Cephalometric is the key ingredient to the serving of orthodontic diagnosis and treatment planning. However, compilation of all parameters, that would give the accountability of all vertical problems of a given malocclusion is rarely found. This presentation is an attempt to help students to go through all existing problems in a orthodontic patient in vertical plane at one go.

1. Cephalometric
analysis of vertical
parameters
Dr. Shriya P. Murarka
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2. Title and Content Layout with List
• Introduction
• Sassouni’s classification of facial types
• Moyer’s classification of malocclusion
• Vertical maxillary excess
• Composite analysis of vertical Parameters
• Sassouni’s Analysis
• Di Paolo Quadrilateral analysis 1984
• Centographic analysis
• Conclusion
• References
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3. INTRODUCTION
• The most popular classification of malocclusion (that introduced by
Angle) was defined in the anteroposterior dimension.
• In recent years clinical experience and research have brought to
light the close interdependence, in three dimensions of space, of
facial proportions.
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Biggerstaff RH, Allen RC, Tuncay OC, Berkowitz J. A vertical cephalometric analysis of the human craniofacial
complex. American Journal of Orthodontics. 1977 Oct;72(4):397–405

4. • The sources of vertical (deep-bite
and open-bite) and transverse
(skeletal cross-bites) dysplasias are
not easily detected and quantified.
• With the addition of a vertical
analysis to the diagnostic data base,
the orthodontist can formulate the
treatment plan necessary to correct
the problem, mask it, or correct and
mask it in combination.
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Biggerstaff RH, Allen RC, Tuncay OC, Berkowitz J. A vertical cephalometric analysis of the human craniofacial
complex. American Journal of Orthodontics. 1977 Oct;72(4):397–405
Improved Diagnosis and treatment
planning
Transverse
Saggital
Vertical

5. Sassouni’s classification of facial types
Sassouni, V. (1969). A classification of skeletal facial types. American Journal of Orthodontics, 55(2), 109–
123. doi:10.1016/0002-9416(69)90122-5
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7. Moyers
classification
of Class II
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Moyers RE, Riolo ML, Guire KE, Wainright RL, Bookstein
FL. Differential diagnosis of Class II malocclusions.
American Journal of Orthodontics. 1980 Nov;78(5):477–
94.
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8. Moyers
classification of
Class III
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9. Long face Syndrome/ Vertical Maxillary Excess
1.
Schendel SA, Eisenfeld J, Bell WH, Epker BN, Mishelevich DJ. The long face syndrome: Vertical maxillary
excess. American Journal of Orthodontics. 1976 Oct;70(4):398–408.
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A clinically recognizable facial morphology, the long
face syndrome, is manifested primarily by
excessive lower vertical facial height.
Although this dysmorphology has been most
commonly classified as a skeletal type of open-bite,
it is apparent that the syndrome has been
discussed under numerous other titles.

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Cephalograms of patients clinically diagnosed as having
the long face syndrome were analyzed .Certain typical
cephalometric features were identified :
1. The total anterior face height was increased,
specifically, the lower face height.
2. The increased face height correlated with excess
development of the maxilla in a vertical direction.
3. Open-bite and non-open-bite are two variants of the
long face syndrome.
(A) A normal ramus height existed in the open-bite
patients.
(B)An increased ramus height was seen in non-open-bite
patients.
4. A high mandibular plane angle was characteristic of
both groups.
5. A normal upper lip length with an excess display of the
anterior maxillary teeth was found in both study groups.

11. Variations of VME
1.
Schendel SA, Carlotti AE. Variations of total vertical maxillary excess. Journal of Oral and Maxillofacial
Surgery. 1985 Aug;43(8):590–6.
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FIGURE 2 Total maxillary excess group: the vertical
maxillary excess and vertical chin excess present are
shown by the shaded areas. A Class II malocclusion
secondary to mandibular deficiency was also present
in this group.
FIGURE 3 Short lip group. This group, while
displaying an excessive amount of incisor, actually
had a deficiency of soft tissue. Confusing the picture
and giving the appearance of a long face was vertical
chin excess (shaded area) and a Class II malocclusion.
The mandibular deficiency was partly compensated
by a forward position of the glenoid fossa.

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FIGURE 4. Total maxillary excess with premaxillary abasement. This group had
vertical maxillary excess and chin excess, as shown by the shading. However, the
anterior excess was exaggerated by a lowering of total premaxillary segment from
the ideal position. The mandibular deficiency was compensated by a forward,
inferior position of the glenoid fossa.
FIGURE 5 Maxillary excess with palatal rotation. This group had maxillary
vertical excess and a clockwise rotation of the total palate-premaxillary complex.
The counter-clockwise rotation is shown here. Vertical chin excess and
mandibular deficiency are also seen in these patients.

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FIGURE 6 Maxillary excess with abasement of the posterior palate. This group was characterized by
vertical maxillary excess and lowering of the posterior palate. In the example shown, chin excess and a
Class II malocclusion are also present. Shaded areas represent areas of excess.
FIGURE 7Maxillary excess with premaxillary elevation. In this group. posterior vertical maxillary excess is
greatest because the premaxillary segment is generally rotated superiorly. resulting in a normal lip-to-
tooth relationship. Open bite is frequently present, as is vertical chin excess. Areas of excess are shaded
and the premaxillary elevation is marked by cross lining.
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14. COMPOSITE ANALYSIS
GROWTH PATTERN
Measurements Mean value Inference Analysis
Go-Gn to SN 32 ̊ Steiner’s
Mandibular palne angle 21.9 ̊̊ Down’s
FMPA 25 ̊̊ Tweed’s
Y- Axis 59 ̊̊ Down’s
Facial axis angle 90 ̊ Rickett’s
Jarabak’s Ratio 60-65 ̊ Rakosi Jarabak
Articular angle 143±6 ̊̊ Rakosi
Gonial angle 128±7 ̊ Rakosi
Upper gonial angle 52-55 ̊ Rakosi
Lower gonial angle 72-75 ̊̊ Rakosi 12/19/2020Add a footer

