Volume 34 Issue 4 Article 1

November 2022

Cephalometric Analysis: History and Clinical Application

Ib Leth Nielsen
Department of Orofacial Sciences, Division of Orthodontics University of California, San Francisco, CA,
USA

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Recommended Citation
Nielsen, Ib Leth (2022) "Cephalometric Analysis: History and Clinical Application," Taiwanese Journal of
Orthodontics: Vol. 34: Iss. 4, Article 1.
DOI: 10.38209/2708-2636.1323
Available at: https://www.tjo.org.tw/tjo/vol34/iss4/1

This Review Article is brought to you for free and open access by Taiwanese Journal of Orthodontics. It has been
accepted for inclusion in Taiwanese Journal of Orthodontics by an authorized editor of Taiwanese Journal of
Orthodontics.
Cephalometric Analysis: History and Clinical Application

Abstract
When roentgen cephalometry was first introduced to the orthodontic profession in 1931 by Broadbent in
the USA and Hofrath in Germany it was a major milestone in terms of new diagnostic tools available to
orthodontists. Until that time only clinical observation and study casts of the patients had been available
to the clinician but now a more in depth understanding of the facial makeup became possible. This meant
that each patient’s malocclusion could now be related to their facial skeletal and dental morphology. The
dentoalveolar components could now be studied in detail and better treatment plans could be developed
that addressed the individual patient’s needs. This new technology, the cephalometric analysis, was
initially only used to developed what is called a morphological analysis. This type of analysis primarily
describes the facial makeup of an individual, so to speak, and is somewhat limited in its clinical value as a
predictor of future facial development. Today there are many morphological analyses available to the
clinician and most are based on individual preferences and frequently lack sufficient data base to support
their use on larger groups of individuals. Unfortunately, many of the cephalometric analysis that now a
days are computerized analysis offer large amounts of data which is not very helpful to the orthodontist.
We shall present a simplified cephalometric analysis, that fits the practical needs for most clinicians. This
so-called “Björk Morphological Analysis,” can be applied to most clinical cases. The introduction of the
CBCT now several decades ago greatly improved the diagnostic possibilities for the orthodontic
profession. Lateral headfilms can now be formatted from the so-called DICOM files that provide greater
details and resolution of the patient’s dental and skeletal problems. We shall discuss the CBCT’s use in
clinical diagnosis and the pros and cons of using this technique. Finally, we shall look at the changes of
some of the most used cephalometric measurements over time as these variables change with the
patient’s growth and maturity.

Keywords
Cephalometric morphological analysis; Integration in treatment planning; The Björk analysis;
Dentoalveolar compensation; Dysplastic dentoalveolar development; Cephalometric variables over time

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REVIEW ARTICLE

Cephalometric Analysis: History and

Clinical Application

Ib Leth Nielsen*

Department of Orofacial Sciences, Division of Orthodontics, University of California, San Francisco, CA, USA

ABSTRACT

When roentgen cephalometry was first introduced to the orthodontic profession in 1931 by Broadbent in the USA and
Hofrath in Germany it was a major milestone in terms of new diagnostic tools available to orthodontists. Until that time
only clinical observation and study casts of the patients had been available to the clinician but now a more in depth
understanding of the facial makeup became possible. This meant that each patient’s malocclusion could now be related
to their facial skeletal and dental morphology. The dentoalveolar components could now be studied in detail and better
treatment plans could be developed that addressed the individual patient’s needs. This new technology, the cephalo-
metric analysis, was initially only used to developed what is called a morphological analysis. This type of analysis
primarily describes the facial makeup of an individual, so to speak, and is somewhat limited in its clinical value as a
predictor of future facial development. Today there are many morphological analyses available to the clinician and most
are based on individual preferences and frequently lack sufficient data base to support their use on larger groups of
individuals. Unfortunately, many of the cephalometric analysis that now a days are computerized analysis offer large
amounts of data which is not very helpful to the orthodontist. We shall present a simplified cephalometric analysis, that
fits the practical needs for most clinicians. This so-called “Bj€
ork Morphological Analysis,” can be applied to most clinical
cases. The introduction of the CBCT now several decades ago greatly improved the diagnostic possibilities for the
orthodontic profession. Lateral headfilms can now be formatted from the so-called DICOM files that provide greater
details and resolution of the patient’s dental and skeletal problems. We shall discuss the CBCT’s use in clinical diag-
nosis and the pros and cons of using this technique. Finally, we shall look at the changes of some of the most used
cephalometric measurements over time as these variables change with the patient’s growth and maturity. Taiwanese
Journal of Orthodontics 2022;34(4):175e184

