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 Aspects 4
Cephalometric X-ray Tracing Techniques 4

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 Bone 15 Nasion  16
Articulation of Frontal Bone 15 Supra-Orbitale  17
Cephalometric Landmarks (Points) on Frontal Bone 15
Roof of the Orbital Cavity  17
Radiographic Anatomy of Frontal Bone 15
Frontonasal/Fronto­maxillary Nasal Suture  18
4. Cephalometric landmarks related to ethmoid bone ............................................................... 21
Parts of Ethmoid Bone 21 Neck of Crista Galli 23
Articulation of Ethmoid Bone 21 Medio-orbitale 23
Cephalometric Landmarks (Points) on Ethmoid Bone 21
Sphenoethmoidal Point 24
Temporale 21
Ethmoidale 24

5. Cephalometric landmarks related to Nasal bone.................................................................... 26

Articulation of frontal bone  26 Frontonasal/Fronto­maxillary Nasal Suture 28
Radiographic anatomy of nasal bone 26 Rhinion 29
Nasion 26

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

Articulation of Temporal Bone  31 Porion 32
Radiographic Anatomy of Temporal Bone 31 Zygomatic Arch 32
Cephalometric Landmarks (Points) on Temporal Bone 31
Mastiodale 33

7. Cephalometric landmarks related to sphenoid bone ............................................................. 35

Cephalometric Landmarks (Points) on Sphenoid Bone  35 Pterygoid point 40
Dorsum of Sella 36 Sella 41
Floor of Sella 37 Sella Entrance 41
Clinoidale 38 Sphenoethmoidal point 42
Spheno-Occipital Synchondrosis 39 Pterygomaxillary Fissure 44
 xii

8. Cephalometric landmarks related to occipital bone .............................................................. 46

Cephalometric landmarks (Points) on occipital bone 46 Opisthion 48
Radiographic anatomy of Occipital bone 46 Bolton’s point 48
Basion 46 Spheno-occipital synchondrosis 50

9. Cephalometric landmarks related to Zygomatic bone ............................................................. 52

Radiographic Anatomy of Zygomatic Bone 52 Orbitale 52
Cephalometric landmarks (Points) on Zygomatic Temporale 54
bone 52

Section 4: Cephalometric Landmarks Related to Facial Bones and Dentition

10. Cephalometric Landmarks Related to Maxilla............................................................................ 59
Cephalometric Landmarks (Points) on Maxilla 59 Posterior Nasal Spine 64
Anterior Nasal Spine 59 Pterygomaxillary Fissure 65
Point A 61 Key Ridge 66
An Atlas on Cephalometric Landmarks

Prosthion 62 Orbitale 67

11. Cephalometric Landmarks Related to Dentition............................................................................ 70

Incision Superius Incisalis 71 Maxillary Central Incisor 79
Incision Superius Apicalis 73 Maxillary First Molar 79
Incision Inferius Incisalis 74 Mandibular Central Incisor 80
Incision Inferius Apicalis 75 Mandibular First Molar 81
Anterior Point of Occlusion 76 mi 82
Posterior Point of Occlusion 77 ms 83

12. Cephalometric Landmarks Related to Mandible............................................................................ 85

Cephalometric landmarks (Points) on Mandible 85 Gnathion 89
Parts of Mandible 85 dd 91
Nerve Supply to Mandible 85
Menton 92
Articulations 86
Gonion 93
Infradentale 86
Articulare 93
Point B 87
kk 94
Pogonion 88
Condylion 95

Section 5: Cephalometric Landmarks Related to Cervical Bones

13. Cephalometric landmarks related to hyoid bone ................................................................. 101
Parts of the Hyoid Bone 101 Cephalometric Landmarks (Points) on Hyoid Bone 101
Radiographic Anatomy of Hyoid Bone 101 Hyoid 101

14. Cephalometric landmarks related to Vertebrae......................................................................... 103

Radiographic anatomy of cervical vertebrae 103 cv2ip 104
Cephalometric Landmarks on Cervical Vertebra 103 cv2ap 104
Cephalometric Landmarks (Points) Related to Cervical cv2ia 106
Vertebra 103 cv3sp 106
 xiii

cv3ip 107 cv5ip 113
cv3sa 107 cv5sa 113
cv3ia 109 cv5ia 115
cv4sp 109 cv6sp 115
cv4ip 110 cv6ip 116
cv4sa 110 cv6sa 116
cv4ia 112 cv6ia 118
cv5sp 112 Cervical Vertebrae as Indicators of Skeletal Maturity 118

Section 6: Cephalometric landmarks related to Pharynx

15. Cephalometric landmarks related to Pharynx........................................................................ 123
Nasopharynx 123 Posterior Pharyngeal Wall 124
Oropharynx 123 Superior Pharyngeal Wall 124
Laryngopharynx 123 Tip of the Uvula 124
Cephalometric Landmarks (Points) on Pharynx 123 Point on the Oral Side of the Soft Palate 124
Anterior Nasal Spine, Posterior Nasal Spine and Point on the Pharyngeal Side of the Soft Palate 124
Pterygomaxillary Fissure 123 Upper Point of Tongue 124
Anterior Pharyngeal Wall 123 Significance 124

Section 7: Soft Tissue Cephalometric Landmarks

16. Soft Tissue Cephalometric Landmarks.......................................................................................... 127

Contents
Soft Tissue Cephalometric Landmarks (Points) Related to Subnasale 131
Forehead 127 Soft Tissue Subspinale 133
Soft Tissue Glabella 127 Labrale Superius 134
Soft Tissue Nasion 128 Stomion 135
Nasal Crown 129 Labrale Inferius 136
Pronasale 129 Soft Tissue Submentale 136
Point “T” 130 Soft Tissue Pogonion 138
Alar Crease Junction 131 Soft Tissue Gnathion 139

Section 8: 3D Cephalometric Landmarks

17. 3D Cephalometric Landmarks.................................................................................................... 143
Vertex 143 Zygomatic Prominence 149
Soft Tissue Nasion 143 Zygion 149
Pronasale 144 Condylion 149
Subnasale 144 Gonion 150
Soft Tissue Subspinale 145 Ch 150
Labrale Superius 146 Cheilion 151
Stomion 146 Alare 151
Labrale Inferius 146 Exocanthion 151
Soft Tissue Submentale 147 Sella 152
Soft Tissue Pogonion 147 Sella entrance 153
Soft Tissue Gnathion 148 Basion 153
Orbitale 148 Anterior Nasal Spine 154
 xiv

Section 9: PA Cephalometric Landmarks

18. PA Cephalometric Landmarks.................................................................................................... 159
Taking Pa Cephalogram 160 Maxillary First Molar 168
Structures Involved in Pa Cephalogram 160 Cuspid  169
Crista galli 160 Incision Inferius Incisalis  169
Top of nasal septum 161 Incision Inferius Apicalis 170
NC 162 Incision inferius frontale 171
Zyg-Zygoma 162 Mandibular First Molar 171
zygion 163 mi 172
Zygomatic arch 163 Mandibular molar 173
Zygomatic suture point 164 Menton 173
Jugal process  164 Articulare 174
Maxillare 165 malare 174
Incision Superius Incisalis 165 Antegonial Tubercles 175
An Atlas on Cephalometric Landmarks

Incision Superius Apicalis 166 Antegonion 175

Maxillary molar 167

Section 10: SV Cephalometric Landmarks

19. SV Cephalometric Landmarks.................................................................................................... 179
Basion 179 Maxillary Apical Base Midline  185
Opisthion 179 Mandibular Dental Midline 185
Foramina spinosa points 180 Mandibular Apical Base Midline 186
Foramina spinosum 180 First Molar Point 187
Odontoid 181 Gonion point 187
Pterygomaxillary fissure 182 Condylion medialis 188
Middle cranial fossa points 182 Condylion lateralis 188
Posterior Vomer point 182 Condylion Anterioris 189
Posterior Cranial vault points 183 Condylion posterioris 190
Angulare point 184

Section 11: Applications of Cephalometric Landmarks

20. Applications of Cephalometric Landmarks.............................................................................. 193
Bjork Cephalometric Analysis 193 Holdaway Cephalometric Analysis 197
Coben Craniofacial and Dentition Cephalometric Legan and Burstone Soft Tissue Cephalometric
Analysis 194 Analysis 198
Downs Cephalometric Analysis 195 Rickett’s Cephalometric Analysis 198
Farkas and Coworkers Soft Tissue Cephalometric Sassouni Cephalometric Analysis 199
Analysis 196 Di Paolo’s Quadrilateral Analysis 200
Harvold Cephalometric Analysis 196 Hasund (Bergen) Cephalometric Analysis 200
 xv

Jarabak Cephalometric Analysis 201 Wit’s Cephalometric Analysis 206

Riedel Cephalometric Analysis 202 Basis Cephalometric Analysis 207
Schwartz Cephalometric Analysis 203 Cagliari Cephalometric Analysis 207
Wylie Cephalometric Analysis 203 Chieti Cephalometric Analysis 208
Steiner’s Cephalometric Analysis 204 McGann Cephalometric Analysis 209
Tweed’s Cephalometric Analysis 205

Index...................................................................................................................................................... 211

Contents
Section 1
Introduction and History

 Cephalometry in Orthodontics
 Chapter
1 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
 4
3. It is used to monitor the changes occurring due to growth
or treatment or their combination. In other words, precise
evaluation of patient’s 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
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
Section 1  Introduction and History
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 Class-
IIDivision 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 2
Classification of Cephalometric
Landmarks

 Classification of Cephalometric Landmarks

 Chapter

2 Classification of
Cephalometric Landmarks

Cephalometry makes use of certain landmarks or points 1. Hard tissue cephalometric landmarks.
on the skull which are used for quantitative analysis and 2. Soft tissue cephalometric landmarks.
measurements. 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.
Hard tissue cephalometric landmarks
Classification of cephalometric landmarks
These landmarks represent the actual hard tissue structures of
based on Origin
the skull, such as nasal bone, ethmoidal bone, frontal bone,
Based on the origin, cephalometric landmarks/points are maxillary bone, mandible and hyoid, etc.
classified in the following two types (Flow chart 2.1):
Examples of hard tissue cephalometric landmarks—
1. Anatomic cephalometric landmarks/points.
• Nasion
2. Derived cephalometric landmarks/points.
• Neck of crista galli
Flow chart 2.1: Cephalometric landmarks/points • Temporale
• Sella
• Menton
• Gonion.

Soft tissue cephalometric landmarks

Cephalometric landmarks/points located on soft tissues are
Anatomic cephalometric landmarks/points categorized as soft tissue cephalometric landmarks/points.
These landmarks represent the actual anatomic structures of Soft tissues:
the skull, e.g. Nasion, point A, point B, ANS, PNS, etc. • Forehead
• Nose
Derived cephalometric landmarks/points • Lips
These are landmarks that have been obtained secondarily from • Chin.
anatomic structures in a lateral cephalogram, e.g. Gnathion,
Examples of soft tissues cephalometric landmarks—
Anterior Point of Occlusion, etc.
• Soft tissue nasion
• Subnasale
cephalometric landmarks Based on
• Subspinale
Structures Involved • Stomion
Based on structures involved, cephalometric landmarks/points • Soft tissue pogonion
can be classified as follows (Flow chart 2.2): • Soft tissue gnathion.
 8

Cephalometric landmarks Based on the type • Point B

or Side Involved • Menton, etc.

Based on the side involved cephalometric landmarks/points Bilateral cephalometric landmarks

can be classified as follows (Flow chart 2.3):
1. Unilateral cephalometric landmarks. These are cephalometric landmarks found on both right and
2. Bilateral cephalometric landmarks. left side.
Examples
Flow chart 2.3: Cephalometric landmarks/points
• Gonion
• Articulare
• APOcc
• U 6
• L 6, etc.

Hard or Soft Tissue cephalometric landmarks

Section 2  Classification of Cephalometric Landmarks

Cephalometric landmarks/points can be hard or soft tissue

Unilateral cephalometric landmarks landmarks. Hard tissue and soft tissue landmarks can be further
These are cephalometric landmarks or points situated in the classified into anatomic and derived and then subclassified
midline. into unilateral or bilateral (Flow chart 2.4).
Examples
• Nasion Cephalometric Landmarks/Points can be Found
• Neck of crista galli on lateral Cephalogram, PA Cephalogram and
• Point A SV Cephalogram (Flow Chart 2.5)

Flow chart 2.4: Cephalometric landmarks/points

Flow chart 2.5: Cephalometric landmarks/points

 9

Types of Cephalometric Landmarks/Points Classification of Cephalometric Landmarks/

Cephalometric landmarks/points can be classified into follow-
ing 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
Points Based on their Location
The detailed description of the cephalometric landmarks/
points in this book follows this working classification (Flow
chart 2.7).

Flow chart 2.6: Cephalometric landmarks/points

Chapter 2  Classification of Cephalometric Landmarks

Flow chart 2.7: Cephalometric landmarks/points

B C
 10

Cephalometric landmarks/points related to Cephalometric landmarks/points related to zygomatic

cranial bones bone

Cephalometric landmarks/points related to frontal • Orbitale

• Temporale
bone
• Nasion Cephalometric landmarks/points related to
• Supra-orbitale Facial Bone and Dentition
• Roof of orbit
• Frontozygomatic suture Cephalometric landmarks/points related to maxilla
• Frontale
• Frontomaxillary nasal suture • Anterior nasal spine
• Point A
Cephalometric landmarks/points related to ethmoid • Anterior point of occlusion
bone • Prosthion
Section 2  Classification of Cephalometric Landmarks

• Posterior nasal spine

• Temporale • Pterygomaxillary fissure
• Neck of crista galli • Key ridge
• Medio-orbitale • Orbitale
• Sphenoethmoidal point
• Ethmoidale Cephalometric landmarks/points related to dentition
Cephalometric landmarks/points related to nasal bone • Incision superius incisalis
• Incision superius apicalis
• Nasion • Incision inferius incisalis
• Rhinion • Incision inferius apicalis
• Frontonasal/frontomaxillary nasal suture • Anterior point of occlusion
• Posterior point of occlusion
Cephalometric landmarks/points related to temporal • Maxillary central incisor
bone • Maxillary first molar
• Porion • Mandibular central incisor
• Zygomatic arch • Mandibular first molar
• Mastiodale • Mi
• Ms
Cephalometric landmarks/points related to sphenoid
bone Cephalometric landmarks/points related to mandible
• Dorsum sella • Infradentale
• Floor of sella • Point B
• Clenoidale • Pogonion
• Spheno-occipital synchondrosis • Gnathion
• Pterygoid point • dd
• Pterygomaxillary fissure • Menton
• Foramen spinosum point • Gonion
• Sella • Articulare
• Sphenoethmoidal point • kk
• Condylion
Cephalometric landmarks/points related to occipital bone
Cephalometric landmarks/points related to Cervical
• Basion
bones
• Opisthion
• Bolton’s point Cephalometric landmarks/points related to hyoid bone
• Spheno-occipital synchondrosis • Hyoid.
 11

Cephalometric landmarks/points related to vertebrae • Nasal crown

• cv2ap • cv4ia • Pronasale
• cv2ip • cv5sp • Point T
• cv2ia • cv5ip 3. Soft tissue cephalometric landmarks or points related to lips
• cv3sp • cv5sa Upper lip
• cv3ip • cv5ia • Soft tissue subspinale
• cv3sa • cv6sp • Labrale superius
• cv3ia • cv6ip • Philtrum
• cv4sp • cv6sa • Cuspid bow
• cv4ip • cv6ia • Vermilion border of upper lips
• cv4sa Lower lip
• Labrale inferius
Soft tissue cephalometric landmarks/points • Soft tissue point B
Soft tissue cephalometric landmarks or points can be classified Upper and lower lips

Chapter 2  Classification of Cephalometric Landmarks

as follows (Flow chart 2.8): • Stomion
1. Soft tissue cephalometric landmarks or points related to - Stomion superius
forehead - Stomion inferius
• Trichion 4. Soft tissue cephalometric landmarks/points related to chin
• Soft tissue glabella. • Soft tissue pogonion
2. Soft tissue cephalometric landmarks or points related to nose • Soft tissue menton
• Soft tissue nasion • Soft tissue gnathion.

Flow chart 2.8: Soft tissue cephalometric landmarks/points

Section 3
Cephalometric Landmarks
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
Cephalometric Landmarks
3 Related to Frontal Bone

The frontal bone (Fig. 3.1) (Os frontale in Latin), is a Table 3.1: Cephalometric landmarks (points) related to frontal bone
membranous bone that forms the anterior part of the cranial
vault. The frontal is like half a shallow, irregular cap forming Cephalometric landmarks Abbreviation Type Origin
the forehead or form on each side a horizontal orbital part roof Nasion N or Na Unilateral Anatomic
of most of an orbital cavity. The frontal bone is thick with Supra-orbitale SOr Bilateral Anatomic
trabecular tissue between compact laminae, trabecular being Roof of orbit RO Bilateral Anatomic
absent near the frontal sinuses.
Frontomaxillary nasal FMN Unilateral Anatomic
suture
Parts of Frontal Bone
Parts of frontal bone are listed below:
Radiographic Anatomy of Frontal Bone (Fig. 3.2)
• Squamous part
• Orbital plates On lateral cephalogram, the inner and outer cortical plates
• Nasal process of frontal bone appear as two parallel radio-opaque lines
• Zygomatic process. descending downwards from coronal suture. Anterio-inferiorly,
these two radio-opaque lines diverge to encase the frontal sinus,
Articulation of Frontal Bone which appears radiolucent area.
The frontal bone articulates with 12 bones in total and is listed The outer radio-opaque line representing outer cortical
below: plates meets nasal bone at frontonasal suture, while the inner
• Parital bone • Sphenoid bone radio-opaque line representing inner cortical plate meets
• Ethmoid bone • Maxillary bone
• Nasal bone • Lacrimal bone
• Zygomatic bone • Temporal bone

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 3.2: Radiographic anatomy of the frontal bone on the

Figure 3.1: Frontal bone 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 N–Nasion 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
Nasion (Figs 3.3A to D) is the most anterior point of the
frontonasal suture in the middle.1
Section 3  Cephalometric Landmarks Related to Cranial Bones

A B

C D

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

According to Willam B Downs
Nasion is the suture between the frontal and nasal bones.1
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
Nasion is the craniometric point where the midsagittal plane
intersects the most anterior point of the frontonasal suture, the
anterior termination of the Bolton’s plane.3
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.
17
• Relationship of anterior and posterior cranial base is
assessed using N-S-Ar angle.
Supra-Orbitale
Abbreviation
SOr–Supra-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
Chapter 3  Cephalometric Landmarks Related to Frontal Bone
According to Viken Sassouni
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.
Significance (Ref to Chapter 20)
• 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
RO–Roof 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
Section 3  Cephalometric Landmarks Related to Cranial Bones

A B

C D

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 Frontonasal/Frontomaxillary
The roof of the orbital cavity is formed by the bone between Nasal Suture
the anterior cranial fossa above and the orbital cavity below.

According to Viken Sassouni

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.
Abbreviation
FMN–Frontomaxillary 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 Frontomaxillary nasal suture (Figs 3.6A to D) is the most
cavity are superimposed and reveal as a radio-opaque line superior point of the suture, where the maxilla articulates with
anteriorly and posteriorly leading to pituitary fossa. the frontal and nasal bones.
 19

A B

Chapter 3  Cephalometric Landmarks Related to Frontal Bone

C D

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

A B

C D
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 1. Downs WB. Variations in facial relationships. Their significance in
treatment and prognosis. Am J of Ortho. 1948;34:812-39.
tissue cephalometric landmark. 2. Graber TM. New horizons in case analysis-clinical cephalometrics. Am
J of Ortho.1952;38:603-24.
Significance (Ref to Chapter 20) 3. Broadbent BH Sr. Bolton’s standards of dentofacial developmental
growth. The CV Mosby Company. 1975;133-5.
Frontomaxillary nasal suture is situated/located on anterior 4. Farkas LG. Anthropometry of the head and face in medicine—Elsevier
North Holland, Inc. 1981;9-14.
cranial base, unlike N and can therefore also be used for 5. Sassouni V. Orthodontics in dental practice. The CV Mosby Company.
measurement or defining the cranial base (Moyers 1988). 1971;330-7.
Section 3  Cephalometric Landmarks Related to Cranial Bones
 Chapter

4 Cephalometric landmarks
related to ethmoid bone

The ethmoid bone (Fig. 4.1) (Os ethmoidale in Latin). The • Lacrimal bone – (2)
Ethmoid bone is cuboidal and fragile, lies anterior in the • Palatine bone – (2)
cranial base and is involved in the structure of the orbital walls • Vomer
and nasal septum, the roof and lateral walls of the nasal cavity. • Maxillary bone – (2)
It is described as a heavy horizontal cribriform plate, a median • Inferior nasal concha – (2)
plate and two total labyrinths. • Nasal bone – (2).

Parts of Ethmoid Bone Cephalometric Landmarks (Points) on

Parts of ethmoid bone are listed below: Ethmoid Bone
• Cribriform plate Cephalometric landmarks seen on the ethmoid bone are of
• Crista galli anatomic origin and are as follows (Table 4.1):
• Perpendicular plate.
Table 4.1: Cephalometric landmarks (points) related to ethmoid bone
Articulation of Ethmoid Bone Cephalometric landmarks Abbreviation Type Origin
The ethmoid bone articulates with 13 bones in total and is Temporale Te Bilateral Anatomic
listed below:
Neck of the crista galli NC Unilateral Anatomic
• Sphenoid bone
• Frontal bone Medio-orbitale mo Bilateral Anatomic
Sphenoethmoidal point 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
Te–Temporale is abbreviated using English alphabets and is
Figure 4.1: Ethmoid bone expressed as capital or upper case T followed by small letter
 22

or lower case e and is written continuously without any space

between the alphabets.

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.

According to Viken Sassouni

Intersection of the shadows of the ethmoid and anterior wall
of the infra-temporal fossa.1
Section 3  Cephalometric Landmarks Related to Cranial Bones

Type
Temporale (Figs 4.3A to D) is a bilateral, anatomic, hard
tissue cephalometric landmark.
Figure 4.2: Radiographic anatomy of ethmoid bone

A B

C D

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

Neck of Crista Galli
Abbreviation
NC–Neck 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
According to Viken sassouni
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
Type
Neck of crista galli is an anatomic, unilateral, hard tissue
cephalometric landmark.
Significance (Ref to chapter 20)
• The crista galli is an important landmark of the midline
for the analysis of bilateral symmetry in a posteroanterior
cephalogram.
A B
Figures 4.5 A and B: Medio-orbitale on the lateral
cephalogram; (B) Magnified image showing
medio-orbitale on the lateral cephalogram A B
23
• Crista galli lies behind the frontal sinuses on the lateral
cephalogram and in the central part of the cranium on the
posteroanterior cephalogram.
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
Chapter 4  Cephalometric Landmarks Related to Ethmoid Bone
Abbreviation
mo–Medio-orbitale is abbreviated using English alphabets
and is expressed as lower case m, o and written continuously
without any space between the alphabets.
Definition
According to Athanasios E Athanasiou
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
 24

Type According to SN Bhatia and BC Leighton

Medio-orbitale is an anatomic, bilateral, hard tissue cephalo­ The point of intersection between the greater wings of the
metric landmark. sphenoid and the anterior cranial base.4

Sphenoethmoidal Point Type

Sphenoethmoidal point is an anatomic, unilateral, hard tissue
Abbreviation cephalometric landmark.

SE–Sphenoethmoidal point is abbreviated using English

alphabets and is expressed as upper case S, E and written Ethmoidale
continuously without any space between the alphabets.
Section 3  Cephalometric Landmarks Related to Cranial Bones

Definition Abbreviation
Eth–Ethmoidale is abbreviated using English alphabets and
According to Robert E Moyers is expressed as capital or upper case E and small alphabets
The intersection of the shadows of the grater wing of or lower case th and written continuously without any space
the sphenoid and the cranial floor as seen in the lateral between the alphabets.
cephalogram3 (Figs 4.6A to D).

A B

C D

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

Chapter 4  Cephalometric Landmarks Related to Ethmoid Bone

A B

C D

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 (D  Magnified image
of ethmoidale on graphic illustration

Definition
According to Arne Bjork
The deepest median point of the anterior cranial fossa, corres­
ponding to the cribriform plate of the ethmoid bone.5
According to SN Bhatia and BC Leighton
Ethmoidale (Figs 4.7A to D) is the lowest point on the anterior
cranial fossa or the outline of the cribriform plate.4
References
1. Viken Sassouni—Orthodontics 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 years–old
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 growth–Oxford University
press. 1993:10-5.
5. A Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.

