Cephalometric Analysis The exercise last week dealt with tracing anatomic structures on the lateral cephalometic radiograph

and identification of relevant anatomic landmarks. Using these landmarks, today we can construct reference planes or lines to represent cranio facial structures, which can then !e "analy#ed$. Analysis involves making select measurements on the cephalometric tracing and comparing them with "normative values$ to identify deviations from normal This helps the practitioner identify where pro!lems exist . There are various sets of normal values for different ethnic, age and gender groups. %hen analy#ing a cephalometric film, it&s important to understand which patient population the su!'ect !elongs to. (or each value, which is one or more standard deviations outside of the normal range, an interpretation can !e made. As mentioned !efore, we can examine certain relationships with the lateral cephalometric film. These include) *. +. ,. -. .. /. The relationship of the maxilla to the cranial !ase. The relationship of the mandi!le to the cranial !ase. The relationship of the maxilla to the mandi!le. The relationship of the maxillary dentition to the maxilla. The relationship of the mandi!ular dentition to the mandi!le. The relationship of the maxillary dentition to the mandi!ular dentition.

.(or this la!oratory, you will have !een provided with . cephalometric tracings and for each of which you will "analy#e$ and write up a cephalometric summary.

01(1015C1 78A519 :n order to examine these relationships, we will first esta!lish certain reference planes on the tracing.

*. ;raw the following reference planes) a. (rankfort <ori#ontal =(<> ? the line constructed form porion =7o> to or!itale =@r> which represents the !asic hori#ontal plane of the head. !. 9ella 5asion =95> ? the line constructed from sella to nasion which represents the anteroposterior extent of the anterior cranial !ase. c. A axis=9 Bn> ? the line constructed through sella and gnathion d. Candi!ular plane=C7> ? constructed as a line from gonion to gnathion. e. (acial 7lane =5 7og> ? the line constructed through nasion and pogonion.

CAD:88A0A A5T10@7@9T10:@0 9E181TA8 A99199C15T

*. 95A
a. 7urpose) esta!lishes the hori#ontal location of the maxilla relative to the cranial !ase. 5ote that the points !eing compared !y this angle are sella and nasion =cranial !ase points> as well as A point =maxillary point>. !. Construction) the angle !etween a line drawn from 9 to 5 and a line drawn from 5 to A. c. 5ormal value and standard deviation) F+GH +G . d. :nterpretation) *> IFJG maxilla is retrognathic relative to the cranial !ase. +> FJG F-G maxilla is normally positioned relative to the cranial !ase. ,> KF-G maxilla is prognathic relative to the cranial !ase.

+. 8andes Angle =5A to (<>

a. 7urpose) esta!lishes the hori#ontal location of the maxilla relative to the cranial !ase. 5ote that the points !eing compared !y this angle are the cranial !ase reference line (< and cranial !ase point 5 as well as A point =maxillary point>. !. Construction) the angle !etween a line drawn from 7o to @r =(<> and a line drawn from 5 to A. c. 5ormal value and standard deviation) LJGH ,G . d. :nterpretation) *> IFMG maxilla is retrognathic relative to the cranial !ase. +> FMG L,G maxilla is normally positioned relative to the cranial !ase. ,> KL,G maxilla is prognathic relative to the cranial !ase.

CA5;:NU8A0 A5T10@7@9T10:@0 9E181TA8 A99199C15T

*. 95N
a. 7urpose) esta!lishes the hori#ontal location of the mandi!le relative to the cranial !ase. 5ote that the points !eing compared !y this angle are sella and nasion =cranial !ase points> as well as N point =mandi!ular point>. !. Construction) the angle !etween a line drawn from 9 to 5 and a line drawn from 5 to N. c. 5ormal value and standard deviation) FJGH +G . d. :nterpretation) *> IMFG mandi!le is retrognathic relative to the cranial !ase. +> MFG F+G mandi!le is normally positioned relative to the cranial !ase. ,> KF+G mandi!le is prognathic relative to the cranial !ase.

+. (acial Angle
a. 7urpose) esta!lishes the hori#ontal location of the mandi!le relative to the cranial !ase. 5ote that the points !eing compared !y this angle are the cranial !ase references (< and nasion as well as 7og point =mandi!ular point>. !. Construction) the angle !etween a line drawn from 7o to @r =(<> and a line drawn from 5 to 7og. c. 5ormal value and standard deviation) FFGH /G . d. :nterpretation) *> IF+G mandi!le is retrognathic relative to the cranial !ase. +> F+G L-G mandi!le is normally positioned relative to the cranial !ase. ,> KL-G mandi!le is prognathic relative to the cranial !ase.

