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Y NILESH DESHPANDE
DEPT OF PEDIATRIC AND PREVENTIVE
DENTISTRY
UP DENTAL COLLESE & RESEARCH CENTRE

CCN1LN1S
1)lnLroducLlon
2)PlsLory
3)1echnlcal aspecLs
4)naLural head poslLlon
3)uevelopmenL of cephalomeLrlc analysls
6)CephalomeLrlc Lraclng Lechnlque
7)CephalomeLrlc landmarks(anLeroposLerlor and laLeral
cephalograms)
Pard Llssue landmarks
SofL Llssue landmarks
8) CephalomeLrlc planes
horlzonLal planes
verLlcal planes
9) CephalomeLrlc analysls
uowns
SLelners
1weeds
10) CephalomeLrlc superlmposlLlon Lechnlque
CLnALCML1k IN1kCDUC1ICN
1he measuremenL of Lhe head of a llvlng sub[ecL from Lhe
bony landmarks locaLed by palpaLlon or presslng Lhrough
Lhe supraad[acenL Llssues ls called CLnALCML1k
1he dlscovery of xrays by koentgen(1893) revoluLlonlzed
Lhe denLal professlon A radlographlc head lmage could be
measured ln Lwo dlmenslons Lhereby maklng posslble Lhe
accuraLe sLudy of cranlofaclal growLh and developmenL
CephalomeLrlcs ls Lhe lnLerpreLaLlon of laLeral skull
radlographs Laken under tandard|zed condlLlons

kA1ICNALL
SLudy cranlofaclal growLh (comparlng Lo Lhe same
lndlvldual)
ulagnosls (comparlng Lo sLandards)
lannlng orLhodonLlc LreaLmenL
valuaLlon of LreaLed cases
1WLN1 CLN1UkILS CI CLnALCML1k
O 1he sclenLlflc approach Lo scruLlny Lhe human cranlofaclal
paLLerns was done flrsL by anLhropologlsLs and anaLomlsLs
on dry skulls
O 1he measuremenL of dry skull from osLeologlcal landmarks
ls called croniometry
O 1he measuremenL of head of llvlng sub[ecLs from bony
landmarks locaLed by palpaLlon and presslng Lhrough
supraad[ascenL sLrucLures ls called cepho/ometry
O Puman form has been sLudled for many reasons
hlsLorlcally
1as an ald ln self porLrayal ln
sculpLuresdrawlngand palnLlng
2Lo LesL Lhe relaLlon of physlque Lo healLh
LemperamenL and behavlour LralLs
O n|ppocrate(S00bc) deslgnaLed Lwo forms
1 hab|tu phth||cu (long Lhln body)
2 hab|tu apop|et|cu (shorL Lhlck body)
O ArlsLoLle(400 8C) Calen(200 Au) 8osLan(1828) carrled on
wlLh Lhe research
O kotan was flrsL Lo lnclude muscle mass as a componenL of
physlque whlch was Laken up agaln by She|don |n 1940
O Sheldon lnLroduced hls meLhod of somaLoLyplng based on
3 componenLs of physlque (|ceroton|a omaton|a and
cerebroton|a)
W retchmer(1921) adhered Lo Lhree greek forms
1 pyknlc(compacL)
2 asLhenlc( wlLhouL sLrengLh)
3 aLhleLlc
laLer he lncluded dysplasLlc physlque measuremenL and
proporLlon
gypLlans developed a proporLlonaLe sysLem of human
body known as canon ConsLrucLlon of lmages ln Lwo
dlmenslons(planer)was based on a module showlng landmarks
Lhrough whlch base llnes were drawn Second gypLlan canon
used beLween Lhlrd and LwelfLh dynasLles dlvlded Lhe canonlal
helghL ln 18 squares

ln laLer canon of gypLlan arL male body conslsLed of 22
squares lnsLead of 18llne 21 was drawn Lhrough upper eyelld
ConsLrucLlon of drawlng for sculpLure of splnx holdlng small
flgure of goddess 1hls drawlng ls composed of 2 sysLems

O reek tem wa not a r|g|d a Lgpt|an
O 1he classlcal arL of Creeks re[ecLed Lhe rlgld gypLlan
sysLem for creaLlng human lmages 1he Creeks needed Lhe
freedom Lo accounL for Lhe shlfLlng dlmenslon of organlc
movemenL and Lhe foreshorLenlng of Lhe upper parL of a
sLaLure relaLlve Lo Lhe lower parL
O 1he gypLlan concepL was noL directed toword the
voriob/e but toword the constont not toword the
symbo/itotion of vito/ present but toword the reo/itotion
of o time/ess eternity" ln conLrasL Lhe Creclan efflgy
commemoraLed a human belng LhaL llved Lhe work of ort
existed in o sphere of esthetic ideo/ity"for Lhe gypLlans
lL remalned in o sphere of moqico/ reo/ity"
O lndlan lconomeLry sLudled exLenslvely by Lhe kue||u was
LransmlLLed Lhrough SanskrlL llLeraLure exLenslvely
revlewed ln lndlan LexLs of archlLecLure
O lace helghL was used as Lhe module of boLh Lhe Sar|putra
a|ekha|akhana proporLlonal sysLem whlch closely
reflecLed Lhe naLural relaLlon of Lhe parLs of Lhe body Lo
each oLher
O 1he Sar|putra tem (1200 AD) ls known for Lhe
sculpLures honorlng Lhe Cod 8uddha
lronLal vlew of Lhe head for a sLandlng
sLaLue of 8uddha accordlng Lo Lhe hlghly deLalled proporLlonal
sysLem
Cf sarlpuLra unlLs 1 angula 8mm

roflle and fronLal vlew of 8uddha face
ln 8yzanLlne emplre recLangular grld was replaced by
scheme of Lhree concenLrlc clrcles wlLh nose lengLh as
radlus of clrcles

W llfLeenLh cenLury's breakLhrough ln arLlsLlc LhoughL
concepL and Lechnlque was exempllfled by Lhe
accompllshmenLs of Leonardo da V|nc| and A|drecht
Durer(14711S28)
W Leonardo da V|nc| (14S21S19) was probably one of Lhe
earllesL people of noLe Lo apply Lhe Lheory of head
measuremenL Lo good effecL ln pracLlcehls drawlngs
lncluded a sLudy of proporLlons and Lhe pro[ecLlon of
coordlnaLe sysLem

1he proporLlon of head and a sLandlng
nude

O D was mosL ouLsLandlng provlded a proporLlonaLe
analysls of Lhe lepLoprosoplc (long and narrow) and
euryprosoplc (shorL and broad) face ln a coordlnaLe
sysLem
O Pe also made use of Lwo llnes Lo glve faclal angle showed
abouL Lhe varlaLlon ln faclal morphology

ln a proporLlonaLe analysls of face of Lwo lndlvlduals

uurer hlghllghLed Lhe dlfferences ln Lhe proflle ouLllne by Lhe
Angle beLween a llne drawn LangenL Lo Lhe forehead and nose
and a llne drawn LangenL Lo chln and lower llp

roflle ouLllnelorward hanglng and backward hanglng faclal
conflguraLlon by changlng Lhe angle beLween verLlcal
And horlzonLal axes of coordlnaLe sysLem
W 1he uuLchman L1kUS CAMLk (1722 1789 AD) was
credlLed wlLh Lhe lnLroducLlon of faclal angle for famous
publlcaLlon "DISSLk1A1ICN SUk LLS VAkIL1LS
NA1UkLLLLS DL LA nSICNCMIL" whlch appeared
posLhumously ln 1791
W 1he key Lo hls meLhodology was Lo orlenL cranla ln space
on a horlzonLal from Lhe mlddle of Lhe CkUS ACUS1ICUS
Lo a polnL below Lhe nose
W Camper's horlzonLal became Lhe reference llne for Lhe
angular measuremenLs used Lo characLerlze evoluLlonary
Lrends ln sLudles of faclal morphology and aglng
W 1he IACIAL ANLL as he descrlbed lL was formed by Lhe
lnLersecLlon of a faclal llne and a horlzonLal plane Lhe
faclal llne was a llne LangenLlal Lo Lhe mosL promlnenL parL
of Lhe fronLal bone and Lo Lhe sllghL convexlLy anLerlor Lo
Lhe upper LeeLh Lhe horlzonLal plane passes Lhrough Lhe
lower parL of Lhe nasal aperLure backwards along Lhe llne
of Lhe zygomaLlc arch and Lhrough Lhe cenLre of Lhe
exLernal audlLory meaLus


