INTERPRETATIONOFCEPHALOMETRIC DATA

EPHALOMETRICS C
Cephalometricsisthestudyofheadfilms(calledcephalograms).Westudy cephsto: observepathologicchange evaluatedentofacialproportionsandclarifytheanatomicbasisof diagnosisofmalocclusion recognizeandevaluatechangesbefore,during,andafterorthodontic treatment predictfuturechangesthatmightoccurinthecraniofacialcomplex Acephalogramisatwodimensionalprojectionoftheskull.Thesefilmsare takeninacephalostat,whichisanxrayapparatuswithastandard5foot sourceobjectdistance.Themostcommonprojectionisthelateralcephalogram. Thestandardizednatureoftheseprojectionshaveallowedforpopulationnorms tobeestablished.Cephscanbemeasuredandcomparedtonormsortoprevious projections.Anteriorposteriorprojectionsmayalsobeobtainedandare somewhatusefulinevaluatingasymmetry. Variouscephalometricanalysesexisttodescribethecraniofacialcomplex.No certainanalysisisconsideredsuperiortoanother.Mostanalysesrelyonthe relativelystableelementsinthecranialbasetoserveasreferencepointsand planesbywhichtomeasurechangingorgrowingstructures.Performingaceph analysisrequiresyoutotracethefilmontoapieceoffrostedacetatewitha pencil.Capturingnecessarydetailsinthecranialbase,maxilla,mandible, dentition,andsofttissueallowsyoutomeasurethevariouselements.Accurate tracingsmayalsobesuperimposedonsubsequentorpreviousfilmstoreveal growthortreatmentchanges. Importantelementsincephalometricanalysesare: Maxillaryposition Mandibularposition Facialproportions/verticalrelationships Incisorpositions(maxillaryandmandibular)

Asinglecephisonlyonepointintime,butaseriesofcephalogramsoverafew yearsgivestheclinicianvaluableinformationonapatient'sgrowthtendencies. Realisticgrowthpredictionrequiresatleast2or3cephscapturedat612month intervals.

 OWTOTRACEACEPHALOGRAM H
1.Tracethecranialbase,orbital rims,andnasalbones 2.Addthepterygomaxillary fissure,keyridges,andmaxilla

3.Tracethemandible,includingthe detailinthesymphysis,canal,and condyle(ifvisible)

4.Addtheincisorsandfirstmolars andtracethesofttissueprofile

ORTHO521

DENTIFYREFERENCEPOINTS I
1. Sella(S)thecenterofthehypophysealfossa(sellatursica) 2. Nasion(Na)thejunctionofthenasalandfrontalbonesatthemostposteriorpointon thecurvatureofthebridgeofthenose 3. Apoint(A)anarbitrarymeasurepointontheinnermostcurvaturefromthemaxillary anteriornasalspinetothecrestofthemaxillaryalveolarprocess.Apointisthemost anteriorpointofthemaxillaryapicalbase. 4. Bpoint(B)Anarbitrarymeasurepointontheanteriorbonycurvatureofthe mandible.Bpointistheinnermostcurvaturefromchintoalveolarjunction 5. Pogonion(Pg)themostanteriorpointonthecontourofthechin 6. Gnathion(Gn)themostoutwardandevertedpointontheprofilecurvatureofthe symphysisofthemandible,locatedmidwaybetweenpogonionandmenton. 7. Menton(Me)thelowestpointonthesymphysisofthemandible 8. AnteriorNasalSpine(ANS)themostanteriorpointonthemaxillaatthenasalbase 9. PosteriorNasalSpine(PNS)thetipoftheposteriornasalspineofthepalatinebone,at thejunctionofthesoftandhardpalate 10. Basion(Ba)theanteriormarginoftheforamenmangnum.Themidpointofthe curvaturebetweenupperandlowersurfacesofthebasilarportionoftheoccipitalbone 11. Palatalrooftheradiopaqueboneofthemaxillaformingtheroofofthepalatalvault 12. Orbitale(Or)apointmidwaybetweenthelowestpointontheinferiormarginofthe twoorbits 13. Gonionapointmidwaybetweenthepointsrepresentingthemiddleofthecurvature attheleftandrightanglesofthemandible

Ortho 521

Interpretation of Cephalometric Data

Page 7

14. Articulare(Ar)apointmidwaybetweenthetwoposteriorbordersoftheleftandright mandibularramiattheintersectionwiththebasilarportionoftheoccipitalbone

15.

