A simple and understandable presentation of steiners analysis

1. PRESENTED BY –
Dr. Firdosh Rozy

2. CONTENTS :
Background history and philosophy
The Analysis
Acceptable compromises
References
Skeletal
Dental
Soft tissue

3. CECILC.STEINERS
Cecil c. Steiner(1896-1989)
One of Edward H.Angle’s
first students in 1921.
He developed a form of
cephalometric analysis,
presented in 1953, referred
to as the Steiner method of
analysis.

4. There are hundreds of measurements & combinations of
measurements can be made from cephalometric x-rays..however
Cecil C. Steiner selected what he considered to be the most
meaningful parameters and evolved a composite analysis, which he
believed would provide the maximum clinical information with
minimal clinical measurements.
Steiner in his analysis took into account that it may not be possible to
reach ideal proportions and relationtionships in all cases, but there
are ways to maximize esthetics.
He chose landmarks, planes and angles other than traditional
landmarks.

5. Cecil C. Steiner- Cephalometrics for you and me,
American Journal Of Orthodontics, 1953, vol -39,729-755
In his analysis he said that much
of this assessment method is made
up of ideas of others. The most
important of these comes from
Drs. Downs, Wylie, Reidel,
Thompson, Margolis, and others. I
have taken ideas from these men
and their ideas have engendered
within me, other ideas which we
think are more direct and more
useful for our purpose.

6.  Steiner uses SELLA to NASION line as
a reference plane for his analysis. This line
represents the anterior cranial base.
Steiner highlighted difficulties in accurate
location of the porion point and its relative
variation.
This difficulty can be explained on the
basis of the fact that porion is a point upon
the external exit of the bony auditory
canal.
 This point is covered by soft tissue
intervening between the ear posts.
 Tracings are not made from the porion
point itself, but from the top of the ear
posts which approximates it in position.

7. As proof that patients can and do move in
relationship to the ear posts when pictures are
taken.
Points S and N are clearly visible in the x-ray
pictures and can be located easily and
accurately.
It is of special importance to note that these
points are located in the midsagittal plane of
the head and, therefore, that they are moved a
minimum amount whenever the head deviates
from the true profile position.
These all are the reason for selection of S-N
plane by Steiner

8. Relative variation in porion position demonstrated by Steiners

9. For Jaw relationship employment
he used SNA & SNB angle of
RICHARD REIDEL.
Difference b/w SNA & SNB was
chosen to demonstrate the
anteroposterior jaw dysplasia.

12. Mean is 82°
 Greater angle indicates relative
forward positioning of maxilla &
lesser angle indicates recessive
location of maxilla

13. Mean is 80°
 Angle less than 80 indicates recessive
mandible while greater angle suggest
Prognathic mandible

14. Mean value 2º
ANB angle tell us only about
“Magnitude of the discrepancy between
the jaws, not the absolute discrepancy.”
The ANB angle provides a general
idea of the anteroposterior discrepancy
of maxillary to mandibular apical bases.
 >2º --- class Ⅱ skeletal tendency and
 < 2º --- suggesting class Ⅲ skeletal
tendency.

15.  Occlusal plane drawn through the region of
overlapping cusps of 1st premolars & 1st
molars.
Angle of occlusal plane & S-N is measured.
Mean reading is 14°
.

16. Drawn between gonion & gnathion
The mandibular plane angle is formed by
joining the mandibular plane to the anterior
cranial base (S-N plane)
Mean reading is 32°
Excessively high or low mandibular plane
angles suggest unfavorable growth pattern
in individuals

18. Angle is formed by intersection of long
axis of upper central incisors & line joining
N-A line.
 22 ºangle and 4mm distance is ideal.
 >22º may be seen in class II div I .
 <22 º may be seen in class II div 2 case.
Measurement >4 mm common in class I
bimaxillary protrusion or in class II div 1
relationship.
< 4 mm common in class II div 2 .

19. Incisor angle at 22 degrees but
(a) Retro positioned (-2mm)
(b) Ideally positioned (4mm)
(c) Positioned too far forward (8mm)
Show inadequacy of relating incisor tip to
millimeter reading only. All three teeth are 4mm
from the NA line but angled differently

20. Angle is formed by intersection of long
axis of lower central incisors & line joining
N-B line
25 ºangle and 4mm distance is ideal
Angle >25 º may be seen in class II div 1
Angle <25 º common in class II div 2 or
class III.

21. Mean value of 130-131°
Reduced angle suggest class II div 1
Larger angle indicates class II div 2

22. This measurement is introduced to evaluate the relative prominence of the
mandibular incisors, as compared to the size of the bony chin.
 According to Holdaway distance between
labial surface of mandibular incisor to N-B line
and the distance from pogonion to N-B line
should be equal (i.e. 4mm)
 Discrepancy
If discrepancy is
• 2mm= Acceptable
• 3mm= Less desirable
• 4mm exceeds = Correction indicated

23. The facial contour line called ‘S’ line of Steiner. A line is drawn on the soft tissue contour
of the chin to the middle of the ‘S’ formed by the lower border of the nose .In a well
balanced face, the lips should touch the line.
If the lips are located beyond this line
lips are believed to be protrusive &
interpreted as convex profile .
If lip behind this line said to be retrusive
with a concave profile.

24. ACCEPTABLE COMPROMISES :
“Variation in biology is the rule rater than the exception.”
“Normal is never a point, it is a range.”
Servoss, J.: Angle Orthod. 63: 161-165, 197 3
And that why steiner give acceptable arrangements of incisor positioning.

25. Servoss, J.: Angle Orthod. 63: 161-165, 197 3
The origin of these so-called
acceptable arrangements or acceptable
com- promises which are an integral
part of the Steiner analysis has always
been a source of perplexity. At no
place in the literature is there
reference as to how or from whence
these arrangements are derived.
Are they a result of a large survey of
individuals, thus reflecting true biologic
data, or are they derived from a geometric
scheme of some sort?

27. Diagrammatic representation of the two triangles involved in
the derivation of of Steiner’ s acceptable arrangements.
(From Servoss, J.: Angle Orthod. 41: 146-150, 1971.)

28. It is his contention that, the chart of acceptable compromises is a result of a
geometric scheme. In fact, a geometric pattern which can explain the
derivation of the entire spectrum of Steiner’ s arrangements has been
demonstrated.
The intersection of four lines involved in the Steiner analysis makes a
figure consisting of two triangles (Figs. 2 and 3). It becomes evident that by
manipulating the sides of the triangles and thus changing the degrees in
various angles of the figure, all the arrangements can be derived.
Throughout the entire range of Steiner’ s incisor positions it can be found
that the angle formed by the nasion-B point line and the long axis of the
maxillary incisor never varies.
The maintenance of a constant relationship of the maxillary incisor to
nasion-B point line has been dictated by convenience in geometrically
designing the scheme of acceptable arrangements.

29. REFERENCES :
 Radiographic Cephalometry – Alexander Jacobson
Cecil C. Steiner- Cephalometrics for you and me, American
Journal Of Orthodontics, 1953, vol -39,729-755
 Servoss, J. Angle Orthod. 41: 146-150, 1971.
Servoss, J. The acceptablity of Steiner’s acceptable
compromises, Angle Orthod. 63: 161-165, 1973