Mc Namara Analysis
Ricketts Analysis
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.c...
Introduction
Since the introduction of cephalometrics
by Broadbent in 1931, a number of
different analyses have been devis...
But from 1970’s clinical orthodontics
has seen the advent of numerous
orthognathic surgery procedures which
allow three-di...
Mc Namara Analysis

•
•
•
•

In this method of analysis described by
Mc Namara in his article on AJO-DO 1984
represents an...
Advantages
1. This method depends primarily upon
linear measurements rather than angles,
so that treatment planning (parti...
Advantages (contd.)
2. This method of analysis is more sensitive to
vertical changes than is an analysis which relies
on t...
Advantages (contd.)
3. This analytical procedure provides
guidelines with respect to normally
occurring growth increments....
Advantages (contd.)
4. The principles of this analysis are easily
explained to nonspecialists and to lay
persons such as p...
Normative Standards
Normative standards were determined
by arbitrarily combining comparable
average values of three sample...
• The second sample contains selected
values from a group of normal children
from the Burlington Orthodontic Research
Cent...
Contents
1.
2.
3.
4.

Relating Maxilla To Mandible
Relating Mandible To Maxilla
Relating the mandible to the cranial base
...
Relating Maxilla To Mandible
1. Hard Tissue Evaluation
2. Soft tissue Evaluation

www.indiandentalacademy.com
Hard Tissue Evaluation
• The anteroposterior orientation of the
maxilla relative to the cranial base can be
determined by ...
HARD TISSUE EVALUATION:
NASION PERPENDICULAR

F-H Plane is drawn
Nasion Perpendicular
from superior aspect
is a veritcal l...
Ajo-Do 1984

Cephalometric values from Ann Arbor sample

Composite Norms

www.indiandentalacademy.com
Examples
Maxillary skeletal protrusion

Maxillary skeletal retrusion

www.indiandentalacademy.com
Soft Tissue Analysis
The nasiolabial angle is formed
By drawing a line tangent to the
base of the nose and a line
tangent ...
Examples
Maxillary protrution

Maxillary retrusion

www.indiandentalacademy.com

Retrusion with normal
Nasolabial angle
The cant of the upper lip Should be
slightly forward to form an angle of
14°± 8° in females and 8°± 8° in
adult males with...
Relating Mandible To Maxilla
1. Anteroposterior Relationship
2. Vertical Relationship

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Anteroposterior Relationship
Of Mandible With Maxilla
A geometric relationship exists between
the effective length of the ...
The effective midfacial length
is determined by measuring a
line from condylion to point A

Condylon is the most
Gnathion ...
Composite Norms

www.indiandentalacademy.com

Ajo-Do 1984
Ajo-Do 1984

Bolton Standards

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Ajo-Do 1984

Burligton Values

www.indiandentalacademy.com
• The effective lengths of midface and
mandible described in the analysis is not
age or sex dependent but related to size
...
Examples
Retrusive mandible

Protrusive mandible

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Retrusive maxilla
Protrusive mandible
Vertical Relationship
lower anterior facial height is
measured from anterior nasal
spine to menton.
This linear measuremen...
Composite Norms

Ajo-Do 1984

Mixed dentition

Adult Female

Adult Male

www.indiandentalacademy.com
Examples
Increase in vertical height

Decrease in vertical height

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The Mandibular Plane Angle

26° ± 4.5° at 9 years and decreases by 1°
every 3 years

www.indiandentalacademy.com
The Facial Axis
Average value is 90 °± 3.5 ° .
Excessive vertical development is
indicated by negative values (values
less...
Examples
Retrusive Mandible

Protrusive mandible

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Relating the mandible to the
cranial base

www.indiandentalacademy.com
• The relationship of the mandible to the
cranial base is determined by measuring
the distance from Pogonion to the Nasion...
www.indiandentalacademy.com
Ajo-Do 1984