1all monkey a young oranguLan a naLlve Afrlcan and a kalmuk

Puman skull aL blrLh aL seven yearsln adulLhood and ln old
age
1he changes lllusLraLe Lhe lncrease ln lower faclal helghL wlLh
age
And lLs decrease afLer Lhe loss of all LeeLh


1he drawback of Camper' fac|a| ang|e
W lL lgnores Lhe conLrlbuLlon made by Lhe lower [aw Lo faclal
forms
W Pe dld noL adhere sLrlcLly Lo hls locaLlon of posLerlor
reference polnL for Lhe horlzonLal plane
W 1he dlrecL comparlson of skull of dlfferenL ages was noL
posslble because Lhe locaLlng polnL mlghL alLer ls poslLlon
relevanL Lo oLher bony sLrucLures wlLh advanclng age

Splx (1813) proposed Lo modlfy Lhe campers llne by
drawlng a llne from prosLhlon LangenL Lo occlplLal condyle

Welcker(1862) analysls of growLh changes from
blrLh(neonaLus) Lo 16101323 years of age by means of
a Lrlangular conflguraLlon and Lhe llne naslon baslon as
reference

Space shape analysls by 8[ork
I- LOO- 1915 advocaLed proper orlenLaLlon of casL
accordlng Lo face Pe was probably Lhe flrsL Lo lnLroduce
cephalomeLrlcs Lo orLhodonLlcs lor analyzlng faclal
growLh he made plasLer casLs of face ln whlch he lnserLed
orlenLed casLs of denLlLlon
9-%1922 ) lnLroduced a meLhod sLandardlzed head
radlography
O ln 1922 au| S|mon gave Lhe ldea of dlagnoslng denLal
deformlLles by means of planes and Lhe angles

O ln 1931 roadbent ln uSA and nofrath ln Cermany
slmulLaneously presenLed a sLandardlzed cephalomeLrlcs
Lechnlque uslng Lhe hlgh powered xray machlne and a
head holder called a Cepha|otat or Lhe Cepha|ometer
O 8roadbenL's slngle goal was Lhe sLudy of cranlofaclal
growLh Lhe broadbenL Lechnlque for cephalomeLrlc
radlography was one of Lhe Lools LhaL he developed for
Lhe lmplemenLaLlon of LhaL sLudy
O 1he Lechnlque used by hlm ellmlnaLed pracLlcally all Lhe
Lechnlcal dlfflculLles encounLered ln prevlous meLhods of
recordlng Lhe denLofaclal changes

1LCnNICAL ASLC1S
1he baslc componenLs of Lhe equlpmenL for
produclng Lhe laLeral cephalogram are
1)An xray apparaLus
2)An lmage recepLor sysLem
3)A cephalosLaL




1P x 8A? AA8A1uS
1he Lhree baslc elemenLs LhaL generaLe LhaL xray are
1)CaLhode
2)Anode
3)1he elecLrlcal power supply

W 1ungsLen fllamenL surrounded by a molybdenum focuslng
cup
W ConnecLed Lo a low volLage hlgh volLage clrculL
W A sLep down Lransformer supplles Lhe low volLage clrculL
wlLh 10v and a hlgh currenL Lo heaL Lhe fllamenL unLll Lhe
elecLrons are emlLLed
W Supplles Lhe hlgh volLage clrculL wlLh 6390kv
W ulfferenLlal poLenLlal acceleraLes Lhe elecLrons
W 1he beams are dlrecLed by Lhe focuslng cup Lo sLrlke a
small LargeL ln Lhe anode called foca| pot

uenLal x8ay machlne clrculLry wlLh Lhe ma[or componenLs
labelled
A)lllamenL sLep down Lransformer
8)fllamenL currenL conLrol(mA swlLch)
C)AuLoLransformer
u)kvp selecLor dlal(swlLch)
)hlgh volLage Lransformer
l)xray Llmer(swlLch)
C)Lube volLage lndlcaLor(ammeLer)
P)x ray Lube
W Small LungsLen block embedded ln Lhe copper sLem whlch
sLops Lhe acceleraLed elecLrons whose klneLlc energy
causes Lhe producLlon of phoLons
W Less Lhen 1 ls converLed Lo phoLons resL ls converLed Lo
heaL
W AlLhough LungsLen ls a hlgh molecular subsLance
W 8uL lLs Lhermal reslsLance ls unable Lo wlLhsLand Lhe heaL
ConsequenLly Lhe copper sLem acLs as a Lhermal
conducLor 1hls ls an lnLegral parL of Lhe coollng sysLem
lL dlsslpaLes Lhe heaL lnLo Lhe oll surroundlng Lhe x8ay
Lube
W 1he slze of Lhe focal spoL follows Lhe 8enson llne focus
prlnclple 1herefore Lhe LargeL face ln Lhe x8ay Lube ls
orlenLed aL an angle of 1320'Lo Lhe caLhode

1nL IMAL kLCL1Ck SS1LM
lL records Lhe flnal producL of x8ays afLer Lhey pass
Lhrough Lhe sub[ecL 1he exLraoral pro[ecLlon llke Lhe
laLeral cephalomeLrlc Lechnlque requlres a complex lmage
recepLor sysLem LhaL conslsLs of
1xLraoral fllm
2lnLenslfylng screen
3A casseLLe
4A grld a sofL Llssue shleld

1nL CLnALCS1A1
W lL ls based on Lhe same prlnclples LhaL descrlbed by Lhe
8roadbenL
W 1he paLlenLs head ls flxed by Lhe Lwo ear rods LhaL are
lnserLed lnLo Lhe ear holes so LhaL Lhe upper borders of
Lhe ear holes resL on Lhe upper border of Lhe ear rods
W 1he head whlch ls cenLered ln Lhe cephalosLaL ls orlenLed
wlLh Lhe lrankfurL plane parallel Lo Lhe floor Lhe
mldsaglLLal plane verLlcal parallel Lo Lhe casseLLe
W 1wo ear rods paLlenL head ls flxed by lnserLed Lhem lnLo
ear holes
W Pas lnfraorblLal polnLer Lo sLandardlze Lhe poslLlon
W lore head clamp Lo supporL Lhe face poslLloned aL naslon
W roper allgnmenL ls checked lf radlopaque clrcle of fllm
slde ear rod ls reasonably cenLered ln beam slde rod

lh plane ls kepL parallel Lo Lhe floor and mld saglLLal plane
parallel Lo casseLLe and perpendlcular Lo Lhe floor Some
prefer canLhomeaLel llne aL 10degree Lo floor

P1he sLandardlzed lrankfurL plane ls achleved by placlng
Lhe lnfraorblLal polnLer aL Lhe paLlenLs orblL and Lhen
ad[usLlng Lhe head verLlcally unLll Lhe lnfraorblLal polnLer
Lhe Lwo ear rods are aL Lhe same levels
P1he upper parL of Lhe face ls supporLed by Lhe forehead
clamp poslLloned aL Lhe naslonLo ellmlnaLe roLaLlon
around Lhe ear rods ln Lhe saglLLal plane and for fuLure
references ln subsequenL exposures

SnCk1CCMINS CI 1nL IkANIUk1 nCkI2CN1AL
LANL
O Some lndlvlduals show a varlaLlon of Lhelr lP plane Lo
Lhe Lrue horlzonLal Lo an exLenL of 10
O 1he landmarks Lo locaLe Lhe lP plane on a cephalogram
orblLale porlon are dlfflculL Lo locaLe accuraLely on
Lhe radlographs
O An alLernaLlve Lo overcome Lhls was Lo use a
funcLlonally derlved nP Accordlng Lo Morrees kean
lL was obLalned by Lhe paLlenL sLandlng up looklng
dlrecLly lnLo Lhe reflecLlon of hls/her eyes ln a mlrror
dlrecLly ahead ln Lhe mlddle of Lhe cephalosLaL
O 1o record Lhe nP Lhe ear rods are noL used for locklng
Lhe paLlenL head lnLo a flxed poslLlon buL serve Lo place
Lhe mldsaglLLal plane aL a flxed dlsLance from Lhe fllm
plane

NA1UkAL nLAD CSI1ICN
O naLural head poslLlon ls a sLandardlsed and
reproduclble poslLlon of Lhe head ln an uprlghL posLure
when person ls focusslng on dlsLanL ob[ecL aL eye
level(Moorrees)
O ln 1884 frankforL agreemenL lP plane was consldered
as sLandard plane for all cranlomeLrlc research
O 8uL downs showed Lhe varlaLlon ln canL of lP
plane(1936)
O 8[ork(1931) also showed ln Lwo adulL banLu men Lhe
varlaLlon ln Sn plane when boLh were shown Lo have
same proflle when alllgned ln ln naLural head poslLlon
O very frequenLly lefL and rlghL ears are asymmeLrlcal ln
horlzonLal and verLlcal dlrecLlon

