Basic cephalometry

BASIC
CEPHALOMETRY
- Raj K Gaddam
www.indiandentalacademy.com

Contents
• History
• Radiographic cephalometric Technique
• Tracing technique
• Normal Radiographic Anatomy and Identificaton
of Landmarks
• Lines and planes
• Applications of Cephalometrics
• Limiatations of Cephalometrics
• Advances in Cephalometrics
• Conclusion.

Cephalometrics includes the
measurement, description, and
appraisal of morphological
congifuration and growth changes
in the skull.

Historically, human form
has been measured for
many purposes, one has
been to aid humanity’s self
portrayal in sculpture,
drawing and painting.
Another has been to test
the relation
of physique to health,
temperament and
behavioral traits

Egyptian art (3000 B.C)

Byzantine art (7th
Century B.C)

Indian sculpture (1200 A.D)

• Anthropometry defined as systemized
art of measuring and taking observations
on man, his skeleton, his brain, and other
organs by the most reliable means and
methods and for scientific purposes.
• Craniometry is the measurement of
cranial features in order to classify people
according to race, criminal temperament,
intelligence, etc.

Hippocrates
(460-357 BC)
known as
Father of Medicine
was a pioneer in
physical
anthropology.

In 15th
century,
Leonardo di vinci (1452-1519)
was one of the earliest people
to apply the theory of head
measurement to good affect
in practice.

He used a variety of lines
related to specific structures in
the head to assist in the
studies of human normwww.indiandentalacademy.com

Albrecht Durer (1471-
1528) used a similar
horizontal line for his
base line. He
published 4 books on
Human proportions.

This is the work
of first published
attempt to apply
Anthropometry
to aesthetics.

In 16th
century,
Spigel(1578-1625) made the first truly
scientific attempt at cranial measurement
by publishing
“Lineae cephalometicae”.
He mentioned Facial, Occipital,
Frontal, Sincipital lines.

The Dutchman
Petrus camper
(1722-1789) was
particularly concerned
with the distinction of
different races of men.

He introduced
‘Facial angle’
which has
been used
widely since
then.

Golden proportions

Wilhelm conrad Rontgen
Invented X-Rays in
1895 which
revolutionized the
Diagnostic medicine

The Nobel Prize in Physics 1901

Van Loon First to introduce
Cephalometrics to
Orthodontics
A J Pacini First identified
(1921) N, Pog,Go,ANS,S
Simpson First to give Method of
(1923) obtaining Profile radiographs
Waldron First to construct a
Cephalometer

Holly broadbent
Director of Bolton-Brush
study, world’s most
extensive longitudinal
growth study.
Redefined
Craniostat and
standardized
cephalometric
technique

Radiographic cephalometric
Technique

It is an instrument for holding the patients head and
the X-ray film in a desired relation to each other and
to the central ray of the X-ray machine.
Cephalometer
Components:
X - Ray source
Adjustable cephalostat
Film cassette with intensifying screen (8” x10”)
Film casette holder

• The orbital pointer and ear rods make it
possible to adjust the patients head along
Frankfort Horizontal plane
• Central ray will go directly through the ear
rods, which will appear as a circle on the
radiographs. So therefore, slightest
deviation will alter the appearance of ear
rods.

Evacuated
glass envelope
Cathode with
filament
Anode with
focal spot
Schematic Representation of an X-ray Tube
STEP-DOWN
TRANSFORME
R
STEP-UP
TRANSFORME
R
Electron
cloud
Radi at i on i s emi t t ed
Window
PRODUCTION OF X-RAYS

Exposure parameters
Posterio Anterior
Kvp = 60 Kw
mA = 60 ma
Lateral cephalogram
Kvp = 60 Kw
mA = 25-40 ma

Profile view:
Distance between Target and subject is 5 feet (152.4cm).
152.4cm
15 cm

P-A projection:
152.4cm
15 cm

Dose: 0.16 r
0.045r ( If 3mm of Alluminium
filter used)
Magnification: 0% near ear rods
24% 60 mm & away from the
ear rods

Requirements
1.Patient sagittal plane in Lateral
cephalogram and Vertical plane in P-A
view should be parallel with film.
2. The Central ray from the tube must pass
through the axis of the ears (porion) and
must strike the X-ray film at right angles
when taking profile view.

Different projections
A. Lateral Cephalogram (profile view):
1. At Occlusion
2. At Rest
3. Mouth wide open
B. Posteroanterior view.
C. Submentovertex (S-V view).

