ff meri can lnstitute for Dio prog ressive Ed ucation

PR06RESSIYE CEPHR LOffiETR ICS

Pff Rff 016ffi 2000

copgr1
ight1991

bg DL Robrert m~Ricketts,
PROGRESSIVE CL CAL CEPHALOMETRICS
PARAD IG 1
2000

Robert M. Rick,etts D.D. S.,, M.S~, .1\-LD.

Q 1996 American ln stttule for Bioprogressive,Educa:tlon

Scottsdate, Arizona

Arid

R~etts Reseal1"Ch Llbrary and Leaming Cenler

Loma Unda University
Loma Linda, C-alifomia

1Robert M. IRí,eketts. D.D.S, M.S., N.M.D

1

Dáector
American lnS1Jtut11 for tBJ,oprvgrelliSive Btuca~on
91i0e E. La Posada Couñ
Soottsoale, Arizona 85255
T,et ,(480) 94M799
Fax (460) 367-C933
E-mail m-,rna@adata.com
 PROGRES SIVE ClJ NlCAl. C EPH A1.0 J\.oif,TRJC S
PAJl'\UJG.'1 2000

.E . h1trocl~u.iío:n
Stnicmcnc of Need
fucr.iccs in 171c=- l\'t'?.v M[ll~ciíum 2
Pmgr"ts::-l,:i~Hl. ín Ccpha.Lomccr_c Applícatio:n 2

IL 3

EJ. Th-::: T,-.·dv-: D::-anchcs oí C1:::pha~ome.tri~-:.., 5

F. .mcüon # J . C<)c 1:,,·t.1 :.,11 ~~ .-~ •J·( )vi fnr D:,ign-.'J8b 6
r .
Def:nition h
• <
...... Thc I..a.teraJ "\lle½· 6
.,
Th~ fro:1~.al Víc=-w l

Ac~ssúry Vl t".\.,.-~ 7
hrnr1 i(W. #?. Pnrvi.c:k~ Acu_·ss for Visual .A..ssc-s.smcm:. and Tracing 8
Thc- Thrc~ ris 8
Tracing and Digiti2.a.tiun 9
Funct.io!~. -#3. Ce r, t.;,i ns J{~fi:'::-t:m·t':s v:ith Hhlklgi.c Sig:-.iñ·.:- anee JO
R~q ui r ~1ni::-u t:,; uf prJiI: t:;: 10
T~.vo Poínt}i Founrl. !vfislf.~ding:
P,.}j :nt Sdl~ 10
Point B 10
Rcfcrc:ncc.s Emp~oyed in l .aL.c-:,:il Pl:':n;pectivt 11
Ci2rvkal Jt¿erence.s 11
Crani ~ l l{~f~rt"XH.'~~ 12
B"~k•n l¿
Nasion 12
Porion 12
Oshita.lé 15
1Jt~ ry goi d Kit í~rf'.n :':e 16
Ptcrygoid Point 16
Mand.ibuhu· r~f~c~1w~~ l7
,. Pogonion 17
ProtuLe,-ance mt'l)Ü 18
Gn.rithion 18
~-knton ld
Xi J-lnint -- 1-U L.() I{ 1· 16
~ubganion J9
Condylicm 20
.
...
1
C undylion. sr..rp::rior ~o
1
 Cu11dyliun posa:rior 20
Articulare 20
Ramrn re.fr;::l'e.n-1.·t': 20
f.v.'l Poi:m 20
.M .\lITél.Y Point ¿(.)
Ivlnxillarv rc:fc:rcnces
~
21
An~.eréor N.a..,;,al .Spi ti.t' 2l
Posti::rior N a~.;J Spinc :n
PojncA 22
;,2
lo. . .vcr Indsor 22
U pper Cenual I n.cisn r 22
Lo-.~ Fint Mol.u-
Uppcr Fir.st Molar
CafliCJf"~
Soft ')'i-GóSu.t: Tt:1-1.:1ng :Hl(L .l:h·f~r-t'll<.·e~
Tltt" Protlk
Thc- T ongr..¡.c ru-i.d H~,.roid
Toe Son Pal 3.TX!
Th~ Nr:tsophl"l ')' l Lge,'1,1 ,u,J Pharyng~.al ~V 2.1:ll
ft,nign J3odks and Patho!ogy
Frontal Pe:.rspec.tive
C:rm:da1 nnd Bm:rdnr Poim:s
Zygomatlc Frontal Po1 r:t
ZygomaL,j C Ar'~J I l'oh'Lt.
Crl f.r~ ns 111 P'oiíl ~
M~ir td í hui ar .8.'iti<'1hr Points 28
.l\g Pomt!:i
Protubc:F,::.nc.c ml:!ntt 2U
La te:r.tl Articulare
M~-:,,;i lfaty Rt":í-t;>.ren,;~s 29
Ne Puint:;.
JugaJ~
Anterior Nrnlll Spim:
Dc:ntal 30
P~o!7\ nc:::i:. .,<:tT tc.l Unes- of r{'krrncr- 31
La tC'rnl Cm.nial Planes 31
Basion-N a.sjo n T'lanf'.
F:r,mkfcrt PI.me
Pt~oid ~lert.kal Plan~
'fh~ C:ranfo.1 lt~_;t"
Plan~s and. li n¿¡¡ for the: fa~ 33
H
 Faci~l Pfan~
i\.·1:m Jibular Plan-e
fa.dal ..Axts 34
Condyle A:,,; is
Corp1 is Axis
.P,,d~t.~l Planc-
Thc A.Po Plane
Rcfcn""!nc:{"~~ fur cl1~ Tei:-i::h
Bw:cal Occlus.al Plane
Di·~· ine Ot·..d p;l-:1 ( Plm L."::

. '
A.--ch 1)~pU1 .-1.nd ~fodd Con\ó~rsion
Lov.'CT Jndsor Poshion
L7pper Jviol :=i.r Po~ t ~on
l n r~ ri n._'i&'Ü .i\ngk
Soft T; ::-::;."\.1(: 39
ílit" Esthetic Llnc {f:: Ll:ci::)
l-'ron tru PLwc5 40
Cr.m..itl
f.~('ir:11
Dr.x1tal
fROI..,lTAL PHOTOGRAPH OFA SKUU 4I
Fur,ction #t. Y.ieUo <l. b.asis for a cHnica! nom1 12
' í'}v~ SácntHic: Bas1s of Clinic:rll Sta:ndards of Refer~nce... , 42
Comp utl.!1' St ~•d y ( 19 66-1 969) 42
Second MfiÍO"r Compl1tcr Study {19!39-1990) 15
Thc.- f.-~dpi.t.adon of thc: Swnmr:1.ry A.:L,~ly::.íti .5 0
Compn:hensh•e foi· c-ümpldt:""-Ilt".SS .50
Thc Lat<:-ral S1..1.ffunacv A1--.. . . ly~b
/ - .'11
Toe: frontal S1mur.,o.::.;ry Ami.lysis 52
F w1cti on # '.1.. l'u.nri~hi:::s a Framcwo!k far Ahst!"at.t.lo11 ~ R t:";foc.·üon 53
A bstrnctíonism 53
Reductionis~ 5:1
Brief S•.,q1istits 54
Seqllcntial Change SS
Functlon #6, Fxndi:::rn a .\k~n.s for Si::qurntial Grovvth An.-~ly:-.,i:; 58
lntt"t"Cst in Grm.-.1.h .5 ~
Con trcvtf.-, i ~S,
"Pol:it Cr(lwt.h (Lriti:-rru)
C1LQ1non Bc:havíor
CHAR T: V ~h.ttt~ for Rit:krlts Crania.J Base.
Bn:-ai<lng Gr°'vth Dawn (Ab..~L.r:l~i1>n}

iii
 Thr:. h;,·.1t·•Posicion A11,. ly!-.-is of Grov....-t.h
1
ó5
Posi ti cm O:n~ 65
Pü~í11r.m Tw'O 66
Posíüon 11u-ec: 67
Position foul" 68
Sofr Tiss ~ 6~1
Front~q.l Gr:-u\"i.1h ~~ the. Bi-Pohu: Phenomcnon 70
Ftincd on # 7, Suppli~s a 'Mn ni Ir 1ri:ng Proce-ss for T ~,') unent 7 'J.
Si::-parat¡on o( Grr.1V1-th from Tn."'.atm~nt Changcs 72
\.Vhf' n. h l:. Change of Y 011T Duing7 72
Thc: Four-"Po~iüon .Alrn.lysis for :\1ooiws:hL~ 73
~ ;, mr-ti.on -# 8 . D~li rH~a k':s Tr~atm e.n L Po~~ bilii:ics 76
Short r.lngc rcsult.s ( l-1 )'t'~rn) 77
l .cHg range re~ult-s (more than 3 y~~n,) 7S:
f\znction #9. AJlcrN.s ProP.;rtosís and SinH1l:&tion of Object.ivt"::;. /8
Forccas1.jllg :; 9
E-.,;Lr-n~iun md Jv1odi;i~1 :1"Jn Tt<("'.·uüquc 79
.\fa:ndibular Are 79
'l1u: Cran i;;i l l¼ i;c:- 8 '.3
:\1v.illá ~:1
Tr-tLh 83
Sott Ti.~~, ie g3
Funcrion # 1O, Gra.nts a p!'QCt>;~~ ÍOT planning .ali t.reatmerus 8--1
Act~al Purpn~t .:iud F,1::1ction of
Vis ll2..l i:;-;t:d Objcccivcs and lT< >:ll"i g4
Scq ur-.n t~ g1
11-:it"' Cyh~rncdc C i rt'.lt" ~~ ·,
·n•t' Surgical Ob/:c.:tivi::- é\Ild thc Divini::= Pmportton 86
Scvcr1tr.c".::"l. Cbss III Characteri~l 1t..1' -'37
Fu:"lc..'tion # l L E,q\lips "th<:- Uscr fot Prm:tk~ Mmu:i.gemenl S9
F:.r:i:cci on # 12, ~a11¡k.sts o:1 Pr·J., <.:i ¡.1al T ool for Ed1.:carl nn g9
Communica.c.i oo 89
Con ~n li..1 tt'~ a La..,guagc .S9
'fht: E.ssenti.al Tool uf Cfinical Rcscarch 89

l V. .Summ.E1ry a.nd C.ondusion 90

Sum m.a:ry o f Conv-:::nd oo r.1 [ an<l 11.,nnoní e Aaal_y>;t:~ 9J

93

Ari g]e:,; r.1 n.d l.:rn:::ar :vkaS1!t<"ú LC'.':its: 94

iv
 Appcndix

105

1\1ECATIVE OF L4TflRAL HTADPLATF POR 'J.K1C1t"-J'G

f.lF.GAJTT/E, OF FRON'JAJ. U1-.'AUPIJ'4Tf FOR TRA.(1NG
2if OBLJQUE SECJ'!01\r '1HR.OUGH {OIJ\í'f &(X X ,'l,USION

'
1- •
: :.
.

. ,
: .
PROGftf,.SS(Vr CEPlIAT.Ol\lETRTC~
P..:\RA.OlG.l\1 ~UUO

by Roben lvl .l:U.c.k.etts. D.. 0-S., .\1. S.

..
I INTRODUCTION

Sta l emt:":nt. of N ~1::'ll

In thc 1YSOsi afta· th~ accepumce of Do,.,;ns' Arn:tly--s'.s ~n 194 8, a forcdül
movi:=-ff1enr. rn\'V¡uj t.h~ di:1k-;il 1l:-,~ of r:f'ph.-;ilnni~trit'~ w,:;:-, wi1 n~~~r.d. ;\fa:1y le.9c:i11g
-c:linid.~:,s foux1d cr:ph~Ú)1n.-:.-tric pn;{:ec.hrr~~ ::i prr.1fr,und ~djunt.:t tr.l thdr prnrtj.;::e~.
Th.t·y nO'\,;.' lmd .a wul to c1'Ptta<.in :1I1.d .::xhibit di:: kka5 whldt lmd i::.kvdopcd ovcr thcir
previ{m:. et..ru.rs. Bu1. limh.11.icmt1 had l:ie.com¿ a dogma, .antl the proíe..ss:on was
d.ividt":1J.

By thc: 1960s c¿:ph.alom~trics iJe::a.m.e expandc:d dUc ;:o SC\'i.:!ral d<::,•elopments.

Crr.;11.t- I' r:1ssih Hit.y of ch ;1 ~l S'c"S wi 1h 11'.f';:!. I fflé':l"l L. \va,,; l'f'.'\'i'.f.llt",;'.'l. Th ~ júl Cl :. :l 1'.f-.q h:K~ '.)~f':n
H\1 cr.n.·l':'red by ou
i:-:u.tt:-:d t umo,t'T~phy. Cro\l,'lh w,:-t~ h:rvugi 1.t i:at r., .~ <Jiri::-tj curnid~.ation
asan ;;;.djunct to trc.:atmcnt. Facia1 trping b.::c.1m.c a dinkal conccpt. TI1c
vjsualL.r-aLion of tre.a.Lment. obj~c:Liv~~ (VTO) developed in LO .a pa.n. oí oc'Lhodon:.ic:
dinic:.~I .s.nd :::_re. Cmn¡.t1..11~r Tt':~~:m:b l~.c.l 1.c.J :m :hlvance·.d S(JH~ o{ iníunlrn1".i nn
~,;::iit1K~
ml(i spi::n cff (1) n~7 ru.1..aly.s-::s, (2) llC'fli gro,,.,.."th r-:vdadons, and (]) da.~a for
forc-casting informacion in a c.h rce-iime.nsional modeL

: ·, \V hile tht' fo:n:.r,oi.ng <'.'.dvrmc-;:-mcnt~ ,'r'CTI' TIUldc by th~ 197 Os. thcrc ,.,c1.s- an
abscncc of acccpt.ancc ~• prac.tiu on crs in thc ma~nsucam. Conscqucrrdy, th e: din fcaJ
llS~ of tl1f. tool d¡d n01. kt":pt. p,V.:t'. wit.h dtrit ptngc~ss. lmaic·...11;Jly, .YT"l :K'..no:i] ck-di:nt": j~i.
n":-:--- oc.-:.'1.l?J."t'd ,it tht:" 5-.:.Hn~ tb\t" thc- urchodonti-:.: prvft:"-:.>Ío~~ at L~rgt:" 5ouglrt to fordKT
s-c-<: urc ci.1c spc.c~.a.l ty.

Unfortunatdy . sonK cdt..cac.ors ha.ve C'i/C:n bdittlcd i:hc c-:phalcrnctrk approa.ch

ri.s an a1d for :?ractical di::=cisio11-1naking ~L Lhe ..::ha.ir. s:ill insisc.ing ch.9.L a sLl.tk m;:,ide.J
anal ~-.o;b ,1mJ ph0 lt1grnph5 ., , .-rn ~1.1 ffi-:...-i::- for lii.ai~n~b UI Lll ¡.11.-m l lh~. Thi::; ic.k-a w.;.15 hdd
bt:"CilllSC¡ Hrst,. i:hcy think .skc:k:taJ changcs are: noi: signiticant 2.nd, sc:condly, thc::v
belíe-i,.·e growr.h tD phy only :l S]1,.9II rdc-" iT"l the c.:uL.c:Gmc oí a treatm~nc.. Thi:-. i:o.

1
r:"t.~spjLe thc faCT ilmt 7% uf dt.iktren ,,,.ritl1. Cl:1s.!: Jl ha-ve: bt=en shm•m to corre-et wHh
~~rmvc.h ak,n,. \ViLh thc. vjgorou.s dfort on thc part of tn.ditir.J:rtf.tl (Jrth;1c..on1.i~ts. to
w.a.ít for ali tccth to bt" pIT~t'nt .ax1(l then .~ppJy old. s.undard straighi:•v.rirr proct'durr>.
~ ~ 1t" 011! ;:nmf'. v.ras ddcy_,atcd to th e a.pplianc~ tL:Jmiqvr.:- ~11.1.nf•. St)m~ t:0ff1 inercial
prcmo-ci:r:.; d,:,1,1111. 1h~ whol~ i:i;:m~ 111 L".tíl.h:Jdo1uks is ·within th::- , ..iIT - - what u1.frr
nonsense:

Practkcs in 'fhe New Jvlill~Jri11tn

ln mdf!r to furi:.hl'.::r progrcs.s. rhc cndn: ort.J:tuuunú: pp)[~~~inn ne~ci':i ,j lifL imn
th.c- n,:-1;,¡.• m.illt·nhJJT1. Ctt":::i 1. .-,.1 rúi.if:s h ::i ...-~ h~en madc in bonding ,.m.6 brn..,::ket
"pl'e:.adjus.i:mcnt- de~igm. I lowi:..-vcr, dü,guo~is, pri",gnt1.~is, r.rl?"..arrncnr de-...sígníng,
nnchornge <:xw.:-,1dc:ra1Jons, thc. rcalizat;on of possibilitks, ¡u1d )rn1g-t.(':un t)l}jt":L.l.ivf":.~ :i:t.rt":
cmbarrassingly ·weAl.:.. iri 1.ht> c<Jn1=:rwri p1·::it:t1cf! of e.he spcdalty as de-i:t::rm.i.:u:d by
.:,.1in·ry:i.. af! late as 1991. Thi~ nccds to be chang~.

Progrt':ssh·isro. 01 CepfodoJ.neu:ic Aflp,1cat¡on

111e actual dinkal a?pHrntion of tht' rltwJpl.11 r:': w.~s preci pils.te.d b-y \\1HJjam H.
nm..,·n:; h~ 1948. His objm.i\'f'. v,.ras r.o enablc thc din.idan to "typ~T th.i;:- pali~tl's
skdctal coruU.tk-11 ~íld {klt'.r..i:unt" thot": rdiH.iolls of the teeth -.;,,.ithin thr.t 11µ[ltkm 11 • l,:
,.-v.1S propos.cd as a:n aicJ in d i..:'1.g:rv}Sis. But ~ll~o, (1hj i--.; • 1i vc=>s ;rn d Tre...'it me.11r. plan~ '>\.'l".n': L". (J
l.it' rd:~Lt-:d 10 an Í:Yipli.:d. a~1ount ot a..ntkípau:d.,r,rm,;_1h m1d h-, direí.·"6-:..1n ÍJl l_)c :•" H' ::;·
rnind.

Thc: r...uthor scartcd 'í-'tork 1r,ith Downs prior t o th.c:- p-ubVit'.-;I ion of 1h~l .·rn8ly,,,,i8.
· 1'hro, tg~ thé' ye~ rs .'ll sf':ri f':.', of d p p ropci at¿ ch a:'.lges wcrc madc- rc-suld::i.~ from bath
controllcxl illV<:'.'otig,',ll lm:v; rn1d p:r~ctic::il i:-:-r,.¡"llt:':JÍ-t':Jn--.e. lL ¼úuld be difflcuh: nm"l to
idcntHjt i:hc origirnú ~chcmc bccau~c no rncHS1lr~rnr:-, 1t s, nlr"•J1,Jdfi ,,r i T\ L ft".t>.1110 l"I:; r.,·r
remain a.s prnposcd orjginally.

Dm.\:ns' Illi:thcid nnd othc-r schi:-mc-:s. t'ocused on th e prcmlt. Th~ Dl.~iÍll h.1t~:5(
Vl'::.S dire.cted to dun µosition _. convexity, and dentur<: position . Yct, in Down.s' ""--crdsi
in l 950, "L.J.1.c:- t".xphn:~, ~cm ,u ·d uuder~l,·mding [ui: cn.mlil.i(:ns that. prf'.~t'J1L in the prnfHi:=:
comes hom c-ffc-<:t ~ of. tht: (Ta.nial and frtd~l stnKil.1r('t: poste.ri ody. Thit is ,.,,,!) ~rt'
v.--01·1< i~ n ee.dcd..-

Si::-icc ! 970, n frol'ltal analvsi5 h.:LS ~xcn fo1.1nd use-ful. .Af.so, in the fo1 t""J"id :md
✓

: ru11 Lal, .sif:n:-,ibl ~ fo rc.t:..=t:'il.i ng ptú('~drn•-t>,~ ~ i-if' f'!'Ovr.n suffic.k..ntly acc-:.ira.,:c as gu.i des for
cli:nic~l applin~tiou. I.u ii.:J<Jitiüii, th.r:::- possibiliti.~s '-'f "o:rL..hfJpédi t"':S" h Av~ h~f':n
dctc:nn1ncd as producc.d bv diffr:r..~nr. r.rr:8t.mcnt modalitk.'S. FinaUy, tht- 'l.--on1putt.'I' hati
l)f-..f'_n 2:1 fut:::q 1-t.hr-ougli tot n".t t'"1:rn,.' l1 ,-u1d i,~ i)~iti g n M •,d tt":gul1!.r1y for di nii.~l in forrn.aLJ 011..

2
< ••

All Lhis need.5 to be- t.au~t m-.tl ,1da~:it.t~l for dirücal use-. Now ji. i:,:; de-.'1r Lh.a.t those:
• J -

dinid.m:l~ v.·~inng for t.he. perrnancm:. dtntili0n w ó'il ,:1r l. 1.ht·'. ra..py and who 1í."r"Drk widt(-n.1;.:.
bt":ll~llt of thc foll appJir::atiü11 i.1f 1l1t. i.ev·dopmcnts 1rvithiIL the ú:~ph:ilom~tric txil are_.
i:.mforti.Ln:11 dy, be.ir:g left bchind . l11cy u1.')y hf' lH,r Rip Van V\'in.kk ... aw.akc:-1riug
CfJ ;:i d1 ffcn:nt wudd ÍJ 1 <) l ( hodon ti L--..~.

Tiu: :,ihe'-'I '1pn1gressiv~•· has bccn .::::mpk'_\"t'd [ur L\-,,·o re.ason5. Fi.rst, it is usc:-d in
-che ~t:'"JlSf'. of modcin, conkmpor::-n:·y, foULti.stk a.nd .ri.dvan:::.ed. f n f.qc.t Langlad.c has
0

~u~cste<.i ,Lc1~w labcl, 11prosp0::tivc 11 ~or Jqrikhg 1.0,v.=ird i:hc futur~). B·.1t .UK•rit. ll1;q~
l.b ;:i L i t. is a.ss-ocfat~d ...,,...¡ 1h I J1~ i d~a that a sc.cp-by-skp nJYl~c of a.ppli cation is
::tpp~ ,pti.CJ.Le for a complcte- r:fñ dc-"n1 íOHti ne clinical rc-wm~ .

r Purposc
'"íl1-f' ,_)r,r..sc:nt syll.::.bus, arn.J. in~Lrm:I iou:~l (:curse5 .anmding ~t, b ,u\ t'.ÍÍür1. Lo
updat,;:- th~ .,1n•:f:.ialtv o[ ortnodoni:ícs as .a wl•.ok ,.,..;1.h, if noc. thc- schC'mcs pR"~r:::i:1kd
hcrdn, thi: cl'1;c:-l'll u,;.p rtf :~pp1iL--.;:irjons propo~ed l.ly ulJt~s· L~pllaJomctric mc-thods.
•r,-,, s L.i=ach.ing ts :un c:-ffort to itxipn;vt". in rormat¡on acrcssLJUi ty aad e.n h anee. knmvle-d.gc
.m d ~ k1II of :=i.pplication in or(kr to ekv:i Lt- s...-Jph i sti catio:n of tht::' pr uÍ~5síun.

U TffF. SEVEN PROCESSES -- 'fhe Rough-In of the lJe~

In tbt::" k~imh1g ,)í .snythi ng, r.hc mind ~~es thrvugl1 threi.:: stagcs. Thc first is
1ht>. 1'ough-in11 sk-:::tch of tht' ide:a. Toe sccond st."\f,~ ís nu ~bRlra.ct process of
11

c1.~5(1daüon ;ind undcrstanding ot thr:-- hlt"fi. Th~ Final stazc. is tlu: '-'.oru:tcl.t::, 1,vhid1 i:,
i:hc de-crol Gf l,:-1._o-....-l~d.ge Lh 1'úLtgh corre<:t .and ro1.1tiIL~ .::ippl tea. tion.

gf"he.~ ,·~al is rc:qwrc:d in orch:r tü ru.:i.stt".r a ny idea or -ccchui,qut", lt i~ 1.1p 1 () Lh~

~n1G.cn t t.() l-t'"~lO~- Als.o. 3S "t\-i th any ,.-..:::rtk-il I Ji:;::;1 u 1il'lg proc.es.s , thcrc é!I.::: i:otüri b::i ~
linc valru:::s llitd pruct':(Jurt::::,; 111;:i l. :-.irnply must be rneinoriz~d. Thi.s \.,,·ill c.nabk i:hc
sL.11'..~nt, or tht:: c1inidun, to emp1'.o/ u,~ 1níúrm.1ticn succcs~folly. h, 1., füct: A-n~w
fong11!igc-> • h.'H. t1"':"l preve~.:; ~; t.h l.1.SC!.

TI1ere aJ~ csscntial]y 5cvcn nmji:....,r 0pr-1·;,i r.i nn s to thc cumpkl~ cunlt'Jl tp1.u,u_y
applin~b.ir\ uf t hi:>: ci:=-.pn a,ornf:tric X-rny :ool fur the 5p~c:iah:.y. For rca.sons of
-communication, LLi.c:~t' ar~ Jfakd fo·sl fl:i a rough~in:

l. Prcxlu<.'"CÍO.O o{ lhe i m~ge

!vlany h<""adtihn~ ~lr.t::' ~ ., p 0 1) r th ,H. t.hey do not giv-e tht' c.-Juú(:utn ~ dl<liK~
to t"':l'..trn(.i. Ch.f'.. a:vailable ínformadon. 111.e te:-d1n1qu.e fur tald.ng ,md pmcc-s-.sing

f.". 3
 c,f th~ fihn shuukl be R~arJ.::-..J as ~~riou:;ly 3.s the &ttcntion to .appliancc
l~:hllLCJ_LJ.e..

?. l\,fotle1 Data Convcrsicm

h)r unJt1c~1t-i11n, 1J1e il"IÍúrmaLJon frcm thc ort.hodontic modd is
assoda-c.::d "ldth -ch::: :iJ.1.formm:ir_:.u fDJ¡h l ht>: L-1tr.1·111 and fro rit;i headfilm. The
a.m,.,unL nl ~,~]aig~rnf-':nL Llf Lhe <'x.phaJomctric imagc: nc--:c.b to be h101rvxl, t rlü.o
r-2fcrs to ±ih~· obi crt di:rti.m-c:.e.
A~aJys[s can hl~ s.tarrcd ,,,.,ith thc tet1:h ¿m.J d1t'ir t:.i:H¡Jlli'-.·eu\t'111., bul. i,. c-Hl
also be gin ~•,Jt ~l ~l l)-' p,·ut el t h~ ~k 1iH.

J, Dfa g.nosj s
Tiu: tin!t stcp t01..,•..m.l dingno:i-.i~ ¡., :ln :1d~lnt.e d.t:scription of skdcuu,
dt'lll~l, :r nd ~\°,h.-Ussu.e cündítions. This.. simply, is o:J.11.atunú<.·,•-d, lt {t.quirt'" 8
sch~ent"" for :<i..hs._r:'l (~l .i nr, .'ln d reduc:Lion in 1hrc-c dimcnsion..s, Tirns, i~ ~ ,t:iil,
both lat-eml <vmkd m:1tl hurironlal) m,L.l frooi.~l {Lsansvcrsc an.d vertical)
d1 :rien.s:i.ons 1n ord~r to be co~ t.

4. Monitoring Base
The orlginaJ aim of ccph:-J.ornctrlc~ wa~ tr.~ :i-.tmiy growl.h r:h.angf"::; in Lh~
Jiving d1ílcL C.:J111pi:1rj:r-;rnl Lk.c:hniqucs 'i.\.'Crc: latcr crnploycd to diffm:ut~te
tn·.atmc.\Ot d~flngt:s.. A crit.ic::d hSiiieltne method for scparation uf normal.
or natural grmvrh frmn tr~atm~nt -c..:h~ng~s fr'l.u.,;;; L he ava¡Jahle. Data now 1s
¡_)f<Jve.n a.nd pr;:;\'tdes a trL1St'\'i-'Orthy rdcrcncc b..1s~.

5. Prognosi~
Antidpation of ;:he futcrc !5 onc of t.hc: hask rn•d("rl)•iiig :lím,. úf 1h~
,.,.J10k .;_-fü~,c.~1 ~-t'.ph~,k,rn~.ric: ~)J"(J("~S..~. This \:.,--as lmplich: in th.c 't~rp~ng1' -:.1f facial
_grm'l:t.h F~tt-rms. Bi.H che t N"lmi i Jl.lt' c>fft':J·h v::lJ u.e. fas l:1eyond d.esc:ripth:--c typing.
Prt"~lic:ÜH~ u.::c.hn]qu,---..s. wit.h .somc: rar,c c-xo::püons, provid{" gor.::d deü1H of d -..('
foturt:': nnt:r't':.<il ~d Íisi' ~ r.1-f I h.~ i~h1 Id .tt ma.turity. "f-'a.ri::iculaTly by agc 8 thc::- pa!:>t
.fVU''1-1h pattc::ms produce ..1. ~iivttL prt"dkH.vt: ba.;it. l ;·,-.ron.1;1.nat~i.y, many
t"du.c.a.._ors: h&•,.'e. ~ven up and spe-nd thdr time ob~..:-cti:ng nith.t'r d•im ~huiyi ng
~m{i ayhlg I fi i.mp,o..,t' ~Jl.'..c..sc:-111 rnr;=-thod:-- of frm:".1..-:asting.

6, Treatment Planning
011hodontic obj(:ct:h~t a-r:---= 1l1...'1Cr: foi- ¡mrpost>-h~ of produ..::ing thc bi.::st
~sr.heti-2s, optimal funccjon .and forcmost s-t~bility, Th~ c::•:phtilomet ric:
pi:-n,;: r-1fort-, ~o,·í1 h :l (nrt-c-:~st wic h,J1ll r.re:8fm~nt, may be cmploycd ffrst. Paren,:~
oftcn ask ,'l.1tat thc chHd1s cor.ditio~ ..,..,iJl be 1tdthout tr~.A1 mt>.l'lt .. lL. ha..:, be.en

4
 d ~-SCL...' vt::u~d tl tal b~l v1-·ct11 5% ~md 10% uf c::~rly I!UX('.'d Jc:-u.li Lt0u youug d tlltlrrn
mav sdf-corrc:ci: CJass JI ,vith groi\._...J,. Th~ treatme-n t obj-ectives ar,e ch..::n
✓ -

,;Llpf'.rimposfrl ori r.hf.t1 h-:j.-,k ml.ci~dylng rn :H rb:.

Of r:vm greatcr val.ue, hov,•c.vcr, anchorab't: clitcrm are.:: ~alcnfa tt-J and
d.etailcd mcchanks ::.re. plan ned for th.e prndu.ction of the resulc.

i. Scllin~
Any r.rf'.aLmf'nL ~-chri-nt> mm,1 be" .-1gn=:f'J ,ipon 1-:y t.h~ part.it>:~ i r"lvc,h-::-.d.
The rni• k;ng uf ;:1. ~aks ccmtrnct ís n pare of m-1.na.gcmc:nt. Thc- c'='¡.i!wlo:mctrlc
VTO or "\TfG pro,;::css sll.o\-v1i .s.-ornething tangibk to sdl. It cnh.m-:cs.
arnun unkattOf~ \.,_.¡ 1I 1 (·.he:- p,• li r:".111., TL. {t"v~r1 h, t o l.he. pa (j f':n L. •.he. t":b j l:".-i.~ i '-•f'.,:; a nd
nu:i:~ r.1f t 1!('.' {1rtlwd0nt:c:-, orthopcdk and S-\.lrr,j.("al proc:~s~es,
·· .•
TH 1'. PROP~R USE ül; Cb.J..-1lL'\.LlHvll:.TKJC~ V~.(K~B.HSS l~S
Tl IROl:-GI-1 TIIESE SEVE.N GROSS STEPS.

111 THE TI-\'ElVE BRANCHES OF CEPH:\LOMETIUCS --

Thc: Ahstr a.e L ! ..e:-vel

Tht:rt::' ~irt' '=S:sentially twdve- ( 12) maiOT dinka! i-.11tcdon!i- of ce?halomttric!i-.

111.cy frJ.l inrn four ~en.eraJ groups:

'fh-:;- .ilnit gro\1p pcrtains to <.k-slTiptiv-c and dfogno~th.' puru:rn:ü.·r~ -:.ln<.i Uu.:-
bél.is ot s:::andards.

Th~ :;f'C-flTí d sn..:1..1p (."íJHWll\:S f;eq,1en ti;::il fow:t Í()ñ,i.; w.hid"! hSt.V,t:'. :r:~frr~nn': l.()
, . .nnalysis. of -change.
·- .
Thi;:- lhi.rd ~ru up h; n)rnl.-::'.dN ,-.·ith p.rognus-is. l un::-.·,~~llng v/llt lht'"
simula tion of" rc~ults is mad.~ to in.dude dcsigning rnd phnning for an.chornge fur
tr~a tmf'.n t..

11\..-: finnl group of functior:s :s approprtatc -co pnK"tice managcmc..nt.

Cc.pha~ome I r'i r-s fonctj on s (;Jr c.x.m.munk.atjon, 1e.a. r nj and se:11 ¡ng oí Lb~••g.
{Jr:..h r.tdt>1•tk· pnxh u::t .
Tw~h.'1! FwKiions of J!iogre.-s,;ive. C,ep halomctrh::s:

1. Cún.,;1 lr.u1 ~~ r1 ·t.onl for Oiagnooi~.

?.. · Providc:s a.ccc:ss for '\-'l~wJ a~.s~:i.srnient a.nd tmcing .
.'1. CünWns reft?n:!n~s ~ith biofohi:.: !:ijgr,ifkance.
4. Yidc.h a I.Jasi:,. for a i.·Jj r,j ~-:al norm .
.i . FtLrnj.sl1es a framcv,.=orlc. for rdJ~tr::\c:t 1níl ~nd re.dt1Ccio11.
6. R r"il dt"t'A ~ m ~3 .-is ínr :o;eg ucndaJ gro1A=t: L i:-11 Lsi,ly:),ÍJi-
7. Supplks a monitming prc,rt-ss frJr U'f!.atmem .
8. 1)f':I i neaLes U"\::atmen t pos si bili. tk::!.
9. i\.How-s progt\OSÍ6- ~ntl :-.i m t1l a tí on of objcctivc:-:;..
l O. G~anr:s a mcdium for pl3ruti..ng itll Lrea.tmen:r:s.
11 . Equ'.p,~ U I t-: 11:-;i:-:r (or J_>facticr managc-mc::-nt-
12. Manifc-~ts <.l prindp.~l ton I ro r r.ducatton.

Funtiion # l . C..01, st.hutc-s a T ou1 for Oi.a.gfl os.j s.

ry.._.:finh.ion of 1)i a.gnosis:
8 Diagnos-is i5 thi: .-1.tt o:r: ::u:t of ,li_.r1t:rii"ninalton of condití.t1n ,:u1il !.ht': fun.hf'.t
distjnguising of indhrjdu.J (·lwrn<:\krislks.
&O nf.'} gn n~ i ~ 3 f:-.0 i nd4 jfl~s in t.uidon an.d t'.x.periew:-t: by Lh~ ri.::cogni úon of

p..·1:ctc:-rn:;, lmt j t i :-; fi rs.L. based on sdene<:,

8 Oiagno:sis consists ot w:o1..·1.lwte 1'Lqs:s1 íit-:;it.ion and dcscri¡..."t:iuu.

a.:l)j.agnosi,r;; pc..rm.it5 a sW1una.ry of thc 5.y•u1.ptcm,s a.nd the condusions m1d

dt:-.c:i s.i 01l :t: R.rt'Lvé'.d ;1 t.

·1·he Lateral V it.'W

.
.i\ mt"l¡il ht:i.l.d k1ldt..r. 1>f ~::it rnds.. shculd no-e. cov.-:-r tht' :oint h~L~Uf;~ Lha.L at\:!a •:s
a part of prcs-:-Pt dfo.gn,ostic C'OTI!:!~dot"rn t., c)n. V\.'ooden or thín pl~ru.c h old~rs fo r th~ ~..:n-
rod..~ sh o uld be. uscd for ptuposcs of nu.lioluc.:t1 u.:y.

}\.. Thc: tc:-durk1ui::- for oo t-n, ~ 1i0n íor 111 f'. l at.e:ra.l is tht: h~ad iu Illin1rnl
postu.r.::: (not on Franldorr: Plan<' nc:ct·:ssad)y).
B. T.11~ j:=rn:s .uf': dose:d ln habitual ccntrlc
C. Thc: lips ar,: do.s-:d ín ord a to pt'rc-:fi.v~ l ip sua1n nc:cdc-d to sea! thc li-ps
l.t, S\vallow.. which is dhmostic. _,
D. A ~t"Cuuo1..I fihu uwy k ut,Hli:-: .ni. phy:üologk ri=st and .at llp ~po~t' i.f ~ü
dcsircd, but _g1vcr, oniy onc fihn :m.tin:: i:i~ ÍCJrmati on is 5t:c:n 'i-dth lip
d ()~ure [".le:('.::H.!.Sf': 1.Jl.q¡_ .ac.l also rnay alter "COl\gllt' po::.í I Ífl1'I.

6
 E 'fhf' 171m i~ hmugh1 1tp t.hc ro::l. ho1dcdn u:i:<lt<r l1J uuJ.Üüli..-:e
t.o
..:rilaTgcmcnt, bu"t. cv-cr1 thc:n th~r-t>: 1f sti 11 a 6% cnl.ur,cmcnt of tb:
111jdline.. f or instancr:, arch di:pth in xur.,i!if'I~ :lr:1 Hall_v a\'f'.rage~
¿2,25 :t 1.4'\ but a 6% e11b.rgf'.mL~nt mal\.Ls it ¿,3,65 mm. &out u1~:..j,ql of
molar to crntcr ot cdgc to crntrtl I j 1LCi~c:ir ce.phalomcttkaUy.

·Thc Frontal Vkw - Od<..·:nt to t t.fl.fl),.for t PI ane

i\., · ('he t~hnique: for orkntatEon on th('.' FJnnkfot't 'Pl:;,ne i~ hy al1gnmcnt. of
btc:-.::-lll Ctl."l1.Ü1.u:; t·-.f t ~ L~ t"yi:-. w: Ll': a mark on thc- n-pki lOJnt°tt:"J'" JS 1r,n1.
ah ove thc car red,
B. Tti': 1.h .-=ir~ hi.".ld in üccl u.·üon_
C. Thl." film is bniught u¡: tci 1.he: nose to minimizt' ntl~'~l.t'Xll.t:':Tlt, b111. .i:;1.il'. ;11.
th~ rnolars a 3% or 1.65 uun. t'l!.Wrgc:;n(::1)1 úÍ thc arch ma:y rc:s\.tlt.

