Hard tissue cephalometry /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


1899 – Edward Angle – Classification of Malocclusion
1915 – Van Loon – developed a method for 3D registration of face
and dentition – Cubus Craniophorus
1922 – Simon – modified Van Loon’s inventon by using a face
bow.
1922 – Pacini – Paved the way for standardized head radiography
1931 – Hofrath in Germany and Broadbent in United States –
published their works in the ‘ Forschritte der Orthodontie’ and
the Angle Orthodontist respectively.
1939 – Lucien de Coster – published his work on proportional
relationships of the face.www.indiandentalacademy.com

Reserve
Craniostat


The Bolton Room in the
Anatomical Laboratory of
the Medical School at
Western Reserve
University, Cleveland.


Cephalometric Equipment
 Cephalostat or head holder
 X-ray source
 Cassette holder
 Cassette

Two types of cephalostats

Broadbent – Bolton method

Higley method

Specifications:
Distance from the midsagittal plane of the subject’s head to the
X-ray tube = 60” (5ft)
Distance from the midsagittal plane of the subject’s head to the
film = 7”
American convention – subject’s left side to the film
European convention – subject’s right side to the film

Natural Head Position
NHP is a standardized and reproducible orientation of
the head in space when one is focusing on a distant
point at eye level.
1884 – German Anthropological Society – Frankfort Agreement
1956 – William Downs – discrepancies in cephalometric facial
typing and photographic facial typing – Analysis of dentofacial
profile


‘Discrepancies between cephalometric facial typing and
photographic facial typing disappear when a correction is
made for those persons who do not have a level frankfort
plane.’
William Downs(1956)


‘Intracranial landmarks are not stable points in the
cranium, their vertical relationship to each other is
therefore also subject to biologic variation.’
Bjerin (1957)


Definition of terminology
Anthropometry – Measurement of dimensions of the human body
and it’s parts.
Craniometry – Branch of anthropometry dealing with
measurements of dimensions and angles of bony skull.
Cephalometry – Scientific measurement of dimensions of the
‘living’ head.
Cephalometric analysis – Process of evaluating the skeletal,
dental, and soft tissue relationships of a patient by comparing
measurements performed on the patient’s cephalometric tracing
with population norms for respective measurements, to come to a
diagnosis of the patient’s orthodontic problem.

DOWN'S ANALYSIS


Mean Reading : 87.5o

Range : 82o – 95o


Mean Reading : 0o

Range : -8.5o – 10o


Mean Reading : -4.6o

Range : 0o – - 9o



Range : 17o – 28o


Range : 53o – 66o


Mean Reading : 9.3o

Range : 1.5o – 1.4o


Mean reading : 135.4o

Range : 130o – 150o


Mean reading : 1.4o

Range : -8.5o – 7o


Wriggle

Vorhies and Adams (1951)


STEINER’ S ANALYSIS


STEINER’S ANALYSIS
SKELETAL ANALYSIS
DENTAL ANALYSIS

SOFT TISSUE ANALYSIS


Mean reading : 82o


Mean reading : 80o


ANB
Mean reading : 2o


Mean reading : 14o


Mean reading : 32o


Mean reading : 130o


WITS ‘APPRAISAL ’
ANALYSIS


RIEDEL - 1952
ANB

University of Witwatersrand

Anteroposterior relationship of the jaws relative to cranium


Rotational effect of the jaws relative to the anterior cranial base


SHORTCOMINGS OF ANB
‘Use of the apical base should be replaced
JENKINS – 1955
by a better method to determine sagittal
TAYLOR – WITS
apical base difference. The1969
appraisal could be used a possible
BEATTY – 1975
alternative.’

JARVINEN – 1985 (1985)
JARVINEN

“ Measurements from the cranial base,
however, do not provide a reliable
expression of anteroposterior jaw
relationship in the dentofacial complex.”

Jacobson

Is the ANB angle a reliable
indicator of jaw discrepancy
or not?

McNAMARA ANALYSIS


McNamara (1984)
•

Lateral cephalogram of children comprising of
the Bolton’s Standards
•

Selected values from a group of untreated
children from Burlington research center.
•

Sample of young adults from Ann Arbor having
excellent dental and facial pattern.


Craniofacial skeleton has been divided into five sections

 Maxilla to cranial base
 Maxilla to mandible
 Mandible to cranial base
 Dentition
 Airway

Maxilla to cranial base


Nasiolabial angle : 102o + 8o


Cant of the Upper lip :
Women : 14o + 8o
Men


: 8o + 8 o

Maxilla to mandible


Maxillomandibular differential = Midfacial length – Effective
mandibular length

Co

A

Gn

Ideal maxillomandibular differential

Small

-

20mm

Medium

-

25 – 27mm

Large

-

30 – 33mm


Mandible to cranial base


Mixed Dentition = 6-8mm behind nasion
perpendicular
Adult woman = 4-0mm behind nasion
perpendicular
Adult men = 2mm behind to 2mm ahead
of nasion perpendicular


Dentition


1-3mm

4-6mm

Airway Analysis


COGS ANALYSIS


COGS – Cephalometrics for Orthognathic Surgery
Charles J. Burstone – 1978

University of Connecticut

COGS
 Chosen landmarks and measurements can
be altered by various surgical procedures.
 The appraisal includes all facial bones
and a cranial base reference.
 Rectilinear measurements can be readily
transferred to a study cast for mock surgery.

 Critical facial components can be
examined.
 Standards and statistics are available for
variations in age and sex from 5 to 20
 Consists of a series of measurements that
can be computerised.

H-P line


Cranial Base


Horizontal Measurements

N-A-Pg

Vertical Measurements


Maxilla and Mandible


Dental Measurements


TWEED’ S ANALYSIS


HARVOLD ANALYSIS


SASSOUNI’ S ANALYSIS
(1969)


JARABAK ANALYSIS


Why do we have to think about
Computer aided Cephalometrics
Computers & Cephalometrics
Videocephalometry?


Conclusions:
• Cephalometric analyses are merely aids in helping
the clinician arrive at a diagnosis and treatment
planning.
• All anteroposterior skeletal discrepancies cannot be
corrected to an ideal jaw relationship.
• Cephalometric measurements are not to be
regarded as final points or values and it is not
necessary that values should exactly tally.

• Variation in biology is a rule, therefore a normal
value is never a point so a mean is to be always
considered.
• Serial cephalograms taken during course of
treatment helps us to ascertain whether our treatment
goals are achieved.
• The Wits appraisal is a linear measurement and not
an analysis per se. It is simply an adjunctive
diagnostic aid that may prove useful in assessing the
extent of anteroposterior skeletal dysplasia and in
determining the reliability of ANB angle.

• We should strive to develop cephalometric norms
and values pertaining to an Indian background instead
of using those meant for Caucasian norms.


Hard tissue cephalometry /certified fixed orthodontic courses by Indian dental academy

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