Hard tissue cephalometric analysis

1899 – Edward Angle – Classification of Malocclusion
1915 – Van Loon – developed a method for 3D registration of face
and dentition – Cubus Craniophorus
1922 – Simon – modified Van Loon’s inventon by using a face
bow.
1922 – Pacini – Paved the way for standardized head radiography
1931 – Hofrath in Germany and Broadbent in United States –
published their works in the ‘ Forschritte der Orthodontie’ and
the Angle Orthodontist respectively.
1939 – Lucien de Coster – published his work on proportional
relationships of the face.www.indiandentalacademy.com

Reserve
Craniostat
www.indiandentalacademy.com

The Bolton Room in the
Anatomical Laboratory of
the Medical School at
Western Reserve
University, Cleveland.

Cephalometric Equipment
 Cephalostat or head holder
 X-ray source
 Cassette holder
 Cassette

Two types of cephalostats
Broadbent – Bolton method Higley method
Specifications:
Distance from the midsagittal plane of the subject’s head to the
X-ray tube = 60” (5ft)
Distance from the midsagittal plane of the subject’s head to the
film = 7”
American convention – subject’s left side to the film
European convention – subject’s right side to the film

Natural Head Position
NHP is a standardized and reproducible orientation of
the head in space when one is focusing on a distant
point at eye level.
1884 – German Anthropological Society – Frankfort Agreement
1956 – William Downs – discrepancies in cephalometric facial
typing and photographic facial typing – Analysis of dentofacial
profile

‘Discrepancies between cephalometric facial typing and
photographic facial typing disappear when a correction is
made for those persons who do not have a level frankfort
plane.’
William Downs(1956)

‘Intracranial landmarks are not stable points in the
cranium, their vertical relationship to each other is
therefore also subject to biologic variation.’
Bjerin (1957)

Definition of terminology
Anthropometry – Measurement of dimensions of the human body
and it’s parts.
Craniometry – Branch of anthropometry dealing with
measurements of dimensions and angles of bony skull.
Cephalometry – Scientific measurement of dimensions of the
‘living’ head.
Cephalometric analysis – Process of evaluating the skeletal,
dental, and soft tissue relationships of a patient by comparing
measurements performed on the patient’s cephalometric tracing
with population norms for respective measurements, to come to a
diagnosis of the patient’s orthodontic problem.www.indiandentalacademy.com

DOWN'SANALYSIS

Mean Reading : 87.5o
Range : 82o
– 95o

Mean Reading : 0o
Range : -8.5o
– 10o

Mean Reading : -4.6o
Range : 0o
– - 9o

Range : 17o
– 28o

Range : 53o
– 66o

Mean Reading : 9.3o
Range : 1.5o
– 1.4o

Mean reading : 135.4o
Range : 130o
– 150o

Mean reading : 1.4o
Range : -8.5o
– 7o

Vorhies and Adams (1951)
Wriggle

STEINER’SANALYSIS

STEINER’S ANALYSIS
SKELETAL ANALYSIS
DENTAL ANALYSIS
SOFT TISSUE ANALYSIS

Mean reading : 82o

Mean reading : 80o

ANB
Mean reading : 2o

Mean reading : 14o

Mean reading : 32o

Mean reading : 130o

WITS ANALYSISAPPRAISAL‘ ’

ANB
RIEDEL - 1952
University of Witwatersrand

Anteroposterior relationship of the jaws relative to cranium

Rotational effect of the jaws relative to the anterior cranial base

JENKINS – 1955
TAYLOR – 1969
BEATTY – 1975
JARVINEN – 1985
SHORTCOMINGS OF ANB
‘Use of the apical base should be replaced
by a better method to determine sagittal
apical base difference. The WITS
appraisal could be used a possible
alternative.’
JARVINEN (1985)

“ Measurements from the cranial base,
however, do not provide a reliable
expression of anteroposterior jaw
relationship in the dentofacial complex.”
Jacobson

Is the ANB angle a reliable
indicator of jaw discrepancy
or not?

McNAMARA ANALYSIS

McNamara (1984)
• Lateral cephalogram of children comprising of
the Bolton’s Standards
• Selected values from a group of untreated
children from Burlington research center.
• Sample of young adults from Ann Arbor having
excellent dental and facial pattern.

Craniofacial skeleton has been divided into five sections
 Maxilla to cranial base
 Maxilla to mandible
 Mandible to cranial base
 Dentition
 Airway

Maxilla to cranial base

Nasiolabial angle : 102o +
8o

Cant of the Upper lip :
Women : 14o +
8o
Men : 8o +
8o

Maxilla to mandible

Co
A
Gn
Maxillomandibular differential = Midfacial length – Effective
mandibular length

Ideal maxillomandibular differential
Small - 20mm
Medium - 25 – 27mm
Large - 30 – 33mm

Mandible to cranial base

Mixed Dentition = 6-8mm behind nasion
perpendicular
Adult woman = 4-0mm behind nasion
perpendicular
Adult men = 2mm behind to 2mm ahead
of nasion perpendicular

Dentition

4-6mm
1-3mm

Airway Analysis

COGSANALYSIS

Charles J. Burstone – 1978
University of Connecticut
COGS – Cephalometrics for Orthognathic Surgery

COGS
 Chosen landmarks and measurements can
be altered by various surgical procedures.
 The appraisal includes all facial bones
and a cranial base reference.
 Rectilinear measurements can be readily
transferred to a study cast for mock surgery.

 Critical facial components can be
examined.
 Standards and statistics are available for
variations in age and sex from 5 to 20
 Consists of a series of measurements that
can be computerised.

H-P line

Cranial Base

Horizontal Measurements
N-A-Pg

Vertical Measurements

Maxilla and Mandible

Dental Measurements

TWEED’SANALYSIS

HARVOLD ANALYSIS

SASSOUNI’SANALYSIS
(1969)

JARABAK ANALYSIS

Computers & Cephalometrics
Why do we have to think about
Videocephalometry?
Computer aided Cephalometrics

Conclusions:
• Cephalometric analyses are merely aids in helping
the clinician arrive at a diagnosis and treatment
planning.
• All anteroposterior skeletal discrepancies cannot be
corrected to an ideal jaw relationship.
• Cephalometric measurements are not to be
regarded as final points or values and it is not
necessary that values should exactly tally.

• Variation in biology is a rule, therefore a normal
value is never a point so a mean is to be always
considered.
• Serial cephalograms taken during course of
treatment helps us to ascertain whether our treatment
goals are achieved.
• The Wits appraisal is a linear measurement and not
an analysis per se. It is simply an adjunctive
diagnostic aid that may prove useful in assessing the
extent of anteroposterior skeletal dysplasia and in
determining the reliability of ANB angle.

• We should strive to develop cephalometric norms
and values pertaining to an Indian background instead
of using those meant for Caucasian norms.

Hard tissue cephalometric analysis

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