Cephalometric values from Ann Arbor sample

Composite Norms

www.indiandentalacademy.com
EXAMPLES
Protrusive

Retrusive

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Relating the upper incisor to
the maxilla
1. Anteroposterior position
2. Vertical position

www.indiandentalacademy.com
Anteroposterior position
• The position of the upper incisor can be located
by using measurements that relate the dental
p...
Ajo-Do 1984

This is accomplished by drawing a
vertical line through point A,
parallel to the nasion perpendicular.
The di...
Ajo-Do 1984

Cephalometric values from Ann Arbor sample

Composite Norms

www.indiandentalacademy.com
Vertical
• The vertical position of the upper
incisor is best determined at the time of
the clinical examination.
• Typica...
It is in the range of 2 to 3 mm.
Women show more within this
range

www.indiandentalacademy.com
Relating the lower incisor to
the mandible
1. Anteroposterior position
2. Vertical position

www.indiandentalacademy.com
Anteroposterior position
• The anteroposterior position of the lower
incisor can be determined by using a
measurement of t...
Ajo-Do 1984

Composite Value is 1 to 3 mm

www.indiandentalacademy.com
Airway analysis
1. Upper pharynx
2. Lower pharynx

www.indiandentalacademy.com
Upper pharynx.
• The upper pharyngeal width is measured from a
point on the posterior outline of the soft palate to
the cl...
Average Value is approximately
15 to 20 mm in width

www.indiandentalacademy.com
Lower pharynx.
Lower pharyngeal width is measured
from the intersection of the posterior
border of the tongue and the infe...
Average Value is 11 to 14 mm.
A greater than average value
suggests anterior positioning
of the tongue

www.indiandentalac...
Ricketts Analysis

www.indiandentalacademy.com
Relation of the Mandible
1. Facial axis
2. Facial(depth)angle
3. Mandibular plane
www.indiandentalacademy.com
1. Facial Axis
• The angle formed between the basionnasion plane and the plane from foramen
rotundum (PT) to gnathion.

ww...
Facial axis isPt line
a point
extending from the the
The junction of
•A foramen rotundum (Pt) a
lesser angle suggests to
p...
2.Facial(depth)angle
• The angle between the facial plane (NPog) and the Frankfort horizontal.
• This angle provides some ...
This angle is 87 ± 3° at 9 years
of age and it has to be
Facial plane
increased by 1 every 3 years
Extends from Nasion to
...
3.Mandibular Plane
• A high or steep mandibular plane angle
implies that an open bite may be due to
the skeletal morpholog...
Mandibular plane
Extends from gnathion to gonion

26. 60° ± 4.5° at 9 years and decreases by 1°
every 3 years

www.indiand...
Convexity

www.indiandentalacademy.com
Convexity At Point A
The convexity of the middle
face is measured from Point
A to the facial plane (N-Pog).

The clinical ...
II.Convexity At Point A
• High Convexity implies a Class II skeletal
pattern. Negative Convexity suggests a
Class III skel...
Dentition

www.indiandentalacademy.com
Lower incisor to A-Pog
• The A-Pog plane is referred to as the
denture plane and is a useful reference
line from which to ...
A-Pog Line
Extends from point A to Pogonion

Ideally, the lower incisor should be
located 1.0 ± 2 mm ahead of the APog lin...
A-Pog Line
• If the measured value of lower incisor to
A-Pog line is more than the average value
then extraction is indica...
Upper Molar To PtV
• This measurement assists in determining
whether the malocclusion is due to the
position of the upper ...
Pterygoid Vertical(PtV)
A vertical line drawn throgh distal
radiographic outline of the
pterygomaxillary fissure and
perpe...
Lower incisor to A-Pog
• This measurement provides some idea of
lower incisor procumbency

www.indiandentalacademy.com
The angle between the long axis of the
lower incisor and the A-PO plane (1 to APO) is measured.
On the ayerage, this angle...
Profile

