presentation1-170223072829.pdf

CONTENTS
• INTRODUCTION
• HISTORY
• CEPHALOMETRIC IMAGING SYSTEM
• USES OF CEPHALOGRAM
• GOALS OF CEPHALOGRAM
• TYPES OF CEPHALOGRAM
• CEPHELOMETRIC LANDMARKS
• TRACING TECHNIQUE
• CEPHELOMETRIC PLANE
• ANALYSIS
• CONCLUAION
• REFRRENCES

Why cephalometric is imp for pedodontist ????
 The American Academy of Pediatric Dentistry (AAPD)
recognizes the importance of managing the developing
dentition and occlusion and its effect on the well-being of
infants, children, and adolescents.
 Early diagnosis and successful treatment of developing
malocclusions can have both short-term and long-term
benefits while achieving the goals of occlusal harmony and
function and dentofacial esthetics.
AAPD Guideline ,2016

 Diagnostic orthodontic records fall into three major
categories of evaluation:
• (1) health of the teeth and oral structures,
• (2) alignment and occlusal relationships of the teeth, &
• (3) facial and jaw proportions which includes both
cephalometric radiographs and facial photographs.
AAPD Guideline ,2016

C’MON MAN,
I Am
Pedodontist.
PEDODONTIST

INTRODUCTION
•Craniometry – measuring skull.
•Cephalometry – measuring head.
• CEPHALOSTAT ??
• CEPHALOGRAM ??
• CEPHALOMETRICS ??

• DEFINATION
 The term cephalometric is
used to describe the analysis
and measurements made on
the cephalometric
radiograph.
- BHALAJHI (5thedition)

HISTORY
• The discovery of x-ray in 1895 by ROENTGEN. It is
provided a method of obtaining the inner cranio-
facial measurements with quite a bit of accuracy and
reproducibility.
• Roentgen 1st discovered x-ray who was professor at
wuerzburg university in Germany.
• On December 28, 1895 he submitted a paper “On A
New Kind of Rays” to the Wurzburg.
• His first experiment was in 1895 on the film of his
wife’s hand.

• Prof. Wilhem Koening & Dr. Otto Walkhoff made the first
dental radiograph in 1896.
• In 1922, paccini standardized radiographic head images by
positioning the subjects against a film cassette at a distance
of 2 meters from x-ray tube.
• In 1931, Boardbent in U.S.A. and Hofrath in Germany
simultaneously presented a standardized cephalometric
technique using high powered x-ray machine.

•William. B. Downs in 1948 developed the first
cephalometric analysis.
•Followed by other analyses by Steiner (1930), Tweed
(1953), Ricketts (1958), Enlow (1969), Jacobson (1975)
etc.

USES OF CEPHALOGRAM
In classification of dental and skeletal abnormalities.
In orthodontic diagnosis & treatment planning.
In evaluation of treatment results.
In predicting growth related changes & changes associated with surgical
treatment.
In establishing facial type.
In research work which involves the cranio-dentofacial region.

GOALS OF CEPHALOMETRICS
• To evaluate the transverse, sagittal & Antero-posterior
relationships of the following components of the face:
1. The Cranium & cranial base
2. The Skeletal maxilla
3. The Skeletal mandible
4. The Maxillary dentition & alveolar process
5. The Mandibular dentition & alveolar process
6. The Maxilla-Mandibular relationship
7. The relation of Maxilla & Mandible to the Cranial base
PROFFIT TEXT BOOK OF ORTHODONTICS,5TH EDITION .

TECHNICAL ASPECTS
The cephalometric radiographs are taken using an
apparatus that consists of an x-ray source & a head
holding device called cephalostat.
Cephalostat consists of,
2 Ear rods- prevents movement of head in the
horizontal plane.
Orbital pointer- helps in vertical stabilization of head.
This contacts the lower border of the left orbit.
Forehead clamp- supports the upper part of face,
positioned above the region of the nasal bridge.
BHALAJI TEXT BOOK OF ORTHODONTICS,5TH EDITION ,2012

 The distance between the x-ray source & the mid-sagittal plane
of the patient is fixed at 5 feet.
Thus, the equipment helps in standardizing the radiographs by
use of constant head position and source-film distance, so that
serial radiographs can be compared.