Type
Ethmoidale is an anatomic, unilateral, hard tissue cephalo­
metric landmark.
 CHAPTER

5 Cephalometric Landmarks
Related to Nasal Bone

The nasal bone (Fig. 5.1) (Os nasale in Latin), are paired Radiographic Anatomy of Nasal Bone (Fig. 5.2)
bones that lie in the midline above the nasal fossae between
the frontal processes of the maxilla. They articulate superiorly On lateral cephalogram, the nasal bone appears as a
with the frontal bone at the fronto-nasal suture. 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
Articulation of Frontal Bone
bones. The posterior part of the inner surface of the nasal
The nasal bone articulates with four bones in total and is listed bone merges with the radio-opaque line of the cribriform
below: plate of the ethmoid bone. The anteromedial point of the
• Maxilla frontonasal suture is identified as nasion and posteroinferior
• Frontal bone point is identified as FMN.
• Ethmoid bone
• Nasal bone of opposite side. Nasion
Cephalometric Landmarks (Points)
on Nasal Bone Abbreviation
Cephalometric landmarks seen on the nasal bone are of N–Nasion is abbreviated using English alphabet and is
anatomic origin and are as follows (Table 5.1): expressed as capital letter or upper case N.

Table 5.1: Cephalometric landmarks related to nasal bone

Cephalometric landmarks Abbreviation Type Orgin
Nasion N OR Na Unilateral Anatomic
Frontonasal/frontomaxillary FMN Unilateral Anatomic
nasal suture
Rhinion 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 Nasion is the suture between the frontal and nasal bone.3
frontonasal suture in the middle.

According to TM Graber Type

Nasion is the junction of the nasal bone and frontal bones as Nasion is a unilateral, anatomic, hard tissue cephalometric
seen on the profile of the cephalometric roentgenogram.1 landmark.

According to B Holly Broadbent

Origin
Nasion is the craniometric point where the midsagittal plane
intersects the most anterior point of the frontonasal suture; the Nasion is a hard tissue cephalometric landmark of anatomic
anterior termination of the Bolton plane.2 origin.

Chapter 5  Cephalometric Landmarks Related to Nasal Bone

A B

C D

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

Significance (Ref to Chapter 20)
Nasion is used as one of the reference point in the
construction of angles and planes for the assessment of the
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
Section 3  Cephalometric Landmarks Related to Cranial Bones
A is a positive value and a posterior position of point A
is a negative value.
• In Rickett’s 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.
Frontonasal/Fronto­maxillary Nasal
Suture

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
Abbreviation
FMN–Frontomaxillary suture is abbreviated using English
alphabets and is expressed as capital F, M and N and is written
continuously without any space between the alphabets.
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.

A B

C
D

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

According to Robert M Moyers Rhinion

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
Rh–Rhinion is abbreviated using English alphabets and is ex-
pressed as capital or upper case R followed by lower case h, and
is written continuously without any space between the alphabets.
Definition

Origin According to Spiro J Chaconas

Frontomaxillary nasal suture is a hard tissue cephalometric According to Spiro J Chaconas, Rhinion (Figs 5.5A to D) is
landmark of anatomic origin. the most anterior-inferior point on the tips of the nasal bones

Chapter 5  Cephalometric Landmarks Related to Nasal Bone

as seen from norma lateralis.5
Significance (Ref to Chapter 20)
Type
Frontomaxillary nasal suture is situated/located on anterior
cranial base, unlike N and can therefore also be used for measure­ Rhinion is an anatomic, unilateral, hard tissue cephalometric
ment or defining the cranial base (Moyers 1988). landmark.

A B

C D

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.
Significance (Ref to Chapter 20)
Position of rhinion differs from individual to individual.
As we learnt in anatomy, there are several types of nasal
Section 3  Cephalometric Landmarks Related to Cranial Bones
bone, especially its inclination that affects the soft tissue
profile.
References
1. Graber TM. New horizons in case analysis-clinical cephalometrics. Am
J of Ortho. 1952;38:603-24.
2. Broadbent BH Sr. Bolton’s standards of dentofacial developmental
growth. The C V Mosby Company. 1975;133-5.
3. Downs WB. Variations in facial relationships. Their significance in
treatment and prognosis. Am J of Ortho. 1948;34:812-39.
4. Moyers RM. Handbook of Orthodontics–Year Book Medical Publishers,
Inc. 1988;251-9.
5. Spiro J Chaconas. Orthodontics-PSG Publishing Company. 1980;37-45.
 Chapter
6 Cephalometric landmarks
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 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 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 radio-
opaque 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.
Cephalometric Landmarks (Points) on
Temporal Bone
Cephalometric landmarks seen on the temporal bone are of
anatomic origin and are as follows (Table 6.1):
Figure 6.2: Radiographic anatomy of temporal bone
 32

Table 6.1: Cephalometric landmarks related to temporal bone Type

Cephalometric Abbreviation Type Origin Porion (Figs 6.3A to D) is a bilateral, hard tissue cephalometric
landmarks
landmark.
Porion Po Bilateral Anatomic
Zygomatic arch Zyg Bilateral Anatomic
Mastoidale Ma Bilateral Anatomic Origin
Porion is a hard tissue cephalometric point of anatomic
Porion origin.

Abbreviation Significance (Ref to Chapter 20)

Po–Porion is abbreviated using English alphabets and is ex- 1. Porion is used as one of the reference points in the
pressed as capital letter or upper case P followed by lower construction of Frankfort horizontal plane and is used
Section 3  Cephalometric Landmarks Related to Cranial Bones

case o, and is written continuously without any space between
the alphabets.
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).
According to Arne Bjork
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
The highest point on the roof of the left external auditory meatus.3
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 FH—long axis of upper incisors.
Zygomatic Arch
Abbreviation
Zyg–Zygomatic 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
between the alphabets.
Definition

According to Robert E Moyers According to Robert M Ricketts

The top of the ear rods Shadows the external auditory meatus.4
According to B Holly Broadbent
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.

According to Leslie G Farkas Origin

Porion (soft) is the highest point on the upper margin of the Zygomatic arch is a hard tissue cephalometric landmark of
cutaneous auditory meatus.6 anatomic origin.
 33

Chapter 6  Cephalometric landmarks related to temporal bone

A B

C D

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 Definition

According to Viken sassouni

Abbreviation
According to Viken Sassouni, the mastiodale is the lowest
Ms–Mastiodale is abbreviated using English alphabets and is point on the contour of the mastoid process.8
expressed as capital or upper case M followed by lower case
s, and is written continuously without any space between the Type
alphabets.
Mastiodale (Figs 6.4A and B) is bilateral, cephalo­metric landmark.
 34
Section 3  Cephalometric Landmarks Related to Cranial Bones
A B
Figures 6.4A and B: (A) Mastiodale on lateral cephalogram; (B) Magnified image showing mastiodale on the lateral cephalogram
Origin
Mastiodale is a hard tissue landmark of anatomic origin.
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.
References
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.
5. Broadbent BH Sr. Bolton’s standards of dentofacial developmental
growth. The CV Mosby Company. 1975;133-5.
6. Farkas LG. Anthropometry of the head and face in medicine—Elsevier
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.
 Chapter
Cephalometric landmarks
7 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.

Cephalometric Landmarks (Points) on

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 Abbreviation Type Origin
landmarks Figure 7.1: sphenoid bone
Dorsum of sella Sp Unilateral anatomic
Floor of sella Si Unilateral anatomic
Clinoidale Cl Bilateral anatomic
Spheno-occipital SOS Unilateral anatomic
synchondrosis
pterygoid point pt Bilateral anatomic
Sella S Unilateral anatomic
Sella entrance Se Unilateral anatomic
Sphenoethmoidal point Se Unilateral anatomic
Foramen spinosum Fsp Bilateral anatomic
point
pterygomaxillary ptm Bilateral anatomic Figure 7.2: radiographic anatomy of sphenoid bone
fissure
The vertical line terminates at the center of the
pterygomaxillary fissure, which on lateral cephalogram appears
Radiographic anatomy of Sphenoid Bone (Fig. 7.2) as inverted teardrop radiolucent area bounded anteriorly by radio-
The frontal bone, ethmoidal bone and sphenoid bone meet opaque line of the maxillary tuberosity and posteriorly by the
at frontosphenoethmoidal suture, which radiographically radio-opaque line of the anterior surface of the pterygoid process
appears as a radiolucent line. At the frontosphenoethmoidal of the sphenoid bone. The sella turcica appears as elliptical
suture, these are two radio-opaque lines, one vertical and the shape radiolucent area surrounded medially radio-opaque line
other horizontal. The vertical radio-opaque line represents the of medial surface of the sella and most inferiorly radio-opaque
anterior border of the sphenoid body whereas horizontal line line of floor of sella anterosuperiorly curved radio-opaque line of
represents the planum sphenoidale, or the superior surface of anterior clenoid process and posterosuperiorly radio-opaque line
the sphenoid body. 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).
Dorsum of Sella
by small letter or lower case p and is written continuously
without any space between the alphabets.
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
Most posterior point on the internal contour of the sella
turcica.1

abbreviation Type
Section 3  Cephalometric Landmarks Related to Cranial Bones

Sp–Dorsum of sella is abbreviated using English alphabets Dorsum of sella (Figs 7.3A to D) is a unilateral, hard tissue
and is expressed as capital letter or upper case S followed cephalometric landmark.

A B

C D

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 letter or lower case i and is written continuously without any

space between the alphabets.
Dorsum of sella is an anatomic hard tissue cephalometric
landmark.
Definition
Floor of sella is the lower most point on the inner contour of
Floor of Sella the sella turcica or hypophyseal fossa or pituitary fossa.

abbreviation Type
Si–Floor of sella is abbreviated using English alphabets and is Floor of sella (Figs 7.4A to D) is a unilateral, hard tissue
expressed as capital letter or upper case S followed by small cephalometric landmark.

Chapter 7  Cephalometric Landmarks Related to Sphenoid Bone

A B

C D

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
 38

Origin Definition
Floor of sella is an anatomic hard tissue cephalometric Clinoidale is the most superior point on the contour of the
landmark. anterior clinoid.

according to Viken Sassouni

Clinoidale
The most superior point on the contour of the anterior clenoid.1

abbreviation Type
Cl–Clinoidale is abbreviated using English alphabets and is Clinoidale (Figs 7.5A to D) is a unilateral, hard tissue
expressed as capital C followed by lower case l.l cephalometric landmark.
Section 3  Cephalometric Landmarks Related to Cranial Bones

A B

C D

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 According to Arne Bjork, the opisthion is the posterior margin
landmark. of the occipital foramen.2

Spheno-Occipital Synchondrosis
abbreviation
SOS–Spheno-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
according to TM Graber
According to TM Graber, the opisthion is the most posterior
point on the posterior margin of the foramen magnum.3
Type
Spheno-occipital synchondrosis (Figs 7.6A to D) is a unilateral,
hard tissue cephalometric landmark.

Chapter 7  Cephalometric Landmarks Related to Sphenoid Bone

the alphabets.
Origin
Definition
Spheno-occipital synchondrosis is a unilateral, anatomic, hard
Opisthion is the posterior edge of the foramen magnum. tissue cephalometric landmark.

A B

C D

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 spheno-
occipital synchondrosis on graphic illustration
 40

Significance (Ref to Chapter 20) lower case t, and is written continuously without any space
between the alphabets.
The spheno-occipital synchondrosis is very important struc-
ture in growth and development of the cranial base in the
Definition
growing child.
According to Robert M Ricketts, the pterygoid point is the
Tracing Spheno-Occipital Synchondrosis on lower lip of the foramen rotundum (represents the position of
the sphenoid bone). Most posterior point on the outline of the
the Lateral Cephalogram
pterygopalatine fossa.4
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 cephalometric landmark.
Section 3  Cephalometric Landmarks Related to Cranial Bones

abbreviation Origin
Pt–Pterygoid point abbreviated using English alphabets and Pterygoid point is a bilateral, hard tissue cephalometric land-
is expressed as capital or upper case P followed by small or mark.

A B

C D
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 according to arne Bjork

Cephalogram The center of sella turcica (the midpoint of the horizontal
Trace the pterygopalatine fossa point usually located immedi- diameter).2
ately behind the posterior part of the fossa.
Type
Significance (Ref to Chapter 20) Sella (Figs 7.8A to D) is a unilateral, hard tissue cephalometric
• Pterygoid point is a useful point for Rickett’s cephalometric landmark.
analysis.
• Pterygoid point is the intersection border of the foramen Origin
rotundum and the posterior wall of pterygopalatine fossa Sella is a unilateral anatomic hard tissue cephalometric
in the lateral cephalogram. landmark point.

Chapter 7  Cephalometric Landmarks Related to Sphenoid Bone

Sella Tracing of Sella on the Lateral Cephalogram
The pituitary fossa is round and bottle shaped hollow space,
abbreviation situated in the upper body of the sphenoid bone. This fossa
contains pituitary gland. This fossa is bounded anterioly
S–Sella is abbreviated using English alphabets and is expressed and posteriorly by anterior and posterior clinoid processes.
as capital or upper case S. Both anterior and posterior clinoid process appears as
radio-opaque line on the lateral cephalogram. First trace
Definition the anterior and posterior cliniod process followed by
inferior border of the pituitary fossa. Center point of the
Sella is the midpoint of sella turcica or hypophyseal fossa or fossa is the point of sella.
pituitary fossa.
Significance (Ref to Chapter 20)
according to Robert E Moyers
Sella is used as one of the reference points in the construction
The center of the hypophyseal fossa (sella turcica). It is of angles and planes for the assessment of following:
selected by the eye since that producer as been shown to be as • Relationship of maxilla to cranial base is assessed using
reliable as a constructed center.4 SNA angle, S-N-Pr angle and saddle angle (N-S-Ar).
• Relationship of mandible to cranial base is assessed using
according to TM Graber SNB angle and S-N-Id angle.
• Relationship of anterior and posterior cranial base assessed
The center of pituitary fossa.3 using N-S-Ar.

according to B Holly Broadbent Sella Entrance

Sella turcica (Turkish saddle): The landmark is the center
of the sella as seen in the lateral radiograph and located by
inspection.5 abbreviation

Se–Sella entrance is abbreviated using English alphabets and

according to LB Higley is expressed as capital letter or upper case S followed by small
The center of sella turcica: The midpoint of the sella turcica letter or lower case e and is written continuously without any
orbitrarily determined.6 space between the alphabets.

according to Willam B Downs Definition

The center of sella turcica: Located by inspection of the profile Sella entrance is the mid entrance point of sella turcica or
image of the fossa.7,8 hypophyseal fossa or pituitary fossa.
 42
Section 3  Cephalometric Landmarks Related to Cranial Bones

A B

C D

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 E and written continuously without any space between the

alphabets.
Sella entrance (Figs 7.9A to D) is a unilateral, hard tissue
cephalometric landmark.
Definition
Origin
according to Robert E Moyers
Sella entrance is a constructed, hard tissue cephalometric
landmark. The intersection of the shadows of the greater wing of
the sphenoid and the cranial floor as seen in the lateral
Sphenoethmoidal Point cephalogram.4

abbreviation according to SN Bhatia and BC Leighton

SE–Sphenoethmoidal point (Figs 7.10A to D) is abbreviated The point of intersection between the greater wings of the
using English alphabets and is expressed as upper case S, sphenoid and the anterior cranial base.9
 43

Chapter 7  Cephalometric Landmarks Related to Sphenoid Bone

A B

C D

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

A B
Figures 7.10A and B: (A) sphenoethmoidal point on lateral cephalogram; (b) Magnified image showing
sphenoethmoidal point on the lateral cephalogram
 44
Section 3  Cephalometric Landmarks Related to Cranial Bones
C D
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 cephalomet-
ric landmark.
Pterygomaxillary Fissure
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
any space between the alphabets.
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.
PTMS–According to Michael L Riolo, Pterygomaxillary
fissure is abbreviated using English alphabets and is expressed
as capital or upper case P,T,M,S, written continuously without
any space between the alphabets.
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.
according to TM Graber
According to TM Graber, the pterygomaxillary fissure is an
oval-looped radiolucency resulting from the fissure between
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
which represents the posterior surface of the tuberosity of the
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 gener-
ally 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
Pterygomaxillary fissure is an anatomic, bilateral, hard tissue
cephalometric landmark.
 45

Chapter 7  Cephalometric Landmarks Related to Sphenoid Bone

A B

C D

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

Significance (Ref to Chapter 20) 4. Robert R. Ricketts–Provocations and perceptions in cranio-facial

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.
2. Arne Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.
3. Graber TM. New horizons in case analysis-clinical cephalometrics.
Am J of Ortho.1952;38:603-24.
orthopedics–dental science and facial art. Rocky Mountain Inc. 1989;
797-803.
5. Moyers RM. Handbook of Orthodontics–Year Book Medical Publishers,
Inc. 1988;251-9.
6. Holley Broadbent B, Sr. Bolton’s standards of dentofacial develop-
mental 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.
8. Downs WB. Variations in facial relationships. Their significance in
treatment and prognosis. Am J of Ortho.1948;34:812-39.
9. Bhatia SN, Leighton BC. A manual of facial growth–Oxford University.
1993;10-5.
 CHAPTER

8 Cephalometric Landmarks
Related to Occipital Bone

The occipital bone (Fig. 8.1) forming much of the back and The inner and outer cortical plates of the occipital bone
base of the cranium and is trapezoidal and concave internally. appear as two radio-opaque lines, which descend parallely
and meet together at formen magnum, where the hard tissue
Cephalometric Landmarks (Points) on cephalometric point opisthion is identified.
Occipital Bone The exocranial and endocranial surfaces of the occipital
bone appear as two radio-opaque lines, the point where these
Cephalometric landmarks seen on the occipital bone are of two surfaces meet is the point of basion, which is an important
anatomic origin and are as follows (Table 8.1): hard tissue cephalometric landmark.
Table 8.1: Cephalometric landmarks related to occipital bone
Cephalometric landmarks Abbreviation Type Origin Basion
Basion Ba Unilateral Anatomic
Opisthion Op Unilateral Anatomic Abbreviation
Bolton’s point Bo Unilateral Anatomic
Ba–Basion is abbreviated using English alphabets and is
Spheno-occipital SOS Unilateral Anatomic denoted as capital letter or upper case B followed by small
synchondrosis
letter or lower case a and is written continuously without any
space between the alphabets.
Radiographic Anatomy of Occipital Bone
(Fig. 8.2) Definition
The occipital bone joins the parietal bone at lambdoid suture, Basion is the median point of the anterior margin of the
which on lateral cephalogram appears as a radiolucent line. 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 8.1: Occipital bone Figure 8.2: Radiographic anatomy of occipital bone

According to Robert M Ricketts
Point at the center of the anterior border of the foramen
magnum at the base of the occipital bone.1
According to TM Graber
The most inferior point on the anterior margin of the foramen
magnum in the midsagittal plane.2
According to Robert E Moyers
The most inferior posterior point in the sagittal plane on the
anterior rim of the foramen magnum.3
According to Arne Bjork
Normal projection of the anterior border of the occipital
foramen (endobasion) on the occipital foramen line.4
A B
C D
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
47
According to Clifton T Forsberg
The most anterior point relative to the interspinosum line, on
the border of the foramen magnum.5
Type
Basion (Figs 8.3A to D) is a unilateral, hard tissue cephalo-
metric landmark.
Origin
Basion is a anatomic hard tissue cephalometric landmark.
Tracing Basion on the Lateral Cephalogram
Chapter 8  Cephalometric Landmarks Related to Occipital Bone
• 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 syn-
chondrosis to the anterior margin of the foramen magnum.
 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
Section 3  Cephalometric Landmarks Related to Cranial Bones
Abbreviation
Op–Opisthion 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
space between the alphabets.
Definition
Opisthion is the posterior edge of the foramen magnum.
According to Arne Bjork
Posterior margin of the occipital foramen.4
According to TM Graber
The most posterior point on the posterior margin of the
foramen magnum.2
A B
Figures 8.4A and B: (A) Opisthion on lateral cephalogram; (B) Magnified image showing opisthion on the
lateral cephalogram
According to Clifton T Forsberg
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
cephalometric landmark.
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.
Bolton’s Point
Abbreviation
Bo–Bolton’s 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
space between the alphabets.
Definition
Bolton’s point is the highest point in the upward curvature of
the retrocondylar fossa.
 49

Chapter 8  Cephalometric Landmarks Related to Occipital Bone

C D

Figures 8.4C and D: (C) Opisthion on graphic illustration; (D) Magnified image of opisthion
on graphic illustration

According to B Holly Broadbent According to Viken Sassouni

Point in space, about the center of foramen magnum, that is Highest point in the upward curvature of the retrocondylar
located on the lateral cephalometric radiograph by the highest fossa. In uncertain cases it may be located as the midpoint
point in the profile image of the postcondylar notches of the between opisthion (Op), and basion (Ba); in other words, at
occipital bone.5 the center of foramen magnum.7

According to Arne Bjork According to TM Graber

The deepest point of the notch in the shadow behind condylus The most superior point in the uppet curvature of the
occipitalis.3 retrocondylar fossa. It is just posterior to the occipital condyle.2

According to William B Downs Type

The highest point on the concavity behind the occipital Bolton’s point (Figs 8.5A to D) is a unilateral, hard tissue
condyles.6 cephalometric landmark.

A B

Figures 8.5A and B: (A) Bolton’s point on lateral cephalogram; (B) Magnified image showing Bolton’s point on the
lateral cephalogram
 50
Section 3  Cephalometric Landmarks Related to Cranial Bones

C D

Figures 8.5C and D: (C) Bolton’s point on graphic illustration: (D) Magnified image of Bolton’s point on
graphic illustration

Origin and is written continuously without any space between the

alphabets.
Bolton’s point is an anatomic hard tissue cephalometric
landmark/point.
Type
Tracing Bolton’s Point on the Lateral
Spheno-occpital synchondrosis (Figs 8.6A to D) is a unilateral,
Cephalogram
hard tissue cephalometric landmark.
Bolton’s point is the midway between the point basion and
opisthion. Trace the basion and opisthion and bisect the distance Origin
between these two points to establish the Bolton’s point. Spheno-occipital synchondrosis is an anatomic hard tissue
cephalometric landmarks.
Spheno-Occipital Synchondrosis
Tracing Spheno-Occipital Synchondrosis on
Abbreviation the Lateral Cephalogram
SOS–Spheno-occipital synchondrosis abbreviated using Tracing of SOS is very easy, if it is before the ossification and
English alphabets and is expressed as capital S, O and S very difficult, if it is after the ossification.

A B

Figures 8.6A and B: Spheno-occipital synchondrosis on lateral cephalogram; (B) Magnified image
showing spheno-occipital synchondrosis on the lateral cephalogram
 51

Chapter 8  Cephalometric Landmarks Related to Occipital Bone

C D

Figures 8.6C and D: (C) Spheno-occipital synchondrosis on graphic illustration; (D) Magnified image of
spheno-occipital synchondrosis on graphic illustration

Significance (Ref to Chapter 20)
The spheno-occipital synchondrosis is very important struc­ture in
growth and development of the cranial base in the growing child.
References
1. Ricketts RR. Provocations and perceptions in cranio-facial orthopedics
–dental science and facial art. Rocky Mountain Inc. 1989;797-803.
2. Graber TM. New horizons in case analysis-clinical cephalometrics. Am
J of Ortho. 1952;38:603-24.
3. Moyers RM. Handbook of Orthodontics. Year Book Medical Publishers,
Inc. 1988;251-9.
4. Arne Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.
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.
6. Downs WB. Variations in facial relationships; Their significance in
treatment and prognosis. Am J of Ortho.1948;34:812-39.
7. Viken Sassouni. Orthodontics in dental practice. The CV Mosby
Company. 1971;330-7.
 Chapter

9 Cephalometric landmarks
related to Zygomatic bone

Each zygomatic bone (Figs 9.1A and B) consists of a process of the zygomatic bone. This line extends posteriorly
diamond-shaped body and following four processes: and merges with the horizontal part of the zygomatic process
• Frontal process articulates with the frontal bone at of the maxilla.
zygomaticofrontal suture forming the lateral wall of the
orbit. Cephalometric landmarks (Points) on
• Temporal process articulates with the zygomatic process Zygomatic bone
of the temporal bone, forming the zygomatic arch.
• Maxillary process articulates with the zygomatic process Cephalometric landmarks seen on the zygomatic bone are of
of the maxilla at the zygomaticomaxillary suture, forming anatomic origin and are as follows (Table 9.1):
the infraorbital rim and the orbital floor. Table 9.1: Cephalometric landmarks related to zygomatic bone
• Jugular process articulates the maxilla at the lateral wall of
the maxillary sinus. Cephalometric landmarks Abbreviation Type Origin
Orbitale Or Bilateral Anatomic
Radiographic Anatomy of Zygomatic Bone Temporale Te Bilateral Anatomic
The frontal process of the zygomatic bone appears as two
radio-opaque lines on the lateral cephalogram, one anterior Orbitale
and the other posterior. The anterior line is curved line
representing the anterior border of the lateral wall of the orbit.
Abbreviation
The posterior line is a vertical line that extends downward
from the junction with the cribriform plate and merges with Or–Orbitale is abbreviated using English alphabets and is
the posterior border of the zygomatic process of the maxilla. denoted as capital letter or upper case O followed by small
Between the inferior parts of the two lines, there is another letter or lower case r and is written continuously without any
horizontal radio-opaque line, which represents the maxillary space between the alphabets.

