An Atlas On Cephalometric Landmarks

An Atlas on
Cephalometric
Landmarks
An Atlas on
Cephalometric
Landmarks
Basavaraj Subhashchandra Phulari

BDS MDS (Ortho-TSMA-Russia) FAGE FRSH
Formerly
Faculty, Department of Orthodontics and
Dentofacial Orthopedics
Mauras College of Dentistry, Hospital and
Oral Research Institute
Republic of Mauritius
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An Atlas on Cephalometric Landmarks
First Edition: 2013
ISBN: 978-93-5090-324-7
Printed at
To
My dear parents Subhashchandra and Shivalingamma Phulari
brothers Sangamesh, Jagadish and manjunath
my beloved wife Dr Rashmi GS
and my dear sons Yashas and Vrishank
Preface
Cephalometrics has been used in orthodontics for diagnosis, treatment planning, to evaluate the dentofacial
changes during treatment and to assess the dentofacial growth and development. Cephalometrics makes use
of certain landmarks on the skull. The first important step in cephalometric analysis is accurate location and
tracing of cephalometric landmarks on the cephalogram. Any error in tracing the landmarks may result in incorrect
cephalometric analysis.
This book focuses on understanding the various cephalometric landmarks. Each cephalometric landmark is
explained in detail including its abbreviation, definition by various researchers, origin and radiographic anatomy of
the landmarks.
There are 20 chapters divided into 11 sections. Chapter two lists the different ways of classifying cephalometric
landmarks given in the literature. In addition, a new working classification has been given that lists the numerous
cephalometric landmarks logically which makes remembering easier.
This working classification is used as a blueprint to systemically explain the cephalometric landmarks from
chapter 3 through chapter 19. Chapter 20 explains application of all types of cephalometric landmarks in various
cephalometric analyses. In addition to the landmarks on lateral cephalogram, the landmarks on the posteroanterior
(P-A) cephalogram and submentovertex (S-V) radiographic projection are also dealt in this book.
I regret any deficiencies and shortcomings that might have crept in despite my best efforts. I would also welcome
comments and suggestions from both students and teachers for further improvement of the book.
Basavaraj Subhashchandra Phulari

basavarajsp@gmail.com
Acknowledgments
I express my heartfelt gratitude to Dr Rajendrasinh Rathore MDS, Chairman of Manubhai Patel Dental College and
Hospital, Vadodara, Gujarat for his inspirational support during this endeavor and throughout my career. I also thank
Dr Yashraj Rathore, Trustee, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India for encouraging
me during this project.
I am indebted to my dear parents for all their love and sacrifices that have made me what I am. My special thanks
are due to my beloved wife for her valuable comments and suggestions, and my dear sons for being the constant
source of inspiration to set and reach new goals in life.
I would like to thank Anatomage Inc. for providing images in chapter 17 and for the cover.
Most of all I thank the Almighty for all His kindness and blessings showered upon me.
Contents
Section 1: Introduction and History
1. Cephalometry in Orthodontics....................................................................................................... 3
Technical Aspects4
Cephalometric X-ray Tracing Techniques4
Section 2: Classification of Cephalometric Landmarks

2. Classification of Cephalometric Landmarks................................................................................. 7
Classification of cephalometric landmarks (Points) 7
Section 3: Cephalometric Landmarks Related to Cranial Bones

3. Cephalometric Landmarks Related to Frontal Bone.................................................................. 15
Parts of Frontal Bone15
Articulation of Frontal Bone15
Cephalometric Landmarks (Points) on Frontal Bone15
Radiographic Anatomy of Frontal Bone15
Nasion 16
Supra-Orbitale 17
Roof of the Orbital Cavity 17
Frontonasal/Frontomaxillary Nasal Suture 18
4. Cephalometric landmarks related to ethmoid bone ............................................................... 21

Parts of Ethmoid Bone21
Articulation of Ethmoid Bone21
Cephalometric Landmarks (Points) on Ethmoid Bone21
Temporale21
Neck of Crista Galli23

Medio-orbitale23
Sphenoethmoidal Point24
Ethmoidale24
5. Cephalometric landmarks related to Nasal bone.................................................................... 26

Articulation of frontal bone 26
Radiographic anatomy of nasal bone26
Nasion26
Frontonasal/Frontomaxillary Nasal Suture28

Rhinion29
6. Cephalometric landmarks related to temporal bone ............................................................. 31

Articulation of Temporal Bone 31
Radiographic Anatomy of Temporal Bone31
Cephalometric Landmarks (Points) on Temporal Bone31
Porion32
Zygomatic Arch32
Mastiodale33
7. Cephalometric landmarks related to sphenoid bone ............................................................. 35

Cephalometric Landmarks (Points) on Sphenoid Bone 35
Dorsum of Sella36
Floor of Sella37
Clinoidale38
Spheno-Occipital Synchondrosis39
Pterygoid point40
Sella41
Sella Entrance41
Sphenoethmoidal point42
Pterygomaxillary Fissure44
xii
8. Cephalometric landmarks related to occipital bone .............................................................. 46

Cephalometric landmarks (Points) on occipital bone46
Radiographic anatomy of Occipital bone46
Basion46
Opisthion48
Boltons point48
Spheno-occipital synchondrosis50
9. Cephalometric landmarks related to Zygomatic bone ............................................................. 52

Radiographic Anatomy of Zygomatic Bone52
Cephalometric landmarks (Points) on Zygomatic
bone52
Orbitale52
Temporale54
Section 4: Cephalometric Landmarks Related to Facial Bones and Dentition

10. Cephalometric Landmarks Related to Maxilla............................................................................ 59
Cephalometric Landmarks (Points) on Maxilla59
Anterior Nasal Spine59

Point A61
Prosthion62
Posterior Nasal Spine64

Key Ridge66
Orbitale67
11. Cephalometric Landmarks Related to Dentition............................................................................ 70

Incision Superius Incisalis71
Incision Superius Apicalis73
Incision Inferius Incisalis74
Incision Inferius Apicalis75
Anterior Point of Occlusion76
Posterior Point of Occlusion77
Maxillary Central Incisor79

Maxillary First Molar79
Mandibular Central Incisor80
Mandibular First Molar81
mi82
ms83
12. Cephalometric Landmarks Related to Mandible............................................................................ 85

Cephalometric landmarks (Points) on Mandible85
Parts of Mandible85
Nerve Supply to Mandible85
Articulations86
Infradentale86
Point B87
Pogonion88
Gnathion89
dd91
Menton92
Gonion93
Articulare93
kk94
Condylion95
Section 5: Cephalometric Landmarks Related to Cervical Bones

13. Cephalometric landmarks related to hyoid bone ................................................................. 101
Parts of the Hyoid Bone101
Radiographic Anatomy of Hyoid Bone101
Cephalometric Landmarks (Points) on Hyoid Bone101
Hyoid101
14. Cephalometric landmarks related to Vertebrae......................................................................... 103

Radiographic anatomy of cervical vertebrae103
Cephalometric Landmarks on Cervical Vertebra103
Cephalometric Landmarks (Points) Related to Cervical
Vertebra103
cv2ip104
cv2ap104
cv2ia106
cv3sp106
xiii
cv5ip113
cv5sa113
cv5ia115
cv6sp115
cv6ip116
cv6sa116
cv6ia118
Cervical Vertebrae as Indicators of Skeletal Maturity118
cv3ip107
cv3sa107
cv3ia109
cv4sp109
cv4ip110
cv4sa110
cv4ia112
cv5sp112
Section 6: Cephalometric landmarks related to Pharynx

15. Cephalometric landmarks related to Pharynx........................................................................ 123
Nasopharynx123
Oropharynx123
Laryngopharynx123
Cephalometric Landmarks (Points) on Pharynx123
Posterior Pharyngeal Wall124

Superior Pharyngeal Wall124
Tip of the Uvula124
Point on the Oral Side of the Soft Palate124
Anterior Nasal Spine, Posterior Nasal Spine and

Point on the Pharyngeal Side of the Soft Palate124
Anterior Pharyngeal Wall123
Upper Point of Tongue124

Significance124
Section 7: Soft Tissue Cephalometric Landmarks

Soft Tissue Cephalometric Landmarks (Points) Related to
Forehead127
Soft Tissue Glabella127

Soft Tissue Nasion128
Nasal Crown129
Pronasale129
Point T130
Alar Crease Junction131
Subnasale131
Soft Tissue Subspinale133
Labrale Superius134
Stomion135
Labrale Inferius136
Soft Tissue Submentale136
Soft Tissue Pogonion138
Soft Tissue Gnathion139
Contents
16. Soft Tissue Cephalometric Landmarks.......................................................................................... 127
Section 8: 3D Cephalometric Landmarks

17. 3D Cephalometric Landmarks.................................................................................................... 143
Vertex143
Soft Tissue Nasion143
Pronasale144
Subnasale144
Soft Tissue Subspinale145
Labrale Superius146
Stomion146
Labrale Inferius146
Soft Tissue Submentale147
Soft Tissue Pogonion147
Soft Tissue Gnathion148
Orbitale148
Zygomatic Prominence149
Zygion149
Condylion149
Gonion150
Ch150
Cheilion151
Alare151
Exocanthion151
Sella152
Sella entrance153
Basion153
Anterior Nasal Spine154
xiv
Section 9: PA Cephalometric Landmarks

18. PA Cephalometric Landmarks.................................................................................................... 159
Taking Pa Cephalogram160
Maxillary First Molar168
Structures Involved in Pa Cephalogram160
Cuspid 169
Crista galli160
Top of nasal septum161
NC162
Incision Inferius Apicalis170

Incision inferius frontale171
Zyg-Zygoma162
Mandibular First Molar171
zygion163
mi172
Zygomatic arch163
Zygomatic suture point164
Jugal process 164
Mandibular molar173
Menton173
Articulare174
Maxillare165
Incision Inferius Incisalis 169
Incision Superius Incisalis165

Incision Superius Apicalis166
Maxillary molar167
malare174
Antegonial Tubercles175
Antegonion175
Section 10: SV Cephalometric Landmarks
19. SV Cephalometric Landmarks.................................................................................................... 179

Basion179
Maxillary Apical Base Midline 185
Opisthion179
Mandibular Dental Midline185
Foramina spinosa points180
Mandibular Apical Base Midline186
Foramina spinosum180
First Molar Point187
Odontoid181
Gonion point187
Pterygomaxillary fissure182
Condylion medialis188
Middle cranial fossa points182
Condylion lateralis188
Posterior Vomer point182
Condylion Anterioris189
Posterior Cranial vault points183
Condylion posterioris190
Angulare point184
Section 11: Applications of Cephalometric Landmarks

20. Applications of Cephalometric Landmarks.............................................................................. 193
Bjork Cephalometric Analysis193
Holdaway Cephalometric Analysis197
Coben Craniofacial and Dentition Cephalometric
Legan and Burstone Soft Tissue Cephalometric
Analysis194
Analysis198
Downs Cephalometric Analysis195
Ricketts Cephalometric Analysis198
Farkas and Coworkers Soft Tissue Cephalometric
Sassouni Cephalometric Analysis199
Analysis196
Di Paolos Quadrilateral Analysis200
Harvold Cephalometric Analysis196
Hasund (Bergen) Cephalometric Analysis200
xv
Jarabak Cephalometric Analysis201
Wits Cephalometric Analysis206
Riedel Cephalometric Analysis202
Basis Cephalometric Analysis207
Schwartz Cephalometric Analysis203
Cagliari Cephalometric Analysis207
Wylie Cephalometric Analysis203
Chieti Cephalometric Analysis208
Steiners Cephalometric Analysis204
McGann Cephalometric Analysis209
Tweeds Cephalometric Analysis205
Index...................................................................................................................................................... 211
Contents
Section
Introduction and History
Cephalometry in Orthodontics
Chapter
Cephalometry in
Orthodontics
Cephalometric radiographs are used in orthodontic diagnosis

to evaluate the pre-treatment dental and facial relationship of a
patient, to evaluate changes during treatment and to assess tooth
movement and facial growth at the end of treatment. On the
cephalometric film, teeth can be related to one another, to the
jaw in which they reside, and to cranial structures. The maxilla
and mandible can be related to one another and other structures
into the cranium and the soft tissue profile can be evaluated.
Cephalometric analysis is one among various diagnostic aids.
An orthodontic diagnosis is not possible only on the basis
of cephalometry. Cephalometric analysis is an important aid
in orthodontic diagnosis only if its findings are correctly and
wisely interpreted with the help of other diagnostic aids.
In the cephalometric assessment, certain carefully defined
points are located on the radiographs, and linear and angular
measurements are made from these points. The expressions
of these measurements in various ways produce analysis of
skeletal size and form.
Figure 1.1: Lateral cephalogram
Types of Cephalogram
There are following two types of cephalograms
1. Lateral cephalogram: Lateral cephalogram provides a
lateral view of the skull (Fig. 1.1). It is taken with the
head in a standardized reproducible position at a specified
distance from the source of the x-ray. Lateral cephalogram
commonly is used for cephalometric analysis.
2. Frontal cephalogram: This provides an antero-posterior
view of the skull (Fig. 1.2).
Uses of Cephalometric Analysis

1. Cephalometric analysis is routinely used for diagnostic
purpose to assess whether malocclusion dental or skeletal
in origin.
2. It enables clinician to know accurately the extent to which
patient deviates from described norms.
Figure 1.2: Frontal cephalogram
3. It is used to monitor the changes occurring due to growth

or treatment or their combination. In other words, precise
evaluation of patients response to treatment is made
possible.
4. Yet another use of cephalometrics is to predict changes
that should occur in future for patient after orthodontic
treatment. An architectural plan / blueprint of orthodontic
treatment.
Technical Aspects
Section 1 Introduction and History
The cephalometric radiographs are taken using an apparatus

that consists of an X-ray source and a head holding device
called cephalostat. The cephalostat consists of two ear rods
that prevent the movement of the head in the horizontal
plane. Vertical stabilization of the head is brought about by
an orbital pointer that contacts the lower border of the left
orbit. The upper part of the face is supported by the forehead
clamp positioned above the region of the nasal bridge. The
distance between the X-ray source and the mid-sagittal plane
of the patient is fixed at 5 feet (152.4 cm). Thus the equipment
helps in standardizing the radiographs by use of constant head
position and source film distance so that serial radiographs
can be compared.
There are many systems of cephalometric analysis, which
utilize various points and outline on the lateral cephalogram
radiograph.
Cephalometric X-ray Tracing Techniques

Masking tape is used to attach the cephalometric X-ray to the
acrylic acetate tracing paper sheet. Tracing is made on the
frosted surface of acetate tracing sheet.
The tracing is begun by marking the hard and soft tissue
points needed for the analysis on the tracing sheet. Soft tissue
profile is traced and then the sella turcica going forward to
the planum sphenoidale along the floor of the anterior cranial
fossa of the shadows of the greater wings of sphenoid bone are
traced. The anterior surface of the frontal and nasal bones are
then traced followed by tracing the outline of the maxilla and
from the anterior nasal spine along the floor of the nasal cavity
back to posterior nasal spine from posterior nasal spine.
Bibliography
1. Bennett GC, Kronman JH. A cephalometric study of mandibular
development and its relationship to the mandibular and occlusal planes.
Angle orthodont.1970;40:119-28.
2. Bjork A. Prediction of mandibular growth rotation. Am J Orthodont.
1969;55:585-99.
3. Broadbent BH. A new X-ray technique and its application to
orthodontics, Angle Orthod. 1931;1:45-66.
4. Brodie AG, Downs WB, Goldstein A, Myer E. Cephalometric appraisal of
orthodontic results: A preliminary report. Angle orthodont. 1938;8:261-5.
5. Downs WB, Variations if facial relationship: Their significance in
treatment and prognosis. Am J Orthod. 1948;34:812.
6. Downs WB. Analysis of the dentofacial profile. Angle Orthod. 1956;
26:191.
7. Downs WB. Analysis of the dento-facial profile. Angle orthodont.
1956;26:191-212.
8. Houston WJB. The analysis of error in orthodontics measurements. AM
J Orthod. 1983;83:382-90
9. Jacobs. Introduction to Radiographic Cephalometry, Lea and Febiger,
Philadelphia. 1985.
10. Jacobson A. Radiographic cephelometry: From basics to video imaging,
Chicago 1995, Quintessence Pub Co.
11. Jacobson A. The appraisal of jaw disharmony. Am J Orthod. 1975;
67:125-38.
12. Jakobson S. Cephelometric evaluation of treatment effect on ClassIIDivision I malocclusions. Amer J Orthodont. 1967;53:446-57.
13. Moorrees, CFA, Lebret L. The mesh diagram and cephalometricss.
Angle Orthodont. 1962;32:214-31.
14. Rickets RM, Bench RW, Hilgers JJ, Schulhof R. An overview of
computerized cephalometrics. Am J Orthodont. 1972;61:1-28.
15. Steiner CC. The use of Cephalometrics as an aid in planning & assessing
orthodontic treatment. Am J Orthod. 1960;46:721.
16. Subtelny JD. Cephalometric diagnoss, growth and treatment: something
old, something new? Am J Orthodont. 1970;57:262-86.
17. Susomi R. A cephalometric evaluation of dentofacial growth in mandi
bular protrusion subjects. J Osaka Univer. Dent. CSch. 1969;9:25-35.
18. Thomas M Graber, Robert L Vanarsdall. Orthodontics current principles
and techniques, Mosby year book Inc. 1994.
19. Tweed CH. The diagnosis facial triangle in the control of treatment
objectives. Am J Orthodont. 1969;55:667.
Section
Classification of Cephalometric
Landmarks
Classification of Cephalometric Landmarks
Chapter
Classification of
Cephalometric Landmarks
Cephalometry makes use of certain landmarks or points

on the skull which are used for quantitative analysis and
measurements.
1. Hard tissue cephalometric landmarks.

2. Soft tissue cephalometric landmarks.
Flow chart 2.2: Cephalometric landmarks/points
Classification of cephalometric landmarks/points

The first two classifications given below are well-known in the
literature. In addition to these basic existing classifications,
the author has attempted to categorize the cephalometric
landmarks in various ways to simplify their understanding and
subsequent applications in various cephalometric analysis.
Classification of cephalometric landmarks

based on Origin
Based on the origin, cephalometric landmarks/points are
classified in the following two types (Flow chart 2.1):
1. Anatomic cephalometric landmarks/points.
2. Derived cephalometric landmarks/points.
Hard tissue cephalometric landmarks

These landmarks represent the actual hard tissue structures of
the skull, such as nasal bone, ethmoidal bone, frontal bone,
maxillary bone, mandible and hyoid, etc.
Examples of hard tissue cephalometric landmarks
Nasion
Neck of crista galli
Temporale
Sella
Menton
Gonion.
Soft tissue cephalometric landmarks

Anatomic cephalometric landmarks/points
These landmarks represent the actual anatomic structures of
the skull, e.g. Nasion, point A, point B, ANS, PNS, etc.
Derived cephalometric landmarks/points

These are landmarks that have been obtained secondarily from
anatomic structures in a lateral cephalogram, e.g. Gnathion,
Anterior Point of Occlusion, etc.
cephalometric landmarks Based on

Structures Involved
Based on structures involved, cephalometric landmarks/points
can be classified as follows (Flow chart 2.2):
Cephalometric landmarks/points located on soft tissues are

categorized as soft tissue cephalometric landmarks/points.
Soft tissues:
Forehead
Nose
Lips
Chin.
Examples of soft tissues cephalometric landmarks
Soft tissue nasion
Subnasale
Subspinale
Stomion
Soft tissue pogonion
Soft tissue gnathion.
Cephalometric landmarks Based on the type

or Side Involved
Point B
Menton, etc.
Based on the side involved cephalometric landmarks/points

can be classified as follows (Flow chart 2.3):
1. Unilateral cephalometric landmarks.
2. Bilateral cephalometric landmarks.
Bilateral cephalometric landmarks
Section 2 Classification of Cephalometric Landmarks
These are cephalometric landmarks found on both right and

left side.
Examples
Gonion
Articulare
APOcc
U 6
L 6, etc.
Hard or Soft Tissue cephalometric landmarks
Unilateral cephalometric landmarks

These are cephalometric landmarks or points situated in the
midline.
Examples
Nasion
Point A
Cephalometric landmarks/points can be hard or soft tissue

landmarks. Hard tissue and soft tissue landmarks can be further
classified into anatomic and derived and then subclassified
into unilateral or bilateral (Flow chart 2.4).
Cephalometric Landmarks/Points can be Found

on lateral Cephalogram, PA Cephalogram and
SV Cephalogram (Flow Chart 2.5)
Types of Cephalometric Landmarks/Points

Cephalometric landmarks/points can be classified into following three types (Flow chart 2.6)
1. Cephalometric landmarks/points related to cranial bones
2. Cephalometric landmarks/points related to pharynx
3. Cephalometric landmarks/points related to cervical vertebrae
Classification of Cephalometric Landmarks/

Points Based on their Location
The detailed description of the cephalometric landmarks/
points in this book follows this working classification (Flow
chart 2.7).
Chapter 2 Classification of Cephalometric Landmarks
10
Cephalometric landmarks/points related to

cranial bones
Cephalometric landmarks/points related to zygomatic

bone
Cephalometric landmarks/points related to frontal

bone
Orbitale
Temporale
Cephalometric landmarks/points related to

Facial Bone and Dentition
Nasion
Supra-orbitale
Roof of orbit
Frontozygomatic suture
Frontale
Frontomaxillary nasal suture
Section 2 Classification of Cephalometric Landmarks
Cephalometric landmarks/points related to ethmoid

bone

Temporale
Medio-orbitale
Sphenoethmoidal point
Ethmoidale
Cephalometric landmarks/points related to nasal bone

Nasion
Rhinion
Frontonasal/frontomaxillary nasal suture
Cephalometric landmarks/points related to temporal

bone
Porion
Zygomatic arch
Mastiodale
Cephalometric landmarks/points related to maxilla

Anterior nasal spine

Point A
Anterior point of occlusion
Prosthion
Posterior nasal spine
Pterygomaxillary fissure
Key ridge
Orbitale
Cephalometric landmarks/points related to dentition

Incision superius incisalis

Incision superius apicalis
Incision inferius incisalis
Incision inferius apicalis
Anterior point of occlusion
Posterior point of occlusion
Maxillary central incisor
Maxillary first molar
Mandibular central incisor
Mandibular first molar
Mi
Ms
Cephalometric landmarks/points related to sphenoid

bone
Cephalometric landmarks/points related to mandible
Dorsum sella
Floor of sella
Clenoidale
Spheno-occipital synchondrosis
Pterygoid point
Foramen spinosum point
Sella
Cephalometric landmarks/points related to occipital bone

Basion
Opisthion
Boltons point
Spheno-occipital synchondrosis
Infradentale
Point B
Pogonion
Gnathion
dd
Menton
Gonion
Articulare
kk
Condylion
Cephalometric landmarks/points related to Cervical

bones
Cephalometric landmarks/points related to hyoid bone
Hyoid.
11
Cephalometric landmarks/points related to vertebrae

cv2ap
cv2ip
cv2ia
cv3sp
cv3ip
cv3sa
cv3ia
cv4sp
cv4ip
cv4sa
cv4ia
cv5sp
cv5ip
cv5sa
cv5ia
cv6sp
cv6ip
cv6sa
cv6ia
Soft tissue cephalometric landmarks/points
Flow chart 2.8: Soft tissue cephalometric landmarks/points
Chapter 2 Classification of Cephalometric Landmarks
Soft tissue cephalometric landmarks or points can be classified

as follows (Flow chart 2.8):
1. Soft tissue cephalometric landmarks or points related to
forehead
Trichion
Soft tissue glabella.
2. Soft tissue cephalometric landmarks or points related to nose
Soft tissue nasion
Nasal crown
Pronasale
Point T
3. Soft tissue cephalometric landmarks or points related to lips
Upper lip
Soft tissue subspinale
Labrale superius
Philtrum
Cuspid bow
Vermilion border of upper lips
Lower lip
Labrale inferius
Soft tissue point B
Upper and lower lips
Stomion
- Stomion superius
- Stomion inferius
4. Soft tissue cephalometric landmarks/points related to chin
Soft tissue menton
Soft tissue gnathion.
Section
Related to Cranial Bones
Cephalometric Landmarks Related to Frontal Bone

Cephalometric Landmarks Related to Ethmoid Bone
Cephalometric Landmarks Related to Nasal Bone
Cephalometric Landmarks Related to Temporal Bone
Cephalometric Landmarks Related to Sphenoid Bone
Cephalometric Landmarks Related to Occipital Bone
Cephalometric Landmarks Related to Zygomatic Bone
ChApTER
Related to Frontal Bone
The frontal bone (Fig. 3.1) (Os frontale in Latin), is a

membranous bone that forms the anterior part of the cranial
vault. The frontal is like half a shallow, irregular cap forming
the forehead or form on each side a horizontal orbital part roof
of most of an orbital cavity. The frontal bone is thick with
trabecular tissue between compact laminae, trabecular being
absent near the frontal sinuses.
Parts of Frontal Bone

Parts of frontal bone are listed below:
Squamous part
Orbital plates
Nasal process
Zygomatic process.
Articulation of Frontal Bone

The frontal bone articulates with 12 bones in total and is listed
below:
Parital bone
Sphenoid bone
Ethmoid bone
Maxillary bone
Nasal bone
Lacrimal bone
Zygomatic bone
Temporal bone
Table 3.1: Cephalometric landmarks (points) related to frontal bone

Cephalometric landmarks
Abbreviation
Type
Origin
Nasion
N or Na
Unilateral
Anatomic
Supra-orbitale
SOr
Bilateral
Anatomic
Roof of orbit
RO
Bilateral
Anatomic
Frontomaxillary nasal
suture
FMN
Unilateral
Anatomic
Radiographic Anatomy of Frontal Bone (Fig. 3.2)

On lateral cephalogram, the inner and outer cortical plates
of frontal bone appear as two parallel radio-opaque lines
descending downwards from coronal suture. Anterio-inferiorly,
these two radio-opaque lines diverge to encase the frontal sinus,
which appears radiolucent area.
The outer radio-opaque line representing outer cortical
plates meets nasal bone at frontonasal suture, while the inner
radio-opaque line representing inner cortical plate meets
Cephalometric Landmarks (Points)

on Frontal Bone
Cephalometric landmarks seen on the frontal bone are of
anatomic origin and are as follows (Table 3.1):
Figure 3.1: Frontal bone
Figure 3.2: Radiographic anatomy of the frontal bone on the

lateral cephalogram
16
ethmoid bone at frontoethmoidal suture. Above the horizontal

Nasion
part of the internal cortical plate, there are two radio-opaque
lines. The upper radio-opaque line represents endocranial
surface of the frontal bone, which forms the base for anterior Abbreviation
cranial fossa, and the other radio-opaque line represents the NNasion is abbreviated using English alphabet and is
exocranial surface of the frontal bone which forms the roof of expressed as capital letter or upper case N.
the orbit.
Definition
Section 3 Cephalometric Landmarks Related to Cranial Bones
Nasion (Figs 3.3A to D) is the most anterior point of the

frontonasal suture in the middle.1
Figures 3.3A to D: (A) Nasion on lateral cephalogram; (B) Magnified image showing nasion on the lateral cephalogram;
(C) Nasion on graphic illustration; and (D) Magnified image of nasion on graphic illustration
17
According to Willam B Downs

Nasion is the suture between the frontal and nasal bones.1
Relationship of anterior and posterior cranial base is

assessed using N-S-Ar angle.
Supra-Orbitale
According to TM Graber
Nasion is the junction of the nasal and frontal bone as seen on
the profile of the cephalometric roentgenogram.2
According to B Holly Broadbent
According to Leslie G Farkas

Nasion is the point in the midline of both the nasal root and
the frontonasal suture.4
Type
Nasion is a unilateral, anatomic, hard tissue cephalometric
landmark (Point).
Origin
Nasion is a hard tissue cephalometric landmark of anatomic
origin.
Tracing of Nasion on the Lateral Cephalogram

The outer cortical plate of frontal bone, nasal bone and
frontonasal suture appears as radio-opaque line on the lateral
cephalogram. The outer cortical plate of frontal bone is denser
radio-opaque than compared to other two bony structures.
Trace outer cortical plate of frontal bone, nasal bone and
frontonasal suture, the point in the midline where all three
structures meet is the point of nasion. In other way nasion is
the most anterosuperior point on the frontonasal suture in the
midline.
Significance (Ref to Chapter 20)

Nasion is used as one of the reference points in the construction
of angles and planes for the assessment of following:
Relationship of maxilla to cranial base is assessed using
SNA angle.
Relationship of mandible to cranial base is assessed using
SNB angle.
Maxillo-mandibular relationship with anterior cranial
base is assessed using ANB angle.
Inclination upper incisors are assessed using NA-Upper
incisor angular and NA-Upper incisor linear.
Inclination lower incisors are assessed using NB-Lower
incisor angular and NB-Lower incisor linear.
SOrSupra-orbitale is abbreviated using English alphabets

and is expressed as capital or upper case S, O followed by
lower case r and is written continuously without any space
between the alphabets.
Definition
According to Viken Sassouni
Chapter 3 Cephalometric Landmarks Related to Frontal Bone
Nasion is the craniometric point where the midsagittal plane

intersects the most anterior point of the frontonasal suture, the
anterior termination of the Boltons plane.3
Abbreviation
Supra-orbitale (Figs 3.4A to D) is the most anterior point of

the intersection of the shadow of the roof of the orbit and its
lateral contour.5
Type
Supra-orbitale is a bilateral, hard tissue lateral cephalometric

landmark (point).
Origin
Supra-orbitale is a hard tissue cephalometric landmark of

anatomic origin.
Tracing the Supra-Orbitale on the Lateral

Cephalogram
Supra-orbitale, the point on the orbital margin where it turns

onto the upper roof of the orbital cavity, is comparatively easy
to trace.
Supra-orbitale is useful reference point for anteroposterior

differences and vertical differences between the right and
left sides when the orbits are traced.
Supra-orbital landmark is used as a landmark in Sassouni
cephalometric analysis.
Roof of the Orbital Cavity

Abbreviation
RORoof of the orbital cavity is abbreviated using English
alphabets and is expressed as capital or upper case R, O
and is written continuously without any space between the
alphabets.
18
Figures 3.4A to D: (A) Supra-orbitale on lateral cephalogram; (B) Magnified image showing supraorbitale on the lateral cephalogram;
(C) Supra-orbitale on graphic illustration; and (D) Magnified image of supra-orbitale on graphic illustration
Definition
The roof of the orbital cavity is formed by the bone between
the anterior cranial fossa above and the orbital cavity below.