FRONTAL LATERAL

 Lateral cephalogram :
It provides a lateral view of
the skull. and taken with the
head in standardized
reproducible position at a
specified distance from the
source of the x-ray.

USES
• Important in orthodontic growth
analysis.
• Diagnosis and treatment planning.
• Evaluation of final treatment
outcome.
• Monitoring of therapy.

 Frontal cephalogram :
• It provides the antero-
posterior view of the skull.

USES
• Provide information related to skull
width.
• Skull symmetry
• Vertical proportions of skull,
craniofacial complex and oral
structure.
• For accessing growth abnormalities
and trauma.

REQUIREMENTS OF LANDMARKS
• Easily seen in a radiograph.
• Should be uniform in outline.
• Should be reproducible.
• Landmarks should be permit valid quantitative
measurements of lines & angles.
• Lines & planes should have significant relationship to
the growth vectors of specific areas.

• There are no ‘fixed points’ in the skull of
living person. Depends on age, sex,
maturation rate, ethnic background, and
other factors.
• Landmarks show a range of normal variation.
so orthodontist determine whether facial
dimensions and relationship fall with in the
range of normal variation or not.
Radiographic cephalometry- Alexander Jacobson

CEPHALOMETRIC LANDMARKS
• A Point on cephalogram that serves as a guide for
measurement on construction of planes.
LANDMARKS
ANATOMIC DERIVED

CEPHALOMETRIC
LANDMARKS
HARD TISSUE SOFT TISSUE
ANATOMIC DERIVED
UNILATERAL BILATERAL
BHALAJI TEXT BOOK OF ORTHODONTICS, 5TH EDITION,2012

HARD TISSUE
CEPHALOMETRIC
LANDMARKS
ANATOMIC DERIVED
Nasion
Anterior nasal
spine
Point A
Prosthion
Infradentale
Point B
Pogonion
Menton
Sella
Orbitale
Gonion
Articulare
Gnathion
Anterior point of
occlusion
Posterior point of
occlusion
Pterygo
maxillary
fissure
PHULARI TEXT BOOK OF ORTHODONTICS,1st Edition ,2011

• Nasion (N) : The most ant. Point midway between the frontal & nasal
bone on the fronto-nasal suture.
• Orbitale (O) : It is lowest point of the inferior bony margin of the
orbit.
• Anterior Nasal spine (ANS) : It is ant. Tip of the sharp bony process of
maxilla in the midline of the lower margin of ant. Nasal opening.
• Posterior nasal spine (PNS) : It is intersection of a continuation of the
ant wall of the pterygo-palatine fossa & the floor of the nose, the
distal limit of the maxilla.

• Point A : It is the deepest point in the midline between the anterior
nasal spine and alveolar crest between two central incisors. Also
called subspinale.
• Point B : It is the deepest point in the midline between the alveolar
crest of mandible & the mental process. Also called supramentale.
• Pogonion (Pog) : It is the most ant. Point of the bony chin in the
median plane.
• Gnathion (Gn) : It is the most Antero-inferior point of the symphysis.

• Menton (Me) : It is the most inferior Midline point on the mandibular
symphysis.
• Sella (S) : The point representing the Midpoint of the pituitary fossa.
It is a constructed point in the mid-sagittal plane.
• Pterygomaxillary fissure (Ptm) : It is the intersection of the inferior
border of the foramen rotundum with the posterior wall of pterygo-
maxillary fissure.
• Articulare (Ar) : Intersection between the shadow of zygomatic arch
and posterior border of ramus.

• Basion (B) : It is the median point of anterior margin of the foramen
magnum.
• Gonion (Go) : It is a constructed point at the junction of ramal plane
& mandibular plane.
• Condylion (Cd) : The most superior point on the head of the
condyle.
• Porion (Po) : The highest bony part/point of the upper margin of
external auditory meatus.