Keywords: Cephalometric morphological analysis; Integration in treatment planning; The Bj€

ork analysis; Dentoalveolar
compensation; Dysplastic dentoalveolar development; Cephalometric variables over time

INTRODUCTION facial skeleton.1,2 In the words of Cecil Steiner

(1953); “it is my opinion that roentgenographic

W ith the introduction of the radiographic

headfilm technique to orthodontists this
new tool initiated a new era in orthodontic diag-
nosis and treatment planning. Around the turn of
the 20th century, Angle and his followers could
only plan treatment based on the patient’s facial
profile and the malocclusion of the teeth. With
this new radiographic headfilm technique, or-
thodontists could plan their treatment using
radiographic information about the patient’s
Received 23 August 2022; revised 29 October 2022; accepted 25 November 2022.
Available online 28 December 2022
cephalometry is one of the most important con-
tributions to the progress in orthodontics.”3
Many possibilities opened up for orthodontists
with this new technique that to this day have proven
an invaluable help in treatment planning, analysis
of growth and treatment and prediction of possible
treatment outcomes.
Applications of cephalometric analysis
a) Cephalometric morphological analysis of indi-
vidual headfilms

* Address correspondence to Emeritus Professor Ib Leth Nielsen: Department of Orofacial Sciences, Division of Orthodontics, University of California, 60
Lambeth Sq. Moraga, San Francisco, CA 94556,USA.
E-mail address: ibortho9@gmail.com.