The roof of the orbit is the uppermost point of the orbit.5
Type
Roof of the orbital cavity (Figs 3.5A to D) is a bilateral,
anatomic hard tissue lateral cephalometric landmark.
Frontonasal/Frontomaxillary
Nasal Suture
Abbreviation
FMNFrontomaxillary suture is abbreviated using English
alphabets and is expressed as capital or upper case F, M and
N and are written continuously without any space between the
alphabets.
Tracing the Roof of Orbit on the Lateral Cephalogram
Definition
On the cephalogram, both right and left roofs of the orbital

cavity are superimposed and reveal as a radio-opaque line
anteriorly and posteriorly leading to pituitary fossa.
Frontomaxillary nasal suture (Figs 3.6A to D) is the most

superior point of the suture, where the maxilla articulates with
the frontal and nasal bones.
19
Chapter 3 Cephalometric Landmarks Related to Frontal Bone
Figures 3.5A to D: (A) Roof of orbit on lateral cephalogram; (B) Magnified image showing roof of orbit on the lateral cephalogram;
(C) Roof of orbit on graphic illustration; and (D) Magnified image of roof of orbit on graphic illustration
Figures 3.6A to D: (A) Frontomaxillary suture on lateral cephalogram; (B) Magnified image showing frontomaxillary suture on the lateral
cephalogram; (C) Frontomaxillary suture on graphic illustration; and (D) Magnified image of frontomaxillary suture on graphic illustration;
20
Type
References
Frontomaxillary nasal suture is a unilateral, anatomic, hard

tissue cephalometric landmark.
1. Downs WB. Variations in facial relationships. Their significance in

treatment and prognosis. Am J of Ortho. 1948;34:812-39.
2. Graber TM. New horizons in case analysis-clinical cephalometrics. Am
J of Ortho.1952;38:603-24.
3. Broadbent BH Sr. Boltons standards of dentofacial developmental
growth. The CV Mosby Company. 1975;133-5.
4. Farkas LG. Anthropometry of the head and face in medicineElsevier
North Holland, Inc. 1981;9-14.
5. Sassouni V. Orthodontics in dental practice. The CV Mosby Company.
1971;330-7.
Frontomaxillary nasal suture is situated/located on anterior

cranial base, unlike N and can therefore also be used for
measurement or defining the cranial base (Moyers 1988).
Chapter
related to ethmoid bone
The ethmoid bone (Fig. 4.1) (Os ethmoidale in Latin). The

Ethmoid bone is cuboidal and fragile, lies anterior in the
cranial base and is involved in the structure of the orbital walls
and nasal septum, the roof and lateral walls of the nasal cavity.
It is described as a heavy horizontal cribriform plate, a median
plate and two total labyrinths.
Parts of Ethmoid Bone
Cephalometric Landmarks (Points) on

Ethmoid Bone
Parts of ethmoid bone are listed below:

Cribriform plate
Crista galli
Perpendicular plate.
Articulation of Ethmoid Bone

The ethmoid bone articulates with 13 bones in total and is
listed below:
Sphenoid bone
Frontal bone
Lacrimal bone (2)

Palatine bone (2)
Vomer
Maxillary bone (2)
Inferior nasal concha (2)
Nasal bone (2).
Cephalometric landmarks seen on the ethmoid bone are of

Table 4.1: Cephalometric landmarks (points) related to ethmoid bone
Abbreviation
Type
Origin
Temporale
Te
Bilateral
Anatomic
Neck of the crista galli
NC
Unilateral
Anatomic
Medio-orbitale
mo
Bilateral
Anatomic
SE
Unilateral
Anatomic
Ethmoidale
Eth
Unilateral
Anatomic
Radiographic Anatomy of Ethmoid bone (Fig. 4.2)

On the lateral cephalogram, the cribriform plate of the ethmoid
bone is seen, which appears as a radio-opaque line below the
horizontal part of the internal cortical plate of the frontal bone.
The intersection of the shadows of the ethmoid and the anterior
wall of the infratemporal fossa is identified as temporal and is a
bilateral hard tissue cephalometric landmark. The intersection
of the shadows of the greater wing of the sphenoid and the
cranial floor is identified as Sphenoethmoidal (SE).
Temporale
Abbreviation
Figure 4.1: Ethmoid bone
TeTemporale is abbreviated using English alphabets and is

expressed as capital or upper case T followed by small letter
22
or lower case e and is written continuously without any space

Definition
Temporale (Figs 4.3A to D) is the intersection of the shadows
of the ethmoid and the anterior wall of the infra-temporal
fossa.

Intersection of the shadows of the ethmoid and anterior wall
of the infra-temporal fossa.1
Type
Temporale (Figs 4.3A to D) is a bilateral, anatomic, hard
Figure 4.2: Radiographic anatomy of ethmoid bone
Figures 4.3A to D: (A) Temporale on lateral cephalogram; (B) Magnified image showing temporale on the lateral cephalogram;
(C) Temporale on graphic illustration; and (D) Magnified image of temporale on graphic illustration
23
Neck of Crista Galli
Crista galli lies behind the frontal sinuses on the lateral

cephalogram and in the central part of the cranium on the
posteroanterior cephalogram.
Abbreviation
NCNeck of Crista Galli is abbreviated using English alpha
bets and is expressed as capital or upper case N and C and is
written continuously without any space between the alphabets.
Definition
Tracing Neck of Crista Galli on The Lateral

Cephalogram
It is difficult to identify on the lateral cephalogram whereas it
can be easily identified on the PA cephalogram.
Medio-orbitale
According to Viken sassouni
Type
Neck of crista galli is an anatomic, unilateral, hard tissue
cephalometric landmark.
Abbreviation
Chapter 4 Cephalometric Landmarks Related to Ethmoid Bone
Neck of the crista galli (Figs 4.4A and B) is the most

constricted point of the projection of the perpendicular lamina
of the ethmoid (almost at the level of planum).1
moMedio-orbitale is abbreviated using English alphabets

and is expressed as lower case m, o and written continuously
without any space between the alphabets.
Definition
Significance (Ref to chapter 20)
According to Athanasios E Athanasiou
The crista galli is an important landmark of the midline

for the analysis of bilateral symmetry in a posteroanterior
cephalogram.
Medio-orbitale (Figs 4.5A and B) is the point on the medial

orbital margin that is closest to the median plane.2
Figures 4.4A and B: (A) Neck of crista galli on frontal

cephalogram; (B) Magnified image showing neck of
crista galli on the frontal cephalogram
Figures 4.5 A and B: Medio-orbitale on the lateral

cephalogram; (B) Magnified image showing
medio-orbitale on the lateral cephalogram
24
Type
According to SN Bhatia and BC Leighton
Medio-orbitale is an anatomic, bilateral, hard tissue cephalo

metric landmark.
The point of intersection between the greater wings of the

sphenoid and the anterior cranial base.4
Type
Sphenoethmoidal Point
Sphenoethmoidal point is an anatomic, unilateral, hard tissue

Abbreviation
SESphenoethmoidal point is abbreviated using English

alphabets and is expressed as upper case S, E and written
continuously without any space between the alphabets.
Ethmoidale
Abbreviation
Definition
According to Robert E Moyers
The intersection of the shadows of the grater wing of

the sphenoid and the cranial floor as seen in the lateral
cephalogram3 (Figs 4.6A to D).
EthEthmoidale is abbreviated using English alphabets and

is expressed as capital or upper case E and small alphabets
or lower case th and written continuously without any space
Figures 4.6A to D: Sphenoethmoidale: (A) Sphenoethmoidale on the lateral cephalogram; (B) Magnified image
showing sphenoethmoidale on the lateral cephalogram; (C) Sphenoethmoidale on graphic illustration; and
(D) Magnified image of sphenoethmoidale on graphic illustration
25
Figures 4.7A to D: Ethmoidale: (A) Ethmoidale on the lateral cephalogram; (B) Magnified image showing
ethmoidale on the lateral cephalogram; (C) Ethmoidale on graphic illustration; and (DMagnified image
of ethmoidale on graphic illustration
Chapter 4 Cephalometric Landmarks Related to Ethmoid Bone
Definition
References
According to Arne Bjork
1. Viken SassouniOrthodontics in dental practice. The CV Mosby

Company. 1971:330-7.
2. Athanasios E Athanasiou, Helmut Drioschk, Charles Bosch. Data
and patterns of transverses dentofacial structure of 6 to 15 yearsold
children; A posteroanterio cephalometric study.
3. Robert M Moyers. Handbook of Orthodontics. Year Book medical
Publishers, inc. 1988:251-9.
4. Bhatia SN, Leighton BC. A manual of facial growthOxford University
press. 1993:10-5.
5. A Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.
The deepest median point of the anterior cranial fossa, corres

ponding to the cribriform plate of the ethmoid bone.5

Ethmoidale (Figs 4.7A to D) is the lowest point on the anterior
cranial fossa or the outline of the cribriform plate.4
Type
Ethmoidale is an anatomic, unilateral, hard tissue cephalo
metric landmark.
CHAPTER
Related to Nasal Bone
The nasal bone (Fig. 5.1) (Os nasale in Latin), are paired
bones that lie in the midline above the nasal fossae between
the frontal processes of the maxilla. They articulate superiorly
with the frontal bone at the fronto-nasal suture.
Articulation of Frontal Bone

The nasal bone articulates with four bones in total and is listed
below:
Maxilla
Frontal bone
Ethmoid bone
Nasal bone of opposite side.
Radiographic Anatomy of Nasal Bone (Fig. 5.2)

On lateral cephalogram, the nasal bone appears as a
triangular radio-opaque area. Its apex points to the tip of the
nose and its base faces the frontonasal suture which appears
as an oblique radiolucent line between frontal and nasal
bones. The posterior part of the inner surface of the nasal
bone merges with the radio-opaque line of the cribriform
plate of the ethmoid bone. The anteromedial point of the
frontonasal suture is identified as nasion and posteroinferior
point is identified as FMN.
Nasion
Cephalometric Landmarks (Points)

on Nasal Bone
Abbreviation
Cephalometric landmarks seen on the nasal bone are of

NNasion is abbreviated using English alphabet and is

expressed as capital letter or upper case N.
Table 5.1: Cephalometric landmarks related to nasal bone

Nasion
Abbreviation Type
N OR Na
Unilateral
Orgin
Anatomic
Frontonasal/frontomaxillary
nasal suture
Rhinion
FMN
Unilateral
Anatomic
Rh
Unilateral
Anatomic
Figure 5.1: Nasal bones
Figure 5.2: Radiographic anatomy of nasal bone
27
Definition
According to William B Downs
Nasion (Figs 5.3A to D) is the most anterior point of the

frontonasal suture in the middle.
Nasion is the suture between the frontal and nasal bone.3
Type
Nasion is the junction of the nasal bone and frontal bones as

seen on the profile of the cephalometric roentgenogram.1
Nasion is a unilateral, anatomic, hard tissue cephalometric

landmark.

Nasion is the craniometric point where the midsagittal plane
intersects the most anterior point of the frontonasal suture; the
anterior termination of the Bolton plane.2
Origin
Nasion is a hard tissue cephalometric landmark of anatomic
origin.
Chapter 5 Cephalometric Landmarks Related to Nasal Bone
Figures 5.3A to D: (A) Nasion on lateral cephalogram; (B) Magnified image showing nasion on the lateral cephalogram; (C) Nasion on
graphic illustration; and (D) Magnified image of nasion on graphic illustration
28
A is a positive value and a posterior position of point A

is a negative value.
In Ricketts cephalometric analysis, the positioning of
the chin is determined by the angle formed between
the Ba-N plane and plane from foramen rotundum (PT)
to Gn. The normal value of this angle is 90 degree. A
larger angle suggests a protrusive or forward growing
chin whereas a lesser angle suggests a retropositioning
of the chin.
Nasion is used as one of the reference point in the

construction of angles and planes for the assessment of the
following:
SNA angle.
Relationship of mandible to cranial base is assessed
using SNB angle.
Inclination lower incisors are assessed using NB-Lower
incisor angular and NB-Lower incisor linear.
Relationship of anterior and posterior cranial base
assessed using N-S-Ar angle.
In McNamara cephalometric analysis, the cant of the
upper lips is evaluated by constructiong an angle using
a line tangent to the upper lip and the nasion. The nasion
perpendicular is a vertical line drawn perpendicular to
Frankfort horizontal plane.
Anteroposterior orientation of the maxilla to the cranial
base is assessed by the linear distance between nasion
perpendicular and point A. An anterior position of point
Frontonasal/Frontomaxillary Nasal
Suture
Abbreviation
FMNFrontomaxillary suture is abbreviated using English
alphabets and is expressed as capital F, M and N and is written
Definition
Frontomaxillary nasal suture (Figs 5.4A to D) is the most
superior point of the suture, where the maxilla articulates
with the frontal and nasal bones.
Figures 5.4A to D: (A) Frontomaxillary nasal suture on lateral cephalogram; (B) Magnified image showing frontomaxillary nasal suture
on the lateral cephalogram; (C) Frontomaxillary nasal suture on graphic illustration; and (D) Magnified image of frontomaxillary nasal
suture on graphic illustration
29
Rhinion
According to Robert M Moyers

According to Robert M Moyers, frontomaxillary nasal suture
is the most superior point of the suture, where the maxilla
articulates with the frontal and nasal bones.4
Type
Frontomaxillary nasal suture is a unilateral, hard tissue cephalo
metric landmark.
Abbreviation
RhRhinion is abbreviated using English alphabets and is expressed as capital or upper case R followed by lower case h, and
is written continuously without any space between the alphabets.
Definition
According to Spiro J Chaconas
Frontomaxillary nasal suture is a hard tissue cephalometric

landmark of anatomic origin.
According to Spiro J Chaconas, Rhinion (Figs 5.5A to D) is

the most anterior-inferior point on the tips of the nasal bones
as seen from norma lateralis.5

Frontomaxillary nasal suture is situated/located on anterior
cranial base, unlike N and can therefore also be used for measure
ment or defining the cranial base (Moyers 1988).
Type
Chapter 5 Cephalometric Landmarks Related to Nasal Bone
Origin
Rhinion is an anatomic, unilateral, hard tissue cephalometric

landmark.
Figures 5.5A to D: (A) Rhinion on lateral cephalogram; (B) Magnified image showing Rhinion on the lateral cephalogram; (C) Rhinion
on graphic illustration; and (D) Magnified image of Rhinion on graphic illustration
30
Tracing Rhinion on the Lateral Cephalogram

Tracing the rhinion is difficult in few cases, where there is faded
image of nasal bone in the tip region, in such cases the margin
of the piriform aperture will be helpful in identifying the point
rhinion. In most of the cases it is easy to identify on the lateral
cephalogram. Trace the nasal bone from the frontonasal suture
till the tip, the tip of the nasal bone is the point of rhinion.
Position of rhinion differs from individual to individual.

As we learnt in anatomy, there are several types of nasal
bone, especially its inclination that affects the soft tissue

profile.
References
J of Ortho. 1952;38:603-24.
growth. The C V Mosby Company. 1975;133-5.
4. Moyers RM. Handbook of OrthodonticsYear Book Medical Publishers,
Inc. 1988;251-9.
5. Spiro J Chaconas. Orthodontics-PSG Publishing Company. 1980;37-45.
Chapter
related to temporal bone
Each temporal bone consists of following two portions

(Fig. 6.1):
Squamous portion
Petrous portion.
Squamous portion of the temporal bone is large and flat
that forms the lateral wall of the cranium. Petrous portion of
temporal bone is an irregular bone which forms the inferior
part of the temporal bone.
Articulation of Temporal Bone

Superiorly temporal bone articulates with parietal bone at
squamoparietal suture. Inferiorly, it articulates with mandibular
condyle at genoid fossa. Zygomatic process of temporal bone
articulates wih zygomatic bone at zygomaticotemporal suture.
The major part of the temporal bone that can usually be
identified from the lateral cephalogram is the endocranial
surface of the petrous portion. It appears as a triangular radioopaque area with its apex pointing upwards and backwards.
The side of the triangle that appears as the anterosuperior
radio-opaque line represents the posteroinferior limit of
the middle cranial fossa. This radio-opaque line continues
anteriorly to the endocranial surface of the squamous portion
of the temporal bone and the greater wing of the sphenoid
Figure 6.1: Temporal bone
bone. The other side of the triangle, which appears as a vertical

line, represents the anterior limit of the posterior cranial fossa.
Radiographic Anatomy of Temporal Bone

(Fig. 6.2)
The major part of the temporal bone that can usually be identified
from the lateral cephalogram is the endocranial surface of the
petrous portion. It appears as a triangular radio-opaque area with
its apex pointing upwards and backwards.The side of the triangle
that appears as the anterosuperior radio-opaque line represents
the posteroinferior limit of the middle cranial fossa. This radioopaque line continues anteriorly to the endocranial surface of the
squamous portion of the temporal bone. The other side of the
triangle, which appears as a vertical line, represents the anterior
limit of the posterior cranial fossa.

Temporal Bone
Cephalometric landmarks seen on the temporal bone are of
Figure 6.2: Radiographic anatomy of temporal bone
32
Table 6.1: Cephalometric landmarks related to temporal bone

Cephalometric
landmarks
Porion
Zygomatic arch
Mastoidale
Abbreviation
Type
Origin
Po
Zyg
Ma
Bilateral
Bilateral
Bilateral
Anatomic
Anatomic
Anatomic
Porion
Type
Porion (Figs 6.3A to D) is a bilateral, hard tissue cephalometric
landmark.
Origin
Porion is a hard tissue cephalometric point of anatomic
origin.
PoPorion is abbreviated using English alphabets and is expressed as capital letter or upper case P followed by lower
case o, and is written continuously without any space between
the alphabets.
1. Porion is used as one of the reference points in the

construction of Frankfort horizontal plane and is used
for the assessment of horizontal growth pattern using
following angles:
FH-Mandibular plane angle (Go-Me)
FH-Palatal plane angle (ANS-PNS)
FH-Occlusal plane (APOcc PPOcc)
2. Porion is also used as one of the reference points in the
construction of angle and is used for the assessment of upper
incisors torque using FHlong axis of upper incisors.
Abbreviation
Definition
Porion is the most superior point of the external auditory meatus
(the superior margin of the TMJ fossa, which lies at the same
level may be substitute in the construction of the FH).

The midpoint of the upper edge of the porous acoustics externus
located by wings of the metal rods on the cephalometer. This
is the cephalometric reference point.1
According to Willam B Downs

The highest point on the superior surface of the soft tissue of
the external auditory meatus.2
According to LB Higley
Zygomatic Arch
Abbreviation
ZygZygomatic arch is abbreviated using English alphabets
and is expressed as capital or upper case Z followed by lower
case y and g, and is written continuously without any space
The highest point on the roof of the left external auditory meatus.3
Definition
According to Robert M Ricketts
The top of the ear rods Shadows the external auditory meatus.4

Point on the upper margin of the porus acusticus externus the two
poria and left orbitale defined the Frankfort horizontal plane.5
According to Robert M Ricketts, the Zygomatic arch is the

center of zygomatic arch by inspection for frontal.7
Type
Zygomatic arch is bilateral, hard tissue landmark.
Origin
Porion (soft) is the highest point on the upper margin of the

cutaneous auditory meatus.6
Zygomatic arch is a hard tissue cephalometric landmark of

anatomic origin.
33
Figures 6.3A and D: (A) Porion on lateral cephalogram; (B) Magnified image showing porion on the lateral cephalogram;
(C) Porion on graphic illustration; and (D) Magnified image of porion on graphic illustration
Mastiodale
Abbreviation
MsMastiodale is abbreviated using English alphabets and is
expressed as capital or upper case M followed by lower case
s, and is written continuously without any space between the
alphabets.
Chapter 6 Cephalometric landmarks related to temporal bone
Definition
According to Viken sassouni
According to Viken Sassouni, the mastiodale is the lowest
point on the contour of the mastoid process.8
Type
Mastiodale (Figs 6.4A and B) is bilateral, cephalometric landmark.
34
Figures 6.4A and B: (A) Mastiodale on lateral cephalogram; (B) Magnified image showing mastiodale on the lateral cephalogram
Origin
References
Mastiodale is a hard tissue landmark of anatomic origin.
1. Arne Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.

2. Downs WB. Variations in facial relationships; Their significance in
treatment and prognosis. Am J of Orthod. 1948;34:812-39.
3. Higley LB. Cephalometric standards for children 4-8 years of age-Am J
of orthod. 1954;40:51-9.
4. Moyers RM. Handbook of Orthodontics. Year Book Medical Publishers,
Inc. 1988;251-9.
6. Farkas LG. Anthropometry of the head and face in medicineElsevier
north Holland Inc. 1981;9-14.
7. Ricketts RR. Provocations and perceptions in cranio-facial orthopedics
dental science and facial art. Rocky Mountain inc. 1989;797-803.
8. Viken Sassouni. Orthodontics in Dental Practice. The CV Mosby
Company. 1971;330-7.
Tracing of Mastiodale on the Lateral

Cephalogram
Trace the mastoid process, which is located between the
temporal bone and cranial base region. The lowest point of
the mastoid process in the P-A cephalogram is the point of
mastiodale. As we learnt in anatomy, the mastoid process is
not so visible in the childhood, but it increases in size with the
age and readily visible in both P-A cephalogram and lateral
cephalogram.
Chapter
related to sphenoid bone
The sphenoid bone (Fig. 7.1) is in the base of the skull,

wedged (as its name implies) between the frontal, temporal
and occipital bones. It has a central body paired greater and
lesser wings of separating laterally from it and two pterygoid
processes descending from the junction of the body of the
greater wing.

Sphenoid Bone
Cephalometric landmarks seen on the sphenoid bone are as
follows (Table 7.1):
Table 7.1: Cephalometric landmarks related to sphenoid bone
Cephalometric
landmarks
Abbreviation
Type
Origin
Dorsum of sella
Sp
Unilateral
anatomic
Floor of sella
Si
Unilateral
anatomic
Clinoidale
Cl
Bilateral
anatomic
Spheno-occipital
synchondrosis
SOS
Unilateral
anatomic
pterygoid point
pt
Bilateral
anatomic
Sella
Unilateral
anatomic
Sella entrance
Se
Unilateral
anatomic
Se
Unilateral
anatomic
Foramen spinosum
point
Fsp
Bilateral
anatomic
pterygomaxillary
fissure
ptm
Bilateral
anatomic
Radiographic anatomy of Sphenoid Bone (Fig. 7.2)

The frontal bone, ethmoidal bone and sphenoid bone meet
at frontosphenoethmoidal suture, which radiographically
appears as a radiolucent line. At the frontosphenoethmoidal
suture, these are two radio-opaque lines, one vertical and the
other horizontal. The vertical radio-opaque line represents the
anterior border of the sphenoid body whereas horizontal line
represents the planum sphenoidale, or the superior surface of
the sphenoid body.
Figure 7.1: sphenoid bone
Figure 7.2: radiographic anatomy of sphenoid bone
The vertical line terminates at the center of the

pterygomaxillary fissure, which on lateral cephalogram appears
as inverted teardrop radiolucent area bounded anteriorly by radioopaque line of the maxillary tuberosity and posteriorly by the
radio-opaque line of the anterior surface of the pterygoid process
of the sphenoid bone. The sella turcica appears as elliptical
shape radiolucent area surrounded medially radio-opaque line
of medial surface of the sella and most inferiorly radio-opaque
line of floor of sella anterosuperiorly curved radio-opaque line of
anterior clenoid process and posterosuperiorly radio-opaque line
of posterior border of the clenoid process.
36
The center of sella turcica is identified as sella abbreviated

using English alphabet as upper case S and the mid-entrance
point of the sella turcica is the sella-entrance (Se). Most
inferior point of the curved radio-opaque line of floor of sella
is identified as Si (Floor of sella ), and the most posterior point
on the internal continuation of the sella turcica is identified as
dorsum sellae. The most superior point on the contour of the
anterior clenoid is identified as clenoidale (Cl).
by small letter or lower case p and is written continuously

Dorsum of Sella
Most posterior point on the internal contour of the sella

turcica.1
Definition
Dorsum of sella is the most posterior point on the internal contour
of the sella turcica or hypophyseal fossa or pituitary fossa.
according to Viken Sassouni
Type
SpDorsum of sella is abbreviated using English alphabets

and is expressed as capital letter or upper case S followed
Dorsum of sella (Figs 7.3A to D) is a unilateral, hard tissue

abbreviation
Figures 7.3A to D: (A) Dorsum of sella on lateral cephalogram; (b) Magnified image showing dorsum of sella on the lateral
cephalogram; (C) Dorsum of sella on graphic illustration; (D) Magnified image of dorsum of sella on graphic illustration
37
Origin
Dorsum of sella is an anatomic hard tissue cephalometric
landmark.
Floor of Sella
letter or lower case i and is written continuously without any

space between the alphabets.
Definition
Floor of sella is the lower most point on the inner contour of
the sella turcica or hypophyseal fossa or pituitary fossa.
abbreviation
Type
SiFloor of sella is abbreviated using English alphabets and is

expressed as capital letter or upper case S followed by small
Floor of sella (Figs 7.4A to D) is a unilateral, hard tissue

Figures 7.4A to D: (A) Floor of sella on lateral cephalogram; (b) Magnified image showing floor of sella on the lateral
cephalogram; (C) Floor of sella on graphic illustration; (D) Magnified image of floor of sella on graphic illustration
Chapter 7 Cephalometric Landmarks Related to Sphenoid Bone
38
Origin
Definition
Floor of sella is an anatomic hard tissue cephalometric

landmark.
Clinoidale is the most superior point on the contour of the

anterior clinoid.
Clinoidale

The most superior point on the contour of the anterior clenoid.1
Type
ClClinoidale is abbreviated using English alphabets and is

expressed as capital C followed by lower case l.l
Clinoidale (Figs 7.5A to D) is a unilateral, hard tissue

abbreviation
Figures 7.5A to D: (A) Clinoidale on lateral cephalogram; (b) Magnified image showing clinoidale on the lateral
cephalogram; (C) Clinoidale on graphic illustration; (D) Magnified image of clinoidale on graphic illustration
39
Origin
according to arne Bjork
Clinoidale is a unilateral, anatomic, hard tissue cephalometric

landmark.
According to Arne Bjork, the opisthion is the posterior margin

of the occipital foramen.2
according to TM Graber
Spheno-Occipital Synchondrosis
According to TM Graber, the opisthion is the most posterior

point on the posterior margin of the foramen magnum.3
abbreviation
Type
SOSSpheno-occipital synchondrosis abbreviated using English

alphabets and is expressed as capital letter or upper case S, O
and S and is written continuously without any space between
the alphabets.
Spheno-occipital synchondrosis (Figs 7.6A to D) is a unilateral,

hard tissue cephalometric landmark.
Spheno-occipital synchondrosis is a unilateral, anatomic, hard

Opisthion is the posterior edge of the foramen magnum.
Origin
Definition
Figures 7.6A to D: (A) spheno-occipital synchondrosis on lateral cephalogram; (b) Magnified image showing spheno-occipital
synchondrosis on the lateral cephalogram; (C) spheno-occipital synchondrosis on graphic illustration; (D) Magnified image of sphenooccipital synchondrosis on graphic illustration
40
lower case t, and is written continuously without any space

The spheno-occipital synchondrosis is very important structure in growth and development of the cranial base in the
growing child.
Definition
According to Robert M Ricketts, the pterygoid point is the
lower lip of the foramen rotundum (represents the position of
the sphenoid bone). Most posterior point on the outline of the
pterygopalatine fossa.4
Tracing Spheno-Occipital Synchondrosis on

the Lateral Cephalogram
Tracing of SOS is very easy, if it is before the ossification and

very difficult if it is after the ossification.
Type
Pterygoid point (Figs 7.7A to D) is a bilateral, hard tissue
Pterygoid Point
abbreviation
Origin
PtPterygoid point abbreviated using English alphabets and

is expressed as capital or upper case P followed by small or
Pterygoid point is a bilateral, hard tissue cephalometric landmark.
Figures 7.7A to D: (A) Pterygoid point on lateral cephalogram; (b) Magnified image showing pterygoid point on the lateral
cephalogram; (C) Pterygoid point on graphic illustration; (D) Magnified image of pterygoid point on graphic illustration
41
Tracing Pterygoid Point on the Lateral

Cephalogram
Trace the pterygopalatine fossa point usually located immediately behind the posterior part of the fossa.

The center of sella turcica (the midpoint of the horizontal
diameter).2
Type
Sella
abbreviation
SSella is abbreviated using English alphabets and is expressed
as capital or upper case S.
Definition
Sella is the midpoint of sella turcica or hypophyseal fossa or
pituitary fossa.
according to Robert E Moyers

The center of the hypophyseal fossa (sella turcica). It is
selected by the eye since that producer as been shown to be as
reliable as a constructed center.4
The center of pituitary fossa.3
Origin
Sella is a unilateral anatomic hard tissue cephalometric
landmark point.
Tracing of Sella on the Lateral Cephalogram
The pituitary fossa is round and bottle shaped hollow space,

situated in the upper body of the sphenoid bone. This fossa
contains pituitary gland. This fossa is bounded anterioly
and posteriorly by anterior and posterior clinoid processes.
Both anterior and posterior clinoid process appears as
radio-opaque line on the lateral cephalogram. First trace
the anterior and posterior cliniod process followed by
inferior border of the pituitary fossa. Center point of the
fossa is the point of sella.
Sella is used as one of the reference points in the construction

SNA angle, S-N-Pr angle and saddle angle (N-S-Ar).
SNB angle and S-N-Id angle.
Relationship of anterior and posterior cranial base assessed
using N-S-Ar.
according to B Holly Broadbent

Sella turcica (Turkish saddle): The landmark is the center
of the sella as seen in the lateral radiograph and located by
inspection.5
Pterygoid point is a useful point for Ricketts cephalometric

analysis.
Pterygoid point is the intersection border of the foramen
rotundum and the posterior wall of pterygopalatine fossa
in the lateral cephalogram.
Sella (Figs 7.8A to D) is a unilateral, hard tissue cephalometric

landmark.
Sella Entrance
abbreviation
The center of sella turcica: The midpoint of the sella turcica

orbitrarily determined.6
SeSella entrance is abbreviated using English alphabets and

is expressed as capital letter or upper case S followed by small
letter or lower case e and is written continuously without any
according to Willam B Downs
Definition
The center of sella turcica: Located by inspection of the profile

image of the fossa.7,8
Sella entrance is the mid entrance point of sella turcica or

hypophyseal fossa or pituitary fossa.
according to LB Higley
42
Figures 7.8A and B: (A) sella on lateral cephalogram; (b) Magnified image showing sella on the lateral
cephalogram; (C) sella on graphic illustration; (D) Magnified image of sella on graphic illustration
Type
Sella entrance (Figs 7.9A to D) is a unilateral, hard tissue
Origin
E and written continuously without any space between the

alphabets.
Definition
Sella entrance is a constructed, hard tissue cephalometric

landmark.
Sphenoethmoidal Point
The intersection of the shadows of the greater wing of

the sphenoid and the cranial floor as seen in the lateral
cephalogram.4
abbreviation
according to SN Bhatia and BC Leighton
SESphenoethmoidal point (Figs 7.10A to D) is abbreviated

using English alphabets and is expressed as upper case S,
The point of intersection between the greater wings of the

sphenoid and the anterior cranial base.9
43
Figures 7.9A to D: (A) sella entrance on lateral cephalogram; (b) Magnified image showing sella entrance
on the lateral cephalogram; (C) sella entrance on graphic illustration; (D) Magnified image of sella entrance
on graphic illustration
Figures 7.10A and B: (A) sphenoethmoidal point on lateral cephalogram; (b) Magnified image showing
sphenoethmoidal point on the lateral cephalogram
44
Figures 7.10C and D: (C) sphenoethmoidal point on graphic illustration; (D) Magnified image of
sphenoethmoidal point on graphic illustration
Type
Sphenoethmoidal point is a unilateral, hard tissue cephalometric landmark.
Pterygomaxillary Fissure
abbreviation
PtmPterygomaxillary fissure is abbreviated using English
alphabets and is expressed as capital or upper case P followed
by small or lower case t and m, written continuously without
any space between the alphabets.
PTMAccording to Robert M Moyers, Pterygomaxillary
fissure is abbreviated using English alphabets and is expressed
as capital or upper case P followed by capital or upper case T
and M, written continuously without any space between the
alphabets.
PTMSAccording to Michael L Riolo, Pterygomaxillary
as capital or upper case P,T,M,S, written continuously without
Definition
Pterygomaxillary fissure (Figs 7.11A to D) is a bilateral tear
drop shaped area of radiolucency, the anterior shadow of
which represents the posterior surface of the tuberosity of the
maxilla; the landmark is taken where the two edges, front and
back, appear to merge inferiorly.
the anterior margin of the pterygoid process of the sphenoid

bone and the profile outline of the posterior surface of the
maxilla.
according to Robert M Moyers

According to Robert M Moyers, the pterygomaxillary fissure
is tear drop shaped radiolucency, the anterior shadow of
maxilla; the landmark itself is at the most inferior confluences
of the curvatures.
according to Clifton T Forceberg

According to Clifton T Forceberg, Pterygomaxillary fissure is
the most medial and posterior point of each pterygomaxillary
fissure. The ptm line connects right and left ptm points. The
ptm access is the perpendicular bisector of the ptm line.
according to Holly Broadbent

Inverted, elongated, tear drop-shaped area formed by the
divergence of the maxilla from the pterygoid process of the
sphenoid. The posterior nasal spine and staphylion are generally located beneath the lower pointed end of this area.
according to LB Higley
Junction of the Frankfort plane and a line perpendicular to it
from the pterygomaxillary fissure.
Type
According to TM Graber, the pterygomaxillary fissure is an

oval-looped radiolucency resulting from the fissure between
Pterygomaxillary fissure is an anatomic, bilateral, hard tissue

45
Figures 7.11A to D: (A) Pterygomaxillary fissure on lateral cephalogram; (b) Magnified image showing
pterygomaxillary fissure; (C) Pterygomaxillary fissure on graphic illustration; (D) Magnified image of
pterygomaxillary fissure on graphic illustration

Pterygomaxillary fissure is used as one of the reference
point in Cox cephalometric analysis and is used to assess the
posterior limit of the maxilla.
References
1. Viken Sassouni. Orthodontics in dental practice. The CV Mosby
Company. 1971;330-7.
3. Graber TM. New horizons in case analysis-clinical cephalometrics.
Am J of Ortho.1952;38:603-24.
4. Robert R. RickettsProvocations and perceptions in cranio-facial

orthopedicsdental science and facial art. Rocky Mountain Inc. 1989;
797-803.
5. Moyers RM. Handbook of OrthodonticsYear Book Medical Publishers,
Inc. 1988;251-9.
6. Holley Broadbent B, Sr. Boltons standards of dentofacial developmental growth. The CV Mosby Company. 1975;133-5.
7. Higley LB. Cephalometric standards for children 4-8 years of age.Am J
of Ortho. 1954;40:51-9.
treatment and prognosis. Am J of Ortho.1948;34:812-39.
9. Bhatia SN, Leighton BC. A manual of facial growthOxford University.
1993;10-5.
CHAPTER
Related to Occipital Bone
The occipital bone (Fig. 8.1) forming much of the back and
base of the cranium and is trapezoidal and concave internally.

