Hmeri can Institute for Bio progressive Education

I PR06RESSIYE CEPHff Lorn ETHICS

I Pff RR Dl6ffi 2000
I

copyrighf 19,91

bg OIL Roh1ert m. Ricketts

PROGRESSIVE CL CAL CEPHALOMETRICS

Robert 1\.l. Ricketts D.D.S..~ M. •~ .M.D.

O 1996 American Institute for Bioprogressive, E<ll!ICatlon

Scottsdale, Arizona

And

R~etts Research Libml)' and Leaming Center

Loma Unda Unlversity
Loma Linda, California

!Robert M. !Ricketts. D.D.S, M.S. f N.M.D

1

'°"C10(
American Institute ror BiopR>gressive Education
9106 E. Ls1 F'osalis Court
Scottsdale, Ark0na 8!5-25.5
Tffl (aO) 94M799
fax (4-60) 367-0933
E-mail m~ma@adata.coro
 PROGRESSIVE cu NlCAl. C EPH A 1.0.r..u~TRICS
PAR'\UIG.\1. 2000

J, h, tw, l~u.1 ion

Strr.tcmcnc of Need
fucr..i c.cs in 171c=- t\"~,.,- 1\·E II ~cl hJ m 2
Pmgrt:s~i'-'i~u-.. in C:cpha.lomccr_c Application 2
IL

EI. Th~ Twdvc D::-anc.hcs or Ct:pha;o me.1 fi ~--.. ~ 5

F. .mi.::tian # J . C()c, :-,t1 :.,11 ~~ :~ •J·( )vi fnr D:,ignQt:i~ 6
Def:nition h
The I...atera.l 1lle½· 6
..,
Th~ f ro:1 ~.:=.t I V ic=-w I

A(:i:':eSS.(JT)' V i t".\',-"~ 7
hrnr1 i,:w. #? . Pwvi.d(:'::;; Aco:~s for Visual A.sscs.smcni:. and Tracing 8
The- Three: P's 8
Tr.acing and Digitl2.a.ti0n 9
Fun~tioP. -#3 . (\; n U,.i J~:o. Hdr:::-t'.n t·.t':s ,.,:it.h )31 rJl,:_}gi.C Sig:1i fi-.:- ,1nc<: JO
Ri:".q ui r ~,nt'H t:,: vf prJil: t:.; 10
TT.m Poinv, Founct Mislf.riding:
F,.}j nt Sdl.a 10
Point B 10
Rcfcrc:nc:cs Employed in l .aLt:,:,il Pr:n;p~ctivt 11
C ervkal References 11
Cn~.ni ri l R~fr;:-c--xw.t":~ 12
B ,!S)OI\ l~
Na.sion 12
Porion 1.2
Ofbita.le 15
l J1.f. ry goi d K..e f~ri'.n :--:e 16
Ptcrvroid Paint 16
Mand_jbul::tJ' ..~r~n=-:1K~O:. l7
,. Po.gonion 17
Protuiie,-antx mc:-1lti rn
Gnllthion 18
.f\-kn ton le
Xi J-lninL -- l·U L.() I{ 1- 18
~libgonion J9
Condylion 20
C undylio n. ~rp~or :dO

i
 Cui1d}•lion posa:rior 20
Articulare 20
Ramu.~ re.f~fi'.n-c~ 20
fr.,.·.o:i. Point 20
.r.t\1:rray Point ~{_)
I\11..ui.lla.rv
.. references 21
Anterior Na..'>.lll .Spint" 2L
Po~ti::rior N a~al Spine ~l
PojmA 22
;,2
Lo"i.\TI Incisor 22
Upper Cenual l n.d.St1 r 22
UJ\~ Fir,-c Molar ::n
Upper Fir~t Molar 2'.j
Caflini:-h~ 23
Soft Ti.ssu.t: Tt:li. -:i ng :l n(l Rt'fernl<.·es- 2-:t
Tl t~ Pr{ltlk :.\-1
The T on~c: fil"td Hyoid ~A
The: Sofr Pal a'C.C 25
Th~ i'-'asophi:i'}'lLged a1,J Pha:ryng~.al ';Vall 25
f i:.)nign I3od'io and Pathofogy :ts
Frontal Pe.rspec.tiv~ 26
-...rnrna,
(·• • 4 :mo:.. n
.s J.)asa. Jnr lJ mru:s
• 26
Zygomatlc Front.al Poir:t
ZygoinaL,j i:: ArJ I L'oint.
Crl s:r.a CF.I I 11 f'oi-n-:-
M,H ld i bu.I ar &tiahu Point, 28
-~£ Points
Protubc:r-.::.nc.c mentt
Lateral Articulare
Ma-:,,;ilfaty Rl:":Ft:r·~n(;~!'i 29
Ne Puint:;.
Jugal~
Anterior Naso:.11 Spine
Dr:nt~ 30
VAnc:::-. imd H.ne:;. of r{'krcncc- 31
l.i.tC'rnl Cranial Planes 31
Basion-N a_sjo n Planf'.
F:nmkfcrt Pl.am::
Ptcrygoid Vertkal Plane
'fh, CrnJtl.-t.l lfa:.;~
Plan~s and ]j n,e.;; for the: fa~ 33

H
..
•'

Fac.i_q} l?fane
i\:1 :l11 dlbular Plane
facial Axts 34
Condyle A:-< is
Corp1 is Axi ~
P~1-n.~l Plane-
The A.Po Plane
Rcfen~11ee-~~ fur du: Tt:C'~h
Bw:cal Occlusal Plane.
Db.-ine Ot:c:l1.=s~ ! Pko: L~

. '
Arch 1)~p01 ~nd ~1odd Con\ie.rsion
.Luwcr h-tc:isor Pos:ition
L7pper Jvf ol ~t P0~ t ion 39
l n r.r. ri ,1.,'i&'ll .,\ngk
Soft Ti ~:n1f::
The- E.stht:-tic Llnc ~l:: Ll:ct.=)
Frontal P1mc.s 40
Crc.nitl
f .'l(.'ir.il
l)l;'Jltll
fRO}\"'lM PHOTOGRAJ>HOFA SKUU 41
Fur,ction #-l. YieUo a bash for a clincca! nonn 12
' !'hf Scientific Basis of Cl i nl c:ril Sumdard.s of Rt::fer~nce.. , 42
Comp uu~I' St ~•d y ( 19 66-1 969) 42
Second Mrt[or Computcr Study {19g9- I 990) '1.S
Tht:" _predpi tm:ion of the: S wnm ary .A.: 1aly~i~ .50
Cornprehensh•e fol' co mp l~tt:"ll.t:'5S .50
The Lat<:-raJ Su.n\aucv An~_ly~b
/ - .'l l
The Frontal S11mu'.~J:)· J\.nr1.Jysis 52
Fw1ctio11 #S. l\mtlshes a. Framcwo!'k for Ahst!'a.-r.t.lol". ~ R1::·d,1c:tion 53
A bs-trnctionism 53
Reductionis~ 5~1
Brief Sta1 is tics 54
Sequential Chmge SS
. :
Fut1ctlon #6. ~ndi:r~ .~ \karu; for Sc:qucrdal GroVl--th An.-~lysi:.; 58
lnttt'Cst in Grm:i;.1.h .5 ~
Con trcve1·.~i ~~
'f)ols.r Cmwth (LrltC"rnl)
C1 t0mon Behavior
CHART: V~l~Lt"..S for PJ.t:kc:tts Cranial Base.
.Brc-aii:ing Gnwth D::iwn (Ab..o;t:r':-lc:t~1m)

iii
 ··.·

Tht". h x.l!·~ Poskion A11~ ly!.h of Grmvih ti5

Posi ci cm O n ~ 65
Po~i1 ir.111 T'r\'O 66
Position 1lrrec 67
Position Four- 68
Soft: TI.s:s ~ 69
Front~q.l Gr:u,.-.'th ~~ the. Bi-Poli:il;' Phenomenon 70
Ftinction # 7. Supplii2s a "Mnni I r1ring Process for Trewtmt:nt 7'J.
Sc::-paration 01 Grr.,v..th from Tn.--:a•.m~nt C.h..mgcs 72
\Vhf' n. b & Change of Y01 J.J" Ooing7 72
Th~ Four-"Po~it~on Analy@s for ~1oni w rllLg 73
l;1mcti.on # 8. Dl':li!leak:s Trcatrne.nL P0~ibilh:ic5 76
Short rci.ngc result.~ ( (-:l )'t'~r5) 77
l.c;ug range re~ults (more than 3 y~~n,) 78
r'·. znction #CJ_ AJl CM'o Prognosis and Si nl n I:~ti OIL. of Ob jecf.ivt"::;. l§
For~cs.~1jng 79
E~Lrnsiun md i'vfod1:;i~1 '.1"ln Tt'c~u~iquc 79
_\·1,mdibular Arc 7 ';-
'11u: Crani.::il l¼i;C" 83
\1axi1la ~~1
Tr-1~-Lh 83
Sott Ti.,:-;, ie g3
Function # l O, Grants a pr(JC~s:; {OT plc·1rming a.l i treatments 8--!
Act-ial Purpmt:- ;;-i ud F,1::1ction of
Vls LJ.al i:;-;ed Objccdvcs and G-c ):lli'> g4
Seq uf.nt~ g1
11'.II!"' Cyh:::mc;Jc Ci rdt> ~ ·}
·n•c:- Surgical Obiec.:tivc::" and the Divin.e Proportion 86
Scvc:111:r.t".::1 Class Ill Chara.ctf'_ri s1 k~ -S 7
f:u:r'lc..1:ion # l L 5q\1ips the Us~r for Prm:tkc:- Mrcrrngecrrenl S9
F:r:1cc.i oc, # 12, !vlanif.:sts .:1 Pd rn.:i11..il Tool for Ech:carl nn g9
C o mmunication B9
Con ~fl lu tt's a La.,gu.a.ge S9
The E.ssentl.e.l Tool c.1f Cfinkal Research 89

l V. .Summ~'"II)' a..nd C.unc lu~:ion 90

Sum m,a:ry of Con v-:nt1 on a[ (lnJ 1 L.1.ITrton1 c A;~a lyl'i<::~ 9J

94
iv
Appendix 9:5

105

l•.1E(;.ATTVE OF L4TflRAL HT:.ADPLATJ? POP. 'J NA CI t"''G

NF.CzATITIE OF FRON'IAI. 1-n.'AJ)Pl.64'1"/::.' FOR TRA.(1!."-lG
2if OBLIQUE SE,CJION THROUGH ror~vT dOCCI,USJOJV
 PROGRf,.SSfVr CEPllAT.Ol\·1ETRTC~
P..:\.lu\Dl GI\11 UUU

by Rohen t,,.,1. Ricketts:. D. n-. S., .\.1. S.

I INTRODUCTION
'. .-

Stal em4:':nt. of N t:t'u

In the 1 Y50sJ after th£:. acceptance of Dut•ms' Anal~--s'.s ~n 1948, a forcc:ful
movr:=-me n r. rmi,.,ad th~ di:) l c.-=i l 1 i:-,~ cir L.f'P h.-=il n n1 N.rit·:-: w..;:-, wi 1n~~~~d. ;\fa :1y le.CJc:i ,1 g·
-c:li.nh..i~:,s fr.111x1d n·:ph:◄ '.01nt"tric prC{."t''.h.1~.-:~ ::i prr.1f..._,und _.t.dJun-1..:t tr.l U1dT pr::u1k.:e~.
They nry;.,;.• h.-:'1.(l <.l toul to c-xpi.~;jn :llld exhibit -ch:: idea~ which had dcvdopcd over their
pr~vi{m:, L:O..ru.rs. But limh.~l.icm.s had become a dogma, and the prof"e.ss:on was
d1v1dl:':1l .

By the 1960s ct:phalomietric::s ae:::ame expanded dUc ;:o .scv~ral developments.

Cr~;-:i 1.e r p:1:-;sihHi t.y of c-h ;-:i 1) g-,c:,s wi 1h 11·e.1:.1 me:n L. \.,.·a,,; rf'."\'c'..CJlt'.-.'."l. Th~ jol n ~- :i re-.CJ h.-~<l '.) ~f':n
Hl1cr.1vl':'red by 01Jt':1~tcd tm:nography. Cro\•,'t.h w,'t~ h1v ug,1.t intr:, .~ dirr-<.:~ c-rJrnid~<.ltion
as an ~djunct to treatment. Facia1 typing b.:cam.c a d.ini-cal concept. TI1c
vis u.al t✓.:aLl(Jn of tJeaLm en t. obj t":i:':Liv~s. (VTO) d.eve]o ped in LO a pa.ri:. of" 01'Lhodon:.1 c:
dinic~I S(.'.l~n.c~ J:.nd ;:::_-..c.. Cmnp-1..11~:c- rl:':~t:::m:b l("'.(.l tu :H1 fHlvance-.d s(~L~ o{ -in(unl1:l1".1 nn
an(i :spi::n cff (1) n~v- an..,.lys-:s, (2) n~ gro1r-,,."th r.:-vdadons., and (3) da~a for
forecasting inform3.cion in a tl1 riee-iime.ns.ional model.

= • • \Vhik thor f o:n:goi.ng .r.dvri.nc-;:-mcnt~ ,'r'CT(' nu:1dc.· by the l 9 7 Os. there l'l-'cl5- an
absence of acceptance ~• practiuoncrs in the majnsucam. Consequcrrdy, the: clinfc.aJ
• . HS~ of 1he tool dtd fl01. kt":pt. p,~(:t'. wit.h thrlt ptngn".sS. lmaiL'"...q;Jlr, .-=:t-ri :K'..n~l <ltd1nt>: i~~
n'-':-- ()'.-:."1.1?J:·t::(l <~t tl1~ 5.c.HH'= tb\t' the uri::hodonti-:.: pn.:,fr~iu~l at large:- ~uuglrt to fon:h._T
sc-.-:: urc the spc.-c~.alty.

Unfortun.atdy, some. cdt..cac.or.s have even bdittlc:d 1:hc o:phalcmctrk a?proa.ch

an a1d for eractical d~cision-fftaking 3L Lhe chair. s:"ill insisc:..ing chsL a st.a.tic: m;:,de.J
:1.s:
anal?-~b ~uJ ph0lt':!:?•◄- Ph~ ~"·ill ~1.1f.fici;:- for lib~::,i1usb <.mll phmuh~ . Thi::; idc:-a w.:.1s hdd
b~c.ms-,;::J first_. 1:hcy think skek:taJ changes. arc: not: signiticant 2.nd, secondly, the;:\-'
believe growth tD phy only it. sr,,.all c·c:dt' i-ri 1he. t1u1.cc-m~ of" a treatm~nt. This is

1
o:"t.~spj Le the: fac,: th..,'l.t 7% of childrrn ,,,._ri·i:h CI :1 si; Jl h ;l'vE: been shm•m to corrc-ct i..,rit h
;~rO\vth al(Jn,. \VHJ1 the. vjgornu.s effort on th~ part of truditir.m.fcll ortl\;)t..0n1.i:sts. to
wa.i t for all tecth to bi::" p~~-t'nt w:1<.i then ..-i ppJ y old. s:r:a.ndard straighr: ~wirr JJL-Uc-t'duIT~.
! fit"' Cl11l ::'X)mf'. v.ras ddcy_,atcd to the appJii.1.nci;: ti:chni4ui;:- ~l1.1nf'. Snm~ commercial
prcrnoci::r, dol\u:n 1hr:". who 1~ ii-;l'ju~ 111 L'ftl.h ~don Lks is ',i,'lthin th~ , ..in: - - whri.t 1J1.t.t'r
nonsense!

Praictkc8 in The New JvWlt"J.rium

ln :1rd~r to furi:hcr progress. rhc cm:in: urtitoounltt.· !)J\)[~~~iL)rl ne~c:t.. ;;i lifL imn
the nc-,,;.• miiln1.iu.m. (.:-ri:>:~ 1. .-;1 ri ,i~s h ~ ~..~ h~en ma.& in bonding anci bra..::kct
"p1·e.adj us;r:mcnt- ck~.gm, I lowt-vcr, cli~,,sHo: )sis, rrngn n.~i s, u1?.armcnr di:..signing,
anchorngc::: o:w.:-:;1 dc:rations, the re.a.Hz a ti on of possibili tics, .u.1 d Jor Ig-t~un L'ihj t":C:l.ivf":.~ :'l rt>:
cm barrassingly "'•{'.Ak ifl 1rw C<JJ:il ::non p1'~-t.:t.1c~ of r:.he: specialty m;. d e--r:crrn.i:nt"d by
.:,.1 u- •ry~ a~ la t.c as 1 991 , Thb needs to be cha:ng-e<l.
1..

Progrt":ssi ,... ism. .irt Cep h~ lo nl.e:uic A fl p! Ji::alion

The actu"'l dinkal ,1?pHrntion of tht" :teadpl;i1 r:". w.~s prec:ipjLs..te.d by \·VHHam l:t
nm.,·n~ ,a I 948. Hi.s objm.i\ f'. 'Was ro e.nabk the dinidan tt, "typt-T tho: palkut's
1

skeletal coruU.tk-11 ~Tl d {k I t'.r:ni nt" thot": rt>fa t.i ons of the teeth -.;,..i thin. th 2. t 11 patkm 11 , Lr:
i,V.lS propos.cd as mi. aid in di.:1.g:no.sis. But ~iho, nhj..-.;·I i,.·c:>'.'. ;rnd T r.e:-itme.m. plan~ ".\."f'.~ r.c,
l.,t' rd:~Lt"'.d 10 .;:,in i:"t"lpli.:.d a~1ount of a.ntkipa'tCd grm,;.ih and b.-; dirertbn JJl Dc:•'\\-11~·
mind.

The "'uthor sc.artcd v;-ork 1r,ith Downs. prior to the:- 1;,,.ibVit'.~.1 iou of 1h~1 .:rn;;ily..,;.ii,:;_
· I'hroug!1 the ye:;.rs ~ sP.ri e:,, of .~pp ropri atr. c:h a~ges -wcrc made- rc.sulr:i~~ from both
runtrnlk·d iTIVoC'.'6tig,',ll ?nno; rmd pr~,;,:ti,·."Jl t:':'!',.J~-t":JH':e. ll \vould be difflc:ult nm1/ to
~•·r
idcntlfjl T:hc original ~chcmc because no mt'.t31TT."i.".'mc:-J rt s, nlr"IJ1,Jdfi ,,r i T'i L r'r:t.8 I 10 n ~
remain a.s proposed orjginally.

Downs' mr:thcid nnd either schemes focused on the:- pmfifr-. Tht' JJ1.,1bi h1tl:'.n:'~t
Vl'::.S dire.c.ted to dtin position_. convexity, and denture position. Yet, in Downs' ~"Crdsi

lll 1 950, '\.he:- t:"v'>.J)hJ):~1 jfJH ,Rd Ull{k·nl~nding [ur {))J1dit.i(~rl~ that. prt".~t"'J1l in t.h~ prnmi:=:
comes horn effcti !:> of. tht.: tTIJ.nial and fad~l stnKil.tr('~ postf.ri or1y. ·rru~ is ,,.,,!) ~rt-
v.'01-k i~ t1 ee.dcd..~

Si::i.cc ! 970, n frontal analv-si.s h.:"IS jccn found useful. .Afso, in th.~ 1,~1 t"J""1d :md
✓

s~n:-:;ibl e fo rr·.-t.'·~~1.i ng pr-1.)('t:dur-t",~ ~ re pr'r,vt>:cl ~uffidc.ntly ac:::'.1raT:c as gu.i des for

: roTH ;:,.l,
di:nirnl illJJ:Ak:..:.tiou. IH ,idJitiOik, th.o::: possibiliti~s. uf "ort,hc"Jp~dit"':'i" h.::t.vt'. h~f':n
dctcnn1ncd as produced bv diffr:r..~nr. T.1T:c1T.mcnt modalitk"'S. .. Finally, thi: -...--omputt.'Y ha!i
l~.n s rn~~hhrnugh for res~.}:IR'l1 ai:1d is b,·ing u.o;::",::l rt":gnl~rly for cl1nk.al informal.ion.
 Al1 I.his needs to be- uuctlt ~n(I ,1dn::it.t-'l for clinical use-. NO\\' jt i:,:; de-~'}r Lh.a.t those
•J -

dinid.:.m-:- v..·:::tWng for th-f'. permanent. dc:ntilion w :.I ;u I. l.hr:ca..py and who ·work witho,1..:.
bt":ll~llt. of the foll ci.ppJirnti011 uf 1l1e ~..evdoµmcnts 1rvithJ.1L tl1e -t:~phalomctric t:xil arc_.
t..mfortun;11 t":ly, be.ir.g left behind. l11cy w.1y h,:=- Hh~ Rip Van VVinkk ... mvlikt>1riug
[.(J a di ffcr-i::nt wudd uI iJ l I hndon tic..~.

T11t· :i~hll"I '1prng~~'"iv~ 1• ha,~ been ~mpki_vt>d fur L\·vo re.ason5 . First, it is med in
thof: ~r.:Jl-'>f'. of modo.n, con(~mponrr:y, fuatri.stk and ndvan:::.ed. fn L-=i.c.C. Langlade has
0

.suMcsted it c11:".\<,' labcl, 11prospa:ti1;c 11 ~or J()r,khg 10,vard. the futur.-:). B·.1t .mt•Xt:': tl1;qi
U1aL it is ass-odat~d ..,,,..-i 1h 1J11:". id~a that a S(.;::p--hy--skp 11-rcl~r of application )S
npp::-c ,pti.'~.Le for a complct~ dB dt"'n1 ro11ti ne clinical rl:-_¢,rt\f:'.

Purpose
I•·
'"fl1-f' '.?r,r..scnt ~ylhbus, .mJ insln1,;,:Iiou:il ccmsLl a-ctrndir1.g ~t, 1.5 ,u\ t'.ll(n1. 1.0
updat..-:' tl1.f:' -,1n-•:cialtv of orlnodontlcs as a whole- ,..,.;1.h, if ooc. the- schemes pR"Sr:::r1ktl
hcrdn, thr: c~t"Tll u~ of :~pplicarjom, propasc:-d I.Jy ulf Lt::"J. t~pllalomctri.c mcthods.
'f1ii s L.cachi.ng 1s :an i:::-ffort to itxipTt;.v~ information ac-ccssfoUi ty :1i td e.n h ance. knmdedge
,llld ~kill of i:i.pplica.tion in or<lcr to d~viilt-- ~Jphistication of the: pwl-t:".ssiun.

11 THF SF.VEN PROCESSES ---- 'fhe Rough-In of the Ide~

In the: k~rtning l)r ~nythi ng, i:-.hc. mind goi:s thT<)\1gh thn.:i.:: stages. The first is
-iht>. 1"ough-ln11 sk-:::tch i:Jf tht id~a. The scco1i.d st.age is au ~ b:c; lr.a.ct process of
11

RS.~.,dal.ion ;ind understanding ot thr:- idt".<:i. Th~ final stazc. is thi:'. '-.:OlU:~, ,,..,.-hkh [:-,
the de-cm.l of lo:-1..owl~<l.ge Lh 1'0-lLgh correct and roi.1ti1L~ .::ipp1ica. t.ion.

g-f"he.-;i 1·sal is rcqwrcd in ordi.:r to lH;i,ste.r ,:i ny idea or -ccchuiqu~. h i:s 1.1p Io Lfot:
5n1c.cnt t.(> 1~.m"l~- Also. 3.S "t\ith any ,;.;::rtk~I k:1u1iTlg process , there ar-:: co:tairi b::i!:wl:'"
line valw::s rutd ~wct"A.Jur~~ 111:-11. ;-;i,nf,ly must be men10rizl:':d. Thi.~ will c.nabk the
sL.10...ent, or the clinid•.m , to emplr_:oy u,~ inrorm.:1ticn succcssfolly. lt i.5 iikt: A -n~w
Jm1g111jgt> I h.'H. h·:1 prove~.:; ~.., t.h use.

111ere a.r~ essentially Sti-'t'n 1trnjo:....,,:- 0pf'1'flr.ions to the compklt: l'..umemp1Jr,uy

applit·,~b..i:i:1. uf l hi:>: C:t'-.pn a,onH'.tric X-ray :ool fur the ~p~c:i a.l i:y. For reasons of
communication: L1.~~1t ar~ Dskd [i?".~I as ;3. rough~in:

1. Pr0<lu(1ion oft.he im~ge

:r,,..1an-y hc-adtihn~ llr.c: s-r.1 p0nr th ,1 r. they do not gi v.:: tht' dh1..k·ut n ~ dl ;;i ilC:I:".
-co ntrnct Ch.fl. a:vailablc: informadon. 11~e ~d1niqu.e fur takin,r; ,md prncc:-~ing

3
..
 d the- fihn slvrnkl bc: r.ew1rJ.::-..J a:;: ~~riims.ly as the &tuention to a.ppllancc
l~:bllL(J_L.lt"...

? .. l\-f odel Data Conversion

lor 1111.Jt1('~,1t1nn, tJ1e il"lrfirmalJon frcm the orthodontic mocld i:s
associa-c.::d ~1,ith i:h::: :h1.forumdr;1L fr0m lht>: faL~•·F.tl and frnnti: headfilm. The
,Ufo.lUfl.L L)[ ~ll).arg~rnf":nl. L)f Lh~ <'x.phaJomctric image: ne-::c.b to lh".' h10v1..1l, f rhio
r~fers to iik:1· ubi c-ct dist.:..m<.·.e..
A ~alys[s can hl": .,;;.tarred ,,,,.ith the i:c:-r:i:h au.J \:heir t:1.oyk1,·eu,t'l 11., lm I. ;,. <..:.i:I n
also begin ~•,:Jt ~l ~l l)-' p,·ut c~r th~ .sl-:.1ill.

J. Dfa g.no:ilj s
Tiu: fir.:ct stq1 toi,.,•,.m.l di,~gno'.';i~ ii:; ;:in :1dN1lBr£ d.£scription of sk.clcral,
dt"llL:l.l, ,:ind :!i<":ih-Li~sLJ.e c:onditions.. This.. simply, i.s ,,m.atumi,c:d. lt 11:-..:·.c.tliin"~ r.1
.:;du:~mC"" for- iths•.r;-i c'.1.1 on .'ln d r~duclion in 1hrc-c dhnensions, Tlms, i_, t::-:r rt:iH,
both lat~ml <vmkd ru:H.1 l\uriwnlal) m1.J f.rc,01.;il (Lsansvc:rsc: and vertical)
clknensions 1n or&r to be -co~t.

4.. Monitoring Base

The original aim of ccp~'11omc:trlcs '-',a:;. w '.';trn1~..- growa.h r:h.flngf".~ in Lh~
.li.-,,'i:i:\g d1ilcl.. Cu111pn'rii-;ml L.t'.C:h1liquc.s "-VC:rc: later employed to differenti.ate
trc.atmt..\Ot f:h.1nge:s. A crit.ic.:ll h~eHne method for separation uf normal
or natural growth hunt u~atnu:nt <..:h.:;11ng~s H\u.'o L he available. Data now 1s
i_)ffive.n and pr::>\'tde.s a trll-St'l".rorthy rc-krcnc-c- b~:::~.

5.. l'rognosi~
Antidpation of ;:h~ futcr.:::- ~5 one of t.hl' b-:.lsk rn•&·rlying ;-:i,m:c; fir 1hi::
\'r·h ok .;__·Jll~\~~~1 ~ ·t'.ph:dmnr-1.ri r. ~)r<J('.t',~~ . Th is ,vas 1rnplich: ln the ·t~"P~ng'' -:.1f foci al
_grO"'i.'1-1.h pcith:'rns. B-m chc- t t·<:hn1 i j\lt' c>(ft".n, v.t.l Llf'.. ; 1l' beyond d.esc:ri pt1vc typing.
Prt>,Ji c:ch·c Li.::c.h nlqu~--..s. ~\• i r.h .some rare ex-cL:ptions , provid(' gor;,d dct~i 1 c)f tJ1.~
foturi::-: nnti't".<il ~d filt' C"'. r.1-f Ih~ t~hi Id at maturity. "f'an:iculaTly by age- 8th~ pa~t
~'1-i.h patterns produce a ~iivei I prt"d kUvt: lia:stt.. l ;-n k,n.1matii.y, many
€'due.ators: ha-..•e glv'=n up and spe-nd their time obj~cting nitht'r tl•im :i-:11. ufyi ng
m1-d t ryu L_g 11) hnp,o...,t' !'r.eo.s<"n, rn~t hods of fort"..1..-:asc.i ng.

6, lreMmenl PLaaming
Onhodontic obj~ah~~ a"(~ TI1...1<.l r:- fc )f' 1mry1()S~$ of prod u..::ing the br.::st
esth-e.ti-.:::s, optimal Funcci on .and foremost .st~ billty. TI1-t' ce:ph,1 LCJi.:nt:1 r.ic:
ptr..:r-durf', wi1 h ;-:i (nrt-c-:ist wic h<HII r.re:r.1£.mf:nt, may be employed fiT5t .. Pa.rents
often ask "'i.'1-Tia.t the chHd's cor.ditio!l ....,ill be wit hu,1t t r~.A1 me.m.. l L. has be.en

4
 ~h(.."L...'Vt.il·t:'d thal v~l ,...,·i;:-en 5% m1d 10% of c::arly I!tlxi::-d Jc:-1tlill on yuuug d tlltlrt'n
mav sdf-corrc:c,: Class JI \Vith gro\:o,
~ . . .J,.
. The treatment objectives a.re ch..::n
~Llpf'.rimposM Ofl r.hfl1 hfj.-.h~ Hflo:i.~dylng rn;1t.rb:.
Of rt'L' tn greater value , h.m,1.rcvcr, anchorab,'C nitcria arc <.:ah.'1.da tt"d iillll
detailed mcch.anks. ae. phn ned for the produ.cti-0n of the resulc.

i. Sellin){
Any r.rf'.aLmi'nL ~-i:lli:=-me mm,1 hc:- .:lg~f".J ,ipon by t.h~ part.11:'::; lnwik::-.d.
The nw k.:ng of a ~aks <."Oiltrnct is n pan: of m,1.n;-i.gt:mc:nt. Th~ ("~phalo:mc.:trlc
1i/TO or 1,/TG pro.;::ess tl10\.v'"S s-omcthing tangible to sell. It enhances.
corn m unit:a tton \,.·i I II the:- p,i br::t 11., TL. ~v~;:i h, to l.he. pa (j f':n L. the. rl Jj t".>l":1 i '\'t"'•.., a ni:i
atu~ r.1f t 1ii::- orthodont c, orthopedic :md s-urgi<"al J.mJc~s~es,

'J'H I~PlZOPL.],t USE 01; Chl:lL\.LO!vll:: l'lUC~ l)R0C1{,l!,SS l~S

Tl IROl:-GH TI IESE SEVEN GROSS STEPS.

H.1 THE TI-\'ELVE BRANCHES OF CEPH.-\.LOMETIUCS --

The: Ahslr a.c L ! ..e,,vel

'fhrrt::" ~irt' ~sstrttially t,velve- ( 12) nrniOT clinical fm:tc..i::ion> of ce?halu111ttric>,

TI1cy fril.1 inrn four ~eneraJ group~:

'fht' fut gro\1p pertains to <.h.·~(.Tiptivc ill'Ld dfo~osth.' Jlf,rru:rn:tt·r~ and Hu:-
bais ot s-:c1ndards.

Tht'. ~ec-t"rr-id g1n1p crm~h\~ f;equenti~l fow:tion..~ ..•,hid'I hAv,. :s:d(":n:nn'". Lt>
, . analy5is of -change.
•. .
Tht'.' third ~n..n1p ;s corn1-e'.:k<l ,,,... ~lh p.rognus-h. lun~,.-.~:sd1t.g v/ lh d1c:
sirnu.la tion ot· n.::sults is made to in.dude designing uid p]mrn.ing for anchorage fur
t,~a tm~n t..

TI\.: final gr our

of hmctions :s approprtatc to pnKtkse mrumgcrru..nt.
C c.pha~ome. I fi ("~~ fonc:Lj on s GJr t.':OlllJ'nUOit'..atjon., l e.·u nj Ilg. and se1li n g 01 Lbf~
{Jr:..h t.tdt>i, tk· pri:.>c.h 1~:t .
, I'w~h.'1.:: FUIK.iions. of .P.r:ogre:s:c:;lve.. C..ephalomctrics:

1. (A:1 n.,;.I l r.1 i1 f".~ c1 ·t .onl for

Diagno:si:!!.
?.. · Provides access fur -,,.is-1.1:-.i.! a~.~it:i:;sm~nt and tracing .
.'j. C<, n w fLS references ~ith biofoJ:.i~: ~i gr,i fa:ance.
4. Yic:kb a l.,.<.lsb for a .._.Jj ni 1·:r.1l norm .
.i. FtLrnj.slLe.s a framcv,.=-orlc. for al>~tr::\c:t 1flrl :tnd redt1ecio11.
6. R r-ii dt"ffi ;1 m~:rn s rnr :i:;eg ncn.daJ grolt\=t: L a1 L,i.ly~iJi.
7. Supplies a monit-c.n:ing pre ;rf'ss for u-eatmem.
8. I)~Ii neat.es t~a.tment possibilltks.
9. .i\Hoi,ys progn.osis. llrlrl :-:;; m Lil r.1 ti on of objective:-,.
l0. c~anr::s a me-di um for pl=:1ru1ing ,'tll tr.e.atmencs.
11 , Equ'. p~ HI t-: 1n;t-:r [or f_>facticr rnam1ogcm<:nt.
I2. lvianifrsts ~ prim.ip~ll tnn I ro r education .

Fun{.iion # 1 . Co1i st.h ut~s a T ou1 for J.Ji.a.gri osi s

-ry,._...fjnjt.ion of Di a.gnosis:
8 Diagnos-is is thi: ci:rt o:r: -'(:t f)f cli.s'-:riminatLon of conditfon ,,md !.ht': fun.hf'.,

distinguising of indhrjdl1 al ,::lwrnn.tri:..1.ks.

~nfagno'.';i~ :1fso iflclml~s intuition and t:.x.perit'ILC.:-t: by Ltle ri.:.:cogniuon -0f
pmtc:-.r.n:;, but it h firs.L. based on sciene<:,
8 Oiagnosi!,: consists ot :lco1..·1.1wte ,.. L'1 s:s1 f'i L"'..r.lI.i on and d::scri1--'"Ciu1 L.

;1,:l)ja.gnosi-r;; permits. a summary of the 5-Y1J1.ptcmis and the condusions nnd

ck.c:i s.i on~ atl'Lve.d :1 t.

·1·he LateraJ V k"'v

A m~ l~il 1te.i.d l l:-,hl i.>-..r. ~w ~;:it rnds.. she uld nm:. cov~ the:- :' 0ir11. ';)~L~1 i:r;~ LhaL at\:!a is
a part of prcs-:-Pt dir..gno~tk con!:!~dot"rn t.1<)B. v\.'ooden or thin pbsth:: bold~r!. for th~ t"~n-
rod.,; should be. used for prnpo.scs of rn<liolm:rtw.~-- .

}1i.. The- tc:-dmkJuit for oot"'n1 ;1 I ion k,r 11,~ lat.t"'.ral fo tht: h~ad iu nan1rnl
posture: (not on Fra.r'.k.forc Plane" nc-c..--e.s~ad ly).
B. TJ, ~ j i::i ws .a.rt". c:k,s~d ln habitual centric.
C. The: lips ar,:: dos-::d 1n order to pc:-rc:f'i.v~ Hp strain nc:cdc-J to seal the liiis
I.L)S\vallow.. which is di3.~ostlc.
_,
D. A st'cun.i..l fihu In;.iy Ix UL,Hl~ .:-:ii. physiologic re-st and at lip :rtpo5t' if ~0
desired, but _g1vc:r, c-niy one fihn :mort: i~~ kJrmat.i on is seen ,;dth lip
d (,~ure be:c:H.!Sf". 1.h.ql_.acl also may alter tOl\gllt' po5i I ii)n.

6
 E ·Jh:=· 17 l n1 i:,:; bmu gh, l l f t.o t.h c rod. holder in ur<lt-r UJ u ul umi ..-:e
~nlargcmcnt, but cvcr1 thc:n tl)t.'I~ i,°' s1.i 11 a 6% eru.ligcmcnt of th(:'.'
midline.. f' or instance, arch di:pth in :i:ur.1dc=-I,; :if':I Hally a\'f'.rage~
12.25 :t l.4'': b1.1t a 6% ~1ib.rgf'.mL~nt makes it 1.3.65 mm. front w~~i~l of
molar to et::ntcr ot edge to crntr::i I j 1Ltj:,:;c:,c ce.phalomctrkally.

