Professional Documents
Culture Documents
In addition to these
there are a number of other criteria that on occasion are valuable and give additional information
that assists the dentist in making the all important diagnostic decisions. The dentist is usually not
equipped to utilize these criteria, however, and must turn the orthodontic specialist, the
laboratory or the radiologist for assistance. If he suspects that such information will aid him in
diagnosis, he should not hestitate to get it by referring the patient to the proper agency. Some of
these records and the information they impart are discussed in the following pages. If he carries
any number of active orthodontic patients in his practice, some of these supplemental diagnositc
criteria . must be transferred to the "Required" list. Reference is again made to the chapter on
diagnosis in the two-volume specialty-oriented text, Current Orthodontic Principles and
Techniques. Cephalometrics is discussed at length because of the importance it has in routine
orthodontic practice. There is no question that much of the information gained can find use in
general dental practice as more dentists learn to use this tool.
Me Menton. The lowermost point on the symphysial shadow as seen in norma lateralis.
Na Nasion. The intersection of the internasal suture with the nasofrontal suture in N, the mid
sagital plane.
Or Orbitale. The lowest point on the lower margin of the bony orbit.
PNS Posterior-nasal spine. The tip of the posterior spine of the palatine bone in the hard palate.
Po Porion. The midpoint on the upper edge of the pores acusticus externus located by means of
the metal rods on the cephalometer (bjork).
Pog Pogonion. Most anterior point in the contour of the chin.
Pt, Pterygomaxillary fissure. The projected contour of the fissure; the anterior
represents closely the retromolar tuberosity of the maxilla, and the posterior wall
represents the anterior curve of the pterygoid process of the sphenoid bone.
Broadbent registration point. The midpoint of the perpendicular from the center
of sella turcica to the Bolton plane.
S Sella turcica. The midpoint of sella turcica. determined by inspection.
SO Spheno-occipital synchondrosis. The uppermost point of the suture.
Naturally, not all these landmarks are used in routine cephalometrics analysis. A sizable number
are more difficult to discern accurately from patient to patient. The more variable landmarks.
such as porion. orbitale, ,onion. Bolton point, basion, anterior and posterior nasal spines and
point (fig 8-33), can produce significant differences in interpretation in cephalometric criteria
from observer to observer.33 35 As Johnston shows, experimental error is likely to be more
variable than the biometric analysis of the data itself. even when using a computer and taking XY Coordinate information directly from the film.33 35
Using combinations of dimensional and angular criteria which employ the various measure
points and landmarks, cephalometrics offers the dentist valuable information in the following
categories.
1.
2.
Craniofacial abnormalities
3.
Facial type
Functional analysis
and ultimate stability reflect tlie limitations imposed by the morphogenetic pattern (Figs. 8-36, 837). There are two major considerations: the position of the maxilla anteroposteriorly in the face
(with reference to the cranium) and the relation of the mandible to the maxilla, which is
responsible for the convex, straight or concave profile line.
If the maxilla is protracted in its relationship to the cranium. the profile is more likely to be
convex. If the maxilla is retracted, the profile more likely to be concave. However, with a
maxillary protraction the face can be convex, straight or concave. The same profile variations
hold true in a face where the maxilla is retracted in relation to the cranium. This further
complicated by an appraisal of general facial type. whether it is dolichocephalic(long and
narrow) or brachycephalic (short and broad) (Fig. 8-29). Observations of large groups would
seem to indicate that the dolichocephalic individual nor so-called Nordic type) is more likely to
have a straight facial profile. The brachycephalic type (Slays, eastern European groups, etc.) is
more prone to profile convexity. Drummond, in research at Baylor University, did a study of 40
Negroes from 8 to 23 years of age to determine differences from the Caucasian race. The maxilla
is more anteriorly placed with respect to the cranial base. the Maxillomandibular basal difference
is greater, the upper incisor more procumbent. and the lower incisor even more procumbent.
Negroes also have a steeper mandibular plane. Racial admixtures make any clear-cut correlation
impossible. Neverthless, incisor tooth inclinations vary depending on the maxillary protraction or
retraction and the relative facial convexity.
The skeletal morphology strongly affects the tooth position and inclination. From our studies of
clinically excellent occlusions. it appears that the apical base difference (maxilla to mandible) is
routinely greater when the maxilla is