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Cephalometric Analysis

The exercise last week dealt with tracing anatomic structures on


the lateral cephalometic radiograph and identification of relevant
anatomic landmarks. Using these landmarks, today we can
construct reference planes or lines to represent cranio-facial
structures, which can then be analyzed. Analysis involves making
select measurements on the cephalometric tracing and comparing
them with normative values to identify deviations from normal
This helps the practitioner identify where problems exist . There are
various sets of normal values for different ethnic, age and gender
groups. When analyzing a cephalometric film, its important to
understand which patient population the subject belongs to. For
each value, which is one or more standard deviations outside of the
normal range, an interpretation can be made.
As mentioned before, we can examine certain relationships with the
lateral cephalometric film. These include:
1.
2.
3.
4.
5.
6.

The relationship of the maxilla to the cranial base.


The relationship of the mandible to the cranial base.
The relationship of the maxilla to the mandible.
The relationship of the maxillary dentition to the maxilla.
The relationship of the mandibular dentition to the mandible.
The relationship of the maxillary dentition to the mandibular
dentition.

.For this laboratory, you will have been provided with 5


cephalometric tracings and for each of which you will analyze and
write-up a cephalometric summary.

REFERENCE PLANES
In order to examine these relationships, we will first establish certain reference planes on the
tracing.

1. Draw the following reference planes:


a. Frankfort Horizontal (FH) the line constructed form porion (Po) to orbitale (Or)
which represents the basic horizontal plane of the head.
b. Sella-Nasion (SN) the line constructed from sella to nasion which represents the
anteroposterior extent of the anterior cranial base.
c. Y-axis(S-Gn) the line constructed through sella and gnathion
d. Mandibular plane(MP) constructed as a line from gonion to gnathion.
e. Facial Plane (N-Pog) the line constructed through nasion and pogonion.

MAXILLARY ANTEROPOSTERIOR SKELETAL ASSESSMENT

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.

2. Landes Angle (NA to FH)


a. Purpose: establishes the horizontal location of the maxilla relative to the cranial base.
Note that the points being compared by this angle are the cranial base reference line FH
and cranial base point N as well as A point (maxillary point).
b. Construction: the angle between a line drawn from Po to Or (FH) and a line drawn from
N to A.
c. Normal value and standard deviation: 903.
d. Interpretation:
1) <87 - maxilla is retrognathic relative to the cranial base.
2) 87-93 - maxilla is normally positioned relative to the cranial base.
3) >93 - maxilla is prognathic relative to the cranial base.

MANDIBULAR ANTEROPOSTERIOR SKELETAL ASSESSMENT

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.

MAXILLARY TO MANDIBULAR SKELETAL


ANTEROPOSTERIOR RELATIONSHIPS

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.

VERTICAL SKELETAL RELATIONSHIPS

1. Mandibular Plane Angle


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 the mandibular plane.
b. Construction: the angle between a line drawn from Po to Or (FH) and a line drawn
between Go and Gn (MP).
c. Normal value and standard deviation: 225.
d. Interpretation:
1) <17 - implies a vertical deficiency often seen in brachyfacial growth patterns or a
counterclockwise rotation of the mandible.
2) 17-27 - mandibular growth pattern is mesofacial.
3) >27 - implies a vertical excess often seen in dolicofacial growth patterns or a
clockwise rotation of the mandible.

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.

3. Upper 1(U1) to NA (Degrees)


a. Purpose: to determine the angulation of the maxillary incisor relative to the
maxilla. Note that the items compared are the long axis of the maxillary incisor
(dental), nasion (cranial base), and A point (maxilla).
b. Construction: the angle between a line drawn from N to A and a line drawn
through the long axis of the maxillary incisor.
c. Normal value and standard deviation: 22.
d. Interpretation:
1) <22 - the maxillary incisor is retroclined.
2) 22-the angulation of the maxillary incisor is within normal limits.
3) >22 - the maxillary incisor is proclined.

