Model Analysis2 / Orthodontic Courses by Indian Dental Academy

Model Analysis
I NDI AN DENTAL ACADEMY

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Dental casts

Essential diagnostic aids

Provides 3 D view of maxilla and mandible

Valuable tool in orthodontic diagnosis and
treatment planning.
Principles of space analysis

Space analysis requires a comparison between
amount of space available for the alignment of the
teeth and the amount of space required to align
them properly.

Two steps in space analysis

1. To calculate the amount of space
available
2. To calculate the amount of space
required

Space available can be measured by

By dividing the dental arch into 4 straight line
segments
By contouring the .026 brass ligature wire to the
line of occlusion
By using a flexible scale
Space requirement can be measured by

By measuring the sum of M- D width of each tooth
from contact point to contact point.

Sum of width of permanent teeth > amount of
space available crowding

Sum of width of permanent teeth < amount of
space available spacing

Mixed dentition space analysis

Permanent dentition space analysis
Mixed dentition space analysis

Three factors are considered mainly

sizes of all permanent teeth

arch perimeter

Expected changes in the arch perimeter

There are three basic approaches for space
analysis

1. Measurement of teeth on radiographs

2. Estimation from proportionality tables

3. Combination of radiographic and prediction
table method
Measurement of teeth on radiographs

Requires undistorted radiographic image
It is necessary to compensate for enlargement of
the radiographic image

True width of E = True width of unerupted PM
Apparent width E Apparent width of unerupted PM
1. Measurement of teeth on radiograph
Nance analysis

2. Estimation from proportionality tables
Moyers analysis
Tanaka Johnston analysis

3. Combination of radiographic and prediction
table
Satley and Kerber analysis

Nance analysis
Proposed by (Nance, 1940)

Materials :
Sharp dividers
A set of periapical radiographs
A millimeter rule
A piece of .026 inch brass ligature wire
A ruled 3 x 5 inch card for recording
measurements
Set of study models

Method of determine arch length

Amount of space required

width of the erupted four mandibular permanent
incisors are measured.

width of unerupted mandibular canines, first and
second premolars on the radiographs are
measured.

Amount of space available

A piece of .026 inch brass ligature wire is placed
on the lower cast extending from the mesial
surface of the first permanent molar on one side of
arch to the mesial surface of the first permanent
molar on the opposite side.
wire should pass over the buccal cusp of the
posterior teeth and the incisal edges of anterior
teeth.
3.4 mm is subtracted.
Two measurements are compared .
Estimation from proportionality tables

Moyers analysis

Tanaka and Johnston
Moyers analysis
Moyers (1969)

The mesiodistal width of the lower incisors is used
to predict the size of both the lower and upper
unerupted canines and premolars.

Why mandibular incisors are chosen?

Procedure:
Measure the sum of mesiodistal width of lower
mandibular incisors.
Measure the space left behind for 345 on either
side.
By using Moyers probability chart find out the
M-D width of upper and lower 345.
Compare the space available and space required in
all the four quadrants.
Moyers prediction values
Advantages:

It has minimal error and the range of possible
error is precisely known.
It can be done with equal reliability by beginner
and the expert.
It is not time consuming.
Does not require special instruments.
Can be used for both the arches.
Tanaka Johnston method:

They developed another way to use the width of
lower incisors to predict the size of unerupted
canines and premolars.

Combination of radiographic and
prediction table

Staley and Kerber
method
This method is used
only for mandibular
arch
Requires periapical
radiograph.
It is quite accurate
method

All three methods are based on data from white
school children of northern European descent.