CAD:88A0A T@ CA5;:NU8A0 9E181TA8 A5T10@7@9T10:@0 018AT:@59<:79

*. A5N
a. 7urpose) esta!lishes the hori#ontal relationship !etween the maxilla and the mandi!le. 5ote that the points !eing compared !y this angle are A point =maxillary>, nasion =cranial !ase>, and N point =mandi!le>. !. Construction) the angle !etween a line drawn from A to 5 and a line drawn from 5 to N. Alternatively) A5N O 95A ? 95N. Therefore, any negative A5N, !y definition, will have the mandi!le ahead of the maxilla in a class ::: relationship. c. 5ormal value and standard deviation) +GH +G . d. :nterpretation) *> IJG The skeletal relationship is class ::: with either a retrognathic maxilla, a prognathic mandi!le, or a com!ination of !oth. A second measurement is rePuired to determine which 'aw is at fault +> JG -G The skeletal relationship is class : with the maxilla slightly ahead of the mandi!le. ,> K-G The skeletal relationship is class :: with either a prognathic maxilla, a retrognathic mandi!le, or a com!ination of !oth. A second measurement is rePuired to determine which 'aw is at fault.

Q10T:CA8 9E181TA8 018AT:@59<:79

*. Candi!ular 7lane Angle

a. 7urpose) This measure is used to assess the direction of the growth of the mandi!le. 5ote that the points !eing compared !y this angle are the cranial !ase reference plane of (< and the mandi!ular plane. !. Construction) the angle !etween a line drawn from 7o to @r =(<> and a line drawn !etween Bo and Bn =C7>. c. 5ormal value and standard deviation) ++GH .G . d. :nterpretation) *> I*MG implies a vertical deficiency often seen in !rachyfacial growth patterns or a counterclockwise rotation of the mandi!le. +> *MG +MG mandi!ular growth pattern is mesofacial. ,> K+MG implies a vertical excess often seen in dolicofacial growth patterns or a clockwise rotation of the mandi!le.

+. A Axis
a. 7urpose) This measure is used to assess the direction of the growth of the mandi!le. 5ote that the points !eing compared !y this angle are the cranial !ase reference plane of (< and a line !etween 9 and Bn. !. Construction) the angle !etween a line drawn from 9 to Bn =A axis> and a line drawn from 7o to @r =(<>. c. 5ormal value and standard deviation) .LGH /G . d. :nterpretation) *> I.,G implies a vertical deficiency often seen in !rachyfacial growth patterns or a counterclockwise rotation of the mandi!le. +> .,G /.G mandi!ular growth pattern is mesofacial. ,> K/.G implies a vertical excess often seen in dolicofacial growth patterns or a clockwise rotation of the mandi!le.

,. R 8(<
a. 7urpose) esta!lishes the vertical proportion of the lower facial height =A59 Ce> to the total facial height =5 Ce>. !. Construction) the ratio of the linear measure of A59 Ce divided !y the linear measure of 5 Ce. Also represented !y 8(<)T(< or A59 Ce)5 Ce. c. 5ormal value and standard deviation) ..R. d. :nterpretation) *> I..R lower face height is decreased. +> ..R lower face height is within normal limits. ,> K..R lower face height is increased.

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*. :nterincisal Angle
a. 7urpose) determines the relationship !etween the angulation of the maxillary incisors and the angulation of the mandi!ular incisors. 5ote that the two items compared are the long axes of the maxillary and mandi!ular incisors =dental>. !. Construction) the angle !etween a line drawn through the long axis of the maxillary incisor and a line drawn through the long axis of the mandi!ular incisor. c. 5ormal value and standard deviation) *,JGHSG . d. :nterpretation) *> I*+.G either the maxillary incisors are proclined, the mandi!ular incisors are proclined, or some com!ination of !oth. A second measurement is needed to determined which incisor angulation is at fault. +> *+.G *,.G the angulation !etween the incisors is within normal limits. ,> K*,.G either the maxillary incisors are retroclined, the mandi!ular incisors are retroclined, or some com!ination of !oth. A second measurement is needed to determined which incisor angulation is at fault..

+. Upper *=U*> to (<

a. 7urpose) to determine the angulation of the maxillary incisor relative to the cranial !ase. 5ote that the items compared are the (< plane =cranial !ase> and the long axis of the maxillary incisor =maxillary dental>. !. Construction) the angle !etween a line drawn from 7o to @r =(<> and a line drawn through the long axis of the maxillary incisor. c. 5ormal value and standard deviation) **JGH .G . d. :nterpretation) *> I*J.G the maxillary incisor is retroclined. +> *J.G **.G the angulation of the maxillary incisor is within normal limits. ,> K**.G the maxillary incisor is proclined.