The Frontal View - Oril·:nt to f r.anJ,.for t Plane

A ·rhe t-e.chnique: for orkntatEon on the F'J-ro..nkfor1 flt,.ne i~ hy alignmcrn:. of
latc:-.::-.tll ~m,~h1,.1-, of t~u~ t"}'I:'. w:Ll': a mark on the co:.-pkilom.c:h:·r 1s· 11~ni.
above the car red.
13. Tt~ 1.h ·" r~ h~.lti in occl u.~1on_
C. Th...: filn, is brr.iugh.t UJ: t (J, l.h ~ nose: to rninimizt' ~tl:rr:gt":i:1 \l:':T lt., b111. ..:. l.i I'. :11.
th c molars a 3% ar 1.6.5 uun. tT.lm',t:::;n(:: 1) I of the arch may· rc:sult.

Accessory Vh.'Vl'S
·' ·The Physlologlc Rest Posi tivn f~ po!iiiure
A. This is ofl f':n i11fr)]'ma.ti-ve. ~or 11 joint p<1tk:i:► 1 s" b~c-...-.-;it1~r. it r~gi.~t.E':t"S rhi.:::
"starting poshion",
B_ The pacien:c ::s ~nstrndc-<l t r.1 , ,t.t~I'.' frit~a ti ve and plosh-t sound~ folk) ..,.-ed
IJy EIi:-:uL.1 ;il ,~,;:mn,b to ai.:.qLur..:: -rest rosrnn:·, Tbt>. wotd 11Boston 11 ,,.-orks
w~l!.
C. The lip5 U'Ll.ry J:"("."lJ:)!~h· ~It n•p(l~~-

The 2_5~0egree Oblique

A. .Dy turning th(:'.' ht:"i.ld 2.:;;" 11t~ joi-nL of one: 5ide b rnc.lvr•:cJ o,1t. of lin~ of the
central beam ancl ~he- condy le": fos~8. rdation can be record e-<l on th,.... sick·
ni:-:-.L LD Lht'. lilm. 17-iis makes a vii:-\Y of tht<. (n':Clu.s:on on one Sid:: for
tr.Jc::iHg ~1id n)Tnp.<i:rison of the othc:r.

•·.. Wtde Open

J\_ \'\'i.i 1.... or~n m:1r h~ di:'l~;T'IOSt.ic of a joim: or 1.nu~ck IUlp;;t~J Hlt'.CIL IL -.vill
furth.c-r rcvcru the morphology f:l~"Lci , ;ym tr.~try ohh.-: condyk:s. 'l11t' d~ht
i.i de is. enlarged due to film r:ibjed c.1 i..-..1 :trH'.t".

Other Funnion...-.1 Cunditio:n~

1\... H.uld t.n.g Ili ~ h r~a th 11i a} s ust:tln the- pal.ak . ck)se<l..
B. Phon.ntion -- 1n wdt:'J"M me.&Sure f U11.ctio~1l m1!:>l'>ph.:JT.}J.lg~~1 ~[):-l.o:".e!; t.he
pa t.i c:nt \vi ll pron ounce thL lOI tg '\( ~i:.,,1 ind or 11 001~ as tn spoon.
.. C. .lrn.i~jort p(~5:;ihili1 y can hf:. recorded to mt"a::.i..~ pn.~I uff'~., -~"ken for
'
incisive action.

7
 D. A frontlJ To-;,,,;nes ·view, v.ith r.lptn mrml h, may rcvcai tlu:· S1nmi:::s anJ thi;:-
fronta~ n~p.-:ct of ci,t' n )ndyks 1,1ivldly.

Tomof¥llphy
fo)cly sccrion X-rays pr0vi::k· d~jJi-; in the. join.. or an;.' S(."ctiun frontltlly <H'
lareral1y. (St'i::: I~ 1e:r;1I obliqae joint section.)

Function. #'J.. Provides Ac.c.ess for Virrna.l Assessment and TTadng

Candidly , many o:r:thodor1ti:;t.o,; wm 11~•~balr a film only. r...x1rnl~r'l:'H.ioc1 vvithou.t
m~asureJue.nt is c:_ypical of the praaicc:5 r.1f t:'HJi o jo~ -~r.'>. lr: gencrM an OI}JliUZt'd
a pp roacr. ,-;ill i..n1pITJ'-'t'. the di 11h·:1 ,ul1s .ability and a{."l.H11t•n, ,A gmss i nteJ-preta:c.i on of
1'1~ X-l',q_y is made from <.l ~1bj~c"th--~ vre.v.·po~ric. A sdf-cmpo::il:"'<.l st"inY--hil"lg ohs~rvai:'.ion
foJlow,eJ by ~L~1 l,i::is.f'.d .-a.Liona1iza.tton is rc:qui'rxd .

.S1.ucl:yin1_; the l'leaJ. X-rny film h :lJl .adv~nrnrc. Fra~1.cnt<1ry bit::- <'lrt:. ,.:nllitc._e.d.
from ~ll ,'1.v~HBble sourceS. 111.e :inal vcr<lkt. Tt':';lli 01\ LJ'le sum of the inforr.ruitkrt\ :rnd
not on the X-m!_. <"!.lnnf':.

'I ·he rl1lree P's

foor p,ilpw,~s cl ;u ~ckrsl.:LJ'lcllng. £. s;:-aKhing of tlu': film might be tho~~ht of LT'l
i.e.r~ of the phy~il".ill ~1r Jl'.()tp! 1oiogj{"..:11, i:he physiologi<", :.it Id th~ pa.Lhologic ~-
ht".-'ICf'\ Fer reference. me three P's.

Phy~ ic.'1 I (l',: rrri and Size)

A F.CCliminaIJ-· hnpression m .ay bt': Tt'.n de:red by o b5crving tho:: hr:-ri~lpfo t~,;.
Expcit'.1'1 L°:t'. has shav.rn tha::. initial hnp~~.sir )11 ~ 111· u 'if' 111 .c.1 photograph rr.ay not ~
jorr,-: out with :u:~i:::tsu,:t".ui ~11 I.. \V~ dh:idcd fadd pattc:ms into R111 ch yf& :i al ,
\'\o;?.siofaciali and Dolichofadnl ill t.t:nr.;i. o[ chir:. p,o.sitiGn . Convo::xity i::; H,~sr:-so;:=a<l
£arLht'I , :J11d dema.l l":mplaa:ment Ls also vi~1....rt:d.

Physical fa.a.ors in th~ hm:ral ftlu L;

1. C.e.~,jca] vertebrae and crani..aj. b.i.~r:.
2. N ,~~opb:rryr 1gl:":i_t fr.:'W'ir:"vi:ork
3. Gross facial form
4. ['4=.t ndi h11I :1 r form
5 . Position of t~c::th
6. S0ft tc:.sue morpho~og;~

8.
.....
Php.j cat frKL o.-.~ in 1ht" frn.nf ~ I hif'~ d fi1 m:
I. Form and svmm..::trv of ,:he armhun. url )11;;. e\asi1l cavi:,Y, m.a.,.:illa and
• ✓ ~

rn.9.~1 oi cl-'>
Symm<::try of the m..rtndibl~ in for:ni ;.rnd posi1.:on
3. C'-..t"o~s c.ooch dJ5pla~m-ent and third rrtoL:ir ,c.:m1di I ic)1i:,:;_

Physiologic
Function will v:1.ty .'1.S b;ls-oo un d~~ skektal pattern c1nd d1r- r,111sdf' Nmdi Iinn~ .
.He:,jd pos::.w·i: is a biologic comidentti0:i:~. l~rt';~I hing .~pa.cc.s may be: cvalmi.1-c-d and
assod...iV:'d wil:1 ;:ongu.e pos:ure& and hyoid bone (.--UJ:',.dit.1t)TiS. SLr.-=i.in i11 the Hps may be
f1nt.hcr as.s~s~J -:'!.~ llp lt:'mi[)u ,md lw1gut>. fu.nction ma:y be:: factors prn<lu,;.:u1.g 1.b'.'
origirl8.1 malocdusion. h·b ndibular ch. 1:i:1. . _gr:-.>i fwn1 ~~r. LO dos1.m:: may be: furtl-.C'r
:: .. c::Jn ':Jd r-i·a 11,1 n,., p.art.icul arly jn a joint dyshnu.."tfon arn.1.ly~s.
0

Physiologit· f:-:t c::t m•::; in hot.h vi ~...-.s:

1. Respiratory ob.stnKti'Jfl ~
2. Positton ni" r.hc hyord bone
.'3 . Cl :1 !--~i fi c:;~ t ion nf ri llT In r111 :1l Lip relationships

Pa.tholog.ic
1. C;JJ.tgt<1 iiL-:11 dd-:-Ji mi 1.y 011.h.:.: ,.•c:rtc:bra or skull b,1;;<.e
2. C--ong~ni t~l Jdur.m.ity 1.lf t t It:': {"~·an i.1.l ha:;~
3. Fractur.::s
-1. frlt;>.rH.i fi•";:1ili OJ) of cysts
5. hi {lflnwi..11 ion.:;. 0{ :;i 11L1iies
6. Adenoids and tonsils. proH.frrnti,;,n
l. L-~orcjgn b:JC.)' iden tificadcn

Tracing and Dij.,'ltiz..~tion

I'L)(lowjng th~ 'i.;i,i:;ua] assessment a tracing ur digiliz,itinEl is p-e.rfon:-i.cd.
) .. Rcmcmbcr tlw.t c."1.ln~d surfac.:~ N.l't:': rn,,JaJly present, md s.hnrp c.k t:,it 1~ 11n•.t".<l in 1J~e.
r.ro..,;s-se:-:tcon of a part. Pm:tin1lar puint~ nn r.h-f' ~ n.Homy arc sought. The tradug ur
digitizu1g i1.~I o I.he cornpu.tcr should be cons-idi::r~ "'1)jc:-ct': 0f .art. The piendl line c,r
stylus is placed pr~ci~dy nn the. outline of rhe ?art not cxl:-=:-mH1 h1 i1 rir lnl t"m:11 Lo ii_

Jn otd.er to trace, tt.ie analyzer needs to MO\\' de Lai led anatomy of hard and
soft tiss-m..-s. 1\ thr~-dint~uskm...-1.I ubft""L~L. i:-; pro j c.c.tcd in to a t\\'o-dimcniu:i:~1
mcd.:wn. Only areas X-mycd in dire-ct c:r<)>s-:i;~t:L.ion l~sve sharp Hnes c,f d.::mar{"ation.
t\1'.f"!i:t, nf 'fl""frn"flc:e. fif'(!llirr. .an LLnd~r-~tandfr,g of du:iT purpusc- nf us~.
Function #'.j _ C:on1.:1.i11s Reference!-:i with Biologic Signifkan'-.·c

A. Requirements of Poinis
Probably u<.1 r.lthkT m,rr:"f:t of ,"t:'phaJirfl)t:"I l'iC's is mor~ -:'Dnt.mw.rsial rhan mcthc:d~
u~ 5-llJ)tX iwposi rt g, ff'.gi SU::ftng. and mc:as urc1m:nt. \-Vhatc:-vcr p·oii1~ a!:"t' u'.5-t'i I, th("}'
should ( I J have biologi(' :,jgnifitt~:O.(t':. {2_) b<=: ,?L.sibl~ or (3) be. capable o{ oci11g
ro1H.1 rt n·.1.ffi. repcau::d.Jy ,..,ith dcpcndabHh:y.

Two Point-, found Misk~di.og

l¼li..-=ip:. at thf: (Jl11.~1. it should ~c mc:ntioncd that tt\U co1.rur.on: ~nd ofkn
fav-oritc, pcint~ ~xr1plu;r.-:-(i jn 1h~ p.isl h:~vt>: bee:n disco1,.•ered to present µroblcrns or
(~:;1rl LO misi nc.crpn::tacion. l11csc. arc Point Sella and P(}int B. lkcc1\1,t;.t ....,.(': clo JH"it m,t:'.
th~m, lY.>th ~!~'.'..t>:iYf'. :'i. di :o::c:u..~si n n .l1:. c.o th-e. re.a.sons for thc:ir abandonment.

Point Sella - Found U me Habk

Sdb, 1.hf' C'.f' n1{'-:' of Sf':1f;1 =:.ti ,·si-:' ~ hy i ns1-:ect.i on, is a mnvcnk"Ilt point at. thi:
c:i::::nte.r of the: h:,-11ophysca.l foss.a and has bct-n the dur:-.f pc)i:\1. of orie.rnatton ·.1se-d ¼'i::.h
N:ision ;~nd Basion by a hos.c of investigators. It ,,.,.-as t1~::d tr., fom, Ji I ri~111gJ~ ,..._.,, 1,
Nri.>ion ,l.nd B,t~fon, ~r1.sion r1n,l P..oll.on PoinL. or Na.sion and ArticuJarr. SX is "l"r"Cll
associated ,i.i.th Htt- rw.s-,.ll c..·ar~i..1k. l lu,.,·1::•:v1::':J:, .St".11.<L h:t:=, beei: found ,..van:r:ing as a
11) r1 n,ti bH:~r rc:fcn::ncc and sc:ri.u rcfcri:-ncc.
S.t'"J I!:! ha.s b~n d..rop pc..I beu.Ltse (] 1 j,:_ v.=ras not trusnvonhy f<.,.r ,;:~?i.ng. {2) it
''i."c:tS (Jllt'StioX\.1iOlt'- r01' ~t'l'i:tl Tt"r~~)('f'" (ijn I hfll i I 1s nor r,,olar t.o the fa.cc}, a.nd (3) ii: \"ra.S
found to be most unT<:liabk for long-range gi-ov.rt.h fon::-(."~tit ir,g. Abo, {-t) ~ft>:ten{'~S
frnrn SdJs.:_,asLon ~o fad.al structures condated cs.9Lntiaily not at all to tht::' r.x-ch1~nl
pfonc. Sn~n :r:-ot"ft>l't>:nc~..~ --.·vt'.l't frnn,d u~t":fu! 1.t"J l.h~ f.rank:o~ plane: h-vhcn t~at plane:
cmplo;""C'd trnc .m,atou-Jc porion). Fin..illy. ( 3) th,::- - ~~1,ll ~ .~ ngle" ·_.......-s E.a of NS Ar o,.-,ra ~
110:.. rcmnd ,D bt::: assodatcl )vith oc pr..:,jiccivc: of m.a:xi.llo•nla!ldibulnr rd. .,tion.
Ou. :'I. L':l 1rren I h:lsi s. Sd I.~ is T"I t}L. ~mp loyt:d in t.hi:s Progressive Cc:phalorr".etric
procc-.ss exo;:~ J)O!.i~iuly for all ~ingula:r a!.>~.-:'~~m~lt ()( Lhe (L;\w-ph~cyc1g~;il r1.p1J:\lcll.lJ..1i
tmmoolatelv below it, or ma.y have a uscfulncs:s for airway· ,.m.'llysi~. .

Poillt B -~ .Afv-l':-Uhu, Not li~AAhH·

Poim. Bin the: past has been tal<..cn to oric:nt the lm~rc.r dLJlturr . .ts for instance
tb·~ lowt'.r h\ti:,ur In I h~ Hm~ NB. Do,,.·r.~~ n-lat..e-d ~.hf'. A-R Plane to the Facial Jllanc and
othcrs :,x.·latccl it to the: occh1sal plane, Ho1rvc-vcr, PoiI 1.t l3 d(:'.vdnp~; ...._.,.h~.vt:":J· thot". icm.rt:r
i nctsor c:rup Ls or dJ°LfL:S a~ dir~cc.ed hy lip ~nd ton gm~ force . A rc:vcr~'il lini:- is fotmd
Gdow JJoi nt J3 h~ d l!".velcJpm-tnt m\d Poir-.t l3 -chm lJ:!;t":,. v,:i.tl1 1h~ rnm.-emen L nf t.he ;c,,.,,•~I'
incisor. (Fina.Hy, Point B disappears when the teeth c.1rc lost , ~md is ll()t prc-sc:r'l.t
1.111 ti l the inti.~(){,-;. t"":01pL)

JO
 TI,f'. bnt' ~:.:t:t:'pHon to f'lc vaiuc: c.f B might b~ TO ~mrloy chlf' :=1~~ lr:r
~,.,.,lu::111Lm :,nd PT~d3r1:kin o,f ~oft tissue ~n the a~~a of supt:-ltr'.~llt~lt':, lr:1bi~l to h:. B·..:t
~e1: ch.~n thi.: corona]-root junr.T[{Jn 01· 1ht>: lflv..r("r· indsnr h j1Vit <~s gr.1od for rcfcrc:--.ce.
Point B became popul.H bt".GlU5e 0{ tht· ~o:;.~ of ah•colar bo:nc: \dth 1,.:igoro1.JS
ct1.:1odon1Ji.:. p~·e.st:":ui-es in ~.ht': pr-es~!lC<' ,_-:f ,'1. ~trong ]c,,.:a;.rr lip rcsiscar.ce. It wa~
0:m51d::--ITd, ch.-::rt"fort", a .stabk: bas,;;Jar point. H;:-:i,..\•cvi.::c fHL'...,:HJr~~., i 11 :ht. n:1u_gt:' o( 0. '.:i
gr.ams per mm. 2 of l;;.bial rc,or s.utr:,.c:f'., cont.rC>I of ne~dless •n~ndibular rotation
(.....,hie-ii in:· r~ao,~ li 11 ~ti: ,li.n), m ~'Clfu:ricti.ona.f therapeutic a-c.tc:nci on, s nrgk-:8 J Ji p
proc.-::durcs, .rind Hr.ally ~en;op] asty, all t~a.i~ ~~~eH l.iS:ill y ~fo ni H.-:1. k ih~ ;i::~rr r:,f imror,cni.c
· ~ cri pp i :1 g" .
Tht1s Seib. and Pain;:. B t'vc.rc: fow~.d l(J bi?. urtpl'nd.1i.c:c.1v~ "in tn:np~ri-5or. tci other
lr-.o:irc desirablc points.

H. Reference~ Fmt•loyed iu LatL":ral Pc-r:spl.x-dvc

Ce.rvk..a I lld'~ rt':11 ~'.t":~
1\J.l i::n>i ca'. ve:-ri::-·xllc need not be t:accd al\"r-ays. Hat:,,.'e:ve.r. d.Y"P i.-v:1 :v, of
vcrLc:bra.c and postw-al pmhlt>n1s .cu:iy b~ ml~ed if lht'y ~.ct" nul ruutiud!• co:nsidc.rcd.
A 1ypiL·d ',"C"'TT~lm:1 (C.'1 t.{i Cl) has a body, a lainina, a Jaterru mass, a pe:;:lidr;:, ::rnd }j
ru.st~ur ~pini:= Thr: 1.1pp-er anr)c of the. body can he ll-~c:d for r~f~r~nc:t>.. Th:-- body
<:c:..tcr and spkc- can be u~ed for ang,ila.fow..
Th-:: a·xl5 ~as .3 l::1rgf: ~phi~ f1nd J: body ~u~sr:~1:;fog Hlmg-r vcrllcal prop or d..:n.s.
ll abr., ~L<'l~ a brr,e .sup-::ri.or faccr \\t1ic1·. Les tnLn t;11,.~ trJ~rior frnsa cif che Alk:s
Th-: AtJ,;,..s has large L;:.. ter-s. I ptl".n.'r::!.i.;~:i-; ,,_.,.-hk·h r.::vt:'rfap tht:': oo:.i pi t.nl -condyle.s which
it ft-:l".,.'.i 'I: i:-~\. Ac 1 .ar I kJ irn .:-md po::i:ci:rior arch i~ prc:scnt, a:ic. chc cant or pos; ri on o( L hf'
b,;-in~ rn:iy lit" rm i~~11r::-: i~1. physi0i:hcra:::1y. 111e. cenc.er of rh.e. a.rch~s i~ ~mplnyr::d {oT
~:nal f Sh,
The h~ut<l. :,one is Ifa{~d in c:ms-;-:-;~c:L.ic:.,.:i:1 !>{ th~ hudy emf!•· Jts t_:riangular ::hapc is
ri?rox'.f't1 ;r nd fi po:n1 .11 1 hr upp~r m1tcrior <m.,r)c is t~c- I ly:iid roint fo::- r..-::krenci2 (H).

11
 C M.'l"L\ I, R l •:I• J•:REN CES
Uasion •· A Biologic Point as an Ocdpital Bone CenLer
11li.:s ()Gint i:s foc~_ted. a~. 1.ht>: .!!Tl.t~ri.rJr b:.:irdcr of fora.men msgr,um which ~.xh:s che
.sµin&l cord and --;,.rc:ssek fn-,q ih~ n~1rocranium. Bas.ion i~ kll"~l~d prt'<..he~y bct\.Yccn
t:'.i~ t w0 o~..::i pi Lll coci d yl.r:-.s on 1.~•hlch the head ts supporl t>:ti .-t il d moved. Ii: i.s a
rr.:r.1:,uJ.,..;iLk ct1Lkr fur the occipital hoci~ wh1ch is n lxvse for support ohhe br:..1n.
B~sion to Nasion is svnonvrno\L~ "'rith the Basi-cr.anial Axi~ nr Hu:<lr:.v trnditiona.J in
, •• J'

ar,thr;1p(,l("Jg)'- A pt')flt' through these pojms -~e.p:ttMe~ tht- facr::- fr:im the carvari9.
B~sion ls us uaHy l0c:r.1 Lt":d ii:Li.ml':'d intdy s 1.-.pc:rlor co l~\~ ck n:-:; r.111 Ll iCl lim: v-::ri:.iau.ly
wit>.. Pt):'ion (-entmal m1clitory canat J- Its selt>:t.tio~, ,rw.y be- confused •,3,1.t:1 r:he. dt.n~ity
of the bcin.-:: of the antcrto:· hnn.kr CJf the:- rnn.c.ylcs. le vanes frcm ,q hltinL mm•d~d
contour c.o a more shar-p rmgl"".' fc-rmed by lllli::s from lhe c:Hvu..~ :oind th,;:- basalar portion
of 1.h 1:: nc-;:..i pi I al.
]{~~hi, ~~ e!nploycd for ~sc:ript.h":n, l':)r ~erial SU?crimposing ~-of c:ha11gt':~, ~nd
11r0v;d,e.s a -:::i tical n:kIT:11 ce for rc~rli L:I l(Hl .
D.C.iJ

N:.si.on
Tb:: rnturcs ar~ growth adju:o.h{lt:nt .sit::.s. During gro-"•••th tne nasa.l l:xm..-:- has
been dcmonst.ra.1..f'.d l.n gruw a,'tc3.Y from the: froe11.al Lorie, The fro:-ttal bon.-:: hous.c.s t.hi::
fnn=•.hr:1in. ~.'.H~ion, ~elected at th~ C:'Onl.d ma~gin of the fronto~::1asa! s.tlhU:E":,
n:prcscnts aci ar~a al. lht junction of squama with tht fH l,it..-.;l platt's and is a useful
po:n~ for , LPl )r:':l" t,1 ci.<tl rdcrcnce.
Not all nasa'. s•.H.u{e:,. ,Ht' paral.k! ta the:: cc:ntral heam of thf'. X-1"~}'- TlLe ~ydid
::11dy L'on fost- th~ .>.' astcm sckct..ion, p::tr·j (.1,.u.i.dy in the .l\1ongoloid race. :\l' as~o 11 Jrn.1 ~l
coruc-gucntly be se:ec:r.e.d ~'iit~\ p(edsion. It may a2pear 1.n h~ nnlLing more thaP. a
I •

...,.
' '

,.
 - - ·- ·. ·----------···· ...

PhotA~ L~f a sa.gittal $1::".t.::ti on of a skull

D
• I

5figh l lnJt':n l ,l th)ll, lL ,t'r\'t"~ tu hdp form thi:: b,1.Si--{_T.J!li.al ax.is a:1.d h.a5 It'Illi:.II.k.lu~,::o
0rd cr witb. th.:: fonv~rd d~"dopmer, t o~· Point A or the max]la.

n.c. :!

PoTion •· A Tcmpurn.1 Bone Ccntot."r and His:curh.:ally U-..e

J\.·1ost Common Anthropometric Point
Pr;-rior,, Sf"lt"1'1NI .~.1 1hr C-f'nLt"f 0f I l~r. ~tlpf'riar h1i"!"d:-r of the. c~r canal. ~as
crad'.t'.on.:.1.Ey be-en 1.1~~d for d::5aipdon of c.T.:i.::i;iai and f.:1da( rt'llil if,n-5hip~- L 1 ~fr(t".~¢"1\I.~
~he i.:ente.r of the temporal bone, th.e. houscng of chc foss.:l.• Na:curc's artkul~ti::r. 1•\1-tlk
. ,_.-( ~i°:Jlt' ln lh~ dry :;.ktJH i l prr:.;.-:-nl:): a ~iight pru 1.1km uf idr::( lLlfi t'.i. l.ki1l in l.h t". 1adi1igi ,i [ ih.
•.. ·.
The '-.'ar rorf of the n~phaJomet'-'.'r G.-t nnot bt: u.s.~d with ::1.CL"'l.1ra.c:y. Ja
ad:::lit~on, the c,;_=_r .::anal i~sdf ...,,..m varyir. the irrn.~ :--==nJ-::rt<l bec:,ni~e th~ .:.·,c1,d -.•/ll ;k
iJ~ :.he sk.ull o1.t dfffi::rent direcc.ion5. The mea:cus is -cval-~hapcd ~nJ noc rnurld.
Th~ ex1 ~rn.";1] m~ar.1J.1: furl h~r may l){'. confus.cd , vi.1h the: :ni:cma[ mc:atu5 ..,_.,.'hkh
1

lk::-5 above it imd hdund it whil{' n::-m,◄ J.nh1g 1n :-:i ,uw,-i.~l.t".nt orien·~ti;:rn to it '\.\-' ith
, . gr-o~\,:h. Tll.c c;in,1k;: ;iho may no'C bi: ~J'UlI'lll':'trk:il in po:i-;11 inl'I b th,:=, film rl.·..1~ t.n ~i11~~1·
....
f~O::.l.udng OJ as~=n·.mc-u:y. It chc:rcforc n::c-ds a (iiffi...'Xcnti"'I ~d~f:t:ior't, p(t:r:-tjcul:-idy for
h:-igli1.. P..01 h sides are h:secLed for one common r~krcncc.
Th~ .fol1'.::-1t,-i ng ~~id, ar-e rt'commtrL(lt:•:d for i"L,:; st"J~t~I ~(m:
1. Look for it in lir.c with 'Che dens, and Bas-i.on.
2. Orit:'Jll. :lh( i frum lhi::: gl~r,oic. i-ns.s.-.:i v.-hic.h i~ ;Jn.1ost bisc:acd; ~.c-.. from
ch~ cminc-ncc: ; :.-o ~he r:::iot of (:,C' fo5:sa ::.,•,Jc rruiy Ut:'- , ·t 1n i"ns-t:"d ID l.h~ en: I( ~
wi t.h l h<' Sf~h f'.n c-Ol~ri pit a 1 ~ynd·,ondmsi.s.
O::icnt fr,_;m ~h~ tmbL°'.'nCt' ur latc::-rnl tubt'rdt..
·!'he rop of the. con dyl e i.s rem.uk.ably con.sistcm: ,,.1th -::hr F rc:nkfurc
Phu:::- i!L dry sk:.ilk Ui Lh~ ,:uwJylt- i:s w,~far HbOYt:' or loo Lu· bdi.:.: w lh~

l4
 FH Plane:.. .some.thing i.s probably ,•,rong- in =:.h:-!. ~dee-Jen_)
:,, Th~ f'.nd oft.he. pos1.-gl~nnld prnce:s& is v~ry t~ons:is~nt with Fra.'11::.fort
Ph1nf' in 11-~ hmn.-::in.
6. ldcn ti~ the- intl'IT!.al canal and dhni.nate th<'l t irn~ge.
0

I. T r.acc- both ioin.ts wich :Jo vcry soft le.ad pcndl dir('aly c:n t ~, i::-: ti hn ( n i h
() [1 ,...,.i Lh f: n ~~r :-., dt"1 n•fJ I. ~f8 s..~)-
8, id t":n tity the ::ondyks al"!d thc:n cnn tpose :i Cf.ln uno11 j ()in L :~ ~:t ((Jr l.h e
c.l:':n tr.:i:..l r~forence f:!"om Tb~e I onward.
9, llorizoutaHy the p<>~k:rior r~lH{gin (r:oiHl?Jion pn.-,1.e:rior) of c.he no~ma.Hy
pcisii:.ionro cordy1e is used as a r.;:krcncc.
10. TJ1rt'-. pnir:1 ~ oJi 1.ht'. c~)nd/e a~ Ccnd\'lion (Co), Ccn<lylion p:istcri-cr
(Cp}, .;.nd Cor:.dylion st:ptTiclJ" (C!:i}.

Oc'bi.1.al€. (0)
11u:: tyi::' b ~1 J1t'l:ri_1lvgk rngan whkh dC".-'o:lops rdativt":lr ea~·ly. B..::eau..s..:: ,:he
orbjc.J ,:::i.vhy is rc-lat<:c tu sight, i.vJuch. i~ in turn oriented to tl1~ Ln1e hofi ✓.:ontaL the
lr.)1vfr ;·irn 01- 1hrf' 01-h:r ,;or Orbitalc). when t:mpluytd wiL..h Porion. has provi:n usefol
for ~aci:al oricntatbn, ,\hhough OrbiLa.le :s located in th~ fo:~ due. to LLS n.e:uraJ nature
~nd t"8dy c"n3turat(on (it 13 so bask it is though~ of 8~ \~rn.nta.l"").
The btern.l burdt.r r:,f lhi::: :-n·:"":i~c is formed by the :z::ygow~1ic bone.. 1n fa<::t it caP..
0

h~ deb~t~d that Orbit.nk point h ,1ctmdly ba.s~d on the zygorrn:,rk bnr1t:'". °St""lf'~'no~
may :..>L a. l L;In'"s rti ffi~ Llh~ :,rnd the right .and kft :skk:; a:::ot" bi.~.z:cc.cd fer c1i t\ctl
bngit.udinal use. The :;:::kctio1i ::;;·~ul:ld not be. c-:in~uscd ...._,/.tl: tht'" l:.itri cn;:ii c::rn;1'., 1.~~
hfrmwl :l Lt":.P_ n 8.1. or air cdls. in ,:.he c:hm.oid ,

15
... . .
Quik cc..1nsi~tntly ili.c F::-ankfort P]anc. precisely biser.L~ i.hf'. :-.ygomacic: aic-h. R)i
.::-x am;ning the .;r-.,;;, tomv closely, Orbit.ale can b~ s~:ecu~J ·.-.·i Lh -i::on:1der'l...::i:>:. Jt. h.'L:-;,
howi.::vi.:.::-. b..::i.:.:n obs~~-~•f!C. t.-:"J bt' ir1ll 11r.11ct'd d1m•J~w,,1 d .;wd 1.•!i;_·;o:..w.l-lrc.l widL ci:-tvl~~~l
l nic:i i er 1 1f 'l 3 gm~...-i n,g cJd ld,

Ptc:ry}.,10id Ilcfcrcn cc (Pr)

Th-f' .1.:..rro~v f 't.c ryg·t)ma :,:;ill:) ry (is ~ure \".':) s foroi trly efrip Ir:yt>:d for r:;> f t:retl(-:t wt ti L
the assumption that it WrlS stable. I-Ioi.•..-c-ve1·, on seeing th.ai: it was influrno:d by
tn·n:nir.n :., ,q hig:ter ?Oint .1.L l be ptJ,~ l.t".r1t",rmos1. ho~!' ni- I.hi:: sphenopal3.:.ine foM;;t w:ls
c--Lr,pl::iycd fo::- rdc-re-uc~ ~nd lab~lled ptITyguid refcrt-uce (Pr). ~G tn:~tment mfr~
":·:-,01.=of the pi:-::1"'!,-T,vid :plates was found. A pcint .r..t the pos~crioanost curva:::urc- of
tlv: f,:_,:;.::;a h ~t>-1 ~r.L ~d. This .'! rf' .'1 1~ d Os.t". t,'l :=i ,o;t :=i ~-;,l ~ cP.nr.er. Poin :. Pr is ~m?lov-2d i::.o
di'O p a pi.::rpcndici.1la:::- fo-.1m Frnr,kfort. The 0~1tfoi~~ f)f bntl ! lm,:sac": al't': bi se:d.~.d for d1 I:'
select:on cf Pr. Titb, crossing forrns the b~.st ~oorclinri.t~ tor ~1lt~rh1g d~1 :i in1 n thr
nm in=.1l
.. ~r ;;.1Ll·.o L.:.~:t.
,:1 of co•.irse, an -v poinc can be used.

Pt.erygoid Po-in( (Jlt.)

A pol-:.1.r -~·ecit~r. r?:Dill ,=vhkh Unes :o forjal p:rr-l~ di~p~.r~e in a.11 01-c~l'ly m:1c1:1.~:·,
11.t:-. L-f'~n s::iugl-n from the beginning of gro ,,.."th studi-cs. lt h logirnl th.i.t the
1

p 1·.~; ·.o: nc-"m·i1~ wc-uld be ~J.q Lt=-:d I c:, n t ur.1~ &stl'i b"i;.:io:1. The larg~ trtgcminal cranitl
n~rYe hr·•.s joLi·, ~em-!Jry aud u~otur {·0m1-1ont'lll~ ,,..,,.hich f~t::d I :1~ Ll(:i::il (avi ..i~s. 11 n:-.
~~)h~1.oi<l hc-n c: ts the cen tra~ bone 1n :he m.ak-::-•.1p of the skull. /m cxhau.sti:.•e study
v,.rVh t ht:' o .m I p111.e.r r~v~:1 I~d il ·.,tt :l ct'n tr;-} I p011H w1B ~S.fi~nti ally found n l:".ar Fora:YI e.n
Rot w1c Lun -- ch-: o.i t of i::.h-: m.a:.i.::tllary :-icrv;:, or si::cor.d d '. vis\on of th~ i:rige-ntln~l
n-erv~ .

... ., .

' ..
,
·- '

16
 ,,V\.ch 1 h~ discovery of 1.h:s i.::entr:i] ai-ea, stuc.ics. v/.th k·ar.kd :-kulb ~knvr-d I hJ:11
1.in:· k,·.•,-ef bord~r of the fornrn~n co·,,ld ht i1l~J1L ifi~d as a p.::dno:., and '.'lc:ne<: '..r-.bdc:d Pt
1

{ror th(:" (,rigin c-f ,:h-: p,:c:rygoid butIIT>~),

Biologiv-:11 :y, th is a n:.:a as a re!fcrcn.c.c: lorn.ticin i:s highly nit,on;,i l. Al'L~hi tf',-:r.urally,
;-il Lhis ar,::::a -.:h.' g=-{"':-::t v.-;Hg::; :.win~ u1Jw,ud .i.l\d ou,:,.-..rard, thC' r,tc::rygCJid pla\.t'.:i; t'.Xlt'.r1.d
thn....·nw~..rd and th~ ro::-trnm r;f th~ ~phi!"fl0Ld :-;i~pp011}i ~.hr. ....,'Dmcr dO\'r':l'L'.'arr:. a!LJ
fon•,.i.rd. 1'r~1Hl 3. n~uroc.rophic standpoint (nt tt1i~ :.,:ph~l(l-pt.!]:=:tL.in~ bcac.ion) the
c1:axHlary n:::rv~ ..-:m c:::r:-~, gmi.gl i:i :1.~. ron Lain ed, internal ma.,dllary blr.H..1d vr:-,.~t'l~ t ~r.<irw h,
,md ll i:-.. ,t ~)=·a cjng area mcdtankally. Uoth I'r ,l.nd Pl p0ints hav~ been hlgh.ly
5 UCC'l:!SSr·ut SOllIT~ uf l d l::"TetlC{',
Th1~ ii1 summary, our 1\_T.ti.ni.J.1" rdt'.lt:'OCe~ ;;11·~: Ba. N, P, 0. Pr .:i.nd Pt, ,,:i:h
Sc E~ rdci:1t~d m1 I? fo,- n.q,soph ai·_yc1gea\ analysis,

J\.11\K DJ B L"lAR REFERENCES

Grcat::st 8ttt'1'1t.inn is necdo.::d for the: mandiblt' hi fac:::=:t.l lyping and .scri.d ,vork.
Ihe 10,".rer jai,v is mr;~ v.i ri.abk~ :ill d has greate::- limi t,l'::ir)n~ stn 1<:t 111':1 Ily w1 t.h Tr~~- tm-::nt
tha: l d •.:-:" c1 1i<l f~.ci.::. in th.c ?,IOVl-rin~ chLd, ·l 'ht:" 1.l I ought fon~, in fad.al t~1;-e ac Id Jl r:::-~:1.i ( )l 1
o:· gr0o;.,.1h, ;.~ dn·. chin. Thus th-2 rr..;.ndibJc :1:-. :i -.-..·ho:e is 9£.SlUne-d to be inilucr1,:l':'"d
',\'r..::n the bi::-havi ur of d 1:-- d Ii 11 i ~ ~cu.died. Sever-D.l point:~ [] F rt:'.lt'.r l'.n cc on tnc ma!:"l.dib;c:

Pogonion (Po)
Tht' CllO~t. anlc::-loc po~nc on th~ 0\1tHrn: of tht' c:hin has long bcc:n uscJ [1.~ <-'-
hor1zom:al r.::-kr,rm·~ h::-r rhh1 p(1si Lion (Po}. Ho1,,vcvc-r, th.at ~urf(l(°:t'. r-.an be o::b.fr:elv

17
n:=i1 :l(!<l nm spixinc fur a ven:irnl r~frn:111.A".

