Seminar 2

records processing
LATERAL Cephalometric
Analysis

Cephalometic Points Used for

POS Analysis
refer to notes
for definitions
of each point

Tips to find points

A Review of Cranial Anatomy as it

relates to Cephalometric Tracing

Presented by Dr Jeffery Taylor

POS Cephalometric Points

(In the order in which they appear in DentalCad/IPSoft)

Nasion (N): The most

anterior point of the nasofrontal suture on the

midsagittal plane.

Refer to slide #2, Seminar #1

N point

POS Cephalometric Points

Nasion (N): The most anterior point of the

naso-frontal suture on the midsagittal plane.

Sella (S): The center of the

contour of Sella Tursica by
inspection.

S point

POS Cephalometric Points

Nasion (N): The most anterior point of the

naso-frontal suture on the midsagittal plane.

Sella (S): The center of the contour of Sella
Tursica by inspection.

Porion (Por): The most

superior point of External

Auditory Meatus.

Porion

Porion

POS Cephalometric Points

Nasion (N): The most anterior point of the

naso-frontal suture on the midsagittal plane.

Sella (S): The center of the contour of Sella
Tursica by inspection.
Porion (Por): The most superior point of
External Auditory Meatus.

Orbitale (O): Lowermost

point of the contour of the

bony orbit.

Orbitale

POS Cephalometric Points

Nasion (N): The most anterior point of the naso-

frontal suture on the midsagittal plane.

Sella (S): The center of the contour of Sella Tursica
by inspection.
Porion (Por): The most superior point of External
Auditory Meatus.
Orbitale (O): Lowermost point of the contour of the
bony orbit.

Posterior Nasal Spine (PNS):

The most posterior point of the
nasal floor. Junction of the hard
and soft palate.

PNS

POS Cephalometric Points

Nasion (N): The most anterior point of the

naso-frontal suture on the midsagittal plane.

Sella (S): The center of the contour of Sella
Tursica by inspection.
Porion (Por): The most superior point of
External Auditory Meatus.
Orbitale (O): Lowermost point of the contour
of the bony orbit.
Posterior Nasal Spine (PNS): The most
posterior point of the nasal floor. Junction of
the hard and soft palate.

Anterior Nasal Spine (ANS):

The most anterior point of the

nasal floor. Tip of the pre-maxilla
on the midsagittal plane.

ANS

POS Cephalometric Points, Section 2

Subspinale (A): The deepest

point on the midsagittal plane

between ANS and Prosthion*. A
point is the most anterior point of
the maxillary denture base. It is
usually located around the level of
and anterior to the apex of the
upper central incisors. Hint: trace
the upper incisor before selecting
A point.

*prosthion(noun)-1.craniometricpointthatisthemostanteriorpointinthe
midlineonthealveolarprocessofthemaxilla

A point

A point

Not here

No
Yes

No
Yes

Dental Cad: Place incisor with tip on edge of incisor

Dental Cad: Move root over pulp

radiolucency using root-tip handle.

Dental Cad: Now place A point using

knowledge of the anatomy.

Dental Cad: Now return back the list of Points and Contours
and place the Maxilla if desired.

(F2 key to advance)

POS Cephalometric Points, Section 2

Subspinale (A): The deepest point on the

midsagittal plane between ANS and Prosthion.

Supramentale (B): The

deepest point on the

midsagittial plane between
infradentale and Pogoion.
Usually anterior to and slightly
below the apices of the lower
incisors.

B point

POS Cephalometric Points, Section 2

Subspinale (A): The deepest point on the

midsagittal plane between ANS and Prosthion.

Supramentale (B): The deepest point on the
midsagittial plane between infradentale and
Pogoion. Usually anterior to and slightly below
the apices of the lower incisors.

Pogonion (P): The most

anterior point on the
midsagittal plane of the
contour of the chin.

Pogoion

POS Cephalometric Points, Section 2

Subspinale (A): The deepest point on the

midsagittal plane between ANS and Prosthion.