Porion(Po)themidpointofthuppercontouroftheexternalauditorycanal(Anatomic Porion)orapointmidwaybetweenthetopoftheimageoftheleftandrightearrodsof thecephalostat(MachinePorion)

16. PterygomaxillaryFissure(Ptm)thepointatthebaseofthefissurewheretheanterior andposteriorwallmeet 17. Keyridgestheposteriorverticalportionandinferiorcurvatureoftheleftandright zygomaticbones

DENTIFYREFERENCEPLANES I
1. SellaNasion(SN)alineconnectingStoNa 2. FrankfortHorizontal(FH)alineconnectingPotoOr 3. MandibularPlane(MP)alineconnectingGotoMe 4. Yaxis(Y)alineconnectingSetoPg 5. UpperAnteriorFacialHeight(UAFH)alineconnectingNatoANS 6. LowerAnteriorFacialHeight(LAFH)alineconnectingANStoMe 7. NasionApoint(NaA)alineconnectingNatoA 8. NasionBpoint(NaB)alineconnectingNatoB 9. UpperIncisor(U1)alineconnectingtheincisaledgeandtherootapexofthemost prominentmaxillaryincisor 10. LowerIncisor(L1)alineconnectingtheincisaledgeandtherootapexofthemost prominentlowerincisor

Ortho 521

Interpretation of Cephalometric Data

Page 8

MAXILLAtoCRANIALBASE SNA
SellaNasionApoint ReferenceLine:SellaNasion Thisangleindicatesthehorizontalpositionofthemaxillarelative tothecranialbase. >85protrusiveorprognathicmaxilla <79deficientorretrognathicmaxilla

82 3

NAFH
NasionApointtoFH

ReferencePlane:FrankfortHorizontal(OrbitalePorion) Thisanglealsoindicatesthehorizontalpositionofthemaxilla relativetothecranialbase. >94protrusiveorprognathicmaxilla <86deficientorretrognathicmaxilla

90 4

Ortho 521

Interpretation of Cephalometric Data

Page 9

MANDIBLEtoCRANIALBASE SNB
SellaNasionBpoint ReferenceLine:SellaNasion Bpointisthemostanteriormeasurepointofthemandibular apicalbase.Thisangleexpressesthehorizontalpositionofthe mandiblerelativetothecranialbaseusingBpointasa cephalometriclandmark. >82prognathicmandible <76retrognathicmandible

79 3

SNPg
SellaNasion Pogonion

ReferenceLine:SellaNasion Thisanglerepresentstheextentofchinprominencerelativetothe referenceplaneSN.Italsoindicatesthehorizontalpositionofthe mandiblerelativetothecranialbaseusingpogonionaslandmark. >83prognathicmandible <77retrognathicmandible

80 3

NPgFH
NasionPogoniontoFH

ReferencePlane:FrankfortHorizontal(OrbitalePorion) SimilartoSNPg,thisanglemeasuresthedegreeofprotrusion andretrusionofthechinbutusesFrankfortHorizontalasa referenceplane.Italsoindicatesthehorizontalpositionofthe mandiblerelativetothecranialbase. >91prognathicmandible <83retrognathicmandible Note:Usingallthreeanglesandbothreferenceplanes,the

87 4

Ortho 521

Interpretation of Cephalometric Data

Page 10

diagnosticiancanmakeagoodevaluationofthepositionof themandibleanddeterminewhetherthemandibleis normal,protrusiveorretrognathic.Inaddition,the prominenceofthechinmayalsobedetermined.Itis possibletohavearetrognathicmandiblebutprominent chin.