A B

Figures 9.1A and B: Zygomatic bone

 53

Definition According to Leslie G Farkas

Orbitale is the lowest point in the inferior margin of the orbit,
midpoint between right and left images.
According to William B Downs
Orbitale is the lowest point on the left infraorbital margin.1
According to TM Graber
Orbitale is the most inferior point on the lower border of the
left orbit.2
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
According to Robert E Moyers
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
According to B Holly Broadbent
Orbitale is the left orbital point used in conjunction with the Origin
poria to orient the skull on the Frankfort horizontal plane.3 Orbitale is an anatomic hard tissue cephalometric landmarks.

A B

C D

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 • FH-Mandibular plane angle (Go- Me)

• FH- Palatal plane angle ( ANS-PNS)
Normally, right and left infra-orbital margins are superimposed • FH-Occlusal plane ( APOcc – PPOcc).
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 Temporale
procedure.
If the patient is inaccurately positioned then in such cases, Abbreviation
the infra-orbital margins appear as two different radio-opaque
lines on the lateral cephalogram making difficult to identify Te–Temporale is abbreviated using English alphabets and is
the point. In such cases, the orbitale is identified as the mid expressed as capital or upper case T followed by small letters
point of right and left infra-orbital margins. or lower case e and is written continuously without any space
between the alphabets.
Significance (Ref to Chapter 20)
Section 3  Cephalometric Landmarks Related to Cranial Bones

Definition
Orbitale is used as one of the reference points in the construction
of Frankfort horizontal plane and is used for the assessment of Temporale (Figs 9.3A to D) is the intersection of the shadows of
horizontal growth pattern using following angles: the ethmoid and the anterior wall of the infratemporal fossa.

A B

C D

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

According to Viken Sassouni References

Intersection of the shadows of the ethmoid and anterior wall
of the infra-temporal fossa.6
Type
Temporale is a bilateral, hard tissue cephalometric landmark.
Origin
Temporale is an 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. Bolton’s 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 Orthodontics—Yearbook medical publishers
inc. 1988;251-9.
6. Viken Sassouni. Orthodontics in dental practice. The CV Mosby
company. 1971;330-7.

Chapter 9  Cephalometric landmarks related to Zygomatic bone

Section 4
Cephalometric Landmarks
Related to Facial Bones
and Dentition

 Cephalometric Landmarks Related to Maxilla

 Cephalometric Landmarks Related to Dentition
 Cephalometric Landmarks Related to Mandible
 ChapteR
Cephalometric Landmarks
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
Cephalometric landmarks Abbreviation Type Origin
anterior nasal spine aNS Unilateral anatomic
point a a Unilateral anatomic
anterior point of maxilla apMax Unilateral anatomic
prosthion pr Unilateral anatomic
posterior nasal spine pNS Unilateral anatomic
Pterygomaxillary fissure • Ptm Bilateral anatomic
Figure 10.1: Maxillary bone
• PTM
• PTMS
According to Viken Sassouni
Key ridge KR Unilateral anatomic
Orbitale Or Bilateral anatomic The most anterior point of the nasal floor tip of pre-maxilla on
mid-sagittal plane.1

Anterior Nasal Spine According to B Holly Broadbent

Abbreviation
ANS–Anterior 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.
Sharp median process formed by the forward prolongation of
the anterior aperture of the nose.2
According to TM Graber
The tip of the anterior nasal spine as seen on the X-ray film in
norma lateralis.3

Definition According to Robert E Moyers

Anterior nasal spine (Figs 10.2A to D) is the tip of bony The most anterior point on the maxilla at the level of the
anterior nasal spine in the midline or median plane. palate. The ANS is of limited use for analysis in the posterior-
 60
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

A B

C D

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 Tracing of Anterior Nasal Spine on Lateral
and its location varies considerably according to radiographic Cephalogram
exposure.4
There is an individual variation exists in length and width of
ANS. In some individuals ANS are long and thin; while in
Type other are short and thick.
Anterior nasal spine is a unilateral, hard tissue cephalometric
landmark. Radiographic Appearance
• ANS appears slightly posterior to the anatomic spine.
Origin • In cases with thin ANS: In such cases, on the cephalogram,
ANS will be unclear because it can superimpose by nasal
Anterior nasal spine is an anatomic hard tissue cephalometric cartilage.
landmark. • In cases with thick ANS: In such cases, on the cephalogram,
ANS is clear and will be ease in tracing.
 61

Significance (Ref to Chapter 20) 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
The deepest midline point on the premaxilla between the
Point A anterior nasal spine and prosthion.5

Abbreviation According to Robert M Ricketts

Point A: Point A is abbreviated using English alphabets and is Deepest point on the curve of the bone between the anterior
expressed as A itself. nasal spine and dental alveolus. Also termed SS or subspinale
(below the spine).6

Chapter 10  Cephalometric Landmarks related to Maxilla

A B

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

According to Viken Sassouni • To establish A point, draw a line between ANS and
prosthion. Then draw a line parallel to the ANS–Pr line,
Deepest point on midsagittal plane between ANS and tangent to the deepest point between ANS and Pr. This is
prosthion, mesially around the level of and anterior to the point A.
apex of the upper central incisors.1
Significance (Ref to Chapter 20)
According to TM Graber
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.
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

of the maxilla.3 • Maxillo-mandibular relationship with anterior cranial

base is assessed using ANB angle.
According to Alex Jacobson and W Caufield • Inclination upper incisors are assessed using NA-Upper
Using a line perpendicular to FH locate the most posterior incisor angular and NA-Upper incisor linear.
point in the concavity between ANS and maxillary alveolar • Point A is useful indicator of the anteroposterior
process.7 relationship between the basal bone of the maxilla and the
malocclusion.
Or • In Mc Namara cephalometric analysis, anteroposterior
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
According to Robert E Moyers in McNamara analysis.
The most posterior point on the curve between ANS and PR • In Mc Namara cephalometric analysis, method of
“A” point usually is found approximately 2 mm anterior to determining of position of maxillary incisor relative to
the apices of the maxillary central incisor roots. A is not an point A. Draw vertical line through the nasion called NP
anatomic point, of course. 4 (Nasion perpendicular) and A vertical line constructed
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 maxi-
Maxillary 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
Type distance is measured between the edge of the incisor and
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 Abbreviation

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

Chapter 10  Cephalometric Landmarks related to Maxilla

A B

C D

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

According to Arne Bjork Type

The transition point between the crown of the most prominent Prosthion is a unilateral, hard tissue cephalometric landmark.
medial maxillary incisor and the alveolar projection.9

According to TM Graber Origin

The point of the maxillary alveolar process in the midline that
projects most anteriorly.3
According to Robert E Moyers
The most anterior inferior point on the maxillary alveolar
process usually found near the cementoenamel junction of the
maxillary central incisor.4
Prosthion is an anatomic hard tissue cephalometric landmark.
Significance (Ref to Chapter 20)
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 According to TM Graber

The bony posterior projection of the horizontal portion of the
Abbreviation palatine bone at the midline.3

PNS: Posterior Nasal Spine is abbreviated using English

alphabets and is expressed as capital letter or upper case P, N
According to B Holly Broadbent
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
According to Viken Sassouni
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

Posterior Nasal Spine (Figs 10.5A to D ) is the intersection of

Most posterior point on the contour of the bony palate.1
a continuation of the anterior wall of the pterygopalatine fossa
and the floor of the nose.
According to Alex Jacobson and W Caufield
According to Michael L Riolo
Using a line perpendicular to FH, locate PNS at the most
The most posterior point at the sagittal plane on the bony hard posterior aspect of the palatine bone.7
palate.10

A B

C D

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

According to Robert M Ricketts which represents the posterior surface of the tuberosity of the
maxilla; the landmark is taken where the two edges, front and
Midpoint of the base of the palatine bone at the posterior back appear to merge inferiorly.
margin of the hard palate.6
According to TM Graber
Type
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
According to Robert M Moyers, the pterygomaxillary fissure

Chapter 10  Cephalometric Landmarks related to Maxilla

Tracing of Posterior Nasal Spine on the is tear drop shaped radiolucency, the anterior shadow of
Lateral Cephalogram which represents the posterior surface of the tuberosity of the
• Like ANS, PNS also has variation in length and width. maxilla; the landmark itself is at the most inferior confluences
• PNS is difficult to trace on the cephalogram when there of the curvatures.
4

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
fissure. The Ptm line connects right and left Ptm points. The
Significance (Ref to Chapter 20)
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
plane angle (ANS-PNS). 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
Pterygomaxillary Fissure generally located beneath the lower pointed end of this area.2

Abbreviation According to LB Higley

Ptm: Pterygomaxillary fissure is abbreviated using English Junction of the Frankfort plane and a line perpendicular to it
alphabets and is expressed as capital or upper case P followed from the pterygomaxillary fissure.12
by small or lower case t and m, written continuously without
any space between the alphabets. Type
PTM: According to Robert. M. Moyers, Pterygomaxillary fissure
is abbreviated using English alphabets and is expressed as capital Pterygomaxillary fissure is bilateral, hard tissue cephalo-
or upper case P followed by capital or upper case T and M, metric landmark.
written continuously without any space between the alphabets.4
Origin
PTMS: According to Michael L Riolo, Pterygomaxillary
fissure is abbreviated using English alphabets and is expressed Pterygomaxillary fissure is an anatomic hard tissue cephalo-
as capital or upper case P, T, M, S, written continuously metric landmark.
without any space between the alphabets.9
Significance (Ref to Chapter 20)
Definition Pterygomaxillary fissure is used as one of the reference
Pterygomaxillary fissure (Figs 10.6A to D) is a bilateral tear points in Cox cephalometric analysis and is used to assess the
drop shaped area of radiolucency, the anterior shadow of posterior limit of the maxilla.
 66
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

A B

C D

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 According to Viken Sassouni

Lowermost point on the contour of the shadow of the anterior
wall of the infratemporal fossa.1
Abbreviation
KR: Key ridge is abbreviated using English alphabets and is According to Robert E Moyers
expressed as capital or upper case K, and R, and is written The lowest point on the outline of the zygoma.4
continuously without any space between the alphabets.
According to TM Graber
Definition The most inferior point on the zygomatic ridge.3
The key ridge (Figs 10.7A to D) is the lowermost point on
Type
the contour shadow of the anterior wall of the infratemporal
fossa. Key ridge is a bilateral, hard tissue cephalometric landmark.
 67

Chapter 10  Cephalometric Landmarks related to Maxilla

A B

C D

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. According to Arne Bjork
The deepest point on the infraorbital margin.The midpoint, or
is used where double projection gives rise to two points, or 1
Orbitale and or 2.9

Abbreviation According to William B Downs

Or: Orbitale is abbreviated using English alphabets and is ex- The lowest point on the left infra-orbital margin.5
pressed as capital or upper case O, followed by small or lower
case r and both alphabets are written continuously without any According to TM Graber
space between them. The most inferior point on the lower border of the left orbit.3
 68

According to B Holly Broadbent Type

The left orbital point is used in conjunction with poria to Orbitale is a bilateral (Figs 10.8A to D), anatomic, hard tissue
orient the skull on the Frankfort horizontal plane.2 cephalometric landmark.

Leslie G Farkas Origin

Orbitale is the lowest point on the lower margin of the each orbit. Orbitale is an anatomic hard tissue cephalometric landmark.
It is identified by palpation and is identical to the bony orbitale.13
Significance (Ref to Chapter 20)
According to Robert E Moyers
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

Orbitale is used as one of the reference points in the construction

In the lateral cephalogram, the outlines of the orbital rims of angles and planes for the assessment of following:
overlap. Usually, the lowest point on the averaged outline is • Growth pattern is assessed using FH plane-Mandibular
used for the construction of Frankfort plane.4 plane.

A B

C D

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 2. Broadbent BH Sr. Bolton’s standards of dentofacial developmental
growth. The CV Mosby Company. 1975;133-5.
upper incisor. 3. Graber TM. New horizons in case analysis. Clinical cephalometrics.
Am J of Ortho. 1952;38:603-24.
Tracing of Orbitale on the Lateral Cephalogram 4. Moyers RM. Handbook of Orthodontics.Year book medical publishers,
Inc. 1988;251-9.
Normally, right and left infra-orbital margins are superimposed 5. Downs WB. Variations in facial relationships. Their significance in
treatment and prognosis. Am J of Ortho. 1948;34:812-39.
on the lateral cephalogram, and then they reveal radio-opaque
6. Ricketts RM. Provocations and perceptions in cranio-facial orthopedics.
line on the lateral cephalogram, when patient is positioned Dental science and facial art. Rocky Mountains, Inc. 1989;797-803.
accurately on the cephalostat during the radiographic taking 7. Alex Jacobson, Caufield W. Introduction to radiographic cephalometry.
procedure. Lea and Febiger. 1985;37-40.
8. Jarabak JR. Technique and treatment with light wire appliance. The CV
If the patient is inaccurately positioned then in such cases,
Mosby company. 1963;132-3.
the infra-orbital margins appear as two different radio-opaque 9. Arne Bjork. The face in profiles. Sven. Tandlak Tidskr. 1947;40:32-3.
lines on the lateral cephalogram making difficult to identify 10. Riolo ML. An atlas of craniofacial growth. Cephalometric standards from
the point. In such cases, the orbitale is identified as the mid- the university school growth study, the university of Michigan.Center for

Chapter 10  Cephalometric Landmarks related to Maxilla

human growth and development. The University of Michigan. 1974;12-21.
point of right and left infra-orbital margins.
11. Forsberg CT. Diagnosis and treatment planning of skeletal asymmetry
with submental. Vertical radiograph. Am J of Ortho. 1984;85:224-37.
References 12. Higley LB. Cephalometric standards for children 4-8 years of age.Am J
of Ortho. 1954;40:51-9.
1. Viken Sassuoni. Orthodontics in dental practice. The CV Mosby 13. Farkas LG. Anthropometry of the head and face in medicine. Elsevier
company. 1971;330-7. north Holland, Inc. 1981;9-14.
 Chapter
Cephalometric Landmarks
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 stage—0–6 months
2. Deciduous dentition—6 months–6 years
3. Mixed dentition—6–12 years
4. Permanent dentition—12 years and beyond.
Gum Pad Stage (0–6 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 portions—buccal 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 D C E
A B D 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 (6–12 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 Table 11.1: Cephalometric landmarks related to dentition

Permanent dentition stage is pretty well established by about Cephalometric Abbreviation Type Origin
landmarks
13 years of age, with the eruption of all permanent teeth
except the 3rd molars. Permanent successors develop from Incision superius Isi Unilateral Anatomic
incisalis
lingual extension of the dental lamina (successional lamina)
and the permanent molar develop from the posterior extension Incision superius Isa Unilateral Anatomic
apicalis
of the dental lamina. The permanent incisors develop lingual
to the primary incisors and move labially as they erupt. The Incision inferius Iii Unilateral Anatomic
incisalis
premolars develop below the divergent roots of the primary
molars. Incision inferius Iia Unilateral Anatomic
apicalis
Permanent dentition begins to form at birth, at which time,
Anterior point of APocc Unilateral Anatomic
calcification of the 1st permanent molars becomes evident.
occlusion
Chronology of permanent dentition is depicted in Table 11.1.

Chapter 11  Cephalometric Landmarks Related to Dentition

Posterior point of PPocc Unilateral Anatomic
Sequence of eruption of permanent dentition is more
occlusion
variable than that of the primary dentition. In addition, there
Maxillary central U1 Unilateral Anatomic
are significant differences in the eruption sequences between incisor
the maxillary and the mandibular arch.
Maxillary first molar U6 Bilateral Anatomic
Mandibular central L1 Unilateral Anatomic
Most Common Eruption Sequence in Maxilla incisor
6-1-2-4-3-5-7-8 or Mandibular first L6 Bilateral Anatomic
6-1-2-4-5-3-7-8 molar
mi mi Bilateral Anatomic
Most Common Eruption Sequence for ms ms Bilateral Anatomic
Mandibular Arch
(6-1)-2-3-4-5-7-8 or is–Incision Superius is abbreviated using English alphabets
(6-1)-2-4-3-5-7-8 and is expressed as small letters or lower case i and s and is
written continuously without any space between the alphabets.
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 Definition
mandibular arch, the canine erupts before the premolars, Incision superius Incisalis (Figs 11.1A to D) is the incisal
whereas in the maxillary arch the canine generally erupts after edge of the maxillary central incisor.
the premolars.
When second molars erupt before the premolars are fully According to Arne Bjork
erupted significant shortening of the arch perimeter occurs,
increasing the likelihood of malocclusion. Incision superius incisalis is the mid-point of the incisal edge
of the most prominent upper central incisor.1
Cephalometric Landmarks on Dentition
According to Robert E Moyers
Cephalometric landmarks seen on the Dentition are of
Incision superius incisalis is the incisal tip of the most anterior
anatomic origin and are as follows (Table 11.1):
maxillary central incisor.2

Incision Superius Incisalis Type

Incision superius incisalis is a unilateral, hard tissue cephalo­
Abbreviation metric landmark.
Isi–Incision Superius Incisalis is abbreviated using English
Origin
alphabets and is expressed as Capital or upper case I followed
by small letters or lower case s and i and is written continuously Incision superius incisalis is a unilateral, anatomic, hard tissue
without any space between the alphabets. cephalometric landmark.
 72
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

A B

C D

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.
Significance (Ref to Chapter 20)
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 Arnett’s 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.
• Anteroposterior positioning of maxillary central incisor is
assessed using the distance between the incision Superius
Incisalis and the A-Pog plane.

Incision Superius Apicalis
Abbreviation
Isa–Incision 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
without any space between the alphabets.
UIA–Upper 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.
Definition
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.
A B
C D
Figures 11.2A to D: Incision superius apicalis
73
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.3
According to SN Bhatia and BC Leighton
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
cephalometric landmark.
Chapter 11  Cephalometric Landmarks Related to Dentition
Origin
Incision superius apicalis is an anatomic hard tissue cephalo­
metric landmark.
 74

Tracing of Incision Superius Apicalis • Inter-incisal relationships of upper and lower incisors are
on Lateral Cephalogram assessed using the angle drawn between the long axis of
upper and lower permanent central incisor.
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 Incision Inferius Incisalis
maxillary permanent central incisor. The point of intersection
of labial and lingual outlines of the root of maxillary permanent Abbreviation
central incisor is the point of incision superius apicalis.
Iii–Incision inferius incisalis is abbreviated using English
Significance (Ref to Chapter 20) alphabets and is expressed as capital or upper case I followed
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

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

Incision superius apicalis 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 Arnett’s analysis, the upper incisor torque is assessed
using the angle drawn between long axis of upper incisor
and occlusal plane.
without any space between the alphabets.
ii–Incision inferius is abbreviated using English alphabets and
is expressed as small letters or lower case i and i and is written
continuously without any space between the alphabets.
Definition
Incision inferius incisalis (Figs 11.3A to D) is the incisal edge
of the most prominent mandibular central incisor.

A B

C D

Figures 11.3A to D: Incision inferius incisalis (A and B) on lateral cephalogram, (C and D) on graphic illustration

According to Arne Bjork
The incision inferius is the incisal point of the most prominent
medial mandibular incisor.1
According to Robert E Moyers
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
cephalometric landmark.
Tracing of Incision Inferius Incisalis
on Lateral Cephalogram
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
edge or the intersection of the labial and lingual outline is the
point of incision inferius incisalis.
Significance (Ref to Chapter 20)
Incision inferius incisalis is used as one of the reference point
in the construction of angles and planes for the assessment of
following:
• Inclination of lower incisor is assessed using angle drawn
between the long axis of lower incisor plane and the
mandibular plane.
• In Arnett’s analysis, the lower incisor torque is assessed
using the angle drawn between long axis of lower 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 mandibular central incisor
is assessed using the distance between the incision inferius
incisalis and the NB plane.
• Anteroposterior positioning of maxillary central incisor is
assessed using the distance between the incision inferius
incisalis and the A-Pog plane.
Incision Inferius Apicalis
Abbreviation
Iia–Incision inferius apicalis is abbreviated using English
alphabets and is expressed as capital or upper case I followed
75
by small letters or lower case i and a and is written continuously
without any space between the alphabets.
LIA–lower 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
Chapter 11  Cephalometric Landmarks Related to Dentition
used.
According to SN Bhatia and BC Leighton
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
cephalometric landmark.
Tracing of Incision Inferius Apicalis
on Lateral Cephalogram
The labial and lingual outline of the root of the mandibular
permanent central incisor appears as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of root of the
mandibular permanent central incisor. The point of intersec-
tion of labial and lingual outlines of the root of mandibular
permanent central incisor is the point of incision inferius
apicalis.
Significance (Ref to Chapter 20)
Incision inferius apicalis is used as one of the reference points
in the construction of angles and planes for the assessment of
following:
• Inclination of lower incisor is assessed using angle drawn
between the long axis of upper incisor plane and the
mandibular plane.
• In Arnett’s analysis, the lower incisor torque is assessed
using the angle drawn between long axis of lower 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 incisors.
 76
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

A B

C D
Figures 11.4A to D: Incision inferius apicalis

Anterior Point of Occlusion Tracing of Anterior Point of Occlusion

Abbreviation
APocc–Anterior 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
written continuously without any space between the alphabets.
Definition
Anterior point of occlusion (Figs 11.5A to D) for the occlusal
plane–A constructed point, the midpoint of the incisor overbite
in occlusion.
Type
Anterior point of occlusion is a unilateral, constructed, hard
tissue cephalometric landmark.
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 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 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 labial and lingual outline of the root of the mandibular
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

Chapter 11  Cephalometric Landmarks Related to Dentition

A B

C D

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.
Significance (Ref to Chapter 20)
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.
• Growth pattern is assessed using angle drawn between the
occlusal plane and FH plane.
• In Arnett’s analysis, the upper incisor torque is assessed
using the angle drawn between long axis of upper incisor
and occlusal plane.
• In Arnett’s analysis, the lower incisor torque is assessed
using the angle drawn between long axis of lower incisor
and occlusal plane.
Posterior Point of Occlusion
Abbreviation
PPocc–Anterior 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
plane—the most distal point of contact between the most
posterior molars in occlusion (Rakosi).
Type
Posterior point of occlusion is a bilateral, anatomic hard tissue
cephalometric landmark.
 78
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition
A B
C D
Figures 11.6A to D: Posterior point of occlusion
Tracing of Posterior Point of Occlusion
on Lateral Cephalogram
• The labial and lingual outline of the crown of the maxillary
permanent first molar appears as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of crown of
the maxillary permanent first molar.
• The labial and lingual outline of the root of the maxillary
permanent first molar appears as radio-opaque lines on the
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.
• The labial and lingual outline of the root of the mandibular
permanent first molar appears as radio-opaque lines on the
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.
Significance (Ref to Chapter 20)
Posterior point of occlusion is used as one of the reference
points in the construction of angles and planes for the
assessment of following:
• Growth pattern is assessed using angle drawn between the
occlusal plane and mandibular plane.
• Growth pattern is assessed using angle drawn between the
occlusal plane and FH plane.
• In Arnett’s analysis, the upper incisor torque is assessed
using the angle drawn between long axis of lower incisor
and occlusal plane.
• In Arnett’s analysis, the lower incisor torque is assessed
using the angle drawn between long axis of lower incisor
and occlusal plane.

A B
C D
Figures 11.7A to D: Maxillary central incisor
Maxillary Central Incisor
Abbreviation
U1–Maxillary 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
cephalometric landmark.
79
Chapter 11  Cephalometric Landmarks Related to Dentition
Tracing of Maxillary Central Incisor
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 most labial point
on the crown of the maxillary central incisor is the point of
maxillary central incisor.
Maxillary First Molar
Abbreviation
U6–Maxillary 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
without any space between the alphabets.
 80
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

A B

C D

Figures 11.8A to D: Maxillary first molar

Definition Mandibular Central Incisor

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
cephalometric landmark.
Abbreviation
L1–Mandibular 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
without any space between the alphabets.