https://doi.org/10.38209/2708-2636.1323
2708-2636/© 2022 Taiwan Association of Orthodontist. This is an open access article under the CC-BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
I.L. NIELSEN
CEPHALOMETRIC ANALYSIS
b) Growth and treatment analysis
c) Growth and treatment prediction
In this article, the primary focus is on the cepha-
lometric morphological analysis, its use in treatment
planning of both conventional clinical cases and in
surgical cases.
The lateral cephalometric headfilm should
always be taken with the x-ray beam perpendicular
to the patient’s sagittal plane. The orientation of
the head should be in natural head position a
position that is reproducible for each individual
subject and used for both analysis of the dentofa-
cial morphology and for photos of the patient. The
concept of natural head position was first intro-
duced by Coenraad Moorrees and M. R. Kean in
1958.4 Historically cephalometric analysis of both
lateral and frontal headfilms have undergone a lot
of changes and numerous analyses have been
available since the introduction of this technique.
The following is a list of the most important anal-
ysis presented to the orthodontic clinicians over
time (see Figure 1).
Down’s analysis (1948)5
Steiner analysis (1953)3
Tweed’s analysis (1954)6
Sassouni analysis (1955)7
Ricketts (1960)8
ork analysis (1963)9
Bj€
Harvold analysis (1974)10
Figure 1. Broadbent cephalostat to ensure a stable head position during
the recording of lateral and frontal headfilm.1
176
Taiwanese Journal of Orthodontics
2022;34(4):175e184
McNamara analysis (1983)11
Jarabak analysis (1972)12
The cephalometric morphological analysis
The main area of application of cephalometrics
today is in the description of a patient’s facial pro-
file, in a so-called morphological analysis (Figure 2)
The most important purpose of a cephalometric
analysis is to determine departures from the
average in skeletal and dentoalveolar morphology.
The information gathered from such a single head-
film is limited and represents information about the
face in profile at one time point and says very little
about future growth and development of the face.
With the information collected from many of the
numerous analysis available today, it is possible,
however, to determine whether the malocclusion is
related to skeletal or dentoalveolar deviations, which
is very valuable to the orthodontist in the treatment
planning phase. Some analysis also enables the
clinician to determine if there is dentoalveolar
compensation or dysplastic development in a patient
with a skeletal discrepancy and where this change is
located. As this type of analysis basically mainly de-
scribes the facial make-up of an individual, so to
speak, it is somewhat limited in its clinical values. It
should therefore not be extensive but limited to
parameters that are meaningful and informative.
Figure 2. Conventional lateral cephalometric headfilm. The x-ray is
taken in a cephalostat that ensure a stable head position. The head
should be oriented in natural balanced head position that can obtained
by placing a mirror in front of the patient. The patient is then asked to
look at his or her eyes while the x-ray is taken.
Taiwanese Journal of Orthodontics
2022;34(4):175e184
Today there are many morphological analyses
available to the clinician. Most are based on indi-
vidual preferences and frequently lack sufficient
data base to support the use on larger groups of
individuals. Furthermore, the values in most anal-
ysis do not take into consideration the patient’s sex,
skeletal age nor the ethnic group. Another issue to
remember is that more numbers are not necessarily
better, in fact they often serve only to confuse the
clinician. As a result, the analysis becomes an
exercise in futility and does not provide much help
with treatment decisions.
Most orthodontists are aware that averages or
mean values should not be applied to the individual
case. The mean values are only a guide to help
determine an individual’s facial make-up and the
standard deviations indicate the extent of the vari-
ation from the mean. Nevertheless, these mean
values are sometimes used as treatment goals with
the interpretation that if the individual does not fit
the mean, something is wrong. This concept of
means, or “norms,” is misleading and erroneous as
it can make the orthodontist think he or she should
treat patients to a given mean value. The fact of the
matter is that all the mean values we routinely use
are associated with large standard deviations, which
demonstrate the great variability within the normal
population. We also should remember that in the
U.S. there are many different ethnic groups. The
esthetic goals from one population are very different
for another. A misunderstanding that we frequently
encounter is the incorrect use of the concept of the
standard deviation. The fact that a measurement of
a skeletal discrepancy is within one standard devi-
ation does not mean that it is almost normal and
therefore insignificant. There are in most cases
several components involved in a malocclusion such
as the protrusion of the maxilla, the prognathism of
the mandible and the shape of the cranial base. Each
of these parameters can be within one standard
deviation, but if they all go in opposite directions,
amount to a pronounced discrepancy.
In a cephalometric analysis, it is preferable to use
angular rather than linear measurements, as
angular measurements vary little due to size and
age differences between individuals. The use of
linear parameters should always be accompanied by
a respect for the wide individual variability. The
cephalometric values in general must be used with
caution and only as guides to what area or structure
an occlusal problem may be related and the
numbers serve only as guides d not as a target.
Most cephalometric analysis are so-called “compo-
nent analysis” that provide information as to
relationships between facial and dental components
177
I.L. NIELSEN
CEPHALOMETRIC ANALYSIS
Figure 3. Schematic illustration of the skeletal and dental components of
the face. The illustrations show the cranial base, maxilla and mandible
and their dentoalveolar components (Solow 1980).13
in the horizontal, vertical and transverse dimension.
As seen in Figure 3, the facial components consist of
the cranial base, the maxilla and the mandible and
the associated dentoalveolar components.
The facial components are highly correlated to
each other and changes in their sagittal and vertical
position influence the dentoalveolar relationships
and thereby the occlusion of the teeth. Similarly, the
cranial base which depending on its shape can affect
the position of the jaws. If, for instance, the median
cranial base, as measured by the (NeSeBa) angle, is
increased or more obtuse than normal, it frequently
is associated with bimaxillary retrognathism.
Conversely, an acute cranial base angle is associated
with bimaxillary prognathism.
Skeletal and dentoalveolar malocclusions
The association between malocclusion and the
dentoalveolar and skeletal components present can
be illustrated in case of excessive overjet, as seen in
Figure 4 below.
The illustration (Figure 4) shows skeletal and
dentalveolar changes that can result in an overjet;
maxillary skeletal protrusion, mandibular retrusion
or a combination of the two (1-2); maxillary den-
toalveolar protrusion, mandibular dentoalveolar
retrusion or combinations thereof (3-4), and maxil-
lary incisor proclination or mandibular incisor ret-
roclination or combinations thereof (5) can all result
in an excessive overjet. In other words, variations in
overjet can be expressed through five factors that
each can be increased, reduced, or remain un-
changed during the development. This yields a total
of 35 ¼ 243 possible combinations for variations in
the development of the overjet and should remind
us of the importance of developing a differential
I.L. NIELSEN Taiwanese Journal of Orthodontics
CEPHALOMETRIC ANALYSIS 2022;34(4):175e184

