Cephalometrics

introduced for use

by orthodontists in
1931 by Dr.
Broadbent in the
USA and Hofrath
in Germany
independently of
one another.

Cephalo: head
Metric: measurments

Cephalometry: is the analysis and the

interpretation of standardized radiographs
of the facial bones.

It is a standardized and reproducible

form of skull radiography used extensively
in orthodontics to asses the relationships of
the teeth to the jaws, and the jaws to the
rest of the facial skeleton.

Head position: the patients head is

oriented in the same position relative
to the x-ray beam every time a film is
taken, with the use of a cephalostat.
Ear rods: in the ear canals (external
auditory meatus).
Frankfort plane: horizontal.
Teeth: in centric occlusion.
Lips: in their habitual position.

Assess facial and dentoskeletal

relationships.
To study growth and growth patterns
Evaluation of post treatment
changes.
Research purposes and long term
follow-up studies.

The cranial base.

The facial skeleton.
Soft tissues.

The midpoint of
the
sella turcica

The most inferior

anterior point on
the margin of the
orbit

 Sella Turcica (S)

Orbitale (Or)

The most anterior

point
of the frontonasal
suture

The

most posterior
inferior point on the
clivus (basiocciput).
It represents the
posterior limit of the
midline cranial base.
It lies on the anterior
margin of foramen
magnum.

 Nasion (N)

Basion (Ba)

The tip of the

anterior nasal
spine

The tip of the

posterior nasal
spine

 Anterior Nasal Spine

(ANS)

Posterior Nasal Spine

(PNS)

The most posterior

point on the profile
of the maxilla
between the
anterior nasal spine
and the alveolar
crest

The most posterior

point on the profile of
the mandible
between the chin
point and the alveolar
crest

 A point

B point

The most anterior

point on the bony
chin

The lowermost point

of the mandibular
symphysis in the
midline

 Pogonion (Pog)

Menton (Me)

The most inferior

point on the
mandibular
symphysis in the
midline

The most posterior

inferior point on the
angle of the
mandible

 Gnathion (Gn)

Gonion (Go)

The uppermost,
outermost point
on the bony
external auditory
meatus

 Porion (Po): superior

point of external
auditory meatus

Machine Porion:

landmark created by
ear
post of cephalostat

The intersection of
the posterior border
of the neck of the
mandibular condyle
and the lower margin
of the posterior
cranial base

The most
superior
posterior point
on the head of
the mandibular
condyle

The tip of the

crown of the
most prominent
upper incisor

The tip of the crown

of the most
prominent lower
incisor (E-lower
incisor edge)

Sella - Nasion
plane:
SN
Represent the cranial
base

Maxillary line:
ANS - PNS

Mandibular
plane:
Me - Go

Line drawn from Menton (Me) to

Gonion (Go)

Occlusal plane:
Cusp tips of molars tip
of lower incisor

The Line from point

A to pogonion:
A Pog
For best aesthetic results: -lower
incisor edges
lay on A-Pog
line
(Willians, 1969)

Measurement:

Skeletal relationships :
Sagittal basal relationships
Vertical basal relationships

Dentoalvealar
relationships
Soft tissues analysis

Angle SNA (82

3)
Prognathism of
maxillary
apical base

Angle SNB (79

3)
Mandibular
prognathism

Angle ANB (3 1)
The
anteroposterior
apical base
relationship
(skeletal
pattern)

Jaw discrepancies (maxillary and

mandibular).
Anteroposterior position of the Nasion
Inclination of S-N line to the Frankfort
plane.
Lower anterior facial height.

Wits analysis
(Jacobson,
1975)
Compares the
relationships of
the maxilla and
mandible with
the occlusal
plane (FOP)

S-N-POG (87 3)
Indicate the
anteroposterior
position of the
chin

Maxillarymandibular
planes angle
(Mx-Mn or MM
angle) (27 5)

Frankfortmandibular
planes angle
(FM angle) (27
5)

If the SN line inclination from the

True horizontal or from Frankfort
plane deviates more than 6
degrees, and less than 11
degrees, measurements based
on the SN line should be
corrected by this difference.

Gonial angle
(Ar-TGp / TGiMe)
(126 5)

Upper incisor to maxillary plane angle

(UI / Mx) (108 5)
Lower incisor to mandibular plane
angle
(LI / Mn) (92 5)
Interincisor angle (UI / LI) (133 10)
Lower incisor edge to A-Pog distance
(E A-Pog) (0-2 mm)

UI / Mx plane angle
(108 5)
LI / Mn plane angle (92
5)
Interincisal angle (133
10)
E A-Pog (0-2 mm)
E C (0-2 mm)
FOP / Mx (10 4)

Cephalometric superimpositions
involve the evaluation of:
Changes

in the overall face.

Changes in the maxilla and its dentition.
Changes in the mandible and its
dentition.
Amount and direction of condylar
growth, and mandibular rotation.
(Kristensen, 1989)

The most accurate superimposition is

obtained by tracing the first radiograph
and superimposing that tracing on the
second film, registering the appropriate
cranial base structures.
(Ekstrom, 1982)
Reliable picture of overall facial growth.

Superimposition on:

S-N line with registration at sella

(reliable)
De Costers line (more reliable).

Maxilla is subject to extensive periosteal

remodelling.

Superimposition on:

The anterior surface of the zygomatic

process little periosteal remodelling with
growth (Bjork and Skieller, 1979) (not
easily seen and too short).
Anterior surface of the palatal vault.
The maxillary plane (at PNS)(contour of
the palate at the alveolar process base).

The mandible undergoes rather

complex remodeling changes
(anterior / posterior growth
rotations.
(Bjork and Skieller,
1972)

Superimposition on:

The inner contour of the cortex of

the mandibular symphysis (most
useful).
To

evaluate remodeling in the mandible with

growth.
To evaluate changes in the lower incisor
position.

The contour of the mandibular canal.

The crypt of the developing third
permanent molars (from the time of
commencement of mineralization until
root formation begins).

A digitizer comprises an illuminated

radiographic viewing screen connected to
a computer.
Information from a lateral cephalometric
radiograph is entered into the computer
by means of a cursor which records the
horizontal and vertical (x,y) co-ordinates
of cephalometric points or bony or soft
tissue outlines.
Specialized software employed to utilize
the information entered to produce a
tracing and/or the analysis of choice.
Research purposes.

Digora scanner.

Studies have shown digitizers to be as

accurate as tracing a radiograph by
hand.

There was no difference in the regional

superimpositions of the mandible, the
maxilla, and the cranial base, manually
vs digitally with Quick Ceph 2000.
(Roden-Johnson et al.,
2008)