Tracing of Maxillary First Molar
on Lateral Cephalogram
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 max-
illary permanent first molar, the tip of the mesiobuccal cusp of the
maxillary permanent molar is the point of maxillary first molar.
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
tissue cephalometric landmark.

A B
C D
Figures 11.9A to D: Mandibular central incisor
Tracing of Mandibular Central Incisor
on Lateral Cephalogram
The labial and lingual outlines of the crown of the mandibular
permanent central incisor appear as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of crown of 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
L6–Mandibular 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
continuously without any space between the alphabets.
81
Chapter 11  Cephalometric Landmarks Related to Dentition
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
cephalometric landmark.
Tracing of Mandibular First Molar
on Lateral Cephalogram
The labial and lingual and cuspal outlines of the crown of the
mandibular permanent first molar appears as radio-opaque
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
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition

A B

C D

Figures 11.10A to D: Mandibular first molar

mi
Abbreviation
mi–mi is abbreviated using English alphabets and is expressed
as lower case m and i and written continuously without any
space between the alphabets.
Definition
mi (Figs 11.11A to D) is the mesial contact of the lower molar
projected normal to the plane of occlusion.
Type
mi is a bilateral, hard tissue cephalometric landmark.
Tracing of mi on Lateral Cephalogram
The labial and lingual and cuspal outlines of the crown of the
mandibular permanent first molar appears as radio-opaque
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. mi is the mesial contact of the
lower molar projected normal to the plane of occlusion.
 83

Chapter 11  Cephalometric Landmarks Related to Dentition

A B

C D

Figures 11.11A to D: mi

Significance (Ref to Chapter 20) Definition

mi is used as one of the reference points in the construction of ms (Figs 11.12A to D) is the mesial contact of the upper molar
plane and angle in the Bjork cephalometric analysis. projected normal to the plane of occlusion.

ms Type
ms is a bilateral hard tissue cephalometric landmark.
Abbreviation
Tracing of ms on Lateral Cephalogram
ms–ms is abbreviated using English alphabets and is expressed
as lower case m and s and written continuously without any The labial and lingual and cuspal outlines of the crown of the
space between the alphabets. mandibular permanent first molar appears as radio-opaque
lines on the lateral cephalogram. Trace these outlines of
 84
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition
A B
C D
Figures 11.12A to D: ms
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. ms is the mesial contact of the
upper molar projected normal to the plane of occlusion.
Significance (Ref to Chapter 20)
ms is used as one of the reference point in the construction of
plane and angle in the Bjork cephalometric analysis.
References
1. Arne Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.
2. Robert M Moyers. Handbook of Orthodontics–Year 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
Cephalometric Landmarks
12 Related to Mandible

The mandible (Fig. 12.1 ) (from Latin mandibula—jawbone) • Mandibular foramen, paired, in the inner (medial) aspect
or inferior maxillary bone forms the lower jaw and holds the of the mandible, superior to the mandibular angle in the
lower teeth in place. middle of the ramus.
• Mental foramen, paired, lateral to the mental protuberance
Cephalometric landmarks (Points) on Mandible on the body of mandible.
Cephalometric landmarks on mandible are as follows (Table Nerve Supply to Mandible
12.1):
Inferior alveolar nerve, branch of the mandibular division
Table 12.1: Cephalometric landmarks related to mandible of trigeminal (V) nerve, enters the mandibular foramen and
runs forward in the mandibular canal, supplying sensation to
Cephalometric Abbreviation Type Origin the teeth. At the mental foramen the nerve divides into two
landmarks
terminal branches: Incisive and mental nerves. The incisive
Infradentale Id Unilateral anatomic nerve runs forward in the mandible and supplies the anterior
point B part B Unilateral anatomic teeth. The mental nerve exits in the mental foramen and
pogonion pog Unilateral anatomic supplies sensation to the lower lip.
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

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 According to Arne Bjork
temporomandibular joints.
The infradentale (Figs 12.2A to D) is the point of transition
from the crown of the most prominent mandibular medial
Infradentale incisor to the alveolar projection.

Abbreviation
According to Robert M Moyers
Id–Infradentale is abbreviated using English alphabets and is
expressed as capital or upper case I followed by lower case The infradentale is the most anterior superior point on the
Section 4  Cephalometric Landmarks Related to Facial Bones and Dentition

or small letters d and written continuously without any space mandibular alveolar process, usually found near cement-
between the alphabets. enamel junction of the mandibular incisors.

A B

C
D

Figures 12.2A to D: Infradentale


According to SN Bhatia and BC leighton
The infradentale is the most anterosuperior point on the labial
crest of the mandibular alveolar process.
Type
Infradentale is a unilateral, anatomic hard tissue landmark.
Tracing of Infradentale on the lateral
Cephalogram
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.
A B
C D
Figures 12.3A to D: Point B
87
Significance (Ref to Chapter 20)
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.
Point B
Abbreviation
Point B–Point B is abbreviated using English alphabets and is
expressed as capital or upper case B.
Chapter 12  Cephalometric Landmarks Related to Mandible
According to William B Downs
The point B (Figs 12.3A to D) is the deepest midline point on
the mandible between infradentale and pogonion.
 88
According to TM Graber
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 Alex Jacobson and W Caufield
Point B is on a line perpendicular to FH, point B is the
most posterior point in the concavity between the chin and
Section 4  Cephalometric Landmarks Related to Facial Bones and Dentition
mandibular alveolar process.
According to Robert E Moyers
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.
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.
It’s 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.
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
Pog–Pogonion 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
space between the alphabets.
Definition
According to KKK lew
Most anterior point of mandibular symphysis.
According to William B Downs
Pogonion (Figs 12.4A to D) is the most anterior point on the
mandible in the midline.
According to TM Graber
The most anterior point on the symphysis of the mandible.
According to Robert M Ricketts
Most anterior point on the mental protuberance.
According to B Holly Broadbent
Most anterior point on the symphysis of the mandible in the
median plane when the head is viewed in Frankfort relation.
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.
Type
Pogonion is a unilateral, anatomic, hard tissue cephalometric
landmark.
Tracing of Pogonion on the lateral Cephalogram
The labial cortical plate of mandible in the anterior symphysis
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

Chapter 12  Cephalometric Landmarks Related to Mandible

A B

C D

Figures 12.4A to D: Pogonion

Significance
Pogonion is used as one of the reference points in the con-
struction of plane and angle for the assessment of anteroposte-
rior relationship of the mandible in relation to anterior cranial
base using S-N-Pog angle (Facial angle).
Gnathion
Definition
Gnathion (Figs 12.5A to D) is a point on the chin determined by
bisecting the angle formed by the facial and mandibular plane.
According to TM Graber
Gnathion is the most outward and everted point on the profile
curvature of the symphysis of the mandible.

Abbreviation According to Robert E Moyers

Gn–Gnathion is abbreviated using English alphabets and is The most anterior inferior point in the lateral shadow of the
expressed as capital or upper case G followed by lower case or chin. Ganthion usually is best determined by selecting the
small letters n and is written continuously without any space midpoint between pogonion and menton on the contour of the
between the alphabets. chin.
 90
Section 4  Cephalometric Landmarks Related to Facial Bones and Dentition
A B
C D
Figures 12.5A to D: Gnathion
According to Viken Sassouni
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
cephalometric landmark.
Tracing of Gnathion on the lateral
Cephalogram
The labial cortical plate of mandible in the anterior symphysis
region appears as vertical shaped radio-opaque line. Trace the
labial cortical plate from the alveolar crest between two per-
manent mandibular incisors in the midline to the point antero-
inferior 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.

A B
C D
Figures 12.6A to D: dd
Significance
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 Rickett’s 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
Abbreviation
dd–dd is abbreviated using English alphabets and is expressed
as lower case or small letters d and d and written continuously
without any space between the alphabets.
91
Chapter 12  Cephalometric Landmarks Related to Mandible
Definition
dd (Figs 12.6A to D) is the most prominent point of the chin
in the direction of measurement.
Type
dd is a unilateral, anatomic, hard tissue cephalometric
landmark.
Tracing of dd on the lateral Cephalogram
The labial cortical plate of mandible in the anterior symphysis
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
 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.
Significance
dd is used as one of the reference points in the construction of
plane and angle in the Bjork cephalometric analysis.
Section 4  Cephalometric Landmarks Related to Facial Bones and Dentition
According to Viken Sassouni
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.
Type

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

tissue landmark.
Abbreviation
Tracing of Menton on the lateral
Me–Menton is abbreviated using English alphabets and is
Cephalogram
expressed as capital or upper case M followed by lower case
or small letter e and is written continuously without any space The labial cortical plate of mandible in the anterior symphysis
between the alphabets. region appears as vertical shaped radio-opaque line. Trace the

A B

C D

Figures 12.7A to D: Menton


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 fol-
lows the convex outline of labial cortical plate of mandible,the
most prominent point is the point of pogonion.The anteroinfe-
rior point of inferior border of the mandible in the midline is
the point of menton.
Significance
Menton 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 (Me-Go) angle.
• Growth pattern is assessed using Go1 and Go2 angles.
Gonion
Abbreviation
Go–Gonion 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
between the alphabets.
Definition
According to Clifton T Forsberg
The midpoint mediolaterally on the posterior border of each
gonial angle.
According to KKK lew
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
cephalometric landmark.
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
93
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 radio-
graphic 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.
Chapter 12  Cephalometric Landmarks Related to Mandible
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-Ar-
Go angle.
• The length of the mandible is measured from condylion
to gonion.
Articulare
Abbreviation
Ar–Articulare 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
between the alphabets.
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.
Type
Articulare is a bilateral, anatomic, hard tissue landmark.
 94
Section 4  Cephalometric Landmarks Related to Facial Bones and Dentition

A B

C D

Figures 12.8A to D: Gonion

Tracing of Articulare on the lateral kk

Cephalogram
The posterior or ramus border of the mandible appears as Abbreviation
radio-opaque line on the lateral cephalogram. Trace ramus
kk–kk is abbreviated using English alphabets and is expressed
border of the mandible. The point on the ramus border of the
as lower case or small letters k and k and written continuously
mandible at the neck region.
without any space between the alphabets.

Significance
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.
• Growth pattern is assessed using Go1 and Go2 angles.
• Rotation of the mandible is also assessed using the S-Ar-
Go angle.
Definition
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.
Type
kk (Figs 12.10A to D) is a bilateral hard tissue cephalometric
landmark.
 95

Chapter 12  Cephalometric Landmarks Related to Mandible

A B

C D

Figures 12.9A to D: Articulare

Tracing of Menton on the lateral Cephalogram Condylion

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
plane and angle in the Bjork cephalometric analysis.
Abbreviation
Cd–Articulare 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
between the alphabets.
Definition
According to Clifton T Forsberg
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
Section 4  Cephalometric Landmarks Related to Facial Bones and Dentition
A B
C D
Figures 12.10A to D: kk
According to KKK lew
Condylion medialis–Most medial aspect of condyle. Bilateral
structure.
According to Clifton T Forsberg
Condylion lateralis–The tangent point in each condylar
border of a line drawn parallel to each mandibular body line.
According to KKK lew
Condylion lateralis–Most lateral aspect of condyle. Bilateral
structure.
According to Clifton T Forsberg
Condylion anterioris–A point on the anterior of each condylar
head which is chosen to represent the mandibular fossa of the
temporal bone.
According to Clifton T Forsberg
Condylion posterialis–The intersection of the mandibular
body line with the posterior border of each condyle.
Type
Condylion is a bilateral, anatomic, hard tissue cephalometric
landmark.

A B
C D
Figures 12.11A to D: Condylion
Tracing of Condylion on the lateral Cephalogram
The posterior or ramus border of the mandible appears as
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 construc-
tion of plane and angle for the assessment of the following:
97
Chapter 12  Cephalometric Landmarks Related to Mandible
• Construction of posterior/ramus border of the mandible,
i.e. the line joining the point Articulare and Gonion.
• Growth pattern is assessed using Go1 and Go2 angles.
• Rotation of the mandible is also assessed using the S-Ar-
Go angle.
• Midfacial length is measured from condylion to point A in
McNamara analysis.
• The length of the mandible is measured from condylion
to gonion.
Section 5
Cephalometric Landmarks
Related to Cervical Bones

 Cephalometric Landmarks Related to Hyoid Bone

 Cephalometric Landmarks Related to Vertebrae
 Chapter

13 Cephalometric landmarks
related to hyoid bone

Like the mandible, the hyoid bone (Figs 13.1A and B) is also • In children, greater cornu is seen separately as it is not
a horse-shoe shaped bone suspended in the neck. fused to the body of hyoid but in adults both lesser and
greater cornu are fused to the body of hyoid bone.
Parts of the Hyoid Bone
Cephalometric Landmarks (Points) on Hyoid Bone
Hyoid bone consists of the following parts:
• A body. Cephalometric landmarks seen on the hyoid bone are of
• Lesser cornu/horn. anatomic origin and are as follows:
• Greater cornu/horn. Table 13.1: Cephalometric landmark related to hyoid bone
The lesser cornu fuses the body of the hyoid bone
superiorly whereas the greater cornu fuses the body of hyoid Cephalometric Abbreviation Type Origin
landmark
bone inferiorly.
Hyoid Hy or H Unilateral Anatomic
Radiographic Anatomy of Hyoid Bone
• The hyoid bone is well appreciated on the lateral cephalogram. Hyoid
• On the lateral cephalogram, the hyoid bone appears
boomerang-shaped radio-opaque area below the inferior
Abbreviation
to the middle of the mandibular body.
• The greater and lesser cornu of the hyoid bone appear as Hy–Hyoid is abbreviated using English alphabet and is
radio-opaque on the lateral cephalogram. expressed as capital or upper case H followed by lower case or
• The body of the hyoid bone on the lateral cephalogram small y, and both are written continuously without any space
appears as radio-opaque. between the alphabets.

A B

Figures 13.1A and B: Hyoid bone

 102
Section 5  Cephalometric Landmarks Related to Cervical Bones

A B

C D

Figures 13.2A to D: Hyoid

H–Hyoid is abbreviated using English alphabet and is Type

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
According to Robert M Ricketts, the hyoid is the point at the
anterior-superior margin of the body of the hyoid.1
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
1. Ricketts RR. Provocations and perceptions in cranio-facial orthopedics–
dental science and facial art. Rocky Mountain Inc. 1989;797-803.
 Chapter
Cephalometric landmarks
14 related to Vertebrae

Radiographic anatomy of Table 14.1: Cephalometric landmarks related to cervical vertebra

cervical vertebrae (fig. 14.1) Cephalometric Abbreviation Type Origin
landmarks
Anteroinferior to the occipital condyle, which appears as a
curved radio-opaque line, the anterior arch of the atlas can be cv2ap cv2ap Unilateral Anatomic
identified as a small triangular radio-opaque area. The apex cv2ip cv2ip Unilateral Anatomic
of the triangle faces the posterior border of the mandibular
cv2ia cv2ia Unilateral Anatomic
ramus, while its base faces the odontoid process of the
axis. The central mass of the atlas, which appears as radio- cv3sp cv3sp Unilateral Anatomic
opaque area superimposed on the radio-opaque shadow of the cv3ip cv3ip Unilateral Anatomic
odontoid process. Posterosuperior to the inferior articular facet
cv3sa cv3sa Unilateral Anatomic
is the superior articular facet, which can be identified as radio-
opaque area. Its superior border is concave and corresponds cv3ia cv3ia Unilateral Anatomic
with the contour of the occipital condyle. Next to the superior cv4sp cv4sp Unilateral Anatomic
articular facet is the posterior arch with the posterior tubercle.
cv4ip cv4ip Unilateral Anatomic
At the superior border of the posterior arch is a groove for the
vertebral artery and the first cervical nerve. cv4sa cv4sa Unilateral Anatomic
The odontoid process and the body of the axis appear as a cv4ia cv4ia Unilateral Anatomic
triangular radio-opaque area. The odontoid process represents
cv5sp cv5sp Unilateral Anatomic
the apex of the triangular points toward the occipital condyle.
The spinous process of the axis appears as a radio-opaque cv5ip cv5ip Unilateral Anatomic
projection extending superiorly. cv5sa cv5sa Unilateral Anatomic
The radiographic appearance of the third cervical vertebra
cv5ia cv5ia Unilateral Anatomic
(C3) to the seventh cervical vertebra (C7) is similar. The body
of the each of these cervical vertebrae appears as wedge shaped cv6sp cv6sp Unilateral Anatomic
radio-opaque area situated behind the pharyngeal space. cv6ip cv6ip Unilateral Anatomic
Posterior to the body is the spinous process. The transverse
cv6sa cv6sa Unilateral Anatomic
processes, the superior articular process and the inferior
articular process appear as radio-opaque area superimposed cv6ia cv6ia Unilateral Anatomic
on the shadow of the body and the spinous process. The
body of each cervical vertebra is separated from the adjacent Cephalometric Landmarks (Points) Related to
ones by the intervertebral disc, which appears as radiolucent Cervical Vertebra
strip. At the midpoint between the third and fourth cervical
vertebrae is the hyoid bone, which is separated anteriorly. • cv2ap–The apex of the odontoid process of the second
cervical vertebra.
• cv2ip–The most inferoposterior point on the body of the
Cephalometric Landmarks on Cervical Vertebra
second cervical vertebra.
Cephalometric landmarks seen on the cervical vertebra are of • cv2ia–The most inferoanterior point on the body of the
anatomic origin and are as follows (Table 14.1): second cervical vertebra.
 104
Section 5  Cephalometric Landmarks Related to Cervical Bones
Figure 14.1: Radiographic anatomy of cervical vertebra
• cv3sp–The most superoposterior point on the body of the
third cervical vertebra.
• cv3ip–The most inferoposterior point on the body of the
third cervical vertebra.
• cv3sa–The most superoanterior point on the body of the
third cervical vertebra.
• cv3ia–The most inferoanterior point on the body of the
third cervical vertebra.
• cv4sp–The most superoposterior point on the body of the
fourth cervical vertebra.
• cv4ip–The most inferoposterior point on the body of the
fourth cervical vertebra.
• cv4sa–The most superoanterior point on the body of the
fourth cervical vertebra.
• cv4ia–The most inferoanterior point on the body of the
fourth cervical vertebra.
• cv5sp–The most superoposterior point on the body of the
fifth cervical vertebra.
• cv5ip–The most inferoposterior point on the body of the
fifth cervical vertebra.
• cv5sa–The most superoanterior point on the body of the
fifth cervical vertebra.
• cv5ia–The most inferoanterior point on the body of the
fifth cervical vertebra.
• cv6sp–The most superoposterior point on the body of the
sixth cervical vertebra.
• cv6ip–The most inferoposterior point on the body of the
sixth cervical vertebra.
• cv6sa–The most superoanterior point on the body of the
sixth cervical vertebra.
• cv6ia–The most inferoanterior point on the body of the
sixth cervical vertebra.
cv2ip
Abbreviation
cv2ip–cv2ip 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
continuously without any space between the alphabets.
Definition
The most inferoposterior point on the body of the second
cervical vertebra.
Type
cv2ip (Figs 14.2A and B) is a unilateral, anatomic, hard tissue
cephalo­metric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
cv2ap
Abbreviation
cv2ap–cv2ap 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
written continuously without any space between the alphabets.
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
cephalo­metric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
 105

Chapter 14  Cephalometric landmarks related to Vertebrae

A B

Figures 14.2A and B: cv2ip-The most inferoposterior point on the body of the second cervical vertebra

A B

Figures 14.3A and B: cv2ap-The apex of the odontoid process of the second cervical vertebra
 106
cv2ia
Abbreviation
cv2ia–cv2ia 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 a and all of them are written
continuously without any space between the alphabets.
Definition
The most inferoanterior point on the body of the second
cervical vertebra.
Section 5  Cephalometric Landmarks Related to Cervical Bones
Type
cv2ia (Figs 14.4A and B) is a unilateral, anatomic, hard tissue
cephalo­metric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
A B
Figures 14.4A and B: cv2ia-The most inferioanterior point on the body of the second cervical vertebra
cv3sp
Abbreviation
cv3sp–cv3sp is abbreviated using English alphabet and
English numeric and is expressed as small letters or lower
case c,v followed by English numeric 3 and then it is followed
with English alphabets lower case s and p and all of them are
written continuously without any space between the alphabets.
Definition
The most superoposterior point on the body of the third
cervical vertebra.
Type
cv3sp (Figs 14.5A and B) is a unilateral, anatomic, hard tissue
cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.

A B
Figures 14.5A and B: cv3sp-The most superoposterior point on the body of the third cervical vertebra
cv3ip
Abbreviation
cv3ip–cv3ip is abbreviated using English alphabet and English
numeric and is expressed as small letters or lower case c,v
followed by English numeric 3 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.
Definition
The most inferoposterior point on the body of the third cervical
vertebra.
Type
cv3ip (Figs 14.6A and B) is a unilateral, anatomic, hard tissue
cephalo­metric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
107
Chapter 14  Cephalometric landmarks related to Vertebrae
cv3sa
Abbreviation
cv3sa—cv3sa is abbreviated using English alphabet and
English numeric and is expressed as small letters or lower
case c,v followed by English numeric 3 and then it is followed
with English alphabets lower case s and a and all of them are
written continuously without any space between the alphabets.
Definition
The most superoanterior point on the body of the third cervical
vertebra.
Type
cv3sa (Figs 14.7A and B) is a unilateral, anatomic, hard tissue
cephalo­metric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
 108
Section 5  Cephalometric Landmarks Related to Cervical Bones

A B

Figures 14.6A and B: cv3ip-The most inferoposterior point on the body of the third cervical vertebra

A B

Figures 14.7A and B: cv3sa-The most superoanterior point on the body of the third cervical vertebra

cv3ia
Abbreviation
cv3ia–cv3ia is abbreviated using English alphabet and English
numeric and is expressed as small letters or lower case c,v
followed by English numeric 3 and then it is followed with
English alphabets lower case i and a and all of them are written
continuously without any space between the alphabets.
Definition
The most inferoanterior point on the body of the third cervical
vertebra.
Type
cv3ia (Figs 14.8A and B) is a unilateral, anatomic, hard tissue
cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
A B
Figures 14.8A and B: cv3ia-The most inferioanterior point on the body of the third cervical vertebra
109
cv4sp
Abbreviation
cv4sp–cv4sp is abbreviated using English alphabet and
English 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 s and p and all of them are
written continuously without any space between the alphabets.
Definition
The most superoposterior point on the body of the fourth
cervical vertebra.
Chapter 14  Cephalometric landmarks related to Vertebrae
Type
cv4sp (Figs 14.9A and B) is a unilateral, anatomic, hard tissue
cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
 110
Section 5  Cephalometric Landmarks Related to Cervical Bones
A B
Figures 14.9A and B: cv4sp-The most superoposterior point on the body of the fourth cervical vertebra
cv4ip
Abbreviation
cv4ip–cv4ip is abbreviated using English alphabet and English
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.
Definition
The most inferoposterior point on the body of the fourth
cervical vertebra.
Type
cv4ip (Figs 14.10A and B) is a unilateral, anatomic, hard
tissue cephalo­metric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
cv4sa
Abbreviation
cv4sa–cv4sa is abbreviated using English alphabet and
English 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 s and a and
all of them are written continuously without any space
between the alphabets.
Definition
The most superoanterior point on the body of the fourth
cervical vertebra.
Type
cv4sa (Figs 14.11A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
 111

Chapter 14  Cephalometric landmarks related to Vertebrae

A B

Figures 14.10A and B: cv4ip-The most inferoposterior point on the body of the fourth cervical vertebra

A B

Figures 14.11A and B: cv4sa-The most superoanterior point on the body of the fourth cervical vertebra
 112
cv4ia
Abbreviation
cv4ia–cv4ia is abbreviated using English alphabet and English
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 a and all of them are written
continuously without any space between the alphabets.
DEFINITION
The most inferoanterior point on the body of the fourth
cervical vertebra.
Section 5  Cephalometric Landmarks Related to Cervical Bones
Type
cv4ia (Figs 14.12A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
A B
Figures 14.12A and B: cv4ia-The most inferoanterior point on the body of the fourth cervical vertebra
cv5sp
Abbreviation
cv5sp–cv5sp is abbreviated using English alphabet and
English numerical and is expressed as small letters or lower
case c,v followed by English numeric 5 and then it is followed
with English alphabets lower case i and a and all of them are
written continuously without any space between the alphabets.
Definition
The most superoposterior point on the body of the fifth
cervical vertebra.
Type
cv5sp (Figs 14.13A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.