,. Upper *=U*> to 5A =;egrees>

a. 7urpose) to determine the angulation of the maxillary incisor relative to the maxilla. 5ote that the items compared are the long axis of the maxillary incisor =dental>, nasion =cranial !ase>, and A point =maxilla>. !. Construction) the angle !etween a line drawn from 5 to A and a line drawn through the long axis of the maxillary incisor. c. 5ormal value and standard deviation) ++G . d. :nterpretation) *> I++G the maxillary incisor is retroclined. +> ++G the angulation of the maxillary incisor is within normal limits. ,> K++G the maxillary incisor is proclined.

-. Upper *=U*> to 5A =mm>

a. 7urpose).to determine the anteroposterior position of the maxillary incisor relative to the cranial !ase and the maxilla. !. Construction) the linear distance measured from the la!ial surface of the maxillary incisor to a line drawn from nasion to A point. c. 5ormal value and standard deviation) -mm d. :nterpretation) *> I-mm ? the maxillary incisor is recum!ent. +> -mm ? the A 7 position of the maxillary incisor is within normal limits. ,> K-mm ?the maxillary incisor is procum!ent..

.. 8ower *=8*> to 5N =;egrees>

a. 7urpose) to determine the angulation of the mandi!ular incisor relative to the mandi!le. 5ote that the items compared are the long axis of the mandi!ular incisor =dental>, nasion =cranial !ase>, and N point =mandi!le>. !. Construction) the angle !etween a line drawn from 5 to N and a line drawn through the long axis of the mandi!ular incisor c. 5ormal value and standard deviation) +.G . d. :nterpretation) *> I+.G the mandi!ular incisor is retroclined. +> +.G the angulation of the mandi!ular incisor is within normal limits. ,> K+.G the mandi!ular incisor is proclined.

/. 8ower *=8*> to 5N =mm>

a. 7urpose). to determine the anteroposterior position of the mandi!ular incisor relative to the cranial !ase and the mandi!le. !. Construction) the linear distance measured from the la!ial surface of the mandi!ular incisor to a line drawn from nasion to N point. c. 5ormal value and standard deviation) -mm. d. :nterpretation) *> I-mm ? the mandi!ular incisor is recum!ent. +> -mm the A 7 position of the mandi!ular incisor is within normal limits. ,> K-mm ? the mandi!ular incisor is procum!ent..

M. 8ower *=8*> to C7 =;egrees>

a. 7urpose) to determine the angulation of the mandi!ular incisor relative to the mandi!le. 5ote that the items compared are the long axis of the mandi!ular incisor =dental> and the C7 =mandi!le>. !. Construction) the angle !etween a line drawn from Bo to Bn =C7> and a line drawn through the axis of the lower incisor. c. 5ormal value and standard deviation) L*GH /G . d. :nterpretation) *> IF.G the mandi!ular incisor is retroclined. +> F.G LMG the angulation of the mandi!ular incisor is within normal limits. ,> KLMG the mandi!ular incisor is proclined.

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*. 5asola!ial Angle
a. 7urpose) to assess the nose to upper lip relationship. !. Construction) the angle !etween a line drawn tangent to columella of the upper lip and a line tangent to the lower !order of the nose =9n to nasal tip>. c. 5ormal value and standard deviation) *J+GH FG . d. :nterpretation) *> IL-G the upper lip is procum!ent. +> L-G **JG the position of the upper lip is within normal limits. ,> K**JG the upper lip is retrusive.

+. 8ower lip to 1 7lane

a. 7urpose) determines the soft tissue !alance !etween lips and profile =nose chin> and assess lip protrusion. !. Construction) the linear distance from the lower lip to a line drawn from the tip of the nose to soft tissue pogonion =7og&>. c. 5ormal value and standard deviation) +mmH +mm d. :nterpretation) *> I -mm the lower lip is retruded. +> ?-mm ? Jmm ? the position of the lower lip is within normal limits. ,> KJmm the lower lip is protruded.

