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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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Model Analysis2 / orthodontic courses by Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Leader in continuing dental education www.indiandentalacademy.com
www.indiandentalacademy.com
Dental casts
Essential diagnostic aids
Provides 3 D view of maxilla and mandible
Valuable tool in orthodontic diagnosis and treatment planning. www.indiandentalacademy.com Principles of space analysis
Space analysis requires a comparison between amount of space available for the alignment of the teeth and the amount of space required to align them properly.
www.indiandentalacademy.com Two steps in space analysis
1. To calculate the amount of space available 2. To calculate the amount of space required
www.indiandentalacademy.com Space available can be measured by
By dividing the dental arch into 4 straight line segments By contouring the .026 brass ligature wire to the line of occlusion By using a flexible scale www.indiandentalacademy.com Space requirement can be measured by
By measuring the sum of M- D width of each tooth from contact point to contact point.
www.indiandentalacademy.com Sum of width of permanent teeth > amount of space available crowding
Sum of width of permanent teeth < amount of space available spacing
www.indiandentalacademy.com Mixed dentition space analysis
Permanent dentition space analysis www.indiandentalacademy.com Mixed dentition space analysis
Three factors are considered mainly
sizes of all permanent teeth
arch perimeter
Expected changes in the arch perimeter
www.indiandentalacademy.com There are three basic approaches for space analysis
1. Measurement of teeth on radiographs
2. Estimation from proportionality tables
3. Combination of radiographic and prediction table method www.indiandentalacademy.com Measurement of teeth on radiographs
Requires undistorted radiographic image It is necessary to compensate for enlargement of the radiographic image
True width of E = True width of unerupted PM Apparent width E Apparent width of unerupted PM www.indiandentalacademy.com www.indiandentalacademy.com 1. Measurement of teeth on radiograph Nance analysis
2. Estimation from proportionality tables Moyers analysis Tanaka Johnston analysis
3. Combination of radiographic and prediction table Satley and Kerber analysis
www.indiandentalacademy.com Nance analysis Proposed by (Nance, 1940)
Materials : Sharp dividers A set of periapical radiographs A millimeter rule A piece of .026 inch brass ligature wire A ruled 3 x 5 inch card for recording measurements Set of study models
www.indiandentalacademy.com Method of determine arch length
Amount of space required
width of the erupted four mandibular permanent incisors are measured.
width of unerupted mandibular canines, first and second premolars on the radiographs are measured.
www.indiandentalacademy.com Amount of space available
A piece of .026 inch brass ligature wire is placed on the lower cast extending from the mesial surface of the first permanent molar on one side of arch to the mesial surface of the first permanent molar on the opposite side. wire should pass over the buccal cusp of the posterior teeth and the incisal edges of anterior teeth. 3.4 mm is subtracted. Two measurements are compared . www.indiandentalacademy.com Estimation from proportionality tables
Moyers analysis
Tanaka and Johnston www.indiandentalacademy.com Moyers analysis Moyers (1969)
The mesiodistal width of the lower incisors is used to predict the size of both the lower and upper unerupted canines and premolars.
Why mandibular incisors are chosen?
www.indiandentalacademy.com Procedure: Measure the sum of mesiodistal width of lower mandibular incisors. Measure the space left behind for 345 on either side. By using Moyers probability chart find out the M-D width of upper and lower 345. Compare the space available and space required in all the four quadrants. www.indiandentalacademy.com Moyers prediction values www.indiandentalacademy.com Advantages:
It has minimal error and the range of possible error is precisely known. It can be done with equal reliability by beginner and the expert. It is not time consuming. Does not require special instruments. Can be used for both the arches. www.indiandentalacademy.com Tanaka Johnston method:
They developed another way to use the width of lower incisors to predict the size of unerupted canines and premolars.
www.indiandentalacademy.com Combination of radiographic and prediction table
Staley and Kerber method This method is used only for mandibular arch Requires periapical radiograph. It is quite accurate method
www.indiandentalacademy.com All three methods are based on data from white school children of northern European descent.