A B
Figures 14.13A and B: cv5sp-The most superoposterior point on the body of the fifth cervical vertebra
cv5ip
Abbreviation
cv5ip–cv5ip is abbreviated using English alphabet and English
numeric and is expressed as small letters or lower case c,v
followed by English numeric 5 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.
Definition
The most inferoposterior point on the body of the fifth cervical
vertebra.
Type
cv5ip (Figs 14.14A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
113
Chapter 14  Cephalometric landmarks related to Vertebrae
cv5sa
Abbreviation
cv5sa–cv5sa is abbreviated using English alphabet and
English numeric and is expressed as small letters or lower
case c,v followed by English numeric 5 and then it is followed
with English alphabets lower case s and a and all of them are
written continuously without any space between the alphabets.
Definition
The most superoanterior point on the body of the fifth cervical
vertebra.
Type
cv5sa (Figs 14.15A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
 114
Section 5  Cephalometric Landmarks Related to Cervical Bones

A B

Figures 14.14A and B: cv5ip-The most inferoposterior point on the body of the fifth cervical vertebra

A B

Figures 14.15A and B: cv5sa-The most superoanterior point on the body of the fifth cervical vertebra

cv5ia
Abbreviation
cv5ia–cv5ia is abbreviated using English alphabet and English
numeric and is expressed as small letters or lower case c,v
followed by English numeric 5 and then it is followed with
English alphabets lower case i and a and all of them are written
continuously without any space between the alphabets.
Definition
The most inferoanterior point on the body of the fifth cervical
vertebra.
Type
Cv5ia (Figs 14.16A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
A B
Figures 14.16A and B: cv5ia-The most inferoanterior point on the body of the fifth cervical vertebra
115
cv6sp
Abbreviation
cv6sp–cv6sp is abbreviated using English alphabet and
English numeric and is expressed as small letters or lower
case c,v followed by English numeric 6 and then it is followed
with English alphabets lower case s and p and all of them are
written continuously without any space between the alphabets.
Definition
The most superoposterior point on the body of the sixth
cervical vertebra.
Chapter 14  Cephalometric landmarks related to Vertebrae
Type
cv6sp (Figs 14.17A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
 116
Section 5  Cephalometric Landmarks Related to Cervical Bones
A B
Figures 14.17A and B: cv6sp-The most superoposterior point on the body of the sixth cervical vertebra
cv6ip
Abbreviation
cv6ip–cv6ip is abbreviated using English alphabet and English
numeric and is expressed as small letters or lower case c,v
followed by English numeric 6 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.
Definition
The most inferoposterior point on the body of the sixth
cervical vertebra.
Type
cv6ip (Figs 14.18A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
cv6sa
Abbreviation
cv6sa–cv6sa is abbreviated using English alphabet and
English numeric and is expressed as small letters or lower
case c,v followed by English numeric 6 and then it is followed
with English alphabets lower case s and a and all of them are
written continuously without any space between the alphabets.
Definition
The most superoanterior point on the body of the sixth cervical
vertebra.
Type
cv6sa (Figs 14.19A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method.
 117

Chapter 14  Cephalometric landmarks related to Vertebrae

A B

Figures 14.18A and B: cv6ip-The most inferoposterior point on the body of the sixth cervical vertebra

A B

Figures 14.19A and B: cv6sa-The most superoanterior point on the body of the sixth cervical vertebra
 118
cv6ia
Abbreviation
cv6ia–cv6ia is abbreviated using English alphabet and English
numeric and is expressed as small letters or lower case c,v
followed by English numeric 6 and then it is followed with
English alphabets lower case i and a and all of them are written
continuously without any space between the alphabets.
Definition
The most inferoanterior point on the body of the sixth cervical
vertebra.
Section 5  Cephalometric Landmarks Related to Cervical Bones
Type
cv6ia (Figs 14.20A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark.
Significance
This cephalometric landmark/point is used as a reference point in
the cervical vertebrae maturity indicator (CMVI) method.
A B
Figures 14.20A and B: cv6ia-The most inferoanterior point on the body of the sixth cervical vertebra
Cervical Vertebrae as Indicators of Skeletal
Maturity
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.
 119

Chapter 14  Cephalometric landmarks related to Vertebrae

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
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 hand-
wrist. 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 patient’s 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 Figure 14.23: The shapes of the cervical vertebral bodies of C3
skeleton matures. 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.
Table 14.2: Assessment of skeletal maturity using cervical vertebrae
Stage 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.
• 80–95% of growth in remaining pubertal.
Stage 2 Acceleration • Acceleration of growth occurs.
• Concavities are developing on the lower
Section 5  Cephalometric Landmarks Related to Cervical Bones
borders of C2 and C3
• Lower border of C4 vertebral body is flat
• C3 and C4 assume rectangular shape
• 65–85% of pubertal growth remains
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.
• 25–65% 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
• 10–25% of pubertal growth is remain­ing
Contd...
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
• 5–10% 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.
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 6
Cephalometric landmarks
related to Pharynx

 Cephalometric landmarks related to Pharynx

 Chapter

15 Cephalometric landmarks
related to Pharynx

The pharynx is a median fibromuscular tube that extends from Table 15.1: Cephalometric landmarks related to pharynx
the base of the skull. Pharynx opens into nasal cavity, the oral
Cephalometric Abbreviation Type Origin
cavity, and the larynx. Pharynx opens into the nasal cavity, landmarks
the oral cavity and the larynx are termed as nasopharynx, Anterior nasal spine ANS or ans Unilateral Anatomic
oropharynx and laryngopharynx respectively.
Posterior nasal spine PNS or pns Unilateral Anatomic
Anterior pharyngeal apw Unilateral Anatomic
Nasopharynx wall
The Nasopharynx is the upper part of the pharynx. It is situated Posterior pharyngeal ppw Unilateral Anatomic
behind the oral cavity above the soft palate. Its superior border wall
is the base of the skull. In the posterior part of the roof and Pterygomaxillary Ptm Unilateral Anatomic
the upper part of the posterior wall, there is an accumulation fissure
of lymphoid tissue—the adenoid or pharyngeal tonsil—which Superior pharyngeal spw Unilateral Anatomic
may be prominent in children but which becomes indistinct wall
in adulthood. In the lateral wall, 1.5 cm posterior to the Tip of uvula U Unilateral Anatomic
inferior nasal concha, is the opening of the auditory tube.The Point on the oral side Uo Unilateral Anatomic
nasopharynx extends downwards and is continuous with the of the soft palate
oropharynx at the level below the soft palate. Point on the Up Unilateral Anatomic
pharyngeal side of
the soft palate
Oropharynx
Upper point of ut Unilateral Anatomic
The oropharynx is the middle part of the pharynx situated tongue
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
Anterior Nasal Spine,
the opening of the oral cavity into the oropharynx, the palatine Posterior Nasal Spine
tonsils are lodged in the tonsilar fossae. and Pterygomaxillary Fissure
Laryngopharynx Anterior nasal spine, posterior nasal spine and pterygo­
maxillary fissure are explained in detail in Chapter 10
The laryngopharynx is the lower part of the pharynx. It extends [Cephalometric Landmarks (Points) Related to Maxilla].
from the superior border of the epiglottis to the inferior border
of the sixth cervical vertebrae, where it becomes continuous Anterior Pharyngeal Wall
with the esophagus. The upper part of the laryngopharynx is
open anteriorly to the larynx via the patent inlet. Abbreviation
apw–Anterior pharyngeal wall is abbreviated using English
Cephalometric Landmarks (Points) on Pharynx
alphabet and is expressed as small letters or lower case, a, p
Cephalometric landmarks seen on the pharynx are of anatomic and w and written continuously without any space between
origin and are as follows (Table 15.1): the alphabets.
 124
Posterior Pharyngeal Wall
Abbreviation
ppw–Posterior pharyngeal wall is abbreviated using English alpha-
bet and is expressed as small letters or lower case, p, p and w and
written continuously without any space between the alphabets.
Superior Pharyngeal Wall
Abbreviation
spw–Superior pharyngeal wall is abbreviated using English alpha-
bet and is expressed as small letters or lower case, s, p and w and
written continuously without any space between the alphabets.
Section 6  Cephalometric Landmarks Related to Pharynx
Tip of the Uvula
Abbreviation
U–Tip 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
Uo–Point 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
continuously without any space between the alphabets.
Point on the Pharyngeal Side of the Soft Palate
Abbreviation
Up–Point 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
continuously without any space between the alphabets.
Upper Point of Tongue
Abbreviation
ut—Upper 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 15–20 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 7
Soft Tissue Cephalometric
Landmarks

 Soft Tissue Cephalometric Landmarks

 ChapTer
Soft Tissue Cephalometric
16 Landmarks

Soft Tissue Cephalometric Landmarks (Points) • Gs–Some authors abbreviate soft tissue glabella as English
Related to Forehead alphabet upper case G followed by lower cases.
• SGLB–Some authors even abbreviate soft tissue glabella
Soft tissue cephalometric landmarks related to forehead are as English alphabets upper case S, G L and B written
listed below and are explained in detail in this chapter. continuously without any space between each alphabet.
• Trichion • Note–Soft tissue glabella can be abbreviated as upper case
• Soft tissue glabella. G or Gs or SGLB, However, G is the most widely used
abbreviation.
Soft Tissue Glabella
Definition
Abbreviation • Soft tissue glabella (Figs 16.1A to D) is the most prominent
or anterior point in the midsagittal plane of the forehead at
• G–Soft tissue glabella is abbreviated using English the level of the superior orbital ridges.
alphabet and is expressed as upper case G.

A B C D

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).
Type
Glabella is a unilateral soft tissue cephalometric landmark.
Significance
Glabella is used as one of the reference points in the construc-
tion of facial angles.
Soft Tissue Cephalometric Landmarks
Related to Nose
Soft tissue cephalometric landmarks (points) related to nose
Section 7  Soft Tissue Cephalometric Landmarks
All above mentioned soft tissue cephalometric landmarks/
points related to nose are explained below:
Soft Tissue Nasion
Abbreviation
n–Soft tissue nasion is abbreviated using English alphabet and
is expressed as lower case n.
N–Soft 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

are listed below: point in the tissue overlying the area of the frontonasal suture.
• Soft tissue nasion
• Nasal crown According to Spiro J Chaconas in 1993
• Pronasale The point of intersection of the soft tissue profile with a line
• Point “T” drawn from the center of sella turcica through nasion.
• Alar crease junction.

A B C D

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

Type
Soft tissue nasion is a unilateral soft tissue cephalometric
landmark.
Significance
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
Abbreviation
NC–Nasal crown is abbreviated using English alphabet and is
expressed as capital (upper case) NC and written continuously
without any space between alphabets.
Definition
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).
A B
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
129
Type
Nasal crown is a unilateral soft tissue cephalometric landmark.
Significance
Nasal crown is used for the assessment of nasal contour.
Pronasale
Abbreviation
Pn–Pronasale 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
Prn–Pronasale 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.
PRN–Pronasale 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.
prn–Pronasale 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.
C D
 130
Section 7  Soft Tissue Cephalometric Landmarks

A B C D

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 is also used as one of the reference points in the

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
The most prominent or anterior point of the nose tip.
According to Spiro J Chaconas in 1969
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
on the midsagittal profile of the nose. Definition
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.
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”
Abbreviation
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
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

Chapter 16  Soft Tissue Cephalometric Landmarks

A B C D

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
ACJ–Alar 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
Alar crease junction (Figs 16.6A to D) is a bilateral constructed
point soft tissue cephalometric landmark.
case) n written continuously without any space between
them.
SN–Subnasale is abbreviated using English alphabet and is
expressed as capital (upper case) S and N written continuously
without any space between them.
sn–Subnasale is abbreviated using English alphabet and is
expressed as lower case (Small alphabets) s and n written
continuously without any space between them.
Definition
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
Abbreviation
Sn–Subnasale is abbreviated using English alphabet and is
expressed as capital (upper case) S followed by small (lower
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
Subnasale is the point at which the nasal septum between the
nostrils merges with the upper cutaneous lip in the midsagittal
plane.
 132
Section 7  Soft Tissue Cephalometric Landmarks

A B C D

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

A B C D

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
Significance • Stomion inferius
• Subnasale helps in the assessment of nasal tip projection
Related to Lower Lip
and nasal height.
• Subnasale is also used as one of the reference points in • Labrale inferius
the construction of following planes for the assessment of • Soft tissue point B
following:
All above mentioned soft tissue cephalometric landmarks
– Burstone’s B line used to assess the relationship of
(points) related to lips are explained below.
upper and lower teeth to the upper and lower lip.
– Height of upper lip (Sn–Ls) can be assessed.
Soft Tissue Subspinale
Soft Tissue Cephalometric Landmarks (Points)

Chapter 16  Soft Tissue Cephalometric Landmarks

Related to Lips Abbreviation
Soft tissue cephalometric landmarks (points) related to lips Ss–Soft tissue subspinale is abbreviated using English
are listed below: alphabet and is expressed as capital S followed by small s.

Related to Upper Lip Definition

• Soft tissue subspinale • Labrale superius Soft tissue subspinale (Figs 16.8A to D) is the point of greatest
• Philtrum • Cuspid bow concavity in the midline of the upper lip between subnasale
• Vermillion border of upper lip (Sn) and labrale superius (Ls).

A B C D

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
Soft tissue subspinale is a unilateral soft tissue cephalometric
landmark.
Significance
Soft tissue subspinale is also used as one of the reference points
in the construction of following planes for the assessment of
following:
• Steiner’s S line used to assess the relationship of upper
and lower teeth to the upper and lower lip.
Labrale Superius
Section 7  Soft Tissue Cephalometric Landmarks
Abbreviation
Ls–Labrale superius is abbreviated using English alphabet
and is expressed as capital L followed by small s.
Definition
Labrale superius (Figs 16.9A to D) is the most anterior point
on the margin of the upper membranous lip.
A B
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
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 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.
• Merfield’s “Z” angle used to assess the relationship of
upper and lower teeth to the upper and lower lip.
• 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).
Philtrum
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.
C D
 135

Chapter 16  Soft Tissue Cephalometric Landmarks

Figure 16.10: Philtrum 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
Sto–Stomion 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
 136
Section 7  Soft Tissue Cephalometric Landmarks

A B C D

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 • It is even used to measure the length of lower lip (Li-Me).

• It can also be used to assess the planed incisor position
Stomion is established only at rest when teeth are in centric (PIP).
occlusion and centric relation. Presence of stomion indicates
averagely positioned upper and lower teeth.
Soft Tissue Submentale
Labrale Inferius (Soft Tissue Point B)

Abbreviation Abbreviation
Li–Labrale inferius is abbreviated using English alphabet and B–Soft tissue point B is abbreviated using English alphabet
is expressed as capital L followed by small i. and is expressed as capital “B”.

Definition Definition
Labrale inferius (Figs 16.14A to D) is the most anterior point Soft tissue point B or Soft tissue submentale (Figs 16.15A to D)
on the lower margin of the lower membrane lip. is the point of greatest concavity in the midline of the lip between
labrale inferius (Li) and soft tissue pogonion (Pog’ or Pogs).
Type
Type
Labrale inferius is a unilateral soft tissue cephalometric
landmark. Soft tissue point B or soft tissue submentale is a unilateral soft
tissue cephalometric landmark.
Significance
Labrale inferius is also used as one of the reference points
Significance
in the construction of following planes for the assessment of • Soft tissue point B or soft tissue submentale is used in the
following: assessment of deepness of submental.
 137

Chapter 16  Soft Tissue Cephalometric Landmarks

A B C D

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

A B C D

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
Section 7  Soft Tissue Cephalometric Landmarks
A B
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
assessment of following:
– It is even used to measure the length of lower lip
(Li-Me).
– It can also be used to assess the planed incisor position
(PIP).
Soft Tissue Cephalometric Landmarks
Related to Chin
Soft tissue cephalometric landmarks/points related to chin are
listed below:
• Soft tissue pogonion
• Soft tissue gnathion
All above mentioned soft tissue cephalometric landmarks/
points related to chin are explained below:
Soft Tissue Pogonion
Abbreviation
Pogs or Pog’–Soft 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
C D
denoted as capital P followed by small o and g’ ending with ’
as a superscript.
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.
Type
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
assessment of following:
– Steiner’s “S” line used to assess the relationship of
upper and lower teeth to the upper and lower lip.
– Rickett’s E-line used to assess the relationship of
upper and lower teeth to the upper and lower lip.
– Burstone’s B line used to assess the relationship of
upper and lower teeth to the upper and lower lip.
– Holdaway “H” line used to assess the relationship of
upper and lower teeth to the upper and lower lip.
 139

Chapter 16  Soft Tissue Cephalometric Landmarks

A B C D

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
Gns–Soft tissue gnathion is abbreviated using English
alphabet and is expressed as capital G followed by small n
with s in subscript position.
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.
Type
Soft tissue gnathion is a unilateral constructed point soft tissue
cephalometric landmark.
SECTION 8
3D Cephalometric
Landmarks

 3D Cephalometric Landmarks
 CHAPTER

17 3D Cephalometric
Landmarks

Vertex Soft Tissue Nasion

Abbreviation
Abbreviation
V–Vertex is abbreviated using English alphabet and is
n–Soft tissue nasion is abbreviated using English alphabet and
expressed as capital or upper case V.
is expressed as small letter or lower case n.
Definition N’–Soft tissue nasion can also be abbreviated using English
alphabet and is expressed as upper case or capital letter N and
Vertex (Fig. 17.1) is the most superior point of calvarium in ending with ’ in superscript position.
center line.
Definition
Type
Soft tissue nasion (Fig. 17.2) is the concave or retruded point
Vertex is an anatomic, unilateral, soft tissue cephalometric in the tissue overlying the area of the frontonasal suture.
landmark.

Significance According to Spiro J Chaconas

The point of intersection of the soft tissue profile with a line
Vertex is used as one of the reference points in the construction
drawn from the center of sella turcica through nasion.
of angles and planes in 3D cephalometric analysis.

Figure 17.1: Vertex (Image created with the Invivo5 software by Figure 17.2: Soft tissue nasion (Image created with the Invivo5
Anatomage Inc.) software by Anatomage Inc.)
 144

Type According to SN Bhatia and

Soft tissue nasion is a unilateral, soft tissue cephalometric BC Leighton in 1993
landmark. The most prominent or anterior point of the nose tip..

Significance According to Spiro J Chaconas

Soft tissue nasion is used as one of the reference points on the
construction planes and angles in 3D cephalometric analysis.
Pronasale
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.

Abbreviation According to Leslie G Farkas in 1981

Pn–Pronasale 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.
Prn–Pronasale is also abbreviated using English alphabet
Section 8  3D Cephalometric Landmarks
Pronasale is the most protruded point of the apex nasi. This
point is difficult to determine if the nasal tip is flat.
Type

and is expressed as capital (upper case) P followed by lower

Pronasale is a unilateral, soft tissue cephalometric landmark.
case r and n written continuously without any space between
alphabets.
Significance
PRN–Pronasale can also be abbreviated using English
Pronasale is used as one of the reference points on the
alphabet and is expressed as capital (upper case) P, R and N
construction planes and angles in 3D cephalometric analysis.
written continuously without any space between alphabets.
prn–Pronasale can also be abbreviated using English alphabet
and is expressed as small (lower case) p, r and n written cont-
Subnasale
inuously without any space between alphabets.
Abbreviation
Definition
Sn–Subnasale is abbreviated using English alphabets and is
Pronasale (Figs 17.3A and B) is the most prominent or expressed as capital (upper case) S followed by small (lower
anterior point of the nose. case) n written continuously without any space between them.

A B

Figures 17.3A and B: Pronasale (Image created with the Invivo5 software by Anatomage Inc.)

SN–Subnasale is abbreviated using English alphabet and is
expressed as capital (upper case) S and N written continuously
without any space between them.
sn–Subnasale is abbreviated using English alphabet and is
expressed as lower case (small alphabets) s and n written
continuously without any space between them.
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 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 (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 a unilateral, soft tissue cephalometric landmark.
Figure 17.4: Subnasale (Image created with the Invivo5 software
by Anatomage Inc.)
145
Significance
Subnasale is used as one of the reference points on the
construction planes and angles in 3D cephalometric
analysis.
Soft Tissue Subspinale
Abbreviation
Ss–Soft 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
space between the alphabets.
Definition
Soft tissue subspinale (Fig. 17.5) is the point of greatest
Chapter 17  3D Cephalometric Landmarks
concavity in the midline of the upper lip between subnasale
(Sn) and labrale superius (Ls).
Type
Soft tissue subspinale is a unilateral soft tissue cephalometric
landmark.
Significance
Soft tissue subspinale is also used as one of the reference points in
the construction of following planes in 3D cephalometric analysis.
Figure 17.5: Soft tissue subspinale (Image created with the Invivo5
software by Anatomage Inc.)
 146

Labrale Superius Definition

Stomion (Fig. 17.7) is the median point of the oral embrassure
Abbreviation when the lips are closed.

Ls–Labrale superius is abbreviated using English alphabets Type

and is expressed as capital L followed by small s and is written
continuously without any space between the alphabets. Stomion is a unilateral soft tissue cephalometric landmark.

Definition Significance
Labrale superius (Fig. 17.6) is the most anterior point on the Stomion is used as one of the reference points on the
margin of the upper membranous lip. construction planes and angles in 3D cephalometric analysis.

Type Labrale Inferius

Labrale superius is a unilateral soft tissue cephalometric
landmark. Abbreviation
Li–Labrale inferius is abbreviated using English alphabets
Section 8  3D Cephalometric Landmarks

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
Sto–Stomion is abbreviated using English alphabets and is
expressed as capital S followed by small t and o and is written
continuously without any space between the 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 17.6: Labrale superius (Image created with the Invivo5 Figure 17.7: Stomion (Image created with the Invivo5 software by
software by Anatomage Inc.) Anatomage Inc.)
 147

Chapter 17  3D Cephalometric Landmarks

Figure 17.8: Labrale inferius (Image created with the Invivo5 Figure 17.9: Soft tissue point B (Image created with the Invivo5
software by Anatomage Inc.) software by Anatomage Inc.)

Significance
Labrale inferius is used as one of the reference point on the
construction planes and angles in 3D cephalometric analysis.

Soft Tissue Submentale

(Soft Tissue Point B)

Abbreviation
B’–Soft 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). Figure 17.10: Soft tissue pogonion (Image created with the
Invivo5 software by Anatomage Inc.)
Type
Soft tissue point B or soft tissue submentale is a unilateral soft
tissue cephalometric landmark.
Soft Tissue Pogonion

Significance Abbreviation
Soft tissue point B is used as one of the reference points on the Pogs or Pog’–Soft tissue pogonion is abbreviated using
construction planes and angles in 3D cephalometric analysis. English alphabets and is expressed as capital P followed
 148

by small o and g with s in subscript position. It can also be Type

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
Soft tissue gnathion is a unilateral, constructed points, soft
tissue cephalometric landmark.
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

Significance
Soft tissue pogonion is used as one of the reference points
on the construction planes and angles in 3D cephalometric
analysis.
Section 8  3D Cephalometric Landmarks
Abbreviation
Ors–Orbitale 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

between the alphabets.

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

Definition Significance
Soft tissue gnathion (Fig. 17.11) is the midpoint between the Orbitale is used as one of the reference points on the
most anterior and inferior points of the soft tissue chin in the construction planes and angles in 3D cephalometric
midsagittal plane. analysis.

Figure 17.11: Soft tissue gnathion (Image created with the Invivo5 Figure 17.12: Orbitale (Image created with the Invivo5 software
software by Anatomage Inc.) by Anatomage Inc.)

Zygomatic Prominence
Abbreviation
ZpS–Zygomatic 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
without any space between the alphabets.
Definition
Zygomatic prominence (Fig. 17.13)—Most protrusive
anterior point on zygomatic arch.
Type
Zygomatic prominence is a bilateral soft tissue cephalometric
landmark.
Significance
Zygomatic prominence is used as one of the reference points
on the construction planes and angles in 3D cephalometric
analysis.
Zygion
Abbreviation
Zys–Zygion is abbreviated using English alphabets and is
expressed as capital Z followed by small y with s in subscript
position and is written continuously without any space
between the alphabets.
Figure 17.13: Zygomatic prominence (Image created with the
Invivo5 software by Anatomage Inc.)
149
Definition
Zygion (Fig. 17.14)–Most lateral point of each zygomatic
arch eye.
Type
Zygion is a unilateral soft tissue cephalometric landmark.
Significance
Zygion is used as one of the reference points on the construction
planes and angles in 3D cephalometric analysis.
Condylion
Abbreviation
Cos–Condylion is abbreviated using English alphabets and is
Chapter 17  3D Cephalometric Landmarks
expressed as capital C followed by small o with s in subscript
position and is written continuously without any space
between the alphabets.
Definition
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
construction planes and angles in 3D cephalometric analysis.
Figure 17.14: Zygion (Image created with the
Invivo5 software by Anatomage Inc.)
 150

A B
Section 8  3D Cephalometric Landmarks

Figures 17.15A and B: Condylion (Image created with the Invivo5 software by Anatomage Inc.)

