Dr. Kazem AL-Nimri BDS, Ph.D, M.Orth.R.C.

Cephalometrics

introduced for use by orthodontists in 1931 by Dr. Broadbent in the USA and Hofrath in Germany independently of one another.

Cephalo: head Metric: measurments

Cephalometry: is the analysis and the interpretation of standardized radiographs of the facial bones. It is a standardized and reproducible form of skull radiography used extensively in orthodontics to asses the relationships of the teeth to the jaws, and the jaws to the rest of the facial skeleton.

 Head

position: the patients head is oriented in the same position relative to the x-ray beam every time a film is taken, with the use of a cephalostat. Ear rods: in the ear canals (external auditory meatus). Frankfort plane: horizontal. Teeth: in centric occlusion. Lips: in their habitual position.

 Assess

facial and dentoskeletal relationships. To study growth and growth patterns Evaluation of post treatment changes. Research purposes and long term follow-up studies.

The

cranial base. The facial skeleton. Soft tissues.

The midpoint of the sella turcica

The most inferior anterior point on the margin of the orbit

 Sella Turcica (S)

Orbitale (Or)

The most anterior point of the frontonasal suture

The

most posterior inferior point on the clivus (basiocciput). It represents the posterior limit of the midline cranial base. It lies on the anterior margin of foramen magnum.

 Nasion (N)

Basion (Ba)

The tip of the anterior nasal spine

The tip of the posterior nasal spine

 Anterior Nasal Spine

(ANS)

Posterior Nasal Spine

(PNS)

The most posterior point on the profile of the maxilla between the anterior nasal spine and the alveolar crest

The most posterior point on the profile of the mandible between the chin point and the alveolar crest

 A point

B point

The most anterior point on the bony chin

The lowermost point of the mandibular symphysis in the midline

 Pogonion (Pog)

Menton (Me)

The most inferior point on the mandibular symphysis in the midline

The most posterior inferior point on the angle of the mandible

 Gnathion (Gn)

Gonion (Go)

The uppermost, outermost point on the bony external auditory meatus

 Porion (Po): superior

point of external auditory meatus

Machine Porion:

landmark created by ear post of cephalostat

The intersection of the posterior border of the neck of the mandibular condyle and the lower margin of the posterior cranial base

The most superior posterior point on the head of the mandibular condyle

The tip of the crown of the most prominent upper incisor

The tip of the crown of the most prominent lower incisor (E-lower incisor edge)

 1:

most anterior upper central incisor lower central

__ 1: most anterior incisor 6: upper permanent first molar __ 6: lower permanent first molar

Sella - Nasion plane: SN

Represent the cranial base

De Costers line:

Follows the floor of the anterior cranial base from the anterior margin of the ethmoid bone to sella turcica

Maxillary line: ANS - PNS

Mandibular plane: Me - Go

 Line

drawn from Menton (Me) to Gonion (Go)

Occlusal plane:
Cusp tips of molars tip of lower incisor

Functional occlusal plane (FOP):

Passes through the occlusion of the premolars or deciduous molars and the first permanent molars

The Line from point A to pogonion: A Pog

For best aesthetic results: -lower incisor edges lay on A-Pog (Willians, 1969) line

Measurement:

Skeletal relationships :

Dentoalvealar relationships Soft tissues analysis

Sagittal basal relationships Vertical basal relationships

Angle SNA (82 3)

Prognathism of maxillary apical base

Angle SNB (79 3)

Mandibular prognathism

Angle ANB (3 1)

The anteroposterior apical base relationship (skeletal pattern)

 Jaw

discrepancies (maxillary and mandibular). Anteroposterior position of the Nasion Inclination of S-N line to the Frankfort plane. Lower anterior facial height.

Wits analysis (Jacobson, 1975)

Compares the relationships of the maxilla and mandible with the occlusal plane (FOP)

S-N-POG (87 3)
Indicate the anteroposterior position of the chin

Maxillary-mandibular planes angle (Mx-Mn or MM angle) (27 5)

Frankfort-mandibular planes angle (FM angle) (27 5)

If the SN line inclination from the True horizontal or from Frankfort plane deviates more than 6 degrees, and less than 11 degrees, measurements based on the SN line should be corrected by this difference.

Face height ratio (Me-Mx / N-Me) (50 - 55 %)

To estimate the anterior intermaxillary height

Gonial angle (Ar-TGp / TGi-Me) (126 5)

 Upper

incisor to maxillary plane angle (UI / Mx) (108 5) Lower incisor to mandibular plane angle (LI / Mn) (92 5) Interincisor angle (UI / LI) (133 10) Lower incisor edge to A-Pog distance (E A-Pog) (0-2 mm)

UI / Mx plane angle (108 5) LI / Mn plane angle (92 5) Interincisal angle (133 10) E A-Pog (0-2 mm) E C (0-2 mm) FOP / Mx (10 4)

Cephalometric

of:

superimpositions involve the evaluation

Changes

in the overall face. Changes in the maxilla and its dentition. Changes in the mandible and its dentition. Amount and direction of condylar growth, and mandibular rotation. (Kristensen, 1989)

 The

most accurate superimposition is obtained by tracing the first radiograph and superimposing that tracing on the second film, registering the appropriate cranial base structures. (Ekstrom, 1982) Reliable picture of overall facial growth.

Superimposition on:
S-N

line with registration at sella (reliable) De Costers line (more reliable).

 Maxilla The

is subject to extensive periosteal remodelling.

Superimposition on:
anterior surface of the zygomatic process little periosteal remodelling with growth (Bjork and Skieller, 1979) (not easily seen and too short). Anterior surface of the palatal vault. The maxillary plane (at PNS)(contour of the palate at the alveolar process base).

The mandible undergoes rather complex remodeling changes (anterior / posterior growth rotations.
(Bjork and Skieller, 1972)

Superimposition on:
The

inner contour of the cortex of the mandibular symphysis (most useful).

To

evaluate remodeling in the mandible with growth. To evaluate changes in the lower incisor position.
The

contour of the mandibular canal. The crypt of the developing third permanent molars (from the time of commencement of mineralization until root formation begins).

digitizer comprises an illuminated radiographic viewing screen connected to a computer. Information from a lateral cephalometric radiograph is entered into the computer by means of a cursor which records the horizontal and vertical (x,y) co-ordinates of cephalometric points or bony or soft tissue outlines. Specialized software employed to utilize the information entered to produce a tracing and/or the analysis of choice. Research purposes.

 Digora Studies

scanner.

have shown digitizers to be as accurate as tracing a radiograph by hand. was no difference in the regional superimpositions of the mandible, the maxilla, and the cranial base, manually vs digitally with Quick Ceph 2000.

There

(Roden-Johnson et al., 2008)