• Bolton point (Bo) : The highest point at the post condylar notch of
the occipital bone.

44444444444444444444444444444444

SOFT TISSUE
LANDMARKS
Glabella
Nasion
Pronasale
Subnasale
Labial superius
Stomion supeperius
Stomion inferius
Stomion
Labial inferius
Pogonion soft tissue
Menton soft tissue

• Glabella (G) : It is the most prominent point in the midsagittal plane
of forhead.
• Nasion soft tissue (Ns) : It is the deepest point in the concavity of
the soft tissue contour of the root of the nose.
• Pronasale (Pn) : The most prominent point of the nose.
• Subnasale (Sn) : It is the intersection of the lower border of the
nose and the outer contour of upper lip.

• Labial superius (Ls) : The median point in the upper margin of the
upper membranous lip.
• Stomion superius : It is the lowest point of the upper lip.
• Stomion inferius : It is the highest point of the lower lip.
• Stomion : It is the midpoint between stomion superius and
stomion inferius.
• Labial inferius : The median point in the lower margin of the lower
membranous lip.

• Pogonion soft tissue : It is the most prominent point on the soft
tissue contour of the chin.
• Menton soft tissue : It is a constructed point at the intersection
of a vertical co-ordinate from menton and the inferior soft tissue
contour of the chin.

• A lateral cephalogram.
• Acetate matte tracing paper(.003 inches thick, 8×10
inches).
• A sharp 3H drawing pencil or a very fine tipped pen.
• tape
Tracing supplies & equipments

•A protractor and template. templates for tracing
the outlines of ear rods.
•Viewbox.
•Pencil sharpener and a eraser.

General considerations for the tracing
•Start by placing the cephalogram on the viewbox with the
patient’s image facing towards the right.
•Tape the four corners of the radiograph to the viewbox.
•Draw three crosses on the radiographs, two within the
cranium and one over the area of the cervical vertebrae
(registration crosses).

•Place the matte acetate film over the radiograph and tape
it securely.
• After that, trace the three registration crosses.
•Print the pt name, record number, age in years and months,
the date on which the cephalogram was taken and your
name on the bottom left corner of the acetate film.
•Begin tracing using smooth continuous pressure.

CEPHALOMETRIC
PLANES
VERTICAL HORIZONTAL

FRANKFORT Horizontal plane :
F-H Plane is the plane that
connects the lowest point of the
orbit to the superior point of the
external auditory meatus.
It is used to assess horizontal
growth during the analysis.
This is the best representation of the
basic horizontal plane of the skull.

MANDIBULAR PLANE:
It is the plane that connects the point
Menton (Me) to the point Gonion (Go).
For growth pattern assessment.
1. Straight line tangent to the lower most border
of the mandible. ( Down)
2. Go – Me - Mc Namara
- Rakosi
- COGS
3. Go – Gn - Steiners’s

OCCLUSAL PLANE :
This plane is formed by a line
connecting anterior point of occlusion
to the posterior point of occlusion.
Anatomical occlusal plane
Functional occlusal plane

•Se-N PLANE :
It is the plane formed by the
line connecting se and Nasion.
•It expresses the anteroposterior
extent of anterior cranial base.

FACIAL Plane :
It is a line from the anterior
point of the frontonasal suture
(N) to the most anterior point
of the mandible (Pog).
Used to record position of chin.
And to relate position of maxilla
to facial plane.

A-Pog plane:
• It is a line from point A on the
maxilla to pogonion on the
mandible.
• Also known as Dental plane.
• Used in measure position of
anterior teeth.

FACIAL AXIS:
A line from ptm point to
cephalometric Gnathion.
Direction of growth of the
chin. Whether it is
horizontal or vertical.

Ar-Go plane:
This plane is formed by the
line connecting from
Articulare to Gonion.
It is important in the
determination of length of
ramus.

PALATAL PLANE
•This plane extends
through the ANS to PNS.
•The relationship of this
plane to FH plane is
useful in evaluating
treatment changes
occurring in the maxilla.
•Assessment of remaining
alveolar bone for implant
placement.

