Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Piyush Verma
Dept of Paedodontics & Preventive Dentistry
Contents
Introduction
Definition
Uses of cephalogram
Principal of cephalometric analysis
Goals of cephalometrics
Types of cephalograms
Cephalometric imaging system
Tracing technique
Cephalometric landmarks
Cephalometric planes
Measurement analysis :
Downs analysis
Steiner analysis
Tweed analysis
Wits appraisal
Rickets analysis
Mc Namara analysis
Holdaway soft tissue analysis
Limitations of cephalograms
Sources of errors in cephalometrics
Conclusion
References
Introduction
Origin: ‘Cephalo’ means head and ‘Metric’ is measurement
An image receptor
Cephalostat
15 cm
Uses of cephalogram
In orthodontic diagnosis & treatment planning
In classification of skeletal & dental abnormalities
In establishing facial types
In evaluation of treatment results
In predicting growth related changes & changes
associated with surgical treatment
Valuable aid in research work involving the cranio-
dentofacial region
-- Moyers
Principle of Cephalometric analysis
To compare the patient with a normal reference
group, so that differences between the patient’s
actual dentofacial relationships and those
expected for his/her racial or ethnic groups are
revealed
-- Jacobson
Goals of Cephalometrics
To evaluate the relationships, both horizontally and
vertically, of the five major functional components of the
face:
The cranium and the cranial base
The skeletal maxilla
The skeletal mandible
The maxillary dentition and the alveolar process
The mandibular dentition and the alveolar process
-- Jacobson
Types of cephalograms
Lateral cephalogram
Skull symmetry
2 types :
1. Anatomic: represent actual anatomic structure of
the skull eg – N, ANS, pt A, Pr, Id, pt B, Pog, Me etc
external cranium
vertebrae
-- Jacobson
Section 2 : Cranial base, internal border of cranium, frontal
sinus, ear rods internal border of
cranium
Bilaterally present
frontal sinuses
Planum sphenoidale
Sella turcica
Dorsum sella
Ear rods
Superior, midline of
occipital bone
Section 3 : Maxilla & related structures including nasal bone
& pterygomaxillary fissures Bilateral pterygomaxillary fissures
PNS
nasal bone
Mandibular condyles
P
O
Sella-Nasion plane
S N
Basion-Nasion plane:
N
Palatal plane:
PNS ANS
Ba
Occlusion plane:
Mandibular plane:
Different definitions
are given in different
analysis
1. Tweed- Tangent to
lower border of the
mandible Go
2. Downs analysis – Gn
Me
extends from Go to Me
3. Steiner’s anlysis –
extends from Go to Gn
Vertical planes
Facial plane
A-Pog line
N
Facial axis Ptm
E plane
Pog
Gn
MEASUREMENT ANALYSIS
DOWN’S ANALYSIS
Given by WB Downs, 1925
One of the most frequently used cephalometric
analysis
FH plane
Gives an indication of
anteroposterior positioning of
mandible in relation to upper face
Pog
Reveals convexity or
concavity of skeletal profile
Average value 0°, Range = - N
8.5 to 10°
Positive angle or increased A
angle – prominent maxillary
denture base relative to
mandible Pog
= 17 to 28°
Increased mandibular
plane angle suggestive of
Go
vertical grower with
Me
hyperdivergent facial
pattern
Y- axis (growth axis)
Mean value = 59° , range = 53
to 66°
S
Angle is larger in class 2 facial
patterns than in class 3 FH plane
patterns
Indicates growth pattern of an
individual
Angle greater than normal – Gn
vertical growth of mandible
Angle smaller than normal –
horizontal growth of
mandible
Dental parameters
Cant of occlusal
plane
FH plane
Measurement is more in
patients with upper incisor
proclination
Limitations of Downs analysis
Too many landmarks
Too many measurements
Time consuming
-- Jacobson
STEINER ANALYSIS
Indicates antero-posterior
N
positioning of the mandible S
tendency
Mean value = 2°
Mandibular plane angle
Gives an indication of
growth pattern of an S
N
individual
Indicates relation of
occlusal plane to the
cranium & face
N
Normal angle = 22°
Angle indicates relative
inclination of upper A
incisors
Increased angle seen in
class 2 div 1 malocclusion
Upper incisor to N-A (
linear)
A
Normal value is 4 mm
Increase in measurement
– proclined upper incisors
Inter-incisal angle Mean value = 130 to 131°
N
Indicates inclination of
lower central incisors
>25 °-- proclination of
lower incisors
B
< 25 °– retroclined
incisors
Lower incisor to N-B
(linear)
N
Helps in assessing lower
incisor inclination
Increase in
measurement indicates
proclined lower incisors B
• IMPA = 90 °
Mand plane
• FMIA = 65 °
WITS APPRAISAL
It is a measure of the extent to which maxilla &
mandible are related to each other in antero-
posterior or sagittal plane
Dr. RM Ricketts
The growth dependent variables
are given a mean change value
that is to be expected and
adjusted in the analysis.
-- Jacobson
Landmarks
This is a 11 factor summary analysis that employs
specific measurements to
Ba-Na plane --
Extends from basion
to the nasion. Divides
the face and cranium.
Occlusal plane --
Represented by line
extending through the
first molars & the
premolars.
Ptm
Gn
Facial axis
Condylar axis
Corpus axis
Interpretation
This consists of analyzing:
Chin in space
Convexity at point A
Teeth
Profile
Chin in Space
This is determined by :
Average measurement is
-2.0mm at 9 yrs of age
2. Maxilla to mandible
4. Dentition
-- Jacobson
5. Airway
MAXILLA TO CRANIAL BASE
Soft tissue evaluation
Nasolabial angle
Acute nasolabial angle –
dentoalveolar protrusion, but
can also occur because of
orientataion of base of nose
Cant of upper lip
14 degree in females
8 degree in males
Hard tissue evaluation
Anterior position of point A
= +ve value
Medium-sized : 27-30mm
Vertical maxillary
deficiency – upward &
forward rotation of
mandible, decreasing
lower anterior facial
height
a) Lower Anterior Face Height
(LAFH)
A higher value
excessive lower facial
height
A negative value
excessive vertical
development of the face
Positive values
deficient vertical
development of the face
MANDIBLE TO CRANIAL BASE
In the mixed dentition - pogonion on the average is
located 6 to 8 mm posterior to nasion perpendicular,
but moves forward during growth
Analysis consists of 11
measurement Dr. Reed Holdaway
-- Jacobson
1. Facial Angle (90
degree)
Measurement should be
approx same as the upper lip
thickness (within 1mm)
Error may occur in the Human error may creep in Use of computerized
measurement of various during the tracing plotters & digitizers to
linear & angular measurements digitize the landmarks &
measurements carry out the various linear
& angular measurements
has proved to be more
accurate
Error : Causes of error How to minimize the
Errors in landmarks error
identification