If patient fits this population group ,the Staley
Kerber will give the best result followed by
Tanaka Johnston and Moyers.
Mixed dentition mandibular arch length analysis: a
step by step approach using the revised Hixon
Oldfather prediction method:
Samir Bishara,Robert Staley(1986)

Revised prediction equation used the same
predictor variables used by Hixon and Oldfather

Objective :

To obtain the most accurate result for a particular
patient by reducing to a minimum of errors
involved in measurement and judgment.
Mandibular tooth size-arch length analysis
Step by step approach

1. From the models
M-D width of lower
central incisor
M-D width of lower
lateral incisor
2. From the periapical
X-rays
M-D width of 1PM
M-D width of 2PM

Measurement of posterior and anterior arch
length
3. From Hixon Oldfather conversion table
Other parameters need to be considered in the
space analysis

Permanent dentition
analysis

Digital model analysis
Permanent dentition analysis:

Ponts Analysis
Boltons Analysis
Ashley Howes Analysis
Peck and Peck analysis
Korkhaus Analysis
Littles irregularity index
Careys Analysis

Ponts analysis
Introduced this analysis in (1909)

Measurement of M-D of 4 maxillary incisors
determines the ideal arch width in PM and molar
area before the eruption of canines.
Ponts analysis helps in determining

Dental arch is narrow or normal
Need for lateral arch expansion
How much expansion is possible at PM and molar
area.

Determination of sum of incisors (S.I.)
Determination of measured PM value (M.P.V.)
Determination of measured molar value (M.M.V.)
Determination of calculated PM value (C.P.V.)
S.I. x 100
80
Determination of calculated molar value (C.M.V.)
S.I. x 100
64
If measured value < calculated value

need for expansion

Did not indicate the sample size
Relationships between the form of the skulls and
form of dental arch
Did not include an assessment of mandibular arch
Reliability of index should be tested in other
populations.

Some studies which critically evaluated use of
Pont's index

Low correlation coefficients between the sum of
M-D width of incisors and the arch width in the
PM & M region

Smyth & Young(1932)
Greve K(1933)
Wroms et al (1969)
J oondeph and co-workers (1970)
Moyers (1988)
Lew K (1991)

Dalidjan, Sampson and Townsend (1995)
Individual variability was noted

Nimkarn et al (1995)
Overestimated the desired arch width by an average
of 2.5mm to 4.7mm
Comparison with present study(Indian population)

Significant differences b/w male and female for
anterior arch width, posterior arch width and sum
of incisors.
Female values were more variable than male
values.
Statistical comparison was not possible.
Individual variation is large.
Moderate correlation coefficients were observed
Comparison with present study (Tibetans population)

The mean value for the PM index was 79.56%
Molar width index was 61%
Tibetans have slightly larger inter-molar width as
compared with Pont's sample.
Boltons analysis:

Introduced by Bolton (1958)
There is a ratio exists between M-D width of
maxillary and mandibular teeth.

Sample:
Evaluated 55 cases with excellent occlusion ;44
had been treated orthodontically without
extraction and 11 were untreated.
Materials:
Three inch needle pointed dividers
Finely calibrated millimeter ruler

Methods :
Following measurements were made on each set
of cast
1. Sum of mandibular 12
2. Sum of maxillary 12
3. Sum of mandibular 6
4. Sum of maxillary 6

The following ratios were established by Bolton:

Overall ratio:
Percentage relationship of mandibular arch length
to maxillary arch length.
Overall ratio = Sum of mandibular 12 x100
Sum of maxillary 12

Overall ratio was given as 91.3% and standard
deviation 1.91

Anterior ratio
Percentage relationship of M-D width of
mandibular anteriors to maxillary anteriors.

Anterior ratio = Sum of mandibular 6 x100
Sum of maxillary 6

Anterior ratio was given as 77.2% and standard
deviation 1.65


If ratio exceeds the normal ratio, it indicates the
discrepancy in the mandibular tooth material.

If value is less, then the discrepancy in maxillary
tooth material.
Drawbacks of Boltons analysis

Bolton(1958, 1962)
Results tabulated were derived from the use of
mean figures. So one must consider each patient
as an individual.
Larry White(1982)
Coefficient of correlation b/w the anterior and
overall ratios was very low.