Accenory Vh."",.'s
·.' Thc Physlologic Rcst Position .E~po!iiure
A. Tl,1:-. 1s üflf':n infotma.t.ive. for 11 joínt piitie:i:► 1:.:." h~c-.aL1~r. it r~gi.~t.P.rS rhe
"st~rting po~h:i'-'n",
B,_ TI1c pacien:c ::s '.nstrnctr-<l t r.1 , ,t.t~i:- fric:'il.i ve and plosivc sounds fo.fü)'l..,,'ed
IJ~t m·:uu ~l ..~(J111),6 tú ai.:.qLür~ rcst rosn1n~. Tht:>. wotd :1Boston11 \'.'Orks
w::-1!-
C. Thc lip.s uwy n'.'1x111iT ~1 t Tt"J't<lfilf:_

The 2_'i ~ Degree Obl iquc

A. .Dy tt1ming tl\(: ht:".Jd 2.:? 1.hC': joiTlL of onc sidc i::;¡ xi:ti:.1ovr-,d 01,1t. of lin~ of the
cen t.ral bcam ancl thi:- condylt": fos:..a rdati.on can be ITr:ord C<l ou t h.,.. si d,
llt' :<. L LD Lht'. íilm . 17-iis rnakcs lL -,,1,~y of tht'. OL':du.s:on on on.c sjd: for

trtH.:ing tmd i;.úmp.(f;T'i.son of th~ othcr.

...
•· 'A.., tde Open
JL \ '\'ti 1.,. . or:-t>-n ,~1 :1 r hi:': di ;tgnost.ic of a j oim: or 1.nu~d e:: 1u tp.i ~.r mt'.u L l L-,vill
furth.c-r revea! thc morphulogy f:l:'Li:1 ..~ymtr.etry of thc condyks. 'l11t' dght
~i de i.s. enlarged du.e to film 0bjed í.H'-1 :trH'~.

Othcr Fun<.,ioruü Cu.ndi'tion~

1\. H.iJkl¡.n.g 11lt~ hrl:':ath ma} su.st:rin thc- palak. cli:)se<l..
B. Phonntio:n -- In urdt:'r M 1nc."'..&Sw·e function.c'tl n~!;;,oph.!Jí.}J.'g~~1 ~p:1.:-.e!: Ü'lc."'_
pat.i cnt ""i 11 pron ouna::: thi:- loug '\( :"_jc_.i11nd úC 11
od~ a.s tn spoon_
.. c. .u ló:,.j-O\~ pé~5:,11)ilj I y can hr: rccordcd to mt"a:.-.1..in=-: pn.~ 1uff'~., ,.-=i kcn for
'
indsiv.::: action,

7
 D. A fro.nt.l.l To-Nnes vi-cw, ,..;1th r.)ptn inrml h, m.ay revea!. 'Ch.:- S111mc::s mtd thr;:-
fronta~ n:-iJ-:ct
··L of clu:· nmdvks.
,. 1,.•ividly,V

Tomo¡.µ-~phy
fü)cly scctlon X-rn.ys provid~ d~iJi-; in 1.he. joi!l.. or an·y sc:cti.on front.~Jly c"H'
lareraHy. (~t'~ 1~ lt":ral nbliqae jojnt scction.)

Fun(.'tiu:o. tf')__ Provide~ Ac.c.ess tor Visual Assessme.nt and TTadng

Candidly, many orthodo11ti;':it.-.:,. wm 11 ~•,;::baW a film o:i:tly. r.,.xm))~rl:'H.10C1 ,.vithout
m~asureruent is cypical of thc praci:kc~ r.1f ,:1di0iog,srs. lr: gcncral m~ or¡.~..utlzed
a:pproocr.. "t-;ill i.mpifJ\'('. the ('ljü1c:ir1n 1s ability and ac1.u11t1:1.. ,A gmss inteJ-pretauon of
111? X-l'.qy is maclc irom <.l :n1bj~c"th:~ vr~_. . . .•po~.nL A sdf-crnro~J St'mY-hi'flg ol-,s~rv.ai:-.ion
fulloH•ot:J by 1,,L(1 l,i::ise.d fa.Lionaljzation is rt::"qui~d-

_S1.mlyin1; thc h,::ac.l X-rny fihu h ,m .adv~nr.ure. Fra~1ncnto:1ry bit::- ~n-: ,;.:nllt'.cted.
from ~ l1 ,'i.vai IR b1e sources. 111,e :inru. vcr<li et. Tt'sCli 0fL LJ'le sum of thc i ~ , t i . ( H \ m'l.d
not on thc X-my ~lnnt>:.

'l'he: 'T'hree Ps
for pulp!:-:;~s c,f ;n'o.ckr,..;L.and1ng. ~ s.:-arching of tfo>: f;Jm might be tho!.!¡;ht of Lri
te.rm!: of thc phy~i4.."'.al e.ir w.c)tf'l I oiogj{~l, thc physiologie, :.i t Id th~ paLhologic ~-
ht"nc·~, Fer refcrcncc. me threc::: P1s.

Phy~ it"'.:11 (l '.-: tfi'l .s n d Si 7.e)

A F.CClir.oin~.uy hnprcssion m,ay br: rt<.Ti de:red by o b5crving the ht:"mlpfo k.-;_
Expcit'.1'n':t'. has shav;.'ll tha::. ini"Cial nnp~~5ir)l1~ 111' u'if' 11í .",t photograph rr.a.y not ~
:Jon-1-: out \vi th :i:ni:.-:-t'.';1.1:(t'.i:n ~• 1l.. \V~ dh-idc:d fadd pattcms into fk11 c:h yí.'k:i al,
\'1¿-.siofacj al, and Dolidrnfadnl ul t.t:nri;i; DÍ chir-, po.si tic,n. Con,."t".xity b ;¡,o.;:,.:r:-:;:,;:=-cl
iarLhc:-:i:, :.le I L°l den i:a.J cm placcmcn t is alsc, vki....rc:d -

Physi caJ fa.o:ors. in tht: lan:rai ftlu L;

l. Cerdea] ve.rtcbrae and craniaj. bn~t:
2. Nn~0phmy11gt:"!i_t f:r.-1rnr'vl.•ork
3. Cross facial fcun
4, Miindih11!:1r form
5. Positi on of tf::eth
6. S0ft tc=,sue morpholog¡~
.·.- .
Php;jcal {,·KLOI.'-~ in 1hi:>- fm.nL~I hif'~clffün:
1• Form and s'vmm..::trv of -che arm.ium. ~lrl )Í11;, nilsB.l ca--ví: \~, ma-.,:illa and
• ✓ ~

rna.~1 oi el~
Symm.:try of the m,:'U"J.dibli:: in fooü a11d p0stl.:on
3. C'-rro~.s c.ooch ill.S plac.c:m-en.t and third mol,ir .:.:o:ti di I inn~.

Physiologíc.
Functj(m wiE v:3Jy .:1.s b:1~ on U)c ~kek:tal l:;,.,,'1.ttcrn -élnd d1r- JHnsd.,o Mmdi I icm-,.
f-le:;id pos::.uri:: is a biologic considi:To!.!.tit:ix\, l~rt'~,11 hjng .~pa.cc:.s may be: ~\ aluatcd and
0

associ..ittd ~·...-iL~ ;:ougue pos:ures and hyoid bon"= {.Vr-'.lit.iot1s. SLr.-=i.ic1 in the Hps may be
f1irt.hcr a.s.s~s~J <"<~ Hp k'nsiuu :.md lL)11gut>. f u.1'1c.tion m~; be: foctors prndu,;_•¡_n g 1.b:-
(>:rigi1ia1 malocdusion, lvinndibular ch..1.1:1._gr:-,'i fn1n1 ~'.',L". LO dos1..m:: ma;,-b<:: furtl-.cr
.-.- 'I
c::.in~dr-r·>.1 11,,n..~, parttc.ularly in a joint dy~functfon r.1.w..1.ly~~ .
Physiologii,: fa ~:t m·s i 1.~ bot.h vi t".'o-.....~ :
1. Rcspirntory ob.stnKti<J(lS
2. PúsitLOfi úr t.hc hyoid bonc
.'3, CI 11 ~:-.i íi c:a t ~on nf fl [)TI n cm :1l lip relationshi~

[).a tholog.ic
l, C;JJ.lgt'l ,H.,:1] ,:kf-:-n rni 1.y L".tr 1.hi.:: o,.•c:rtcbra or skull b":-e
2. C.-:ang~D.it..ü Jd·i:.ir:m.ity 1.lf H11:': {'_fanial ~ t !
3. Fractures
-1. frli.>.T"I ti fit""a ti on of cy.s ls
5, h 1{1,'lJHw..'l1 ioni; o{ :;i nt:l.!,es
6. Adcnoids ru.,d ton~il:;. prolif¡::rnti~m
/. [-'.orcign b:::ic.·y iden ti.ficadcn

l'racing and Dij.,ritiz..~ tim.1

l 'nUowjng 1h~ "i.;i,o:;LJ;Ja) asses.smcnt a trad.ng ur digiliz,iti()El is p-e.rfon:i.cd.
) . ." Rcmcmbcr th::d. c.7..ln"t"c~ my-Út.c~ al't>: rn,~JaJly pre-scnt, and shnrp c.k t:üt 1t- 11ott'A. in lhe
r.ro.ss-se:.:tfon of a pan. Pmtk1..1l.élr- puint:<'.; nn r.h-f' a n.:H.omy are sought. Ti lt' trndug ur
digitizu,g inl o 1.he cornpu.tcr should be con:;.idi:.·r~ ~ 1)jc:-c t': of .art. The pendl linc c,r
stylus is pla,cc:.·d pri:::ci~dy (>tl Lhe. ouL.line: üfr.he ?ªn not l'Xl:e-m.ll t(1 j1 rirlnl i:":"rHl L.O il.

Jn 0td.er to trace, tt.e an2..lyzcr nccds t o knO\\' deLailed anatomy of hard and
~oft tissues. A ttLr~-dimeusi.u:i:i.al CJ6ft't~L. i:-; projc.c.tcd into a t\'1.ro-<iime.niun;•Ü
mcd.:wn. On1y ru.·ca.s. X-mycd in dírcct cro~s-:,,;~(:L.iún l~e.ve sharp Unes c,f d.:::marcation.,
,.¡_,._.,.fj~ nf tt>-J~n"'o ~ fif'q 11ir~ a n Ltn d~r-~tandir,g of du:iT purpL>Sc- nf •1:-;e.
runction #~1- C:of'I l:1:i ns Re.ference!; with Bíologic Si~ifk:inr.:"c

A . .Req\úreme:nl.S of Poinu
Probably J:Kl r.ltl~r ,t~J)t:'"f.1 uf r"t:"pb,<tJ1 H"ll ~1 rk~ is 1fü"l-r~ ('Dn t.m-vr.:rsial rhan mcthcd~
of ~'-lJ)tJ: í..wpos~ n g, ff.gí sc:..2úng. a.nd me.as LJ.Icm~nt. \Vhatc::v-tr p·oi:n~ ar.-,e u:s-tc 1, t hc:-y
should ( 1J havt' Liok;,gir :,jg:nific:-t~:O.t.'~. (2.> bf! vt:,ibl€: or (3) be. capabk o{ bdng
ron,;1 rtn·.1.ffi. repcau::d.Jy i.,ith dcpcndabHi:ty.

Two Point-; Found Misk~diog

1¼1"'¡,_~p;,:; a1. 1.hf: f,111.~1. i1. should be mentionc:d that tt,,_'D couur.un, "'nd 0fkn
favoritc-, pcint~ ~xnrlo;r-t'ü in H1~ p.isl h:~v~ be~n rltsco1,•ered to prcscnt problc-ms or
[~::id L.o mi si n c.crprctaci on. TI1csc. ar<: Point S-:::lla and Point B. lkc.:i:11,.1.--.e ..,..,.t:': ,l() 11 rn·. u:,,i:-.
thtTl.1, J.:i,Jth d~:i:;~íYt?. :t di:i:.c:u.~s;nn a:. e.o •. he. reasons for thcir abandonmeHt.

Point Sella - Found Umcliabb.-:

Sdh, 1.hf' c.,o n I i:":' 0f Sf':I !:1 =:.tH~k il hy i nsp"ct.i on, is a ronvcnient point at. thr:-
ci::n1.e.r of thc hyvophyscru fos:')a r1.11d h ..'ls bc-t"n th.e <::h.ir:--i Jtc1i:\1. of or~e.matLon ase-el '/4'i::-.h
N:~:-.i.cm and Basjon by .a hos( of invcstigators. lt ,,,,.-as l150..l tr.1 fonn !i I rfo11g.l~ v..·í1 li
N.i.>ion ,lJ1.d B,t~fo-n, ~·~si(m ¡:u~,l P,ohon Poim.. or Na.sion and Articuhrc-. SX is ,"r'"Cll
associa.tcd v.ith tht" :i:w.s.~l cay)~1.1k. l lowt:':ve:r:, ~t=-.11.::l. h:t~ be~i: fou.nd \Y.an:cing as a
1,l ,i ncli b~ú~r rcfercnce and scriru rctcrr:ncc,
S.d !1:1 has b~n d.rop pc..l be-.:aLtse ( 1 } j-.:. "'.eras not trustlvonhy fór ,;:~?hlg. {2) i t
''í.'~S {)llt"5tioruihJ.t"- Í(]l' $f'l'i:tl Tt'"rf'-n"'~l("."'" t~n I h,.ql i 1 1s nnr _rolar lo t.hc fa.e~). and (3} h: \"ra.S
found to be most unrcliabk for long-rnngc gro,;;.1.h. frJrc=-C.l'ltit 111g. A!:-.0, {-1-) t~f~ren<:,;=:s
frt)n~ SdJa-Xaston ~o fad.a.1 struct.ures condated c-s.S>LntiaUy not at ali to tl~e r.x:ch1~ai
p!anc. s~vt'n :r:-.:--frr~nct"}; ..,..,...t'.1''.": fom,d u.-,~fu~ 1.ú 1.hi::= f.rank:o:-t planc (1,vhcn t~at planc
emplo;--cd trne .m.atomk porion). Firt-:llly. (:)) the -::;,:_¡ddl~ ;rngle" ·.......-sBa or NSAr ">"13~
uo:.. íound to bt:: a.ssoc.íati:.d "i,-i,.·ith ar prulia.ívc of maxi.llo•mandibulru- c:-d...1tion.
Un :'l. L':11rren1 b.'lsis. Sdl.'l is T"lúL. employt:J i.n t.his Progr-essivc Ccphalorr..etríc
procc.ss t'X-CC~ po::.siuly for au .m1gu6:r ~tS.S-t'~:SI.Cl'=Xlt 1) ( Lbt' (L,~~~>-ph,:11yc1gt:'.:il ;:i_p1,:ui:IL.1Vi
Lmm e.día.telv bi?low ít, or may havc- a uscfuJnc-ss for am,;.•ny ,.m.'ll . ysi¡.,

POÍ.l'l.tB -~ AlVl':Ohu, Not .B~s.alM

Poim:. B in thc pa..st has been tak.cn to oricnt thc lowc.r dt"llturr. ,ls forin5-tancc
tb: l,:,)wt>.r hwi:,-ur In I he". Hrn~ NB. JJ()wr.1~ n:-fav-d 1..ht?. A-R Plan e. to the Facial Plane and
othcr-:s n.· late-el it to thl' occh.1 sal plane. Ho1rvcvcr, Poh 1.t J3 \k.vd[}¡ ~ ...,.¡ •~.vt:":J· 11,.:--. ic n-\it:T
i ncLsor crup Ls or dr¡ fi.:.s a~ dir~cc.ed h_y 1i p :-Hld tongul~ force. A fC.'1,'Cfs.al linr: 1s fotmd
bdov.· JJ,:i,nt J3 ix1. d~velop1U-tnt m-..d Pofr-.t l3 chml_gr=::,. v,..i.tl1 1 h~ movernf:nc. nf Lhe ;ow~•·
incisor. (Firutll)•, Point B disappean: when the t<.'cth are lost, mui is nrJc pr~cr\t
,111 ti 1the inÓ-5(),:-,-; ~-:upe-)

JO
 TI11?. b1'lt"" t".:-:-t.·l::'pHon to t~c va'i.uc c,f B might b~ t.o f.mploy r.he 8~:'l ír:r
t'.'-'tJu:ll im1 :énd pr::-d.kt:h.in o.f ,:;o±"t üssue ~n the ar'~a of supr~m~ntJ:tlt:':, lrlbi.1~1 to h. B-;;t
t:Vt"J: ch.:::n tlli.: corona]-root junr.T[ún of 1ht': lnv.•t-r- indsor is j11,t m; gr.1od .for rcfcrc:.ce.
Po1nt B beca.me popub r b~GlU5t" 0{ tht· :os.~ of ahrc-:ilar bonc: \"1 th \' igoro L1S
crt:-iodon1Jc p:·es::.ute:s in ~.ht': prt'$~!1CC' d <'l ~trong ]cn.\TI lip rc-sistance. h. was
0:)11.~id::--n:d, ch..-:::n::-fon:, a stabk: bas"'.Jar VJJflt. H:1,..\ cvi.::c pn-:,s.3urf'~"> i ,., :ht. nm~t:' u( O. '.:i 1

grarns p.::r mm.::: of ~;;.bial rc,or ~utí:-.c:f'., conc.roi of needless m~ndibular rurntion
( ·...,. htc-'.) in~· r,~o,~ ltl' ~trnin), m ~'Clfu:nctiona.f thcrapcutk ai:.tcnci on, s mgk:8 l li p
rroc.-::durc-s, -:lnd Hnally ~en;opJ a.sty, all t'.aJ~ t>:~<it'.H 1.¡.<:1]1 y d imi i u k ÚR' ;t::~ir r.Jofiri.uogcnk
·~e ri ppi :1 g".
Thu5 Sc-ih and Poim. B ".Ve.re: fow).d lO:-J DI?. t.;:nptndtic:tivt". in t't">:np:-Hi.sor. t0 other
lr.o:irc desirnblc points.

B. lleference:c; Fmf,lO}'t"d iu LatL"ral Pcr:sp..._x-dvc

Ct.rvfr:A 1 1-tt'.)°:'é rt":11 ~~,:.s
i\ll c:n.'i ca'. ve::tt".X.tK' ncc-d not be t:acc:d al\"r-ays. HO".ve:ve.r. dyi:;p L,v;i :i.~ of
v crLc:bL"ac an d _postilla] pfob lt> n Is .i:u,i y JJ~ mí ~ed if thty ,.jJ: t' 1w L ruutic td !' con.si dr.rcd.
A 1ypit·;d ',.'"C"'TT('.'lml (C.'1 t.{_i C7) has <'l. body, a la.mena, a ]aler.:tl mas.s, a ped.id~, i:rnd .:-:i
¡.::Jstt'rior ~pint" The 1.1pp-er anr)c of the hody can be usc:d for r~ft>:r~nc:r-.. Th:-- hmly
<:o:..T.tc-r and spkc- can be uted for .ang,.1la1.Lol'..
Th-:-: a·xl5 j,as .1 largf: <;ph)o:" .:1nd ~: l>rxly ~usse~~Ü\\-l a lnrgt' vc:rLkni prop or d..::n.s.
ll abr., ~L~~ a 1.'U"gt" sup-::rior fa..cct \\ttid·. Lts tnrn 1:-ii..~ tJ".Í~rior fo.=.sa c,f tht Alk~
Th-:: AtJ.;;.s has large L~t~r.11 f'l.'l'.K'~~i;~~ vvhkh r.1vt:'rfap tht:': oo:.:ipit.nl <"ondyle.s -,.•,hich
it ft".l'.,·'.j•,.-i:-~~- Ac1 "1rlkJ irn ~nd po:;.n~rior ,.trch í~ prcscnt, a:1.c. e.he ca.nl or pos~rion 0( Lhc=-
lx,n~ rn:iy he r1ll i~~1ti::-: i~1. physioi::hcra:¡::ry. 111e. cem.er of [h.e. a.rcht=s j~ ttmplúy~d {ot
mm.lfsh.
Thc hyotd. :,one is 1ra{~d in c:ru-;~-~~cL.i~}ll il d1., hudy rn1(!', Jt~ triangular ::hapc is
rnnx.c=-\t ;rnd fi pn:ni .'H I hr 1.1ppe-r m1tcrior <my)c- is thc- Hy::iid FOint fo::: rd-c:rencc: (H :1.
/ 1
,. _.,..-.j ./ ¡' 1
~_.,. ~- . /(,,' ... 1
.----~-<-1::.J.Y•,:'"' \ ,
,_
-.... •••
\--~~~h
1
. . ·,_&y.J~-r :\
:_, -
,-, '"'"..........._.,..... r ;

~-
/t'--,__ '\_\.

,\.
1, ..,._-:- -._>--.........
,. ...
'' !1 f '1.1. 6'' JI ) - ., \
~-í \ 1
\. ... .
.... .......
1

. ., ,........-----.. --------.--1
1 ' •• '
·1 -:- •..
1 •-
/"- '
=,.. / ,...~,.-
e-
/
i ... -. •

...-·--l'(;:..::rttTI~. . ~ri- \
~-_, -:,~tpr: \:.LA:~
, .. )~ 1

;:~~1~'.V~
.,.,.-::---· 1 /} ~- :é~•,.,
<:-;)1 /7'·'
\ ----~---!
c__¿J_f_ r------~:..-vt,'~ . . ~I
; 1 --::--,, r>-t-----.~.
0

ít;' J·
_ ... .-
:;:.:::~..:..
--
:..• i..:¾.,.
-........ C'~
,l -----~. }_!
::.-,.-'
J
.::: ,...,...--.,l¡. : .-... -.-'. c~I ,\ . . ~ ----
,_ ..:¿
"-.'_,..-- ~ C::t
·~-J

11
 CM~l..\I, Rl•:l•l·'.RENCES
Ullsion •· A Biologic Poi nt as an ücdpital Bonc: Cen Ler
Tiü:s pc:int Í:s foc;:;.ted a~. 1.ht;>: ,'lntc::ri.rJr b8rdcr of foramen msg1"1111'll whkh ~.xh:s che
spin&l cc-rd anc. ·vcssel..; frúq the ne1.1rocraniU1n. Basit1n is kw~l~d ]Jrt'd~e~y bct1,-yccn
t:'Jc (,;,..o..:, O{:..:::ipit.31 cond_yl.t:'6 o:n i.'i.•hlch the head. LS supp0rl t":ti ,iild moved. le i.s a
rr.:r.1~u1l~Lk ct1tk1 for thc.: ocópital hon~ whkh is n base for support of ,:he b,r;-;_1n.
B~sion to N.asion j.s svn011vrnu:1.t::-
.. .· \l\'lth thc- Basi-cran¡aJ Axi:. ::-..í Huxlt•:'...Vtrndi tiona.J in
ar.:thr:1pol("lgy. A pt')r,t' through thiese poinLs -~e.p:-u·1~te~ the faci::- fr:im the ca!vari9.
B~sion is us ually l0c:r.1 t ~d hn;:nc:d i.ntdy s t...pc-rlc-r co t:\~ ck nt. r.1ml iu line v-:nically
wit.i P\):'i01l (t';-.:.ltawl m1clitory canatJ. It.s selt:":i..tion ,nay br:- confuocd .•,,it:1 che dt.n::.ity
uf the bcin.:: cf thc: antcúo~· hnn.kr uf thc:- rnnc.yles. II van es: frcm .fl h lt11, L mm .c.i ~d
::0ri.t::.ui- co a more shar'p rmgl-1'.' fr::-rmc-d by lincs from •he. r:Hvu.~ :i:i.id th~ basal.ar portian
of 1.h ~ lX:<."J pi I aJ.
fü~~bJ, ~'> e~nploycd fcir d.esc:rirt.hm, í-ú:r ~c:rial s,1?crimposing :óf c:h;:.rngt':~, ~nd
J.IP.>v;dt"s a -:::it!GJ.l rdcIT:11 ce fo r pc~rtí L~I ÍCH) .
D ,C-, 1$

N:t.si.on
Th:: sutures ar~ growtri adjn:<;hclt:'Jlt .sit::.s. During grcy...th tne nasa.l l)(.in~ has
bec-n dcmonst.rat.f'.d. l.ú gww a,...-ay from the frontal h ·.trH•:, 'fhe fnr.-ttal oon.:: hou5c:.s t.hi::
f0rf'.hrc1ín. ~.l!Sion, .sdccted at thc C:-onL~l mnrgin of thc fronto~::1asa! SllhU'f':,
n:prcscnu an ar~a at. @h-c:: juw..-tion of squama with th:· f,c lJiu,¡l platt'~ .a.nd is a wcful
po:n~ foc nppr:':í fociill ri:-krcnce.
N-ot ali nasa'. !':: .1C.u{e:,. aie panillc:~ to thc: central hea.m of thf". X-ray. Tltt: ~ydid
1

:1"1.-;iy L'0n fu~e the ~aslon sck:cúon, p;;tt·j culady in the l\1ongoloid rae.e. :\J"asio 1"1 mi.1,L
conscgucntly be se~ec:r.e.d ~•,it!\ predsion, lt may a2peac 1.n ht: n0d',ing more- tha11. a
1 •

. . .....

y •

;, .
 - - ·- . . ·-~-----··- ...... .

Phoo~ L~f .a sa.gittal ~i:::t.-:ti on oí a skull

D
• 1

.'.:iilgh l lfidt'xll ,i. tJ 'JJ.1, 1L :.;.:::T1,'e-s to hdp fonn tho:: brl5i-tTt!!Üal axis a:1.d ha.s r<=m.rrhlLk·
0rdcr 1rdtb. th:: fonv~rd <l.::'\'Cloprnent o:· Point A 8r the ma1{]la.

/ :1 '1

.....
•

PoTion •· A Temporal Bonc Ccntt."r a:nd His:corkally U-..e

J\·1ost Common Anthropometrk Point
Pr;-rior1, sf"lt"1'lf';·I ,-::.1 1ht>- c-:=-nLt"f 0f I I:~ ~LIJlf'r~or lxi"!"df'r of thr. car canal. ~as
erad~f on.aHy been 1.1 s.-:d for d ::saipcion of c.T.:1.~ia~ and f.1 da! rt' L, 1i(,n.5hi p~. L 1 t-ptt>. ~~, \l.~
~he i.:cnte.r of the te:mpor.al bonc, th.e. houscng of dl.c foss.él.. Nanue's arti-::-ulati::r. 1.•\1-llk
v~ ~i':Jlt' ln lhi::- d ry :,klJU i l prr:;-enl:> a siight pru 1.1km t.>f idt:c lÜfü'.1 l.iri1l in l.h t'. 1 adi(ig, ,1 [ ih.
'·. ·. Thc '-'ar ro'1 of thc ccphaJom~tc:r cannot bt-: u.s~d '\-\' ith ~1.1 r .acy. J=L
adii t~on, thc C:.:.'.r canal i~sdf .,_.,.m vary ir. thc- inu:i.g~ :-~nJ-::n:d becni~e thi::- .:.:,e 1,ü "<'/ H ik
iH the SKulJ at dffforent dhections. Toe me.m:us is cv.al-shapcd ~nJ noc round.
Th ~ ex1f':rn.'=I l m~ar.1 J.li Íufl h~t' may l)f'. con f us.ed 'i/Vilh c.h<:: :n,:cma[ mc:atu.s .,_•,hkh
lk:s aboye ít ,md bduri,~ ít whil{' rruwinh1g 1n ri n )rn,-i.~l.t'.nt ocit:cY~ti:::in to ¡t \,;,.'ith
, . gro~:i,:c.h. Tltc Cflrl8~~ ;il~o may no,: be- tyi:nri1r.tf.rnl in ¡,ostl inn b t.he" ftlm ci-..1:f': t.n ~i1 h~r
....
p::.i::. l.ud ng -or asyn·.mctry. It ch<:rc:forc n::cds a 11;.iiffi..'"X'cnt i~ 1 ~eJ r.:'.'-f:ti o n:, p('lnfrul H dy for
hf'igb1.. P,0 1 h si des are h:sei.::Led for cine common rckrcn~ .
The .folh::-1t,-i:ng ;~id:.;. ~r-e r<=c:oxmnt:i:ti:.lt:•:d for i'l.1:> sd ~r':I iún:
l. look for it in lir-.c 'Nith ,:he drns, and Basion .
2. Cl!ii:-Hl. ;lh<i frum lhi:::: g.l~r1oicl. ,-ns.s.-:i whir.h ii ,:Jrnost bis<:acd; ~.e-., from
ch~ cmincncc rn th~ r::iot of (:,C' fos:s..i :Jll'C rcwy lit:'. ,·:H'1l°ns-t:d ir) 1.h~ C,'l:I(~
wi t.h l h~ SF h i:>.n c-..-ocri pita1 synd·,ondrnsis.
0:-icnt from o::hl.: tT.L"'lbL":"nct- or latc:rnl tubc"rc.J.t.,
·!'he i:.op of the. con dyl e j~ remarka.bly consistcm: "i.'r1th :hr Fr.snkfurc
Pb.u:::- in dry sk-.1lk (li Lhe ,:u~tJyl~ is 1.ü1~ far HhJYt:' or.· loo tu· bt:>kw ltt~

l4
 fH Planc.. .somc.thing ls probably i',Tong- in =:.h2. ~dcc-Jcn.)
:::-, Th~ end of t.he pos1.-gl~nnld prnr:€ss. is v~ry -1.:ons:is!.ent with "f ra..'1kfort
Ph1nf' ín I h· hmti!:!ñ.
6. ldcn tify thc- inttnuü canaJ and dirnínate th~t irn~gc:::.
/. Tra.~c- both joints wich a. vcry soft lcad pcndl dirca:ly en t~1(,": :t:ilm. (nib
<JÍÍ ,.,,.!Lh f.n~~r:-:;, do núl. ~fa~ ...--:).
8, id t-:n tiíy thc- ::ondylc-.s a~d th~n c-rm LptJ~e a c-rm u:no1Lj (¡j n L :~~:1 ( n ( l.h e
ct:=:n tral r~forence f:om Tb~e I onward.
9, llorizoucaHy the po:skrfor x~lHi:-giJ:i (r-.o1ldrlion pc.ir,l.~riar) of e.he no:1mally
JKi::frcione.d. cordy1e is used as a rd.:::r~ncc.
l. ü. TJ1rt'-t' pni-r.1 ~ 0J1 1.lw. (:tmtl.}.-'. e a~ Ccndylion (Ce,), Ccnd:-,-·lion p8stcricr
(Cp}, ~nd Cor:.dylion st:pmn1· (C~;•.

( )t'bi.tal€. (O)
11le t-ye b ~1 Jlt'l:r◄.1lvgk rngtin which dC"1..'dops re-btivdy t'.a1·ly. B..::~u.s..:: i:h<:
orbiw ,::1vky is rdat.:c.: ta Slght, wJuch i:1; in turn oricntcd to ti,~ Lnie hor"i ✓.: ontaL thc
l,_m--tr ;·irn 01- 1hrf' orh:r ,;or Orbitalc). when t:mpluyt.':d wiL,h Porion. has provi:n u~efoJ
for 2aci:a} oricnt ati::Jn, 1\h holtg h Orbi La.le :-5 locatc:d in th~ fo :r. due. tú LLS ne:uraJ nat urc
~nd t>ady 01.::iturat'.on (it i3 so bask h is though: of a~ 11 ..~ra.nia.l".).
Th.:- btern.l bord~r of lhi::: ~n·:--:,~r. is formc:d by thc :z:ygunt~l ic bcme. 1n fact, it can
h~ deb.a~d that Orbit.nk poÜ'lt h ~1ctrndly ba.scd o.n thc zygorr\~ rí-c br ;m•. ~..-1.f'.('!l on
nv.Ly ji:::- ,ii,l L:.cw~-:s ciiffit:L1lc~ a11d thc: L"ight and kft :sh.k:; a:::-t' hi.~..::cccd fer c1it\ctl
bngit.udinal use. The :;dt"ctiu11 : -::·lol:ld not be. con~uscd i,,.~_tl: tht:" farri m~s c::rn:3'., 1.h~
bfrn,:_wl :il t'.Jl.11:=d. or air cdl..s. in i:.hc c:hmoid,

15
.....
Qlli t r cc:.,n!ii;tt:1 tly 'Ch~ F:-ru-..kfort PJanc:. p!:"l.::i.:::isely bist:cH í.h f'_ -.-.ygc, rn ac.i L~ ai ("h. Br
('"Xd.m;ning thc ar..éi.t-0mv d os~Jy, OrbH..ale: can b~ s~:ecu::=J ·.-.·iLh í:on:1.Jer'!..::t>:. Jt h!l:i.;,
howcvi.:::-_ b..::i.::n obsct·~·eé t.(J bt' ir1íl ur.11<: td d1m Jrn·,~1 d o:l.JH.l l.f~.;_-;<._w~rd willL ct:""rvk..~l
1

lr,w{ j ◊r1 Ú 'I 3 growin,g cJdld,

Pt(:rygoid Itck:rcn ce (Pr)

·1-hf' :i:..rrCJ'i.'>' f 't.c ryg-l)m~ :,-;j 11:J ry lis !i:Ure w:J s foro1 td.y tm1-11 nyt>:d fo:r- r.' f ~t.".(tce '-'il t ¡L
thc: assum.ption that et was stabk:_ 1-10'-.~'c-r, on scc:ing tha,: it wa..s influi::n~cd by
tJ"t""tl~n1r:>:n :., -9 hig:ier _?Oint :-tL t be pú,~ l.t".r1Mmos1. hotru-:r' nf l.he sphénopab.:.ine Íú,~:i-;t ~•,::js
c-mpbycd fo:- rdt're-uct" -c_jnd lab:::lle-d ptITyguid refrrenc~ (Pr), ~o trt"<'i.tmc:-Ht -:.lt fr.t'
":·:--,01. ' 0 ~ the pi:-:ryr,oid pla.tc.s -..11,-·as found... A pcínt &t thc pos,;:crioanost curva:urc cif
thr: f<.,:_..~.;_¡ h st>-l~L'.L~d. Thi s .1.rf'fl l~ do~. t.-:-.i r.1 ,r;tr.1'.11~ cf':nr.er. Poin~. Pr is 2m;:,lovcd i:.o
di'CJ p a pcrpcnoici..ila::: fr-<.1rn Frnr.kfon. The o-,1rJj ri~~ f)f bc,d ! ín,~:sa.t": Ar'I:': bi se.-ctf'_d for d, i:-
se lect:on e-f Pr. Tiú~ crossing forrns thc bc-.st :-oorc.Hnnte tor ~1ltt:'rh1g ih1:i in1n tfw
r-orm~:.1t~r ;;.]L]·_oL.:.::::-:1, of -co .1rse, anv poinc can be u.sed.
.. i :I
1
-

literygoid l·oint (Pl)

A pol~r -~·ecHe-r. rwm ,vltlch Unt':!i : o forjal p:n-l~ di!i.J'f'.r!'ie ln .a.n <)l"C.ci·ly man:1.~:·,
;1;l:-. L-f'~n s::iught from the bcginning oÍ gro ,·vth studks . lt h logirnl th<'i.t thr:
1

p1·.~;•.o:nC"'rn·i1~ \·.-e-uld be ~J~Lt=-:d In n~ur1: d~.sttibt.:io:1. The larg~ tri.gcminal cranié<l

n..::rve- h t";.5 juü·, ::-t:rn'~iry ami u~0tur -í.·0sn¡.iCJnt'1iL::; ,'•-'hi<.:lt fet::d 1:1~ f✓.1.-.:;i,:1] (avi ..i~!'>. 111t.
1

~:-:-h~1.0i<l hc-n e: is thc centra.~ bo nc 1n :he mak-:-up of thc slrnlL An cxha.usth•c study
v,.ridl tht:' <.:(m1p111R.r' r~v~:1,~d I h tt :i <:t'J1.tr;ll point 1N."lS ~ss~n1.ia1ly found nE"_ar Fora:-ne.n
( .
Rot unóun -- ch<: exi t cif i:.h~ maxtllary :i.crve, or sc:cor.d d lvis:on of th.::- uig~m.inal
r'l~r.. .- ~-

1/--
e:_
.r-:-<-.:.- ~ . ---- :___
~-~..___ -
' ..
,
._. .

16
 ,,V:;.ch 1h~ disoove1y úÍ 1.h~s ~~ntral a.l'ea, stuc.ics. v/.th k-~v.kd ~kulb ~bf.1,Nc"d I hJ:11
1.i,, k,-•.,·e:f bordi:-r vf the forn.men co,-.ld ht id~J1L i[ir::'.d as a p0inr:., an.d ic:ne<: '.r-.bdc:d Pt
(ror th(:" (,rigin cf 1:h-:: p1:c:rygoid butrn:-s.s),
Biologic_-,:.il:y,, ~.h is a!'~a a.s a r~fr:rcncc: locaüon is higlüy n1t,m1;:1 l. Al'L':hi tf'cr.uraHy,
:-:1l Lhis ar,::a d·.c g=-t<.~t ¼;llgs :;win~ u¡Jwa.i·d .;.nd ou,:,.-.,ard, thc- pt~rygnhl ¡Jla\.t'.:i. <=-."<Lt>.rtd
d!no1.·nw.::i..rd and th-: ro~trnm r.>f th~ ~phi!"n0id :-;1:pp011A~ ~.hr. vomcr dO\"r~n-.·arc. aaJ
for;.•,.tr<l, l'rnH1 a n:::LJiocrophic standpoint (nt t!1b :.-;plu:~:n(l-p~l:=.tLin~ bcation) the
c1:a>.1H.ary n:::rv~ ('llt i:::t~, g~m.gl b nte. ron Lajn ed, in tcrnal ma.'\illary blr.H..1d vt:-~-~t"J.~ ~ ~r.1Ílt' h,
tuul ll i:-.. ,t !):·acing arca mcdi..m-..i..:ally. Uoth J1r ,{nd Pl p0int.s hav~ b,;::cn hlgl-..1?
.s uc~ssr'ut sourr~ uf r d t:Jett e~,
Th1.-, ih summarv, our 11t.Tl.i,.ni~1" relt'J.t:'O(:es :;ir~: Ba. N, P, O. Pr &nci Pt, 'ivi:h
SeE~ rdciri.tt-d fm 1? fo,- 1\.'l.:-.oph a!'_yngea~ analy"Si.S,

J\1.l\.:KDJ Bt:lAR .REFERENCE.S

Grr:at::.st 8ltt'l'1t.inn is ni~cdo.::d for thc: mm\t.Hbli:: hi fac::al typing and scrid ,...-ork.
1he 10,',.rer jai,v !5 mr.::n: v,1 ri.abk :i1'1 d has greate:- liIIÚ tmir.m~ .stn ic:t 111:11 ly w1 t.h ne,;:_tm·:::nt
ttrn: l d I(:' CII j d Í,,._ci.::. in thc r,rov-rin~ chLd, Thc:- 1.l I ough C. fon-:i., j L1 fad.rJ. tn.: <:: a[ 1d Jh:;-~:1.i ()]l
o:· r,ro•;-'•1h, :s ::J11:·. chin. Thus thc tr.,;.ndibk :1s Jl ·,-..·ho~~ is e...ssLuned to be influcn,:t."d
',vr..::n thc bdwvi<Jr ()Í d 1:- dd 11 i~ sc.udicd. Several point~ CJF Tt:.lt=:r1.'.nl.X! ori tnc ma~dib;c:

Pogunio.n (Po)
Thi:: Cl10:-:t anLc:-loc po~m on th~ m1t.lhu: uf tht' c:hin has long bcc:n uscu .'i.~ t:.
horlzom:al rc-kr~n:::~ h.,r rhh1 p(~si Lion (Po;-. Ho1,vcvcr, that 5urf;-1i:.':t'. ("J111 be rd2fr:clv

17
na, :-.~<l not spi:ciR-::: fura vtn:irnl n::f:::rt111.X".