Figure 4. The possible combinations of dental, alveolar and skeletal deviations that can cause an excessive overjet are illustrated as seen below (from
Bj€ork).8

diagnosis for each patient in order to correctly planned following extractions to reduce the
address the problems at hand. It should also show compensation and maximize the mandibular
us that it is important that the cephalometric anal- advancement. The concept of dentoalveolar
ysis includes measurements that can measure these compensation has been incorporated not only in
components.9 ork (19619) analysis, but also in other analysis
the Bj€
on an intuitive basis. For example, Steiner (195614)
Dentoalveolar compensation
Another biological phenomenon that is critical to a
successful treatment outcome is to recognize and
understand the role of dentoalveolar compensation.
In patients with sagittal, vertical, or transverse skel-
etal discrepancies, there is often a considerable
amount of dentoalveolar compensation. This
biological mechanism often masks the actual skeletal
deviations and must be considered during treatment
planning. In most patients, it is necessary to reduce or
remove the compensation to achieve a skeletal
correction, especially in growing patients when
treating with growth adaptation or in adults who are
planned for orthognathic surgical correction.
In other patients, it may be desirable to maintain
the compensatory changes or even accentuate them
to achieve an acceptable treatment result. In the
example seen in Figure 5, the patient has a Class II,
Div. 1 malocclusion due to a retrognathic mandible.
The lower incisors show compensatory procli-
nation as the natural biological mechanism
attempts to mask the skeletal problem (Solow
Figure 5. Lateral cephalometric headfilm of patient with a Class II, Div.
198013). No compensation is seen in the maxilla
1 malocclusion. There is dentoalveolar compensation in the mandible
where the teeth are dysplastically proclined, with proclination of the incisors and increased alveolar protrusion. In
possibly due to a lip habit. In this patient, surgical the maxilla there is dysplastic changes with increased alveolar protru-
correction through mandibular advancement was sion and proclination of the incisors.

178
Taiwanese Journal of Orthodontics I.L. NIELSEN
2022;34(4):175e184 CEPHALOMETRIC ANALYSIS

developed a series of acceptable compromises for

variations in the sagittal jaw relationship. As seen
in Figure 6, varying jaw relationships, according to
Steiner, require different changes in upper and
lower incisor inclination for an acceptable occlu-
sion of the anterior teeth.
A further step towards incorporating compensa-
tion in treatment planning has been put forward by
Ricketts (1957), who set up treatment goals in his
visual treatment plan incorporating compensation
for variations in the jaw relationship.15 He used a
line from point A to Pog. as a so-called “compen-
sation line,” and related the incisal edge of the lower
incisor to this line. By relating the incisal edge to this
line, he automatically introduced a certain amount
of dental compensation. Then different positions
would be developed relative to the individual facial
growth type (Figure 7).
The approach to analyzing a headfilm should first
concentrate on determining the jaw relationship
and then to what extent departures from the normal
jaw relationship have been compensated in the
dentoalveolar structures. The goal for treatment will
then depend on whether the skeletal problem is best
corrected by growth modification, tooth movements
or surgical correction.