Supramentale (B): The deepest point on the
midsagittial plane between infradentale and
Pogoion. Usually anterior to and slightly below the
apices of the lower incisors.
Pogonion (P): The most anterior point on the
midsagittal plane of the contour of the chin.

Gnathion (Gn): The point on the

anterior symphsis closest to the
intersection of N-Po line and the
inferior border of the mandible.

Gnathion

Gnathion

POS Cephalometric Points, Section 2

Subspinale (A): The deepest point on the

midsagittal plane between ANS and Prosthion.

Supramentale (B): The deepest point on the
midsagittial plane between infradentale and
Pogoion. Usually anterior to and slightly below
the apices of the lower incisors.
Pogonion (P): The most anterior point on the
midsagittal plane of the contour of the chin.
Gnathion (Gn): The point on the anterior
symphsis closest to the intersection of N-Po
line and the inferior border of the mandible.

Menton (Me): The lowermost

point on the contour of the
symphysis.

Menton

POS Cephalometric Points, Section 3

Gonion (Go): The point on

the posterior mandible* closest

to the vertex of the gonial
angle.

Note: McGann prefers using the most

inferior point of the ramus +Menton for the

mandibular plane (as in Downs analysis)
Note: Steiner analysis used Gonion-Gnathion
for mandibular plane

True definition of Gonion

Gonion

POS Cephalometric Points, Section 3

Gonion (Go): The point on the posterior

mandible closest to the vertex of the gonial

angle.

Articulare (Ar): The point of

intersection between the
posterior border of the
mandible and the occipital
bone (base of the bony skull.)

Articulare

POS Cephalometric Points, Section 3

Gonion (Go): The point on the posterior

mandible closest to the vertex of the gonial

angle.
Articulare (Ar): The point of intersection
between the posterior border of the mandible
and the occipital bone (base of the bony skull.)

Condylion (Co): The most

superior and distal point on the

head of the condyle.

POS Cephalometric Points, Section 3

Gonion (Go): The point on the posterior mandible
closest to the vertex of the gonial angle.
Articulare (Ar): The point of intersection between
the posterior border of the mandible and the
occipital bone (base of the bony skull.)
Condylion (Con): The most superior and distal
point on the head of the condyle.

Subnasale (simplified): The

bisection of the angle formed by a

line on the inferior border of the
nose and a line on the filtrum
area.

Subnasale

POS Cephalometric Points, Section 3

Gonion (Go): The point on the posterior

mandible closest to the vertex of the gonial

angle.
Articulare (Ar): The point of intersection
between the posterior border of the mandible
and the occipital bone (base of the bony skull.)
Condylion (Con): The most superior and distal
point on the head of the condyle.
Subnasale (simplified): The bisection of the
angle formed by a line on the inferior border of
the nose and a line on the filtrum area.

Stomion: The point where the

inferior of the upper lip (at rest)

and the central incisor meet.

Stomion

Planes used in the POS

Analysis
mandibular plane: Menton-lower

border of ramus
Occlusal plane: Intersection of cusp
tips upper and lower 6s, bisection of
incisors overbite or open bite
Palatal Plane: ANS-PNS
Frankfurt Horizontal: Por-Orbitale
SN: Cranial Base

Planes used in the

McGann analysis
SN line
Frankfurt Horizontal
Palatal plane
Occlusal plane
Mandibular plane

Locate the points

Skeletal Analysis
Determine if the patient is
skeletal open, average, or
closed

Measurement 1

Measurement 2

Dropping a Parallel (to FH)

Planes intersect off the page
Only needed when doing a manual

tracing
Use parallel lines on the ormacepha
measuring instrument
NOT needed when doing a computer
tracing!

Double Measurements:
determine skeletal open,
average, or closed
Palatal-Mand. plane FMA

Y-axis
Politically correct: GP
understands growth?