P,:o t 1• bera n ce \1.en ti (Pm)

f,01· ~ sc~bk \'tTtk~d rdertT-Ct'., fot 1.h~ rne.asurerncn: of tor.itb t'rup1.ion. and.
gTm.vt h ch:1n.ge, a revcrsa1 Hnr has- bc::-!:"-11 fo~1nd at che cop of thc- tngrJJ11JTn •nt"n1 :=ill
(prutt:.1er~xu:e ,:-md inen.i:a.l tubcrdc:s), Pm is s-":"l-v.:tt.d wht:".n:: rh..:: cortkal f~tt ~tü:;;
an.d '\";:hc:re thc- ~uprmn~cl1.a.l C(Jntour starts to rece-de into tJ~e :1lvcdar prcccs.s. Mctat
ilnrl:H'i1 n,;i.rkcr~ .:i.t thb pu-int Jr; l,Ol i:.:!wngt> ~lllfLng no!lr.a.l grov.rth. ~,~ ~h:)1Jld b,:~
.:x..:.::rchc<l t<.i ~l::"l~L'.L Lltc .'lame poínt ~n r: s-cr.cs uf ~n1<":ing-~. Bo:ys havc- adddom- of b:.H1,
~·.i c'C:·.1m fe rErn:ially =.1do~v Prn poh, 1•

C:nathion ( Gn)
Tt'dtnj caH.v, Gn ,,.,1:; t he- rno~t c_h}",.VT1w.::i.rd a.nd fon...ud poh\t <m t.111.:•: chi n. for
.:J.J~tlur1p•:J1n::•.u·ics. Pracücally, it h ~c::-ko:.,v.d c~phaJometrtcally ru1d c.:r.:,rn,t.r-.u1 f':d hy the
int<:::rs-cctic.m vf lh~ f,:-.._c¡al Plane'\\~th thc: :\fon<lib1.1ku- Nanc. whlch bccomes th::- Cn
rekrc-ncc. Tht c:rús..~ing of the Facial Axis depi<.is tht': worldng gnathion puhit on thl"-
('hin. Ceµhalom.etric G-u b p~•.d lt)(' t.he Facia1 A:ris a5 it COJl:flt'.Cts lO rt.

.'v\enton {r,.-1)
Slrnply th~ lm,.-f'..st point on th.-e inferior burc.l~:-- of Lhe S_y:F-Lphysis..

Xi Point ~ R1 to R4
ÜJK: of t he mr...~ l ,1...,~ful r1::[f:l't'.:lt::es e,•~r discovcred h Xi Po in L. l t v.ras sck:cr,.::d
:l~ ,o:i if'nt.rnirl rc:i·crcncc- for th::: :-amu:; anc: wa:). a trm~ l::C1.::ak•chroil~h in n:·5-::,uch ,HLi:.Í
dinkal sdt"Il'-~-

--...

-----
 1-'i.n.ir puint~ CJl'l t h(:' rnnms nrc uscd for Xi sclection. Rl is locar:.ed at the
;~m.t-ri.:..ir bonkr at the- narruwcst ?Oint on thc :amu~. JU is thus sdccr~d a-.: t.hr.
dc.:..::pc~ cw-..,--e on the s':..,b-coro~oid :nt~1snn~. R?. is o:;iL il'.r.'-'. -~ami?: ]e•.•f'.l ..4.-:; R 1 .:-,n t ht"
püster~~"JI' bnrdu. R3 i.s ~.kt'. :o.,_,,,.~-~t po:n~ ~:n t~Le sigi:notd 110(.dl. R.4 i~ ,frr:t:':cfy bd:J\V
R3 c-n the lnf:ri-.:ir poinc ot the r.amus. Thus, thc hclgt.t ML:J de?ch o:· th<: rnrnus ac~
bisected .1nd. th e. i.:.ommon poi :1.t i.,; Xi l-'0i nr:..
Ald,ough rnt,lturt:"d fux ib ::;dt"liiuu, Xi Poinc ~~ ::tlrungly uíL1lug.ical for :ievera]
r~::i sons. It [3 ( 1) fou::1d nt th.;:: m<1ndib·.1la.r for.ani.e:n hmnc-1. 1t b (~) hígh]y re~ ..1l~.r
V.'H.h t.h~ T:-Lk"'. fh.::cca] Oc-.dl1';a.] Planf".. [r:c; (3} d19gn<1;i;t.ic: p0sition is r1?:lat.iv~ :.o (Y(V. l1
i:; (4) cm p]oycJ to ¡ocate po¡nu for ,:h.;:: r,ro'\vi::h are. .., 1
X: Pohlt is: also {.5) use.d for Jes-cription of the siz-2 and forn1 oh:hc mandibk-. . '
h :s (6) used for di(:' ¡:t[laly:;b of thc::- Oh-in:: 1--roportiOIL T1. is (7; c::mp]o_vr.d íor í.-=tc1al
ty-ping. \-Vlth gro•,,n:h :t is (8} a v-crtl::X ccr.tcr for -:he ornl <;□v-hy h._wig~1t . lt i~ l9) ll':ied :· ,J

fo:· dl':SL'1·~1:L~úi"'I of both tocal facial ....1,d dental hc:ight. Firrnlly, ( l ü), it is used for
prt'dkti,1n of :h·-ve]Qpmc:nt ot -:::ict~hL.~1cn ,qnJ fo1· the ~sessment o~ ~ruptio:-i a::1d cooch
et LlH Lg~::; c.: lil Li r allJ.
V-/ich ~::n ;i.ppi.iQ;itJtnts, ó.i: s<:"kction of Xi nc"t"c.b {·:~rr:. Tht': sig:r.01d núLCh i:-:.
thin oor,e. Bor:.h c::_1,::,:cmal obhquc tidgcs are o~cn 5upc-rirnpo::.t:d ,.m.J cmtfll~d with
1 hr niedi.iü t~cr·.po:·.;.lLs crt"h~L. Tht'. rr..;::.rgins úL both side..s of tr:c ramus need to :>e

bj•::,ec\cd. In ~c:'\'t"=t-' :◄ ~ynHHt"'try, 1·,-.•c, "X, poli.H~ -- nne foí t":a.c:h side -- ma.-y b~ ü,~eful fCJi-
caku~ations.

SulJgoniu.n (Sgo)
Gon1nn is by 6.::flnitlon the: mo.5t infer,or-posterior point on thc an~k o.t thc
ni;m( ;i l:,k- T11t" ln"A'C"f IY.Jd.c=-.r nf ~.ht>: !lnglt>. ís 11~t::LI fo~ :;r.1ectiDn of the mandihu]a.r pla:: ..~
and hcncc is labclt-:J subgunbD (:S go).

• y'
 Condvlion {Co)
T i.::i.:hntcally, by dt:"l:i(.Tipt.ion, el. is thc most suprnOT point on thc condvln.r ~,c,td.
Practic:..illy, ;1.i, LJsed, it is oftcn tht:" 1fü1~t upw;1rcl and bacb,,,.·..u::d pnin1. t-:~%e:nt.iaJly, it
can be locmed by ti',("' 11( f'(,inE. D -... . tkh has bi:-en ~det:1 ~d by bísc-cting t~e ,,,.,.i.dth of
1 ht> nmdylc: nc:ck ne-ar the B.:t;:-~ol,-N.:-:1:;ioCt pla.ne,

Con~t yHon Supe-riOT {Cs)

\.·Vhen tl"\r2 mo~ S.llJ.leriot :!'.';!lt".t'.I. of Lhe -condylc i5 usr-.rl w~ ~n it f:ondylíon
Supc:fr:_1.r (C-s). TI is tu.i.::d in forccastlnr,,

Condylion P~t~h11· (Cp)

ln oroc:-::: 1t"J ]oc-Al~ a i-eltablc áorizonv~l rdt'rt:".I1ce. for thc condyl{' mto:.l tJ,.é'. j()it"l :.
c:.h~ mo~ postcrir>r. pi iin1 ls SP.~~t"':T~d on r.hc condyk bun.Jt'"..r. Ca!"c should oc c:xerdsc:d
11 11
in ch1:·:-1.:brig mandibular po.sturr. Tht:': (Oíldyle. nee.d not bt" 5t'~'1 te:d L~fmina.Hy •

Artk.·ufa re {Ar)
A,·1.10.~tLlarc has bc-ln {'I.HpJ~))'t::d ;j_i; 1.he. r.ighesr: visibk p[)iílL on rhe. ro~te.rior
l::ordcr o.f ttL~ tnntl~.-loid proccss benc-ath .:hr. ~l·,~d.o:)",.,, of thc- cranütl b~:s~.
Convenkntly, it c1ü ht>: »e:l~c.ttd on -r:.ru:: Basi.on-Na~j()n pl3.n..: at thc postcriür rt.mtgh~
ní 1hf': cnndvk nef.:k.

R:1.m us Referencc (Rr)

Thi.:: top h-.1lf c:.'f thr "t.:-:111111.-. (X, 1.0- R3) is blscdcd, .:-n Id. a. horizon:cru lim:: is d:rm,rx1
t'J ULc:: imC.e.i·ior borc:cr ,,1.rhkh dr:ttn:i:~,,.t~s l.he Rarnus. rcfcrt:JJ.'."t:". Tf-tjs i:-. 11:-.e.d For
prcdictiou.

PY.<.t Poiut (EvM)

By f:üJ: 11t~<:Li ng Rr poin:c to RJ (thC'.' (."ljl :.t'r oí 1.he sigmoid uutd 1) .1 li ne. dl:'.pi o.::ri ng
Lne ..:::o.ron0id pr<'.)Ct" .•;!-; ;:,:; fnrmé',:J By h i sectinr,: that Ünt', ¡ 10 i .-t1. Eva is sdcctcd, ...,,+ü.ch :is
u~r:d tu consu·u.ct an. are rn_gc..··d \(T ,.,..i t.h Pin po:nt.

Murr~y Poinl (Mu)

·1"hi~ i:S a rcfcrcnce poi.nt t:':lñpkiyf"..d. ÍOI' fore,casting ,)1 t.h(". c:rossi ng of rh:: are
1,.vítl1 tltt- :!:iiJ:l)ILUÍd rl otch
e urllnc.
Thus.. in s\mLUtiHY, - cJ,e. se.ven:.een mandibular tt:'"Íi':r't':nc.es are cmdov-::d.
. .
()1L the-
.;;y:i:x1ph:v:,h; ::ir~ Pm, Po, Gn, tuu.l M. l'r_:.1· :Jw. rarnus th.cy .m: Sg., Rl to fl4, íl.ri Xii
Eva and. Mu. 1-'ur Lhe. eo11d.yle thcy are D, Co, C!i: fn"Ld. Cp.
 iYlA.XllL\RY R F.[·'l ',R 1{NC.FS
Cümpa.rcd to thc n:f::r!:"JH't'.~ for the mandibk, the rr:·.fr.J't".rH:es. fer thc rnidfoo(t" .ií.::-

fc,,,v aJ1d 'iÍJ':"lplr=. bL:t are sOIIlC':Ímt'~ Jjffh'1Jlt r.o idcn:ify.

Antcrio.r N a6al Spine (AN S)

Aíi 1~1·i orrnost on thc: t\\'U ma..v..i.ll(I e is. a sptnc v,•¡hich acfo as. 1t :=.h c:.lf 10 s upport
::h-:: nasal c.:.u-til.'.tginuu~ sf'.ptum. Thc: t1Irc-:ri0r n..~:-.:d spil"le is thcrcfurt": rd~t,ed le, Lhe
;1:1sal -:a1,.•ity arid ±5 m.r. ,ilv::--:A')t procP.ss. lt fa somttimt":'.i- diífic1i.t to beato: pn:-dst"'.y,
\·Vi:h &n ()"1{(."I-t''l<.po.scd, or unshadcd X-ruy 1.t"drn.ique, it JTu'lY bt vi~ihJ.e cnly in .spou-::d
:ight, lL .also vark:,; b k,,gth. Rarcly is it not pri:~t'l~\, huL. in long nos.es it uwy Lic:-
:.urr;(:'.r th..:m h: s.hort noscs. AfoIL.E ""i t ll l.he s pir.c:, a hcmry br.m y ti dge whlch n::ns
0

'..ransvcrsd:l bctwtt>:r"L Lhe two ma.xUlac, may bf'. i<lenti fLed togl:'d\t"r wl Lh ~ h~ f0ra rner.
ror U,t". ín.ci.sivc canul mt<lüJ lo ti 1t~ t~r'LJ.pting canineti wbh.-11 rr-.~y 0bsn1rc it,

JJ'o~Le.rior Nasal Spin~ (PNS)

TI-..c pos:::-1':'rfor na~,al ~pi:1e it: ocnm.l~y un ,.h-:-: p:3.fatin.e bonc, n<Jt t:}ho.: i'nf1xiHa. l: is
'.-:.Ji e::cer. tion c,f -::ht' m :o: i ll:t1y h 3cd. paiatc: and u~1.1 a~ly h; r ~v..::a.kd as a tip. h i5 pJaj nly
vbíbk b cros.swscction in adl1lb, 1t n-..~J', ho',\::e-.•crJ be superiJtipúSt=d bj the j,:::vdoping
m,)hr ~n'i.'TL~ in children.
\Vhen h: h ~_iffii.:ull lo locatc ~i:hc: att,H~hm~nl of e.he soft pri.lat~ c.:~n h, n~.d tú
L:.f'i<l iL 11-..~ s,qerior bc;-t.\~e;· immf'.diitely a1 thc tjp u~i..L,il]y s:=-1,..-i;=:s as t.hc uppcr veL.:r : :

,1tt~1c.tm1('-ül, -....·hHC"'. tr.c: vclum haB a bruad::·-r ba~{' in~c-:ricrly. In r;.íl::ne-ra~ dt:'Íl p:=.t!.,,1.f'.
c•.::-,.dlcions tr.cr(:'. b po :_)c:,~l.t:":ciL::t spin~ but in si::rg:irnJy dost>:d soh ddt palai:c:s the
L":l·os s se.ction of 3cnr tbsl1 e mny ~fVt:" f3 s ;-:1, refe.rf'.ncc.

B.C . .j

21
 POlJl.t A {A)
Dy ckfi nition Poi nL. A is ustwJJ.y ~t':l ~r.t.r.:d at t~~ <lt'tpe-.st cun·.!lt m:'.f' of thc con tour
bt>-lmv t~c rur.t'.dor nasal 5piut-, h. es cftcn C(J11SLdered to be: th~ jLmction uf ;lh:e.ohr
proce5;:; wt d~ basa) brm ~- l n long lowlf".r fa~ h c~ght. 1he=- m.mUm:y ir tCi sms supm-t:-n!{J l .
l ·h is m.ay t'X L.end -che ah·e-o11 lfl tio~TIYi."<.rrd ,u Kl 1.h e: &cpc~t c:fln LOur IrulY bt" low and
éW'i.'ªy frnm thc:- ~-~s~ of thc spirn.", l n normal ad uJ 1. !'.ondt tim~ pe, in t A is <.lh:tH)s•
0

e.:li.accly p:n·.<tl1e1 to tht:": h~ight of thc:- ronl Lip oh:hc c.1::nlr~l indsor. .Pui:nL. A is tlm:;.
~i:"i~cr.c:d at tl,r-. hase of a tri,mgdar f::.1-m fur tht>: anterior 1ms:1l spinc (~K"'t': illw,1.ration).
fr-1 ~rct:n(:' g·.1m my smik p;ü ii'.n es ,,,,ith ~, long ,q l-.. e.ohl!i J>!"t'~t'11 l.. ánd h1 ,.,..hich
0

sLu-girnl 11l:1Y.ilfa.1y :1:npo:.\c..ü1.ip is plannc-d, .J:r1 artificial Püil1 -:, A fo scktii;,c,t ~1 Lhe kvd of
t.11,f.. i ncisor tli) rú r planning rdr:>:re.nce. Ilu:s i.s t":O"l. plqroo fer: t hf' Dl'i,,1TIC ProprA:l ion in
pL't:rrning in ord~· •. e, loe.ate: thc- palul,.t' _;.ind thc lO"\'r"n" jncisor cdgc-: :51.t ~ golden p-obt
bct1,o,'t"en .A and Pm, Thi:-: Mtifidal A pvi.J.H. ¡~ e.mployt-<l tu 1ocatc Puinl .A lr, ,t goldcn
l'c la:r:ion to Fr:tn k!on Phm::-- ,, 11 d Pm.
171us, in ~,nnmar."'· thc m~xi J1:tty points are A n~, Pns, and Po in t A.

TEETH
\V0. ha.ve L1un,l l.hl'. use of th~ Rickctts t~mp~tt:-: 1.<i be a va$'t ,Lid fol' dsai\ing
tc.::th! ln 01-der to rc(<.ir<J fol' greatcs.-c dtU1ii ~_ll c.ecch may bt>: 1r.~cd. Iluwr::·:vt':r , l.h-.::
0

f i rst molm:~ Hn d t h f: central ind~i::rs a n.~ rcfcren,:~$ 1L'.1.taJly cm.ployi'.<l as keys t o tkntur~
(:'rn pl;u.x:inc-n t, TJ1 I:'! lov~r b uc-c.al t l:"-t'.d1 afc. emplcyed fot Lhe T n1~ B-rnx:al Oc-clusal
.l'lm1t'. \.\~en th.~ righ l. .and Jeft mokr 1 t"~L b ;uc: dirct..-tly :,- uptrimposc:d , trndng.~ ar-e
c~-y. Bul when a.symmrtry t:'.:<ists, al1 dc-I1-:al "1Ltuc.tures are:- Liist"x'.te.d for a ~i11gk.
rep.rC!scnrnt \<':íl foi- meas\.lrcn \~n1 . .fit1 d planning,
\'\7Jthout HL\JCh ado '-\"C (lllktly c~iló.1lar:.cd m.olnr J"t"lalionship for <:bMili-ca:ic,n
f:nr_c\ t}1t': lo¼>er molar u1thf'J' th.111 thc uppt'r... ~trar.gcly, rnJ one rthjcctcd, 1,vhidt we,ml
pcrhavs th~1 mosr. dinidm1!i ;~cl..1lflll1,· think ÍP.m\ tht': lüv\'LT molaT.

•r he Lowc-r J nc.i sor ( [ j 1) (B 1}

Sd t::~I ion of thc mo~t rt>:prc:sc.nt:'ltivc- po~it.i on. o f thc couuurm Iowcr central
indsor is attt-nlpte.d.. ff onc 1r.,. .,. -~ f"t'n1 r.~1 indsor b dbpLKt'.d for.,,.-ard it J~.1ts not
J:t'¡J:i::--A~;\1. Lli.c positiun of 1.ht>: cnth-c l~ver l;ITl1.~rior ~ctic,n. h) g-enerali 1:hc m~m\ oí
tht" Í\Yü Iow~r e.en trnl in.dsurs tf':presenr:.s a 'rV(lJ-l-íng posir.1 on. llt"":t I c.:c--, 1li L''! LC.:Lll plmi: is
of r,ood i..-ruut- fox ,,;.:c.tira.cy .and dfitkn~, í n tracing,

Tbe: Upper Ccntnd lnci8>0r (J. I J} {Al}

.As in 1:he lr.n•..-t>.r, a common p o$Ítiúft bet~\--c:cn the t1.-\ 0 uppcr ccntrnls r:e-pr~~enr.,;;
0

:'I \.V~)tking fe.lai::ionshlp, Agi-iin., the tcinplat(:' nfflf".i':'l the hcst. cu1u;h,f.r.nc.y and accurn.-cy.
 The Lower Fírst Molar {616) (B6)
Thc- lo1Art:T rn ol ;-u· :r::t>:n·e_., a~ ==. ba~e. !'eference for ruagnosjs, p1'Ul.I1ing, anr.i
,u~d,0.c.:..gr..~ ccinsider~tion. lts- p(ishk1n ¡¡, the t:.wn :-,ides is bise.c-:.cd for a cornmon
r-cft-r:-:-i:H:x-:_ Jl. Scf',tes to c.alc:ulac,e arch dcpth. It h u~etl fo, mt'.á.'>u1·i ng s.rch
G11.phicc:m.-:-Ill vf'!'tiLA.lly .:i.s ~ll a.~ h0.ñ7.o~taUy. Thc::. lm\'"tr mQlar Ltnd~ lu Geh,.i.1,-·c:-
vc=:~·t i L""_q_]l y with JG Point during d,~vdopm~nt. 'Tl\t po,;;tertol' margin is u.sed for distal
rc.tt"rence:.: .:rnd Lhe mes:al ma.rgin for anterior rc:fcrrr.cc , and tht' bí5~1'.'L 11Y1 CJf thf'. mnhr
oi.:...::'.u.sion is. used for :i:nt"~i.:.i\.n·emt•-nt,j v~tk.all:y.

The L ppt:r fixs L .M.olar ( 6 1(,) (A6)

Th~ uppcr molm also i5 bb<:"cted- .A pr'0:)le".m 1-riay oceur in cts. r oslthm in
suzidi·/áon ,i;l i 11.q rl on,, . St.Jl. a hisectl on wiU yic:id a mt".u L putiÍ Liun.

-....... -
_ Jantnes
A.ll Í~"Jut caninc-s are probkm5 c.lh,i q Hy. 8.ll d ,.he. es.nine cusp tips art:- rtfr~:-tc::--5
for thi:..· rom¡ 11·e::1c:.:1s:,, e. ar.2.l~rsl~.
 SOFT TISS~E TRACJNG AKD REFERENCES
l n .~e{:. 1.i,ssues, .s,~iatJ ]e1.1.ers tn'.f' ~mp!oy~d for refe.r~:1c-e.

The Proftlc
The i.::or.to..irs of aJl f1e ci5su-2 on th.c ?r:ifilc- .are uscf•,1l fr.)r t.h~ ,~~1:ril1:z~1.irn: d
rt~ Li Lt' tic~ ,il! ü (:.JHC( i 011: (pr n) i:-; pn )r I asa Ijs. ppo i :=:. pro p•.:igon;or., n is 5c,ft Üs5ue
na<o n, gn is gnadrion, and m is mcnton.)
1 )ist~IJi,sf":d pre_\'l0Lts1y w:~fi ch~ manncr in ,vhich -che lips a-:-~ 1----u~iciow~d for th~

film ..::x,::,cstm.:-. S::.1xtl:t ,:,-1,ní :j::m::=- 6~<.-f.JT:1t': ~m01.l()n.cd ahouL ~J-,is is:;u-e. 'N-e. prd'er the.
j;:,..,·.~ :rnd lips te hdc togc:th.er for a funniorn.d di.agoosis., 1\ d()s:=-d H~_) p(]s~L 1nn ili :i
)ip sea.) . . .,i ll ir,di c:a Lr. Lh~ lJ't":8 l 1~l i:>.n t pm b] cm_
Ho,r..·cvc-r, .::i ~r~:o:1d fücx~ Gin bc-- nL'l<lr: 1,.vi1.h p~tiems. ~t phy~ioJGgi::: resi: and '.j:::-,
., · : .:-: post' ai\d c.:in be tr.accd an.d cc.,m p¿red, Also, b arh.1m '::W~ Um•,s rn :-iy il'.di cE:t Li.:: Lh..-:
t ::.m -~l1, :i nd 1=p behavi or :n dcgl uti ci on..
Ll? Cüll tr.:1.1.r s ~1 ,;] dr:".m im :;i L.i l >CI ,;:¡f vt~rw1.il1ion. bordcrs dso hel p 1~t1.l s-::::ft. tis ~ll~
dew] (ls is sup<:"xíor Jip, J1 is ::t11:r.riúr iip). The. e ~ of thc- aJa of thc- 1rnse {..i.l) al~o
mr~y bf' diagn.cstjc_ Th~ rlf,ht -:i!d kft -tyd¡<l::; ,u-.d ~lül),~~ o!- 1:t~ t'.yes ar..~ also ·1is~bk
,l!K1 SGUl('"limf".~ ~ LL."ie:·u] !"eÍere.nCc ac ~he Jatc-ral canthm (k:,. ~n h- ~1:bJ·..~s.:Lt'. l) or :,:;:in 1

j~ sq-.rri.cn('": 1! :, 1:. ¡
RC.¡j ~, 1
Q ~ )4 '/.-./_,./~:;E~- . tr
.,,,:,1 ,.~V J-·· -;, \
~ ..,:;:~~..--=;i- ~··,, '
r, ---...., t<:;;- •' 1J 1 1 ~ ~)\
·'--
"- -., \' a k~ .. / :1Íir,...\ · 1 '\.
"-~.\

..., ,

,._ - -...
'-----------~
11

_--~--:z.--
'----..._
~i
·, _
._ l ()~"~;;PI/\
1 ¡ __ ,. \
J·

¡:,,; _¡
_¡·-/
,,,~#~ \~' . ;_'7 ( ~..
:1. i( ,.,...-.-- -
\

.1
\__ . J

j r~
/

11.
"-.

~ir--~- : -. ··~ ~. ~
1

;, . yl . / .
~
--------.;_.r- ' A ..:,.
~ 1 \ '( ) ·, ¿~ '\ / : 1,
~
• \__ , , . . . - - ~ ~
• 1 (
\ { t
'
c.·\•.-_ . -~~·
- _, --:,..,.....,,,... - .. : .,/

,~-.. . - - - - j ) 1 " \?,{;(_'¡¡,. ~: i

.
( __ \ ./~ '.-_j 1
/.::-.j.,,:e-: ~-r--,,
!:~_J~
~
......._____ -

~j
'e:::' ..... .q 1
-----
\
i
-........_~,
J
l•l· v
..

e 1 L-~ ~
<1;~ 4 ~~ ~- -------

Thc Tonguc anu Hyokl (H,

Tl,e GuL1inc of ~he tongue is n:ostly (illitc vb,ibk- po:.--tt"riorly, h111 ~omf'1 ~mrs
d: fA.,;_·l= ~ t to bc:rc~ b.::-c,nt~t:- i: i:; 1hu ¡.¡ :\1.i:>.ri n d y. T11c: tongw:: dorsum. and po>ccrfor
::icrri~r sho...Lld b-e aaccd down e::i a:1d :nd\1tHn_g thc:- t·:piglol ti:,:;_
ThP h?nkl bone ~s f.t';"].(:~d in cmss-si2..::tio:1 c-f tr..c b:xiy only. Its tri:..:.q;ula.:- sh=.pe- b

24
rt'oJn:kd. ru-.J a point nt thc upr~·-.J' a1'1Li::c'ior ::ingli:: 1~ lht" Hyüid point fur rdcn:ncc (H).

·1'he SofL Pala Le

.\'uz:n1:Lll_v, L ht' pu.stt·d~r margin of t~c tongue. Jies in ;:ornAC( \-..·il ;1 lhl"' ~:ft
palate. \.Vhen a :sp~cc c-xi.sts. the p::issibmty of rno1..;.1.h bl'l:":fll hiiig !:ihould be
h~•;.-:--5ti.§:,"Jlr:':d. Chang~s ()(x,·ur, m:ui th~:::~ can b<:- n·ruumi:::d with tractngs. TIK st~rl
palntt· b tr~l(",t:-d in ~Tll:S:s s.:::cdcn and r.as bcen stud_je.d in le.ngt},, Lhickries.!i, :~nd
posi Ljon fron:: the hard pal a~.e ~ mi i ,.,_ fo,vJj ~¡e I d Ul :.n~ :sv..·allu•Aring m:Kl spc~h.

Thc N.a~opharynge.al and Ph.sryngeJ1l \.V.RilJ

1\ clt":! 1oi ,t ~)j 1-t'Jl t arn.i posction h an is:suc. Thc:::cforc, stnrtir-.g ,.,ith i:hc scft tissul.!
po~ccrio!' to thc:- .superior che.anal arca, thc- trac~n.g is condnued c.otvn~...-ard to th~ l.e\•t'.I
of Lhc e.so phagL.1.S.

l-'ore.ig.n )lodies. .l;:l.nd P:ithology

1\ztti'nct~. objccts h -che nosc, gunshct 1rvounds, 9-·s:.s, fract:..u-es and tum::irs L~::.y
run.he ( lx: jj~ n c.i t1 e.d. aJ:d wl 1~, 1 l r~ l.'~L.l wj 11
r:J 1('".t'. ~ di".' 1;..¡; Jt.d j r 1~pt:''-."Ül.)I L.

Patknt with adenoid blo~k..tgc ..ul<.l

hil atcTal lingual l..Tos:i::-hite

25
i '

f RO'.:'fTAL PERSPECHVE
T~,c ttor.tal hns not Cl('r.v,mu: popukr::- d1'"5pite- th~ con, r,:ion p,') 1:◄ t· ;i l ~p1i 1t in g
¡iracL.ic.cs and attcmpts to <:xp2.nd ~awcr :1.rchc-s by thc: mcl.Jn'.:itr{'<'I.Jn. c.f onhodor~tbt-;.. [::
'N,i~:rú uf1L.il pai"an·.ctet·s &J'!.d. dau were a.vail.abk f.rom th.~ ccimputcr that it ri:-c1<.·lu:~d
~o.r,;cnt applia.ttiu1 L

Rtfere-nc~.'ii Jimpl oyed in Fmn tal f'erspecth"C

Cr.a.n ial a.nd B.asalar Points

Zygom.atic Frontal .Point {z.f)
·J -~t= tw,:;. zygom.atico fronuJ. sutures ,lrt' ~c::ught :rnd i f T'ICJ Lp l.ái.n l_y vi.sibie may be
itlt"t'.tific:-d !J5 a bkrnl HOL<.:h .al thit a1:_rn-:•:\'tma~í! hdght of ~.as1on, Trie: ir..side xuargin
al che orbic is sdecti::d bU"ti:-:rnlly :~s. / ,g pn-in1.s.
¡._;
Zygomatíc Arch Point (Za)
C:1n·fnl ~x:lrnin.·uh1n v:ill ::-cvca.l thc- cross sel"tcOll ui lbi::- zy_~1Jm;.itic .tn.~he::.. Th~
ccr.tcr is sdiXtnl b? it1spt'<,:~.im1. 7a SLAl'IC.S :or Zygom....tic ari::h ;:c-m:-::-r,

C1·isLA GalH Point (Cg)

Cr. st ,1 C~lli i ~ di-::\se: and commonly !:how·~ en t he- frrJnt,11 fi Im. Th t': 1i p 1~
cmFbvcd for a point, Vv'ht'n it h "º'i, vi~ihlc. thc. base: or top of thc- :scptum i5
~mploy~L1 íor a miclin~ point.

B.C. rJ
1
8.504

\
.•

~- 1 \
\ 11 !

, . l Cg
I

L1
\
f

Ji'
1 R
\ Za

·:,..-1 / ' r
I~ L' 1

26
z-r
' ·:
J\:~andihular Bas:alar Points-
Ag Poinis
Th.-: grn1ia: an.giie tnay flan:: outwa.rd an.d is ?OStcrtor to ch:: dC'nturi:-. Thkk.
ccircicd bonc: b h..:t',tl::'d at the: knnin,-:i.l.Lon of t.he. e..."\'c.ernal obliq1J.C ridgc antcricr i:o
thf. rnandibulaT notd:. Ti:chnically, thb j~ (~1lkd eh:=- tri h:=-<iral f'.minence. Jt wa.s
rnL.::-d thc: A1,tt::gonial T.1bf:rck and fab..:::kd Ag a.s r: m.andE:ml~r b.~::.e- l:"t'furt":J:1<.·~- l1. i :-:.
onc. key to -che ::i.1.1rcessful use o( ihe l;rnnLal Analysis:.

ProU1bf'.rance men ti (P'm)

rn 1'.--it". f rrintal vkw a trian¡;k of bom:· h oftt'n i:.pt~le visili)t' ,1c. 1.h~ s_vJ~l~hysis.
Th:::: ;:c,p of th~ t.:Í,'lúglf' is chüsec1 as. Pm point. h rcprc:~rnt5 ~he !X1i.dliC1e 0f the
syi~ physis.

:-·· LateraJ Ardcubrc (Ar)

This is sdt"(.:ki:.( nr, t(H~ laLr.tal bordcr of thc- mnndibk:: a:: tb~ c,-nssin's of a
:.r ;l :,:--:ve:·.se li ne through pO?nt~ JH\fl l~.

l
,
.,

28
 'l\.{axill~ry Re.íe.rences
N ~~ Poi.nt.s
Thr:: l:1te.rahno5t tn.mgi:n of 1.he. tnsidr:- margi11 t.JÍ thc nasal ca-,,.ity l~ sdcct.ed .md
b l.1f' l led ~ c.

Juga1e (J}
At t:hc lTOS:-..ing on t:hc z:ygc-1:naLj.c. proocss on tht rna..-.:illary v,:i.tn tht O\Ltli ne.. of
th~ ml,e.rúsity a poiat b .'ii:'"1tc:r~d to rcpn:st11l thr: ha.sal boru: uf thr: anaxilla. lt is
point JUf;d:: ~wd i L is sdccu:d for ..,..,.ídl h of thc rnmáH;'l.ty oosc.
Anti:rior N assl 8p inc (AN S)
Til.e actunl !:-ph'lt:> i.s 11ot visi bk, but .a cen.ter of tht: !w itl p8latc. at thr: ju1 Lti.Ll'.Jn
,,.,ri~h th('" ',.,,."':pt1tm can btt ~t.~k:t:lt:'.d. 11-te mid-m;:i.xílbu·y sutuoc idl!:'l"ltifir_'ilíon v.riU b::lp
ma.rk th~ 1;:-e;\1.t:r also.

B.C .. d"
8.504

íl

L R
.~~~~~----~-.~~..,..~~!!mll'IIIIIÍiJi!~íiiiii-~z~--

:29
 .. '
CSpl
\
I
I

~
1 \ I
1) '~ ,( 1¡
1~ \ - . ~---~ ·1 1

1
I
R
!
1

L 1
\
~/1 ,
1

1
1
\
\
\
I
\ /

? .
.,

1J t•:N·I'A!.
Th-e- b·ta:~·,dmo5t p::iint, are ~i:>.lt>:(': tc:d for molan . :\ 6J., AGR 1 B6L, ,ll~<~ H6R, and
p rf mola.rs B4 L :md .B4 R. ·n1c biscction o f Lhe. molar ou:h.1 si o n is ~elccrcd fur Lht'
Fri:.:clio-(H:dusa: Pl:mi:-. Thr:- tir~ of t.hf: canin~ C'.1'.>().!i are s.f'.l~ct-:::d a!i A3L ,,w,
A'.iR, .;r;d
B:3 L ar:.c! BJ R.

;-· :
•;
....

..
;
 Pl.A.NTS AND J.lNP.S or: Rrr:r.Rr.":'J'CP. .&..~n PARAMF'f'f..R8
A lirn: s~mply io:ns two poir.H and rnn scrvc for othcr point5 to be mcruurcd te
it_ A pfanc is l:kk'nc-d to a tlat .surfac-::: or 1:hrcc--dimcns¡on:,-J as a thour,:h1: forro. B-::,ó
~; ~ t>.l'n. pb,'r't".~l in u::: ph.a.Jc in~Ll'V.
, Somi.::: vi.:::rv, ba.sic a.n d Ltsc:f:..i.l ¡:::la:ic.s and Un.c:s ha...,,,c:
pnr..·~n 1o utt o{ 1.h t>. m r1$ 1 8u b~• ,jJ:lfüj: v~ 1LJ.~ :1 n d .'J,:'t". now de~c:ri l">-f:d.

l .a.t.eral Cran i al Plan e~

I.\,'l síon-~asiou Plane
Tht' ~.':'elb ..,.,·e-.n:-: glu-t:'d 1ogt-1.ht>:t fll"I skull.s and -~ :sa.w c1L was rnad.e. from Basto:-t :.0
Kas\-::,n, This plan~ <.7Jts off th<:' t;a5c ,,;,f H1'" pterygr.,jd pl.i.t..:::-;, L~ ~):ff~lld LO Ll~t'.
;.,,y¿(J1:1n:jL ·f1-l.t'.l'llfJ•.:Jfal .suL..:.rc and -~..::ccions off che: man.díbd.ar ce-ndyk. It truly can br:
thc:ught ot -!AS n i'rit':i::il :;l:'JJ,-=3HttiOil pl.'ln~- V\iil.h expe{t~ni.:::e :l has be:come a remark.ab~y
i..::scful plan-:: for :.mth de-~t:riptiv-1: antl st'(¡uc:-nl Úll f mKLLuus.
f ra nkfon: Pli,nc
·í1, is ,~ rerhap.s thc- bese p'.IDc "C.o srnn ,'ri th for ch~ scuJ~, o( ht-l.lJ pu:. ll.:r t:':.
1-'r:.H:1 Pcrir~'l'. ~◄ :;; Lh~ t~inpr-Jf~l !':iúne C.€'J1c.er, tt essentiaJly orkn.1:s 1:hc: ccnt<:r ot r.c.!ring
ar.e. cqllilibrit1m 1:0 die- ,;rbit, t:tt: -:.rrgrrn ní s\gtiL Thi'.': pl~-:1f' fmm P to O bisP.,.ts tb.:~
zyg:"Jrnai.ic. ML.h, and ts a p..::rp:::ndicu.la.r to thc coronal. :suti.1n:- in gCitr::r,·d,

:e.e. ,:J

31
 PteFygo id Verlical P1ane
A pe.:pe:r:·,dicular to frci.Dldc-rt ~t~ ;;is (i :,;t',p,"1rr.1Li~-=T'I lint'. Íúl' L'."1.c: fa.ce a.w2.y from
.i
~.he base of ü.~ pcc!')1gcid platcs_ It rc-aso:a.•JJly fr,nm It'J.}T'e:;~nl:H.1on nf the. l~::,ron.al
::;l1Lun·. 'Tl1t" hyc,id h<,n~ al~,::, ~nds to oricnt to it. This pla.nt: ~~bd~d PTV rJor th.t:":
7-(::tygoi, l rriút. vt".r ..1c"Al ~• fon'll :=:: .e.n cX..::eJle:nc. coordina te i'or cnm:mcc Dt data for t b ~
com.putcr. TI1-t pc-int üf Gossi,iB r~f Iht.'i linf'. wir.h f'l'.ankfort hai b_cc.n labc::.lkd Cf.

'
'·
 Pfaoes ~nd Li.nes for the ~ace
Facial Pianc:
This 1.fMi.t~onal p].a.11-f'."i!i forme.d by coru1«ring~asi.on -r.vith Pogonio:t.
\.·ka~~1:"ed t,()cn h~cl klntl I h~ ~ngl<"' ( l,.9L~i:.:ii r.ingle.) is perhaps thc. singk bcS1:. ~prcssion
P0ir1 l A from lhi ~

t,.·13 ndibufar Pl.'lne

Diffcf-ent mandtbu1ar plar.cs ha~ °b(:t:n employ·«t but thf.:' nto~t simplt ,u1d
11<>t":~11! :s LI,~. ~ower bc:tc..el' of t.he angle of thc raF-tus (Subgonicn}(Sg) to th('. lc>.ver 1

bUT.:..kr uf the, ~y:i:.u~ILy:.;b (.i\tr.:\nW11) (\1). Jt ha5 bccn w;c:d eJ.Ton-cously as a grm•rth
for-ccam:-=r. lfo1r,'t'vt"r. thr: -lngk uf the mtmd¡bular plane c:a.n be an indicator of a skk
c:ondylf'.. The inu::r.sccrton of e.he: Faciru anti .:vtu~í.'.H.ll1l,u Ph11~~ i:,.; u ..'>t".d. to i.:..úJ~SLc uc:..
cepl Lak):.u.d cic Gri fl 1hinn { Gn ;-.

