Dr.

Kazem AL-Nimri BDS,

Ph.D, M.Orth.R.C.S
Cephalometrics introduced for
use by orthodontists in 1931 by
Dr. Broadbent in the USA and
Hofrath in Germany
independently of one another.

Cephalo: head
Metric: measurments
Cephalometry: is the analysis and the interpretation of standardized
radiographs of the facial bones.

It is a standardized and reproducible form of skull radiography used
extensively in orthodontics to asses the relationships of the teeth to the jaws,
and the jaws to the rest of the facial skeleton.
Head position: the patients head is oriented in the same position
relative to the x-ray beam every time a film is taken, with the use
of a cephalostat.
Ear rods: in the ear canals (external auditory meatus).
Frankfort plane: horizontal.
Teeth: in centric occlusion.
Lips: in their habitual position.
Assess facial and dentoskeletal relationships.
To study growth and growth patterns
Evaluation of post treatment changes.
Research purposes and long term follow-up studies.
The cranial base.
The facial skeleton.
Soft tissues.

The midpoint of the
sella turcica

The most inferior anterior point on
the margin of the orbit

Sella Turcica (S)

Orbitale (Or)

The most anterior point
of the frontonasal
suture

The most posterior inferior point on the
clivus (basiocciput).
It represents the posterior limit of the
midline cranial base.
It lies on the anterior margin of
foramen magnum.



Nasion (N)
Basion (Ba)

The tip of the anterior nasal spine


The tip of the
posterior nasal spine

Anterior Nasal Spine
(ANS)
Posterior Nasal Spine
(PNS)
The most posterior point on the profile of
the maxilla between the
anterior nasal spine and the alveolar crest

The most posterior point on the profile of
the mandible between the chin point and
the alveolar crest

A point
B point
The most anterior point on the bony
chin


The lowermost point of the mandibular
symphysis in the midline

Pogonion (Pog)

Menton (Me)


The most inferior point on the mandibular
symphysis in the midline


The most posterior inferior point on the
angle of the mandible

Gnathion (Gn)

Gonion (Go)


The uppermost, outermost point on
the bony external auditory meatus


Porion (Po): superior
point of external
auditory meatus
Machine Porion:
landmark created by ear
post of cephalostat

The intersection of the posterior border of
the neck of the mandibular condyle and
the lower margin of the posterior cranial
base


The most superior posterior point
on the head of the mandibular
condyle

The tip of the crown of the most
prominent upper incisor

The tip of the crown of the most
prominent lower incisor (E-lower
incisor edge)

1: most anterior upper
central incisor

__
1: most anterior lower central
incisor


6: upper permanent
first molar
__
6: lower permanent
first molar

Sella - Nasion plane:
S N
Represent the cranial base


De Costers line:
Follows the floor of the anterior
cranial base from the anterior margin of the ethmoid bone
to sella turcica

Maxillary line:
ANS - PNS

Mandibular plane:
Me - Go

Line drawn from Menton (Me) to
Gonion (Go)
Occlusal plane:
Cusp tips of molars tip of lower incisor

Functional occlusal plane (FOP):
Passes through the occlusion of the premolars or deciduous
molars and the first permanent molars
The Line from point A
to pogonion:
A Pog
For best aesthetic results: -lower incisor edges
lay on A-Pog line
(Willians, 1969)
Measurement:
Skeletal relationships :
Sagittal basal relationships
Vertical basal relationships
Dentoalvealar relationships
Soft tissues analysis
Angle SNA (82 3)
Prognathism of maxillary apical
base

Angle SNB (79 3)
Mandibular prognathism


Angle ANB (3 1)
The anteroposterior apical base
relationship (skeletal pattern)
Jaw discrepancies (maxillary and mandibular).
Anteroposterior position of the Nasion
Inclination of S-N line to the Frankfort plane.
Lower anterior facial height.
Wits analysis (Jacobson, 1975)
Compares the relationships of the
maxilla and mandible with the
occlusal plane (FOP)


S-N-POG (87 3)
Indicate the anteroposterior
position of the chin

Maxillary-mandibular planes
angle (Mx-Mn or MM angle)
(27 5)

Frankfort-mandibular planes
angle (FM angle) (27 5)

If the SN line inclination from the True horizontal or
from Frankfort plane deviates more than 6 degrees, and
less than 11 degrees, measurements based on the SN line
should be corrected by this difference.
Face height ratio
(Me-Mx / N-Me) (50 - 55
%)
To estimate the anterior
intermaxillary height
Gonial angle
(Ar-TGp / TGi-Me)
(126 5)
Upper incisor to maxillary plane angle
(UI / Mx) (108 5)
Lower incisor to mandibular plane angle
(LI / Mn) (92 5)
Interincisor angle (UI / LI) (133 10)
Lower incisor edge to A-Pog distance (E A-Pog) (0-2 mm)

UI / Mx plane angle (108 5)
LI / Mn plane angle (92 5)
Interincisal angle (133 10)
E A-Pog (0-2 mm)
E C (0-2 mm)
FOP / Mx (10 4)
Cephalometric superimpositions involve the evaluation
of:
Changes in the overall face.
Changes in the maxilla and its dentition.
Changes in the mandible and its dentition.
Amount and direction of condylar growth, and mandibular
rotation.

(Kristensen, 1989)

The most accurate superimposition is obtained by tracing the first
radiograph and superimposing that tracing on the second film,
registering the appropriate cranial base structures.
(Ekstrom, 1982)
Reliable picture of overall facial growth.
Superimposition on:
S-N line with registration at sella (reliable)
De Costers line (more reliable).

Maxilla is subject to extensive periosteal remodelling.
Superimposition on:
The anterior surface of the zygomatic process little periosteal
remodelling with growth (Bjork and Skieller, 1979) (not easily
seen and too short).
Anterior surface of the palatal vault.
The maxillary plane (at PNS)(contour of the palate at the alveolar
process base).
The mandible undergoes rather complex remodeling
changes (anterior / posterior growth rotations.

(Bjork and Skieller, 1972)



Superimposition on:
The inner contour of the cortex of the mandibular symphysis
(most useful).
To evaluate remodeling in the mandible with growth.
To evaluate changes in the lower incisor position.
The contour of the mandibular canal.
The crypt of the developing third permanent molars (from the
time of commencement of mineralization until root formation
begins).


A digitizer comprises an illuminated radiographic viewing screen
connected to a computer.
Information from a lateral cephalometric radiograph is entered into the
computer by means of a cursor which records the horizontal and
vertical (x,y) co-ordinates of cephalometric points or bony or soft
tissue outlines.
Specialized software employed to utilize the information entered to
produce a tracing and/or the analysis of choice.
Research purposes.
Digora scanner.

Studies have shown digitizers to be as accurate as tracing a
radiograph by hand.

There was no difference in the regional superimpositions of the
mandible, the maxilla, and the cranial base, manually vs digitally
with Quick Ceph 2000.

(Roden-Johnson et al., 2008)