This document provides an overview of cephalometrics including:
- Definitions of cephalometrics as the scientific measurement of the bones of the cranium and face using lateral radiographs.
- The goals of cephalometrics which are to evaluate relationships between the five major facial components.
- Types of cephalometric landmarks including anatomical, derived, hard tissue, and soft tissue landmarks.
- Examples of important cephalometric landmarks such as nasion, orbitale, pogonion, sella, point A, and point B.
- Classification of cephalometric lines and planes as horizontal or vertical including planes such as the SN plane, Frankfort horizontal, and mandibular plane.
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Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of pertinent data in a systemic manner to help in the identifying the nature and cause of the problem.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Cephalometry and cephalometric analysis
For general practitioners
Prepared by
Dr M. Alruby
The assessment of cranio- facial structures forms a part of orthodontic diagnosis. The discovery of X-rays in 1895 by Roentgen revolutionized dentistry. It provided a method of obtaining the inner cranio – facial measurements with quite a bite of accuracy and reproducibility. In 1922 Paccini standardized the radiographic head images by positioning the subjects against a film cassette at a distance of 2 meters from the X-ray tube. In 1931 Broadbent in USA and Hofrath in Germany simultaneously presented a standardized cephalometric technique using a high powered X-ray machine and head holder called cephalostat. The term cephalometrics is used to describe the analysis and measurements made on the cephalometric radiographs.
Cephalogram: standardized radiograph of the head and face
Standardization:
= presence of head orientation for all subjects and for the same subject in the serial studies. =The target film distance was 60 inches= 5 feet = 180 cm.
=from film to midsagittal plane= 15 cm.
= the exposure time varies according to the age of the patient and usually from 1/2 to 3/4 second.
Important of standardization:
1-Make it possible to study facial growth by taking a serial radiographs in a standard manner, thus any changes incorporated by growth can be detected.
2-Make it possible to localize the disease and the site of dentofacial deformities.
3-Comparisons of cephalograms before and after treatment thus the changes due to treatment can be detected.
Uses of cephalometrics in orthodontics:
1-Classification of dental and skeletal abnormalities.
2-growth studies.
3-Aids in treatment planning.
4-Evaluation of effectiveness of various orthodontic procedures.
5-Evaluation of effectiveness of retention.
6-Evaluation of growth changes after treatment was completed.
Limitation, disadvantage of cephalometric:
1-It is two dimensional representations for three dimensional structures.
2-Superimpostion.
3-Degree of reliability of landmark as measuring points is still uncertain.
4-Locate the site of discrepancy but do not reveal the basic etiologic factors.
5-Magnification, Distortion and Blurring.
Magnification:
Proportional enlargement of all parts of structure in the Cephalometry. This error occurs because the X-ray beams are not parallel with all points of the object. We can minimize this error by using a long focus- object distance and a short film – object distance and by use of angular rather than linear measurements.
Distortion:
Lack of exact reproduction of a structure in the term of proportion. Magnification occurs when all parts of structure are increase proportionally, while in distortion, the different parts of structure are not increase proportionally. In lateral film, the only structure that not distorted are those situated on the midsagittal plane (midline structure) while, all other bilat
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of pertinent data in a systemic manner to help in the identifying the nature and cause of the problem.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cephalometry and cephalometric analysis
For general practitioners
Prepared by
Dr M. Alruby
The assessment of cranio- facial structures forms a part of orthodontic diagnosis. The discovery of X-rays in 1895 by Roentgen revolutionized dentistry. It provided a method of obtaining the inner cranio – facial measurements with quite a bite of accuracy and reproducibility. In 1922 Paccini standardized the radiographic head images by positioning the subjects against a film cassette at a distance of 2 meters from the X-ray tube. In 1931 Broadbent in USA and Hofrath in Germany simultaneously presented a standardized cephalometric technique using a high powered X-ray machine and head holder called cephalostat. The term cephalometrics is used to describe the analysis and measurements made on the cephalometric radiographs.
Cephalogram: standardized radiograph of the head and face
Standardization:
= presence of head orientation for all subjects and for the same subject in the serial studies. =The target film distance was 60 inches= 5 feet = 180 cm.
=from film to midsagittal plane= 15 cm.
= the exposure time varies according to the age of the patient and usually from 1/2 to 3/4 second.
Important of standardization:
1-Make it possible to study facial growth by taking a serial radiographs in a standard manner, thus any changes incorporated by growth can be detected.