Epker and fish (1986)
Geometry of arch form was not considered.
Labio-lingual thickness of teeth is not taken into
account.
Axial inclination of teeth was not considered.
Moyers (1988)
Sexual dimorphism in maxillary cuspids was not
considered.


Comparison with present study
Significant differences were observed for mean
value of TTM and anterior tooth material.
For the overall ratio significant differences were
observed for female.
Showed very minimal magnitude of sexual
dimorphism.

Ashley Howes Analysis:

In 1947 his first article was published in AJO and
oral surgery which dealt with adequacy of apical
base.
In 1954 published another article:considered the
relationship of TTM to supporting bone.
He measured 14 normal dentition and 200
subsequent cases.

Methods

Determination of total tooth material(T.T.M.)
Determination of premolar diameter (P.M.D.)
Determination of premolar basal arch width
(P.M.B.A.W.)

Ratios were derived separately for maxilla and
mandible

PM distance ratio= PM distance x 100
TTM

Basal arch width ratio= Basal arch width x 100
TTM

Basal arch length ratio= Basal arch length x 100
TTM
Inference
The P.M.B.A.W.and P.M.D. are compared.
If P.M.B.A.W is < P.M.D. arch expansion is
possible.
If P.M.B.A.W is > P.M.D arch expansion is not
possible.

P.M.B.A.W Ratio:
The ratio between the apical base width at the
premolar region and the total tooth material is
called the P.M.B.A.W percentage.

P.M.B.A.W % = P.M.B.A.W. x 100
T.T.M.

IF P.M.B.A.W.% is 37% or less.
If P.M.B.A.W.% is 44% or more
If P.M.B.A.W.% is 37-44%
Evaluation of Howes index.
Martinek(1957) disagreed because Howe's analysis
was derived from limited no. of normal occlusions
based only on clinical cases.
Stifter(1958) Howe's theory stating that canine
fossa cannot be exceeded by bicuspid arch width
is not valid.
Moyers(1988) more logical and superior to Ponts
index.
Comparison with present study
Only an approximate comparison could be made
Significant differences were observed both in
maxilla and mandible for TTM and BAW for
males.
Significant differences existed in maxilla only for
bicuspid ratio.
Significant differences were observed both in
maxilla and mandible for TTM, bicuspid distance
,bicuspid ratio,basal arch width and BAL.
Some cases bicuspid width exceeded the basal
arch width.
Comparison with present study(Tibetan population)

PMD,PMBAW and PMBAW/TTM values are
higher than Howes in both in mandibular and
maxillary arch.
Peck and Peck Analysis

This analysis was proposed by Harvey Peck and
Sheldon Peck AJ O-DO (1972)
Purpose of this article is to present the scientific
basis and the clinical application of a new method
for detecting and evaluating tooth shape deviations
of the mandibular incisors.
Materials and methods
Two groups of young female
First group- Group with perfect mandibular incisor
alignment
Second group Control population group

First group 45 subjects
Complete mandibular dentition
No orthodontic treatment received
A proximal contact present among the mandibular
incisor.
The absence of overlapping in the mandibular
incisors
Minimal rotational deviation from the ideal .
Second group consisted of 70 subjects of
comparable age
In both the groups the maximal M-D and the
maximal F-L dimensions were measured directly
in patients mouth by Helios Dial Caliper.

Index = MD crown diameter in mm x 100
FL crown diameter in mm

Desirable MD/FL index values are
Mandibular central incisor:88-92
Mandibular lateral incisor: 90-95

Higher the MD/FL index Greater the tooth shape
deviation and greater the likelihood of associate
crowding.