Pro L• • be.r.an c:e. \1.cn ti f Prn)

fool'-=- sc . . .blc \'tTtic;d rdertT-(:t'., fot 1.h~ me..a.suremcn: of tomb t'.ruption a.n.:::l
~n t,.vt I l ch :1r1.ge, a rcvcrsa1 Hnr has- b~t:':J'l fo~ind a.t che cop of the trigrJ111..1m • n¢"n1 ::;ill
(prutt:.l.:ier.,H\◄:e .l-:lrld ine:nc:a.l tubcrdcs), Pm is sd~ttd whi::.rc th..:: cortkal p'.o:.!.tt ~Ld~
a.n.d ,._•her~ the- ~upriirn~n1.a.l (:(Jntour stans to r~cc-<lc 1nw tJ~e :1h•colar precess. Mctnt
i,n rb 1'11 mr1.rl~rs. .:'.t thb })llllli cJ r_:, l ,O l ckmgt> ~11 JJL ng no:!"lr..a.l grovvt h. Ci::tr~ .,h :)1Jld b,:'.
~x.:.::rds-cJ t{) ~i::-lt>:L'.L Lhc .r.ame point ~n r: ~erk::: uf tr,1(':ing·i:;_ Boys have- adddon:;. ui bm1,
f.i rc:·.1rn fe rErn:iallv =Ji::-lo,.,..- Prn poh11 .

G:nathion (Gn)
Tc:-,+1.ni caU:•. Gn ,,.,.ts the 1no~t d~n.v-r1w.a1.rd and for-'.Tird poi J:\t {)T) t.1i e: chin for
,l!,J1thrrip-:nne.u·ics. Praccically, it b ~ek,:_.""tr.d c:t:':ph;1Jometrtcally mu.l U>H~tr-.nj e:d hy the
intcr~cction uf lht:': f:.,_c:ial Plane: ,=-.--ith the: ~-fan<libuJar Plane. which bccorne5 th::- Cn
reference. Tht' ,-:r-0:;.,-,ing of the Facial A.xis depic;is tht': woddng gnathion pr:,h)t nn tht"-
~h.in. C~halom.t'tric (}u b 1.~s.t<.d [ur L.he Facia1 Axis a5 it c:x:.m:flt'.C:l.s to Pt.

.\'\en ton (r,.-1)

Slmply th~ lmvf'..st point on the tnfcrior bun.Lt".:-- of Lhe Sy"F-Lphysis.

Xi Point ~ R 1 to R 4
Ono: of the mr.i-.i;l \i_t;e:ful n=.Je:~:1.ces ev~r discovcri:::-d h Xi PoinL lt v.ra:s sck:cr.::d
n~ ;,1 <'f'nt.rnirl r,:-:~·crcncc- for th.-:: :-a.1m1::;. •.me.= W.l.'.)- .::i trm~ l-;rcahchrough in r~~;uch ,HLl'..I
dlnkal sdt11(~-

--------
 I·'1.1,1r pui :n t ~ vr l th~ rm:m1s nrc 1.1scd for Xi sclection. R 1 is locac.cd at the
;i r l~t-:i:i,.1r b(.)Hkr at th<:" rntrrc,•;,.rcst ?Oint on tll-c ;amu~. R l is th us sdccr.ed at th f".
dc.:.::pc~ cw;,ee on the: s~s,-coro!"'.:oid :nt:ist1r~. R?. i~ al i],_~ .qamt?: Je•.•f'.l A.~ RI .:-,,-.. l hoe
poste.rit"Jr b()tdt:>C". R3 j_q ~.ri.e :o..-.·.t'.~t po:m c.~n t~Le sigm0ld 11oi.d l. R4 i~ dirt:':c(y bdo,,v
R3 c-n ,:he- lnf:rfor painc ot the ra.tnus. Thus. ,:he hclgr.t an:::l dc-?ch o:· i:h:: rntr1-11s a.r~
bisected .1nd. the. common poj :1.t is Xi l· 10i n c.
AlLh(Jll!5h 1nt,'\tur(:'d fo:i: ib ::;di;:-liiun, Xi P(Jim ~s :;.Lrungly u1L1luglo:.:al fr_:.r :;.evt:ra]
r~::i sons, It [3 { 1) fou::1d at th..-:: mandib·..1la.r fora.t11.en hmnd. 1t b (~) high]y re~ ...Llc-.r
1,:,•j th th~ T me B ~cca] Ood LL';a] Pl 8 n r:. [ r~ (-~} d.l :=.t gno~ti c: p0si tion is rr:l a ti \'r."': :.o (>'IV. l 1
iJ (4) cm p]oycd to locate- po~nr:s for i:h-:: r,ro ;:vi:h arc.1

X: Point is also (5) use.cl for Jes{:ription of the siz~ and forn1. of -chc mandibk.
It :5 (6) rnc-d .for th~ .-:I Cl,-t.l yJb of the::- Dh-1nr Propurti011. l1. j s (7: emp]oyr.cl rOI' r~ :i a1
ty-ping. \·\1th gro•,vth ~tis (8} a vnt{:X. ccr.tcr for :he ornl c:□v-hy h:·igl1t. lt i!:> (9) ll~ed :·..,

fo:· dl".S.L' ri 11 l ;..JI, of both 10r:aJ facta1 a.nd den ta.l hc:ight. Finally, (l O), it is us~d for
pr{"dh:tinn of dt'Velopmc=nt of .::,c:du.~icn . ,.q.-nd fo1· the: ~si=.ssment o~ (!I\.tptio~ a~d r:oor:h
d nu tges ,.:li.J Li r allJ,
\Vlr:h ~:::n ,1.pp'.dotJtlJ:1.S, t'.1.~ sc-kction of Xl Ilt't''.b cm-:. Thi:": sigmoid nntc:h i~
thjn oor1e. Bm.h ~:i:emal oblique tidgcs arc often sup::rimp0::.t:d i:lnd '3.Jitfo~d ~1,.•ith
I hr niedi~l t~n·.po:·1:i.lis c:rt". qL . The ff!..,:.tgins (}L both side..s of tr:c rmnus ne{!d to je
hl'ie<:H:d. In St::'\-'t"=-t- :i~ymmt:"'tt:,, 1 ·.-.·o "X, point'.'> -- n1,e fof ~ac:h sjde -- ma:y ht': ~1.~eful fCJ1·
caku~ations.

SulJgoniu.n (Sgo)
Goninn is by c....==finitbn the mo-st tnfer,or-po.sterlor point on the an~k ot the
n1;1r~c ~il:ik T11t" ln"A'f"f IY.Jd.c=-.r c,f ~.ht>: ..'lngli:>. ,s 11'.'>t".L°! f fJr' :;~1ec:t.iun of the ma.ndihu]ar pla::L~
r1nd hence is l□.bck:.l subgmlbll (Sgo).

il.t_:, J
13,61}4
--..
 Condvl ion {Co)
T i.::c.hntcally, by dt:"lic.Tipf.ion, cl. is the: most supcriOT point -0n the condvJ...'"Lr :1cad.
Practic:..illy, a:=.: LJsed, it is often th-t' mf.1~t 1.1pw:1rcl and b.ad(\\'.;,i.rd pnini _ t:-:~-,:-;e:nt.iaJly. it
can be locmt'd t l,Y t 1~_.... n( Poi n E. D \-.ti kh has bC'cn ~d~c:1 c".d by bisecting th~ ,,,.,.id th uf
th~ nmdylc: neck nc-aT tht"' B,%~C)l,-N.:-i:;ic.Hi plane.

Co:i:\dyHon SuperiOT {Cs)

tl~ mo~ s.up.:::·ri UT ~!:o;ii~:-.1. of Lhe -cc,ndylc is usr-fl
I,'\,' hen w~ {';':I H it Con dylion
Supc:rl::>r (C-s). l I is 1i.si.::tl in forccastinr,-.

Condylion P~taJ.01· (Cp}

1n on:k:::: 1n ;ocac.e a refo:.b]o;:: i10rlzonv~l r(.':fr:rt".r1ce. for th.c rondyk ~md tJ1.~. ji)iti :.
ch~ mos-: postcrir>r. I" ii n I ls sP.b:~1':T ~d on r.hc condyk bunJ t"J - Ca.!'"c should lx i:xerdsc:d
11 11
in cht:":t.·hf1g mandjbula:r posttm.·. Tht:': COTidyle_ need not be: !;;t\~t~d L~rminaJJy· _

Artk,;,d~ ,:e (Ar)

A,·ti ,_~1 LI arc has bC'lTI C'mphry."t::d :i.i; 1.h e. r.i ghesi: visi bk J.1c )iTi 1. on rhe po,~teri or
border llf ttu: (..nntl_yloid process =ienc-ath .:hr. ~l·,~d.o:Y....' of the- cra:nfal b~~~.
Convenk:ntly, it c~1\ hi:": s~l~c.tc.d on~ Basi.on-Na~j()rt pb.nc at the posterior rnm:-ghi
nf 1hf': c.:1ndvk neck.

R:1.m us .Reference (Rr)

The top half cA thr 1:.:-in111..., {X. 1.c~ R3) ls bis('('tcd, .imd a horizonntl line: i:3 d!'m"l'J:l
t'J tfo:-: imt.ei·ior borc:cr 1.•;.rhkh (kttn:i::i.,.t~s I.he Ramus. rcfcrt··u.,:t>-. ·1ht,; is. IJf.~d for
prcdictiou.

fva Poiut (Ev.-.)

By o:A Iuc-:c:Li ng Rr poim: to RJ (thi::- '-.'t"Jl :.('r Cl f 1.he si.~moid ur>td 1) .'! li 1,e. dt>_pi ..::ring
Lne -co.ron0i.d proct".~s ,:,:; fnrme:i:-L Ry hise-c.tinf. that line, point Eva is sc:kctc:d, ...,,ni.ch is
u~t:d t ci consu·uct rut arc i:ogc,:her ,,,,i t.f I Pm po~nt.

Murray Poinl (Mu)

This 1:s a rcfcrcnce poi.nt t:':lnployt",d fol' forecasting <i1 t.h~. c:rossi ng of rh:: arc
""'1th tfo:· :5i~)WJid 11 otch c udinc_
Thus.. in s\uum::ny, - cJ'le. Sf'_vEn:.een mandibular rt[.f':r'i?.nces are ,cm,.,lovcd_
' .
()l.L th~
~yu1ph:v:,.1:<"; f.lr~ Pm, Po, Gn, cmd M. l'r_:.r =.bf'. ramu.s they .m: Sg? Rl lo ll4, flri Xli
E,•a and Mu. 1-'ur Lhe co11dyle they s:.re D, Co, c~ :1nd Cp.
 i\1AXJI.L\RY R r.n ',R 1~NC.FS
C1,nlparcd to the :n::ft"rr:-:ric·~~ for the mandibk, the rr:7t'.ft".TH:.e£ for the mldfo.. t" Oi'O::
fc,,:v mid ~jr:1plc. bL:t arc SDIM':imt'::. diffk1Jlt ro idcn:ify.

...\.ntcriO.£ N ~6.:1..l Spine (ANS)

A1"11 ~1·iormost on the: t\'r'U mi::L'<lllcte is. a &pine: .,,.,.-tdch a.ct,:; r.1~ a ::-.hdf 10 support
::.h-:: nasal curtihtgh\ou~ Sf'.ptucn. The :::im:-::riu:r n.~:i-:-l.l spine is thcrcfurt': rcl:-JL.e<l lCi Lhe
;1.:1sal .;:,a\•ity and i5 n<.r.: .ih't•:-,bt rrocP.ss . It is .somttimt":i- diffic1.i.t to beat-: pn:-dst"'.y.
\·Vi:h &n (.)1{(."It'x.po.sc:d, or unshaded X-rny 1..f'c:hnique, it may bt vi:;.ible t1nly i!l .spou-::d
:ighL, lL also \'ane~ b kl1gth. Ra~ly is it not pr~.st'I~t, hut. in long nos.cs it uwy lit'
'..u.rr.;~r tlum k :;h.ort nosc:s. AlmL.E ,,,,.,ith l.he. spir.c, a heavy br.iny ridge, which n::ns
'..ransvcr.sdy bct,,.vt~n. Lhe t,;,,.ro ma.--<lllac, :m.ay bf'. i<lenti fled tog!:·d\t"r wh h ~ h~ fora mer.
ror- U1.f'. i ncisivc canal m~ld Li, l.l 1t":. l~f u.pting cmim:ti wbi,;,:11 rr-,~y eobscurc it,
J'o!i:Lerior Nasal Spin~ (PNS)
TI-..c po~~~rfor na~,al ~pi~e i::: accual~y un J-,-:-: p=ilatin.e bone, n<Jt th:-: it)fsxiila. I: is
'.-J"'J e:c er.tion c,f-::ht m:o:i lla1y h;1cu. paiate and u~1.ia'.ly h ri:-:v1::akd as a tip. 1t is pJainly
vis\bk i:; cro~swscction in adult~. lt ma~.., ho-.,.,-evcri be superiwpos~d by the j,::\•doping
1rn)lm ~n,,,'Ti.~ ir1 children.
1-Vhen h: is ~_; ffi i.:uk lo locate) "Che: att ac.hcn~nt of (he. soft p.i.laH: c.m h, u:,..f'.d t(J
Ln<l i c. TI-..~ s,qt-rior bc.;-1:(t:;· i mm e.di ite.ly a 1 the tip u::;u,i lJ y Sf' 1-....-~s as 'th{: uppcr veL.r : :

,1tt:1 drn I i:"n I , ·,-.·h 11 r-: tr.c vcl um b.ns a bruad ::·-r ba ~{' Lri ~l.":ri c-d y. In r;,ilatera~ ~-lt:· fl p:=i !,,,1.f'.
c•.:-:'.d1tlons tr.er~ b no ~)(:,~ l.t:":cic.:r- spine but in si;rgirnJy du:i.~d soft ddt pala"Ccs tht:
c:rns s Sf'.ction of 3cnr tisst1 e may ~rvt:' .'1 s :'I. re.ferf'.ncc.

B.C,rj

. ~ _____ ___...,..,._

21
 Point A {A)
JJy ckfinition Point. A is usually :-.t':l~r.t.cd at t!~ dt't.pe-.st curv.ltn(f' of the contrJuT
ht>-l o►l.' t.~c rur.t'ftOI' nasal sph1t-, lt. cs c.ftrn c011side.red to l;(: th~ jLmctioc1 of ::i.h=e.olar
procc:-5~ wi d~ basn) brm ~- l n long lo wt"'.f faiY he~g.ht. t h¢" m.mUary ir ll':i sors suprn-<~rup l.
! ·his m..ay t'" Lend -chc ah·-ro1, lfi dowm=vanl ,u,d 1.h L &qw:~t ,.. ,.,..,.., LO Ur tru.1~' be- lo~..-and
a";.ray frnm the ~-~"~ of the spin~, l n normal ad ,1J I. {'..Ondi tioxl.5, Pc, int A is. ~ilm<)SI
e.:li.accly pu1·.<tllel to tht:': hr.ight of the rr.>rtl Ljp of tlit: C'(:nlr~l incisor_ Puir,L. A j5 tlms-
~t"iif'c.r.cd at (1,i:-. base of a trfangdar f8'1ID fur th~ anterior 1rns:1l spine (stt: illw,1.ra.tjon).
In ~:rc1:n~ g·,1mmy smik p;~l 1~.m.s ,,-,,.ith cl l~)ng ,q J,.,e.o]us pn::.i:-/1l.. and h-t i,'l.·hich
sLu"girnl 11i:n:-ilfa.1y :1:npl!.t lir.111 is pJar1.n~d, .JJI artificial Pou,.:, A is sckc.ii:,c.l. :.1 Lhe level of
t.l1e.. incisor tl1) r<,r planni~ ref~re.nce. This -i.s ~mplayoo fur: thf' Dh,inc Propr;1:lio n in
pL"t:nt1ing in ordr:-r· •. o loC'..atc the- pal.Ht· ~nd the 11')"\"r'('!" jnc.isor edgC': M t: golden pobt
br:tv.rt:t:r:\ .,-\ and Pm, The a..-t.ifidal A p0im. i~ e.mplO)•t"<l tc , ]ocate Pdnl .A i r, r1. golden
1"c l.ation to h ·an krort P~m:: ., 11 d Pm.
'Tli.u:s, in ~-.1mm,:U,"'· the m~:x.i JI :try points are .An~, Pns, and Point A.

TEETH
\Vf': have L1uncl I.h f. use: of tht" Ri cketts t~mp~k: 1.-n be a VJ.~ 11.id f.::'Jl' d.J"a.v.vi.ng
te.::th! ln Ol'der to rcc(..'Id fo,· greatcs.-c dt:U,H, .i:_ll c.eec.h may bi:>: I fol.Ced. Iluwi:-:vi:-:r, 1.h-.::
fi r.s.t molar-- m1 d th~ ccnu·al i.nd~,::rs a re rcfcrc::rn:e$ 1 v,;1.1aJly Clllployt'.d as keys -co tkntu.rt'!
~1r1pld..lX:.in~nt, Tht'! loviil:r bucc.al tt:'"-t'.1h a~ emplcye<.l for Lhe Trni:'.' B-uc:c:11 Oc,;::lusal
Ptm,e. \.\:'hen tho:'.' righ I. .and left rnokr 1 r"R:L b rlTL d.irct.1:ly :,1,1 perimpos<:d, trndng.~ a.re.
easy, BlJl when asymmrtry i:-.:-cist.s, all dcrP:al "'Li'uc.tures .an:- Liist>:C.te.d for a si11gk.
repr~srnrnt ir.ri foi· meaS\1rcnH::-n1 . .and planning,
\'\7Jthout HLuch ado we ~uktly c~1ln.1lar:.cd mobr n·l:-ilionship for <.·.lm;.,:;1f"i.<::a:ic,n
fro--_c\ thi:>: loVl.\::T m olar :wt.hN Lh.1.11 the uppt'r. Strar.gcly, w.> ont> nhjcctcd, i,.vhich Wt'.,ml
µcrhav:- th~1 mosr. dinidm1~ ,1U.,11/tlly think rr<.JU\ thi:-: kn-\'..'.:r molar.
'...
'rhe Lowi:-r Jod'.'ior ( [ j 1) (Bl}
Sd('!C:I ion of the TI\o~t re:pr'cse.nt:'"1.tiYe po~it.i on of the couuunn Iowc:r ccrttra'.
indsor is attt-nipte.d.. ff one 1r., .,. -~ i'"f'n1 f.',ll ind5or b dbpL:K~d for.,,-ard it Ji..1ts not
1:e1,:i::--...,t'.:~1. Lhe posidrm of th~ cntht lmver 1:m1.~rior s.ection. lrr g~Eleral, the ni.i:'.',U\ of
th~ hYU Iow~r ecntral in.dsurs tf':presenr:.:s a ,,,,(lJ'ldng posir.i on. llt":t 1[.:t' r Il, L': LC.:lll plmr: is
of r►ood vnlu~ for ,,,:i:-.1.ua.Ly and c::ffic..kn=~y in tracing,

Tbt1: Upper C~ntnd lndwr (J. I J) {Al}

i\.s in tho:: lrJ\vt>.r, a common pu:;:hion be.t~\."'"Ccn tho:'.' t,.-\'O upp;:r ccntrnl.s r:-rprt",~enr...,
:-i \\-"ntking 1·ela.tionwp. Ag~in, the tcmplak n((t"'.ffl t.lH•. best:. cunsb!.r.nc.y and accuray•,

,.,...,
,,:.,,,_
 The Lower Firsc Molar (616) (B6)
The- 101,,1.reT molar ~~n•.f'_., a~ ==. base. 1-eference for ruagnosis, p1'U1Iling, and
,uwh0cn.gc c.onsidcn.1.tiou. lt:;. J.l('Sitk1n hi the 1:.wn :-:;ide:,:; ih bise.c~c:d for a common
r-cfe:r:-:-i:H:r.. JI. :.cf'.,-es to calculac-e arch depth. It is- u~ell fo:- mt'.~m•i i\g acch
c-,11.phic~mt'rll vf'!'(ir-Ally .:ts ~11 a.~ h0.rizo:1taUy. The: lm•..-c:r mul-1:!lr Ltm.h lu Gt:h,~1,-·t'
v~i·l 11'_a:i.lly v-·ith Xi Point during d~·~lopmt'nt, 'I1\it po,;;tert0•· margin is wed for distal
rcrt'renct':-. !3nd Lh~ mes:al ma.i·gin for antcrior rdcrc:r.cc, ar\ll tht' bi5C"C-L if)Tj of tht>. mnbr
oi.:...:~ u.sion is- used for mc:-,{:.;;,,,rn:mt""nu; vt.>Ttk.a11:y.

Thl: t."pper l;irsl fit1olar (61 (,) (A6}

Th~ up p~r molar also i-5 b-b~cted. ./\ pM~)l~m 1"c'I ay occur in tts. positi.on in
sujdh•:.sic;n ,~1!11.<irlo-n,~. SLll. a. hisection \:\1U yiLid a mc:-cUL pu~h..i.un,

Canines
A11 l:"Jut canines arc probkm5 d.h1k~ Hy. ail d the. ce.nine cusp tips arr- rcf::re::K:t5
for thi:..· ~·orr1111'!!".:\c:!ls:,, e. ar.alys]s.
1

I
B.C.
~·
~

S.504
 SOFT TISSC"E TRAClNG AND REFERENCES
l n sof~. 1.i-Ssui=~, s1~iatJ ]f.1.1.ers Al'f' ~rnpioy€d for ri::fe.re:1c-e.

The Profile
Th-e c:or. to•J.rs of aJl t:'1e ci:£s u-2 on the ?r:ifilc- arc- use-f~, l t'r.'r t.h~ vi ~1 :ri li 7.,!j 1.i rn: d
its Li Lt' Lies ,'..l! d (,me( i 1)11: (p( n) i :-; pn )r 18.S8 Vi,~. ppo is pro p•.:.igon;or., n is soft t)s5ui:-
nas~o n, gn i& gnm:hi0n, and mis m.cnto:n,)
I)isL~1msf":d prf'.Vi.OLLs1y w:=i:::; r.h-?. manner in ,=vhkh i:bc lips a:-e po:sicion~d fi:...ir th~
mm (:.'(':)Cstm.:·, s~Jltl:;" o::linf cj::rn~ bc:,r)Tllt': ~mOi.l!m.0.1 ahouL ~his is:;uc . \'Voe prefer the.
j;:w.~ :rnd lips tc h..::k together for a funuional dfag.t.05:iS, i\ d()Sf'd H~) r1(]~~L 11·,n ill :l
ii[:;, s~ a] . . .,, ll i ndi c.;:;i Lr. Lh~ lJ't':8 l 1~l t>.M. prn bJcm.
Ho,r..·cvc-r, ~ ~t".::o:1d tHcx: cm b~ rl'LM~ ,..vith p~tienH -"l phy~iolGgi:: rest and '.1:::-,
., . : ~ post' aild c.:1n be traced an.d cc..mp""re<l. iJso, b ;:ni um ~W-~ Hmvs rn :-i~: ir.,li ci:I LL~ Lh...:
.-·. . t:.:ir,5 11.-:- :md l:p beh3.vjor in dcglutkfon.
Li? c:0Htr.:1.1.rs ,:,i11d dt".1rnuciL.iun of vt.:~fffLHJion. oord-crs dso help reveal ,:::ft ti:;::;u.::-
dew] (ls is suptTior lip, Ji is '.nl:ml°tT iip). The. cutVe of the ah of the nose {ul) JJl~-o
lY'lfly bf cUagn.c~tic. Th.;:: ri~ht ~;.nd kft -eydi<ls (U'.d _glubt"~~ of I :L~ eyf.:s ar . ~. ;:;ilso ,,..jsibk
,l!\d sGi:n~iimf':, 8 L1...,~:·u1 :-efe.re.ni.:.c ac. :he Jatc-r.nl. c.mthm (k\ ~n h- ~1tbJ·..-:i..s,i.t'. l) or sm1

j ~ st· prrim~~ 1! :l I:.

n.c. d

1,1 ,;;

The Tongue antl Hyokl (H'

Tl, e G uL1 inc of ~he tongu~ is n~ostly quite "i-1::-.i bk po~C-(:'n orly, hll I ~omf' 1'. mrs
d: fA,,;:,·l=: t to bciH:c: t.H:·c,nL~t:" i: i::. 1h u r:1 :\1.t>.ri n d y. T11c tongu{: dorsum and po:;.cc-ri,Jr
::.crrio2r she ..1ld be aaccd do·,'r-n c.a a:'.'ld :nch.1 ding tl lt' t:':pi glo l l i :o::.
ThP h~•1°JM bone. 3S t.1"7\cf':d in cmss-~~..::tio::1 of tr..c b:::xiy only. It:; tri;.;q;ular sb=.pe b

24
rtoJrc.i:e·d. ar.J a poi~t at the upp~.":.J· a11L~r·i0r ;rngl~ ,s lhi::- li>'t.'id p'.Jint for rdc::rcncc (H)_
·1'he SofL Pala. Lt=
.\'oa-.:1:Lll_y, L ht' pr;.stni-::n margin of tic tongue. Jies in ~om.AC( ~•,ii ;1 th:-- s-c.:ft
palate. \.Vhm a sp<1.cc exists.. tht= possibmty of rno~th brt>:fH his)g !:ihould be
b\v~.:;tig.-:;.li:".Ll. Chang~s Nx:ur, m1d the~.: can be c·yaluaci::d ,:,,rith tractng.s. TI-.~ s~~ll
1

pal.alt' is trno::-..t:'d 1n ~-rt1s~ s.:::C"Ckn and r.as been stuille.d in le.ngtJ1, LhiC'kt)es~, :~rid
pos~ Lj on fro,r: the hard pal ate c11 Li:1 i 1'1. f tn)<fj ~)CI d ux i.ng ~v.·aJluv,.ring and spi:.:-r--...:h.

Th~ Na~opharynge.al .i:ind Ph:uyngt"...41 \ValJ

Adt:':i1oi,t t:,;knt :irn.i position i:;. an is:suc. Thc:::cfcirc, :stnrtir-.g ,.,ith ;:he scft tissu~
po!i,ccrio!' to the .supt"rior chcanal a::-ca, the- trac~n.g is condr:.ued CD"<vtl'V.'3.rd to th~ le\• t>.I
of Lh~ c.so phagL.1.S.

l-'ore.ign nodies. J::1.nd P:n:hology

1\rtii'.1.t"ts. ,;.bj ct"ts h the nos c, gun.sh.ct 'rvounds, cys:.s, fr act :ires and tumors L":L~y
f urc.h er l">L jdf! n ci fk.d. aJ'·:d ~...-1, ~I I l 1'(:I t:r.d wj 11 IU ll~ ,l di;:' 1c1: lt'.d j r1~pt'.th)H,

P~tknt with adenoid blo"-•ka.gc ...uu.l

bil a.tcTal lingual LTos,;-hite

25
i '

f RO:--/TAL .Pt:RSPECHVE
T~c f.ror.tal h,1.:s not bt:"r:v-.:imc popuhi::- dl"'~piti::- th~ .::c-n11l)OJL p.11:it;il ~pli1t11ig
pracL.ic.cs and attempts to cx.µ.;:.1,d ~owcr arches by i::hc: ma1nstr.-:-<'l.m c.f onhodornbt-;.. (:::
\.ql'iXl.-l unLil p;1i-an·.i:::te.rs. £.Jl.d dat.s w-ere available from th.c computer that it re.m:lL<:d
~o.r;cnt applic..ttitJI L

Rtf-e-rt nce'ii J'.mpl oyed in Fmn t..:11 Perspective

Cr.a.n Lal and B.as:alar Points

Zygomatic Frontal .Point {Zf)
· J -~e tw,::;, .zygomatk::o froni::ru. suturt-s m:t ~ought ;.rn.d if T'ICJL plai.nly visi.b1e may be
iclc:-c~tifie-d <.I~ a bkw.l noli.:h .Sl th.it arpc(Y~:tma~r: height of ~J.S]Oil, The: iI'..5ide :margin
at the c-rbic is scki:.."ti:::d bU,m·rnUy :~s. / ,g. pu-i n 1.s.

Z\""gOmatic Arch Point (Za)

C:1n-·f11l ~x:i.minarion ;,~·ill ::-cv-:::a.J the- cross sel"tio1l oi U1t:" zy_gumJtic .tn.:he::.. Th~
ccr.tcr is sd::x:t{'<l br ic1spt'-:~.irn1. 7a. SL.£.nc.s :or Zygom.....tic arch ;:::c-m:~r.

CrisL.a Galli Pojnt (Cg)

Cr. st ,1 ( ~:-ll Ii i ~ &.:lse: and commonly !i:ho1,,~ en the- hr.mt,il fi Im. · rh I:". 1i p l ~
l~mFbvc:d for a poini::. \Vh-':'n it h " <A vi~ihl~ the. base: or top of the- sc-ptum is
~,n pl oy~d for a mk.lin~ point.

B~C- (!
I
8.504
. .
·.

.,

~-
..
Il \
\
\
Cg
11
I
!

:Ji'
/J \
I 2. f
I

LI I R
\ Za

26
 r

Z7
, ..
J\.·i andihular Basalar Points
.. Ag Poinrs
Th-t' grn Ii a: an.glie ti\ay flare outward .:1.n.d j.s ?O:Stcrtor to ch(: cknturt", Thick.
rnrdc.d bone b k:t',tt::-d at the u-rrnjn,tl.Lon oft.hf'. Exc.emaJ obliq1.J.C ridge- antcti.cr 1:0
tht>. mandibular notd~. Ti:chnically, d1h: h; (~1Ht•d chf' tri hf"<ir:=il ::-.minence. Jt was
rnLi:::-d thi:: ,.\Iltt::gonial T.1btrck .:1:nd fa.b..::~kd Ag as['; mmdi~llli!l.r b,~:ie rc:-kr:.-.xu:~. l1. i!->
on.c key to the ~..1rces.d ul ,1~e u{ Ult:': l;rnnLaJ Analysis.

ProU1berance men ti (Pm)

r,-, 1'.--i~ rrr)ntal vkw a triani;Ic of b0m:· b oftt'n quf Le visib)I:' ,:H. tht". s_vJ~\~hy.sis.
Th::: ;:c,p ot the tri:inglf' is dl<,si:=c1 as Pm point. lt rcprc~rnts ~h-t' ~x,,dlit1t:': of the
S;{J~physis.

.. Lateral Ardcubrc (1\r)

:···
This is sdt"'.:k(: 1"tf, t(l~ laL.r.tal border of the- mnncliblc a~ tb-t< (:Tns!iing of a
~.r;~:..sve:·se nne t~rough pi,f.nt~ JHg;-il~.

Ar

28
 "i\{axill<lt)' Re-Serences
N..~ Points
Tit~ b.te.ra1rnost m..ar_gin of the. imid~ margi.11 t.Jf the nas.al ca-,,.ity l~ se!itcc.cd and
hi l.if'llied ~ c.

Juga1e (J}
At ,:h~ t"TOS~i ng on ,:he: zygc-nw Li-c. proocss on tht ma.":ill ary v,:i.tn tht O\Ltl i ne.. of
th~ :r:ulie.·rns ity a poi~t h; .~,::-1er:r ~d to rcprc:st:11~ tht basal barn: of tht maxilla_ l t is
point JUf;d:: ,wd i L is ~clcct-cd for ,..,.id.I h of the rnaxiHtry bssc_

Antcrior Nasal Sp inc (ANS)

1lle actunl qJirie i.s 1lot visi bk, but A cen.ter of the !w rd prilate. at thi: jm Lli.L.CJli.
wh:h the- -.e:pt,im. can bi;:- :scli:::l~lt.d. 11-1.c mid-m-1.xillaty suture: id,::-f'ltifir-_'ition v;,'iU r.dp
ma.rk the l-e;\1.er also.

B.c .. er
8.50-4

L R
.~:;;~~~Oi..L~IJ.J.~~~...;~~~ Z~•--

:29
 .. '
<::$pl
\
I
I \ I
I

J
I)'~ 1/
\\ ~~ -
I

' I
J

L I - ~/1 I R
\ \
,
I
I

\
\
I
\ /

~
. ,.

IJt,:N·fA!.
Th~ lr1a::·almo5t p8ints ar::- ~t:>.l~1":L(:d fur mulau /\6f., A6R1 B6L, ;lJ ~<~ H6R, and
p r'f mola.rs B4 L :.md. .tt4 R. ·n1~ bisection o [ the. molar o(:ch.1sj on is ~~lccrcd fur L1 \t'
Fri:.:c110-na :lusa~ Pl:mi:-. Tht:" tirs <1f t.hf! canine rn,p5 arc:- ~r..lcct-:d. a~ A3L ,,nd ,A.'.iR, .sr;d
B:3L ar.d l3JR.

....
 PT.A.NfS AND J.lNf.S or: RP.ff.Rr.~CP. .-\"Nll PARAMV'ff..RS
A lin4.: imply io'.ns t'iYO poir.t~ .and can scrvc for other points to be measured tc
it. A plane is Uc..:-n.:-d to a flat .rnrfac.::: or i:hrec-,dirncnslon..ru. as a though,: form. B-of1.
~: ~ t>.rn pkJ yt".~l in u:: pha.Jc m~t.ry. Somi.:: very bas~c an cl usc:f:..il ~la.:1e.s and li nc:s ha~•c
pn)v~n 1o Ut:" o{ 1.h t>. i'!'H1i, I sub~• ,l:n(i:l: v~ Iut: :1 n d .<:itt". now d.e:,:;c:ri b-f:d..

T.ait.eral Cr an i al Plan e:i;

n.-i sion- ~a.siou Pia.ne
'l'h,r ~t't'lb ~"'{'.n:-: glued 1ogt1.ht>:t 1111 skulb and a :saw c11·.. was rnad.e. from Ba.s.LO:l :.0
J\.".asi-on. This plane (.1Jts off the 1.Hl.5<' ,;f tb(:': pterygr.1jd pl.i.te:i-, i.~ ~):ff~lld LO Lht'.
;--,y.i{~J1:1c1 : jL ·(1-l.t'.rnp,.:iral .suL..:.rc and s..::ccions. off chc: mand1bL..1.ar cc-ndyk. It truly can be:
thought ot ll5 n 1·rlt':i::il ~t'p.~r.Hio1i pl.in~. V1,·i1.h experl~nce it has become a remark.ab~y
i.;:scful plan-: for :::,0th dL~uiptiv-1:: an<l ~1uc:-nl ~1 h.u:1.<:LLCJH~.
Frankfort Ph,nc
·r11is 1~ perhaps the- best p'.IDc i:.o srnrc '\'rith for ch.-e scu<l~t' o( ht'~J pv:il1.~x:-:':.
t'r~ix~ P(:rir.:-l1. ,i::,: Lht: l ~mprm~I '.')one c:t?.n.c.er, Lt -esse.ntia1ly orkni:s i:h-: center or r.c-<,!.ring
.ar.c. equilibrium ,:o ,:h~ (Jrbit, t:lt: {lTWi?I nr s\gtii . Thi'.'> pl:-i:1i:=- fmm P t.o O bisP.•.tS th~
zyg~miai.ic: arc:h, and LS a p..::rp:::ndicu.la.r to the coronal sut\ln:' in gCTlt'::nd.

:e.c. cf
 Pt.erygo id Verlical Plane
A pe.:pex·,dicular to fr.wl..-for.t ~t"tti i:l s ::t ~-ep,t r;:i Li l''lT'I li 1 lt'. r(n' L'."1.c: face: aw~y from
'..he base of 1:h~ pccrygcid pla tcs. It rc-aso:r~ lily fr)rm.s ,◄ r~.~~,n L:-i ti on n r the. l~fJ ronal
~llll.lXt:'. Tlu" hynid. hfJn~ als,::-i ~nds to orient to it. This plru1i: ~~bdc-d PTV (for thi::
?"=crygi:)id ,riot. vt".r..ic"..c1l~, fon'llS an ~c:eJle:nc coordinate ~·or cmrancc ot dat.[I for tbr::"
c:omputcr. '111◄:: p0int {)f Go::;si,if.. nf I ht.'1 lin~ wir.h f'1·ankfort ha~ b_cc.n labelled Cf.