E – PLANE: (soft tissue)
It is also called as Esthetic plane.
It is also known as RICKETT’s esthetic
line (By rickett in 1960). Which extends
from the tip of the nose to the chin.
The lips should be slightly behind this
line for esthetics.
This affects the lips prominency.

MEASUREMENT ANALYSIS
• DOWN’S (1948)
• STEINER’S (1950)
• WITS APPRAISAL (1952)
• TWEED’S (1954)
• COGS (1978)
• RAKOSI’S (1979)
• Mc NAMARA’S (1984)
• HOLDAWAY’S
(1984)
HARD TISSUE
ANALYSIS
SOFT TISSUE
ANALYSIS

DOWN’S ANALYSIS (1948)
•One of the most commonly used analysis.
•Downs had based his findings on 20 Caucasian
individuals of 12-17 years age group of both sexes.
•Downs analysis consists of 10 parameters 5 skeletal
and 5 dental.

SKELETAL PARAMETERS
I. Facial angle
II. Angle of convexity
III. A-B Plane
IV. Mandibular plane angle
V. Y-axis

Mean Reading : 87.5o
Range : 82o
– 95o
N
Pog
Po
Or
1. Facial angle: The intersection
of nasion-pogonion plane and
the FH plane.
This angle gives us an indication
of the antero-posterior
positioning of the mandible to
the cranium.
This value increases in cases of
skeletal CL-III & it decreases
in CL-II cases
Skeletal parameter

Mean Reading : 0o
Range : -8.5o
– 10o
Angle of convexity: By the
intersection of a line from nasion
to Point A ,and a line from Point A
to pogonion.
This angle gives idea about the
convexity or concavity of the
skeletal profile.
A positive angle or an increased
angle shows a prominent
maxillary base compared to
mandible (retrognathic profile)
while a negative or decreased
angle shows a prognathic profile.
N
A
Pog
Skeletal parameter

Mean Reading : -4.6o
Range : -9o
- 0o
A-B Plane: this angle is formed
between a line connecting
Point A and Point B ,and a
line joining nasion to
pogonion.
This angle is indicative of the
maxillo-mandibular
relationship in relation to the
facial plane.
In cases of CL-III
malocclusions, a positive
angle is seen.
N
A
Pog
B
Skeletal parameter

Mean Reading : 21.9o
Range : 17o
– 28o
Formed by intersection of
mandibular plane with FH
Plane.
An increased plane is
suggestive of a vertical grower.
P
o Or
Go
Me

Mean Reading : 59o
Range : 53o
– 66o
This angle is formed by
joining sella-gnathion line
with FH plane .
This angle is larger in CL-II.
It indicates the growth pattern
of the individual.
If the angle is greater than
normal, it indicates greater
vertical growth of the
mandible.
if it is lesser,it indicates
horizontal growth of the
mandible.
P
o Or
Gn
Se
Skeletal parameter

DENTAL PARAMETERS
I. Cant of occlusion plane
II. Lower incisor to occlusal plane
III. Lower incisor to mandibular plane
IV. Interincisal angle
V. Upper incisor to A-point

Mean Reading : 9.3o
Range : 1.5o
– 14o
.
.
This angle is formed
between occlusal plane
and F.H. plane.
This angle gives us a
measure of the slope of
occlusal plane to F.H.
plane
P
o Or
OP
Dental parameter

Mean reading : 135.4o
Range : 130o
– 150o
This angle is formed between
the long axis of upper and
lower incisors.
This angle decreases in CL-I
bimax.protrusion and CL II
Div-I cases.
it increases in CL-II Div-II
cases.
Deciduous - 151
Dental parameter

OP
Dental parameter
Mean reading : 14.5o
Range : 3.5o
– 20o
the long axis of lower
central incisor and OP.
This angle Increases is
suggestive of increases
the lower incisor
proclination.

