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REFERENCE PLANES
In order to examine these relationships, we will first establish certain reference planes on the
tracing.
1. SNA
a. Purpose: establishes the horizontal location of the maxilla relative to the cranial base.
Note that the points being compared by this angle are sella and nasion (cranial base
points) as well as A point (maxillary point).
b. Construction: the angle between a line drawn from S to N and a line drawn from N to
A.
c. Normal value and standard deviation: 822.
d. Interpretation:
1) <80 - maxilla is retrognathic relative to the cranial base.
2) 80-84 - maxilla is normally positioned relative to the cranial base.
3) >84 - maxilla is prognathic relative to the cranial base.
1. SNB
a. Purpose: establishes the horizontal location of the mandible relative to the cranial base.
Note that the points being compared by this angle are sella and nasion (cranial base
points) as well as B point (mandibular point).
b. Construction: the angle between a line drawn from S to N and a line drawn from N to
B.
c. Normal value and standard deviation: 802.
d. Interpretation:
1) <78 - mandible is retrognathic relative to the cranial base.
2) 78-82 - mandible is normally positioned relative to the cranial base.
3) >82 - mandible is prognathic relative to the cranial base.
2. Facial Angle
a. Purpose: establishes the horizontal location of the mandible relative to the cranial base.
Note that the points being compared by this angle are the cranial base references FH and
nasion as well as Pog point (mandibular point).
b. Construction: the angle between a line drawn from Po to Or (FH) and a line drawn from
N to Pog.
c. Normal value and standard deviation: 886.
d. Interpretation:
1) <82 - mandible is retrognathic relative to the cranial base.
2) 82-94 - mandible is normally positioned relative to the cranial base.
3) >94 - mandible is prognathic relative to the cranial base.
1. ANB
a. Purpose: establishes the horizontal relationship between the maxilla and the mandible.
Note that the points being compared by this angle are A point (maxillary), nasion (cranial
base), and B point (mandible).
b. Construction: the angle between a line drawn from A to N and a line drawn from N to
B. Alternatively: ANB = SNA SNB. Therefore, any negative ANB, by definition, will
have the mandible ahead of the maxilla in a class III relationship.
c. Normal value and standard deviation: 22.
d. Interpretation:
1) <0 - The skeletal relationship is class III with either a retrognathic maxilla, a
prognathic mandible, or a combination of both. A second measurement is required to
determine which jaw is at fault
2) 0-4 - The skeletal relationship is class I with the maxilla slightly ahead of the
mandible.
3) >4 - The skeletal relationship is class II with either a prognathic maxilla, a
retrognathic mandible, or a combination of both. A second measurement is required
to determine which jaw is at fault.
2. Y-Axis
a. Purpose: This measure is used to assess the direction of the growth of the mandible.
Note that the points being compared by this angle are the cranial base reference plane of
FH and a line between S and Gn.
b. Construction: the angle between a line drawn from S to Gn (Y-axis) and a line drawn
from Po to Or (FH).
c. Normal value and standard deviation: 596.
d. Interpretation:
1) <53 - implies a vertical deficiency often seen in brachyfacial growth patterns or a
counterclockwise rotation of the mandible.
2) 53-65 - mandibular growth pattern is mesofacial.
3) >65 - implies a vertical excess often seen in dolicofacial growth patterns or a
clockwise rotation of the mandible.
3. % LFH
a. Purpose: establishes the vertical proportion of the lower facial height (ANS-Me)
to the total facial height (N-Me).
b. Construction: the ratio of the linear measure of ANS-Me divided by the linear
measure of N-Me. Also represented by LFH:TFH or ANS-Me:N-Me.
c. Normal value and standard deviation: 55%.
d. Interpretation:
1) <55% - lower face height is decreased.
2) 55% - lower face height is within normal limits.
3) >55% - lower face height is increased.
DENTAL RELATIONSHIPS
1. Interincisal Angle
a. Purpose: determines the relationship between the angulation of the maxillary
incisors and the angulation of the mandibular incisors. Note that the two items
compared are the long axes of the maxillary and mandibular incisors (dental).
b. Construction: the angle between a line drawn through the long axis of the
maxillary incisor and a line drawn through the long axis of the mandibular incisor.
c. Normal value and standard deviation: 130 .
d. Interpretation:
1) <125 -either the maxillary incisors are proclined, the mandibular incisors are
proclined, or some combination of both. A second measurement is needed to
determined which incisor angulation is at fault.
