeof under &sec are desirable"



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The 7A cephalometric pro8ection alsocalled as the Caldwell pro8ection pro!ides

information related to skull widthsymmetry and !ertical proportions of theskull craniofacial comple$ and oralstructures"

:agnification ' +)ray source to ob8ect distance

source to film distance



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Tracing technique

Armamentarium ?

&" A lateral cephalogram ($&<inches

2" Acetate matte tracing paper<<3inch

3" %harp 3H drawing pencil

4" :asking tape

-" 7rotractor



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General considerations-

7rint the patients name record number agein years and months date of cephalogramand your name in bottom left hand cornerof tracing paper"

Technique –*raw 3 orientation crosses

Trace the soft tissue profile

Trace the e$ternal contour of the craniumTrace the cer!ical !ertebrae

Trace the remaining hard tissue landmarks"



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Nasion

NA



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Ba

Basion

Ant. Margin offor.magnum



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Ptm

Pterygomaillary fissure

!or. "otundum #ith ptergoma. fissure



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$

$ella



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$eMidpoint of entrance

of sella



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PoPorion



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Point A

or $u%spinale

or $$



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AN$

Anterior nasal spine

&r

$P

$pinal point



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&" &r%itale



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PN$

Posterior nasal spine



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Ar

Articulare

'n. &f post. Border

of ramus and inf.

Part of %asilar part

of occ. %one



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Point B

$upramentale



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Co or Cd

Condylion



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(n

(nathion



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(o

(onion



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Me

Menton



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Pog

Pogonion



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). $oft tissue profile

#t e$tends from the hairline @trichion tothe superior cer!ical crease"The upper frontal le!elB located between thehairline and supra)orbital ridge"

The middle ma$illary le!elB located betweenthe supra)orbital ridge and occlusal le!el

The inferior mandibular le!elB locatedbetween the occlusal plane and superiorcer!ical crease



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(

(la%ela



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I*$

Inferior la%ial sulcus



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$*$

$uperior la%ial sulcus



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*i

*a%rale inferius



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*s

*a%rale superius



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Ms

Menton soft tissue



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Ns

Nasion soft tissue



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Pr Pronasale



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$n

$u%nasale



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$t

$tomion



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$ti

$tomion inferius



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$ts

$tomion superius



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$i

Mentola%ial sulcus



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Pog+

$oft tissue Pogonion



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(n+

$oft tissue gnathion



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C

Cer,ical point



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-. entition

AP&CC

Anterior point for

the occlusal plane



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Planes

1. Horizontal – SN plane

FH plane

Palatal plane

Occl!al plane

"an#i$lar plane

2. %ertical –

&-Po' line

Facial plane

Facial a(i!

)-plane



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Planes

!/H plane



53

Mandi%ular plane

Tweed and Ricketts) straight line tangentto the lower most border of the mandible"

*owns) line 8oining 0onion to menton

%teiner) line 8oining 0onion to gnathion

.imler’s line) line 8oining menton to

antegonial notch



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(n

Me

Me

(o

"an#i$lar plane



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$/N plane



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&cclusal plane

*owns and %teiner) line 8oining the midpoint ofthe o!erlap of the :. cusp of the upper andlower first molars with point bisecting theo!erbite of the incisors

Ricketts and wits appraisal) “;unctional occlusalplane”)line 8oining the midpoint of the o!erlap ofthe :. cusp of the first molars and the buccalcusp of the premolar or deciduous molars"

ine 8oining the midsection of the molar cusps tothe tip of the upper incisor



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Occl!al plane



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&r%ital plane

"amus plane



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Cephalometric analysis

Th it i l



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The #its appraisal

*e!eloped in &,><s by *r"Ale$ Dacobson =ne of the most basic used for

determination of the structural andskeletal relationship between the upperand lower 8aw"

AE. reading has limitation in showinganterioposterior relationship of 8aws

F Anterioposterior position of nasion

F Rotational effect of the 8aws i"e""changein mandibular plane angleF #t does not accurately reflect the

e$tent of anterioposterior 8aw dysplasia"



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A&

B&



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isad,antage of #its analysis

#t does not indicate in a malocclusionsituation which 8aw is at fault

This approach fails to distinguishskeletal discrepancies from problemcaused by displacement of the

dentition



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o#ns analysis

*e!eloped in &,4( He obser!ed retrognathicmesognathic

prognathic and true prognathism as four

basic facial types" He obser!ed that position of the mandible

could be used in determining facial types"

He used ;)H plane for analysis" .oth point)A and point). originated in this

system



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Since t*e FH plane appro(i+ate! a

le,el po!ition *en !tan#in' in a

po!tre o #i!tant ,i!ion/ on! electe#to !e t*i! a! a reerence plane.

20 *ite !$ect!/ in a'e ro+ 12-17 r!

it* an eal n+$er o $o! an# 'irl!. &ll t*e !$ect! po!!e!!e# e(cellent

occl!ion.



