1.
CEPHALOMETRICS
Dr. Gul-e-Erum
Assistant Professor Orthodontics

2.
 Clinically by the overall profile view of the patient.
Barnett 1975
 Palpation of anterior surfaces of the basal
part of the jaw. Mills 1987
 Better assessment with lateral skull radiograph.
 Pacini 1922 – Cephalometrics
 Broadbent (USA), Hofrath (Germany) 1934 –
Standardization and Popularization
Historical Review

3.
How you evaluate a face
• Soft tissue
• Hard tissue
• Dental tissue

4.
Importance
Many of the difficulties experienced in the
treatment can be attributed directly to the
extent of the excessive disharmony of the
skeletal pattern.

5.
Simply calling a dimension ‘large’ or ‘small’
or ‘good’ or ‘bad’ does not mean the same to
everyone. In order to be critical or descriptive
it is more useful to express dimensions in
terms of angles or linear measurements.
BUT
Cephalometrics is not an exact science

6.
Cephalometric radiography
• Cephalometric radiography is a
standardized and reproducible form of
skull radiography used extensively in
orthodontics
• Standardization was essential for the
development of cephalometry

7.
Uses
• Diagnosis
• Treatment planning
• Monitoring treatment progress
• Appraisal of treatment resullts
• Growth studies

8.
• Lateral ceph
• PA ceph

9.
15"60"
Source Plane
X-ray Source
Patient in Head
Positioning Device
Mid-saggital
Plane
Film Plane
X-ray Film in
Cassette
Cephalostat

10.
Cephalostat

11.
Cephalostat

12.
What Are We Trying to
Accomplish?
• Find out skeletal classification
– anteroposterior
– vertical
• Find out angulation of incisors
• Consider soft tissue
– facial profile
– airway considerations

13.
Cephalometric Evaluation
• Identification of anatomic landmarks
• Landmarks: stable reference structures
maxillary and mandibular skeletal and
dental
• Graphically relating the dento-facial
elements to these reference structures
• Angular and or linear measurements

14.
METHODS OF CEPHALOMETRIC
ANALYSIS
• Two basic approaches
• Metric approach - use of selected linear
and angular measures
• Graphic approach - “overlay” of
individual’s tracing on a reference
template and visual inspection of degree
of variation

15.
Metric Method - Use of selected
linear and angular measures

16.
Graphic Method - Use of a
Composite Template

17.
GOALS OF CEPHALOMETRIC
ANLYSIS
• Evaluating relationships, both horizontal
and vertical of 5 major functional
components of the face:
• The cranial base
• The maxilla
• The mandible
• The maxillary dento-alveolus
• The mandibular dento-alveolus

18.
Radiograph

19.
Tracing

20.
Steps of tracing
• Draw soft tissue outline
• Cranial base
• Midface structures
• Maxillary dentition
• Mandibular structures
• Mandibular dentition

21.
LANDMARKS

22.
Sella
Porion
Gonion
PNS
Menton Gnathion
Pogonion
B Point
A Point
ANS
Orbitale
Nasion
Articulare
Standard Cephalometric
Landmarks

23.
Landmarks definition
• Sella:
Centre of sella turcica
• Nasion:
Most anterior point on frontonasal suture
• Orbitale:
Lowest point on infraorbital margin
• ANS
Tip of ant nasal spine

24.
• PNS
Tip post nasal spine
• Point A
Deepest midline point b/w ANS and prosthion
• Point B
Deepest point in the bony outline b/w infradentale and
pogonion
• Pogonion
Most ant point on bony chin
• Gnathion
Most anterior and inferior on bony chin
• Menton
Lowest point on the bony outline of the md symphysis

25.
• Gonion
Most lateral external point at the junction of
horizontal and ascending rami of the
mandible
• Articulare
Intersection post border of md and temporal
bone
• Porion
Upper most point on the EAM

26.
Structures to be Traced

27.
SN Plane
Frankfort Plane
Palatal Plane
Occlusal Plane
Mandibular Plane
Frequently Used Planes
Facial Plane

28.
Cephalometric Analyses
• Down’s
• Steiner’s
• Tweed’s
• McNamara’s
• Wits
• Mc Namara
• Rickett’s

29.
• Sagittal Analysis
• Vertical Analysis
• Dental Analysis
• Soft Tissue Analysis

30.
SAGITTAL ANALYSIS

31.
Sagittal Analysis
Skeletal Horizontal - Maxilla
SNA 82 ± 2 deg
NA TO FH 90 ± 3 deg
S N
A
F H

32.
Sagittal Analysis
Skeletal Horizontal - Mandible
S
N
B
P g
F H
SNB 80 ± 2 deg
N-PG TO FH 87 ± 4 deg

33.
Sagittal Analysis
Maxilla To Mandible
N
A
B
ANB 2 ± 2 deg

34.
Sagittal Analysis
Maxilla and Mandible
N
A
B
Wit’s Analysis 0-2mm

35.
VERTICAL ANALYSIS

36.
SKELETAL VERTICAL
S
Me
Go
SN-Md Plane 32 ± 4 deg
N

37.
SKELETAL VERTICAL
Me
Go
FH-Md Plane 25 ± 4 deg
FH

38.
SKELETAL VERTICAL
Gn
S
Y axis angle 60 ± 4 deg
FH

39.
SKELETAL VERTICAL
Me
Go
PFH/TAFH ratio 65 %
S N

40.
SKELETAL VERTICAL
Me
LFH/TAFH ratio 55 %
N
ANS

41.
UI-SN angle=102
+/_ 5
IMPA=90
Interincisal
angle= 125-135

42.
Soft tissue analysis
S-plane
E-plane