CEPHALOMETRICS

By

GUIDED BY:
DR. SHASHIKALA
Professor and H.O.D.,
Dept. Of orthodontics.
DR. APARNA.
DR. ROSHAN.
DR. SHEELA.

Shameel ahmed sharif

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

Introduction

Assessment of cranio-facial structures forms a

part of orthodontic diagnosis.
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 BROADENT(USA) and
HOFRATH(Germany) who introduced and
popularized in 1931.
Clinical application of cephalometry was
introduced by DOWNS.

EQUIPMENT
Broadent

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..

Broadent bolton
type

HIGHLEYS TYPE
Uses

one x ray source and one film

holder
Patient is repositioned for various
projections..
Less reliable results as there is
movement of subject.

Other type of cephalometers of

historical interest

HOFRATH TYPE

Korkhaus, 1938

Waldo, 1938

Thurow, 1951

Marcolis, 1940

Bjork, 1951

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.

Exposure parameters
75

80 Kvp
7 8 ma
0.8 sec

Types

Lateral cephalogram; provides lateral view of

skull.
Frontal cephalogram; provides anteroposterior
view of skull.

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.

LANDMARKS

Sella: the midpoint of Sella Turcica

N
Nasion: the extreme anterior point on the
frontonasal suture
sna
Spina nasalis anterior: the extreme anterior point
on the maxilla
snp
Spina nasalis posterior: the extreme posterior
point on the maxilla
Pt
Pterygoid point: the extreme superior point of the
pterygopalatine fossa

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

Go
Gonion: the midpoint of the mandibular angle between ramus and
corpus mandibulae
O
Opisthion: the posterior border of foramen magnum
Ba
Basion: the anterior border of foramen magnum
Cd
Condylion: the extreme superior point of the condyle
Fc
Fossa cranialis: the intersection between the sphenoidal plane and the
larger wing of the sphenoid
L

Lambda: the midpoint of the lambdoid suture on the external cranial

contour

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.

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.

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 bace 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.

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.

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 lover 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
lover incisor proclination.
Incisor mandibular plane angle:
This angel 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.

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)

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

TWEED ANALYSIS
FMA (Frankfurt plane to
mandibular plane)

25.0

25.8

+- 5.19

FMIA (Frankfurt plane to lower

65.0
incisor angulation)

62.7

+- 6,97

IMPA (Lower incisor to

mandibular plane)

91.5

+- 5.97

90.0

TWEEDS TRIANGLE

THE WITS APPRAISAL

"Wits" Male mm
------------------------------ 1.0
-----------

-2.9

+- 2.45

"Wits" Female mm
------------------------------ 0.0
--------

-2.5

+- 2.54

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

References
Beggs techniques,
Bishara,
Graber, modern principles,
M.S.Rani,
Balaji,
Internet,

Acknowledgements
Dr. Shashikala madam,
My Parents,
My Sister, Dr.Ayesha,
My brother, Dr.Suhail
Mr. Sadakath,
Librarian sir,