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$0eletal pattern

!acial angle 1)/12

mean 13.1 deg



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Angle of con,eity

/1.2 to 456

mean is 6 deg

A B l



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A/B plane

0 to -9 #e'



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Mandi%ular plane angle

53 to )1

mean )5.7 deg

8 i



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8/ais

2- to 99

mean 27.: deg

t tt



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entre pattern

ant o occl!al plane

1.5 to 14 +ean 9.3 #e'

nterinci!al an'le



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nterinci!al an'le

130 to 150

+ean 135.4 #e'



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nci!or-occl!al plane an'le

3.5 to 20

+ean 14.5 #e'



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nci!or-+an#i$lar plane an'le

-8.5 to 7

+ean o 1.4 #e'



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Protr!ion o +a(illar inci!or

-1 to 5 ++

+ean 2.7 ++



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isad,antage =nly ten measurements in analysisobtaining a

manageable mental picture of the entire case isdifficult

*owns selected only ten male and ten female

Caucasian sub8ects with what were consideredideal occlusions to ser!e as a sample for thedetermination of his norms"

:ost of the reference planes relate to themandible and not to the ma$illa because at thetime of introduction *owns thought that themandible is at fault in most of themalocclusions"



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$teiner+s analysis

*e!eloped in &,-<s /sed to determine the nature of the malocclusion and

to act as a guide or goal toward which treatmentmodalities could be directed"

;irst to employ both linear and angular measurement todescribe the relationship of the upper and lowerincisors"

This is composite of systems

He used %)E line of .rodie" He ga!e skeletal dental and soft tissue analyses.

Seletal anal!i!



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Seletal anal!i!

SN&

82 #e'



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SN

80 #e'

"a(illa to +an#i$le



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"a(illa to +an#i$le

&N

Occl!al plane an'le



80

Occl!al plane an'le

14 #e'

"an#i$lar plane an'le



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o

n

"an#i$lar plane an'le

32 #e'



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ental anal!i!

"a(illar

inci!or po!ition

22 #e'

4 ++



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"an#i$lar inci!or

po!ition

25 #e'

4 ++



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Sot ti!!e anal!i!

:ip! !*ol# !t

toc* t*e S-

line

t i i l l



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nterinci!al an'le

130 to 150

+ean 135.4

#e'

*i it ti f $t i ; l i



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*imitations of $teiner;s analysis

S-N line i! not !ta$le &N an'le i! aecte# $ t*e +an#i$lar plane an'le

&- point i! #iiclt to i#enti

No ;-a(i!. "an#i$lar plane an'lation to #eter+ine 'rot*

actor i! !o+e*at re+ote an# in#irect +et*o#

oe! not !peci t*e an'le t*at !c* S –line !*ol# +ae

relati,e to a i(e# plane o reerence !c* a! F-H line

ra$ac in nctional a ort*ope#ic!.

:e!! e+p*a!i! on loer acial *ei'*t/ len't* o +a(illa an#

+an#i$le/ #e'ree o acial con,e(it or po!terior cranial $a!e

len't*

T d+ t i l



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T#eed+s triangle

*r"C"H"Tweed de!eloped in &,-<s *esigned to act as a guide to obtaining insight asto what the anatomical relationship of the lowercentral incisor should be at the completion oftreatment

He belie!ed that teeth had to be properlyrepositioned o!er their correct location on thebasal arches in order to obtain orthodonticharmony and stability"

He belie!ed that a certain limited range of lowerincisor angulation relati!e to the mandibular plane

angle would ensure orthodontic balance andstability"



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F"&-25 #e'

F"&-65 #e'

"P&-90 #e'



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*imitation of T#eed+s triangle

The system was ne!er intented to be atotal facial analysis it was merely an aidto determine the relationships of certainteeth relati!e to the inclination of themandibular plane



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Sa!!oni anal!i!

Holdaway soft tissue analysis



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Poster anterior cephalometric



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Poster anterior cephalometric

analysis

<icett! anal!i!

S,an*olt an# !olo anal!i!

r++on! anal!i! ra!on anal!i!

*eirici +et*o#

r++on! anal!i!



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r++on! anal!i!



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r++on! anal!i!

Ad,antages of cephalometry



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d, ges o cep o e y Onl +et*o# t*at per+it! t*e in,e!ti'ation o t*e !patial

relation!*ip! $eteen cranial !trctre! an# $eteen #ental!race !trctre!. = ra$er 1966>

Non in,a!i,e an# non #e!trcti,e

Pro#ce! *i'* inor+ation iel# at relati,el lo p*!iolo'ic co!t

Serial a!!e!!+ent o 'rot* i! po!!i$le

t pro#ce! tan'i$le p*!ical recor#! t*at are relati,elper+anent

Since t*e are 2- / t*e are relati,el ea! to !tore/ repro#cean# tran!port

isad,antages of cephalometry



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g p y ?*e actor o ra#iation e(po!re

?ec*nical li+itation! *ic* li+it t*e e(act location oanato+ical lan#+ar! an# !race!

Strctre! $ein' e(a+ine# are 3 in a 2cep*alo'ra+

Proection error! o $ilaterall paire# !trctre! pont*e +i# !a'ittal plane.

Since it i! 2/ it i! i+po!!i$le to inte'rate inor+ationit* 3 recor#! lie !t# ca!t!.

"eferences



1. Ort*o#ontic ep*alo+etr- &t*ana!io! ). &t*ana!io

2. <a#io'rap*ic cep*alo+etr – &le(an#er @aco$!on

3. &tla! an# +anal o cep*alo+etric ra#io'rap* – ?*o+a!rao!i

4. &@O O 1987 @an. Point & re,i!ite# – @aco$!on

5. onte+porar ort*o#ontic! – Aillia+ <. Proitt

?e(t $oo o ra#iolo' – A*ite B oaz

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