Occipital Bone
Cephalometric landmarks seen on the occipital bone are of
The inner and outer cortical plates of the occipital bone

appear as two radio-opaque lines, which descend parallely
and meet together at formen magnum, where the hard tissue
cephalometric point opisthion is identified.
The exocranial and endocranial surfaces of the occipital
bone appear as two radio-opaque lines, the point where these
two surfaces meet is the point of basion, which is an important
Table 8.1: Cephalometric landmarks related to occipital bone
Basion
Abbreviation
Type
Origin
Basion
Ba
Unilateral
Anatomic
Opisthion
Op
Unilateral
Anatomic
Abbreviation
Boltons point
Bo
Unilateral
Anatomic
Spheno-occipital
synchondrosis
SOS
Unilateral
Anatomic
BaBasion is abbreviated using English alphabets and is

denoted as capital letter or upper case B followed by small
letter or lower case a and is written continuously without any
Radiographic Anatomy of Occipital Bone

(Fig. 8.2)
The occipital bone joins the parietal bone at lambdoid suture,
which on lateral cephalogram appears as a radiolucent line.
Figure 8.1: Occipital bone
Definition
Basion is the median point of the anterior margin of the
foramen magnum can be located by following the images of
the slope the inferior border of the basilar part of the occipital
bone to its posterior limit.
Figure 8.2: Radiographic anatomy of occipital bone
47
According to Clifton T Forsberg
Point at the center of the anterior border of the foramen

magnum at the base of the occipital bone.1
The most anterior point relative to the interspinosum line, on

the border of the foramen magnum.5
Type
The most inferior point on the anterior margin of the foramen

magnum in the midsagittal plane.2
Basion (Figs 8.3A to D) is a unilateral, hard tissue cephalometric landmark.
Origin

Normal projection of the anterior border of the occipital
foramen (endobasion) on the occipital foramen line.4
Basion is a anatomic hard tissue cephalometric landmark.
Tracing Basion on the Lateral Cephalogram
Chapter 8 Cephalometric Landmarks Related to Occipital Bone
The most inferior posterior point in the sagittal plane on the

anterior rim of the foramen magnum.3
To identify basion on the lateral cephalogram, following

structures need to be traced.
Trace from the posterior clinoid process, down the upper part
of the clivus, and past the region of the spheno-occipital synchondrosis to the anterior margin of the foramen magnum.
Figures 8.3A to D: (A) Basion on lateral cephalogram; (B) Magnified image showing basion on the lateral
cephalogram; (C) Basion on graphic illustration; (D) Magnified image of basion on graphic illustration
48
Trace the cranial aspect of the greater wing of the sphenoid

one, the inferior, ectocranial aspect of the base of the
occipital bone, and the anterior margin of the foramen
magnum. These are separate lines and should not be drawn
a one continuous line.
Trace carefully from the base of the occipital bone
to the compact bone of the occipital condyles. The
anterior margins of the occipital condyle and basion are
radio-opaque on the lateral cephalogram and should be
differentiated. Basion is usually behind the anterior part of
the occipital condyle.
Opisthion
Abbreviation
OpOpisthion is abbreviated using English alphabets and is
expressed as capital letter or upper case O followed by small
letter or lower case p and is written continuously without any
Definition
Opisthion is the posterior edge of the foramen magnum.

The most posterior point, relative to the inter-spinosum line
on the border of the foramen magnum.5
Type
Opisthion (Figs 8.4A to D) is a unilateral, hard tissue
Origin
Opisthion is an anatomic, hard tissue cephalometric landmark.
Tracing Opisthion on Lateral Cephalogram

Trace both the outer, ectocranial surface of the external occipital
protuberance and the inner, endocranial surface of the occipital
bone. Follow the surfaces anteroinferiorly until the two lines
merge as the radio-opaque point, which is opisthion.
Boltons Point
Abbreviation
Posterior margin of the occipital foramen.4
BoBoltons point is abbreviated using English alphabets and

is expressed as capital letter or upper case B followed by small
letter or lower case o and is written continuously without any
Definition
The most posterior point on the posterior margin of the

foramen magnum.2
Boltons point is the highest point in the upward curvature of

the retrocondylar fossa.
Figures 8.4A and B: (A) Opisthion on lateral cephalogram; (B) Magnified image showing opisthion on the
lateral cephalogram
49
Figures 8.4C and D: (C) Opisthion on graphic illustration; (D) Magnified image of opisthion
on graphic illustration
Point in space, about the center of foramen magnum, that is

located on the lateral cephalometric radiograph by the highest
point in the profile image of the postcondylar notches of the
occipital bone.5
Highest point in the upward curvature of the retrocondylar

fossa. In uncertain cases it may be located as the midpoint
between opisthion (Op), and basion (Ba); in other words, at
the center of foramen magnum.7
The deepest point of the notch in the shadow behind condylus

occipitalis.3
The most superior point in the uppet curvature of the

retrocondylar fossa. It is just posterior to the occipital condyle.2
Type
The highest point on the concavity behind the occipital

condyles.6
Boltons point (Figs 8.5A to D) is a unilateral, hard tissue

Figures 8.5A and B: (A) Boltons point on lateral cephalogram; (B) Magnified image showing Boltons point on the
lateral cephalogram
50
Figures 8.5C and D: (C) Boltons point on graphic illustration: (D) Magnified image of Boltons point on
graphic illustration
Origin
Boltons point is an anatomic hard tissue cephalometric
landmark/point.
Tracing Boltons Point on the Lateral

Cephalogram
Boltons point is the midway between the point basion and
opisthion. Trace the basion and opisthion and bisect the distance
between these two points to establish the Boltons point.
Spheno-Occipital Synchondrosis

alphabets.
Type
Spheno-occpital synchondrosis (Figs 8.6A to D) is a unilateral,
Origin
Spheno-occipital synchondrosis is an anatomic hard tissue
cephalometric landmarks.
Abbreviation
Tracing Spheno-Occipital Synchondrosis on

the Lateral Cephalogram
SOSSpheno-occipital synchondrosis abbreviated using

English alphabets and is expressed as capital S, O and S
Tracing of SOS is very easy, if it is before the ossification and

very difficult, if it is after the ossification.
Figures 8.6A and B: Spheno-occipital synchondrosis on lateral cephalogram; (B) Magnified image
showing spheno-occipital synchondrosis on the lateral cephalogram
51
Figures 8.6C and D: (C) Spheno-occipital synchondrosis on graphic illustration; (D) Magnified image of
spheno-occipital synchondrosis on graphic illustration

The spheno-occipital synchondrosis is very important structure in
growth and development of the cranial base in the growing child.
References
dental science and facial art. Rocky Mountain Inc. 1989;797-803.
J of Ortho. 1952;38:603-24.
3. Moyers RM. Handbook of Orthodontics. Year Book Medical Publishers,

Inc. 1988;251-9.
5. Clifton T Forsberg. Diagnosis and treatment planning of skeletal
asymmetry with the sub-mental vertical radiograph. Am J of Ortho.
1984;85:224-37.
treatment and prognosis. Am J of Ortho.1948;34:812-39.
Company. 1971;330-7.
Chapter
related to Zygomatic bone
Each zygomatic bone (Figs 9.1A and B) consists of a

diamond-shaped body and following four processes:
Frontal process articulates with the frontal bone at
zygomaticofrontal suture forming the lateral wall of the
orbit.
Temporal process articulates with the zygomatic process
of the temporal bone, forming the zygomatic arch.
Maxillary process articulates with the zygomatic process
of the maxilla at the zygomaticomaxillary suture, forming
the infraorbital rim and the orbital floor.
Jugular process articulates the maxilla at the lateral wall of
the maxillary sinus.
Radiographic Anatomy of Zygomatic Bone

The frontal process of the zygomatic bone appears as two
radio-opaque lines on the lateral cephalogram, one anterior
and the other posterior. The anterior line is curved line
representing the anterior border of the lateral wall of the orbit.
The posterior line is a vertical line that extends downward
from the junction with the cribriform plate and merges with
the posterior border of the zygomatic process of the maxilla.
Between the inferior parts of the two lines, there is another
horizontal radio-opaque line, which represents the maxillary
process of the zygomatic bone. This line extends posteriorly

and merges with the horizontal part of the zygomatic process
of the maxilla.
Cephalometric landmarks (Points) on

Zygomatic bone
Cephalometric landmarks seen on the zygomatic bone are of
Table 9.1: Cephalometric landmarks related to zygomatic bone
Abbreviation
Type
Origin
Orbitale
Or
Bilateral
Anatomic
Temporale
Te
Bilateral
Anatomic
Orbitale
Abbreviation
OrOrbitale is abbreviated using English alphabets and is
denoted as capital letter or upper case O followed by small
letter or lower case r and is written continuously without any
Figures 9.1A and B: Zygomatic bone
53
Definition
Orbitale is the lowest point in the inferior margin of the orbit,

midpoint between right and left images.
Orbitale is the lowest point on the lower margin of each

orbit.It is identified by palpation and is identical to the
bony orbitale.4

Orbitale is the lowest point on the left infraorbital margin.1
Orbitale is the most inferior point on the lower border of the
left orbit.2
Orbitale is the left orbital point used in conjunction with the

poria to orient the skull on the Frankfort horizontal plane.3
In the lateral cephalogram, the outlines of the orbital rims

overlap. Usually, the lowest point on the averaged outline is
used for the construction of Frankfort plane.5
Type
Chapter 9 Cephalometric landmarks related to Zygomatic bone
Orbitale (Figs 9.2A to D) is a bilateral, hard tissue cephalometric.l
Origin
Orbitale is an anatomic hard tissue cephalometric landmarks.
Figures 9.2A to D: (A) Orbitale on lateral cephalogram; (B) Magnified image showing orbitale on the lateral cephalogram;
(C) Orbitale on graphic illustration; (D) Magnified image of orbitale on graphic illustration
54
Tracing of Orbitale on Lateral Cephalogram

Normally, right and left infra-orbital margins are superimposed
on the lateral cephalogram, then they reveal radio-opaque
line on the lateral cephalogram, when patient is positioned
accurately on the cephalostat during the radiographic taking
procedure.
If the patient is inaccurately positioned then in such cases,
the infra-orbital margins appear as two different radio-opaque
lines on the lateral cephalogram making difficult to identify
the point. In such cases, the orbitale is identified as the mid
point of right and left infra-orbital margins.

Orbitale is used as one of the reference points in the construction
of Frankfort horizontal plane and is used for the assessment of
horizontal growth pattern using following angles:
FH-Mandibular plane angle (Go- Me)

FH- Palatal plane angle ( ANS-PNS)
FH-Occlusal plane ( APOcc PPOcc).
Temporale
Abbreviation
TeTemporale is abbreviated using English alphabets and is
expressed as capital or upper case T followed by small letters
or lower case e and is written continuously without any space
Definition
Temporale (Figs 9.3A to D) is the intersection of the shadows of
the ethmoid and the anterior wall of the infratemporal fossa.
Figures 9.3A to D: (A) Temporale on lateral cephalogram; (B) Magnified image showing temporale on the lateral cephalogram;
(C) Temporale on graphic illustration; (D) Magnified image of temporale on graphic illustration
55
References
Intersection of the shadows of the ethmoid and anterior wall

of the infra-temporal fossa.6

J of Ortho. 1952;38:603-24.
3. Broadbent BH, Sr. Boltons standards of dentofacial developmental
growth. The CV Mosby Company. 1975; 133-5.
4. Farkas LG. Anthropometry of the head and face in medicine. Elsevier
north Holland inc. 1981;9-14.
5. Moyers RM. Handbook of OrthodonticsYearbook medical publishers
inc. 1988;251-9.
company. 1971;330-7.
Type
Temporale is a bilateral, hard tissue cephalometric landmark.
Origin
Temporale is an anatomic hard tissue cephalometric landmark.
Chapter 9 Cephalometric landmarks related to Zygomatic bone
Section
Related to Facial Bones
and Dentition
Cephalometric Landmarks Related to Maxilla

Cephalometric Landmarks Related to Dentition
Cephalometric Landmarks Related to Mandible
ChapteR
10
Related to Maxilla
The maxilla (Fig. 10.1) consists of a large hollow body that

houses the maxillary sinus and the four prominent processes.
The frontal process
The zygomatic process
The palatine process
The alveolar process.
Cephalometric Landmarks (Points) on Maxilla

Cephalometric landmarks seen on the maxilla are as follows
(Table 10.1):
Table 10.1: Cephalometric landmarks related to maxilla
Abbreviation
Type
Origin
anterior nasal spine

point a
aNS
Unilateral
anatomic
Unilateral
anatomic
anterior point of maxilla
apMax
Unilateral
anatomic
prosthion
pr
Unilateral
anatomic
posterior nasal spine
pNS
Unilateral
anatomic
Ptm
PTM
PTMS
Bilateral
anatomic
Key ridge
KR
Unilateral
anatomic
Orbitale
Or
Bilateral
anatomic
Anterior Nasal Spine

Abbreviation
ANSAnterior nasal spine is abbreviated using English
alphabets and is expressed as capital or upper case A, N
and S, written continuously without any space between the
alphabets.
Figure 10.1: Maxillary bone

The most anterior point of the nasal floor tip of pre-maxilla on
mid-sagittal plane.1

Sharp median process formed by the forward prolongation of
the anterior aperture of the nose.2
The tip of the anterior nasal spine as seen on the X-ray film in
norma lateralis.3
Definition
Anterior nasal spine (Figs 10.2A to D) is the tip of bony

anterior nasal spine in the midline or median plane.
The most anterior point on the maxilla at the level of the

palate. The ANS is of limited use for analysis in the posterior-
Section 4 Cephalometric Landmarks related to Facial Bones and Dentition
60
Figures 10.2A to D: (A) Anterior nasal spine on lateral cephalogram; (B) Magnified image showing anterior nasal spine on the lateral
cephalogram; (C) Anterior nasal spine on graphic illustration; and (D) Magnified image of Anterior nasal spine on graphic illustration
anterior projection as the actual spine often cannot be seen

and its location varies considerably according to radiographic
exposure.4
Tracing of Anterior Nasal Spine on Lateral

Cephalogram
Type
There is an individual variation exists in length and width of

ANS. In some individuals ANS are long and thin; while in
other are short and thick.
Anterior nasal spine is a unilateral, hard tissue cephalometric

landmark.
Radiographic Appearance
Origin
Anterior nasal spine is an anatomic hard tissue cephalometric
landmark.
ANS appears slightly posterior to the anatomic spine.

In cases with thin ANS: In such cases, on the cephalogram,
ANS will be unclear because it can superimpose by nasal
cartilage.
In cases with thick ANS: In such cases, on the cephalogram,
ANS is clear and will be ease in tracing.
61
Definition
Anterior nasal spine is used as one of the reference points Point A (Figs 10.3A to D) is the deepest point on the curved
in the construction of occlusal plane and is used for the bony outline between the anterior nasal spine (ANS) and
assessment of horizontal growth pattern using FH-palatal prosthion (Pr).
plane angle (ANS-PNS).
According to Willian B Downs
Point A
Abbreviation
The deepest midline point on the premaxilla between the

anterior nasal spine and prosthion.5
Chapter 10 Cephalometric Landmarks related to Maxilla
Point A: Point A is abbreviated using English alphabets and is Deepest point on the curve of the bone between the anterior
nasal spine and dental alveolus. Also termed SS or subspinale
expressed as A itself.
(below the spine).6
C
D
Figures 10.3A to D: (A) Point A on lateral cephalogram; (B) Magnified image showing point A on the lateral cephalogram; (C) Point A
on graphic illustration; and (D) Magnified image of point A on graphic illustration
62

Deepest point on midsagittal plane between ANS and
prosthion, mesially around the level of and anterior to the
apex of the upper central incisors.1
To establish A point, draw a line between ANS and

prosthion. Then draw a line parallel to the ANSPr line,
tangent to the deepest point between ANS and Pr. This is
point A.
Point A is used as one of the reference points in the construction

The most posterior point on the pre-maxilla above prosthion of angles and planes for the assessment of the following:
and immediately lateral to the contour of projection of the Relationship of maxilla to cranial base is assessed using
anterior nasal spine. It is the junction of the alveolar and basal
SNA angle.
of the maxilla.3
According to Alex Jacobson and W Caufield
Using a line perpendicular to FH locate the most posterior
point in the concavity between ANS and maxillary alveolar Point A is useful indicator of the anteroposterior
relationship between the basal bone of the maxilla and the
process.7
malocclusion.
In Mc Namara cephalometric analysis, anteroposterior
Or
orientation of the maxilla to the cranial base is assessed
The most posterior midline point in the concavity between the
by the linear distance between nasion perpendicular and
ANS and prosthion (The most inferior point on the alveolar
point A. An anterior position of point A is a positive value
bone overlying the maxillary central incisor).
and a posterior position of point A is a negative value.
Mid facial length is measured from condylion to Point A
in McNamara analysis.

In Mc Namara cephalometric analysis, method of
The most posterior point on the curve between ANS and PR
determining of position of maxillary incisor relative to
A point usually is found approximately 2 mm anterior to
point A. Draw vertical line through the nasion called NP
the apices of the maxillary central incisor roots. A is not an
(Nasion
perpendicular) and A vertical line constructed
4
anatomic point, of course.
through the point A parallel to the Nasion perpendicular
line called the parallel to nasion perpendicular through
According to JR Jarabak
point A (PNP). The anteroposterior distance from maxiMaxillary denture base, point A is 2 mm labial to the apices of
llary incisor to point A.
the central incisors.8
In Mc Namara cephalometric analysis, to determine the
anteroposterior position of the mandibular incisors, the
distance is measured between the edge of the incisor and
Type
a line drawn from point A to Pog. In a well-balanced face,
Point A is a unilateral, hard tissue cephalometric landmark.
this distance should be 13 mm.
Origin
Prosthion
Point A is an anatomic hard tissue cephalometric landmark.
Tracing Procedure for Point A

First trace the palatal bone, the anterior nasal spine, the
marginal bone of the alveolar process and the anterior
facial surface of the alveolar process.
Thereafter, trace the outline of maxillary central incisor
which includes tracing of incisal edge, apex of the root outer
surface of the crown and root of maxillary central incisor.
Note:The most important factor which helps in location of
point A is that it is at almost the same height as the apex
of the incisor.
Abbreviation
Pr: Prosthion is abbreviated using English alphabets and is
expressed as capital letter or upper case P followed by small
letter or lower case r and is written continuously without any
Definition
Prosthion (Figs 10.4A to D) is the lowermost anterior point
of alveolar process of pre-maxilla in the midline between two
maxillary central incisors.
63
Figures 10.4A to D: (A) Prosthion on lateral cephalogram; (B) Magnified image showing prosthion on the lateral cephalogram;
(C) Prosthion on graphic illustration; and (D) Magnified image of prosthion on graphic illustration
Type
The transition point between the crown of the most prominent

medial maxillary incisor and the alveolar projection.9
Prosthion is a unilateral, hard tissue cephalometric landmark.
Origin
The point of the maxillary alveolar process in the midline that

projects most anteriorly.3
Prosthion is an anatomic hard tissue cephalometric landmark.
The most anterior inferior point on the maxillary alveolar

process usually found near the cementoenamel junction of the
maxillary central incisor.4
Prosthion is used as one of the reference points in the

construction of angles for the assessment of relationship of
maxilla skeletal base to cranial base using S-N-Pr angle.
64
Posterior Nasal Spine
The bony posterior projection of the horizontal portion of the

palatine bone at the midline.3
Abbreviation
PNS: Posterior Nasal Spine is abbreviated using English

alphabets and is expressed as capital letter or upper case P, N
and S and is written continuously without any space between Process formed by the united projecting medial ends of the
the alphabets.
posterior borders of the two palatine bones.2
Definition
Posterior Nasal Spine (Figs 10.5A to D ) is the intersection of
a continuation of the anterior wall of the pterygopalatine fossa
and the floor of the nose.
According to Michael L Riolo

The most posterior point at the sagittal plane on the bony hard
palate.10

Most posterior point on the contour of the bony palate.1

Using a line perpendicular to FH, locate PNS at the most
posterior aspect of the palatine bone.7
Figures 10.5A to D: (A) Posterior nasal spine on lateral cephalogram; (B) Magnified image showing posterior nasal spine on the lateral
cephalogram; (C) Posterior nasal spine on graphic illustration; and (D) Magnified image of posterior nasal spine on graphic illustration
65

Midpoint of the base of the palatine bone at the posterior
margin of the hard palate.6
Type

maxilla; the landmark is taken where the two edges, front and
back appear to merge inferiorly.
According to TM Graber, the pterygomaxillary fissure is an

Posterior nasal spine is a unilateral, hard tissue cephalometric
oval-looped radiolucency resulting from the fissure between
landmark.
the anterior margin of the pterygoid process of the sphenoid
bone and the profile outline of the posterior surface of the
Origin
maxilla.3
Posterior nasal spine is an anatomic hard tissue cephalometric
landmark.
According to Robert M Moyers, the pterygomaxillary fissure

is tear drop shaped radiolucency, the anterior shadow of
maxilla; the landmark itself is at the most inferior confluences
Like ANS, PNS also has variation in length and width.
4
PNS is difficult to trace on the cephalogram when there of the curvatures.
is unerupted teeth, in these cases the PNS can be located
between the floor of nasal cavity and the inferior surface According to Clifton T Forsberg
of the palatine bone.
According to Clifton T Forsberg, pterygomaxillary fissure is
Usually, it is found that PNS is located below the Ptm.
the most medial and posterior point of each pterygomaxillary
Tracing of Posterior Nasal Spine on the

Lateral Cephalogram
fissure. The Ptm line connects right and left Ptm points. The
Ptm access is the perpendicular bisector of the Ptm line.11
Posterior nasal spine is used as one of the reference points

in the construction of occlusal plane and is used for the According to Holly Broadbent
assessment of horizontal growth pattern using FH-Palatal
Inverted, elongated, tear drop-shaped area formed by the
divergence of the maxilla from the pterygoid process of
the sphenoid. The posterior nasal spine and staphylion are
generally located beneath the lower pointed end of this area.2
Abbreviation
Ptm: Pterygomaxillary fissure is abbreviated using English
alphabets and is expressed as capital or upper case P followed
by small or lower case t and m, written continuously without
PTM: According to Robert. M. Moyers, Pterygomaxillary fissure
is abbreviated using English alphabets and is expressed as capital
or upper case P followed by capital or upper case T and M,
written continuously without any space between the alphabets.4
PTMS: According to Michael L Riolo, Pterygomaxillary
as capital or upper case P, T, M, S, written continuously
without any space between the alphabets.9
Definition
Pterygomaxillary fissure (Figs 10.6A to D) is a bilateral tear
drop shaped area of radiolucency, the anterior shadow of
Junction of the Frankfort plane and a line perpendicular to it

from the pterygomaxillary fissure.12
Type
Pterygomaxillary fissure is bilateral, hard tissue cephalometric landmark.
Origin
Pterygomaxillary fissure is an anatomic hard tissue cephalometric landmark.

Pterygomaxillary fissure is used as one of the reference
points in Cox cephalometric analysis and is used to assess the
posterior limit of the maxilla.
66
Figures 10.6A to D: (A) Pterygomaxillary fissure on lateral cephalogram; (B) Magnified image showing pterygomaxillary
fissure on the lateral cephalogram; (C) Pterygomaxillary fissure on graphic illustration; and (D) Magnified image of
pterygomaxillary fissure on graphic illustration
Key Ridge
Abbreviation
KR: Key ridge is abbreviated using English alphabets and is
expressed as capital or upper case K, and R, and is written

Lowermost point on the contour of the shadow of the anterior
wall of the infratemporal fossa.1

The lowest point on the outline of the zygoma.4
Definition
The key ridge (Figs 10.7A to D) is the lowermost point on
the contour shadow of the anterior wall of the infratemporal
fossa.
The most inferior point on the zygomatic ridge.3
Type
Key ridge is a bilateral, hard tissue cephalometric landmark.
67
Figures 10.7A to D: (A) key ridge on lateral cephalogram; (B) Magnified image showing key ridge on the lateral cephalogram; (C) key
ridge on graphic illustration; and (D) Magnified image of key ridge on graphic illustration
Origin
Definition
Key ridge is an anatomic hard tissue cephalometric landmark.
Orbitale
Abbreviation
Or: Orbitale is abbreviated using English alphabets and is expressed as capital or upper case O, followed by small or lower
case r and both alphabets are written continuously without any
space between them.
The deepest point on the infraorbital margin.The midpoint, or

is used where double projection gives rise to two points, or 1
and or 2.9

The lowest point on the left infra-orbital margin.5
The most inferior point on the lower border of the left orbit.3
68
Type
The left orbital point is used in conjunction with poria to

orient the skull on the Frankfort horizontal plane.2
Orbitale is a bilateral (Figs 10.8A to D), anatomic, hard tissue

Leslie G Farkas
Origin
Orbitale is the lowest point on the lower margin of the each orbit.
It is identified by palpation and is identical to the bony orbitale.13
Orbitale is an anatomic hard tissue cephalometric landmark.
Orbitale is used as one of the reference points in the construction

Growth pattern is assessed using FH plane-Mandibular
plane.
In the lateral cephalogram, the outlines of the orbital rims

overlap. Usually, the lowest point on the averaged outline is
used for the construction of Frankfort plane.4
Figures 10.8A to D: (A) Orbitale on lateral cephalogram; (B) Magnified image showing orbitale on the lateral cephalogram;
(C) Orbitale on graphic illustration; and (D) Magnified image of orbitale on graphic illustration
69
Upper incisor torque is assessed using FH-long axis of

upper incisor.
Tracing of Orbitale on the Lateral Cephalogram
References
1. Viken Sassuoni. Orthodontics in dental practice. The CV Mosby
company. 1971;330-7.
Normally, right and left infra-orbital margins are superimposed

on the lateral cephalogram, and then they reveal radio-opaque
line on the lateral cephalogram, when patient is positioned
accurately on the cephalostat during the radiographic taking
procedure.
If the patient is inaccurately positioned then in such cases,
the infra-orbital margins appear as two different radio-opaque
lines on the lateral cephalogram making difficult to identify
the point. In such cases, the orbitale is identified as the mid-
point of right and left infra-orbital margins.