If patient fits this population group ,the Staley Kerber will give the best result followed by Tanaka Johnston and Moyers. www.indiandentalacademy.com Mixed dentition mandibular arch length analysis: a step by step approach using the revised Hixon Oldfather prediction method: Samir Bishara,Robert Staley(1986)
Revised prediction equation used the same predictor variables used by Hixon and Oldfather
www.indiandentalacademy.com Objective :
To obtain the most accurate result for a particular patient by reducing to a minimum of errors involved in measurement and judgment. www.indiandentalacademy.com Mandibular tooth size-arch length analysis Step by step approach
1. From the models M-D width of lower central incisor M-D width of lower lateral incisor 2. From the periapical X-rays M-D width of 1PM M-D width of 2PM
www.indiandentalacademy.com Measurement of posterior and anterior arch length www.indiandentalacademy.com 3. From Hixon Oldfather conversion table www.indiandentalacademy.com Other parameters need to be considered in the space analysis
Digital model analysis www.indiandentalacademy.com Permanent dentition analysis:
Ponts Analysis Boltons Analysis Ashley Howes Analysis Peck and Peck analysis Korkhaus Analysis Littles irregularity index Careys Analysis
www.indiandentalacademy.com Ponts analysis Introduced this analysis in (1909)
Measurement of M-D of 4 maxillary incisors determines the ideal arch width in PM and molar area before the eruption of canines. www.indiandentalacademy.com Ponts analysis helps in determining
Dental arch is narrow or normal Need for lateral arch expansion How much expansion is possible at PM and molar area.
www.indiandentalacademy.com Determination of sum of incisors (S.I.) Determination of measured PM value (M.P.V.) Determination of measured molar value (M.M.V.) Determination of calculated PM value (C.P.V.) S.I. x 100 80 Determination of calculated molar value (C.M.V.) S.I. x 100 64 www.indiandentalacademy.com If measured value < calculated value
need for expansion
www.indiandentalacademy.com Did not indicate the sample size Relationships between the form of the skulls and form of dental arch Did not include an assessment of mandibular arch Reliability of index should be tested in other populations.
www.indiandentalacademy.com Some studies which critically evaluated use of Pont's index
Low correlation coefficients between the sum of M-D width of incisors and the arch width in the PM & M region
Smyth & Young(1932) Greve K(1933) Wroms et al (1969) J oondeph and co-workers (1970) Moyers (1988) Lew K (1991)
www.indiandentalacademy.com Dalidjan, Sampson and Townsend (1995) Individual variability was noted
Nimkarn et al (1995) Overestimated the desired arch width by an average of 2.5mm to 4.7mm www.indiandentalacademy.com Comparison with present study(Indian population)
Significant differences b/w male and female for anterior arch width, posterior arch width and sum of incisors. Female values were more variable than male values. Statistical comparison was not possible. Individual variation is large. Moderate correlation coefficients were observed www.indiandentalacademy.com Comparison with present study (Tibetans population)
The mean value for the PM index was 79.56% Molar width index was 61% Tibetans have slightly larger inter-molar width as compared with Pont's sample. www.indiandentalacademy.com Boltons analysis:
Introduced by Bolton (1958) There is a ratio exists between M-D width of maxillary and mandibular teeth.
Sample: Evaluated 55 cases with excellent occlusion ;44 had been treated orthodontically without extraction and 11 were untreated. www.indiandentalacademy.com Materials: Three inch needle pointed dividers Finely calibrated millimeter ruler
Methods : Following measurements were made on each set of cast 1. Sum of mandibular 12 2. Sum of maxillary 12 3. Sum of mandibular 6 4. Sum of maxillary 6 www.indiandentalacademy.com www.indiandentalacademy.com
The following ratios were established by Bolton:
Overall ratio: Percentage relationship of mandibular arch length to maxillary arch length. Overall ratio = Sum of mandibular 12 x100 Sum of maxillary 12
Overall ratio was given as 91.3% and standard deviation 1.91
www.indiandentalacademy.com Anterior ratio Percentage relationship of M-D width of mandibular anteriors to maxillary anteriors.