Var|at|on |n cant of frankfort hor|zonta| p|ane








CkILN1A1ICN CI NA1UkAL nLAD CSI1ICN
vA8lCuS M1PCuS
Some accepL mosL relaxed poslLlon of Lhe head (self
balance poslLlon)
Crhan proposed LargeL on Lhe mlrror Lechnlque"
Serdar usumez(2001) devlced an lncllnomeLer whlch was
very useful ln reproduclng Lhe naLural head poslLlon
naLural head posLure lL's Lhe orLhoposlLlon of Lhe sub[ecLs
namely momenLary lnLerlm poslLlon when Laklng Lhe flrsL
sLep from sLandlng Lo walklng posLure









NA1UkAL nLAD CSI1ICN VS NA1UkAL nLAD CS1UkL
O noL lnLerchangeable as posLure ls recorded ln dynamlc
moLlon and more physlologlc ln characLer and charcLerlsLlc
of an lndlvldual where as poslLlon ls a sLaLlc and ls
measured by sLandardlsed procedure applled Lo all
lndlvlduals
O Moorrees proposes laLeral ceph Lo be Laken ln
sLandardlsed naLural head poslLlon
O naLural head posLure ls Lhe one ln whlch paLlenL presenLs
hlmself Lo Lhe world

O kA SCUkCL CSI1ICN
PlL ls poslLloned 3 feeL(1324cm) from Lhe sub[ecL's
mldsaglLLal plane
P1he pro[ecLlon ls Laken when Lhe LeeLh are ln cenLrlc
occluslon Lhe llps ln Lhe repose unless oLher
speclflcaLlons have been recommended ( eg wlLh Lhe
mouLh open or wlLh a speclflc lnLerocclusal reglsLraLlon
used as orlenLaLlon
IILM CSI1ICN
PMagnlflcaLlon facLors are affecLed by Lhe dlsLance from
Lhe fllm casseLLe Lo Lhe mldsaglLLal plane of Lhe paLlenL
P1o mlnlmlze varlaLlons ln magnlflcaLlon from paLlenL Lo
paLlenL Lo obLaln conslsLenL measuremenLs on Lhe
paLlenL over Llme a dlsLance of 13cm ls ofLen
usedPowever Lo place Lhe fllm casseLLe as close Lo Lhe
paLlenL head as posslble ls also ln pracLlce
DLVLLCMLN1 CI CLnALCML1kIC ANALSIS
CephalomeLrlc analysls ls carrled ouL noL on Lhe
radlograph lLself buL on a Lraclng or dlglLal model LhaL
emphaslzes Lhe relaLlonshlp of selecLed polnLs
1raclng or Lhe model ls used Lo reduce Lhe amounL of
lnformaLlon Lo a manageable level

1kACIN CI A CLnALCkAM
1horough famlllarlLy wlLh Lhe gross anaLomy ls requlred
before Lhe Lraclng
8y convenLlon Lhe bllaLeral sLrucLures (eg Lhe raml and
lnferlor borders of Lhe mandlble) are flrsL Lraced
lndependenLly An average ls Lhen drawn by vlsual
approxlmaLlon whlch ls represenLed by a broken llne

1kACIN SULILS AND LUIMLN1S
A laLeral cephalogram
AceLaLe maLLe Lraclng paper(003 lnches Lhlck 810
lnches)
A sharp 3P drawlng pencll or a very flne Llpped pen
Masklng Lape
A few sheeLs of cardboard (preferably black)
A proLracLor and LooLh symbol Lraclng LemplaLe for
drawlng Lhe LeeLh Also LemplaLes for Lraclng Lhe
ouLllnes of ear rods
uenLal casLs Lrlmmed Lo maxlmum lnLercuspaLlon of Lhe
LeeLh ln occluslon
vlewbox
encll sharpener and a eraser

LNLkAL CCNSIDLkA1ICNS ICk 1nL 1kACIN
SLarL by placlng Lhe cephalogram on Lhe vlewbox wlLh Lhe
paLlenL's lmage faclng Lowards Lhe rlghL
1ape Lhe four corners of Lhe radlograph Lo Lhe vlewbox
uraw Lhree crosses on Lhe radlographs Lwo wlLhln Lhe
cranlum and one over Lhe area of Lhe cervlcal verLebrae
lace Lhe maLLe aceLaLe fllm over Lhe radlograph and Lape
lL securely
AfLer flrmly afflxlng Lhe aceLaLe fllm Lrace Lhe Lhree
reglsLraLlon crosses
rlnL Lhe pL name record number age ln years and
monLhs Lhe daLe on whlch Lhe cephalogram was Laken
and your name on Lhe boLLom lefL corner of Lhe aceLaLe
fllm
8egln Lraclng uslng smooLh conLlnuous pressure

S1LWISL 1kACIN 1LCnNIUL
uraw Lhree reglsLraLlon crosses
1race SofL 1lssue roflle
1race exLernal conLour of cranlum
1race ouLllne of aLlas and axls verLebra
1race lnLernal border of cranlum
1race orblLal roof
1race ouLllne of plLulLary fossa or sella Lurclca
1race planum sphenoldale
1race fronLal slnus
1race dorsum sella
1race occlplLal bone
1race ouLllne of floor of mlddle cranlal fossa
1race lefL and rlghL ear rods
1race ouLllne of nasal bone
1race plrlform aperLure
1race laLeral orblLal marglns and lnfra orblLal rldges
1race ouLllne of key rldges
1race Lerygomaxlllary flssure
1Lrace anLerlor border of symphysls of mandlble
1race lnLernal marrow space of symphysls
1race lnferlor border of mandlble
1race posLerlor aspecL of raml
1race mandlbular condyles
1race mandlbular noLches
1race anLerlor aspecL of raml lnLerlorly
1race mandlbular flrsL molars
1race mosL anLerlorly placed lower lnclsors

CLnALCML1kIC LANDMAkS
A landmark ls a polnL whlch serves as a gulde for
measuremenL or consLrucLlon of planes 1hey are dlvlded
lnLo Lwo Lypes
1Aootomlc 1hese represenL acLual anaLomlc sLrucLure of
Lhe skull
2 oosttocteJ 1hese have been consLrucLed or obLalned
secondarlly from anaLomlc sLrucLures ln Lhe cephalogram

kLUISI1LS ICk A LANDMAk
Landmark should be easlly seen on Lhe roenLegenogram
be unlform ln ouLllne and easlly reproduclble
Llnes and planes should have slgnlflcanL relaLlonshlp Lo Lhe
vecLors of growLh of speclflc areas
Landmark should permlL valld quanLlLaLlve measuremenL
of llnes and angles
Measured polnLs and Lhe measuremenL should have
slgnlflcanL relaLlon Lo Lhe lnformaLlon soughL
MeasuremenLs should be amenable Lo sLaLlsLlcal analysls
buL should preferably noL requlre exLenslve speclallzed
Lralnlng ln sLaLlsLlcal meLhods
Landmarks are of Lwo Lypes
hard Llssue landmarks
sofL Llssue landmarks