Natural Head position (Downs 1956)
It is a standardized
and reproducible
orientation of the
head in space when
one is focusing on a
distant point at eye
level.

1. Mirror located on a wall directly facing the
patient. The height from the center of the
mirror should be the same distance as the
ear rods of the cephalometer which are kept
at this level by raising the stool which the
patient is seated.
2. Instead of the mirror, place a light source.
3. Ask the patient to sit upright and look at a
distant object at eyelevel.

4. Position of greatest comfort (self balance
method).
5 A true vertical, provided by a radio-
opaque plumb line.
6. Fluid level /Bubble device. (Showfety
1983).
7. Photographic superimposition method
(Ferrara 1994).

Natural Head position (static)
vs
Natural Head posture (Dynamic)
Lundstorm defined natural head posture as
a small range of positions oscillating
around the individual’s mean Natural
Head Position.

Inclinometer attached to spectacles
A switchbox (power source)
Adaptive data logger

Todres JI. Static and Continuing Measurement of
Head posture – A Comparative Investigation.
Johanesburg: University of the Witwatersrand;
1993. Thesis
1. Mean walking head posture positions are
recorded a more extension of head
Compared with mean static head position.
2. Mean walking head posture is found highly
repeatable compared to static head position.

Standardization of Cephalometric
measurements
1. Length of the time intervals between
observations should be constant.
2. The distances between target, subject and film
should be kept constant. X-ray film distanced
of 60inches is most commonly used in the
United States.
3. Position the patient as comfortably as possible
and place the patient in the same relative
position for subsequent roentgenograms. The
left side should be toward cassette for lateral
projections.

4. Consistent occlusal relationships and
postural relationships of the head in
space should be obtained.
5.The ear rods should not interfere with the
position of the patient.
6. Landmarks should be easily
reproducible. Obscured landmarks
should be avoided

7. Motion of the patient or the machine when
the x-ray film is being exposed should be
avoided. The patient should be told to hold
his breath when the film is being exposed.
8.Roentgenographic equipment should be
maintained in good working order.
9.Film exposures and development should
be standardized.
10.The patient should be protected by a
leaded apron and other safety measures
should be used.

Patient protection
1. The patient should not be exposed
unnecessarily.
2. Use of high speed films.
3. Diaphragms or cones shall be used
4. Filtration equal to 2mm of Al, shall be used
with dental X-ray machines.
5. All films shall be processed according to the
direction.
6. Use of lead aprons with thryoid collars for
pregnant women and children.

Tracing Technique

• Lateral or P-A cephalograms
• acetate matte tracing paper [0.003” 8x10”]
• sharp 3 H drawing pencils
• protractor ,tooth symbol tracing template
• dental casts of teeth in occlusion
• viewbox
• sharpner eraser
• black cardboard sheet

Normal Radiographic Anatomy and

The most anterior
point of the fronto
nasal suture in the
median plane
Nasion
(N)

Roof of the orbit
(RO)
Uppermost point on the
roof of the orbit
(Viken Sassouni 1971)

Frontomaxillary nasal
suture (FMN)
The most superior point of the
suture where the maxilla
articulates with the frontal and
nasal bones.
(Robert E Moyers 1988)

Glabella (G)
The height of
curvature of bone
overlying the
frontal sinus

Rhinion (R)
The most anterioinfeior point
on the tips of the nasal bones
as seen from norma lateralis
(Spiro J Chaconas 1969)

Sella (S)
This is the point
representing the
midpoint of the pitutory
fossa
(Sella turcica). It is a
constructed point in the
median plane.

Midpoint of entrance
to the sella (Se)
This point represents the
midpoint of the line
connecting the posterior
clinoid process and the
anterior opening of the sella
turcica. It is independent of
depth of the sella (Schwartz).

