GOALS:

Horizontal and vertical relationships of 5 major functional components of the face: cranial base; maxilla mandible, the maxillary and mandibular dentoalveolus

UTILITY
1) Describe the subjects dento-facial morphology. 2) Quantitative description of morphological deviations. 3) Make diagnostic and treatment planing decisions. 4) Vertebral anomalies.

4) Evaluate change over time - treatment results. - growth changes. 5) Predicting growth related changes. 6) Predicting changes ass with surgical t/t. 7) Research work.

Morphological Description
Skeletal - horizontal and vertical. Dental - horizontal and vertical. Soft tissue. Comparing subjects tracing to the ideal. Reference sample
Cross-sectional Longitudinal - growth studies eg. BoltonBrush, Ann Arbor and Burlington

CLASS II
Division 1

CEPHALOSTAT

Cephalometric Evaluation
Identification of anatomic landmarks Angular and or linear measurements Graphically relating the dento-facial elements to these reference structures

 Landmarks: stable reference structures.

-Anatomic
-derived

-Hard tissue
-Soft tissue

-Bilateral
-Unilateral

NASION

Most anterior point of the intersection between the frontal $ nasal bones.

PORION

Anatomic porion: midpoint of upper contour of external auditory canal. Machine porion: midpoint of the upper contour of the metal ear rod of the cephalometer.

ORBITALE

Lowest point on the inferior margin of the orbit.

ANS

Tip of the ANS. Modified as the point on upper or lower contour of the spine where it is 3mm thick.

POINT A

Inner most point on the contour of the premaxilla b/w ANS & incisor. [subspinale]

POINT B

Inner most point on the contour of the mandible b/w the incisor tooth & bony chin. [supramentale]

 Most anterior point on the contour of the chin.

 Most inferior point on mandibular symphysis.

 Constructed point at the junction of ramal plane & mandibular plane.

 Most antero inferior point on the symphysis of the chin. Constructed by intersecting a line drawn perpendicular to a line connecting menton & pogonion.

 Mid point of pituitary fossa or sella tursica. Constructed point in mid sagittal plane.

 Tip of the posterior spine of palatine bone at he junction of hard & soft palates..

BASION

The lowest point on the anterior margin of the foramen magnum; at the base of the clivus.

BOLTON POINT

Highest point in the upward curvature of retrocondylar fossa of the occipital bone.

ARTICULAR

Point of intersection between the shadow of zygomatic arch & posterior border of mandibular ramus.

SPHENO OCCIPITAL SYNCHONDROSIS

The junction b/w occipital & sphenoid bones.

Ptm point

The point at the base of the fissure where its anterior & posterior walls meet.

METHODS OF CEPHALOMETRIC ANALYSIS

Two basic approaches Metric approach - use of selected linear and angular measures Graphic approach - overlay of individuals tracing on a reference template and visual inspection of degree of variation

Metric Method - Use of selected

linear and angular measures

Graphic Method - Use of a

Composite Template

REFERENCE LINES
Frankforts Horizontal (porion to orbitale) Sella - Nasion line True horizontal plane True vertical plane

sella

nasion

porion

orbitale

TWEED TANGENT

STEINERS : Go - Gn

Go

Gn

DOWNS: Go - Me

Go

Me

CEPHALOMETRIC ANALYSES
Downs Steiners Tweeds McNamaras Sassouni Harvold Wits

82 to 95degree

FACIAL ANGLE

Na FH

Pog

-8.5 to 10 degree

ANGLE OF CONVEXITY

-9 to 0degree

A-B PLANE ANGLE

17 to 28 degree

MANDIBULAR PLANE ANGLE

53 to 66 degree

Y-AXIS

[GROWTH AXIS]

1.4 to 14 degree

CANT OF OCCLUSAL PLANE

INTERINCISAL 130 5 deg

INTER INCISAL ANGLE

3.5 to 20 degree

INCISOR OCCLUSAL PLANE ANGLE

INCISOR MANDIBULAR PLANE ANGLE

-8.5 to 7 degree

UPPER INCISOR A Pog LINE

-

1 to 5mm

SNA 82 2 de

SKELETAL HORIZONTAL - MAXILLA

SNB 80 2 deg

SKELETAL HORIZONTAL - MANDIBLE

ANB 2 2 deg

SKELETAL HORIZONTAL - MAXILLA TO MANDIBLE

A B

 LIMITATIONS of ANB
Position of nasion. Vertical height. Increased SNA & SNB.

MANDIBULAR PLANE ANGLE

OCCLUSAL PLANE ANGLE

UPPER INCISOR to N A angle

N A

U1 TO NA 4mm

UPPER INCISOR to N A line

N A

U1 TO NB 22deg

LOWER INCISOR NB angle

U1 TO NB 4mm

LOWER INCISOR NB linear

INTER INCISAL ANGLE

NASOLABIAL ANGLE 102 8 deg L.LIP TO E PLANE[S-line] -2 2mm

SOFT TISSUE

F H plane

Mandibular plane

Long axis Of lower incisor

Limitations of the Metric Method

Reference structures may not be stable always. Error in landmark identification

Graphic Method
Template Changes between 2 time points

Superimposition Method - on the

cranial base

Maxillary and mandibular superimposition

Limitations
Individual variability Ethnic variability Gender variability