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Jan 09, 2015

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the lateral cephalometic radiograph and identification of relevant

anatomic landmarks. Using these landmarks, today we can

construct reference planes or lines to represent cranio-facial

structures, which can then be analyzed. Analysis involves making

select measurements on the cephalometric tracing and comparing

them with normative values to identify deviations from normal

This helps the practitioner identify where problems exist . There are

various sets of normal values for different ethnic, age and gender

groups. When analyzing a cephalometric film, its important to

understand which patient population the subject belongs to. For

each value, which is one or more standard deviations outside of the

normal range, an interpretation can be made.

As mentioned before, we can examine certain relationships with the

lateral cephalometric film. These include:

1.

2.

3.

4.

5.

6.

The relationship of the mandible to the cranial base.

The relationship of the maxilla to the mandible.

The relationship of the maxillary dentition to the maxilla.

The relationship of the mandibular dentition to the mandible.

The relationship of the maxillary dentition to the mandibular

dentition.

cephalometric tracings and for each of which you will analyze and

write-up a cephalometric summary.

REFERENCE PLANES

In order to examine these relationships, we will first establish certain reference planes on the

tracing.

a. Frankfort Horizontal (FH) the line constructed form porion (Po) to orbitale (Or)

which represents the basic horizontal plane of the head.

b. Sella-Nasion (SN) the line constructed from sella to nasion which represents the

anteroposterior extent of the anterior cranial base.

c. Y-axis(S-Gn) the line constructed through sella and gnathion

d. Mandibular plane(MP) constructed as a line from gonion to gnathion.

e. Facial Plane (N-Pog) the line constructed through nasion and pogonion.

1. SNA

a. Purpose: establishes the horizontal location of the maxilla relative to the cranial base.

Note that the points being compared by this angle are sella and nasion (cranial base

points) as well as A point (maxillary point).

b. Construction: the angle between a line drawn from S to N and a line drawn from N to

A.

c. Normal value and standard deviation: 822.

d. Interpretation:

1) <80 - maxilla is retrognathic relative to the cranial base.

2) 80-84 - maxilla is normally positioned relative to the cranial base.

3) >84 - maxilla is prognathic relative to the cranial base.

a. Purpose: establishes the horizontal location of the maxilla relative to the cranial base.

Note that the points being compared by this angle are the cranial base reference line FH

and cranial base point N as well as A point (maxillary point).

b. Construction: the angle between a line drawn from Po to Or (FH) and a line drawn from

N to A.

c. Normal value and standard deviation: 903.

d. Interpretation:

1) <87 - maxilla is retrognathic relative to the cranial base.

2) 87-93 - maxilla is normally positioned relative to the cranial base.

3) >93 - maxilla is prognathic relative to the cranial base.

1. SNB

a. Purpose: establishes the horizontal location of the mandible relative to the cranial base.

Note that the points being compared by this angle are sella and nasion (cranial base

points) as well as B point (mandibular point).

b. Construction: the angle between a line drawn from S to N and a line drawn from N to

B.

c. Normal value and standard deviation: 802.

d. Interpretation:

1) <78 - mandible is retrognathic relative to the cranial base.

2) 78-82 - mandible is normally positioned relative to the cranial base.

3) >82 - mandible is prognathic relative to the cranial base.

2. Facial Angle

a. Purpose: establishes the horizontal location of the mandible relative to the cranial base.

Note that the points being compared by this angle are the cranial base references FH and

nasion as well as Pog point (mandibular point).

b. Construction: the angle between a line drawn from Po to Or (FH) and a line drawn from

N to Pog.

c. Normal value and standard deviation: 886.

d. Interpretation:

1) <82 - mandible is retrognathic relative to the cranial base.

2) 82-94 - mandible is normally positioned relative to the cranial base.

3) >94 - mandible is prognathic relative to the cranial base.

ANTEROPOSTERIOR RELATIONSHIPS

1. ANB

a. Purpose: establishes the horizontal relationship between the maxilla and the mandible.

Note that the points being compared by this angle are A point (maxillary), nasion (cranial

base), and B point (mandible).

b. Construction: the angle between a line drawn from A to N and a line drawn from N to

B. Alternatively: ANB = SNA SNB. Therefore, any negative ANB, by definition, will

have the mandible ahead of the maxilla in a class III relationship.

c. Normal value and standard deviation: 22.

d. Interpretation:

1) <0 - The skeletal relationship is class III with either a retrognathic maxilla, a

prognathic mandible, or a combination of both. A second measurement is required to

determine which jaw is at fault

2) 0-4 - The skeletal relationship is class I with the maxilla slightly ahead of the

mandible.

3) >4 - The skeletal relationship is class II with either a prognathic maxilla, a

retrognathic mandible, or a combination of both. A second measurement is required

to determine which jaw is at fault.

a. Purpose: This measure is used to assess the direction of the growth of the mandible.

Note that the points being compared by this angle are the cranial base reference plane of

FH and the mandibular plane.

b. Construction: the angle between a line drawn from Po to Or (FH) and a line drawn

between Go and Gn (MP).

c. Normal value and standard deviation: 225.

d. Interpretation:

1) <17 - implies a vertical deficiency often seen in brachyfacial growth patterns or a

counterclockwise rotation of the mandible.