2) 125-135 -the angulation between the incisors is within normal limits.
3) >135 - either the maxillary incisors are retroclined, the mandibular incisors
are retroclined, or some combination of both. A second measurement is
needed to determined which incisor angulation is at fault..
2. Upper 1(U1) to FH
a. Purpose: to determine the angulation of the maxillary incisor relative to the
cranial base. Note that the items compared are the FH plane (cranial base) and the
long axis of the maxillary incisor (maxillary dental).
b. Construction: the angle between a line drawn from Po to Or (FH) and a line
drawn through the long axis of the maxillary incisor.
c. Normal value and standard deviation: 1105.
d. Interpretation:
1) <105 - the maxillary incisor is retroclined.
2) 105-115 - the angulation of the maxillary incisor is within normal limits.
3) >115 - the maxillary incisor is proclined.
1. Nasolabial Angle
a. Purpose: to assess the nose to upper lip relationship.
b. Construction: the angle between a line drawn tangent to columella of the upper
lip and a line tangent to the lower border of the nose (Sn to nasal tip).
c. Normal value and standard deviation: 1028.
d. Interpretation:
1) <94 - the upper lip is procumbent.
2) 94-110 - the position of the upper lip is within normal limits.
3) >110 - the upper lip is retrusive.
SUMMARY TABLE
Area of Study
Maxilla ry A-P Position
Measurements
CEPHALOMETRIC SUMMARY
Standard
< normal 1SD
>normal + 1SD
SNA
N-A to FH
822
903
Retrognathic maxilla
Retrognathic maxilla
Prognathic maxilla
Prognathic maxilla
SNB
N-Pog to FH
802
886
Retrognathic mandible
Retrognathic mandible
Prognathic mandible
Prognathic mandible
ANB
22
Y-axis
596
FMA
225
55%
Interincisal
1305
U1 to FH ()
U1 to NA ()
U1 to NA (mm)
L1 to NB ()
L1 to NB (mm)
L1 to MP ()
1103
22
4mm
25
4mm
916
L lip to E plane
Nasolabial
Angle
-2mm2mm
1028
% LFH
Maxillary and Mandibular
Incisor Position
Soft Tissue
LABORATORY CASES
CEPHALOMETRIC SUMMARY
Area of Study
Maxillary A-P Position
Measurements
Standard
Case 1
SNA
N-A to FH
822
903
SNB
N-Pog to FH
802
886
ANB
22
Y-axis
FMA
% LFH
596
225
55%
Interincisal
U1 to FH ()
U1 to NA ()
U1 to NA (mm)
L1 to NB ()
L1 to NB (mm)
L1 to MP ()
1305
1103
22
4mm
25
4mm
916
L lip to E plane
Nasolabial
Angle
-2mm2mm
1028
Soft Tissue
Narrative Summary
Patient 1
Antero-posterior relations:
Case 2
Case 3
Case 4
Case 5
Maxilla
Mandible
Maxillary incisors
Anglular
Linear
Mandibular Incisor
Angular
Linear
Vertical relations:
Increased
Decreased
Normal
Proportional face height
Soft tissue:
Upper lip
Lower lip
Narrative Summary
Patient 2
Antero-posterior relations:
Maxilla
Mandible
Maxillary incisors
Anglular
Linear
Mandibular Incisor
Angular
Linear
Vertical relations:
Increased
Decreased
Normal
Proportional face height
Soft tissue:
Upper lip
Lower lip
Narrative Summary
Patient 3
Antero-posterior relations:
Maxilla
Mandible
Maxillary incisors
Anglular
Linear
Mandibular Incisor
Angular
Linear
Vertical relations:
Increased
Decreased
Normal
Proportional face height
Soft tissue:
Upper lip
Lower lip
Narrative Summary
Patient 4
Antero-posterior relations:
Maxilla
Mandible
Maxillary incisors
Anglular
Linear
Mandibular Incisor
Angular
Linear
Vertical relations:
Increased
Decreased
Normal
Proportional face height
Soft tissue:
Upper lip
Lower lip
Narrative Summary
Patient 5
Antero-posterior relations:
Maxilla
Mandible
Maxillary incisors
Anglular
Linear
Mandibular Incisor
Angular
Linear
Vertical relations:
Increased
Decreased
Normal
Proportional face height
Soft tissue:
Upper lip
Lower lip