Various studies which supports this analysis are:

Boese (1980)
Guide for interproximal tooth reduction
Barrer (1975) Boese (1980)
Shape of these teeth is important in protecting the
integrity of this region after orthodontic therapy.
Various criticisms on peck and peck index

Various studies have reported that there is lack of
relationship b/w the shape ratios and lower incisor
crowding.
Narrow MD widths of mandibular incisors did not
insure long term stability in orthodontically treated
cases.
Kuftinec (1975)
Keene and Engle (1979)
Gilmore and Little (1984)
Puneky, Sadowsky and Begole (1984)
Comparison with present study (Indian population)

Significant difference were observed for the tooth
shape ratios for well aligned CI & LI b/w two
sexes
Significant difference was found for the M-D
width b/w two sexes.


Range observed in the present study was very wide
: 80-109%
The irregularity index:A quantitative score
of mandibular anterior alignment
Robert M Little AJ O 1975
Measuring the linear displacement of the anatomic
contact point, the sum of these five displacements
represents the relative degree of anterior
irregularity.
Material and methods
Dial caliper calibrated to at least tenth of a mm
.
Mandibular casts

Measurements are obtained directly from the
mandibular cast.
Caliper is held parallel to the occlusal plane.
Each of the five measurements represents a
horizontal linear distance between the anatomic
point of the adjacent teeth.
Each cast was subjectively ranked on a scale
ranging from 0-10

0 perfect alignment
1-3 minimal irregularity
4-6 moderate irregularity
7-9 severe irregularity
10 Very severe irregularity
Korkhaus analysis
He proposed two index
1. Anterior arch length index
2. Palatal height index

1. Anterior arch length index
Introduced in (1938)
Material and method

Masel dental dial
caliper
Korkhaus 3 D
orthodontic divider
Metallic scale
Finely pointed lead
pencil
Dental casts
Formula for calculating the standard value of
upper anterior arch length

Sum of upper incisors x 100
160


No statistically significant difference were
observed for the mean values of ant. arch length
and arch length index.
SI shows significant differences b/w male and
female
Statistical comparison was not done because the
sample size was not specified
Large differences were noticed b/w the observed
and predicted arch lengths

Palatal height index

This index was introduced in (1939). Purpose of
this index was to evaluate the palatal shape.

Posterior arch width = mesial pits on occlusal
surface of upper first molar

Palatal height = perpendicular distance from the
connecting line between the reference points for
posterior arch width to the surface of the palate


Average value for palatal index is 42% and is
derived from the formula

Palatal height x100
Posterior arch width

I ncreased value shows that the palatal vault is high
relative to transverse arch development.
Decreased value shows that palatal vault is shallow

Significant differences were observed b/w the two
sexes for all the variables related to this index.
Posterior arch width, palatal depth & palatal depth
index.
Weak correlation was observed b/w palatal depth
and posterior arch width.

Tibetans have shallow palate as shown korkhaus
palatal height index.
Careys analysis

Helps in determining the extent of discrepancy

Performed in lower cast

Same analysis on upper cast is called arch
perimeter analysis
Determination of arch length

Arch length anterior to first permanent molar is
measured by using a soft brass wire.

The wire is placed touching the mesial surface of
the first permanent molar and is passed over the
buccal cusps of premolar and along the anterior
and is continued on the opposite side.

Determination of tooth material

M-D width of teeth anterior to first molars is
measured and summed
Inference
If discrepancy is
0-2.5 mm minimal tooth material excess,proximal
reduction can be carried out
2.5 5 mm need to extract second PM
> 5 mm need to extract the first PM

Digital study model
Dental cast:
Advantages
Production is easy,routine and predictable
Relatively inexpensive to produce
Easy to examine and measure
Can be mounted articulated in variety of ways to
stimulate occlusal relationships.
True 3D medium that accurately represents normal
malocclusions.
Disadvantages :
Storage is a major problem
Easily lost or damaged
Bulky to transfer
Various methods have been employed in 3D
assessment and recording of dental study models

These includes:
Holography
Moire topography
Various types of lasers
Holography
Introduced in 1948 and involved microscopy by
reconstructed wavefronts.