A B
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
Gos–Gonion is abbreviated using English alphabets and is Gonion is used as one of the reference points on the
expressed as capital G followed by small o with s in subscript construction planes and angles in 3D cephalometric analysis.
position and is written continuously without any space
between the alphabets. Ch
Abbreviation
Definition
Ch—Ch is abbreviated using English alphabets and is
Gos (Figs 17.16A and B)—Most everted point of angle of expressed as capital C followed by small h written continuously
mandible. without any space between the alphabets.
 151

Definition Alare
Ch (Fig. 17.17)–Most lateral border point of chin.
Abbreviation
Type
Al–Alare is abbreviated using English alphabets and is
Ch is a unilateral soft tissue cephalometric landmark. expressed as capital A followed by small or lower case l
and is written continuously without any space between the
Significance alphabets.
Ch is used as one of the reference points on the construction
planes and angles in 3D cephalometric analysis. Definition
Alare (Fig. 17.19)–The most lateral point on each alar contour.
Cheilion
Type
Abbreviation Alare is a bilateral soft tissue cephalometric landmark.
C–Cheilion is abbreviated using English alphabet and is
Significance

Chapter 17  3D Cephalometric Landmarks

expressed as capital C.
Alare is used as one of the reference points on the construction
Definition planes and angles in 3D cephalometric analysis.
Cheilion (Fig. 17.18)–Most lateral point located at each labial
commissure.
Exocanthion
Type
Cheilion is a unilateral soft tissue cephalometric landmark. Abbreviation
Ex–Exocanthion is abbreviated using English alphabets and
Significance
is expressed as capital E followed by small or lower case x
Cheilion is used as one of the reference points on the and is written continuously without any space between the
construction planes and angles in 3D cephalometric analysis. alphabets.

Figure 17.17: Ch (Image created with the Invivo5 software by Figure 17.18: Cheilion (Image created with the Invivo5 software
Anatomage Inc.) by Anatomage Inc.)
 152
Section 8  3D Cephalometric Landmarks

Figure 17.19: Alare (Image created with the Invivo5 software by Figure 17.20: Exocanthion (Image created with the Invivo5
Anatomage Inc.) software by Anatomage Inc.)

Definition According to B Holly Broadbent

Exocanthion–The point at the inner commissure of the eye Sella turcica (Turkish saddle).
tissue. The landmark is the center of the sella as seen in the lateral
radiograph and located by inspection.
Type
According to LB Higley
Exocathion is a bilateral soft tissue cephalometric landmark.
The center of sella turcica.
Significance The midpoint of the sella turcica arbitrarily determined.
Exocathion is used as one of the reference points on the According to William B Downs
construction planes and angles in 3D cephalometric analysis.
The center of sella turcica.
Located by inspection of the profile image of the fossa.
Sella
According to Arne Bjork
Abbreviation The center of sella turcica (the midpoint of the horizontal
S–Sella is abbreviated using English alphabet and is expressed diameter).
as capital or upper case S.
Type
Definition Sella is a unilateral, anatomic, hard tissue cephalometric
Sella (Fig. 17.20) is the midpoint of sella turcica or hypophyseal landmark.
fossa or pituitary fossa.
Tracing of Sella on the Lateral Cephalogram
According to Robert E Moyers The pituitary fossa is round and bottle shaped hollow space,
The center of the hypophyseal fossa (sella turcica). It is situated in the upper body of the sphenoid bone. This fossa
selected by the eye since that producer as been shown to be as contains pituitary gland. This fossa is bounded anterioly and
reliable as a constructed center. 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
According to TM Graber
posterior clinoid process followed by inferior border of the
The center of pituitary fossa. pituitary fossa. Center point of the fossa is the point of sella.

Significance (Ref to Chapter 20)
Sella 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, S-N-Pr angle and saddle angle (N-S-Ar).
• Relationship of mandible to cranial base is assessed using
SNB angle and S-N-Id angle.
• Relationship of anterior and posterior cranial base assessed
using N-S-Ar.
Sella Entrance
Abbreviation
Se–Sella 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
space between the alphabets.
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.
Figure 17.21: Sella entrance (Image created with the Invivo5
software by Anatomage Inc.)
153
Basion
Abbreviation
Ba–Basion 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
space between the alphabets.
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.
According to Robert M Ricketts
Chapter 17  3D Cephalometric Landmarks
Point at the center of the anterior border of the foramen
magnum at the base of the occipital bone.
According to TM Graber
The most inferior point on the anterior margin of the foramen
magnum in the midsagittal plane.
According to Robert E Moyers
The most inferior posterior point in the sagittal plane on the
anterior rim of the foramen magnum.
According to Arne Bjork
Normal projection of the anterior border of the occipital
foramen (endobasion) on the occipital foramen line.
According to Clifton T Forsberg
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
• 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

A B
Section 8  3D Cephalometric Landmarks

C D

Figures 17.22A to D: Basion (Image created with the Invivo5 software by Anatomage Inc.)

occipital synchondrosis to the anterior margin of the Anterior Nasal Spine

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.
Abbreviation
ANS–Anterior 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

According to Robert E Moyers

The most anterior point on the maxilla at the level of the
palate. The ANS is of limited use for analysis in the posterior-
anterior 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
cephalometric landmark.

Tracing of Anterior Nasal Spine on Lateral

Cephalogram
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.

Chapter 17  3D Cephalometric Landmarks

Figure 17.23: Anterior nasal spine (Image created with the Invivo5
software by Anatomage Inc.)
Radiographic Appearance
According to Viken Sassouni • ANS appears slightly posterior to the anatomic spine.
The most anterior point of the nasal floor tip of pre-maxilla on • In cases with thin ANS–in such cases, on the cephalogram,
mid-sagittal plane. ANS will be unclear because it can superimpose by nasal
cartilage.
• In cases with thick ANS–in such cases, on the cephalogram,
According to B Holly Broadbent
ANS is clear and will be ease in tracing.
Sharp median process formed by the forward prolongation of
the anterior aperature of the nose. Significance (Ref to Chapter 20)
Anterior nasal spine is used as one of the reference points
According to TM Graber
in the construction of occlusal plane and is used for the
The tip of the anterior nasal spine as seen on the X-ray film in assessment of horizontal growth pattern using FH-Palatal
norma lateralis. plane angle (ANS-PNS).
Section 9
PA Cephalometric
Landmarks

 PA Cephalometric Landmarks
 ChAPter
PA Cephalometric
18 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 6–15 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 1. Cephalometric landmarks (points) related to ethmoid bone.
of malocclusions in the frontal plane, particularly for 2. Cephalometric landmarks (points) related to nasal bone.
adolescent subjects. The aim of this study was to establish 3. Cephalometric landmarks (points) related to zygomatic
PA cephalometric norms for adolescent Kuwaitis of an bone.
age comparable with the normal start of comprehensive 4. Cephalometric landmarks (points) related to maxillary bone.
orthodontic treatment, and to compare these norms with those 5. Cephalometric landmarks (points) related to dentition.
suggested in the available analysis systems as well as to other 6. Cephalometric landmarks (points) related to mandible.
published information.
Pa Cephalometric Landmarks Related to
Taking Pa Cephalogram Ethmoid Bone
The PA cephalogram is taken with the patient’s head held Cephalometric landmark related to ethmoid bone are as
straight (natural head position) or slightly down. The plane follows (Table 18.1):
that intersects the ear rods, which help to stabilize the head,
is known as the porionic, transporionic, or otic plane or axis Table 18.1: Cephalometric landmark related to ethmoid bone
because it presumably interacts with the external auditory meati. Cephalometric landmark Abbreviation Type Origin
The film-object, film with ear rod, or porion-film distance Crista galli Nc Unilateral Anatomic
determines the amount of magnification of the head structure.
Section 9  PA Cephalometric Landmarks

In early traditional cephalometry, the film holder was placed

to touch the nose, and the percentage of magnification was Crista galli
computed and corrected. Later, the film-poronic axis distance
could be set at a fixed distance (13-15 cm) with corresponding abbreviation
magnification factors. In digital machines, technological
requirements dictate a greater sensor object distance (around Nc–Crista galli is abbreviated using English alphabets and is
20 cm), leading to enlargement factors of more than 13 percent expressed as capital letter or upper case N and small letter or
that can be corrected in the imaging software. lower case c and is written continuously without any space
between the alphabets.
Structures Involved in Pa Cephalogram
Definition
Following structures are involved in PA cephalogram and
need to be traced; Structures of right and left side need to be Neck of crista galli (Figs 18.1A and B) is the neck of
traced in PA cephalogram: perpendicular lamina of the ethmoid.
• External peripheral cranial bone surfaces.
• Coronal suture. according to Viken Sassouni
• Mastoid processes.
Neck of crista galli, most constricted point of the projection of
• Occipital condyles.
the perpendicular lamina of the ethmoid (almost at the level
• Planum sphenoidale and superior surface of the floor of
of planum).
the pituitary fossa.
• Floor of the nose.
• Orbital outline and inferior surface of the orbital plate of Type
the frontal bone. Neck of crista galli is a unilateral, anatomic, hard tissue PA
• Oblique line formed by the external surface of the greater cephalometric landmark.
wing of the sphenoid in the area of the temporal fossa.
• Arcuate eminence . Pa Cephalometric Landmarks Related to Nasal
• Lateral surface of the frontosphenoidal process of the zygoma Bone
and the zygomatic arch down to and including the key ridge
• Cross-section of the zygomatic arch. Cephalometric landmarks related to nasal bone are as follows
• Infratemporal surface of the maxilla in the area of the (Table 18.2):
tuberosity, which is seen lateral to the lower outlines of the Table 18.2: Cephalometric landmarks related to nasal bone
key ridge after the eruption of the permanent first molar.
Cephalometric Abbreviation Type Origin
• Body of the mandible. landmarks
• Complete dentition or selected dental units.
top of nasal septum tns Unilateral Anatomic
PA cephalometric landmarks/points related to specific bones
NC NC Unilateral Anatomic
are listed below:
 161

Chapter 18  PA Cephalometric Landmarks

A B
Figures 18.1A and B: Crista galli

A B

Figures 18.2A and B: Top of nasal septum

Top of Nasal Septum Definition

according to athanasios E athanasiou
abbreviation The highest point onto the superior aspect of the nasal septum
(Figs 18.2A and B).
tns–Top of nasal septum is abbreviated using English
alphabet and is expressed as small letter or lower case t, Type
n, s and is written continuously without any space between
Top of nasal septum is a unilateral, anatomic, hard tissue PA
the alphabets.
cephalometric landmark.
 162

NC Pa Cephalometric Landmarks Related to

zygomatic Bone
abbreviation Cephalometric landmarks related to zygomatic bone are as
NC–NC is abbreviated using English alphabets and is follows (Table 18.3):
expressed as capital letter or upper case N, C and is written Table 18.3: Cephalometric landmarks related to zygomatic bone
continuously without any space between the alphabets.
Cephalometric Abbreviation Type Origin
landmarks
Definition
Zygoma Zyg Bilateral Anatomic
according to Robert M Ricketts
Zygion Zy Bilateral Anatomic
Lateral most point on inside surface of the bony nasal cavity
(Fig. 18.3). Zygomatic arch ZA Bilateral Anatomic

Zygomatic suture Z Bilateral Anatomic

Type point
NC is a unilateral, anatomic, hard tissue PA cephalometric Jugal process J Bilateral Anatomic
landmark.
Section 9  PA Cephalometric Landmarks

zyg-zygoma

abbreviation
Zyg–Zygoma 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
any space between the alphabets.

Definition

according to Viken Sassouni

Most lateral and superior point of the shadow of the zygomatic
arch (Figs 18.4A and B).
Figure 18.3: NC

A B
Figures 18.4A and B: Zygoma
 163

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

zygion zygomatic arch

abbreviation
Zy–Zygion 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
space between the alphabets.
abbreviation
ZA–Zygomatic 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
according to Robert M Ricketts according to Robert M Ricketts

Chapter 18  PA Cephalometric Landmarks

Zygion is the most lateral point of each zygomatic arch Center of zygomatic arch by inspection for frontal (Figs
(Figs 18.5A and B). 18.6A and B).

A B

Figures 18.5A and B: Zygion

A B

Figures 18.6A and B: Zygomatic arch

 164

Type Jugal Process

Zygomatic arch is a bilateral, anatomic, hard tissue PA cephalo-
metric landmark. abbreviation

zygomatic Suture Point J–Jugal process is abbreviated using English alphabet and is
expressed as capital letter or upper case J.
abbreviation
Definition
Z–Zygomatic suture point is abbreviated using English
alphabet and is expressed as capital letter or upper case Z. according to Robert M Ricketts
Definition Lowest point on the curve of zygomatic bone used in the
lateral film, also the point on the jugal process of the maxilla
according to Robert M Ricketts at a crossing with the tuberosity of the maxilla (in the frontal)
Medial and anterior junction of the zygomatic bone with the (Figs 18.8A and B).
frontal bone (Figs 18.7A and B).
Type
Type
Section 9  PA Cephalometric Landmarks

Jugal process is a bilateral, anatomic, hard tissue PA cephalo-

Zygomatic suture point is a bilateral, anatomic, hard tissue PA metric landmark.
cephalometric landmark.

A B

Figures 18.7A and B: Zygomatic suture point

A B
Figures 18.8A and B: Jugal process
 165

Pa Cephalometric Landmarks Related to Pa Cephalometric Landmarks Related to

Maxilla Dentition
Cephalometric landmarks related to maxilla is as follows PA cephalogram landmarks/points related to dentition are as
(Table 18.4): 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 Cephalometric landmarks 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
Maxillare Maxillary molar um Bilateral Anatomic
Maxillary first molar U6 or A6 Bilateral Anatomic
abbreviation
Mx–Maxillare is abbreviated using English alphabets and is Table 18.6: Cephalometric landmarks related to mandibular teeth
expressed as capital letter or upper case M and small letter or Cephalometric landmarks Abbreviation Type Origin
lower case x and is written continuously without any space Incision inferior incisalis Iii or ii Unilateral Anatomic
between the alphabets. Incision inferior apicalis Iia or LIA Unilateral Anatomic

Chapter 18  PA Cephalometric Landmarks

mx–Maxillare is also abbreviated using English alphabet and Incision inferius frontale iif Unilateral Anatomic
is expressed as small letter or lower case m, x and is written Mandibular first molar L6 or A6 Bilateral Anatomic
continuously without any space between the alphabets. mi mi Bilateral Anatomic
Mandibular molar Im Bilateral Anatomic
Definition
• Maximum concavity on the contour of the maxilla between Incision Superius Incisalis
the first molar and malare (Figs 18.9A and B).
• Maximum concavity on the contour of the maxilla abbreviation
between malare (Ma) and the maxillary first molar (U6).
Isi–Incision superius incisalis is abbreviated using English
Closely corresponds to the key ridge.
alphabets and is expressed as capital or upper case I followed
• The intersection of the lateral contour of the maxillary
by small letters or lower case s and i and is written continuously
alveolar process and the lower contour of the
without any space between the alphabets.
maxillozygomatic process of the maxilla (left and right).
Or
is–Incision superius is abbreviated using English alphabets
Type and is expressed as small letters or lower case s and i and
Maxillare is a bilateral, anatomic, hard tissue PA cephalometric is written continuously without any space between the
landmark. alphabets.

A B

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.
according to arne Bjork
Incision superius incisalis is the mid-point of the incisal edge
of the most prominent upper central incisor.
according to Robert E Moyers
Incision superius incisalis is the incisal tip of the most anterior
maxillary central incisor.
Type
Incision superius incisalis is a unilateral, anatomic, hard tissue
cephalometric landmark.
Section 9  PA Cephalometric Landmarks
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.
Significance (Ref to Chapter 20)
Incision superius incisalis is used as one of the reference point
in the construction of angles and planes for the assessment of
following:
A B
Figures 18.10A and B: Incision superius incisalis
• Inclination of upper incisor is assessed using angle drawn
between the long axis of upper incisor plane and the FH
plane.
• In Arnett’s 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.
• Anteroposterior positioning of maxillary central incisor is
assessed using the distance between the incision Superius
Incisalis and the A-Pog plane.
Incision Superius apicalis
abbreviation
Isa–Incision 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
without any space between the alphabets.
UIA–Upper 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.
Definition
Incision superius apicalis (Figs 18.11A and B) is the root
apex of the most anterior maxillary central incisor; if this

A B
Figures 18.11A and B: Incision superius apicalis
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.
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
The upper incisor apex is the root apex of the most prominent
upper incisor.
Type
Incision superius apicalis is a unilateral, anatomic, hard tissue
cephalometric landmark.
Tracing of Incision Superius apicalis on
Lateral Cephalogram
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.
Significance (Ref to Chapter 20)
Incision superius apicalis is used as one of the reference points
in the construction of angles and planes for the assessment of
following:
167
Chapter 18  PA Cephalometric Landmarks
• Inclination of upper incisor is assessed using angle drawn
between the long axis of upper incisor plane and the FH
plane.
• In Arnett’s 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.
Maxillary Molar
abbreviation
um–Maxillary molar is abbreviated using English alphabets
and is expressed as lower case u and m and is written
continuously without any space between the alphabets.
Definition
according to athanasios E athanasiou
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

A B

Figures 18.12A and B: Maxillary molar

Section 9  PA Cephalometric Landmarks

A B

Figures 18.13A and B: Maxillary first molar

Maxillary First Molar Definition

Maxillary first molar (Figs 18.13A and B) is the tip of the
abbreviation mesiobuccal cusp of the maxillary first permanent molar.

U6–Maxillary first molar is abbreviated using English Type

alphabet and numeric and is expressed as capital or upper case
U followed by English numeric 6 and is written continuously
without any space between the alphabets.
OR
A6—Maxillary first molar is abbreviated using English
alphabet and numeric and is expressed as capital or upper case
A followed by English numeric 6 and is written continuously
without any space between the alphabets.
Maxillary first molar is a bilateral, anatomic, hard tissue
cephalometric landmark.
Tracing of Maxillary First Molar on Lateral
Cephalogram
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.
Cuspid
abbreviation
A3–Cuspid is abbreviated using English alphabet and numeric
and is expressed as upper case A and numeric 3 and are written
continuously without any space between the alphabets.
Definition
according to Carl F gugino
Tip of the upper permanent canine (Figs 18.14A and B).
Type
Cuspid is a bilateral, hard tissue cephalometric landmark.
Incision Inferius Incisalis
abbreviation
Iii–Incision inferius incisalis is abbreviated using English
alphabets and is expressed as capital or upper case I followed
by small letters or lower case i and i and is written continuously
without any space between the alphabets.
ii—Incision inferius is abbreviated using English alphabets
and is expressed as small letters or lower case i and i and is
written continuously without any space between the alphabets.
A B
Figures 18.14A and B: Cuspid
169
Definition
Incision inferius incisalis (Figs 18.15A and B) is the incisal
edge of the most prominent mandibular central incisor.
according to arne Bjork
The incision inferius is the incisal point of the most prominent
medial mandibular incisor.
according to Robert E Moyers
The incision inferius is the incisal tip of the most labial
mandibular central incisor.
Type
Incision inferius incisalis is a unilateral, anatomic, hard tissue
Chapter 18  PA Cephalometric Landmarks
cephalometric landmark.
Tracing of Incision Inferius Incisalis on Lateal
Cephalogram
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
edge or the intersection of the labial and lingual outline is the
point of incision inferius incisalis.
Significance (Ref to Chapter 20)
Incision inferius incisalis is used as one of the reference point
in the construction of angles and planes for the assessment of
following:
 170

A B
Figures 18.15A and B: Incision inferius incisalis
Section 9  PA Cephalometric Landmarks

A B

Figures 18.16A and B: Incision inferius apicalis

• Inclination of lower incisor is assessed using angle drawn
between the Long axis of lower incisor plane and the
mandibular plane.
• In Arnett’s analysis, the lower incisor torque is assessed
using the angle drawn between long axis of lower 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 incisorl.
• Anteroposterior positioning of mandibular central incisor
is assessed using the distance between the incision inferius
Incisalis and the NB plane.
• Anteroposterior positioning of maxillary central incisor is
assessed using the distance between the incision inferius
incisalis and the A-Pog plane.
Incision Inferius apicalis
abbreviation
Iia–Incision inferius apicalis is abbreviated using English
alphabets and is expressed as capital or upper case I followed
by small letters or lower case i and a and is written continuously
without any space between the alphabets.
LIA–lower 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 18.16A and B) 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.
SN Bhatia and BC Leighton
The lower incisor apex is the root apex of the most prominent
lower incisor.
Type
Incision inferius apicalis is a unilateral, anatomic, hard tissue
cephalometric landmark.
Tracing of Incision Inferius apicalis on Lateal
Cephalogram
The labial and lingual outline of the root of the mandibular
permanent central incisor appears as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of root of the
mandibular permanent central incisor. The point of intersection
of labial and lingual outlines of the root of mmandibular per-
manent central incisor is the point of incision inferius apicalis.
Significance (Ref to Chapter 20)
Incision inferius apicalis is used as one of the reference point
in the construction of angles and planes for the assessment of
following:
• Inclination of lower incisor is assessed using angle drawn
between the long axis of upper incisor plane and the mandi-
bular plane.
• In Arnett’s analysis, the lower incisor torque is assessed
using the angle drawn between long axis of lower 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 incisors.
A B
Figures 18.17A and B: Incision inferius frontale
171
Incision Inferius Frontale
abbreviation
iif–Incision inferius frontale is abbreviated using English
alphabets and is expressed as lower case i, i and f and is written
continuously without any space between the alphabets.
Definition
according to athanasios E athanasiou
The midpoint between the mandibular central incisors at the
level of the incisal edges (Figs 18.17A and B).
Type
Chapter 18  PA Cephalometric Landmarks
Incision inferius frontale is a unilateral, hard tissue cephalo-
metric landmark.
Mandibular First Molar
abbreviation
L6–Mandibular first molar is abbreviated using English
alphabet and numeric and is expressed as capital or upper case
L followed by English numeric 6 and is written continuously
without any space between the alphabets.
Definition
Mandibular first molar (Figs 18.18A and B) is the tip of the
mesiobuccal cusp of the mandibular first permanent molar.
 172

A B

Figures 18.18A and B: Mandibular first molar

Section 9  PA Cephalometric Landmarks

A B

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
cephalometric landmark. molar projected normal to the plane of occlusion.

Tracing of Mandibular First Molar on Lateral Type

Cephalogram
The labial and lingual and cuspal outlines of the crown of the
mandibular permanent first molar appears as radio-opaque
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.
mi
abbreviation
mi–mi is abbreviated using English alphabets and is expressed
as lower case m and i and is written continuously without any
space between the alphabets.
mi is a bilateral, hard tissue cephalometric landmark.
Tracing of mi on Lateral Cephalogram
The labial and lingual and cuspal outlines of the crown of the
mandibular permanent first molar appears as radio-opaque
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. mi is the mesial contact of the
lower molar projected normal to the plane of occlusion.
Significance (Ref to Chapter 20)
mi is used as one of the reference points in the construction of
plane and angle in the Bjork cephalometric analysis.
 173

Mandibular Molar Table 18.6: Cephalometric landmarks related to mandible

Cephalometric landmarks Abbreviation Type Origin
Menton Me Unilateral Anatomic
abbreviation
Articulare Ar Bilateral Anatomic
Im–Mandibular molar is abbreviated using English alphabets
Malare ma Bilateral Anatomic
and is expressed as upper case I and lower case m and is written
Antegonial tubercle Ag Bilateral Anatomic
continuously without any space between the alphabets.
Antegonion Ag Bilateral Anatomic

Definition
Menton
according to athanasios E athanasiou
abbreviation
The most prominent lateral point on the buccal surface of
the second deciduous or first permanent mandibular molar Me–Menton is abbreviated using English alphabets and is
(Figs 18.20A and B). expressed as capital or upper case M followed by lower case
or small letter e and is written continuously without any space
Type between the alphabets.

