Cephalometrics II

Tracing Technique: Tracing lines between different landmarks in order to determine and
compare facial dimensions
o Trace the average of bilateral structures
o The most anteriorly positioned incisor is traced, unless grossly displaced in comparison
to the other incisors
Easier to move teeth out to this point than trying to find a middle ground
Landmarks
o Anterior Nasal Spine (ANS): anterior tip of the sharp bony process of the maxilla at the
lower margin of the anterior nasal opening
o Articulare (Ar): a point at the junction of the posterior border of the ramus and the
inferior border of the posterior cranial base (occipital bone
o Basion (Ba): the lowest point on the anterior rim of the foramen magnum
o Gonion (Go): a point on the curvature of the angle of the mandible located by bisecting
the angle formed by the lines tangent to the posterior ramus and the inferior border of
the mandible
o Gnathion (Gn): a point located by taking the midpoint between the anterior (Pog) and
inferior (Me) points of the bony chin
o Mention (Me): lowest point on the symphyseal shadow of the mandible seen on a
lateral ceph
o Pogonion (Pog): the most anterior point on the bony chin
o Nasion (N): the most anterior point on the frontonasal suture in the midsagittal plane
o Orbitale (Or): The lowest point on the inferior rim of the orbit
o Posterior nasal spine (PNS): posterior spine of the palatine bone constituting the hard
palate
o Porion (Po): the most superiorly positioned point of the EAM
o Point A (subspinale): the most posterior midline point of the concavity between the ANS
and the most inferior point of the alveolar bone overlying the maxillary incisors
(prosthion)
o Point B (supramentale): the most posterior midline point in the concavity of the
mandible between the most superior point on the alveolar bone overlying the incisors
(infradentale) and Pog
o Sella (S): the geometric center of the pituitary fossa
Cephalometric Planes
o Frankfort Horizontal (FH): plane through the obitale and porion
o Sella-Nasion (SN): plane through sella tursica and nasion
o Facial Plane (FP): plane through the nasion and pogonion
o Mandibular Plane (MP): plane through menton and gonion
o SNA & SNB: SN plane compared to lines from the nasion to point A or point B
SNA: Give the A-P position of the maxilla related to the cranial base
SNA = 82 4
SNA angle less than 82 is maxillary retrognathism
SNB: Give the A-P position of the mandible related to the cranial base
 SNB = 80 4
SNB angle less than 80 is mandibular retrognathism
o ANB: the difference between SNA and SNB. Provides a general idea of the A-P
discrepancy of the maxillary to mandibular apical bases
ANB = 2 4
o A point to N-perpendicular: the difference in A-P position of point A to N on a
perpendicular line
Give the A-P relation of the maxilla to the cranium and upper face
A-NP = 0 1 mm
o Facial Angle: The angle in which the facial plane (N-Pog) intersects the Frankfort
Horizontal plane (FH)
Gives the A-P position of the mandible in relation to the cranium and upper face
FA = 88 3.5
o Mandibular Plane angle: angle between Mandibular plane and the Frankfort Horizontal
plane (FH)
Vector of growth
Key indicator of case difficulty
MP = 22 4
o Vertical Facial Proportions
Total Facial Height (TFH): Distance from Nasion (N) to Menton (Me)
Upper facial height (UFH): Nasion to Anterior Nasal Spine (ANS)
Lower facial height (LFH): ANS to Me
Well balanced face
UFH is 45% of TFH
LFH is 55% of TFH
o Incisor proclination
Mx incisor: the angle of the line drawn through the long axis of the most
anterior maxillary incisor up to the sella-nasion line.
Normal = 102 5
Md incisor: the angle of the line drawn through the long axis of the most
anterior mandibular incisor to the mandibular plane
Normal = 90 4
Interincisal angle: angle made on the lingual side of intersecting lines drawn
through the long axis of the Mx and Md incisors
Assessment of the degree of incisor proclination
Normal = 135 6
o Incisor AP position
Maxillary: distance of the incisal edge of the maxillary incisor to the Nasion-
Point A line (N-A) along the occlusal plane
Assessment of the amount of incisor protrusion
Normal = 4 mm
Mandibular: distance of the incisal edge of the mandibular incisor to the Nasion-
Point B line (N-B) along the occlusal plane
Assessment of the amount of incisor protrusion
 Normal = 4 mm
o E-Plane: line from the most anterior portion of the soft tissue nose to the most anterior
soft tissue portion of the chin
Lips should be behind this line
Normal:
4 mm upper lip behind
2 mm lower lip behind
o Nasolabial Angle: angle between tangent line to the base of the nose and a tangent line
to the upper lip
Acute angle may be a reflection of dentoalveolar protrusion
Random notes
o Send class III patients to orthodontists earlier (around age 5-6) to try and modify growth
earlier
Will have a negative ANB angle
o Angle between Mandibular plane and Frankfort plane (Mandibular plane angle) is
important for growth tracking and possible use of head gear
o Md incisors to md plane (Md incisor proclination) is an important plane for syndromic
patients
o Extractions arent always just for space, sometimes it allows for drastic changes in soft
tissue
o When doing ortho try and give a little more gingival display since the upper lip will
droop over time.