nAkD 1ISSUL LANDMAkS

Subsplnale (A polnL) 1he mosL posLerlor mldllne polnL ln
Lhe concavlLy beLween Lhe anLerlor nasal splne(AnS) and Lhe
rosLhlon (Lhe mosL lnferlor polnL on Lhe alveolar bone
overlylng Lhe maxlllary lnclsors)
A81lCuLA8 (A8) A polnL aL Lhe [uncLlon of Lhe posLerlor
border of Lhe ramus and Lhe lnferlor border of Lhe posLerlor
cranlal base(occlplLal bone)
AnLerlor nasal splne (AnS)1he anLerlor Llp of Lhe sharp
bony process of Lhe maxllla aL Lhe lower margln of
Lhe anLerlor nasal openlng
Su8AMn1AL (Cln1 8) 1he mosL posLerlor mldllne
polnL ln Lhe concavlLy of Lhe mandlble beLween Lhe mosL
superlor polnL on Lhe alvelolar bone overlylng Lhe
mandlbular lnclsors(lnfradenLale) and ogonlon
8ASlCn 1he mosL anLerlor lnferlor polnL on Lhe anLerlor
margln of loramen magnum
8CL1Cn Cln1(8o) 1he lnLersecLlon of Lhe ouLllne of Lhe
occlplLal condyle and Lhe loramen Magnum aL Lhe hlghesL
polnL on Lhe noLch posLerlor Lo Lhe occlplLal condyle
Condyllon (Co) 1he mosL superlor polnL on Lhe head of
mandlbular condyle
Clabella(C) 1he mosL promlnenL polnL of Lhe anLerlor
conLour of Lhe fronLal bone
CnaLhlon(Cn) A polnL locaLed by Laklng Lhe mldpolnL
beLween Lhe anLerlor(ogonlon) and lnferlor
polnL(MenLon) on Lhe bony chln
Conlon(Co) A polnL on Lhe curvaLure of angle of Lhe
mandlble locaLed by blsecLlng Lhe angle formed by llnes
LangenL Lo Lhe posLerlor ramus and lnferlor border of Lhe
mandlble
lnclslon lnferlus(ll) 1he lnclsal Llp of Lhe mosL lablaly
placed mandlbular lnclsor
lnclslon superlus(ls)
1he lnclsal Llp of Lhe mosL lablaly placed maxlllary lnclsor
lnl8Aun1AL(lu)lnl8lC8 8CS1PlCn) 1he mosL
superlor anLerlor polnL on mandlbular alveolar process
beLween Lhe cenLral lnclsors
MenLon(Me) 1he mosL lnferlor polnL of Lhe mandlbular
symphysls ln Lhe mldsaglLLal plane
naslon(n) 1he mosL anLerlor polnL on Lhe fronLonasal
suLure ln mldsaglLLal plane
CplsLhlon(Cp) 1he mosL posLerlor lnferlor polnL on Lhe
margln of Lhe foramen Magnum ln Lhe mldsaglLLal plane
CrblLale(Cr) 1he lowesL polnL on Lhe lnferlor orblLal
margln
ogonlon(og) 1he mosL anLerlor polnL on Lhe conLour of
bony chln ln Lhe mldsaglLLal plane
orlon(o) 1he mosL superlor polnL of Lhe ouLllne of Lhe
exLernal audlLory meaLus (anaLomlc porlon) When Lhe
anaLomlc porlon cannoL be readlly locaLedLhe
superlormosL polnL of Lhe lmage of Lhe ear rods (machlne
porlon) ls used
osLerlor nasal Splne(nS) 1he mosL posLerlor polnL on
Lhe bony hard palaLe ln Lhe mldsaglLLal plane
rosLhlon (r) Superlor rosLhlon SupradenLale) 1he
mosL lnferlor anLerlor polnL on Lhe maxlllary alveolar
process beLween Lhe cenLral lnclsors
Lerygomaxlllare (Lm) 1he conLour of Lhe
pLerygomaxlllary flssure formed anLerlorly by Lhe
reLromolar LuberoslLy of maxllla and posLerlorly by
anLerlor curve of Lhe pLerygold process of sphenold
boneLhe lowesL polnL of Lhe openlng ls used
Lm landmark ls Laken aL Lhe mosL lnferlor polnL of Lhe
flssure where Lhe anLerlor and Lhe posLerlor ouLllnes of
Lhe lnverLed Leardrop merge wlLh each oLher
8eglsLraLlon polnL (8olnL) A CephalomeLrlc reference
polnL for reglsLraLlon of superlmposed Lraclngs
Sella (S) 1he geomeLrlc cenLre of Lhe plLulLary fossa
(sella Lurslca) deLermlned by lnspecLlon

SCI1 1ISSUL LANDMAkS
lnferlor Lablal Sulcus (lls) 1he polnL of greaLesL
concavlLy of Lhe lower llp beLween Lhe labrale lnferlus
and MenLon ln Lhe mldsaglLLal plane
Labrale lnferlus (Ll) 1he polnL denoLlng Lhe vermllllon
border of Lhe lower llp ln Lhe mldsaglLLal plane
Labrale superlus (Ls) 1he polnL denoLlng Lhe
vermllllon border of Lhe upper llp ln Lhe mldsaglLLal
plane
ronasale (n) 1he mosL promlnenL polnL on Lhe Llp
of Lhe nose
SofL Llssue Clabellla (C') 1he mosL promlnenL polnL
on Lhe sofL Llssue drape of Lhe forehead
SofL Llssue MenLon (Me') 1he mosL lnferlor polnL on
Lhe sofL Llssue chln
SofL Llssue naslon (na') 1he deepesL polnL of Lhe
concavlLy beLween Lhe forehead and sofL Llssue
conLour of Lhe nose
SofL Llssue ogonlon (og') 1he mosL promlnenL
polnL on Lhe sofL Llssue conLour of Lhe chln ln Lhe
mldsaglLLal plane

SLomlon (SL) 1he mosL anLerlor polnL of conLacL
beLween Lhe upper and lower llp When Lhe llps are
aparL aL resL a superlor and lnferlor sLomlon polnLs
can be dlsLlngulshed
SLomlon Superlus (SLs) 1he lowesL mldllne polnL of
Lhe upper llp
SLomlon lnferlus (SLl) 1he hlghesL mldllne polnL of
Lhe upper llp
Subnasale (Sn) 1he polnL ln Lhe mldsaglLLal plane
where Lhe base of Lhe columella of Lhe nose meeLs
Lhe upper llp
1rlchlon (1r) uemarcaLlon polnL of Lhe halrllne ln Lhe
mldllne of Lhe forehead

CLnALCML1kIC LANLS
1hey are derlved from aL leasL 2 or 3 landmarks
and are used for measuremenLs separaLlon of anaLomlc
dlvlslons deflnlLlon of anaLomlc sLrucLures of relaLlng
parLs of Lhe face Lo one anoLher 1he varlous
cephalomeLrlc planes used are
lrankfurL PorlzonLal plane 1hls plane ls drawn from
o Lo Cr 1he name ls glven ln Lhe conference of
anLhropology held aL lrankfurL ln 1883
Sellanaslon plane lL represenLs Lhe anLerlor cranlal
base Can be accuraLely locaLed on Lhe radlographs
Cranlal base undergoes llLLle change afLer Lhe age of
67 years buL Lhe npolnL can drlfL elLher forwards or
verLlcally glvlng rlse Lo an error
8aslonnaslon plane 1hls plane ls used ln Lhe
8lckeLL's analysls
alaLal plane plane passlng Lhrough Lhe AnS and Lhe
nS
Cccluslon plane lL ls Lhe plane passlng Lhrough Lhe
cusp Llps of Lhe upper and lower flrsL molars and a
polnL blsecLlng Lhe overblLe
8olLonnaslon plane
Mandlbular plane ulfferenL deflnlLlons are glven ln
dlfferenL analysls
1owos ooolysls lL exLends from Co Lo Me
2teloets oolysls lL exLends from Co Lo Cn
3olzmooo Look lower border of Lhe mandlble as Lhe
mandlbular plane

VLk1ICAL LANLS
laclal plane lL exLends from naslon Lo pogonlon
?axls lL ls Lhe llne [olnlng sella Lo gnaLhlon
8amal plane lL ls drawn LangenL Lo Lhe posLerlor border
of Lhe ramus and Lhe condyles





CS1LkCAN1LkICk CLnALCML1k
8eference planes
PorlzonLal cranlal reference llnes
11he superlor conLours of Lhe orblL
21he anLerlor cranlal base
31he cenLer of orblL
41he zygomaLlcofronLal suLure
31he cenLer of zygomaLlc arch secLlonal lmage
1he maln verLlcal reference
1 1he mldllne plane

ILA1LkAL LANDMAkS
(CC) cenLer of orblL
(u) eurlon 1he mosL promlnenL polnLs on Lhe elLher
slde of cranlum
(AC8) anLerlor cranlal base 1he marglns of AC8
deLermlned by Lhe shadow of Lhe fronLozygomaLlc
processes wlLh Lhe laLeral exLenLlon of Lhe anLerlor
cranlal base floor
(lrz) fronLomalare Lemporal ouLer edge of
fronLozygomaLlc suLure
(Zy) Zyglon 1he mosL laLerally slLuaLed polnL on Lhe
zygomaLlc arch
(Ma) masLoldale 1he apex of Lhe masLold process
(Cr) CrblLale
(Co) gonlon
(AC) anLegonlon AL Lhe anLegonlal noLch Lhe laLeral
lnferlor margln of Lhe anLegonlal proLuberances
(!) !ugale AL Lhe [ugal process Lhe lnLersecLlon of Lhe
ouLllne of Lhe maxlllary LuberoslLy and Lhe zygomaLlc
buLLress some auLhors use Lhe landmark
maxlllare(Max) Lhe lnLersecLlon of Lhe laLeral conLour of
Lhe laLeral conLour of zygomaLlc process of maxllla ln
pracLlcal appllcaLlon Lhe landmarks ! and Max are nearly
colncldenL
Landmarks ln Lhe mldllne
naslon
CrlsLa galll MosL superlor polnL aL lLs lnLersecLlon wlLh
Lhe sphenold
8eglsLraLlon polnL(8)
8aslon
(AnS) AnLerlor nasal splne
CauLhlon
(Me) MenLon


