'Gr.T.

Popa' UMPh, Iasi, Romania

Department of Orthodontics and Dentofacial Orthopedics

CEPHALOMETRIC
ANALYSIS
-TWEED METHOD-

ORTHO LAB no. 3

VITH YEAR
Analysis and interpretation of the lateral cephalometric
radiograph
I. Introductory elements

Medical
history

Clinical •  Extraoral
Examination •  Intraoral

•  Study cast analysis

Paraclinical •  Radiologic
investigations investigation
•  Photo-static analysis
II. Radiological examination in orthodontics.
Types of X-rays. Intraoral radiographs

Bite-wing X-rays

Occlusal X-rays Periapical X-rays

II. Radiological examination in orthodontics.
Types of X-rays. Extraoral radiographs

Panoramic X-rays

Cephalometric
CBCT projections

Hand X-rays
III. Lateral cephalometric analysis:
technique

A cephalogram is a two-dimensional projection of the

skull. These films are taken in a cephalostat, which is an
x-ray apparatus with a standard 5-foot source-object
distance. The most common projection is the lateral
cephalogram. The standardized nature of these
projections have allowed for population norms to be
established.
III. Lateral cephalometric analysis:
definition and indications
Establishing
the diagnosis

Lateral Establishing
Prediction of
growth
cephalometric the treatment
analysis plan

Monitoring
and evaluation
of treatment
III. Lateral cephalometric analysis:
analysis methods

Steiner
•  Various cephalometric
analyses exist to describe
the craniofacial complex.
Sassouni Rickets •  No certain analysis is
considered superior to
Analysis methods another.
•  Most analyses rely on the
relatively stable elements
in the cranial base to serve
as reference points and
planes by which to
Tweed McNammara measure changing or
growing structures.
III. Lateral cephalometric analysis:
tracing
III. Lateral cephalometric analysis:
tracing
III. Lateral cephalometric analysis:
tracing the bony contour

•  Trace the cranial

base, orbital rims,
frontal and nasal
bones
III. Lateral cephalometric analysis:
tracing the bony contour

•  Trace the maxilla,

the mandible,
including the
detail in the
symphysis, canal
and condyle
 III. Lateral cephalometric analysis:
tracing the soft tissue contour

•  Add the incisors and

first molars and trace
the soft tissue profile
III. Lateral cephalometric analysis.
Landmarks identification

Midsagittal/
Lateral

Anatomical/ Bony/ Dental/

Constructed Cutaneous
III. Lateral cephalometric analysis.
Midsagittal landmarks. Nasion- N

NASION (N) – most anterior point on the frontonasal suture

in the mid-sagittal plane; it corresponds to the nasal root.
III. Lateral cephalometric analysis. Midsagittal
landmarks. Anterior Nasal Spine (ANS)

THE ANTERIOR NASAL SPINE (ANS) – the anteriormost

point of the nasal spine
There is an individual variation in the length and widh of the
anterior nasal spine; in some cases, it can be long and thin, in
other cases it can be short and thick.
•  If the nasal spine is thin, it will appear unclear and it will
overlap with the nasal cartilage
•  If the nasal spine is thick, it will appear clear and it will be
easy to trace.
 III. Lateral cephalometric analysis. Midsagittal
landmarks. A point, B point

A POINT –The most posterior point on the bony outline of the

maxillary alveolar process (between ANS-Pr)
 III. Lateral cephalometric analysis. Midsagittal
landmarks. A point, B point

B POINT –The most posteriorpoint point on the profile of

the mandibular alveolar process (between Id and Pog)
III. Lateral cephalometric analysis. Midsagittal
landmarks. Incisor superior (Is), Incisor inferior (Ii)

INCISOR SUPERIOR –Is-

the tip of the upper central
incisor

INCISOR INFERIOR –Ii-

the tip of the lower central
incisor
III. Lateral cephalometric analysis. Midsagittal
landmarks. Pogonion (Pog), Menton (Me)

POGONION (Pog) – the most

anterior point of the bony chin
in the midsagittal plan

MENTON (Me) – the most

inferior point of the outline of
the symphysis in the
midsagittal plane
 III. Lateral cephalometric analysis. Midsagittal
landmarks. Pogonion (Pog), Gnation (Gn), Menton (Me)

GNATHION (Gn) – the most anterior and inferior point of the bony chin
Constructed point- the point determined by the bisector of the angle of intersection
of the facial plane (N-Pog) and the mandibular plane, according to Downs (Go-
Me).
III. Lateral cephalometric analysis. Lateral landmarks.
Sella turcica- S

SELLA (S) – the midpoint of sella turcica-is

located in the upper body of the sphenoid bone and
it is bounded by the anterior and posterior clinoid
processes
III. Lateral cephalometric analysis. Lateral landmarks.
Porion- Po

Porion (Po)- the superior (most external) point on the

bony delimitation of the external auditory meatus
- 3-4 mm radiolucence, located approximately
at the same height as the condylar head
- the internal auditory meatus is in an ”11 o’clock
position” as compared to the external auditory
meatus
III. Lateral cephalometric analysis. Lateral landmarks.
Articulare- Ar

ARTICULARE (Ar)—a point at the intersection of the image of the posterior

margin of the ramus and the outer margin of the cranial base
III. Lateral cephalometric analysis. Lateral landmarks.
Orbitale- Or

