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Define cephalometrics
Types of cephalograms
Lateral cephalogram
Oblique cephalogram
Used of cephalogram
The difficulty in locating landmarks and surfaces on the X-ray image as the
image lacks hard edges and defined outlines.
Some reference landmarks and planes do not agree with the anatomical
landmarks.
Patient is positioned with the ear rods in the external acoustic meatus. The
operator assumes that the meatuses are symmetrical. It need not be so.
CEPHALOMETRIC LANDMARKS
Nasion (N) : point where frontonasal and internasal sutures meet in the
midline.
Anterior nasal spine (ANS) : Most anterior point of maxilla. Used for
vertical measurement.
Pogonion (Pog): Anterior most point in the contour of the lateral shadow of
the chin.
Gnathion (Gn): The most anterior and inferior point on the lateral shadow
of chin. It is approximately in the midpoint between pogonion and menton.
Menyon (Me): The inferior most point in the contour of the chin.
Basion (Ba): The most posterior and inferior point in the sagittal plane on
the anterior rim of foramen magnum.
Bilateral points
Orbitale (O): The lowest point on the outline of the bony orbit. In the
lateral cephalogram, overlapping of the two side is seen. In that situation,
lowest point in the averaged outline is used for constructing this point.
Gonion (Go): The most posterior and inferior point at the angle of
mandible.
Articulare (Ar): Intersection of the inferior surface of the cranial base and
the posterior surfaces of the necks of the condyles of mandible.
Porion (Po): Superior most point of the external auditory meatus. Usually
only anatomic porion is taken into consideration. The machine porion
which is the shadow of the car rods are not considered.
Bolton point (Bo): The highest point in the upward curvature of the
retrocondylar fossa.
Soft tissue glabella (G): The most prominent point in the midline of the
forehead.
Soft tissue pogonion (S Pog): Most prominent point in the soft tissue
contour of chin.
Plane
Definiton
Sella-nsion
plane (SN)
Frankfort
horizontal plane
(FH)
Maxillary plane
(Max)
Occlusal plane
(Occ)
Plane
Definiton
Mandibular
plane (MP)
Bolton plane
(BO)
Pterygold
vertical plane
(PTV)
APo line
E plane
(aesthetic
plane)
Methodological classification
1.
analysis.
2.
II.
Tweeds
COGS.
1.
2.
Dentoalveolar analysis-upper 1 to NA
3.
Steiners analysis
Skeletal analysis
Dental analysis
Landmarks
The cephalometric landmarks used are:
Sella (S)
Point A (A)
Nasion (N)
Point B (B)
Steiner used the sella-nasion (S-N) plane, the plane obtained by joining
sella and nasion.
Skeletal analysis
SNA angle
SNB angle
ANB angle
It is the angle formed by the S-N plane and the occlusal plane. Occlusal
plane is drawn through the overlapping cusps of first molars.
It is the angle formed by the S-N plane and the mandibular plane.
Mandibular plane is drawn by a line connecting gonion and gnathion.
Dental analysis
Maxillary Incisor position
Upper incisor to N-A (linear): the distance between incisal edge of upper
incisor to the N-A line. Mean value is 4 mm.
Upper incisor to N-A (angular): The angle between long axis of upper
incisor to the N-A line. Mean value is 22.
Lower incisor to N-B (liner): The distance between incisal edges of lower
incisor to the N-B line. Mean value is 4mm.
Lower incisor to N-B (angular): The angle between long axis of lower
incisor to the N-B line. Mean value is 25.
Interincisal angle
Interincisal angle is formed by long axis of the upper incisor and long axis
of the lower incisor.
More acute angulations are found when upper and or lower incisors are
proclined.
More obtuse angulations are found when upper and /or lower incisor are
retroclined.
Noting the angulations of upper teeth to N-A line and lower incisor to N-B
line is helpful in detecting incisors with defective angulations.
Steiners line is drawn from the middle of S-shaped curve formed by lower
border of nose to the soft tissue contour of the chin.
The lips in well balanced faces should lie along this line.
Norma
l
Increased
Decreased
1.
SNA
82
Prognathic
maxilla
Retrognathic maxilla
2.
SNB
80
Prognathic
mandible
Retrognathic mandible
3.
ANB
Class II skeletal
pattern
4.
Occlusal
plane
14
Clockwise
rotation of
occlusal plane
Counterclockwise rotation of
occlusal plane
5.
Mandibular
plane
32
Vertical growth
pattern
6.
U incisor to
NA (angular)
22
Upper incisor
proclination
7.
U incisor to
NA (linear)
4mm
Upper incisor
proclination
8.
L incisor to
NB (angular)
25
Lower incisor
proclination
9.
L incisor to
NB (angular)
4 mm
Lower incisor
prolination
1
0.
Interincisal
angle
132
Retroclined
incisors
Proclined incisors
1
1.
S line
0mm
Protrusive lips
Retrusive lips
Interpretations
Rakosis T-axis
Mean value = 66
Rakosis Y-axis
Planes \ used
1. Frankfort horizontal plane: Obtained by joining porion and orbitale.
2. Long axis of lower incisor: Obtained by drawing a line along the long axis
of incisors.
3. Mandibular plane: Obtained by drawing a tangent to lower border of
mandible.
Angles formed
1. Frankfort mandibular plan angle (FMA): it is the angle formed at the
intersection of Frankfort horizontal plane and mandibular plane. Value is
25 in well-balanced faces.
2. Incisor mandibular plane angle (IMPA): It is the angle formed at the
intersection of mandibular plane and long axis of lower incisor. Value is 90
in well-balanced faces.
3. Frankfort mandibular incisor angle (FMIA): It is the angle formed at the
intersection of long axis of lower incisor and Frankfort horizontal plane.
Value is 65in well-balanced faces.
Interpretations
FMA > 28 means high angle patient and mandible grows clockwise.
FMA < 23 means low angle patient and mandible grows counterclockwise.
Clinical applications