\_~ \ it~,Z"''j/ ] ¡: e·
1
/; } _J/

-~rr~ ~
/"j_/4~~ j
C}[~
.,,..~r: r---._
l ". .
1 \ ..' ~

J
-...,J /-~-~ --~8
---...:,__¡.,.-L.. __J

JJ
 Facial Axis
Tht' Hm:,.; 1 n":n tnu ,n<ls of thc- fc1IT d i5CO'-Tr-c¿ is thc lim:: fr::im Pi:c-rygok. Point
·'.Pr:) t:J Cm1.dtl01L. It is mcasured rclativc to thc Ba.sion-Na.sion Planc- a.nd fonn.s, on
avc-ra..gc. almos-r: a pcrfe.c: right angle in the Caucas.tan pc•pulacion. 'TI1e. point üf
crossjn% -:if 1.he.se ~ines i.-. bbdlf'.d Ce: (foe· C1·a1üa..l i..---.e.nli:>:t')- b son'le pr1c.i~nl~ Pt nlfi)' f:dl
bdr.11.-,. :he lfatd cr.uJRl axis .:.m<l th u:::, thc- 1-'~ciru. cis is o..,:c:ndc-d UJn'r.ird :o form Ce.
T.:"lc Facial axis doses: only slightly- \4iith .:1\•erage. normal grm,:i,.1:h (about one <legre
f'vi'.1) fivt". )-'t".ars). Tiii,~ CJ(;,%iCLg h Posilío.o. Ooe. b,i~ ín Lh~ :s,.umw.ry gru·.vLh
:uwJ.y~is.
Jr... -:¡. j~ nt a.lly, th0. lt-=i;1;i on _._'\ ;:i ~ion a:-. N:=isi-o n h~r.ome~ t hr. r~gist.ra:t.i ori. fm
i.l~:se::-:;m~nt 0f tht': po:;.ition uf PoiILt A 'Jr the xmwll<"l. 'l:Le NA iint Gm b~ tl'l.ot:.5ht of
as ~h.e Nasal PJarn2.

E..C. <J
.S.504-

~ \ e

~ \.
~ • ,e\-_
~-J~
(

1 -

1 . :
Com.JykA.xis
A Hne. from Xl Potnt e.).tend.c.=:d c.hrough Point D to Condylion {Co} fo:~"l\S Lht
C.on<l}{~ A :ds. fe L-. m. .~;;m·f':<l for r!inrph-:-1lngic- an:=ily.fr~ .':.tnd grn·w1 !l nr Lre.81 n1t'111
0

l°lL.:'.nge :rom thi: C'OIJ)1;3 ruds. lt bc-:omcs critic.-al b thc .malyscs cr trC'atment cha11ig~s.
 Corpus A~i s:
Thjs p:d.ne is foi-m~d from Protubcrance l\-1-ent¡ (Pm) through Xi :Point.
Üt.':'H'.k·d C/,J u:-~i:s.:, .13,~N, i: forms. V-c.rtigo:i. (Ve:}. Th~ angli;: fonnt"r.l ii;. ..1. rq1rc-scnta:iein
or· total bc:al hcight, \'lrt.ich :s 60" ± _•:r .i'!,r1krio:dy, wh::r. s-1.1pcrimposcd .al Pnl I b:·
Corpus Pu.is b<-comcs a Su(>f'.l'b r l:':fr:r~HCt:' k,r '.knturc bchavior and ls Posi ti on i-;o,1r
in Lh\:: ,~um m.=..ry growL b ,ma~ysis.
 Thus, Xi Pcint is. in. a sc:nse, a radiation poin: for th.e .:nin, the c.o~dyle, e.he
;-m;.c--r '.ú1· nasal ~pine, and á lille l.u (\: ~i:-:n•é'~ 8S a.i':. aid in g:úwth foreUi,"il: 11g ;-_:-; 1he-: Xi
i\..u::;, In ,idci (.i ()1'' ~ fü 11::•: fri.:x: l Xj t r.: ÜU': utds-i I p< Ji rI f. r<:'pn:-~~r I t); l h~ l)[ ,._.; nt' Ot.::~us:d
P~.:.nc for :-cf.;::r-t'IlCt:. Fllithr::r, thc Xi e~ cmployec. to <.!et.:=rrninc:- points- for thi:: ~01rvt~""::
:-m: ,-.,_n¿ ;oc· rr.c.;...sudn_g d..::nturc bcadon as '.vdl as mandibular position. Thus, c.if;ht
~tn.i.:::tmt:":.. in nlJ are. relate.J frnm Xi Poim!

Palatal Plan e
A fa,~ Íg)rn án.l f.r·j•J.l lL) p•-Y)l'"ric>r· 1\,tfi::ll spi I)~ c~pr~si:>.nL~ L;1l': pfani:>. nf I h~ h;:i:d
p,;.la~. 'l.'i!lÍch j5 t!lc floor Gf ch-2 nosc and rc-of o::" thc rnouth. lt <'~rn.ngc~ li~dc ín
:,ngul:H k:•fl fr0i"fl Rasil)n ?\:a~icm dLirlng nan.!Ta.1 grm.,.-i:h, bt:.t can be: i::-iílu-rnccd se\.·cral
::tqic-::.:; wi. th trcat:l:!lr:":T 1t J)<'\rtil7Jlady >Vit h ,e-,.,_t-r~·::.mi1 11'9'i.J.i ()(1. A1. .A.~s L.h~ p:-i !~- t f:11 p hu:'"
is Position Th.rcc fc,r thc maxillahy u::..::th rc-frr~ncc in thr: s•,1n:ut1rlT}' grr.;wth analysis.

'.

Thc: i\.Po Plane

Pninl A !<J (Jog0C"\1;::in h~c;::ir~~s:; Hne cf rcfcrc~c,;: for :he pr-:itrnsion o::- rctmsic,:ri.
et thc .;.r,tcnor c..~r--::h. Tht angk of :lú5 jkm::: tu dtt' 1:.-~,:_-i,d pl::im.~ llpriglw..; wj lf 1
~c-owth. Bot~ Point A and Pogonion posidons .1:re iDth.rt'ncc:-d by tr::- <.lt mrDt, 1t t-:)n11~
ch-e- bé~t xdettn(i:> 1r, rf'.'M0n :'l.hl)ul in di..c.gnfl-~is, and is the hr~~t rr.fcrcnce1. for planning.
It LS a li.r:c e.o ·whid1 th-: "ti::cth can be rdated redprucaHy, 'l'ht' lc)",'r"t',dnd..für te.:· foe
-~ l-10 P ..~ ,,e is :1 -:-:fi ticai :ss1..;.e.

',...
 REFERENCFS FOll TTTP. TEETH
Huccal Oc¡;_,h.1 s~J Planc-
1\ füu: d:nJ1..1gh thc biscctio:--. of the cusp.s of L"lt': bl~t,::.ti tcei:h reprc-s:::nts a plan.i:::
L:nir:.th.1crK.i.::d by a lcp and Long11e ¡ibnomuüity. lt ís th:rdore djagnost.il-: c,f :-:.upr:~ u~·
hfra t'.1'upüún úÍ ;-i.i~l.t":Tinr terth. In cases of posc~rior Ol){!n !:l!Le Lh~ :s¡)~c-t'. í:; bbco;__-i:c-d.
h te11tb Lu havt' hiy)L ordcr ,,,.,ith IhL corpm; ;:rxj:s_

Divj ne (kch1,; tJ Ph1ne

Thr::- ~okkn '.Set:tion connik~ :vvo ~lrts whkh an: pruportiona.Hy rdatc:d to ? .O
tu 1.6:. 8, Tnis is .nlso caHed a divine proportlon, and rc:ferred e.o wíth 1hc: ~ymbol iti ,
\\-1"!,~n c1 p.cin ic-ul;rii· pc/nl Í'i k,c:i!~d rl"'"l~tJvt' ~o Uu:"" i wr.1 ~w.lpoín;:s it will b~ rnlkd
Jjvindy orkn tcd , or [; divine poin t. U thc: ,:.,-holc li ne is cc,nsi dcrcd: t.hc bng:..::t p o tLj on
is O. 618 the 1.m..:11 le.ngrh.
A lov..=-cr indsor divine: point is sclc.ctc:d bctw-ccn Point A .an.d Pm. 11'le height
fro~r: inci5al edg-e ro Pm shúuld b~ ú.6 l 8: the total height from A te, l..,,m _ Th.:l.t poiHt
..:on rn::cl r-.d l u Xí bt-tumt.s a rdi::-r~m.·t: liai:: for pla.rming unhm.bntics in thc long rangc.
The lcA'írcr inciscr tip -.,.1,-íll b:::. on thc: Enr., an.d th(: lm:..'f-:: r molar I t.:l 2 fr.úL bdv•..,· h for
t:'lc na:ural o~:d 11s::1 I t."t1tve.

.n
 :\rdt DqJth and Modd Convcrs.ion
The- ,lctual mockl a.nru-~---sis L!. aiso a. part of rh~ P1"0gtbiisiv~ t~p'.1álo:nt'.1.rk
pr-c:cc:~.s. J\.'o!TJUd dimcnsion.:; -..vit.h m.;rndard df'.V:,1.1 ior.s f( l'm ~ h~ h:1.':it" i'nr evnl~1,dr>rl.
1

Arc:h d-e p Lh ¡,., m~11.~~L1~, 1fr,:_:.rn tht' , nc:-s~~l of thc lc-1rvcr □olar t•:::i thc ccnter of thc:
h,~.-i~;d ::-i:.~g-!':' nf t!1~ m~nn l1J h"'C'I C'cnu.ru in¿so:::-. It is .a cr~ti::-3.l me.:u;u~menL u·ansft.c·t~d
1

t::--om f-1c ml)dd .nnd .-:mploycd for d.ia.gno,'ii~ fün'..Ca:::..Lj11g .;.;.n1l pl.'-lJ ,niJ1g r1tr-dl,mk::-. A
6% (or abolll 1 mi~.) -enhrg~rnf'nl i:-:: prt~nt in Hu: us-\1~1ly htternl l".cadpl"-tC-.
i\.rch c.t'plh and mch "i.',.1dth are both a.s.mdau::d. \Vidrh Llii t~1k~n frnm t.hf-
c,::,ninc tips- .J.nd the bu e cal 0f th~ íifs L pn::cn-::-J)Ar F.I nd G1-:-; l. TII e:J r.1 r t ~~ D::-xt p~ge),

Lm'\.'{.'r 1ndsor Position

Th~ lo\\·er in :]sor is m f'.a.~ urf'..d from rJw~ Den '..uf'~ Pl:-i.n~ (A P0) hu 1. i ~ pJ :ir 111 ~d
17:-rnn tht:": -" Po T't"fotb:mhip produ(.1:·:d wi.th treatmcnr. {Se;: APo Plane-.)

) '

_/~~
'j',;~J
_./;>\ ---- i ~~/~J:
~'
() ~ - - - - ) j - r .
/ '---' 1~

. : ]
1 :

\ \ s::;i

(S(:"1:' dso i\.PPf.NDIX fur :l!u~t¡·,:üun oi norJH,11 d:r1'.t'i1::,;;;"Jnt

as com pared r.o G .A.)
 U ppcT Molar Position
1he: upper mola.l' js m€asu~d from thc dist[.l of th(' crcn.'rr:t dir~c.:tly to:1 IYfV. 11
h,~.:.; 1or, g f.rtn ~~:...c.t llH.i, he<l Io .1it: r.ypi c.;~ Uy al age: plus i:.hrc-c rrúllim1::ttni. \,V! v:u d0~e.:-
ü1an aver.'.:..gc it duc'~ nGt meaH it caunot or ~hould no1 be moved Gistally, but í: ciocs
s·.1g~est lack of spacc ultír.natd:r for ,:h{' ~:zpp"'1" t.h i rd 1-:-i ú 1:it.

lntcrindsal .Angle
Tht>: prinr:ipa] mnc~rn for r.his re]ation a..t a ,1onmú meau uf 130~ :_n lhe !iJul(
c:aiJ.casoid popr.1 :~tion:i;; is afét"r tIT,~ tmc:, ,t _ fo r: 1"I ¡:-,J~l 11g. a 12 6::. an.gle is prckrnb]~. In
boll~ ,~~grcid a:::d rnor.g0Joid po¡:::ulations thc ::nt",m ~:i:lgJ.t' by .hiul1 hr:-:-J0. :~ b .."'.k,·.v 1?.Y.

Soft Tfasuc
The Es.thetic Línc fE Line)
;:
Thc- nf)o(:' t.ip püint i,',. rnl~~d prona.sJi ~pm~. Thc mo.st rrr.::mint-nt chin poin, ;~
labdlcd pro?OJ~ou.iuu ~[J1J(J). Ti,(:' l. :iw:· (Est.hnit~ lir1.12) sc:rvc:s .as a refrr~nc.:: for
p roLruslon of thc- líps. Thc lowcr lip b H rt:'.ft-.r~n~ to -.-,-hich ,:he u¡::pcr is c:omparcd.
S f'.v~ral ot.hc.r pl2.ncs are: of us::: 1n thc: 11.annuni c .E1.1H:J C..i L)n, huL ac't'. dt'Ah. w: t.h
d~(:',,,·hc:rt>.

'.l9
1 ••

f<RONTAL PLANES
Cr:-.n:w.l
'J i·.·rn '.':\: er.sc Hnc-s are drai,,·u tbn.mgh mm rnon poinc.s.

ZA • ZA a fri:.mfol fr:n, kfot1. plane

Zf ~ Zf H lrrJnt..~1 ht:-.,d pla.nc. on úc: Frontal 6~..'XLC:::

Cg-Vtt Lle.al a droppt::-d t !1rnugh f-r'ún La.l Fra.nkfo:::t froro

fJt::L" p..:::-:.dic.ulnr
Cñ.st.~ C,aln re{'r-.::sc:nts thr: :m.ids.t;iitt.:11 plane

fa.cia1
!',.J~ndihuJ~r
Ag-Ag a Froncal :r:umJ ib1,.1fa i:- pl;.111 l.":

.\l~.riUa ry
J• J a Front~l xm1xilbry p1in',e.

( :ra.n i o-1\:!.andibubr
Zf -A~ (bilaa·-r::-1) a JíJ1t:<: f n-:-cn Zf J)l)int to Ag n::prcsrnt.5 thi:- frrn,t.n-facial
phncs

z..~ -Ag {biJate ral} 8 l in e: from thc. zygornatic arch ct·.:n ttr t ~ t.h i:": fr"tandJbh::
rqn1.·>t"nt:s f r.lro l m--i d post.i.1re of the mandibk.

Ma.~illowA{and ibu lar

(lJilat~t.iJ.) ll JjJ 1::-. fn~rn Jug·ak: to antcgonion rcpl\':sen't5 ,{ tt<)nt:d
dcnt urc- pla..'lc
¡.'
/L~S to J:>nl ~ lh,~ t:'"<)rnAnl.~riof Nasal Spinc to P1:1 :rcprrscnts a
pl.H\t' b1::·t1.-v<"i:"n I h.f' m8-xi llalry .-rnd. mandcbulaT midlin..-::s
.'
Dent:d

KGL to H61t a hi'.':e.ction of thc: molnr ocdu3i{ln ,:_uxu,e~:l ~on re:pn=-h,;::-.m.s

a foJu-..AJ-m'.i.':h1s.al pla.-:.i..=:.

40
4l
.......
! .

Fun.4..-iion #4. Yif"Jd~ .-1 l\.'l~i s ínr s r.J in i cal Norm

The Sci en l i 11.c Has is of C:U ni-cal Standard.s for Rc-tt.rence ..

thc Clink~l N urm ApplicaLion

: .• TIu: id~.:, of ,1 dJ3.1k."l J\()l'ú"'I '.°of nrt.hodont.ics '"vas propo.sed by ~imon priur Lo
l"<dio~0gk r:cphalonKtry. His gcm. 'rYa.5 tci ~otabJioh ~ -S-tm\CJi:trd f0r comparhon oh:he
abnormd ()"{ th~ ~xi 1:·:nt rJ dys.phslk irre.gularity_ lt V.'3.3 prupo~c:-d trJ J.l{•: rvidr:" :1 h:lsí "
for 0,d~r in cmrcccion to,;,.:-nrd. th.-: nünn en "1.lu~ i(u~aI 11 _

Toe- sam::: i:..un:.:t:"ptiuu Y\',:.H; l"-~ JfK,s::-.d by Do,"ns and -Stcincr. Thc: c.p1c:-,tÍ.un,
jlU\',.'t":vt":r, be.~amc thc: riKidity by wlúch d\.:-- dit~ic:ián -.vas su?posed to .;.dhcrc te: the
prototyp.-:· , or _,;i p;HCkul r.1 r moclel of pc:rfc.ction_ Thi:: ba.sb for ücJwrn;' 11tmn was L\"'-·t~nty
young normd full -dentition :su bji'i;._'t.5 ,....:t how. -v..-:iat hí: j udgc:d to be protnisiv.-:-
r_}{·dnsion . H~occ. i:hcrc i."i-ras som{' bi.:1s in hii-: ~C"lect.i0n. The b.:...Sis of Stc:incr1s norm
~•,-as. only on.-:-: :-.·n~ )j~c:L, ~ íull dt:~1.ition kmruc sdc-ctc-d ~~ !ú:; ,>hjt":c.':1.i1.·e. frnm his t~Jinic.al
~·
ex.p~r~cn~e. fra:r:u ,."1,i ch 1lt'. , l~ri 'Jt'.d hi.s "ideal" -~ a fla:l["ant W:..1~.

Jt . '"'""-% obvio L.J..:; thar. di.n ical norm n.'Íc-reni:.- e:~ 11 ~t"i·.lt'.c.1 i mpl'(Jve.menc. for s:e;cral
rcasons. First. a nm.got n~d,(l tu In'. t'.S1..ablt.5h..::di nota :;ingle point. St:,cx;i-rnL -v.:.ilu.~
·, Cor age.s necdc-d to be prrJovkkd. Third, ::-R.x dffferero_ce.:s "i.\TIC: nlX'c-ssr.J:,' '.n i::~1ahfüh.h1g
i I I,j ~~J.i ves_ fo LL.rth, racial a:n.d consd tlltiun 1YI tf'S n f'if<lr~i d::-~~cri p-cJ on. Hfth. thc

mu:i.lys-h n~<.h:",L t.o bl:': ftl úre in di.::pch b ord.cr t0 pruv-idc:-: irn;égh t ¡,'IL.O responslblc
.anatornic variH1k~. Shli,, lh~ff'. n~~d~ to be: a consídc-rntk1:r:, for· t h.:--- 1r.'-lnt,vf'r.~ .
. .. ll.i.J.uer1sion_ Scvc::.th, a thrc-~-dim.rns-ion;:-1.l ,'ilb.~ CJÍ normaJ morpholor,k v.i.riation :::i:nd
nn ::i.t.J..,.o:; úrr unnn:J gro-wth nee.ded to be ;iv.i.ilei bjt". for ref~1-ence. Eighi:h. a mcthocl
.s.hould oc avuilaLlot fl)J: lht" Uuh.)gic n)fl"t"~c.tion ,:,f va~ues du~ to 1"Jv~r::11l ~í ;--.t>.. t--Jinth, a
rn~l.ho;:J. ..:i· dis-;::>fay for ckscripti~t uf ('.'xt,~me. d:ysplatia vtoulcl bC' hdphll. Tt":r:,tlL, ~
rn1i1 ,·1x fnr progr;.0sr.icari1.1n 'Viras dc.sircd.

Compu ter .Study ( 19 66 to 19 69)

J\.'\a1erial
Fivc coUe-'-iions uf IUate:üal ½"t'fé e.mpJoyi:d for thc- sti..1dy. Rt"ca(1 uf i'0
ul'lL.r~~l~d and normal .subjects n'Il.s corulu,;,:tt:".d :111.d headfilms jn .Ia-:::cra.1 and .frol1.tru
vit'l~.':,; v.rt:r~ r_1,h1 ~111 ~d _ l ·rnm th O..'\.of'.,. for~.y (40) subi r:tt:;. ,.-.·t-:r.-:- ~dr:{ ·.I n.l fOl s._ud_r .S(:rially_
T\'V~nry (20) "\'\.'CTI: mru~ .and. tvi.'t"nty (20) \-\-eff'. fcm.alcs. T\.vi::nty (10} Wt'Tt" m ud1::::nü.e
Cla~~ U, ,H"'l<-Í h,~emy (20) i "r---e..re nonnal, or Ch~~ l. [l'l i.....·enty (10) chHdrcn thc mean

42
tjmcdiffi;>::sences.Y,'t"I~ ám"tt.':> 1.<, ~3y~a.rs ofagt' (Sye.arsdurntio11). In ,-,-.~nt.y('.2O)
tl1t': I.Lmc- diffrre.nc..e \vas 5 :ycar.¡ (tro1n 8 l.ú ¡ 3 y~ar5 of ~gt:).

Thi:.--: :':~L~nd colkction '-\'ii.i;. fmn1 _rasr Ríck.e-cL~ ~(i..di~:-,_ TI-ds COf'_sistt--d of lht>.
d:H.n íor oru: d\•JlL"ia.nd ( l OOOJ c.onsC'Cl..1tÍv-t'. pali..-::nts from th~ ú~.h;::idontk fiks , :t:.nd
.:.wo n.u11.dr~d Hftv ;~50) ::;c:-ritü t~l'<l.:. from 1960 mod.aJity studk~. ·rhlo; 1nd.tdr:d
longitudiru1l cl.nt~ of fift.y (50) subjc:ct:s Ln·~t.ed ~Yith c:dgn-..is~ mt>.f:h;;..nics.

TJ11:>: Lhird colkctior. wa~ ,1 N():;,,; st>.ct.ton of tl:trt'i::'-}''-',H•olj chil~r- co t ~te\H.11.h~

(bta bad.:. to l"I:§' thn~t": . Thi:: foun:h colki:..-ünl'l ,,_-as a ?,IDllfl uf Lh11'1._y {30) n-ear-adult
~k::; in order t-o ,::.:¡..knd U, t': <.l.a.l.;1 to ag.::: 1S :r~,lp; . · fhe fifth {.i'.Jlkdiü1t w,:Vi data f rom
t.hi:: Urcrature up unt,l 1966 i,.vh-::n tht::- wo.-king srand-é:. r<.h w("'.l'f'_ determinro. P-1.u-dn1L'ir
nf,r:re11ce "\'1-'aS mnd(" 1.n p11bli.c.ations of Sas~ul'li ;1.-,.d Krogman, ["2,T(J:lcfü~nt and
BCMri.k-11 .

l\.1cthoo
Lft~1,·.;:illy ~:c:iy scns-ibk 1nc:-x:-;1¡tf'.mer..t or a:nglt: c=-:ver proposc-d -,,.yas >"llbi~i..~I t':fl to
compar:sc,n , .tnd rnany poin:r:s w~-,.-,~t"rim'igt1kU.f'.d. ~ár rnntrnl o{ t'.l°fc,r. 171rcc hundn:d
~i:,.;t.y-,.wo (36'.l) line::i:r:- rn· ,mgul-=_r mcasur~mt::r1t-o;. \'-'t':Cc recordc<l in Tin•t'. 1 :1nd 'Tim,2 11
tor t'llt'h p.-ir.ie:n~. For th~ fiv~-y~.'l.1°-olds thrc-c agr: p."tt<,cls wcrc. studkd, 1i,, .·1d'.:h u1.~.:-mt
Time IU tr,tdng.s h;S.d e.o be m.1.de. . AJ.bnt".-;i:sw·c:mcnt5 ,.,.~~ re..cn-rd.ed.1n -che comp1.1tt:r
1.0 indudc thc: <.~k:1.ilaücru of ,r,rmvt.h di.o:mgt".s.. lvieans, stm1d:u:,d d~viations, .and
e:'l'. l1.·e.me. valucs ,,..t:((:' romr~LLL~cL f.vi.::ry m~a!:!lur~.me.n L was cross-11.:ou:d,qt~rl with
cvcry o-the:r, and thc ~::i-,"rth grnJkr\l was oorn:::L.1.1:~d .tJ{> ·.-.·di. Tn all, c,...,'Cr 400,0·0ü
coe:ffk:i{'J\"C~ (Jf oon-elaüc-n \v..:-rc tabul<•t r---d .

J'or an invc-sti.gatíon fol.' pobr }?henomrnon, 1.('lfH1Hal oornp:::isitcs 1r·v en: nrn.dt'
from d u: ni ~fl I L t-L-=i.ta : n both la t~rnl ,md hn-n tal for visual grv...·t.h c:r.1-m parison and
.st ud.y ,'l.ri;:h ~ x:n.et:ri r: polar grid.

Resuh:s
TI\<" :n:snl I w11.~ snrn ~ Fortv contrlbutirn t::; lu l h ~ lhld-.i· of knc-1,,..ic-dgt- fur t h~
~ ~

prof~s:sLon_ An. atlas of nOTirnd n.1 <H:-phúlogy and nor:m,;iJ grm•.-th 't,)i.'3.S establishcd for
th~ contput.e.l'. A ct.:be~rooi:. indcx wa, (kv)~f'.d for com:::c-riun, fo[ ~i..lt:'.. CcJfíi2CLions
\,"1¡(:J.""C: ma.d.c- [tS W{'il for: agt>:, ~--:,,., an.d rada! -rypi:~.

A c:cmpreh.,:n.sh-"'"C' analyá~ ,v,L~ <loou.ce.d :n 1969 t b :, t r.. -1~ sr.o()d é'..sscn tiaHy-
nndrnngc-d nu,,.. fr,r morf: tha.n 25 y (:a:-s. h1úmr étdjwtmcnts hav~ b..-:en ,n:=tdf": in onl?
t v.·o ( Jl' tlue.e ?arnxni::kr::;, J;..·try i:': '.°"'forr. to test thc J,~t~ \.\~1.h n.ormal matcrfal h.:..is
rcsuhl'd i11 .'3 r-e:-:::ont1nnation of th(' vmgr~,..., _

43
,..

11
. '

\ ·.
( \ ',
. '•
'1
1
11
'
1

' .

COORl.>lNA·rr: GRID
POLARGRID

44
 A S umma.ry D.:-scrlpi::ive t\J:~~Jy:--;h w :1s r-:;~~ected ami pcpularizt"<.i. fur ~ ~-.1m.n.1~.l y
_grm'..'th :-.nd u:·e..auncnl ba.•;;;c:, a. clitkal fou:::-p0:5iHou i:nJ:oi lysts \\--as de.'.ói s~d.. This
pri'Nt".'d t.o be thc mo:st tru:st\\'1.1,xi.hy method for procuring t:re.itrrlt""Xlt h1(mm:1t.1on f,:r
t.hc clhtidau ~.,_-j;;;hing t.o knmv thc: díffcr-c:nt ~:n1lt~ \Vilh v:uious tcchniqucs..

Spin-offs
from th~ fo1 din gs fm"1.h ~r resc:arch lcd. by l 971, te,) 1h~ di sr.o-v12ry o f an· are of
gl'L)\vlh of thc 1nandibk, dcscribt'd hl-t':t·. 'fhjs l.e.d in turn to mrtho d::. for ~t:'n:.::1hlt"
long-n11Lge [1JH'.L:a,-,Ling 1.0 mai'.".uric:y. Th;s abo le<l h) d1.:rnges ln lx:lkfs and µracti-ccs
fe.gard.ini tr-catmr=nt m{'c..-l L,mlc~,

The S(':L.nnd M.n.jor Compute¡- Stlldy ( 1989-l 990)

Toe- ardal method f.lt fo-r:..-(·:l si.l ~-.g \..,'3 s i mprovcd. rrtt:ste-<l , ,m.<l fun..h-e-r J."t.:fo I t"":U,
bnsttl ü!t t:'Jnpificr.11 fc.cábaéc Aft-cr ninctt-en yc:f.n_,; of use, botfi s.tatistica! and uütl-
and~cnor t:ésHng hm l. bt".t".'rl ~'..()ndu.c8ed. Concrete daVl ~uffkí-f'l'II Ln ;i:;:i. l i.~ry t.hr.:".
~1'.i~ntifo:. o::.immLu-..ity v;,-as sought. 'lhe{t'fol'~, a n..::,1,"i.' long-tcrm. sc-qucri.tial ~tudy v.~~
~t.;;.rtt'd in l ':.189 at\d complet..:::G. in 1990.

f..1atcrial
Onr hH::-.¿rr.d thirty-thr-c...: (l 33i '.)1.ll,jt::'l'l~ wt"rr. 1J:-.f:tl. Bc:.gkn1ng b.tcral
hca.dpbtc-~ "i.'r'~ rx,Ht":i.'1t":d írc1-m se.-.=en. institution:s. St'vr:-J1ty-1.hce..e ('i 3} ]ud. ha.d. no
orthodon:r::ic attcntion :Lt :~U- T~n { l O) ~•.:~.re s..::rially cxtnu.-t,d \•¡i Ibrmt fm·1 hc"'r'
l11C~1 \'~ntion. Fihy {50) patknts- \'\'t'rl:' t~,◄ tt'<l íor a va.rkty of rnaloccl\.l.sions. Of th('.'si;::
2 5 wt:rt= ro::dt'.9 .:1 nd 2 S \V~.re fe.males. Thc St"\'tl.L ty-th1-e~ ( 7 3) w,treated chii.drc-n \.Yen.·
from ar,-: 6 to age- 18. Sumt: X.-:.•.f.ly~ ·we.re from agc 5 to as m\1(:.h. ,i.~ 28 yt".',n:,., oí age..

l\·1ethod
All bt-girnu:ng bc:.:~dp181...~11 ~v~rc uac¿,j bv Rickcth ,.md di.gi tit', eíl. l °L)rec.a-,;.Ls
withol1t ucatm.c nt "i...,'crt" :u~d.-:- fr:ii:- ("~c-h !iHhj-e.('.f either m a rna..tmity cm.-off or w tht'
:J_gr. o{ t.he fas::. hcad.plac.c. 111osc 'W\:IT also digitizt:":d .~1,d it1-.Lered into the ~omputer.

Aft.cr thc for~ca:st.s ,..,'C!'e complett:.J, t.he ílna.J lar.eral hcadplaks "i.'r"CTC collm~
mnJ trrn:~d. 'l'h.~se: ~rer-e. abo d1g1ti:zcd .and r<:"crmk·d. AII foCcca.sts wer-e. compa.rcd to
rhc actual Titt' 1'.:r) ~uhjn·~h'i v.·t:":ce hfúki.::Jl do~n for s.ex and Jndividu.al t}'J.'l't'l:i,
T \•,,t".n,y--e.'tght (2 8) norm..'tl ucdusiun un.tr~:1 t.ed s~1bj ects ,,..."'C:IT: .studicd. Sc-vi: :-n.ttt'n
!70'1 p~ 'l.\'t"r~ rnmi'H"J:-.l tf'J fo!' l~om par1-mn.

For Sfjli:.iscic:.al a.nal~s, 2. ' 1kus mvJ , . _,t,j,c:J-t":',-," 1f"-~1 . ,;,.,-as c:onductcd far thc sampks
to ccmpar-e- sc~thli:.:ii.lly lhe ¡it'lH8l ag':'li11.st thc pr<:diction.

45
 N::73
46 Males
·1-
27 Fema.les

.
1

1
,1
:

18 . 1. Yrs~ ,r
1'
1
)
1

r
I '

-- ---
f." AC.IAL t1A1 1 E:r?N: M!LO t!PV, CPI YFI\C'I ,\L
--- - ·
f: ""'~: rt1ns YT:"'-~' nrtJ
- ·-- - - - -·-"-·
N11m...
vt,.UJF,
1 rl ~ "1 · 1 •1~ F~ 1t1 1 1, •19 1n l~0 . 1 t!~ {I u
Cc-ri-1 ~ ¡,- 1 t,r _,_,
'1 $~ '- .,1
~

Lo..-11r t·-a-::-í ~ r pr~ 191 ,t, ""''

-:J'3 C> . ,.
ft.f!. M::i t a.t· l 'c::-:!'I i t. 1•.) ,, t,o r rv :Z 1 . U rrn, I} _ ~
Ul t~ A-ro P,n~e 1 .5 11~11 r¡ ~
Bl l11cfl 1!i't. lon
0
'1;,:i 1\- t'o ~~ - 5 d ,t o :,.¡
ra ,_. l 9 I í) ,.,r,t-.h
r,.:-c,, .-. ... ,:') eo . J ú ;.1 . () . ,1
•: : !)Q . 7 :l:1 rJ :.'
Ma "- 11 11!1 r y I)~ p t h 9<L :J thJ () . 1
►.A t•i•ll t111
htr P l l'!hl!I 'I;-, HI 21. 9' rlg . u . :J
M1rnd 11:nd D r .... r , . 3.!: . l rí!J • 1 ,t
•·ot1J I FAc: 1~ 1 11~; 9ht 67 . 1 i;f!1 ·ºrna11

C1.11'1J,n·n:1t.1 nn a f ori ginal co1r.puter data,

46
N=73
non

46/2-7

Growth Dura tion

9.64 Yrs.

47
 N=73
non

( .

. :
'

...

N=73
.. :
._

,.

·-:,::.
4 ,,

~~-t~
~
=4,:-:z,r,tt
¡
 FindhW-
'f1-ie. findings \'i.'~ri::- ~o vulu:r:1.lulúUS ih.•u. the.y are yel:. to bt: pllblish(:'.J iu buuk.
form. Thf:: d,-.la ~verc: colkctcd h1 ci-...:: roi:tin-: :-equt"n.;.·~, i.t>., the ;:ranial basei
rnflft<lible, maxilhi, tr'.'tth, ,m<! '.': nfr tissn~.

Thc r,:: sult~ t\ tnn<il ht rr.portf'rl hcrein for rcruC'llL~ uf ~p..-H.'~- HO\V<'.\.'t:.r, the ':
fo lk)•. . .·i ng can be statcd~

J. Boys' hea<.l tm.<l foc-e m-t:';~surt"ri,~rll~,; are about onc y1::·ar~ grrJwl h ,;=.rgf":t Lh.-1n girl~
◄1li:t.'i<ly ar. thc. j uvcik agCJ.

; _ Grú\\.--:h forcc"3t..s preved, as cxpcctc-d, tu bt:' i11 1.he 90% range •·- maií.~y almos-c
:-i ~,sol 1.1.te..

8. TI1e composite be-carne a brillirni t ~0,1rn-:: fnr .-~~~;11'{J1, similar to t.he VTO for
di nica1 ~. .---ork.

1 J. Thc rescarch c:1.-µcrl~nce rcinforrcd thc S\.mun:uy m L'tly~f-~ :l !l d .,;1 in~, i 11} rrd
n•:n :iín :r:,:1 od1 fi <".3t i vn:;.,

12. P.1 Li ::.nL.fi - rn i s.s.c.d II in 1.he Fo rcc:a.sr kd to .a Ílli'"thcr sea.:ch f c-r hi<ld t'n varia~ks,

Curn:nt Confitlcnt..'t.'
T1n.is tl11:". 0,·igin.:i.l P\H.n, ";:,.l dh1k,.q] da.ta, the 1966 compm:cr i.~'DI'k, and thc- 1990
<:omputcr -:-onfinnatüm has lcd t'., bdt.er <:onfht~fü:~ le:vds.

49
 1 •

TI1~ Prt"dpitation. of thc Summary Analysh:

In swnmary , as e:-<pla1,.ned bf'Jore. Lhi-!; Progr1;:S-!::ive program for {:1;:pha]omeuics · 0

h:~.<; b~P:n ,-;n P-v r,~11ü0n f".':.:lt".nding !ot h:tlf :1 ri:".:n.1.l1ry. lr. t.he. faú.~ of ~ ~l!C:'."l
con:rcvt'r?t, t'"h.l':tu~livt' o:..>inputt'r sH1dyw,➔::, nmd1wti:".Ll frc r,1 1CJ6S L0 1969. Sl.l.uli~s
con ::i::--, l'.C-d th (.'Te'Hit er ·..,-it h nu-::hcr rdlncmc.:n ::5 ~1r 1)]' til J 9 9 5. l;()í" t he- l 96 9 ~~ miy :l IJ
l~n- :-:111;ily.,t~S prc.,poscd w11H Li".. L:n ~,,.~f~ ~~omb:ncci and cmss-corrd..1.ted, 1rvhich tn3.y
c.xp.lnir: =t~
xern.~r.::..9.blt>: <t~pt>.rufabifüy.

Cmnprehcn~ive. for C.ompleleness

Thc- rcsult of the- origina~ wor!..-. v.r<1s th~ seki:.-tirJrt. of f1 <'(1f!'lrrt"ht"'n ~iv:--" ~u 't:ly~\~ 11

t: 1 s1::1ply infonna.tic,n both fro:n.taHy a.nd Ja-ccrally to answc:r ~hr.ost any qi..~csüon
so\i¡~ht by it dini ci.4n. L';imi lit>:'i <>f n,~:1suremenLs werc 3l:l advantagc- for din:cal o-raer.
Hc'.vc>.•cr. ~h~ com~r.i:ns~ve j5 ::-cmarlcabk for ::h::- c.kt,◄ íl~d .-~n:tly:--.;is cf ~x,r.pl.i or .-➔,l
en nd:1: on.s. For cogrncy . .a sdccLon v.ras sugr,cs~cci for :l ''Sllll ,nL;! ~ 1" fonl"1 by C; tghrn
rn i6 i:táll\.- a:1.d b:::..:a.1K n:od~fo::d (1.rnugh c."pcrknc<: sino: :97ü.

rv:.,.. . , ,.. ......