2) 17-27 - mandibular growth pattern is mesofacial.

3) >27 - implies a vertical excess often seen in dolicofacial growth patterns or a

clockwise rotation of the mandible.

2. Y-Axis

a. Purpose: This measure is used to assess the direction of the growth of the mandible.

Note that the points being compared by this angle are the cranial base reference plane of

FH and a line between S and Gn.

b. Construction: the angle between a line drawn from S to Gn (Y-axis) and a line drawn

from Po to Or (FH).

c. Normal value and standard deviation: 596.

d. Interpretation:

1) <53 - implies a vertical deficiency often seen in brachyfacial growth patterns or a

counterclockwise rotation of the mandible.

2) 53-65 - mandibular growth pattern is mesofacial.

3) >65 - implies a vertical excess often seen in dolicofacial growth patterns or a

clockwise rotation of the mandible.

3. % LFH

a. Purpose: establishes the vertical proportion of the lower facial height (ANS-Me)

to the total facial height (N-Me).

b. Construction: the ratio of the linear measure of ANS-Me divided by the linear

measure of N-Me. Also represented by LFH:TFH or ANS-Me:N-Me.

c. Normal value and standard deviation: 55%.

d. Interpretation:

1) <55% - lower face height is decreased.

2) 55% - lower face height is within normal limits.

3) >55% - lower face height is increased.

DENTAL RELATIONSHIPS

1. Interincisal Angle

a. Purpose: determines the relationship between the angulation of the maxillary

incisors and the angulation of the mandibular incisors. Note that the two items

compared are the long axes of the maxillary and mandibular incisors (dental).

b. Construction: the angle between a line drawn through the long axis of the

maxillary incisor and a line drawn through the long axis of the mandibular incisor.

c. Normal value and standard deviation: 130 .

d. Interpretation:

1) <125 -either the maxillary incisors are proclined, the mandibular incisors are

proclined, or some combination of both. A second measurement is needed to

determined which incisor angulation is at fault.

2) 125-135 -the angulation between the incisors is within normal limits.

3) >135 - either the maxillary incisors are retroclined, the mandibular incisors

are retroclined, or some combination of both. A second measurement is

needed to determined which incisor angulation is at fault..

2. Upper 1(U1) to FH

a. Purpose: to determine the angulation of the maxillary incisor relative to the

cranial base. Note that the items compared are the FH plane (cranial base) and the

long axis of the maxillary incisor (maxillary dental).

b. Construction: the angle between a line drawn from Po to Or (FH) and a line

drawn through the long axis of the maxillary incisor.

c. Normal value and standard deviation: 1105.

d. Interpretation:

1) <105 - the maxillary incisor is retroclined.

2) 105-115 - the angulation of the maxillary incisor is within normal limits.

3) >115 - the maxillary incisor is proclined.

a. Purpose: to determine the angulation of the maxillary incisor relative to the

maxilla. Note that the items compared are the long axis of the maxillary incisor

(dental), nasion (cranial base), and A point (maxilla).

b. Construction: the angle between a line drawn from N to A and a line drawn

through the long axis of the maxillary incisor.

c. Normal value and standard deviation: 22.

d. Interpretation:

1) <22 - the maxillary incisor is retroclined.

2) 22-the angulation of the maxillary incisor is within normal limits.

3) >22 - the maxillary incisor is proclined.

a. Purpose:.to determine the anteroposterior position of the maxillary incisor

relative to the cranial base and the maxilla.

b. Construction: the linear distance measured from the labial surface of the

maxillary incisor to a line drawn from nasion to A point.

c. Normal value and standard deviation: 4mm

d. Interpretation:

1) <4mm the maxillary incisor is recumbent.

2) 4mm the A-P position of the maxillary incisor is within normal limits.

3) >4mm the maxillary incisor is procumbent..

a. Purpose: to determine the angulation of the mandibular incisor relative to the

mandible. Note that the items compared are the long axis of the mandibular

incisor (dental), nasion (cranial base), and B point (mandible).

b. Construction: the angle between a line drawn from N to B and a line drawn

through the long axis of the mandibular incisor

c. Normal value and standard deviation: 25.

d. Interpretation:

1) <25 - the mandibular incisor is retroclined.

2) 25 - the angulation of the mandibular incisor is within normal limits.

3) >25 -the mandibular incisor is proclined.

a. Purpose:. to determine the anteroposterior position of the mandibular incisor

relative to the cranial base and the mandible.

b. Construction: the linear distance measured from the labial surface of the

mandibular incisor to a line drawn from nasion to B point.

c. Normal value and standard deviation: 4mm.

d. Interpretation:

1) <4mm the mandibular incisor is recumbent.

2) 4mm - the A-P position of the mandibular incisor is within normal limits.

3) >4mm the mandibular incisor is procumbent..

a. Purpose: to determine the angulation of the mandibular incisor relative to the

mandible. Note that the items compared are the long axis of the mandibular

incisor (dental) and the MP (mandible).

b. Construction: the angle between a line drawn from Go to Gn (MP) and a line

drawn through the axis of the lower incisor.

c. Normal value and standard deviation: 916.

d. Interpretation:

1) <85 - the mandibular incisor is retroclined.