www.indiandentalacademy.com
Lower lip to E-plane
• The distance between the lower lip and
the esthetic (nose-chin) plane is an
indication of the soft ...
Esthetic line (E-line)
Extends from soft tissue tip of
nose(En) to soft tissue Chin
point(DT)
• The average norm for this
...
Condylar Axis and
Corpus Axis
• These are used to describe the morphology
of the mandible

www.indiandentalacademy.com
Xi Point
Locate FHP and Draw PtV Plane
R1 is the deepest point on the
perpendicular to the FHP and anterior
R2 is located ...
Condyle (Dc) point
The point In the center of the
the condyle neck along the
Ba-N plane
Condylar Axis extends
from Xi to D...
Thank you

www.indiandentalacademy.com
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Mc namara analysis /certified fixed orthodontic courses by Indian dental academy

  1. 1. Mc Namara Analysis Ricketts Analysis INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Introduction Since the introduction of cephalometrics by Broadbent in 1931, a number of different analyses have been devised. Most of the analyses were conceived during the period (1940 to 1970) when significant alterations in craniofacial structural relationships were thought impossible………... www.indiandentalacademy.com
  3. 3. But from 1970’s clinical orthodontics has seen the advent of numerous orthognathic surgery procedures which allow three-dimensional repositioning of almost every bony structure in the facial region. Therefore, a need has arisen for a method of cephalometric analysis that is sensitive not only to the position of the teeth within a given bone but also to the relationship of the jaw elements and cranial base structures one to another. www.indiandentalacademy.com
  4. 4. Mc Namara Analysis • • • • In this method of analysis described by Mc Namara in his article on AJO-DO 1984 represents an effort to relate teeth to teeth teeth to jaws each jaw to the other the jaws to the cranial base. www.indiandentalacademy.com
  5. 5. Advantages 1. This method depends primarily upon linear measurements rather than angles, so that treatment planning (particularly treatment planning for the orthognathic surgery patient) is made easier. www.indiandentalacademy.com
  6. 6. Advantages (contd.) 2. This method of analysis is more sensitive to vertical changes than is an analysis which relies on the ANB angle, such as that of Steiner. The use of the ANB angle can be misleading, since it tends to be insensitive to the vertical component of jaw discrepancies. Similarly, changes in growth pattern, which include both horizontal and vertical adaptations, may be completely missed if only a change in the ANB angle is measured. www.indiandentalacademy.com
  7. 7. Advantages (contd.) 3. This analytical procedure provides guidelines with respect to normally occurring growth increments. Therefore, the norms derived from the Bolton standards, the Burlington sample, and the Ann Arbor sample and the composite norms presented in this article can be used to evaluate treatment results. www.indiandentalacademy.com
  8. 8. Advantages (contd.) 4. The principles of this analysis are easily explained to nonspecialists and to lay persons such as patients and parents. www.indiandentalacademy.com
  9. 9. Normative Standards Normative standards were determined by arbitrarily combining comparable average values of three samples. • The first sample contains normative data derived from lateral cephalograms of the children comprising the Bolton standards, the longitudinal records of whom were retraced and digitized by Behrents and McNamara to include all the landmarks necessary for the present analysis. www.indiandentalacademy.com
  10. 10. • The second sample contains selected values from a group of normal children from the Burlington Orthodontic Research Centre who also were followed longitudinally. • The third group considered is the Ann Arbor sample of 111 young adults who had good to excellent facial configurations. Patients in this latter group had a Class I occlusion and good skeletal balance with an orthognathic facial profile. www.indiandentalacademy.com