Pterygomaxillary
fissure (Ptm)
A bilateral teardrop shaped
area of radiolucency, the
anterior shadow of which
represents the posterior
surfaces of the tuberosities of
the maxilla
(Robert E Moyers 1978)

v
The intersection of the
shadows of the greater
wing of the sphenoid
and the cranial floor as
seen in the lateral
cephalogram.
Sphenoethmoidal (SE)

Basion (Ba)
The median point of the
anterior margin of the foramen
magnum can be located by
following the image of the
slope of the anterior border of
the basilar part of the occipital
bone to its posteiror limit.
(Coben)

Bolton point (Bo)
The highest point in upward
curvature of the retrocondylar
fossa.
(Broadbent 1931)

Opisthion (Op)
The posterior edge of
foramen magnum
(T M Graber 1975)

Orbitale (Or)
The lowest point in the
inferior margin of the orbit,
midpoint between right and
left images (Arne Bjork1947)

Anatomical Porion
(Po-a)
The superior point of the
external auditory meatus(the
superior margin of the
temporomandibular fossa,
which lies at the same level,
may be substituted in the
construction of Frankfort
horizontal)

Machine Porion (Po-
m)
The top of the ear rods shadows,
the external auditory meatus
(Robert E Moyers 1973).

(i) The registration error of Po-a was larger than of Po-m;
(ii) for Po-a the registration error from the 11 year head
films was approximately twice as large as from the 14
year head films; (iii) Po-m was, on average, located ~9
mm below and 2 mm anterior to Po-a; (iv) during the 3
years of observation, Po-m changed its position
downward markedly more than Po-a; (v) due to the
diverging location of machine Porion (Po-m) in relation to
true Porion (Po-a) and the large change of Po-m with
time, the FH was affected considerably. It was concluded
that machine Porion was unsuitable for the construction
of the FH.
The reliability of the Frankfort Horizontal in
roentgenographic cephalometry
H Pancherz and K Gokbuget EJO 1996 18(4): 367-372

Point A
(Subspinale)
The point at the deepest
midline concavity on the
maxilla between the anterior
nasal spine and prosthion
(Downs 1948)

Point A revisited- Jacobson and
Jacobson AJO jan 1980;77: vol 1
A point is plotted 3mm labial to point A
between the upper third and lower two
thirds of the long axis of the root of the
maxillary central incisors was found to be
a suitable point through which to draw the
NA line and one which most closely
approximates the true NA plane

Anterior nasal spine
(ANS or Spinal point)
This is the tip of the bony
anterior nasal spine, in the
medial plane. It corresponds
to the anthropometrical point
acanthion.

APMax
Anterior point for
determining the length of
the maxilla- this is
constructed by dropping a
perpendicular from point A
to the palatal plane
(Rakosi)

Key Ridge (KR)
The lowermost point on the
contour of the shadow of the
anterior wall of the
infratemporal fossa.
(Viken Sassouni 1971)

Prosthion (Pr)
The lowest and most anterior point
on the alveolar portion of the
premaxila, in the median plane,
between the upper central incisors

Posterior nasal spine
(PNS)
The intersection of a
continuation of the anteror wall
of the pterygopalatine fossa
and the floor of the nose,
marking the dorsal surface of
the maxilla at the level of the
nasal floor, which resembles
the dorsal surface of the
maxilla at the level of nasal
floor

pm
pog

APMan
Anterior landmark for determining
the length of the mandible. It is
defined as the perpendicular
dropped from Pog to the
mandibular plane.

Articulare (Ar)
The point of intersection of
the images of the posterior
border of the condylar
process of the mandible
and the inferior border of
the basilar part of the
occipital bone (redefined
by coben after Bjork)

Point B
(sm-supramentale)
The point at the deepest
midline concavity on the
mandibular symphysis
between infradentale and
pogonion(Downs 1948)

Condylion (cd)
The most superior point on
the head of the condylar
head.

Gnathion (Gn)
This is the most anterior
point on the alveolar
process, in the median
plane between the
mandibular central incisors.

Gonion (Go)
The constructed point of
intersection of the ramus
plane and the mandibular
plane

Infradentale (Id)
The highest and most anterior
point on the alveolar process,
in the median plane between
the mandibular central incisors

Menton (Me)
The most inferior
midline point on the
mandibular symphysis.

Pogonion (Pog)
The most anterior
point of the bony chin
in the median plane.

Point D
A point at the center of the
mass of the symphysis(Cecil
C.Steiner 1959)

Point C
At the center of the condyle
(Cecil C Steiner1953).