I
_i :
 Pfaoes :1 nd Lines for the face
Facial Plan~
This tradi.t~on.3:l plane.·is forme.d by conr1.-c-ctlng~asi.on -r,.vith Pogonio-:i..
\.·k~ls~1:--ed t,-om 1:r:rn k(nrl Ih~ t.nglf' ( 111=H~ir1i ::ingle.) is perhaps the. sin!Jk bcsi:. expression
l:\)ill t A from ~hi_,

f-.·13 rn.1ibuL.-u: Plane

Diff~ff:J"lt mandibular pla.r".CS have: k,:n employ·ro, b11t th,i:- lllCJ~t simplt- ,u1d
, :u;t':~n! :.!:i LI, t. so wee be: tc.el' of 1...he angle of the rar.:iu s (Subgonicn) (Sg) to thC". !0 ,"-'t'T
1

bun.kr of the- ~ym~hy:.;b (.i\tt".nw11) (\1). Jt ha5 been u.sc:d cJ.Toncously a.s a growth
forccasi:c-r. 1-fo'r't'"t"\.'tT. thr a.ngk uf the m[}Tldtbular plane can be .an ir:.dic.ator of a sick
c:ondylf'.. The in~rsccrton of c.he Facial and .:vtui('.ib~1l;u Pl;mt'.~ i:,.; lJ...",.t'.d. to i:.4°iJ~SLc uct
cepl La1u:n.d cic Gri 91hi-:')n {c-'rt'I ;-.

JJ
 Facial Axis
Th.-:- 1110:,.;I n":nt.r:Ll ::iris of thr::- fac-c dbCO'-'<"r-cc: is the line fr:::im Pr:C-I)-"gOIC Point
·'. Pc) t::., Cnmhion. It is measured rc:lati"vc to the Ba.sion-Nasion Plane- and form.s. on
ave-rage. a]mos-c a µcrfe.c: right angle in the Cauca&Lan popL1lac.ion. 17-i.e. point cif
erossj ng .::,f th e.se ~ines i~ b bdl f'.d Cc: (fo!' C:1·::i.1'1 i.:u l~l'I Lt:>:r) . b s0me. p:1c1 ~C'l l.!; Pt nl :1y f.~II
bt' lr.11,-,,.- :h::: .Ba~l tT,uJRl a)i.J.s <m<l th u::. the Facial ms i..s C"}.l:r::nded UP1-"r.ird :o form Cc.
The Facial axis closes 011.l_~- slightly- \½th average. normal grmvr:h (about onie de.gr~
-f'v~,y f:vt". yt".;:u:-:;). llli~ C.r(;,%iCLg h PosiLlm1 One. lx◄~ Jn Utt' s,;umw.ry gri:J',-..·Ll,
:m..;il ysis.
Jr'.il°'.L j.f. nt a.Hy, thf! fi.-:i;<::i on-·.. . .-;=i ~iCJf'l ;:i :-. N::isjo n hi?!r.0me.~ t hr. r~gi;,:;t.r~t.i 0~ for
il~S(:'."::-:::-ment of tht<: pu,ition uf PoiILt A 'J r the maxilla. '1':tc:' NA iim~ c.1n be th.oi.:ght of
as ~.he N as;al PJanc .

B.C. <1
S.504

,..

Contlyk Axis
A line. from Xl PoLnt e.)o.t~nde.d c.hrough P(Jlnt D to Condylion {Co} fo:ms Lht
(\-.11id}-{~ A :-:.1 :-:. f c [,~ ll'I!',':!lo'illl'ffi rO r f!lnr"Jl h-:-iIn-gi c .:=in :=i Iy,0,1 '.-, .•:ind growl h (IT' t re .,;i I frll"'l 11
d 1~nge ~om the C'orp,;s rods. lt occomcs critical b the an"'lyscs cf trca tmcn t chaPig.:::s.
 Corpus Axis
Thi.s p:ane is form~d from Protubcrnncc- l\:lenti (Pm) through Xi Point.
b•.-t'u(.k·d VJ ~·w:s.:i J-3,iN, i: forms \7-c.rti.go:1 (Ve}. Th~ ;rngl~ kmm·d ii; a r-:prc-.sc:nta:ic.,n
or" to~al tac:al hcight, wr.ich :.s 60'" ± _'Jj 0 _ .Ainkriu:-ly, wh(:r. s-1.1pcrimposc:d at Pni I f·,c:-
Corpus Pu.is becomes a su~r'h rt:':fl:':~HCI::' k,:r dt:':1:lturc behavior an.d l.s Pos.itic,n i-;0,1.r
in Lh.~~ ,~un:l m.:=..ry g-rowL b ,ma~}'Jis.
 Thus, Xi Feint is. in a sense:, a radiation poin: for the ;::nin, the c.o~dyle, c.he
r.1r1;.c--r'.(i1· nasal ~pin~, and ;i liile l.u (\: m·:n-t":. 8~ a.J, aid. i11 g:o,..·l.h fo(el°~i.-;I: 11g :~:,; 1he-: Xi
Au::.. In ~idcit1on, ~ 1irn::': fru:i:a XJ tr.: the i.uds::il p<1ir1f. l"t'p~~o::-:riu; lh(:" Dh.-int' Oc~:~us.-d
r:.:.nc for :-cfo::n.'I1Ct:. f'.Jitlu:r, the Xi c~ c:mploy.:::c. t,_, <!et~nnine points. for thi: 1~01r,t":
r.irc ;.;_n~ :01· mc.:..sudng d..::nturc bcadon a:s '.vdl a.s man.dibubr rosition. Thus, c.if;ht
~t ro.:::t1n t:":, ill fl lJ a.re. relate.J fr-om Xi Poi m!

Pala ta! Plane

.A ljr I I:" rg)m a 1\ 1f.r-j IJl lv l iv'>L '"ri i)i· 1\,tfi1l l spi 1)~ c~pr~st".n Ls L;'it': plan I". nr I h~ hi-l: d
p,;.l a~, --w~ich 1s t!lc- floor Gf ch-2 nose and rc,of o:::· the m01.1th. lt ('tlangc-s- li!.de in
!jngul;H ic-ri from Ras inn N;:i ...;ion during nanlial grm.oi,.,:h, bt:.t can be i::-1flucnced several
::k~~c-:::s 1rvi.th trca Wlr:":T Lt p<'i.rth.1J.lady .dth t'-:-;.tr~·:JI:i1 1t:K1.i on. A1. .A. ·.,~"S L.h~ p:-:1: .=-:.b:11 p 1H.c:'"
is Position Th.rec for the maxillahy t-e:..::th rc-fcrcnc.::- in thl" s 1aunrrry grr~'r'i.rth analysis .
0
..

...

The: J\.Po Plane

Pnil"ll A !<i (J0go11.i;::in Hne cf rcfcrc::1c,;:: for :he protrnsion o-: rctmsic,:r.
h~L~81-:-t~s :-:
ct the .;.r,tcnor c.-:o:-:h. Ttu: m:1!1c:- of :l1Ls j!an:::: tu lht" l;;,.ci,d 11l;;1cte 11prighi::- wj lh
gc-owth. Both Point A and Po~onion posidon::: .'.:ln: h,tl\1t'n(1:"d by trt'<ltmt:'J:)t, lt t,.)nrn
ch,e bc~t :i:t'fettn<'t" 1n rf'n.~on ;'lhOuL in diJ:.gnn~1s, ;:ind is the hr~~t rr:fcrcncr. for planning.
It is a li.r:c c.o ·~vh.ich th~ "to:cth can be rdatc:-·d redprm. .,tHy. 'l'ht' l()'•'t·-t'.r ,rn:~0r tc..:· the
A l-10 P .•~. 1"'1-e ; 5 ;1 -2!'i ticai '.:SSt;.e_

',...
 REFERENCFS FOU TTTP. TEETH
Huccal Ocdu s~J Planc-
1\ Hue d:H.:-ugh the bis.cctio:--. of the: cus:p-s or C--it>: lmc-;::ai t~e,:h reprc-s:::nts a plan~
L:ni~Jlucno::d by a Hp and tongrn:-: ..ibnorn\illity. It Is th:r~torc- djagnost.i~-: of !'>up,-;~ u~·
i~fr& t'.tup[j(J1~ c.)f ai~l.t':Ti[]r tecth. In casc-5 of posc-::rior op-en ~;Le Lhe: :spri.ct'. is bb~i:..-i:cd.
h tc-1Kb LU havt' ldy) L urdcr 1r"\oi th rhL corpu.<ii axis.

Divine 01...'"Ch1:r;:J PJ=3.ne

Th~ !:uld-en sr.:-ctkm co1rrnk~ ~'l'VG ?<II13 which an: proportionally related to ! .0
tu 1.6:. 8. T11is is also called a divin.€ proµortlon, and referred c.o with 1he -"ymhol (11,
V..-~~n r.1 p,.qn ic-ul;'"i1' po~nl i~ k1<-:i~,rd r'"'l~tii.'"t' r-o Hu:- 1wr.1 eudpuh1.::s it will be rnlkd
Jivineiy oric-ntcd, or,; divine- point. lh.hc \",:hole line is considered, 1:hc fong..::J' potLion
is 0. 618 the 1.oc.11 le.ngrh.
A lo1r1=-c:r incisor divine point is .sdc.ctcd bctwci:n Pojnt A .and Pm. TI~e heighl.
fro~r: inci5al edge ro Pm should b~ 0 .6 J 8, the tot:1~ height from A tc.t l-'m. Tk\t poiut
..::onnl~t.l r:-.d lu Xi Vt:"-(0lil~5 a rt'frr~nce lini:: for pla.Iming unhm.bntic~ in thi: long range.
The lo- .,ri:-r incisor tip -.,1,.ill b2. on the Enc:., .and th(! lc.wr-.:r molar I t.::l 2 mm. hd0~.,.- h for
1

f'lc na :ural o::d 1J.S:8 I c:un·e.

J7
 ,.\rd i Ot:"pth and Model Conversion
Tht" ,lctu~l mc,dd anru.ysis ~.!; aiso a. part of rh~ Pr'0gtb.siv~ L~piialo:nt'.1.rk
prccc~5. J\:'a!Tfld dimc:nsion.=. \1.--it.h ;t:;t.;:i!"ldard df'.v:.t1 ions k,tm • h~ h:1.~t" i"i.ir t''-'<~1~1,don .
Arc:h d-epth 1.~ m~11.~~Ln'.'d frvrn tht' mc:-::s}~l of th-:: lc-1rvcr □olar ,:,:::;i the cent-er of the.:
in:j!:=~il ::-,jg-!'.' nf t~1~ m~an l1J ,"1,,""C'I C'cnuru in~so:::-. It is a cr;i:i::-~ me-iSu~menL u·a(lsft:.c·ted
1

~·::-0m t'.--ie mG•dd and employed for ,iia_g.!lo.sis fon'..C:8.:-..1jc1~ .;:.nil pl.!:!J ,niJ1g rJ.to:::duud-~·::-;. A
6% (or about 1 mJ~.) -en I:H'g~H'1 f'n t i ~ ptt~T\t in Hu:: us-\rnlly lateral l·.cad pla tc-.
Arch c.t'p l h ~md mch R1dth arc both a.s.md au::d.. \Yi dTh ],,;; t~l k~n fmrn th f-
er.nine: tips- :md :he b uccaJ 0f th~ f"ifSL pn:~clKJlA.r f:I nd Gr-:-; I. r1 1c:J :-:i, { o;.c-~ xi :::--:-;.t p,1:lg~,l,

Lm i:c-r 1ndsor Position

2

ThQ lovi,.·er in:l~or i~ mf'.a.~urf'..d from rh.~ D~n'..n~~ l-">l:1J~~ (AP0J hut i~ phrni~d
7
1:-i:>in tht:": ..\Po n."l;)th;n,hip proJu(.~I with treatment. {Sc.: APo Plane-.)

) '

_./~~

R <('e~C--,t-~
/ '-_., I

,-

.:
J CP-11 trnJ

\ \~
I ;

(So::--i:- 1Jso i\.PPf.NDIX for :l!u:st i·,: l iun oi Jl(HJll,1 l d:n'.t'l I::-;~;"JJ"Jt
as c.orn pared T.O C .A.)
 UppcT Mob.u Pu~ition
1h ~ upper molai- is mea.su~d from the dist~l of the -crcn.'r-:1. di Tt:'(.:tly t,: 1 IY rv. I 1
}n:.; km g f_)t'f'T'I ~'.':'..£1 bli.r:; he.<l Io .Ii~ r.ypi c;:i ,1y a1 age plus c.hrcc milli1m:ten;_ \,Vht:1 Ldu'.Se.:-
than avcr"-gc lt dut's not mean it caunut o,- :c.:hould no1 be moved distally, but i: docs
s-..L~~est lack of space ultirrlatd:,- for ,:h{' ~.-zpp"=.T" third 1-:-i L"J I:ir-.

lnte.rindsal Angle
Thi:": pri nr:ipal tY.111c~rn for r.his relation a..t a ,1onna.E mc:-.m uf 130~ 1.n lhi::: !-lJul(
...::ai.ica.soid popr.i~Mfon:!:i 15 aR:oer t:roeahw:,,t. fo t:T'l i:':il~1og. a 126) an.gle is prckrabl~. In
bulb n~grcid ;1:-:.d. rnor.g0loid po~ulation:s the :::ne,ln ~Dg.lt' by ,lLlul1 hr:-:J<! ::-- b..o.k,·.v 1?. S~.

Soft Tiii:suc
The Esthctic Linc fE Line}
·rh~ l\f)ot' t.ip Jlf,int j_<,. C:!ll!t'.d pronasli ~pm1. The mo.st rrr;mh1t·nt dun puinc ;~ .
:

labdlcd pro;:.:ioJ~c::x t.i.ut 1 ~ [~1J(JJ. T~,t" l. ai le' ( Est.h f':Li L'. [j flc:) sc:rv...::s a..s a refc:rc:nc.:: for
r roLP..Lsiori. of the- Hp5. The lower lip i~ H rt:'.ft-.n>:n(".e. to -....-hich ilic upper is compared,
Sf'. .?f'!ral othc.r pl2.ncs are of us:::. in the Ilannuxtlc fa1 u:.i C,i rm, hut c1.c"t'. dt,.ah. w:t.h
1

d~t"whc:rt' .

l('
£sthellc lln13

J9
I •.

fRONTAJ. PLANES
Cr~nwJ
'J i·an~-..:erse lines arc dni.,,,·u th.n.:. mgh mmmon poinc.s.

ZA • ZA a fJ.unfol h:n I kfot1. plane

Zf • Zf a hunul h.t~11 l plane. on t:1c: Frontal U(me

Cg-VtrLlcal a pt:q1..:::~dic.ul.ir dropped thrnugh ftnmal Frankfort from

Crist.~ r ~al!i rerri!scnts the mids,lr.-.,riH.:'l I ph.t n e:

:\l:.1 ndi hu !Ri r

Ag-Ag .a Frontal r.1anJ ib\.1fru· pl_.qTl f':

.'Vl~.riUary
J• J a Front~l nrnxmm:y pl,.qT",e.

( :ran i o-1\1.andibular
Zt-Ag (bila1t·r~i) a Jir11:": f n-:-cn Zf point to Ag ri.:pr~scnts thr:- frrn1f~)-facial
planes

z....._ - .A g {bilateral) 8 1in e from the. zygornatic arch crnttr t nt.h i:>: man&bl.e
rq;rc-~nt~ foro l :~Tl d posture of th€ mandible-.

M a.~illou~\{and ibu lar

J -Ag (l,ilakn·d) ,l JjJ ,~. frcm JLJ~}lk to antcgonion rrprc::serrl:~ ,{ front:d
dent urc pla.."lc
j,'
J-\:.~S to Pm ~ !b1~ fmm Anl.~ri.oc· Nasal Spille to P1-::1 :rcprc-scnts n
pumc- bt:'1·,-'l'<""'n I ht" rn 8-:.:-i 11 a Iry :. n j m :=i.ndcbul aT midlin~s
.'

K(,l , to H61t a hi~-e.ction of the molar occlusion i:.:orn1ecl '.On 't't":Jlr~. ,;.:?.nr.s
.
.ti foJI l'..A)-nC-1.':l u ...~ 1 phf'.i.':.

40
 Fun11.."'tion #4. Yie-Jd:i.. .ri l\..'l">l s for _q C.1 in i cal Norm

The St.--:ie.n ii f'ic: Hasi~ of C:Bnkal Standards for &tt.rence ra

the c:Iink~l N urm .Appl:ic..alion

t .• TI 1e- id~.:1 of .1 dJ ~1 k."1 nnrm '."Of nrt.h rxiont.ics ,..vas proposed by Simon prior Lo
r,-dio;0g11.·. r:cphalonKtry. His gc-81. 'rYa.5 to e.stabjj.oh ~ -S.t~i\dard for l-:Ompadson oh:he
abnormd 0{ 1.h ~ t-x It>:rl t r: i- (tys.phslk i rre.gularity. It v.:as prupo~ed t rJ p{•:,,.., d t'" rj b~ si ~
for 01di2r in c01rcccion to•,rru:d. th~ no:..n::i:n ()r "Liu~ id.1.~al 11 •

Th:: smm: i:..urn."'t'ptiuu 1tvw~; p.l JfJ('lSf'.d by Om\ns an.d Steiner. The: (p1c:-:;.t1.un,
Ilow1:":-vt":r, be.came the: ri~dity by whkh d\.:-- di i~i c:i an .,.,,-:=i.s. su ?posed to .;.dhcrc tc: thc-
protot}1)t', 01' .CJ p;Hth--:111 ;;i r rnorlel of pc:rfc.ction. Th(:' b~is fur Dm.,.u:-;' 11w in was Lwt~nty
_young normal full <.ientition subjt'k.'t.~ w:Lhou.t -v.r:ia.t h£ judged to be protm~vt
1
r.">l'.·dnsion. Hieoco. i:hcrc l."j."3.S som{' ht..,~ in hi :o. ~('-lectl on. The b.:...sjs of Stc:incr s norn1
-.•,':ls only on.-:-: :o.·n~ lj ~c:L~ ;:,, 1ul1 di::"tlition km.nlc sdcctcd ai; hi::; (>hj t>t":1.i ,..~ from his din i cal
ex.p~rkncc-. aolu ,.,..hich ht'. d~r-i :itd hi.,; "ide.a.l11 -~ a tla[['ant bb:s.
1
~'

J1 . \.v.<i~ obvioL..LS thar. c:linical norm rctc-ITnce~ 11~1;":fu>.c.1 impl'(Jve.menc. for several
reasons. Fir:st. a rangt' Ht:"A:'d,(l tu In'. ~s1.ab1t-5h..::di not a single point. S~cx;,-rnl valu.~
Cor age.s needed to be- prnviC'.kd. Thi rd, s-f'.x di ffere~ce.:s ,.,_TIC n.C<"css"'r:,• '.n (:'~ti hli~hh1g
nhj~~~l.ives. fourth, racial and cons:dtutiun 1y{'f':-: nf':f'<lr1i df'~~criptJon. Fifth. the
mi.alys-h n~dit:"(L to bt': nlon::: in dc:pch b ord.crt-::-i provide:-: lrn;ight inL.o responsible
<.'.· anatomic varfobk~. Shli1, lh~ff'. il.r.~d~ to be: a considcr~tk1J1 fort ht6 I i.ln:,vf'r.~.
.... llhuerl si on. Scvc::-.th, a thrcc-dim.rns-io-:n;:-t.1 ,'i l Lci.i. CJ I normaJ morpholof,ic vc1.ria ti.on :J:nd
.:in ::i.tl.,-'> ior 11onnal growth nee.ded to be- c:ivc1.1h1bJ~ for ref~1-ence. Eighi:h. a method
should be avv.ilaiilt' fo,1: lht' U:.1h.,gi c n)ffccUon of values dt1c:- to fJV~Ti'l ll i.i ;--.t>.. Ni nth, a.
rn~l.ho;:l of dls-?hY for dcscripti~1 r.lf ~xtJ~ine. dysplas.ia ">\"Dttld be- hdphll. TeJith, ~
rn;i1 rlx fnr pmgr;,osr.ic;:irion 'V'.ra.s de.sired.

Computer .Study ( l 9 66 to 19 69)

Material
Five co1.le-'Li±on~ uf D.L,Ht'll<Al 1t,.~re if.rnp]ayc.d for the- study. Rec:a[1 uf 'i"O
uT"lL.r~:=tlt:d and normal .subjects "i.'l.'cl5 con<lu,tt:'d :11 1.d headfilms jn la-;:cral rind .frol1.tru.
vii::.,.'l. ¼'t.:Tt' r_1,h1 {l:11l~d. l·rnm tho..'\t\ fo1"".'.y (40) subit"ct:,;. ,,..t'rt ~dt':t'.I 1:,J f01 study .S(:rially.
1~

T,.,.~nry (20) 'i\'CTC: males md tvi.renty (20) vi.-ere. km.ales. T\~nty (10} Wt"'IT mudi::r:<'it.e
Cla~~ U, ,md hvemy (20) '.\--ere nonnal, or Ch~~ l. lT"l h ...·enty (10) chHdrcn the me-an

42
lj me diff('::'ences. Yi.'(."It" fu)n l .'> 1.o ~ 3 years of ag-e ( S. years durntir.m). hl 1·,-.~n t. v ( 20)
thr: l.tmc- diffl!"'i'e.nc.e i.vas 5 :ycan (fum1 8 ~.( J I j ) 'C.U5 of ~g~).

The ~t:':Lx:tnd collection ,,_,,.,:i.i; fmn1 pasr Ricketl:::- ~(uJi~~- TI·Lis ror..sbt~J uf •hf'.
d:H.:1 r0r oru::: d1utL'ia.1'1d ( l OOOJ consc--cutivt'. pa.Lic:nts. from tht:: L}~.h:::idontk tiks , t:.nd
cwo itundrt:':d Hftv ;'.250) ~t'ri,11 tf':-C:01'di from 1960 mod.aJity st11dk~. ·rhlo; 1nl°-:l1tdr:d
k:ingitudirull d.:1L.1 of fihy (50) subjc::ct:5 LJ.·-t~t.ed ~Yith Ldgnvist ff1f'.ch£nics.

T}1t:>: Lhird collc-ctior, wa~ ,i c-rn:;,,; Sf'.~t.ion of t.hrt'i::--_y~A1·•old. chil~r. co nt~••d th~
(l;lta back to agt" thn·:t:>: . The.: fourch c0Hc::i:.."t.1Jn1 ,,._--as a ?,TOllp c.f Lhh1.y {'.30) n-ear-adult
::ru:ik::; 1n order t1J (."Xt-::'nd t.lir: d.a.l.a to ag~ 18 )'t"HTi; . '!'he fifth (.-Vlkdiou 1,.v_rl.-; data. from
t.hi:: lircrature up until 1966 i,vh-::n th(:" wo ..k1ng 5ranchnh w~.-e. determinro. P-:.1rdn1kn'
rtf~11ct". 'i.'1-'aS mnd~ 1.0 p11bli.ca.tions of SasR>uTli and Krogman, ["2,,:-eJ:1jbif.nt and
Bowdi::-11 .

l\.1cthoct
Lft'"r.-=illy ~·c1y sensible:: 1n.t'.:-t.~1;1'f'.ment or ,mgl~ ~ver proposc--d "\-Ya.5 ~ubi~~:I i:•.d to
compar..s0n, ,tnd many poincs w,:r<~ tr:i m',g,.1l,u.e.d ~·o-r c-:.mtTul u{ t'.l°rnr. 171 rec hundn:d
~i>;t.y-,.wo (36'.l) lintJ::1:r: ur ,mgul==_r mca.sur..-:'me:r1t-o,;. \',.·~re recorded in Tin•t'. I :1nd 'Timi2 11
tor t'<.l(h pacie:n.:.. For th~ fiv".'-y~.'l.1·-olds three a~:~ p.udcids were. :n.udkd, ,.,,,.hk:h u,~.:-mt
Time Ill tr,-1.cing.s had. c.o b~ m. ade. All Jnc-~~:sw·cmcnts w~~ ri'..C(>rd.ed. in ,;:he comp,1k:r
1.0 indu.dc i:h~ <::..',}h':1.1lacJcru of _r,rmvth d-.nl._~t"".s. Means, stm1d:-1..-o1.i dr.viations, and
~·,...t.-e.,ne. v9.l.ues ,,.·e~ rompttL~Li. F.very m'L..'a!!lu.r~.1.n~n L was cros!.M.:ou,:J..qt~rl with
every othe:r, and the ~::i-,,._rth g:rnJknl was corrcla.i:cd .J~ ·.-.·di. Tn alli c,vcr 400,00U
coeffid{'n,:~ of oon-ela(ic-n ,._...,...:-re tabuht nl.

J'ot an investigation fot pol.~t phenomenon, 1.n:m~1al oornpositcs 1,-,,,1:rr rnadt'

from tl t.r.:- ni e:-i IL tfata ; n both la t.:rnl ,,.1,.d frn-n 1.a.l for visual grv.,.·t.h c:rm1 parison and
study ,,ri;:h ~ :u-.et:ri r: polar grid.

Resuhs
TI\t' :r.t:snl I w,"l,,; sr-.rn ~ Fort\:-- c.ontributious Lu l h~ bod-.r of h1c1,-,,,ic-dgt- fur th~
~ ~

prof~s5 ton. .An. atlas of n0Irn -!1:l n.1 (ir:phdogy and norm.,iJ grn-....·th -v-.ras established trJJ"
th~ c:~mtput.e.l'. A ct.:be~rooi:. index wa~ d~vJse-:d for corrc:c..-rium for ~i.o::-.. Ll'."ifr..::c:uons
-..~~re: ma.de- a.s W{'il for: ~g~, f.f':i.. , and rad.al type~.
A ccmpreh.::nsh-'"C' an<1.lytj_._., w,Ls rloou.ced ~n 1969 1h~1t 11."l~ sr.ood e..sscntialty-
undumgr:d nuv,· (or rnorf: than 25 -~a:s. l\.1i.nu-:r r.idjwtmcnts havt:' l~~n ,midf': in onlr
t v.·o nr tlue.1:: ?aTai:n~kr::;. J\·try (':'.Torr. to test the J,,t (l \.\'11.h n ormal m~1.tcrfal ki.s
rc-!mltt:-d itl .~ re-:ont1nnation of th~ pmgr·~-n1.

43
f.
: .

; .

,. .

I'
.
I

COOIWlNA·r I: GR m
POLAR GRID

44
 A S UirlII'IEl11:' D~:scripi:ivt' (\n"~Jys~., w:-i:.; SP.~ec:ted anci pcpuhrrizt'd. fur ~ ~-.m u11 <"ll y
_grr,l\'th ~nd •.i:-e..auncnl base:. a. clitkal fou:::-p0~Hou !-11.l:ol lyst:. \\--as de.-.;is~d. This
prfN~d t.o be: the n \o~t tnist'-\'Lll¼y method for procuring trr.itxr ln 11 h 1(n1 m :-:i L.1 on F.: r
t.hc clhtidau .,_.,.·jshi11g to knmv the diffcr-c:nt rt:~\.llt~ .,,,,.-j lh v,iftous techniques..

Spin-of~
from thr:: foldir1gs 1ui1.ht?:r ~earch led. by 1971, tc.> Ih~ disC':O\.'~ry of an· arc of
gtL"nvlh of the m.andibk, dcscribt"d b I t':t·. •J'hj s ].ed. in tum to mrthud:;. for :':it:'-0:':1 hl t"
long-rmtge [1J.C~1:a,-,Ling 1.0 mat.uric:y. Th~s also led tf.) d,~rlg~:.; ln lx:lkfs and µrncti-cc:s
fe.gardlng trcatmi=-nt mt'<.:l t,rnic.i.;.

The s(':L.On d Mri.j or Compute-£ St\.l dy ( 1989- l 9 90)

The ardal method {1t foi:-..-c·i si.h-.g \.,-,is i mprnvc:d. rrtt:ste-<l , .lnu fun.ht-r ,.~fim-:J,
bi:1.sed 0! t t:'JTL p1 !'i c:,i I ii.c:dba.c:.<. After ntm:t~t~n ytf:tr_,-; o I use, botJi s.tatisti..::a.l and i::riru-
.. .
and~cn·or testing hiid l,~~T) .;.'..0nd.u.cQed. Concrete d-:1t<l ~uffki("fll LL) ;,,!LI i.~ry L.h~
~1'.i ~n ti fit: comm Lmity i'\"a5 sought. 'lhc:J:C"'forf':, a no2.t,' lon~-tcrm sc-qu.::ntia.l :;.tudy v...,_~
~t,:;,rtt'd in I ':Jg9 a,"ld c.omplet-ec.. in 1990.

[-..1atcrial
Onr:=- ha::iciroo thirty-thr-e...-: (l 33:~ ~1.1ujt'lt~ ,vt'rt': 1J:-.~l. Bc.gir.nlng b.tcral
hcadpbtc!:i 'i.'r't:"-rt" c·.o!lt":i.'1t>:,;.l rrnm se.~=i:n. institutions. St'Vr:";t1ty-1.hre~ ("i 3} had had. no
orthod:in:dc attcuti on :1 t :1U. T~n { l 0) ,.._..:e..re Sl:!ri.:1lly cxtr-ctl"t,d '-"ii I b r mt f, n·1 he=- r
t11c~1 \.. ~r1tion. F.ihy {50) patirnt::t ,,,.rer,c-- tJ"\-,◄ tt'<l rOJ' a varkty of mruocd\.lsions. Of thi::~t::
2.5 'i."r't:re ro_:tlt'ii .:1nd 25 \'--ere fe.mak.s. The St."'\'eILty-th1'c'~ u ·3) W\treated chiidrcn were-
from ar,c 6 to age l 8. Su1ue X-~•iiyt. we..rl": from age: 5 to as m\1<:~h. ,{~ 2 8 y~,f~-.~ ol age..

J\.·1ethod
All b~girntlng he..~dp hi l~;o:; \.VP.re uaec.d bv Rickctb ;.md d1.git i.:r..e<l. I 't)rec:a..G.Ls
with0l1t treatment ..-.crt: u!llldt" fr:ii:- e-~c-h 1i11hj-f'.('.t either ro a maturity cm.-off or rn tltt:'
:.i_gt": o{ the. fa.....: . hc:ad.plarx:. 111osc ~IT also digitiz;l;".(l ,'!Tld ~nlc:red into the .::omputer.

After th.c forecasts ,..,n~ complc:tt-.J, t.he Jina.J lar.c:ral hcadplatcs 'i.'r'CTC collm~
.:mcJ triJn~d. ·rh.~s-e ~rere abo rugltiz..::d .and ri::crJr.dt"(i. All fo~ca.sts wi=r-e. com pa.red to
rhc actual. Tilt' 1'.:tl ~\1lJjt"i.:b; \'>'~r"t'.. bmlu::Jl do~n for sex and Jndhridu~l t)']?!:'l:i,
Tw~n,f-dght (28) normal ucdusion unttP.:1t.e.d :.;11bject.s ~'cr"C: .studied. Sc:·vi:::ntt"t'n
grm.1 p~ \'\."t"r.f' rom i"H"J:-.l E.f•J for ..~om pa1~.mn.

l ~or st.a[i sci c.a.l ana1ysis, ~- ''kus .a nd ,,.._.Ju .':ht":',-," 1f'--~1 . -.-.,-,is con ducted for the sam pkt.
to ccmpare sc~ti!:ili~·~lly lhi::- ~d11::il ag-aill.st the: prediction.

45
 46 Males
-~
27 Females

I
I '

I
I
•
.'
'

Age
J
"
I

I
.
r
I '

--- -
f: ...-..~: rnm;
r-
.
.-\C.IAL t181 I --
E:HN : -·- M!LU
~....._~, nrtJ
~Plf\CPI YF"I\CI
·--A L
N11m...
_____ ............. __
vt,.UJF;
.! rl I.; Cl I · I •1-:: F!I"' I 1\ 0
19 I n l:1.0 . 1 dl,l l-.'11n . o {I \]
0 _1_,
Cc:-r1 ·,- @1"" I t,r
lo..-11r r--a-::-,~r PP~l•l1t,
tr.~ M::i t :tt· l'c:-:'11 t. I •.)11 t,o r rv
~.1
'1 S , ·7
21 . 'IJ
ffl'111
,j'3
rm,
45
u G
21 . <J
Cl
111 11 1
dg () . ,.
(}. I..'
Ul ~~ A -ro Pl~~e 1 . .!, ll'111 l .O rJ ~
Bl t11cr I ·,~t.ton ~ A-t'u 2::1 . 5 d,t :..?:J, . O {) : ,i
ra ,:-18 I r),-r,t-.11 oa . J U;.l ~!t . D . (). ,1
r~.:-i~I ..-,,.,,:') !)(J . 7 :( :J ~tip . Q rJ :;.•
~! "- I 1I "r y 1/.: p ~ h
t.As-•1° i 1t111 i ~ r 1-1" 1 l'I he 'I.~ HI
90_:J
21- 9"
ll!,J
rl!]'
!'J'I.) . 0
~3 . 3
n.l
. U.3
t,,!{lond I hllr ri,r .~ ~,_ 3.!: . l rr!J :::m . 7 4I ,t
•·o ti,, I FAc: I-,.. I 11~; 9ht 57 . 1 ~!1 00:L(l .0 '1
rnun

{\1nfi nn ~Linn o f original co:i::r.put tr d ata,

46
N=73
non

46/2-7

Growth Dura tio:n

9.64 Yrs.

,.
47
 non

( .

..
<

N=73
:.' :

,.

----~.
4 ,,
y,.. ,:rr
~
f'Z'2~
i

48
 Findh)gS
'l7'1f'. findings VV('rt:· so vulunlulOUS i h.'H. th f'.y arc yec. to br:: pll L,16h~J iI L li(Jok
i-orm. Th(: d~la ..verc colkctcd h1 ci1i2 roi:tin.:: ~qutn.;,,·~, i.t"., the .::ranial basc:i
rn fl ri<li b]e, maxill..i, tr.-rt.h, ,m<l snfr ti S~Ll~.

The n.·sult~ t\t nn,J I ht r~port f',;'.f h~re:in fur rcnscYIL~ uf ::-p-.'1t'i;:. H O\'V<'.'..'f'.r, the •:
fo l[()•....·i ng can be st:'ltcd~

1. 'Boys' hea<.l ~x-.<l focot> m~ i\SUrt<n 1~nl.G are about one }~Hrs grrJwl h t=.rgf':r t.h.-1 n girl!,
.11':t-~<ly a r. the. j u-..•cik age3.

S. Point A moved fon1•.u<l <1hout otit' di;:gr-e.t: in JO ye.a.rs.

6. ,l"hc- pr~vi rn:11; L":()ffl pu1 f'.t d:11 :1 w.qs corroborated,

;. G(c.,w-::.h forcc~ts proved, as cxpcctrxl, t(J t.a:- i11 1.he. 90% range •·- ma.n:v almos.1:
rl :)S~}I 1l ti'..

8. 'TI"le composite became a brllli.rnt 5(J\1r<·~ l~rw r-~:--:~:-itd1, simHar to the VTO for
di nic'll ~...urk.

1 J. The research c1..-µc:rl~n,;:e rcinforrcd the .s.lmun,try ~m ,'tly~i.i: :wd -~I in~11brrd
n·:ti :iin w odi nC-..it i urn,,

12. Pa Li f.n Lii - mi s..s.c.d II in 1.h1:. fo 1't:c:ast Ic:d to a .m."1.hi:r sc:-a:ch fc::-r ILi<.ld ::-n ,..arial>ks,

ClllT~nt Confitlcnl.1:
T1n1:=: tl1~ 01·igina.l f!'\H.r~1,.:i.l dh1lr-..8l data, the l 966 compm:cri.~'OI'k, and the- IC)~m
~omputc-r ('Ollfiruw.ti(m has led to :bdti::r ,·ouOd~nci;: lttvds.

49
 I •
Tl1~ Prt"dpi tation of the Summary Analysis
In swnmar-y, as explat,.n~d before. Lhi~ P rogn~~ive pro,r;rnrr. for cepha]omeuics · 0

h~.<: b~f':n ,; n ~vn: 11t.~0n f":-:.:1 t".n di 1'lg ~~or h~ff :-i ri::n h1ry. li-1 the fau.~ of ~ =-ri l!o:::'..
con~rcvc.-n-r, t""h.l-lu.'i I iv, ('(.)l.Clputc.-r st-.1dy W,• :, c-rmdrnt i::d rr'l°: (1l I 96.':i l () I 969. sl.utli~s
con~i::--.1:cd thc.:t".iher ·.•,ith .fm-::hcr rdlncmcn:.s ~1p urtil ]9 9 5. hw t ht" 1969 :'it m iy alJ
lt1r :-:111~l y,,1.~. s prc.,poscd wuH Lh"!n ~,..~f<! l~o mb'. ncd and cross-com:11.tro, 1rvhich m~y
c.xp1.1ir: :t::; r t':fn,,i r'-~9.blt': <l.t':pt>.ntfa biJity.