  11. 11. Contents 1. 2. 3. 4. Relating Maxilla To Mandible Relating Mandible To Maxilla Relating the mandible to the cranial base Relating the upper incisor to the maxilla 5. Relating the lower incisor to the mandible 6. Airway analysis www.indiandentalacademy.com
  12. 12. Relating Maxilla To Mandible 1. Hard Tissue Evaluation 2. Soft tissue Evaluation www.indiandentalacademy.com
  13. 13. Hard Tissue Evaluation • The anteroposterior orientation of the maxilla relative to the cranial base can be determined by measuring the linear distance between Nasion perpendicular and point A. www.indiandentalacademy.com
  14. 14. HARD TISSUE EVALUATION: NASION PERPENDICULAR F-H Plane is drawn Nasion Perpendicular from superior aspect is a veritcal line of the external Perpendicular to FHP auditory inferiorly extendingmeatus to the nasion fromlower border of the orbit www.indiandentalacademy.com
  15. 15. Ajo-Do 1984 Cephalometric values from Ann Arbor sample Composite Norms www.indiandentalacademy.com
  16. 16. Examples Maxillary skeletal protrusion Maxillary skeletal retrusion www.indiandentalacademy.com
  17. 17. Soft Tissue Analysis The nasiolabial angle is formed By drawing a line tangent to the base of the nose and a line tangent to the upper lip The ideal value is 102° ± 8° www.indiandentalacademy.com
  18. 18. Examples Maxillary protrution Maxillary retrusion www.indiandentalacademy.com Retrusion with normal Nasolabial angle
  19. 19. The cant of the upper lip Should be slightly forward to form an angle of 14°± 8° in females and 8°± 8° in adult males with the Nasion perpendicular www.indiandentalacademy.com
  20. 20. Relating Mandible To Maxilla 1. Anteroposterior Relationship 2. Vertical Relationship www.indiandentalacademy.com
  21. 21. Anteroposterior Relationship Of Mandible With Maxilla A geometric relationship exists between the effective length of the midface and that of the mandible. Any given effective midfacial length corresponds to a given effective mandibular length. www.indiandentalacademy.com
  22. 22. The effective midfacial length is determined by measuring a line from condylion to point A Condylon is the most Gnathion is the most posterosuperior point anteroinferior aspect of on the outline the mandibular of the mandibular condyle symphysis The effective mandibular length is derived by constructing a line from condylion to anatomic gnathion www.indiandentalacademy.com
  23. 23. Composite Norms www.indiandentalacademy.com Ajo-Do 1984
  24. 24. Ajo-Do 1984 Bolton Standards www.indiandentalacademy.com
  25. 25. Ajo-Do 1984 Burligton Values www.indiandentalacademy.com
  26. 26. • The effective lengths of midface and mandible described in the analysis is not age or sex dependent but related to size of the component parts. So the term "small” "medium," and "large" are used rather than "mixed dentition," "adult female" and "adult male." www.indiandentalacademy.com
  27. 27. Examples Retrusive mandible Protrusive mandible www.indiandentalacademy.com Retrusive maxilla Protrusive mandible
  28. 28. Vertical Relationship lower anterior facial height is measured from anterior nasal spine to menton. This linear measurement increases with age and is correlated to the effective length of the midface www.indiandentalacademy.com
  29. 29. Composite Norms Ajo-Do 1984 Mixed dentition Adult Female Adult Male www.indiandentalacademy.com
  30. 30. Examples Increase in vertical height Decrease in vertical height www.indiandentalacademy.com
  31. 31. The Mandibular Plane Angle 26° ± 4.5° at 9 years and decreases by 1° every 3 years www.indiandentalacademy.com
  32. 32. The Facial Axis Average value is 90 °± 3.5 ° . Excessive vertical development is indicated by negative values (values less than 90°), and deficient vertical facial development is indicated by positive values (values greater than 90°). www.indiandentalacademy.com
  33. 33. Examples Retrusive Mandible Protrusive mandible www.indiandentalacademy.com
  34. 34. Relating the mandible to the cranial base www.indiandentalacademy.com
  35. 35. • The relationship of the mandible to the cranial base is determined by measuring the distance from Pogonion to the Nasion perpendicular. www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com