Mean reading : 1.4o
Range : -8.5o
– 7o
Formed by intersection of
long axis of lower incisor
and mandibular plane.
An increase in this
angle is indicative of lower
incisor proclination. Go
Me
Dental parameter

This is a measurement between
incisal edge of maxillary
central incisor and a line
joining Point A to pogonion.
Average value is 2.7mm
range is -1 to 5mm
It is more in patients with upper
incisor proclination
A
Pog
Dental parameter

TWEED’S ANALYSIS (1954)
Tweed used three planes to establish a diagnostic triangle,
the three planes used in this analysis are:
1. Frankfort horizontal plane
2. Mandibular plane
3. Long axis of lower incisor

FMA
FMIA
IMPA
The Diagnostic Facial Triangle

 Frankfort mandibular incisor
angle- 65ᴼ (long axis of Lower
incisor to FH plane) pedo- 63ᴼ
 Frankfort mandibular plane angle-
25ᴼ (FH to MP)
pedo 27ᴼ
 Incisor mandibular plane angle-
90ᴼ (long axis of lower incisor to
Mandibular plane) pedo- 90ᴼ
FMA

The value for tweed’s analysis :
Frankfort mandibular
plane angle (FMPA)
25ᴼ (16- 35)
Incisor mandibular plane
angle (IMPA)
90ᴼ (85- 95)
Frankfort mandibular
incisor angle (FMIA)
65ᴼ (60-75)

STEINER’S ANALYSIS
Developed by Steiner in the 1930’s can be considered the first of the
modern cephalometric analysis for two reasons:
1. It displayed measurements in a way that emphasized not just the
individual measurements but their interrelationship into a pattern.
2. Specific guide for use of cephalometric measurements in
treatment planning.
AJO-1959 Radiographic cephalometry- Alexander Jacobson

Steiner analysis
•Steiner did analysis only on 1 Hollywood starlet. so it is
a questionable. But he had very good eye b’z
recalculation of his original values from larger samples
produced only minor changes.
• Skeletal analysis
• Dental analysis
• Soft tissue analysis AJO DO-1959

SKELETAL PARAMETERS
I. SNA angle
II. SNB angle
III. ANB angle
IV. Mandibular plane angle
V. Occlusal plane angle

Mean reading : 82o
Pedo - 81ᴼ
It is the angle formed by
the intersection of SN plane
and a line joining from nasion
and point A.
This angle indicates the
relative antero-posterior
positioning of maxilla in relation
to cranial base.
A larger than normal
value indicates a prognathic
maxilla while a smaller value
suggests a retrognathic maxilla.
N
A
S
Skeletal parameter

Mean reading : 80o
Pedo : 76ᴼ
It is the angle between SN
plane and a line joining nasion
to Point B. This angle
indicates the antero-posterior
positioning of the mandible in
relation to cranial base.
An increase indicates a
prognathic mandible and
lesser value suggests
retrusive mandible.
N
S
B
Skeletal parameter

ANB
Mean reading : 2o
Pedo :4ᴼ
intersection of the lines
joining nasion to Point A, and
nasion to Point B.
It denotes the relative
position of maxilla and
mandible to each other.
An increase is suggestive of
CL-II skeletal tendency while
lesser than normal suggests
CL-III skeletal relationship
Skeletal parameter

Mean reading : 14o
Formed between occlusal
plane and SN plane.
The occlusal plane is
represented by a line passing
between the overlapping
cusps of first premolars and
first molars.
This angle denotes the
relation of occlusal plane to
cranium and face.
N
S
O
P
Skeletal parameter

Mean reading : 32o
It is the angle formed between
Mandibular plane and SN plane. The
mandibular plane is a line
connecting gonion and gnathion.
This angle indicates growth pattern;
a lower angle suggests a horizontal
growing face and increased angle
shows a vertical pattern
N
S
e
Go
Gn
Skeletal parameter

DENTAL PARAMETERS
I. Upper incisor to N-A angle
II. Upper incisor to N-A linear
III. Lower incisor to N-A angle
IV. Lower incisor to N-B linear
V. Inter-incisor angle

