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DEPARTMENT OF

PEDODONTICS
CEPHALOMETRIC DIAGNOSIS
Submitted to : Dr. RITU J INDAL
Head of the department


Submitted by: Sharanjit walia
Roll no. 57
BDS Final prof.

Introduction
History
Equipment
Technical aspect
Positioning of the patient
Exposure parameters
Types
Uses
Landmarks and planes
Analysis

Introduction
Craniometry can be said to be the
forerunner of cephalometry.

Craniometry involved measurements of
cranio facial dimensions of skulls of dead
persons.

This method was not practical in living
individual due to soft tissue envelope that
made direct measurement difficult and far
reliable.
History
Cephalometry was a modification of
anthropological studies and
craniometry.
PACINI in 1922 published the first
paper on cephalometry.
But it was BOARDBENT(USA) and
HOFRATH(Germany) who introduced
and popularized in 1931.
Clinical application of cephalometry was
introduced by DOWNS.
EQUIPMENT
BOARDBENT bolton type:
Uses two x ray sources and two
film holders.
Lateral and AP cephalograms
can be taken without moving the
subject.
More precise results can be
obtained..
BOARDBENT bolton
type
Bjork, 1951
Thurow, 1951
Marcolis, 1940
Waldo, 1938
Technical aspect
Cephalometric radiographs are taken using
an apparatus that consist of an x ray
source and an head holding device called
cephalostat.

Cephalostat consists of two ear rods
preventing movement of head.

Vertical stabilisation of head is by orbital
pointer contacting lower border of orbit.


Upper part of face is supported by
forehead clamp positioned above the
region of nasal bridge.

The distance between the x ray source
and mid saggital plane of the patient is
fixed at 5 feet.

Thus the equipment helps in
standardising the radiographs.
POSITIONING OF THE PATIENT
F.H. plane should be parallel to
floor.
Ear rods stabilize the patient on the
horizontal plane.
Patient is made to close the mouth
in centric occlusion.
Orbital pointer should be fixed for
vertical plane stabilization of
patient.





head
holding
device
X-ray
sourc
e
:

Cephalostat:

Consist of:
Uses
Helps in orthodontic diagnosis.
Helps in classification of skeletal
and dental abnormalities.
Helps in planning treatment of an
individual.
Helps in evaluation of treatment
results.
Helps in predicting growth related
changes.


A
Point A: the deepest point in the curvature
of the maxillary alveolar process
B
Point B: the deepest point in the curvature
of the mandibular alveolar process
Pg
Pogonion: the extreme anterior point of the
chin
Me
Menton: the extreme inferior point of the
chin
Gn
Gnathion: the midpoint between pogonion and
menton
A
r point of
the chin
Me

Menton:
the
extreme
inferior
point of
the chin
Gn

Gnathion
: the
midpoint
between
pogonion
and
menton
B
Gonion(GO)-:It is constructed point at the
junction of ramal plane and the
mandibular plane.
Porion (p)-:The highest bony point on the
upper margin of external auditory
meatus.
Sella-:point representing pituitary fossa
or sella turcica. .
Orbitale-:lowest point on the inferior bony
margin of the orbit.
Nasion-:most anterior point midway
between frontal and nasal bones on the
frontonasal sutures.
Go
Gonion: the midpoint
of the mandibular
angle between ramus
and corpus mandibulae

O-The lowest point
on the inferior bony
margin

N-The most anterior
pt Midway b/w
frontal &nasal bones.

P- The highest bony
point on the upper
margin of external
auditory meatus
anterior pt.


N

N

G O
Planes used in
cephalometrics
Horizontal planes:
S.N. Plane sella to nasion.
F.H. Plane orbitale to porion.
Occlusal plane plane bisecting
posterior occlusion.
Palatal plane ANS to PNS of
palatine bone.
Mandibular plane gonion to
gnathion.

Planes used in
cephalometrics
Horizontal planes:
S.N. Plane sella to nasion.
F.H. Plane orbitale to porion.
Occlusal plane plane bisecting
posterior occlusion.
Palatal plane ANS to PNS of
palatine bone.
Mandibular plane gonion to
gnathion.

sella
nasion
porion orbitale
Reference Lines
VERTICAL PLANES:
A-Pog line point A on maxilla to
pogonion on mandible.
Facial plane nasion to pogonion,
Facial axis ptm point to gnathion.
E-plane esthethic plane is a line
between the most anterior point of soft
tissue nose to soft tissue chin.
Downs analysis;
It is one of the most frequently
used cephalometric analysis.

Downs analysis consists of ten
parameters of which five are
skeletal and five are dental.
Skeletal parameters;
Facial angle;
it is the inside inferior angle formed
by intersection of nasion-pogonion
plane and F.H. plane.
average value; 87.8 ( 82 95)
significance; indication of antero-
posterior positioning of mandible in
relation to upper face. Angle is
increased in skeletal class III with
prominent chin while decreased in
skeletal class II.
SKELETAL HORIZONTAL -
MAXILLA
SNA 82 2 deg
NA TO FH 90 3
deg
s
n
a
F H
Angle of convexity;
Nasion-point A to point A pogonion.
Average value; 0 ( -8.5 to 10).
Significance; A positive angle suggest a
prominent maxillary denture base in
relation to mandible.
Negative angle is indicative of
prognathic profile.