Chapter 18  PA Cephalometric Landmarks

Mandibular molar is a bilateral, hard tissue cephalometric according to Viken Sassouni
landmark. Lower most point of the contour of the chin.

Pa Cephalometric Landmarks Related to according to Carl F gugino

Mandible
Menton (Figs 18.21A and B) is the point on inferior border of
Cephalometric landmarks related to mandible are as follows symphysis directly inferior to mental protuberance and below
(Table 18.6): center of trigonium mentali.

A B

Figures 18.20A and B: Mandibular molar

 174
A B
Figures 18.21A and B: Menton
Type
Section 9  PA Cephalometric Landmarks
Menton (see Figs 12.7A and B) is a unilateral, anatomic, hard
tissue landmark.
Tracing of Menton on the Lateral Cephalogram
The labial cortical plate of mandible in the anterior symphysis
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.
Significance
Menton is used as one of the reference points in the construction
of plane and angle for the assessment of the 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 (Me-Go) angle.
• Growth pattern is assessed using Go1 and Go2 angles.
articulare
abbreviation
Ar–Articulare 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
between the alphabets.
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
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.
Significance
Articulare is used as one of the reference points in the construction
of plane and angle for the assessment of following:
• Constructions of posterior/ramus border of the mandible
i.e. the line joining the point articulare and gonion.
• Growth pattern is assessed using Go1 and Go2 angles.
• Rotation of the mandible is also assessed using the S-Ar-
Go angle.
Malare
abbreviation
ma–Malare is abbreviated using English alphabets and is
expressed as lower case or small letters m, a and is written
continuously without any space between the alphabets.
 175

A B
Figures 18.22A and B: Articulare

Chapter 18  PA Cephalometric Landmarks

A B
Figures 18.23A and B: Malare

Definition Definition
according to Viken Sassouni according to Robert M Ricketts
Midpoint of intersection between the projection of the Intersection of the outline of the dense bone of the
coronoid process and the lower contour of the malar bone trihedral eminence with the lower border of the ramus.
(Figs 18.23A and B). (Figs 18.24A and B).

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

antegonial Tubercles antegonion

abbreviation abbreviation

Ag–Antegonial tubercles are abbreviated using English Ag–Antegonion is abbreviated using English alphabets and is
alphabets and is expressed as upper case or capital letter A expressed as upper case or capital letter A and lower case or
and lower case or small letters g and is written continuously small letter g and is written continuously without any space
without any space between the alphabets. between the alphabets.
 176
Section 9  PA Cephalometric Landmarks

A B
Figures 18.24A and B: Antegonial tubercles

A B
Figures 18.25A and B: Antegonion

Definition Type
according to athanasios E athanasiou Antegonion is a bilateral, anatomic, hard tissue PA cephalo-
metric landmark.
The highest point in the antegonial notch (left and right)
(Figs 18.25A and B).
SECTION 10
SV Cephalometric
Landmarks

 SV Cephalometric Landmarks
 CHAPTER

19 SV Cephalometric
Landmarks

Basion Opisthion

Abbreviation Abbreviation
Op–Opisthion is abbreviated as capital or upper case O
Ba–Basion is abbreviated as capital or upper case B followed
followed by small letter or lower case p and is written
by small letter or lower case a and is written continuously
continuously without any space between the alphabets.
without any space between the alphabets.

Definition Definition
According to Clifton T Forsberg
According to Clifton T Forsberg
Opisthion is the most posterior point, relative to the
Basion is the most anterior point, relative to the interspinosum interspinosum line, on the border of the foramen magnum
line, on the border of the foramen magnum (Figs 19.1A and B). (Figs 19.2A and B).

Type Type
Basion is a unilateral hard tissue SV cephalometric landmark/ Opisthion is a unilateral hard tissue SV cephalometric
point. landmark/point.

Origin Origin
Basion is an anatomic SV cephalometric landmark/point. Opisthion is an anatomic SV cephalometric landmark/point.

A B

Figures 19.1A and B: Basion

 180

A B

Figures 19.2A and B: Opisthion

Section 10  SV Cephalometric Landmarks

A B

Figures 19.3A and B: Foramina spinosa points

Foramina Spinosa Points Type

Foramina spinosa points are bilateral hard tissue SV cephalo­
metric landmarks/points.
Abbreviation
FSP–Foramina spinosa point is abbreviated as capital or Origin
upper case F, S and P and is written continuously without any Foramina spinosa points are an anatomic SV cephalometric
space between the alphabets. landmarks/points.

Definition Foramina Spinosum

According to Clifton T Forsberg Abbreviation

Foramina spinosa points are the geometric center of each SP–Foramina spinosum is abbreviated as capital or upper
foramina spinosa (Figs 19.3A and B). case S and P and is written continuously without any space
between the alphabets.
 181

Definition Odontoid
According to KKK Lew
The geometric center of each foramen spinosum (Figs 19.4A Abbreviation
and B).
Od–Odontoid is abbreviated as capital letter or upper case O
and followed by small letter or lower case d and is written
Type
continuously without any space between the alphabets.
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
Center of odontoid process on the SMV (Figs 19.5A and B).
landmarks/points.

Chapter 19  SV Cephalometric Landmarks

A B

Figures 19.4A and B: Foramina spinosum

A B

Figures 19.5A and B: Odontoid

 182

Type Middle Cranial Fossa Points

Odontoid is a unilateral hard tissue SV cephalometric
landmark/point.
Origin
Odontoid is an anatomic SV cephalometric landmark/point.
Abbreviation
MCF–Middle cranial fossa point is abbreviated as capital
letters or upper case MCF and is written continuously without
any space between the alphabets.

Pterygomaxillary Fissure Definition

Abbreviation According to Clifton T Forsberg

PTM–Pterygomaxillary fissure is abbreviated as capital letter The most anterior point relative to the interspinosum line, on each
or upper case P, T and M and are written continuously without lesser wing of the sphenoid bone (LWS) (Figs 19.7A and B).
any space between the alphabets.
Type
Definition
Middle cranial fossa points is a bilateral hard tissue SV
Section 10  SV Cephalometric Landmarks

According to Clifton T Forsberg cephalometric landmark/point.

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

Type
Posterior Vomer Point
Pterygomaxillary fissure is a bilateral hard tissue SV
cephalometric landmark/point.
Abbreviation
Origin PVP–Posterior vomer point is abbreviated as capital letter or
Pterygomaxillary fissure is an anatomic SV cephalometric upper case PVP and is written continuously without any space
landmark/point. between the alphabets.

A B
Figures 19.6A and B: Pterygomaxillary fissure
 183

A B

Figures 19.7A and B: Middle cranial fossa points

Chapter 19  SV Cephalometric Landmarks

A B

Figures 19.8A and B: Posterior vomer point

Definition Posterior Cranial Vault Points

According to Clifton T Forsberg
Abbreviation
The intersection of the vomer with the PTM line (Figs 19.8A
PCV–Posterior cranial vault points is abbreviated as capital
and B).
letter or upper case PVP and is written continuously without
any space between the alphabets.
Type
Posterior vomer point is a unilateral hard tissue SV cephalo­ Definition
metric landmark/point. According to Clifton T Forsberg
Origin The intersections of the lateral borders of the cranial vault
with a line, parallel to the interspinosum line, which is
Posterior vomer point is an anatomic SV cephalometric drawn across the cranial vault at its section of greatest width
landmark/point. (Figs  19.9A and B).
 184

A B

Figures 19.9A and B: Posterior cranial vault points

Section 10  SV Cephalometric Landmarks

A B

Figures 19.10A and B: Angulare point

Type Definition
Posterior cranial vault points are bilateral hard tissue SV According to Clifton T Forsberg
cephalometric landmark/point.
The most anterior point, relative to the PTM line, of the
triangular opacities present at the external orbital angle where
Origin the upper and lower orbital rims meet and the zygomatic arch
Posterior cranial vault point is an SV anatomic cephalometric inserts (Figs 19.10A and B).
landmark/point.
Type
Angulare Point Angulare point is a bilateral hard tissue SV cephalometric
landmark/point.

Abbreviation Origin
A–Angulare point is abbreviated as capital letter or upper Angulare point is an anatomic SV cephalometric landmark/
case A. point.
 185

Maxillary Apical Base Midline Mandibular Dental Midline

Abbreviation Abbreviation
MAB–Maxillary apical base midline is abbreviated as capital Mand DM–Mandibular dental midline is abbreviated as Mand
letter or upper case MAB. DM.

Definition Definition

According to Clifton T Forsberg According to Clifton T Forsberg

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).
Type
Mandibular dental midline is a unilateral hard tissue SV cephalo­
metric landmark/point.

Chapter 19  SV Cephalometric Landmarks

Type Origin
Maxillary apical base midline is a unilateral hard tissue SV
Mandibular dental midline is an anatomic SV cephalometric
cephalometric landmark/point.
landmark/point.

Origin
Maxillary apical base midline is an anatomic SV cephalometric
landmark/point.

A B

Figures 19.11A and B: Maxillary apical base midline

 186
Section 10  SV Cephalometric Landmarks

A B

Figures 19.12A and B: Mandibular dental midline

A B

Figures 19.13A and B: Mandibular apical base midline

Mandibular Apical Base Midline incisors at a level which is one third of the distance from the
apex to the alveolar crest (Figs 19.13A and B).

Abbreviation
Type
MAB–Mandibular apical base midline is abbreviated as
Mandibular apical base midline is a unilateral hard tissue SV
capital letter or upper case MAB.
cephalometric landmark/point.
Definition
Origin
According to Clifton T Forsberg
Mandibular apical base midline is an anatomic SV cephalo­
A point midway between the roots of the mandibular central metric landmark/point.
 187

First Molar Point Origin

First molar point is an anatomic SV cephalometric landmark/
Abbreviation point.

FMP–First molar point is abbreviated as capital letter or

upper case FMP and is written continuously without any space Gonion Point
between the alphabets.
Abbreviation
Definition Go–Gonion point is abbreviated as capital letter or upper
case G followed by small letter or lower case o and is written
According to Clifton T Forsberg
continuously without any space between the alphabets.
The most distal point in line with the central groove on each
mandibular first molar (Figs 19.14A and B). Definition

Type According to Clifton T Forsberg

First molar point is a bilateral hard tissue SV cephalometric The midpoint mediolaterally on the posterior border of each

Chapter 19  SV Cephalometric Landmarks

landmark/point. gonial angle (Figs 19.15A and B).

A B
Figures 19.14A and B: First molar point

A B
Figures 19.15A and B: Gonion point
 188

Type Origin
Gonion point is a bilateral hard tissue SV cephalometric Condylion medialis is an anatomic SV cephalometric
landmark/point. landmark/point.

Origin Condylion Lateralis

Gonion point is an anatomic SV cephalometric landmark/
point. Abbreviation
CL–Condylion lateralis is abbreviated as capital letter or
Condylion Medialis upper case CL and is written continuously without any space
between the alphabets.
Abbreviation Or
CoL–Condylion lateralis is abbreviated as capital letter or
CM–Condylion medialis is abbreviated as capital letter or upper case C, small letter o followed by capital letter L
upper case CM and is written continuously without any space and is written continuously without any space between the
between the alphabets. alphabets.
OR
Section 10  SV Cephalometric Landmarks

CoM–Condylion medialis is abbreviated as capital letter or Definition

upper case C, small letter o followed by capital letter M and is
written continuously without any space between the alphabets. According to Clifton T Forsberg
The tangent point to each lateral condylar border of a line
Definition
drawn parallel to each mandibular body line (Figs 19.17A
and B).
According to Clifton T Forsberg
Type
The tangent point to each medial condylar border of a line
drawn parallel to each mandibular body line (Figs 19.16A Condylion lateralis is a bilateral hard tissue SV cephalometric
and B). landmark/point.

Type Origin
Condylion medialis is a bilateral hard tissue SV cephalometric Condylion lateralis is an anatomic SV cephalometric land­
landmark/point. mark/point.

A B

Figures 19.16A and B: Condylion medialis

 189

Chapter 19  SV Cephalometric Landmarks

A B
Figures 19.17A and B: Condylion lateralis

A B
Figures 19.18A and B: Condylion anterioris

Condylion Anterioris Definition

According to Clifton T Forsberg

Abbreviation
CA–Condylion anterioris is abbreviated as capital letter or A point on the anterior of each condylar head which is chosen
upper case C and A, and is written continuously without any to represent the mandibular fossa of the temporal bone
space between the alphabets. (Figs  19.18A and B).
 190
Section 10  SV Cephalometric Landmarks

A B
Figures 19.19A and B: Condylion posterioris

Type Definition
Condylion anterioris is a bilateral hard tissue SV cephalometric
According to Clifton T Forsberg
landmark/point.
A point on the posterior of each condylar head which is
Origin chosen to represent the mandibular fossa of the temporal bone
Condylion anterioris is an anatomic SV cephalometric land­ (Figs  19.19A and B).
mark/point.
Type
Condylion Posterioris Condylion posterioris is a bilateral hard tissue SV cephalo­
metric landmark/point.
Abbreviation
Origin
CP–Condylion posterioris is abbreviated as capital letter or
upper case C, P and are written continuously without any Condylion posterioris is an anatomic SV cephalometric land­
space between the alphabets. mark/point.
SECTION 11
Applications of Cephalometric
Landmarks

 Applications of Cephalometric Landmarks

 CHAPTER
20 Applications of
Cephalometric Landmarks
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. Rickett’s cephalometric analysis
9. Sassouni cephalometric analysis
10. Di Paolo’s 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. Steiner’s cephalometric analysis
A B
Figures 20.1A and B: Bjork cephalometric analysis
17. Tweed’s cephalometric analysis
18. Wit’s 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-articulare–The 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.
dd–The most prominent point of the chin in the direction of
measurement.
gn-gnathion–The deepest point on the chin.
 194
id-infradentale–The point of transition from the crown of
the most prominent mandibular medial incisor to the alveolar
projection.
ii-incision inferius–The incisal point of the most prominent
medial mandibular incisor.
is-incision superius–The incisal point of the most prominent
medial maxillary incisor.
kk–The point of intersection between the base and ramus
tangents to the mandible. The midpoint is used where double
projection gives rise to two points.
mi–The mesial contact point of the lower molar projected
normal to the plane of occlusion.
ms–The mesial contact point of the upper molar projected
Section 11  Applications of Cephalometric Landmarks
normal to the plane of occlusion.
N-nasion–Nasion is the most anterior point of the frontonasal
suture in the middle.
or-orbitale–The deepest point on the infraorbital margin. The
midpoint is used where double projection gives rise to two
points.
pg-pogonion–The most prominent point on the chin.
Po-porion–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).
pr-prosthion–The transition point between the crown of the
most prominent medial maxillary incisor and the alveolar
projection.
A B
Figures 20.2A and B: Coben craniofacial and dentition analysis
s–The center of sella turcica (the midpoint of the horizontal
diameter).
sm-supramentale–The deepest point on the contour of the
alveolar projection, between infradentale and pogonion.
sp-the spinal point–The apex of spina nasalis anterior.
snp-spina nasalis posterior–The point of intersection of palatum
posterior durum, palatum molle and fossa pterygopalatina.
ss-subspinale–The deepest point on the contour of the alveolar
projection, between the spinal point and prosthion.
io–The 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)
Cephalometric landmarks used in Coben craniofacial and
dentition analysis are as given below:
A-point A (subspinale)–The point at the deepest midline
concavity on the maxilla between the anterior nasal spine and
prosthion.
Ans-anterior nasal spine–The most anterior point of the
anterior nasal spine.
Ar-articulare–The 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.

Ba–Basion 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.
M-menton–The most inferior midline point on the mandibular
symphysis.
N-nasion–Nasion is the most anterior point of the frontonasal
suture in the middle.
Or-orbitale–The 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-pogonion–The 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.
A B
Figures 20.3A and B: Downs cephalometric analysis
195
Ptm-pterygomaxillary fissure–The 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.
S-sella–The point representing the geometric center of the
pituitary fossa (sella turcica).
Ul-maxillary central incisor (horizontal)–The most labial
point on the crown of the maxillary central incisor.
Ul-maxillary central incisor (vertical)–The incisal edge of
the maxillary central incisor.
L1-mandibular central incisor (horizontal)–The most labial
point on the crown of the mandibular central incisor.
L1-mandibular central incisor (vertical)–The incisal edge of
the mandibular central incisor.
Chapter 20  Applications of Cephalometric Landmarks
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
analysis are as given below:
 196
Section 11  Applications of Cephalometric Landmarks
A B
Figures 20.4A and B: Farkas and coworkers soft tissue cephalometric analysis
N-nasion–Nasion is the most anterior point of the frontonasal
suture in the middle.
Bolton point–The highest point on the concavity behind the
occipital condyles.
The centre of sella turcica–Located by inspection of the
profile image of the fossa.
Orbitale–The lowest point on the left infraorbital margin.
Porion (cephalometric)–The highest point on the superior
surface of the soft tissue of the external auditory meati.
Pogonion–The most anterior point on the mandible in the
midline.
Point A-subspinale–The deepest midline point on the
premaxilla between the anterior nasal spine and prosthion.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
Gnathion–A point on the chin determined by bisecting the
angle formed by the facial and mandibular planes.
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.
Glabella (g)–The most prominent midline point between the
eyebrows.
Subnasion (n’)–Deepest point of the nasofrontal angle.
Pronasale (prn)–The most protruded point of the apex nasi.
Subnasale (sn)–Midpoint of the columella base at the apex of
the nasolabial angle.
Labiale superius (ls)–Midpoint of the upper vermilion line.
Labiale inferius (li)–Midpoint of the lower vermilion line.
Sublabiale (si)–Midpoint of the horizontal labiomental skin ridge.
Pogonion (pg)–The most anterior midpoint of the chin.
Harvold Cephalometric Analysis
(Figs 20.5A and B)
Cephalometric landmarks used in Harvold cephalometric
analysis are as given below:
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.
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

Chapter 20  Applications of Cephalometric Landmarks

A B

Figures 20.5A and B: Harvold cephalometric analysis

A B

Figures 20.6A and B: Holdaway cephalometric analysis

Prognathion (PGN)–A point on the contour of the chin Lower face height measured from ANS to GN.
indicating maximum mandibular length measured from the
The angle of convexity–The angle between the lines PG-ANS
temporomandibular joint.
and ANS-N.
Gnathion (GN)–The most inferior point on the contour of the chin.
Pogonion (PG)–The most anterior point on the chin. Holdaway Cephalometric Analysis
(Figs 20.6A and B)
Nasion (N)–The point at which the nasofrontal suture reaches
the contour line of the bones. The forward position of the Cephalometric landmarks used in Holdaway cephalometric
maxilla, measured from TM to ANS. analysis are as given below:
1. The H line or harmony line drawn tangent to the soft
Mandibular length measured from TM to PGN. tissue chin and the upper lip.
 198
Section 11  Applications of Cephalometric Landmarks
A B
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 Rickett’s 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.
Columella point (Cm)–The most anterior point on the
columella of the nose.
Subnasale (Sn)–The point at which the nasal septum merges
with the upper cutaneous lip in the midsagittal plane.
Labrale superius (Ls)–A point indicating the mucocutaneous
border of the upper lip.
Stomion superius (Stms)–The lowermost point on the
vermilion of the upper lip.
Stomion inferius (Stmi)–The uppermost point on the
vermilion of the lower lip.
Labrale inferius (Li)–A point indicating the mucocutaneous
border of the lower lip.
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.
Rickett’s Cephalometric Analysis
(Figs 20.8A and B)
Cephalometric landmarks used in Rickett’s cephalometric
analysis are as given below:
A–The deepest point on the curve of the maxilla between the
anterior nasal spine and the dental alveolus.
ANS–Tip of the anterior nasal spine.
BA–Most inferior posterior point of the occipital bone.
CC–Point where the basion-nasion plane and the facial axis
intersect.
DC–A point selected in the center of the neck of the condyle,
where the basion-nasion plane crosses it.
 199

Chapter 20  Applications of Cephalometric Landmarks

A B

Figures 20.8A and B: Rickett’s cephalometric analysis

NA–A point at the anterior limit of the nasofrontal suture. Angle I’–Angle formed by i and the palatal plane.

PM–Point selected at the anterior border of the symphysis Angle I”–Angle formed by I and che ancerior cranial base
plane.
between point B and pogonion where the curvature changes
from concave to convex.

PO–Most anterior point on the midsagittal symphysis tangent

to the facial plane.

XI–The geometric center of the ramus of the mandible.

Sassouni Cephalometric Analysis (Fig. 20.9)

Cephalometric landmarks used in Sassouni cephalometric
analysis are as given below:
Palatocranial angle–Angle formed by the palatal plane and
the anterior cranial base plane.
Palatomandibular angle–Angle formed by the palatal plane
and the mandibular base plane.
Occlusopalatal angle–Angle formed by the occlusal plane
and the palatal plane.
Occlusomandibular angle–Angle formed by the occlusal
plane and the mandibular base plane.
Angle M–Angle formed by the 6 axis and the occlusal plane.
Angle M’ –Angle formed by the 6 axis and che palatal plane.
Angle M”–Angle formed by the 6 axis and the anterior cranial
base plane.
Angle I–Angle formed by 1 and the occlusal plane. Figure 20.9: Sassouni cephalometric analysis
 200
Angle R–Angle formed by the occlusal plane and the ramal plane.
Angle i–Angle formed by the occlusal plane and the axis of 1.
Angle rfl’–Angle formed by the occlusal plane and the axis
of 6.
Di Paolo’s Quadrilateral Analysis (Fig. 20.10)
Cephalometric landmarks used in Di Paolo’s Quadrilateral
cephalometric analysis are as given below:
A–The deepest point on the curve of the maxilla between the
anterior nasal spine and the dental alveolus.
ANS–Tip of the anterior nasal spine.
Nasion (N)–The point at which the nasofrontal suture reaches
Section 11  Applications of Cephalometric Landmarks
the contour line of the bones.
Pogonion (PG)–The most anterior point on the chin.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
Ptm-pterygomaxillary fissure–The 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.
Go-gonion (constructed)–The point of intersection of the
ramus plane and the mandibular plane.
Figure 20.10: Di Paolo’s quadrilateral cephalometric analysis
Ar-articulare–The 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.
snp-spina nasalis posterior–The point of intersection of
palatum posterior durum, palatum molle and fossa pterygo-
palatina.
Hasund (Bergen) Cephalometric Analysis
(Fig. 20.11)
Cephalometric landmarks used in Hasund (Bergen)
cephalometric analysis are as given below:
A-point A (subspinale)–The point at the deepest midline
concavity on the maxilla between the anterior nasal spine and
prosthion.
Ans-anterior nasal spine–The most anterior point of the
anterior nasal spine.
Ar-articulate–The 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.
Figure 20.11: Hasund (Bergen) cephalometric analysis

Ba-basion–The 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-nasion–The most anterior (midline) point of the frontonasal
suture.
S-sella–The point representing the geometric centrer of the
pituitary fossa (sella turcica).
Pogonion–The most anterior point on the mandible in the
midline.
Gnathion–A point on the chin determined by bisecting the
angle formed by the facial and mandibular planes.
ii-incision inferius–The incisal point of the most prominent
medial mandibular incisor.
is-incision superius–The incisal point of the most prominent
medial maxillary incisor.
Jarabak Cephalometric Analysis
(Figs 20.12A and B)
Cephalometric landmarks used in Jarabak cephalometric
analysis are as given below:
A-point A (subspinale)–The point at the deepest midline concavity
on the maxilla between the anterior nasal spine and prosthion.
Ans-anterior nasal spine–The most anterior point of the
anterior nasal spine.
A B
Figures 20.12A and B: Jarabak cephalometric analysis
201
Ar-articulare–The 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.
Ba-basion–The 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-nasion–The most anterior (midline) point of the frontonasal
suture.
Chapter 20  Applications of Cephalometric Landmarks
S-sella–The point representing the geometric centrer of the
pituitary fossa (sella turcica).
Pogonion–The most anterior point on the mandible in the
midline.
Gnathion–A point on the chin determined by bisecting the
angle formed by the facial and mandibular planes.
ii-incision inferius–The incisal point of the most prominent
medial mandibular incisor.
is-incision superius–The incisal point of the most prominent
medial maxillary incisor.
snp-spina nasalis posterior–The point of intersection of palatum
posterior durum, palatum molle and fossa pterygo-palatina.
 202
Po-porion (anatomic)–The superior point of the external­
auditory meatus (superior margin of temporomandibular
fossa, which lies at the same level, may be substituted in the
construction of Frankfort horizontal).
Riedel Cephalometric Analysis
(Figs 20.13A and B)
Cephalometric landmarks used in Riedel cephalometric
analysis are as given below:
A-point A (subspinale)–The point at the deepest midline
concavity on the maxilla between the anterior nasal spine and
prosthion.
Ans-anterior nasal spine–The most anterior point of the
Section 11  Applications of Cephalometric Landmarks
anterior nasal spine.
B-point B (supramentale)–The point at the deepest midline
concavity on the mandibular symphysis between infradentale
and pogonion.
N-nasion–The most anterior (midline) point of the frontonasal
suture.
S-sella–The point representing the geometric center of the
pituitary fossa (sella turcica).
Pogonion–The most anterior point on the mandible in the midline.
ii-incision inferius–The incisal point of the most prominent
medial mandibular incisor.
A B
Figures 20.13A and B: Riedel cephalometric analysis
is-incision superius–The incisal point of the most prominent
medial maxillary incisor.
snp-spina nasalis posterior–The point of intersection of
palatum posterior durum, palatum molle and fossa pterygo-
palatina.
Po-porion (anatomic)–The superior point of the external­
auditory meatus (superior margin of temporomandibular
fossa, which lies at the same level, may be substituted in the
construction of Frankfort horizontal).
Or-orbitale–The lowest point on the inferior margin of the
orbit, midpoint between right and left images.
Ul-maxillary central incisor (horizontal)–The most labial
point on the crown of the maxillary central incisor.
Ul-maxillary central incisor (vertical)–The incisal edge of
the maxillary central incisor.
L1-mandibular central incisor (horizontal)–The most labial
point on the crown of the mandibular central incisor.
L1-mandibular central incisor (vertical)–The incisal edge of
the mandibular central incisor.
Gnathion (GN)–The most inferior point on the contour of the
chin.
Go-gonion (constructed)–The point of intersection of the
ramus plane and the mandibular plane.