,. RMO ~- ;:1/,!l;N:',IJ: S~tY,:°f~
----:-=====:.:.:... ..----==
. .... .. '"'Ar, .... r, ·.::a
i:.. ......... : . . ~ _ ,_ • .-< >111
;y,:-. -.--, "-4 · LII 1T
.. . :~11 .C◄~ ~• ~ · e,
n , .:¡; -~'-- ·••
r: , ,:..,...• :, .. ~:I:~•

,,,,-r ,-.-:., 11 ..r-!º '<' l'f-fO r. ■ •·• 'ou.-b■r- : ( ,-~~ ~\ ■,( ~-~•{ :■ ~ v: 111~~/ ~D "'f~ . ~A . J
0 ; ~~~~~,¡~hr •t.1a R>,t:, Flu,· dt,.. · r;:i¡~,'9~ 'I! 1 • ""t:h ': ■ : unli:11v ,ui :.a,:: µ, 1 t

c::r.- !11::tH~OIJhl-' e CCHD:TIJN!; C(D s~rL~t~L ~~NOTT1~N~

LJ. TB"'-. llCT':11!!!. Tll:E)\"!\,ef!' IA1 l:.'IM. l!EFME TRE.~n.r.rT
1 n..1·.JII

_ _ _ _,...._ _ _ _ ~ -<;T""- IICJJ.l1CUS - - - - - - - - -

[:EN7,q_ Rl:1.>,TJ:N:. - - - - - - - - -
(: 1 Uf\ 1r r •!•
I a b i :::1n -1 . 1 Wr ~! .C ..,, ~IJ C~nvax l\1 • -: . ) ..,.
..o.$ . , ,1111
O.t. ..., o .&
: :ft C: t- n Ir.• "" : 1 ': i cr ' l . 2 m-- ... ~ .0- M ~l!i ~ c~■r- ~■ci~ ' M.j~h~ _.r; _(I dg- -:0. 2
C! ln~i ■ ~r O••rj•~ 4 .1.., s; _::, r,r, l:!-4 Pr+11 ■ nt. 19■ I>• ■ n':. ~~ i 1)1, '!. 'l"Jl ,.-.,,.n..-1¿1,_F..
C7 Jncl ■ c - (.l,..,,..t,i i,... ~. 71111'> :C$nn 5: l t--c:114 r i e> r f I e■ h• I g l11_. n~ . e ffft
C"':i' "-'Drd I • 1\ ·• ,..,_,. 5: • t.-v■ i :,in 9.◄ ... 13nn: ,¡:2 ,._,.tllr- • .,. Í t ~• f, ♦ 1Dh~ ló!~ .:1 ..,
1·. , Jr-t ■• • -~•••I >.--i, :r. 1SC.~ ~1 !::>:o o ~~ ~~ Fic,t te• ,~r J'.■.n~•r- i Di- r P't l r, ~o . a ll
~j :,O-de 1 ■ Arr;,I t lóLd.P ~p \?l . ~~~ ~- ~
IIS COM, tar..,A p t>Í •t 2:.i ~ tof. 6G 1 m -e e.
p;r t,;.:,ndy i i1C.1ra-:;n ■ tr. ,;in _ U,J l ""';.;z,- z r'llt - (,, -:'
·.... ~J!I A6 1.1~1,r- rc:r : tl:n k P,,.-~ l.Z .O nn ~i .o - c .r:- 8~ ~,,.¡.,,n~ Ol'f~• ■ ,l · a 1
U .2 rw-. ::1-t'.O""' ~- . 1
p:i I! : t:, .■. - h: Pr .... v j C rm l . !1 nn 1: ~ -.....-..c
p:, 1r.1............. 7 0.9..., 73 . 1...,. --0 .::.
~2 -',j ~ ,., ~-l'c, .. , .,,,r, b . S .Y.r !!Ir..-.. r:-:~
p:.I◄ &J l,,o:: 11 r .>o l Ion tt> .-..r=--o 1l . ~ d11 ;z;z .~ ,J... e- ◄ ~ - - - - - - - - J~ll 10 t.R.■J'i)UJ - - - - - - - - - -
n;.
~ "!"
AJ Jn~I =- .. ~l<>n w .■.~
0(c l •UI" ~, ■ IIIJ te, )('
-.:,:, I•·d; -.,,~. ,an cí o~.r ?fr.n~
:>r, . C d;¡
~ - r, .,,.
2:.! . ~ º"
2B . C ~g
-.i 7 n ,
~; :¡ ,.e¡
.e,
]
.. J. ;z
,4
.... .
•
,:12 l•■ci•I r.~1=l ~
•-1◄ raci a I A,· t-
qr, J d11
00 T rfo
!lll . 6 d,¡;
11:J . D d~
, ::i. •
:>. 2
.!!,¿ )!;, [-:1 •1e :. lr. - ~ 'H r.~ ~ cR e! I:' d~ • ~ •• r¡ .,~~ .._. . ; 1 1a .· r l:l~o~h Po ., dp ~ !I r. " t D 1
l", •n~; 11_.,l 11 ■ • ~h~ ri T .~ dg ~~- 1 .J ~ ~ :i
..v; ratat•. fo . t,ur -:. , n• l.~ .,.,, l C : ;, ~- C"' •

Le~•• ~,~h~~lc ria,~

i~S 1..f •.::l~ .- ~r ~I••·~ 1-0 r:1; H., d~ 23 i c p -e:!
~~ L1p ~~ ·9 ~ n, -~ .9 rm 11 Bl •N -.\ E~ ◄ ~ i; ea ,;, ~., o:, ~
U: ~■ r L1~ Le-.,1.f, ~E e- :?T . o -nn ~ ~-f-1 .... -=~ o ~p (, t

__,,.~----
.2~ M {l."( ~ 1:-7
~1 L 11 "r.1":.r- ■■.., r1 ';:, Dcc I PI ■ r.~ -◄ ◄ 171 - ~ . () M'- 1$ !'-N-1:1 71 \ ~ ... l.'■:> O ~11 -o.,
')t' t-lr -..J ..:,; ,-1 A._:::JI• 11 r. 7 ~ Jl~ . O dp r,g ~-N-n o,• ◄~.-~-~~ ~ z ::., 2 Q :10 o J
r.~ ; ~.,
1 ••
----- l~L■-~~E,o,J.. 1-J,--.~-( _ , . , . . , . . . -_ __
rT!i. T~~, 1 Co,r: 1a I ti~ - ;,:,I,
T'.TT':'~ ~
"°·"' "11 -(, n
a•,_r.: IU'lE _..,._:.,.. _.,..._ _ __
~? ~ . 11 dg 12~.e ~9 ,, a
!',:, r.a-:--1-te
~!i 1- . -~ .. : ~1:r-c•r- L-
~~-& d~ e~ e~~
~l .~ fl tll(I ! 'll
-! ., • ◄C C ~ ■ n¡at
c.- ■:, 1 a ·
~ •r a o.c~ lar
L111,p';.ti 1,,..,~•r- 1c-
2T e d11 2r . c ~;
-:0 . l 14~ 6~.~ '" S:J . ◄ n ,
~e i.. i .,_e, - ,r-on-40.•. A.Dl ? , . \ rm ~1 .é ...... . !I . ¡ .,., ~ ...... •■ ti ■ fht:. (CF-0...~ ,Q.e.,. f4 ~..., ~ ¡¡ ..
!. : ~: -.,;: ■ r-'a • :.·1·, ( •··
99 ~ . c.t. ■ r.:~ "1 "/ t.:ii l di:-1·0; ti
m, 21 . 9 cm PJ ~,..
l, . e ..... l ! .2 ""
. ~-1;
n. l
◄~
4;, ra-
P,~-•
-:,n
~ r~■ ltio,
Lb,•o.r I o-· (ro· t o Pl\') -•H l , ,.
1~ e ~s; 7~ ~
- ◄ :¡
~o
l- nn:
~o
• •J -
!!-tr 1.1• ··· ;':,~ .... ,-~ :i:;; •• -::; 80., da o ..
~J éo-~..i ~•r.p~ ~~ l m ,~.o ~ -t"l.1:

5ll
 THE LATERAI , Sül\·1MARY ANAi .V~l S
Purposc Paramett:"':r
1. 'J'ol;~l f.e¡c:~-~l h t:':i g h1 . , , , Co:i:pu5 . :'\::<l~ to .13aN
'> L,. :,,.,..-.::r fo r:i:1 r ht:'1 ght . . Corpt1 s A.ns to Org li.nc
:3. C<:ncrnl fadal d:rcc.L'.ún FaciaJ A..xts to Ba~<
1. J.-adal d.e pth . .
J , Cür;v..:xity , . . . . Puint A -.::o Fadal Planc
6. R.amUt: ~ie;ght. . . . ;\-fandib ul 9.t' Pl 9.r"l I:": 1.::-1 f.n'.} nk fo rt
. - , P,i lr1 l-1íl P lm lt> Pusitiun . Pnb tal Pbn::- to FmnkJurt
8. Po-3t.c:.ri ;:ir Cra.nia.l lengLl~ . Po.sterior Cond:--1ion to PT\l
9 , 1\11t:--r.nr Cr.~ni:~J 1.::-J)f.th . . C.r::i.ni aí e.en L~t to ~:1s.i on
l O. Lc!\'i-'Cr '.ncisor posi ci on {horizcnr:allv) . . Ind5or ti p w APo
1 . . l l.)w~r : nt:i so I' pü.~i Li üfl ( vt> r1 ic:tl Iy) . l ndsor te p t;:i Buc:cal Oc:] u.sal Plane
l ::2. l '.~pt-r mol.ir ¡.,iu~itioCL , , 1)i:-:l;~i üL LlfJfJ<::T 1c1ul:-:1r l.f• F"t'V
l 3, D.::-pt h of 10\'>'t':t" (1 ~-eh , . Mt'.~Í al tl f i noJ :Jr t.o i 1Ld.!io T ti p
: 4 . L1-pper tu kw..-er :ndsor , inu:r-j Jv..:i.-;~ 1 ,uigli::-
L'; . Lci•,1,;cf li p p:-otr usi on . , Lov..'C'r li p -co E '.inc
 THF.. FROt'tlAL SLM1\1ARY ANALYSIS
Purpost' Panuneter
J. N.é:.~d.l l~'.-:1viLv wiLhJ 1
/
. Neto Ne
¿. ."vl.L•,¡jll;~r_:,' wic.lth . . f ug-=-1~ 10 J-.1gl;I lt":
J. ~:fandH;,\ilar widch . An ~gon ion :i) :\r~t r.gox1h:1
4. \fa_-..;Llb-n~a.ndibufa.r wiclth (L) . . Jug-,ü~ ,;:o fronCo• Faci at Plan::
, . ,\1:~ xiJ lo- rr..ct n di bu1..ff i..vid th (R) .
(
_Jugalc to frcmo- f aci :=i I Pi.'J..J'lif'
G. ~1:1.n.dibular symm..::try _ . P.:olubc:-rm1c~ .\knti to Mid Planc
i. M :-i :< i 11 ;tiy ~yJ'tlrnet.ry . . Pob t .:í.n:s rn \1ld PJ an~
Demal ¡.-,·ontal
8. Mol ar ~.,-idth Tri::lrn--bucc-:.ll of lowcr molar.s
9. Vi~~ prt'rn,/ ~~r vád ch . Trans-buccal oflo'.'.;-er first premolar
1O I.nc..::::-~.anini.:: -..vid th. . T c-an.~-(:.at) iTlt'. ti r~
11. lviolar posi tion (l) _ Mo!M bucr-.a.1 te; Fr:J"nt (,)- Dt:':l:l:al PLu-...:..·
1 2 _ l\1oh r· pt).~i C.i 0:1 (R j . . . MGtu· buc<"ill to Fronto-D::m:al Planc:
13 . .rvtoJar biL~ (l.; . _ Bm:c:al nf i\tt t.:-.1 ]36
l ,1. h1olar bit e: (R} . Duccal of A6 to BG
l 5. !vli dline of Jmver . Ec11 b ra~ Llre úf kwvf'.r i 1K~.s0r 1(: t,..1_ ¡(: Pl.

For exp Is.nrd ion oí

! . f':acl I pa.ran1eter,
~et: A ppt:n(I ur.

Thr: frcma.J provi.des i n ro rm a r.i Oi:7 fo r r.h ~- t.rar.svers~. di m~:r.:-.ifl ns. For i h f'
fron.r:.al, i"ifl.l:':~n ic1t'..~S1JTl"':TW:~J1ts ~IT cmployt'd; 5t·v~n ~kdt':t.'d ~ui<l l"i.ght dcn:al
m t"...'¾ 'il.lrt"mo::-n: ~ ar.::: ma.:_=,,:. Thus. thiri:v mcasurc:mcnc.s can be evalu.a.tcd evcn for e.he
/
11
.Summary .J\n¡.:¡lysis'·.. ,..·he:) buLh vkv,·~ Wt:' ,:U~l.!S~Jt'rtu ~lld ~-. ::;1.)phisticatiü:l LS füll?ht.
 l ;uncr ion #5. Fu rnishes a Framcwork for Ah~"tr:,ction a nd .Red,1c-Hon

Ah stTa"-'tionism.
A1l ~l•:Slf.ac.l.ion L, a ,,um maci;.f'.d sLal ~m~l"'l1. c,f a major composition_ Jf :he.
anatorny and phyiology uf the ,vhok he.ad i-s to bt:: crJn~iclt':r-ed, á gtt':Rt bt":"'A-ikkrin.g
-eo:-npl~..--ity ,\"Ould r,::sult ir. its measurcmt:nt and dcsaí.ption. But throt1gh a s.de<..""tion
of b~,sefüu:· püÚ rts .-.i nd vfo.:nt't (.lf rdt'Tt·.n~:e ,~n OJ:g;i:t'li ,~d methüd and r.he. pa f::lim f".L.ers
can be sdcctcd. ThC'sc rcfcrcnc.::-s should havc, .first, biologi<: sign.ifj c~nc.e .tlnd,
.~~(~ J rHll.Y, a..vail ahi] ity of per ce1) t¡on : n Ili ~ X-fa _v v k,..,.. 'Vli th a val td ¡:,roo.::ss th.::: bc:sl.
<! bstraaion for d t'5,::ri pti.on can bi:: achic.-v~d,

lur 01c>: he~~I pro~cl11tt": {r:.:iJ: t.lll:": ("'.V.i; l11~-:1tiri:cl of :s''<rv,:1.h or Li-eatment change, the
most stabk o,:- ~1nch..~nging ,:-eh_"Xcnc~s. a:n~ exnployr:-d- Sud, ,:-: dlt" (11'i(;'ut.-11Jnn {r,:r:
thi;>. polar phc:n.om,.:::r,on of grmi,·El-.. Also, points on ;;:he ja\YS s.crvc for ru.1...'"11:,-'Sis cif -cooj1
ch:;mgt:!:>, Sta1.1tb1á v:tlut'.s for d1:mgl:":i; ,it:t' ;,ivai.hl,1~ fo!" rde-_ren~ in the compuí.e..r_

h)C' the. forecasti ng of gro\-,·,.h, an. ar..:: c.,f grO't'r.rth for thc mandibk ·was
ab:;,trnc.ted, St'CC)J.11:.l ly, pht'tJUUlt'lli.t for Lhi:=- a~6ud.tUon r:.if UL,trnlihuht:1· grnwl h ...,..¡ 1(1 Lll~-
.'7"0'"i-1h of thc cnmü.J base nnd rnid-facc .n.150 tollo1rv, Thi~ in t urn l )'"c,:uu~ t he b..i,i;c:- for:-
pl ot.rj n_g dt"'J"'tta] and soft tissu.e c.hang~s-

Ju cffc-rt, thr::~t' pr,K·~i1,.1n·s are- ;iJJ nb~rnctiVt: .md 1h~ir 11s.t' lJ1!3y tx--. li.\~-:nc-l 1 11 l :L
short-ha.11 tl J~cd1cd fur thc tak:ng of dtctatlon_

ReJu...-tiooism
R.oducdonism is simplitkation_ It is a procc:ss that pcmüts not only n
:::urnm~ri:7.a1h1n hL1t l1;m\oitlE"~G :l. :-nif,tn-~ foc thf': se.le..ction of t.hc:: most. ~iP.:nific.ant.
-.., or
ir, 1¡Jo:i:1 -lLJ lt ~i-::ipt'~-v; e~f :':iUUlt"t hi11.g compkx.

TI, u~, a prüpci ce.~)hal c,m~~-tk a na: lysis wi1l pt'.rmi l a 11summar/ forrn 11 • Ev'o.:::n i [ .a
.,d. . ~tr.t.é': l,'=' n1 ()'{f c:OJHpi:-tlldlb-i Yt' in --·,)ntt'nt, :such as l h:11. ~vtü l.'1 h!~ ,,vi i.h I h~ (Ofl'\fn1L ~i'.',
i t stm rcprcscnts an abstrac.tion. B ut clf,.:::ctlvcly, by comparbon a. program can
reduce Lhe. surnrn:1,y fnmi b_v t.ht>. sdc>:c:1 irin of t.ht>: niosL. me-~qningful ,.qnd sigr1ffic:ac1.1.
Int'éLSltn:'m~1ts for du:: cünidml's a-ct-tudon :1ucl cht: ,;,m.Lo1,.mi uf h.u¡.:iulÜULCt' tv bL
~tta-ched to a me:1.~uremc:m.. 11-. is ¡_s the bea.ut:y of appli a:i.tion by thc computcr
bt"C".-11, .,C" f ht" el t"I ~l l ~ no rs Li-r:i g flf cfo t :1 , t 1tfG,rrl:,:;

VVtLh th~ comput~c· an;.ly:-:i:; ~lso tht". is abs.tTacted by dh;ision of the

p-t\)L~~s

m mlysls ím:o fidd ~ of intt:Te-st ar familks of mLmllrt'lIH::nt~, Re.d ~ ction b

accom plishcd by che use of 1ndk:cs fo.r v;,-e.igh ci ng and h}· the us~ of sy1nbols (or
 ,,

~st:.:rbks) to denote sc:veiity. Bor.h ;th~c.ract ion :rn d rf'.dLl.('t.i on hlf'I p e.o rh:-1 ~rm lnf' eh t"-
<l~g1·~,e of dlf:-k.ulcy in a giv~n :.i hl11tii m,

·i.ltr:-- PJ\.1tb~ stancfo.rc clc·.riatbn is understood_ b ordcr to ímpro\'C 1cs

,;.ppli~adon ól din:-::-n: dC1i.iat:on concep,: ..,,,as inuodu..:c-d? Th:s ro·.mded ou-c :1Umccrs
ínr i.::asc of mcrn.ory. gradf:c~ v:-¼l ue;,:; ÍL)r di Jl i L'..::-1 .t pr,l ic:atj l"H1, .:11·1(l ; m pe ov~d
c:Jnl m un ic.:1 :.i ocL

Br ie t" Sta tis tic..-.i;.

Dc:-scríption
lL has been ffin l..f'.r'I ckd. he:~1 t, t.h~ L d·.e fran kfoc-L plan~ pro,.•ídes thc. mo.st u.se ful
,srit·.:nL"~i1ioT\ for:- d~::.,Tiptim1ml~ Hmt tht. fü1~1r:m-N:lslrn\ pl:~n~ is 1.ht>: rnn~t cogf'_-nL ÍtX-
:s<:r'.ru ~--Qrk. In rnpport of th'.s :he-sis. a.síde from thc: practica! ~""<:"ryd ay V-é'.lu::- ga:ncd
, .. :
"-V:.fr. its L1sc:, somc .st:nplc dat3. a.re offer(!d_

1-h-t" supt>:riúrüy el J-'r.tnkfor1. fr.-,r· '°l.ypi,1g- of ::he faec "tva.s s-een in tne flr.st
compu-:tT s.ampk of N::-:40 subject:;S at a~,e- U yta:r:~. hJr lt:',~li 11g c.)1- 1~'t:'. G:}lnl:-il
ftf-erenc.-.::, for rclatbR fo.cía! poini:s, the SN pl.'Ulc, FH plane ami .13aN phnt ..,_,,_,~
n,_..~_.,,irf'.d írr:m , ht Fr:1ch! pl:i..nf' C'<.t~k:in-Pogo11ion)_ T~1c Stand.:l.ri Dc\'iation h-,:im
~-N ,:wd 1;,¼-t< w¡.¡ :-. .-.. 1n·.o:~t ¡d~x,t ic-,i l, :,n =::i _'/(¡ l.ú ± 3. W fi:-..s peccively. f mm F ra~k~·c rt
plan.e (P-0) -~'rvith tn1c Porion) thc S_D. 'rVa.s J..:2}{. h<l:tkforl LhtrefoR' ,hlJ'r'L't'r.l Lht'
ue~l 1.)'.-0:.k;· íor d~so•i bing ptD~u~ l h.i.:>m oí th t <'hin_

....

/ J
(Cr
....."'--" .'
54 1
 Sequ cntial Change
1'r.u- ;J b gh '.. nrtlcr foi· asscssmcm: ot dircctiomd dvm g~ Lh~ avc:raf,C- valr..1 e-~ m~i:..:
:«.tar:._d.a.l·d crrors o f th.t' :U\t'~l' ......-e.r~ -c:;1lcula.ted, ú:!sdr.g ch~ sam.t' thrrt h;1sic planes (SN,
Fil, ,md B~N}. 17K chin (Po) . -ch..: n1.c1Jdlla {AL ~he r.amu.~ {Xit thc n osc tip (e) 8.nd
thi.:: lov►,,.'Cr mofar .136 .,_,,-t'.t ~ cümpa1·-e.d (sec Table 1) .

TCJble l.
--r " ---l--á-n-1~fi_u_r_~~---- . . ,--.~-.-,'y-.----.--·~-----.---R-A--1',-,--~----
t a•.-errigr Fn·nf.:.joN m·~mii• S -.'', t-i -..l ·ru.irc:- BA -l't'
j d~,JIIJíe 10,fS d1ange .í?.WS c/za71g.e- JU,f.S
Poi11t I x I i~·· - x 1 ,.. -~X l r x r-¡.. .:r I f x . r ··,.:.- -
-U.14 -1..l-4 0.26 0 ..26 -0.47 ·· I .'1}. Q.J~ fl.32 -0.90 -0.80 U.Z1 0,14
1.5':.: -L.~2. o.:-:5 o..io ll.9~ ··· l .48 ·:.l.SS lY~i D.05 -2.J2 0.4~ O.Je:,
O.R~ -0.9~- OJ(: 0.12 ü .bU -1 43 D.34 O.JO ó.O~ -1 .25 G-.25 0.24
l.~~ ·· fl.50 0.41! n.~-4 i.i'l -L?.b 0.:5-9 0.4 l L.11 -l.4'11 O.tf7 0.~9
L.~-!-- -1.76 o.:n u.:.d l.líl -2.23 11 .:18 l1.29 O.Jl -i .rn 0,1',1 fl.2:5
- - - - ---·
C::i.:~ll bt iimi; w1,r1~ 11: 11:.lí?
-·
U.u ll 1.'~ 1~ ;:!P. ,~?1 :tll~o.: lu lhu X ;( 1~ 11 Y ,UrECtic-Ll.-!I fl 2 w1il] a~
l.1) :1 0~1'!-ra1 iLLe
1 li l' r , 1(11 ri~•~a:L·!'l,¡U.'Ll'1'!u C'LTl)~i;.. ~~ i:-. 11l1•..: n1i~ t.ltnt in l:\'UfJ h,ddo:1<:o?. •,t1r. n •f'l!1·e11ise frami_i 1,~licl1
\ 1L.Li ~od the }t'r;1.11.k1'111·I. 1•. (l l'LY.IHil~L~ \', :u:¡ :lppn:: (;!i~ bl:· 111 :tk!J t.lt~ll\ u.a!~ wl d r.t Lltj]j ,.ec1 gi.:;[~-11 ll~ illiL.

l\n· Pog·011ion, from thc BaN coordinate. th-e u1e.G-n change in milliin-:.:tc:n
horizo~1üdly \.\'<~:s ().05 mm. At 0 .48 sta.n.d ard error. it -.■..·,)l.1ld -~ugg.f:c:1 ft!:i.t. th12 uuc:
mi.::~.n for a .s:l.lnpk v,mild h~ l>ct.v..'t'~a 0.-1 '.1- tnm. and 0.53 mm . .llmu~t 70% o~ the
L.1m-e.. ·rhis \-,.vould suggcst thm chin gn.r.'rth v..i:i:it-" ~ssentialJy from a pcrpcwj ir.:i..1hr:-: 1:·►
t.ltt' UaN pla.ut".

From S~ -che Ill{'..nn horizunwl ch,mgi::' w;;1~. 99 (,;-,r I mm.) pc:r ;re.ar -rather th,•m
O.0.'i 1,itr y~:,H· i::i ~ rn~asu~d from BaT\' -ec,o-rdir:Dtc. fruxn t'lJ 1.hi:: cha.nge \-,,"as 1.59 mm.
hr.wizoJE J.~lly. T), r:- B.:~ N r"t" ft-1'.fr'ICf' W.f.t-~ t.h ·. ~s a f1 ;iperi or base for lungi. l tHtn..il ,H.L,-1.lys~~ nf
horízonUJ.l b.::havior of thc- chin. (.S~o;::- Hl.1.1~trnti.nn 0 11 p8ge 56.)

l'oJ.· -vcrtin t.l (d ü \'VJ r•.,.·,n:d r1.nd foi·wa rd) changc: (of Po) thc rnc::-rm ·w..l s- 2. ~2 mm.
and the standard ~rrm· wa-s 0.36 xruu. \A/ ~ krve t":SL..9.J,fished a hypothc-sís of 2. :5 mm.
pt'r ye.u: ~ l GJ L.-~1eI iun. Tha:: ,.·CJ1.ica1 c:hangc: o.f Pogonion from ~ ~ w ¡:¡,~ 2. 4 8 1n m . b ut
trom F. H. was only l. 9'2 rnro. The. J.q rg-er "Valt.:.e reflects thc ~,ntenml d un Lge~ o f th f':
eta n h tm. Jn t h~ 1990 study of 7 3 chEJrt11, t.he- nLtttH t fa ~j~1 a.xi~ dosc.d 'i."i.rhilc th.c o1d
Y a:ris frmn .SN ()p~ni::.J.

Bt't.~1.1!-l~ Ct· and CF po1nts a.re d os~ toge-ch'!r th.c: run.<. nmt r:í dta.ng~. for Xi Point
,,rrn...ld be rdkctcd only iu <lin-:1~1 io:n .
 f wm Ila~\' ac. Pt. th f' Xi Poí n L irio,.-~d h~"k 'Ar;qrd O.9 m n, . .!)nd dov•'J\Witrcl O. 8
mm .. sho~>:.'ing a strai ~~11.
~ . ( kr..vi: lWa{"(.l and b~do:,w<.l:rd trnd l'ncv
. frcim thc Fada] Axis
CJfirdi r.~t.f (st"f' sr1rnplr N-:: :;q of 1970 b~~ow, .ru1d N= 73 of 1990 on fc.Ho,.vh1g pa_f;.Z:) .
Tfn.1.~ i1 .,._. }j~ c~)rKh.1{kd chat for longitudinru analvs:.s :he BaN rd"cr..::nix: \..,·as s·.if>f!.f:úr'
t0-r thr. :::nn:ndibu1,r points on i:he clün and raro.u:..

hir'l.ht:".:·, wh-e1'! ljnhlt /\. i,,;.•~s c.::m5kler-ttl from .S:---i ic ::r1.u~·.:.·d fon\ trrd. ü. 6 nun. a~c!
0

tlc:•,,,,1m':.U<l l. 43 mm. Frorn fH , Poin:-. A rnave.c fon-.rard 0.88 mrn. :m<l clownw:;rrl
O. 9 S 1~1 rY>:. f :"{)nl :fi.8~ T"t"fr-rrr.cr it moved fo:r'i-'r":1.:-d only ,09" mm, yc.ar.ty .and d ownwnrd
; .2 5 r.1rr...nlr.r,osc rarnlld t-o the beh.avj or of the. ]O'i\rer indsor.

h1 v\:-.:ll:ll ur1,1]ya;t"s thc :1o~c- tip ~r-:: and b~bJ.l,,.'Ív-r uf the l::.,v..rer: tnul:.ff (E6;, v.1r b~
.!lOt~d.

Bo:Hter Po~ar
\ 1;..--¡1
. --.....:
\ .
.... ./

:5-6

'·
 On SN at S

1990
Composite N~73

BaN at Ce

1
.'
/
.'
1

'

57
 111Jncr.ion #6. Rcm..l~r~ a M~~n:o., for SeA..ltJ("J.U..iaJ Growth Am:üy~ís

lnteri:st :in Grovd h

Grow1.h has. bccn a conttnucd 1ntcr-cst ::::::nce tht' begm:1ing of orchodontics.
De,..relopm~t1t. j~ 1~11:i:ly ri~ociated ~vith gro\\.~h to includc é1Jl c.h..:rng~- D~,~dopmcnt
t(.1\vMd -~~nHkv r- '"•-mtim1c::s .!.:títt::"r ~,
11ru,~·Lh iu :,.l:.:::e .:;lun.o;.
r / ín on:h.odom:k theorv
F.adv _.
grmvth w..i-~ it.ssurned to be. ESsenti a.Hy controllc-J by tht- tre:Hm~nc. mecha.njsms.

R-t:;c:r.Lgcnograµhic ccph.alomctry "\'Yo:'!.:'! lk·vd:.1p~,l íitsl [or gro•Nth rc-s-cMCh.

Latcr ~t 'N,i::i H:i-;t':d for sp~L~ifj{'_ de.tail of u·eauncnt dumgc-. Thix-t>: mJ:t1n divii:;i11n.~ of
l1 t".ad gro\\'th o: conc.:rtL aD:" .s-kek1:~L dMl ':../,l l .'in J fioi-c. ·..i ss.u...::.
·:.

..
., - Jv1mulibul:-ir: _grov.·ih h (if g~;:l1. :-.ignilica.ncr dtnicaüy. Th::- dini<.fan c~sirC'.~ tú
-df'.L.ermi ne its partidpation iIL tht' U1ITt'Ct.ic rfl O f e: l:~s fl tt..c trcatmc:."1,t of {kq.1 bitr.,
O

.:m d 1 hif' rint-:e.,;;ses. encol..lI'ltcrii:!d in thc mar..v.gc-m(.:'.nt of CL.l.:;,.:; (JJ L"'..ond..hj cn.s.

~o or..c (]ll t.' .sti.01'l!i dv:' abj_lj t y 1 n ~ 11 ~i· 1h ~ J.r.-t,-~Jopmcnr :::if dt11rnl a pparatu~ ur
tLc:- i nfl,:~ncr. of tc-c.th or thc son tí~sucs. But of Wi:..:tn:' fn L~e'{'_.:;:. is th€. q uc.st\on of
po~~ibk 1-r-..~:Ll.mem influe.n~s. ~m gro\.vth and dC""►'dopm~1r 01' 1·a~ h.1fi~J skt".l-f'.1 on.

Con trovcrsh.-:s
H:-.1 h j n anrr. rr+i,ology and ccpha~omctry prugr~~~ 1ta:,. bet>:n ha mp~ced. by
diifc.'Tt"'nc:~:-- o( npiilif:T"t 1t>:gatd111.g cditt-f'.Cl.:CS to be uS<'.d for ns-se~~ix\~ gmwl.h dt.:11"1_g!?:.
Studks of rt"\.. ~,...¡ Hni:"s 1:i-y F-l1J1 iw :-l.nd 1mpl::rn1. sh1di12~, hy Bjork ltavL hdJJc::-tl tu ::,.tlix:L
:i.tr.1bh=: sicc:s for .analysis of chang-cs and havc:- '-·lar;B.ed .50m.f'. argumen::s r..:gardtn~
gm,,_v, h. CompLner ~search and t~ avaílabílity of cornpo,-;.jt.:--s h:h,~ hf'.lpf'.<l imm~nsdr
te providi:- _groi,'t1h d.--1.;i .;;iwJ gn;,,,.vtli v.-::iriabiliL.y.

Origi r1al stud1cs on drv 5kulls ..,,,..ere condu.aed from Porion. \-Vit.h <1.l"'to<1ly.sis,
ho,.>¡,·cvcr, i:. b~c:mL~ re:oog11iz~d Lhál growth o..:c::t.1rt'€d on both ~des of th-t" ,,.o,-ona.l
~utuTc compk:x.. The L~tr Gmal (Imtl Pr>1iüa) h;u.l u.:--~J~ cúnvc:nic,-it ...nd ea5y points
fm~~1 vvhi ch to me asure skulls. V'r'íth hc-adplatc-s- Se-:lla Ti.1~i.<.'~~ \",.·.'l.s .t.l;S(J pla.i nly visible.
irn.d -CcYJJV('Xl.Ít:"ut. h1 i Is favnr. Sf'lb Hf")i j n pmxj rn it.y ro Ihc ant.<:rim l-r,mid rd'errnu:·>
or d-ic. supcrstructurc for thc n..'í5al (·3'1.ty. Al:-::n, t.h<':' Sdh-Nasion linc. l.s rea.son...1.bly
orj.f':nL.e.11 L.O rhc •.ippcr a.nd mid•fa.cc:.

Hov.·e'i!Cr, S.::-lla has :sc·vcrru linritation~ for grr1w1h 3flalys..is. lt (1) lic-~ bd"'.inci
d1c:- lvrun..il 1,-ulrn't"., i:. {2) i:-. rdal.1.::d l.ú bcain or ncuro-cr.nni.:.'tl grr.::,¡,,-th., ~md it (3) li.1.:'"ho;
nbovc thc principal brndng 0{ tht fa,:e at. • ht>: .K,.o:i~i-Cranial Axis.. Sella .nho (4) is a
po0t rf'_re.renc:e forthe mandiblc-,,.. . .i1i.ch is support~d lntt:"T:illy ír11h~ 1~mp0ral hnn~. J11

S8
grGv:.rth it (.5} ha1: :1 poor· ~xrre_c;sion of polar ¡.::hcnoxnt:'1v... .n v..i,1 h 1h~ oral ,c.;¡_vit.y. Tt was
{6) fr¡1tnd wc1.nti11g in rrliabifü:y fo:r gru~'tth foc"t'.~Ling. (Hfi:c:cn to twcr1ty pt"l"'-..l:'.nt. nf
groYi!th on ~ h~ Y aJds t-va.s a-an1al 3..tld not m.uwJíh·,ilm.) h)c all these n::asons wc "i.\'CTC
for(-:f'.d to ab,.mJun :t íux· ...,1:c1r(J,..,.'th ml,i.h--.si~ ~nd 1m-:.díction
/ { .

Polar Gn.,wth (i .J:Llera.1)

A cc1·rcn:1] rdcrcncc: "i-Vas found tc.i e-:rist ;tt I h t': hasi.s of thc: .sphcnoid bon-e- at
fo:r;~mt:'n rrn 11ndum. "Brodi e fr~q uently rcm.c1.rh-<l tl L;~t wl ,itn '."le s upciünpo.s.eci. a series
of t.~ctn~ he -P~IT"d riglLc JtJ\,..u Lh~ :-:.pli~cll")-pa.1.acinc .tossae·~.

A 111( 1it'" C-1)m¡1li'.1 f: po~• f'.ri.-.. r r.o a n t.c:1ior a-a.nial ba~e is rt"'pl"t'~t:"J:lté'<l hy B:-.:"ii on -
~;.i :-:.ion. A cm through thh pkmc si:.."?.u:-~t (':s. 1.h~ r&et::': fron~ thc cmnh.::m. l.16,:_- of thr:-:
J3n::..i0lL-N~,;:;1on plane registercd from fornm,en r1.-.Hnlt:hnn (P'r.) ar. Cranial c.cntcr (Ce)
simplifks growth MMlysjs signiGcanlly.

\Vil], 111,s. o.-ii.::ntation a n~markabk: order "i."r'<'-S notr:·.d \H fa ria 1 hL~havior a.nd cvc~
in :.he nasoph,u:yn.".', ,'ln.d vt'r~br:H':. fhus, ".\-nen t'i."i!O or more t rrn.:in}_..~ ,11~
:r;npr.fi mposc:d in thi.s mmmcr on a polar griJ, JJo¡_n ..Ao; c.e.fKl tú follo,.,• thc- polar co:.ir.si:.
 \POLAR PHENOMENA

\ ;;:; 1 /
~
'¡v[_:/,~
,J ~
J .

: .

ORIGINAL 1968

13
\ ______ 18
UPDATE 1990
\

5 Cm.
 (t
GNOMON
r 1
1 1
1 1
i .

!.

61
 N73 '
non
46/27 '~-
:

,.
1 .~DT~~~:,,....___ ......---+--'--~L..+---~ e>
1

Age 3

Age 18

' .

: .
Normal Growth and C1
D eve lopemen t of Oc el usiou

62
 Gnomon Bc:hm.ríor
Growf], mx-:nn in proportion. A gnomon i.s thc add.cd pan to a form -..,hiel'.
e.Ir.~:<; w.>t durnge h g,o:rr1i::-tric:&lly. As ccrLtCTS or YG.-:~s of angie~ l\rere lccate.d,
suµ-::rpositi,:m !:hm•rcd rdadvc ccnr.in1Ját.ioc1 i r'I for111 for t.h~ OtL 1bal, nc1s8I, ¡md fJJ:':{1
c:ivities. fronica.Hy, the Vf'.f1R.x~s c,f :l11gl~s ()T b,~!,~,t. OT ~re~nC.:1:":S Wt:".rt: lornted ll.t
t:'.11L.1 :mct'.:-; L;f Ilt'PIC-:~- 'i11b ph('.'ltomc=non also bc:c::imi:-s usc:ful fOT ~_:Toi.\'1.h .a112.lysis..
/\llumdric is ~nothcr- ,'i-"Ord e:mploye.d for relative: con.st.ancy of shape. Tvie.cha:1.isms for
.r,ro,,,,:h of rhe. i:·:rani um, r h(" m:1.n<l1 hlt. :~ nrl I ht m,·\':{HLi :.;t:"t'm to rnke [)rtcedt:"J'.cc m th.a:c
ütdt'T.

ORBITAL

NASAL
.
ry-
•,_' v

ORAL
Pl.

63
 CH AR T p o F.

fl':1!'i-t.~;-i or .:i..-.t:.or-io~
f-7'{ to C l} .Q-º.:1i

..,.. 29.0
'?
23.0
X
51.5
e?'
5 2. 5

28.5 S2.3 5.3.3 s:.3

e:
.J 2. 9. S 53.! 54.1 52.l
53.9 .5 2 J
1

7 30.5 ;., /;. • 7 55.7

..
, ~ [~5. 5] 56.5 54.5

s 31 • 5 32.0 31.0 56.3 57. 3 55.3

lC· 32.0 32.S .5 7 , 1 5 6. 1

11 32.5 33.0 32.0

33.0 33.5 S8,7 :9.7

33.5 59.3 ó0.3

14 34.5 60.l 61.1

35.0 (.0.9 61 • 9 El.S

35.5 62.7
'1.1 17 36.0
54.3

64
 13 l:'efj king í.i-l'O\vth Oown {Ahstrat'1 ion}
Fr::qu<:r.tly gt'0t\1:h d:rcc.tion is unckar co thc clirücian. In fact, df:á·('.:r.t
dire.cLion.s can he inc.erpretcd fron·. d,ffere:nt planes of re.ference. 111e1~~orc-. a ccniral
a:·t'"'- {:::um 1rvhich tu .1::1s,~e~~ truvdh .?.nJ dut:'TL:un Jlt't:'d!:> i:.:iJJ.Úldt".cl~"'.f' lt".vd~. Sud·. úvi:-:call
~acial gT8''i1.h behavir.ir is v;.ri:cn:::~scJ frum the l3a~-iur.-Na:;iri11 l'l::me: rt:":gi~C.-tr~d A1. C,\ a:-::
shovv"'ll i~ polar 9-IDWth.

Tht: Fo,ir-Position J\.n~lysis of c_.;,rO\\-'th

Tn g~ncraL thc c'.1ni:ian ís intc:n::s.ci.::d 1n ióur phi.::noml!na. Thc:se ,trc: tl1e ch'.n
1)'osídon l) the uw..xilfa (Positio.n :l), the \lPf~T l.ert.h (Po:c;iüon ,'l), .s.nd the lo~r
:rf'~~h (Posítlon 4,. T:ii~ lnfcrma:cion is provtdi.::d by tht "Summ~ry" ~r.;5Li.uH:~J
a::1ai ~~h ancl i ~ :; h,;,.,•,'l:1. ~t l-l gt":c; 3 1 u 8, 8 l.n J 3 an d 13 to i 8 (or d1~e iivc- ··ve-ar
0

intervals).