The Bj€ork cephalometric analysis

Following his extensive study of the facial
morphology in Swedish twelve-year-old boys (322)
and 21-year-old conscripts (281) Bj€ ork realized that
for clinical use the numbers had to be limited to the
most important to be applicable in orthodontic
treatment planning.16 He also found that whereas
the linear measurements of the two groups in his Figure 7. Ricketts compensation line from Point A to Pogonion (Pog).
study changed notably over time the angular mea- The lower incisors are related in angulation (22e23) and ante-
surements showed much less variation. From this roposterior position1 mm in front of this plane (Ricketts 19578,15).
finding he decided to average the measurements of
the two groups and the standard deviations.9
Furthermore, several the initial measurements were Bj€
ork analysis we are showing the analysis of the
found to be less informative for clinical purposes, so patient seen in Figure 8.
they were not included in the final cephalometric The measurements of the headfilm of the patient
analysis. To illustrate the clinical application of the seen in Figure 8 show a severely increased overjet of

Figure 6. Cephalometric compromises with the Ideal measurements for normal cases and acceptable compromises (from Steiner 195614).

179
I.L. NIELSEN
CEPHALOMETRIC ANALYSIS
Figure 8. Lateral cephalometric headfilm of a patient with a Class II, Div. 1 malocclusion and a deep overbite. The pretreatment measurements of the
patient and the Means and SD for the normal sample have been provided for this patient using the Bj€ork analysis.9Abbreviations for the most
common reference lines in the analysis are listed with their descriptions.
11 mm that is dentoalveolar. How do with know
that? Because the sagittal jaw relationship is
normal (2.0 ). However, the sagittal apical base
relationship (A-N-B) on the other hand is
increased due to mandibular alveolar retrusion.
The maxillary incisors are severely proclined (123 )
whereas the mandibular incisor inclination is
within normal limits. The vertical occlusion is
characterized by a severe deep overbite (7 mm)
that is skeletal as seen from the reduced vertical
jaw relationship (NL-ML). The Maxillary zone (NL-
OLs) is reduced as a sign of dentoalveolar
compensation in the maxilla. In the mandible,
however, the Mandibular zone is within normal
limits. The cranial base measurements are normal.
As seen from this example it is possible with a
180
Taiwanese Journal of Orthodontics
2022;34(4):175e184
limited number of cephalometric measurements to
obtain valuable information about a patient’s facial
make-up. The skeletal and dentoalveolar compo-
nents are clearly measured, and possible dentoal-
veolar compensation or dysplastic development
can easily be ascertained. These measurements of
compensatory or dysplastic dentoalveolar devel-
opment should only be applied in cases of skeletal
deviations in the sagittal or vertical jaw relation-
ship. One measurement that is particularly inter-
esting and used to distinguish between a skeletal
and dentoalveolar malocclusion is the so-called
sagittal jaw relationship. For an average facial
profile this measurement’s mean value is 2 with a
SD of ±2 . However, the mean value and SD
changes if the patient is either bimaxillary
Taiwanese Journal of Orthodontics
2022;34(4):175e184
Figure 9. The sagittal jaw relationship variations in subjects with
different skeletal relationships. The normal jaw relationship is marked
with. . The mean value changes depending on whether the patient is
bimaxillary prognathic or has a retrognathic jaw relationship. In all
three cases there is a normal overjet and overbite. When the jaws are
protrusive the value of the mean sagittal jaw relationship changes to-
wards a negative value. The opposite is the case when both jaws are
retrusive then the maxilla is further ahead of the mandible.
retrognathic or bimaxillary prognathic as illus-
trated in Figure 9. This is an important detail when
analyzing clinical cases and in treatment planning.
Growth and treatment analysis
The cephalometric headfilm is of great value in
analyzing growth and treatment changes. By
superimposing two headfilms on stable structures
in the cranial base, and on stable structures in the
maxilla and mandible important information can
be obtained that not only can tell the clinician
about the treatment but also about facial growth
during treatment. The most reliable technique for
such superimposition is the so-called “structural
superimposition technique” developed by Bj€ ork
et al.20 This method of superimpositioning and its
scientific background has been described in detail
by Nielsen and falls outside the scope of this
review.17
Cephalometric variables and their change during
facial growth
Most cephalometric analysis use angular mea-
surements to describe the facial morphology as they
change much less than linear measurements during
the growth period. This was already recognized
many years ago by Broadbent et al., Riolo et al. and
Ingerslev et al.18,19,21 However, their longitudinal
data confirmed that even though the use of means
values for the most common cephalometric
measurements annual changes in these mean values
