CEPHALOMETRICS Cephalometrics is the study of headfilms .

We study cephs to: observe pathologic change evaluate dentofacial proportions and clarify the anatomic basis of diagnosis of malocclusion recognize and evaluate changes before, during, and after orthodontic treatment predict future changes that might occur in the craniofacial complex

Important elements in cephalometric analyses are: Maxillary position

Mandibular position Facial proportions/vertical relationships

Incisor positions (maxillary and mandibular)

How to Trace a Cephalogram

1. Trace the cranial base, orbital rims, and nasal bones

2. Add the pterygomaxillary fissure,key ridges, and maxilla

3. Trace the mandible, including the detail in the symphysis, canal, and condyle (if visible)

4. Add the incisors and first molars and trace the soft tissue profile

IDENTIFY REFERENCE POINTS

Sella (S)the center of the hypophyseal fossa (sella tursica)

Nasion (Na)the junction of the nasal and frontal bones at the most posterior point on the curvature of the bridge of the nose
A-point (A) A-point is the most anterior point of the maxillary apical base. B-point (B) B point is the innermost curvature from chin to alveolar junction Pogonion (Pg)the most anterior point on the contour of the chin

Gnathion (Gn)the most outward and everted point on the profile curvature of the symphysis of the mandible, located midway between pogonion and menton. Menton (Me)the lowest point on the symphysis of the mandible
Anterior Nasal Spine (ANS)the most anterior point on the maxilla at the nasal base Posterior Nasal Spine (PNS)the tip of the posterior nasal spine of the palatine bone, at the junction of the soft and hard palate

Basion (Ba)the anterior margin of the foramen mangnum. The midpoint of the curvature between upper and lower surfaces of the basilar portion of the occipital bone

Orbitale (Or)a point midway between the lowest point on the inferior margin of the two orbits

Goniona point midway between the points representing the middle of the curvature at the left and right angles of the mandible Porion (Po)the midpoint of the upper contour of the external auditory canal (Anatomic Porion) or a point midway between the top of the image of the left and right ear-rods of the cephalostat (Machine Porion)
Pterygomaxillary Fissure (Ptm)the point at the base of the fissure where the anterior and posterior wall meet

IDENTIFY REFERENCE PLANES Sella-Nasion (S-N)a line connecting S to Na Frankfort Horizontal (FH) a line connecting Po to Or

Mandibular Plane (MP) a line connecting Go to Me

Y-axis (Y)a line connecting Se to Pg Upper Anterior Facial Height (UAFH)a line connecting Na to ANS

Lower Anterior Facial Height (LAFH)a line connecting ANS to Me

Nasion-A point (Na-A)a line connecting Na to A Nasion-B point (Na-B)a line connecting Na to B

Upper Incisor (U1)a line connecting the incisal edge and the root apex of the most prominent maxillary incisor Lower Incisor (L1)a line connecting the incisal edge and the root apex of the most prominent lower incisor

SNA Reference Line: Sella - Nasion Sella - Nasion - A point 84.5 5. 3 This angle indicates the horizontal position of the maxilla relative to the cranial base. >89.8 - protrusive or prognathic maxilla <79.2 - deficient or retrognathic maxilla

SNA

Sella - Nasion - A point 84.5 5. 3

SNA is 86, which is within the normal range. it means that the maxilla is neither protruded nor retruded in relation to cranial base SN

SNB Reference Line: Sella - Nasion

Sella - Nasion - B point 82.0 4.9

B-point is the most anterior measure point of the mandibular apical base. This angle expresses the horizontal position of the mandible relative to the cranial base using B-point as a cephalometric landmark. >86.9 - prognathic mandible <77.1 - retrognathic mandible

SNB

Sella - Nasion - B point 82.0 4.9

SNB is 80, which is within the normal range. it means that the mandible is neither protruded nor retruded in relation to cranial base SN

ANB

A point - Nasion - B point 2.5 2.5

The ANB angle measures the relative position of the maxilla to mandible. The ANB angle can be measured or calculated from the formula: ANB = SNA - SNB. 1. A positive ANB angle indicates that the maxilla is positioned anteriorly relatively to the mandible (Class I or Class II malocclusion cases). 2. A negative ANB angle indicates that the maxilla is positioned posteriorly relative to the mandible (Class III malocclusion cases). The normal range is 1-5. >5 indicates a Class II skeletal jaw relationship, protrusive maxilla or retrognathic mandible. <1 indicates a Class III skeletal jaw relationship, deficient maxilla or prognathic mandible.