3. Graber TM. New horizons in case analysis. Clinical cephalometrics.
Am J of Ortho. 1952;38:603-24.
4. Moyers RM. Handbook of Orthodontics.Year book medical publishers,
Inc. 1988;251-9.
6. Ricketts RM. Provocations and perceptions in cranio-facial orthopedics.
Dental science and facial art. Rocky Mountains, Inc. 1989;797-803.
7. Alex Jacobson, Caufield W. Introduction to radiographic cephalometry.
Lea and Febiger. 1985;37-40.
8. Jarabak JR. Technique and treatment with light wire appliance. The CV
Mosby company. 1963;132-3.
9. Arne Bjork. The face in profiles. Sven. Tandlak Tidskr. 1947;40:32-3.
10. Riolo ML. An atlas of craniofacial growth. Cephalometric standards from
the university school growth study, the university of Michigan.Center for
human growth and development. The University of Michigan. 1974;12-21.
11. Forsberg CT. Diagnosis and treatment planning of skeletal asymmetry
with submental. Vertical radiograph. Am J of Ortho. 1984;85:224-37.
12. Higley LB. Cephalometric standards for children 4-8 years of age.Am J
of Ortho. 1954;40:51-9.
13. Farkas LG. Anthropometry of the head and face in medicine. Elsevier
north Holland, Inc. 1981;9-14.
Chapter
11
Related to Dentition
Dental occlusion undergoes significant changes from birth

until adulthood and beyond. This continuation of changes in
the dental relationship during various stages of the dentition
can be divided into four stages:
1. Gum pad stage06 months
2. Deciduous dentition6 months6 years
3. Mixed dentition612 years
4. Permanent dentition12 years and beyond.
Gum Pad Stage (06 Months)

Usually jaws are devoid of teeth at birth. Gum pad stage
extends from birth up to the eruption of first primary tooth
usually the lower central incisors at around 6 months of age.
The gum pads are pink in color and firm in consistency. The
maxillary gum pad is U/square shaped, and the mandibular
gum pad is horse-shoe shaped.
The gum pads develop in two portionsbuccal and
lingual portions which are separated by the dental groove.
The gum pads in both the arches show certain elevations and
grooves that outline the portion of the various primary teeth
that are still developing in the alveolar ridges. These grooves
are called as transverse grooves. The prominent transverse
groove separating canine and first deciduous molar segments
in both the arches is called the lateral sulcus. The lateral sulcii
are often used to judge the inter-arch relationship at a very
early stage. The gingival groove separates the maxillary and
mandibular gum pads from the palate and floor of the mouth
respectively.
Deciduous Dentition Stage

(6 Months to 6 Years)
The deciduous dentition stage spans from the time of eruption
of primary teeth until the eruption of the first permanent tooth
around 6 years of age.
Eruption Chronology of Primary Teeth

Eruption of the primary teeth begins by 6 months of age when
primary mandibular incisors erupt into oral cavity. Eruption
of all the primary teeth is usually complete by two and half

years by which age, the deciduous dentition is in full function.
Root formation of primary teeth is usually completed by three
years of age.
Although considerable variation is seen in the eruption
timing of deciduous teeth, there appears to be no significant
gender differences. The chronology of primary teeth is
presented in the Table 11.1.
The sequence of eruption of primary teeth may also show
some variation. However, in most of the cases, the lower
central incisors are the first teeth to erupt, followed by the
upper central incisors. Usually the lateral incisor, first molar
and canine tend to erupt earlier in maxilla than in the mandible.
Deciduous dentition generally shows the following orders of
eruption:
AB
A

D
B
C
D
E
CE
Central incisors
Lateral incisors
First molars
Canines
Second molars
By 3 years of age, the occlusion of deciduous dentition

is completely established and dental arches remain relatively
constant with no significant changes up to 6 years of age.
Mixed Dentition Stage (612 Years)

Mixed dentition stage is a transition stage when primary
teeth are exfoliated in a sequential manner, followed by the
eruption of their permanent successors. This stage spans from
6 to 12 years of age, beginning with the eruption of the first
permanent tooth, usually a mandibular central incisor or a first
molar. It is completed at the time the last primary tooth is shed.
Significant changes in occlusion are seen in mixed dentition
period due to the loss of 20 primary teeth and eruption of their
successor permanent teeth. Most malocclusions are developed
at this stage.
71
Permanent Dentition Stage
Most Common Eruption Sequence in Maxilla

6-1-2-4-3-5-7-8 or
6-1-2-4-5-3-7-8
Most Common Eruption Sequence for

Mandibular Arch
(6-1)-2-3-4-5-7-8 or
(6-1)-2-4-3-5-7-8
These are also the most favorable sequences for the prevention
of malocclusion. It must be noted that, there is a difference
in eruption timing of the canines in the two arches. In the
mandibular arch, the canine erupts before the premolars,
whereas in the maxillary arch the canine generally erupts after
the premolars.
When second molars erupt before the premolars are fully
erupted significant shortening of the arch perimeter occurs,
increasing the likelihood of malocclusion.
Cephalometric Landmarks on Dentition

Cephalometric landmarks seen on the Dentition are of
Incision Superius Incisalis

Abbreviation
IsiIncision Superius Incisalis is abbreviated using English
alphabets and is expressed as Capital or upper case I followed
by small letters or lower case s and i and is written continuously
Cephalometric
landmarks
Abbreviation
Type
Origin
Incision superius
incisalis
Isi
Unilateral
Anatomic
Incision superius
apicalis
Isa
Unilateral
Anatomic
Incision inferius
incisalis
Iii
Unilateral
Anatomic
Incision inferius
apicalis
Iia
Unilateral
Anatomic
Anterior point of
occlusion
APocc
Unilateral
Anatomic
Posterior point of
occlusion
PPocc
Unilateral
Anatomic
Maxillary central
incisor
U1
Unilateral
Anatomic
U6
Bilateral
Anatomic
Mandibular central
incisor
L1
Unilateral
Anatomic
Mandibular first
molar
L6
Bilateral
Anatomic
mi
mi
Bilateral
Anatomic
ms
ms
Bilateral
Anatomic
Chapter 11 Cephalometric Landmarks Related to Dentition
Permanent dentition stage is pretty well established by about

13 years of age, with the eruption of all permanent teeth
except the 3rd molars. Permanent successors develop from
lingual extension of the dental lamina (successional lamina)
and the permanent molar develop from the posterior extension
of the dental lamina. The permanent incisors develop lingual
to the primary incisors and move labially as they erupt. The
premolars develop below the divergent roots of the primary
molars.
Permanent dentition begins to form at birth, at which time,
calcification of the 1st permanent molars becomes evident.
Chronology of permanent dentition is depicted in Table 11.1.
Sequence of eruption of permanent dentition is more
variable than that of the primary dentition. In addition, there
are significant differences in the eruption sequences between
the maxillary and the mandibular arch.
Table 11.1: Cephalometric landmarks related to dentition
isIncision Superius is abbreviated using English alphabets

and is expressed as small letters or lower case i and s and is
Definition
Incision superius Incisalis (Figs 11.1A to D) is the incisal

edge of the maxillary central incisor.
Incision superius incisalis is the mid-point of the incisal edge

of the most prominent upper central incisor.1
Incision superius incisalis is the incisal tip of the most anterior

maxillary central incisor.2
Type
Incision superius incisalis is a unilateral, hard tissue cephalo
metric landmark.
Origin
Incision superius incisalis is a unilateral, anatomic, hard tissue
72
Figures 11.1A to D: (A) Incision superius incisalis on lateral cephalogram; (B) Magnified image showing incision
superius Incisalis on the lateral cephalogram; (C) Incision superius incisalis on graphic illustration; (D) Magnified
image of incision superius Incisalis on graphic illustration
Tracing of Incision Superius Incisalis

on Lateral Cephalogram
The labial and lingual outline of the crown of the maxillary
permanent central incisor appears as radio-opaque line on
the lateral cephalogram. Trace these two outlines of crown of
the maxillary permanent central incisor. The tip of the incisal
edge or the intersection of the labial and lingual outline is the
point of Incision Superius Incisalis.

Incision superius incisalis is used as one of the reference points
in the construction of angles and planes for the assessment of
following:
Inclination of upper incisor is assessed using angle drawn

between the long axis of upper incisor plane and the FH plane.
In Arnetts analysis, the upper incisor torque is assessed
using the angle drawn between long axis of upper incisor
and occlusal plane.
Inter-incisal relationship of upper and lower incisors are
assessed using the angle drawn between the long axis of
upper and lower permanent central incisor.
Anteroposterior positioning of maxillary central incisor is
assessed using the distance between the incision Superius
Incisalis and the NA plane.
Incisalis and the A-Pog plane.
73
According to Michael L Riolo
Incision Superius Apicalis

Abbreviation
IsaIncision Superius Apicalis is abbreviated using English
alphabets and is expressed as capital or upper case I followed
by small letters or lower case s and a and is written continuously
UIAUpper incisor apex is abbreviated using English
alphabets and is expressed as capital or upper case U, I and
A and is written continuously without any space between the
alphabets.
Incision superius apicalis (Figs 11.2A to D) is the root apex

of the most anterior maxillary central incisor; if this point
is needed only for defining the long axis of the tooth, the
midpoint on the bisection of the apical root width can be used.

The upper incisor apex is the root apex of the most prominent
upper incisor.4
Type
Incision superius apicalis is a unilateral, anatomic, hard tissue
Origin
Definition
The upper incisor apex is the root tip of the maxillary central
incisor. In cases where the root is not yet completed, the
midpoint of the growing root tip is marked.3
Incision superius apicalis is an anatomic hard tissue cephalo

metric landmark.
Figures 11.2A to D: Incision superius apicalis
74
Tracing of Incision Superius Apicalis

The labial and lingual outline of the root of the maxillary
permanent central incisor appears as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of root of the
maxillary permanent central incisor. The point of intersection
of labial and lingual outlines of the root of maxillary permanent
central incisor is the point of incision superius apicalis.

Incision superius apicalis is used as one of the reference points
following:
between the long axis of upper incisor plane and the FH
plane.
and occlusal plane.
Inter-incisal relationships of upper and lower incisors are

Incision Inferius Incisalis

Abbreviation
IiiIncision inferius incisalis is abbreviated using English
by small letters or lower case i and i and is written continuously
iiIncision inferius is abbreviated using English alphabets and
is expressed as small letters or lower case i and i and is written
Definition
Incision inferius incisalis (Figs 11.3A to D) is the incisal edge
of the most prominent mandibular central incisor.
Figures 11.3A to D: Incision inferius incisalis (A and B) on lateral cephalogram, (C and D) on graphic illustration
75

The incision inferius is the incisal point of the most prominent
medial mandibular incisor.1

The incision inferius is the incisal tip of the most labial mandi
bular central incisor.2
Type
Incision inferius incisalis is a unilateral, anatomic, hard tissue
The labial and lingual outline of the crown of the mandibular

permanent central incisor appears as radio-opaque line on the
lateral cephalogram. Trace these two outlines of crown of the
mandibular permanent central incisor. The tip of the incisal
point of incision inferius incisalis.

Incision inferius incisalis is used as one of the reference point
following:
Inclination of lower incisor is assessed using angle drawn
between the long axis of lower incisor plane and the
mandibular plane.
In Arnetts analysis, the lower incisor torque is assessed
using the angle drawn between long axis of lower incisor
and occlusal plane.
Anteroposterior positioning of mandibular central incisor
is assessed using the distance between the incision inferius
incisalis and the NB plane.
assessed using the distance between the incision inferius
incisalis and the A-Pog plane.
Incision Inferius Apicalis

Abbreviation
IiaIncision inferius apicalis is abbreviated using English
LIAlower incisor apex is abbreviated using English

alphabets and is expressed as capital or upper case L, I and
A and is written continuously without any space between the
alphabets.
Definition
Incision inferius apicalis (Figs 11.4A to D) is the root apex
of the most anterior mandibular central incisor; if this point
is needed only for defining the long axis of the tooth, the
midpoint on the bisection of the apical root width can be
used.
Tracing of Incision Inferius Incisalis

by small letters or lower case i and a and is written continuously

The lower incisor apex is the root apex of the most prominent
lower incisor.4
Type
Incision inferius apicalis is a unilateral, anatomic, hard tissue

Tracing of Incision Inferius Apicalis

The labial and lingual outline of the root of the mandibular

mandibular permanent central incisor. The point of intersection of labial and lingual outlines of the root of mandibular
permanent central incisor is the point of incision inferius
apicalis.
Incision inferius apicalis is used as one of the reference points

following:
between the long axis of upper incisor plane and the
mandibular plane.
and occlusal plane.
upper and lower permanent central incisors.
76
Figures 11.4A to D: Incision inferius apicalis
Anterior Point of Occlusion
Abbreviation
APoccAnterior point of occlusion is abbreviated using
English alphabets and is expressed as capital or upper case A
and P followed by small letters or lower case o, c and c and
Definition
Anterior point of occlusion (Figs 11.5A to D) for the occlusal
planeA constructed point, the midpoint of the incisor overbite
in occlusion.
Type
Anterior point of occlusion is a unilateral, constructed, hard
Tracing of Anterior Point of Occlusion

the lateral cephalogram. Trace these two outlines of crown
of the maxillary permanent central incisor.
permanent central incisor appears as radio-opaque lines
on the lateral cephalogram. Trace these two outlines of
root of the maxillary permanent central incisor.
the lateral cephalogram. Trace these two outlines of crown
of the mandibular permanent central incisor.
permanent central incisor appears as radio-opaque lines
on the lateral cephalogram. Trace these two outlines of
root of the mandibular permanent central incisor.
77
Figures 11.5A to D: Anterior point of occlusion
Locate the point where there is maximum intercuspation

of maxillary and mandibular permanent central incisors,
which is the point of anterior point of occlusion.

Anterior point of occlusion is used as one of the reference
points in the construction of angles and planes for the
assessment of the following:
Growth pattern is assessed using angle drawn between the
occlusal plane and mandibular plane.
occlusal plane and FH plane.
and occlusal plane.
and occlusal plane.
Posterior Point of Occlusion

Abbreviation
PPoccAnterior point of occlusion is abbreviated using

English alphabets and is expressed as capital or upper case
P and P followed by small letters or lower case o, c and c
and are written continuously without any space between the
alphabets.
Definition
Posterior point of occlusion (Figs 11.6A to D) for the occlusal
planethe most distal point of contact between the most
posterior molars in occlusion (Rakosi).
Type
Posterior point of occlusion is a bilateral, anatomic hard tissue
78
Figures 11.6A to D: Posterior point of occlusion
Tracing of Posterior Point of Occlusion

permanent first molar appears as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of crown of
the maxillary permanent first molar.
lateral cephalogram. Trace these two outlines of root of
the maxillary permanent first molar.
The labial and lingual outline of the crown of the
mandibular permanent first molar appears as radio-opaque
lines on the lateral cephalogram. Trace these two outlines
of crown of the mandibular permanent first molar.
lateral cephalogram. Trace these two outlines of root of
the mandibular permanent first molar.
Locate the point where there is maximum intercuspation

of maxillary and mandibular permanent first molars,
which is the point of anterior point of occlusion.

Posterior point of occlusion is used as one of the reference
points in the construction of angles and planes for the
assessment of following:
occlusal plane and mandibular plane.
occlusal plane and FH plane.
and occlusal plane.
and occlusal plane.
79
Figures 11.7A to D: Maxillary central incisor
Maxillary Central Incisor

Abbreviation
U1Maxillary central incisor is abbreviated using English
alphabets and numeric and is expressed as Capital or
upper case U followed by English numeric 1 and is written
continuously without any space between them.
Definition
Maxillary central incisor (Figs 11.7A to D) is the most labial
point on the crown of the maxillary central incisor.
Type
Maxillary central incisor is a unilateral, anatomic, hard tissue
Tracing of Maxillary Central Incisor


maxillary permanent central incisor. The most labial point
on the crown of the maxillary central incisor is the point of
maxillary central incisor.
Maxillary First Molar

Abbreviation
U6Maxillary first molar is abbreviated using English
alphabets and numeric and is expressed as capital or upper case
U followed by English numeric 6 and is written continuously
80
Figures 11.8A to D: Maxillary first molar
Definition
Maxillary first molar (Figs 11.8A to D) is the tip of the
mesiobuccal cusp of the maxillary first permanent molar.
Type
Maxillary first molar is a bilateral, anatomic, hard tissue
Tracing of Maxillary First Molar

The labial and lingual and cuspal outlines of the crown of the
maxillary permanent first molar appears as radio-opaque lines on
the lateral cephalogram. Trace these outlines of crown of the maxillary permanent first molar, the tip of the mesiobuccal cusp of the
maxillary permanent molar is the point of maxillary first molar.
Mandibular Central Incisor

Abbreviation
L1Mandibular central incisor is abbreviated using English
alphabets and numeric and is expressed as capital or upper case
L followed by English numeric 1 and is written continuously
Definition
Mandibular central incisor (Figs 11.9A to D) is the most labial
point on the crown of the mandibular central incisor.
Type
Mandibular central incisor is a unilateral, anatomic, hard
81
Figures 11.9A to D: Mandibular central incisor
Tracing of Mandibular Central Incisor

The labial and lingual outlines of the crown of the mandibular
permanent central incisor appear as radio-opaque lines on the
mandibular permanent central incisor. The most labial point
on the crown of the mandibular central incisor is the point of
mandibular central incisor.
Mandibular First Molar

Abbreviation
L6Mandibular first molar is abbreviated using English
alphabets and numerical and is expressed as capital or
upper case L followed by English numeric 6 and is written
Definition
Mandibular first molar (Figs 11.10A to D) is the tip of the

mesiobuccal cusp of the mandibular first permanent molar.
Type
Mandibular first molar is a bilateral, anatomic, hard tissue

Tracing of Mandibular First Molar

lines on the lateral cephalogram. Trace these outlines of
crown of the mandibular permanent first molar, the tip of the
mesiobuccal cusp of the mandibular permanent molar is the
point of maxillary first molar.
82
Figures 11.10A to D: Mandibular first molar
mi
Type
mi is a bilateral, hard tissue cephalometric landmark.
Abbreviation
mimi is abbreviated using English alphabets and is expressed
as lower case m and i and written continuously without any
Definition
mi (Figs 11.11A to D) is the mesial contact of the lower molar
projected normal to the plane of occlusion.
Tracing of mi on Lateral Cephalogram

point of maxillary first molar. mi is the mesial contact of the
lower molar projected normal to the plane of occlusion.
83
Figures 11.11A to D: mi
Definition
mi is used as one of the reference points in the construction of

plane and angle in the Bjork cephalometric analysis.
ms (Figs 11.12A to D) is the mesial contact of the upper molar

projected normal to the plane of occlusion.
ms
Type
ms is a bilateral hard tissue cephalometric landmark.
Abbreviation
msms is abbreviated using English alphabets and is expressed
as lower case m and s and written continuously without any
Tracing of ms on Lateral Cephalogram

84
Figures 11.12A to D: ms

point of maxillary first molar. ms is the mesial contact of the
upper molar projected normal to the plane of occlusion.

ms is used as one of the reference point in the construction of
References
2. Robert M Moyers. Handbook of OrthodonticsYear Book Medical
Publishers, Inc. 1988;251-9.
3. Michael L Riolo. An atlas of craniofacial growth: Cephalometric
standards from the university school growth study, the University of
Michigan. Center for human growth and development. The University
of Michigan. 1974;12-21.
4. Bhatia SN, Leighton BC. A manual of facial growth. Oxford University
Press. 1993;10-5.
Chapter
12
Related to Mandible
The mandible (Fig. 12.1 ) (from Latin mandibulajawbone)

or inferior maxillary bone forms the lower jaw and holds the
lower teeth in place.
Cephalometric landmarks (Points) on Mandible

Cephalometric landmarks on mandible are as follows (Table
12.1):
Table 12.1: Cephalometric landmarks related to mandible
Cephalometric
landmarks
Abbreviation
Type
Origin
Infradentale
Id
Unilateral
anatomic
point B
part B
Unilateral
anatomic
pogonion
pog
Unilateral
anatomic
Gnathion
Gn
Unilateral
anatomic
dd
dd
Unilateral
anatomic
Menton
Me
Unilateral
anatomic
Gonion
Go
Unilateral
anatomic
Articulare
ar
Bilateral
anatomic
kk
kk
Unilateral
anatomic
Condylion
Cd
Bilateral
anatomic
Mandibular foramen, paired, in the inner (medial) aspect

of the mandible, superior to the mandibular angle in the
middle of the ramus.
Mental foramen, paired, lateral to the mental protuberance
on the body of mandible.
Nerve Supply to Mandible

Inferior alveolar nerve, branch of the mandibular division
of trigeminal (V) nerve, enters the mandibular foramen and
runs forward in the mandibular canal, supplying sensation to
the teeth. At the mental foramen the nerve divides into two
terminal branches: Incisive and mental nerves. The incisive
nerve runs forward in the mandible and supplies the anterior
teeth. The mental nerve exits in the mental foramen and
supplies sensation to the lower lip.
Parts of Mandible
The mandible consists of:
A curved, horizontal portion, the body.
Two perpendicular portions, the rami, which unite with
the ends of the body nearly at right angles.
Alveolar process, the tooth bearing area of the mandible.
Condyle, superior (upper) and posterior projection from
the ramus, which makes the temporomandibular joint with
the temporal bone.
Coronoid process, superior and anterior.
Projection from the ramus. This provides attachment to
the temporalis muscle.
Figure 12.1: Mandible
86
Articulations
Definition
The mandible articulates with the two temporal bones at the

temporomandibular joints.

The infradentale (Figs 12.2A to D) is the point of transition
from the crown of the most prominent mandibular medial
incisor to the alveolar projection.
Infradentale
Abbreviation
Section 4 Cephalometric Landmarks Related to Facial Bones and Dentition
IdInfradentale is abbreviated using English alphabets and is

expressed as capital or upper case I followed by lower case
or small letters d and written continuously without any space
The infradentale is the most anterior superior point on the

mandibular alveolar process, usually found near cementenamel junction of the mandibular incisors.
Figures 12.2A to D: Infradentale
87
According to SN Bhatia and BC leighton
The infradentale is the most anterosuperior point on the labial

crest of the mandibular alveolar process.
Infradentale is used as one of the reference points in the

construction of plane and angle for the assessment of mandibular
prognathism in the anterior region using S-N-Id angle.
Type
Point B
Infradentale is a unilateral, anatomic hard tissue landmark.
Tracing of Infradentale on the lateral

Cephalogram
Abbreviation
Point BPoint B is abbreviated using English alphabets and is

expressed as capital or upper case B.
Chapter 12 Cephalometric Landmarks Related to Mandible
The alveolar crest between two mandibular permanent

central incisors in the midline appears as radio-opaque lines
on the lateral cephalogram. Trace these radio-opaque lines.
The intersection of radio-opaque lines of interdental cortical
plate in the alveolar crest region between two mandibular
permanent central incisors, is the point of infradentale.
The point B (Figs 12.3A to D) is the deepest midline point on

the mandible between infradentale and pogonion.
Figures 12.3A to D: Point B
88
Definition
The point B is an arbitrary measure point on the anterior profile

curvature from the mandibular anthropometric landmark
pogonion to the crest of the alveolar process. This most posterior
point usually falls just anterior to the apices of the incisor teeth.
According to KKK lew
Point B is on a line perpendicular to FH, point B is the

most posterior point in the concavity between the chin and
mandibular alveolar process.
Most anterior point of mandibular symphysis.

Pogonion (Figs 12.4A to D) is the most anterior point on the
mandible in the midline.
The most anterior point on the symphysis of the mandible.
The point B is the most posterior point of the bony curvature

of the mandible below infradentale and above pogonion. B
point usually is found near the apical third of the roots of the
mandibular incisors and may be obscured during eruption
of these teeth, when the profile of the chin is not concave, B
point cannot be determined.

Most anterior point on the mental protuberance.

Most anterior point on the symphysis of the mandible in the
median plane when the head is viewed in Frankfort relation.
Type
Point B is a unilateral, anatomic, hard tissue cephalometric
landmark.
Tracing of Point B on the lateral Cephalogram

The labial cortical plate of mandible in the anterior symphysis
region appears as vertical shaped radio-opaque line. Trace this
line from the infradentale to the point of pogonion.
Its been tough task to establish the precise location of
point B on the lateral cephalogram. To make it easy, try to
locate infradentale and pogonion and then the mid deepest
point is the point B.
According to leslie G Farkas

Pogonion is the most anterior midpoint of the chin, located on
the skin surface in front of the identical bony landmark of the
mandible.
Robert E Moyers
The most anterior point on the contour of the chin, pogonion
usually is located by drawing a tangent perpendicular to the
mandibular plane or by a tangent dropped to the chin from nasion.
Alex Jacobson and W Caufield

Move the perpendicular line to FH forward then back to where
it first touches the chin. This is pogonion.
Significance
Point B is used as one of the reference points in the construction
of plane and angle for the assessment of anteroposterior
relationship of the mandible in relation to anterior cranial base
using S-N-B angle.
Pogonion
Abbreviation
PogPogonion is abbreviated using English alphabets and is
expressed as capital or upper case P followed by lower case or
small letters o and g and are written continuously without any
Type
Pogonion is a unilateral, anatomic, hard tissue cephalometric
landmark.
Tracing of Pogonion on the lateral Cephalogram

region appears as vertical shaped radio-opaque line. Trace
the labial cortical plate from the alveolar crest between two
permanent mandibular incisors in the midline to the point
anteroinferior point on the mandible. Below the point B follows
the convex outline of labial cortical plate of mandible, the most
prominent point is the point of pogonion.
89
Figures 12.4A to D: Pogonion
Significance
Definition
Pogonion is used as one of the reference points in the construction of plane and angle for the assessment of anteroposterior relationship of the mandible in relation to anterior cranial
base using S-N-Pog angle (Facial angle).
Gnathion (Figs 12.5A to D) is a point on the chin determined by

bisecting the angle formed by the facial and mandibular plane.
Gnathion
Gnathion is the most outward and everted point on the profile
curvature of the symphysis of the mandible.
Abbreviation
GnGnathion is abbreviated using English alphabets and is

expressed as capital or upper case G followed by lower case or
small letters n and is written continuously without any space
The most anterior inferior point in the lateral shadow of the

chin. Ganthion usually is best determined by selecting the
midpoint between pogonion and menton on the contour of the
chin.
90
Figures 12.5A to D: Gnathion

Midpoint between pogonion and menton can be located at the
intersection of the facial; line (Na-Pog) and the mandibular
plane (lower border).
Alex Jacobson and W Caufield

A point located by taking the point between the anterior
(Pogonion) and inferior (Menton) points of the bony chin.
Arne Bjork
Lowest point of the mandibular symphysis.
Type
Gnathion is a unilateral, constructed or derived, hard tissue
Tracing of Gnathion on the lateral

Cephalogram
region appears as vertical shaped radio-opaque line. Trace the
labial cortical plate from the alveolar crest between two permanent mandibular incisors in the midline to the point anteroinferior point on the mandible. Below the point B follows the
convex outline of labial cortical plate of mandible, the most
prominent point is the point of pogonion.The anteroinferior
point of inferior border of the mandible in the midline is the
point of menton. The ganthion is a constructed or derived hard
tissue cephalometric point. Draw a line joining the point of
pogonion to the menton, the midpoint of this line is the point
of gnathion.
91
Figures 12.6A to D: dd
Significance
Definition
Gnathion is used as one of the reference points in the

construction of plane and angle for the assessment of growth
pattern using N-S-Gn angle.
In Ricketts cephalometric analysis, the positioning of the
chin is determined by the angle formed between the Ba-N
plane and plane from foramen rotundum (PT) to Gn. The
normal value of this angle is 90 degree. A larger angle suggests
a protrusive or forward growing chin whereas a lesser angle
suggests a retropositioning of the chin.
dd (Figs 12.6A to D) is the most prominent point of the chin

in the direction of measurement.
dd
Abbreviation
dddd is abbreviated using English alphabets and is expressed
as lower case or small letters d and d and written continuously
Type
dd is a unilateral, anatomic, hard tissue cephalometric

landmark.
Tracing of dd on the lateral Cephalogram

region appears as vertical shaped radio-opaque line. Trace
the labial cortical plate from the alveolar crest between two
anteroinferior point on the mandible. Below the point B
follows the convex outline of labial cortical plate of mandible,
the most prominent point is the point of pogonion. The
anteroinferior point of inferior border of the mandible in the
92
midline is the point of menton. The gnathion is a constructed

or derived hard tissue cephalometric point. Draw a line joining
the point of pogonion to the menton,the midpoint of this line
is the point of gnathion. dd is the most prominent point of the
chin in the direction of measurement.

Lower most point of the contour of the chin.
According to Carl F Gugino

Menton (Figs 12.7A to D) is the point of the inferior border
of the symphysis directly inferior to mental protuberance and
inferior to the center of trigoniun mentali.
Significance
dd is used as one of the reference points in the construction of

Type
Menton
Menton (Figs 12.7A to D) is a unilateral, anatomic, hard

tissue landmark.
Abbreviation
Tracing of Menton on the lateral
Cephalogram
MeMenton is abbreviated using English alphabets and is

or small letter e and is written continuously without any space

Figures 12.7A to D: Menton
93
labial cortical plate from the alveolar crest between two

anteroinferior point on the mandible. Below the point B follows the convex outline of labial cortical plate of mandible,the
most prominent point is the point of pogonion.The anteroinferior point of inferior border of the mandible in the midline is
the point of menton.
Significance
Gonion
Abbreviation
GoGonion is abbreviated using English alphabets and is
expressed as capital or upper case G followed by lower case
or small letter o and is written continuously without any space
Significance
Gonion is used as one of the reference points in the construction

of plane and angle for the assessment of following:
Constructions of mandibular plane, i.e. the line joining the
point menton and gonion.
Growth pattern is assessed using S-N to mandibular plane
angle.
Growth pattern is assessed using FH to mandibular plane
angle.
Cant of occlusal plane is assessed using occlusal plane
(APocc-Ppocc ) to mandibular plane (AvMe-Go) angle.
Growth pattern is assessed using Go1 and Go2 angles.
Rotation of the mandible is also assessed using the S-ArGo angle.
The length of the mandible is measured from condylion
to gonion.
Definition
Articulare

The midpoint mediolaterally on the posterior border of each
gonial angle.

