Seminar 2
records processing
LATERAL Cephalometric
Analysis
Cephalometic Points Used for
POS Analysis
refer to notes
for definitions
of each point
Tips to find points
A Review of Cranial Anatomy as it
relates to Cephalometric Tracing
Presented by Dr Jeffery Taylor
POS Cephalometric Points
(In the order in which they appear in DentalCad/IPSoft)
Nasion (N): The most
anterior point of the nasofrontal suture on the
midsagittal plane.
Refer to slide #2, Seminar #1
N point
POS Cephalometric Points
Nasion (N): The most anterior point of the
naso-frontal suture on the midsagittal plane.
Sella (S): The center of the
contour of Sella Tursica by
inspection.
S point
POS Cephalometric Points
Nasion (N): The most anterior point of the
naso-frontal suture on the midsagittal plane.
Sella (S): The center of the contour of Sella
Tursica by inspection.
Porion (Por): The most
superior point of External
Auditory Meatus.
Porion
Porion
POS Cephalometric Points
Nasion (N): The most anterior point of the
naso-frontal suture on the midsagittal plane.
Sella (S): The center of the contour of Sella
Tursica by inspection.
Porion (Por): The most superior point of
External Auditory Meatus.
Orbitale (O): Lowermost
point of the contour of the
bony orbit.
Orbitale
POS Cephalometric Points
Nasion (N): The most anterior point of the naso-
frontal suture on the midsagittal plane.
Sella (S): The center of the contour of Sella Tursica
by inspection.
Porion (Por): The most superior point of External
Auditory Meatus.
Orbitale (O): Lowermost point of the contour of the
bony orbit.
Posterior Nasal Spine (PNS):
The most posterior point of the
nasal floor. Junction of the hard
and soft palate.
PNS
POS Cephalometric Points
Nasion (N): The most anterior point of the
naso-frontal suture on the midsagittal plane.
Sella (S): The center of the contour of Sella
Tursica by inspection.
Porion (Por): The most superior point of
External Auditory Meatus.
Orbitale (O): Lowermost point of the contour
of the bony orbit.
Posterior Nasal Spine (PNS): The most
posterior point of the nasal floor. Junction of
the hard and soft palate.
Anterior Nasal Spine (ANS):
The most anterior point of the
nasal floor. Tip of the pre-maxilla
on the midsagittal plane.
ANS
POS Cephalometric Points, Section 2
Subspinale (A): The deepest
point on the midsagittal plane
between ANS and Prosthion*. A
point is the most anterior point of
the maxillary denture base. It is
usually located around the level of
and anterior to the apex of the
upper central incisors. Hint: trace
the upper incisor before selecting
A point.
*prosthion(noun)-1.craniometricpointthatisthemostanteriorpointinthe
midlineonthealveolarprocessofthemaxilla
A point
A point
Not here
No
Yes
No
Yes
Dental Cad: Place incisor with tip on edge of incisor
Dental Cad: Move root over pulp
radiolucency using root-tip handle.
Dental Cad: Now place A point using
knowledge of the anatomy.
Dental Cad: Now return back the list of Points and Contours
and place the Maxilla if desired.
(F2 key to advance)
POS Cephalometric Points, Section 2
Subspinale (A): The deepest point on the
midsagittal plane between ANS and Prosthion.
Supramentale (B): The
deepest point on the
midsagittial plane between
infradentale and Pogoion.
Usually anterior to and slightly
below the apices of the lower
incisors.
B point
POS Cephalometric Points, Section 2
Subspinale (A): The deepest point on the
midsagittal plane between ANS and Prosthion.
Supramentale (B): The deepest point on the
midsagittial plane between infradentale and
Pogoion. Usually anterior to and slightly below
the apices of the lower incisors.
Pogonion (P): The most
anterior point on the
midsagittal plane of the
contour of the chin.
Pogoion
POS Cephalometric Points, Section 2
Subspinale (A): The deepest point on the
midsagittal plane between ANS and Prosthion.