  37. 37. Ajo-Do 1984 Cephalometric values from Ann Arbor sample Composite Norms www.indiandentalacademy.com
  38. 38. EXAMPLES Protrusive Retrusive www.indiandentalacademy.com
  39. 39. Relating the upper incisor to the maxilla 1. Anteroposterior position 2. Vertical position www.indiandentalacademy.com
  40. 40. Anteroposterior position • The position of the upper incisor can be located by using measurements that relate the dental portion of the maxilla to the skeletal portion of the maxilla. www.indiandentalacademy.com
  41. 41. Ajo-Do 1984 This is accomplished by drawing a vertical line through point A, parallel to the nasion perpendicular. The distance from this constructed The measurement from point AA to the facial surface point perpendicular to the facial surfaceupper incisor incisor is of the of the upper horizontally measured. is 4 to 6 mm www.indiandentalacademy.com
  42. 42. Ajo-Do 1984 Cephalometric values from Ann Arbor sample Composite Norms www.indiandentalacademy.com
  43. 43. Vertical • The vertical position of the upper incisor is best determined at the time of the clinical examination. • Typically, the incisal edge of the upper incisor lies 2 to 3 mm below the upper lip at rest. www.indiandentalacademy.com
  44. 44. It is in the range of 2 to 3 mm. Women show more within this range www.indiandentalacademy.com
  45. 45. Relating the lower incisor to the mandible 1. Anteroposterior position 2. Vertical position www.indiandentalacademy.com
  46. 46. Anteroposterior position • The anteroposterior position of the lower incisor can be determined by using a measurement of the facial surface of the lower incisor to the A-pogonion line www.indiandentalacademy.com
  47. 47. Ajo-Do 1984 Composite Value is 1 to 3 mm www.indiandentalacademy.com
  48. 48. Airway analysis 1. Upper pharynx 2. Lower pharynx www.indiandentalacademy.com
  49. 49. Upper pharynx. • The upper pharyngeal width is measured from a point on the posterior outline of the soft palate to the closest point on the posterior pharyngeal wall. • This measurement is taken on the anterior half of the soft palate outline because the area immediately adjacent to the posterior opening of the nose is critical in determining upper respiratory patency. www.indiandentalacademy.com
  50. 50. Average Value is approximately 15 to 20 mm in width www.indiandentalacademy.com
  51. 51. 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. www.indiandentalacademy.com
  52. 52. Average Value is 11 to 14 mm. A greater than average value suggests anterior positioning of the tongue www.indiandentalacademy.com
  53. 53. Ricketts Analysis www.indiandentalacademy.com
  54. 54. Relation of the Mandible 1. Facial axis 2. Facial(depth)angle 3. Mandibular plane www.indiandentalacademy.com
  55. 55. 1. Facial Axis • The angle formed between the basionnasion plane and the plane from foramen rotundum (PT) to gnathion. www.indiandentalacademy.com
  56. 56. Facial axis isPt line a point extending from the the The junction of •A foramen rotundum (Pt) a lesser angle suggests to pterygomaxillary gnathion retropositioned chin, whereas fissure and the an angle greaterrotundum foramen than a right The outline of protrusive or angle suggests athe foramen rotundum forward growing chin can be angle formed The approximated at the 10.30 (face basionbetween the of a clock) position on and the nasion plane the circular outline of foramen plane from the superior border of the rotundum (PT) to pterygomaxillary fissure gnathion is 90 ± 3.5° www.indiandentalacademy.com
  57. 57. 2.Facial(depth)angle • The angle between the facial plane (NPog) and the Frankfort horizontal. • This angle provides some indication of the horizontal position of the chin. • It also suggests whether a skteletal Class II or III pattern is due to the position of the mandible www.indiandentalacademy.com
  58. 58. This angle is 87 ± 3° at 9 years of age and it has to be Facial plane increased by 1 every 3 years Extends from Nasion to Pogonion Facial angle is formed between facial plane (N-Pog) and the Frankfurt horizontal line www.indiandentalacademy.com