The midpoint mediolaterally on the posterior most border of
each gonial angle. Gonion is a bilateral structure.
Type
Gonion (Figs 12.8A to D) is a unilateral, anatomic, hard tissue
Abbreviation
ArArticulare is abbreviated using English alphabets and is

expressed as capital or upper case A followed by lower case
or small letter r and is written continuously without any space
Definition
Articulare (Figs 12.9A to D) is the point of intersection the
dorsal contours of the processus articularis mandibulare and
os tempoarle. The midpoint, a is used where double projection
gives rise to two points, a1 and a2.
Tracing of Menton on the lateral Cephalogram

The inferior and posterior borders of the mandible appear as
radio-opaque lines on the lateral cephalogram.Trace these two
Menton is used as one of the reference points in the construction

angle.
angle.
(APocc-Ppocc) to mandibular plane (Me-Go) angle.
radio-opaque lines and then draw a line tangent to inferior

and posterior/ramus borders of the mandible; the point where
these two intersects is the point of gonion.
Improper positioning of head during cephalometric radiographic projection procedure will result in superimposition
of right and left mandibular inferior border. In such cases,
there are two radio-opaque lines of right and left mandibular
inferior borders. Then trace these two radio-opaque lines and
draw an imaginary line exactly middistance between right and
left inferior borders of the mandible. To establish the point
Gonion tangent line is drawn from the imaginary line and
posterior border/ramus border, the instersection of these two
lines is the point of Gonion.
Type
Articulare is a bilateral, anatomic, hard tissue landmark.
94
Figures 12.8A to D: Gonion
Tracing of Articulare on the lateral

Cephalogram
kk
The posterior or ramus border of the mandible appears as

radio-opaque line on the lateral cephalogram. Trace ramus
border of the mandible. The point on the ramus border of the
mandible at the neck region.
Abbreviation
Significance
Definition
Articulare is used as one of the reference points in the construction

of plane and angle for the assessment of the following:
Construction of posterior/ramus border of the mandible,
i.e. the line joining the point Articulare and Gonion.
kk is the point of intersection between the base and ramus

tangents to the mandible. The midpoint is used where double
projections gives rise to two points.
kkkk is abbreviated using English alphabets and is expressed

as lower case or small letters k and k and written continuously
Type
kk (Figs 12.10A to D) is a bilateral hard tissue cephalometric
landmark.
95
Figures 12.9A to D: Articulare
Tracing of Menton on the lateral Cephalogram

The inferior and posterior borders of the mandible appear as
radio-opaque lines on the lateral cephalogram. Trace these
two radio-opaque lines and then draw a line tangent to inferior
and posterior/ramus borders of the mandible; the point where
these two intersect is the point of gonion. kk is the point
of intersection between the base and ramus tangents to the
mandible. The midpoint is used where double projections give
rise to two points.
Significance
kk is used as one of the reference points in the construction of
Condylion
Abbreviation
CdArticulare is abbreviated using English alphabets and is

expressed as capital or upper case C followed by lower case
or small letter d and is written continuously without any space
Definition
Condylion medialis (Figs 12.11A to D)The tangent point to
each medial condylar border of a line drawn parallel to each
mandibular body line.
96
Figures 12.10A to D: kk
Condylion medialisMost medial aspect of condyle. Bilateral

structure.
Condylion anteriorisA point on the anterior of each condylar

head which is chosen to represent the mandibular fossa of the
temporal bone.
Condylion lateralisThe tangent point in each condylar

border of a line drawn parallel to each mandibular body line.
Condylion posterialisThe intersection of the mandibular

body line with the posterior border of each condyle.
Type
Condylion lateralisMost lateral aspect of condyle. Bilateral

structure.
Condylion is a bilateral, anatomic, hard tissue cephalometric

landmark.
97
Figures 12.11A to D: Condylion
Tracing of Condylion on the lateral Cephalogram

radio-opaque line on the lateral cephalogram. Condyle of the
mandible appears as a circular radio-opaque line on the lateral
cephalogram. The highest point of superior curvature of the
condyle of the mandible is the point of condylion.
Significance
Condylion is used as one of the reference points in the construction of plane and angle for the assessment of the following:
Construction of posterior/ramus border of the mandible,

i.e. the line joining the point Articulare and Gonion.
Midfacial length is measured from condylion to point A in
McNamara analysis.
The length of the mandible is measured from condylion
to gonion.
Section
Related to Cervical Bones
Cephalometric Landmarks Related to Hyoid Bone

Cephalometric Landmarks Related to Vertebrae
Chapter
13
related to hyoid bone
Like the mandible, the hyoid bone (Figs 13.1A and B) is also
a horse-shoe shaped bone suspended in the neck.
Parts of the Hyoid Bone

Hyoid bone consists of the following parts:
A body.
Lesser cornu/horn.
Greater cornu/horn.
The lesser cornu fuses the body of the hyoid bone
superiorly whereas the greater cornu fuses the body of hyoid
bone inferiorly.
In children, greater cornu is seen separately as it is not

fused to the body of hyoid but in adults both lesser and
greater cornu are fused to the body of hyoid bone.
Cephalometric Landmarks (Points) on Hyoid Bone

Cephalometric landmarks seen on the hyoid bone are of
anatomic origin and are as follows:
Table 13.1: Cephalometric landmark related to hyoid bone
Cephalometric
landmark
Abbreviation
Type
Origin
Hyoid
Hy or H
Unilateral
Anatomic
Radiographic Anatomy of Hyoid Bone

The hyoid bone is well appreciated on the lateral cephalogram.
On the lateral cephalogram, the hyoid bone appears
boomerang-shaped radio-opaque area below the inferior
to the middle of the mandibular body.
The greater and lesser cornu of the hyoid bone appear as
radio-opaque on the lateral cephalogram.
The body of the hyoid bone on the lateral cephalogram
appears as radio-opaque.
Hyoid
Abbreviation
HyHyoid is abbreviated using English alphabet and is
expressed as capital or upper case H followed by lower case or
small y, and both are written continuously without any space
Figures 13.1A and B: Hyoid bone
Section 5 Cephalometric Landmarks Related to Cervical Bones
102
Figures 13.2A to D: Hyoid
HHyoid is abbreviated using English alphabet and is

expressed as capital or upper case H.
Note: Most widely and commonly used abbreviation for hyoid
is Hy.
Definition
Hyoid (Figs 13.2A to D) is the most superoanterior point on
the body of the hyoid bone.

According to Robert M Ricketts, the hyoid is the point at the
anterior-superior margin of the body of the hyoid.1
Type
Hyoid is a unilateral, anatomic, hard tissue cephalometric
landmark.
Tracing of Hyoid on the Lateral Cephalogram

The body, lesser and greater cornu of the hyoid bone appears
as boomerang shaped radio-opaque area. The superioanterior
point on the body of the hyoid bone is the point of hyoid. It
is a unilateral, anatomic hard tissue cephalometric landmark.
Reference
dental science and facial art. Rocky Mountain Inc. 1989;797-803.
Chapter
14
related to Vertebrae
Radiographic anatomy of
cervical vertebrae (fig. 14.1)
Anteroinferior to the occipital condyle, which appears as a
curved radio-opaque line, the anterior arch of the atlas can be
identified as a small triangular radio-opaque area. The apex
of the triangle faces the posterior border of the mandibular
ramus, while its base faces the odontoid process of the
axis. The central mass of the atlas, which appears as radioopaque area superimposed on the radio-opaque shadow of the
odontoid process. Posterosuperior to the inferior articular facet
is the superior articular facet, which can be identified as radioopaque area. Its superior border is concave and corresponds
with the contour of the occipital condyle. Next to the superior
articular facet is the posterior arch with the posterior tubercle.
At the superior border of the posterior arch is a groove for the
vertebral artery and the first cervical nerve.
The odontoid process and the body of the axis appear as a
triangular radio-opaque area. The odontoid process represents
the apex of the triangular points toward the occipital condyle.
The spinous process of the axis appears as a radio-opaque
projection extending superiorly.
The radiographic appearance of the third cervical vertebra
(C3) to the seventh cervical vertebra (C7) is similar. The body
of the each of these cervical vertebrae appears as wedge shaped
radio-opaque area situated behind the pharyngeal space.
Posterior to the body is the spinous process. The transverse
processes, the superior articular process and the inferior
articular process appear as radio-opaque area superimposed
on the shadow of the body and the spinous process. The
body of each cervical vertebra is separated from the adjacent
ones by the intervertebral disc, which appears as radiolucent
strip. At the midpoint between the third and fourth cervical
vertebrae is the hyoid bone, which is separated anteriorly.
Cephalometric Landmarks on Cervical Vertebra

Cephalometric landmarks seen on the cervical vertebra are of
Table 14.1: Cephalometric landmarks related to cervical vertebra

Cephalometric
landmarks
Abbreviation
Type
Origin
cv2ap
cv2ap
Unilateral
Anatomic
cv2ip
cv2ip
Unilateral
Anatomic
cv2ia
cv2ia
Unilateral
Anatomic
cv3sp
cv3sp
Unilateral
Anatomic
cv3ip
cv3ip
Unilateral
Anatomic
cv3sa
cv3sa
Unilateral
Anatomic
cv3ia
cv3ia
Unilateral
Anatomic
cv4sp
cv4sp
Unilateral
Anatomic
cv4ip
cv4ip
Unilateral
Anatomic
cv4sa
cv4sa
Unilateral
Anatomic
cv4ia
cv4ia
Unilateral
Anatomic
cv5sp
cv5sp
Unilateral
Anatomic
cv5ip
cv5ip
Unilateral
Anatomic
cv5sa
cv5sa
Unilateral
Anatomic
cv5ia
cv5ia
Unilateral
Anatomic
cv6sp
cv6sp
Unilateral
Anatomic
cv6ip
cv6ip
Unilateral
Anatomic
cv6sa
cv6sa
Unilateral
Anatomic
cv6ia
cv6ia
Unilateral
Anatomic
Cephalometric Landmarks (Points) Related to

Cervical Vertebra
cv2apThe apex of the odontoid process of the second
cervical vertebra.
cv2ipThe most inferoposterior point on the body of the
second cervical vertebra.
cv2iaThe most inferoanterior point on the body of the
second cervical vertebra.
104

sixth cervical vertebra.
cv6saThe most superoanterior point on the body of the
cv2ip
Abbreviation
cv2ipcv2ip is abbreviated using English alphabet and English
numeric and is expressed as small letters or lower case c,v
followed by English numeric 2 and then it is followed with
English alphabets lower case i and p and all of them are written
Definition
The most inferoposterior point on the body of the second
cervical vertebra.
Type
Figure 14.1: Radiographic anatomy of cervical vertebra
cv3spThe most superoposterior point on the body of the

third cervical vertebra.
fourth cervical vertebra.
fifth cervical vertebra.
cv2ip (Figs 14.2A and B) is a unilateral, anatomic, hard tissue

Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
cv2ap
Abbreviation
cv2apcv2ap is abbreviated using English alphabet and
English numeric and is expressed as small letters or lower
case c,v followed by English numeric 2 and then it is followed
with English alphabets lower case a and p and all of them are
Definition
The apex of the odontoid process of the second cervical
vertebra.
Type
cv2ap (Figs 14.3A and B) is a unilateral, anatomic, hard tissue
Significance
105
Figures 14.2A and B: cv2ip-The most inferoposterior point on the body of the second cervical vertebra
Figures 14.3A and B: cv2ap-The apex of the odontoid process of the second cervical vertebra
Chapter 14 Cephalometric landmarks related to Vertebrae
106
cv3sp
Abbreviation
Abbreviation
cv2iacv2ia is abbreviated using English alphabet and English

English alphabets lower case i and a and all of them are written
cv3spcv3sp is abbreviated using English alphabet and

with English alphabets lower case s and p and all of them are
Definition
Definition
The most inferoanterior point on the body of the second

cervical vertebra.
The most superoposterior point on the body of the third

cervical vertebra.
Type
Type
cv2ia (Figs 14.4A and B) is a unilateral, anatomic, hard tissue

cv3sp (Figs 14.5A and B) is a unilateral, anatomic, hard tissue

Significance
Significance


cv2ia
Figures 14.4A and B: cv2ia-The most inferioanterior point on the body of the second cervical vertebra
107
Figures 14.5A and B: cv3sp-The most superoposterior point on the body of the third cervical vertebra
cv3ip
cv3sa
Abbreviation
Abbreviation

cv3sacv3sa is abbreviated using English alphabet and

with English alphabets lower case s and a and all of them are
Definition
Definition
The most inferoposterior point on the body of the third cervical

vertebra.
The most superoanterior point on the body of the third cervical

vertebra.
Type
Type
cv3ip (Figs 14.6A and B) is a unilateral, anatomic, hard tissue

cv3sa (Figs 14.7A and B) is a unilateral, anatomic, hard tissue

Significance
Significance


108
Figures 14.6A and B: cv3ip-The most inferoposterior point on the body of the third cervical vertebra
Figures 14.7A and B: cv3sa-The most superoanterior point on the body of the third cervical vertebra
109
cv4sp
Abbreviation
Abbreviation


Definition
Definition
The most inferoanterior point on the body of the third cervical

vertebra.
The most superoposterior point on the body of the fourth

cervical vertebra.
Type
Type
cv3ia (Figs 14.8A and B) is a unilateral, anatomic, hard tissue

cv4sp (Figs 14.9A and B) is a unilateral, anatomic, hard tissue

Significance
Significance


Figures 14.8A and B: cv3ia-The most inferioanterior point on the body of the third cervical vertebra
cv3ia
110
Figures 14.9A and B: cv4sp-The most superoposterior point on the body of the fourth cervical vertebra
cv4ip
cv4sa
Abbreviation
Abbreviation

numeric and is expressed as small letters or lower case
c,v followed by English numeric 4 and then it is followed
with English alphabets lower case i and p and all of them
are written continuously without any space between the
alphabets.

case c,v followed by English numeric 4 and then it is
followed with English alphabets lower case s and a and
all of them are written continuously without any space
Definition
Definition
The most inferoposterior point on the body of the fourth

cervical vertebra.
The most superoanterior point on the body of the fourth

cervical vertebra.
Type
Type
cv4ip (Figs 14.10A and B) is a unilateral, anatomic, hard

cv4sa (Figs 14.11A and B) is a unilateral, anatomic, hard

Significance
Significance


111
Figures 14.10A and B: cv4ip-The most inferoposterior point on the body of the fourth cervical vertebra
Figures 14.11A and B: cv4sa-The most superoanterior point on the body of the fourth cervical vertebra
112
cv5sp
Abbreviation
Abbreviation


English numerical and is expressed as small letters or lower
with English alphabets lower case i and a and all of them are
DEFINITION
Definition
The most inferoanterior point on the body of the fourth

cervical vertebra.
The most superoposterior point on the body of the fifth

cervical vertebra.
Type
Type
cv4ia (Figs 14.12A and B) is a unilateral, anatomic, hard

cv5sp (Figs 14.13A and B) is a unilateral, anatomic, hard

Significance
Significance


cv4ia
Figures 14.12A and B: cv4ia-The most inferoanterior point on the body of the fourth cervical vertebra
113
Figures 14.13A and B: cv5sp-The most superoposterior point on the body of the fifth cervical vertebra
cv5ip
cv5sa
Abbreviation
Abbreviation


Definition
Definition
The most inferoposterior point on the body of the fifth cervical

vertebra.
The most superoanterior point on the body of the fifth cervical

vertebra.
Type
Type


Significance
Significance


114
Figures 14.14A and B: cv5ip-The most inferoposterior point on the body of the fifth cervical vertebra
Figures 14.15A and B: cv5sa-The most superoanterior point on the body of the fifth cervical vertebra
115
cv6sp
Abbreviation
Abbreviation


Definition
Definition
The most inferoanterior point on the body of the fifth cervical

vertebra.
The most superoposterior point on the body of the sixth

cervical vertebra.
Type
Type
Cv5ia (Figs 14.16A and B) is a unilateral, anatomic, hard

cv6sp (Figs 14.17A and B) is a unilateral, anatomic, hard

Significance
Significance


Figures 14.16A and B: cv5ia-The most inferoanterior point on the body of the fifth cervical vertebra
cv5ia
116
Figures 14.17A and B: cv6sp-The most superoposterior point on the body of the sixth cervical vertebra
cv6ip
cv6sa
Abbreviation
Abbreviation


Definition
Definition
The most inferoposterior point on the body of the sixth

cervical vertebra.
The most superoanterior point on the body of the sixth cervical

vertebra.
Type
Type


Significance
Significance


117
Figures 14.18A and B: cv6ip-The most inferoposterior point on the body of the sixth cervical vertebra
Figures 14.19A and B: cv6sa-The most superoanterior point on the body of the sixth cervical vertebra
118
cv6ia
Cervical Vertebrae as Indicators of Skeletal

Maturity
Abbreviation
Definition
The most inferoanterior point on the body of the sixth cervical

vertebra.
Type
cv6ia (Figs 14.20A and B) is a unilateral, anatomic, hard
Significance
This cephalometric landmark/point is used as a reference point in
the cervical vertebrae maturity indicator (CMVI) method.
Hand-wrist radiographs have been used conventionally as the

standard method of evaluating skeletal maturity. Although
accurate, this method necessitates additional radiation
exposure to patients. Furthermore, the hand-wrist site is
far removed from the jaw which is the site of orthodontic
correction. In recent years, evaluation of cervical vertebrae
has been increasingly used to determine skeletal maturation.
A new system of skeletal maturation assessment using the
cervical vertebrae was first developed by Hassel and Farman.
A number of subsequent stu dies have shown significant
correlation between developmental or maturational changes
occurring in the cervical vertebrae than that of the hand-wrist
region.
Cervical vertebrae maturity indicator (CMVI) method
is increasingly being used in the recent years instead of the
conventional hand-wrist radiograph method. One of the main
reasons for the rising popularity of the method is that cervical
vertebral maturation can be assessed on lateral cephalograms
(Fig. 14.21), which is used regularly in orthodontic diagnosis,
thus precluding the need for an additional radiograph.
Figures 14.20A and B: cv6ia-The most inferoanterior point on the body of the sixth cervical vertebra
119
In 1972, Lamparki stated that the cervical vertebrae were

as statistically and clinically reliable in assessing skeletal age
as the hand-wrist technique. Several authors (San-Roman et
al 2002) have reported a high correlation between cervical
vertebrae maturation and skeletal maturation of the handwrist. It has been found that cervical vertebrae could offer an
alternative method for assessing maturity without the need of
hand-wrist radiographs and thus decreasing patients radiation
exposure.
Most methods of cervical vertebral maturation are based
on morphologic changes that occur in cervical vertebral bodies
as growth progresses. Hassel and Farman developed a method
of skeletal maturation assessment using cervical vertebrae in
which there are 6 stages of development (Fig. 14.22). They
take into account the morphologic characteristics of the
cervical (C2, C3 and C4) vertebrae such as:
Shape of the vertebral bodies
Height of the vertebral bodies
Concavity of the lower border of the cervical bodies.
The shapes of the cervical vertebral bodies of C3 and C4
change at each level of skeletal development are assessed
(Fig. 14.23).
At first they are wedge-shaped, then changed to rectangular,
next to square-shaped.
The vertical dimensions of the cervical vertebral bodies
increase with increased skeletal maturity.
It is also observed that the inferior borders of the cervical
vertebral bodies which are flat at the beginning become
concave as they mature.
The concavity of the inferior vertebral borders is seen to
appear sequentially from C2 to C3 and then to C4 as the
skeleton matures.
Figure 14.21: Cervical vertebral maturation can be assessed on

lateral cephalograms
Figure 14.22: Hassel and Farman developed a method of skeletal

maturation assessment using cervical vertebrae in which there are
6 stages of development
Figure 14.23: The shapes of the cervical vertebral bodies of C3

and C4 change at each level of skeletal development are assessed
120
Depending on these changes observed in C2, C3 and

C4 cervical vertebrae, Hassel and Farman gave 6 stages of
development depicted in Table 14.2.
Contd...
Stage
Name
Changes in vertebrae
Stage 5
Maturation
Cervical vertebrae attain maturity

Concavities at lower borders of C2, C3 and
C4 become more accentuated
C3 and C4 are more square in shape
510% pubertal growth remaining
Stage 6
Completion
Adolescent growth is nearly complete

More accentuated concavities are seen at
lower borders of C2, C3 and C4.
Shape of C3 and C4 is square with greater
vertical dimension than width
Pubertal growth is complete with no more
growth potential remaining.
Table 14.2: Assessment of skeletal maturity using cervical vertebrae

Name
Changes in vertebrae
Stage 1
Initiation
Marks the beginning of adolescent growth.

The cervical vertebral bodies and C2, C3 and
C4 are wedge-shaped with their superior
borders tapering posteroanteriorly.
Their inferior borders are flat.
8095% of growth in remaining pubertal.
Stage 2
Acceleration
Acceleration of growth occurs.

Concavities are developing on the lower
borders of C2 and C3
Lower border of C4 vertebral body is flat
C3 and C4 assume rectangular shape
6585% of pubertal growth remains
Stage
Stage 3
Transition
Growth is accelerated to reach peak height

velocity
Distinct concavity seen in lower borders of
C2 and C3.
Concavity is developing in the lower
borders of C4.
C3 and C4 are more rectangular in shape.
2565% pubertal growth is remaining
Stage 4
Deceleration
Deceleration of adolescent growth spurt

begins
Distinct concavities seen at the lower borders
of all three vertebrae, that is, C2, C3 and C4
C3 and C4 are nearly square in shape
1025% of pubertal growth is remaining
Contd...
Bibliography
1. Anderson Dl, Thompson GW, Popovich F. Interrelationship of dental
maturity, skeletal maturity, height and weight from age 4 to 14 years,
Growth. 1975;39:453-62.
2. Bowden BD. Epiphyseal changes in the hand/wrist area as an indicator
of adolescent. Aust Orthod J. 1976;4:87-104.
3. Fishman LS. Radiographic evaluation of skeletal maturity. Angle
Orthodont. 1982;88-112.
4. Grave, Brown. Skeletal ossification and adolescent growth spurt. Am J
Orthod. 1976;69-80.
5. Houston WJB, Miller JC, Tanner JM. pRediction of the timing of the
adolescent growth spurt from ossification events in hand/wrist films,
Brit J Ortho. 1979;6:145-52.
6. Moore, Moyer, Dubois. Skeletal maturation and craniofacial growth.
Am J Orthod. 1990;33-40.
7. Revelo, Fishman. Evaluation of ossification of midpalatal suture. Am J
Orthod. 1994;288-92.
Section
related to Pharynx
Cephalometric landmarks related to Pharynx
Chapter
15
related to Pharynx
The pharynx is a median fibromuscular tube that extends from

the base of the skull. Pharynx opens into nasal cavity, the oral
cavity, and the larynx. Pharynx opens into the nasal cavity,
the oral cavity and the larynx are termed as nasopharynx,
oropharynx and laryngopharynx respectively.
Table 15.1: Cephalometric landmarks related to pharynx

Cephalometric
landmarks
Abbreviation
Type
Anterior nasal spine
ANS or ans
Unilateral
Anatomic
Posterior nasal spine
PNS or pns
Unilateral
Anatomic
Nasopharynx
Anterior pharyngeal
wall
apw
Unilateral
Anatomic
The Nasopharynx is the upper part of the pharynx. It is situated

behind the oral cavity above the soft palate. Its superior border
is the base of the skull. In the posterior part of the roof and
the upper part of the posterior wall, there is an accumulation
of lymphoid tissuethe adenoid or pharyngeal tonsilwhich
may be prominent in children but which becomes indistinct
in adulthood. In the lateral wall, 1.5 cm posterior to the
inferior nasal concha, is the opening of the auditory tube.The
nasopharynx extends downwards and is continuous with the
oropharynx at the level below the soft palate.
Posterior pharyngeal
wall
ppw
Unilateral
Anatomic
Pterygomaxillary
fissure
Ptm
Unilateral
Anatomic
Superior pharyngeal
wall
spw
Unilateral
Anatomic
Tip of uvula
Unilateral
Anatomic
Point on the oral side

of the soft palate
Uo
Unilateral
Anatomic
Point on the
pharyngeal side of
the soft palate
Up
Unilateral
Anatomic
Upper point of
tongue
ut
Unilateral
Anatomic
Oropharynx
The oropharynx is the middle part of the pharynx situated
between the soft palate and the superior border of the epiglottis.
Anteriorly, it opens to the oral cavity and is bordered by the
posterior one-third of the tongue. At the lateral boundaries of
the opening of the oral cavity into the oropharynx, the palatine
tonsils are lodged in the tonsilar fossae.
Laryngopharynx
The laryngopharynx is the lower part of the pharynx. It extends
from the superior border of the epiglottis to the inferior border
of the sixth cervical vertebrae, where it becomes continuous
with the esophagus. The upper part of the laryngopharynx is
open anteriorly to the larynx via the patent inlet.
Cephalometric Landmarks (Points) on Pharynx

Cephalometric landmarks seen on the pharynx are of anatomic
origin and are as follows (Table 15.1):
Origin
Anterior Nasal Spine,

Posterior Nasal Spine
and Pterygomaxillary Fissure
Anterior nasal spine, posterior nasal spine and pterygo
maxillary fissure are explained in detail in Chapter 10
[Cephalometric Landmarks (Points) Related to Maxilla].
Anterior Pharyngeal Wall

Abbreviation
apwAnterior pharyngeal wall is abbreviated using English
alphabet and is expressed as small letters or lower case, a, p
and w and written continuously without any space between
the alphabets.
124
Posterior Pharyngeal Wall

Abbreviation
ppwPosterior pharyngeal wall is abbreviated using English alphabet and is expressed as small letters or lower case, p, p and w and
Superior Pharyngeal Wall

Abbreviation
Section 6 Cephalometric Landmarks Related to Pharynx
spwSuperior pharyngeal wall is abbreviated using English alphabet and is expressed as small letters or lower case, s, p and w and
Tip of the Uvula

Abbreviation
UTip of the uvula is abbreviated using English alphabet and
is expressed as capital or upper case U.
Point on the Oral Side of the Soft Palate

Abbreviation
UoPoint on the oral side of the soft palate is abbreviated
using English alphabet and is expressed as capital or upper
case U followed by small letter or lower case o and is written
Point on the Pharyngeal Side of the Soft Palate

Abbreviation
UpPoint on the oral side of the soft palate is abbreviated
using English alphabet and is expressed as capital or upper
case U followed by small letter or lower case p and is written

Upper Point of Tongue

Abbreviation
utUpper point of tongue is abbreviated using English
alphabet and is expressed as small letters or lower case u and
t and is written continuously without any space between the
alphabets.
Significance
In Mc Namara Analysis
Upper pharynx
Upper pharyngeal width is measured from a point on the
posterior outline of the soft palate to the closet point on the
pharyngeal wall. This measurement is taken on the anterior
half of the soft palate outline. The average nasopharnyx is
approximately 1520 mm in width. A width of 2 mm or less in
this region indicates airway impairment.
Lower Pharynx
Lower pharyngeal width is measured from the point of
intersection of the posterior border of the tongue and the
inferior border of the mandible to the closet point on the
posterior pharyngeal wall. The average measurement is 11
to 14 mm independent of age. Greater than average lower
pharyngeal walls is of possible anterior positioning of the
tongue, either as a result of habitual posture or due to tonsillar
enlargements A lower than average lower pharyngeal wall
indicates the posterior positioning of the tongue.
Section
Soft Tissue Cephalometric

Landmarks
Soft Tissue Cephalometric Landmarks
ChapTer
16
Soft Tissue Cephalometric

Landmarks
Soft Tissue Cephalometric Landmarks (Points)

Related to Forehead
Soft tissue cephalometric landmarks related to forehead are
listed below and are explained in detail in this chapter.
Trichion
Soft tissue glabella.
Soft Tissue Glabella
Definition
Abbreviation
GSoft tissue glabella is abbreviated using English
alphabet and is expressed as upper case G.
GsSome authors abbreviate soft tissue glabella as English

alphabet upper case G followed by lower cases.
SGLBSome authors even abbreviate soft tissue glabella
as English alphabets upper case S, G L and B written
continuously without any space between each alphabet.
NoteSoft tissue glabella can be abbreviated as upper case
G or Gs or SGLB, However, G is the most widely used
abbreviation.
Soft tissue glabella (Figs 16.1A to D) is the most prominent

or anterior point in the midsagittal plane of the forehead at
the level of the superior orbital ridges.
Figures 16.1A to D: (A) Soft tissue glabella on lateral cephalogram; (B) Magnified image showing soft tissue glabella on the lateral
cephalogram; (C) Soft tissue glabella on graphic illustration; (D) Magnified image of soft tissue glabella on graphic illustration
128
The most prominent or anterior point in mid-sagittal plane

of the forehead at the level of the superior orbital ridges
(SN Bhatia, BC Leighton, 1993).
All above mentioned soft tissue cephalometric landmarks/

points related to nose are explained below:
Soft Tissue Nasion
Type
Glabella is a unilateral soft tissue cephalometric landmark.
Abbreviation
Significance
nSoft tissue nasion is abbreviated using English alphabet and

is expressed as lower case n.
Glabella is used as one of the reference points in the construction of facial angles.

Related to Nose
Section 7 Soft Tissue Cephalometric Landmarks
Soft tissue cephalometric landmarks (points) related to nose

are listed below:
Soft tissue nasion
Nasal crown
Pronasale
Point T
Alar crease junction.
NSoft tissue nasion can also be abbreviated using English

alphabet and is expressed as upper case N.
Definition
Soft tissue nasion (Figs 16.2A to D) is the concave or retruded
point in the tissue overlying the area of the frontonasal suture.
According to Spiro J Chaconas in 1993

The point of intersection of the soft tissue profile with a line
drawn from the center of sella turcica through nasion.
Figures 16.2A to D: (A) soft tissue nasion on lateral cephalogram; (B) Magnified image showing soft tissue nasion on the lateral
cephalogram; (C) Soft tissue nasion on graphic illustration; (D) Magnified image of soft tissue nasion on graphic illustration
129
Type
Type
Soft tissue nasion is a unilateral soft tissue cephalometric

landmark.
Nasal crown is a unilateral soft tissue cephalometric landmark.
Significance
Significance
Nasal crown is used for the assessment of nasal contour.
Soft tissue nasion is used as one of the reference points on the

construction of nasion and soft tissue pogonion plane which
is used along with the dorsum surface of nose to determine
the nasal prominence and subsequently helps in evaluation of
malocclusion pattern.
Nasal Crown
NCNasal crown is abbreviated using English alphabet and is

expressed as capital (upper case) NC and written continuously
without any space between alphabets.
Abbreviation
PnPronasale is abbreviated using English alphabet and is
expressed as capital (upper case) P followed by lower case
n written continuously without any space between alphabets.
Chapter 16 Soft Tissue Cephalometric Landmarks
Abbreviation
Pronasale
PrnPronasale is also abbreviated using English alphabet and is

expressed as capital (upper case) P followed by lower case r and
n and written continuously without any space between alphabets.
Definition
PRNPronasale can also be abbreviated using English alphabet

and is expressed as capital (upper case) P, R and N and written
continuously without any space between alphabets.
Nasal crown (Figs 16.3A to D) is a point along the bridge of

the nose halfway between soft tissue nasion (n) and pronasale
(Pn).
prnPronasale can also be abbreviated using English alphabet

and is expressed as small (lower case) p, r and n and written
continuously without any space between alphabets.
Figures 16.3A to D: (A) Nasal crown on lateral cephalogram; (B) Magnified image showing nasal crown on the lateral cephalogram;
(C) Soft tissue nasal crown on graphic illustration; (D) Magnified image of nasal crown on graphic illustration
130
Figures 16.4A to D: (A) Pronasale on lateral cephalogram; (B) Magnified image showing pronasale on the lateral cephalogram;
(C) Pronasale on graphic illustration; (D) Magnified image of pronasale on graphic illustration
Definition
Pronasale (Figs 16.4A to D) is the most prominent or anterior
point of the nose.
According to SN Bhatia and BC Leighton in 1993
Pronasale is also used as one of the reference points in the

construction of following planes for the assessment of
following:
Ricketts E-line used to assess the relationship of
upper and lower teeth to the upper and lower lip.
Point T
The most prominent or anterior point of the nose tip.
According to Spiro J Chaconas in 1969
Abbreviation
The most anterior point on the midsagittal profile of the nose.