Anterior ratio = Sum of mandibular 6 x100 Sum of maxillary 6
Anterior ratio was given as 77.2% and standard deviation 1.65
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If ratio exceeds the normal ratio, it indicates the discrepancy in the mandibular tooth material.
If value is less, then the discrepancy in maxillary tooth material. www.indiandentalacademy.com Drawbacks of Boltons analysis
Bolton(1958, 1962) Results tabulated were derived from the use of mean figures. So one must consider each patient as an individual. Larry White(1982) Coefficient of correlation b/w the anterior and overall ratios was very low.
www.indiandentalacademy.com Epker and fish (1986) Geometry of arch form was not considered. Labio-lingual thickness of teeth is not taken into account. Axial inclination of teeth was not considered. Moyers (1988) Sexual dimorphism in maxillary cuspids was not considered.
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Comparison with present study Significant differences were observed for mean value of TTM and anterior tooth material. For the overall ratio significant differences were observed for female. Showed very minimal magnitude of sexual dimorphism.
In 1947 his first article was published in AJO and oral surgery which dealt with adequacy of apical base. In 1954 published another article:considered the relationship of TTM to supporting bone. He measured 14 normal dentition and 200 subsequent cases.
www.indiandentalacademy.com Methods
Determination of total tooth material(T.T.M.) Determination of premolar diameter (P.M.D.) Determination of premolar basal arch width (P.M.B.A.W.)
www.indiandentalacademy.com www.indiandentalacademy.com Ratios were derived separately for maxilla and mandible
PM distance ratio= PM distance x 100 TTM
Basal arch width ratio= Basal arch width x 100 TTM
Basal arch length ratio= Basal arch length x 100 TTM www.indiandentalacademy.com Inference The P.M.B.A.W.and P.M.D. are compared. If P.M.B.A.W is < P.M.D. arch expansion is possible. If P.M.B.A.W is > P.M.D arch expansion is not possible.
P.M.B.A.W Ratio: The ratio between the apical base width at the premolar region and the total tooth material is called the P.M.B.A.W percentage. www.indiandentalacademy.com
P.M.B.A.W % = P.M.B.A.W. x 100 T.T.M.
IF P.M.B.A.W.% is 37% or less. If P.M.B.A.W.% is 44% or more If P.M.B.A.W.% is 37-44% www.indiandentalacademy.com Evaluation of Howes index. Martinek(1957) disagreed because Howe's analysis was derived from limited no. of normal occlusions based only on clinical cases. Stifter(1958) Howe's theory stating that canine fossa cannot be exceeded by bicuspid arch width is not valid. Moyers(1988) more logical and superior to Ponts index. www.indiandentalacademy.com Comparison with present study Only an approximate comparison could be made Significant differences were observed both in maxilla and mandible for TTM and BAW for males. Significant differences existed in maxilla only for bicuspid ratio. Significant differences were observed both in maxilla and mandible for TTM, bicuspid distance ,bicuspid ratio,basal arch width and BAL. Some cases bicuspid width exceeded the basal arch width. www.indiandentalacademy.com Comparison with present study(Tibetan population)
PMD,PMBAW and PMBAW/TTM values are higher than Howes in both in mandibular and maxillary arch. www.indiandentalacademy.com Peck and Peck Analysis
This analysis was proposed by Harvey Peck and Sheldon Peck AJ O-DO (1972) Purpose of this article is to present the scientific basis and the clinical application of a new method for detecting and evaluating tooth shape deviations of the mandibular incisors. www.indiandentalacademy.com Materials and methods Two groups of young female First group- Group with perfect mandibular incisor alignment Second group Control population group
www.indiandentalacademy.com First group 45 subjects Complete mandibular dentition No orthodontic treatment received A proximal contact present among the mandibular incisor. The absence of overlapping in the mandibular incisors Minimal rotational deviation from the ideal . Second group consisted of 70 subjects of comparable age www.indiandentalacademy.com In both the groups the maximal M-D and the maximal F-L dimensions were measured directly in patients mouth by Helios Dial Caliper.
