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Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
Cephalometrics /certified fixed orthodontic courses by Indian dental academy
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Cephalometrics /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. SEMINAR ON CEPHALOMETRICS IN ORTHOGNATHIC SURGERY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. INTRODUCTION AIM & OBJECTIVES HISTORY RADIOGRAPHIC CEPHALOMETRIC TECHNIQUE CEPHALOMETRIC TRACING HARD SOFT LANDMARKS TECHNIQUE AND IDENTIFICATION OF LANDMARKS TISSUE ANALYSIS TISSUE ANALYSIS CEPHALOMETRIC LIMITATIONS RECENT PREDICTION TRACING OF CEPHALOMETRICS ADVANCES CONCLUSION REFERENCES www.indiandentalacademy.com
  • 3. www.indiandentalacademy.com
  • 4. www.indiandentalacademy.com
  • 5. ANCIENT - TIMES Historically human form measurements. 1 - self portrayal in sculpture, drawing and painting. 2 - relation of physique - health, temperament and behavioral traits. www.indiandentalacademy.com
  • 6. Paleolithic age some 35,000 years ago www.indiandentalacademy.com
  • 7. The ancient Egyptians developed an intricate quantitative system that defined the proportions of the human body. It became the CANON. www.indiandentalacademy.com
  • 8. THE CANONS Unit – length of foot = 18 Horiz lines www.indiandentalacademy.com
  • 9. RENAISSANCE TO 2 0 TH C E N T U R Y Leonardo da Vinci (1451 – 1519) Albrecht Durer Petrus Camper Spix Welcker Hellman Korkhaus Bjork www.indiandentalacademy.com
  • 10. 2 0 TH C E N T U R Y Craniometry to Cephalometry Van Loon Paul Simon Paccini 1922 1931 Carrera Broadbent Hofrath Lucien de Coster www.indiandentalacademy.com
  • 11. 15" 5 feet Film Plane Source Plane X-ray Source Mid-saggital Plane X-ray Film in Cassette Patient in Head Positioning Device www.indiandentalacademy.com
  • 12. www.indiandentalacademy.com
  • 13. HARD TISSUE LANDMARKS GLABELLA NASION SELLA ORBITALE PORION ANTERIOR NASAL SPINE POINT A BASION PTERYGOMAXILLARE GONION POINT B POSTERIOR NASAL SPINE www.indiandentalacademy.com POGONION GNATHION MENTON
  • 14. www.indiandentalacademy.com
  • 15. SOFT TISSUE LANDMARKS GLABELLA NASION PRONASALE SUBNASALE LABRALE SUPERIUS STOMIUM SUPERIUS STOMIUM INFERIUS LABRALE INFERIUS POGONION MENTON CERVICAL POINT www.indiandentalacademy.com
  • 16. www.indiandentalacademy.com
  • 17.      Radiograph with good resolution Matte Acetate Tracing paper (non glossy side for the tracing) – 0.003 inches thick & 8 x 10 inches thick Sharp 3H fine drawing pencil Protractor Viewbox www.indiandentalacademy.com
  • 18. PLACEMENT OF THREE ORIENTATION CROSSES www.indiandentalacademy.com
  • 19. AVERAGING OF BILATERAL IMAGES ON TRACING USING A BROKEN LINE www.indiandentalacademy.com
  • 20. SEQUENCE OF STEPS INVOLVED IN CEPHALOMETRIC TRACING 1) Gross anatomic inspection 2) Identifying relevant landmarks 3) Initiate Tracing www.indiandentalacademy.com
  • 21. A:sella: center of sella turcica B:anterior cranial base B C:middle cranial base A C www.indiandentalacademy.com
  • 22. A:Nasion ; B:Orbitale; C:Porion A C B www.indiandentalacademy.com
  • 23. A: ANS; B: PNS; C: “A” Point B A C www.indiandentalacademy.com
  • 24. Maxillary and mandibular dentition Incisal Tip and Apex of maxillary and mandibular incisor www.indiandentalacademy.com