2) 85-97 - the angulation of the mandibular incisor is within normal limits.

3) >97 - the mandibular incisor is proclined.

1. Nasolabial Angle

a. Purpose: to assess the nose to upper lip relationship.

b. Construction: the angle between a line drawn tangent to columella of the upper

lip and a line tangent to the lower border of the nose (Sn to nasal tip).

c. Normal value and standard deviation: 1028.

d. Interpretation:

1) <94 - the upper lip is procumbent.

2) 94-110 - the position of the upper lip is within normal limits.

3) >110 - the upper lip is retrusive.

a. Purpose: determines the soft-tissue balance between lips and profile (nose-chin) and

assess lip protrusion.

b. Construction: the linear distance from the lower lip to a line drawn from the tip of

the nose to soft tissue pogonion (Pog).

c. Normal value and standard deviation: -2mm2mm

d. Interpretation:

1) <-4mm - the lower lip is retruded.

2) 4mm 0mm the position of the lower lip is within normal limits.

3) >0mm - the lower lip is protruded.

SUMMARY TABLE

Area of Study

Maxilla ry A-P Position

Measurements

CEPHALOMETRIC SUMMARY

Standard

< normal 1SD

>normal + 1SD

SNA

N-A to FH

822

903

Retrognathic maxilla

Retrognathic maxilla

Prognathic maxilla

Prognathic maxilla

SNB

N-Pog to FH

802

886

Retrognathic mandible

Retrognathic mandible

Prognathic mandible

Prognathic mandible

ANB

22

prognathic mandible, or a combination of both.

retrognathic mandible, or a combination of both.

Y-axis

596

FMA

225

Counterclockwise mandibular rotation

Brachyfacial; decreased vertical;

Counterclockwise mandibular rotation

Clockwise mandibular rotation

Dolichofacial; increased vertical;

Clockwise mandibular rotation

55%

Interincisal

1305

mandibular incisors, or a combination of both.

mandibular incisors, or a combination of both.

U1 to FH ()

U1 to NA ()

U1 to NA (mm)

L1 to NB ()

L1 to NB (mm)

L1 to MP ()

1103

22

4mm

25

4mm

916

Retroclined maxillary incisors

Recumbent maxillary incisors

Retroclined mandibular incisors

Recumbent mandibular incisors

Retroclined mandibular incisors

Proclined maxillary incisors

Procumbent maxillary incisors

Proclined mandibular incisors

Procumbent mandibular incisors

Proclined mandibular incisors

L lip to E plane

Nasolabial

Angle

-2mm2mm

1028

Protruded upper lip

Retruded upper lip or tipped up nose

Maxillo-mandibular Relations

Vertical Relations

% LFH

Maxillary and Mandibular

Incisor Position

Soft Tissue

LABORATORY CASES

CEPHALOMETRIC SUMMARY

Area of Study

Maxillary A-P Position

Measurements

Standard

Case 1

SNA

N-A to FH

822

903

SNB

N-Pog to FH

802

886

ANB

22

Y-axis

FMA

% LFH

596

225

55%

Interincisal

U1 to FH ()

U1 to NA ()

U1 to NA (mm)

L1 to NB ()

L1 to NB (mm)

L1 to MP ()

1305

1103

22

4mm

25

4mm

916

L lip to E plane

Nasolabial

Angle

-2mm2mm

1028

Maxillo-mandibular Relations

Vertical Relations

Incisor Position

Soft Tissue

Narrative Summary

Patient 1

Antero-posterior relations:

Case 2

Case 3

Case 4

Case 5

Maxilla

Mandible

Maxillary incisors

Anglular

Linear

Mandibular Incisor

Angular

Linear

Vertical relations:

Increased

Decreased

Normal

Proportional face height

Soft tissue:

Upper lip

Lower lip

Narrative Summary

Patient 2

Antero-posterior relations:

Maxilla

Mandible

Maxillary incisors

Anglular

Linear

Mandibular Incisor

Angular

Linear

Vertical relations:

Increased

Decreased

Normal

Proportional face height

Soft tissue:

Upper lip

Lower lip

Narrative Summary

Patient 3

Antero-posterior relations:

Maxilla

Mandible

Maxillary incisors

Anglular

Linear

Mandibular Incisor

Angular

Linear

Vertical relations:

Increased

Decreased

Normal

Proportional face height

Soft tissue:

Upper lip

Lower lip

Narrative Summary

Patient 4

Antero-posterior relations:

Maxilla

Mandible

Maxillary incisors

Anglular

Linear

Mandibular Incisor

Angular

Linear

Vertical relations:

Increased

Decreased

Normal

Proportional face height

Soft tissue:

Upper lip

Lower lip

Narrative Summary

Patient 5

Antero-posterior relations:

Maxilla

Mandible

Maxillary incisors

Anglular

Linear

Mandibular Incisor

Angular

Linear

Vertical relations:

Increased

Decreased

Normal

Proportional face height

Soft tissue:

Upper lip

Lower lip

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