Supramentale (B): The deepest point on the
midsagittial plane between infradentale and
Pogoion. Usually anterior to and slightly below the
apices of the lower incisors.
Pogonion (P): The most anterior point on the
midsagittal plane of the contour of the chin.
Gnathion (Gn): The point on the
anterior symphsis closest to the
intersection of N-Po line and the
inferior border of the mandible.
Gnathion
Gnathion
POS Cephalometric Points, Section 2
Subspinale (A): The deepest point on the
midsagittal plane between ANS and Prosthion.
Supramentale (B): The deepest point on the
midsagittial plane between infradentale and
Pogoion. Usually anterior to and slightly below
the apices of the lower incisors.
Pogonion (P): The most anterior point on the
midsagittal plane of the contour of the chin.
Gnathion (Gn): The point on the anterior
symphsis closest to the intersection of N-Po
line and the inferior border of the mandible.
Menton (Me): The lowermost
point on the contour of the
symphysis.
Menton
POS Cephalometric Points, Section 3
Gonion (Go): The point on
the posterior mandible* closest
to the vertex of the gonial
angle.
Note: McGann prefers using the most
inferior point of the ramus +Menton for the
mandibular plane (as in Downs analysis)
Note: Steiner analysis used Gonion-Gnathion
for mandibular plane
True definition of Gonion
Gonion
POS Cephalometric Points, Section 3
Gonion (Go): The point on the posterior
mandible closest to the vertex of the gonial
angle.
Articulare (Ar): The point of
intersection between the
posterior border of the
mandible and the occipital
bone (base of the bony skull.)
Articulare
POS Cephalometric Points, Section 3
Gonion (Go): The point on the posterior
mandible closest to the vertex of the gonial
angle.
Articulare (Ar): The point of intersection
between the posterior border of the mandible
and the occipital bone (base of the bony skull.)
Condylion (Co): The most
superior and distal point on the
head of the condyle.
POS Cephalometric Points, Section 3
Gonion (Go): The point on the posterior mandible
closest to the vertex of the gonial angle.
Articulare (Ar): The point of intersection between
the posterior border of the mandible and the
occipital bone (base of the bony skull.)
Condylion (Con): The most superior and distal
point on the head of the condyle.
Subnasale (simplified): The
bisection of the angle formed by a
line on the inferior border of the
nose and a line on the filtrum
area.
Subnasale
POS Cephalometric Points, Section 3
Gonion (Go): The point on the posterior
mandible closest to the vertex of the gonial
angle.
Articulare (Ar): The point of intersection
between the posterior border of the mandible
and the occipital bone (base of the bony skull.)
Condylion (Con): The most superior and distal
point on the head of the condyle.
Subnasale (simplified): The bisection of the
angle formed by a line on the inferior border of
the nose and a line on the filtrum area.
Stomion: The point where the
inferior of the upper lip (at rest)
and the central incisor meet.
Stomion
Planes used in the POS
Analysis
mandibular plane: Menton-lower
border of ramus
Occlusal plane: Intersection of cusp
tips upper and lower 6s, bisection of
incisors overbite or open bite
Palatal Plane: ANS-PNS
Frankfurt Horizontal: Por-Orbitale
SN: Cranial Base
Planes used in the
McGann analysis
SN line
Frankfurt Horizontal
Palatal plane
Occlusal plane
Mandibular plane
Locate the points
Skeletal Analysis
Determine if the patient is
skeletal open, average, or
closed
Measurement 1
Measurement 2
Dropping a Parallel (to FH)
Planes intersect off the page
Only needed when doing a manual
tracing
Use parallel lines on the ormacepha
measuring instrument
NOT needed when doing a computer
tracing!
Double Measurements:
determine skeletal open,
average, or closed
Palatal-Mand. plane FMA
Y-axis
Politically correct: GP
understands growth?