Upper incisor to N-A (angle)- Formed by
intersection of long axis of upper centrals and
line joining nasion to point A.
It indicates the relative inclination of upper
incisors;
increased angle is seen during proclination.
Upper incisor to N.A (Linear)-
It is a linear measurement formed between
labial surface of upper central incisor and a
line joining nasion to Point A.
This value helps in determining upper incisor
position. it increases in proclined upper
incisors.
Dental parameter
Pedo-
4 mm
24ᴼ

Lower incisor to N.B (angle)-
Formed between N-B plane and long axis
of lower incisor.
It shows us the inclination of lower central
incisor; an increased value shows proclined
incisor and decreased angle gives
retroclined incisor.
Lower incisor to N.B (Linear)-
It is the linear distance between Labial
surface of lower central incisor and a line
joining nasion to Point B.
It helps us to assess lower incisor
inclination; increased value shows
proclination and vice-versa
Dental parameter
pedo
4 mm
26ᴼ

Mean reading : 130o
151ᴼ - pedo
Interincisal angle- Formed
between long axis of upper central
and long axis of lower central
incisors.
A decreased angle is seen in
proclination of incisors and
increased in retroclined incisors.
Dental parameter

Pog’
Soft tissue analysis
S-line –
Steiner suggests that in a well
balanced face the lips should touch a
line extending from soft tissue contour
of the chin to the middle of an ‘S’
formed by lower border of nose
If lips are beyond this line , it indicates
protrusive lips and convex profile.
and behind the line shows retrusive
lips and the patient may have concave.

SOFT TISSUE ANALYSIS
STEINER’S
S-LINE
AJO DO-1959

Presented by Dr. James Mc Namara in the
December 1984 issue of the American Journal of
orthodontics.
 It divides craniofacial complex into 5 major sections
1. Maxilla to cranial base
2. Maxilla to mandible
3. Mandible to cranial base
4. Dentition
5. Airway

SOFT TISSUE EVALUATION
NASOLABIAL ANGLE
It is formed by a line tangent to the base of the nose & a line
tangent to the upper lip.
This angle may be reflection of the dentoalveolar protrusion.
MEAN VALUE IS 102ᴼ
RANGE = 102 ± 8 DEGREES IN BOTH MALE AND FEMALE
CANT OF UPPER LIP
By constructing an angle using a line tangent to the upper lip nd
the nasion perpendicular to FH plane.
MEAN VALUE IS 14ᴼ
RANGE = MALES 8 ± 8 DEGREES
FEMALES 14 ± 8 DEGREES

HARD TISSUE EVALUATION
The distance is measured between NASION PERPENDICULAR- POINT A.
MEAN VALUE :- 0 MM
RANGE ; MALES 1.1 ± 2.7 MM
FEMALES 0.4 ± 2.3 MM

 Maxillary skeletal protrusion, as indicated by the 5 mm distance
from point A to the nasion perpendicular.
 Maxillary skeletal retrusion, as indicated by the -4 mm
distance from point A to the nasion perpendicular.
PROTRUSIVE MAXILLA RETRUDED MAXILLA

MAXILLA TO MANDIBLE
A LINEAR RELATIONSHIP EXISTS BETWEEN EFFECTIVE LENGTH OF MID FACE AND THAT OF
THE MANDIBLE.
EFFECTIVE LENGTH OF MAXILLA
CONDYLION TO POINT A.
MEAN RANGE – 91mm
MALES 99.8 ± 6.0 MM
FEMALES 91 ± 4.3 MM
EFFECTIVE LENGTH OF MANDIBLE
CONDYLION TO GNATHION.
MEAN RANGE – 117 mm
MALES 134.3 ± 6.8 MM
FEMALES 120.2 ± 5.3 MM

 Terms = small (mixed dentition),
medium (adult F), large (adult M).
 Maxillo-mandibular differential:
 it is the difference between the effective
mandibular length and effective mid face length.