should not be ignored. To simplify cephalometric
analysis of the lateral headfilm averages and
181
I.L. NIELSEN
CEPHALOMETRIC ANALYSIS
standard deviations have been used in most anal-
ysis. Little or no attention has mostly been placed to
sex, skeletal age nor ethnic differences nor have any
details of how the data was collected. However,
several longitudinal studies have found that even
though angular measurements used in most anal-
ysis have been used, in order to reduce the varia-
tions during the growth period, several of these
measurements do change during the growth period.
To illustrate such changes with time we have below
provided examples of four of the most important
cephalometric measurements. As seen in Figure 10
the measurement SeN-A that describes maxillary
protrusion on average remains unchanged in both
girls and boys. Mandibular prognathism (SeN-Pg)
on the other hand increases in both girls and boys
from an average value of 77 at age 7 to 80 in girls
and 81 in boys at age 21. In other words, the
mandible on average becomes more prognathic
with time in both girls and boys.
Changes over time also affects the sagittal jaw
relation (A-N-Pg) and the sagittal apical base
relations (A-N-B) as illustrated in Figure 11. It is
seen that whereas the sagittal jaw relation (A-N-Pg)
on average decreases from 4.7 at age 7 to 1 at age
21 the sagittal apical relationship decreases only
about 2 over a similar period. This difference is
undoubtedly associated with some degree of for-
ward rotation of the mandible that takes place in
most subjects.
Growth prediction
As to the predictive value of individual headfilms,
it is possible to some degree to predict the quality of
future facial growth and in particular of mandibular
growth. Bj€ork (1966), in his facial growth studies of
the mandible, demonstrated that certain structures
remained stable in the mandible and could consis-
tently be relied upon as indicators of future growth
rotation of this jaw.22e24 He also emphasized that
these structural signs were only indicators and had
the greatest predictive value in the more pro-
nounced cases of mandibular growth rotations. In a
previous article we have introduced the structures
used for predictive purposes and discussed their
limitations so in this review we shall limit the
description to a brief review.24 Subjects where
anterior or forward facial rotation can be expected
usually have the following structural signs a) short
anterior face height and a concave profile; b) ante-
rior inclination of the symphysis; c) thick cortical
bone under the mandibular symphysis; d) down-
ward convex anterior lower border of the mandible.
Subjects where posterior or backward rotation can
be expected are characterized by a) a convex profile;
I.L. NIELSEN
CEPHALOMETRIC ANALYSIS
Figure 10. Changes in SeN-A in girls and boys from age 9 to age 18. Notice maxillary protrusion on average remain unchanged in both girls and
boys. The measurement SeN-Pg on the other hand increases from an average of 77 at age 7 to 81 at the age of 21.
b) retrognathic mandible with lack of chin promi-
nence; c) increased anterior and short posterior face
height; d) posterior inclination of the mandible; e)
thin cortical bone below the symphysis; f) straight
ant. lower border of the mandible. It should be
noted that these structural signs develop gradually
over time and can be somewhat difficult to recog-
nize in young growing patients. They are the com-
bined result of the patient’s facial growth pattern
and surface modeling of the mandible.
CBCT and cephalometric analysis
The introduction of the 3D Cone Beam CT
technology in 1994 by Dr. Aral in Japan and Dr.
Mozzo in Italy provided a more detailed way of
analyzing the patients skeletal and dental compo-
nents. From Dicom files lateral headfilms, Panorex
and frontal headfilms could now be formatted with
great ease and resolution. One challenge with this
new way of creating headfilms is the lack of head
orientation as these images are not taken in a
cephalostat but the patient is placed with the head
182
Taiwanese Journal of Orthodontics
2022;34(4):175e184
oriented to the Frankfurt horizontal plane. The
problem using the Frankfurt plane was already
pointed out many years ago by Downs, who
warned the profession that although it is normally
distributed around a true extracranial horizontal it
does not relate to the natural balanced head posi-
tion. Sadly, his warnings were completely dis-
regarded by the orthodontic profession.25 In other
words, when using headfilms formatted from a
CBCT it is up to the clinician to decide how the
headfilm is oriented which will be arbitrary and
often in a non-standardized way something that
needs to be improved.26
What does it all mean?
The initial analysis of the lateral headfilm is an
important part of the work up of the patient. The in-
formation gathered should be an integral part of the
diagnosis and guide the clinician towards the right
treatment plan. Differentiating between skeletal or
primarily dentoalveolar malocclusions is important,
as it tells the clinician what problems he or she is
Taiwanese Journal of Orthodontics I.L. NIELSEN
2022;34(4):175e184 CEPHALOMETRIC ANALYSIS