4. Upper 1(U1) to NA (mm)


a. Purpose:.to determine the anteroposterior position of the maxillary incisor
relative to the cranial base and the maxilla.
b. Construction: the linear distance measured from the labial surface of the
maxillary incisor to a line drawn from nasion to A point.
c. Normal value and standard deviation: 4mm
d. Interpretation:
1) <4mm the maxillary incisor is recumbent.
2) 4mm the A-P position of the maxillary incisor is within normal limits.
3) >4mm the maxillary incisor is procumbent..

5. Lower 1(L1) to NB (Degrees)


a. Purpose: to determine the angulation of the mandibular incisor relative to the
mandible. Note that the items compared are the long axis of the mandibular
incisor (dental), nasion (cranial base), and B point (mandible).
b. Construction: the angle between a line drawn from N to B and a line drawn
through the long axis of the mandibular incisor
c. Normal value and standard deviation: 25.
d. Interpretation:
1) <25 - the mandibular incisor is retroclined.
2) 25 - the angulation of the mandibular incisor is within normal limits.
3) >25 -the mandibular incisor is proclined.

6. Lower 1(L1) to NB (mm)


a. Purpose:. to determine the anteroposterior position of the mandibular incisor
relative to the cranial base and the mandible.
b. Construction: the linear distance measured from the labial surface of the
mandibular incisor to a line drawn from nasion to B point.
c. Normal value and standard deviation: 4mm.
d. Interpretation:
1) <4mm the mandibular incisor is recumbent.
2) 4mm - the A-P position of the mandibular incisor is within normal limits.
3) >4mm the mandibular incisor is procumbent..

7. Lower 1(L1) to MP (Degrees)


a. Purpose: to determine the angulation of the mandibular incisor relative to the
mandible. Note that the items compared are the long axis of the mandibular
incisor (dental) and the MP (mandible).
b. Construction: the angle between a line drawn from Go to Gn (MP) and a line
drawn through the axis of the lower incisor.
c. Normal value and standard deviation: 916.
d. Interpretation:
1) <85 - the mandibular incisor is retroclined.
2) 85-97 - the angulation of the mandibular incisor is within normal limits.
3) >97 - the mandibular incisor is proclined.

SOFT TISSUE ASSESSMENT

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.

2. Lower lip to E Plane


a. Purpose: determines the soft-tissue balance between lips and profile (nose-chin) and
assess lip protrusion.
b. Construction: the linear distance from the lower lip to a line drawn from the tip of
the nose to soft tissue pogonion (Pog).
c. Normal value and standard deviation: -2mm2mm
d. Interpretation:
1) <-4mm - the lower lip is retruded.
2) 4mm 0mm the position of the lower lip is within normal limits.
3) >0mm - the lower lip is protruded.

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

Skeletal Class III; Either retrognathic maxilla,


prognathic mandible, or a combination of both.

Skeletal Class II; Either prognathic maxilla,


retrognathic mandible, or a combination of both.

Y-axis

596

FMA

225

Brachyfacial; decreased vertical;


Counterclockwise mandibular rotation
Brachyfacial; decreased vertical;
Counterclockwise mandibular rotation

Dolichofacial; increased vertical;


Clockwise mandibular rotation
Dolichofacial; increased vertical;
Clockwise mandibular rotation

55%

Brachyfacial; decreased vertical

Dolichofacial; increased vertical

Interincisal

1305

Either proclined maxillary incisors, proclined


mandibular incisors, or a combination of both.

Either retroclined maxillary incisors, retroclined


mandibular incisors, or a combination of both.

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

Retroclined maxillary incisors


Retroclined maxillary incisors
Recumbent maxillary incisors
Retroclined mandibular incisors
Recumbent mandibular incisors
Retroclined mandibular incisors

Proclined maxillary incisors


Proclined maxillary incisors
Procumbent maxillary incisors
Proclined mandibular incisors
Procumbent mandibular incisors
Proclined mandibular incisors

L lip to E plane
Nasolabial
Angle

-2mm2mm
1028

Retruded lower lip


Protruded upper lip

Protruded lower lip


Retruded upper lip or tipped up nose

Mandibular A-P Position


Maxillo-mandibular Relations
Vertical Relations

% 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

Mandibular A-P Position


Maxillo-mandibular Relations
Vertical Relations

Maxillary and Mandibular


Incisor Position

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

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