Comprehcrn;ive. ror C.ompletene~s

...,.., 1 f · ,. . I 1 ·
!. LlL n.:su t () tJ Lt" 0Il~7J.na'. wor -'· W-D.S tt '(: St" t'l'...i:HJr\ ()!° f1 ('(lf!'lJ'. rt"rl ~Cl~ IV:-"
1 L
:• ]' f: l '~
v~; ~ II 'II

~· J

t: 1 :-;1::.iply infonnatic,n both frnntaHy and Ja1:crally to answc:r alrr.ost an;· qi..~estJon
so\i~~ht by ,t dini ci.an. [';~mi lit':'i <>f n1t'::1sureme11Ls were an advant age- for clin:cal o-ra er.
Hc\.vC'.'<:r, ~h~ com~r.c-ns\vc- j5 :cmarkabk: for :hr dtt,•iled .- .n:tlysi;-, cf ~xcr.pl.ior.-d 0

c:nnd.:1:ons. For C05!C'TICV. " ,

a sdcct]on 'Was 5llo(TfTC3~cd
f,.;,f >
fr.lr :.i 1'Suu1mnv _,.
fr:r,r1 hy -
C ;Lgh1r: 11

m i 6 i:Lally a:1.d b:..:a.1K n:od~fo::d (1.rnugh ,.::.xpcrknc.: : since : 9 7n .

RMO
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Q i ~~~~~, j ~hr ~t.1a f;J.r.) l'tu,· dt,.. · ,;:i; :::.,'9~ !.a,: : µ,It

C~r.- :JRtH"JO0N- l t CCMO:TI)r..'; c(.C,.S"KrLl!to\L ~~r-;o :rT1t-N,

LJ. TB"- r.cr":i:!!. TTl:E-',!1"3'f!' I A 1 t.'VIL l!EFm E TRE.~ Poor.rT

P- .,_:,Dt1tr ■ -an t -a :-,,_.

t-ar-1.1.. Rl:\.-',1'J ~ _ _ _ _.....,_ _ _ _ 9<::1_c;-r...._ 111:1.AllCUS - - - - - - - - -
(: J LM-.frr- •!•l:abi:::1n -1 . 1 w, ~! . C ..,, o .oe- ~IJ C2nvaxl\7 • -: . ~ '9ft 0. f; ffl1 o.£t
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C? ,ncl ■c- (.1,...,,.1, ; .._. 2 . 7.,.... ~.Snn -:i . 1 Si L t-ci1A • i r;- r 1' • c ■ h• I g l•'• n!: . C nn
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li~ .~ ...
SD . II~
91 :<,a~cl 1 .t.~I~ 1.!il . t QP \?l .c- ~~ c. ~
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P ~ Co ndy i i~(l-:jn ■~. eT'I
9r. l.'11-IJ ■ n~ Ol "f,..•1,t.: :11 1
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t'.~
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10 . .., ,.., 70. 1 -

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n ;. Al lnd :.,u. 1~n to A-M:o

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!-.L I!. [- : I ' " :., Ir. - ~ 'H r.~ !I CR ~! t' o:I~ . .:, . r: ol:i!~ L-..o ., ; 1 la.•y l.'iro":h PQ., dp ~~ r. nt D 1
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"251 LCl(I • LI p ~ ._ ~._r,h,.~ IC I :II "11C' r- ·3 ~ rn -~ -~ ""' 11 B• •N-.\ [~ ◄ ~ !. e-a t> :-~ £, ~
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~\ L u ;:::-.L":.r ■■'\J r ■ ~:, Oicic I Pl 1 "" -◄ ◄ 171 -:!:.() ,.,.. ~ !'-N-1:1 71 \ ~ ',/ l'OQ ~Q -o.,
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5<.J
 THE LATERAI , SUJ\·1MARY ANAi .VS l S
Purpose Psr,amet~r
I . 'l'ol;:;i] L'ic::_.:~l ht>:igh1 _ , Corpu5 ..:'\:,;.is to 8.aN
') l,.:,,..v.::r foci:,r ht:'1ght . . Corpll 5 Ans to Org line
3. C:::nu:1.l fadal d:rcc.Lon FaciaJ A«ts to Ba~·
-1. J.-adal depth . _
.J. C(Jr:v-c::xity . . . _ _ Point A rn f adal Plane
6. R.amll!: ~eight . _ . . ;'\-fandib1lar' Planl:": HJ f.nrnkfr,rt
7. P,i lr1 u~J P Im tt> Pu~itiun . Pah t .tl Pbn:: to Frnnkfurt
8. Po~t.c.ri ::ir Cra.nia.J JengLh Po.sterior Cond)'1ion to PT\l
9 . 1\11 t:--r. nT Cr·.~ni al 1.::-J)f.th Cr.:,_J)1 al c.en L~r to ";\.':1:;.i on
l O. LC.'i\'Cr :ncbor posi ci on (horizcrn:allvJ . Ind5or tip i.O APo
I _. L-0\~·~c· : 1wi so..- po.._1 L.i t}fl ( vt> r1 ic:tl Iy) _ I nd.sor tc p t::i Buccal Oc:] usal Plane
11. l'.:?PJ:r ;.i:1()hi r pi.: ~i tiuCL . . D1H;~l ()l t1ppt::r mul:-:ic· I.fl F1TV
l 3. D.::'pt h of Ioo;.,."t':t" ::i ::-<" h . _ !\olt·:sbl :if mohir t.o i JLC?.!io r lip
1
: 4. l. ppe-r tu lo,;,ve-r :ndsor . lnt.t'r- j Jv.:i.~~ I ,u 1gli::-
J _';. Lc,•1.·cf lip p:-otr usi on . Lov..'C'r Ii p tQ E '.inc
 THE FROt,tJAL SLMI\lARY ANALYSIS
Purpose.' Para1neter
J. N_::,,,~.i.l c:~viLv
,,. widiJ, . Nc10Nc
~. ."vl.Lxj ll.~rf width . . fug.:.l-e to J-.1g::1le
J. ~viand HJular wid ch . An Lr.gonion :x) :\nt r:"go:nki.:1
4. \-fa._-.; Wo- n~a.ndib ut1r wi ( lth (L} , . Jug-,lk -co Fron~o• Faci a[ Plan::
1. ,\1:ojHn-rr..<:indi b,1far width (R) , (
_Jugalc to Frcmo- f .:ac:i fl I Pi.'J..n~
G. r-,hndjbula, 3y~nn11::try _ . Fi::ulubt'rnnc.--e ."vknti to Mid Plane
i. M:1:-:i ll;t!} symrnet.ry. . Pob t ,:m:s rn \1ld Pl e.n~
D~ntal 1:1•ontal
8. Molar ~.,·idth 'i'rnrn-= -bu<:cal uf lower molars
9, h n;~ J1It'Ul(). ~~r .-vid ch
1
. Trans-buccal of lo-wer first premolar
10 I.nc..::::-c,:u~inc ,,vid th. . T c·.a.n.-.-c.atl inc: t.i p~
11 . h-iolar position (l) _ Mo~M bm.:r-.."il tc; Fr:J~)t o- Dr:·:n:al PL-u:K'
I 2 _ MoL:H" p:).~i c.i 0:1 (R j tvl.i::;-1,tr bucrnl to Fronto-D::nrnl Pla.;c
I 3. Molar biL~ (L~ . _ Bm:c:nl nf ~\.6 k .1 136
1,1. Molar bite: (R} . Buccal of .AG to B (j
l 5. !vli dline of Jm,,.-er . Ern h ras tire of kwvf'.r i 1K:~OT I (: J\~- i(: P1.

For exp Is.n.:lt ion of

! . f':acJ I pij.raJneter,
~ee A ppend ix.

The:: frcmal provi.dl~S i nrormar.im, for r.h::-. t.rar.~ri.;::-_ dim~r.:-.i.rms. For ihf'
he n.c.al, i"ifl.t':~n 1nt<~~:-:i1 JTt':TH'"J1 t:; <.lIT cmploy-td; ~ev.-:-1:i. ~kdrt...d ,1,lx,.d dght den :al
1

fflt"..:'~'iure-mi::-n:s an.:: m.;,i(.:.-=. Thus. thir-cv ,,. mcasurc:mcnr:s can be evaluated even for c.he
11
~ummary .An;:ilysis'·. ,..,·ht:l !JuLh vk\'r'~ mt' .;_·u~~~J-ertu ~nLl ~-. ::;1..)phbticatiu:L is !-.UU?ht.
 Ab stTar.."1ionism
An ~l1;<,lfac.1.ion L, a sum m8t'it'.f'.d sE.al ~rn~111. of a major composition. Tf :he.
anatomy and phy:riolCJgy uf the -..vhok he~d h to bt:-: CfJJl-~icl~r-ed, do w~9t bt":"A-ikkrin.g
r:o::n pl e..,ity --would result ir. its measurement and dcsaiption. But through a sclc:-<."tion
of b .....~Ene pCJU rts ;:i ,-.d pfant't uf rd.-:-rt·.nc::t ,~:n (J{g,'iX'li "~d meth1Jd :!! nd. r.he'. pa ~m ~L.e.rs
can be selected. These rcfcrcnc.:-s should have, .first, biologic sig.rilik;"!Jl.t.'.e <.lrnl,
.~~(~ 1 ritll y, .avail ability of perception : n I li ~ X-f8 _v v ic-_,,,.. \I'll th a val Ld ;:,ro02Ss th.:: bc:st
~ bstracdon for d t°Y<.TI pti.on G.Ul be achit"Ved,

hJr HI I!': l ~~~ I pm~clutt"": fo-,: t.h t': ~n lu.'-:ltfrm of g,"Owl.h or Ll-eatment chxnge, tl1e
most stable- o.r: llOCru:toging r-eb.-xcw:es. an~ c:i:nployr:-d. S11c-h 1s 1ht" (1l'i,11t.i1lnn fr)J'."
1.ht>. pol.8r phc:n.om..::r1on of grc,,.vr.h. Also, points 011 ~he ja\.YS s.crvc: b:ir ru1..nlysis c,f i:oo-:.h
ch:;ingt:!:>, Stm1(b1-d ,.-:tlut'.s (l)r chm1gt':~ ,1-& ~vai.hblt'.: for re.feri:=ni:c in the com pt.ti.et.

hx the. fore-casting of gro-,...,·,.h, 3.11 .3.rc c,f gr0t:.,rt.h for the man dibk ·was
ab:;.trnttt:"d, St'<.:cm d ly, pht'~IUUlt'J:Ut for Lh~ <.1 ~~ud,lHon ~)f w,mc li bufa1· gfnwl h wi I II Ll lt:'-
t,rm'i-'th of the cnmhJ b-'."lsc .nnd mid-face .n.J.50 tollo'r,~. Thb in turn h~(~ml~ thl" b«,~c:: for:
plot.r]n_g de.11tal and soft. tissue c.hang~s.

Jn. c-ffcrt, thr::~t' pr,K~h1:n..·s arc all abstrnctiVt" -i.lnd 1h("':i.r lts.t' JJ1.'3Y be·. Ji.\t-:nc-x i • 1l iL

.shon-han d J~cr:hcd for the tak:ng of dLctarlon.

ReJu4..··tiooism
Roductionism is simplitka.tion. It is a procc:ss that permits oot only a
:-::umm~ri7.a1 km hut pmv'itlf;"~'i ;1 :-n~.rn-~ for thf': se.le.ction of the mo.st. ~ignifcc.8nt. or
i:i:11poi:-1 ~J\t ~i-:.;pt'dJ; i1f :':iUUlt1ltlng compkx.

TI, u~, a. pn;.p<:.r lY!!1hal r,m~~.n L~ :!! il.al~::-.is will permil a 11summary forrn 11 • Ev'..::n i [ a.
~,J,if.me: b, n101:"t t':01Hpi:-th(:':lbi v.-:- in ,:_·,)nknt, ~uch a:, t h:11. ,qvfl ib hi~ .vi th Ih~ (.Oft\fn1L ~i:',
1

it still rcpre5cnts an abstraction. But cff..::.ctivcly, by com.parhon a. prof.Iara can

reduce Lh.e surnrn:1!'y form by tht>. s~ll!".c:1 irJn oft.ht>: mosL. rne..qningful .qnd signifLc:anl.
1m:a~1,.1rt"m-e-11ts for d1f:: cUnidm1 1s mv:i:rdon aucl cht:- anL01..mt uf h.upul·lmLCt" tv he-
~tta.:hed to a me:i.s.uremcm.. This is the beauty of a.pplic:r.tion by the computer
bt"c-.'"!11 ~c:- t h...- d t"I ~il ;:i ,-.<l ra L i-n g nf cfo t :1 1t :tff-: rrYI'.':

\.VtLh th~ comput~r an.::.ly'.':is ~L~o th!:". pn)L~ss ts abs.tTacted by d.i,;jsion of the
c.1.m.tly:.<ls icrco fidd~ uf intt""r::st or familks of me-murcim:nt~. Re.diuclion h
ace om pl ish~d. by che use of i nru c:cs for ">'1.'- f'.igh ci ng and by the us~ of symbols (or
 ,,

~:n.:.:Ii5ks) to cic:notc scveiity. Bm.h ;'lhs.u·action :rnd rf'.dt1.Ct.ion hf'tp to rlf'1 ~rrriin-f' cht"
d~gr~e of dlf;k.ulcy in a giv~n .~i tt~ti◄ m,

·;Jtr:-- PYl1tbe .stand.ire de·.ri.atbn \s under.stood_ b order to improve ics

.;.ppli.::-adon ~ din:-::-::i.: dC\iat:on con.c~pc -..vas incrodu..:ecl? Th::s ro·.mded out :rnmbers
rnr case of memo ry. gradf:c~ v~lu-e;-, Ct-ir diJl.iL·..:=J .tpplic.atjun, a1Kl ~mprov~d
c:ml mun ic:1 :.i (>c\_

Brief St..ati:r.tics
Dc-s<:riptif.m
lL has been ronli'.r.~d. h~:"t'111 t.h_,il Ll·.e frankfoc'L plane:. pro,.•ides the. m o.st LJ.Sd ul
'JT'lt"-ll.L"~i1 ion fot:" d~:;.c:ripti(m out ttrnt tht'. B:1~1r)J:l-N::1sio n pl::1.11.~ is I.ht>: mn~t (:O~t-l"IL (ot
~r~.n.l ..,,,_.eork. ln rnpport of th:s :11.c-sis . aside from the pra~tk.:11 n"<:'ryd RY V.['..h.1.::- ga:ni:-d
...: ,,.,_'ifr. its us-::, some- .si::nplc dat3. are offered_

n,{" supt>:riL"Jrily of J·'rankforl for· '"typtng- of ::he fa~ \•,:.a.s seen tn. tne fir-5t
compu;:er .s~mµk of N:-:40 su1j,e-ct;S at nf:','= S }'t'm~. h Jr lt:',~li 11g c.l 1:1e '.T}lni:-:11
f:::ferenc.-.::, J0r rclatbR facia! poincs, the SN pklllc, FH pl(lnt: •.md 13-llN pu.u1.t' '-'t'~
n,_.,~_,:;11rf'.d frr:rn , h::: Fc.1r.i::l! pl::o.nf' { :---..·.t~km-Pogoni.on)_ T1c Stand.:l.r:::l. Deviation fr,:m.1
~-N ,•md I;,-1;-t< ,·m !-> .,; In·.o!->t idC'.'Dt ic',} l, fit =:=J. '/v 1.1.~ ± 3.W rl:"...s peccively. Fi-om Fra~k~·c rt
plane (P-OJ •'.1rvith tm<: Porion) the S_D. ,,,,-as :!:2.b~. Fr,l:tkfrJrl Lllttcfore :.,.huwer.l Lh.::
be~~ ~):-.:.k;· [or d~so-ibing prugH<',llh.i.~rn of the <"hi.-1-

•·.·

54
 Sequ cntial Change
l'r."tJ:" ;.i tigh~- ocdc:r foi' a.ssi::ssmcm: of dirccthm~l dvmg~ Lhi= avc:rnf,C- va.li:.1c-~ m~c;
:r-:1..ar,_d ard ..-::rrors of th.t' mt'~\i -...-e.rt". f:alc.uhted, i:.i:!s;:ir.g chc samt' tlvt"t" b:l:-;ic pl,rnes (SN,
Fl 1, ,md J3~N}. 17K chin (Po) , -ch~ n1<'mila (A)" the t.3n~u.-; {Xi)" the nose- tip (e) ~rnl
the lov.\'"1::r molar .136 -.vt".tt". C(.n1l pal't>..d (sec Table l ) ,

Tobie I.

iIA-N
s -,"," Cl ~~•ro1t,lfC' BA-for'
.9.WS ckcmg,r- JU,f.S
X 1·-y _:i;: I f x ·r··v--
X[ -U .14 -1. .U 0.26 0.26 -0.47 ·· 1.41 '.J,J~ flJ2 -0 .90 -0.80 u.:;n o,u
ro 1.5'.i -Ln (l,,'.-:5 (J.40 ll.9~ ---1..48 ·J5) IJ.~. 0.05 -2.J2 0.4:::; 0, Jt-
,It,. 0.8~ -0.9:'- (),2(: 0.12 I.) .oU- - I 4?.. D.~ O.JO o.o~ -1.25 G.25 0.24
L L.~9 ·- fl. 50 IJA"i! fl, ~-4 Li'J - l. 2ti n.i9 1).4[ l.l'~ -l.4'.>I DA7
l.l~ L.~-~ - 1.76 O. IJ U.ll ].JO -2 .23 11.:IR t"J. l(} O.Jl -i! .JIJ 0.1','
-------· -·
:1a.. t"!1 "a1ill~ LJ,u Hl'o:."!1-:l~f'! ,:l1:mw.: ln lhu X ;(1~ 1 y ,Un::ctit.'LUI '12 w1~l] a~
c::i.:o.!-llklti~m!-; w1 , r1i 11!11:.ll'"! l.1) 1

I Ill' r,1(11m1\:L:L·!'t,lU.'Lr1"!J. C'LTl)f!-;. ii i:-- 11l1°.":1)1J~ t-k~t in l.;"l.'L!O:] il,d<fo:11:€! ',tir. n•r1.:1·~110.::~ rralll{\ \1o~Lic.l1
u L-Li iorJ the } 1 r:,.11J.::f1 ,,·I. 1°.<1rirnu l~Li \", :u; :lpp1-.:.01":!i~ bl:· 11 1 !:tfor t.lm I\ l l.1 i~ wl ii r,t LLtiJi ~€!<1 gl::[~-111l~i u:L.

l\n· Pog·o11ion, from the- Ea1' coordinate. tht:": uie.-=1n cha.ngie in millimdcrs
horizo~1taUy \.\.-<is 0.05 mm . At 0 .48 standard error. it -....'(J1.1ld .o;uggof'~1 1"i1;i.t. the ,:.rue
mc~.n fur a s:U.npk v,oi.ild bl" IJM.v.'t'~i 1 0. 4 9- mm. and 0.53 mm. ru.JJ"IJJ6t 70% c)~ t.he
Ll me.. ·rh is \;,'D uJ d suggest thm chin gr<Y•'tth v.J:i:fr·-~ t".ssenti.all y from a pcrpcm; ir.1.1hr:-:- 1:·f
t.llt' CaN poott".

From s-:--,.: -ch,;:: m~an huriwnL~l ch,mgr::' w;;i~ • 9 9 ((Jf I mm.J pi;::r ;rear -rather tb-m
0 .0.'i JJitr r~:-H· ::ls m~asu~d from BaI'\' cc,ordir:atc-. hum Fl J 1.he'. change \i,-""3.S 1.59 mm.
lwrizr_i.JE ;_~Uy. T} 1t'.' B.:~ N r"t"' ft-1'.f' 11cf' w,.q.,; th·, ~s a s ;iperi or base fur lungi l mbw ,H.t,tlys~s nf
horizon t.al b.::havior of the- chin. (S..:-t"' Hhi~trntinn 0 11 pi:i ge 5 6.)

l'o:1.· ,,mi{-,'f,1 ((lo~.,.·i1·...·;1--.:d r1.nd fr)l'ward) change (of Po) the me,m ·w..lS- 232 mm.
and the standard ~rroJ.· 1rYa-s 0.]6 u:un. \lo,.-.,. kw~- i:>::.:L..!3..hl"ished a hypothesis of 2. j mm.
J.lt'r yt:',U ,'\ l GJ t;• IcIiun. ll1.1::: ,.-crttca1 change of Pogonion from ~ ~ w,:1,~ 2 . 48 mm. but
horn. F, H, was only l. 91 rnro. The. J.q rg~r -v.alt.:.e ref1ects the inknrnl chm Lge~ of th~
c-ranjum. Jn th~ 1990 study of 73 chhht11, the Il.Lt"~Hl fa:Sr1l a.xi~ dos.c.d 1".•hilc th.c- o1d
Y axis from .SN ()p~1-.r:::J.

Bt:t.~\l:-lt". Ct· r.1nd. CF poJnts arc dose: togethf!r the: ,w:K11n,t c.1 dla.11ge. for Xi Point
,,;,rot.id be- rdkcto::d only il1 ilin>:t~I ion .
 Fram na::,..: ar:. Pt. th f' Xi Poi rn mo....-~d h~c-k 'A~l'Ll O. 9 nm1. !lnd dov..'J'\W,Ud O. 8
mm .. .sho~,•in~ a .str~i~!lt
~ . do-..vi:lwt\rd and b~do::.wllni tcrukncv . from the Fada] Axis
c:o-:-,rdi r..::.t.f (st"-f' sr1mplt" N-:: 30 of 1970 b~~ow, ruul N= 73 of 1990 on fc.tlo,.ving pag~l.
Tfn..1.'i i1 'r'.:.l:I.:; condu:.kd chat .for longitudinal afi:'U'i,-"3:.s :b.c Ba.N r..::fcr..::nc:1:: ~...-a.s s·..1f>f'.r:fJr'
k,r tht:' :::n.muli bular pcint5 on d1 e chin and ramu.:;.

Furl.h~:·, wh-e,~ l-'olHt .:'\ v:.·.:.:.s conskkr-t'ci from .S~ h: ::r1.o·~·.:..-d fom,:rrd. 0. 6 nun. a::-:.G
UG'A·Im..:.Utl 1.43 mm. From FH, Poin:. A move.c fon,vard 0.88 mm. c1n<l rlownw.-;rrl
0. 9 ) 1~1 rro:. f :-..)ni :R:,i-:,.. n:frrcr.cr it moved fur·'i.:o,":l.:-d only ,01:::"t mm, yc.1r.ty and d 01r,'11.ward.
; .25 r.1rr...alrr,os.c raralk:l to the behavjor ::if the. JO'i:.,.rer indsor.

hl vi.im:ll :m:1l?~~:s the :10~~ tip ~r-:: and bd1~,.,i.0-r of the l::.,v,.rer: m.umr (£6} ~,.,I b~
noccd.

:5(.,

'·
 On SN at S

J -,-••• • 1
" • ~ ,~• • : . : : : ~ : . : : ~ :: : ~ " , : : •'~:.:i::: r • •"'

....

-' ''
~

'- I ....

··-·-,_ \ ,_, ·-..>·~-~-.. -

.. .. .. _
'
• , J ....... ... , - •f-
' ,, .
.
IV .. I

..L - 4." ' , ..