Index = MD crown diameter in mm x 100 FL crown diameter in mm
Desirable MD/FL index values are Mandibular central incisor:88-92 Mandibular lateral incisor: 90-95
www.indiandentalacademy.com Higher the MD/FL index Greater the tooth shape deviation and greater the likelihood of associate crowding.
www.indiandentalacademy.com Various studies which supports this analysis are:
Boese (1980) Guide for interproximal tooth reduction Barrer (1975) Boese (1980) Shape of these teeth is important in protecting the integrity of this region after orthodontic therapy. www.indiandentalacademy.com Various criticisms on peck and peck index
Various studies have reported that there is lack of relationship b/w the shape ratios and lower incisor crowding. Narrow MD widths of mandibular incisors did not insure long term stability in orthodontically treated cases. Kuftinec (1975) Keene and Engle (1979) Gilmore and Little (1984) Puneky, Sadowsky and Begole (1984) www.indiandentalacademy.com Comparison with present study (Indian population)
Significant difference were observed for the tooth shape ratios for well aligned CI & LI b/w two sexes Significant difference was found for the M-D width b/w two sexes.
www.indiandentalacademy.com Comparison with present study (Tibetans population)
Range observed in the present study was very wide : 80-109% www.indiandentalacademy.com The irregularity index:A quantitative score of mandibular anterior alignment Robert M Little AJ O 1975 Measuring the linear displacement of the anatomic contact point, the sum of these five displacements represents the relative degree of anterior irregularity. www.indiandentalacademy.com Material and methods Dial caliper calibrated to at least tenth of a mm . Mandibular casts
Measurements are obtained directly from the mandibular cast. Caliper is held parallel to the occlusal plane. Each of the five measurements represents a horizontal linear distance between the anatomic point of the adjacent teeth. www.indiandentalacademy.com www.indiandentalacademy.com Each cast was subjectively ranked on a scale ranging from 0-10
0 perfect alignment 1-3 minimal irregularity 4-6 moderate irregularity 7-9 severe irregularity 10 Very severe irregularity www.indiandentalacademy.com Korkhaus analysis He proposed two index 1. Anterior arch length index 2. Palatal height index
1. Anterior arch length index Introduced in (1938) www.indiandentalacademy.com Material and method
Masel dental dial caliper Korkhaus 3 D orthodontic divider Metallic scale Finely pointed lead pencil Dental casts www.indiandentalacademy.com Formula for calculating the standard value of upper anterior arch length
Sum of upper incisors x 100 160
www.indiandentalacademy.com Comparison with present study (Indian population)
No statistically significant difference were observed for the mean values of ant. arch length and arch length index. SI shows significant differences b/w male and female Statistical comparison was not done because the sample size was not specified Large differences were noticed b/w the observed and predicted arch lengths
www.indiandentalacademy.com Palatal height index
This index was introduced in (1939). Purpose of this index was to evaluate the palatal shape.
Posterior arch width = mesial pits on occlusal surface of upper first molar
Palatal height = perpendicular distance from the connecting line between the reference points for posterior arch width to the surface of the palate
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www.indiandentalacademy.com Average value for palatal index is 42% and is derived from the formula
Palatal height x100 Posterior arch width
I ncreased value shows that the palatal vault is high relative to transverse arch development. Decreased value shows that palatal vault is shallow www.indiandentalacademy.com Comparison with present study (Indian population)
Significant differences were observed b/w the two sexes for all the variables related to this index. Posterior arch width, palatal depth & palatal depth index. Weak correlation was observed b/w palatal depth and posterior arch width. www.indiandentalacademy.com Comparison with present study (Tibetans population)
Tibetans have shallow palate as shown korkhaus palatal height index. www.indiandentalacademy.com Careys analysis
Helps in determining the extent of discrepancy
Performed in lower cast
Same analysis on upper cast is called arch perimeter analysis www.indiandentalacademy.com Determination of arch length
Arch length anterior to first permanent molar is measured by using a soft brass wire.