Po~iLion One -- ~:o~· the chin .:i~andibk:)

\Vi.th ~h-::- o::t'nt,:-c.1 : pn:;1:::i~m of 1,,,.vo {tacin~ at Ce, growth aJK~ =,c-h;1.\i~.ir of :h.t"
chir. is 'i-isibk by bdu.nivr uf th.t' F:ld:i~ ..\xi:'.:. GmwLL r.ends co follmv thc origir.-:'.l ax.is.
p,:n 11c:ul::id_v in shorc ::-a..ngc.. a.nd incrca5e.s at ;!.. r.::mark.:1ble lmifonn rr.1l~ úÍ 2.S mm. rA'.r
?~;tr. b·. L,mg r:l.1ig~ (_S to l ~:i ye::l...l'S} :he facial A.x:.is tcn::ls to clr.1i;e slightly ón itv~ragt=.

ft.JJ-,.'(:&'LOK~ li'u:Hc8toY t'lf Dlrct'1.io11

.s,nd ,'li,mf)uc'l.t of (;~,,~,.... h
(m o.::rum~I,." in o.::M11)

_Dlxc:c.;ti:;.m: O" ~+2" 1;1 JO }'e(Lr~)

Su1 (1d:1.1 d V lllrl<~L luil:
1_j.L' :it 5 yé.;'U'!i
:l. _(I~ !-ti I O yc:arl>
5 Cm.
(lU fl'i.) ;\mr.nmt: 2. S :mm. c.ach y~ár.
oT I O ,nin. ,:.:,ne·;, 4 yc:a.r~,
8 t.o 13 to lS yt~. eJ.). :.-: :t o. '.:l m IL\. cach )'l':,i r :

65
 Posi ti on T wo -· For thc ma:x¡]fa:
Sh::h:ing fon.:r;.-ard on the B9l.icm-;'.\.."":i.sio11 plmu~- to n:gisci::-r at Nasion si::1vcs as a
rdiablc rd~re:\ce. l.ú ~v:•dl.L!l.1.t' u-..uxillary or p¿i,Jatal bchavi.or. 11,e. angle of BaN i:-.ú
l'oinl A is flhHrn,I ,¡ perko:.."t <.""OTis-cant. In long range PoinL A rnay mnvi:>. focw~rd oc1t_- or
1 ,·..-r 1 , :c:-g:n:~s., but h b rcmarkablc- hov,• conscant it j ~, ru. ~t::-,cii t>. 1)rod ri ¡nted. Tht:'" ,ln.{k
.::l -.:he pailatal pla..rK: ce., Ba.":-: {:ha.ngts h,m.lly m~ tbm a u.adng ~rroT "'i."1,1.t'.'loi...cc
t::--eatment.

•:·

8
13
, 18
Cm. A

f'OSIJIO~: . TINO
fACTOlt:

... ln.dkacor foa 1) ¡r~tUon and

uf Growth (c:h.1-i:,!:,.rt:)
.A..i~u)m tl
~n Ant.c:riot M .l..ldl.J.a

CH :\.l\"(a; VAtl.1E S:

D~ra:liop: o~ Scafüi.·.mJ Vuiatl-O-Ll :!:: j .O

(V c:ty t..lre t:n~,; .sH~1tl)' ..,.. )

.-\mount; hJr .-\1\'~ VtrtkaJ.

1 . 1j P~...,i.:-h. yt.;i.r.
e.o. = =.: 0 .25 t::,u.-h yc:su·.
 Posjüoo Th.ree -- Fon:he. u1)[>et ltt':th
The maxillru:y mol:-:..rs AT'I d iT I d~ors havc- bccn target te.eth ror tt:ft'"J"eTicc by ma.n:y
prnctitto!:~r.!i. TI1e.ir nom·.,·d bc-havíor is rc:lav.::d t:::i 1.ht: i)¡,¡tüa: pl.!u1i::- registcrc:d at ANS.
· 111 i ~ r~(t> rr-n c-.c- h:=i~ rt"uudncd c-ssen tialfy 1.mc:h ;1nget1 ~ínr:t: 193 O,

13
0.7 mm~
.,. lS
1
f 0.4 mm
.,.3mm. -

f..o\CTOI? : Jl;a.l íÚ.1.1 Pl:u1~ {/1..NS-P.N S) .s.t A.NS

for r(',11.tling of ü1d:,;1)r w Molw-
+ 0-c.cl LLS3.l PJ.anli!

I-l.NCilON; lc,,di..c:nh1r f(tr :-,..1:sxm~t')"

lkntLLrc Crumge-

1-·orw;im~
O,3 mn:i . ~::.i.o1.:h year.
(:.n. = ± 0.1 mm.
0(.du9al lJLo.nc- - drop::, lit rn.::,l ,~;r: nmn-:,
U.(,~es.ch }'<=.:J.r, l.~ 3° ut .S y.-.u~,
6~ oll.t J. U JéUS,
~ =-~ O. 7 mm~.ycar =
1 0.-1: nun ..'yt'iu·

67
 Position four -- for low..::r tc.cth
\-\'hile tht: in:ixilJ:H"v t.noth beha,.•ior is r.::'lativdv i-.-lt',~T, 1hi::: h~h.·w ior of
: J

1~uu1,:_líl~ul.1r tc:eth has b~rn mor~ problernd.l=(:;a.)_ T}...:: m~;i.dibul::-ir pla:te r~gistere.d at
t:i.c sy-:xlphy!>i ~ have. Jed to conuovcrsy. I {u-..-.·i:':vf..c, ,vith thc d{·v~:0pu:lt'XH <JÍ Xi ;:m d Pm
f!CJb ts, i t v,.~s 1 H.,:; r nv f'T'f'.<l 1lur. th f.. ar.gk. of ttu:· bue-;.·,{: IJ(.:d 1ts.al planc to i:h-: co:r:pu J ,oo::;
ribo It'JTl a.i nc:d a solid bri.:;:.:- for rdc:-1:1:'1'11.'.e. This is so I"C' :.fo.ble. in fa.et. that it is uscd for
prc:d ic:ti ül : nf mo1ar bchavior.
It .sh-ould ]:;(' ,Ln dt>.rsr.0nj Lha. t thc whol~ >.y.-,·i::r ,~nt11re eru¡:;ts up .\~rd ,!:nd
1 1

fo:r,,.,r;-,rd as r(!v,;::alc<l by tht' ~'i0>\"-i h :1 fC .

11os1noN f.'OUR

f AC 1 OH.:. J , 1..1:t'.: ()1.~J.'..lü11al PI ai-..c ti.)

Corpus ~ .a:t 1-'M polnt

HJ'\;C:TIO:" i: lmlin1tv, for Ch1-1T1gr- i.n

I.(rwer l)~J1LL~

{ ~h;m ~ V., h•I;'.:~; if ,'rullt!,~ :in ()cdu:;ul Plani:'

r.xnJpt¡,m frr.l,n Cu:q:itl!:; .kti:s o,:;: mm. oew;: h vcm
I .<1W,Ct 11l('i:i;cl"'lr -~-O r.-.111, ·
 Soft l1s~uc
Nosc growth is i:ie..a.<;1,ir-t"d from .A.NS (Pos~tion 'J'hre-e.). J....ip Uri.;:-kncss and
pos itioi1 a:'t'. ~1H t~, l to the lc¡.bia.l s urface.~ 0[ t.l l, i.1. ld.5ur~, Chin ti5suc- is rela tf'.d t.o l ht;"
S)'l~)ph_y-~b: (Posh:ion Four).

S.ut:ma:=;9.Ji is c01t~id~r{:¿ 1n ~ do,,.,=1nvard and íorw.:ud obliq~.1c dircaicn from ti 1e

ha:i.~ (1 r 1h t" ,tx· tenor ['.asal spine. Supr.c. m t'.T tt.di (s--uft tiss·.1c. B) is. calc.ulate.d. fro1u t.:,c:
r<.iof of t~c: lc~;-cr ir:cL~o I' ne,v t ht- root-cro\.,'11 jun c.tion.

1
3 'fÉ,l,.R$

8
13
). g ¿

¡
0 @·::.,
~ I 1 '

1\

69
 Fronrnl GrO'n1:h •· T11e Bi-Polar l'htJ•únit'nou
\.Vl"i.en 1.h~ poJ.qT' gri J ~·:i ~ :i;tu<li r:d rtfoi::h~ te Ti~,c I and Time- lI, for thc frontal
~=
1:rJ.i:.n¡.1CJ~l l 0nt' ;:i::-i tkr f..VU ltl n'..Jt b(: foun<l . I-Jo,.ycvc:r, ,.,.ttc:n c;;,ch foramen rn:1.mdum
w~ cmp!oycd h: was- dí scc-vc:red tha t gro,,:,;.rt.h occ.Lm:~ d í re:: m l wo Ct".m.ci·s or pú 1-f.:-. in If n·
Cro:'l. Lal ,P~J'~ pecti'\ e. Thi:. i de.& e:-[ L;ü~ i :'Lfl ut'.nCt>: 0f 1,,.,L;- ll~·. J.mtmp~lit~ ~~~e) 1~r:; w.t~
1

h;rt ht:r ~upport c--ü 1~y : hi ~ R:nHng, l l.01r,•l:'ve-r, D\"O cencers •;v-:re .'.1.lrn05t 1..m·,vork.a.bl:: fe,,r
t:'lc l}"pical clinidan. Th{:rcfore, the data. was collf'.ct~d for .3 stngle cooJ"din:..tt"., Lht>:
r:·(¡.=,~~ng c,f rh~ FfankÍ'on ,.,,.¡ lh lht rJLid-~;-1gitlat ~tfü\t'.

x
;<
/'

>:
',y__.....};
\..--,
-\
1
1

,
': ..

. .

81-POI.AR

: . ?C
 \Yith this coord~na:r::c: oli-2ntation, thc- rdath'C' gro1r,.."tr. ot' th~ nm:~ll c¡ivi.ty, irtga)
pm~:.-:~~. ,wd antegonial poinls was obscive:d. Thcn::: 9C.Cm...:::d to bi;:: a 11 o~•two-thrcc:11
onkr, ,·.•Jtlch w<~:,.; kütr found tu b~ {·oni:;í1;1 r-:nt. wi I h d-,e divin.it prcporcion.

hoin 1.hL origin.aJ 1966 <:omputc:n','Drk grcwth dar:..:. was coll{"(:t-rcl .l-'iw.lixlg5
ii~ shf.l\-'1.'J.L i o • ~ t:•ul:lt r()J'nl.

l:. ., ~ . .t
12 - ~.:::
.:..J"'I :3 - .;:: r::::n . L~.o rrr.
e - se
::: - s::
"º-~
,. .
; ~
'.E - ,C !.2, 1
l l.$

;:.;;Q ~ - ?:;e.~:! r:M. ~c. :,; - 7-;-. 7'J !&!I.

4 - ~~. l;,,:0 ~l - ·-·~- ~~
HN:itt:f: ♦ ½N l"1 "V R1;;t ... ·¡, 't!s-; 1 ~ 70,!IS
. 7~ ·'"'º
~
;.2 - ~o 'J
6 ~.: M S'.. 75
AIJ"' l · ~:::! • e r:m. ,-..qo 10 - J ~ _: rm _ AIJ" 1o - ~9. :i ...,._ ~ - 7!,S3- ~.,j ft 9S . 10
• ~.2 , =- 1 ~ ~ .:!? . 5 '. _; ~J ,.::;
'
~
e: -
·· ~ '.: . C·
¡~--=-
11 -
1¡
2 E. Co
- J G. ~ 1~ - )0, J
::e• • 3.! . .!i
F.
~
~

-
7!:.0
76,~S ~s . A.:-,. $si
lj - ~-:_r:,
7 - '.<.4.0 ~1115
14 - 27.: 2! - 32.J
E - 24.~ 1 !, - ~':!- r:, ~:-.: .. 32. !i ~.. : ? - :17 • ~6 c:c .
!? - 2::0.) H, - ~,.: 2~ - 3J. J 16 - ~a ..=..~
1~ - E!l.85
.=!O - 5 ~ • .20

T:'1c Dh•tnc: Pro,:,crtion

. rnalyds. 1,vns fm.:.nd usdul in t:::anwr:~e ,:_·,J1: t~i.der,i '. 1t-r1~.
T·l i :-. 1:-:. (:(':s~:r.. b~d in .1 SI:'p:tr-:-..1 ~ JJ■'lpe t.
 F11.uc:t.ion #7, Supplíes a ,' \1onil.oring P["{Jll"t:"Ss fot °f(eatmcnt

~e.paration of Gto-w-t.h f rom Trcaune.1.u Ch:imges

Oh.en dirúdans m.FJy be. reluctnnt tf., ()1-:-{.4.tn progr-::ss h,::<1dpl.~1.t=-A., bec.ausc of th::i"r
irubilit;.- or u.nccrtaínty of conlp!'r.hf'.nding scqut:'.'ntfal ~.ual_ysis. As statr:-d prt':l.·iotJj)_f, a
1rusc,:.,-orthy HLt:':t..horl and &..ta are IT<.l\.lht:d íor confldcncc to h::-: g3Jne.d.

* Monítoring pruvi<lc:-~ ~ ckvio..:. for chccHng ,·u\d. ~gu]ating th~ ptrfntff1ance of

tr~¡:3t1f1 t':c"I t rne.chanks.
'•.

....~- ..: '~Monítoring m:::-lm~ tr.1 Vr':l:·n, r-.audon OT ..1J-vi5-t'.,

:+;~1onit-orjng ¡mwick!s a f(:.fr:rcncc iur: 1J1t•. íonowln~ ot a g1 ..."t'n st.rif'...s. of ~·vctTcs

in opcratior.s.

1, ••
Mon,t.o.l'ii'I g 1 \.,,.¡ L~ th€. fo.r-::cast to :z:n.atlll'il._y , penníts tht" d~ 1t"L'I kin of ;;i 11y
::-.at.as:uc:phk <.l•:.:dd t'l l l, •Ji ~t=-:;.¡ Sé'.. or trc-aum:ri:t '!JU :i;forl.unc: that V•"0\1 ld r,1vt':T·I '.\tLIB'
,.he t.úrgor of thc n..'ltural gr:cJwl.b process.

\.Vlu:.n i:s a c.hange o[ your doing?

Th¿ idea of Clinic::.;d l)l:;':'\.-i.'1Ljon \.Vas an nd;u~U.ot'il1 c,f St.a.ndaTil Dcviatiui, fur
bd~c:-r ap11lication to thc: dinknl ap,.rit::TH:~- A.s st,itcrl bdore, for the sake: of
mcmory-, ~tlJ vr, h~s n~ded ro:..inding a\.lt. i\ 1:;:o fo!' the sak.c- of :nr::-t H'i C:i • 1on 11F
importana:, Yill\.l~~ t1e~t",j (f, !naL.l~h ch;:- dinko!t.l expt:':l'if'.T"lLX:. Thcsc ~djrntmt·nt~ for
c:iniC.:1.tton d,.:-víadom;. i.'{t"re .f,:yy: d~:,..:,·.ript:ions of morph,)lugic v:1ciab~es for th.c an,üy~;b,

/•}. difft'ro: tt cúndi 1.ion e.'<-ists, ho.'i-"C'Ycr, h:i sm.,') 11 incte:men t.s of ch<'1.%1t" fol'.' t.h t':
monir.ork,g of tr.:.:v:tm.e:ut. (:tJ"n\\o'l h ln ;;in8.lysis and forecw;.lirtg is n::duu::d oo a
".modular concepr". A m.oduk val1Je h, ~ nl~r.1.n grai.\rt.h hom ,m ,H.kA.p.i;Hi'. ..,;,amp]e. of
o[K' yem:\ du:::at í.on. · rh us:, .'1 tl•/o- moduk i:-xpt:'11.t;, ('(' ínr üsLial ucatmcr1.t .,.,.·m1ld u~
l.ypical L'1.\'0•yc-ar grow'th. l lowt:'."v~, ,;.¡ paLJe.nt may be slO\'i-"(":1{' or faster in .~ro,'í.1.h.
e.4¡rr:t.-,i:.ian. Th~rcforc, thc dír,íd¿m'~ conC:f!ffL is not i:i;:n.c cxw:tly. h{1L ;ri:-ncJ1mt. r.o bc-.
c:rnplo:vcd or built inLO Lht phn, ff two modulo ocn1ri n 1.5 ,vc:ar.s, fine. If it tal~<:"~
.~.5 yt'.a.i·.s, it may rust talo:::.-: long,i:-:r to c·.c:ii~l1)·1ete the trcatmcnt.

Thc:- ,fa\ l'et(~Jlt Rule.

Th~ cc-ncept for dinícal intcq.1Tt:t:11.ion is forthcr complluitC"'d h'I 1'flnn:rr:-ri ng for

Tl
JJt'ÚAb '-'f wi:".-f:ks or cn(mths. As a t•,;:orkl ng hypoth.:sis, tho::-:~furt', ;.. pr~J1 f".;:".1.L-..,c.
-.,adation of ten perct"n.t (10%) it {:'rnployM. ln othe.r ,.,,,"Clrd~. thc ycady muJuk i.!-.
di.vid t"<l bv t ~n For a hase r-cfcrcnc-c: .
~

The Four-Positíon Analylids for .rv.oni lt"')ri n g

The 1 iu ru 1;:1] vr.1 lu~s w i 1.h g-to~vth nccd to be mc-moriu'd on <'-' 11\f>d11 lar ba si :s ímn 1
each posttion, togcthcr "ith a our.-:-ye:l-r val u~ of dinie..,..1 dr.:viation. Ar.y dcparturt'
f T<"lrY1 1 hos~ lf'.X p~CT.erl valu.es 1s thoug=-. t to be a:n htflut11,r__1: from lltr::-,.Ja~.n..i c:a I or
n-c-atmc-nt prr_1,(~d un· o,

Po.si L1Otl O ne. -- fo r :'vla.ndíbular Orthoprdics

. Thr dtln :i:nove~ <m t.bt' ~:.i (':i.~i l ,'1."<i s 1. 5 mm. pee ye.1.r. Ten µ.:::rccnt ·woul<l he .2 5
mm. This ,l\·ould n-1.can thc clinidan can nmdidly t.üo::.c: credi1 fr1r r:1ny1 hh1g· moK tha.n
2. l \ :rum. nr 1~s._i; 1n;1:1 2_2_:; m rn. in one yea.r's time. 1f thc monitoon.g is 6 1nnn t.hs,
1:hcn a. I.25 mm. ba~~ k;. u:-,;t'<l :+: 10% ~vHi.iJtl 1.Jt'.. 125 nlm. úc l.3735 nu~. ( 1.4) or k:ss
rJ1an l . ! 25 mm. (1 . l }-

Givc:n a trndng c-rrur uf O.5\ if ,"1 ch :=11-ag~ -'."Jf nn t>: c~gw·..e on thc faciaJ a.-xis occur.s-
in six montt.s, thc clir:ician m.ay m1·.clt1(~e th::- du~:,~r- 1-; p:rodtu'c=-cl hy :.r~;H.mP.nt.

PnsiUon Two -- i\.·1axi11.a ry O rt.hope.dlc.s.

ExpcriC'lKt' has shO'\\'Il r.hat .::illlirJs L m L}' ch.mge iu. ~ J:ki ~j on.-Na~¡ on Po: n c. A
a.ngle 1s trea.tmor:n1:--induced. T..::n-y·e.::rr grm-,oth pcrlods m.r1.y .s-hc:'r\' n mt':m iJ1c:r~:lSt". úÍ
;-ihour. onP. ~grff'.. Abour l.iNO de:_grP.1:'s i~ tt.c: max:irnum evcr ob.s-:::rved. T11m: in shürt
tha1c po::rlods 0f rmc- tr) thr-t't' yc::~r::; ¡.1CJiw:1t A dumgi::: j~ v,:itlii:n l.1·.:tdt1g e..rror.

11H'. samc. i'f'.gularít:v ~:s ~pc:ctc:d 1n thc a.nglc of thc. pa3atal planc to B<'.h"f. lt is
MJ sm~ I[ ovt":T' 1()r 1g pt':ri nd-, 1ti :tt. -"fl y ~h 8 n.gi:: {::rn bi;: .f.lfif;iJrnt:d 1.D be ueac.mcnt-indLLced.

1n summaiy. si nce the: ..::--iange. in 1:hc ar.bk of the facial a:<ls is seo small on a
yr.r.1rly b-:1')h, ;_md bi:::t.:aLLo;'" U.\t' .t:l~NA ;t1.i.g,l.t-: i:-; .si·J \'t"..l}' uXLh-..dy, :•n_y L~hangt=-. al .a.U ¡n sh
nrnnth..s ta a ycaI is- takrn to sugY,-:st trcatment intlu.:n,;:c on the'.' :i:n,mdihu~u- ¡1ud
1naxilfarv has:f'~.;;.

7J
 ~ ~
g.-:z..,
1
¿1 I
. '
,__. 1 fl,

_·
.,
.
~°'
~ .._ ilO
t ~~~~~~~~L \. !
~;:;;;;- ~
'· .
¿t}~
r~·
( _,. .f
.......... / / .
~~ 1 ( .' ,~a
:;:;;~(j, .
L•-..__.// ~)/.
1• ·, 2

d~/, ~ '/ 111.. i:\

c::r;. v'~ ·1 1./
~ ~) r' ;
,_ l i

J
:'
I •
(
1 '
\~ ;i ¡
JI~ª

..
1
- Í)4'7
7/ tJe z· ~
'(Ji2J

74
 ..
'
·vo~ition 'l"h.ree -- :\1axH1ary ortho<lontks
Thc ocdr..i::ml plaue b-du..iYiur b hir.gr.ly t'nntrolk.d by c:vcn1.:s in thc- bchavior of
tht' mm:ti:.li.bleJ \Yich normaJ dc:vdopmcnt th.c-.: ocdu~al pl,mt drnr-,; po..sL.e.riorly from
the pal.ate about 3 JlHr\. t":H ·h 4 y't':<t.r-, . ·n,e. &rHrn-r: movcs fonyard abuut 01l.t' 11uu.
c:til':h d1J~.e :v..::a.rs. Any a.kc:r.ation trom thl:s p,i:c.t~1 i11 .shúrt :·.a:nge. e.an be ukcn e.o
SU~;C~t altt"J'.~1 ion or m ,1::-!ill,.cii)' 1.ee.t.n posi'cions,

f,0r de.a.iled conside~tion, the upp,cr molm mU\'t$ for,..vMd lno,.v.:1rd. A.\·s on]y·
0..3 mn1. p-cr yt"rtr. b1 .i.;b,· rn(i.~ 1h~ il w011~d he ar:.ly 0.15 mm. (riot ~...-.:na trad1-.g
error}. And í n t'NO ~tc:a.r:s its fon"l."ru'd movt.·uLt"J Lt h CJ:uly O. 6 n:1 m. TI1erf'.fore,
7r.•.Kti c:JJ ly :~ ny ho rLwnU [ mo,.'emen t undcr h\"O ye.ars .sii:nab ei tn:·~ t l'('i("n1 t':h.:1 ríg~ in
e:ithcr dj n::o:ion.

\'c::rtica.fly, Üt-t: upptT mnt-n· ~n1p1 s f'cum thc pala'Uil plan-e ata rate of 0.7 U',HL-
:_)~r yc~U'. This. i"l.'O'l.lld be only O.:;., nrtn, in :fr•.: nwm.hs. Ag.ain .. this is s!milar to a
treidng ~rr()I' ~ss.enrülly. Tho.r~Forc, tf in on~ y~ar the upptr mul~n· -l~ ,;','~trnd2Li. '.-lHlrn.,
2.3 mm. G~E be '-·j;t1u1r,l to bt>: c'.aL.1.,.,;ed hy tr.eatment. U, on thc othcr ru.md, it h
¡n lruded 2. O mm. , thm R'=t'.mUy i.t }, :! ~ l lf'f'n c1 rr~r:, ~rl ?. . 'l mm. from í. ts prcdicr.cd
prn;ltj ()ri _ .Bu1. by usj ng 1.:hc T ..::n P-c1"C\::nt Rule thi::- ~m'.Jl.rut for di rí ichm -21°f'.di 1. is 2 _63
mm.

Position Four · · Mandi bula:r rm hod etJ I t.k ..

l~mm .ci c.atl"fLtlly sf'.l~c:t~d Corpus Axis rcgisttn:tl at Pm dtt:::' moku luc.:Í-'•,ü r
i
positions .are c.·0:u:~pmt:d to the r I um11tl. This wiU re\' eal índuC'Cd ch.:mgcs, 1
1.

J\·1olars
Cri!ic.:.u pui:u.t:.,; for rno c1ü.otir1g of t.reatment are 1.:h~ mol.ars bccamor of and10rng,t
í n te.rcs.r:.s. 1111:: ]01.,tcr molar c-rupts at a righ t .:.mgk te) 1.h~ rorpu..~ a.'üs •~gi stcrcd at Pm.
On ,n,~r:tg~, o_.:;: pcr year or L.0 mm. in 2 yca.rs i:s thc- (u~rnl?) b~ú:tvio~·. Ar:c:t}rd.1ng 1.0
thc-Ten Pt":'n:t.Li Ruie, Ht~ ¡.•wkc Llvt' v:lJLahlL~ vvo L.ud be 0.5 X .10-=- .05 mm. Tht1~ in
oc1e year O.4 5 mm. to O,.5 5- m.m.. ,....,,,ould be- tht> s~ 1s~h lt'. rt>:li' r~nec. If in on e. yea.r tltc
d1:mgr- is 4.0 mm. th~n {"'A r;..';~ntir.1Uy 3.45 mm. v.rould b~ due tü trt'~Lmt·nl. lf ~x
mondts' durntion, 3, 7 ()J' J~c:~rlv <Ali n·o=.1kl b~ c.lu.e.. ta tr1catment. In the fo:rwc::ird
J

cLrt".r:tfon, a.ny chan.gc is 1.:houghc te be tn:•.éltrn~~•t -:rn~foo1.'{"CI.

TI'l.c lo 1i't'r iw:.i.sor: (fro:m the '..·nt.p11.:; ax l:; orienta tion) 1ends to move bodily
1

~L[WY,-ml al:d hacl.ward alsoo, about 0 .5 mm pcr yc:c:1r. lt movt:~ b.1d.:.,-..•,ml 4 mm. in J.5
:',-"'C.' ms, ·whk!t i~ abc.n1l O. :l. \ mm. ~:tc:h ~ar. ll1ere.fore, tf thc loi,vcr índsor movt-~
str:1.tgh1.: upiva.rd i1.: nas bc.:-n movt'd fcn,.·Hd fmn1 1ltl'jl ,.,..-hiel, wrn1ld hi;=: f'xpect¿,.d
,.,_.jti1CA1t tr't:,itm,enl. T~-_é t>.:<:Ct'T1tion may be: 1.:ho.K pm:icnts dc,,,.dopjng gcnc:rc-m; dt'I~t.~l

75
: .

pr;:i.t!'illii om from th<..· i:nfl1.1r., 1C{": i )f J:ffg~ t.o.-,,guc~ anc:. loo.se lips.

S oft ·ns.s:ues
l .ip t"'hangcs aTC intlucnc,;.::J t))' tul)tlt .tut"f•.,:.=-.nit>:cHf;_ Bc.havtor of tru: dti.:n c~m he.
altcr~d by d1:mge.:-, in t.h e: rnc.n e&lts provokcd by th-c- urigirn:11 mafocc.l u.sien .nnd
1.:ú u.-e.cred ,..,1tli. tTt' .u bnt"11t,

Fu t:H:' Uon #8. Ddil.H::-~tt:::s Tn::-uhueJ.H Po~s ibili lics ( s~c: p~.r,-= 7 4)

In 1 ~)]8 thc" •1~1 t''c:-.¡1hah)mt".tric st.udy .of treaceJ ¡.:atk:nl~ 't\".<t:-, c"r.pnn.cd by
JJrc.1di r>:, Downs Goldstdn, .1I'ld .f\:lycr. C o1K:;11..r;jons \.4.---ere: dra~'ll on only fou:i:t.t'.~1l.
0

Class ll p~,tit'.nt.s .and six Class III paticnts. TX't'~h'O~flt v,:lrJ¡ thf'. edgC'.','\oisl'..'. mr:ck.111bn.t
...,~as aJlcgoo to havc: W) dfoo un l h~ .skd..::tal pancrn. cxci:..-pt fw. ,r,~ndihular rotatlon
, _.,..tli:.'h ":endcd rn ITCD'-rc:r". Sh:: CJ..:J!jS I p::..l.ienLs w~rc treatc:d ,,,..ilh e::<p,tn~ín-n ~T'ld
,,,.w.1kl Xt4J l l 1~ l:".:.:p..:"!.~~;.cd e.o havc basal .skektal ch.1mgt"". u1JJ~l' Lhar. ma.rtdibu1."U." rot'.l.ti011.
A.U arc!l ch.ru1g,:¿¡ ~....~ .:1ch1t':vt'".d by rhc use of intcnnmdllary .el;HI ic.s in tha.t samplc.

R~nlt>:mher that tlfrs Sl:Udy 'rYrts 1'prtlin1i.rn1ry". Yct i~ost condlls.íons <lrn,'<'l\
~l{:l"C con~r.. kr..,.., 1 h_y m :1~t 1r: h~ fj n al. Also , tr-tatrnent ~,-w., pl:':r-Í( irnl.~d in rnostly full
tk-:ntition agcs or btyoud agt":; whr.,~ ske.lecaJ dfc:cts wo·.:dd bt:" u1,:mif~.,:;1.t-d a..s
,u,d~fstood. prc:srndy,

~o c.xtrnontl L.\':11.':liCJ-O wAA f'.mp]oycd (pardnilnrly l:ll> Ctu1'f':T"ldy presc:ribc.d ,:r,.'ith

1.~-rvical trac□on}. No a.nt~rlor touth h- 1rn.."iion ';,,,lth transform.o mi.ch<.1r.l.gc- w~..~ u~~'l a."l
pT.:■~t':J'.1t.ly appHed. :\~o pos!tioning d-:::vi,;_·e~ (){ p:11.'":11ai 3.t;)piiances "WCT"C cmployec~. N o
tr.msvt::",:.~t d ;i1 ~ wa ~ r.e:p0rt.t=>d fmm r.h:. frontal fihn, 11te DnfL ng'f.i s.uggcsti::d
orthodontics or tooth U\ove-1rn:"..l I t :-: we.re: Jimtts of possfüilitks-.

·r,,.,,'('.'t">d, ;~ c11l <~, ,rnd S 1.ra ng· joc ncd forces ,,.,..i t h St.ór I t":t' áfl.d many others in
.acc~pting thc "d<.K""CIÚlt'. of Jin,i t.:n.i ons". 'Il-ie concc[){ ,vas t~1:1t lr(:'I h r.o·,rki h~ mi:·y~--ed
<J\'t'I .~i.gniltca nt dhc.ancc:s but that "patt~rrt c:;;,:;,1:Jt:'·$SÍO(l" accow-u:c:d for thc b,{sal ch.u1g~
.r111d that th~ ha;o.;;<tf ~•.ruc:t.ufe.~ v.·ere. immutabk,

'fhw1.1gho ut the nai:. t',,;o dcrndt's thl:': ('t':phalome.tric tool bccmrn.· t ht" prinw.ry
SO'..L.fCC of ::rc;itnt".1'11· írlÍí,n"Jl:1; ion. fo l 960 rhc irnmutablc:- tlu:,:·Jt_y -.......~s :=-;~vttrdy
cb ,{llt".ngr~d. \\.~'1Hc mean compr>:;itt""~ ,,,..~.-e. manuaJly madc in th~ P:f:fü~, t ( i ~1.l1.dy :-md
.... aíspl3)' grr.l,.vlh he.havjor, oompositc data of ttt'.3t.f.'d {'JIS~s rlid not bccomc: avaikbk
1mtjl me applicatiun uf Lhi:= oJtnpJ.L~r tn thc 1970s.

76
 _,,,-e':,•/ findings 1n 1957 :,1.nd 1 960 inrlicatcd th.at -~1:t-lt"l.ql mr1xillary d1a~1~~t' vV..l~
possfük vd:th c:-~l l".H( JJ"ai ~J-a.i::Lion. Th us tn::-,{tn:tc>:nt pos.síbilitics ..._.,~ ~ti~~~,;ed to líe in
th:ret:': rtrf'-..a.s: i:ikdct...1..l, Jart•.d, and t.=m,i ro::1m.cntal.

Shon Ran.ge Re..,;-¡ul u (onc to thn.·-t~ ye..& t."i)

,\níJI her s-_uestion IT_gardt"d p~r·1:-i.ane:n~r ~- tlu: .skkk1.:)I c.h:'llng~s, and scability of
d.:.ntaJ mtl sofr ~ü,~u~ d1r1ngt'.- From thi:- b~ghu.1ü-1g H. ,,,--a.s dc:tcrminc:d tlwt. i:i Lwo-yea.r
phi n ,nade se.ns.~ for trc~:tm.t"at pi :"HUl i ng_ Th.crcfurt', " hvo-ye.:;.r or trcatmcnt
-c:qJ-:rku(r:- .·rn.~ [y.,;:,i s, 'i.\rould oc con5iJ ~1-ed ~ ~hon L.c!1n 1r,i1.rn com¡nm:·.d 1ü th e whok
gro,-...th pcriod. fu '.:--pt:<::il:k ~pplianc:es Wí:r<: ust-d , ~ignificant changcs w•-::r~ ~t"l;':ll in the
5hurt r:ing~- The foHm'i-ing ~tc1.t<':'rlir·r1~~ ~pn?..sent thc CUlTI'ttt ,;_:undu.sifms rcad1cd from
at~alysis of st'Ft"rnl }Hind,~_d paticnts r-::n.d c.-on11)~"t-..,1tffl of a.bout 30 srrrnpk)j 0[ L.1'eAL~d
I ~n t.1 i:>:n r.s_

Crs.11ial
P0st~rior crani.n.l ba,t' y.vv,11 h r'n<l)' be: .affi:-cti:-<l s.llt 1.t Iy, 'rvh iJr-_ thc: bchmrior of
-:he "tcxnpc:r~l complex antcrior lTmtla1 dt':VdO,Pmcnt s-::cn"\:5 tü b(;': 1c:L1.lly gc:11etic. This
cond1Jsion <¡,_,.-;, íH !:~r-g~c ~e1 m ples and cart"fol study prn::'r.dt!.fcs.

Jvtandibu~r
.'vl;_m<.Hbu.lar l;,~ndin.g and condyk bdt..•wic>1' me.y be: íntlucncc-d by w~1nd.i hu..1.ar
posturin~ <lcvkco;: m,d vigo mus d3..Stic tra~:ioo, F.-~ :.-~s.s1v~ mandibular ~otc1.tioy1 rw~y
0

,·~ 1lfi~ c.o mprc.ssion ut tl Lt' c.:huad x1_;g-t< 11 k: ..-:úJK:. in thc: condyk ~nd 111 h1hi L. gr01.'i.ot.h.

Di.r.t'("t ~111 lt"rif)t SLL_pe.rior or sup:::rior t:o:mpxt':,:,lw1 úÍ l.he condyk rnay inhihit
gro,.,.•(.h and som.ctimc:;: it :i:.tUJY 1H) t. r~bo 1..1nd.

0Jn(iylc: 5 rc.1wl h v~f"Lj L".AHy may tcm por~• bc- ffi hFL nc-E:d by produdng po5t ~ri o.-
s upport if not Q{i:_~~~h~-

Maxi llary
Majar skrkt'"d mul pal.-1. t :i I ch e1 ngc: can be madc- in 1hrc:-c: di J:i.lt,':[l si(Jn.~- Chang<:5
j~"LJnc:-f'<l may be. srnall, to am much iJS ~ c:i:•:n.tirn~c.cr or mru\::_ Tcchnk1u-c--.s ~u,ph-,y~tl
an~ critk¡i l to t.hf' c:h r1 ng·~s i ndu.c.ed_

D~tal
.i\11 ti:-cth can h~ h1t.n1d.eci or c:xuud-cd. ¡,...-¡ofan caIJ bi:-: -o,m. ~d d1sl:ll"tv, ~I'l.c:si...1.llv
•• J

o~· bH.c:~o"linguaJly. E-..:paDsion GH"l be fkm~ safdy_ Tec:th can be- movt:"d :!-it':'vf're1I
millimd-t'r;.; ,l.i.t.h:r1 1hr;=- he1se1Lu :.1ppaTatus. as Ait.nt's:;c:-d ín ,;__·;:l njn~ impact.ion_
1 1

Tl
 Sof1. , 1·¡ :c;:s:ue
Mus.el..::· a.daptation oft.rn oo:un m.,wui.l'ltjc,~·dly. \\1-te:n ~habít.!111 pc:rsb.ti grcatcr
,rtt.c:-1ü1on m:1y t,~ n::-..f'.dcd thcr.ap~utically. Toa :::m.Kh m.;,mdibHl.:::.r 1'úL;tl.ioo m.ay be
dangc:rou.s.

Long fuwge ( more lhan three ·ycars}

I"•.
Cr&n i al Base
:!vHm.1r tc-m.purnl bunt' 1..: I ,u ü,d a 11.::-xa:.ion may h.:: pc.i11u1n.en:r::,

l\·1 a n<l i hu !.ar

A.ny •nd•.1c-:::d changc in th(:' fo:nt1 (H· si l'..f'. oí Lhc ma.ndfük is tcmporru:y. VVhC'.'n
pt'f'(Uc.1.ions of con:poslr::.es. ac Irk'ldc- in long ti::-:r::i:~t 1·hf_v c-r1mp::i.r~ r~cis~ly ,,--.,ii:hthc:
tremed actmtl c.-um1n>,:;il::-J.l. Opf'.ning rotatlc-n <::t thc: rna.ri.dibk nH~Y uo:.;,t ,i.Jw.~ys Jf'.L.Ul'r'l.
and car. damage thc- ~:üJ:1.dyk t f tt'.flr~L.1 e.al l~·.
L •
1\1::.lJ 11 ary
Mcr trcaun~nt a nwxlfüu:v .r:-!:' bnumi mav occ.ur 1f nm. rctain..:d, but ,Yh<:"n
~ ~

rn.il.n.9ge.d. pr-operly h:. does not c:inunonly c;,n:1,1r, ,1\ fr,ti.v.:ltcl_ gt"D'í:.¡.-th of th-:! m.andibk
w:,y - l.1c:- .--i fR<'.I fJ r i 11 m,rxil la1v
,
r,.~t-c.ntion.

~-fa.Ji:illary rcduc,:ion for. higl1 c,:rn·.vt'.:-::1ty f.eiKL!:i to be: perma.ncnt.

neo.tal
Firutl tooi:h i1o~tíoning ís at lht: Jll~c'(:y oC th,.~ musdc:s, and ncrvc: direcb
m a..,..::l e.. 0 1,.'~rtreau.n.cnt is (!Ssrntiaily n c~dt:•:d for :i H t·.rt>::l tmen t v./4 Lh the. p~siblc
~:r..(·t"[.>11 n n o r m:=i Ir- grn\~·tb in ere.atr:d Class. I or Cl~s 11.

·.:. .. l'1.1nr:tio.n #9. Allows Prognosis and Simulation of Objt:-:ctives

fu,¡..,,.n.o:sh i!:> .- for.i:n nf ¡w~.dic:c.ion. rrogn.o.sis is madc at c-a.:h. nd1,1~trnr-ut d1:.tt
1h~ L~f.d·, ,,,;u mo\ as dcsi~d and (iin:-t.i t-0 v.ith .-ipplj;J r"l LY'~'>- f ai th ls n c.cd.cd.
1
·.:

D::{j :n1 ti (m:

1'Prognosis is the prcdiction o1 th.C'.' ¡.IDJ b,Ülle C(',ur1it=: ú f a :-.ondH:.io n or the

~ )t:'~t f"l ]J 1 ~g r;( Lbt" ni 1 eC-t"l m t=:.