  • 25. Mandibular outline “B” Point; Pogonion: Gnathion; Menton; Gonion www.indiandentalacademy.com
  • 26. 1st and 2nd Vertebrae Posterior cranium www.indiandentalacademy.com
  • 27. Soft tissue profile Nasal Tip; Subnasale; Soft Tissue Pogonion www.indiandentalacademy.com
  • 28. nasion sella porion www.indiandentalacademy.com orbitale
  • 29.  Metric approach - use of selected linear and angular measures  Graphic approach - “overlay” of individual’s tracing on a reference template and visual inspection of degree of variation www.indiandentalacademy.com
  • 30. www.indiandentalacademy.com
  • 31. www.indiandentalacademy.com
  • 32. www.indiandentalacademy.com
  • 33.       SN PLANE HP PLANE PALATAL PLANE OCCLUSAL PLANE MANDIBULAR PLANE Constructed points like Gnathion & Gonion www.indiandentalacademy.com
  • 34. Length of cranial base is measured from Articulare to nasion parallel to HP   Ar-Ptm Ptm-N www.indiandentalacademy.com
  • 35.     Ar-PTM is measured parallel to HP to determine the horizontal distance between the posterior aspects of mandible and maxilla. Male – 37.1 +/- 2.8 Female – 32.8+/-1.9 Increase or decrease in these values indicates prognathism/retrognathism www.indiandentalacademy.com
  • 36. MALE FEMALE 52.8 +/- 4.1 50.9 +/- 3 www.indiandentalacademy.com
  • 37.      In this analysis all measurements are made parallel to HP N-A-Pg(angle) N-A (Linear) N-B (Linear) N-Pg (Linear) www.indiandentalacademy.com
  • 38.      This measurement indicates the degree of skeletal convexity Male – 3.9 +/- 6.4o Female – 2.6 +/- 5.1o + ve angle indicates convex face -ve angle indicates concave face www.indiandentalacademy.com
  • 39.       Here apical base of maxilla is related to N. Used to determine if anterior part of maxilla is protrusive/retrusive. Male – 0.0 +/- 3.7 Female - -2 +/- 3.7 +ve indicates prognathism -ve indicates retrognathism www.indiandentalacademy.com
  • 40.     Here apical base of mandible is related to N. Male : -5.3 +/- 6.7 Female : -6.9 +/- 4.3 This quantitates the AP position of mandible and degree of mandibular horizontal dysplasia www.indiandentalacademy.com
  • 41.    This indicates prominence of chin Male - -4.3 +/- 8.5 Female - -6.5 +/- 5.1 www.indiandentalacademy.com
  • 42.       In this analysis all measurements are made perpendicular to HP. Reflects the anterior, posterior or complex dysplasia of face. N-ANS(Linear) ANS-GN(Linear) PNS-N(Linear) MP-HP(Angle) www.indiandentalacademy.com
  • 43.    It signifies the middle third facial height. Male – 54.7 +/3.2 Female – 50 +/- 2.4 www.indiandentalacademy.com
  • 44. www.indiandentalacademy.com
  • 45.    It signifies the lower third facial height. Male – 68.6 +/3.8 Female – 61.3 +/3.3 www.indiandentalacademy.com
  • 46. www.indiandentalacademy.com
  • 47.    It signifies the posterior maxillary height Male – 53.9 +/1.7 Female – 50.6 +/2.2 www.indiandentalacademy.com
  • 48. www.indiandentalacademy.com
  • 49.     It signifies the posterior divergence of mandible shown by MP angle. The angle relates the posterior facial divergence with respect to anterior facial height Male - 23o +/- 5.9o Female – 24.2o +/- 5o www.indiandentalacademy.com
  • 50. www.indiandentalacademy.com
  • 51.  Measurements for this analysis UI perpendicular to NF LI perpendicular to MP U6 perpendicular to NF L6 perpendicular to MP www.indiandentalacademy.com