The wire is placed touching the mesial surface of the first permanent molar and is passed over the buccal cusps of premolar and along the anterior and is continued on the opposite side. www.indiandentalacademy.com
Determination of tooth material
M-D width of teeth anterior to first molars is measured and summed Inference If discrepancy is 0-2.5 mm minimal tooth material excess,proximal reduction can be carried out 2.5 5 mm need to extract second PM > 5 mm need to extract the first PM
www.indiandentalacademy.com Digital study model Dental cast: Advantages Production is easy,routine and predictable Relatively inexpensive to produce Easy to examine and measure Can be mounted articulated in variety of ways to stimulate occlusal relationships. True 3D medium that accurately represents normal malocclusions. www.indiandentalacademy.com Disadvantages : Storage is a major problem Easily lost or damaged Bulky to transfer www.indiandentalacademy.com Various methods have been employed in 3D assessment and recording of dental study models
These includes: Holography Moire topography Various types of lasers www.indiandentalacademy.com Holography Introduced in 1948 and involved microscopy by reconstructed wavefronts.
Materials Holography camera Disadvantages Expensive Difficult to produce Cannot be manipulated as a set of study models can Poor quality of recording www.indiandentalacademy.com Moire Topography Contour mapping technique designed to produce successive contour lines directly on an object.
Disadvantage Resolution is poor especially for dental morphology
www.indiandentalacademy.com Two software are commercially available for digital study models
Ortho Cad by Cadent Inc, Fairview, N.J., U.SA. E- models by Geodigm Corporation, Minnesota U.S.A.
www.indiandentalacademy.com Orthocad Steps involved in preparing Orthocad DSM
Step 1: alginate impressions and wax bite are taken. Step 2: mailed to the computer center Step 3: digital models are sent from company to the user through the internet. Step 4: digital models can be utilized with Ortho CAD 3D software. www.indiandentalacademy.com Three components are mainly required FTP software Designated folder on the hard disc An electronic browser
Program runs on any MS windows File size of each model is about 3 MB Can be stored on any hard disc or CD (CD of 650 MB allows storage of 200 models) www.indiandentalacademy.com www.indiandentalacademy.com www.indiandentalacademy.com Advantages of ESM are: Can be easily recalled at the touch of button at each patient visit. Can be sent any where around the world Valuable tool in tele conferencing with virtual display Tooth material analysis can be calculated rapidly The model can be electronically sectioned sagitally or transversely. Five simultaneous view of model in the same window.
www.indiandentalacademy.com Limitations Inability to articulate the models in terminal hinge position Yet to be approved for American Board Certification www.indiandentalacademy.com E- models This software is very similar to Ortho Cad excepting that the features are perhaps a shade lesser. www.indiandentalacademy.com
Frontal asymmetry analysis Cephalometrics for orthognathic surgery Soft tissue cephalometric analysis for orthognathic surgery www.indiandentalacademy.com Cephalometry
Scientific measurement of the dimensions of the head. Roengenographic Cephalometry (Krogman & Sassouni ) The measurement of the head from the shadows of bony and soft tissue landmarks on the radiographic image became known as Roentgenographic Cephalometry. www.indiandentalacademy.com Purpose of Cephalometry
In morphological analysis In growth analysis In treatment analysis
www.indiandentalacademy.com History 16 century artists Albretcht Durer and Leonardo da Vinci had sketched series of human faces with straight lines joining homologous anatomic stuctures. www.indiandentalacademy.com www.indiandentalacademy.com Backward hanging Forward hanging or or Retroclined facial contour Proclined facial contour (De Coster & Moorees) www.indiandentalacademy.com Teleroentgenographic technique Pacini (1922)
The following authors Mac Gowen (1923) Simpson (1923) Compte (1927) Riesner (1929) & others
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In (1931) Broadbent in USA & Hofrath in Germany simultaneously & independently developed standardized methods for production of cephalometric radiographs using special holder known as cephalostat. Cephalostat two types: Broadbent-Bolton method Higley method www.indiandentalacademy.com Anatomic structures in the cephalogram
The major bony structures are Sphenoid bone Zygomatic bone Maxillae Mandible www.indiandentalacademy.com Sphenoid bone www.indiandentalacademy.com Zygomatic bone www.indiandentalacademy.com Maxillary bone www.indiandentalacademy.com Mandible www.indiandentalacademy.com In lateral cephalogram
Unilateral landmarks Bilateral landmarks www.indiandentalacademy.com In posteroanterior projection
Importance Dentoalveolar and facial asymmetry Dental and skeletal cross bites Functional mandibular displacements Qualitative and quantitative evaluation of dentofacial region www.indiandentalacademy.com Cephalometric set-up Head holder or Cephalostat X-ray source Cassette holder containing the film www.indiandentalacademy.com Natural head position Natural head position is a standardized orientation of the head,which is readily assumed by focusing on a distant eye level. (Moorrees, 1985) www.indiandentalacademy.com Fixed head position www.indiandentalacademy.com Other techniques of head positioning Chierici(1981) , patients head should be positioned with the tip of the nose and forehead lightly touching the cassette holder.