9UCCA0A TAN81
Area of 9tudy Caxilla ry A 7 7osition Candi!ular A 7 7osition 95N 5 7og to (< Caxillo mandi!ular 0elations A5N Qertical 0elations A axis (CA R 8(< Caxillary and Candi!ular :ncisor 7osition :nterincisal U* to (< =G> U* to 5A =G> U* to 5A =mm> 8* to 5N =G> 8* to 5N =mm> 8* to C7 =G> 9oft Tissue 8 lip to 1 plane 5asola!ial Angle +mmH+mm *J+GHFG 0etruded lower lip 7rotruded upper lip 7rotruded lower lip 0etruded upper lip or tipped up nose *,JGH.G **JGH,G ++G -mm +.G -mm L*GH/G
1ither proclined maxillary incisors, proclined mandi!ular incisors, or a com!ination of !oth. 1ither retroclined maxillary incisors, retroclined mandi!ular incisors, or a com!ination of !oth.

Ceasurements 95A 5 A to (<

C17<A8@C1T0:C 9UCCA0A 9tandard I normal ? *9; F+GH+G LJGH,G FJGH+G FFGH/G +GH+G .LGH/G ++GH.G ..R 0etrognathic maxilla 0etrognathic maxilla 0etrognathic mandi!le 0etrognathic mandi!le
9keletal Class :::U 1ither retrognathic maxilla, prognathic mandi!le, or a com!ination of !oth. NrachyfacialU decreased verticalU Counterclockwise mandi!ular rotation NrachyfacialU decreased verticalU Counterclockwise mandi!ular rotation

Knormal T *9; 7rognathic maxilla 7rognathic maxilla 7rognathic mandi!le 7rognathic mandi!le
9keletal Class ::U 1ither prognathic maxilla, retrognathic mandi!le, or a com!ination of !oth. ;olichofacialU increased verticalU Clockwise mandi!ular rotation ;olichofacialU increased verticalU Clockwise mandi!ular rotation

NrachyfacialU decreased vertical

;olichofacialU increased vertical

0etroclined maxillary incisors 0etroclined maxillary incisors 0ecum!ent maxillary incisors 0etroclined mandi!ular incisors 0ecum!ent mandi!ular incisors 0etroclined mandi!ular incisors

7roclined maxillary incisors 7roclined maxillary incisors 7rocum!ent maxillary incisors 7roclined mandi!ular incisors 7rocum!ent mandi!ular incisors 7roclined mandi!ular incisors

8AN@0AT@0A CA919
C17<A8@C1T0:C 9UCCA0A

Area of 9tudy Caxillary A 7 7osition Candi!ular A 7 7osition

Ceasurements 95A 5 A to (< 95N 5 7og to (<

9tandard F+GH+G LJGH,G FJGH+G FFGH/G +GH+G .LGH/G ++GH.G ..R *,JGH.G **JGH,G ++G -mm +.G -mm L*GH/G +mmH+mm *J+GHFG

Case *

Case +

Case ,

Case -

Case .

Caxillo mandi!ular 0elations A5N Qertical 0elations A axis (CA R 8(< Caxillary and Candi!ular :ncisor 7osition :nterincisal U* to (< =G> U* to 5A =G> U* to 5A =mm> 8* to 5N =G> 8* to 5N =mm> 8* to C7 =G> 9oft Tissue 8 lip to 1 plane 5asola!ial Angle

5arrative 9ummary 7atient * Antero posterior relations)

Caxilla Candi!le Caxillary incisors Anglular 8inear Candi!ular :ncisor Angular 8inear Qertical relations) :ncreased ;ecreased 5ormal 7roportional face height 9oft tissue) Upper lip 8ower lip

5arrative 9ummary 7atient + Antero posterior relations) Caxilla Candi!le Caxillary incisors Anglular 8inear Candi!ular :ncisor Angular 8inear Qertical relations) :ncreased ;ecreased 5ormal 7roportional face height 9oft tissue) Upper lip 8ower lip

5arrative 9ummary 7atient , Antero posterior relations) Caxilla Candi!le Caxillary incisors Anglular 8inear Candi!ular :ncisor Angular 8inear Qertical relations) :ncreased ;ecreased 5ormal 7roportional face height 9oft tissue) Upper lip 8ower lip

5arrative 9ummary 7atient Antero posterior relations) Caxilla Candi!le Caxillary incisors Anglular 8inear Candi!ular :ncisor Angular 8inear Qertical relations) :ncreased ;ecreased 5ormal 7roportional face height 9oft tissue) Upper lip 8ower lip

5arrative 9ummary 7atient . Antero posterior relations) Caxilla Candi!le Caxillary incisors Anglular 8inear Candi!ular :ncisor Angular 8inear Qertical relations) :ncreased ;ecreased 5ormal 7roportional face height 9oft tissue) Upper lip 8ower lip