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Cephalometrics

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Dr. Gul-e-Erum

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Cephalometrics

  1. 1. CEPHALOMETRICS Dr. Gul-e-Erum Assistant Professor Orthodontics
  2. 2.  Clinically by the overall profile view of the patient. Barnett 1975  Palpation of anterior surfaces of the basal part of the jaw. Mills 1987  Better assessment with lateral skull radiograph.  Pacini 1922 – Cephalometrics  Broadbent (USA), Hofrath (Germany) 1934 – Standardization and Popularization Historical Review
  3. 3. How you evaluate a face • Soft tissue • Hard tissue • Dental tissue
  4. 4. Importance Many of the difficulties experienced in the treatment can be attributed directly to the extent of the excessive disharmony of the skeletal pattern.
  5. 5. Simply calling a dimension ‘large’ or ‘small’ or ‘good’ or ‘bad’ does not mean the same to everyone. In order to be critical or descriptive it is more useful to express dimensions in terms of angles or linear measurements. BUT Cephalometrics is not an exact science
  6. 6. Cephalometric radiography • Cephalometric radiography is a standardized and reproducible form of skull radiography used extensively in orthodontics • Standardization was essential for the development of cephalometry
  7. 7. Uses • Diagnosis • Treatment planning • Monitoring treatment progress • Appraisal of treatment resullts • Growth studies
  8. 8. • Lateral ceph • PA ceph
  9. 9. 15"60" Source Plane X-ray Source Patient in Head Positioning Device Mid-saggital Plane Film Plane X-ray Film in Cassette Cephalostat
  10. 10. Cephalostat
  11. 11. Cephalostat
  12. 12. What Are We Trying to Accomplish? • Find out skeletal classification – anteroposterior – vertical • Find out angulation of incisors • Consider soft tissue – facial profile – airway considerations
  13. 13. Cephalometric Evaluation • Identification of anatomic landmarks • Landmarks: stable reference structures maxillary and mandibular skeletal and dental • Graphically relating the dento-facial elements to these reference structures • Angular and or linear measurements
  14. 14. METHODS OF CEPHALOMETRIC ANALYSIS • Two basic approaches • 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
  15. 15. Metric Method - Use of selected linear and angular measures
  16. 16. Graphic Method - Use of a Composite Template
  17. 17. GOALS OF CEPHALOMETRIC ANLYSIS • Evaluating relationships, both horizontal and vertical of 5 major functional components of the face: • The cranial base • The maxilla • The mandible • The maxillary dento-alveolus • The mandibular dento-alveolus
  18. 18. Radiograph
  19. 19. Tracing
  20. 20. Steps of tracing • Draw soft tissue outline • Cranial base • Midface structures • Maxillary dentition • Mandibular structures • Mandibular dentition
  21. 21. LANDMARKS
  22. 22. Sella Porion Gonion PNS Menton Gnathion Pogonion B Point A Point ANS Orbitale Nasion Articulare Standard Cephalometric Landmarks
  23. 23. Landmarks definition • Sella: Centre of sella turcica • Nasion: Most anterior point on frontonasal suture • Orbitale: Lowest point on infraorbital margin • ANS Tip of ant nasal spine
  24. 24. • PNS Tip post nasal spine • Point A Deepest midline point b/w ANS and prosthion • Point B Deepest point in the bony outline b/w infradentale and pogonion • Pogonion Most ant point on bony chin • Gnathion Most anterior and inferior on bony chin • Menton Lowest point on the bony outline of the md symphysis
  25. 25. • Gonion Most lateral external point at the junction of horizontal and ascending rami of the mandible • Articulare Intersection post border of md and temporal bone • Porion Upper most point on the EAM
  26. 26. Structures to be Traced
  27. 27. SN Plane Frankfort Plane Palatal Plane Occlusal Plane Mandibular Plane Frequently Used Planes Facial Plane
  28. 28. Cephalometric Analyses • Down’s • Steiner’s • Tweed’s • McNamara’s • Wits • Mc Namara • Rickett’s
  29. 29. • Sagittal Analysis • Vertical Analysis • Dental Analysis • Soft Tissue Analysis
  30. 30. SAGITTAL ANALYSIS
  31. 31. Sagittal Analysis Skeletal Horizontal - Maxilla SNA 82 ± 2 deg NA TO FH 90 ± 3 deg S N A F H
  32. 32. Sagittal Analysis Skeletal Horizontal - Mandible S N B P g F H SNB 80 ± 2 deg N-PG TO FH 87 ± 4 deg
  33. 33. Sagittal Analysis Maxilla To Mandible N A B ANB 2 ± 2 deg
  34. 34. Sagittal Analysis Maxilla and Mandible N A B Wit’s Analysis 0-2mm
  35. 35. VERTICAL ANALYSIS
  36. 36. SKELETAL VERTICAL S Me Go SN-Md Plane 32 ± 4 deg N
  37. 37. SKELETAL VERTICAL Me Go FH-Md Plane 25 ± 4 deg FH
  38. 38. SKELETAL VERTICAL Gn S Y axis angle 60 ± 4 deg FH
  39. 39. SKELETAL VERTICAL Me Go PFH/TAFH ratio 65 % S N
  40. 40. SKELETAL VERTICAL Me LFH/TAFH ratio 55 % N ANS
  41. 41. UI-SN angle=102 +/_ 5 IMPA=90 Interincisal angle= 125-135
  42. 42. Soft tissue analysis S-plane E-plane

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