In small sized person, such as in mixed-dentition
In medium-sized person, such as an adult female:
In large person, such as an adult male:

MANDIBLE TO CRANIAL BASE=
POGONION TO NA PERPENDICULAR.
MALES -0.3 +/- 3.8 MM
FEMALES -1.8 +/- 4.5 MM
Both point A nd Pog are located on N perpendicular,
indicating normal maxilla and mandible.
MEAN VALUE
SEVERELY RETRUDED MANDIBLE = -31mm
Mildly retrusive maxilla = -3mm

DENTITION
FOR UPPER INCISOR= VERTICAL LINE THROUGH POINT A
PARALLEL TO N-PERPENDICULAR.
The distance from point A to Facial surface of maxillary
incisor. And this value is between 4-6 mm.
FOR LOWER INCISOR =
 The distance Measured b/w edge
 of the incisor & line drawn from
 point A to Pog. This value is 0.
 Normal : 1 mm to 3 mm

AIRWAY MEASUREMENT
UPPER PHARYNX :
MEASURED FROM
POSTERIOR PHARYNGEAL
WALL TO THE ANT. HALF OF
SOFT PALATE.
AVERAGE IS
15 -20 mm IN WIDTH.
2 mm or Less indicate airway
impairment.

LOWER PHARYNX :
 Lower pharyngeal width is measured
from the intersection of the posterior
border of the tongue and the inferior
border of the mandible to the closest
point on the posterior pharyngeal wall.
 22 mm.
 The average measurement is
11-14mm
 Higher value suggests Patient with
enlarged tonsils and a forward
tongue position.

- the effective length of the mid-face will increase
approximately 1 to 2 mm per year.
- the effective length of the mandible will increase
approximately 2 to 3 mm per year.
- anterior facial height will increase approximately
1 mm per year.

A. Cephalometric tracing of ideal 9-year-old.
B. Cephalometric tracing of the same ideal patient 2 years
later.
A

RADIATION PROTECTION PRINCIPLES
For patients
•No radiograph taken unless prescribed
•ALARA (As Low As Reasonably Achievable).
•Use of high speed films.
•Use of lead aprons or Thyroid collar.

For radiologist
•No person below age of 19 yrs.
•Operator must stand 6 feet away from X-Ray
source.
•Use of lead shields.
•Maximum permissible dose -20mSv/year.

Cephalometric basics and errors
Digital Cephalometry and 3D
Imaging

DOLPHIN IMAGING PLUS
•Snap your photos in sequence and Dolphin will
automatically arranged the images into a standard layout,
such as composite of extraoral, intraoral and occlusal
photos.
•Preview, crop, rotate, enhance and align photos in a single
screen.
•Enhancements include brightness, contrast, hue, saturation,
and red eye reduction.

•Drag and drop images from your file folders into
Dolphin.
•Option to automatically preserve the original,
un-retouched image.
•Demonstrate how the patient might look with
braces on, with straight teeth, or after
completing the procedure.

CLASS I
Normal skeletal and dental &
soft tissue profile.

CLASS II DIV I
Reason of this may be skeletal,
dental or in combination.
Excessive overjet .
Vertical growth.(clockwise growth
pattern)
Facial type- Dolicofacial.

CLAAS II DIV II
horizontal growth.
(Counterclockwise pattern)
deep bite.
Facial type- Brachyfacial.

CLASS III
Negative overjet.
Obtuse gonion angle.(vertical,
excessive Mandible growth.
Concave profile.

• MAXILLA
SNA (ᴼ) 81 ± 3 82 ± 2
A-Na Perpendibular (mm) 0 ± 2 1 ± 2
Mx. Length : Co-A (mm) 87 ± 6 (m) 99 ± 6 (m)
85 ± 6 (f) 91 ± 4 (f)
9 Year Adult

• Maxillary length measured from
cd to point A.
• Pedo patient – 85mm
• Increases 1 mm per year until the
adult size.
(95 to 100mm)

Maxillary Depth
• The angle formed by the intersection of the
FH and N-A plane.
• It is 90ᴼ ± 3.
• It indicates horizontal position of maxilla.
Class II skeletal malocclusion caused by
prognathic maxilla show more than 90ᴼ.
• Chrnic thumb suckers have also large value.