Materials
Holography camera
Disadvantages
Expensive
Difficult to produce
Cannot be manipulated as a set of study models
can
Poor quality of recording
Moire Topography
Contour mapping technique designed to produce
successive contour lines directly on an object.

Disadvantage
Resolution is poor especially for dental morphology

Two software are commercially available for digital
study models

Ortho Cad by Cadent Inc, Fairview, N.J., U.SA.
E- models by Geodigm Corporation, Minnesota
U.S.A.

Orthocad
Steps involved in preparing Orthocad DSM

Step 1: alginate impressions and wax bite are taken.
Step 2: mailed to the computer center
Step 3: digital models are sent from company to the
user through the internet.
Step 4: digital models can be utilized with Ortho
CAD 3D software.
Three components are mainly required
FTP software
Designated folder on the hard disc
An electronic browser

Program runs on any MS windows
File size of each model is about 3 MB
Can be stored on any hard disc or CD (CD of 650
MB allows storage of 200 models)
Advantages of ESM are:
Can be easily recalled at the touch of button at
each patient visit.
Can be sent any where around the world
Valuable tool in tele conferencing with virtual
display
Tooth material analysis can be calculated rapidly
The model can be electronically sectioned
sagitally or transversely.
Five simultaneous view of model in the same
window.

Limitations
Inability to articulate the models in terminal hinge
position
Yet to be approved for American Board
Certification
E- models
This software is very similar to Ortho Cad
excepting that the features are perhaps a shade
lesser.

Frontal asymmetry analysis
Cephalometrics for
orthognathic surgery
Soft tissue cephalometric
analysis for orthognathic
surgery
Cephalometry

Scientific measurement of the dimensions of the
head.
Roengenographic Cephalometry (Krogman &
Sassouni )
The measurement of the head from the shadows of
bony and soft tissue landmarks on the
radiographic image became known as
Roentgenographic Cephalometry.
Purpose of Cephalometry

In morphological analysis
In growth analysis
In treatment analysis

History
16 century artists
Albretcht Durer and
Leonardo da Vinci
had sketched series of
human faces with
straight lines joining
homologous
anatomic stuctures.
Backward hanging Forward hanging
or or
Retroclined facial contour Proclined facial contour
(De Coster & Moorees)
Teleroentgenographic technique
Pacini (1922)

The following authors
Mac Gowen (1923)
Simpson (1923)
Compte (1927)
Riesner (1929) & others


In (1931)
Broadbent in USA & Hofrath in Germany
simultaneously & independently developed
standardized methods for production of
cephalometric radiographs using special holder
known as cephalostat.
Cephalostat two types:
Broadbent-Bolton method
Higley method
Anatomic structures in the cephalogram

The major bony structures are
Sphenoid bone
Zygomatic bone
Maxillae
Mandible
Sphenoid bone
Zygomatic bone
Maxillary bone
Mandible
In lateral cephalogram

Unilateral landmarks
Bilateral landmarks
In posteroanterior projection

Midline structures
Bilateral structures
Posteroanterior (frontal) Cephalometry

Importance
Dentoalveolar and facial asymmetry
Dental and skeletal cross bites
Functional mandibular displacements
Qualitative and quantitative evaluation of
dentofacial region
Cephalometric set-up
Head holder or Cephalostat
X-ray source
Cassette holder containing the film
Natural head position
Natural head position
is a standardized
orientation of the
head,which is readily
assumed by focusing
on a distant eye level.
(Moorrees, 1985)
Fixed head position
Other techniques of head positioning
Chierici(1981) ,
patients head should
be positioned with the
tip of the nose and
forehead lightly
touching the cassette
holder.