1xLernal perlpheral cranlal bone surfaces
2Coronal suLures
3lloor of Lhe nose
4 CcclplLal condyles
3CrblLal ouLllne and lnferlor surface of Lhe orblLal plaLe of
fronLal bone
6Cbllque llne formed by Lhe exLernal surface of Lhe greaLer
wlng of sphenold ln Lhe area of Lhe Lemporal fossa
7 arcuaLe emlnence
8 LaLeral surface of Lhe fronLosphenoldal process of Lhe
zygoma and zygomaLlc arch down Lo and lncludlng Lhe key
rldge
9 Cross secLlon of Lhe zygomaLlc arch
10 lnfra Lemporal surface of Lhe maxllla ln Lhe area of Lhe
LuberoslLy whlch ls seen laLeral Lo Lhe lower ouLllnes of
Lhe key rldge afLer Lhe erupLlon of permanenL flrsL molars
11 8ody of mandlble Lhe ascendlng raml coronold
process and Lhe condyles(when vlslble)
12 CompleLe denLlLlon











LA1LkAL CLnALCML1kIC ANALSIS

DCWN'S ANALSIS
ln Lhls analysls In p|ane ls used as Lhe reference plane
lL was based on hls flndlngs on caucaslan lndlvlduals of 12
17 years age group belonglng Lo boLh Lhe sexes
uowns analysls conslsLs of ten parameLers
P flve ke|eta|
P flve denta|


S1LINLk'S ANALSIS
ecll teloet ln Lhe year 1930 developed Lhls analysls
wlLh Lhe ldea of provldlng maxlmal cllnlcal lnformaLlon
wlLh leasL number of measuremenLs
1he sLelners analysls ls dlvlded lnLo Lhree parLs
1) SkeleLal analysls
2) uenLal analysls
3) SofL Llssue analysls
Skeletal ean value
SNA angle 82 deg
SNB angle 80 deg
ANB angle 2 deg
Occlusal plane angle 14.5 deg
Mandibular plane angle 32 deg

Dental ean value
Upper incisor to NA(angle) 22 deg
Upper incisor to NA(linear) 4 mm
Lower incisor to NB(angle) 25 deg
Lower incisor to NB(linear) 4 mm
Interincisal angle 131 deg

1WLLD' ANALSIS
1he 1weed analysls makes use of Lhree planes Lo
esLabllsh a dlagnosLlc Lrlangle
1he Lhree planes used ln Lhls analysls are
1lrankfurL horlzonLal plane
2Mandlbular plane
3Long axls of lower lnclsor
1he values of Lhe angles accordlng Lo 1weed's flndlng are
as follows
1lMA lrankfurL Mandlbular plane angle 23
2lMlA lrankfurL Mandlbular lnclsor plane angle 63
3 lMA lnclsor Mandlbular angle 90














CONTENT5
O Inlioduclion
O Dofinilions
O &sos of CophaIonoliic supoiinposilion
O CoIoi-coding foi liacing
O Changos in ovoiaII faco
O Changos in lho naxiIIa and ils donlilion
O Changos in lho nandilIo and ils donlilion
O nounl and diioclion of condyIai giovlh
O andiluIai iolalion
O ConcIusion




NTRODUCTON
cophaIonoliic supoi inposilion is an anaIysis of
IaloiaI cophaIogians of lho sano palionl lakon al diffoionl
linos. Thoso supoi inposilions aio usod lo ovaIualo a
palionls giovlh palloin lolvoon diffoionl agos and lo
ovaIualo changos in donloaIvooIai and lasaI ioIalionships
afloi a couiso of oilhodonlic oi suigicaI lioalnonl.

To do lhis il ioquiios al Ioasl a voiking knovIodgo of
lho silos oi aioas of skoIolaI giovlh. In gioving skuIIs lho
vaiious lonos novo apail fion oach olhoi al diffoionl
ialos. Tho analonicaI Iandnaiks adjaconl lo lho giovlh
Iocalions viII novo apail noio lhan lhoso fuilhoi fion
giovlh silos. To doloinino lho offocl of giovlh oi
lioalnonl, liacings of lho hoad fiIns aio supoiinposod on
lhoso Iandnaiks Ioasl affoclod ly giovlh.

n oaiIy nolhod usod lo doloinino lho changos lhal
occui in donlofaciaI conpIox vas lho conpaiison of Iinoai
and anguIai noasuiononls fion consoculivo
cophaIogians. Tho disadvanlago of lhis nolhod is lhal il
doos nol accuialoIy poiliay lho acluaI changos in
donlofaciaI sliucluios, lul iofIocls ioIalivo changos
lolvoon spocific cophaIonoliic Iandnaiks Iocalod on lho
iadiogiaphic piofiIos of vaiious lonos. (LxanpIo. ngIo
SN nol onIy iopiosonls lho changos poinl , lul aIso lho
spaliaI changos lhal occui al soIIa and al nasion).
Tho uso of soiiaI supoiinposilions fion
cophaIogians lhal havo loon lakon al diffoionl linos is
ono nolhod foi accuialoIy doloinining lho ioIalivo
changos in lho faco. Ioi a noaningfuI inloipiolalion of
lhoso supoiinposilions lhoy havo lo lo iogisloiod on
slalIo iofoionco aioas. ioas in cianiofaciaI conpIox lhal
do nol chango duiing lho poiiod of giovlh nusl lo
idonlifiod. Tho pIacononl of nolaIIic inpIanls in lho
naxiIIa and nandilIo foi sulsoquonl uso as slalIo
sliucluios has loon advocalod ly iosoaichois (}ORK,
1968). Il is nol ioconnondod lhal such inpIanls aio
ioulinoIy usod as a noans of doloinining lho changos lhal
occui as a iosuIl of giovlh and lioalnonl. Infoinalion
galhoiod fion oaiIioi inpIanl sludios aio usofuI in
idonlifying aioas vhich aio ioIalivoIy slalIo oi vhoio lho
changos aio of ioIalivoIy snaII nagniludo. CophaIonoliic
supoiinposilions poifoinod on palionls vho havo
conpIolod lhoii giovlh aio IikoIy lo lo noio accuialo.
Ioi cophaIonoliic supoiinposilions lo lo accuialo
lhoy shouId lo lakon undoi idonlicaI condilions of
nagnificalion, hoad posilion, iadioIogicaI oxposuio and
lho liacing of lho supoiinposilions nusl lo accuialo.
ccoiding lo ioadlonl (1975) vhon liacing soiiaI fiIns,
ono shouId slail vilh lho snaIIosl ago and foIIov lho chiId
lovaids naluiily oi slail al lho nosl naluio slago and
voik lackvaids. Lilhoi nolhod aIIovs lho oxaninoi lo
olsoivo giaduaI noiphoIogicaI changos. Ono of lho
pioioquisilos of liacing is lo Iocalo piocisoIy lho oulIinos of
lho ioIovanl sliucluios and lo oIininalo lho confusing,
unusalIo dolaiIs.
DEFNTON5
VaIidily: VaIidily oi accuiacy is lho oxlonl lo vhich, in
alsonco of noasuiononl oiioi, lho vaIuo ollainod
iopiosonls lho oljocl of inloiosl.
RopioduciliIily: RopioduciliIily oi piocossion, is lho
cIosonoss of succossivo noasuiononls of lho sano oljocl.
U5E5 OF CEPHALOMETRC 5UPERMPO5TON
LvaIualo a palionls giovlh palloin lolvoon
diffoionl agos
LvaIualo changos in donloaIvooIai and lasaI
ioIalionships afloi oilhodonlic oi suigicaI
lioalnonl
Diffoionlialo lho changos duo lo giovlh and lhal
duo lo lioalnonl
Consliuclion of VTO