Maxillary incisor angulation
• The angle formed by SN and the
INCISOR long axis.
• Value is 102ᴼ ± 3.
• Relates the upper incisor angulation to
the upper face. Increase in value
shows incisor protrusion.

• BASAL RELATIONSHIP : MAXILLA TO MANDIBLE
ANB(ᴼ) 9 Year 4 ± 2 2 ± 2 Adult
Difference between SNA and SNB
Indicates horizontal relationship between maxilla
and mandible.
Positive value indicates maxilaa is forward
to mandible.
Negative value – class III

•MANDIBLE
SNB (ᴼ) 76 ± 2 80 ± 2
Pg-Na Perpendicular (mm) -6 ± 3 -2 ± 2
Md. Length : Co-Gn (mm) 117 ± 6 (m) 134 ± 6 (m)
105 ± 6 (f) 120 ± 6 (f)
9 Year Adult

Mandibular incisor protrusion
•The horizontal distance
between tip of the
mandibular incisor to A
point-Pog line.
•It defines the AP position
of the mandibular dental
unit
•Value is 2 mm.

• FACIAL TYPE/GROWTH PATTERN
FMA(ᴼ) 29 ± 5 26 ± 4
This angle formed by the intersection
of the FH and MP.
It decrease 1 degree every 4 years
during normal growth.
Value is excess of 31 degree may
indicate clockwise growth.
Nd value less than 21 degree
indicates horizontal growth.
9 Year Adult

Facial Height
• The vertical relationship between upper and lower facial height.
• For upper facial height = N-ANS
• For lower facial height = ANS- M
• UPPER= 53 mm
• LOWER = 65 mm

• MANDIBULAR DENTITION
IMPA (ᴼ) 95 ± 5 93 ± 5
The inner angle between the long axis of the
mandibular incisor and MP.
It gives evaluation of the angular position of the
incisor to the mandibular basal bone.
Value is 90 degree.
9 Year Adult

• FACIAL / SOFT TISSUE PROFILE
Upper lip- E line (mm) -1 ± 2 -4 ± 2
Lower lip- E line (mm) 0 ± 2 -2 ± 2
9 Year Adult

CONCLUSION
•Cephalogram is 2D representation of 3D object.
•The treatment of skeletal disharmonies presents better results
when performed during the growth period. The physical
changes that occur in every individual express growth, which is
ruled by genetic, general and environmental factors. In order to
identify such disharmonies and hence concentrate the clinical
actions during treatment and influence facial growth,
cephalometrics appears as a useful diagnostic tool for
identifying facial growth patterns or growth direction.

REFERENCES
1. AA. Jacobson. Radiographic cephalometry: from basics to 3D
imaging .2nd edition.
2. Mc Namara JA Jr, Brudon WL. Orthodontics and dentofacial
orthopedics. Needham Press. 2nd Ed. 2002.
3. ORTHODONTIC CEPHALOMETRY – ATHANASIOS E
ATHANASIOU
4. RADIOGRAPHIC CEPHALOMETRY- ALEXANDER JACOBSON
5. CEPHALOMETRIC RADIOGRAPHY – THOMAS RAKOSI
6. CEPHALOMETRICS FOR ORTHOGNTHIC SURGERY. JOURNAL OF
ORAL SURGERY, VOLUME 36.APRIL 1978 - CHARLES J
BURNSTONE

• Johnston LE Jr: An objective evaluation of the pitchfork analysis
(PFA), EJO 2002 vol 24 page 121- 123.
• J.A Salzmann. Practice of orthodontics. volume one:538-542
• Athanasio E Athanasiou: Orthodontic Cephalometry, 1995 pg
269
• Thomas Rakosi. An atlas and manual of cephalometric
radiography.
• Jarabak and Fizzell. Technique and treatment with light wire
edgewise appliances. 2nd edition.
• Mannchen R. A critical evaluation of pitchforks analysis.
Ejo.2001;23(1):1-14.

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