CEPHALOMETRICS

Dr. Mohamed E. Amer, DDS, M.Sc

Orthodontics department
 Panoramic
&
Cephalometric
X-ray Machine
Panorama X-ray Film
 Role of Panoramic radiography in Orthodontics

• Helpful during pre-treatment planning

• Presence or absence of teeth, their morphology and structure
• Presence of supernumerary teeth
• Dental age
• Eruption sequence
• Helpful for accurate bracket positioning during bonding
• post-treatment evaluation of success or failure and root parallism
Lateral cephalometric X-ray Film
 Role of lateral cephalometric Film in Orthodontics

• Used primarily in orthodontic diagnosis and treatment planning, particularly when

considering orthognathic surgery.
• It is a useful record prior to treatment and can be used during treatment to assess
progress.
• It is used to assess the etiology of malocclusion; to determine whether the
malocclusion is due to skeletal relationship, dental relationship or both.
• Can also be used for research purposes

Once taken, the lateral cephalometric film should be traced; either by hand or
digitally and analysed to help with treatment planning and diagnosis.
Value of Cephalometric in Orthodontic Diagnosis

1. Skeletal Pattern of the patient

2. Soft Tissue Morphology
3. Study Growth & Treatment Progress
4. Relationship of teeth
5. Skeletal growth maturation index
Superimposition
Cephalometric Landmarks
 Cephalometric Landmarks
• Sella (S) The midpoint of the sella turcica (pituitary fossa)

• Nasion (N) The most anterior point on the fronto-nasal suture

• Orbitale (Or) The most anterior, inferior point on the infraorbital rim

• Anterior Nasal Spine (ANS) The tip of the anterior nasal spine

• Posterior Nasal Spine (PNS) The tip of the posterior nasal spine

• point (A) The point of the deepest concavity anteriorly on the maxillary alveolus

• point (B) The point of the deepest concavity anteriorly on the mandibular symphysis
 Cephalometric Landmarks
• Pogonion (Pog) The most anterior point on the mandibular symphysis

• Menton (Me) The most inferior point on the mandibular symphysis

• Gnathion (Gn) The most anterior, inferior point on the mandibular symphysis

• Gonion (Go) The most posterior, inferior point on the mandibular angle

• Articulare: point on the intersection between the posterior border of the ramus
and lower border of the cranial base

• Condylion: The highest point on the head of the condylar process

 Nasion

Orbitale

Condylion
ANS

Point A (Subnasale)

Point B (Supramentale)

Gonion
Pogonion

Gnathion
Menton
 Sella
Nasion

Orbitale
Porion

Articulare ANS

A Point

B Point

Gonion Pogonion

PNS
Menton Gnathion
 Cephalometric Lines & Planes
• SN line The plane demonstrated by a line through the nasion and sella

• Frankfort Plane The plane demonstrated by a line through the orbitale and
porion

• Maxillary Plane (MxPl) The plane demonstrated by a line through the anterior
and posterior nasal spines

• Mandibular Plane (MnPl) The plane demonstrated by a line through the gonion
and menton.

• Occlusal plane the plane connecting anterior point of occlusion and posterior
point of occlusion
S – N Line
FHP
Palatal Plane
Occlusal Plane
Mandibular Plane
 S – N Line

FHP

Palatal Plane

Occlusal Plane

Mandibular Plane
NALYSIS
 Anteroposterior skeletal relation
Angular measurements

• SNA (sella, nasion, A point) illustrate the anteroposterior relation between

maxillary base and cranial base indicating whether or not the maxilla is normal,
prognathic, or retrognathic

• SNB (sella, nasion, B point) illustrate the anteroposterior relation between

mandibular base and cranial base indicating whether or not the mandible is normal,
prognathic, or retrognathic.

• ANB (A point, nasion, B point) illustrate the anteroposterior relation between

maxillary base and mandibular base indicating whether the skeletal relationship
between the maxilla and mandible is a normal skeletal class I (3+2 degrees), a
skeletal Class II (<5 degrees or more), or skeletal class III (0 or negative)
relationship
 Anteroposterior skeletal relation

Linear measurement

• Wits appraisal: the distance between the intersection of a perpendicular line to

occlusal plane from Point A and the intersection of a perpendicular line to the
occlusal plane from Point B.
SNA
SNB
ANB
SNA
83 ± 2
SNB
80 ± 2
ANB
3±2
Wits appraisal
0±3
6 mm Class II
-12 mm Class III
 Vertical skeletal relation

Angular measurements

• Maxillary-Mandibular plane angle (MMA): the acute angle formed by the

intersection of the line gonion-menton with the maxillary plane.

• Frankfurt-Mandibular plane angle (FMA): the acute angle formed by the

intersection of the line gonion-menton with the frankfurt plane.

• Y-axis angle: the acute angle formed by intersection of a line from sella turcica to
gnathion (S-Gn) with Frankfurt plane
 Vertical skeletal relation
Linear measurements

Face height ratio (Jarabak ratio): the ratio of posterior facial height (S-Go) to
anterior facial height (N-Me).

It’s given by the formula Posterior facial height

X 100
Anterior facial height

A ratio of less than 62% express vertical growth pattern whereas more than 67%
express a horizontal growth pattern
FMA
25 ± 3
MMA
25 ± 3
Y- Axis
59 ± 3
Face height ratio
67 %
 Dental relation

• Upper incisor to palatine plane angle: the angle formed by the intersection of the
long axis of the upper central incisor and the palatine plane

• Lower incisor to mandibular plane angle: the angle formed by the intersection of the
long axis of the lower central incisor and mandibular plane from gonion to menton.

• Interincisal angle: the inside angle formed by the intersection of long axis of the
lower central incisor and long axis of upper central incisor. The angle is decreased in
bimaxillary protrusion and increased in cases of retroclined incisors (i.e: Class II div 2)
U1- PP
112 ± 5
L1 to Man. Pl.
98 ± 6
L1 to U1
128 ± 5
The cervical vertebral bodies change in shape in a typical sequence, progressing from
trapezoidal to rectangular horizontal, to square, and to rectangular vertical. Typically,
cervical stages (CSs) 1 and CS 2 are considered prepubertal, CS 3 and CS 4 circumpubertal,
and CS 5 and CS 6 postpubertal
The purpose of hand and wrist radiograph analysis is to determine parameters such
as patient's skeletal age
OSTRO ANTERIOR
 Postero-Anterior
Cephalometric
▪ In orthodontics, the primary indication for
obtaining a posteroanterior cephalometric
film is the presence of facial asymmetry.
▪ it is also important in cases of dentoalveolar
asymmetries, dental and skeletal
crossbites, and functional mandibular
displacements. (transverse discrepancies)
▪ The posteroanterior cephalometric
projection, also called as the Caldwell
projection.
Thank You