In cases where the tip of the nose was more than a definite Point T is abbreviated using English alphabet and is expressed
point, pronasale was determined by drawing a line parallel to as capital T.
the line nasion to pogonion tangent to the most anterior point
Definition
on the midsagittal profile of the nose.
According to Leslie G Farkas in 1981

Pronasale is the most protruded point of the apex nasi.This
point is difficult to determine if the nasal tip is flat.
The point T is the midline point on the nasal tip taken at

the level of the dome projecting points of the lower lateral
cartilage.
Type
Type
Pronasale is a unilateral soft tissue cephalometric landmark.
Point T (Figs 16.5A to D) is a unilateral constructed point

soft tissue cephalometric landmark.
Significance
Significance
Pronasale helps in the assessment of nasal tip projection.
Point T is used in the assessment of nasal tip projection.
131
Figures 16.5A to D: (A) Point T on lateral cephalogram; (B) Magnified image showing point T on the lateral cephalogram; (C) Point
T on graphic illustration; (D) Magnified image of point T on graphic illustration
Alar Crease Junction

Abbreviation
ACJAlar crease junction is abbreviated using English
alphabet and is expressed as capital A,C and J.
Definition
Alar crease junction is the most posterior point of the curved
line formed by the alar crease.
Type
case) n written continuously without any space between

them.
SNSubnasale is abbreviated using English alphabet and is
expressed as capital (upper case) S and N written continuously
without any space between them.
snSubnasale is abbreviated using English alphabet and is
expressed as lower case (Small alphabets) s and n written
Definition
Alar crease junction (Figs 16.6A to D) is a bilateral constructed

point soft tissue cephalometric landmark.
Subnasale (Figs 16.7A to D) is the point at which the nasal

septum between the nostrils merges with the upper cutaneous
tip in the midsagittal plane.
Significance
According to TM Graber (1975)
Alar crease junction is used as a landmark for measuring nasal

tip projection.
Subnasale
According to TM Graber, subnasale is the point where

the lower margin of the nasal septum is confluent with the
integumental upper lip.
According to Spiro J Chaconas and SN Bhatia

Abbreviation
SnSubnasale is abbreviated using English alphabet and is
expressed as capital (upper case) S followed by small (lower
Subnasale is the point at which the nasal septum between the

nostrils merges with the upper cutaneous lip in the midsagittal
plane.
132
Figures 16.6A to D: (A) Alar crease junction on lateral cephalogram; (B) Magnified image showing Alar crease junction on the lateral
cephalogram; (C) Alar crease junction on graphic illustration; (D) Magnified image of Alar crease junction on graphic illustration
Figures 16.7A to D: (A) Subnasale on lateral cephalogram; (B) Magnified image showing subnasale on the lateral cephalogram;
(C) Subnasale on graphic illustration; (D) Magnified image of subnasale on graphic illustration
133
Type
Related to Upper and Lower Lip Together
Subnasale is a unilateral soft tissue cephalometric landmark.
Stomion
Stomion superius
Stomion inferius
Significance
Subnasale helps in the assessment of nasal tip projection
and nasal height.
Subnasale is also used as one of the reference points in
the construction of following planes for the assessment of
following:
Burstones B line used to assess the relationship of
Height of upper lip (SnLs) can be assessed.
Related to Lower Lip

Labrale inferius
Soft tissue point B
All above mentioned soft tissue cephalometric landmarks
(points) related to lips are explained below.
Soft Tissue Subspinale

Abbreviation
Soft tissue cephalometric landmarks (points) related to lips

are listed below:
SsSoft tissue subspinale is abbreviated using English

alphabet and is expressed as capital S followed by small s.
Related to Upper Lip
Definition
Soft tissue subspinale

Labrale superius
Philtrum
Cuspid bow
Vermillion border of upper lip
Soft tissue subspinale (Figs 16.8A to D) is the point of greatest

concavity in the midline of the upper lip between subnasale
(Sn) and labrale superius (Ls).
Soft Tissue Cephalometric Landmarks (Points)

Related to Lips
Figures 16.8A to D: (A) Subspinale on lateral cephalogram; (B) Magnified image showing subspinale on the lateral cephalogram;
(C) Subspinale on graphic illustration; (D) Magnified image of subspinale on graphic illustration
134
Type
Type
Soft tissue subspinale is a unilateral soft tissue cephalometric

landmark.
Labrale superius is a unilateral soft tissue cephalometric

landmark.
Significance
Significance
Soft tissue subspinale is also used as one of the reference points

in the construction of following planes for the assessment of
following:
Steiners S line used to assess the relationship of upper
and lower teeth to the upper and lower lip.
Abbreviation
Labrale superius is also used as one of the reference points in

the construction of following planes for the assessment of the
following:
Holdaway H line used to assess the relationship of upper
and lower teeth to the upper and lower lip.
Merfields Z angle used to assess the relationship of
It is even used to measure the length of upper lip (Ls-Sn).
It can also be used to assess the planed incisor position
(PIP).
LsLabrale superius is abbreviated using English alphabet

and is expressed as capital L followed by small s.
Philtrum
Labrale Superius
Definition
Labrale superius (Figs 16.9A to D) is the most anterior point
on the margin of the upper membranous lip.
Philtrum (Fig. 16.10) is the central and vertically oriented

position of the upper lip situated between the two skin reliefs
of the philtrum columns. There is gentle concavity on its
lower portion, the philtrum dimple.
Figures 16.9A to D: (A) Labrale superius on lateral cephalogram; (B) Magnified image showing labrale superius on the lateral
cephalogram; (C) Labrale superius on graphic illustration; (D) Magnified image of labrale superius on graphic illustration
135
Figure 16.11: Cuspid bow
Cuspid Bow (Fig. 16.11)

The central linear portion of the upper lip while roll skin relief
of the upper lip between the philtrum and the vermilion. It
connects the inferior ends of the philtrum columns.
Vermilion (Fig. 16.12)

The most anterior point on the vermilion of the upper lip
showing in Figure 16.12.
Stomion
Abbreviation
StoStomion is abbreviated using English alphabet and is
expressed as capital S followed by small t and o.
Definition
Stomion (Figs 16.13A to D) is the median point of the oral
embrassure when the lips are closed.
Type
Stomion is a unilateral soft tissue cephalometric landmark.
Figures 16.12: Vermillion
Figure 16.10: Philtrum
136
Figures 16.13A to D: (A) Stomion on lateral cephalogram; (B) Magnified image showing stomion on the lateral cephalogram;
(C) Stomion on graphic illustration; (D) Magnified image of stomion on graphic illustration
Significance
Stomion is established only at rest when teeth are in centric
occlusion and centric relation. Presence of stomion indicates
averagely positioned upper and lower teeth.
It is even used to measure the length of lower lip (Li-Me).

(PIP).
Soft Tissue Submentale

(Soft Tissue Point B)
Labrale Inferius
Abbreviation
Abbreviation
LiLabrale inferius is abbreviated using English alphabet and

is expressed as capital L followed by small i.
BSoft tissue point B is abbreviated using English alphabet

and is expressed as capital B.
Definition
Definition
Labrale inferius (Figs 16.14A to D) is the most anterior point

on the lower margin of the lower membrane lip.
Soft tissue point B or Soft tissue submentale (Figs 16.15A to D)

is the point of greatest concavity in the midline of the lip between
labrale inferius (Li) and soft tissue pogonion (Pog or Pogs).
Type
Labrale inferius is a unilateral soft tissue cephalometric
landmark.
Significance
Labrale inferius is also used as one of the reference points
in the construction of following planes for the assessment of
following:
Type
Soft tissue point B or soft tissue submentale is a unilateral soft
Significance
Soft tissue point B or soft tissue submentale is used in the
assessment of deepness of submental.
137
Figures 16.14A to D: (A) Labrale inferius on lateral cephalogram; (B) Magnified image showing labrale inferius on the lateral
cephalogram; (C) Labrale inferius on graphic illustration; (D) Magnified image of labrale inferius on graphic illustration
Figures 16.15A to D: (A) Soft tissue point B on lateral cephalogram; (B) Magnified image showing soft tissue point B on the lateral
cephalogram; (C) Soft tissue point B on graphic illustration; (D) Magnified image of soft tissue point B on graphic illustration
138
Figures 16.16A to D: (A) Soft tissue pogonion on lateral cephalogram; (B) Magnified image showing soft tissue pogonion on the lateral
cephalogram; (C) Soft tissue pogonion on graphic illustration; (D) Magnified image of soft tissue pogonion on graphic illustration
Soft tissue pogonion is also used as one of the reference

points in the construction of following planes for the
It is even used to measure the length of lower lip
(Li-Me).
(PIP).
denoted as capital P followed by small o and g ending with

as a superscript.

Related to Chin
Type
Soft tissue cephalometric landmarks/points related to chin are

listed below:
Soft tissue gnathion
All above mentioned soft tissue cephalometric landmarks/
points related to chin are explained below:
Soft Tissue Pogonion

Abbreviation
Pogs or PogSoft tissue pogonion is abbreviated using
English alphabet and is expressed as capital P followed by
small o and g with s in subscript position. It can also be
Definition
Soft tissue pogonion (Figs 16.16A to D) is the most prominent
or anterior point on the soft tissue chin in the midsagittal plane.
Soft tissue pogonion is a unilateral soft tissue cephalometric

landmark.
Significance
Soft tissue pogonion is used to the prominence of the chin.
Soft tissue pogonion is also used as one of the reference
points in the construction of following planes for the
Steiners S line used to assess the relationship of
Ricketts E-line used to assess the relationship of
Burstones B line used to assess the relationship of
Holdaway H line used to assess the relationship of
139
Figures 16.17A to D: (A) Soft tissue gnathion on lateral cephalogram; (B) Magnified image showing soft tissue gnathion on the lateral
cephalogram; (C) Soft tissue gnathion on graphic illustration; (D) Magnified image of soft tissue gnathion on graphic illustration
Soft Tissue Gnathion
Definition
Abbreviation
Soft tissue gnathion (Figs 16.17A to D) is the midpoint

between the most anterior and inferior points of the soft tissue
chin in the midsagittal plane.
GnsSoft tissue gnathion is abbreviated using English

alphabet and is expressed as capital G followed by small n
with s in subscript position.
Type
Soft tissue gnathion is a unilateral constructed point soft tissue

SECTION
3D Cephalometric
Landmarks
3D Cephalometric Landmarks
CHAPTER
17
3D Cephalometric
Landmarks
Vertex
Abbreviation
VVertex is abbreviated using English alphabet and is
expressed as capital or upper case V.
Definition
Vertex (Fig. 17.1) is the most superior point of calvarium in
center line.
Type
Vertex is an anatomic, unilateral, soft tissue cephalometric
landmark.
Significance
Vertex is used as one of the reference points in the construction
of angles and planes in 3D cephalometric analysis.
Figure 17.1: Vertex (Image created with the Invivo5 software by

Anatomage Inc.)
Soft Tissue Nasion

Abbreviation
nSoft tissue nasion is abbreviated using English alphabet and
is expressed as small letter or lower case n.
NSoft tissue nasion can also be abbreviated using English
alphabet and is expressed as upper case or capital letter N and
ending with in superscript position.
Definition
Soft tissue nasion (Fig. 17.2) is the concave or retruded point
in the tissue overlying the area of the frontonasal suture.

The point of intersection of the soft tissue profile with a line
drawn from the center of sella turcica through nasion.
Figure 17.2: Soft tissue nasion (Image created with the Invivo5
software by Anatomage Inc.)
144
Type
Soft tissue nasion is a unilateral, soft tissue cephalometric
landmark.
According to SN Bhatia and

BC Leighton in 1993
The most prominent or anterior point of the nose tip..
Significance
Soft tissue nasion is used as one of the reference points on the

construction planes and angles in 3D cephalometric analysis.
The most anterior point on the midsagittal profile of the nose.

In cases where the tip of the nose was more than a definite
point, pronasale was determined by drawing a line parallel to
the line nasion to pogonion tangent to the most anterior point
on the midsagittal profile of the nose.
Pronasale
Abbreviation
PnPronasale is abbreviated using English alphabets and is
expressed as capital (upper case) P followed by lower case
n written continuously without any space between alphabets.
Section 8 3D Cephalometric Landmarks
PrnPronasale is also abbreviated using English alphabet

and is expressed as capital (upper case) P followed by lower
case r and n written continuously without any space between
alphabets.
PRNPronasale can also be abbreviated using English
alphabet and is expressed as capital (upper case) P, R and N
written continuously without any space between alphabets.
prnPronasale can also be abbreviated using English alphabet
and is expressed as small (lower case) p, r and n written continuously without any space between alphabets.
Definition
Pronasale (Figs 17.3A and B) is the most prominent or
anterior point of the nose.
According to Leslie G Farkas in 1981

Pronasale is the most protruded point of the apex nasi. This
point is difficult to determine if the nasal tip is flat.
Type
Pronasale is a unilateral, soft tissue cephalometric landmark.
Significance
Pronasale is used as one of the reference points on the
Subnasale
Abbreviation
SnSubnasale is abbreviated using English alphabets and is
expressed as capital (upper case) S followed by small (lower
case) n written continuously without any space between them.
Figures 17.3A and B: Pronasale (Image created with the Invivo5 software by Anatomage Inc.)
145
SNSubnasale is abbreviated using English alphabet and is

expressed as capital (upper case) S and N written continuously
without any space between them.
snSubnasale is abbreviated using English alphabet and is
expressed as lower case (small alphabets) s and n written
Definition
Subnasale (Fig. 17.4) is the point at which the nasal septum
between the nostrils merges with the upper cutaneous tip in
the midsagittal plane.
According to TM Graber (1975)
According to Spiro J Chaconas (1980) and SN

Bhatia
According to Spiro J Chaconas (1980) subnasale is the point
at which the nasal septum between the nostrils merges with
the upper cutaneous lip in the midsagittal plane.
Type
Subnasale is used as one of the reference points on the

construction planes and angles in 3D cephalometric
analysis.
Soft Tissue Subspinale

Abbreviation
SsSoft tissue subspinale is abbreviated using English
alphabets and is expressed as capital S followed by small
letter or lower case s and is written continuously without any
Definition
Soft tissue subspinale (Fig. 17.5) is the point of greatest
concavity in the midline of the upper lip between subnasale
(Sn) and labrale superius (Ls).
Type
Chapter 17 3D Cephalometric Landmarks
According to TM Graber, subnasale is the point where

the lower margin of the nasal septum is confluent with the
integumental upper lip.
Significance
Soft tissue subspinale is a unilateral soft tissue cephalometric

landmark.
Significance
Subnasale is a unilateral, soft tissue cephalometric landmark.
Soft tissue subspinale is also used as one of the reference points in

the construction of following planes in 3D cephalometric analysis.
Figure 17.4: Subnasale (Image created with the Invivo5 software

by Anatomage Inc.)
Figure 17.5: Soft tissue subspinale (Image created with the Invivo5
146
Labrale Superius
Definition
Stomion (Fig. 17.7) is the median point of the oral embrassure
when the lips are closed.
Abbreviation
LsLabrale superius is abbreviated using English alphabets
and is expressed as capital L followed by small s and is written
Type
Definition
Significance
Labrale superius (Fig. 17.6) is the most anterior point on the

margin of the upper membranous lip.
Stomion is used as one of the reference points on the

Stomion is a unilateral soft tissue cephalometric landmark.
Labrale Inferius
Type
Labrale superius is a unilateral soft tissue cephalometric

landmark.
Significance
Labrale superius is also used as one of the reference points
in the construction of planes and angles in 3D cephalometric
analysis.
Stomion
Abbreviation
StoStomion is abbreviated using English alphabets and is
expressed as capital S followed by small t and o and is written
Figure 17.6: Labrale superius (Image created with the Invivo5

Abbreviation
LiLabrale inferius is abbreviated using English alphabets
and is expressed as capital L followed by small i and is
written continuously without any space between the
alphabets.
Definition
Labrale inferius (Fig. 17.8) is the most anterior point on the
lower margin of the lower membrane lip
Type
Labrale inferius is a unilateral soft tissue cephalometric
landmark.
Figure 17.7: Stomion (Image created with the Invivo5 software by

Anatomage Inc.)
147
Figure 17.8: Labrale inferius (Image created with the Invivo5

Figure 17.9: Soft tissue point B (Image created with the Invivo5
Significance
Labrale inferius is used as one of the reference point on the
Soft Tissue Submentale

(Soft Tissue Point B)
Abbreviation
BSoft tissue point B is abbreviated using English alphabet
and is expressed as capital B.
Definition
Soft tissue point B or soft tissue submentale (Fig. 17.9) is the
point of greatest concavity in the midline of the lip between
labrale inferius (Li) and soft tissue pogonion (Pog or Pogs).
Type
Soft tissue point B or soft tissue submentale is a unilateral soft
Figure 17.10: Soft tissue pogonion (Image created with the

Invivo5 software by Anatomage Inc.)
Soft Tissue Pogonion
Significance
Abbreviation
Soft tissue point B is used as one of the reference points on the

Pogs or PogSoft tissue pogonion is abbreviated using

English alphabets and is expressed as capital P followed
148
by small o and g with s in subscript position. It can also be

denoted as Capital P followed by small o and g ending with
as a superscript.
Definition
Soft tissue pogonion (Fig. 17.10) is the most prominent or
anterior point on the soft tissue chin in the midsagittal plane.
Type
Type
Soft tissue gnathion is a unilateral, constructed points, soft
Significance
Soft tissue gnathion is used as one of the reference point
on the construction planes and angles in 3D cephalometric
analysis.
Soft tissue pogonion is a unilateral soft tissue cephalometric

landmark.
Orbitale
Abbreviation
Soft tissue pogonion is used as one of the reference points

analysis.
OrsOrbitale is abbreviated using English alphabets and is

expressed as capital O followed by small r with s in subscript
position and is written continuously without any space
Significance
Soft Tissue Gnathion
Abbreviation
GnsSoft tissue gnathion is abbreviated using English
alphabets and is expressed as capital G followed by small
n with s in subscript position and is written continuously
Definition
Orbitale (Fig. 17.12)Most inferior portion of orbital floor
below the center of eye.
Type
Orbitale is a bilateral soft tissue cephalometric landmark.
Definition
Significance
Soft tissue gnathion (Fig. 17.11) is the midpoint between the

most anterior and inferior points of the soft tissue chin in the
midsagittal plane.
Orbitale is used as one of the reference points on the

construction planes and angles in 3D cephalometric
analysis.
Figure 17.11: Soft tissue gnathion (Image created with the Invivo5
Figure 17.12: Orbitale (Image created with the Invivo5 software

by Anatomage Inc.)
149
Zygomatic Prominence
Definition
Zygion (Fig. 17.14)Most lateral point of each zygomatic
arch eye.
Abbreviation
ZpSZygomatic prominence is abbreviated using English
alphabets and is expressed as capital Z followed by small
p with s in subscript position and is written continuously
Type
Definition
Zygion is used as one of the reference points on the construction

planes and angles in 3D cephalometric analysis.
Zygomatic prominence (Fig. 17.13)Most protrusive

anterior point on zygomatic arch.
Type
Significance
Zygomatic prominence is used as one of the reference points
analysis.
Zygion
Abbreviation
ZysZygion is abbreviated using English alphabets and is
expressed as capital Z followed by small y with s in subscript
Figure 17.13: Zygomatic prominence (Image created with the

Significance
Condylion
Abbreviation
CosCondylion is abbreviated using English alphabets and is
expressed as capital C followed by small o with s in subscript
Definition
Zygomatic prominence is a bilateral soft tissue cephalometric

landmark.
Zygion is a unilateral soft tissue cephalometric landmark.
Condylion (Figs 17.15A and B)Most superior midline point

on condyle of mandible.
Type
Condylion is a bilateral soft tissue cephalometric landmark.
Significance
Condylion is used as one of the reference points on the

Figure 17.14: Zygion (Image created with the

150
Figures 17.15A and B: Condylion (Image created with the Invivo5 software by Anatomage Inc.)
Figures 17.16A and B: Gonion (Image created with the Invivo5 software by Anatomage Inc.)
Gonion
Type
Gonion is a bilateral soft tissue cephalometric landmark.
Abbreviation
Significance
GosGonion is abbreviated using English alphabets and is

expressed as capital G followed by small o with s in subscript
Gonion is used as one of the reference points on the

Definition
Gos (Figs 17.16A and B)Most everted point of angle of
mandible.
Ch
Abbreviation
ChCh is abbreviated using English alphabets and is
expressed as capital C followed by small h written continuously
151
Alare
Definition
Ch (Fig. 17.17)Most lateral border point of chin.
Abbreviation
Type
Significance
AlAlare is abbreviated using English alphabets and is

expressed as capital A followed by small or lower case l
alphabets.
Ch is used as one of the reference points on the construction

Definition
Ch is a unilateral soft tissue cephalometric landmark.
Cheilion
Alare (Fig. 17.19)The most lateral point on each alar contour.
Type
Alare is a bilateral soft tissue cephalometric landmark.
CCheilion is abbreviated using English alphabet and is

expressed as capital C.
Significance
Definition
Alare is used as one of the reference points on the construction

Cheilion (Fig. 17.18)Most lateral point located at each labial

commissure.
Exocanthion
Type
Abbreviation
Cheilion is a unilateral soft tissue cephalometric landmark.
Abbreviation
Significance
Cheilion is used as one of the reference points on the
ExExocanthion is abbreviated using English alphabets and

is expressed as capital E followed by small or lower case x
alphabets.
Figure 17.17: Ch (Image created with the Invivo5 software by

Anatomage Inc.)
Figure 17.18: Cheilion (Image created with the Invivo5 software

by Anatomage Inc.)
152
Figure 17.19: Alare (Image created with the Invivo5 software by

Anatomage Inc.)
Figure 17.20: Exocanthion (Image created with the Invivo5

Definition
ExocanthionThe point at the inner commissure of the eye

tissue.
Sella turcica (Turkish saddle).

The landmark is the center of the sella as seen in the lateral
radiograph and located by inspection.
Type
Exocathion is a bilateral soft tissue cephalometric landmark.
Significance
Exocathion is used as one of the reference points on the
Sella
Abbreviation
SSella is abbreviated using English alphabet and is expressed
as capital or upper case S.
Definition
Sella (Fig. 17.20) is the midpoint of sella turcica or hypophyseal
fossa or pituitary fossa.

The center of the hypophyseal fossa (sella turcica). It is
selected by the eye since that producer as been shown to be as
reliable as a constructed center.
The center of pituitary fossa.
The center of sella turcica.
The midpoint of the sella turcica arbitrarily determined.

The center of sella turcica.
Located by inspection of the profile image of the fossa.

The center of sella turcica (the midpoint of the horizontal
diameter).
Type
Sella is a unilateral, anatomic, hard tissue cephalometric
landmark.
Tracing of Sella on the Lateral Cephalogram

The pituitary fossa is round and bottle shaped hollow space,
situated in the upper body of the sphenoid bone. This fossa
contains pituitary gland. This fossa is bounded anterioly and
posteriorly by anterior and posterior clinoid processes. Both
anterior and posterior clinoid process appears radio-opaque
line on the lateral cephalogram. First trace the anterior and
posterior clinoid process followed by inferior border of the
pituitary fossa. Center point of the fossa is the point of sella.
153
Basion

Sella is used as one of the reference points in the construction
SNA angle, S-N-Pr angle and saddle angle (N-S-Ar).
SNB angle and S-N-Id angle.
Relationship of anterior and posterior cranial base assessed
using N-S-Ar.
Sella Entrance
Abbreviation
Definition
Sella entrance (Fig. 17.21) is the mid entrance point of sella
turcica or hypophyseal fossa or pituitary fossa.
Type
Sella entrance is a unilateral, constructed, hard tissue cephalo
metric landmark.
BaBasion is abbreviated using English alphabets and is

denoted as capital letter or upper case B followed by small
letter or lower case a and is written continuously without any
Definition
Basion (Figs 17.22A to D) is the median point of the anterior
margin of the foramen magnum can be located by following
the images of the slope the inferior border of the basilar part
of the occipital bone to its posterior limit.
SeSella entrance is abbreviated using English alphabets and

is expressed as capital letter or upper case S followed by small
letter or lower case e and is written continuously without any
Abbreviation
Point at the center of the anterior border of the foramen

magnum at the base of the occipital bone.
The most inferior point on the anterior margin of the foramen

magnum in the midsagittal plane.
The most inferior posterior point in the sagittal plane on the

anterior rim of the foramen magnum.
Normal projection of the anterior border of the occipital

foramen (endobasion) on the occipital foramen line.
The most anterior point relative to the interspinosum line, on

the border of the foramen magnum.
Type
Basion is a unilateral, anatomic, hard tissue cephalometric
landmark.
Tracing Basion on the Lateral Cephalogram
Figure 17.21: Sella entrance (Image created with the Invivo5

To identify basion on the lateral cephalogram, following

structures need to be traced.
Trace from the posterior cliniod process, down the upper
part of the clivus, and past the region of the spheno-
154
Figures 17.22A to D: Basion (Image created with the Invivo5 software by Anatomage Inc.)
occipital synchondrosis to the anterior margin of the

foramen magnum.
Trace the cranial aspect of the greater wing of the sphenoid
one, the inferior, ectocranial aspect of the base of the
occipital bone, and the anterior margin of the foramen
magnum. These are separate lines and should not be drawn
a one continuous line.
Trace carefully from the base of the occipital bone
to the compact bone of the occipital condyles. The
anterior margins of the occipital condyle and basion are
radio-opaque on the lateral cephalogram and should be
differentiated. Basion is usually behind the anterior part of
the occipital condyle.
Anterior Nasal Spine

Abbreviation
ANSAnterior nasal spine is abbreviated using English
alphabets and is expressed as capital or upper case A, N
and S, written continuously without any space between the
alphabets.
Definition
Anterior nasal spine (Fig. 17.23) is the tip of bony anterior
nasal spine in the midline or median plane.
155

The most anterior point on the maxilla at the level of the
palate. The ANS is of limited use for analysis in the posterioranterior projection as the actual spine often cannot be seen
and its location varies considerably according to radiographic
exposure.
Type
Anterior nasal spine is a unilateral, anatomic, hard tissue
Tracing of Anterior Nasal Spine on Lateral

Cephalogram

The most anterior point of the nasal floor tip of pre-maxilla on
mid-sagittal plane.

Sharp median process formed by the forward prolongation of
the anterior aperature of the nose.
The tip of the anterior nasal spine as seen on the X-ray film in
norma lateralis.
Radiographic Appearance
Figure 17.23: Anterior nasal spine (Image created with the Invivo5
There exists an individual variation in length and width of

ANS. In some individuals ANS are long and thin; while in
other are short and thick.
ANS appears slightly posterior to the anatomic spine.

In cases with thin ANSin such cases, on the cephalogram,
ANS will be unclear because it can superimpose by nasal
cartilage.
In cases with thick ANSin such cases, on the cephalogram,
ANS is clear and will be ease in tracing.
Anterior nasal spine is used as one of the reference points

in the construction of occlusal plane and is used for the
assessment of horizontal growth pattern using FH-Palatal
Section
PA Cephalometric
Landmarks
PA Cephalometric Landmarks
ChAPter
18
PA Cephalometric
Landmarks
Comprehensive cephalometric analysis systems have been

developed to determine the lateral skeletal and dentoalveolar
components of a malocclusion (Steiner, 1959; Ricketts,
1960). Approximately 90 percent of orthodontic practitioners
in the USA make routine use of lateral cephalograms for
every comprehensive case (Keim et al., 2002), illustrating
the accepted value of lateral cephalometric analysis as an aid
in orthodontic diagnosis and treatment planning. However,
accurate diagnosis of discrepancies in width dimensions as
well as of occlusal cants and asymmetries may also require a
posteroanterior (PA) cephalometric evaluation.
Increases in transverse dental arch dimensions are
associated with arch perimeter gain (Adkins et al., 1990).
Bimaxillary expansion has therefore been recommended
as a suitable alternative to premolar extraction, particularly
in patients presenting with narrow dental arches (Cetlin and
Ten Hoeve, 1983;Vanarsdall, 1999; McNamara et al., 2003;
Ferris et al., 2005). However, that treatment decision should
be based not only on dental arch measurements but also on
suitable PA cephalometric analysis. The high prevalence
of arch length deficiency and transverse malocclusions in
different populations (Hill, 1992; Behbehani et al., 2005) may
indicate that a considerable proportion of orthodontic patients
may benefit from PA cephalometric evaluation.
Several PA cephalometric analysis systems have been
proposed (Sassouni, 1958;Letzer and Kronman, 1967; Ricketts
et al., 1972; Hewitt, 1975; Svanholt and Solow, 1977; Grayson
et al., 1983; Grummons and Kappeyne Van De Coppello,
1987). Of the two that are commercially available through
the Dolphin software (Ricketts et al., 1972; Grummons and
Kappeyne Van De Coppello, 1987), only Ricketts analysis
(Ricketts et al., 1972) is accompanied by a comprehensive set
of norms, proposing age specific adjustments from adolescence
to adulthood (Ricketts, 1981, Ricketts et al., 1982). However,
the specific materials and methods used for calculating the
norms have not been published. Grummons and Kappeyne
Van De Coppello (1987) have presented a comprehensive
analysis system for comparison of right and left triangular
shapes, linear dimensions, and facial proportions. Since their
purpose is to identify individual areas of asymmetry rather
than determining actual discrepancies, the analysis is not

accompanied by normative data. The focus of the remaining
analyses is to evaluate the skeletal and dental components of
asymmetry through comparison of right and left triangular
measurements (Letzer and Kronman, 1967; Hewitt, 1975),
variables suitable for assessment of midline discrepancies
(Svanholt and Solow, 1977; Grayson et al., 1983), or to
determine the individual harmony of various proportions
(Sassouni, 1958). Only a few of these analyses are supported
by a limited set of normative data (Letzer and Kronman, 1967;
Hewitt, 1975;Svanholt and Solow, 1977).
Several well-known craniofacial growth studies include
records suitable for transverse analyses. However, with the
exception of select measurements of relatively small samples
(Woods, 1950; Snodell et al., 1993; Cortella et al., 1997;
Huertas and Ghafari, 2001; Hesby et al., 2006), normative
data have been published only for 60 subjects without an
ideal occlusion (Basyouni and Nanda, 2000). Athanasiou
et al. (1992) provided norms for selected PA cephalometric
measurements of 588 Austrian schoolchildren aged 615 years.
Although the sample of adolescents was large, the inclusion
of subjects without an ideal occlusion limits the validity of the
findings. In addition, while Uysal and Sari (2005) provided PA
cephalometric norms for adult Turks, analyzing a large sample
with a Class I occlusion and pleasing facial morphology, no
adolescents were included in their sample.
Ethnic differences of clinical significance have been
established in selected width measurements of Chinese
relative to published data for Japanese and American Whites
(Wei, 1970). Although the sample of Chinese was relatively
large, only adults were included without occlusal selection
criteria. In addition, similar differences have been established
between Egyptians and other ethnic groups (Aboul-Azm and
Korayem, 1987). The Egyptian sample was also limited to
adults.
Cephalometric norms should represent the means and
ranges or clinically useful parameters from large samples of
subjects of a similar age and ethnicity with untreated almost
ideal occlusions to be valid as standards for comparison.
According to these criteria, few of the existing data allow
160
valid interpretations of skeletal versus dental components

of malocclusions in the frontal plane, particularly for
adolescent subjects. The aim of this study was to establish
PA cephalometric norms for adolescent Kuwaitis of an
age comparable with the normal start of comprehensive
orthodontic treatment, and to compare these norms with those
suggested in the available analysis systems as well as to other
published information.
Taking Pa Cephalogram
Section 9 PA Cephalometric Landmarks
The PA cephalogram is taken with the patients head held

straight (natural head position) or slightly down. The plane
that intersects the ear rods, which help to stabilize the head,
is known as the porionic, transporionic, or otic plane or axis
because it presumably interacts with the external auditory meati.
The film-object, film with ear rod, or porion-film distance
determines the amount of magnification of the head structure.
In early traditional cephalometry, the film holder was placed
to touch the nose, and the percentage of magnification was
computed and corrected. Later, the film-poronic axis distance
could be set at a fixed distance (13-15 cm) with corresponding
magnification factors. In digital machines, technological
requirements dictate a greater sensor object distance (around
20 cm), leading to enlargement factors of more than 13 percent
that can be corrected in the imaging software.
Structures Involved in Pa Cephalogram

Following structures are involved in PA cephalogram and
need to be traced; Structures of right and left side need to be
traced in PA cephalogram:
External peripheral cranial bone surfaces.
Coronal suture.
Mastoid processes.
Occipital condyles.
Planum sphenoidale and superior surface of the floor of
the pituitary fossa.
Floor of the nose.
Orbital outline and inferior surface of the orbital plate of
the frontal bone.
Oblique line formed by the external surface of the greater
wing of the sphenoid in the area of the temporal fossa.
Arcuate eminence .
Lateral surface of the frontosphenoidal process of the zygoma
and the zygomatic arch down to and including the key ridge
Cross-section of the zygomatic arch.
Infratemporal surface of the maxilla in the area of the
tuberosity, which is seen lateral to the lower outlines of the
key ridge after the eruption of the permanent first molar.
Body of the mandible.
Complete dentition or selected dental units.
PA cephalometric landmarks/points related to specific bones
are listed below:
1. Cephalometric landmarks (points) related to ethmoid bone.