www.indiandentalacademy.com Other techniques of head positioning Faber (1985) PA cephalogram should be taken with the mouth of the patient is slightly opened. (significant mandibular displacement cases)
www.indiandentalacademy.com Structures that should be included in the tracing of PA cephalogram www.indiandentalacademy.com Purpose of PA Cephalometry
Gross inspection Description and comparison Diagnosis Treatment planning Growth assessment and evaluation of treatment results www.indiandentalacademy.com A Frontal Asymmetry Analysis Grummons analysis Ricketts analysis Grayson analysis Hewitt analysis Chierici method www.indiandentalacademy.com
Grummons Analysis
Proposed by Duane C Grummons (1987) Martin A Kappeyene Van De Coppello
Comparative and quantitative posteroanterior Cephalometric analysis not normative. Two forms Comprehensive frontal analysis Summary frontal analysis www.indiandentalacademy.com Landmarks and abbreviations
www.indiandentalacademy.com Different components of Grummons Analysis
Four horizontal planes are constructed: Connecting the medial aspects of the zygomaticofrontal suture (Z) Connecting the centres of the zygomatic arches Connecting the medial aspects of the jugal process (J) Parallel to the Z plane through menton www.indiandentalacademy.com Horizontal planes
www.indiandentalacademy.com Mid sagittal reference line (MSR)
www.indiandentalacademy.com Mandibular morphology
www.indiandentalacademy.com Volumetric comparison
www.indiandentalacademy.com Maxillomandibular comparison of asymmetry
www.indiandentalacademy.com Linear asymmetry assessment
www.indiandentalacademy.com Summary frontal analysis Includes: Construction of horizontal planes Mandibular morphology analysis Maxillomandibular comparison of facial asymmetry www.indiandentalacademy.com Summary frontal analysis
www.indiandentalacademy.com Grayson Analysis (Barry H Grayson et al 1983, AJ O-DO)
Analyzing craniofacial asymmetry with the use of multiplane posteroanterior cephalometry.
Landmarks are identified in different frontal planes at selected depths of the craniofacial complex and subsequent skeletal midlines are constructed. www.indiandentalacademy.com Tracing 1
Orbital rims Pyriform aperture Maxillary and mandibular incisors Mid point of the symphysis.
www.indiandentalacademy.com Midline construct for A plane
www.indiandentalacademy.com Tracing 2
Greater and the lesser wing of the sphenoid Zygomatic arch(the most lateral cross- section) Maxillary and mandibular first permanent molar The body of the mandible The mental foramina www.indiandentalacademy.com Midline construct for the B plane
www.indiandentalacademy.com Tracing 3 Superior surface of petrous portion of temporal bone Mandibular condyle with outer border of ramus Mastoid process www.indiandentalacademy.com Midline construct for C plane
www.indiandentalacademy.com Superimposition of three tracings
www.indiandentalacademy.com Key triangles are constructed in each of the horizontal planes and related to the posterior midsagittal plane.
www.indiandentalacademy.com .
