Cephalometry

International students, 4th year Department of Orthodontics

What radiograph to take?

panoramic (OPG)
supernumerary and missing teeth screening for any pathologic lesions variations in development or eruption timing impaction deviations in tooth morphology quality and quantity of alveolar bone TMJ mandibular asymmetries

What radiograph to take?

intraoral periapical
more accurate evaluation of pathologic lesions to assess periodontal status to evaluate root morphology root length (resorption cases) PDL space assessment (possible ankylosis)

What radiograph to take?

posteroanterior
significant clinical facial asymmetries severe dental midline discrepancies

lateral
evaluation of jaws axial inclination of incisors soft tissue morphology growth pattern

Cephalometric landmarks
hard tissue landmarks soft tissue landmarks

Cephalometric landmarks
hard tissue landmarks, midsaggital
Sella (S) Nasion (Na) Anterior nasal spine (ANS) A point or subspinale (A) B point or supramentale (B) Pogonion (Pog) Menton (Me) Gnation (Gn)

Figure 6-45 Definitions of cephalometric landmarks (as they would be seen in a dissected skull): Point A, the innermost point on the contour of the premaxilla between anterior nasal spine and the incisor tooth. ANS (anterior nasal spine), the tip of anterior nasal spine (sometimes modified as the point on the upper or lower contour of the spine where it is 3 mm thick; see Harvold analysis); Point B, the innermost point on the contour of the mandible between the incisor tooth and the bony chin; Ba (basion), the lowest point on the anterior margin of foramen magnum, at the base of the clivus; Gn (gnathion), the center of the inferior point on the mandibular symphysis (i.e., the bottom of the chin); Na (nasion), the anterior point of the intersection between the nasal and frontal bones; PNS (posterior nasal spine), the tip of the posterior spine of the palatine bone, at the junction of the hard and soft palates; Pog (Pogonion), the most anterior point on the contour of the chin.
Downloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 9 September 2009 05:54 PM) 2007 Elsevier

Figure 6-46 Definitions of cephalometric landmarks (as seen in a lateral cephalometric tracing): 1. Bo (Bolton point), the highest point in the upward curvature of the retrocondylar fossa of the occipital bone; 2. Ba (basion), the lowest point on the anterior margin of the foramen magnum, at the base of the clivus; 3. Ar (articular), the point of intersection between the shadow of the zygomatic arch and the posterior border of the mandibular ramus; 4. Po (porion), the midpoint of the upper contour of the xternal auditory canal (anatomic porion); or, the midpoint of the upper contour of the metal ear rod of the cephalometer (machine porion); 5. SO (sphenoc-cipital synchondrosis), the junction between the occipital and basisphenoid bones (if wide, the upper margin); 6. S (sella), the mid-point of the cavity of sella turcica; 7. Ptm (pterygomaxillary fissure), the point at the base of the fissure where the anterior and posterior walls meet; 8. Or (orbitale), the lowest point on the inferior margin of the orbit; 9. ANS (anterior nasal spine), the tip of the anterior nasal spine (sometimes modified as the point on the upper or lower contour of the spine where it is 3 mm thick; see Harvold analy-sis); 10. Point A, the innermost point on the contour of the premaxilla between anterior nasal spine and the incisor tooth; 11. Point B, the innermost point on the contour of the mandible between the incisor tooth and the bony chin; 12. Pog (pogonion), the most ante-rior point on the contour of the chin; 13. Me (menton), the most inferior point on the mandibular symphysis (i.e., the bottom of thechin); 14. Go (gonion), the midpoint of the contour connecting the ramus and body of the mandible. from: Proffit: Contemporary Orthodontics, 4th edition (on 9 September 2009 05:54 PM) Downloaded
2007 Elsevier

Cephalometric landmarks
hard tissue landmarks, bilateral
Orbitale (Or) Porion (P) Articulare (Ar) Gonion (Go)

Cephalometric landmarks
soft tissue landmarks
Glabella (Gla) Subnasale (Sn) Stomion (St)

Anatomic planes
SellaSella-nasion (SN) Frankfort horizontal (FH) Palatal plane (PP) Mandibular plane (MP) Y-axis (S-Gn) (S-

Figure 6-48 A, The Frankfort plane as originally described for orientation of dried skulls. This plane extends from the upper border of the external auditory canal (A) (porion) anteriorly to the upper border of the lower orbital rim (orbitale) (B). B, Using "machine porion," the upper surface of the ear rod of the cephalometric headholder, can give a different Frankfort plane than using "anatomic porion," the upper surface of the shadow of the auditory canal. Both porion and orbitale, the landmarks for the Frankfort plane, are difficult to locate accurately on cephalometric films, making Frankfort a relatively unreliable reference for cephalometric analysis.

Downloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 9 September 2009 05:54 PM) 2007 Elsevier

Figure 6-55 Inspection of the horizontal planes for this patient makes it clear that the maxilla is rotated downward posteriorly and the mandible rotated downward anteriorly. These rotations of the jaws contribute to an open bite tendency, so the skeletal pattern revealed here is often referred to as "skeletal open bite."

Downloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 9 September 2009 05:54 PM) 2007 Elsevier

Skeletal measurements
anteroposterior
SNA angle SNB angle ANB angle 82+-3 82 80+-3 80 2+-2

Figure 6-50 In the Steiner analysis, the angles SNA and SNB are used to establish the relationship of the maxilla and mandible to the cranial base, while the SN-MP (mandibular plane) angle is used to establish the vertical position of the mandible.

Downloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 9 September 2009 05:54 PM) 2007 Elsevier

Skeletal measurements
vertical
SN-MP SN SGn-FH SGn32+-5 32 59+-3 59

Skeletal measurements
incisor
U1-SN (upper incisor to SN) U1103+-5 103 U1-NA (upper incisor to NA line) +3mm+-2 U1+3mm+ L1-MP (lower incisor to mandibular plane) L193 93+-7 L1-NB (lower incisor to NB line) +3mm+-2 L1+3mm+ U1-L1 (interincisal angle) U1130+-2 130

Figure 6-52 In the Steiner analysis, the relationship of the upper incisor to the NA line is used to establish the position of the maxillary dentition relative to the maxilla. Both the millimeter distance that the labial surface of the incisor is in front of the line and the inclination of the long axis of the incisor to the line are measured. The position of the lower incisor relative to the mandible is established by similar measurements to the line NB. In addition, the prominence of the chin is established by measuring the millimeter distance from the NB line to pogonion, the most prominent point on the bony chin.

Downloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 9 September 2009 05:54 PM) 2007 Elsevier

Soft tissue measurements

Pog-NB (pogonion to NB line) Pog E plane (esthetic line) +3mm+-2 +3mm+-2mm+-2 2mm+-