2. Cephalometric landmarks (points) related to nasal bone.
3. Cephalometric landmarks (points) related to zygomatic
bone.
4. Cephalometric landmarks (points) related to maxillary bone.
5. Cephalometric landmarks (points) related to dentition.
6. Cephalometric landmarks (points) related to mandible.
Pa Cephalometric Landmarks Related to

Ethmoid Bone
Cephalometric landmark related to ethmoid bone are as
Table 18.1: Cephalometric landmark related to ethmoid bone
Cephalometric landmark
Abbreviation
Type
Origin
Crista galli
Nc
Unilateral
Anatomic
Crista galli
abbreviation
NcCrista galli is abbreviated using English alphabets and is
expressed as capital letter or upper case N and small letter or
lower case c and is written continuously without any space
Definition
Neck of crista galli (Figs 18.1A and B) is the neck of
perpendicular lamina of the ethmoid.

Neck of crista galli, most constricted point of the projection of
the perpendicular lamina of the ethmoid (almost at the level
of planum).
Type
Neck of crista galli is a unilateral, anatomic, hard tissue PA
Pa Cephalometric Landmarks Related to Nasal

Bone
Cephalometric landmarks related to nasal bone are as follows
(Table 18.2):
Table 18.2: Cephalometric landmarks related to nasal bone
Cephalometric
landmarks
Abbreviation
Type
Origin
top of nasal septum
tns
Unilateral
Anatomic
NC
NC
Unilateral
Anatomic
161
Figures 18.1A and B: Crista galli
Chapter 18 PA Cephalometric Landmarks
Figures 18.2A and B: Top of nasal septum
Top of Nasal Septum
Definition
according to athanasios E athanasiou
abbreviation
tnsTop of nasal septum is abbreviated using English
alphabet and is expressed as small letter or lower case t,
n, s and is written continuously without any space between
the alphabets.
The highest point onto the superior aspect of the nasal septum
(Figs 18.2A and B).
Type
Top of nasal septum is a unilateral, anatomic, hard tissue PA
162

zygomatic Bone
NC
abbreviation
NCNC is abbreviated using English alphabets and is
expressed as capital letter or upper case N, C and is written
Cephalometric landmarks related to zygomatic bone are as

Table 18.3: Cephalometric landmarks related to zygomatic bone
Cephalometric
landmarks
Abbreviation
Type
Origin
Zygoma
Zyg
Bilateral
Anatomic
Zygion
Zy
Bilateral
Anatomic
Zygomatic arch
ZA
Bilateral
Anatomic
Type
Zygomatic suture
point
Bilateral
Anatomic
NC is a unilateral, anatomic, hard tissue PA cephalometric

landmark.
Jugal process
Bilateral
Anatomic
Definition
according to Robert M Ricketts
Lateral most point on inside surface of the bony nasal cavity

(Fig. 18.3).
zyg-zygoma
abbreviation
ZygZygoma is abbreviated using English alphabet and is
expressed as capital letter or upper case Z followed by lower
case or small letter y, g and is written continuously without
Definition
Figure 18.3: NC
Most lateral and superior point of the shadow of the zygomatic

arch (Figs 18.4A and B).
Figures 18.4A and B: Zygoma
163
Type
Type
Zygoma is a bilateral, anatomic, hard tissue PA cephalometric

landmark.
Zygion is a bilateral, anatomic, hard tissue PA cephalometric

landmark.
zygion
zygomatic arch
abbreviation
ZyZygion is abbreviated using English alphabets and is

expressed as capital letter or upper case Z followed by lower
case or small letter y and is written continuously without any
ZAZygomatic arch is abbreviated using English alphabet

and is expressed as capital letter or upper case Z, A and
is written continuously without any space between the
alphabets.
Definition
Definition
Zygion is the most lateral point of each zygomatic arch

(Figs 18.5A and B).
Center of zygomatic arch by inspection for frontal (Figs

18.6A and B).
Figures 18.5A and B: Zygion
Figures 18.6A and B: Zygomatic arch
abbreviation
164
Type
Jugal Process
Zygomatic arch is a bilateral, anatomic, hard tissue PA cephalometric landmark.
abbreviation
JJugal process is abbreviated using English alphabet and is
expressed as capital letter or upper case J.
zygomatic Suture Point

abbreviation
Definition
ZZygomatic suture point is abbreviated using English

alphabet and is expressed as capital letter or upper case Z.
Definition
Lowest point on the curve of zygomatic bone used in the

lateral film, also the point on the jugal process of the maxilla
at a crossing with the tuberosity of the maxilla (in the frontal)
(Figs 18.8A and B).

Medial and anterior junction of the zygomatic bone with the
frontal bone (Figs 18.7A and B).
Type
Type
Jugal process is a bilateral, anatomic, hard tissue PA cephalometric landmark.
Zygomatic suture point is a bilateral, anatomic, hard tissue PA

Figures 18.7A and B: Zygomatic suture point
Figures 18.8A and B: Jugal process
165

Maxilla

Dentition
Cephalometric landmarks related to maxilla is as follows

(Table 18.4):
PA cephalogram landmarks/points related to dentition are as

follows (Tables 18.5 and 18.6):
Table 18.4: Cephalometric landmark related to maxilla
Table 18.5: Cephalometric landmarks related to maxillary teeth
Cephalometric landmark
Abbreviation
Type
Origin
Abbreviation
Type
Origin
Maxillare
Mx or mx
Bilateral
Anatomic
Incision superius incisalis
Isi or is
Unilateral
Anatomic
Incision superius apicalis
Isa or ULA
Unilateral
Anatomic
Maxillary molar
um
Bilateral
Anatomic
U6 or A6
Bilateral
Anatomic
Maxillare
abbreviation
Table 18.6: Cephalometric landmarks related to mandibular teeth
MxMaxillare is abbreviated using English alphabets and is

expressed as capital letter or upper case M and small letter or
lower case x and is written continuously without any space
Definition
Type
Origin
Iii or ii
Unilateral
Anatomic
Incision inferior apicalis
Iia or LIA
Unilateral
Anatomic
Incision inferius frontale
iif
Unilateral
Anatomic
Mandibular first molar
L6 or A6
Bilateral
Anatomic
mi
mi
Bilateral
Anatomic
Mandibular molar
Im
Bilateral
Anatomic
Incision Superius Incisalis
Maximum concavity on the contour of the maxilla between

the first molar and malare (Figs 18.9A and B).
Maximum concavity on the contour of the maxilla
between malare (Ma) and the maxillary first molar (U6).
Closely corresponds to the key ridge.
The intersection of the lateral contour of the maxillary
alveolar process and the lower contour of the
maxillozygomatic process of the maxilla (left and right).
abbreviation
IsiIncision superius incisalis is abbreviated using English

by small letters or lower case s and i and is written continuously
Or
isIncision superius is abbreviated using English alphabets
and is expressed as small letters or lower case s and i and
is written continuously without any space between the
alphabets.
Type
Maxillare is a bilateral, anatomic, hard tissue PA cephalometric
landmark.
Abbreviation
Incision inferior incisalis
mxMaxillare is also abbreviated using English alphabet and

is expressed as small letter or lower case m, x and is written
Figures 18.9A and B: Maxillare
166
Definition
Incision superius incisalis (Figs 18.10A and B) is the incisal
edge of the maxillary central incisor.

Incision superius incisalis is the mid-point of the incisal edge
of the most prominent upper central incisor.
Incision superius incisalis is the incisal tip of the most anterior

Type
Incision superius incisalis is a unilateral, anatomic, hard tissue

Tracing of Incision Superius Incisalis on

Lateral Cephalogram
Incision Superius apicalis

abbreviation

the lateral cephalogram. Trace these two outlines of crown of
the maxillary permanent central incisor. The tip of the incisal
point of Incision Superius Incisalis.

Incision superius incisalis is used as one of the reference point
following:

plane.
and occlusal plane.
Incisalis and the NA plane.
Incisalis and the A-Pog plane.
IsaIncision superius apicalis is abbreviated using English

by small letters or lower case s and a and is written continuously
UIAUpper incisor apex is abbreviated using English alphabets
and is expressed as capital or upper case U, I and A and is written
Definition
Incision superius apicalis (Figs 18.11A and B) is the root
apex of the most anterior maxillary central incisor; if this
Figures 18.10A and B: Incision superius incisalis
167
Figures 18.11A and B: Incision superius apicalis
point is needed only for defining the long axis of the tooth, the
according to Michael L Riolo
The upper incisor apex is the root tip of the maxillary central
incisor. In cases where the root is not yet completed, the
midpoint of the growing root tip is marked.
SN Bhatia and BC Leighton

plane.
and occlusal plane.
The upper incisor apex is the root apex of the most prominent
upper incisor.
Maxillary Molar
Type
Incision superius apicalis is a unilateral, anatomic, hard tissue
Tracing of Incision Superius apicalis on

Lateral Cephalogram
maxillary permanent central incisor. The point of intersection
of labial and lingual outlines of the root of maxillary permanent
central incisor is the point of Incision Superius Apicalis.

Incision superius apicalis is used as one of the reference points
following:
abbreviation
umMaxillary molar is abbreviated using English alphabets

and is expressed as lower case u and m and is written
Definition
The most prominent lateral point on the buccal surface of
the second deciduous or first permanent maxillary molar
(Figs 18.12A and B).
Type
Maxillary molar is a bilateral, hard tissue cephalometric
landmark.
168
Figures 18.12A and B: Maxillary molar
Figures 18.13A and B: Maxillary first molar
Maxillary First Molar

abbreviation
U6Maxillary first molar is abbreviated using English
alphabet and numeric and is expressed as capital or upper case
U followed by English numeric 6 and is written continuously
OR
A6Maxillary first molar is abbreviated using English
A followed by English numeric 6 and is written continuously
Definition
Maxillary first molar (Figs 18.13A and B) is the tip of the
mesiobuccal cusp of the maxillary first permanent molar.
Type
Maxillary first molar is a bilateral, anatomic, hard tissue
Tracing of Maxillary First Molar on Lateral

Cephalogram
maxillary permanent first molar appears as radio-opaque lines
169
Definition
on the lateral cephalogram. Trace these outlines of crown of

the maxillary permanent first molar, the tip of the mesiobuccal
cusp of the maxillary permanent molar is the point of maxillary
first molar.
Incision inferius incisalis (Figs 18.15A and B) is the incisal

edge of the most prominent mandibular central incisor.
Cuspid
The incision inferius is the incisal point of the most prominent

medial mandibular incisor.
abbreviation
A3Cuspid is abbreviated using English alphabet and numeric
and is expressed as upper case A and numeric 3 and are written

The incision inferius is the incisal tip of the most labial
mandibular central incisor.
Definition
Type
according to Carl F gugino
Type
Tracing of Incision Inferius Incisalis on Lateal

Cephalogram
Cuspid is a bilateral, hard tissue cephalometric landmark.

mandibular permanent central incisor. The tip of the incisal
point of incision inferius incisalis.
Incision Inferius Incisalis

abbreviation
IiiIncision inferius incisalis is abbreviated using English
by small letters or lower case i and i and is written continuously
iiIncision inferius is abbreviated using English alphabets

and is expressed as small letters or lower case i and i and is
Incision inferius incisalis is a unilateral, anatomic, hard tissue

Tip of the upper permanent canine (Figs 18.14A and B).
Incision inferius incisalis is used as one of the reference point

following:
Figures 18.14A and B: Cuspid
170
Figures 18.15A and B: Incision inferius incisalis
Figures 18.16A and B: Incision inferius apicalis

between the Long axis of lower incisor plane and the
mandibular plane.
and occlusal plane.
upper and lower permanent central incisorl.
Anteroposterior positioning of mandibular central incisor
is assessed using the distance between the incision inferius
Incisalis and the NB plane.
assessed using the distance between the incision inferius
incisalis and the A-Pog plane.
Incision Inferius apicalis

abbreviation
IiaIncision inferius apicalis is abbreviated using English
by small letters or lower case i and a and is written continuously
LIAlower incisor apex is abbreviated using English alphabets
and is expressed as capital or upper case L, I and A and is
Definition
Incision inferius apicalis (Figs 18.16A and B) is the root
apex of the most anterior mandibular central incisor; if this
171
point is needed only for defining the long axis of the tooth, the
Incision Inferius Frontale
SN Bhatia and BC Leighton
abbreviation
The lower incisor apex is the root apex of the most prominent
lower incisor.
iifIncision inferius frontale is abbreviated using English

alphabets and is expressed as lower case i, i and f and is written
Type
Definition
Incision inferius apicalis is a unilateral, anatomic, hard tissue

Tracing of Incision Inferius apicalis on Lateal

Cephalogram
The midpoint between the mandibular central incisors at the

level of the incisal edges (Figs 18.17A and B).

mandibular permanent central incisor. The point of intersection
of labial and lingual outlines of the root of mmandibular permanent central incisor is the point of incision inferius apicalis.
Type
Mandibular First Molar
Incision inferius apicalis is used as one of the reference point

following:
between the long axis of upper incisor plane and the mandibular plane.
and occlusal plane.
upper and lower permanent central incisors.
Incision inferius frontale is a unilateral, hard tissue cephalometric landmark.
abbreviation
L6Mandibular first molar is abbreviated using English

L followed by English numeric 6 and is written continuously
Definition
Mandibular first molar (Figs 18.18A and B) is the tip of the

mesiobuccal cusp of the mandibular first permanent molar.
Figures 18.17A and B: Incision inferius frontale
172
Figures 18.18A and B: Mandibular first molar
Figures 18.19A and B: mi
Type
Definition
Mandibular first molar is a unilateral, anatomic, hard tissue

mi (Figs 18.19A and B) is the mesial contact of the lower

molar projected normal to the plane of occlusion.
Tracing of Mandibular First Molar on Lateral

Cephalogram
Type
point of maxillary first molar.
mi
abbreviation
mimi is abbreviated using English alphabets and is expressed
as lower case m and i and is written continuously without any
mi is a bilateral, hard tissue cephalometric landmark.
Tracing of mi on Lateral Cephalogram

point of maxillary first molar. mi is the mesial contact of the
lower molar projected normal to the plane of occlusion.

mi is used as one of the reference points in the construction of
173
Table 18.6: Cephalometric landmarks related to mandible
Mandibular Molar
abbreviation
ImMandibular molar is abbreviated using English alphabets
and is expressed as upper case I and lower case m and is written
Abbreviation
Type
Origin
Menton
Me
Unilateral
Anatomic
Articulare
Ar
Bilateral
Anatomic
Malare
ma
Bilateral
Anatomic
Antegonial tubercle
Ag
Bilateral
Anatomic
Antegonion
Ag
Bilateral
Anatomic
Definition
Menton

abbreviation
The most prominent lateral point on the buccal surface of

the second deciduous or first permanent mandibular molar
Type
Mandibular molar is a bilateral, hard tissue cephalometric
landmark.

Mandible
according to Carl F gugino
Lower most point of the contour of the chin.
Menton (Figs 18.21A and B) is the point on inferior border of

symphysis directly inferior to mental protuberance and below
center of trigonium mentali.
Cephalometric landmarks related to mandible are as follows

(Table 18.6):
MeMenton is abbreviated using English alphabets and is

or small letter e and is written continuously without any space
Figures 18.20A and B: Mandibular molar
174
Figures 18.21A and B: Menton
Type
Menton (see Figs 12.7A and B) is a unilateral, anatomic, hard
tissue landmark.
Tracing of Menton on the Lateral Cephalogram

labial cortical plate from the alveolar crest between two permanent
mandibular incisors in the midline to the point anteroinferior
point on the mandible. Below the point B follows the convex
outline of labial cortical plate of mandible,the most prominent
point is the point of pogonion.The anteroinferior point of inferior
border of the mandible in the midline is the point of menton.
Significance
or small letter r and is written continuously without any space

Definition
Articulare (Figs 18.22A and B) is the point of intersection the
dorsal contours of the processus articularis mandibulare and
os tempoarle.The midpoint, a is used where double projection
gives rise to two points a1 and a2.
Type
Articulare is a bilateral, anatomic, hard tissue landmark.
Tracing of articulare on the Lateral Cephalogram

radio-opaque line on the lateral cephalogram. Trace ramus
border of the mandible. The point on the ramus border of the
mandible at the neck region.
Menton is used as one of the reference points in the construction

of plane and angle for the assessment of the following:
angle.
angle.
(APocc PPocc ) to mandibular plane (Me-Go) angle.
Articulare is used as one of the reference points in the construction

Constructions of posterior/ramus border of the mandible
i.e. the line joining the point articulare and gonion.
articulare
Malare
Significance
abbreviation
abbreviation
ArArticulare is abbreviated using English alphabets and is
expressed as capital or upper case A followed by lower case
maMalare is abbreviated using English alphabets and is

expressed as lower case or small letters m, a and is written
175
Figures 18.22A and B: Articulare
Figures 18.23A and B: Malare
Definition
Definition
Midpoint of intersection between the projection of the

coronoid process and the lower contour of the malar bone
Intersection of the outline of the dense bone of the

trihedral eminence with the lower border of the ramus.
Type
Type
Malare is a bilateral, anatomic, hard tissue PA cephalometric

landmark.
Antegonial tubercle is a bilateral, anatomic, hard tissue PA

antegonial Tubercles
antegonion
abbreviation
abbreviation
AgAntegonial tubercles are abbreviated using English

alphabets and is expressed as upper case or capital letter A
and lower case or small letters g and is written continuously
AgAntegonion is abbreviated using English alphabets and is

expressed as upper case or capital letter A and lower case or
small letter g and is written continuously without any space
176
Figures 18.24A and B: Antegonial tubercles
Figures 18.25A and B: Antegonion
Definition
Type
Antegonion is a bilateral, anatomic, hard tissue PA cephalometric landmark.
The highest point in the antegonial notch (left and right)

SECTION
10
SV Cephalometric
Landmarks
SV Cephalometric Landmarks
CHAPTER
19
SV Cephalometric
Landmarks
Basion
Opisthion
Abbreviation
Abbreviation
BaBasion is abbreviated as capital or upper case B followed
by small letter or lower case a and is written continuously
OpOpisthion is abbreviated as capital or upper case O

followed by small letter or lower case p and is written
Definition
Definition

Basion is the most anterior point, relative to the interspinosum
line, on the border of the foramen magnum (Figs 19.1A and B).
Opisthion is the most posterior point, relative to the

interspinosum line, on the border of the foramen magnum
(Figs 19.2A and B).
Type
Type
Basion is a unilateral hard tissue SV cephalometric landmark/

point.
Opisthion is a unilateral hard tissue SV cephalometric

landmark/point.
Origin
Origin
Basion is an anatomic SV cephalometric landmark/point.
Opisthion is an anatomic SV cephalometric landmark/point.
Figures 19.1A and B: Basion
180
Section 10 SV Cephalometric Landmarks
Figures 19.2A and B: Opisthion
Figures 19.3A and B: Foramina spinosa points
Foramina Spinosa Points

Abbreviation
FSPForamina spinosa point is abbreviated as capital or
upper case F, S and P and is written continuously without any
Definition
Type
Foramina spinosa points are bilateral hard tissue SV cephalo
metric landmarks/points.
Origin
Foramina spinosa points are an anatomic SV cephalometric
landmarks/points.
Foramina Spinosum
Abbreviation
Foramina spinosa points are the geometric center of each

foramina spinosa (Figs 19.3A and B).
SPForamina spinosum is abbreviated as capital or upper

case S and P and is written continuously without any space
181
Odontoid
Definition
According to KKK Lew
Abbreviation
The geometric center of each foramen spinosum (Figs 19.4A

and B).
OdOdontoid is abbreviated as capital letter or upper case O

and followed by small letter or lower case d and is written
Type
Foramina spinosum points are bilateral hard tissue SV cephalo
metric landmarks/points.
Definition
Origin
According to KKK Lew
Foramina spinosum points are an anatomic SV cephalometric

landmarks/points.
Figures 19.4A and B: Foramina spinosum
Figures 19.5A and B: Odontoid
Chapter 19 SV Cephalometric Landmarks
Center of odontoid process on the SMV (Figs 19.5A and B).
182
Middle Cranial Fossa Points
Type
Odontoid is a unilateral hard tissue SV cephalometric
landmark/point.
Origin
Odontoid is an anatomic SV cephalometric landmark/point.
Abbreviation
MCFMiddle cranial fossa point is abbreviated as capital
letters or upper case MCF and is written continuously without
Definition
Abbreviation
PTMPterygomaxillary fissure is abbreviated as capital letter

or upper case P, T and M and are written continuously without
The most anterior point relative to the interspinosum line, on each

lesser wing of the sphenoid bone (LWS) (Figs 19.7A and B).
Definition
Type
Middle cranial fossa points is a bilateral hard tissue SV
cephalometric landmark/point.

The most medial and posterior point of each pterygomaxillary
fissure. The PTM line connects the right and left PTM points.
The PTM axis is the perpendicular bisector of the PTM line
(Figs 19.6A and B).
Origin
Middle cranial fossa point is an anatomic SV cephalometric
landmark/point.
Type
Pterygomaxillary fissure is a bilateral hard tissue SV
Origin
Pterygomaxillary fissure is an anatomic SV cephalometric
landmark/point.
Posterior Vomer Point

Abbreviation
PVPPosterior vomer point is abbreviated as capital letter or
upper case PVP and is written continuously without any space
Figures 19.6A and B: Pterygomaxillary fissure
183
Figures 19.7A and B: Middle cranial fossa points
Figures 19.8A and B: Posterior vomer point
Definition
The intersection of the vomer with the PTM line (Figs 19.8A
and B).
Type
Posterior vomer point is a unilateral hard tissue SV cephalo
metric landmark/point.
Origin
Posterior vomer point is an anatomic SV cephalometric
landmark/point.
Posterior Cranial Vault Points
Abbreviation
PCVPosterior cranial vault points is abbreviated as capital
letter or upper case PVP and is written continuously without
Definition
The intersections of the lateral borders of the cranial vault
with a line, parallel to the interspinosum line, which is
drawn across the cranial vault at its section of greatest width
(Figs19.9A and B).
184
Figures 19.9A and B: Posterior cranial vault points
Figures 19.10A and B: Angulare point
Type
Definition
Posterior cranial vault points are bilateral hard tissue SV

Origin
Posterior cranial vault point is an SV anatomic cephalometric
landmark/point.
Angulare Point
The most anterior point, relative to the PTM line, of the

triangular opacities present at the external orbital angle where
the upper and lower orbital rims meet and the zygomatic arch
inserts (Figs 19.10A and B).
Type
Angulare point is a bilateral hard tissue SV cephalometric
landmark/point.
Abbreviation
Origin
AAngulare point is abbreviated as capital letter or upper

case A.
Angulare point is an anatomic SV cephalometric landmark/

point.
185
Maxillary Apical Base Midline
Mandibular Dental Midline
Abbreviation
Abbreviation
MABMaxillary apical base midline is abbreviated as capital

letter or upper case MAB.
Mand DMMandibular dental midline is abbreviated as Mand

DM.
Definition
Definition
A point midway between the roots of the maxillary central

incisors at a level which is one third of the distance from the
apex of the tooth to the alveolar crest. This point is determined
on the PA radiograph and its position is then transferred to
the SV radiograph in its proper position relative to the dental
midline (Figs 19.11A and B).
The point contact between the mesial surfaces of the crowns

of the mandibular central incisors (Figs 19.12A and B).
Maxillary apical base midline is a unilateral hard tissue SV

Mandibular dental midline is a unilateral hard tissue SV cephalo

Origin
Mandibular dental midline is an anatomic SV cephalometric

landmark/point.
Origin
Maxillary apical base midline is an anatomic SV cephalometric
landmark/point.
Type
Type
Figures 19.11A and B: Maxillary apical base midline
186
Figures 19.12A and B: Mandibular dental midline
Figures 19.13A and B: Mandibular apical base midline
Mandibular Apical Base Midline

Abbreviation
MABMandibular apical base midline is abbreviated as
capital letter or upper case MAB.
Definition
A point midway between the roots of the mandibular central
incisors at a level which is one third of the distance from the

apex to the alveolar crest (Figs 19.13A and B).
Type
Mandibular apical base midline is a unilateral hard tissue SV
Origin
Mandibular apical base midline is an anatomic SV cephalo
187
First Molar Point
Origin
First molar point is an anatomic SV cephalometric landmark/
point.
Abbreviation
FMPFirst molar point is abbreviated as capital letter or
upper case FMP and is written continuously without any space
Gonion Point
Abbreviation
Definition
GoGonion point is abbreviated as capital letter or upper

case G followed by small letter or lower case o and is written

The most distal point in line with the central groove on each
mandibular first molar (Figs 19.14A and B).
Definition
First molar point is a bilateral hard tissue SV cephalometric

landmark/point.
The midpoint mediolaterally on the posterior border of each

gonial angle (Figs 19.15A and B).
Figures 19.14A and B: First molar point
Figures 19.15A and B: Gonion point
Type
188
Type
Origin
Gonion point is a bilateral hard tissue SV cephalometric

landmark/point.
Condylion medialis is an anatomic SV cephalometric

landmark/point.
Condylion Lateralis
Origin
Gonion point is an anatomic SV cephalometric landmark/
point.
Condylion Medialis
Abbreviation
CMCondylion medialis is abbreviated as capital letter or

upper case CM and is written continuously without any space
OR
CoMCondylion medialis is abbreviated as capital letter or
upper case C, small letter o followed by capital letter M and is
Abbreviation
CLCondylion lateralis is abbreviated as capital letter or
upper case CL and is written continuously without any space
Or
CoLCondylion lateralis is abbreviated as capital letter or
upper case C, small letter o followed by capital letter L
alphabets.
Definition
The tangent point to each lateral condylar border of a line
drawn parallel to each mandibular body line (Figs 19.17A
and B).
Definition
The tangent point to each medial condylar border of a line
drawn parallel to each mandibular body line (Figs 19.16A
and B).
Type
Condylion lateralis is a bilateral hard tissue SV cephalometric
landmark/point.
Type
Origin
Condylion medialis is a bilateral hard tissue SV cephalometric

landmark/point.
Condylion lateralis is an anatomic SV cephalometric land

mark/point.
Figures 19.16A and B: Condylion medialis
189
Figures 19.17A and B: Condylion lateralis
Figures 19.18A and B: Condylion anterioris
Condylion Anterioris
Abbreviation
CACondylion anterioris is abbreviated as capital letter or
upper case C and A, and is written continuously without any
Definition
A point on the anterior of each condylar head which is chosen
to represent the mandibular fossa of the temporal bone
(Figs19.18A and B).
190
Figures 19.19A and B: Condylion posterioris
Type
Definition
Condylion anterioris is a bilateral hard tissue SV cephalometric

landmark/point.
Origin
Condylion anterioris is an anatomic SV cephalometric land
mark/point.
Condylion Posterioris
Abbreviation
CPCondylion posterioris is abbreviated as capital letter or
upper case C, P and are written continuously without any
A point on the posterior of each condylar head which is

chosen to represent the mandibular fossa of the temporal bone
(Figs19.19A and B).
Type
Condylion posterioris is a bilateral hard tissue SV cephalo
Origin
Condylion posterioris is an anatomic SV cephalometric land
mark/point.
SECTION
11
Applications of Cephalometric
Landmarks
Applications of Cephalometric Landmarks
CHAPTER
20
Applications of
Cephalometric Landmarks (Points) used in various cephalo

emtric analyses are listed below:
1. Bjork cephalometric analysis
2. Coben craniofacial and dentition analysis
3. Downs cephalometric analysis
4. Farkas and Coworkers soft tissue cephalometric analysis
5. Harvold cephalometric analysis
6. Holdaway cephalometric analysis
7. Legan and burstone soft tissue cephalometric analysis
8. Ricketts cephalometric analysis
9. Sassouni cephalometric analysis
10. Di Paolos quadrilateral cephalometric analysis
11. Hasund (Bergen) cephalometric analysis
12. Jarabak cephalometric analysis
13. Riedel cephalometric analysis
14. Schwartz cephalometric analysis
15. Wylie cephalometric analysis
16. Steiners cephalometric analysis
17. Tweeds cephalometric analysis

18. Wits cephalometric analysis
19. Basis cephalometric analysis
20. Cagliari cephalometric analysis
21. Chieti cephalometric analysis
22. McGann cephalometric analysis.
Bjork Cephalometric Analysis (Figs 20.1A and B)

Cephalometric landmarks used in Bjork cephalometric
analysis are as given below:
Ar-articulareThe point of intersection of the dorsal contours
of processus articularis mandibulae and os temporale. The
midpoint is used where double projection gives rise to two
articulare points.
ddThe most prominent point of the chin in the direction of
measurement.
gn-gnathionThe deepest point on the chin.
Figures 20.1A and B: Bjork cephalometric analysis
194
id-infradentaleThe point of transition from the crown of

the most prominent mandibular medial incisor to the alveolar
projection.
ii-incision inferiusThe incisal point of the most prominent
sThe center of sella turcica (the midpoint of the horizontal

diameter).
sm-supramentaleThe deepest point on the contour of the
alveolar projection, between infradentale and pogonion.
sp-the spinal pointThe apex of spina nasalis anterior.
is-incision superiusThe incisal point of the most prominent

medial maxillary incisor.
snp-spina nasalis posteriorThe point of intersection of palatum

posterior durum, palatum molle and fossa pterygopalatina.
kkThe point of intersection between the base and ramus

tangents to the mandible. The midpoint is used where double
projection gives rise to two points.
ss-subspinaleThe deepest point on the contour of the alveolar

projection, between the spinal point and prosthion.
miThe mesial contact point of the lower molar projected

normal to the plane of occlusion.
ioThe incisal point of the most prominent medial mandibular

incisor, projected normal to the plane of occlusion.
Coben Craniofacial and Dentition

Cephalometric Analysis (Figs 20.2A and B)
N-nasionNasion is the most anterior point of the frontonasal

suture in the middle.
Cephalometric landmarks used in Coben craniofacial and

dentition analysis are as given below:
or-orbitaleThe deepest point on the infraorbital margin. The

points.
A-point A (subspinale)The point at the deepest midline

concavity on the maxilla between the anterior nasal spine and
prosthion.
pg-pogonionThe most prominent point on the chin.
Ans-anterior nasal spineThe most anterior point of the

anterior nasal spine.
Section 11 Applications of Cephalometric Landmarks
msThe mesial contact point of the upper molar projected

normal to the plane of occlusion.
Po-porionPorion is the most superior point of the external

auditory meatus (the superior margin of the TMJ fossa, which
lies at the same level may be substitute in the construction of
the FH).
pr-prosthionThe transition point between the crown of the
most prominent medial maxillary incisor and the alveolar
projection.
Ar-articulareThe point of intersection of the images of the

posterior border of the condylar process of the mandible and
the inferior border of the basilar part of the occipital bone.
B-point B (supramentale)The point at the deepest midline
concavity on the mandibular symphysis between infradentale
and pogonion.
Figures 20.2A and B: Coben craniofacial and dentition analysis
195
BaBasion is the median point of the anterior margin of the

foramen magnum can be located by following the images
of the slope of the inferior border of the basilar part of the
occipital bone to its posterior limit.
F-point F (constructed)The point approximating foramen
cecum representing the anatomic anterior limit of the cranial
base, constructed as the point of intersection of a perpendicular
to the S-N plane from the point of crossing of the images of
the orbital roofs and the internal plate of the frontal bone.
Go-gonion (constructed)The point of intersection of the
ramus plane and the mandibular plane.