Superimposition of the triangles shows that the greatest amount of deviation from the midline occurs at the level of the mandible (C), decreasing in a cephalic direction, Maxilla,(B) Cranial base(A).
www.indiandentalacademy.com Ricketts Analysis (Ricketts et al, 1972)
Following clinical norms are presented : Nasal cavity width Mandibular width Maxillary width Symmetry Intermolar width Intercuspid width Denture symmetry Upper to lower molar relation
www.indiandentalacademy.com Hewitt analysis
Hewitt (1975),by dividing the craniofacial complex in dividing triangles. Different regions are: The cranial base The lateral maxillary region The upper maxillary region The middle maxillary region The lower maxillary region The dental region The mandibular region
www.indiandentalacademy.com Triangulations of the face www.indiandentalacademy.com Chierici method
Chierici, (1983)
www.indiandentalacademy.com An assessment of the range of variation in bilateral location of various skeletal structures from posteroanterior radiographs of acceptable faces. Dr. Amitabh Kallury, September 1999
Aims and objectives To determine the acceptable range of deviations in facial symmetry. To determine which of the two sagittal plane Cg- ANS and ZZ-ANS is more reliable.
www.indiandentalacademy.com Sample 30 males and 30 females (18-27 years)
Conclusion 1.Norms are proposed for the acceptable variation in the location of bilateral skeletal structures in the postero anterior radiographs.
www.indiandentalacademy.com 2. Cg- ANS was more reliable than ZZ- ANS as the MSR
Anatomic and developmental considerations Smaller mean and standard deviation of the landmarks From a practical point of view
www.indiandentalacademy.com Cephalometrics for orthognathic surgery Soft tissue cephalometric analysis for orthognathic surgery Soft tissue analysis Model analysis
www.indiandentalacademy.com Cephalometric analysis for orthognathic surgery (COGS)
Developed at the University of Connecticut by Burstone et al (1978)
www.indiandentalacademy.com Landmarks used in cephalometric analysis Sella (S) Nasion (N) Articulare(Ar) Pterygomaxillary fissure (PTM) Subspinale (A) Pogonion (Pg) Supramentale (B) Anterior nasal spine (ANS)
1. Cranial Base Horizontal plane Length of the cranial base : Ar to N To determine the horizontal distance between the posterior aspect of maxilla and mandible:Ar to Ptm
www.indiandentalacademy.com Cranial Base www.indiandentalacademy.com
Anterior component Middle third facial height Lower third facial height www.indiandentalacademy.com Vertical skeletal dysplasia
Posterior maxillary height Mandibular plane angle Vertical dysplasia of the posterior components www.indiandentalacademy.com
Anterior and posterior skeletal component of the face help in the
Diagnosis of maxillary hyperplasia or hypoplasia. Rotation of the maxilla and mandible. Typical surgical correction of these problems includes: Total maxillary advancement or reduction. Posterior maxillary vertical augmentation reduction. Combination of anterior or posterior maxillary vertical augmentation or reduction. Mandibular ramus rotation. Ramus height reduction. www.indiandentalacademy.com Vertical Dental Dysplasia
Two components Anterior component Posterior component Anterior component Anterior maxillary dental height or Total vertical dimension of premaxilla Anterior mandibular dental height or Total vertical dimension of anterior mandible www.indiandentalacademy.com Vertical skeletal and dental measurements www.indiandentalacademy.com Posterior dental measurement
Determines the posterior molar eruption or Posterior dental - mandibular or maxillary vertical height www.indiandentalacademy.com Maxilla and Mandible
Maxilla Length of the maxilla (PNS-ANS) Mandible Length of the mandibular ramus(Ar-Go) Length of the mandibular body(Go-Pg) Relationship between ramal plane and mandibular plane(Ar-Go-Gn) Prominence of chin(B-Pg) www.indiandentalacademy.com Maxilla and mandible www.indiandentalacademy.com These measurements are helpful in diagnosis of
Ramus height Mandibular body length Acute or obtuse gonial angle Assessment of chin prominence