I • -
'
.... ~ . . .... ., ..1• ,.
• .
°"c• --.. .
• I I ,• I I,

~~~
..... .... ...
~

···~ =-::-~.
·- 'I ..

1990
Composite N~73

BaN at Cc

57
. , I:t.mcr.ion #6. Rcm..lit'n a Mt:-i.uu,. for Seque-..OU.8.) Growth Analy~is

Interest in Grovd h
Grow 1.h ha~ been a contlnucd inter-est s:ilt~ tht' be.gin:1i n g of on:hodontics.
D~•elopml"11t. j s 1liu:l: Iy :1 ~0ci ;1•.ed with gro,;.:i,.--d, to include ~J l durn g~. D~,~dopm..:nt
,,. ;:_,_mtinuc::::i; .attc:-r ,r,,
ttn,.v!Hd -~~nilltv uru,~·lh ii. :,L:::e .:;lun,'i.
.r Eadv
/' in on.hodom:ic throrv
.,,
gro1rvth w~-~ ,q_ssum~d to be. E&senti ally controllc-<l by tht- t-reri l rn~n c. mechanisms.

Rt';c:r,Lgcnographic ccph,."Uomc-tI}' ''io'.'l:::C J~·d:.1p~(l llr..~L [or gro•.:vth IT!'.Cn.rch.

Latcr ~t ,,.,,.-.i~ Hs~d ror sp~L~ifit"'. detail of u·eaancnc. change-. Thn"t>: mah, divii::i,m.~ of
h i:-:ad groivch o: conccrrL ~ s.kk·,;:al. dnl':..'l l ~n J i-;oft ·..i ss.LIL.
·:.

.
.., . Jv1..mtlil1ul:,ir: _grOY,•i}t h (if grt:r1.l. ;-,ignilicana:: dtnic."U~'. Th:t di11idr1in (k:-..ir("~i to
df.L~rminc its pa.rticip~tion iIL tht' (Alrrt'Ct.iun or {.];.d;S H, tr.e trcatmellt uf ,kq1 bi.tt"":,
~111 d 1hif' f'r'CJtY-!.ses. encountered in the mar. ,J.gc-rm::nt of Cill-'.:il'i (JJ L:Ofiill t.i ens.

~o or..c qu t.'.sti.01l!i th~ alAli t y 1r1 a 11 ~l' 1h ~ <f.r.,1,-~krpmc:m :if dttm.tl J. pp~ratu~ ur
tLt' i rul-..:~nc:c of teeth or the soft tissues. But of x:oun:- fn 1~1t=-_"l:. jS the q uc5t\on of
po~~ibk 1r~iLl.mem in.fh.J.e.n.~s. or.: gro,..·v th and d('",.•dopm~,r 01' I·a~ b:~i-;:-iJ skt".l{'.1 on.

Con t:ruvcrsi11..~s
H:1-1 h in anrr.rcpology and ccpha~omc:try prugn::s~ 1ta:,. bei:>:n hainp~~d by
diif.:..'Tt"n,~~ o{ npini..:m ri::gacd.1ng cdrt:'.f..t"li:cS to b..:: us-cd for ns-sc::-~~ix\~ gmwl.h -ch.'lT'l_gf':.
Studies of n:"i.. r::-n-:~l Hn~s hy Fl1J1 iw :lnd 1rnplan1. st.11di!Z!~ by Bjork h..nre- hdJJt<<l tl'...1 :,d~l
:r.tr.1 bh: si ;:cs for fil'Laly>is of changes and have d.,•u-~:6.c::-d .~ome. argume:n ::.s t\:ga_Tdtng
gu..,,.,.-1 h. Comp Luer ri.:search and t~ availability of compm.jt,:-o:'. h:h,~ hf'.lpf'.d. lmm~ni::~ty,
tc provide" grm't1h , ,~1 ;i .;;iud gx1.;,,..,..tJi v,,:1r1 ahrl i Ly.

Ortgi r,al studies on d.rv 5kulls '.Ve.re conduaed from Porion. \Vit.h a.n.-=ilysis,
hO'\:o:.·c-vcr, i-:-. b~c.am~ r1::oogni:..:~d Lh:i.L gr'O. .,:th o..:c:tllT€d on both ~cit's of th.:- ,'mon:d
sutun.:: compkx.. Tht< e-ar canal (aml PrJiiua) h;lJ lw~n convc:.nic£1t ;;;_nd ca.5y points
fn)lll which to measure skulls. \-\'ith hc-adpJatc-s- St"ila Ti.1~i.<"~~ ........'l,C.: .1l;S(J plainly visible.
md ,:cYJJv,rnkut. hi i Is favor. Sf'Hfi Hf"A in pmximit.y r.o rhc ant.<:riUT l-r,mid rci'rrenct:'~
or ::he. superstructure for the na..sal ('3'.ity. Ahn, t.ht Sdfa-Nasion line. l5 rea.son...1.bly
orjf':nL.eLi LO rh..: •.ippcr and mid,facc.

Ho-wevc:r, SdJa has scvC'rru .li:nutatiun~ fOT grrrwl h 3nalys.is. lt (l) lic-s bel"'.in~
d1t" lvrun~l ,">LJlrn~, i~. {2) i:-. rdat.1.~d l.O lxain cir nc:u.ro-cr.nnbl grr.::'io,-th., ,~nd it {3) li.i::-h-;
above the principal brndng u£ tht fa,:~ at.• h~ _K.q;Si-Crani.al Axis. Sella also (4) is a
poor rf'.le renc:e for -che mandible ,..-.-.i1ich is supported lat t:"T"iil Iy iT'l 1h ~ 1 ~m por.a l h,,n ~- Jn

S8
gr°"";.rth it (.5} h~ ;1 poor ~xrre_...:sion of polar µh.cr1JJxur:-1v.1on v..·h h 1h~ oral c<i.vit.y. Tt was
~ 6) frJ, a.nd 'i-"i--.J.nting in rdiabilh:y for gt"U.,,.,-t,}, foc"t'...::a.s Ling. (Fifcc:cn to tv,'crlty r ~-nt. nf
gro,.,;.'th on i h~ Y a>-.is: ~ra.s a ·anial :illd not m.andilY,ilm.) h)f all these reasons we \\TI"C

. to abanJu11 :1. fox· gr,:.1,-vth ml,{lysii,, .~nd lm-:.dicdon.

for. --:r.d

Pol~r Growth (l ...a.ter.al)

A c:cm:rn] rdcr-cncc: ·was found ici c:J.:i-;t ;tt lhi:": hasi.s of the: .sµh-cnoid bone fit
for,~mf:'n n"JL 11.ndum. ·srodi e fr'=q uently rcm.:1rk.t"d d L;~t wl ,en :1:e s upcrLmpo.sea. a .scri-:::s
of traicin~ he -p~red rig.he JU\'VH Lh~ spli~no-pa.l.acinc .tossae·~.

A 111c,rt=- c-,)mplf'.1 f: posl f'.rior rn c1ntc1ior cranial La~t' b: :n:vrt'~t:'..nlt'<l hy B.:=..:-:;ion-

~nsion. A cm through thfa pbnc si:.'?a£:"./:ltl!':s. 1.h~ r&ee: fron~ th.~ cmnh.::m. l.l.si:: of thr::
J3asi0lt-N.11;o:;ion plane registered from fornrn-til r1.lHm.dum (t·Jr.) ar. C.:r;:inial ccntcr (Cc)
simplifk~ growth Ml.Alysis sig.ni(icantly.

\Vi~J1 ll~,~ o.-i..::ntatioEl a n~markabk: ordet" 'i.'r'RS nutr:-,d ,u f;:iri;:i l hL~ha.vior and eve~
1n :he -ru1.:::oph,u:yn-:-;_ ,'IJ\d vt""rt..t.br:H>:. fh.us, -..:,,.-hen ti.'.'O or more trnd.,\t,~ ,11~
:r;up~fi rnposc:d in this mmmc:r on u polar griJ, {)oi.n-.Ao; c.e.f'ld to folio,,,• the- polar co:.irn::.
 \POLAR PHENOMENA

. I
~
--------./ ) .
-
(

ORIGINAL 1968

13
\ --=---- 18
UPDATE 1990
\

5 Cm.
 /t
. GNOMCN
, I
1 I ,.fS~a
I I
1 .

i I

II ,

6}
 N73
non

46/27
. <JlT(~:----~-.J ........-+--,!.~L..1-----....J-.C>

Age 3

Age 18

..
' . I

: .
Normal Growth and
D eve lopemen t of Occlusion

(i2
 Gnomon Bc:hav'tor
Gr0wf.J1 occ:, JJ"~ in proportivn. A gnomon is the add.c:d part to a form -..,·hicl'.
dr.~'.'. not dl.mge h gc:-o:rr1i::-tric:.dly. As ccntcrs or v~..r:~s. of angie~ '1\rere lccattd,
rnp-:::rpositi-:m !::howcd rdadvc conr.in1JA.t.i0n i f'I fonll ror t.he on 1bal, n;is;'-JI, :::iltd m:,{l
c:ivities. fronica.lly, the vof'.f!RY.~S of :~1lglits ():r b,t~r:-~ or n::fr~n'-.'.t':~ Wt:'.rr= l0c..;ited s.1.t
t:'.11L.1 :rnc:t'.:-; t;f llt'PIC-:~- 'l11b pht::'ltumc::nun also- bc:c::imi:-s usc:ful foT gro,\rth .analysis..
/Vlumdric is anotha word employe.d for relative: constancy of shape. Me.cha:"1.isrn$ for
.r,ro. .,,...c:.h of rhe. f:ranium, rhf' n1:1.n<l,hk·. :~!"tel I ht m,'\xHLi St:'t'UL to rnJ:.t' ptt-ct'dt::T.cc in th.a,:
{JrdtT.

ORBITAL

NASAL
ry-
.,' _ v,

Pl.

63
 CH ~ RT F O F.

P:1st.!'!;-i (",Ir .A,. I: o r-io:r

F'";"'rl .:; O [ 'l> ~
;.,He
x <? X Ci"
...,'l 28.$ 29.0 23.1) 51. 5 5 2. 5

29, ·:J 29.5 28.S S2.3 53.3 s:.3

2. 9 • S ~0.0 53.! 54.l 52 , l
30.O .3 O~ 5 53.9 52,J

7 30.5 31 JJ 51. • 7 55.7 52-.7

,
'' .
~ ~1.5 [~5. 5 j 56.5 54.5

31. 5- 3:!.0 56.3 57.3 55.3

lC- 32. J 32.S .5 7 , 1 56. 1

1l 32.5 33.0 32.0

33.5 .=-3,7

33.5 33,0 5().3 60.3

14 34.J 34.5 3 3 ,$ 60.l 61.1

}5.0 C0.9 61 , 9

l: 35.5 62.7
;
I.I
17 36.0

:. 5 54.3

64
 13('e~k.)ng l:.i-to,vth Down (Amtraliion}
Fr:::qu<:r.tly gIO\Vth d:rcc.tion is ,..mdc.ar co the clinician. In fact, df:·e ~r.t
di rec:L j o ns can he interpreted fron·. different p1anes of reference. The-11::~orc-, a crnira.1
,l:·t"a f ::um whlo:.:h (0 J;:15,o;c:~~ truvi.•lh ~nJ di..c~n:u11 Jlt't:'lb o:.:1Ji.tlld~n~":f' l~vd8. Sud·. ovl:':rall
~acial gr~'i.'th b-ehavir.1r is ¥- ii::rn::ssc<l frnm the l3a~-iu:r.:-.-Na~irin l'l::mf: rt":gisC.-tl'~d ;,_1. C'-\ as
1

shoYvTl. i~ polar 2IDWth.

Tht: Four-Posit ion /\.n ~l ysis of C..>i.rO\\-th

Tn g~nC!raL the: c'.J ni :i an , s intc:n::s.cc:d ln four phc:nomi.::na.. Thc:se D.r..: the ch~n
1: Posidon l ) the nw.xill..1 (Position ::! ) , tht' \ipp-t·r l.ert.h (J-'o:i; i lion ,1), and the ]o~f
:if'~~h (Position 4 1. T:iis lnfcrrna.tion ls provtdi.:d by th(: "Summ-t;ry" pr.:.:;Li.0n,1J
a::10.~ys-b and b :; ~l'J.•,ri:1. <1t ~ g~:'\ .'i 1u 8, 8 l.n J 3 and l 3 to j 8 (or chrc:e five- ·v·c.u
1
0

imervals).

Po~ i Li on One -- ! ;o~· the chin i: 1-:-iandibk)

\Vi.th. ~hl:' <:t'Tl t°T,j: pri:;1 d ~-r I of 1.vvo tracings at Cc, grotHh D.TK~ :::ichavi ::.ir {){ ·Ju:
chir. j s vi::;ibk b:· bdw,._ivr uf tht' F:~ d ;i ~ Ax i :-:.;_ GrnwL L r.e.nds co foll mi..· the origi.,.~.l ax.is,
p,H 11L~u]r.1tl_v in shore :;-a.ngc., and incrcase.s at :J.. r..:mark.:1ble i..mili.m.n r,ll~ 1Jf 2 ..5 mm. pc·.r
?~;ir. b·. l<mg r:111g~ (_S to l .'..i ye;1J·:;} :h.e Facial Axis tends to ci(1i;e ~lightly on iiv~rn.ge:.

ru~ rnor:; o_N.t

pu.r,.:-c r!O:K; ht.dic-!ltOT c",f rn.cc1.iu1,
.s.nd )\1111ount of c;~(I 12.-"1.h
( m cl..singl' in cl\tn)

_I) ITCC!i(,J-1\: Q'-' ~ + J:" i~I ] 0 }"e,Lr~)

Su, c1da1 d Y1.ulHL t~Jll:
I _jY :,it 5 ye.;'U'!;
'l. .o~ ~i IO }'C:an;.
5 Cm.
funr,mnt: 2, S :mm. each y~.ar,
o:r I O ,nm, o::-nc·;, 4 year~,
8 t,o 13 t.o ts yr~. CJ)_ ,.-: :.t 0,J 11,, L\. cacbl yr:,u :
 Positj on Two -T For the: maxmd:
Shifting forv,ard on the B91iior1-~:t~i011 pl::mt- to r-r:gisi:i::-r at Nasion S(rvcs as a
rcliabk ri.::f~i"i.!:\r;::e. l.t': ~v;t)u.:-dt' ulliXillary or p.:.1.Iatal behavior. 11-.e angJe of BaN rn
l'oinl A i~ ~1lntrn,I ,l perk·o:.."t {.UTist:ant. In long range Poim A may mn,.·i:>. focw.11.rd oc11:" or
11·,..r1 c'.t:"_gn=t:~, but h hi rcn-..arkable how consc:ant it i~, ru:; ~t:,c1it>. 1)rc)dr1lmed. Thi::" ~lJllk
of -i::hc pcl!atal plan..:: cc, Ra:-." {:h~ngts h,m..lly mon:- tbm a ua.dng c:ITOT "l.\1.t'.1.01.1-c
t:-~atment.

~----
~--:-:-r.::;:.; ■';I~! :- ;=--:;;~ ~~~~
8
13
-~•:·.·.:::·

Cm.
. .--'"----...J------'--'
~

.... : ln.dkacor fo1 I) i r~i;,:tion and

.A..i~uiui Ll uf Growth (c:h.:i.,:1brc:)
in :\nt.crtnl" M .l..ll'..il.l.a

l)~n-,.:1 i {j{"l: op Sca1"ui.·1rd V ui..atlC.Ll :!:: I .0

(V c:ry r..1re q,~,; .sH~1tl)' "'"")

.-\mguQt; hJr .-\ l\'~ Yt:rtlcaJ.

1 . I j P~'\d1. y~ar.
C.1). = ::: 0.25 ~.u·h ycSt.1'.
 PosjUon Tlu-e:e -- For i:.he u1)[>e.J' let1.h
Th~ n 'L-Wdllary mo]:.,_rs AT'I d h I d~ors h..1.vc b~n target te.eth ror n·:fr·J"'ent"C by m.an:y
prnctitto!".er.!.. TI1e.il' nom·.,·d behavior is rcla1cd to 1.ht. p:::it"ta: planl".' :registi::::rcd at ANS_
· 11, is n~(t> rt"il C'f' h:=i'.'. n"uuci.:nt::d c.sscn tialfy unc:h ;'li\gt;;':-li ~irn::e 193 0,

® An 9

13
,s
0.7 mm~
T
I
"f 0.4 mm
,.3mm .....

f.Af T( m: 1ia1 c..tal PJ.:1..111! {ANS-P.N S) .at ANS

for rr~c.ling of i.(ad:-;,;1)r ;\folw-
w

+ O«.I LLS3.L 1-"J.anli!

I-l.NCilON; fodi.,·i,tc 1r f< rr M.'!xtflat',t

lkntLL.rc: Change-

1-·ora·:im~
0 ,3 mn:, - t'!::a:h year_
CD. = ± {1-1 LUm.
()i:;clu9.al lJLfl.lK - clrop~ l~t rn.;,l 1~;r: nmn-:,
U. (," c:ai::h }""C:.:lr, l, 1! 3° 1.11 .S y.-.u~,
6" il.t 1 U yc-ai:s,
!! ~~ 0 .7 mm~.yc.u 1 = 0.-i HUCL,/j't'lLr

67
 Posit ion Four -- Tor low..::r tc.cth
\\'hilc thi:' in:i.x.ill:Hv t.rJ01.h beha,.•ior is r.::-l..ativdv dt'<(T, 1 h<': hf:h.·w ior of
-· J

1:rn1•dHiul.ti' tc:eth h.as been more problem."1.6.::21. Th:: ma;i.dibufor rhc1~ rt>.:gist~re.d at
t:ic sy:nphy!>i~ have. Jed to comrovcrsy. I fov1-'t':vf'.r, ,vi.th the dn·l:''.0pu)c:-x1l cJf Xi :rnd Pm
or
fJCJi ::"I.t~, it \71.~~ 1~i.':C'IW f'l'f'-'1 1h ar. th t: ar.gk. t~u~ l.iuc.;_,·,{; IJ(,'d 1is.al pla.nc to i:h..: corpu J ,oo:;
rtl~o rrJl'lainc:d a solid ba:;:.:- for rdc:-t:l:'"J'lt'.e. This is so -rc:.fo.bk. in fact. th.at it is used for
prc:dtctiu, ~ nf molar behavior.
It should l:;~ ,1ndt>.rsr.0nj Lhat the 1,,;:hol~ ~cY>'F,::t .!~nt11re erupts up'."ic.!.rd <(xid
1

for,,.r,, rd .1.S r-2v-::ak<l ~· tht' ~r;:'(')1,'i.i. h :1 ~c.

i.:•.··
0

Cm,

•.:, ·.

11( )Slfi( )N FOUR.

fACIOH.: J, u<: (\:11-w.al Pl ai\C ti.)

Corpus ~ .a:t PM point

:. ..
FU'XC:THW: lmlin1l..,,- for Clum~ ,n
I.( l>Wer n~] I L L ~

~ ,-rumb"" in (~.:h•sul Plane

n.,l.lptfon frrm, Cc_irpll!S Ati:s O.:;: mm. em:h vcm
I ..:1w-e, I 11('1:'iel"lr -~-0 r1111l, ·
 Soft 11s!!!uc
N-osc groi•,'th js i:ie.a..;ur-rd from ANS (Position 'J'hr~.)- Lip thk·kn.css and.
position a~'t'. rd Ht~d to the lc1-bi.;1.l s 1.trfaces 0[ t.h, i nt."i5urs, Ch111 tissue- is rel a tf'.d to i h I:"
symphysh (Poshion Fo11r).

Suf::.na~ali is C0.r l~i d(:'r.:-.:c! en ~ d°"unvard and forw,•uu () bliqll C d irc:aicn from ti I~
haf>~ (1 r 1ht" ,tx· t~cior r·.asal ~pine. Supr.c. m t'.T t~dl (!i-Oft tiss:ic. B) is c.alc.ulate.d. fo)H L t:,i.:
r.:-__,of of t!",c lo-..vcr ir:dsol' neti.r tht- root-cro\.,'11 junctEon.

13
~ J. g

I :_.,:' I

I\:'_'.} @·~: .. .-

~r
C -~ mrr,

\~ )..,
~,~'
SOF''r .ISSUE Gi,10WTr-
,t .lr........_

1~,)

69
: '
Fronrnl Grmnh •· Tl,e Bj-Pola{ .Phe-JHHlli:=nou
\.Vl"i~n th~ poJ.qr- grU ~-:~~ :i-;tmJJr:d rd:rdvl':' tc Ti~'L{' I and Time IL for the frcntru.
1:rJ.cn.1-1()::;ll~~ UClt' ;:c':tk-r could n::_-.t b.-: found. Hov.rcvc:r, ,.,.ttc:n c:dch foramcn ro:ur,dum
,,,,as cmployed iT: w:as- d1 sccvcred that grov-.rth occ.1..m~d f re in l , ...,o Cf'.n L~1·s or pn l-e:<i in I hi:-
Cro:1. Lal pr:f~pecti". e. Thi::. ideri cf L~\~ i:-..fltienct>: of 1,-..•L;- 1L~·.1mtmp~lit: ~:~clkr:; w.i~
1

h;rthi:r :.;upportc--d I01 :hi~ Rn.ling. llow~v~r, n:i,"O ccncers ,,,..·-::re .alma.st \ln-,,,;orkabl:: for
t'.--ic typical dinidan. Th<:rcforc-, the data was cc,!le-.ct.cd for .3 stngle: cooJ'din~te., Lht>:
,:·cJ.~s:ng nf rh~ Ffankr-on ,.,·i 1h dw: rnid-~o1tgitlal pt~1\t:'.

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 \-Vi th this coord~n.atc 011..::ntation, the- rclad....,.'"C gro1r~-ti·. of thr:- n,i~ml Gl'-'l.t}', iuga)
pmc.:(:'N~. ;wd art1.1!.gonia! poinls was ob.s~rve:d. There 9CJ.::m(:,i to b~ a 11 onc•two-thKi: 11
order, which w,~:i; kJer fouHd tr) b~ {·ons1s1 t>:nt. -.-.·i I h tJ;e divintt prcporcion.

h om 1.h..:: origina.J 1966 computer , ',Drk growth dat~ was coll{"(.:t~d. J-'lndillg5
jiJ:"'." r
sh.f.l\-'1.'J.L j (1 • :'} t:,ub.J' Q J'nl .

;,__ ~ L:..r.L: .~.Q

,.,,., ~ - ~ • (. 1D'I .

s - e .o
~ & ~- E
:J - "i' .E
1~ ., ~ . .t
12 - ~ . :::
~--- 3 - ,;: r:n . L~.o rrr.
1: - SC ~Q_(;
.:.:: - s:: l:.,
~E - "iC !.2,1
13. $
1~ . :!
;~. ~

/:,t;Q ~ - !j@ . ~~ n:J . ]liJQ :c - 71.7-J !&II .

4 - ~<lo . 1;,D :.1 - -. ~. ~=-
~ 70,!IS ;.2 - ~Cl ~J
. ,~ . .:.0
~

6 ~.: M S •.. 7.5

NJ" l · ~::! . C r:.ro. i'.qo 10 - ~~-= rm. AIJIO 1 ° - : 9. ) ..u:.. ~ - i'!,S::» .'....1 ft 9S . 1Q
,_:;
" • ~.1 • ,; 1F ~ .:n .s F. .~ . 0 '. _; - ~~
11 - 2€.C.
. A!, . $u
~

!: .. ~:: . C· l'.<. - ~ G. :! 1(; - )0, J ~ - 16 , 3S ~s

6 - '.<.~ . !o l j - ~-,'.C' :::c- • J.! . !i
7 - :..4 . 0 :2:: - 3:2: . J ~111.s
14 - 21.:
E - 24 . ::0 15 - ~~-{' :;:~ ~ 32 . !i ~w ~? - 37 . ~s =.
~ - :2:=:. . ) :2:~ - 33.J 18 - ~a ..=..:,
H - ~~.:
1~ - E!I.S.S
2 0 - s :. . .2a

T he: Dh• tn,;:: Pro,:,crt:on

. .
rnaly.sis ,.,..-:i.s fm.:.nd useru l in t:::mtwc-~e vJrn-i- .dt'r,i '. i C·T1~ .
 F1 U.lction #7, Supp]ie~ a ,"1 on i L.orj n g P[U4,_""t:'S~ for 'f(ea tmc:nt

~e.paration of Gtaw--t.h rrom Trc~tmt'".1.U Changes

Ofo:n dinidans m.f:l_y be. reluct..'U1t tf.l ()t:-rn.1:1 progr-::ss h.::ad1)l~1.t=-.~ bee.a.use ()f th:i'r
in.ability or 1.mcertainty of c(rnlp~h~nding mqueu.tfal ~uial_ysi.s . .As sta.tr:d prt>:Yious1\, a
1 ruscv,-orthy n Lct.h0d .·rn d &i.ta arc ITquh~l ror confidc:ncc tu b:?: g3J ne.d.

~ Monitoring pruviJc:-~ u i'kvio..: for chcddng ,·uvl ~gu]ati.ng the ptrfnc-n1ance: of

: '
tr~.3t.n1 t>:c'l t m-e.chanics.
. .
~- .
.... :
''Monitoring rn~an!:> tr., \J,:l:·n, C".audon OT ~J..,·i!:>t'.,

'\\1onitoring pTfJ\•icks a rch::rcncc for 1}1r. 10Uowln?," ot .i. ¢:,'t'n sr.rif"~ of ~vciTcs 1

in opcratioI'~.

I, .·
Mon,t.oti 1"I g 1 -...·i I.•~ the. for-::east -co :m. atufi 1.y, pt:nni-cs tht" df' 1t"L'I kin of r.11Ty
::-.at.a~:ucphk a.:.:dd r::-11 i, i Ji :,,;i;::~ Si'•• or trc-auncri:r:. '!JU sforl.unc: that V•'Ol1 ld r.~vt":T·I '.1ttm'
1.ht> t.urgor of the natural g~)wl.h process.

\.\'n,:.n is a c.han ge or your doing?

The: idea. of Clinic.;d D1::·:vi.'1LjOn wa.s an. adju~unt-i-.1 nf St.a.ndaitl Dcviatic.n• fur
bttc:-r an1lic:ation to the: dinirnl cq.1,.rit:·:rl~- .-\:ii s-cr1tc-d before, for the sake of
men·;ory ~iJJ vr1 h ~s 11.f'.:cdt:d rounding out. i\ I:,;:o fo!' the sake- of nm if1 c:◄ ~ 1on r,f
0

importar1.cc::, yaJ1..11::~ :1~~c-,i ,i,fJ 1naL.ch ch;:- cHnk~l t"Xpt:"Jif'.l'llY.. Thc:sc "'djrntmrnt._; for·
c1n1catton d~-ia-cion~ i.~"t"r-r fo:J?:" cl~:v.·.ripLJons. of morphrJlu_gic v:1riables for the .mal~b.

~\ diffrrrr: lt co1Kl11.io1\ e..-.;.ists, hO"'.'i-'C-Ycr, ii, !-.,::u.,') 11 increments of c-h,'1.J:'4_,l't" {Cft' t.h t>:
monatoririg of trcatult'J)t. ()trM'L h 1n r.1 nal).rsi.s and forrcill:i-l u l_g is n.::dua:d [O a
".modulaF conce.pr 11 • A module valut" it- ..i rn~an gra1.">rt.h from ,m ,◄ d!'."A.IU.ll~ .s.amp]e. of
O!:K' y~ar·~ du:atkrn. ·fhus:, .:1 n . ."O-moduk ~t:1'1.1:"'J'l('f' (nr (LSLial uc.atmcnt '\"r'U1..1ld t,~
1.ypical L'\~<o-yc-ar ~Ov'i!th. l lc,,,,"t'Vn:-, ~ paUe.nt may be slo.._,."(:':'{ or- fasle.r in .~ro,,vth.
t'.~ prt~~sic.1 n. Th ~rdorc, the dir,idtm\ cc):n,~rn. is n.ot i:i:nc cx.ar:1..ly. rm L :i :-ncJ I mt. r.o be=.
employed or built iuL0 Lht phn. ff tv;,ro modulo ocn1rin I ..) ,vc:ar.s, tine:. If it tal-=.<::-~
.?.. 5 )"t'.iu·~, it may f ust talo:::.-:: long~r to r.0m1)·it:te the tr~atm<:nt.

Th~ ,f ~\ l'et4..':("Jlt Ru le.

Th~ c.oc'lcept for dinical intc:::r:prd:lt.10n is f1Jrthi2r compJk::itt""d h, i'rt11n:r0.ri ng for

Tl.
JJt'l ~c)(b '-'f \'\.·~k" As. a .,,_,,:orki ng hypoth<:sis, tht":~fur~, ;_ pt~J1 f':::'.1.L -.. c
or rnnn 1.hs. 0

-.=ad ation of ten pen.-::x\t (10%) j ~ -::-rn ploy.f'.:d. l n oth e.r 'A-'OrdL the ycady moJuk i~
dt vid t><l hv t ~n For a hasc: reference .
✓

The Four-Position An.alysds for .rv-.oniLOring

Th~ J.)cJruv:11 vr.1lu~s with g·to~vth need to be rnc-moriud on ... 11,od11l.:-n· h=isi:s [mn,
each post ti on, togcthcr "i. th ~ uur:-:-ye:-\T va Iu~ of dini c-=i.l dc:vi ation. Ar.y dcp:.utun:
fr4""1T"il I IK1s~ r.x p~CT~ct values is thoug~ t to be::: an htflut1K--c: from uti::-iJ1,-uli c:a l or
u-c-atmcn1 prr.Kt"d urt' ~,

Po.s1.Lio11 One. -- for :\lla.ndlbuJar Orthopedics

. Thr dtln rnO\-- e~ ()11 t.h~ :-':.i(':i.~il .-1.--=:is 2.5 mm. pee ye.1..r. Ten p.-::rccnt 1,,•oukl be: .25
mm. This. li\·ould n1.can the clinician can rnndidly take: i:.::n:-di1 Ji.rt .in_yl Mng· mor<:. thar.:
2. l ). :ti.LUl, nr l~s_i; I h:1:1 2.25 mm . in one year's time. 1f the monitorfo.g is 6 1nnnt.h:i;,
"Chen a I.25 mm. ba~~ is u~t:'d :+: 10% w111,iJtl 1..lt".. J 25 mm. or l.3735 nu~. (I .4} or kss
d)an l . [ 2.5 mm. 0 . l }-

Given a trnd.ag c--rrur uf 0.5\ if ,q ch:=i,-ig~ •:"if nclt": c~gw·..e. on the faciaJ a."'<ls occill.s-
in sii: montl-.s, the clinician m..ay ..ci1·.c::luc.:c: th::- chti:1gr- io..; pn)dt11'f'ci by ~-r~::itmP.nt..

P-osi.ljot\ Two -- i\·1 :1xi Ila ry O rt.hofl€-dh~

Expcrknct" h.a5 sh0'\\11 lh.at .al.u.1u~l ,.my cf wuge in (I. .tki~jrn\-Nr.1s.iofl "Po~nc. A
angle is. treatmcn'C--induccd . Ticn·;=-ear gr.::i,..,rth periods m,_'l.y .s-how n m .t<:n1 ipcr~:lSt'. ()f
:1 hoc rt on P. ~grff'.. Ab our ,.W'n de:gre~s. is tr.c maxi mum ever obs-:::rvc:d. Tim~ in short
til11c po::rlod:; iA r.mc- tr) thr('"(' yt'~r:; pc;ii:1t A dwng~ j ~ v,:itl,iri l.t',ildtlg e1ror.

11-ic same. i'f'.gulafit:v :s r:xpc:ctc:d in the angle of the. pa3atal plane to Ba..."f. lt is
MJ smal[ i.'1vt>:r i()t1g J)t".rind~ Ih:tt. .afly ~h:=ing1::: ~;:in bt:: aiif:itH"rii'<l 1.0 be ueac.mcnl-induced.

In summaiy, since the: ..::'lange. in "Che ar.gk of the facial ms is sci .sm:all on a
yt'.r.1 r·ly I i:,i ">h, ,md b~~-;.'i tL~'" u,c:- R~NA :t ng.h·: i :-; .sfJ Vt".J.}' uult:",dy, :t n _y t~h r.1 ngt=-. al .ali Lri :sh
munth.s to a yc.rr i~ tr.1kcn to sugv,-:st trc-atment in.tlucn,;:c on thc:- xrnmdihu~ff rnld
m:n:ilfarv hasf'~'II.

7J
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2

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I

74
 "Position 'three -- :\.faxHlaiy orthodontics
The ocdu:-:ml pl,me b<::havbr b 1~ r.gr:-:ly c.'l")fl Ut:illc.d by cvcni:s in the behavior of
the :i:rnut(libleJ \Yic.h normaJ d.0tc:lopmcnt the ocdu::.al pl.me drnr-~ po..c.:t.e.riorly from
the palai:e abot1t 3 nilr\. .,..;wh 4 yt-:-::t.f~. 'T11e. ru=:tii.111~ mm-"CS. forn•ard about 0ue nuu.
~:.nil d11't'.e '.r'..::ars. Any ali:eration trom thi:s p:.H.t~1 i11 .~hort :·a:nge e.a.n be ukcn co
su~;c~t ~tltttJ".1t1 ion(;{ m.'l.:i!ilLq,y 1.ee.t.n posi'i:ions.

for <ktailed mnside1a..t1on, the upper molar mCJ\'t':S. forw,-:.rd 1.0......·~td. A.\."S only
0 ..3 mm. ptr yt";"tr. hi .,.;ix 1n(n~ 1h:c; il w011~d he only 0.15 mm. (not i:\-'t'.Il a tmdu.g
error}. And in t•,-vo y-"Cars its fon'lclld movi.."'.ULt"l Lt h u:i:..l:y 0. 6 ni m. T11e.rf'.fore,
7-a<"ti c:.iJ ly :l ny ho rt.:wnu [ mo,.•emen t under n'-"O years .!iii:rnd~ ,i tTtti t mr-n1 t'':h .') ng~ in
E:i thcr d.l n::aion.

Vc::rtirn.fly, Ott: uppr::-.1.· mnhu: l".n1p1 s f"rom the palatal plane at a rate of 0. l u-.rn.
:_):=r' ycal'. This ,,rmlld be ,:,nly O..'.V i wu1. in :o;i:-: 1w.1-11.c.hs. Again. this is slmilar to a
tr;idng ~t((W ~ss.enrjalJy. Thcr~Forc, if in on~ y~ar tht' uppt'r mul:ir l~ ~~tn.L(kLl ~ulrn.,
2 .3 mm. C..!:E he .;__·j;iiuml to l-:•t>: (°'.aL.1...~e.d hy treatment. If, on tho:..· othcr ru.mo, it b
in Lruded 2. 0 nun. , thrn. .n'=t'.mUy i.t } 1:! ::; I lf'f'n ~ ff~r:1 ~rl 'J.. 'l mm. from its prcdicrcd
pm;i tj (m. Bu1. by usj ng i:hc T ..::n P<::rc-:nt Rule th~ .rm,Ul.rut for din id.AT1 -2i'f'.di 1. is. 2. 63
m.m..

Position Four · · Mandi buw:r rm J10, IctJ I t.i ,:..

l~mm c.at't'f ttlly Sf'.l~r:t~d Corpus Axis rcgistc:n:tl at Pm dti:: i:uuku lud.-.,..;·n
,q
positions arc c::uulpmt:::d to the 11 un\1a.l . This will r-e.\' e.al induc-cd changes. I

I .

J\·1olars
Crl~k~u. puint:-. for I\LOt1i.t.otir1g of treatment are i:h~ molars became of ~mchor,igt
i fi te.ccsr:.s. Th.:: lm".""Cr molar erupts at a rlgit t .angle to 1.h~ rorpl1..'l a.xi.s •~gi stcrcd at Pm.
On ,1,..~l':l_g~, O.i pier year or L.O mm. in 2 years is the- (u51:.mr() b6t:tvio~·. Ar.cording 1.0
th~ Ten P~•r:ttLi R\1lt', thi: pwl..<:'<.:Llvt' v~JtahlL~ ,,vould be 0.5 X .10-=- .05 mm . Tht1s- in
one year 0. 4 5 mm. to O. S5 mm.. ,.....rould be- tht St:'l Is~ h It'. l't>:le r~nec. Jf in on t. year tli.c
ch:mgr- i:-: 4.0 mm. thP.n .f"Ar;.r;P.ntir.1Uy 3.45 mm. Vi'Ould be- due tu tit':lHU\t'lll. H ~-;,,.
moni:hs 1 <lltrntion, 3.-; 01: ~~c~rlv ,:jll .,.,..()=.1kl b~ du.e. ta u12atment. In the forward
J

dir~r:1.Jon, any change is i:houghc tc be tn:·atme!1t-httfot'{'(I.

TI1c lo•NtT ind:sor: (fro:i:n the (,:nqn1., a.xi:; (Wient3. tion) tends to move bodily
~tpw;mLH~d had,ward also, about 0 ..5 mm per year. It movt:s b;:id:. ,--.•ci:rd 1- w1n. in J5
:',-Tel.TS, whk!t j~ abc.mt, 0. :!. \ mm. ~:tc:h year. ll1ere.fo:re, tf the lo1tvcr incisor movt-~
stratghi: upward ii: nas bc.:-n moved fo:n,.·,1nl fmnl Ih>11 whicli W\111ld h~ f'xpectt".d
,,,_.jthU\1t tre,it.J:ne111. Ti1e t>.:-:c-r.1)ti0n inay be i:ho.K: pm:icnts dc-vdopjng gcrn.·rc-u:; d~·rt~l

75
 Soft Tissues
l .ip {'hangcs a.TC intlucncctl uy tuutlt .lun•.-f•.n)~Olf;_ Bc.havLor of the dun c..ltl he.
altcn:d by d1.-mge.:-:; in the: mc.n~fo; pro·vokcd by th~ urigin:-:11 rna1oc:clusicn .nnd
~:()u.-e.cred ,..,.'ith trr "'-t.m.e11t,

Fu(H'Ucm #:S. Ddil1~t1tts Tn~~t.ui.r;..1.H Possihililks (Sec: prig~ 74)

In 1~,:~ 8 t: he" •'.'irs1 L°'f'.p hB l nrnl:'.l ri c study of tn::mc:tl y.:atitnL~ Y..\"t:", rr. pnru::d by
lJ;rc-.1,di r:, Downs, Goldstdni .md 1'--tycr, C0nc~1;1.-,jons \.4.--ere: drn~il on only fo1.1rt.t'.~1'l.
Class 11 p.,t i~.n L', and sh: Clas.s III patients, TXt"":l! m~flt. wl tJ1 th f'. e:dge1,i,,isc mLCl'Ll.tr1i~m
~v.as alleged to have= uo dfro un l h~ -~kd..::tal pactan cxc,:pt for. ,r,,"tndi hular rotatlon
~,..·t,1d"! ":end~d rn ITCD\.rcr". Sb;: Chi!:>s I p~l.ienLs wer~ treated ,,,..i.th c::::_.p,tn~1nl'I fll'ld
,.,:oukl Xt•Jl I1~ t:":X})•.:°'..l.~~.cd co have basal sk.ekta! ch..1u1.g.:-. uiJi~l' Lhar. mandibular rot::i.tiOJ1.
All arc~ chm:1g~~ -.-.·~ .'K:h11:':'\:t",d by Ih~ use of intcnrmxillary el:1s.1 ic.s i.n that sample.

f.::.,nlt":mher that tlfrs si:udy 1rYris 1'prtfut11.rn1~:"_ '"c' ct l~ost con.elm.ions <lrn,•,.rn
".'VCl''C' con~o:J(:'r_..., I h_y m nst 1~ h~ fj n al. Alw, tn:::atrn~nt 1tv~ti pt":rf( irn'l.~d in mostly full
dC':nt.ition ages or btyoud agt':; wh~rt'. ske.lecaJ dlc:cts wo-.Jld br:- ni.:iuif.:-J:;1i'd as
, u I cl~fstood. prc:sem:ly,

~o t·.xtrnorw. Ll.':1L~licm w.o:u, f'.mploycd (parcinllnrly iJ~ Ou't'f':ildy prescribc.d ,:i;'ith

L":r.rvical traccion). Na ant<::rlor tooth h· 1n.1.."iion -,-,,.1th trai1s.fonno mch<.1r.l.g('" w~-~ H~t•;,d a.1
pr.:-~t"::m.ly appHe<l. -:\"o pos!tio.ning d-:vi'-.'t::':~ (){ p,1l.:1Lai 3.pp~iances ~,: C'mplciyre,~. No
trmmrt::"r.i;t ,ti1 ~ wB~ re:poH.f'Li from !.h:. frontal fihu, 11tt' DNLn~-s s.uggcstc:d
onhodontics or tollth U\(l\.'e'UL~ 1t ~ we.re li.mLts of possibilitk~.

Ti.-.-et:.d, ;~ r.11l (~, AT'ld S u·a ng· joc ncd furccs ,,.,..it h St~ir 11:":r' and many others in
a.:,,::-e.pting the ,dunru1t'. of foti1 t.:H.10i"IS 'TI1e. concept ,;.vas t~L:1t fr~I h r.0·,rki h~ mo\.ved
11
•

U\'t'I .~ignific8n1. d.is.c:ancc:s but tha,: "pattc::at t:":'xJ.:Jt"'Ssioo" ac-countc:d for the basal chm1g~
and that th~ hm-:~! struc:1.ures v'.·e!'e. 1mmutabk,

·f hr{mgho ut the nl!:\i:. t ,,;o decades t1 Lr::: ('r•:ph ;1.lome.tric tool became tht° prin Lary
1

so-:.i.rcc of ::rc,c1tnt'11 L· h) fnn"J) ~ ~ ion. ln L9 60 rhc immutablc:- thKJt_y ~vas :=-;~vitrdy

cballt':T"l_gy.d. '\\.i-:.'1Hc mean -compr;:;it::-~ ,.~·c-:re. maoua.Jly made in th~ Frm~, tn :i-;1.udy rind
display grr_,.,ylh he.havior, composite darn of tre-rit.~d 1.!ls~s did not become: avaikbk
1mtH i:hc. application uf Lht" '-.'UtnFUL:t':r Ln the l ')70s.

76
 -'°'~'-.' findings ~n l 9:i7 :;J.nd l 960 indicat<'d that -~kr-lt"l.al m:=rxillary d1a~1~;~ 'A--..l~
_p,;issiblc vvith t'~l r.1-:1( iJ"a.i IJ·a.i.::Lion. Thus tre,{tn:t~nt pos.!:lbilitics . ..,~ .l6~~~~ to lle in
three arf'-.ss: .:.kdcta.l, ,kut •.d, and ~m.i ro::1m..:::ntal.

Short Ran.ge Re.~uh.s. (one to thn.•-4..~ ye..s:rs)

,\nol her ';_u.estion rc-gardt"d p~n:-i.ane:ncy· ~- th.:: .skr~-k·L~I c.h:mg~s, and su.bEity of
d,.-,_ntaJ a..I'!d son ~i~~ui:-: d1:-1ng.~- From the br:gilu1ir"tg H. 'WM dc:tcrmin~d dwt. 9 Lwo-year
ph:i n made se.ns.L" for trc:..rtutr:H.t pl :-rnni ng_ Thcrdort', ,i .,,.,,o-ye;:;r or t!:"catm.cnt
-c:q.r:rkm.'c:- ~na [:•tc,i s, 'i.\'"Ould b:. con5iJ ~"t'd i-l sl"ton L.c!1n ,,,,h.en comp~rt:·.d 1(J th c: whok
gr(nvth period. fu ~pt:-dfk ~ppliance.s \Yi::rc ust-d, ~ignifica.nt changes 1,.~r~ :sr:t:".l:1 in the
5hurt r:mg~- The foH.cn.'i-ing stntt'J).1 ran'. 1; ~ prt".sent the currc:ut ,.:1Jndusi 011s read1cd from
at~alysis of Si:'\=-t:rnJ h~.i.nd,~_d patients r-.nd C.""QltlJ>~"t-.~it-f.:'J of a.bout 30 Si:1.1I\pk..o; 0[ L.1'ML~d
I,.~ t.i t:>:n rs_

Crfj_nial
P0st~Tior ~rani.n.l bmt' _g.r.xJw Ih ma-)' be: .affected s.llt 1.t Iy, ""rvh ilr_the behavior of
the tt·xnpc:r"fil complex anterior l"Titxtlal clt":Vdo_pmcnt sc:cm.s tu be 1c:Li.lly g-eoetic. Thi.s
cond1Jsion ~i,.,:;1i1:i. !:~rg~c '.',,implc.~ and rnn:-f.Jl '.)tu,ly prn~r.dtlc:.s.

Jvfandibufur
.'vl.andibula1· h~ndi ng and condyk br: h.•.w i 01· m 11y be lntlucnccd by m:incli b11.1.ar
posturin~ dcvkcr;: mid ,:igomus d;l.StiC trac-:ioo, f.,,~.-~s.sive m.andibular ~otnth)J'1 rw~y
1·:-:i rn,~ co mprc:.ssion ot th~ c.:ho: u.i r 1,;.gt" I 1k ..-:one:. in the: condyk ~nd it I hil)il. gf01.,rt.h.

Di.rrrt ~111 lt"rif)r s ttp,e.rior or sup.::rior '-.:o:mprt":,;slw1 or 1.he condyk may inhibit
gro-.."\.·lh and som.ctimc~ it rn.::JY aot. r~bou.nd.

Con(iyl~ _gr<Jwlh v~rLjt'..'lHy may tcmporaril:v be- -t":flh11.nc..ed by producing po~tr;.-jo.-

sup port if not c:.'{C..~:s,h½-

M.axi 11.a:ry
Major skrkt;..ll ..md p.tl.-1.t:ll th8n.g-E: can be made- in 1hrt'~ &O.lt.':tlSicin.~- Changc5
m.11y be. small , to am much ~c: ~ c~ti rn t:c.cr or more. Techniqt.1~.s t".c11pk,y~tl
j 1\<l.uc:.f'.d.
,:.m:· cdtk~◄ l to t.hf' t~h ;:mg·i;=:s i nduccd.

D~ta1
J·\11 teeth can hr. h1t.r,1(led or cxo·udcd. 1'.-lofon Gtri Ot::': u10v~d dist.ally, ~,<:si...'lily
o~· hH.c:-2olingua:lly. E""<pansion can l_:,e, d.cm~ safely. Teeth can be- mov-t{l ~r':'vf'f81
millimdt'n- ,dth:T'l Ihr b8s8Lu ~pparntus. as Ait.I1t",:;t"d hl Gl.l'l.in~ impact.ion.
1 1
 Soft. Ti:i.:Sue
Mus.d.::· adaptation oft.en occur:; ai:.,wuuiti'-..._·,Jly. \\1-te:n ~hab1:ts11 pc:rsi:;ti greater
,rtt.t'nl1on m:1y I-,~ n::"..f'~d thcrap.z:utically. Too ::nm:h m-:.:.l\(litmlt.1' 1'tJL:tl.io11 m.ay be
dangerous.

Long ~ge ( more lhan three years)

•··.
C:rs.n i al Base
Minor tc-m.purnl buut' 1...Jaui<il ;ill.::".ra:.ion may b,.:: pc11n.ar1.en:c.

r\·1 a n<l i hu brr

A.ny in.d";Icr:d change in th<:" forrr, (n· siz.f'. o[ Lhc m<ind.ibk is tcmporm:y. '1/Vh~n
p1'f'dir.1.ion:s of con~posii:.es. ac m..'ldc- in lung tt:"T.ln 1"hf_v c-rmip;'lrt p~cis~ly wlchthc:
trem:ed actmtl c(nupc>,:;it::-A. Of)f'.r"ling rotation cf the: rnandibk may uot ,~Jw.~ys :rf'.LUT'n
and ,car.. darri.agc thi::- (:OI1.dyk: t t lmr~L.1 CI:Ll ly.
L •
I\1~~ 11 :try
After treatment a maxlll<".rv .1.·o!-:' bni 1.rnl mav
~ .· occur lf nm:. rctain.;:d, but \Yhen
rnA. rn"ged. pc"operly k does not CJJllII\Oitly c.:-n :1.1r, I\ for,..,.·,'ltd_ gt"Ol>i,1n. of i:h-2 m.andibk
w<iv -· l.,t' n r.gel w i 11 m ,rxilla1v
,
rt~tcntion.

~-faJi:illary red uccion for higl1 o: ,,._ v~:-::1 ty l.t'.nds to be perma.nen t.

Dental
Fin~tl tooi:h posidoning b at l {Lt: J n~r,:y oC Lht: m LLSdc:s, and nerve: dirm~
1Y1.1L~..::le.. 01,.•-erueat.Lncnt is -essentially ncedt.•:d for iiU trt>::itm~nt v.'ilh the. p~siblc
C"'X(:r·p11 n n () r mf.111:" gmv,th j n [re.atr!d Class. I or a~s 11.

l'unr:tioo #9. Allows Prognosis and Simulation of Objectives

fu)w~o~h i~ .. fonil nf rn·e.di c:t.i on. Prognosis is made at ea.:h ;ulj m;twt"ut d I ,lt
1ht: L1::f.LI·. ,:.,111 mo\'·~ as d-csin::d and (liree,i t"<l with ,':lppl:i;i n1.Y"JL r alth ls n c.cdcd.
.LJ.di Ill ti ()I\:

i'Prognosis is the prediction of th~ pl"<Jli,ihk ('(',1.1.N.~ of a ::-.ondicion or the

fc >t:ol:'t r--1 ]j, 1g d Lht" rn, cC-t1 ni ~-

-"Progn os.i s is~ t.wo-edgc:d sv.u:d for orthu.::.lonth~: unt" i~ 1.ho;=- pmhc1h,~ grm',1.h
.rrtu d~vdvputc:uwl c.:umt'o:.11Jc-H('~S ,,-ithour. treatment; the oth.cr is t~ pt"0;t'cteJ
!'csu.lts wi~h therapy by one at v..::ric:.,ut- 1J\n,fa)1t1t".s nt I.heir c:ombinitior!S.

78
 VV('" hH ...'C': list~d fifl.v-sr:vt':n f"unc:Lion.s of a forec.:ut to m..1.t1."'Iity in a young child.
J - •

But a. forcc~st fort her be'l.'011\tS ft m..'1. tr:U: on which p[a nn in g is made.. °TIH'_refort>.,
h't·o fo:::--t"'.·;:isE.-, or prognosr~~ may he. a:rn5tructcri. One: is vdthout trt\'i,tm.~nt" <'tnJ the:
second i.s the- ch,tr~7t's n:mdr:: "'ridl the t.Tt"~-11.inr:nt objmives.

ht .:;h1Jrt r:wge 11:-t"~.llntnL ohjective."a .a~ ,,i~t.ia.ltzed (YIU), Jn lon~ ran.gc- the:
c.h:'.)ugh:c is fo: ~ ~~ll of fina) ::-csults (\o"TC)(vhudizt"d 1 r.f'~I mif'n1. go:1J}.

TI1i: pru,u::,.~ of 1.:ou:.--tr...it.ijon u{ :{ "hre1~~~r• may he linear, or an:i.aJ with

riK,ti.i fi('.at.ton of \' i::c.tors. and di recd ona1 componCT1ts. Conni but rJry ,'i,llmv~mce~ ,u--::--
m.;1d~ ,1(·.c:crnlh1g t.n s.izt>:, fmn,. :.}:ltlt:l'T'l, age,~ and rc1ationship5. Therefore, a mean
th!.ta basl.' V'ct.lue i!!I only a st~rtiu~ l,~sis.

\iorPc:1 ~ting
fu"f)-°1.h!ng th~t can be- cxpbiocd and c,JJ:Tt" Jfltr.d c:-i? 1 ht'. pred.kLed. Tii t': c-n.-1.c:~pt
of simulation js: more appropriate because prediction carr.it"s li di:-11.:::--t"c of ,lbsoiutcuc~s.
for:xascs arc r.-::rn.l-t"nx.l ht pt'rc-t'nta;ges. 'J'lw qnt",,;1 it"111 r~garding ci.Ccuracy has hc.c.n
raist:d since the b::gim:tlng. How ;;1.ccurm:.,:_• :r:r:~ust ..:i for,(.:,1~t. bt": 1.o bt>: of v::ilut", iinrl by
hnw rnuc:h ~•.:ill i I. nr~~ci. t-::-, miss. Le- he miskailin~ tn a. plan? Many rc:sc:-aTCh.crs objccting-
t r.1 :f:(.)!"t'.(:,1 ::,~j1,! g 1-:iJ:"-'1~1 j (:t"'1 iltl \."C:' l l()t .:trulrt':Sii~d the,;~ fond.ame.ntaJ qt::cstions..

Ext.ens ion and Modification Technique

Tht>: forf'.C:;~sting :·.ec:h?1iquf"...S. s1.acL~d with cranial bas~ e:;."trnsion and a plane
d::J1,,,n the- long .a.-..is of the con(iyk to (:c,rn~ec."t ,'tith tht: nt;,:nid:hllhl' pl<1n.f'..
:ivlodifications wae mad£ for biologic faci::ors, and treatment d:tt":~:.to; rn, the- u:l.::.mdi.bll!:'
~.,"t' r ~ c:-:1 Jculf! 1.nl i lltt"J 1.h e ~,-,:ig n _ In fact. Ll1e t:ffc:£.ts of (Jcannc-nt far 0 1,:crs.h.adol\-"'Cd the

gIU'"rih uminltudc:-~-

The. original 1.e..:hni...l1~ was nrndirte.d to the ba.skranial a:xi.s and the cond~~le
r, II in 1h~ :i::pacf". he.tw~en t".l';ll",ial h:i.:r;~
('nrp1l:-: .-1xis .-n.'31nx. T1\C" m;rcill::i \,,m fort'\'.',11.sl Io
,.md mand ibk.

1\·fa.ndibl1.lar Ace
A tn1c breakthrough for long :ran.gc- occurred i.\ith the- Ji:;n..:n,.'t"ry of a ~rrowth arc
foe i.hE': ,na,idi.blt". (nol. Le.- ht t.Y)fllu~d ,--.1,L.h SasscJLmi's profile: arc). The: subsequent
dbccvcry ot moditlcatiorts for s-r:x an{i type- lt'<l tu h:irJlt'l" J:t'fi.nt'.l't"li:T"lt. :1c1d .:H.:~.:u1::H':y,
oft.en a.pproachlng perfection of tit of r.h~ fc-Tcra.st to the: actu.tl. T1t<:: II~m<libk cm be:
forcc~6t inuc:-p~ ld~o t1~· of tht' CJ,",1U ci ~1 hl:1-St.

79
 Co
\

·: ·.

I •

80
 P::?0.JT::CT!ON M.BTHOD
-A.Re LAL J. 912- I 9!:!41

-t--

~~~)~
!.~ /
\•
•
.-- I
I

!
la,

~---=-~

, ........_ , I
"'- N -
~1~0
:.··,

~ORMAL N~8
RICKETT~JORECASTS

,' ...