Other techniques of head positioning
Faber (1985) PA
cephalogram should
be taken with the
mouth of the patient is
slightly opened.
(significant mandibular
displacement cases)

Structures that should be included in the
tracing of PA cephalogram
Purpose of PA Cephalometry

Gross inspection
Description and comparison
Diagnosis
Treatment planning
Growth assessment and evaluation of treatment
results
A Frontal Asymmetry Analysis
Grummons analysis
Ricketts analysis
Grayson analysis
Hewitt analysis
Chierici method

Grummons Analysis

Proposed by Duane C Grummons (1987)
Martin A Kappeyene Van De Coppello

Comparative and quantitative posteroanterior
Cephalometric analysis not normative.
Two forms
Comprehensive frontal analysis
Summary frontal analysis
Landmarks and abbreviations

Different components of Grummons Analysis

Horizontal planes
Mandibular morphology
Volumetric comparison
Maxillomandibular comparison of asymmetry
Linear asymmetry assessment
Maxillomandibular relation
Frontal vertical proportions
Horizontal planes

Four horizontal planes are constructed:
Connecting the medial aspects of the
zygomaticofrontal suture (Z)
Connecting the centres of the zygomatic arches
Connecting the medial aspects of the jugal process
(J)
Parallel to the Z plane through menton
Horizontal planes

Mid sagittal reference line (MSR)

Mandibular morphology

Volumetric comparison

Maxillomandibular comparison of
asymmetry

Linear asymmetry assessment

Maxillomandibular relation

Frontal vertical proportions

Upper facial ratio- Cg-
ANS/Cg-Me
Lower facial ratio- ANS-
Me/Cg-Me
Maxillary ratio- ANS-
A1/ANS-Me
Total maxillary ratio-
ANS A1/Cg-Me
Total mandibular ratio- B1
Me/Cg-Me
Maxillo-mandibular ratio-
ANS-A1/B1-Me

Comprehensive frontal analysis

Includes:
Construction of horizontal planes
Mandibular morphology analysis
Maxillomandibular comparison of facial
asymmetry

Grayson Analysis
(Barry H Grayson et al 1983, AJ O-DO)

Analyzing craniofacial asymmetry with the use of
multiplane posteroanterior cephalometry.

Landmarks are identified in different frontal
planes at selected depths of the craniofacial
complex and subsequent skeletal midlines are
constructed.
Tracing 1

Orbital rims
Pyriform aperture
Maxillary and
mandibular incisors
Mid point of the
symphysis.

Midline construct for A plane

Tracing 2

Greater and the lesser
wing of the sphenoid
Zygomatic arch(the most
lateral cross- section)
Maxillary and mandibular
first permanent molar
The body of the mandible
The mental foramina
Midline construct for the B plane

Tracing 3
Superior surface of
petrous portion of
temporal bone
Mandibular condyle
with outer border of
ramus
Mastoid process
Midline construct for C plane

Superimposition of three tracings

Key triangles are constructed in each of the
horizontal planes and related to the posterior
midsagittal plane.

.

Superimposition of the
triangles shows that the
greatest amount of
deviation from the
midline occurs at the
level of the mandible (C),
decreasing in a cephalic
direction, Maxilla,(B)
Cranial base(A).

Ricketts Analysis
(Ricketts et al, 1972)

Following clinical norms
are presented :
Nasal cavity width
Mandibular width
Maxillary width
Symmetry
Intermolar width
Intercuspid width
Denture symmetry
Upper to lower molar
relation

Hewitt analysis

Hewitt (1975),by dividing the craniofacial
complex in dividing triangles.
Different regions are:
The cranial base
The lateral maxillary region
The upper maxillary region
The middle maxillary region
The lower maxillary region
The dental region
The mandibular region

Triangulations of the face
Chierici method

Chierici, (1983)

An assessment of the range of variation in bilateral
location of various skeletal structures from
posteroanterior radiographs of acceptable faces.
Dr. Amitabh Kallury, September 1999

Aims and objectives
To determine the acceptable range of deviations in
facial symmetry.
To determine which of the two sagittal plane Cg-
ANS and ZZ-ANS is more reliable.