Ortho 521

Interpretation of Cephalometric Data

Page 11

MAXILLAtoMANDIBLE ANB
ApointNasionB point TheANBanglemeasurestherelativepositionofthemaxillato mandible.TheANBanglecanbemeasuredorcalculatedfrom theformula:ANB=SNASNB. ApositiveANBangleindicatesthatthemaxillaispositioned anteriorlyrelativelytothemandible(ClassIorClassII malocclusioncases). AnegativeANBangleindicatesthatthemaxillaispositioned posteriorlyrelativetothemandible(ClassIIImalocclusion cases). Thenormalrangeis15. >5indicatesaClassIIskeletaljawrelationship,protrusive maxillaorretrognathicmandible. <1indicatesaClassIIIskeletaljawrelationship,deficientmaxilla orprognathicmandible.

3 2

MANDIBULARPLANE SNMP
SNtoMand.Lower Borders ReferenceLine:SellaNasion Themandibularplaneisrepresentedbyalinewhichbisectsthe distancebetweentheleftandrightmandibularlowerbordersand connectsanteriorlywithMenton.Themandibularplanecanalso beusedasameasureofmandibulargrowthandlowerfacial growthdirection. Note: Alwaysdrawthemandibularplanemidwaybetweenthe leftandrightlowerbordersattheangleofthemandible.

32 5

FHMP
FHtoMand.Lower Borders

ReferencePlane:FrankfortHorizontal(OrbitalePorion) AlsoknownasFrankfortMandibularPlaneAngle(FMA)many orthodontistsprefertouseFrankfortHorizontalthanSN. Theyconsiderthemandibularplaneangletobeameasureof

24 3

Ortho 521

Interpretation of Cephalometric Data

Page 12

difficultyoftreatment,thegreater(higher)theangle,themore verticalthegrowthdirectionandthemorecomplicatedthe treatment.

YAXIS YAxisSN
GnathionSellaNasion ReferenceLine:SellaNasion TheYaxis(thelineconnectingSellatoGnathion)isanestimate ofmandibulargrowthdirection.Alargerangleindicatesamore downwardandverticalgrowthdirectionofthemandible.A smallerangleindicatesamorehorizontalandanteriorgrowth directionofthemandible.Italsoindicatesthedegreeof downwardandforwardpositionofthechininrelationtothe upperface. ClassIIdivision1casesusuallyhaveanaveragetohighY axis. ClassIIdivision2casesusuallyhaveasmallerYaxis. HighYaxisisusuallyseenwithahighmandibularplane angle. AsthemandibularplaneandtheYaxisincrease,therelative chinprominencedecreases.

66 3

YAxisFH
GnathionMentonto FH

ReferencePlane:FrankfortHorizontal(OrbitalePorion) ThesameinterpretationasaboveusingSellaNasion.Many orthodontistsprefertouseFrankfortHorizontalthanSN.

59 3

Ortho 521

Interpretation of Cephalometric Data

Page 13

Ortho 521

Interpretation of Cephalometric Data

Page 14

ANTERIORFACEHEIGHT UAFH LAFH

UpperAnteriorFaceHeight LinearmeasurementfromNasiontoAnterior NasalSpine(NANS).

LowerAnteriorFaceHeight LinearmeasurementfromAnteriorNasal SpinetoMenton(ANSMe).

UAFH/LAFHRatio
TheratioofUAFHtoLAFHismoreimportantthantheindividuallinearmeasurementsof UAFHandLAFH.UAFHvarieswiththesuperiorinferiordimensionofthesizeofanadult skullwhiletheratioofUAFH/LAFHindicatesthebalanceoffacialproportions. UAFH/LAFHratio<0.8indicatesagreaterLAFH,orlongerloweranteriorfaceheight. UAFH/LAFHratio>0.8indicatesasmallerLAFH,orshorterloweranteriorfaceheight.

CHIN PgNB
PogoniontoNasionB point ReferenceLine:NasionBpoint Theprominenceofthebonychin(nottobeconfusedwiththesoft tissuechin)ismeasuredbythedistanceofPogonion(themost anteriorpointofthechin)tothereferenceNBline. Asmallerthanaveragevalueindicatesarecessivechinwhilea greaterthanaverageindicatesaprominentchin. Chinprominenceisalsoaffectedbyautorotationofthemandible (hingeaxisrotationatCentricRelation).Rotationofthemandible

3mm 2mm

Ortho 521

Interpretation of Cephalometric Data

Page 15

inananteriorsuperiordirection(forward)increaseschin prominencerelativetoNB.Rotationofthemandibleinan inferiorposteriordirection(backward)decreaseschin prominencerelativetoNB. SNPgandNPgFHalsomeasurechinprominencewithrespect toSNandFHreferenceplanes.