-" Progn o~i s is ~ t.wo-edgc:d sv:o:::d for orthu-::.lontk:!J: onf' i~ 1.h~ pmh-i hl~ grm•,1.h
arttl d~vdr_:,¡..'ln~Ltal curuc:-q11r;:'.l\C'~:-.. ,-.-ithour. 1.n-:atmi.::nt; the othcr is t~ pt"0jc:-cteJ
1-csu.lts wi:h th~rapy by onc at v~rfou.s 1Ju1o,.bJ1t1~:; nt 1.heir oombinitioris.

78
 \-V(" hi:1-.·~ lisLi".d íifl:v-st":v~n func:Lion.s of a forcca.st to rnat1...""ri.ty
~ - Ín a voung
. child.
But a forcx.:ast forth{.'T bt'l.'011\i:S [{ mat:tb on wh.ic:h pLsnning 1s ma.de_ 171-e.refor¿i_,
t'r't·o fo~t't:;)st~ or progno:-.0.1 may be. cr.in.structcd. Onc: is v..i.thout tr.::-,'t.tm.c:nta o!f;nJ thc:
second t:..s thc: cli<tJ~~'.'.,; :u:md e v,.ritli. t he trt"..:'l l.1nt>:n l. obj ~ives_

h L .:.;hJJrt r:H~ge 1;i:-t"~.l menl. oh je:ctive.!i a~ dmia1 t✓.:ed (VTO), In lon~ ran.ge thc:
di.::i-ughc is fo::-;;. ~ro.al of final :::<::sults (VTG)('\risu<dh:t"d 1 r("~I mc=-n1. go;1.J}.

TI11: pr0<·e~!:> o¿ ,.:oxu•tr. .idjon o{:{ "fr}rer-.~~1." m:-ty he Jinea.r or arcia.J with 0

rnfJti.i fk.a.tton of \' c:c.tors a..nd dl rc:ccJ onal compon.c:nts. Contri but ury ,'t.illYrvmK~~ ,ff-t"
m ..ad~ ,1c.-x:,mlh1g tü ::.izt":, ÍLITT"l1. ~):ll.Lt:l'l1, age .s¿,... and rclaüonshlps. Therc:forc , a mean
0

tl.a ta basl:' v~lu-t" i~ onl y a sta.rtiu~ 1.n"sis.

liorf"c:l ~t.i ng
Anythmg th~t c<'l.n be cxpbiocd ami c.:..:irrc:Joitr.d c:rn bt'_ f'te.d.icLed. Tiit": ('..01i.c:~ri·•·
,.:"Jf :e; irnu1 at.ion is more appropriatc bccausc prcdíctiun carri('~ a d t:"g:t"e of ,lbsoiutaLe:,;is,
for::-.:.lsc5 ar~ r~n<lt"red hL pt-rct'nta;gc:~. 'fh.~ qnt",~I iflr1 r~garding accuracy has bc.c.n
rajsed sincc the b;:,o/nrung. How .i.ccurmx: n:~ust a for,'-.'.., :-.t. bt': 1.0 bt": of v=:i luc:", ;jn d by
h(Jw rnuc:h .,. ,.-rn i l. nf.1.~ci. to'.'J miss Le- he mtskailing tn a plar/::' Many rc:st:"aTchc:rs objccting-
t r.1 iül't'.t·,,:,~i'l.! g l)J'.'-'l~1 j (:t>.~ rl.~L '1,'t' 1 L()t .:tckll't":~.:;~d. the,::e fond..ame..nta.J ,:p.::cstions..

Ex Len s ¡on and Mod.ificatíon Tcchniquc

Th t': fote.c:;~se.i ng ~·.ec:h il.j q ,1f"...s. s1.a.cL~d wi th era.nial base CA"trnsion and a planc
d::i,\,n the long a_,j:s uf the con<iyk to ,:01m.i::-n "'tith tht: U\;.-md:h~1l;::11· plane-..
\.·lodifications w-.::re: mado( for biologic faci:ors , and trcatment efh•.~:.to; cm th.:: :i:n..i11di.bli::
wt<ri:-: c--:1kulf!l.1:"'.-1.l i1itú 1.he (ki,,:ign_ ln fa.et. L11e efCc:...:.ts of ucai:ment far ovc:r.sl1adol\.""OO thc
gru,."rih mnvtltudt'~-

The. originFil 1.~c.hni,\1J.e. was niodWLe.d to t.he basiuanial axi.s and th.e c-::i-nd~tle
('L)rr,1 l::. ,'l xi :'i 1Y1.'J I TÍ x _ ·nv• m;n:ill~ ,.,..m fort"{' ,11.:(:1 1 [) rrn i,~ 1 h ~ :r:ipac.f'. hetw~en {'.r;·u•, i al h~u.~

~nd mand ibk.

:\fa.ndjb-.1lar A.ce
A tn1c brcakthrough for long ran.gc- occurr.;::d i.\ith tlu: Ji:;;rnvi::¡y of a ~rrowth are
for í.hf': ,na1idi.bl~ (nol. Ln ht ~Ymfu~d ,..,1,L.h Sa,~scHmi's pn:,filc: are). TI1c subscqucnt
dbccvcry ot modifkations for s.rx and ~'f"l:" lro to turJu:·.r rdi.nt:rnt:r~t. :1c,d !H.1.:u;i:-ar.y,
ofter:. appro;i..chjng pcrfoction of fit ot' th,::: forcrast to the actual Th.:.: m1.mdibk can be
foreG•H;-t iriJqx-, ldto t l :r oí tht' u ·fü ci ~1 h~-5t.

79
 t
-1
·: ·.

1 •

80
 P.:?0.Jf::GT!ON METHOD
-ARCIAL l912-I9~Q

A'l'

-,¡.,.