  • 52.      It denotes the anterior maxillary dental height. Aids to evaluate the total vertical dimensions of premaxilla from approximate piriform aperture perpendicular to tip of maxillary incisor crown. Signifance: indicates how far the incisor have erupted in relation to nasal floor. Male - 30.5 +/- 2.1 Female – 27.5 +/- 1.7 www.indiandentalacademy.com
  • 53.      This measures the anterior mandibular dental height. Determines the total dmensions of anterior mandible from MP perpendicular to tip of mandibular incisor crown. Signifance: denotes how far the incisor have erupted in relation to MP Male - 45 +/- 2.1 Female – 40.8 +/- 1.8 www.indiandentalacademy.com
  • 54.    This measures the posterior maxillary dental height. Male - 26.2 +/- 2 Female – 23 +/- 1.3 www.indiandentalacademy.com
  • 55.    Measures the posterior mandibular dental height Male - 35.8 +/- 2.6 Female – 32.1 +/- 1.9 www.indiandentalacademy.com
  • 56.  This is analysed by following measures PNS – ANS AR – GO GO - PG AR-GO-GN B - PG www.indiandentalacademy.com
  • 57.    Denotes the total effective length of maxilla. Male - 57.7 +/- 2.5 Female – 52.6 +/3.5 www.indiandentalacademy.com
  • 58. www.indiandentalacademy.com
  • 59.    Quantitates the length of mandibular ramus Male - 52 +/- 4.2 Female – 46.8 +/- 2.5 www.indiandentalacademy.com
  • 60.    Aids in establishing the length of mandibular body Male – 83.7 +/- 4.6 Female – 74.3 +/- 5.8 www.indiandentalacademy.com
  • 61.    This measurements denotes prominence of chin related to mandibular denture base Male - 8.9 +/- 1.7 Female – 7.2 +/- 1.9 www.indiandentalacademy.com
  • 62.    This angle denotes relationship between ramal plane and MP. Aids in diagnosis of skeletal open/closed bite problems. Male – 119.1o +/- 6.5o Female – 122o +/- 6.9o www.indiandentalacademy.com
  • 63. Measurements for this analysis  OP – HP (Angle)  A – B(Linear)  U6 – NF(Angle)  L1 – MP(Angle) www.indiandentalacademy.com
  • 64.      OP denotes its steepness/flatness Increased angle: assess skeletal open bite, lip incompetence,increased facial height, retrognathia. Decreased angle: assess deep bite, decreased facial height, lip redundancy. Male - 6.2o+/- 5.1o Female – 7.1o+/-2.5o www.indiandentalacademy.com
  • 65. www.indiandentalacademy.com
  • 66. www.indiandentalacademy.com
  • 67.     This linear measurements represents the relationship of maxillary and mandibular apical base to OP Male - -1.1 +/- 2 Female - -0.4 +/- 2.5 Significance: if A-B distance is large with point B projected posteriorly to point A denotes class II occlusion and vice versa www.indiandentalacademy.com
  • 68.      Represents angulations of maxillary central incisors to NF Male - 111o +/- 4.7o Female – 112o +/- 5.3o Signifance: aids to determine the procumbency/recumbency of incisor Vital in assessing long term stability of dentitionwww.indiandentalacademy.com
  • 69.     Denotes angulation of mandibular incisors to MP Male - 95.9o+/- 5.2o Female – 95.9o+/-5.7o Significance: determines the procumbency/recumbency of lower incisor. www.indiandentalacademy.com
  • 70. www.indiandentalacademy.com