Figure 11. Changes in the sagittal jaw relationship and the apical base relationship from age 7 to age 20 in girls and boys. Notice that greater change
occurs in the jaw relationship than in the apical base relationship possibly because of the gradual forward or anterior rotation of the mandible.

dealing with. It is just as important in these cases to
determine if dysplastic changes have taken place, as it
is in cases with skeletal problems to discern if den-
toalveolar compensations are present. Then it must
be decided to what extent this compensation needs to
be removed in order to achieve an ideal result. In
cases where there are the so-called dysplastic
changes, it is frequently an indication that some form
of soft tissue problem such as a lip habit, tongue
thrust, or airway problem is present that needs to be
taken into consideration. A careful cephalometric
analysis is therefore not only a great help in locating
the problems, but often points to what other habits
and soft tissue areas needs to be corrected, and these
should not be ignored as an integral part of the
treatment planning. It is important to remember that
meaningful data can be obtained from the headfilm
and if the information is carefully applied, it can
guide the clinician towards the correct treatment plan
for the patient. The cephalometric morphological
analysis has its limitations. Whereas it is very valu-
able in describing the face and permit the clinician to
get an in depth understanding of where the problems
are located in each individual case, it does not
provide much information about future growth of the
facial structures. Such information can best be
provided by comparing a pre-treatment and an in-
treatment headfilm using a reliable super-
impositioning technique.14,17
ACKNOWLEDGEMENT
The author wishes to thank Dr. Jens Bjørn-
Jørgensen, Roskilde, Denmark for his kind assis-
tance with the data on the longitudinal changes of
the cephalometric measurements. His insight and
experience are greatly appreciated.
FUNDING
The author declares that the study has received no
financial support.
PATIENT CONSENT
Not required.
CONFLICT OF INTEREST STATEMENT
The authors declares no conflicts of interest.

183
I.L. NIELSEN
CEPHALOMETRIC ANALYSIS
ETHICAL APPROVAL
Not required.
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3. Steiner CC. The use of cephalometrics as an aid to planning
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Orthod 1960;46(10):721e35.
4. Moorees CF, Kean MR. Natural head position, a basic
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