2-Make it possible to localize the disease and the site of dentofacial deformities.
3-Comparisons of cephalograms before and after treatment thus the changes due to treatment can be detected.
Uses of cephalometrics in orthodontics:
1-Classification of dental and skeletal abnormalities.
2-growth studies.
3-Aids in treatment planning.
4-Evaluation of effectiveness of various orthodontic procedures.
5-Evaluation of effectiveness of retention.
6-Evaluation of growth changes after treatment was completed.
Limitation, disadvantage of cephalometric:
1-It is two dimensional representations for three dimensional structures.
2-Superimpostion.
3-Degree of reliability of landmark as measuring points is still uncertain.
4-Locate the site of discrepancy but do not reveal the basic etiologic factors.
5-Magnification, Distortion and Blurring.
Magnification:
Proportional enlargement of all parts of structure in the Cephalometry. This error occurs because the X-ray beams are not parallel with all points of the object. We can minimize this error by using a long focus- object distance and a short film – object distance and by use of angular rather than linear measurements.
Distortion:
Lack of exact reproduction of a structure in the term of proportion. Magnification occurs when all parts of structure are increase proportionally, while in distortion, the different parts of structure are not increase proportionally. In lateral film, the only structure that not distorted are those situated on the midsagittal plane (midline structure) while, all other bilat
The Middle Third Of The Facial Skeleton Is Defined As An Area Bounded,
Superiorly –Line Drawn Across The skull from the Zygomatico frontal Suture across the Frontonasal & Frontomaxillary sutures to the Zygomaticofrontal suture on the opposite side
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
It is made up of the following bones:
1. Two maxillae
2. Tw o palatine bones
3. Two zygomatic bones and their temporal processes
4. Two zygomatic processes of the temporal bone
5. Two nasal bones
this presentation describes about each bone individually and its applied anatomy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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3. INTRODUCTION
Origin: ‘Cephalo’ means head and ‘Metric’ is
measurement
Discovery of X-rays measurement of the head
from shadows of bony and soft tissue
landmarks on the roentgenographic image ,
known as the Roentgenographic cephalometry.
4. DEFINITIONS
“The scientific measurement of the bones of the cranium
and face, utilizing a fixed, reproducible position for lateral
radiographic exposure of skull and facial bones” -- Moyers
“ A scientific study of the measurements of the head with
relation to specific reference points; used for evaluation of
facial growth and development, including soft tissue
profile” -- Grabers
5. GOALS OF CEPHALOMETRICS
To evaluate the relationships, both horizontally and
vertically, of the five major functional components of
the face:
The cranium and the cranial base
The skeletal maxilla
The skeletal mandible
The maxillary dentition and the alveolar process
The mandibular dentition and the alveolar process
-- Jacobson
6. CEPHALOMETRIC LANDMARKS
cephalometric landmarks are readily recognizable
points on a cephalometric radiograph or tracing,
representing certain hard or soft tissue anatomical
structures (anatomical landmarks) & (constructed
landmarks).
7. Requirement of Cephalometric
Landmarks
It should be easily seen in radiograph.
It should be uniform in outline and should be
reproducible.
The landmarks should permit valid quantitative
measurements of lines and angles projected
from them.
8. TYPES OF CEPHALOMETRIC
LANDMARKS
Two types of Cephalometric landmarks are :
1. ANATOMICAL LANDMARKS –These landmarks represent
actual anatomic structures of the skull.
1. DERIVED LANDMARKS – These are the landmarks that have
been obtained secondarily from anatomic structures in a
cephalogram.
9. BASED ON TISSUE :
Landmarks can also be classified into :-
1.HARD TISSUE LANDMARKS
2.SOFT TISSUE LANDMARKS
10.
11. Hard tissue landmarks
Some of the important hard tissue landmarks are:-
NASION : The most anterior point midway between the frontal
and nasal bones on the fronto-nasal suture.
ORBITALE: The lowest point on the inferior bony margin of the
orbit.
PORION: The highest bony point on the upper margin of
external auditory meatus.
SELLA: The point represented the midpoint of the pituitary fossa
or sella turcica.It is a constructed point in the mid sagittal plane.
POINT A : It is the deepest point in the midline between the
anterior nasal spine and alveolar crest between the two central
incisors.
POINT B : It is the deepest point in the midline between the
alveolar crest of mandible and the mental process.
12. BASION : It is the median point of anterior margin of foramen
magnum.
BOLTON POINT : The highest point at the post condylar notch of
the occipital bone.