Skeletal analysis
Determine if the maxilla is
protrusive, average, or
retrusive

N perpendicular At A
manual measuring
Use parallel lines and the
outside edge of the
ormacepha (90 deg) to create
the reference line

Appliances to alter the

maxilla
Reverse headgear

Cervical headgear

Skeletal analysis
Determine if the mandible is
protrusive, average, or
retrusive

Skeletal Analysis
Determine if the upper and
lower jaws are well related (or
not)

ANB: manual
measurement
Do not measure this angle,
subtract the numbers SNB from
SNA

Wits
The best measurement to predict

skeletal resistance in class III cases

(not ANB)
Not sensitive to changes in the
vertical dimension (as is ANB)
Errors in the occlusal plane are
significant and may make this
measurement invalid

Wits versus ANB

Use ANB in Class II diagnosis (not

wits)
Use Wits in Class III diagnosis (not
ANB)
Use Wits in skeletal open bite cases
(ANB is sensitive to vertical
dimension)

Dental Analysis
Determine the anteroposterior position and
inclination of the incisor teeth

The lower incisor

3 measurements

The upper incisor

4 measurements

Facial Analysis

Quick (manual) tracing

method
Trace anatomy and choose points
Draw lines and planes as you think of them
Measure as you remember locations of
measurements
Write the number on the tracing
Transfer the measurements to the form
after you cannot remember any more
Return to the tracing to complete forgotten
measurements.

Head positioning error

Lateral ceph tilt the head

2 structures
porion, orbitale, gonion, molars

Tilt the head positioning

error correction
Trace the double structures on the

same side of the face

The most superior orbitale is the
easiest to see. Therefore, choose the
most superior porion, mandible, and
molars to be consistent.

True skeletal asymmetry

2 mandibles

True skeletal asymmetry

Frontal ceph numbers
Mandibular plane cant is at least 3

degrees
Vertical height difference (antegonial
notch to zygomatic plane)

The headholder is not calibrated

correctly
looking to the side head positioning
error

Consequences of looking to
the side positioning error
Difficult to trace the molars,

especially when comparing x-rays

before and after treatment (overlay)
Occlusal plane is NOT effected
Double Ramus is of no consequence
Orbitale is NOT effected
Porion level to Frankfurt Horizontal is
NOT effected

Overlays
Comparing ceph x-rays taken on the
same patient, at different times, on
the SAME machine.
On Adult patient = Treatment effect
only
On Growing patient = Growth plus
treatment.

Start (age 32)

Ceph

Final

Skeletal overlay

Dental Overlays

Prediction

Actual

Growth
what happens without
treatment

Face: grows down and forward, not

necessarily in the same direction

each year
Upper molar: down and forward
Upper incisor: down and slightly back
Lower molar: up and forward
Lower incisor: up and slightly back

Skeletal overlay: start age 11

female

Dental overlays

Prediction

Actual

Nose overlay

Overlay x-ray 6+3

X-ray 3 = female age 10
X-ray 6 = same female, age 13
Pubertal growth spurt for girls age 1113

Ceph for Reconstruction

Tutorials
Study at home
Run Tscc.exe file to view avi video
files. Only one time installation of
this program

Digital Ceph calibration

Digital cephs are typically calibrated
wrong, being saved as 72dpi jpeg
instead of 96dpi tif or bitmap.
The resulting image of the head is
smaller than actual size.

Same patient
Wrong
Correct

How to determine if ceph is

calibrated correctly
If there is a millimeter ruler in the

image, then import the ceph into

dentalcad and measure using Co + A
points (maxillary length) on the ruler,
40mm may measure 27mm in a
typical out-of-calibration machine.
Lineal measurements are wrong,
Dental vto is distorted.

Same patient
wrong
correct

If no calibration ruler
Take an x-ray with a metal object of
known length (piece of wire, endo
file) taped to the machine at the
nose or on the x-ray cassette
Measure after importing into
dentalcad or directly on a printed
image

What to do if out of
calibration
Ask manufacturer to make the

software correction (update)

Import into adobe photoshop and
resize image-size, change pixels to
1000 as a starting point, and check
calibration