~-1_ !·~ /
~)~
.--\'
•
1
1

thl.
~~~

, I f

' .......... i '

'--- N -
~Jpº
:. ··.

1
:-. 0R:MAL N~8
RICKRTIS' JORECASTS

...
 The {'.ranl ~ l fü=i ~e:
Tht:>. ma.ndiblc: cxprcsscs. iuclf froxn a C:.T."l:r:u~l s:1ppL'irl.. TI-i-e oond:-vl,ei hm'i.rc:vcri
rc:sidcs in t:L~ t~mpor:11 bon-t".. ML.J.5,Ctes are: attnchcd to ,:::nmhü b()fll;"S. Th~IY'Í01'f'., r."N()
puJct:rluri:-:s can oc i:mployed, but buth n:quire. ::i h.-:i.~iL". i.:::ra.nia.l prc:dktion. Our
postc::riur. h~s.-e j:; 1.h1.: dimension from postt'rior c,Jndylic>11 tCp) to 'PTV. The ante.rior
is ,:ale.en to be Ce to N.•t~iou. '11,f h~si-c~rrral furcra~r can be indeptnd~nt uf ~ill dtit'
h'I. l 11~ :. k 1 dl a.nd la.ce:.

Maxílla
Vl'c )t"-,.•ü-..[ y 1.h e phf': nom e non that kd Brodk -:o tht' \·:01-.,.:; l.::rn 1·:y" i &a ~,as the
gnc,mic bcllaviur of HL~ palak to c:x~mi<l1 bndcnal~ {Sl\'). Gros:siy·, th~ núG-foce is
l1 l,kfJ~:1J.r.n Lin behavior of mandibt1 l..:.r ~fket:o, !vll.H :h gn'::1 --~r '\•a1ü.t.i on is .sieen in ,:he
lo\\'tr foce th.::m 111 L11:=-- Hp('l~r' he.e.. Afrer rhc maxilla ha5 I.Jt:t'.'l1 luo:;t"Htv .-tl ll ~ ~111 un:·s
•t,;i t.h uc.atmcn,: th.c mantti bular l7Tlm·t.h v-u.1y l>\v.f.ty i ts biehavior to sorne dc:grc-c,

'I'mh
:\·fa.ndbuhr tccth are pR··dict('.'d Ú'<.tl'll c.1,e 1xirpu.s axis at Pm. ~faxil1,ry t(."(:'th
°"rt' furt:':r~~l ÍJt'icn Lhf'. Pa.la;~-=i.l T'lanc: at .Al\TS. l3oth ar.::-..t:s ar:('.' ~·o=tu~cL~d a.L Lhe oLC[Ltsa.l
p1.'Ulc ~nd redpnJCiJ l fo c:I en".'i I il 11. y ..,;, to Ie:.

Soft Ti ssu.e
;\ftt":T· t.he. s.k.e.lda~ rn.:1Lrb:' and teeth are pr:xlicti:::-d, ox1Jy I l1n1 c-:t1'- :~ pm!ll~
prc:dictlon b,: con.stn1ct"='cl, Na !:ihm. ~mkri or nasal spi ne:, lncisor.s a cid ~k.5- in d'I.('.' :Jr.my
c:hin s~1ve .1.S rdercncc:s for grm•,1h -::idJitiCJrn. Chiing-t".., -.1-·ith (in?) func.tion ,:r;•i"ch
c.:-uu~t·Hon l~f 1.11r.1kit'x.' lu....,ions makt~ jt more cornp~icated to prooii:::t.. wJlh f'.l<.8::'.1.iL.ude.
 function #10. Grant-3 a Mcdiurn for Pfanning All Tre~tme.11ts.

Thc- }U:tu ~J Pu.rposc: -i.UU.l r UUl"tíOU. of Vh,1.1aHl.t.d Ob¡ei.~live:~ and Goals

Cnnsrructlng a vi.s uaE.z.e.d r~ndcring is nm:. just a. mcanin~s.s an:isdc o:c..ni.si:=,
It h ..'1.5 au c:'".xtn•:n1dy \•Jllu:ib!~ usc-- to hdp \.vith staging the me.cha.nii:.tl trca.tm~nt. Tr.ís
il'> a poinc. ofi:c:n oyi:i·lookcd by dinkb.ns.. vVíth tht" \-'TO üT VTG, :u.wrillo-mM,,iilml~r:
11:l,~tf,ox,~hi? has bt==i::n ccrr~.1.1:'.cl, .:rnd a. n15.,.vAPo -e:;dsc.s.

Sequencc
Pl!n'líling ~ti:iri.s 'ls•I h n~~d~d c:h;'lngps in ch~ l<ru.•er incísm. Tf ·e.he objcctivc h.
acccptcd , thcn hl'..Y\v cloc-~ th~ incbor x-.i:=ed to bt: d ,~nge'., l? J.s i L [tm'-•;::u·d, düwnwa:rd,
h:~do:.-. .i.i&rd, or u!:)".1,---a.ri.i?
. How does its movem.cnt afkct arch knr,t.h and arrh di:pth? Ji
~

c:xp,lT-51.DJ:1. b o:.:r:rx1tt':!11pl;1t.t-d , h()v.· ......; 11 t.r;m~v,;>::·.St'. r~mcú..r 2.hange:s aIT~t .a.n::h k.ngth
..
¡ -

...
':,• and dcpi:h ?

1 .
~'\hi::-r t::jk:ul.11.¡01 : L"JÍ dít:c Li- úT'1 .-~rd'I le.ngrh, 1.ht== lower molar is posidoned. ls
cxuacti-on ni:::ce-ssv.rv mtd u.:,trt1
~ ~, Lt?

· l'hl"' ••ppe.r ind~nr 1~ 1h~11 r.CJIL'.1ilat~d for mov~mt>nr n.P.r.derl. Hm:o,ymuch

mov.;:mcnt is r-.-::-c.~uir.t'd, m1d ho.._,,. muo:.:.h .:.md,nrr{gt': b l\-'."'~ ,l~d? \·1n.'i1. 1h~ lt•'A~r b~
mod.Hle!d i:o comprom.is.c thc objccth:c?

1.:, ~tJy, 1hi:': u.pper mol.ar is vi.,.-;ual1 ✓-~d í rom il.2, ta.."e. •'--h~fl pul in LD a. noi·.rnal
lockr-<.l (..1as5 I po:;ition., IIav,.• TI\tKh v.w.:~tora!~,e b Ht't'UN? ~rJ',,\', a~ a fri::-dkKk, 11.m:st
other com promisc:s be ma.d.e?

; .
.:. .;

' .

84
 Th~ L'ybt-:rn~tic Clrde
l n. orde1· to visual i7.~ r.h 1s ~t:=:L}1Lt':c1 c:e wi 1h f.t pi L:t, Lt't':, Ri c:ke.t rn de'"v(" Jop(':ci 1.hc=-
cy~ )t:".m~1lc r1rd~ a~ an M.b:=;.;t.r~ctiux1 and ;:-~ductiun of the- tn':fltmt'.nt planning s~qui::-occ.
Th.~ orcl er '"'HS th.t' ,.ke ktal m.atri."'!(, to,vcr aITh and u¡:,p.:r ~rch, to be: fcllo•.:vcc. by &olí:
:js.sue co.ns1dcra.tbns.

BtOLº__º_1__c____B.....E__
1i.Av10~

/
~

¡ &
~

-•~· J
i
1
\ 1
1

85
 TI1e. Surgical Objt>:ctive {STO} and tht Divine .Proportion
f.=.-:i;.ti::-J~~ív~ -~ k.d e-::al ,dtq-ation GH\ be- m,1.de , , _.;_ th ~urgtt:y. Th~ ::.l:"qui::-ncr::- fur
pl<'lr.nin.1; i.s the sroni:- <1s '"'ith Oftho9'c:dics. but now '..s rnualiy in ad utts 'i."/--11::r-: 1,TC":i..'th
a:-Ld orthopcdic.s are changed l.O -~kde~..al c.rts.
Th~ Div in~ P!0pnr1i cn {nr golih·n c:u1) A.,~~ly~[,;; is ::i se.p:u:i:.e ~ubject. H-cwc~.•-f:r,
:h.::: gddcn rc'..r:.tion bt': .:o;.:ccn .Fn:mkfort Pk.nc:, P:Ji.i.t A. and Pm h h.ighly valu~bk. L'fu::-
1

hcighc of the lower indsor to A and Pm is of paramount v.alue for dcnttrrc-

tT-0 pl1-1~:t"U\t'Dt.

: .

,.: .

: J

... .
.
StYtN·n~Er..: CI J\SS UJ CR..™.(:;JERJ_.STICS
(N<YI' A.Lv\'AYS IN EVF.RY PATIRN"f)

l. SY\1PHYSlS T70RM (LO~G)

2.. OBT{;$E r-.-1A"-TT)ffiJ,F.
3. \VE..-\ K GOl\lAL ANGLE
.....
,1
CORPCS T,F~Glli
5 CO~D\LE LENG n J
CONUYLE fORl\·f {KA.RROW S.A.GTTTAT.T..Y)
Xl P()SlTJC)N T70RW..i\RD
JOn--.:-1 CP\"V.A.RD Ml.l .1:-"0H.WARD .!:<'ROM BASHJ:--l
') SPACF Th1 JO:?"NT lHlvllNlSHED SlºPERlüRLY
IC•. EWNENCE fLAJ
l J. _,\1\.TER!OR CRA.~L\L BASE SHORT (CC-~)
12.. PüSTEIUOR CR.A...lflAL DASE SJTORT (PTV-P)
13. ~HORT .M.:'\XlLLA (Ilul'."A}
M. :---J.c.GAT!VE l"Al.ATAL PL/\l\T,
15. VERY WIDE FREE\VAY SPAr.-E
] 6. :;..ow TO~CL'[. PO~ITTO'-.;"
] 7. CR :\ NJA L DEfol ,f.C'II01'1

87
 y ADULT COMPOSITE N82

; .
·, .

..
i

.
,.

: ¡

. :
Function # l l . F..quíps thc Usc:r fu1 .P.c:ac.( k.e. Managc-me:nt

\•Vh-t":n an .;.nistic visi.1;;J:iz.cl) íw:-ig~ CJÍ" t.ht:>: prcscnt ccmdillom; ii-. 8vaHabk. in. th~
rrn-rr, of an ru1.aly~~. ,U ~d ......-l I t".T'I Lhc im.agc of th::- <.1 tij ~::l.i ves LS .shu..:r.n: it [!;Qt'"li iL 10:lg v,~·a..y
in cr.~:=i ti ng confidcncc in th~ t'}'t"Ji. o( 1he pa'Cicnt ar pnTt'nl . 1:1 adji.tion., when thr:-
nccc-s~.ary r~1(>\,~IY'lf'1'1 s arf. ~plainc:d and makJjaH1.e.d on paper, thc::- p~ü:;-tH. dt~r1vcs a
f~l.l.e.r imprcssion of th.c naturt:': (>Í 1..he needcd co:m:-o:,_-r.üm .ind jts ac~ptimC'<:'-,

furthcr, dmí.ng trt'.'lh.:r:i~ul .a..~ thc patknt i~ monH.ol·ed and thc prrtkut i). :d'lúwn
th~ TI"'sulLs: Lo l)¿ es:!.eotia.lly as pl:;i.;tnécl, i higher a..T1d h.igh.~r lf':'.'f•:l of c:onftd.cncc h;
rc:ad11:<l Ly bu UL tlc)ct.o f <11J'ld !:'aticnt.

Ct"ph:1lorrH.nic.s in this prat1.ic::~1 V.".l? cnn:ributc:s to a ·.íl0·,,.·'1• h 1s a too] for

0
0

nul<lng th..:- s.alC'.'- H is E.1.~o a. vehLde for tcnd\ir1g l.he patj€nt th(' rrsults of 1.r~:1t.n-1.-=nt.

l.:J.:nplr,yt".d corrcct.ly, pro.r,rcs:t....·t ('f':¡)h8lomc:.trics can be :j 1~me:ndous t.ool fm

interna] practk~ 1t1 :jrkotting and providing ~cJrt1f':1 hlng tangi.bk for ~llirL~.

Furn..:tion # 1.2. !\.la.n iíe~ls a Princip3l T ooJ f-01 f ducation

Com1nunkcttíon

Edurntiun i.~ 1a1lL-1m0u,1t to comm,;11kminr'I. A..-:. analvsi.s .. ::.--onunu1th.-ale~ 1.he

~xac:L naturc of thc conditi.on to tJ1-t": dinician {dL1gnosb!. Ct".phalometrlcs ?rovic.ks
m~ a ,:,:(~s..~ 1.ú 1.hi:: l iterat are: and to ub lt::'r t'A.l lle.agues for .sccon(l opini 0n~.

Connítu te~ a L=-utguage

Lnnguagt is .a 1()(Jl of •.0mmttnicm:i0n. (~fo~~i11cation aids in tht- bn:-;Jk11_)g dc:ro....'n

of complcxity. vVhc::-n th~ ,1s.t'1 kr,,nw.~ the. lang-i1aj;i:. apprt'd81 t".S. 1.hr: natun::: of
po~'>j biliti~~ a.nd c:ffcct5 of uc::1.trnrnt. 1<11.111,.vli::dg~ is immcd~ntdy .r•.•,'.]jL1bl~.

ll1c Ess:cn tial Tool of Cfuucal RcscaTch

Oh~~1'V:'l.:ion cf patter.ts in tht- d1,tir a.nd comparison ot bd',>T.t---:~11<l-;tÍtf':r modds
or ph 1..lw~7..i.phs u:nly yídd ~~,i~~:-..Lions. Tf direct intrJrnU:tt.i.nn is d-.:sircd th-:: o:nly tooJ
for SL~i ent_¡ fi e study LS =:.h;: tool of cc::-ph.:, 1n rnetri es. ThU5 ~ th~ u1.<J~t :,:;oph i.~ti :.ate:d
mi.:thud ~huuld he" uSé>.d for 1h~ hif.st knm,,,•le<lg~ tu b~ ~ppli,.,.J.l

S9
IV SU.1\1.\IARY ANO co:r,.,·cLUSION

'l11t:' p:r0pt:T si.pplical~v:i:~ uf i:.:t:"pfi;ikJü)i:>.1 ri(-:s is 1.hr,.,-~~dimcnsional and pro~essc:s

rhrough stagc:s for clinical .J.se. Sevcn. m.ajr:,r pnx~:s::-t~ a!1d t wt>:lv(". hr:lslc.h~h~ 0f
!11 t¡ ~i i ;' ;'j C.i C)ftS ,q ñ: d~.iiC:d [)e.(1.

Thes::-. processes are divided into four .main aR"~s ~H.1 gru,~sly pert~'Üt) 1.0
diagr.osi:s, pr:.:ignr.1.sh, tr-t"at.m-t'11L rki n11 i ng. acu:l pra1...··üce.: managcmcnt.

\'Vit.h '.'iUL~h ;;i "l'mgrc=-:-;siYt=t prngram of ccphaJomerrü.:s the- orLlL0do:uci~t h.a'.5 :J.
tool to pcr.son~Jly find out ,dm.t h~ cir .:;hf'. is. a.c:L.ua.lly doing eHnícally wb:h employ'"Cd
modalities . F·.:a:thC!r_. objectivcs can be- ,:~t.':lb)ish-t''.i aitd 1::irgt>-L~ <"rtn l'N'" ~t>:1_

Tht" skp-by-sti:=p applicatiou l't""trni1~~ ~fftde.r,cy a1'..d com¡::etency, and providc~

a corn pc.ú th"C ..::dr,c:.

P:nJt,rc:::ssi.ve- Ct'phd:.Jrne-~ri,:s is 1,hc-- t:"1<Jl fcw sL",ph i :-, l.i L~al.i on for orc.l·.odo.-ittsts ín
the m::w milkni um.

Mo~t p~:i:-~Ol\,"ll ,.-~ 1mp111 t".r,; <Jl' tYHn mierci all? ta.:.ied laborntori~ adopt -ch.:
Progrcss.i.Yot" proti'Tmn bernu~c: of its b:()k1g1c" b.!1.:-::t"., i Is ('íimplf'tf'.ness, th::-. informar.ion
ga¡ n<rl fro m it...:; use, and ¡ts so~í d tra.ck. rccorcL

Thi::: Pn>µp::-:5::-iv-t' prugra1.n ULU~iv, h<JW~V~I", bf'. ]e;:\..fnt=-:d and t.mdi.::rstooc. en ordc:r
tltar the clinician can .apply ii::s full ocndit ~. C0mpdt"":J:1c~• in the. rne.1hnd t~q ui rés. a
mi:t.i n~ applk.ation and _prac.ti.c.f:. TI1c di:rdail bcncfi..-.1i far Olll\lL't'!_gh tl~t:' d fmt ent.úlr:.J
in k,·uni.ng.

k. L":-'."mnec.tinn wi1":-t. the cEnkaJ ficld, ,,¡_re: can pm:aphrasc Dr. Ronald Roth, wh0
~1.:1 l.ét l ht'. t'-'L:i-:~ f m· cti >I1.u.101:t 1~·.ti es :;m.~c:inctly.

Toe Suatght V•/ire. appliaiK.e (or any m:hcr .appfumcc) v,.riil nut dictJ-.,'lt0 ~t tt.~
<"il-<;t'-, will nut dt<vt:11.Jp ~ trt::-a(mtu l pfa.n {VTO )_ nú r d.esign thi.:: mcch anks
n.cc-cssary to correa the ma.k:icch.1>iOl'., Thís is the l'e.-.ponsibilH.y of lhe
orthodondst. Rot.h St.ar.es, '"Assuming krmulation of r..!. thu.ruu~h ..1ud
~<:curnt(-: díag.oo!lih: ~:o.d t.rea1..nJent plant a.c:q_L1iting good. pattent cocpe..ration
and pcrforrníng appropriatc medw 1tlc.~, "."r •11 ~ :i-:t t"tl l ly ,t--11 :thli:" rt'S11 l I s. ~ 1KJ11 Id h~
pmd1 J.(:t".d . '1
 YA HA 11 IG.'1. 2000 CEPJTAI.O\fETRICS
.. · -·--···- ·· ---··-- -- ___ ____ LA_.._.....
TE.....~R.
....4.....L
_ _ _ _ _ _ _ _ __
(:_ontl.11 tio.n .al Harmonie
CraniaJ .Base:
Po~teraor Cp-PTil
Anterior Ce-~
·- · -·-·- ·-·. ··-. . ..... . .. -··-·------- -..... - - - - - - - - - - - - -
1·1n ad i bular:
TotJd •·au~r Jldght {'.'JVePm) Co-Xi-Pm el>
.Facial Axis (Ba~ at PtGn) lc•f\tl-J\-1 ©
Facial Plane (FTT at N-Po) F·H-Xi-Mpi ~

!\1a :r~lla ry:

Pnla híl l Pht.nc (FH to P n1.Pl.) C p.-PTV 4> PTV-.1\
{~~nve:dty (h.:\. to _Fat4.Pi.)
Lo1'·~r Far.e- .Ht (A.ns-Xi-Pm} FI-1-lt.-Pm cJl

Teeth:
T.. B.Ocduslll P~. t~111t (to Xi) Pnl.pt-OcctpL-?t'lpL (>
Lowcr indsor __ ( Íl to .Al'o)
6-1
Ar~ h dt~pth .6. A- I1-Pm w
A Molar Position (PTV to
In teriu eisa J a ugle l
1

Soft Tis.sut:
Lower lip to E Liu e sn-Xj-st ti> ~t-Xi-ppo
nil •S t~gn <I>
1'1 -prn-gn (})
n-ppo-li <P prn-ppo-li
N-prn-a <f> a~N-glil

91
 PARA U'J G'l\:f 2000 CEPlL\LO.\f.ETRlCS
... ----··--··-·- J<'RONTAL
(~onyrntion a1 Hannoni~
Cranial:
Tran.sverse Parallelism
z -z
:,., ~ Z -- .DA - Z
Zn~ZA
("

J\·1 andihu la ..:

Width Ag-Ag
i\-fidljue Pm to CSpl

i . l\·f a. xillary:
J •
Nasal ,,·itlth -:'\JcwNc N~>1't w 0.5 A.g-Ag
\Yidth ,_l to Z.Ag .J-.J <P Ra-Ra
\\'idth J-J .J-.J = 80•Vo Ag-A.g

Tertb:
Or,dusa.l Plane Pe.r"allelism
3 - Í3
4 - Í4
6 - 1-6 6 - 6 4l RS - R5
B6 to JAg
.. 6
! .
6
1 l n1idlinc

Soft Tissue: l'J IOTOG RAPH

: .. k -st = al-n~
tri-al = Jc-m
r h-lil = <I> .ó.
ls-st-li 4'

.
: .
 GL08SARY
PUlNTS Oi-' RJJH~Rl:::NCI:::
Th,;:: una.tom:r is tra.ccd. an d point.s are cmployc.d first for thc sc:lccó on of planes.
ftlr :r:de~-eri('e .qnd ~ ....~_hiaünn ~nJ, ~C::.ln<l, for i~:~1 i.fic-.aLk:n of lca·;.-.tinn.-5 Ú.'Qffl. wru,;;-h
dirc-ct mcmur~n~u t ~ Gl:L be Irk'"l.dc fu::: dcti:.::mtlnatior~ of rch tio:nships,
A gkJ:=-;s.ary of the pt::11 ine.m . reí~rt>.nr:i..~s is appropd,itt"".;
lla (U:~ ~iouJ - .::1.IL ucd pitru ccntcr at Üll' ~u bas.r
N (Nas.ion) • at t.he suture sr..parating facial bonc:s
p tPori ::"JT'I) - .Y Ct"J:\t(':J:" of th~ tr.111 p0r!! l h 0n~ flt',.(jr L.h.." join L.
o (Orlit..tk) - lov,•u bord-:r of thc organ of sight
Pt a fü~t:.ral la11cLmad~ i-o r Lhf': maxillary nt:~r-.·e
Pr (.Pt~i:ygoid Rdt'rt:"::nct·) - d~ep~&t ,111 terfor püi~ it fl t. Pt~i:ygüii b
Co (Corufylion) • poínt ..vh.c:rc cond:yla.r axis curs condyle
Cp (Condyli o n Pru l.t>:ri or) - posr.e.ri.ormost poL n L. on condy J~
e~ (Cü: Ld_vlion ~upc:rior) - ~u~riunno!St püínt oJ Li:mLd rl~
Xi a neurotrophíc stte for Lhe mandibular bu~dl-e
RI-H4 ( l l ,i nrnf.i wi i:1.1 h rrnfl ht>-i gh 1) - p0r n ·..-:; l.CJ fi 11d Xi
(.11amu~ rdcrcncc) -
(Gnathion) ~ the i.:::entral poin t of th.:: symphysis.
{Ñkl:túc"l) - kw,t'.T' bnttkr o r 1.h t": chi c"l
Po (Pogort~on) - ant~riunnost l)onirr llf tht'.: dLÍ.n
Prn ( Protabcrancc: mc:nt'.) • 1=oínt a,: srnn of rcvcrsal linc:
Sg (Subgorúon} - re:Íf".csenc.-e-: aL li.J'►'r'l::1' bocd.er oí ra.mus
ANS ( Am f':rl 1,1r N~s~1 Spl.'Ot-') - ,'3 fn.8 xi ll.1iry fN;1 fOf 1 h~ .i;t"p, 1m.i
PNS (Po5tcrior Nasal Spiru:} origin fo::: thc soft pal.ate
T

Point A (MaxiHarv Basal Referrence) a t base of nasal spiru::

M

Ve (V l:".rtj güu.) - C<.ln-:;truct ed ¡.wJl.nt l3t. H.-i.!ii-Cr.utl,i.l ;-i (l.( l C:t1r.pu~ A~t'!i-
Tr (Truc: r.adius} • construct·::d point cq1ü<listant from P:n and Eva,
Ce (Cranial L".enkr) - ..~onsutJ.Cl.t'.d fH)1nL at Fac:íal A.:.ir:ts cro.s.~inf;- BaN

PIANES OF REFERF.NCE

Cr;mw,1
Basion•Níl.SiOfL -- .l:lbl~i-Cnuúal A'<ls
PoriOnrUrbi tale - Franktorc. PlfillC
Ftcrygoi.d VertkaJ -- Cool'di.nat.c tD Frankfort frorn f'r
 F9c.ia)
Pt~"IJ•goid Polnt--GriatJti.011 -- f..,.c.i&l Axis
N asion-Pogoníon ... Facial Planc-
N ~ !:>iOn-.Poin1. A -- ;-,;i(js..'il Pl:1.ne.
Point A-Pogonion -- Dtntun:•: Ph11.1é (k~i:iproc.:al Planc)
AN S-PN S -- Pí¾lat~ l Pfa.ne
Sub~íon~ t,,,le..oton -- l\·fan<lihL Ll fif Pl ane
Prowberancr Mentí-Xi -- Corp.1~ ..'\ri.~
Con<.l·vHon-Xi
-· -- Co.-1.dvli.::.
. Axis

Drntai
Hoce Bucrnl Ot-ch.15-al Pkn t.-:-
Doc.c Divine Occlmal P].nn.c

Soft_T_i_ss,u,~ Flanc::i
prn-ppo -- E.sthetic Lln~ (<:•a.)

Soft..Ihsm;. Mm:s
i:l nasion
µr.o prGn.1..-,;1J i ( t".) ~nd of nos,:::
sn ~uhn:::iS!i)í
ls sup..::rlor lip
ti,t .,;.t om ion (li p embrasur.-:)
1i i:nfrr.k1:r Jjp
sm(b) .suprnm::·nt"Ji
ppo pcopogonLon {d) chh cli:mplt"
ft•

gn gr 1;H.h LOn
rn menton
k la.t-era1 cand,us
M ahr rim

ANGl[S AND LINEAR MEA.SlfREMEN'fS

Tctal Facial lkigJit -- NuVe-Am
Postcricr Cranial Bast: -- PTV -C.: p
Fadal A-.J.t; -- f rom Ba on BaN
Antcrior Cr.:.:.:ufo l Bt,¡:;~ -- (;e t.o N
1;,~c.i~l Angk~ -~ Fadal Plan-L: fron1 l•H.

Palatal P'.l:.nc: -- l>al.PJ.. from f.T-l

Ctlnv-e:.x'. ty (Conca~ity) A to f ai-:i..a) Plan
r~

94

.. ..
 APPl~NDTX

O n Di agn ~ j s an d the R.easons for th.c

Ccphalom.enic P.:.tramete-.rs Chose:n

Diagnosis

ln tht· v,rholoC"" ).nc:-üic,~1--d.:-:-nti! l fii:>:ld, diagnosis in orthodontks is muque:.

Di~riosis h1 dcnci&try con.sl&cs of thc disti~~hhí.ng uf ~ign,-, ;.ind :-,yrnpl.oms or Lcsi.:s
tur ~ d~;5e,1st':. T,-e.~Lmf'.f'll. i~ L)ÍL~f:. 8. pro..Hhc:ttc rcplaccmc-nt or 31.U}jc.al proc.~d1.1:::,.

Dii=..gnú.sjs Ll\ me.dh::tn..: LS also dírccc.cd at idc:ntm,rntiüll r::.f ti dji,;~:H-t•. Oc' il'"lfir'fflity,
but tfo: t'ti.r.1Jr1gy núi'n oom't"J1"'1-; :-:_y~1 f':ml-r.. facrors. Orthopc.dic mc:didm: b in.vulYc:d
wi L.h bod:v deforma tionsi in! urics i bum:.;., ptltit \1rc:- ri 11 d d'!e t>:íftc~e 1~t. functton of j oints
;1a( l ;iml-n..

ln ort.hodom:ics th.-c diagnosis nnd tn:..1tx1 lt"J:\t •:':1í"Uli I ckc:isions rcga..rdin.g

muxvhufo~iL·. cf'l=ttinn'.'ihips.. Tht>: diag.:',osis starts ..,_\.¡th the r::-lati,JI1~hip of thc:- lt:t.':lh .·md
i:i;ocs in t,'r'"v dir...,djorn;: out.....wml to 1.l-,t'. !ip.s .:1nd cheeks, bt..:t inv,"3.l'd im:ci thc: j.aw~, thc:
era.ni um. -che ,•.~•ok head m1d ni::c.:k .a:mJ pc:-rh.lp:; c:-w· u h idy pt)S Lu.fc:. Bi.::caW3c csthc:dcs.
;i.1ci psyc:hofogic fa.cto!"s ar¿ jnvo1ved \"rlth spccch and 1nn.n::-ro1,.1s S.lK:i:1biol0gic
fonc..-ti0T1~, cfüjgflo!>iS héc:c.mlt'::i fu,-the.c compU.cated.

f Jj agnosjs rizquircs kno\"1.c-dgc- [dia = throug.b., !(n(J~· lS :-:-: J.:.fL()\.,·le.d~ j .

TI,e fin;t ~ha ir. ort:1odontk c1.;t1gH0si..i; i..s 1.0 describe. the con<litions prrscnt so
.a~ to dlstingub1h thc: nar.w·c ,: if thc s'.x:d c,:tl, dental muJ 1;u{l lÍ~liUt:": iil a fa'-J.u.al
maIUlt'.T- l 'r~r corllplétf':n-t":.1; ~nd df':L;Jl -eephalomctric.s is c-mployc-d.

Thc sc-:ond pu.rposc ln dJagno::¡is is intcrpret ario.o. eif t.ht' c:-ondi l.i on:s de.sc1·tbc:d.
Th is en 1.3 i Is I J~~ de:Lern1j n;ltio.n of thc c.omponc:nts o~· a rnalocdt1sirm..:~~ r., nnp:l f~ci t<1 :1
:standard or a ki.O't•m frrune of rd.:n:-uct' -- h t:":Jl ~ th e: 11 nü rrn ~ conccpt.

'l1•c:- tluxd .n,.,p,d v( úd}1L"1,1.]unL.ic djag~osi.s h thc: dc.d.sion reached -:-.-:-g..u-c.1ing tlv:.
futurc out-l""Ornt: -~••:hid1 is n'-tmlly ptog.oo:i;.ti;. P~di{'_tion of hoth short-tcnn c1.I1d
liíng-rr.rrn t.o mar.urity arf': to b(:,_ considcrcc.., whcthc:r it be: intuiliYt: ux '-~t'D bt-:u-iL.dy
pcrformc{i uu t_Jap:·J:", Tht" '1pattr;:ru" h~C);"ifflt"~'-= a ha:fr~ fur the lndle:1.tion.s of -chi~ mo5t
1ikely to coLlh::.

From J 6-2 measuTcmcn b- stlldkd ...i bm1t 60 Wf:1't. c:h osen 3S a ccmprehensive

9S
 l."OHlµtltt'r prugram to sacisfy thc broad. inr.crcst jn T.hc pmfes:si on . Thf.. und.erlyir:g goa1
of the resulcing para.111~L~f wH~ l.o ~11 :,,.hlt" 1••hl:': '-:foüciim t.[.] dr-:t(:".JJ"1:frnt:' th~ crimp')T1cr,t.:;. of
1:lf' i rid i ,:J (h :~ l prn bl.::-xn iu thc dbgn~is .:.nd prugno~k

In or-d.e1· l.n tt>..cfnt::: -: tJ1.t:': p:1rmnden:: to..¡ pw<.iíc::nl r,:yutim.·. '2.7 mt',1$llri::mcrrc5 \\"'CD.'
talejj1: 15 in Úu'.' l.atc:Tal and 12 in Ihc frontal 1,-víth thrc.c: Iake.n bila.t.e.rallv. The
sE=l~ct.ed ,., al u.es 'l.:.rere r.e.sterl. (J'\.rc?I' -H pc".ri od o:"i[ :)O :1t·t:--~ts. 11\~' VL't'T, L.-1mclidiy ~t' l::-ckd a'.'j
fr("t' ri bh1:-. ; i.~ p1·~~slhlr-, :ind t°< lch ha~ ~ :;tu:po:sr:- ora rcm~on fur h:s bdn,~-

~ntning iu tr1 d~b,ltc--, l hr:': func1 i.m~ :.r¡ 1d purpuSt' Llf t.",1 cl1. u.{ tht' 2 7
~ ;1 e.he.!' t.han
parmn~i::rs. are no,.,¡• duddatcd.

-:--HE. IATERAL SUr..1IviARY A.'\J"ALYSJS

fm dtc". ~'keletii.l p~tte.n1 .l),Jv,.rn·; !t..~d fivt (.5} ptrr~metc:~ . A.ll ·w<'rc changed in
Sl)iH.C: 1.1:,muta, s,,b~C"<.)1.K'nt~y. ni.ne (9) ,l.'[(' lLO,.'.' dccm'=a to be impcrativc for
cictcm1ining thc. skclc.ia1 CDmpone.nts to a ma.Jocdusion_

SJ<ELl~...:\L
Purpast· Parameur
, .

L ·l'ota.l faci.a.l heighL . . . . • CotJlu~ Airi:~ .PmXi t.ó Ua.N

Rt'm;;rAl: Tht' long OJ:' slw:rt fac,c- b o.f prlmary inten:5t h::cm.15c fa<."t's tend in
~ o,¡¡.rt.h to '.'ary arou11d d1t: origina] pa.tc.c:rn. Hcwcv..:r, a<:cs.sh.'I.:: fao.;
heighc. is noc. nec.:('_~:i:;~rily C-..íJl'lílt"-...1.~Lt".t-l wic.h o ~:ien hite. no1· ~hcn'L fo:~s w ith
de."'.'p bit t:, ;,,.1.ore cr.tic.il. is lo1r,..~r facc:" hcight bec::i:u:.;;i=-tlw.t is the
immcciiatc dcn::..a l :nvironmcnt. Onc sünpJc an~c dcscrtbcs totaJ fa,(:;al
h•.: ighL TI~e rrtt'~n :iu.gle i.~ fi(t'~~-ff'. This nnl:". ,-=ingl~ prn·.·i(ks ,-=i q_11ick
fmd ~y way to dl~pict br::ich)f,1drll p.:l.tte:o\i ( ,W rnttg(") or
dolidtofadal patccms (7 ü° ranec) _

2. l.m:1,ver f:iir-1:,d hd.ght . . . Corpu~ .i\tl!-ii to Org fuu·

Rc-.i.son: On::- s¡mpk angk. dcs<:rilxs vcn:kal rn.axillo-mandlbular rdatlons.
The J~ean is <1·6"± -~-0". ·r lle pm porc.i on be.twee.1, th e: H\'O i.s aro W"td ·¡ 6%
(or thn:e-f.ourtlu), Theorc:-tirnlly iong,:r fa-d ...11 hcighu havc highcr l ü'i-\LT
fa.ce 'Valucs to be in ha.rmony. BLJLt if, for ínsr:.:ll1c.c, e.he: total face l.s 600
,iuc.l i..h::- dt."'..HLm-e hdghL io '.>2" lh~ rnliu lo 86% wluch rnt:"...ut~ t".,e;.ce:,.fri.·t'
~O'i-','CT facc oruy. Thc rc:lation s-crvc:s n.s an indc.x: kr,.'l.'CT facr X 100 +
cotal f.aLC = h~ighL ir,d~'<- Thj.s. d.iagnosis i:; lmponant LO the gummy

96

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3. Cc.ntr~l fo cia1 direcl.iori . . . . . . . . l :1id al Axis to BaN
l..tt"~-=iscn"i: Thc: Facjal A.xi s i.s thi:: b,i::st ce.11traJ a}dr. of 1hc facc in tcrni.s of
fJiL1L.ru~¡on úr Cctrusion of thc ch.in. ,fht' 1nf:'.'U'I in L'he Llui:~i an
pt'}'\1mtion is 90":+-:.'1_()..,_ Mf'3:cilfff':<l from Basion a r-e-aubtg uf 93"
l 11dh:a.tc:.s. one dinkal d.c\.'iation forv,·o:".rd. Th f': most common. m.:ís in Cb~s
11 is &9"". V.'"!Ju.e.'i :-ihc-v~ 9{f fa\'or Oass I <.kVt::"lf_1p111t"'n1. C:l.s.s~ JH mor~
typkally is 9 S,;, and :J.b°'"~. 11)~ l ';~,-j r.1 l A.v. i s ~si.sts in d~scríptior. r;f fad.aL
l_yp~.
la ad dhkm, Lht' l'a, j ;:iJ A,:-: l~ r. .~nds rc:markably tu be tht"" g.rowcl1
ax•s. Jt u::nds on av~ragc- to muvr:-: foJ"'..,-m-d eme degree 12~ch sc:vc:n yc-ars.
TJ1t>: st:-inct;-ifd v.-=ir!arion in rnrccdcn -,..va5 ft}tU:l,l l1t be oaly 2---= in !O y<'..ars.

4. f.:lc.fal d.epth . . . Tadal PI.a.ne to Frankfort

Re-a.son: Thfa ,.,_·a~ fn:,¡:n J)(mm:, ;4nd is e.he. be~-c dc~nib~.:r: for p,:ognat.hism of t.he
chin. Il-ut true: Porion ii; ns.t>.d insl~ of thc car ruJ. 11,t' m\glt::'"
t~ha1, 6-es •..-,,;ith. grov,,._tli_ 1° c:ach tirt:'t' yt\'U, .-:i.n<l ;_dtima.~y rea.ches
90"± :~_0" ir, Lht'. ilutmal m.a-r:.u1-e mak. In adn;t i-e..n1al~s i l. 51.ops at about
S 8" 0.1 avc:-rng.::::. In Ürre-~yt::":1-1 r-old..,, Lhe an_gk: is no:rnally 64,., .-.1• 3 ,(r·.

.5-. Corrve.xit.y . roint A to Fada1 PJanc

Reason: Point A :b \1,i:d ~'.'-; .'l ·ul:◄ ~ill.'iry basaJ rclcrcncx:. lts po~tif.ln rl:":l."tt.ivt'. Hl á
straight linc f~~o -· th~ fod~l pl.·rne) j~ a. superb simple t'x.p.i:t-ssjo.o. ot'
boriz.ontal rnaxmo-mandibulac- rd.."ttionslüp. Poinl. B i.s alveolar bonc:
i'.1.:'.lC.Í ,:1üt ~}dl:':t..:il or b::!:'i~I bone. Becausc: thc- Fc1.ci~d m1gle. ch:-rng~s whh
agc: (chin fon-.w c1Td) anJ P!Jhl A lt'u.c.b to fl'10VC d.ircctly v..ric.h Na~iol". . , th~
[;::i_cial CQ.nve-xiLy normally r-:ducc-s ,.,_i.th gt:Jwl h. ln fe~ales, by .a.duJthc-od
2 um1. nf ,·rn1'\-""t""·-11L y i-fi íd~..'il, \l'rlerc:as males. p,utin1lady -.-.·hif..t'- 1.n~lt"s,
u.::nd to gr:n,.. to a straight prflfi lt>. 01· O.O mm. Nonn.al dtlldrcn .i.t a~e 3
_y~3..!'s may have. convcxity of .5.O HLln.
Coll:vt'lli.ty j ~ ,1 d.t':ba L~d issuc:. in orthod ontko. Tht'CJJ:"1:":Li<~o:iHy 1h~
strnightcr thc fa-ce thc :o::u;:re \.lflJ'\!}1 l. 1he Al'o planc and thc mor~ ll?right
Lli.c- }o\·.·~.-- int~i>'.io,. Thc: d1okc: is to u-e.m thi:- tt:.t'.1h to t.ht~. e<mv~hv or ;

corrert the (X"ll\Vt'v-..:.i 1_y ;<!l"lfl t.reat r.o dle nC\\' maxifü.1-:i:q,n tdi.bi..1l~r
í'.ondJci on.
A,:. .=i d)f'.(:k íor imerpretation ot convtJÓ.ty, t.he. ,,--Púi11t A Une is
usc:d as a ''n~:sal plam:" ~1J1d r'C"lm~ct. rn ;:-_he frankfort Plan::. 1<.k-ally iL i::;
9 lY'--+ 2 ~. Poi n t. A is fonvard in typirn.l. C(a:s~ n .:;in d thf! n.asal pfanc i.s
<:ommon.ly l.n,-c:J.-~\V.:lrd i:o Cl8&,;. rn. Tiüs mc:ans that tht:' :i.ru.1;,,.ill,1 ji:¡_ ~n

97
' .

.' '

c:ss c:ntial compone:r:-.t l n t h f": c:b..ss..i.c ma1occlusioru:,

6. Rarnus hei~t . . _ _ . . .. . . .Ylandibular Piane to Frankfort

R::. ~son: Th c. m a:-irubula~ pLmc ~~ ofteu lo:-il.:..t".1l a~ a 11\i.::asurc te d~scriJ:-.e düi 1
pu~i t.inn, bul i lh~ real huKtion is to indk..'iti:-: verlical height or posítiou
of thc run1us. 1t h.d¡.1"'3 í.ü df'_fine. fadaJ patttn'I.S. ·11\t ..-rngl~ ls eao::;ily
mt>.a.rn.rt::d c,ff a righc angk tci th~ 1'1. t7)-'gú1 d V c.rtical Plan:::.. A mt'"ml 2'l ~
ang.lt:': \~ pT~:i:,1 .~I .9ge.: 3 and reduCC's ab<.,ut 0 .6" e:1c:h year ,;vith 1:hc ardal
r-:-xprcssbn of ,,-01rvtlt of tltt:' n1,~1~dibk LO aboLtt 220:- by ,,dt1fth,):1<J.
11"Lt": ,~ain value. of tt.c: high rn,nLcL1hulaf plane is ihat it m<1.y hen,td
a sick cr.in<lyl~. ' lfo=· v:1ti:11io_11 of thc: anr)t- .tlt z.5" i~ highr.r th~n \"1,óOLLld
he dcsi ri.::d for a dc:::initivc p~nt.lJ\t"'.l.t":f.
l.ong faces can be iong, tnpett(I ,vH.h hlgt. anglc:s, or oblonr, i.-vith
1

squa.rc: lI"k'Ul.di bum:r. typt>-h~ Ot' ki"V.' angic:s,

7. Palat.td .Pl:j.lJe l106itioo _ _ , .. .. , . . _ Palatal Planc to FHua.Jdo.rt

Rtason: Thc pulat.tl piunt' lo[)lne.d in importan.a.' wht<n 1.1. ~-..·:-~s c1.1 ~:ove red i:h.at :h.c-
floor of thc nosc Lilll bt'. •.:han.ged ·m growín¡.;: chih.Jrc:-n. Hy d1,·-n·1giílg
•.ht": a1~L~l'1or nasal spinc thc- nusc:: is ,·lt.~1ig&1. b~a.usc thc- spinc- i~ a
pbtfrm:n for t h,::, c:ln.11.s:igt".nous s.c.ptcrn. The fü1t' f,om...\ns 1.0 Pns js
m..::asw-cd likc-,;,,isl:" from -~ pt•.r-p~ndk:.ular to 1:h<: Ptt-r.ygoid vl:;':T"1.ü::-ii.
1be. normal pabt~l ang.lt": 1!; abc,ut 2,:,±2º to thc F:r.ankfurt 1ilm1t".
Thl~ .;-:1J1glt j~; u~J.i ;__e, hdp dcti:rmine :na:j~I <iy:,,plasia. IL LS also
rombi:nro ,•,it.h tht> or.,q I gnomon in d-:scrlbi:r:18 lL l nxi Il:l.ry t':h.ara.cc:.eristics
bec.ausc thc: whok pruata.l ¡.ilam-: c~.n bi,; 1e-..• cl but ~till be loi.::att'<l
su¡*.iiúily 01' 1lÜcrtorly. \Vico i::ht'" \o,.1_,ole. 1):1~:::.te is superíor th:::: ~:i-mm·.:y
~m:dk tt'Hc.::i,; to fJ~ve-lr.r .

.8. Po~Lerior CraniaJ length.. . . . Po~tt:dOT Condyliun to PTV

Re,lsr.l:n; T1:-,b :r:nea!'-..1-1:n·ult'.nt. dt:":rn)LCS c.h.c condyk :.1.Tid jninl relal1on (H position to
thc coordiruitc {"OULJ,Üt:':">.:.. lt. i,,; a mean. of J l nun. ~t ~l!:,'t" .':l !{t lrl gn)i.v.,;
O.:i mm. ún a-verage pc:r ye.nr..
ln Cfri ss l J t 1. i li oíe.en longer and in Cl:i s.~ [ J I i 1. is. shofL~r. It :a.lso
wa.s suggcsn~d to li.::: a~su,;_·w l~( l l iy th:c:p bitt. d uring devdopm~:nt, u1.ovi.ng
mnre dj.sLally. Po.stc:rior cranfa.l dq1tl1 ili a -~ignifican1: com.pon--:nt of
:r:rnlk1i:.:1·hr~kri:~-.; t :{"1 ng ~horr. in Class 111 arnl loug C:lwi;~ U ni r-:;-:u1
com posj e.es.

9. Antcrim Cnmial knJ.,rth . . , Cnu\ia.! cente.r lO Na..,¡:_¡ion

Rr.~son: Thé rna..xilla js suspended o±t thc- m1k.r1L"H' -i.::.1aniai floo:::-. Ce point b

.- :
 l":úT"liil nirted frum Pt point Joc.]ti:=d at fornmcn rotundum on the base of
,he- gn::at ,'\oing of thc sph:noid.. Thc k=igth 10 Nis t.aken t.t1 rt>:prr.st>:n1
1

ch f'.. hofi.:/.OEl l..'l l dhnt'.:rn,iou 1.•f t hr::: m ttc:'rfor b~:;;t', b1..1t it b <.1 b.lique on
!iVt:"T<tgi:= 17" to thc Frar.Jdort horizontal ..
\-\.1.e. 11 1.h i.,:; 1 nt't-is, if::-.111 ~rl!. i ~ 11 :r1g i l. b~lx iv 1t:"..-; r:1 o.:u._¡.,out'nl uí Class
11 ~tfüt when 5hort it contributi::-.s to CL.'1.ss III {Y,nrn thc mrudlla is
nom-.ally rr..late<l. to t.h~ antP.rior ~r,1nir11 has:f'.}.. Th11.'i. shnc-1.nf'~~ Cn'l hoth
e:nd:c; i :5 cc.~uunon in Cb.:;t. 111 <"ln.J long:ni::-~s is typical of a C1.us II cranía)
cnmpontnt .
1l1i:i. n~~-,~~u:-~i:~lt.•·.:ut i.-~ ,~ sc•.r\~jlJ!t" tt·ot fur the po~üon of _N¿;sion .n..s &
b:..i !:>-i ~ fr.1r thi:..• Facial Planc- origin. In 5omi::- pa ti.ents thc- cranial base a'.one..
GU'I. acco-unl íor OJK!-hal( 1.h~ mn1-phologíc .~l:..d~tal dy'.'>pl:-i.~[.;;i,

or:NTAJ.

l.J(lWl~ cho8c- fiv-:: parmnct..::rs for thc tcc:h. Four c-f thcn·. ,ve.t"\~ r.ha ng1:>:d íor
<.k:scrip:ivc ?Urposcs for thé prese:nt su::-om:uy an.s.Jysis. One. ffi~;'lturt-1: 1t":T1t. ,.._,,~~ :.idd«l
for .50J1. [j S.S L~ .

l O. Lu,,n:T indsor positjon (horizonlally) . . . .. . . .. . hwJsor tip tu .APu

Rcason: The ~owec in,:.i sm" i ;', t.h.t:>. f1.n,t. ),f'!y to de..ntal cmpl.~ccrru.·nt. Thc rda,íng
fJ f 1h t:"' k:1,.vt:'r hu:t:sur to -:.mtcrirJrmosi: skdctal 1:'Ul.dmark.s in thc j a..,,;.rs
th...:rdorr relates to a.. r..:::cLproc-il Hne... Thf': fflíH~ ÍOl'v1.-actl 1ht. A pc;iut thi::
more fo.rward is Lhe. :1ver.rl.g,t'- Jov..rer 111 ds( ):( ~n ,:1 nnrrn 1 ~Kch1 !5-ion.
C'.c.mvl:'.n;r.-:I y, th-: n \ore ~'JTicave thc: fa.a: :he- more- the lowcr ínc:sor is
retn}J.1(1sh:ioncd to be in harr.1ony. Diffe.rem. i·.~ces o~ :-iv~:·ag{' defou tdy
hav c. di ffi:::ren 1 ::1 n to, 11.11 s o f dt::"J t l..il p1Qt11.1~iun.
· l"hi:·: ;1;h1dy of <.l s,tmpk ot 15 childrcn, mixc-d denútion, age 9,
~-..·hh :r tonmtl ocdusíon, r~•e-..alcd a m i?:an o F + 1.. l) mrn. ít1 r t.hol" kn.-.·t:"-1:"
indsor e.d.gc CD thf'. AP0 l)' ::i ne. ·1.'ht ,·ui.g.le w~::i 2 ~ ª. On compru.in,v, thís
v,1]1Jt=- Lí"l :1tfolt~ ,,,.rtth tl•.~ nto~ ao:."('ptc'l.bk rc-htions it \vas found. to be
c::onsistcnt. Thc standard dc:.. . •i..::_tion 1n C~11(~.(¡i,1n L"K'dnsim~ "\Vi:!.'.> fc.und
to be + 2 ..5 mm.. Th '. ~ v~lu~ h.a-5 b~ti LcüILSÍ<.knxl by th~ author, 5ince
! 9'18" to bi:- th(: m.o.st ideal a..s an e b ¡cc.tl\o"c in plannj ng Hea :.n.i ~•l l.
Currentl y m aoy c.ii ni d ;l.n:s p.-e íel' il tr-:hit.i n:n ~hip of + 2. );: 1. In
bt.Kk auJ CJrku wi 11 Lt-i: L. :::he- me-.;.m \V-i.1!:t found to ~i::- 5 mm ... as shm\.TI bv • J

_:,,..Jc:zu.. Thc !~ver jnctsor L~ 8. ba.sk ,';.L.;:.. rting fl(>if'lr ror pfanrung H1t' vro
.an..i ,c3Jr. ul~L ic1g :ind1o{!lgt' for ~1tedwuk~- TH~ i~ onC' rcascn for
antid pating (or forcca.sting) thc ch tn pof;t Liü n ¡¡_nd ma :-: i.llai )' :.i l l t"..t"~ lfoa iI L

99
 the cybcrnctics of the VTO con sc.rüt~.t ion_

11. Lowcr ini1.:isor pos-ition (verl.ica.ily) . . Indsor tip to llur:c:al Ocdusal Plam.::
R.::--."'Ri(Jl1: 'l1~if' '..i"hi:>: hu.c~J ocdnsal pbnt' ignr.~~ 1.hi.=-: inciso.rs whkh <l:rc infh.1t"n{'~rl
by pc:-r.·.::-:i:ttcl lip fmK:~.iOfL Thc: buc..'<..·~l plá.ne. is. .a f L.lllctíonal plant" ..tl'.d
for dc-scriptio:i the- 1,.)wt:'r 1l'IJ':1Sflr if'<lge is c.sscntia.Hy on that fü11:::_
l n ü1n,~ Lru,,:1.Lon of a VTO d-.e hm.:c:a l fJ l 9.ne can be u.sed but for
gt<'~ttr 5ophhtk~1 .ifJr1 in pb.nning. thc divhir:- prnprn·1 i11íl fr0m A to Pm is
c,·,a.,·vdous. Point A to lOl'r-eT. ind~fll' ed.g\.': to Pm j-3 a divine- prfJJ.lnrtincL
Th(:' h,cism w Prn i.,; J . 6 ! 8 thc hdght t, i Poifü. A. In gro~ir'.g chlld,x:r:t.
-.;.,..i.th .short lips. aJaptmi,.tn CJÍ c.l-1if'_ Jp to thc- divine h(:'i.gbt (l Lhe lrn-..-c.r
i"fl L:j sor ha~ b~en notcd to o,;:nir wi th ckvdo pment.

': 12- Uppcr molar pos:i tion . , . T _ , Distal of u p pif'..r m o Iar to PTV
R~on: 'l'he dLr&t distancc from t h.t- dh;1 ri 1,, f 1.h f'. u p per f_rsc. n1ohlr to PTV
tlesc..·-..6bt"-S mo !ar po~it• on_ O bsc:rv-~tio:n j n 1.h I:': J9 50s suggesr:ed i:ru.t
i::hc 1.:ppcr [n<c :i:nrJln-r:- idt>-~'llly er .i.pi:s a:t :he Vttkuh c-hm:wk,gi{'. agf! in
cl'! 1lL _plus :3 mm. (l..:: .. ag-e S + 3 umL = 1 l mm.), b: maiP._taín:.;. tl1at
1( ' . ~ l:i Ij L°ITl,~ h ir ucl 1.i I gro\'.-"Ch st.ops bt->::a '.l~t": tt II:': cki~ture mov-es. fon.,;~:r:c!
1

l .ü mut. pc:r yttar. A n1J1H'lal posir:ion doc-s not nt'".an it (:.'~T11rnt ,.) !' shotiid
nor:. be: mo\'cd di&rnlly but j I dcii:::s s uggeH an ul timat~ Emi.t.t"c l si ,at":.t: [ o r
th ird rn ola1-s .
Thi:; !wwmt.:~l m~~asurcm::nt of t~1C'.' up¡,if'r 1"()úlar ,-.,as thi.: s-:cond
moE-i: frc-qucntly <.º')r:rt;":l;,1 ~d in the. 362 mcas.urc-mevt ~ (lf Lh,:=, t':CJm put¿,J·
:iludy. fn othc:r \\"On:ls, h. con::--hitt:cl ,..,...¡¡ h Corm anci. sizc: of thc 11p..lttt:·::rn",

13, DqJth uf 1o'-~'tr :udl . _ . . . . , . l\kshü of mol ar to ¡ndsor tip

R~ason: Depi:h of thc aren :rom in<.·i:-n.:-r c.i p Lo tr.e molars is diagno!:itk <1ü.d •~~t':ds
Lo h,:=, m r~btP.d wH.h -d,c den tal mudd. Thi.s ,-,1t:as.un::m(:m conirt"rts thc
info:n :uatio.n :6:oJn lhe denta1 cast to tlu:: ht~:ld X-r.a.y_ Ho,...·ev~r. this
paramcte-r for ,m:h c.kpH1 J'.'i t':·:•ff.rt~~m~)~r uscful b pl.nming dtrL".tH~
empla..::r_mcnts in r:hc VTO,
J)ul;': to ~,~1:-u-gernent in thc X-rny th~ m:di ,·lé':['1 h rn,:=,:u;1cre.ment Í:i-
l argcr b )'" abo u.t 1 mm. ;:nort: th:-m 1.h~ a.ct.u.aL In normal arch fonn t.ht"":
d~pth {:eph.1.kJmeuirnly is a.pproxiu')jlt':ly :J:_'"-3 ..5 to 24 mm_ Sizc of tbt..·
tctth a.a.J i:m..:h fon:i.1:. ,u·t' v~riables_ In c::.\.-craction GJ.:s-t'ti ~JH:' de1it.h is
re-duced ro a mean of ab---Jut l H :: nn'I _

14. Uppcr to 1owcr ind:sor , . , lnter-t.o.dsa.l a.ngle

R1:"::is.-tn1: l"ht': inlf'.rincis;1] ;3.ngle is carricd cv-t"J: (mm Drm,ns.. Ir: has lítú:- w.iu.:..·

100
 CX<.'q't ín plannín g .'w1.d oon.~ l l'L1('J.i 0n ú f 1.h ~ V' l '()_ Ovetb\t.e :n td ov-rzj¡:t
o uj('t.·tivt"~ m-c so .stand.ad at 2, O mrn. th.ey nc-{:d nor be mc:.a.s Lu·cd. Bue
intcrlnci.sa1 ang]~s ai.: tr~acsne.nt's ~nd 3.fe cri1.ic-.al. 'I 1,e mean goal :a.t
J..l'ealnl~. O.l'S tnu is 126''.
Trirr.orphic anangemi.::nts \i.-cri.:: found from rcsearcll. fc,r
brachJfacial far-.e1; :)el([ p10lti..,$ive types 12.<r' to 12.3º "'"'°'S fuuu<l, Fue:
lu1_t.g faces and Clas5 IIT anglcs of l :JSC w l ]Y -.,,,1:J:c a.ppropiat.e.

I :j. J ..0\41,•e:c Iip p r:oli:usiou . , . , , . . , Lowi..:r li p to E line

Rc:-ns..on: Esthctics is a majar conecr.n in orthodon[ÍC:.s. The lmver lip if.
infi u.en ced by ho ! h I hf'. 1O\.~f':r .'l nd I t ppe.e in.d ~o r. A U1:i(" , frcm i:-rJrt
tí ti!iUt:". t-hin to thc cn<l of thc nosc, has s·c rvd as thc bc.n si ngk: c'i2f..::1°f'.n e.e.
Th~ low.:-r i~ ideal\r .· abo ut 2 mm . closer to t.h~ li ne. 1);th t":L.l e: h~rrnonv j 5
~

t.emp~~d by Jl')'.:i-t" k·xigtb arn.l fadal t:n>e, llcn~•er, ju5t as th..: lm,'Cr
fod.:;.c.Jor b él ba:sic r.::f-:rcncc starting ?Ointi thc lowcr lip becomes. a
starting rcfcrc.nce for e:i;lhedc e~--alu.alJon.

™E FRONTA I . SUJvfJ\''IARY ANAIYSlS

fxn•\'l,,., c.>ff~d xm frontal ru:u1.ty.sis. This \.Ya.s pos.sibJ-y du.:: i::.o la.ck of
i:nrnn11;.1f.\oi:1 ~nd fünh:cd intcrcst in transvers.e phcnomena.. H Ol'.-evec. wi u-i 1.h~ ~dvt':Tl t
of palatal scpararion, ci'lc. fJndíngs o( ;.i!lt"J;'.I Í4Jl\ l.>( ,.u;-i~lfar:y lia.:.;~ in llm:'t' dhueiLsions
with certain df'.vicf'.'i, .'3J'l<l v,.,ith. surgícnl ú11:--=rvc-ntion in both jm•;.''Si intc:rc-st in the
,i
fruu.l l be-;.·,-1.mt' prnfound. 1\-ion: than thro:: oF C\'<::.ry four orr.hodon tic 1l.~r.i f'.n r11 ;;i r'f"
involvi:-d váth thc transvers€ diülf:cl~iúl'I. Du.t>: l.ú 1.ht>: d1ffic:ult.y úf [1mn.1ri::i:·1:': identka.l
films, dircct rrnnsvf!r.~if. miftt:o-n'(HJlt"i•t :11.~ t hi::- :mo:-;I tn15tl.'r'ortlry. Ch.1rt~ for
cii:.....-e.]opn1t':T1f.'il v..':th1~:; nrcd to !:,e consultcd i: thc comp-:.Jtc.r programs ari.:: noL
,tv-:.iibbk.

SKI.LETAL

f.. :,.¡~ Sif.11 (~v it}' witJth . . . J\e 1.0 N L.

R.ca~on~ Brcathjng- sp.ac~ ~nd r'l:::i.s::.11 ~ynu.nelty ~tt o[ itnm-edi~tc:- (-i:Jni;:·tn1, Aír flov,.r
1hr 1-.11gh I lir:- :¡1 <tss1.l ctl'-ity is ot int~ri:sc to mo.st clinicians. TI11; pjytform
apcrturci ai::. its lm..-c:r :)rnd.cr, j.s thc: base fo,· s11ppnflLíig rft=nfd~s <)Í the
LLpper Hp e.i:: Lh~1.iq1Hy. Tk s ;Li:-t".:l h~cc.lme:-: :~ <:tlJ:u::t"m for many clinidarL&.
A Jire,ct mc:asurcmcnt from thc irisid.c margrn of th f': n.'m na.~al
w.'l.Yi tk~s y1 elds ,,q n ,e,.:p re:i.s1on o( n s~8.l ...,,vjdth whi d t naturnlly incrc-ascs

1U1
 m'l ly O. S" mm. per )l"f:ar.

2. M;lx:Hlsry width . , . . , . . . . _ • . . . . . . Jugalt. LD Jugale

Re.a.son: lnter Jug.:.tl-e dÍlittmi::'f' i:; c.-=i.kcn to rc-prrs1~nt t}tt;•. h8I>9.l bonc and hc:ri.u~
transvcrsc dimcwsions: o r lhe ma:\.illa. Thls i~ n ) 1 n pared to knr.n11,n
-~' :tncfarcts ;;.nd to n;:i.sal and 1mm.Ji1Jubr ifldj~•~duaJ transvi::-r-!it" <li:i:ut:"J1sicrn.s.
It incrcasc5 abi::,1.1t LO mm. :·with na.tur~l gro1rvth ,-.t:-if1 ing ::.t 55 mm. at
.'lg.e. 3.

:J. M:t ndihular ·wi.dth . . , . _ . . . . - An1 if':gon ion to Antcbronion

Rcarnn: .A11 ~x :.)resslon of v--Tidth uf the Jtl andiblc 1s dciliabk <.lt th~ J~vd n í tl1e
tccth.' Tht': C, rnj .-~J ángle furc:s in rr~k:s n:r i!i ífa.t in fcmaks a.n(l b
postcrior tci tl~ .rxdll:,ioH; 1nt>.a:'it1rc:mcnts from th.e gonial 1'í:.gion i,v..::rc-
, u 1[)ffiduci:h-'e. Osc.eolcigic s-tudif-.,i; sh.ovve.d. that -che triht'.drn l t':ffii n~11C..e:
wri:o; pr..,si:--11 1 ~ 1 1h~ {'.HIVE': of Ih.;:: ~"ten tal ultHc i u~ d dgc. di.rc:ct.ly bdoi.'\' ~hé
molars. This ~•,"as fut"Jl:d to b~ vtstble on frontru filrw=: :rn-d vi-'.1.S just.
..-rn:erior to thc mandibi..llirr 1,01 t':h . [r. i.s also rak<:n c.ts ~ layi::-J· L.ff cur l.ic;.J
bon(;'." ,•,h~, tht not.c:h is .sh:1lla,,,;.r, Th~ i:)~ijnl wF.ts 1abelc:d .Ag- (tor
ani::q;onüi.l -cu b~RJC"").
Chasc:s \"K:rc- compos-~d ;md tht::. mandiblc \"i-"a~ fu,md t -: , g1-ow in
,..,,.i(l1 h J _:).-; mrn. per year. 1-J,:y;.,."C'Vt":r:-, jn t)bliqlli: dtrcctio1~ (tkn-,'l 11/L~l'd
and ouhv;mJ ~r0wth) t.hP- na.sal G!.Vity, l(u_~;,JU:i, áfi.d n1ancibk bchc'1.VC- on
th..:: di vine proportíon X 1 . 6 J 8.

4. Ma...:illo-nrn.ndibula:t' ""'idth (L) . . . . . _ . Jugale to Frontonf,Kiat .Pl~l"le

.'>. I'Ylaxillo-mancl ibu l=--:t width ( R) _ _ . . J1 ,g~ le: to f'Tonto-F a<...iaJ Plant:
Re:.n,on : h~íorrnation ·js ni:::eded for proporLíon and ~•mJ:n4..":tJ:y c.if the: tn.AxHla Lo
th.t'. individual mandibk. J-1,.15t ~ ~ :ho ri,-.ontal m.a:cillc--mmLdil">l1lin· Tt"l:11 icJn;o;.
are" 1nec.1.s,1red .Cr:om l'i:ú n L A to thc: Fad.al 1.'kmt' {°:--T'o) rh..:: J points are
~fated to thc lin.:: from L.F L.o AG for n-ansvcrs~ h::,infü)clJ . · ll,is rd.ation
L'..H'I h~ t.hought. of as rna.x.illmy <.:1_;.ut."..':lvil.y rc-.lad"V"C: to thc:- m<ln<lible.
The -i: lilll•\1:1 l rns1xilla dutlng dcvdu¡,Jf'l.{':íl t. Si'..ems to mainta.ín abollt
80% of che "l1,idth of tl1t." rl'!~ndihle.. Thus. th,:: '-'r'iJLh uf lht"": J.El8xilfa
hwidt": 1.ll~ 1!land.iblc dccrcasc::s "'>vHl1 d1:•:vdnf'm~nt ata r.lh' rJt n-e~1rly 2
mm. -tm:.} _ 5 )-'t:',ts:S { nr L mm. pc:r side}, Th::- 1ft rr:{i lh (l) a.t agc 3 is a
n, ~;:in of 9. O mm. f::-om Z Ag p ~l'l t"., ,H. agc 8 is 1O mul.. iAt !3 yt'MS i :-. L l
m:i:n." :ind :l E. .~-e 18 is I 2 mm.

6. M..1 nd:i.bular symmctry . . . . . 1>:rotub<.'TmH:e" Menti to r.vtid Plan e

Reas.on: Th~ ,:::a1kr of 1Jlt:>: c:hin -can be off th.e "cr.'Lnl::i I" mrdlin~ duc to both
 1nnrphology OT funct'Eonal cause.:~ . Thc trir,onu:1:.1 Im.-nta1i . is vbibk
and J.'m i~ sdcctcd at its ap('X,
From the. c:€..nO-a.J sagittal planc- (or 1J:1üJ-:,,,1gitvll pla:lt:) ~1 po~tion
trJ th(:' rlg¿Lt is ¡.,luJ <1.nd tL, tlte l("Íl if: m1nH:-;.

7. M:·u: i lh,rv
.,,
~meln•
J -·
. _ . .
. Point .Ans to Mid Planc
Rc:ason: I\1axHlas may .n.lrto be .n.symmt":rirnL /\ll, for lht írünLcil j:,:; t.·Ü;,_~rl w ht>: ,<:it
1.he Lop of r:.he mii.-ma.-xm~y suttu-c:. Ii: :.s cvalu~tr:-d from thc.: mi.dlinc.
Pfo~; i~ rlght, :mi.t~~ b ktt,

DEN'f/U.

• T • .. . l'ran s-buccal of lovi!er molan;.

Reason: }\rch wi<lth is ot intc:n..·51: to di::-tt""nn111t I hr ,.vi:r,:;dorn -1.1í huc-rnl f'"'{píinsion.
Thc. Hrst intt.:.rc:sL lics in ilic:. acuw @:ch ,,,,:ich:h at thc- fir5,,: molnrs -..vid..::st
ex 1nt out ht":t·~u.,i:-: t.h.:1 l. LA th f'. rn o..,;t. \• isi blt: on thc from..al hcadpl;;;. te. Thc
mean of normal ocdusions at tht' :<ft't't:r fir'.'-1 nlúl.í:lt' i:-:. S.5 mm, \\.'itl:i 1l1~
cbject film distance in "th.c frontal th.at mc~s ~ typk:ü .'1 % ir1.~Tt"ase in
Lllt' -...·idl 1~ vx·11h.Hk1rn~1 rkr.1! ly, which 1)1.akcs mean molar ,vidr:h c:s~::..nciaJl-v
56 ..3 1:1m1.. The .;:_·Jinirnl dt·'-~ ,~ti.un i.:-; +LO mrlL

9. firs.t prc.molaT w1dlh . . . , Trans-bucca! of km,r-cr first premolar

R~.,sun: A.tch foon j.s pp:•JJtly <lt1~rmined hy 1,.'idLh at the first premolar a.re.a.
Forty mm. (40 mm.) is thi: me-an in th.e p o¡.n,htf.i.011. 'l1ü:: . h tai:1.¡.~rr:d by
tocth si21;:, 1rch ty pe a.nd v~1y s1igh tly by sc-x, bd:ng m1..ali<T in km.:1lc-s.
Tfo-: ,Jii1h:d dt'1r'Ü'.lk1n b ± J -~ lnn, .

1O. Tntcrcanínc: ·w idth . . T.rn..ns•l.iinine típs

Fr..:mri:,: 1.,fJ¼'t".í intm::H1i:r1t". '"'idtl, 1:-,; •-h~ füO..SL. Cl"l..i.Cta.l a.rea o~· :---O\'e~pa.n:sloc1 11•
TI1e nmrnd tips of Gurlnl.~ Is 26.0 uru1., t~~1~btlly. 1)1if' 10 Lhf'- c-ln~t>:s:;
of Lhi.:: ('.a.nínl":s LO t.he. fllrn rhc c::1larg:..::mcnt fuctor b 2%. This is only 0 . .5
r:i:m1. :m,I :.~ ~,.~~nt.i.:1lly :~ r.r.1.c.:il'lg er"?'Or dime:n.sion. V•.le. usua]y oonsid.er it
i;.'ltithGm cnbrgc:m~nt, i:h.:reforc:, The dinkal Jeviafio;1 fa ± ¡ .ú m:i:n.

l 1. Mofa.r posítion {L) . ;.\.\olar bu(".(".al Lo Fro n tn-O~n líJl Plan~

l2. J\.·l olar position {R) . . . . .:\1oJaJ:" b11crul to f:s:-onto-Dcotal P.lanc
li f!':';'l ~nn: 'l 1)f: df' n 1111,'é' i:,; c-nfl'1" !Ii I f'd. r"r:',-:'. pmc-..g lly -.....i t.l, r.hc. skck.ton. Th~-.. bu.c;:-.al of
thc: lc-...,'-':r molar is rdat~d to a ri::-d.pro<...·,i.l lint' b t Lw ~t.fl. l ht' f-"\v. -s "'t"tfot·h i~
1.3.~(e.n to b1;: JAg.
·;. . , I3ccau!.ic die ¡av1. s gru~v lhí:r; diinf'.11,~ion .also changcs t•,ith a.gr:. M
1

Hg~ 7 iL. ¡_s f:tpp1'(Jxim.aLdy 5 mm. and by adultllo(>d in nude..s ,s about 15

Im:u. At ~~:,..t"udally :i~t" l .'1 h. l~ ( O rr.m ., "i."i-il.kh makc, & ~~uoJ rdc:-rt'H~-:t:'
dtnicallv. /

13. Molar bite.: (L) . . . . , Buccal of A6 to ll6

14. Molar hice {R) . . . . Kuccal of A6 to 'B 6
Reason: i \ ...'i~t"'i;~,:,1 i--r 1t .'i r.~f n 1~~i110-m>'l ndi h1 !Ln d.o.::~ta! ,dation.s a~ h Lliicalt'd [1.1.r
dc.scripdon. Thc ',vides,: point on J1t' 1 tpp~r molar 1s measurcd
pt>.rpe:ci d¡cHlar LO rh: :-ronto-ocdus.al pbn:: ,.,,+ i 1·h hiM:r:1 :-; L h~ motar
0
:

ocdu~ion l.~t:::;:--lllly.
Thc up¡::cr, in ideal occh.1~Jo11~, i.o;; 2 mm. -..'Vi.d.e:r on (!:teh .sídc.
Pn:li' l.i (:<ir Iy ;:il l :,;t':vt':r~ Cfa:-.s n ca.5-.'.:3 are actuaily .Ü:ngu8l '1X ]~~l n1 t:"...~ i [) Lh i.s
mrnly.sb unlt:s-~, ot count', " l ) 1 n-:c:-i l t:rnssbj üe ( or Brodic .syndromc:-) i~
prr:scnt.

15. MidHrn.' of lot=ver . . 1-.mhTasurc of lm-,,~r :i:n...:i.sur tu I\1icJ .Pfan~

J{1;:ason : T.llc dcnturc midlinc: of thc loYVtT b .<t SL.ftrC.ing pclnt of r-eforencc. 1t can
bé mca.su~d. to i.:.he ..::e.rruaI phnc or 1) lin~ fr.,: m1 A I o Prn . (>las is. righr.•
r.-iixu.w k;. ldt.

1 •
105
 .....

.. ..

. .
' .

LEFT
 )
,

'.
119

I
/

Lip~ ~t
Re~ ose

107
 R

,i .
\.

108
 ~~..9t:U
3E1.8 :t 2..0
, ) ~ ~0.96 :11..e.

NORMAL DIMENSIONB
G. A.· éf'
Befor,e A ftt?. r
-~
1

. 3s-., 1 r
..... ., • 1 '

~ ~~- 8
- .. :· 1

--· --···-
¡
·.,
f . '

# 6748
Age 8-4
:
'
.,

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1
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1

.1

G.A. <:r
5/1/70
.Age 11~5 Yr. 90
1

'
•
At Reteniion 34
; . -~ --..
1 1~ ,
, '
1
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1
1 1
1

126

~1
1
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110
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G.A~ a·
12/13/79
Age 21.167 ./
/

, 3 yean; fater . 92
~......................--~ - ~ ~ - - r - -.............- - ~ l
90

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' .
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 1 -

Robert M. Ricl«itRi D.D.S., M.S., N.M.D.

Director

AmeTlcan lnstitute f or 9ioprogressive Eá i.-c.atjon

9106 E:. La ?osada Court
Scottsdale, Arizona 852:55
Phone-:480/948-4799
Fax: 480/'367-0933
~"í!!W, rifl8tlsbiopro.com
Cap,iright 1900. A.11 nghts reseJVed