Genion (Ge)
The most inward and
everted point on the profile
curvature of the symphysis
of the mandible.
(Mentale-Bimler)

Superorbital line
A line from the anterior
clinoid process along
the roof of the orbits,
bounded anteriorly by
the frontal bone and
posteriorly by the
sphenoid bone

SOFT TISSUE
LANDMARKS

menton soft tissue
(ms)
The constructed point of
intersection of a vertical co-
ordinate from menton and
the inferior soft tissue
contour of the chin.

pogonion soft tissue
(pos)
The most prominent point
on the soft tissue contour of
the chin

inferior labial sulcus
(ils)
The point of greatest concavity
in the midline of the lower lip
between labrale inferius and
menton

labrale inferius (li)
The median point in the
lower margin of the lower
membranous lip

labrale superius
(ls)
The median point in the
upper margin of the upper
membranous lip

stomion inferius
(sti)
The highest point of the
lower lip

stomion(st)
The midpoint between stomion
superius and stomion inferius

stomion superius
(sts)
The lowest point of the
upper lip.

superior labial sulcus
(sls)
The point of greatest
concavity in the midline of
the upper lip between
subnasale and labrale
superius

subnasale(Sn)
The point where the lower
border of the nose meets the
outer contour of the upper lip

pronasale (pn)
The most prominent point
of the nose

e
The most anterior point on
the end of the nose
(Robert M.Ricketts 1960)

nasion soft tissue
(ns)
The point of deepest
concavity of the soft
tissue contour of the root
of the nose.

Glabella (G)
The most prominent
point in the
midsagittal plane of
forehead

It is the point on the
hairline in the midline of
the forehead
(Leslie G.Farkas 1981)
Trichion (tr):
tr

FRONTAL
CEPHALOGRAM
LANDMARKS

The highest point in the
antegonial notch
antegonion(ag)

condylar (cd)

anterior
nasal spine
(ans)

The most superior point of
the coronoid process
coronoid (cor)

The midpoint between the
mandibular central incisors at
the level of the incisal edges
incision inferior frontale
(iif)

The midpoint between the
maxillary central incisors at the
level of the incisal edges
incision superior frontale
(isf)

The most lateral aspect of the
piriform aperture
Lateral piriform aperture
(lpa)

The intersection of the lateral
orbital contour with the
innominate line
latero-orbitale (lo)

It is located by
projecting the mental
spine on the lower
mandibular border,
perpendicular to the
line ag-ag
mandibular midpoint
(m)

The most prominent lateral
point on the buccal surface of
the second deciduous or first
permanent mandibular molar
mandibular molar (lm)

The lowest point of the
mastoid process
Mastoid (ma)

The intersection of the lateral
contour of the maxillary alveolar
process and the lower contour of
the maxillozygomatic process of
the maxilla
Maxillare (mx)

The most prominent lateral
point on the buccal surface of
the second deciduous or first
maxillary molar
maxillary molar (um)

The point on the medial
orbital margin that is closest
to the median plane
medio-orbitale (mo)

The centre of the
mental foramen
mental foramen(mf)

The projection on the line
lo-lo of the top of the
nasal septum at the base
of the crista galli
orbital midpoint
(om)

Point at the most
lateral border of the
centre of the zygomatic
arch
zygomatic arch
(za)

The highest point on the
superior aspect of the
nasal septum
top nasal septum
(tns)

point at the medial margin of
the zygomaticofrontal suture
zygomaticofrontal
medial suture point-in
(mzmf)

Point at the lateral
margin of the
zygomaticofrontal suture
zygomaticofrontal
lateral suture point-
out (lzmf)

Relation of A- point
(Infraspinale) to B- Point
(Supramentale).
It represents the anterior points
of the basal arches of the jaws
to one another and to the facial
line.
A-B line

A-pog line

Glabella to opisthion.
Anonymous line

Broadbent-Bolton
Line
Nasioin to upper most
point on occipital
postcondylar fossa
(Bolton point)

Cranial Base length
Nasion to Bolton point

Bjork’s line
Nasion to the point on the
profile roentgenogram where
the posterior border of the
posterior border of the condyle
intersects the contour of the
temporal bone.

Blumenbach’s
plane
The plane drawn
through the points on
the skull, without the
mandible, which touch
a flat horizontal
surface

Broadbent’s line
Nasion to sell turcica
midpoint on the
profile
roentgenogram

Broca’s line
Prosthion (the tip of the
alveolar septum between
the maxillary central
incisors) to lowest point on
the occipital condyle when
the skull is resting on
horizontal surface

Camper’s line
A line from the tip of the
anterior nasal spine (ANS) to
the external auditory meatus

Camper’s Plane
Tip of anterior nasal
spine (acanthion) to the
center of the bony
external meatus on the
right and left sides.

