MC Namara Analysis. / Orthodontic Courses by Indian Dental Academy

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Mc NAMARA
ANALYSIS
INTRODUCTION
Dr James. A. McNamara..
described a method of cephalometric analysis which is
used in the evaluation and treatment planning of
orthodontic and orthognathic surgery patients
The analysis represents an effort to relate
Teeth to teeth
Teeth to jaws
Each jaw to the other
Jaws to the cranial base
Composite Normative Standards
Are Based On..
Bolton's Standards
Burlington Orthodontic Research Centre
Ann Arbor sample of 111 young adults
(Female 26 yrs 8 mon, Male 30 yrs 9 mon )

The analysis method is derived in part from the
principles of cephalometric analyses of Ricketts
and Harvold

Why Another Analysis ?
1940 1970 : Significant alteration in the craniofacial
relationship were thought impossible
Advent of numerous Orthognathic surgery procedures
which allow three dimensional repositioning of almost
every bony structure in the facial region

Functional appliance therapy which present new
possibilities in the treatment of skeletal discrepancies
In the decade from 1970 - 1980
s
po
Ba
Co
Or
N
ANS
A
Ptm
Me
Gn
Pog
Landmarks And Planes :
Nasion- Most anterior point
on Nasofrontal Suture
Porion- Superior aspect of
the external auditory meatus

Orbital- lowermost point on
the orbit
Basion- lowest point on the
foramen magnum in the
median plane
Ptm-

Go
s
po
Ba
Co
Or
N
ANS
A
Ptm
Me
Gn
Pog
ANS- Tip of the bony
anterior nasal spine
Point A- Deepest point on the
curved bony outline
( subspinale )
Pogonion- Most anterior point
on the bony chin
Menton- Lowest point on the
outline of the symphysis
Gonion- Constructed by
intersection of the lines
tangent to the posterior
margin of the ascending
ramus & the lower border

Go
s
po
Ba
Co
Or
N
ANS
A
Ptm
Me
Gn
Pog
Gnathion- Constructed by
intersecting a line drawn
perpendicularly to the line
connecting Me and Pog
Condylion- Most
posterosuperior point on the
outline of the condyle
Mandibular plane Go Me

Facial axis Ptm Gn

Go
Craniofacial Skeletal Complex Is
Divided Into Five Major Sections
Maxilla to Cranial base
Maxilla to Mandible
Mandible to Cranial base
Dentition
Airway
Relating Maxilla To The Cranial
Base
Hard tissue evaluation:

Linear distance is measured
Between nasion
perpendicular to point A

0 mm in mixed dentition
1 mm in adults
po
or
N
1 mm
FH
Maxillary Skeletal Protrusion Maxillary Skeletal Retrusion
With Obtuse Nasolabial Angle

Base
Soft Tissue Evaluation:

Nasolabial Angle:
Formed by line drawn tangent
to the base of the nose and a
line tangent to the upper lip
Base
Soft Tissue Evaluation:

Cant Of Upper Lip :
Female 14 degree
Male 8 degree
( SD 8
0
)
N Perpendicular
Relating Maxilla To The Mandible:
Anteroposterior Relationship:

Effective Midfacial Length :
Measured from Condylion to
point A

Effective mandibular length :
Measured from Condylion to
gnathion

Any given effective midfacial length corresponds to a
given effective mandibular length
Mandibular length Midfacial length =
Maxillomandibular differential

Effective lengths are not age or sex related
but are related to size of component parts

Small - Mixed dentition
Medium - Adult female
Large - Adult male

Small : 20 mm Medium : 25 to 27 mm
Large : 30 to 33 mm
CLASS II DIV 1
Mandible 12 mm deficient
Relating Maxilla To The Mandible:
Vertical Relationship :
Lower Anterior Face Height :
Measured from ANS to Menton

Increases with age and is correlated
With effective midfacial length

60 62 mm
66 68 mm
70 74 mm
Vertical maxillary excess can cause a downward
and backward rotation of mandible resulting in an
increase in lower anterior face height and vice
versa
An increase or decrease in the lower anterior face
height can have a profound effect on the
horizontal relationship of the maxilla and
mandible
If the lower anterior face height is increased then
the mandible will appear to be more retrognathic
and vice - versa
Mandibular Plane Angle :
Angle between FH plane and
the Mandibular plane
( Gonion Menton )
22
0
+ 4
0

Facial Axis Angle :
Angle between a line from
basion to nasion and the
facial axis i.e. PTM to Gn
90
0
< 90
0
( -ve value ) excessive
vertical development
> 90
0
( +ve value ) deficient
vertical development
Relating Mandible To The Cranial
Base
Distance from Pog to the nasion
Perpendicular

- 8 mm to 6 mm - 4 mm to 0 mm
- 2 mm to 2 mm
Mandibular Skeletal

Mandibular Prognathism
Retrusion
Dentition :
In cases of malrelationship between the maxillary
and mandibular skeletal structures, errors may result
if the position of the upper incisor is determined by
any measurement that uses mandible as a reference
point
e.g. A pogonion line

A measurement of upper incisor to the N A line is
valid only if the maxilla is in neutral position
anteroposteriorly relative to the cranial base

N
A
Relating upper Incisor to Maxilla :
Anteroposterior position
Position of the upper incisor can be located by
using measurement that relate dental portion of
maxilla to the skeletal portion
Line parallel to nasion
perpendicular through
point A
Distance from point A
er

To the facial surface of
upper incisor is measured
Vertical position :
The incisal edge of the upper incisor lies 2
3 mm below the upper lip at rest

Vertical position of the upper lip is best
determined at the time of clinical
examination
Relating Lower Incisor To
Mandible :
Anteroposterior position :

Measurement of the facial
surface of the lower
incisor to the A Pog line
Normal : 1 mm to 3 mm
anterior
A
Pog

If there is a discrepancy in Anteroposterior or
vertical positioning of the maxilla and the
mandible then modifications in this measurement
procedure is necessary

To predict Anteroposterior position of the incisor
after functional or surgical intervention
A second tracing of the mandible
and the incisor is made
The tracing is moved so that the
mandible is in the desired
position relative to the maxilla
A new A Pog line is drawn
The incisor is expected to lie 1 2
mm anterior to the constructed
line
Estimate the number of mm that the
mandible will be brought forward
relative to the maxilla at the end of the
treatment
Then a new point A is constructed the
same number of mm in the opposite
direction
Post treatment A Pog line
Vertical Position Of The Lower
Incisor :
Relating the lower incisor tip to the functional
occlusal plane
Evaluated on the basis of existing lower anterior
facial height
Excessive Curve of Spee
LAFH is normal or excess Intruded
LAFH is inadequate Eruption of the
Molars
Airway :
Upper pharynx
Width is measured from a point on the
posterior outline of the soft palate to the
closest point on the posterior pharyngeal
wall
Average : 15 - 20 mm
2 mm
Airway :
Lower pharynx
Width is measured from intersection of
the posterior border of tongue and the
inferior border of the mandible to the
closest point on the posterior pharyngeal
wall
Average : 10 12 mm

Advantages :
Linear measurements rather than angles
Provides guidelines with respect to normally
occurring growth increments
The method is more sensitive to the vertical
changes
Easily explained to non specialist and lay
persons such as patients and parents

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