ANTERIOR NASAL SPINE : It is the anterior tip of the sharp bony
process of the maxilla in the midline of the lower margin of
anterior nasal opening.
GONION : It is a constructed point at the junction of the ramal
plane and the mandibular plane.
POGONION : It is the most anterior point of the bony chin in the
median plane.
MENTON : It is the most inferior midline point on the
mandibular symphysis.
GNATHION : It is the most antero-inferior point on the
symphysis of the chin .
13. ARTICULARE : It is a point at the junction of the posterior borde of
ramus and the inferior border of the basilar part of the occipital
bone.
CONDYLION : The most superior point on the head of the condyle.
PROSTHION : The lowest and most anterior point on the alveolar
bone in the midline , between the upper central incisors. It is also
called Supradentale .
POSTERIOR NASAL SPINE : The intersection of a continuation of the
anterior wall of the pterygo-palatine fossa and the floor of the
nose, marking the distal limit of the maxilla.
GLABELLA : It is the most prominent point of the forehead in the
mid sagittal plane.
CHELION : It is the lateral terminus of the oral slit on the outer
corner of the mouth.
SUBNASALE : The point where the lowest border of the nose meets
the outer contour of the upper lip.
14. SOFT TISSUE LANDMARKS
Some of the important soft tissue landmarks are :-
GLABELLA : It is the most prominent point in the med-sagittal plane
of forehead.
NASION SOFT TISSUE : It is the deepest point in the concavity of the
soft tissue contour of the root of the nose.
PRONASALE : The most prominent point of the nose.
SUBNASALE : It is the intersection of the lower border of the nose
and the outer contour of the upper lip.
LABRALE SUPERIUS : The median point in the upper margin of the
upper membranous lip.
LABRALE INFERIUS : The median point in the lower margin of the
lower membranous lip.
15. SUPERIOR LABIAL SULCUS : It is the point of the greatest
concavity in the midline of the upper lip.
STOMION SUPERIUS : It is the lowest point of the upper
lip.
STOMION INFERIUS : It is the highest point of the lower
lip.
STOMION : It is the ,midpoint between stomion superius
and stomion inferius.
POGONION SOFT TISSUE : It is the most prominent point
on the soft tissue contour of the chin.
MENTON SOFT TISSUE : It is a constructed point at the
intersection of a vertical co-ordinate from menton and
the inferior soft tissue contour of the chin.
16. CEPHALOMETRICS : LINES AND
PLANES
• The lines are obtained by connecting two landmarks.
• Based on their orientation the lines or planes can be
classified into horizontal and vertical.
17. HORIZONTAL PLANES
1. S.N. PLANE : It is the
cranial line between the
centre of the sella turcica
(sella) and the anterior
point of the fronto– nasal
suture (nasion) .
• It represents the anterior
cranial base.
18. 2. FRANKFORT
HORIZONTAL PLANE :
This plane connects
the lowest point of the
orbit (orbitale) and the
superior point of the
external auditory
meatus.
19. 3.OCCLUSAL PLANE : It is
a denture plane bisecting
the posterior occlusion of
the permanent molars
and premolars ( or
deciduous molars in
mixed dentition ) and
extends anteriorly.
20. 4.PALATAL PLANE : It
is a line linking the
anterior nasal spine
of the maxilla and
the posterior nasal
spine of the palatine
bone.
21. 5. MANDIBULAR PLANE :
Several mandibular planes
are used in cephalometrics ,
based on the analysis being
done.
• The most commonly used
ones are :
a. Tangent to the lower
border of the mandible
(Tweed).
b. A line connecting gonion
and gnathion (Steiner) .
c. A line connecting gonion
and menton (Downs) .
22. 6. BASION - NASAL PLANE : It is
a line connecting the basion
and nasion .
• It represents the cranial
base.
23. 7. BOLTON’S PLANE : This
is a plane that connects
the Bolton’s point
posterior to the occipital
condyles and nasion.
24. VERTICAL PLANES
1. A – POG LINE : It is
a line from point A on
the maxilla to
pogonion on the
mandible .
25. 2. FACIAL PLANE : It is a
line from the anterior
point of the fronto-nasal
suture ( nasion ) to the
most anterior point of the
mandible ( pogonion ).
26. 3. FACIAL AXIS : A line
from Ptm point to
cephalometric gnathion .
27. 4. ESTHETIC PLANE :
It is a line between
the most anterior
point of the soft
tissue nose and soft
tissue chin.