Or-orbitaleThe lowest point on the inferior margin of the
orbit, midpoint between right and left images.
Po-porion (anatomic)The superior point of the externa
Lauditory meatus (superior margin of temporomandibular
fossa, which lies at the same level, may be substituted in the
construction of Frankfort horizontal).
Pog-pogonionThe most anterior midline point of the
mandibular symphysis.
Po-pogonion (constructed)The point of tangency of
a perpendicular from the mandibular plane to the most
prominent convexity of the mandibular symphysis.
S-sellaThe point representing the geometric center of the

pituitary fossa (sella turcica).
Ul-maxillary central incisor (horizontal)The most labial
Ul-maxillary central incisor (vertical)The incisal edge of
the maxillary central incisor.
L1-mandibular central incisor (horizontal)The most labial
L1-mandibular central incisor (vertical)The incisal edge of
the mandibular central incisor.
Chapter 20 Applications of Cephalometric Landmarks
M-mentonThe most inferior midline point on the mandibular

symphysis.
Ptm-pterygomaxillary fissureThe point of intersection of the

images of the anterior surface of the pterygoid process of the
sphenoid bone and the posterior margin of the maxilla.
U6-maxillary first molar (horizontal)The most distal point

on the crown of the maxillary first permanent molar.
U6-maxillary first molar (vertical)The tip of the mesiobuccal
cusp of the maxillary first permanent molar.
L6-mandibular first molar (horizontal)The most distal
point on the crown of the mandibular first permanent molar.
L6-mandibular first molar (vertical)The tip of the mesiobu
ccal cusp of the mandibular first permanent molar.
Downs Cephalometric Analysis (Figs 20.3A and B)

Cephalometric landmarks used in Downs cephalometric
Figures 20.3A and B: Downs cephalometric analysis
196
Figures 20.4A and B: Farkas and coworkers soft tissue cephalometric analysis

Glabella (g)The most prominent midline point between the

eyebrows.
Bolton pointThe highest point on the concavity behind the

occipital condyles.
Subnasion (n)Deepest point of the nasofrontal angle.
The centre of sella turcicaLocated by inspection of the

profile image of the fossa.
Subnasale (sn)Midpoint of the columella base at the apex of

the nasolabial angle.
Pronasale (prn)The most protruded point of the apex nasi.
OrbitaleThe lowest point on the left infraorbital margin.
Labiale superius (ls)Midpoint of the upper vermilion line.
Porion (cephalometric)The highest point on the superior

surface of the soft tissue of the external auditory meati.
Labiale inferius (li)Midpoint of the lower vermilion line.
PogonionThe most anterior point on the mandible in the

midline.
Pogonion (pg)The most anterior midpoint of the chin.
Sublabiale (si)Midpoint of the horizontal labiomental skin ridge.
Point A-subspinaleThe deepest midline point on the

premaxilla between the anterior nasal spine and prosthion.
Harvold Cephalometric Analysis

(Figs 20.5A and B)
Point B-supramentaleThe deepest midline point on the

mandible between infradentale and pogonion.
Cephalometric landmarks used in Harvold cephalometric

GnathionA point on the chin determined by bisecting the

angle formed by the facial and mandibular planes.
Temporomandibular joint (TMJ)A point on the contour

of the glenoid fossa, where the line indicating the maximum
length of the mandible intercepts the contour of the
temporomandibular fossa. The midpoint between the right
and left side is marked.
Farkas and Coworkers Soft Tissue

Cephalometric Analysis (Figs 20.4A and A)
Cephalometric landmarks used in Farkas and Coworkers soft
tissue cephalometric analysis are as given below:
Trichion (tr)Point on the hairline in the midline of the
forehead.
Anterior nasal spine (ANS)A point on the lower contour

of the anterior nasal spine where the vertical thickness is 3
mm, used for horizontal measurements; a point on the upper
contour of the anterior nasal spine, where the vertical thickness
is 3 mm, employed for vertical measurements.
197
Figures 20.5A and B: Harvold cephalometric analysis
Figures 20.6A and B: Holdaway cephalometric analysis
Prognathion (PGN)A point on the contour of the chin

indicating maximum mandibular length measured from the
temporomandibular joint.
Gnathion (GN)The most inferior point on the contour of the chin.
Pogonion (PG)The most anterior point on the chin.
Nasion (N)The point at which the nasofrontal suture reaches
the contour line of the bones. The forward position of the
maxilla, measured from TM to ANS.
Mandibular length measured from TM to PGN.
Lower face height measured from ANS to GN.

The angle of convexityThe angle between the lines PG-ANS
and ANS-N.
Holdaway Cephalometric Analysis

(Figs 20.6A and B)
Cephalometric landmarks used in Holdaway cephalometric
1. The H line or harmony line drawn tangent to the soft
tissue chin and the upper lip.
198
Figures 20.7A and B: Legan and Burstone soft tissue cephalometric analysis
2. A soft tissue facial line from soft-tissue nasion to the point

on the soft tissue chin overlying Ricketts suprapogonion.
3. The usual hard tissue facial plane.
4. The sella-nasion line.
5. Frankfort horizontal plane (FH).
6. A line running at a right angle to the Frankfort plane
down tangent to the vermilion border of the upper lip.
Legan and Burstone Soft Tissue

Cephalometric Analysis (Figs 20.7A and B)
Cephalometric landmarks used in Legan and Burstone soft
tissue cephalometric analysis are as given below:
Glabella (G)The most prominent point in the midsagittal
plane of the forehead.
Mentolabial sulcus (Si)The point of greatest concavity in

the midline between the lower lip (Li) and chin (Pg).
Soft tissue pogonion (Pg)The most anterior point on soft
tissue chin.
Soft tissue gnathion (Gn)The constructed midpoint between
soft tissue pogonion and soft tissue menton; can be located at
the intersection of the subnasale to soft tissue pogonion line
and the line from C to Me.
Soft tissue menton (Me)The lowest point on the contour of
the soft tissue chin; found by dropping a perpendicular from
horizontal plane through menton.
Cervical point (C)The innermost point between the
submental area and the neck located at the intersection of lines
drawn tangent to the neck and submental areas.
Columella point (Cm)The most anterior point on the

columella of the nose.
Ricketts Cephalometric Analysis

(Figs 20.8A and B)
Subnasale (Sn)The point at which the nasal septum merges

with the upper cutaneous lip in the midsagittal plane.
Cephalometric landmarks used in Ricketts cephalometric

Labrale superius (Ls)A point indicating the mucocutaneous

border of the upper lip.
AThe deepest point on the curve of the maxilla between the

anterior nasal spine and the dental alveolus.
Stomion superius (Stms)The lowermost point on the

vermilion of the upper lip.
ANSTip of the anterior nasal spine.
Stomion inferius (Stmi)The uppermost point on the

vermilion of the lower lip.
CCPoint where the basion-nasion plane and the facial axis

intersect.
Labrale inferius (Li)A point indicating the mucocutaneous

border of the lower lip.
DCA point selected in the center of the neck of the condyle,

where the basion-nasion plane crosses it.
BAMost inferior posterior point of the occipital bone.
199
Figures 20.8A and B: Ricketts cephalometric analysis
NAA point at the anterior limit of the nasofrontal suture.
Angle IAngle formed by i and the palatal plane.
PMPoint selected at the anterior border of the symphysis

between point B and pogonion where the curvature changes
from concave to convex.
Angle IAngle formed by I and che ancerior cranial base

plane.
POMost anterior point on the midsagittal symphysis tangent

to the facial plane.
XIThe geometric center of the ramus of the mandible.
Sassouni Cephalometric Analysis (Fig. 20.9)

Cephalometric landmarks used in Sassouni cephalometric
Palatocranial angleAngle formed by the palatal plane and
the anterior cranial base plane.
Palatomandibular angleAngle formed by the palatal plane
and the mandibular base plane.
Occlusopalatal angleAngle formed by the occlusal plane
and the palatal plane.
Occlusomandibular angleAngle formed by the occlusal
plane and the mandibular base plane.
Angle MAngle formed by the 6 axis and the occlusal plane.
Angle M Angle formed by the 6 axis and che palatal plane.
Angle MAngle formed by the 6 axis and the anterior cranial
base plane.
Angle IAngle formed by 1 and the occlusal plane.
Figure 20.9: Sassouni cephalometric analysis
200
Angle RAngle formed by the occlusal plane and the ramal plane.
Angle iAngle formed by the occlusal plane and the axis of 1.
Angle rflAngle formed by the occlusal plane and the axis
of 6.
Di Paolos Quadrilateral Analysis (Fig. 20.10)

Cephalometric landmarks used in Di Paolos Quadrilateral
cephalometric analysis are as given below:
AThe deepest point on the curve of the maxilla between the
anterior nasal spine and the dental alveolus.
ANSTip of the anterior nasal spine.
Nasion (N)The point at which the nasofrontal suture reaches

the contour line of the bones.
Ptm-pterygomaxillary fissureThe point of intersection of the
images of the anterior surface of the pterygoid process of the
sphenoid bone and the posterior margin of the maxilla.
Ar-articulareThe point of intersection of the dorsal contours

of processus articularis mandibulae and os temporale. The
articulare points.
snp-spina nasalis posteriorThe point of intersection of
palatum posterior durum, palatum molle and fossa pterygopalatina.
Hasund (Bergen) Cephalometric Analysis

(Fig. 20.11)
Cephalometric landmarks used in Hasund
cephalometric analysis are as given below:
(Bergen)

prosthion.
Ar-articulateThe point of intersection of the images of the


and pogonion.
Figure 20.10: Di Paolos quadrilateral cephalometric analysis
Figure 20.11: Hasund (Bergen) cephalometric analysis
201
Ba-basionThe median point of the anterior margin of the

foramen magnum located by following the image of the slope
of the inferior border of the basilar part of the occipital bone
to its posterior limit.
N-nasionThe most anterior (midline) point of the frontonasal
suture.
S-sellaThe point representing the geometric centrer of the
Ar-articulareThe point of intersection of the images of the

and pogonion.


suture.

S-sellaThe point representing the geometric centrer of the



midline.
Jarabak Cephalometric Analysis

(Figs 20.12A and B)

Cephalometric landmarks used in Jarabak cephalometric


A-point A (subspinale)The point at the deepest midline concavity

on the maxilla between the anterior nasal spine and prosthion.


snp-spina nasalis posteriorThe point of intersection of palatum

posterior durum, palatum molle and fossa pterygo-palatina.
Figures 20.12A and B: Jarabak cephalometric analysis

midline.
Ba-basionThe median point of the anterior margin of the

foramen magnum located by following the image of the slope
of the inferior border of the basilar part of the occipital bone
to its posterior limit.
202
Po-porion (anatomic)The superior point of the external

auditory meatus (superior margin of temporomandibular
Riedel Cephalometric Analysis

(Figs 20.13A and B)
Cephalometric landmarks used in Riedel cephalometric
prosthion.

snp-spina nasalis posteriorThe point of intersection of
palatum posterior durum, palatum molle and fossa pterygopalatina.
Ul-maxillary central incisor (horizontal)The most labial

and pogonion.
Ul-maxillary central incisor (vertical)The incisal edge of

the maxillary central incisor.


suture.
L1-mandibular central incisor (horizontal)The most labial

L1-mandibular central incisor (vertical)The incisal edge of
the mandibular central incisor.
PogonionThe most anterior point on the mandible in the midline.
Gnathion (GN)The most inferior point on the contour of the

chin.


Figures 20.13A and B: Riedel cephalometric analysis
203
IipIncision inferius apicalis is the root apex of the most

anterior mandibular central incisor; if this point is needed only
for defining the long axis of the tooth, the midpoint on the
bisection of the apical root width can be used.
APOcc-Anterior point of occlusion for the occlusal planeA
constructed point, the midpoint of the incisor overbite in
occlusion
PPOcc-Posterior point of occlusion for the occlusal plane
The most distal point of contact between the most posterior
molars in occlusion (Rakosi).
Maxillary central incisor is the most labial point on the
crown of the maxillary central incisor.

suture.
midline.
medial mandibular incisor
Wylie Cephalometric Analysis

(Figs 20.15A and B)
Schwartz Cephalometric Analysis

(Figs 20.14A and B)
Cephalometric landmarks used in Wylie cephalometric

Cephalometric landmarks used in Schwartz cephalometric

A-point A (subspinale)The point at the deepest midline concavity
on the maxilla between the anterior nasal spine and prosthion.
and pogonion.
Mandibular central incisor is the most labial point on the

crown of the mandibular central incisor.
spDorsum of sella is the most posterior point on the internal

contour of the sella turcica or hypophyseal fossa or pituitary
fossa.
siFloor of sella is the lower most point on the inner contour

of the sella turcica or hypophyseal fossa or pituitary fossa.
ClClinoidale is the most superior point on the contour of the
anterior clinoid.
SSella is the midpoint of sella turcica or hypophyseal fossa
or pituitary fossa.
Figures 20.14A and B: Schwartz cephalometric analysis
204
Figures 20.15A and B: Wylie cephalometric analysis
ANSAnterior nasal spine is the tip of bony anterior nasal

spine in the midline or median plane.
Steiners Cephalometric Analysis

(Figs 20.16A and B)
APoint A is the deepest point on the curved bony outline

between the anterior nasal spine (ANS) and prosthion (Pr).
Cephalometric landmarks used in Steiners cephalometric

PNSPosterior nasal spine is the intersection of continuation

of the anterior wall of the pterygopalatine fossa and the floor
of the nose.

PtmPterygomaxillary fissure is a bilateral tear drop shaped

area of radiolucency, the anterior shadow of which represents
the posterior surface of the tuberosity of the maxilla; the
landmark is taken where the two edges, front and back appears
to merge inferiorly.
OrbitaleThe deepest point on the infraorbital margin.The

midpoint, or is used where double projection gives rise to two
points, or 1 and/or 2.
The center of sella turcicaLocated by inspection of the

profile image of the fossa.
Gnathion (GN)The most inferior point on the contour of the

chin.



PNSPosterior nasal spine is the intersection of a continuation

of the nose.
205
Figures 20.16A and B: Steiners cephalometric analysis
is - incision superiusThe incisal point of the most prominent

APOcc-Anterior point of occlusion for the occlusal planeA
constructed point, the midpoint of the incisor overbite in occlusion
The most distal point of contact between the most posterior
isaIncision superius apicalis is the root apex of the most
anterior maxillary central incisor; if this point is needed only
iiaIncision inferius apicalis is the root apex of the most
PnThe most anterior point on the midsagittal profile of
the nose. In cases where the tip of the nose was more than
a definite point, pronasale was determined by drawing a line
parallel to the line nasion to pogonion tangent to the most
anterior point on the midsagittal profile of the nose.
Tweeds Cephalometric Analysis

(Figs 20.17A and B)
Cephalometric landmarks used in Tweeds cephalometric




isaIncision superius apicalis is the root apex of the most
iiaIncision inferius apicalis is the root apex of the most
206
Figures 20.17A and B: Tweeds cephalometric analysis
Figures 20.18A and B: Wits appraisal
Wits Cephalometric Analysis

(Figs 20.18A and B)
Wits Appraisal
The WITS (University of Witwatersrand, South Africa)
appraisal.
WITS appraisalWITS appraisal measures the extent to
which the jaws are related to each other anteroposteriorly.
Cephalometric landmarks used in Wits cephalometric

The method of assessing the extent of jaw disharmony
entails drawing perpendicular on a lateral cephalometric head
film tracing from point A and B on the maxilla and mandible
respectively, into the occlusal plane which is drawn through
the region of maximum cuspal interdigitation:
The point of contact on the occlusal plane from A and B
are labeled AO and BO respectively.
207
Cephalometric landmarks used in Basis cephalometric

Analysis are as given below:
IsaIncision superius apicalis is the root apex of the most


IiiIncision inferius incisalis is the incisal edge of the most

prominent mandibular central incisor.
s-the center of sella turcica (the midpoint of the horizontal

diameter).
IiaIncision inferius apicalis is the root apex of the most

Basis Cephalometric Analysis (Fig. 20.19)


Gn-gnathionThe deepest point on the chin.
projection.
Cagliari Cephalometric Analysis (Fig. 20.20)

Cephalometric landmarks used in basis cephalometric analysis
are as given below:

of the nose.

sThe center of sella turcica (the midpoint of the horizontal
diameter).

Pog-pogonionThe most prominent point on the chin.

of the nose.


IsiIncision superius incisalis is the incisal edge of the


Figure 20.19: Basis cephalometric analysis
Figure 20.20: Cagliari cephalometric analysis
208

projection.

APOcc-Anterior point of occlusion for the occlusal plane
a constructed point, the midpoint of the incisor overbite in
occlusion.
the most distal point of contact between the most posterior

of the nose.
projection.

ArticulareArticulare is the point of intersection the dorsal
contours of the processus articularis mandibulare and os
temporale. The midpoint, a is used where double projection
Chieti Cephalometric Analysis (Fig. 20.21)

are as given below:
sthe center of sella turcica (the midpoint of the horizontal
diameter).
Figure 20.21: Chieti cephalometric analysis
209

occlusion.

temporale. The midpoint, a is used where double projection
gives rise to two point, a1 and a2.
McGann Cephalometric Analysis (Fig. 20.22)

are as given below:
Figure 20.22: McGann cephalometric analysis

auditory meatus (superior margin of temporo
mandibular

s-the center of sella turcica (the midpoint of the horizontal

diameter).




of the nose.

occlusion



projection.

auditory meatus (superior margin of temporomandi
bular
temporale.The midpoint, a is used where double projection
Index
Page numbers followed by f refer to figure
a
Alar crease junction 128, 131
on graphic illustration 132f
on lateral cephalogram 132f
Angle of convexity 197
Angulare point 184, 184f
Antegonial tubercles 175, 176f
Antegonion 176f
Anterior
nasal spine 10, 59, 123, 155f, 174, 194, 196,
200, 202, 204, 208, 209
pharyngeal wall 123
point of occlusion 10, 76, 77f, 208, 209
for occlusal plane 203, 205
Applications of cephalometric landmarks 191, 193,
Articulare 93, 95f, 174, 175f, 193
Articulation of
ethmoid bone 21
frontal bone 15, 26
temporal bone 31
b
Basion 154f, 179f
Basis cephalometric analysis 207, 207f
Bjork cephalometric analysis 193, 193f
Boltons point 10, 48, 196
c
Cagliari cephalometric analysis 207, 207f
Center of sella turcica 196, 204, 208, 209
Cephalometric
analysis 3
X-ray tracing techniques 4
Cephalostat 4
Cervical
bones 10, 99
point 198
vertebra 103, 104f, 118
vertebral maturation 119f
Cheilion 151
Chieti cephalometric analysis 208, 208f
Clinoidale 38
Coben craniofacial and dentition
analysis 194f
cephalometric analysis 194
Columella point 198
Condylion 95, 97f, 149, 150f

anterioris 189, 189f
lateralis 188, 189f
medialis 188, 188f
posterioris 190, 190f
Coronal suture 160
Cranial bones 10, 13
Crista galli 160, 161f
Cuspid 169
bow 11, 135, 135f
d
Deciduous dentition stage 70
Dentition 71
Di Paolos quadrilateral cephalometric analysis
200, 200f
Dorsum of sella 10, 36
Downs cephalometric analysis 195, 195f
e
Eruption chronology of primary teeth 70
Ethmoid bone 10, 15, 21, 21f, 22f, 26
Ethmoidale 24, 25f
Exocanthion 151, 152
f
Facial bone and dentition 10, 57
Farkas and coworkers soft tissue cephalometric
analysis 196, 196f
First molar point 187, 187f
Fissure 123
Floor of
nose 160
sella 10, 37
Foramina
spinosa points 180, 180f
spinosum 180, 181f
Frontal
bone 10, 26, 15, 15f
cephalogram 3, 3f
Frontomaxillary
nasal suture 10
suture on
graphic illustration 19f
lateral cephalogram 19f
Frontozygomatic suture 10
g
Glabella 198
Gnathion 89, 90f, 193, 196, 197, 201, 202, 204
Gonion 93, 94f, 150, 150f, 202
point 187, 187f
h
Harvold cephalometric analysis 196, 197f
Hassel and Farman developed method of skeletal
maturation 119f
Hasund cephalometric analysis 200, 200f
Holdaway cephalometric analysis 197, 197f
Hyoid 101, 102f
bone 101, 101f
i
Incision
inferius 194, 201, 202, 203, 204, 205
apicalis 10, 75, 76f, 170, 170f
frontale 171, 171f
incisalis 10, 74, 74f, 169, 170f
superius 194, 201, 202, 203, 205
apicalis 10, 73, 73f, 166, 167f
incisalis 10, 71, 72f, 165, 166f
Infradentale 86, 194
j
Jarabak cephalometric analysis 201, 201f
Jugal process 164, 164f
l
Labrale
inferius 11, 136, 146, 147f, 198
superius 11, 134, 146, 146f, 198
Lacrimal bone 15
Laryngopharynx 123
Lateral cephalogram 3, 3f
Legan and Burstone soft tissue cephalometric
analysis 198, 198f
Lower
face height 197
lip 11
pharynx 124
m
Magnified image of anterior nasal spine on
graphic 60f
Malare 175f
212
Mandibular
apical base midline 186, 186f
central incisor 10, 80, 81f, 195, 202, 203
dental midline 185, 186f
first molar 10, 81, 82f, 171, 171f, 195
length 197
molar 173, 173f
Mastiodale on lateral cephalogram 34f
Mastoid processes 160
Maxilla 26, 59
Maxillary
apical base midline 185, 185f
bone 15, 59f
central incisor 10, 79, 79f, 195, 202, 203
first molar 10, 79, 80f, 168, 168f, 195
molar 167, 168f
McGann cephalometric analysis 209, 209f
Medio-orbitale on lateral cephalogram 23f
Mentolabial sulcus 198
Menton 92, 92f, 173, 174f
Middle cranial fossa points 182, 183f
Mixed dentition stage 70
Nasal
bone 10, 15, 26, 26f, 26f
crown 128, 129
on lateral cephalogram 129f, 129f
process 15
Nasion 16, 26, 194-196, 197, 200
on graphic illustration 16f, 27f
Nasopharynx 123
Neck of crista galli 10, 23
on frontal cephalogram 23f
Nerve supply to mandible 85
Occipital
bone 10, 46, 46f
condyles 160
Occlusomandibular angle 199
Occlusopalatal angle 199
Odontoid 181, 181f
Opisthion 48, 179, 180f
Orbital plates 15
Orbitale 52, 67, 148, 148f, 194-196
Oropharynx 123
p
Palatocranial angle 199
Palatomandibular angle 199
Parital bone 15
Parts of
ethmoid bone 21
frontal bone 15
hyoid bone 101
mandible 85
Permanent dentition stage 71
Pharynx 123
Philtrum 135f
Planed incisor position 136
Planum sphenoidale 160
Pogonion 88, 196, 197, 200, 201, 204
Point
A on
on oral side of soft palate 123, 124
on pharyngeal side of soft palate 123, 124
T on
graphic illustration 131
Porion 32, 194-196
Posterior
cranial vault points 183, 184f
nasal spine 10, 64, 123, 208, 209
pharyngeal wall 123, 124
point of occlusion 10, 77, 78f, 208, 209
Vomer point 182, 183f
Prognathion 197
Pronasale 129, 144, 144f
Prosthion 62, 194
Pterygoid point 10, 40
Pterygomaxillary fissure 10, 44, 65, 123, 182,
182f, 195, 200
on graphic illustration 45, 66f
r
Rhinion 29
Ricketts cephalometric analysis 198, 199f
Riedel cephalometric analysis 202
Roof of
orbit on
orbital cavity 17
s
Sassouni cephalometric analysis 199, 199f
Schwartz cephalometric analysis 203, 203f
Sella 10, 41, 152, 195
entrance 41, 153, 153f
Shapes of cervical vertebral bodies 119f
Soft tissue
cephalometric landmarks 11, 125, 127, 128,
133, 138
glabella 127
gnathion 11, 139, 148, 148f, 198

on graphic illustration 139
menton 11, 198
nasal crown on graphic illustration 129f
nasion 128, 143, 143f
pogonion 11, 138, 147, 198
point B 147f
submentale 136, 147
subspinale 11, 133, 145, 145f
Sphenoethmoidal point 10, 24, 42
Sphenoethmoidale 24f
Sphenoid bone 10, 15, 35, 35f
Spheno-occipital synchondrosis 10, 39, 50
Spina nasalis posterior 194, 200-202
Spinal point 194
Squamous part 15
Steiners cephalometric analysis 204, 205f
Stomion
inferius 11, 198
superius 11, 198
Subnasale 131, 144, 198
Subspinale 194
Superior
pharyngeal wall 123, 124
surface of floor of pituitary fossa 160
Supra-orbitale 17
t
Temporal bone 10, 15, 31, 31f
Temporale on
graphic illustration 22f, 54f
lateral cephalogram 22, 54f
Temporomandibular joint 196
Tip of uvula 123, 124
Top of nasal septum 161, 161f
Tracing
basion on lateral cephalogram 47
Boltons point on lateral cephalogram 50
neck of crista galli on lateral cephalogram 23
of anterior
nasal spine on lateral cephalogram 60, 155
point of occlusion on lateral cephalogram
76
of articulare on lateral cephalogram 94, 174
213
of gnathion on lateral cephalogram 90

of hyoid on lateral cephalogram 102
of incision inferius
apicalis on lateral cephalogram 75, 171
incisalis on lateral cephalogram 75
of incision superius
apicalis on lateral cephalogram 74, 167
incisalis on lateral cephalogram 72, 166
of infradentale on lateral cephalogram 87
of mandibular
central incisor on lateral cephalogram 81
first molar on lateral cephalogram 81, 172
of mastiodale on lateral cephalogram 34
of maxillary
central incisor on lateral cephalogram 79
first molar on lateral cephalogram 80, 168
of menton on lateral cephalogram 92, 93, 95,
174
of MI on lateral cephalogram 82, 172
of MS on lateral cephalogram 83
of nasion on lateral cephalogram 17
of orbitale on lateral cephalogram 54
of pogonion on lateral cephalogram 88

of point B on lateral cephalogram 88
of posterior
nasal spine on lateral cephalogram 65
point of occlusion on lateral cephalogram
78
of sella on lateral cephalogram 41, 152
opisthion on lateral cephalogram 48
pterygoid point on lateral cephalogram 41
rhinion on lateral cephalogram 30
roof of orbit on lateral cephalogram 18
spheno-occipital synchondrosis on lateral
cephalogram 40, 51
supra-orbitale on lateral cephalogram 17
Trichion 196
Tweeds cephalometric analysis 205, 206f
Types of cephalogram 3
u
Upper
and lower lips 11
lip 11
pharynx 124
point of tongue 123, 124
Uses of cephalometric analysis 3
v
Vermillion 135, 135f
border of upper lips 11
Vertex 143, 143f
w
Wits cephalometric analysis 206
Wylie cephalometric analysis 203, 204f
z
Zygion 149, 149f, 163, 163f
Zygoma 162, 162f
Zygomatic
arch 10, 32, 163, 163f
bone 10, 15, 52, 52f
process 15
prominence 149, 149f
suture point 164, 164f
Index

An Atlas On Cephalometric Landmarks

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An Atlas On Cephalometric Landmarks

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An Atlas on

Basavaraj Subhashchandra Phulari

JAYPEE BROTHERS MEDICAL

Jaypee Brothers Medical Publishers (P) Ltd

Jaypee-Highlights Medical Publishers Inc.

Jaypee Brothers Medical Publishers, Ltd

Jaypee Brothers Medical Publishers (P) Ltd

Basavaraj Subhashchandra Phulari

Section 2: Classification of Cephalometric Landmarks

Section 3: Cephalometric Landmarks Related to Cranial Bones

4. Cephalometric landmarks related to ethmoid bone ............................................................... 21

Neck of Crista Galli23

5. Cephalometric landmarks related to Nasal bone.................................................................... 26

Frontonasal/Frontomaxillary Nasal Suture28

6. Cephalometric landmarks related to temporal bone ............................................................. 31

7. Cephalometric landmarks related to sphenoid bone ............................................................. 35

8. Cephalometric landmarks related to occipital bone .............................................................. 46

9. Cephalometric landmarks related to Zygomatic bone ............................................................. 52

Section 4: Cephalometric Landmarks Related to Facial Bones and Dentition

An Atlas on Cephalometric Landmarks

Cephalometric Landmarks (Points) on Maxilla59

Anterior Nasal Spine59

Posterior Nasal Spine64

11. Cephalometric Landmarks Related to Dentition............................................................................ 70

Maxillary Central Incisor79

12. Cephalometric Landmarks Related to Mandible............................................................................ 85

Section 5: Cephalometric Landmarks Related to Cervical Bones

Cephalometric Landmarks (Points) on Hyoid Bone101

14. Cephalometric landmarks related to Vertebrae......................................................................... 103

Section 6: Cephalometric landmarks related to Pharynx

Posterior Pharyngeal Wall124

Anterior Nasal Spine, Posterior Nasal Spine and

Point on the Pharyngeal Side of the Soft Palate124

Anterior Pharyngeal Wall123

Upper Point of Tongue124

Section 7: Soft Tissue Cephalometric Landmarks

Soft Tissue Glabella127

16. Soft Tissue Cephalometric Landmarks.......................................................................................... 127

Section 8: 3D Cephalometric Landmarks

Section 9: PA Cephalometric Landmarks

Maxillary First Molar168

Structures Involved in Pa Cephalogram160

Incision Inferius Apicalis170

Mandibular First Molar171

An Atlas on Cephalometric Landmarks

Incision Inferius Incisalis 169

Incision Superius Incisalis165

Section 10: SV Cephalometric Landmarks

19. SV Cephalometric Landmarks.................................................................................................... 179

Maxillary Apical Base Midline 185

Mandibular Dental Midline185

Foramina spinosa points180

Mandibular Apical Base Midline186

First Molar Point187

Middle cranial fossa points182

Posterior Vomer point182

Posterior Cranial vault points183

Section 11: Applications of Cephalometric Landmarks

Holdaway Cephalometric Analysis197

Coben Craniofacial and Dentition Cephalometric

Legan and Burstone Soft Tissue Cephalometric

Downs Cephalometric Analysis195

Ricketts Cephalometric Analysis198