Sample
30 males and 30 females (18-27 years)

Conclusion
1.Norms are proposed for the acceptable variation in
the location of bilateral skeletal structures in the
postero anterior radiographs.

2. Cg- ANS was more reliable than ZZ- ANS as the
MSR

Anatomic and developmental considerations
Smaller mean and standard deviation of the
landmarks
From a practical point of view

Cephalometrics for
orthognathic surgery
surgery
Soft tissue analysis
Model analysis

Cephalometric analysis for
orthognathic surgery (COGS)

Developed at the University of Connecticut by
Burstone et al (1978)

Landmarks used in cephalometric analysis
Sella (S)
Nasion (N)
Articulare(Ar)
Pterygomaxillary fissure (PTM)
Subspinale (A)
Pogonion (Pg)
Supramentale (B)
Anterior nasal spine (ANS)


Menton (Me)
Gnathion (Gn)
Posterior nasal spine (PNS)
Mandibular plane (MP)
Nasal floor (NF)
Gonion (Go)
Landmarks

1. Cranial Base
Horizontal plane
Length of the cranial base : Ar to N
To determine the horizontal distance between
the posterior aspect of maxilla and mandible:Ar
to Ptm

Cranial Base

2. Horizontal Skeletal Profile
Skeletal facial convexity
N-A
N-B
N-Pg

Horizontal skeletal profile

Skeletal facial
convexity
N-A
N-B
N-Pg

Vertical skeletal and dental discrepancy
Vertical skeletal component
Anterior component
Posterior component

Anterior component
Middle third facial height
Lower third facial height
Vertical skeletal dysplasia

Posterior maxillary
height
Mandibular plane
angle
Vertical dysplasia of the
posterior components

Anterior and posterior skeletal component of
the face help in the

Diagnosis of maxillary hyperplasia or hypoplasia.
Rotation of the maxilla and mandible.
Typical surgical correction of these problems
includes:
Total maxillary advancement or reduction.
Posterior maxillary vertical augmentation
reduction.
Combination of anterior or posterior maxillary
vertical augmentation or reduction.
Mandibular ramus rotation.
Ramus height reduction.
Vertical Dental Dysplasia

Two components
Anterior component
Posterior component
Anterior component
Anterior maxillary dental height
or
Total vertical dimension of premaxilla
Anterior mandibular dental height
or
Total vertical dimension of anterior mandible
Vertical skeletal and dental measurements
Posterior dental measurement

Determines the posterior
molar eruption
or
Posterior dental -
mandibular or maxillary
vertical height
Maxilla and Mandible

Maxilla
Length of the maxilla (PNS-ANS)
Mandible
Length of the mandibular ramus(Ar-Go)
Length of the mandibular body(Go-Pg)
Relationship between ramal plane and mandibular
plane(Ar-Go-Gn)
Prominence of chin(B-Pg)
Maxilla and mandible
These measurements are helpful in diagnosis
of

Ramus height
Mandibular body length
Acute or obtuse gonial angle
Assessment of chin prominence

Dental relationship

Occlusal plane
Mandibular plane
Nasal floor
Occlusal plane

OP angle
Increased OP-HP may be associated with
Skeletal open bite
Lip incompetence
Increased facial height
Increased mandibular plane angle
Decreased OP-HP may be associated with
Deep bite
Decreased facial height
Lip redundancy

Measurements of AB-OP

Angulation of
mandibular central
incisor to MP
Angulation of
maxillary central
incisor to NF

surgery

Cephalometric landmarks

Glabella (G)
Columella point (Cm)
Subnasale (Sn)
Labrale superius (Ls)
Stomion superius (Stms)
Stomion inferius (Stmi)
Labrale inferius (Li)