Ortho 521

Interpretation of Cephalometric Data

Page 16

MAXILLARYINCISORS U1toSN
Max.IncisortoSN ReferenceLine:SellaNasion Thisangularmeasurementdeterminestheinclinationofthe centralincisorrelativetotheanteriorcranialbase. Agreaterthanaverageangleindicatesproclination (labioversion)ofincisorsasoftenseeninClassIIdivision1 cases. Asmallerthanaverageangleindicatesuprightorretroclined (linguallyinclined)incisorsasoftenseeninClassIIdivision2 cases.

103 6

U1toNA
Max.IncisortoNA

ReferenceLine:NasionApoint TherelationshipofthemaxillarycentralincisortotheNA referencelineisusedtoestablishthepositionofmaxillary incisorsrelativetothemaxillaryapicalbase. Boththeinclinationofthelongaxisoftheincisortothelineand thedistancethatthelabialsurfaceoftheincisorinfrontoftheline aremeasured.Bothangularandlinearmeasurementsindicates theamountofmaxillarydentalprotrusion. Labiallyproclinedincisorswillhaveagreaterthanaverage angularandlinearmeasurement(ClassIIdivision1cases) Uprightorretroclined(linguallyinclined)incisorswillhavea smallerthanaverageangularandlinearmeasurement(Class IIdivision2cases). Positivevaluesarerecordedifthelabialsurfaceoftheincisor isanteriortotheNAline,negativevaluesifitisposterior.

Angular: 22 6

Linear:3mm 2mm

Ortho 521

Interpretation of Cephalometric Data

Page 17

MANDIBULARINCISORS L1toNB
Mand.IncisortoNB ReferenceLine:NasionBpoint TherelationshipofthemandibularcentralincisortotheNB referencelineisusedtoestablishthepositionofthemandibular incisorsrelativetothemandibularapicalbase. Boththeinclinationofthelongaxisoftheincisortothelineand thedistanceofthelabialsurfaceoftheincisorinfrontoftheline aremeasured.Themillimeterdistanceestablishesthe prominenceoftheincisorsrelativetothesupportingbone,while theinclinationindicateswhetherthetoothhasbeentippedtoits positionormovedbodily. Labiallyinclined(proclined)incisorswillhaveagreaterthan averageangularandlinearmeasurement(ClassIIdivision1 cases). Uprightorretroclinedincisorswillhaveasmallerthan averageangularandlinearmeasurement(ClassIIdivision2 cases). Positivevaluesarerecordedifthelabialsurfaceoftheincisor isanteriortotheNBline,negativevaluesifposterior.

Angular: 25 7

Linear:3mm 2mm

L1MP

Ortho 521

Interpretation of Cephalometric Data

Page 18

Mand.IncisortoMP

90 5

ReferencePlane:MandibularPlane AlsoknownasIMPA(IncisorMandibularPlaneAngle).It definestheaxialinclinationbetweenthemandibularincisorand theinferiorborderofthemandible.Themoretheincisoris labiallyinclined,thegreatertheangle.

INTERINCISALANGLE U1L1
Max.toMand.Incisor Theinterincisalanglemeasurestherelativespatialpositionalong thelongaxisofthemostprominent(anteriorlypositioned) maxillaryandmandibularcentralincisors.Itdeterminesthe degreeofprocumbency(labialinclination)oftheincisors.The morelabiallyinclined(proclined)theincisorsare,thelessthe interincisalangle.Themorelinguallyinclined(retroclined)the incisorsare,themoretheinterincisalangle. ClassIIdivision1casesusuallyhaveasmallerthanaverage interincisalangle. ClassIIdivision2casesusuallyhavealargerthanaverage interincisalangleduetothelingualinclinationofthe maxillarycentralincisors.

135 11