ORBITALE (Or) – The lowest point in the

inferior margin of the orbit
III. Lateral cephalometric analysis. Lateral landmarks.
Posterior Nasal Spine- PNS

THE POSTERIOR NASAL SPINE (PNS)

The most posterior point of the hard palate-at the
junction of the soft and hard palate
Just as for the anterior nasal spine, the length as well as
the height of the posterior nasal spine may vary; it is
difficult to trace it when there are unerupted teeth
III. Lateral cephalometric analysis. Lateral landmarks.
Gonion- Go

GONION (Go) -the middle of the curvature of

the goniac angle
Constructed point-a point at the intersection of
lines tangent to the posterior border of the
ramus and the lower border of the mandible
III. Lateral cephalometric analysis. Lateral landmarks.
Upper molar tip-UMT, Lower molar tip-LMT

UMT/LMT
The tip of the
mesio-buccal cusp
of upper / lower
first molar
 III. Lateral cephalometric analysis.
Reference planes

S-N
Po-Or
The anterior part of the
Frankfurt plane
cranial base
III. Lateral cephalometric analysis.
Reference planes

Occlusal plane

Mandibular
Maxillary plane plane
IV. Lateral cephalometric analysis.
TWEED Method

Analysis of
Analysis of
skeletal
Tweed triangle structures

Determining Esthetic
the type of analysis of soft
growth tissues

Analysis of
the space
available in
the lower arch
IV. Lateral cephalometric analysis.
TWEED Method

SNA angle assesses the position of the maxilla as

SNA= 82º±2º compared to the cranial base in the sagittal plane.
Higher values => protrusive/prognathic maxilla
Lower values => retrusive/retrognathic maxilla
IV. Lateral cephalometric analysis.
TWEED Method

SNB= 80º±2º SNB angle assesses the position of the mandible as

compared to the cranial base in the sagittal plane.
Higher values => protrusive/prognathic mandible
Lower values => retrusive/retrognathic mandible
IV. Lateral cephalometric analysis.
TWEED Method

ANB angle assesses the discrepancy of the

ANB= 2º±2º mandible as compared to the maxilla in the sagittal
plane.
Higher values => Skeletal class II pattern
Lower or even negative values => Skeletal class III
pattern
 IV. Lateral cephalometric analysis.
TWEED Method
AoBo= 0-2 mm
According to Wits, the limit values of
skeletal occlusions are the following:
• Skeletal class I = 0-2 mm
• Skeletal class II = +2 mm
• Skeletal class III = - mm
It describes the relative position of the maxilla
as compared to the mandible in the mid-sagittal
plane.
It is obtained by tracing two vertical lines from
points A and B and measuring the distance
between the intersection points on the occlusal
plane. When B point is located in front of A
point , the result is a negative value.
IV. Lateral cephalometric analysis.
TWEED Method

PO-PF= 10º Is-Ii= 131-135º

Is-Ii Expresses the reciprocal incisor angulation without any reference to the
bony base. Value higher than 135° => the incisors are retroclined. Value lower
than 131° => the incisors are proclined
IV. Lateral cephalometric analysis.
TWEED Method
The drawing of a triangle, Tweed’s
Triangle, is the basis of this method.
Planes used for Tweed’s facial triangle :
• Frankfort’s Horizontal Plane: Porion -
Orbitale
• The mandibular plane: Gonion –
Menton
• The axis of the mandibular incisors –
which goes through the incisal edge and
through their apex
 IV. Lateral cephalometric analysis.
TWEED Method

FMA= 25º±3º
Allows the assessment of the skeletal growth pattern on the vertical line
When the value is between the normal limits, the growth pattern is normal divergent
When the value is higher than 28°, the growth type is hyperdivergent
When the value is lower than 22°, the growth type is hypodivergent
IV. Lateral cephalometric analysis.
TWEED Method

FMIA= 67º±3º
Allows the assessment of the position of the mandibular incisor in the facial
outline.
Value higher than 70°=> the incisors are retroclined
Value lower than 64° => the incisors are proclined
 IV. Lateral cephalometric analysis.
TWEED Method

IMPA= 88º±2º
Allows the assessment of the position of the mandibular incisors as compared to the
bony base.
Value higher than 90°=> the incisors are proclined
Value lower than 86°=> the incisors are retroclined
IV. Lateral cephalometric analysis.
TWEED Method

HFP/HFA= 0.69
IV. Lateral cephalometric analysis.
TWEED Method

Unghiul Z= 75º
IV. Lateral cephalometric analysis.
TWEED Method

UL = TC
IV. Lateral cephalometric analysis. Diagnosis

ANB= 2º±2º
I
AoBo= 0-2 mm

ANB> 2º±2º
Skeletal class II
AoBo > 0-2 mm

ANB< 2º±2º
III
AoBo < 0-2 mm

Prognathic/
Retrognathic maxilla SNA>/< 82º±2º

Prognathic/
Retrognathic SNB>/< 80º±2º
mandible
Dento-maxillary
anomaly

Hypodivergent FMA< 22º

Type of growth Normodivergent FMA= 22º- 28º

Hyperdivergent FMA> 28º

Proclined/
Retroclined upper/ IMPA>/<90º/ Ii >/
<131-135º
lowe incisors

Balanced/
unbalanced soft Z>/< 75º, UL>/
<TC
tissue profile
Which is definition of the landmark?
Wich are the points that define this angle
and which is the definition of the angle?
Which are the normal values for the angle
of the Tweed,s triangle?