COLOR-CODNG FOR TRACNG
In oidoi lo faciIilalo idonlificalion of consoculivo
cophaIogians a coIoi codo has loon suggoslod ly lho
noiican loaid of oilhodonlisls (199O)
!iolioalnonl - lIack
!iogioss - lIuo
Lnd of lioalnonl - iod
Rolonlion - gioon

Tho goaI of cophaIonoliic anaIysis is lo ovaIualo lho
ioIalionships, lolh hoiizonlaIIy and voilicaIIy of lho fivo
najoi funclionaI conpononls of lho faco.
Cianiun and cianiaI laso
SkoIolaI naxiIIa
SkoIolaI nandilIo
axiIIaiy donlilion and aIvooIai piocoss
andiluIai donlilion and aIvooIai piocoss

ny cophaIonoliic anaIysis is a piocoduio dosignod lo
yioId a dosciiplion of lho ioIalionships anong lhoso
funclionaI unils.
Thoio aio lvo nolhods of cophaIonoliic anaIysis
&so of soIoclod Iinoai and anguIai noasuiononls lo
oslalIish appiopiialo conpaiisons.
Lxpioss lho noinalivo dala giaphicaIIy and lo
conpaio lho palionls donlofaciaI foin diioclIy vilh
giaphic iofoionco (lonpIalo) - TL!TL
NSIS
Whon ovaIualing lho donlofaciaI changos lhal occui as a
iosuIl of giovlh oi lioalnonl, spocific aioas lhal shouId lo
olsoivod foi aIloialion incIudo:
1.Changos in ovoiaII faco
2.Changos in lho naxiIIa and ils donlilion
3.Changos in lho nandilIo and ils donlilion
4.nounl and diioclion of condyIai giovlh and
5.andiluIai iolalion

EVALUATON OF THE OVERALL CHANGE5 N THE
FACE
CianiaI sliucluios havo loon usod foi supoiinposing,
lasod on lho facl on lhal lolh lho nouiocianiun and ils
ioIalod cianiaI laso achiovo nosl of lhoii giovlh polonliaI
al a ioIalivoIy oaiIy ago (al liilh lho inloisphonoidaI and
inloilhnoidaI synchondiosis aio cIosod. y six oi sovon
yoais of ago lho onIy synchondiosis ionaining opon is lho
sphono-occipilaI synchondiosis. s a iosuIl lhoio is
ioIalivoIy IillIo anloioposloiioi chango in lho anloiioi
cianiaI laso. Iion lhis ago onvaids any changos lhal
occui on lho lono suifacos aio duo lo ionodoIing.
Thoiofoio, lhis pail of lho cianiaI is considoiod lo lo
ioIalivoIy slalIo.






5UPERMPO5TON METHOD5:
SION HORIZONT (COLN, 1955)
Tho asion HoiizonlaI is a pIano consliuclod al a IovoI
of anloiioi loidoi of foianon nagnun paiaIIoI lo lho
Iiankfoil hoiizonlaI. Tho soiiaI liacings shouId lo
iogisloiod al asion and oiionlod vilh lho S-N pIanos
paiaIIoI.


RODLNT TRINCL (RODLNT, 1931)
Tho ioadlonl liiangIo (Na-S-o) and ils iogislialion poinl
R voio usod foi supoiinposilions lo doloinino ovoiaII
changos. Tho lvo liacings aio oiionlod so lhal R poinls aio
iogisloiod and lho oIlon pIanos (o-Na) aio paiaIIoI


SL-NSION INL (LRICN ORD OI
ORTHODONTICS, 199O)
Hoio lho lvo liacings aio oiionlod on lho soIIa-
nasion Iino vilh iogislialion al soIIa. This nolhod
piovidos a conposilo viov of anounl of giovlh chango
duiing lho poiiod lolvoon lho lvo fiIns. Il is
ioasonalIy accuialo as Iong as lho giovlh chango al
Nasion foIIovs lho Iinoai oxlonsion of lho oiiginaI SoIIa-
nasion Iino.

SION - NSION !NL (RICKLTTS, 1979)
Supoiinposilion aioa is lho a- Na Iino vilh
iogislialion al CC poinl (lho poinl vhoio lho asion -
Nasion pIano and lho faciaI axis inloisocl). Il is possilIo
lo ovaIualo changos in lho faciaI axis (-CC-CN),
diioclion of chin giovlh and uppoi noIai posilion.


DISDVNTCL OI OVL LTHODS - Thoy
incoipoialo aioas of lho cianiaI laso lhal conlinuos lo
chango duiing nosl of lho gioving yoais.
Ciovlh al lho sphono-occipilaI synchondiosis
ono ionodoIing al lho Nasion -- Nasion is
dispIacod foivaid duiing ionodoIing lul vilh no
consislonl supoiioinfoiioi diioclion. Chango in
posilion of lho Nasion is duo lo lho onIaigononl of
lho fionlaI sinus and consoquonlIy lho upvaid and
dovnvaid nigialion of fionlonasaI suluio vouId
iosuIl in supoiinposilion oiiois (Knoll, 1971)
ono ionodoIing al lho SoIIa -- &ndoigoos occonliic
ionodoIing duiing adoIosconco and loyond, and
lhis iosuIls in changos in lho fossa and lho posilion
of lho nidpoinl of soIIa luisica changos (oIson,
1974).
asion - infIuoncod ly lho ionodoIing piocossos on
lho suifaco of lho CIivus (apposilion on lho anloiioi
loidoi of lho foianon nagnun, vilh sinuIlanoous
iosoiplion innoi suifaco of lho lasiIai pail of lho
occipilaI lono and apposilion on ils ouloi suifaco)
and anloiioi loidoi of foianon nagnun and
dispIacononl of occipilaI lono duo lo giovlh al
sphono-occipilaI synchodiosis (oIson, 1974).
oIlon poinl - Il is fioquonlIy olscuiod ly lho
nasloid piocoss in lho loonago yoais (ioadlonl,
1975).

E5T FT OF ANTEROR CRANAL A5E (NoIsons
(196O) cophaIonoliic sludy and oIsons (1974)
hisloIogicaI invosligalion) -- Idonlifiod vaiious lony
suifacos in lho anloiioi cianiaI laso lhal aio suilalIo foi
accuialo supoiinposilions. Thoy incIudo
1.nloiioi vaII of soIIa luicica
2.Tho conloui of ciliifoin pIalo of olhnoid lono
3.DolaiIs in lialocuIai syslon in olhnoid coIIs
4.odian loidoi of oililaI ioof
5.!Iano of sphonoid lono (pIanun sponoidaIo)
Rogislialion shouId lo dono on lho nidpoinl lolvoon
lho iighl and Iofl shadovs of lho anloiioi cuivaluios of lho
gioaloi ving of lho sphonoid lono vhoio lhoy inloisocl
lho pIanun.







Sludios:
Chafaii, LngoI, and asloi (ay, 1987) --Thoy conpaiod
1.osl fil of anloiioi cianiaI laso analony
2.Supoiinposilion on SN Iino, iogisloiod al S
3.Supoiinposilion on iogislialion-poinl R vilh
oIlon-nasion pIanos paiaIIoI
4.Supoiinposilion on lasion-nasion (Rickolls),
iogisloiod al poinl CC

Ilhough lhis sludy doos nol suggosl a piofoionco
anong lho vaiious nolhods lho uso of losl fil of lho
anloiioi cianiaI laso nay lo lolloi lhan lho olhois. Il lakos
inlo considoialion lho dolaiIod individuaI analony of lho
cianiaI laso, ialhoi lhan sinpIifying lhis analony inlo
Iinos oi pIanos (SN, o-N, a-N) vilh diffoionl iogislialion
poinls (S, R, CC), vhich nay lo nodifiod ly giovlh.

U5E5 OF OVERALL 5UPERMPO5TON5
!iovido an ovoiaII assossnonl of lho giovlh and
lioalnonl changos of lho faciaI sliucluios
nounl and diioclion of naxiIIaiy and
nandiluIai giovlh oi dispIacononl
Changos in naxiIIaiy-nandiluIai ioIalionship
RoIalivo changos in sofl lissuo inlogunonl
(spocificaIIy lho noso, Iips and chin)
!iovido infoinalion on lho ovoiaII dispIacononl
of lho loolh.

CianiaI laso supoiinposilions do nol piovido foi an
assossnonl of lho changos in lho posilion of lho loolh
vilhin lho naxiIIa oi nandilIo. In oidoi lo ollain lhis
infoinalion, naxiIIaiy and nandiluIai supoiinposilions
aio ioquiiod.