Skeletal analysis
Determine if the maxilla is
protrusive, average, or
retrusive
N perpendicular At A
manual measuring
Use parallel lines and the
outside edge of the
ormacepha (90 deg) to create
the reference line
Appliances to alter the
maxilla
Reverse headgear
Cervical headgear
Skeletal analysis
Determine if the mandible is
protrusive, average, or
retrusive
Skeletal Analysis
Determine if the upper and
lower jaws are well related (or
not)
ANB: manual
measurement
Do not measure this angle,
subtract the numbers SNB from
SNA
Wits
The best measurement to predict
skeletal resistance in class III cases
(not ANB)
Not sensitive to changes in the
vertical dimension (as is ANB)
Errors in the occlusal plane are
significant and may make this
measurement invalid
Wits versus ANB
Use ANB in Class II diagnosis (not
wits)
Use Wits in Class III diagnosis (not
ANB)
Use Wits in skeletal open bite cases
(ANB is sensitive to vertical
dimension)
Dental Analysis
Determine the anteroposterior position and
inclination of the incisor teeth
The lower incisor
3 measurements
The upper incisor
4 measurements
Facial Analysis
Quick (manual) tracing
method
Trace anatomy and choose points
Draw lines and planes as you think of them
Measure as you remember locations of
measurements
Write the number on the tracing
Transfer the measurements to the form
after you cannot remember any more
Return to the tracing to complete forgotten
measurements.
Head positioning error
Lateral ceph tilt the head
2 structures
porion, orbitale, gonion, molars
Tilt the head positioning
error correction
Trace the double structures on the
same side of the face
The most superior orbitale is the
easiest to see. Therefore, choose the
most superior porion, mandible, and
molars to be consistent.
True skeletal asymmetry
2 mandibles
True skeletal asymmetry
Frontal ceph numbers
Mandibular plane cant is at least 3
degrees
Vertical height difference (antegonial
notch to zygomatic plane)
The headholder is not calibrated
correctly
looking to the side head positioning
error
Consequences of looking to
the side positioning error
Difficult to trace the molars,
especially when comparing x-rays
before and after treatment (overlay)
Occlusal plane is NOT effected
Double Ramus is of no consequence
Orbitale is NOT effected
Porion level to Frankfurt Horizontal is
NOT effected
Overlays
Comparing ceph x-rays taken on the
same patient, at different times, on
the SAME machine.
On Adult patient = Treatment effect
only
On Growing patient = Growth plus
treatment.
Start (age 32)
Ceph
Final
Skeletal overlay
Dental Overlays
Prediction
Actual
Growth
what happens without
treatment
Face: grows down and forward, not
necessarily in the same direction
each year
Upper molar: down and forward
Upper incisor: down and slightly back
Lower molar: up and forward
Lower incisor: up and slightly back
Skeletal overlay: start age 11
female
Dental overlays
Prediction
Actual
Nose overlay
Overlay x-ray 6+3
X-ray 3 = female age 10
X-ray 6 = same female, age 13
Pubertal growth spurt for girls age 1113
Ceph for Reconstruction
Tutorials
Study at home
Run Tscc.exe file to view avi video
files. Only one time installation of
this program
Digital Ceph calibration
Digital cephs are typically calibrated
wrong, being saved as 72dpi jpeg
instead of 96dpi tif or bitmap.
The resulting image of the head is
smaller than actual size.
Same patient
Wrong
Correct
How to determine if ceph is
calibrated correctly
If there is a millimeter ruler in the
image, then import the ceph into
dentalcad and measure using Co + A
points (maxillary length) on the ruler,
40mm may measure 27mm in a
typical out-of-calibration machine.
Lineal measurements are wrong,
Dental vto is distorted.
Same patient
wrong
correct
If no calibration ruler
Take an x-ray with a metal object of
known length (piece of wire, endo
file) taped to the machine at the
nose or on the x-ray cassette
Measure after importing into
dentalcad or directly on a printed
image
What to do if out of
calibration
Ask manufacturer to make the
software correction (update)
Import into adobe photoshop and
resize image-size, change pixels to
1000 as a starting point, and check
calibration