OP angle Increased OP-HP may be associated with Skeletal open bite Lip incompetence Increased facial height Increased mandibular plane angle Decreased OP-HP may be associated with Deep bite Decreased facial height Lip redundancy
www.indiandentalacademy.com Measurements of AB-OP www.indiandentalacademy.com
Angulation of mandibular central incisor to MP Angulation of maxillary central incisor to NF
www.indiandentalacademy.com Soft tissue cephalometric analysis for orthognathic surgery
www.indiandentalacademy.com Cephalometric landmarks www.indiandentalacademy.com The soft tissue analysis
Facial form Angle of facial convexity Relationship of the maxilla and mandible Position of Pogonion Lower face neck angle (Sn-Gn-C) Assessment of lower face vertical ht. to depth. (Sn-Gn/Gn-C) The ratio of middle third face ht. to lower third face ht. measured to HP
www.indiandentalacademy.com Measurements of facial form
Angle of facial convexity Lower face neck angle Lower vertical ht.- depth ratio
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Anteroposterior maxillary and mandibular measurements Vertical facial height proportionality
www.indiandentalacademy.com Lip position Nasolabial angle Antero posterior lip position Mentolabial sulcus Upper and lower lip protrusion Interlabial gap Lower third facial height proportionality www.indiandentalacademy.com Lip position
Nasolabial angle A-P max. dysplasia position of upper lip Mentolabial sulcus www.indiandentalacademy.com Lip position
Interlabial gap Lower third facial height proportionality Antero posterior lip position
The Roman architect Vitruvius had divided the face into three equal parts. www.indiandentalacademy.com Facial symmetry Face is divided along the mid-sagittal plane www.indiandentalacademy.com Composite photograph to indicate normal facial asymmetry www.indiandentalacademy.com Maxillary incisor to lip relation Stomion superius to incisal edge of maxillary incisor www.indiandentalacademy.com Soft tissue evaluation : Profile view Middle to lower third facial ratio Upper lip lower lip height ratio Assessment of the nose Nasomental angle Nasolabial angle Maxillary prognathism Upper lip prominence
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Mandibular prognathism Lower lip prominence Interlabial gap Chin prominence Chin neck contour Angle of facial convexity E-line Merrifields Z angle www.indiandentalacademy.com Vertical proportions in profile view Middle to lower third facial ratio Upper lip- lower lip height ratio www.indiandentalacademy.com Assessment of nose Landmarks used to evaluate the nose are: Glabella The radix The nasal dorsum The tip of the nose The columella Nasolabial angle www.indiandentalacademy.com Nasofacial angle www.indiandentalacademy.com Inclination of the nasal base www.indiandentalacademy.com Nasomental angle
www.indiandentalacademy.com Nasolabial angle www.indiandentalacademy.com Horizontal nasal prominence Schiedeman et al (Glabella-Pronasal) should be approximate one third of the vertical ht. of the nose (glabella subnasale) www.indiandentalacademy.com Mentocervical angle Submental- neck angle
www.indiandentalacademy.com Maxillary and mandibular prognathism www.indiandentalacademy.com Upper lip-Lower lip prominence www.indiandentalacademy.com Upper lip- lower lip-Chin prominence www.indiandentalacademy.com 0 Degree Meridian www.indiandentalacademy.com Angle of facial convexity www.indiandentalacademy.com Ricketts E-Line www.indiandentalacademy.com Stieners S-line www.indiandentalacademy.com Merrifields Z angle www.indiandentalacademy.com The Holdaway Soft -Tissue Analysis www.indiandentalacademy.com Holdaway Soft Tissue Analysis Reed Holdaway His analysis comprises 11 measurements Facial angle Upper lip curvature Skeletal convexity at point A H-line angle Nose tip to H- line Upper sulcus depth Upper lip thickness www.indiandentalacademy.com Upper lip strain Lower lip to H- line Lower sulcus depth Soft tissue - chin thicknes www.indiandentalacademy.com Facial angle upper lip curvature www.indiandentalacademy.com Holdaways H line Angle www.indiandentalacademy.com Nose Tip to H line Upper Sulcus Depth Lower lip to H - line Lower sulcus Depth Soft-tissue chin thickness. www.indiandentalacademy.com Upper lip thickness www.indiandentalacademy.com
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