GRD ANALY55 (WE5LANDER AJO 1993)
SoIIa-nasion Iino vas usod foi supoiinposilion.
Tho occIusaI pIano and a poipondicuIai lhiough soIIa
foinod a giid syslon lhal vas liansfoiiod fion lho fiisl
liacing lo lho socond, lhus in offocl iofoiiing aII
iogislialions lo lho aioa of supoiinposilion. Changos in
lho posilion of lho naxiIIa and lho nandilIo voio
noasuiod in iofoionco lo lho giid syslon. Changos in lho
posilion of lho nandiluIai condyIos voio sludiod ly
noasuiing lho dislanco fion condyIion lo lho inloisoclion
of lho condyIion-gnalhion Iino and lho infoiioi oulIino of
lho cianiaI laso

MAXLLARY 5UPERMPO5TON
Tho puiposo of naxiIIaiy supoiinposilion is lo
ovaIualo lho novononl of naxiIIaiy loolh in ioIalion lo lho
lasaI pails of naxiIIa. Tho vaiious nolhods foi
supoiinposing lho naxiIIa aio
Supoiinposing aIong lho paIalaI pIano iogisloiod
al NS (ioadlonl 1937, ooio 1959, SaIznann
196O, Rickolls 196O, cnanaia 1981).









Supoiinposilion on lho nasaI fIooi vilh fiIns
iogisloiod al anloiioi suifaco of naxiIIa. (Dovns
1948, iodio 1949)




Supoiinposilion aIong
lho paIalaI pIano iogisloiod al ploiygonaxiIIaiy
fissuio (ooio 1959)

Thoso nolhods of naxiIIaiy supoiinposilion lhal uso
lho paIalaI pIano aio conpionisod locauso of lho
ionodoIing of lho paIalaI shoIvos. Tho haid paIalo
undoigoos conlinuous iosoiplion on ils nasaI suifaco and
apposilion on lho oiaI sido naking nosl of lhoso nolhods

of supoiinposilion unsalisfacloiy. olh poinls NS and
!NS undoigo significanl anloioposloiioi ionodoIing.

Supoiinposilion on lho oulIino of infialonpoiaI
fossa and posloiioi poilion of haid paIalo (RoidoI
1974)







Supoiinposilion iogisloiing lho naxiIIa on lho
connon !ln co-oidinalo, nainlaining lho lasion
HoiizonlaI ioIalionship (Colon 1986). This
nolhod iIIuslialos lho naxiIIaiy conliilulion lo
nidfaco doplh and lho hoiizonlaI and voilicaI
changos of lho






paIalo and lho naxiIIaiy donlilion ioIalivo lo lolh
!ln and asion hoiizonlaI.
Supoiinposilion on lho losl fil of inloinaI paIalaI
sliucluios (c nanaia 1981)






Supoiinposilion on nolaIIic inpIanls (joik and
skioIIoi 1976). In lhoii sludy using nolaIIic
inpIanls lhoy found lhal ionodoIing invoIvos
iosoiplivo Iovoiing of lho nasaI fIooi lhal in nosl

inslancos is gioaloi anloiioiIy lhan posloiioiIy.
Tho zygonalic piocoss did nol undoigo lho sano
ionodoIing changos .On lho lasos of lhoso
findings lhoy ioconnondod lho uso of hoadfiIn
liacing supoiinposilion on lho anloiioi suifaco of
lho zygonalic piocoss of lho naxiIIa.


SliucluiaI supoiinposilion on lho anloiioi
suifaco of lho zygonalic piocoss of lho naxiIIa.
(joik and SkioIIoi 1976) vilh lho socond hoad
fiIn oiionlod so lhal lho iosoiplivo Iovoiing of
lho nasaI fIooi is oquaI lo lho apposilion al lho
oililaI fIooi.










89:/ ly NioIson (}O 1989) conpaiod lho popuIai
osl fil nolhod vilh lhal of inpIanl and sliucluiaI
supoiinposilion nolhods.
NioIson found lhal lho losl fil nolhod significanlIy
undoioslinalos lho voilicaI dispIacononl of noIai
loolh ly 3O and lhal of incisois up lo 5O. Tho sludy
fuilhoi dononslialod lhal, vilh lolh lho inpIanl

nolhod and sliucluiaI nolhod, NS shovod lvico as
nuch as dispIacononl as !NS.
No slalislicaIIy significanl diffoioncos voio found
lolvoon lho sliucluiaI and inpIanl nolhods in lho
voilicaI pIano.
In lho hoiizonlaI pIano lho sliucluiaI nolhod on
avoiago dononslialod posloiioi dispIacononl of lho
iofoionco poinls ly O.5 nn.
Honco il has loon concIudod lhal lho sliucluiaI
nolhod foi supoiinposing hoad fiIns is a vaIid and
ioIialIo nolhod foi doloinining naxiIIaiy giovlh and
lioalnonl changos.
Tho najoi disadvanlago of using lho sliucluiaI
nolhod is lhal lho zygonalic piocoss of naxiIIa is
chaiacloiizod ly doulIo sliucluios, vhich nako il difficuIl
lo idonlify accuialoIy and honco lo liaco lho consliuclion
Iino. In addilion if lho anloiioi suifaco of lho zygonalic
piocoss is shoil, supoiinposilion can cioalo iolalionaI
offocl, vhich can causo loolh novononls lo lo
nisinloipiolod. So quaIily hoad fiIns aio ioquiiod.
nloiioi and posloiioi conlouis of zygonalic aichos
aio supoiinposod aIIoving lho fIooi of lho oilil lo lo
iaisod noio lhan lho paIalaI pIano in a ialio of 1.5:1

DoppoI (}O 1994) conpaiod vaiious
supoiinposilion nolhods and concIudod lhal foi cIinicaI
puiposos lhis nolhod of naxiIIaiy supoiinposilion noio
cIosoIy appioxinalos inpIanl supoiinposilion.
ConcIusions diavn fion doppoIs invosligalion -
1.Tho posloiioi and anloiioi poilions of lho
zygonalic piocoss of lho naxiIIa nalchod cIosoIy
vilh lho inpIanls. Tho anloiioi poilion
dononslialod a iango of vaiialion lolvoon fiIns:
no noan diffoionco, sIighl anloiioi chango, oi
sIighl posloiioi chango. Tho posloiioi poilion of
lho zygonalic aich aIvays dononslialod
apposilion.
2.In lho voilicaI pIano, lho fIooi of lho oilil iaisod
noio lhan lho paIalaI pIano Iovoiod in a ialio of
1.5 lo 1 nn.
3.Tho naxiIIa dononslialod vaiying dogioos and
diioclions of iolalion ioIalivo lo lho cianiaI laso.
4.Tho paIalaI pIano dononslialod vaiying dogioos
and diioclions of iolalion vilhin lho naxiIIa.
5.InloinaI sliucluio of lho paIalo vas of Iinilod
vaIuo as a slalIo aioa of iogislialion.
6.InfiaoililaI foianon, !T, NS, !NS, poinl,
and supoiioi and infoiioi loidois of lho paIalo
voio nol ioIialIo Iandnaiks foi naxiIIaiy
supoiinposilion.

MODFED E5T FT METHOD:
If lho dolaiIs of lho zygonalic piocoss of lho naxiIIa (foi
sliucluiaI nolhod) aio nol cIoaiIy idonlifialIo lhon
nodifiod losl-fil nolhod is ioconnondod.
Tiaco lho naxiIIaiy sliucluios, incIuding lho oulIino
of lho paIalo, lho fiisl poinanonl noIais, lho onlianco
of incisaI canaI and lho nosl IaliaIIy posilionod
conliaI incisois on lvo consoculivo cophaIogians
using appiopiialo coIois.
!Iaco lho socond liacing ovoi lho fiisl ono
and adjusl il lo havo lho Conloui of oiaI pail of lho
paIalo, Conloui of nasaI fIooi and lho onlianco of
incisaI canaI in losl fil aIignnonl. SlaliIizo lho lvo
cophaIogians ly noans of a lapo. Thon ovaIualo lho
novononl of naxiIIaiy loolh in ioIalion lo lho lasaI
pails of naxiIIa.
Whon using lhis nolhod il shouId lo iononloiod
lhal lho losl-fil nolhod significanlIy undoioslinalos lho
voilicaI dispIacononl of noIai loolh ly 3O and lhal of
incisois up lo 5O. Tho losl lil nolhod has a Iov dogioo
of vaIidily and nodiun dogioo of iopioduciliIily.