A-B plane angle;
point A point B to nasion pogonion.
Average value; -4.6 ( -9 to 0)
Significance; indicative of maxillo
mandibular relationship in relation to
facial plane.
Negative since point B is positioned
behind point A.
Positive in class III malocclusion.
SKELETAL HORIZONTAL -
MAXILLA TO MANDIBLE
N
A
B
ANB 2 2 deg
Mandibular plane angle;
Intersection of mandibular plane with
F.H. Plane.
Average value; 21.9 ( 17 to 28)

Y-Axis;
Sella gnathion to F.H. plane.
Average value; 59 ( 53 to 66)
Angle is larger in class II facial patterns.
Indicates growth pattern of a individual.

SKELETAL VERTICAL
F H
S
G N
M E
G O
FH TO GOGN 22
5 deg
Y AXIS 59 6
deg
LFH 55% OF
TFH
DENTAL PARAMETERS
Cant of occlusal plane;
OCCLUSAL PLANE TO F.H. Plane
Average value; 9.3 ( 1.5 to 14) Gives a
measure of slope of occlusal plane relative to
F.H. Plane.

Inter incisal angle;
Angle between long axes of upper and lower
incisors.
Average value: 135.4 ( 130 to 150.5)
increased in class I bimaxillary protrusion.


Incisor occlusal plane angle;
This is the inside inferior angle formed by the
intersection between the long axis of lower central
incisor and the occlusal plane and is read as a plus
or minus deviation from a right angle
Average value: 14.5 ( 3.5 to 20)
An increase in this angle is suggestive of increased
lower incisor proclination.

Incisor mandibular plane angle:
This angle is formed by intersection of the long
axis of the lower incisor and the mandibular plane.
Average value: 1.4(-8.2 to 7)
An increase in this angle is suggestive of increased
lower incisor proclination.
DENTAL - UPPER TO LOWER
INCISOR
INTERINCISAL
130 5 deg
Upper incisor to A-pog line:
This is a linear measurement between
the incisal edge of the maxillary
central incisor and the line joining
point A to pogonion. This distance is on
an average 2.7 mm(rang-1 to 5 mm)
The measurement is more in patients
presenting with upper incisor
proclination.

Steiners analysis
SNA (Maxillary position) 82.0
SNB (Mandibular position) 80

ANB (Maxillary/Mandibular relation) 2
l to NA (Upper incisors to NA mm) 4mm
l to NA (Upper incisors to NA degree) 22
l to NB (Lower incisors to NB mm) 4mm
l to NB (Lower incisors to NB degree) 25
l to l (lnter-incisal angle) 131
SN to GoGn (Mandibular plane angle 32
SN to occlusal plane 14
SKELETAL
ANALYSIS
S.N.A Angle formed by intersection
of s.n.plane and a line joining nasion
and point A.
Mean value is 82
I. In class II value is larger.
II. In classIII value is smaller.
S.N.B ANGLE
S.N.B. ANGLE-angle between S.N
plane and a line joining nasion to
point B.
Shows anteroposterior postioning of
mandible to cranial base.
Average value is 80.
A.N.B ANGLE-
angle is formed by
intersection of
nasion to point A
and nasion to point
B.
Average value is 2.
MANDIBULAR
PLANE ANGLE-
Angle formed
between S.N.
PLANE and
mandibular
plane(line
connecting gonion
and gnathion).
Average value is
32.
DENTAL ANALYSIS
Upper incisor to N-
A(ANGLE); angle
formed by intersection of
long axis of upper
central incisor and line
joining nasion to point A.
Normal value is 22.
Upper incisor to N-A(linear)
Linear
measurement
between upper
central incisor and
line joining nasion
to point A.
Normal value is
4mm.
LOWER INCISOR TO N-
B(angle)
Angle formed
between N-B PLANE
and long axis of lower
incisor.
Average value is 25.
Increased value
indicates proclination
of lower incisors.
Lower incisor to N-B (linear)
Linear distance
between lower central
incisor and line joining
nasion to point B.
Normal value is 4mm.
INTER-INCISAL ANGLE
Angle formed between
long axis of upper and
lower central incisors.
Reduced interincisal
angle in classII,div1.
Larger than normal in
classII,div2
malocclusion.
SOFT TISSUE ANALYSIS

S LINE;- According to steiner lips should
touch line extending from soft tissue
contour of the chin to the middle of an S
formed by the lower border of the nose.
If lips are located behind this line then
lips are retrusive,and patient has
concave profile.
If lips are located beyond this line then
lips are believed to be protrusive,and is
convex profile.
SOFT TISSUE
N
A
S
O
L
A
B
I
A
L

A
N
G
L
E

1
0
2


8

d
e
g
L
.
L
I
P

T
O

E

P
L
A
N
E

-
2

2
m
m
TWEED ANALYSIS
Tweed analysis makes the use of 3
planes that form triangle.:-
Frankfort horizontal plane
Mandibular plane
Long axis of lower incisor
Angles formed by these planes are-:
Frankfort horizontal Mandibular plane
(FMPA)
Incisor mandiular plane angle (IMPA)
Frankfort mandibular incisor angle
(FMIA)


TWEED ANALYSIS
FMA (Frankfort plane to
mandibular plane)
25.0
2
5
.
8
FMIA (Frankfort plane to lower
incisor angulation)
65.0
6
2
.
7
IMPA (Lower incisor to
mandibular plane)
90.0
9
1
.
5
TWEEDS TRIANGLE
WITS APPRAISAL

It determines the extent to which
mandible and maxilla are related to
each other.

Wits appraisal is used in cases where
the ANB angle is considered not so
reliable due to factors such as
position of nasion or rotation of jaws.
Method
The method includes drawing an occlusal
plane through overlapping cusps of first
premolars and molars.
Then perpendiculars are drawn to occlusal
plane from point A and point B.
The point of contact are termed as AO and
BO.
Distance between AO and BO gives antero
posterior relationship between two jaws.
WITS APPRAISAL

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