Camper’s triangle
Camper’s line and line
tangent to the facial profile

De Coster’s line
The plano-ethmoidal
line from the anterior
contour of sell turcica
to the roof of the
cribriform plate and
the internal plate of
the frontal bone

Facial line
A line from nasion to Pogonion

At the 13 th Anthropological
congress held at Frankfurt,
Germany 1884, Von Ihering’s Line
introduced in 1872, was accepted
as what is now know as Frankfurt
Horizontal.

Frankfort Horizontal
(FH plane)
Plane intersecting right and
left porion and left orbitale. It
is drawn on the profile
roentgenogram or photograph
from the superior margin of
the acoustic meatus to
orbitale.

Pterygoid true
vertical

Hamy’s Line
The most anterior point
on the frontal bone
(glabella)to the
intersection of the sagittal
and lambdoidal sutures
(lambda)

His’s line
Extends from tip of the
anterior nasal spine
(acanthion) to the hindmost
point on the posterior margin
of the foramen magnum
(opisthion) and divides the
face into an upper and a
lower, or dental part

Huxley’s line
Nasion to the most
forward point on the
anterior margin of the
foramen magnum
(basion)

Facial axis

Margolis Line
Nasion to top of
spheno occipital
synchondriosis

Martin’s line
Nasion to the most elevated
point on the external occipital
protuberance (inion).

Montagu’s plane
Nasion to the most lateral
points on the roof of the
bony external auditory
meati (porion)

Line joining center of
sella and nasion as
seen on the profile
roentgenogram
S-N line

McNamara Jr. Components of class
II malocclusion in children 8-10 yrs
of age AO 1981; 51: 177-202
• His data sowed marked differences in the
maxillary development of patients with Cl
II div 1 type of malocclusion.
• The range covers maxillary prognathism
and retrognathism which should not be
encountered in this malocclusion.
• Only 23.8% showed an ideal SNA while
50% showed a retruded SNA and 26.2%
showed the appropriate prognathic values.

Occlusal plane(Occ)
The occlusal plane of the
teeth. A line drawn
between points
representing one half of
the incisor overbite and
one half of the cusp height
of the last occluding
molars.

Orbital plane(OP)
Perpendicular to Frankfort
plane at the orbitale

Palatal plane
From the anterior nasal spine to
the posterior nasal spine

Ricketts Esthetic line
A tangent to the tip of the nose
and the most anterior point on
the chin

Steiner’s S-Line
Line joining soft tissue pogonion
and mid point of s-shaped curve
between subnasale and nasal
tip.

Holdaway’s H- line
Line joining soft tissue pogonion
and labrale superioris

S-B.P Line
connects sella with
the Bolton point.
This line indicates
the posterior portion
of the cranial base

Salzmann’s basal
arch
The basal arch is the area in
the jaws which begins at the
most constricted point on the
body of the maxilla and of the
mandible when seen on the
profile cephalogram. It
includes Downs A point
(subspinale) and B point
(supramentale), Axel
Lundstrom’s apical base, and
extends around the jaws at
the most constricted portions
parallel to the alveolar
processes

Registration point
[R]
It is the midpoint
on a perpendicular
Line from the center
of
Sella turcica to the
Bolton-nasion line

MANDIBULAR
PLANE

Applications of Cephalometrics

1. Diagnosis & Treatment planning
• Assessment using ceph analysis
– The superimposition a most suitable method
but can only be used in relation to a serial
study for an individual.
– For group studies it is better to use the
Reference planes like SN plane and FH plane
along with linear and angular measurements.

• Comparison using ceph analysis
– The assesment of craniofacial patterns
between different races, different age groups,
sexes and dental occlusion.
– To compare the effect of two or more different
mechanotherapeutic approaches on jaws and
teeth.

• Cephalometrics can be used to assess the
spatial relationships. (Localization of
Malocclusion).
– Relationships between the cranium and jaws
– Relationships between the jaws themselves
– Relationship between the chin and the
mandible.
– Relationship of the incisors to the jaw bases
and the planes of reference with regard to
axes and position.
– Relationhips of the facial thirds to each other.

-Cephalometrics can be used to assess the tongue
position in the cranium and its relationship to the
various dentoskeletal structures.
-Cephalometrics can be used to assess the glide
and rotatory movements in the closing of the
mandible and it is termed functional analysis.
-Cephalometrics can assess the patency of the
airway .
-It is also used to asses the lip incompetency with
regard to incisal position and angulation in the
craniofacial complex.