  59. 59. 3.Mandibular Plane • A high or steep mandibular plane angle implies that an open bite may be due to the skeletal morphologic characteristics of the mandible. A low mandibular plane suggests the opposite (ie, a deep bite). www.indiandentalacademy.com
  60. 60. Mandibular plane Extends from gnathion to gonion 26. 60° ± 4.5° at 9 years and decreases by 1° every 3 years www.indiandentalacademy.com
  61. 61. Convexity www.indiandentalacademy.com
  62. 62. Convexity At Point A The convexity of the middle face is measured from Point A to the facial plane (N-Pog). The clinical norm at 9 years of age is 2.0 mm and decreases 1 degree every 5 years www.indiandentalacademy.com
  63. 63. II.Convexity At Point A • High Convexity implies a Class II skeletal pattern. Negative Convexity suggests a Class III skeletal pattern. www.indiandentalacademy.com
  64. 64. Dentition www.indiandentalacademy.com
  65. 65. Lower incisor to A-Pog • The A-Pog plane is referred to as the denture plane and is a useful reference line from which to measure the position of the anterior teeth. www.indiandentalacademy.com
  66. 66. A-Pog Line Extends from point A to Pogonion Ideally, the lower incisor should be located 1.0 ± 2 mm ahead of the APog line . This measurement is used to define the protrusion of the lower arch. www.indiandentalacademy.com
  67. 67. A-Pog Line • If the measured value of lower incisor to A-Pog line is more than the average value then extraction is indicated. www.indiandentalacademy.com
  68. 68. Upper Molar To PtV • This measurement assists in determining whether the malocclusion is due to the position of the upper or lower molar. It is also useful in deciding whether extractions are necessary. www.indiandentalacademy.com
  69. 69. Pterygoid Vertical(PtV) A vertical line drawn throgh distal radiographic outline of the pterygomaxillary fissure and perpendicular to FHP The distance from the pterygoid vertical (back of the maxilla) to the distal of the upper molar. On average is measured, This measurement should equal the age of the patient +3.0 mm (eg, a patient 11 years of age has a norm of 11 + 3 = 14 mm). www.indiandentalacademy.com
  70. 70. Lower incisor to A-Pog • This measurement provides some idea of lower incisor procumbency www.indiandentalacademy.com
  71. 71. The angle between the long axis of the lower incisor and the A-PO plane (1 to APO) is measured. On the ayerage, this angle should be 28 ± 4°. www.indiandentalacademy.com
  72. 72. Profile www.indiandentalacademy.com
  73. 73. Lower lip to E-plane • The distance between the lower lip and the esthetic (nose-chin) plane is an indication of the soft tissue balance between the lips and the profile www.indiandentalacademy.com
  74. 74. Esthetic line (E-line) Extends from soft tissue tip of nose(En) to soft tissue Chin point(DT) • The average norm for this measurement is -2.0 mm at 9 years of age. The positive values are those ahead of the Eline. www.indiandentalacademy.com
  75. 75. Condylar Axis and Corpus Axis • These are used to describe the morphology of the mandible www.indiandentalacademy.com
  76. 76. Xi Point Locate FHP and Draw PtV Plane R1 is the deepest point on the perpendicular to the FHP and anterior R2 is located on the posterior border borderfour R1, R2, R3, of the ramus locateramus ,opposite & R4 of thethe deepest pointR1 the R3 is of sigmoid notch R3 on the R4 is opposite inferior border of the mandible Construct four Planes tangent to thes Xipoints can beforms a rectangle enclosing point and it located at the center ofthe ramus the rectangle at the intersection of the diagonals www.indiandentalacademy.com
  77. 77. Condyle (Dc) point The point In the center of the the condyle neck along the Ba-N plane Condylar Axis extends from Xi to Dc Suprapogonion (PM) point Corpus axis extends shape The point at which thefrom Xi to symphysis of the PM point mentalis changes from convex to concave www.indiandentalacademy.com
  78. 78. Thank you www.indiandentalacademy.com

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