15. COMPOSITE ANALYSIS
POSITION OF MOLARS
Measurements Mean value Analysis
U6 To NF 26.2-23 mm Burstone
L6 to MP 35-32 mm Burstone
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16. COMPOSITE ANALYSIS
OCCLUSAL PLANE
Measurements Mean value Analysis
Occlusal plane to SN 14 ̊ Steiner’s
Cant of Occlusal plane 9.3 ̊̊ Down’s
Pn to Occlusal plane 75 ̊ Rakosi
Palatal to Occlusal plane 110 ̊ Rakosi
Occlusal to mandibular
plane
14 ̊ Rakosi
Basal plane angle 25 ̊ Rakosi
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17. 396+/-60
122+144+130=396+/-60
Given by Bjork
>3960 –vertical growth
<3960 –Horizontal
growth
Sum of Posterior Angles
• An Atlas and Manual of Cephalometric Radiography; T. Rakosi, Wolfe Medical Publications.
Bjork (1947)
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19. Anterior face height- N-Me
Posterior face height- S-GO
Post face height X100 = 62-65%
Anterior face Height
Anterior and Posterior face
Height
• Dentofacial Orthopaedics WITH FUNCTIONAL APPLIANCES; t.m. Graber, Rakosi, A.P. Petrovic,2nd edition,
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22. Sassouni analysis (1955)
A ROENTGENOGRAPHIC CEPHALOMETRIC SNALYSIS OF
CEPHALO-FACIO-DENTAL RELATIONSHIPS
PIKEN SASSOUNI; 1955
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Anterior Arc.-The arc of a circle, between anterior cranial
base plane and mandibular plane, with 0 as center and 0-
ANS as radius.
Posterior Arc.-The arc of a circle, between anterior cranial
base planeand mandibular base plane, with 0 as center
and OSp as radius.
(Sp is the most posterior point on the rear margin of sella
turcica.)

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Vertical Proportions.-comparison of lower face (below the palatal plane) to upper
face.
I. Equal: The distance from ANS to the mandibular plane is equal
to the distance from ANS to the cranial base plane, on the arc
II. Minus: Where the lower face is smaller than the upper face (Fig.
III. Plus: Where the lower face is larger than the upper face
The classification is based on ANS for the anterior face and PNS for the
posterior face.

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25. The quadrilateral analysis 1984
Di Paolo, R. J., Philip, C., Maganzini, A. L., & Hirce, J. D. (1984). The quadrilateral analysis:
A differential diagnosis for surgical orthodontics. American Journal of Orthodontics,
86(6), 470–482. doi:10.1016/s0002-9416(84)90353-1
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The quadrilateral
analysis indicates that in a balanced facial pattern
a 1: 1 ratio exists between the maxillary bony base
length (Max.Lth.) and the mandibular bony base
length (Mand.Lth.);
the average of the anterior lower
facial height (ALFH) and posterior lower facial
height (PLFH) equals these bony base lengths. S
the Max.Lth. = Man.Lth. = ALFH ± PLFH
2

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30. Centographic analysis (1997)
Fishman, L. S. (1997). Individualized evaluation of facial form. American Journal of Orthodontics and
Dentofacial Orthopedics, 111(5), 510–517. doi:10.1016/s0889-5406(97)70288-9
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A centroid represents the center of mass or
gravity of a two-dimensional area or a three-
dimensional volume.
The most convenient centroid construction
method for a triangle involves the intersection of
two or three planes derived by connecting a
triangular vertex to the midpoint of the opposing
side.
An important characteristic of centroids is that
they change minimally in position as a triangle
increases in size and shape. Points located on
the periphery of an enlarged area, such as
traditionally used cephalometric landmarks, alter
positionally more than their representative
centroids.

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Cephalomorphic is a more appropriate term than
cephalometric to use, as it implies a
nonnumerical analysis of morphologic shape
and position.

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harmonious
Upper centroid
discrepancy
Lower centroid
discrepancy

34. Conclusion
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To have a meaningful value for clinical purposes, a cephalometric analysis must
combine the basic knowledge of facial architecture with the functional components
of the masticatory apparatus, with the genetic growth potential, and with the
possibilities and limitations of orthodontic treatment, but at the same time it must
not exclude esthetic and social considerations.

35. • 1. Sassouni V, Nanda S. Analysis of dentofacial vertical proportions. American Journal of
Orthodontics. 1964 Nov;50(11):801–23.
• 2. Sassouni and Nanda - 1964 - Analysis of dentofacial vertical proportions.pdf.
• 3. Felicita As, Chandrasekar S, Shanthasundari K. Determination of craniofacial relation among
the subethnic Indian population: A modified approach (vertical evaluation). Indian Journal of
Dental Research. 2013;24(4):456.
• 4. Bock JJ, Fuhrmann RAW. Evaluation of Vertical Parameters in Cephalometry. Journal of
Orofacial Orthopedics / Fortschritte der Kieferorthopädie. 2007 May;68(3):210–22.
• 5. Biggerstaff RH, Allen RC, Tuncay OC, Berkowitz J. A vertical cephalometric analysis of the
human craniofacial complex. American Journal of Orthodontics. 1977 Oct;72(4):397–405.
• 6. Ahmed M, Shaikh A, Fida M. Diagnostic performance of various cephalometric parameters
for the assessment of vertical growth pattern. Dental Press Journal of Orthodontics. 2016
Aug;21(4):41–9.
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36. THANKYOU
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