Iip–Incision 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 plane–A
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.
Mandibular central incisor is the most labial point on the
crown of the mandibular central incisor.
Schwartz Cephalometric Analysis
(Figs 20.14A and B)
Cephalometric landmarks used in Schwartz cephalometric
analysis are as given below:
A-point A (subspinale)–The point at the deepest midline concavity
on the maxilla between the anterior nasal spine and prosthion.
Ans-anterior nasal spine–The most anterior point of the
anterior nasal spine.
B-point B (supramentale)–The point at the deepest midline
concavity on the mandibular symphysis between infradentale
and pogonion.
A B
Figures 20.14A and B: Schwartz cephalometric analysis
203
N-nasion–The most anterior (midline) point of the frontonasal
suture.
S-sella–The point representing the geometric center of the
pituitary fossa (sella turcica).
Pogonion–The most anterior point on the mandible in the
midline.
ii-incision inferius–The incisal point of the most prominent
medial mandibular incisor
is-incision superius–The incisal point of the most prominent
medial maxillary incisor.
Wylie Cephalometric Analysis
Chapter 20  Applications of Cephalometric Landmarks
(Figs 20.15A and B)
Cephalometric landmarks used in Wylie cephalometric
analysis are as given below:
sp–Dorsum of sella is the most posterior point on the internal
contour of the sella turcica or hypophyseal fossa or pituitary
fossa.
si–Floor of sella is the lower most point on the inner contour
of the sella turcica or hypophyseal fossa or pituitary fossa.
Cl–Clinoidale is the most superior point on the contour of the
anterior clinoid.
S–Sella is the midpoint of sella turcica or hypophyseal fossa
or pituitary fossa.
 204
Section 11  Applications of Cephalometric Landmarks
A B
Figures 20.15A and B: Wylie cephalometric analysis
ANS–Anterior nasal spine is the tip of bony anterior nasal
spine in the midline or median plane.
A–Point A is the deepest point on the curved bony outline
between the anterior nasal spine (ANS) and prosthion (Pr).
PNS–Posterior nasal spine is the intersection of continuation
of the anterior wall of the pterygopalatine fossa and the floor
of the nose.
Ptm–Pterygomaxillary 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.
Orbitale–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.
Gnathion (GN)–The most inferior point on the contour of the
chin.
Pogonion (PG)–The most anterior point on the chin.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
Po-porion (anatomic)–The superior point of the external­
auditory meatus (superior margin of temporomandibular
fossa, which lies at the same level, may be substituted in the
construction of Frankfort horizontal).
Steiner’s Cephalometric Analysis
(Figs 20.16A and B)
Cephalometric landmarks used in Steiner’s cephalometric
analysis are as given below:
N-nasion–Nasion is the most anterior point of the frontonasal
suture in the middle.
The center of sella turcica–Located by inspection of the
profile image of the fossa.
Orbitale–The lowest point on the left infraorbital margin.
Porion (cephalometric)–The highest point on the superior
surface of the soft tissue of the external auditory meati.
Point A-subspinale–The deepest midline point on the
premaxilla between the anterior nasal spine and prosthion.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
ANS–Anterior nasal spine is the tip of bony anterior nasal
spine in the midline or median plane.
PNS–Posterior nasal spine is the intersection of a continuation
of the anterior wall of the pterygopalatine fossa and the floor
of the nose.
ii-incision inferius–The incisal point of the most prominent
medial mandibular incisor.

A B
Figures 20.16A and B: Steiner’s cephalometric analysis
is - incision superius–The incisal point of the most prominent
medial maxillary incisor.
Go-gonion (constructed)–The point of intersection of the
ramus plane and the mandibular plane.
APOcc-Anterior point of occlusion for the occlusal plane–A
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).
isa–Incision superius apicalis 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.
iia–Incision 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.
Pogonion (PG)–The most anterior point on the chin.
Pn–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.
205
Chapter 20  Applications of Cephalometric Landmarks
Tweed’s Cephalometric Analysis
(Figs 20.17A and B)
Cephalometric landmarks used in Tweed’s cephalometric
analysis are as given below:
Orbitale–The lowest point on the left infraorbital margin.
Porion (cephalometric)–The highest point on the superior
surface of the soft tissue of the external auditory meati.
ii-incision inferius–The incisal point of the most prominent
medial mandibular incisor.
is-incision superius–The incisal point of the most prominent
medial maxillary incisor.
Go-gonion (constructed)–The point of intersection of the
ramus plane and the mandibular plane.
isa–Incision superius apicalis 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.
iia–Incision 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.
 206
Section 11  Applications of Cephalometric Landmarks

A B

Figures 20.17A and B: Tweed’s cephalometric analysis

A B

Figures 20.18A and B: Wit’s appraisal

Wit’s Cephalometric Analysis Point A-subspinale–The deepest midline point on the

(Figs 20.18A and B)
Wit’s Appraisal
The WIT’S (University of Witwatersrand, South Africa)
appraisal.
WIT’S appraisal–WIT’S appraisal measures the extent to
which the jaws are related to each other anteroposteriorly.
Cephalometric landmarks used in Wit’s cephalometric
analysis are as given below:
premaxilla between the anterior nasal spine and prosthion.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
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.

Basis Cephalometric Analysis (Fig. 20.19)
Cephalometric landmarks used in Basis cephalometric
Analysis are as given below:
N-nasion–Nasion is the most anterior point of the frontonasal
suture in the middle.
s-the center of sella turcica (the midpoint of the horizontal
diameter).
ANS–Anterior nasal spine is the tip of bony anterior nasal
spine in the midline or median plane.
PNS–Posterior nasal spine is the intersection of a continuation
of the anterior wall of the pterygopalatine fossa and the floor
of the nose.
Point A-subspinale–The deepest midline point on the
premaxilla between the anterior nasal spine and prosthion.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
Gn-gnathion–The deepest point on the chin.
id-infradentale–The point of transition from the crown of
the most prominent mandibular medial incisor to the alveolar
projection.
Pog-pogonion–The most prominent point on the chin.
sm-supramentale–The deepest point on the contour of the
alveolar projection, between infradentale and pogonion.
Isi–Incision superius incisalis is the incisal edge of the
maxillary central incisor.
Figure 20.19: Basis cephalometric analysis
207
Isa–Incision superius apicalis 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.
Iii–Incision inferius incisalis is the incisal edge of the most
prominent mandibular central incisor.
Iia–Incision 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.
Cagliari Cephalometric Analysis (Fig. 20.20)
Cephalometric landmarks used in basis cephalometric analysis
are as given below:
Chapter 20  Applications of Cephalometric Landmarks
N-nasion–Nasion is the most anterior point of the frontonasal
suture in the middle.
s–The center of sella turcica (the midpoint of the horizontal
diameter).
ANS–Anterior nasal spine is the tip of bony anterior nasal
spine in the midline or median plane.
PNS–Posterior nasal spine is the intersection of a continuation
of the anterior wall of the pterygopalatine fossa and the floor
of the nose.
Point A-subspinale–The deepest midline point on the
premaxilla between the anterior nasal spine and prosthion.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
Figure 20.20: Cagliari cephalometric analysis
 208

Gn-gnathion–The deepest point on the chin.
id-infradentale–The point of transition from the crown of
the most prominent mandibular medial incisor to the alveolar
projection.
Pog-pogonion–The most prominent point on the chin.
sm-supramentale–The deepest point on the contour of the
alveolar projection, between infradentale and pogonion.
Isi–Incision superius incisalis is the incisal edge of the
maxillary central incisor.
Isa–Incision superius apicalis 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.
Section 11  Applications of Cephalometric Landmarks
ANS–Anterior nasal spine is the tip of bony anterior nasal
spine in the midline or median plane.
PNS–Posterior nasal spine is the intersection of a continuation
of the anterior wall of the pterygopalatine fossa and the floor
of the nose.
Point A-subspinale–The deepest midline point on the
premaxilla between the anterior nasal spine and prosthion.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
Gn-gnathion–The deepest point on the chin.
id-infradentale–The point of transition from the crown of
the most prominent mandibular medial incisor to the alveolar
projection.

Iii–Incision inferius incisalis is the incisal edge of the most Pog-pogonion–The most prominent point on the chin.
prominent mandibular central incisor.
sm-supramentale–The deepest point on the contour of the
Iia–Incision inferius apicalis is the root apex of the most alveolar projection, between infradentale and pogonion.
anterior mandibular central incisor; if this point is needed only
Isi–Incision superius incisalis is the incisal edge of the
for defining the long axis of the tooth, the midpoint on the
maxillary central incisor.
bisection of the apical root width can be used.
Go-gonion (constructed)–The point of intersection of the Isa–Incision superius apicalis is the root apex of the most
ramus plane and the mandibular plane. anterior maxillary central incisor; if this point is needed only
for defining the long axis of the tooth, the midpoint on the
APOcc-Anterior point of occlusion for the occlusal plane– bisection of the apical root width can be used.
a constructed point, the midpoint of the incisor overbite in
occlusion. Iii–Incision inferius incisalis is the incisal edge of the most
prominent mandibular central incisor.
PPOcc-Posterior point of occlusion for the occlusal plane–
the most distal point of contact between the most posterior Iia–Incision inferius apicalis is the root apex of the most
molars in occlusion (Rakosi). anterior mandibular central incisor; if this point is needed only
for defining the long axis of the tooth, the midpoint on the
Pogonion (PG)–The most anterior point on the chin. bisection of the apical root width can be used.
Po-porion (anatomic)–The superior point of the external­
auditory meatus (superior margin of temporomandibular
fossa, which lies at the same level, may be substituted in the
construction of Frankfort horizontal).
Or-orbitale–The lowest point on the inferior margin of the
orbit, midpoint between right and left images.
Articulare–Articulare is the point of intersection the dorsal
contours of the processus articularis mandibulare and os
temporale. The midpoint, a is used where double projection
gives rise to two points, a1 and a2.

Chieti Cephalometric Analysis (Fig. 20.21)

Cephalometric landmarks used in basis cephalometric analysis
are as given below:
N-nasion–Nasion is the most anterior point of the frontonasal
suture in the middle.
s–the center of sella turcica (the midpoint of the horizontal
diameter). Figure 20.21: Chieti cephalometric analysis

Go-gonion (constructed)–The point of intersection of the
ramus plane and the mandibular plane.
APOcc-Anterior point of occlusion for the occlusal plane–
a 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).
Pogonion (PG)–The most anterior point on the chin.
Po-porion (anatomic)–The superior point of the external
auditory meatus (superior margin of temporo­ mandibular
fossa, which lies at the same level, may be substituted in the
construction of Frankfort horizontal).
Or-orbitale–The lowest point on the inferior margin of the
orbit, midpoint between right and left images.
Articulare–Articulare is the point of intersection the dorsal
contours of the processus articularis mandibulare and os
temporale. The midpoint, a is used where double projection
gives rise to two point, a1 and a2.
McGann Cephalometric Analysis (Fig. 20.22)
Cephalometric landmarks used in basis cephalometric analysis
are as given below:
N-nasion–Nasion is the most anterior point of the frontonasal
suture in the middle.
s-the center of sella turcica (the midpoint of the horizontal
diameter).
ANS–Anterior nasal spine is the tip of bony anterior nasal
spine in the midline or median plane.
PNS–Posterior nasal spine is the intersection of a continuation
of the anterior wall of the pterygopalatine fossa and the floor
of the nose.
Point A-subspinale–The deepest midline point on the
premaxilla between the anterior nasal spine and prosthion.
Point B-supramentale–The deepest midline point on the
mandible between infradentale and pogonion.
Gn-gnathion–The deepest point on the chin.
id-infradentale–The point of transition from the crown of
the most prominent mandibular medial incisor to the alveolar
projection.
Pog-pogonion–The most prominent point on the chin.
sm-supramentale–The deepest point on the contour of the
alveolar projection, between infradentale and pogonion.
Isi–Incision superius incisalis is the incisal edge of the
maxillary central incisor.
209
Chapter 20  Applications of Cephalometric Landmarks
Figure 20.22: McGann cephalometric analysis
Isa–Incision superius apicalis 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.
Iii–Incision inferius incisalis is the incisal edge of the most
prominent mandibular central incisor.
Iia—Incision 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.
Go-gonion (constructed)–The point of intersection of the
ramus plane and the mandibular plane.
APOcc-Anterior point of occlusion for the occlusal plane–
a 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).
Pogonion (PG)–The most anterior point on the chin.
Po-porion (anatomic)–The superior point of the external­
auditory meatus (superior margin of temporomandi­ bular
fossa, which lies at the same level, may be substituted in the
construction of Frankfort horizontal).
Or-orbitale–The lowest point on the inferior margin of the
orbit, midpoint between right and left images.
Articulare–Articulare is the point of intersection the dorsal
contours of the processus articularis mandibulare and os
temporale.The midpoint, a is used where double projection
gives rise to two points, a1 and a2.
Index

Page numbers followed by f refer to figure

a Condylion 95, 97f, 149, 150f g

anterioris 189, 189f
Alar crease junction 128, 131 Glabella 198
lateralis 188, 189f
on graphic illustration 132f Gnathion 89, 90f, 193, 196, 197, 201, 202, 204
medialis 188, 188f
on lateral cephalogram 132f Gonion 93, 94f, 150, 150f, 202
posterioris 190, 190f
Angle of convexity 197 point 187, 187f
Coronal suture 160
Angulare point 184, 184f
Cranial bones 10, 13
Antegonial tubercles 175, 176f h
Crista galli 160, 161f
Antegonion 176f
Cuspid 169 Harvold cephalometric analysis 196, 197f
Anterior
bow 11, 135, 135f Hassel and Farman developed method of skeletal
nasal spine 10, 59, 123, 155f, 174, 194, 196,
200, 202, 204, 208, 209 maturation 119f
d Hasund cephalometric analysis 200, 200f
on graphic illustration 60f
on lateral cephalogram 60f Deciduous dentition stage 70 Holdaway cephalometric analysis 197, 197f
pharyngeal wall 123 Dentition 71 Hyoid 101, 102f
point of occlusion 10, 76, 77f, 208, 209 Di Paolo’s quadrilateral cephalometric analysis bone 101, 101f
for occlusal plane 203, 205 200, 200f
Applications of cephalometric landmarks 191, 193, Dorsum of sella 10, 36 i
Articulare 93, 95f, 174, 175f, 193 on graphic illustration 36f
Incision
Articulation of on lateral cephalogram 36f
inferius 194, 201, 202, 203, 204, 205
ethmoid bone 21 Downs cephalometric analysis 195, 195f
apicalis 10, 75, 76f, 170, 170f
frontal bone 15, 26 e frontale 171, 171f
temporal bone 31 incisalis 10, 74, 74f, 169, 170f
Eruption chronology of primary teeth 70
superius 194, 201, 202, 203, 205
b Ethmoid bone 10, 15, 21, 21f, 22f, 26
apicalis 10, 73, 73f, 166, 167f
Ethmoidale 24, 25f
Basion 154f, 179f incisalis 10, 71, 72f, 165, 166f
on lateral cephalogram 25f
on graphic illustration 47f Infradentale 86, 194
on graphic illustration 25f
on lateral cephalogram 47f Exocanthion 151, 152
Basis cephalometric analysis 207, 207f j
Bjork cephalometric analysis 193, 193f f Jarabak cephalometric analysis 201, 201f
Bolton’s point 10, 48, 196 Facial bone and dentition 10, 57 Jugal process 164, 164f
on graphic illustration 50f Farkas and coworkers soft tissue cephalometric
on lateral cephalogram 49f analysis 196, 196f l
First molar point 187, 187f Labrale
c Fissure 123 inferius 11, 136, 146, 147f, 198
Cagliari cephalometric analysis 207, 207f Floor of on graphic illustration 137f
Center of sella turcica 196, 204, 208, 209 nose 160 on lateral cephalogram 137f
Cephalometric sella 10, 37 superius 11, 134, 146, 146f, 198
analysis 3 on graphic illustration 37f on graphic illustration 134f
X-ray tracing techniques 4 on lateral cephalogram 37f
on lateral cephalogram 134f
Cephalostat 4 Foramina
Lacrimal bone 15
Cervical spinosa points 180, 180f
Laryngopharynx 123
bones 10, 99 spinosum 180, 181f
Lateral cephalogram 3, 3f
point 198 Frontal
vertebra 103, 104f, 118 bone 10, 26, 15, 15f Legan and Burstone soft tissue cephalometric
vertebral maturation 119f on lateral cephalogram 15f analysis 198, 198f
Cheilion 151 cephalogram 3, 3f Lower
Chieti cephalometric analysis 208, 208f Frontomaxillary face height 197
Clinoidale 38 nasal suture 10 lip 11
on graphic illustration 38f on graphic illustration 28f pharynx 124
on lateral cephalogram 38f on lateral cephalogram 28f
Coben craniofacial and dentition suture on m
analysis 194f graphic illustration 19f Magnified image of anterior nasal spine on
cephalometric analysis 194 lateral cephalogram 19f graphic 60f
Columella point 198 Frontozygomatic suture 10 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
An Atlas on Cephalometric Landmarks
n Prognathion 197
Nasal
bone 10, 15, 26, 26f, 26f
crown 128, 129
on graphic illustration 129f
on lateral cephalogram 129f, 129f
process 15
Nasion 16, 26, 194-196, 197, 200
on graphic illustration 16f, 27f
on lateral cephalogram 16f, 27f
Nasopharynx 123
Neck of crista galli 10, 23
on frontal cephalogram 23f
Nerve supply to mandible 85
o
Occipital
bone 10, 46, 46f
condyles 160
Occlusomandibular angle 199
Occlusopalatal angle 199
Odontoid 181, 181f
Opisthion 48, 179, 180f
on graphic illustration 49f
on lateral cephalogram 48f
Orbital plates 15
Orbitale 52, 67, 148, 148f, 194-196
on graphic illustration 53f, 68f
on lateral cephalogram 53f, 68f
Oropharynx 123
p on graphic illustration 43f
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
graphic illustration 61f
lateral cephalogram 61f
on oral side of soft palate 123, 124
on pharyngeal side of soft palate 123, 124
T on
graphic illustration 131
lateral cephalogram 131f
Porion 32, 194-196
on lateral cephalogram 33f
Posterior
cranial vault points 183, 184f
nasal spine 10, 64, 123, 208, 209
on graphic illustration 64f
on lateral cephalogram 64f
pharyngeal wall 123, 124
point of occlusion 10, 77, 78f, 208, 209
Vomer point 182, 183f
Pronasale 129, 144, 144f
on graphic illustration 130f
on lateral cephalogram 130f
Prosthion 62, 194
on graphic illustration 63f
on lateral cephalogram 63f
Pterygoid point 10, 40
on graphic illustration 40f
on lateral cephalogram 40f
Pterygomaxillary fissure 10, 44, 65, 123, 182,
182f, 195, 200
on graphic illustration 45, 66f
on lateral cephalogram 45f, 66f
r on lateral cephalogram 132f
Rhinion 29
on graphic illustration 29f
on lateral cephalogram 29f
Rickett’s cephalometric analysis 198, 199f
Riedel cephalometric analysis 202
Roof of
orbit on
graphic illustration 19f
lateral cephalogram 19f
orbital cavity 17
s Temporal bone 10, 15, 31, 31f
Sassouni cephalometric analysis 199, 199f
Schwartz cephalometric analysis 203, 203f
Sella 10, 41, 152, 195
entrance 41, 153, 153f
on lateral cephalogram 43f
on graphic illustration 42f
on lateral cephalogram 42f
Shapes of cervical vertebral bodies 119f
Soft tissue
cephalometric landmarks 11, 125, 127, 128,
133, 138
glabella 127
on graphic illustration 127f
on lateral cephalogram 129f
gnathion 11, 139, 148, 148f, 198
on graphic illustration 139
on lateral cephalogram 139f
menton 11, 198
nasal crown on graphic illustration 129f
nasion 128, 143, 143f
on graphic illustration 128f
on lateral cephalogram 128f
pogonion 11, 138, 147, 198
on graphic illustration 138f
on lateral cephalogram 138f
point B 147f
on graphic illustration 137f
on lateral cephalogram 137f
submentale 136, 147
subspinale 11, 133, 145, 145f
Sphenoethmoidal point 10, 24, 42
on graphic illustration 44f
on lateral cephalogram 43f
Sphenoethmoidale 24f
on graphic illustration 24f
on lateral cephalogram 24f
Sphenoid bone 10, 15, 35, 35f
Spheno-occipital synchondrosis 10, 39, 50
on graphic illustration 39f, 51f
on lateral cephalogram 39f, 50f
Spina nasalis posterior 194, 200-202
Spinal point 194
Squamous part 15
Steiner’s cephalometric analysis 204, 205f
Stomion
inferius 11, 198
on graphic illustration 136f
on lateral cephalogram 136f
superius 11, 198
Subnasale 131, 144, 198
on graphic illustration 132f
Subspinale 194
on graphic illustration 133f
on lateral cephalogram 133f
Superior
pharyngeal wall 123, 124
surface of floor of pituitary fossa 160
Supra-orbitale 17
on graphic illustration 18f
on lateral cephalogram 18f
t
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
Bolton’s 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 pogonion on lateral cephalogram 88 pharynx 124

of hyoid on lateral cephalogram 102 of point B on lateral cephalogram 88 point of tongue 123, 124
of incision inferius of posterior Uses of cephalometric analysis 3
apicalis on lateral cephalogram 75, 171 nasal spine on lateral cephalogram 65
incisalis on lateral cephalogram 75 point of occlusion on lateral cephalogram v
of incision superius 78 Vermillion 135, 135f
apicalis on lateral cephalogram 74, 167 of sella on lateral cephalogram 41, 152 border of upper lips 11
incisalis on lateral cephalogram 72, 166 opisthion on lateral cephalogram 48 Vertex 143, 143f
of infradentale on lateral cephalogram 87 pterygoid point on lateral cephalogram 41
of mandibular rhinion on lateral cephalogram 30 w
central incisor on lateral cephalogram 81 roof of orbit on lateral cephalogram 18 Wit’s cephalometric analysis 206
first molar on lateral cephalogram 81, 172 spheno-occipital synchondrosis on lateral Wylie cephalometric analysis 203, 204f
of mastiodale on lateral cephalogram 34 cephalogram 40, 51
of maxillary supra-orbitale on lateral cephalogram 17 z
central incisor on lateral cephalogram 79 Trichion 196 Zygion 149, 149f, 163, 163f
first molar on lateral cephalogram 80, 168 Tweed’s cephalometric analysis 205, 206f Zygoma 162, 162f
of menton on lateral cephalogram 92, 93, 95, Types of cephalogram 3 Zygomatic
174 arch 10, 32, 163, 163f
of MI on lateral cephalogram 82, 172 u bone 10, 15, 52, 52f
of MS on lateral cephalogram 83 Upper process 15
of nasion on lateral cephalogram 17 and lower lips 11 prominence 149, 149f
of orbitale on lateral cephalogram 54 lip 11 suture point 164, 164f

Index