2. Prediction of surgical treatment outcome
• A lat ceph can be used to predict the line of treatment vis
surgery.
• A number of factors must be considered before the
prediction can be accurate and they are :-
– Age.
– Sex.
– Race.
– Facial type.
– Malocclusion type.
– Spatial relatonships of the different parts of the face.
– Growth prognosis: No method has yet been devised to
accurately record this and predict the future changes.

• Cephalometrics is a useful tool to evaluate
the stage of treatment that the patient is
in.
• Many clinicians revaluate the case during
treatment with cephalometrics to see if the
treatment plan needs modification.
• The clinicians call it “Re-analysis”.www.indiandentalacademy.com

3. Cephalometrics and Growth
• To evaluate the remaining growth through the
comparison of chronological and biological
growth.
• To determine the time frame for growth spurts.
• To determine the direction of growth.
– To assess whether interception is required during the
mixed dentition period.
– To assess mandibular morphology for growth signs.

• To assess the rate of growth through a
comparison with standard measurements
considering age and sex.
• To predict growth which is complex and even
areas of quiescence will show change during
orthodontic treatment with the following
methods.

Methods of prediction
– Johnston’s method – Through the use of a
forecast grid which when placed on a ceph
can aid in growth prediction. It is said to be
65% accurate.
– Broadbent, Kilpatrick and Jacobsen
discovered an annual increase in size based
on growth using SN as the reference.

– Ricketts- arcial growth pattern for short term
prediction to distinguish between horizontal
and vertical growth pattern and is 80%
reliable.
– Moorees and Herbert used the mesh co-
ordinate system to help predict growth
pattern.

Growth Prediction Errors
• Growth prediction vs Weather forecast
• Growth based on certain data but numerous
unknowns:-
– Variable growth rate in various locations.
– Growth pattern in it entirety not fully taken into
account.
– The effect of persistent dysfunction on form and
function.
– The effect of age on growth (direction of growth
changes as age increases)
– The effect of discontinuation of habits or change of
functional environment on growth.

Limitations of cephalometry
1. Radiation hazards
2. Image enlargement and distortion
3. Equipment limitatons
4. Patient educaton is tough.
5. 2-D registration of Data.
6. Technique sensitivity.
7. Time

Advances in
Cephalometric Analysis

• Came to be, due to the inefficiency of hand
tracing such as:-
– Increased time.
– Difficulties in data presentation for patient
education.
– Image enlargement and distortion.
– Patient exposure to radiation.
– Chemical hazards due to developing.
– The limitations of a 2D image.

Digitization
Graphical information of cephalogram is
converted into numbers which can be
stored retrieved and manipulated on the
computer. It is done by a digitizing tablet
or On-screen digitizaztion.

– Digitizing tablet- A pen or stylus is used on a
writing surface or tablet. The stylus converts
the graphical format into a digital format.
– On-screen digitization- A ceph is fed into the
computer and a mouse is used to digitize the
image.

Advantages of Digitization
• The superimpositions of different
exposures can be done much more
efficiently.
• More advantageous to the clinician for
patient education.

Method for Patient Education
• Paste a ceph on a wall
• Project a photo on to the ceph till the
borders match.
• Trace the photos on a blank tracing sheet.
• Superimpose the ceph on the photograph.
• Construct the relevant hard and soft tissue
changes.
• Final picture is readied which can even be
superimposed on an old photograph.

Video Imaging
• The imaging software allows for movements of
various sections in the image thereby simulating
the expected profile or frontal changes.
• Advantage- Quantification of the treatment plan
thereby improving the chances of achieving the
proposed treatment plan.
• Disadvantage- Inability to let the clinician view
the underlying dento-osseous relationships.

Method of Video Imaging
• Graphic Imaging softwares were used to modify
image.
• Co-ordination of calibrated profile images with
facial profile images to permit precise
measurements of bony and dental movements.
• The application of logarithmic prediction ratios to
produce images that expose the expected
surgical and orthodontic outcome.

Digigraphy
• Created by Dr. Marc Lenscher and Mr.
Gary Engel
• Based on a videoimaging computer
capable of generating 2D and 3D facial
analyses.