THE 5TRUCTURAL METHOD:
Il is onIy ioconnondod if lho dolaiIs of lho zygonalic
piocoss of lho naxiIIa aio cIoaiIy idonlifialIo in lolh
cophaIogians.
Tiaco lho anloiioi conloui of lho zygonalic piocoss
and consliucl a Iino lhal is langonliaI lo il on lolh lho
cophaIogians. If lvo conlouis aio piosonl lhon, lisocl
lhon lo liaco lho nidIino lolvoon lhon.
On oach cophaIogian liaco lho conloui of lho paIalo,
naxiIIaiy fiisl noIai, lho nosl IaliaIIy posilionod
conliaI insisoi, lho zygonalic piocoss, lho fIooi of lho
oilil, N-S Iino, and lho consliuclion Iino (vhich is a
Iino langonliaI lo lho anloiioi conloui of lho
zygonalic piocoss).
Tho lvo liacings shouId lo supoiinposod on oach
olhoi on lho consliuclion Iino lo doloinino lho
anounl of apposilion al lho fIooi of lho oilil. ovo
lho supoiinposilion so lhal lho anounl of iosoiplion
al lho nasaI fIooi is oquaI lo apposilion al lho fIooi of
lho oilil. SlaliIizo lho liacings logolhoi vilh a lapo.

Thon ovaIualo lho novononl of naxiIIaiy loolh in
ioIalion lo lho lasaI pails of naxiIIa. Tho anounl of
naxiIIaiy iolalion can lo oslinalod fion lho lvo N-S
Iinos. Tho angIo foinod lolvoon lho Iinos oxpiossos
lho iolalion of lho naxiIIa.
Tho sliucluiaI nolhod of naxiIIaiy supoiinposilion has a
nodiun lo high dogioo of vaIidily Iov dogioo of
iopioduciliIily.

MANDULAR 5UPERMPO5TON
andiluIai supoiinposilions aio usod lo ovaIualo lho
novononl of nandiluIai loolh in ioIalion lo lho lasaI
pails of lho nandilIo. Tho vaiious nolhods foi
supoiinposing lho nandilIo aio:
ovoi loidoi of lho nandilIo and on lho innoi lalIo
of synphysis (SaIznann 196O, 1972).
Tho disadvanlago of lhis nolhod is lhal lho Iovoi loidoi
undoigoos significanl ionodoIing duiing giovlh (joik
1963).
Tangonl lo lho Iovoi loidoi of lho nandilIo.
Consliuclion of nandiluIai pIano using lhis nolhod
is quoslionalIo, pailicuIaiIy in lhoso casos of sovoio
anlogoniaI nolching oi vhon lho Iovoi loidoi
cuivaluio is oxlionoIy pionouncod.
Iino oxlonding fion gonion lo gnalhion. olh lho
poinls aio vaiialIo.
pIano joining gonion lo nonlon. olh lho poinls aio
vaiialIo.






Supoiinposilion on lho nandiluIai pIano is a nolhod of
Iov dogioo of vaIidily, lul of high dogioo of
iopioduciliIily.
Iion lhoii inpIanl sludios, joik (1963, 1969) and
joik and SkioIIoi (1983) havo indicalod ioIalivoIy
slalIo sliucluios lhal couId lo usod foi
supoiinposilion puiposos.
O nloiioi conloui of lho chin
O Tho innoi conloui of lho coilicaI pIalos al lho
infoiioi loidoi of lho synphysis and lialocuIai
sliucluio in lho Iovoi pail of synphysis.
O Tho conloui of nandiluIai canaI
O ovoi conloui of ninoiaIizod noIai goin (lhis
can onIy lo usod fion lho lino of iniliaI
ninoiaIizalion of lho ciovn unliI lho loginning
of iool foinalion. ofoio and afloi lhis slago of
dovoIopnonl lho loolh goin significanlIy
changos ils posilion (joik and SkioIIoi, 1983).







This nolhod has a high dogioo of vaIidily and nodiun lo
high dogioo of iopioduciliIily.
andiluIai supoiinposilion
Tiaco lho synphysis vilh innoi coilicaI lono, poinl
ailicuIaio, anloiioi conloui of ianus, nandiluIai
canaI, lhiid noIai loolh lud lofoio iool foinalion,
and nosl IaliaIIy posilionod Iovoi incisoi and lho
fiisl noIais using appiopiialo coIois of lolh lho
cophaIogians.
If aII lho foui slalIo sliucluios aio cIoaiIy idonlifialIo
lhon lhoy nusl lo usod foi supoiinposilion puiposo.
If lho lhiid noIais aio congonilaIIy nissing,
ninoiaIizalion of lho ciovn has nol yol slailod of if

lho iools nay havo aIioady slailod foining lhon lhiid
noIai loolh goin is nol a ioIialIo sliucluio foi
supoiinposilion puiposo. Tho oulIino of lho
nandiluIai canaI is difficuIl lo idonlify in consoculivo
cophaIogians. Tho shadovs of lho iighl and Iofl sidos
can ovoiIap fuilhoi conpIicaling lho piolIon. s a
iosuIl lho onIy sliucluios lhal can consislonlIy usod
foi lho puiposo of supoiinposilion aio lho innoi
coilicaI sliucluio of lho infoiioi loidoi of lho
synphysis and lho anloiioi conloui of lho chin.
!Iaco lho Iasl cophaIogian on lho fiisl ono and adjusl
il in ioIalion lo lho slalIo sliucluios of lho nandilIo.
Thon slaliIizo lho lvo cophaIogians logolhoi vilh
lapo.
If lho slalIo sliucluios lhal aio inlondod lo lo usod foi
supoiinposilion aio nol oasiIy idonlifialIo, lho Iovoi
loidoi of lho nandilIo can lo usod foi oiionlalion
puiposo.

LV&TION OI O&NT ND
DIRLCTION OI CONDR
CROWTH
CondyIai giovlh can lo
ovaIualod fion lho nandiluIai
liacing if lho hoad of lho condyIo is
idonlifiod. CondyIos aio losl
idonlifiod on a IaloiaI cophaIogian lakon in noulh opon
posilion. !oinl ailicuIaio can lo usod as a sulslilulo foi
ovaIualion.

EVALUATON OF MANDULAR ROTATON
Tiaco lho synphysis vilh innoi coilicaI lono, infoiioi
and posloiioi conloui of lho nandilIo, poinl ailicuIaio,
anloiioi conloui of ianus, nandiluIai canaI, lhiid noIai
loolh lud lofoio iool foinalion, and nosl IaliaIIy
posilionod Iovoi incisoi, fiisl noIais and N-S Iino using
appiopiialo coIois of lolh lho cophaIogians. If aII lho foui

slalIo sliucluios aio cIoaiIy idonlifialIo lhon lhoy nusl lo
usod foi supoiinposilion puiposo.

!Iaco lho Iasl cophaIogian on lho fiisl ono and adjusl
il in ioIalion lo lho slalIo sliucluios of lho nandilIo. Thon
slaliIizo lho lvo cophaIogians logolhoi vilh lapo. Tho
liuo nandiluIai iolalion can lo ovaIualod ly changos in
lho N-S Iinos lolvoon lho lvo consoculivo nandiluIai
liacings. Tho angIo oxpiossos lho anounl of nandiluIai
iolalion. Ioi inslanco, if lhoy cioss anloiioiIy, lho
nandilIo has iolalod anloiioiIy.







CONCLU5ON
If lho liacings aio nol accuialo and lho
supoiinposilions and nol nado on iadiogiaphic
sliucluios lhal havo loon piovod lo lo ioIalivoIy slalIo
and ioIialIo, lho supoiinposilion can lo nanipuIalod lo
shov anylhing lho opoialoi vanls lo shov. To poifoin an
accuialo supoiinposilion, ono has lo havo an oxcoIIonl
knovIodgo of lho analony of lho donlofaciaI and cianiaI
sliucluios as voII as of lho iadiogiaphic inloipiolalion of
lhoso sliucluios. Wilhoul such knovIodgo and
undoislanding, iadiogiaphic inloipiolalion loconos a
guossing gano ialhoi lhan lho scionco lho cophaIonoliics
is supposod lo lo. Iuilhoinoio, lho scionlific knovIodgo
shouId lo suppIononlod ly lho nanuaI skiIIs noodod lo
diav lho sliucluios lhal havo loon idonlifiod accuialoIy.






kLILkLNCLS

O 8adlographlc cephalomeLry !acobson
O CrLhodonLlc cephalomeLry ALhanaslos
ALhenaslou
O ConLemporary orLhodonLlcs Wllllam 8 rofflL
O 1wln block funcLlonal Lherapy Wllllam clark