I •

y
..
 The Cranl s l J~,:i !'.e:
Tht>. mandible expresses. iuc-lf frmn a (.Tl-JJ:Uo!'l sapf'L}Tl.. n,~ oond:-vleJ hm,;,rc:vcrJ
rc:sjdc-s 1n fa~ t~mror~l bone.. Mus.ctes :I.IT attached tu <.Tm1.J/1l b()flt."S. Th~rf'k,,·f'., r.wa
p1vc.:t"iiuri::s can oc i:mployed, but both rt'quirf. ;;i h.~-~ic. c:ranjal prediction. Our
posteriur. h~~ j~ the dimension from postt""rior cundyJi(m (Cp) to 'PTV. The ante.rjor
is -i::alc.c:n to be Cc to N~-~i011 . '11,f b:--i si-crc:.11ial furcras.r can bt" iI1c.kptnd~1t of ~ill dtit'
i:i:1. llLt>: ~k1dl And face:.

Maxllla
p h-e nom enon that kd Brodk -::o tht' ··('x m,..-; I.:) n L'~/· i i:-fr.3. was. the
Vl'c >r-.-.-1 b-ly l.h e
gnomic bcli.avit>r of lht' pa.lak t(J c:1,q)j.~.l fandm;;,rks {SJ\'). Gro:s:siy, the miG-fact::" i:s
i11d~p~:1ci~nl in behav ior of mandibt1l~r -:::-:fket:~ . .\-lu<:h g~~h~r '\.•.3.rh'don is seen in ,:he
lo\vrr fof.."t' th..an 111 LI,:=-- hpp~r· far-.e.. A fr.p_r rhc ma.xi.Ha ~ Ltt:i:1 luust'.ue-J ~ l ll ~ ~11 I ur,:s
•,--;,;i th m:.at.rnc.n,: th.c m.11uti bular l~'-t.h fnf:I y f:'.vf:ly its behavior to some dc:~C'<!,

"I'mh
:\-fancibuhr teeth ar~ FR··dict('.'d frcm1 the. i:.cirpu.s axis at Pm. ~fax.illary tc:cth
~r~ fort:":u-1.~l [J nm t.hf'. PalaLg,l T'lanc: at ,.\N'S. l3oth .i.r~<'ts ~iT.('.' ~·o=tH~r:".L~d al 1.he. oi:c(Ltja.l
pbnc- [Ind ri:...,..i.pn.:,c;i l fo c:1 cn~ I ~I ;'I. y & t<"J Ie:.

Soft Ti ssu.e
;\ft t':T' t.h.e ~[(..f. It'. L3.~ lLL'lLl'b:· and teeth arc prC'dicti:::-d o:i:iJy I II t"'Tl (':'l l', :l rm m~
I

prc:dictlon b-: con.stn1ct<:"d. N~ ~iQJ1. :m1 t':ri Of na:;al spj nc, incisors aod si tc,s. md1.('.' :;,r.my
c:h~o s~1ve as rekrc::ncc:s for grm•;th .;id<litiurn. Ch;~nge..:; .,,..,·ith (in?) function ,:r,•ich
curr-ti.:Hun uf u1r.1kn·x.-lu:,ions n1akt~ jt more comp!irntc-d to pn:·Jic::t. wllh f'.l<'.E.t ;:-.1.iUJd~.
 function #10. Grant'3 a Medium for Planning All Ttt...itme..n.ts.

11u.:· ..\,.:tu ~J Pu.rpusL mul r uudion of V.isuali:t'..t.<l Obiet.~Llve!ii and Goals

C:on.sr n.1c.tlng a vi.s u.al~.2.e.d rendering is nm. just a mc:anin~ss anisdc c::-xt'Tt±:i('.',
It h..,'1.s au i::-.xt rc•:n1dy \•Jl I, ui ht~ ust"" UJ h ~lp \vi th staging the m.e.chani~al trca.tm~nt. Tr.is
ii,, a po,n[ ofn::n oyi:-i-lookcd by dinkbns, VVith the" \-TO UT VTG, 11.wrillo-m.:'(ndjbul;;1,r:
l-ctdi.ox\~hi:.) has bi=t=n cc(r~.1.1:'_ci, .and & nev.. . APo ciscs_
y

Sequence
PIAl''liling i::t..-=i(ls. \v11 h n~~d~d c:h~nw-s in ch~ lffil.•er incisOT_ If the::: objective is
acccptc-d , thtTL hmv dot-~ thi:- inci.5ur n.('.'t"d to bt: d,~n,g,t'.,l? fo iL rL)n\•;:l,·d, downward,
h~c[.-..,.-;_:.9.rd, or C.L?"-1,--an±.l How does ii:s mm.-cmcnt affixt arch kngth and arch di:~pth? Ji
~.:rr- :st:1:n b cr.'tl1tr.111.pl ;it.t', L, h(),_,,.. \.,; 11 t.rc1r 1:-:.,,r:::·.s~ premo:a.r ;:hange:s arr1Xt .uc:h lc.ngth
':•·
.I..
and dcp1:h?

I•

.. ~'\ftc:'r rnk:ul.Htoi : n1 dfC".cL~ fJt1 .~rd, le.ngrh, I.hi= loweT molar is posidoned. ls
C\.Uaction ru:::c~sa:r:y aILd o:._:.gtt Lt?

·n,t' uppe.r indsnr 1,; 1fl~n r:;ilt·.11lat~d for mov~mt'nr rtP.r.derL Hm:i,v much
movement :b r-::-'.~uir.i:::-d, m1 d IL.Y.'r much ,.mchnr.tgt': h rn·~,l~d? \.·1 n:;1. 1h ~ It 11A~r b~
modJ fled 1:0 compromis.c the objccth.·c?

1. ,., ~tJy, I hr:: upper molar 1s vii::uali ✓-~d Irom i L.£ 1::a.,;e when puL in Lo a noi·mal
lock.t'{l Class I po::dtion. I kn=v nmch am.::tora!~~ b Ht't."UN? ~rJ'r\', as a fri::-dh,Kk, mu~(
other c.om promises be ma.de?

84
 Th...: L'ybt.":I"m.·tic Circle
l n. order to vi n.Jal i:7.c=: r.h is :'1t=:t}1tt':n t".e ""'i1h fl pi t:t I trt>:, Ri c:ke.t rn de"v<" lClpl!':cl 1.hc=-
..__-y: )~rr1~1lc rfrd~ as an ,'lb~t.n1ctiu:n ,:1,nd ::-.i::ductiun of th~ tn':;:it:mt'nt planning s~qui::-occ.
Th.~ order '"-'HS th.t' ~s.d~tal matri"l{, !cn-."CT aoch and 1..rpp.:r arch, to be: follo ,v~c. by s.o.ft: 1

:jssue coru·tdcr2.tbns.

BtoLo__o__i__c___B""'"'E--]fdV]o~

:-·

85
 TI1e. Surgical Obj t>:ctiVt': { STO} and th t Divine .rroportion
f_;.-..:.ti::-Ji~iv~ -~kek:al ,dtC!.ation c.:in be m,1de '."-'l. th ~lu--gr:ry. Tht' ::.L:"qui::-nn:· fur
pl.arming is the- same ~s \1 ic.h oflho~c:dics. but now :s mu.ally in adutts 1•/-11:::r~ 1,K'"\,._'th
1

a:1.d orthopc:di~ are ch3.nge.d to -~kele~.al C-...It.s .

'l"hol"' Div1n~ Propnr1icn {nr golib) ~u1) A1~.;ly~t-~ is _q SE'.p~ra:.e. ~ubjf'ci.. Hcwc:-1.•~r.
~h:-.: gddcn rc-'..r:.tion bc:•,,;,=-c-cn .fn:mkfc-rt Pknc: , P::.:ii.tt A. and Pm hi h:ighly v,~Ju~bk. l'ht:'"
hcighc of the lower incisor to A and Pm is of paramount value fur dc:nttlIT
i::--rn pl1:1-=.·t::1:nt'xit.

,,..--,.....~____,---

•.: .

:J

: .
:-:' .. •.

.
.' ..
sgyu~ -n~EN' CI .I\SS 111 CHAEA,{:;JERJ_.STICS
{N<JJ.' A.L\i\1 AYS IN EVERY PATIENT)

1. SY\1PHYS~S roRM (J.O"\JG)

2.. Oil Tl ."SE r-.-fAi\fDffiJ ,F.
3. \VE.-·\ K GOl\l_.:\L .-\NGLE
,1
""T . C'ORPCS T,R~Gl li
Cff'lDYLE. LJ::.NGn J
CONOY LE fORl\·f {KAR ROW SAGTTT ALT..Yl
Xl PO~ lTl ON rnRW..i\R.D
JO~T L"P\V_.:\RD _.i\};1) lO!tWAR.D .1:'ROM BASIO:\J
,) S?ACF. fl\1 JO!"NT lH1·11NlSHJ:ID SL"PE.RlORLY
10 E~CEfLA"f
11. ..\J\ThlUOR Cfu.\.~L\L BASE SHORT (CC-~)
12.. POSTERlOR C&\.."NlAL DASE SJ TORT (PTV-P)
Li. ~HORT .M.:'\..X.lLL/\ (IluKA)
M. ~EG.-\T!VE PALATAL PL,\ l\T,
1~- VERY \\'IDE FREEWAY SPA~
16. !...O\\.' TONCLT P{)~TTTQ'..;-
17. CR .•\NTAL DEfoLP.C'TIO}.

R7
 <;/ ADULT COMPOSITE N82

I
j
I
I

/i Za

Ra

..
i

,.
'

: ;

' :
Functio~1 # l l . F..q uips the User fur P'(acJ ice. Managc-mr.nt

\·V ht>:n an .;.rdstic visi..1:tli.z.ct) IH! ~ s~ Cl r- t.h f". present condillo,.1 ~ i:,, a vanabk:. in. th(:
10 ITC"l of .an ru-..a1y~~. ,u •c I --.vl I t:>.T'I Lhc image of tb: {1 h.j ~::l.i ves LS .shO\:i:.n, it g[)t"Ji n Io:~g \-..•a..y
iIL t~:::iting confidence in th~ t'Yt"Ji. o{ I h~ pa-.:icnt ,x pctl"t'nl. In addition, when the
ncccs~.ary X\10v~.-nlf'nl s arf. ~plained and m.{(tJjalt..-.ed on pa.pet", the p~d~L dt~ri'VLs a
ht·.1.1.e:r' i m prcss1on of the naturt:: of 1..he needed COXR'ct.i.m'I .\.J1d jts ac~pt:mC'<.'..

Furthcr, dmi.ng tn:~h.):iif'.ul .a..~ the patknt i:s moni ..oi·ed and the: p::i.tknt i.~ shown
th~ TI"'SuiLs Lo be essentially as ph:i:;u:i~d., a hjgher a..Ttd h.igh.:--r lf":'.,f':l of confid.encr is.
rcadu:·<l Ly bu UL tlc)C(.(Jf <11Jid !:'aticnt.

Ct"'ph:1.k,mf'.rri.cs in -.:his practic,~1 w.-:i:!, Cl)n:ribu"C.Ls to a '"flo·.•.:' 1• his. a tool for

miling th.:- s.al~- H is .!=.l.~0 a vehLcle fox- tc::i.drix1g I.he paHent th(' rt'sults of t.r~:ll.ffti:=nt.

ful.plr,yt".d cocrec.tly, pro.r,rcst....·e ce:phalomi;;.ttics can be :j 1~me:ndous wol fm

in-.:erna1 practk~ rn:u-kotting and providing ~cn'r1f':I h1ng tangible for ~llirL~.

Furn..:tion # 1.2, '1,la.11 i [e~ls; a Principal Tool for fducation

Communk.ation

Ed urntiu11 i.~ I :tn UHnoun t to corrum;11 ic:m i n-T'I. A.n analvsi.s ::.Dn un unka le-~ I .he
~

~:<ac:L nature: of the condition to tJ1t': dinician {<liag:nosb~. Ct>.phalometrlcs ?rovic.ks

i:U:i ac<:~s.s 1.n the literature: and to obu:r c::t1llea.gues for .sccon(l upiriion:c;_

Constitu tcs a L:Utgu.:.l.ge

L:mg,lage is R Iool of rnrnmti.nicmhm. Cb,-sil""ication .aids in th~ l,~;Jki,1g Mw'l)

of complexity. "\IVhen th~ 1.1!,{'J knnw.~ the. lang-i.Jaj:e. aw"t'd<'il t".S. thf: nature: of
po~'>i I)il i ti~~ .tnd c:ffccts. of 'trc:1.tmcn t, 1-::.n, r..vl i::dgi:: is lmmc-d~.ntdy ,iv."Ji Lj bl~-

1111: Es,;cn ti al Tool of Cfuucal RcscaTch

Oh:c;r.1'v:'l.:ion cf patter.ts in th~ cJ1,til' 3.nd comparison of bdr)l'_"t"-:ln<l-;l.ft~r models
or ph'..lwgrc.1.ph~ unly ykld ~~1~~:-.L ions. Tf dire-ct infoncwt.i.nn is d-.:slrcd th.;: only tooJ
(or sdent.tfic study LS ±t.: tool of c~ph.:,lnrnetrias. Thus~ th.:: u,c)~t S(1f>hi.~ti:.a.ted
mi.:thod o.;huuld he:- 11s.f'd for 1h~ hc:st knm,,,•lrugc:: tub~ ~ppli~.d..

S9
JV SUI\1.\IARY AND COl\'CLUSION

'l1•t' JJJ:Df)t:T ;:,1.vplicaL'.un uf ci::-pfi;1kJ1~h'.1 i"i~-:.s is 1.hr~..e•dimc.nsional and pro~essc:s

r]·,rough stagc:s for clinical -..1se. Seven m.aj r:,r proc~~~s a~ 1d t wt:':I ve: hm11 c:h t"h-; of
J1J tJ ~Ji ;';'l Li 01\s a~ de..sc:ri ~)e.(l.

Thes::-. pro,;::e:sses are divided into fo".Jr main alt'~s '.UH.l gru,~sty pert/1.itl rn
dia~;I".ush, pr:Jgnr.1.sb, trt"a\mt'lll pl,1n11 i ng. anfl prat."'1.ici:.: management.

\'\,'ir.h SUL~h ;;i "rrngrf'ssivt"'.11 program of cephalomenics the- ortlLcxlouchi h.a~ ;J.
tDol to pcr.son~.Uy find out ,drn.t he Pr ~hf'. i~ ac:t.ua.Jly doing c:Hnlcrilly wh:h c:mplo~tcd
modalities. F·.:a:thC!r_. objectives can b~ cst--'.lbJis.hc"'.i aitd 1:1~rgt"L'.', c;:in l"'tf" '.':l:':I_

The :skp-by-~tc:jJ '-'pplicatiOJ l I •t-rrn i 1.,; ~ffLde.ncy and comi:;c:tency, and provides
a c.om pet~th"C i2dt,c.

.Prop;~~s:i.ve- Ct'phduntc-~rl,:s 1~ Ult"" u1oJ fol' soph i ~ l.i ..~al.ion for orcl·.odo.:lttsts ln
the m:~=-.• milknium.

Mo"t p~:i:-~mVJl '-·ump111 t':r.i <JT f':cnnmcrcially la.:;cd laborntori~ adopt -ch-::
Pro.grc.·ssiye pruh'TclJI\ bemuse: of its bi ()k1g1 c- hA~t':, i I s c-ri nl p lf't f'.ness, th f'. in form a !.ion
ga t n<.:d from iv use:, and Lts soij d track record.

The Prugr"t"~::-ivt' p:::ugra,.n JJLU~i..., hmVt'.v~f, hf'. Je:~.fnHt.1 and l.mdcrstooc. en order
i:har the clinician can .apply ks full lxn..:H. t !:>, Comp~fr:ncy in the. me.1 hc-.s1:l r~q ui r~s, a
mi:t.i nr2 applk.atior.. and _prac.tic.P.. The dirdcal bcncfi,....s far OlllY.'C'1g.h tlit' dfort cHht.ilr:.u
in k,,mtlng.

k. L"Dnn-ec.tinn wi1¼ I.he c:Enic.aJ field, '"-'C ,;:an pnra.phrasc Dr. Ron-:.1.ld Ruth, who
'.'iL1 l.t'.!> l he t'~'L:i;~ foT ci:~p, I."J.101:t 11;·:1":n Cs s1J£:c:inctly.

The: Suatght VVhe. app1iaiK.e (or any ochcr .applimicc) v,.riil nut diaJ-,ll.!O~~ E~
('.(t.s:t-, v..rill nut dc:-vt:11.Jp t1. tr~a(rntul pfa.n {VTO)_ n<Jr design the mechanics

IK'c-cssa.ry to correa the maJoccl\1s-ior-.. This i~ the re.-.ponsibilH.y of the

onhodonrcst. Roth St.ar.es 'Assuming knmtlation of~ tho.ruu~ih ~ud
0

~(:Curc'\t(--.. diag.oo!'jh: =-:nd t.rea1J"o en l pl.an~ ac:q L1i l'i ng good patten t coc p,e.ration
and pcrlorrning appropriate mcdu1ltlc.o;, ~n11N:i;tt"l11 ly n'·lhnlr rt-'.':iil I~ sl1ci11ld h~
prod1 ].(:t>..,l. '1
 YA HA 11 IG.\1. 2000 CEPJIAI.O\fETRICS
. .... ··-···- ·· ---···- __ . __ _____
LA......___.TE__,:R,.__4
__L_ _ _ _ _ _ _ _ __
~-onun fun .a1. Hannonit
Crania] Base:
Po~teraor Cp-PTit AR-Cc-~ <P
Anterior Cc-~
·- . ····· ... . . .. . . ... . .... -··-·-------. .. . .. - - - - - - - - - - - - - -
1·1n nd i b nlar:
Total •·au:c Jldght {~Ve.Pm) Co-Xi-Pm ct>
Facial Axis (Ba~ at PtGn) lc•f\11-J\1 IP
Facial P!ane (FIT at N---Po) F·H-Xi-Mpi ~

!\ta :r~ll~ ry:

Pltlatli l Phtne (FH io P ll1.PL) Cp-PTV 4' PTV-~.\
{.~o,nve:dty (.:\ to .Fat4.PI,)
Lower Far.e- Ht. (Ans-Xi-Pm) FI-1-./l-Pm cJl

Teeth:
T.. B.Ocdusal Pl. CHllt (to Xi) Pnl.pl.-Ocd.pL-1t'lpL 4>
Lower incisor __ ( to A.Po)r1
6-1
Ar~h dt~pth .6. A- 11-Pm ct-
A '1olar Po~ition (P"l'V to
lntcriudsaJ augle I
1

Soft Ti~sut:
Lovrer lip to E Liu e sn-Xj-st -t> st-Xi-ppo
al•s tygn <I>
ll-prn-gn (})
u-ppo-li <P prn-ppo-li
N-pm-a (fl a-N~glil

91
 PA RAU] Gl\-1 2000 CEPlL\J...0)-f_JDTJilCS
.. . ____.. __ .. ___ FRONTAL
Conyention aI Hannoni~
Cranial!
Transverse Parallelism
Z-Z Z--.DA - Z
Za~ZA

J\·1 andihu lar:

Widtb Ag-Ag
i\-fidljue Pm to CSpl

i . l\.·l ll '.\illa.rl:
J •
Nasal ,,·it.Ith :'\Jc~Nc Nc~Kc $ 0.5 Ag-Ag
'"'idth ,J to Z...-\g .J-.f <P Ra~Ra
\Vi.:Rth J-J .J-.J = 80•Vo Ag-Ag

Teeth:
Ordmsal Plane P:lr"a.llelism
3 - 13 3-3.P6-6
4 - 14
6 - 1-6 6 - 6 I'.{} R5 - R5
B6 to JAg
6
! .
6
1 l 1nidlinc

Soll Tissu c: PJIOTOGRAPH

: .. k-st = a)-m
tri-al = Jc-m
~ h-ln = 4l A
ls-st-Ii 4'

.
: .
 GLOSSARY
PUlNTS Ok' Rl.U•ER£NCE
Tho:: c1na.tom:,· is. traced. and points arc cmpJoyc.d fir.st for the sc:Jccd on of pJancs.
for :r:de~t>fl('~ .-=ind ~v11J LJ.'I L..i.nn <'l.nJ, .;.t:'C~lXld, for i (k:~1 i fi c-.£i Lien of 1t,t"1lit ion.s u'Offt wlti<" h
dire-ct measur~:men t !:i can be .m.:1.dc fo:::- dctcmuMtio1~ of rda tioztships,
A _gkJ:-.sary of the pt':1 I ineJ.1L. l't'll':l°l:'.no.~s is appropri,H.t"'..:
lla (~~~iouJ - mL ucdpitru ccntC"r at the ~ll oo.se
N (Nas.ion) - at the sL1tur~ sr.parating fadaJ bones
p (Porirm) - .':I ,:t"X\ter <){ th-t' t~i1p0r~l hon~ T)t'iff Lh~ joinL.
0 (Orl±t..tk) - loY,'cr bord.::r of the organ of .sight
Pt a nl~cral la11chriark for (hf": maxillary !:lt.:~f'►'<'-
Pr (Pt~i:ygoid Rrtt'n''lK<"i - d(:'ep~st ~111 t,·:·.rfor pui'ut flt. Pt~a:yguii b
Co (Corufylion) - point whc:rc cond:yhu axis curs condyk
Cp (Concfyiion l-3(},L,1.t:':rior) - post.e.riormCJst poLnL. on condyJ~
C:o, (Cu: Ld_vlion :')upc:rior) - 5-ll'P"='.riunnu~t pui..nt ()] Ll'UILd rk
Xi a neurotrophk st te for Lhe mandibular bu~dlc
i:t I-H4 ( Il :rn1 Ils wi i:11 h ,'1 rH.·I ht'"i gh, J - p01 n ·.•-, t.CJ fi 11d Xi
il
&:.T. (bl.'.lmu~ IT!tn::ncc) -
Cn (Gnathion) • the central point of th..:: S}"Illphysis.
M {:rvki:ton) - lowt".T' brntkJ' () r th~ chi (I
Po ( l?ogOH~on) - anteriurmust l 1 unk-r. tif th~ cl Ll.XL
Prn ( Pratubcrancc: rnc:nt'.) • point m start of reversal line:
Sg ( S ubgont on} - re[f'.rence aL lo\...-e:e· border of ra.mus
ANS (Arn f":rl or N~s::.1 Spin~) - ~ in:=i xi Il.~ry f.f'fi1 few 1 h~ ,i;~p, 1Jnl
PNS (Posterior Nasal Spini:} origin fu:::- the soft pv.l.atc
T

Point A (MaxiHarv BasaJ Reference) at base of nasal spine

w

Ve (Vt'.rtj gun) - cc.ln-,trnct ed J.:NJin.t at. B:i.~i-Cr.u1fat ;i fL< l C:r:-..r.pu~ A-:,;:.c:-~-

Tr (Troi:::- r.adius} • construct·::d point C(]lli<list.rmt from P:n and Eva,
Cc (Cranial c~nkr) - l~onsuLJ.C:tf~d p(~cnL a[ Fac:ia] A1::ts cro.s.sing BaN

PlANBS OF REFERF.NCE

Cr;mi;,l,1
Rasi on -N :lSi on -- B<-"l~i-Cr:.u Lia! A-J~
PorionrOrbi talc - Franldorc. Plane
Ftcrygoid VertkaJ -- Cool'.:ii.na.t.c tD Frankfort from Pr
 Hic:iaJ
Pt~Tygoid Point-G:n atJu,on -- f.~c.ial Axis
N aslon-Pogonion •· Facial Pl.mt"
N~!:-ion-Point A -- ".\r.1ul Pl:-:1.ne.
Point A-Pogonio.n -- Dtnturi::-: Fl,1ne (R~dprocal Plane)
AN S-PN S -- Pr.1 lat.al Pfam:
Subi.,"Ollion~ IYle-.nton -- I\·1::mnibL Ll ~ ... Plane
Prowberancr M.enti-Xi -- Corp.1~ ..'\n.~
Con<.l\•Hon-Xi
-· -- Conolvlt.
,
Axis
ANS-Xi .. Org line {Or-:ll Cu<m\t)l\)

~
Bocc Bucrnl o~:ch.1.sal Pkn \t'
Doc.c Divj ne Occlmal Plru.1c

Soft_TJssJJ.i: Planc::i
p rn-ppo -- E.sthetic LlnL {c-a)

Soft...Iis:mc. Points
n nasion
µr.n pmn.u;aJ i (if'.) end of nos,;:
sn ~uhn~s1di
ls .sup..::dor lip
-St sL omion (lip embrasur.::)
li infrric.1r Jjp
sm(b) .supmm:::nti,ll
ppo pcopogonLOfi {d) chi!l: dimpl~
n•

gn w1:tthton
m mc::nton
k la.teral Cfil'l.dnLs
,.q l al:lr rim

ANGLES AND LINEAR MEA..slfRE-MEN'J'S

Tctal Fadal Udght -- NwVe-Am
f'ostaicr Cranial Ba5r= -- PTV -C p
Fad al /\..-..J.1; -- from Ba on BaN
Antcrior Crn:ufo l i;.,.$~ -- (;c t.o N
I ;.~c.i ~ l Angle -~ Fadal Plaiu.· fron1 FH.
Palatal P'. l:.nt' -- Pal.Pl. from C-l-l
Cllrn---ex~ty (Conca:dty) •~ A to F~d.~ Pls.n

94
 APf.>l~NOfX

0 n Di ~gn ru.i s and the Reasons for the

Ccphalomcnic P,tramete-.rs Cho~en

Diagnosis.

ln thl' v,·hol~ Jnt'c.iic.al-d.-:-nt:d fit":ld, d.iagno.sis in orthodontics is mriqu(..".

Di agr,osis in dcndsuy consists of the- disti~~hhi.ng uf ~j gn,"5 ;.ind :-:;yrnp I.oms or Lcsi.:s
iur '-' c.f,t.t:,1 st". T l'e.ei Lm.f'.n L. i:,:; L"i L~1-:. :1 pros c.hcti.c rcp1accmcnt or si.1rgic-:.ll proc~d 1.1:::,,

Oi .cign(J,Sj S Ll\ LS also dlr-:cc.cd at id cntm•:::slti0ll r::,f ,1 dj :,,;~rl ~ - 0r' h--i fi r'f(I ct1/,
fi1 e.d.i C:Lnc
but tfo~ .::-ti(1J r,gy n( Li-'1~ oo, 1Ct"J11 ~ :c:y:i.1 f':m 1f'. facrors. Orthopedic mcdidm: is invulYt::"d
wlt.h body dcformationsi in~urksi bums, ptltit\l~ rmd tl,e t"rftc~e,~t. functton of joints
.rnc1 ;imhs.

ln orthodom:ic5 the diagnosis and trr:.i.ltJ:' ll:"'llt r:".fli,.'li I &c:isions rega.J"dtn.g

m·urvltulogit·. rf'.l::itinnships. Tht>: diagr.osis starts 'i. thh th~ rdati,JI1~.hip uf the:- li':~!h .·m d
1

~o::-s in t,"r'"v dir-i--djorn-;: nut.-..w1rd tot.ht'. Bps .:ind cheeks, bt..:t im:i:.'"3.l"d into th(." j-:.lv,.r~, th~
cranium. chc ,•.~•ok head m1d rn:t:k. -:.lnd pt'rh.tp:; t'\'("'ll hidy posLt.tfC:. Bi.::causc csthc:dcs.
::ir1d psyc:hofogic factc!"s ar~ involved with spc~ch. .i.mt m1111::·-ro\1s s~K:i:1biologlc
Sin.c..-ti0r1~, (h:jgc10!.is h~c-.c.ml~s ru,-the.r complicated.

f Ji agnosis reqllircs kno\'-1.cdgc [dif-1 = through, wi_..,!i.lS :-:-:: J.:.ft0\.,·led~ j .

TI,c fin;t ~ha h•, onhodont k ilj,1gn0si..,; i,c, 1.0 d.cscrjbe. the con<litions prC"Scnt so
a,,; to distinguish the: nar.urc ,:;if the. s'.>-:-:ki:.d, d~ntu.l •.mJ t;u{l litil'i\r~ i11 a rad.u..al
rn,'UUlt:'"J". I 'rlJ· cornpl~l.f':n~fi :-rnd dl:":t;Jl ~phalom..:t[ics ~ employed.

The sc-cond purpose in dl.agnosis is interpret aitio.n i if t.h r mndi Li on:. de.sc1·tbcd.
This e1\l.:1ils 1J~~ de:Lerrnination of the c.omponc:nts o~· a m.i.locdusir.l:n :~~ r.,nnp:ir·.-,ci tn :1.
standard or a mO'i.'tn frnrnt" of rcl(:rt"lLCt' -- h~lc:e the: 11norrn~ conc:c:pt.

·n~t' llurd v( oxtbL"M.lunL.ic diag;:-.osi.s ls. the: dc.dsion reached :-.-:-garding tfot.
.-:1,~Jlc:'d
future outcome -1,.·h.ich is ad-:..wlly progom;.-ii.. LJfl?.dif'.tion of both short- term and
l11ng-rr.rrn to mar.urtty a.rf': to be. mnsidcrcc., wh(:th.c:r it be: intuiliYi:= ur li.~t'D ln-::vH.dy
performed uu t>ap:-:t:, Tht'" ''pattrxu" b~cx-imt:'~c; A ha.sis fur the indl~'"ltion.s of things mmt
likely to ..:om..::.

Fro m J 6-2 rnr::-asuTcmcn t ~ stl1Jkd ._.1 hm1t 60 ~1'f'. c:h osf.:n as a comprehensive

9S
 t.uu1pt1ttT program to sarls:ty 1:h,;:: broad im.crcst in r.hc pmfes~jon. Thf. underlyir:g gna1
of the resuMng para11le.L~r· w~,.., l.o ~1l~hlt> 1••ht:': dirllc:i:m t.o ,lr:t:l!:'T.l"-a:nt:' tht:': cnmp')Tl~t-, of
I :lf' iridi,.•j(h:~l prnbJ.-:-nL iu the dbgn~i~ ~nd prugno~i.5.

b~ or'<l21· I.L) rt".d.11(::: -: tJ1.t:': p,1r.:.und~ to ..l pnidh:.n.l rm1tint"'. 27 mi:::-,1$t1ri:..·mcn-c~ ~\"'"crt'
tal~1: 1 5 in the- lat~al and 12 in Ihc frontaJ. i,.vith thrc.c: Iake.n bilate.rallv. The.
s~l~ct~d ~· alu.es. "\';.~re r.e.ste.ci (J\'"C:'T si r~ri od ,:-J[ ~o :re-.ars. 11\ey ¼'t''{"~ c-~mclidiy -;dt'Ctt'd as
fo-·t: r.}f Iii,., s i!.i:; pr~'::i;l hit", :ind e,lch has a ~Au:po:sf'.' or a rc,l:son fur h:s bdng.

~ 3 the.rt.h.:m ~nte ring it I hi dd),lt.t-\ l h,:: fun,:1 ion :Ji Id 1n.1rpu5t' llf ~., ch oJ the 2 7
parmni:-1:c:rs. are now dudda.ted.

:HE IATERAL SU1\1J\.1ARY &~ALYSJS

L ·n I h~ :i;\.eletal p~tter.l.l. .lRJVi-'ll.''.i !t..~d fivr::: (.5) ptrr::_met~~. AU ,ver~ cfom.gt"'d in

smne H,,u:uter. Sub~N]lK'nt~y. nine- (9) arc ILO\'i-' deemed to be impcrati.vc for
determining the. skclnal CDmpone.nts to a ma.Jocdusion.

SKELl:.~.lU...
Purpost· Paramet.er
' .