Components:-
Computer
Monitor
Keyboard
RGB video camera with light source
Sonic digitizing probe with receptor
phones capable of producing any ceph
landmark in 3D.www.indiandentalacademy.com

Disadvantages of Digigraphy
• Increased cost .
• The technology is still in its primitive
stages.

Xeroradiography
Started for the evaluation of breast lesions,
however in dentistry it is used to evaluate
the larynx and TMJ.
• Uses Se coated Al pates in a plastic
cassette, when charged it becomes
sensitive.

Xeroradiography
• Advantages:-
– Can be viewed without transillumination
– Radiograph need not be traced.
– Density of soft and hard tissue directly
displayed over head film.
– Image quality is superior with a high degree of
contrast and an edge enhancement effect
(mirror image).

Conclusion
Cephalometrics has given us a way of
placing the historical dental problem within
the dentofacial complex. Inspite of its
complexity and limitations, cephalometrics
can be a potential diagnostic tool if used
logically.

Conclusion
The future of cephalometrics as it becomes
more integrated with computer technology
is inordinately bright. Currently though not
feasible the promise of cephalometrics as
a diagnotic and prognostic tool may yet be
fulfilled.

Bibliography
• Jacobson: Radographic Cephalometry: From Basics to
Videoimaging, Quintessence publishing company, 1995.
• Athanasiou:Orthodontic Cephalometry, Mosby-Wolfe
publishing company, 1995
• Rakosi: Atlas and Manual of Cephalometric
Radiography, Wolfe medical publications, 1982
• Miyashita& Dixon: Contemporary Cephalometric
Radiography, Quintessence publishing company, 1996.
• Poddar &Bhagat: Handbook of Osteology, 10th
edition,
Scientific book company, 2001.

Bibliography
• Moyers & Bookstein :The inappropriateness of conventional
cephalometrics, JCO, vol 75 : pg 599-617 June 1979.
• Roth: The Wits’ Appraisal- its skeletal and dento-alveolar
background, EJO, vol 4: pg 21-28, 1982.
• Ricketts: The biologic significance of the divine proportion and the
fibonacci series, AJODO, vol 81:pg 351-71, 1982.
• Jacobson: Point A revisited, AJODO, vol77: pg92-96,1980.
• Ricketts: Perspectives in the clinical application of cephalometrics :
the first fifty years, AO, vol 51: pg 115-149, 1981.
• Braun, Rudman et al: C-axis:a growth vector for the maxilla,AO, Vol
69: pg539-42,1999.
• Braun,Kittleson et al: the G axis : a vector for the mandible, AO, Vol
74: pg 328-31, 2004.
• DeCoster: The network method of orthodontic diagnosis, AO, Vol 9 :
pg3-14, 1939

Bibliography
• Jacobson, Evans et al: Mandibular prognathism,
AJODO,Vol66: pg140-171, 1974.
• Showfety, Vig et al: A simple method for taking natural
head position cephalograms, AJODO, Vol 83: pg 495-99,
1983.
• Steiner: Cephalometrics for you and me, AJODO, Vol
39: pg 729-755, 1953.
• Chaconas: A statistical evaluation of nasal growth,
AJODO, Vol 56: pg 403-7, 1969.
• Finlay: Craniometry and Cephalometry- A history prior to
the advent of Radiography, AO, Vol 50: pg 312-21, 1980.
• Seward: Relation of Basion to Articulare,AO, Vol 51:
pg151-71, 1981.

Bibliography
• Broadbent: Developing Dental patterns, AO, Vol 51: pg 86-88, 1981.
• Todd: The orthodontic value of research and observations in the
developmental growth of the face, AO, Vol 51: pg 93-114, 1981.
• Nagasaka, Fujimura et al: Development of a non-radiographic
cephalometric system, EJO, Vol 25: pg 77-85, 2003.
• Fatouros, Gibbs et al: Imaging characteristics of new screen/film
systems for cephalometric radiography, AO, Vol 54: pg 36-54, 1984
• Tsang & Cooke: Comparison of cephalometric analysis using a non-
radiographic sonic digitizer(Digigraph Workstation) with
conventional radiography, EJO, Vol 21: Pg 1-13, 1999
• Lowey: The development of a new method of cephalometric and
study cast mensuration with a computer controlled Video image
capture system: part I, BJO, Vol 20: pg 203-213, 1993.
• Johnson: Xeroradiography for cephalometric analysis, AJODO, Vol
59: pg 524-6, 1976.

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Basic cephalometry

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