ANB

A point - Nasion - B point 2.5 2.5

ANB is 6, which is more than the SD range, meaning that maxillary tooth is protruded in relation to mandibular insicor

FH/NP(Facial Angle) Purpose: establishes the horizontal location of the mandible relative to the cranial base. Note that the points being compared by this angle are the cranial base references FH and nasion as well as Pog point (mandibular point). Construction: the angle between a line drawn from Po to Or (FH) and a line drawn from N to Pog. Normal value and standard deviation: 886. Interpretation: <82 - mandible is retrognathic relative to the cranial base. 85.1-+3.0 - mandible is normally positioned relative to the cranial base. >88 - mandible is prognathic relative to the cranial base.

FH/NP(Facial Angle) 85.1-+3.0

FH/NP is 88 which is within the normal range. the mandible or chin is neither retrusive nor protrusive in relation to frankfort horizontal plane

U1 to SN Max. Incisor to SN 103 5.0

Reference Line: Sella - Nasion This angular measurement determines the inclination of the central incisor relative to the anterior cranial base. 1. A greater than average angle indicates proclination (labioversion) of incisors as often seen in Class II division 1 cases. 2. A smaller than average angle indicates upright or retroclined (lingually inclined) incisors as often seen in Class II division 2 cases.

U1 to SN Max. Incisor to SN 103 5.0

1/SN is 97 which is less than the normal range, meaning the maxillary central incisor is not protruded in relation to cranial base SN

U1 - L1 Max. to Mand. Incisor 122.8 8.7

The interincisal angle measures the relative spatial position along the long axis of the most prominent (anteriorly positioned) maxillary and mandibular central incisors. It determines the degree of procumbency (labial inclination) of the incisors. The more labially inclined (proclined) the incisors are, the less the interincisal angle. The more lingually inclined (retroclined) the incisors are, the more the interincisal angle. 1. Class II division 1 cases usually have a smaller than average interincisal angle. 2. Class II division 2 cases usually have a larger than average interincisal angle due to the lingual inclination of the maxillary central incisors.

U1 - L1
Max. to Mand. Incisor 122.8 8.7

1/1 is 133 which is more than the normal range,meaning that the maxillary central insicor is more protruded compared to mandibular or mandibular central insicor is more retruded compared to maxillary

IMPA Purpose: to determine the angulation of the mandibular incisor relative to the mandible. Note that the items compared are the long axis of the mandibular incisor (dental) and the MP (mandible). Construction: the angle between a line drawn from Go to Gn (MP) and a line drawn through the axis of the lower incisor. Interpretation: <85 - the mandibular incisor is retroclined. 96.0-+7.4 - the angulation of the mandibular incisor is within normal limits. >97 - the mandibular incisor is proclined.

IMPA the angle between a line drawn from Go to Gn (MP) and a line drawn through the axis of the lower incisor. 96.0-+7.4 IMPA ia 90, which is within the normal range. meaning the mandibular central incisor is neither retrusive nor protrusive in relation to mandibular plane.

FMIA

Shows the relation between the axis of the most protrided mandobular central imcisor to frankfort horizontal plane 55.2+_6.9
FMIA is 60 which is within the normal range. meaning the mandibular central incisor is neither retrusive nor protrusive in relation to frankfort horizontal plane.

FMA Purpose: This measure is used to assess the direction of the growth of the mandible. Note that the points being compared by this angle are the cranial base reference plane of FH and the mandibular plane. Construction: the angle between a line drawn from Po to Or (FH) and a line drawn between Go and Gn (MP). Normal value and standard deviation: 225. Interpretation: <22.9 - implies a vertical deficiency often seen in brachyfacial growth patterns or a counterclockwise rotation of the mandible. 28.7-+5.8 - mandibular growth pattern is mesofacial. 34.5 - implies a vertical excess often seen in dolicofacial growth patterns or a clockwise rotation of the mandible

FMA
the angle between a line drawn from Po to Or (FH) and a line drawn between Go and Gn (MP).

28.75.8.

FMA is 27 which is within the normal range. which means the mandible is growing equally in downward and forward direction.

Y-Axis Purpose: This measure is used to assess the direction of the growth of the mandible. Note that the points being compared by this angle are the cranial base reference plane of FH and a line between S and Gn. Construction: the angle between a line drawn from S to Gn (Y-axis) and a line drawn from Po to Or (FH). Normal value and standard deviation: 596. Interpretation: <62.2 - implies a vertical deficiency often seen in brachyfacial growth patterns or a counterclockwise rotation of the mandible. 65.0-+2.8 - mandibular growth pattern is mesofacial. >67.8 - implies a vertical excess often seen in dolicofacial growth patterns or a clockwise rotation of the mandible.

Y-Axis the angle between a line drawn from S to Gn (Y-axis) and a line drawn from Po to Or (FH).

65.02.8.