L · l'ol&l facial heighL _ _ _ _ . Cotpu~ Aifr~ .Pm.Xi t.o Ua.N

Rt'11w1.l~ Tht' long ox- !ilhort fac~ is of prim. ary mtt'rt' st h :cm.1.sc faci:::-s tend in
?,rov,.rth to '.' ary .:1 round d1€: origj nal pa.tc.i.::rn. H mvcv..:r, exccssi'vi.:: fa~
height is not 1-.~c.e_~s~rily c..r,nrlt""..-1.~Ln:l wjth o~:ien hi1.e. nol' s:ho·tL rrl~~s with
de-c:T bit~. More:- cf..tirnl is 101.-,..~r fa("('.' hcight b«au~~ thnt ts. thc-
immcciia,c dcn::..:'"ll :::nvironmcnt. One simple angk dc:scribc-s total tac;al
heLghL 11,~ rl);t";::t.n :tu.gle i.:-. fiW+:UY'. Thi.s nn~ .;;ingl~ fJffJ•.·i(k,-, .~ q_11ick
fm,l eJ:lf.:y way to dt~pict bn1ch)f.,drll p.:.atten\~ ( ,er= rnng<:") or
dulichofo.dal patc.cms (7 00 range)_

2. T.mver f:u-1sJ hf'ight . . . Corpu ~ .,\ tls to Org fuu·

.Rc-.=i.SlOn~ One- sim pk: a.ngk:. describes vcrrkal maxillo-mandibular relations.
The: J~ean is 1-6~±-~.0''. 'rh~ pmpon:.ion be.twe:e.n the: t-.-..-o i.s aroW"ld '/6%
(or thn:e-fourth~}. Thc-oretirnHy ~ong-::r fad...11 hcighu h..avi:- high(::r l~\-LT
face valuc.s to be jn harmony. Bu.t if, for lnsc.:ll1.c.c, c.he total fa~ l.s 600
,◄ ml U1.t' dl:.'".J:llm~ hdghl [o 52" lht::' rnllu lo 86% wlui:.:h rni:::arn-: -t'.",.Ct:,fr,.,t'
~O'i-',TI face on.ty. The relation .serves ri.s an index: lov-..TI fo.cr X 100 +
c.otal fa.~ = h~ighL i11ck'<. Thj.s. ruagnosis is !mponant LO the gummy

96

' '
3. Cc.ntr:.l focial direc:l.io,n . [=;Reial Axis to BaN
H.t'".-;isnn: The: Facial .Axis j5 the: bc:st ttJ.lttaJ a:.,df. of the face in tc:rms of
pn)Lru:;.ton or ~trusion of th.c chin. Tht' 1rn•.')J'I i r1 L'h~ Llu.i'.:~j an
ptrpl1btion is 90'"':+-:.'1 .(}..,_ Mf'3:«ilfff".d from Ba.sioa a r~arJbtg uf 93"
1ftruc.atc.s one clinical dc\.'iation farv..·f.r<l. Tht?: most common axis in Cb~s
u is $9'". V .~Jue.-; ;"j hc-v~ SI{).:, fa\•or 03SS I <.k'Yt::'lupnl ffi I . C:!.11:,:;:,:; rn mor~
typk.='.lly is 9.5'=' and D.b°"~· 11l~ I·,K:ir.11 Axis dSsi.sts in dcscdptiOT. r;f facial
l_yp~-
1::.t ad ditiun, Lht' l',i., :j ;:iJ _,i\ ~ i:s r.1.~.nd.s rem.ark.ably to be tJ lt' g.row1J1
ax• s;_ Jt u::nds on av~rn.g-c to mr.>vr:: fo:n-.,md ::-me degree e~ch sc:vi::n years.
Th t>: :,:;1 :"l r1 cfa 1-d v,-;i r!a ri on i l'I rurccdcn Wa5 fourn.l l I t be only 2--= in !O years.

4. f.!lc.ia~ depth _ . . fadal Plane to FrankJ'ort

Rc-ason: Thfa ,.,.·a:s fn.)Jn J1( )wn:. aad i:s r:h c. be~-c dc!!!crlb~-1: for ptogn st.h i.,;,m of the
chin. Ih1t tru~ Puri.on h ns.t>.d inslca.d of the caT ruJ. T1lt mi.glt:"
(~hang-es •;,;ith gro-..,,-tli. 1° c:ach b.rL"'.' yt'\'U, ,tnd ;Jitima~_..,,v reaches
90"± :U)" iri Lht'. ilu-t'1nal mai::.u1T male. In adnjt re.nial~s 11. stops ~t about
SS" tm avc:.:-ag~. Iu llrrt'~)'t::-:tr-old.°' Lhe aE1gk: is no:rnally 84~ :.1• 3,(r·,

5. Conve.xit.y . f"oint A to Fada1 PJanc-

Rcason! Point A h \1,l"d ~:,.; .Ii ·u l,◄ ~;IJ;i ry basaJ rct<:rcncx:, Its po~tion rd,tt.ivt>. to a
straight line (:---'To -- th~ fod:◄.l pl:rnt:) j~ a superb simpl(..' t"xp,:-essio.o. of
bori:1,0ntal maxmo-mandibular rd..""-ttion.ship. Point B i.s alveolar bone:
i'.l.::l!.L ~ 1ut ~hJt:":t..:1 l or b~:,:;.1 I bone. Because: thc Facial m I glot". ch :-rng.~s whh
age ( chin for,.-..-aTd) ..mJ P:_ih• l A tt-n,b to move directly v,,rich N as-iol'.., th~
[<lei al convexh.y normallr red ucc-~ ·with w:Jwl h. ln fe~.ales, by .adu1thood
2 um1. nf ,·rn,,"C"'...,ll y i-:c; ide,;,.l, -..i,.tierc:as males. partin1lady ·,-..·hii..t'. 1.n~lt?h(,,
u:nd to _gIO\Y to a straight prnfi [t>. 01· 0.0 mm. Norm:.'tl chlldrrn nt age 3
years may have. convexity of 3.0 m1n.
Convt"Kity l ti ,◄ ,kba L~d issuc. in orthod ontko, Tht'CJ{t':l.11~~n~, 1h~
stTaightcr the fa-cc the mort: up1i~!1 I. d~e. Al'o plane and the mor-=:- 11?right
1.-h.~ Jowt".f i r1 L~i sot_ Th c: d1okc: is to n-c-m thi:- t i.-:t.1 h to t.hr. rn 1wLX,1v or ✓

corrrrt the (XJHVt:v~ t )' ~nd t.re.at C.0 r:he. IlC'i.\" rnaxillo-J:(UJ? td iln.1lat
t"'.ond.h.l on.
/ii,{; ;i dv·.c::l for imerpretation ot cunY~.ty, t.he. !\'-Po111t A [jne is
usc:d as a 1'na~<:tl plm 1.t::" ~IJ Id r'f' 1.'1 L~d rn ;:-.h~. Frankfort Pla.r\o:, l<.kally i L i::;
11

9lY'±2~. Point. A is forvt.•ard in typic.nl C(a~~ H .-;ind the nasal plane 1.s
comrnr.>n.ly tJ~1<.:.kw,1rd in Cl~.:=...,; Ill. TI1is means that t.ht:' ~n:Jxill," ii:;. ;51.,-,

97
' .

ess cntial componexd l n. th f': c:b..ss..ic ma1occl uS1oru:,

6. Ramus heiwtt . . . . . . . . . .Ylandibufur 1->iane to Frankfort

R:>P.tson: The. m8.::1dJbula~ plane i~ often (f!l.:..~,) a~ a nli.::a.surc tc di:scrih~ dl.iit
pu~i t.111n, bul i IA~ i'ea.l function is w indk,:.m-: verlical height or position
,.o
of the runnu. lt h.dp-, -1.if'.fine. fadaJ patttn'I.S. ·t1\t' 1l11 gl ~ ls ea.:·,ily
mt>.a.~ u.red off a righ1: angk to th~ Pt t~ryg<1i d V crt.ical Plan:::. A mt"an 2 '/ J

ang.li::: h pT-t:':1'>t':i:,I .')I .9ge: 3 and reduccs ab(iut ().6" e~c:h year '.\.ith 1:hc ardal
i::xprcssion of J}I'OWtlt uf the n1 ,mdi bl~"! LO abo Ltt 220:- by .l.d t1Utv.md.
11lt:": 1~8.i n value. of tt.e high n:w lL( Li hub.l' pla.n.e is ,h,c1.t it m<1.y her,1 ld
a ~ick c:r.1rnlyl-". 'llu'· v:1:-i;11ion of the ru:1.r)t- at z.3" is high~f th~n \'tiOLtld
he dcsi r..::d. for a defuutivc p~ni.111.t'.l.t:":t.
I .nng I.aces can be i.ong, trrpt"IWI i,vH.h blgt. 8.ngk:s, or oblun.r, 1,.vith
square: IIk'lIH.ii buGr t)'V~A~ en· k,w angles.

7, Pt.dalal .Plm1e l1ositioo . . , . Palatal Plane to Fnm.kfo.rt

R:::ason: The pal.aml plant' k,[)l:ne<l in import an.cc 'rYht'n i.1. v..·:is rt1 s..t.:overed i:h.at :he
floor of the nose cru1 bt'. 1,:fou\ge.d. "in growin~ chlh.lren. Uy d1.:mgir1g
._ht-: an Le1for nasal spine the- nu~e ls d 1."t1ig6:i b~a.usc the spine i~ a
platfor.:m f-t1r th~ c~n.1hgc>.nous ,'\.C.ptcm. The ii.rit' fJ()m. .t\n:-- Lo Pos js
.. nKMillcd li~isl" from t~ p,....r-p~ndj-:_u]a.r to 1:hc Pttr.ygoid vt;':T"1.i ui '..
'
The. normal palaul mi.glt"": is about 2'-"±2° to the Franl/r_1,rt 1il.:mt".
Thl~ .;u I gl~ j :-; u~J.l ;..(J hd p dcti:rminc:- na::.!:I I <iy:,:;plasi a.. IL LS also
combined ,•,ith tbt" ot.,q I gnomGn in d,;::sc.:rlbing u Hl xi llary (':h.ara.ci:.eristics
he.:ausc the 1,.vhok p.alatal 1.1larn:-: c:i.n b~ le:\' cl but :;.till he- loi::atoo
su1*-ii1.'J1ly or infcrtorly. \Vico 1:he whole. p:-i~~te is superior i::h::: gunux·.y
~ui.il e tt'W.: :i-; to flc=-ve I,: p .

.8. 1-'osLerior CraniaJ length. . . PostcdOT Condyliun to ITV

R~,lsr.u1.: Tr.h rn~a:i-.1.ux·uu•.nt. dt":c10LCs c.lK condyk and joint relal1on or position i::o
the coordiru1tc conLpln. lt. Lo; a n1eai1. of J 1 rru:n. ~ t ii~ .3 i◄:i: ln gn)'l.v.-,
O.:i mm. on a-vcragc per yenr.
.ln Chs~ lJ ti. iii o[cen long~r and in Cl:is.~ [JI it is. sho1'Ler. It :also
,;,;as suggcs1:ed t,_, lx a~~(.:i...H""( l l )y ili:i.::p bite. during dc-vcfopin~nt, u u fvin g
more dLGLally. Posterior cranial dq1ll1 is a ..Gignifican.1: compon.:::nt of
m,lk1cdu~i oi::..-. t :{"1 ng :c:horr. Ln Clas~ 111 antl lo, 1g C:kR;~ .Ll ni ~;:in
com posj c.cs.

9. Anterior Cranial kn,..,ith . . . . , Cnmia! centt':".t (O Na.sion

Rr.:=i,~on! Th~ maxilla js suspended oit the- m1k.11tH' -t.:.taniai floo:. Cc point b
 l°'.OT"lii Ini~d fn1m Pt potnt foc.:Jtc:d at fornmcn rotund um on the base of
,he- great ',"ing of the .sph-:noi d_ The k::i.gth r.o N i.s take. n to rf':r~~~n 1
c.h::-_ hofi.;:,:oE) 1..1:11 tliHlt.:rn:-iou 1.ff the .;-mttriur Li~st', but H is oblique on
;N1:·rngc: 1 T to the Frar-ldort horizon ta!_
\-V}.. e.1"l 1.hi.,:, lnt'<":ti-:;ur::-.1i1~rH. is 11 :rig i I. ~,~~xii.r1t:";; r:1 n:.w-110nc:-nl u{ Class
l I ~n"-i when !ihort it contributc-s to Cl..'"1.ss HI t,.-.tu:n the mrudJla is
nom1ally rrJat.e.d to th~ ant~rior c:r:=mi::il h8~f'.}_ Tim.~. shorl.nif''.':~ nn hoth
end:c; 1~ n.~u:unc}n in. CG5t. Hi (l:u.J lox\gnc-~:s is typical of a CL.us II cranial
c{1mpontnt.
Thi:c. n~~ti~u~i:~lt:':J:tt 1.-.,. ,~ sc-1l~iblt' t::-ot fur the poition of N;_;sion m d-..
bu !,-i ~ fr.,r the Fcldal Plane- origin. In some- pa ticn ts the cranial base alone_
c?n account for om""!-hal( 1.h~ mnrpholt)gk: :;kd~tal dy~pl:-i.~[<'I,

DT:NTAJ.

l.)(.,,~'ll!; cho:::i::- fiv..-:: para.met..:rs for the i::ee:.h. Four c-f thens. ~\·e.rl""-: .. hang1:":-d for
lk!>cri p:ivc ?Urposes for the: present. su:-n mar_y anfJysi s. One. ffic:j :i::urt'i: 1t':T, t. ,,,_ 1:::-; ,HJ ded 0

for .soft ti s..s tie.

10. Lm-,,'cT incisor positjon (hori:,.ont.ally) _ . _ _ _ l.ndsor tip tu APu

Reason: 111e ~owec iT"li.".lsnr j;-; t.ht:". ftn.t. l,~y to dental cmpl.~ccrru.·nt. The rdadng
fif 1 ht"' k:1,v~r hu.·t!>ur to -1.mtcriurmos,: skeletal 1mdmark.s in the ja.,,;.rs
th.crdorc- relates to a. r..:cLproca1 Hne__ Th~ frl{H~ 10l'vv8t'rt 1he. A puiut th~
mo roe fo.rv;.iard is Lhe. :1v~:r.f1~,t"- Jov..re:r 111 dso:( i.n i:mn:rrn I '.KCl~.1 s-ion,
Cc.mvt'.rsr:I y, th.-: n torr c'JTlcavc- the face !.he mori:- the- lowr:r inc~.rnr is
retropo~itioncd to be in hamony. Oiffere:nf. l'.~ces on :h--~!'age dt.foti tciy
hav c. dj fft.::(~i\ I '.-11·noun 1 ~ c)f dt:"J l l.;_il pn;,tn,~iun.
· L·hi:-: ;i-;h1 dy of <.l :s,lmpk ot 15 childr{:n, mixed dentttion, age 9,
~'r·rth uonmtl ocdu:sion, r~•e..alcd a m e:an of + LO mm. io r t.hf' kw.·~
incisor e.d.g~ Lo thf'. APo pL-:ine. 'l.'ht ,·ui.gle w~::: 2~". On compru.in,v, this
wd IJf' 1.0 :1 tfo Ito; ,.,_rlth tl•.i: nLo~ aC'-""('ptabk rdations it -.:.va.s found to be
c::onsistcnt, The standard ck:..•i,;:_tion 1n C:-m(:.;.t~l,ln LK'dn:•;i()l~ "\VI\S round
to be. +2_5 mnL Th~~ v,'\lue l-ws ui:~1 cmtsid~ by thl'" author, since
! 948, to bi:- i::h~ mo.st ideal as an Db jec.tivc j n plannj ng H~8 :.ro ~1) l-
Curre:ntl y m aoy ci1 nid ans pl"f' fotl' il n·lr,t.i (IJ) ~hip of + 2 ;~ 1, In
bt-1(-k arn.J (JrkuLal u1tt1. ~h:: me-mt \Vas found to ~c- 5 mm __. a.s s}.m:i..TI bv ~

~c:zu_ The !ui.ver inCLSOr L~ a bask SL.f.rting r,oinr tor phtnrung H1t' VTO
.an,l c3lr.ul Q.L 1cIg :ind Io{:1gc:- fo;:- l' ledwuk~- TMS? i!> one rcasc-n for
ant idpa.ting ( or forc:ca.sth-tg) the ch Ln post Li<J n rtnd ma:<i.llai y :.i Il t"..r~ lfon iI 1

99
 the- cybcrn.ctks of the VTO con sc.nH·.t ion_

I 1. lower in4..-isor position {vertic.aHy) . . Indsor tip to nur:cal Ocdusal Plane

&~ti()ll; 'l. h::'' J°H~ h 1.1c~l ocd nsal plant igw.~s thf: i ndso.rs which arc- influt'n{'~d
=••

by pt:"-n·~rttc l li.p fmK:!.i.OfL The bu c..v..·~l plaot. is .a f L.lllctional planl' ar'.d

for dc-.scripti0:1 th~ ~,Jwrr i nt~1 S11 r e<lge: i.s csscntia.Hy on t11.a( Hue-
l n C:frns LrtK:1.Lon of a VTO th.~ hm:rn l !Jl ::i.ne can be used but for
gr<'~ ttx sophi~tic..i1 .ic"JT'1 in pfa.nning. the- divin r::- prnpol'1 i11l"I from A to Pm is
c1·,a.fvdo us. Point A to lcn\-er. ind ~i)l' ed.g\.': LO f'm j3 a divine- prfJI-H1rt.i o,L
Th(:' im~~m 1.n J-'m i.,; J .Gt S the- hd.ght tll Poi1u. A. In gro~ir:.g children
-..dth .shun lips. aJapt~iLi1.t.O cJr c.he. Jp to th~ divine h6glit or Lhe lm,,'C.r
i11 L:j sor has. been noted to on:i.1r ,.vi th ~ . . . ~lopment.

J2_ Upper molar pos:itiun . , . . _ , , Distal of uppe-r molaT to PTV

R~on: ·rhe dtrect distance- from t ht" dh1 fj I (1 r th f'. up per Erse. mobr tt.' PTV
c.lesc..~.6h~s mo(ar position_ Obs.-:r'i.=-ation jn 1.ht>: J950s suggesi:.ed 'Chat
-che 1-:ppcr [~c molar:- id l:"~'1 Uy e:r ..t.p'C.S at :he patku t'.~ c-11 m~"1:oi0g1{'. ;::ig~ in
mm_ plus :3 mm. (i...: .. ag~ S + 3 uml. = I L mm.). h: m,airi,_tain::- tliat
I
( .
' ~ b I i LITlS h j f' UC) ti I grov,;·'(h stops bt-:ca :1~t": t tJ I:': dr.1: ture mov·es. fon.,;c1:r:c!
1..0 mm. pc::r :•ta.r. A n1mnal posjcion does. not ni::--<3n jt (:.c.111110t t)f shotiid
noc. be: mo\=cd diH.rilly but l I do~s s uggeH an ul timati:= Emi.t.¢"c Ls11.'k~ ror
third in ola1-s.
Thi:.;; hrJwm1.:~l m-.:-:as1,.m.::mcnt of th~ upp~r ffll}laf ,">'ilS th~ .s.:cond
.mo~'C frc-quc-ntly ("')r:rt:':l.:11 t".d i i1 the. 362 mcas.m~meut ~ (>f 1. hif' LYJrn put~J-
11
,', l ud y. fo othc:n:.,."Ords, k cul"r::-fott:d wi I h form anci SLZ(: of the p.utti::•.:rn",

l 3, DqJth uf lo\\'tr ~n:h . _ . . . ~1tshiil of molar to j nds.or tip

Reason: Dep'Ch of the arcn :rom il1J_·i s-i_:, tip Lo the molars is diagno!:i-tk and ,-.~~ds
1. 0 hif' t':O rrd.:.1tP.d ~H.h ,J1e. den ta.l mudd. Thls mitas.u.rcm(:m convt-rts the
info:r.01-atio.n fro.01 the dental cnst to tht; ht~:ld X- r.a.y·_ H ow~1.--er, this
parameter for mch depH1 j:c; ~r.rP.m~!? u.sefu1 b phmning dt11.·.ui:~
em1.L1.c:r_mcnts i t1 d1~ VTO,
J)ut;": tc, ~nl:11·gement in the X-ray thi:= m:·ch 1·leri1 h mif','lsure.me:nt i::;.
l argi.::r by abo u.t 1 mm. ::non:: tharl 1.h~ act.u.a.L 1n norn:tal arch fom~ tl1-t"":
d~p1.h -r.e_ph:1.kJm~rrirnly is .approxlu•_;il~ly 1:3 ..5 to 24 mm_ Size of the
tcttb a.aJ i:ln.:h fonn art' \.\,;i{i;::ibles_ Tn c::.\.-c:raction '.:,1.:s-t'ti :ht de1~t.h is
rt:=clu-ced r.c, a mean of ll.b-'Jut l ~ : nm_

14. Uppcr to lOl=vcr incbor , . . . , lnter-io.ds.8.I angle

Rl:'::ls.iH1: rh~ in1.f'.rin.c:i:sal angle is carried cvt".T. tmn) Do~,.,·ns.. le has litt:c:· vniu.::

100
 CX<-"C}'t in planning .-1nd oonM n1c.ti0n <Jf 1.h~ V'r()_ Ovt.rbi:tt" :md ovctjct
o bjet-1.ive-~ ~re 50 .stand.r,.rd at 2, 0 mm_ th.ey nc-cd nor be mca.s lu·cd. Bue
intcrincisa1 angl~s ai.: tr~acment's t:nd 3fe cfilic..,ql_ '11,e mean goal :flt
i,:ea~nie-..ors e-ntl is 126''".
Trirr.orphk anangemcnts ,,.--cr..:: found From rcseafClL For
brachyfac:ial far-.eii :)cl([ J.:-tOlr~,s-ive types J2.(r' to 12.3~ ,-v<l.S fuun<l. Fur
lCJ1_t.g fac~s .nnd Clas5 Ill a.ngl~ of 138: m 137' .,,,,~re a.ppropiaLe_

1_-j. J .Qwe( Iip p r:-ou·usiou . , . . , . . , Lowi.:r lip to E 1ine

&as.on: Esthctics is a ma)or co.n c:cm in o rthodonci c.s. The lm.'loTel' 1ip i~
infiu.enced by ho!h I he. I0\.'11f':r and ,•ppe.c i.n.d!iior_ A lh1t■ , fo·~m i:-rJrt
ti ti~Ut:: t·Hn to the end of the nose , has s·crvd as the b.::.n sl ngk: Ci.::f..::1'<'. n ce..
Th-c lcrµ.•..:-r is. ideal) \ r about 2 mm. cJoser tD the.: line_ I·::c.th t":L.1 L. h:"trrnonv j 5
•• J

t.emli~~<l. b_v .ll'J>t' k·xigtb anJ fadai type. llO'"LVL\.•er, ju5t as the lower
fod::.or h ~ basic r.:::krcncc starting ? Ointi the lowcr lip becomes a
starting reference for e:Hhedc e'-"--alu.alJOtl.

'!HE FRONTAI . SUJvfJ\'fARY ANAlYSlS

fXJ\JL'l\"1 c.>ff~d :i: lo frontal .nnalysis. This ,..Ya.s p055ihl'y dt.K: i::.o lack of
hlrcrn11;.1t.1.m1 ~:nd lin1.h:cd interest in c.ra..nsverse phcnome:na.. H Ol".--evec. wi Ll1 1.h~ ~dvnl t
of palatal separarion, c.hc. fo1 ding,-; o [ :ifIt"J :~Iiu n t )( J.llo"-i:tlll:i r.y lia.:;c:: l n llm:'t' llhut"! L~ions
with certain df'.vi C:i?~~, .:1.n<l v,.rith 5urgical 1111:~rvcntion in both jm'i.rsI intcrc-st in the
fro u.l,il bt:\.·,uuit profound. l'viorc than three. of" L\•o(.ry four 011:..hod.ont.ic p..-;ir.if'.nt.,;; ,n'f'
involvc-d \.l'lth the- transverst= -di ,-.1 t'-:cl si(JJ) . Due: I.ti l.h t>: di ffi cult.y ( Jf _rmn.1ri-:i:· g i d~ntical
films, direct rrr.1n:TI?f:r-~~ mc=-;'i:i-rn:-:>ulr:"i tt f1rr:· t ht Jno:i-;I u1..15h"r'orthy. Chc1rt~ for
<kvelopn1n1f~l v.:-:1h1~:; nec-d to !:,c consulted i: the comp{JlC.J programs an:: noL
,w.;;,ibbk-.

SKELETAL
Purpv~e

J.. ~.1SifJl t.:.vttl wit.Ith. . . . , . . . , . . . _Kc 1.0 N"

Reas-on: Breathing- spac~ .qnd ni::1-,;gl !,.ynu.nelry :l.tt r,f ii:.nmei:Ji::itt' c:uw::ttn. Alr flm=-.•
I hm11gh I lir:- ~1as<1.l ca'-ity is ot interest to mo.st clinicians. TI1E piTiform
aperture i m. its lm...-c:r ~)01tlcr, i.s thl~ ba..~ fol' f;11~)p1)rt.L Tl g rft\1~dl':s (){ the
LLpp~r lip e..i.UH·:1.i,·~dly. Th:5 ,u:-1;'".:1 bt"cc.1:i:w:::~ ,~ corn::e-m for many clinicians..
A uirt'<.1. mcasurcmcn t from the inside margin of th f': t'i,>m na.~~l
w.'l.vitk~s y]elds an e-,.:press;ion o( na~al wjdth which naturally inCRasc.s

lUJ
2. M;l.riilsry width .. . _ . . . . .. . . Jug~e LD Jugalc
Rea.son: lnter Jug,.d.-:: dtBtt{n('t' i.~ c.~ken -r::o rcprrs,:nt thr. h~i;9.] hone a.n.d hcn-ce
transverse dimcu!SJofl.S of the mm..illa. This i~ compared to knr.:n\'Il
-~' :-lnd.,.rct~ ;;ind to nasal and 1mmJiL;,ul,-tl' i.-id~\•~dua.1 tranSVt:"r5e -dirnt:"J1si:01"1.~.
It incrcasc5 abo1-1t LO rnn·L ~·dth na.tur~l i,-01r,-th ,'lL:"H1 ing :a 55 mm.. m
.'lge 3_

3. M:t ndihular v.ridth . . - .Ao.1 if':gon, on to Antc:bronion

Rca~on: }1,.11 ~x 0.-e.sslon of "i\-Tidth of the fr, andihlc ls desirabk at the lr:":vt:':I n I tl1e
teeth. ' Thi:"': (~rn'"Ji ,-'.tJ a.ngl~ fhrcs in rr~ks n:r- iii Cl:11 in fcmaks an<.l b.
postcrior rn thL rn:dui0H; 1rlt'.E:ISL1Jc:mcnts from th.e gon1~l 1'f:.gion ,,,-..::re-
, m tw,--,duc.c.ive. Os;:eologic s-tudif'..'i showed tha.t -chc triht'.dr,1 l t':TT'L1lll:'.llC.-e:
W[l:t;- pr..-~t'11 I ~I ,h~ {'.HIV€': of Ih-::: C}.-Cerm-t.l ul~Hc:1_ur. ddgc. dlrcctly bdm'I! :hr.:-
molars_ This -...•,c1.s fut11:d to b~ visible on front.ti him:,:: :1nd vi-'.:l.S jus(
..'l n :erior to the mand ibuhlT 1,<l IL~h. [r. i-~ also raken ~s a lli)'t:"J" ,A cur l.icill
bone: ,..,_.h~, thc:- not.ch is .shalla,."i.', Th,;:- i/uinl wEJs labeled .Ag- (tor
an ~q;oninl -cuber<.Jt"')-
Cha..n:s iv-.::rc- compos-r:~l :md thi: mandible ,,;.--as: fu1.md t-:, g1-ow in
,.,,_.icl1 h J -~--.; mm. per yf.:ar. 1-JCJ\,."CVt::r:, in obliql..k'.: direction.::: (lkn'i.'ll\o\~rd
and ouh.,..-~mJ ~nw.-1.h) t.h~ 11.a..sal ca-,,--i.ty, rrw..-,.J]fa, :-ll"i.d rnandbk bchc'l\'C- on
tlK -divine proportion X I .6 J 8_

4 . Ma..-ici.110-nrn.1.l(Hbulat -,.,.,,;dth H .. ) . . . . , _ .. Jugale to FrontonF.Kial Phme

.'i . .l\llaxlllo-manclibul;-ta:- v,ridth (R) _ _ . _Jugs I~ to f-ronto-Fa<...ial Plane:::
Rt:;,i ~)f1: TJ) formation h n(:edi:-d for propor Lion and ~'IllIH"'-":U)' c.>f the:". rnF.tx HJ a Lo
th.~ individuaJ mandible-. Jmt .i~ hori;,:ontaJ m.axillc,-.mnw.m-,,.111n· n·l:11icm;o;
arr mer..1.~1.1~d frum l'o:i n l A to the Fad.al J!km~ (\.L'o) IlK: J points arc-
related to the lin.:: from Z. F Lo AG for -cranS\-""CTSt" hr.imH)cl _y. · l"'h is rcbtion
L'..1. n h~ t.hough t. of as, ma.xilhuy ,:i_;m-:.<:1vi Ly rrJac.lvc to the mi:.1ndible,
1

The Hc.>:rJ:I\~ ~ m.9xilla during dcvdup:r:n{':TI L. ~.ems to maintain about

60% of chc "\\1dth of ti,~ rr.~ndihle.. Thus. th:: ·wlJLh uf lht"": m;;l,;ilfa.
jr1,51 dt": I.fl~ 1~l ai1d.iblc dccrcasc:s '-VH I, d1:':1.,dopm~nt at a rrri;:._• rJt n-t:idy J.
mm. <:.;1<.}_ 5 ::,~i-trS {c:r l mm_ per side), Tht" O'Hr:,:-ill,t (J) .a.t age 3 is a
n.~an of 9.0 mm. f::-om Z Ag pl...Yilt>., at age 8 is 10 mm .. iAt !3 p·M~ is l l
m:i:rt.,, 11,-,d :l E. &g-e I 8 is 12 nun.

6. M..1 niHbular symmetry . . _ _ _ I>rotubni.uu.:e- Men ti to ¼<l Plane

Ri::awn: Th~ ,:::crI k:r of 1JH>: c:h in -c:in be off th.t.:' \,--.'L ni ~ I" m idl i nl?. due to both
 morphology OT functional causLs. The trir,onum mt.-nta1i is \:hibk
and l'm is sdcctcd .at its ap~x.
from the. c-E.ntraJ sagittal plane- (or IniJ-:..igitvil pla:~) .a po:.i.tiun
trJ th~ rlg~Lt b ph.1~ <\nd tL, the lt-Jl i:-:: minH~.

7. M:=n: i llan~ svmmelTV .

J J J
. Point Ans to Mid Plane
_ . .
Rea.son: I\1axHlas may nls-o be- ~ymrn~rirnl. /Ul':> for the iroriL.:il j:i:; t...'1k~rl w \)t~ ~t
1.he Lop of r:he.: mic-ma.-xm~y suttm:. Ir: :s cvalu:!iti:d from the.: midlinc-.
Pfo~ h right, mi,u.:~ hi left,

D.EN'f/U.

8. ~10.lar ,-..'idth . - .. - .. .. .. . . Tran s:-buccal of lov.•er molars

Reason: }\rch width is ot int(.'n·st to di::-tt"nnhit I hr ...vi:i::dom -t.1i hue-ml f'"<r■'1f'lsion.
171c. first inkt'CSL Jics in ilic. ace.Lt.al ru:ch ,"11.dch at the- firs.t: molars ,;,vid..::st
ex Jl"i Lout r:11:-:-1.·::iu°'i~ LI t:'l l. LA th£-. m os.1. \; isj bJ1:: on the from..al hcadpl;;;. tc. The:
mean of normal ocdusions at the:- '.()'l.'t't:r fir:--1 ulf1hl'f i:-. S.5 ,nrn, \\.'ill) llit':
cbject film distance in the hom:al that rnems .:.i t:.-,-pkal .'1% u1.~Tt"~st· in
dtt' -,,.·idl 11 t-.c-"ph..':lkirn~, rkc.1Hy, which fr1.ak...::.s mean molan.vjdr:.h csx.miaJlv
56 ..3 XHill., T!Le .,._-Ji:nic:.il d-t·'i.~iit i.1.1u i.:-.: ±:1. .0 mm.

9 _ fi r~t prc.molaT wi dlh . . Trans-bucca! of lovn.T first premolar

R~<1s[)Jl: A.tch foo:n. i.s J!,R"JJdy ,clt:t~J:O•irtied hy "i.-.'ldt.h at the first premolar area.
Forty mm. (40 mm.) is the- m~an in th.e popuh1ti.cm. 'l1u:::; h ta.i:1.1-1(;:'n:d by
tocth s.ize, 1.J·cl1 type a.nd vc1y slightly by sc-x, bdng ~1.allcr in fr.::m..:,lc-s.
Tfo·: tfo, h:-,-:J dt' r' l~. l k1u h: ± J . il lcl n1.
1

10. Intcrcaninc ·width . _ . . . T.rn..ns•l.i.tninc tips

Fr~i-~rn:,: 1.,fJ¼'t':r intm:imh1r:: vd,dtl, fa th~ mo..sL. cn.lc:'ial area ot· ~O\,et'c.,<{panslon. 11•
Du· m.mn~l tips of GurlnL-'5 is 26.0 U1J11.. t":<":~111;:i.lly. I)1lc=- lfJ Lhf" c-loSf"J1~~
of Lh~ c.a..n i nl":s rn t.he. mrn Ihc c:1larg.::mcnt factor b 2%. This is only 0 . .5
rxm1. :me I :-~ i:::i;.~~J1t.i.:1 Uy a ,·.1-~tci11g er::'Or dim ens.ion. '\It/ e. usc.1a1y c:onsj cl.er ii.
,;vithom cnlargc:m,:nt, t:h~r-dorc, The- dinical Jevfa.Hu;, it; ± i. ,0 uun,

t L Mofa.r position {L) . .:.\.\ola.r bucr-.al Lo Fron to-Oen la11-'la.n~

l 2. Jvlolru- pos:ition {R) . , . . . . , Molal:' buccal to .F:r:-(mto-Dcntal Prune
0

IV:":i:-:nn: l1)t': dc=-r~, 1,re 1~ c-1)fr"t'!."11 f'd l"r:"t~'.pmcally -.....it.h r.hc skdc.rnn. Th~~ buc,.al of
thi:: k·w·.-:r mofor i5 rel a t~d to a re<..ipro<.:al lint' bt.L w~t.n i he:- j,~v,"S "t't·h;dt i~
1.3.:._:e.n to be JAg.
...
· Bcca11!:ic 1:hc iav..•s grU\-v Lhi:i; ili mf'.n,~i on al s.o d1an.gcs "l'ri:th agi:, M
~g~ 7 iL. l.~ ripp1'(i,:.im.aLdy 5 mm. and by ~thiltho<~d in m~le..s is about 15
IIUJ:l. At e'~'.:-,t'Htiallv :io::tt" l .'i h . !;,:; ! 0 tl'.m ., "\"i-nkh make:>"- )'l-'U<l rdt'rt'Ill.-:t:'
~ n ·•
dinicaUv. /

13. Molar bite.: (L) . . . . , Buccal of A6 to ll 6

14. Molar hic:e {R) . . . . Kua:al of A6 to B6
R.:-ason: ...:\$st"~s1:11 t"r 11 .~ r.~f n 1:-i ~
i I l0-1nj:j ndi h1 ~br di.::nta1 ,dations aTe h Lllicatt:'d fur
d~criptlon. The ',Vides,: point on d1-t' 1tpp~r mofa.r 1s measured
pt>.rp~ndicHb..r L.o rJ-,e :-ronto-occlusa.l pbn::-- ,.,,..t,;,-h t:. •.~~c:1 ~ L ll~ mol.:u
occh.1~ion l.~t::--r.ally.
The upper, in ideal occh.1~h)J1:-., i..~ 2 mm. -..v-tde:r on ~ach .side.
Pra;.'l.icr.1rly .r.1ll s~v~r~ Cl<t:,,s H ~..::s arc act1,.m.ily .lingu~l ,"1X1:-;~bi.1 l;'"h~ in this
ru.uuysb mul."s-~, ot cour:..-t", 11 bur-.c:) l r:rnssbj re ~or Brodie 5yndrome) i~
present.

15. Midlirn.' of lowt:':r . _ I·.mhrn.sun.:: of lmver in~isur tu I\1id Pfo nlit.

J·kason : T'1.e dc:nturc mid.Jioc of the lo1rvt'r b ,'t SLitrC.i~~g pcint of r-cfon::n~e. 1t can
be mcasu:""cd to L:.he ..::e.nual phn.c or Jl Jin~ f:r.<m1 A Io Pen. (>las is righr.•
□imw ~ lc:ft.

I •
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105
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Lips at
Rep use

107
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108
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3['.8 U ..D
I~ :10.9'5 :11.e-
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NORMAL DIMENSIONS
G. A.· cf
After
Before r-;;:.
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Age 8-4 --~---~-·
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G.A. er
5/1/70
~Age 11~5 Yr. 90
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12/13/79
Age 21.167 .;
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.. i
 Robert M. Ric~tts 1 D.D.S., M.S,, N.M.D.
Director

American lnstitute for Bioprogressive Ed 1.1CM◄on

9100 E. La ?osada Court
Scottsdale, Arizona 8!5255
Phone:400/048--4799
Fruc480/367-0933
\":f!tll, ii_ci<8ttsbiopro.com
CoP:yright 1900. ~I rlghts rMeJVed