Mentolabial sulcus (Si)
Soft tissue pogonion (pg)
Soft tissue gnathion (Gn)
Soft tissue menton (Me)
Cervical point (C)
Horizontal reference plane(HP)

Cephalometric landmarks
The soft tissue analysis

Facial form
Angle of facial convexity
Relationship of the maxilla and mandible
Position of Pogonion
Lower face neck angle (Sn-Gn-C)
Assessment of lower face vertical ht. to depth.
(Sn-Gn/Gn-C)
The ratio of middle third face ht. to lower third
face ht. measured to HP

Measurements of facial form

Angle of facial
convexity
Lower face neck
angle
Lower vertical ht.-
depth ratio


Anteroposterior
maxillary and
mandibular
measurements
Vertical facial height
proportionality

Lip position
Nasolabial angle
Antero posterior lip position
Mentolabial sulcus
Upper and lower lip protrusion
Interlabial gap
Lower third facial height proportionality
Lip position

Nasolabial angle
A-P max. dysplasia
position of upper lip
Mentolabial sulcus
Lip position

Interlabial gap
Lower third facial
height proportionality
Antero posterior lip
position

Soft tissue analysis
Soft tissue landmarks
Glabella (G)
Columella point (Cm)
Subnasale (Sn)
Labrale superius (Ls)
Stomion superius (Stms)
Stomion inferius (Stmi)
Labrale inferius (Li)


Mentolabial sulcus (Si)
Soft tissue pogonion (pg)
Soft tissue gnathion (Gn)
Soft tissue menton (Me)
Cervical point (C)
Horizontal reference plane(HP)

Soft tissue landmarks
Cephalometric planes of reference

Sella nasion plane
Frankfort horizontal
Constructed horizontal
plane

Soft Tissue Evaluation: Frontal View
Vertical facial proportions
Facial symmetry
Maxillary incisor to lip relationship
Vertical facial proportions

The Roman architect
Vitruvius had divided
the face into three
equal parts.
Facial symmetry
Face is divided along the
mid-sagittal plane
Composite photograph to indicate normal
facial asymmetry
Maxillary incisor to lip relation
Stomion superius to incisal edge of maxillary incisor
Soft tissue evaluation : Profile view
Middle to lower third facial ratio
Upper lip lower lip height ratio
Assessment of the nose
Nasomental angle
Nasolabial angle
Maxillary prognathism
Upper lip prominence


Mandibular prognathism
Lower lip prominence
Interlabial gap
Chin prominence
Chin neck contour
E-line
Merrifields Z angle
Vertical proportions in profile view
Middle to lower third
facial ratio
Upper lip- lower lip
height ratio
Assessment of nose
Landmarks used to evaluate the nose are:
Glabella
The radix
The nasal dorsum
The tip of the nose
The columella
Nasolabial angle
Nasofacial angle
Inclination of the nasal base
Nasomental angle

Nasolabial angle
Horizontal nasal prominence
Schiedeman et al
(Glabella-Pronasal)
should be approximate
one third of the
vertical ht. of the nose
(glabella subnasale)
Mentocervical angle
Submental- neck angle

Maxillary and mandibular prognathism
Upper lip-Lower lip prominence
Upper lip- lower lip-Chin prominence
0 Degree Meridian
Ricketts E-Line
Stieners S-line
Merrifields Z angle
The Holdaway
Soft -Tissue Analysis
Holdaway Soft Tissue Analysis
Reed Holdaway
His analysis comprises 11 measurements
Facial angle
Upper lip curvature
Skeletal convexity at point A
H-line angle
Nose tip to H- line
Upper sulcus depth
Upper lip thickness
Upper lip strain
Lower lip to H- line
Lower sulcus depth
Soft tissue - chin thicknes
Facial angle upper lip curvature
Holdaways H line Angle
Nose Tip to H line
Upper Sulcus Depth
Lower lip to H - line
Lower sulcus Depth
Soft-tissue chin
thickness.
Upper lip thickness

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