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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Cephalometrics /certified fixed orthodontic courses by Indian dental academy

  1. 1. SEMINAR ON CEPHALOMETRICS IN ORTHOGNATHIC SURGERY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 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. 3. www.indiandentalacademy.com
  4. 4. www.indiandentalacademy.com
  5. 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. 6. Paleolithic age some 35,000 years ago www.indiandentalacademy.com
  7. 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. 8. THE CANONS Unit – length of foot = 18 Horiz lines www.indiandentalacademy.com
  9. 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. 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. 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. 12. www.indiandentalacademy.com
  13. 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. 14. www.indiandentalacademy.com
  15. 15. SOFT TISSUE LANDMARKS GLABELLA NASION PRONASALE SUBNASALE LABRALE SUPERIUS STOMIUM SUPERIUS STOMIUM INFERIUS LABRALE INFERIUS POGONION MENTON CERVICAL POINT www.indiandentalacademy.com
  16. 16. www.indiandentalacademy.com
  17. 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. 18. PLACEMENT OF THREE ORIENTATION CROSSES www.indiandentalacademy.com
  19. 19. AVERAGING OF BILATERAL IMAGES ON TRACING USING A BROKEN LINE www.indiandentalacademy.com
  20. 20. SEQUENCE OF STEPS INVOLVED IN CEPHALOMETRIC TRACING 1) Gross anatomic inspection 2) Identifying relevant landmarks 3) Initiate Tracing www.indiandentalacademy.com
  21. 21. A:sella: center of sella turcica B:anterior cranial base B C:middle cranial base A C www.indiandentalacademy.com
  22. 22. A:Nasion ; B:Orbitale; C:Porion A C B www.indiandentalacademy.com
  23. 23. A: ANS; B: PNS; C: “A” Point B A C www.indiandentalacademy.com
  24. 24. Maxillary and mandibular dentition Incisal Tip and Apex of maxillary and mandibular incisor www.indiandentalacademy.com
  25. 25. Mandibular outline “B” Point; Pogonion: Gnathion; Menton; Gonion www.indiandentalacademy.com
  26. 26. 1st and 2nd Vertebrae Posterior cranium www.indiandentalacademy.com
  27. 27. Soft tissue profile Nasal Tip; Subnasale; Soft Tissue Pogonion www.indiandentalacademy.com
  28. 28. nasion sella porion www.indiandentalacademy.com orbitale
  29. 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. 30. www.indiandentalacademy.com
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  32. 32. www.indiandentalacademy.com
  33. 33.       SN PLANE HP PLANE PALATAL PLANE OCCLUSAL PLANE MANDIBULAR PLANE Constructed points like Gnathion & Gonion www.indiandentalacademy.com
  34. 34. Length of cranial base is measured from Articulare to nasion parallel to HP   Ar-Ptm Ptm-N www.indiandentalacademy.com
  35. 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. 36. MALE FEMALE 52.8 +/- 4.1 50.9 +/- 3 www.indiandentalacademy.com
  37. 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. 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. 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. 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. 41.    This indicates prominence of chin Male - -4.3 +/- 8.5 Female - -6.5 +/- 5.1 www.indiandentalacademy.com
  42. 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. 43.    It signifies the middle third facial height. Male – 54.7 +/3.2 Female – 50 +/- 2.4 www.indiandentalacademy.com
  44. 44. www.indiandentalacademy.com
  45. 45.    It signifies the lower third facial height. Male – 68.6 +/3.8 Female – 61.3 +/3.3 www.indiandentalacademy.com
  46. 46. www.indiandentalacademy.com
  47. 47.    It signifies the posterior maxillary height Male – 53.9 +/1.7 Female – 50.6 +/2.2 www.indiandentalacademy.com
  48. 48. www.indiandentalacademy.com
  49. 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. 50. www.indiandentalacademy.com
  51. 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. 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. 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. 54.    This measures the posterior maxillary dental height. Male - 26.2 +/- 2 Female – 23 +/- 1.3 www.indiandentalacademy.com
  55. 55.    Measures the posterior mandibular dental height Male - 35.8 +/- 2.6 Female – 32.1 +/- 1.9 www.indiandentalacademy.com
  56. 56.  This is analysed by following measures PNS – ANS AR – GO GO - PG AR-GO-GN B - PG www.indiandentalacademy.com
  57. 57.    Denotes the total effective length of maxilla. Male - 57.7 +/- 2.5 Female – 52.6 +/3.5 www.indiandentalacademy.com
  58. 58. www.indiandentalacademy.com
  59. 59.    Quantitates the length of mandibular ramus Male - 52 +/- 4.2 Female – 46.8 +/- 2.5 www.indiandentalacademy.com
  60. 60.    Aids in establishing the length of mandibular body Male – 83.7 +/- 4.6 Female – 74.3 +/- 5.8 www.indiandentalacademy.com
  61. 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. 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. 63. Measurements for this analysis  OP – HP (Angle)  A – B(Linear)  U6 – NF(Angle)  L1 – MP(Angle) www.indiandentalacademy.com
  64. 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. 65. www.indiandentalacademy.com
  66. 66. www.indiandentalacademy.com
  67. 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. 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. 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. 70. www.indiandentalacademy.com
  71. 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. 72. www.indiandentalacademy.com
  73. 73. HORIZONTAL PLANE COLUMELLA CERVICAL POINT www.indiandentalacademy.com GNATHION
  74. 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. 75. FACIAL CONVEXITY ANGLE  MEAN VALUE : 12 ⁰ +/- 4  POSITIVE VALUE – CONVEX PROFILE  NEGATIVE VALUE CONCAVE PROFILE www.indiandentalacademy.com G – Sn - Pog
  76. 76. ANTERO - POSTERIOR MAXILLARY (Mean value 6+/-3) AND MANDIBULAR (Mean value 0+/-4) MEASUREMENTS www.indiandentalacademy.com ,
  77. 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. 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. 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. 80. NASOLABIAL ANGLE (Cm – Sn – Ls) Mean Value - 102o +/- 8o Obtuse angle indicates maxillary hypoplasia and vice-versa www.indiandentalacademy.com
  81. 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. 82. MENTO LABIAL SULCUS Li Mean Value - 4 ± 2mm Sm Pog www.indiandentalacademy.com
  83. 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. 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. 85. www.indiandentalacademy.com
  86. 86. www.indiandentalacademy.com
  87. 87. www.indiandentalacademy.com
  88. 88. www.indiandentalacademy.com
  89. 89. www.indiandentalacademy.com
  90. 90. Newer advances and techniques Digital cephalometry Softwares - Dolphin - Vistadent - OPAL www.indiandentalacademy.com
  91. 91. www.indiandentalacademy.com
  92. 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. 93. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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