  • 71. VARIOUS SOFT TISSUE CEPHALOMETRIC ANALYSES HAVE BEEN PUT FORTH……. Steiner Ricketts McNamara Merrifield’s Z angle Holdaway Burstone – COGS Arnett, Bergman et al - STCA www.indiandentalacademy.com
  • 72. www.indiandentalacademy.com
  • 73. HORIZONTAL PLANE COLUMELLA CERVICAL POINT www.indiandentalacademy.com GNATHION
  • 74. This analysis describes overall horizontal soft tissue profile. The following analysis is used:  Facial convexity angle(G-Sn-Pg)  Maxillary prognathism(G-Sn)  Mandibular prognathism(G-Pg)  Vertical height ratio(G-Sn/Sn-Me)  Lower face throat angle(Sn-Gn-C)  Lower vertical height depth ratio(Sn-Gn/C-Gn) www.indiandentalacademy.com
  • 75. FACIAL CONVEXITY ANGLE  MEAN VALUE : 12 ⁰ +/- 4  POSITIVE VALUE – CONVEX PROFILE  NEGATIVE VALUE CONCAVE PROFILE www.indiandentalacademy.com G – Sn - Pog
  • 76. ANTERO - POSTERIOR MAXILLARY (Mean value 6+/-3) AND MANDIBULAR (Mean value 0+/-4) MEASUREMENTS www.indiandentalacademy.com ,
  • 77. (G-Sn To Sn-Me) Mean value 1:1 Inference: Ratio <1 denotes disproportionality and there is large lower 3rd face height and viceversa www.indiandentalacademy.com
  • 78. LOWER FACE THROAT ANGLE (Sn-Gn –C) MEAN VALUE – 100 DEGREES DECREASE IN VALUE INDICATES PROMINENT CHIN LOWER FACIAL HEIGHT TO DEPTH RATIO Mean value 1.2:1 Inference Ratio>1 indicates short neck www.indiandentalacademy.com
  • 79. The following analysis is used        Nasolabial angle(Cm-Sn-Ls) Upper lip protrution(Ls to Sn-Pg) Lower lip position(Li to Sn-PG) Mento labial sulcus(Si to Li-Pg) Vertical lip chin ratio(Sn-Stms/Stmi-Me) Maxillary incisor exposure(Stm-U1) Interlabial gap(Stms-Stmi) www.indiandentalacademy.com
  • 80. NASOLABIAL ANGLE (Cm – Sn – Ls) Mean Value - 102o +/- 8o Obtuse angle indicates maxillary hypoplasia and vice-versa www.indiandentalacademy.com
  • 81. UPPER AND LOWER LIP PROTRUSIO Sn Ls Li Pog Mean Values Ls – Sn Pog 3 ± 1mm Li – Sn Pog 2 ± 1mm LIP POSITION AND FORM www.indiandentalacademy.com
  • 82. MENTO LABIAL SULCUS Li Mean Value - 4 ± 2mm Sm Pog www.indiandentalacademy.com
  • 83. VERTICAL LIP : CHIN RATIO (Sn-Stms /Stmi-Me) Mean Value - 1:2 INTER LABIAL GAP Mean Value - 2 ± 2 mm MAXILLARY INCISOR EXPOSURE Mean Value- 2 mm www.indiandentalacademy.com
  • 84. By Epker and Fish (1980 JCO) adopted in part from the mechanics developed by Ricketts for cephalometric analysis, growth prediction and visual treatment objective construction as presented by Bench, Gugino, and Hilgers. www.indiandentalacademy.com
  • 85. www.indiandentalacademy.com
  • 86. www.indiandentalacademy.com
  • 87. www.indiandentalacademy.com
  • 88. www.indiandentalacademy.com
  • 89. www.indiandentalacademy.com
  • 90. Newer advances and techniques Digital cephalometry Softwares - Dolphin - Vistadent - OPAL www.indiandentalacademy.com
  • 91. www.indiandentalacademy.com
  • 92.  Burstone CJ, Legan HL: Cephalometrics for orthognathic surgery, J Oral Surg 1978;36:269-277  Text book of Radiographic Cephalometry by Alexander Jacobson.  Textbook of Essentials of orthognathic surgery by Johan P Reyneke  Text book of Orthodontic Cephalomerty by Athanasios E Athanasiou  A colour atlas and manual of Three Dimentional cephalometry by GRJ Swennen  Textbook of Orthognathic surgery by Raymond Fonseca www.indiandentalacademy.com
  • 93. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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