1	Basic Cephalometrics Mark H. Taylor, D.D.S., F.A.C.D.
2	Major Points Purpose and Basic Information Structures to Trace Cephalometric Landmarks Cephalometric Assessment Skeletal Dental Soft Tissue Cases
3	Purpose and Basics
4	Purpose of Cephalometrics Study craniofacial growth Diagnosis Planning orthodontic treatment Evaluation of treated cases
5	Purpose in Diagnosis/TP Find out skeletal classification anteroposterior vertical Find out angulation of incisors Consider soft tissue facial profile airway considerations
6	Cephalostat
7	Cephalostat
8	Cephalostat
9	Computerized Cephalometrics
10	CCD Sensor
11	Example
12	Structures to Trace
13	Structures to be Traced Facial Profile
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16	Structures to be Traced Sella Orbit Nasal bone
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19	Structures to be Traced Ear rod Posterior pharyngeal wall Pterygomaxillary fissure Soft palate
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22	Structures to be Traced Maxilla Long axis U1 Labial U1
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25	Structures to be Traced Mandible Permanent 1st molars Long axis L1 Labial L1
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29	Cephalometric Landmarks
30	Cephalometric Landmarks
31	Cephalometric Points S, Sella - midpoint sella turcica N, nasion - most anterior point of the nasofrontal suture A, subspinal - deepest midline point below the anterior nasal spine B, Supramentale - most posterior point on the outer contour of the mandibular alveolar process
32	Cephalometric Points ANS, anterior nasal spine - tip of the anterior nasal spine PNS, posterior nasal spine - tip of the posterior spine of the palate Pog, pogonion - most anterior point of the bony chin Gn, gnathion - midpoint between the most anterior and inferior points on the bony chin Me, menton - most inferior point on the outline of the symphysis
33	Cephalometric Points Go, gonion - point midway between the most inferior and most posterior points in the angle of the mandible P, porion - uppermost point on the outline of the ear rods of the cephalostat Or, orbitale - lowermost point on the orbit PTM, pterygomaxillary fissure - the projected contour on the lateral film; anterior wall represents maxillary tuberosity outline, and the posterior, the anterior curve of the pterygoid process.
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35	Nasion Can be difficult to see Very important landmark Inward notch, or sideways “v”
36	B Point Most posterior point on the outer contour of the mandibular alveolar process
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39	Frequently Used Planes
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41	Cephalometric Assessment
42	Cephalometric Measurements Many different analyses This one is essentially Steiner Remember…. This is NOT an exact science Combine information from ceph with other clinical information to make a diagnosis and treatment plan.
43	Variance of Cephalometric Values
44	Friday, November 8, 1895 Bertha’s hand with ring One of Wilhelm Roentgen’s earliest plates. February 8, 1896: X-rays were being used clinically the United States (Dartmouth, Massachusetts).
45	Criminal Anthropometry On Criminal Anthropometry and the Identification of Criminals, W. R. Macdonell, Biometrika, Vol. 1, No.2. (Jan., 1902), pp. 177-227. Purpose: “To test to what extent the criminal classes diverge in physical characters from other classes of the community.” “To determine what is the best manner in which these measurements can be applied to the identification of criminals.” Summary “Then as regards the criminals; they are shown to be homogeneous…. Markedly different from the educated classes in stature, and in size and shape of the head…” “We…. Have indicated a method of calculating uncorrelated characters which would furnish an ideal system of identification.”
46	Experiment Line up according to GPA…
47	Skeletal Measurements Anteroposterior measurements SNA (maxilla) SNB (mandible) ANB Wit’s Vertical measurements Y axis Mandibular plane angle
48	Skeletal Assessment- SNA
49	Skeletal Assessment - SNB
50	Skeletal Assessment - ANB
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52	Skeletal Assessment - Wits (AO-BO)
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54	Skeletal Assessment - Y Axis
55	Y Axis (to Frankfort Horizontal)
56	Skeletal Assessment SN - GoGn
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58	Dental Measurements Maxillary incisor measurements Mandibular incisor measurements
59	Dental Assessment U1-SN (Max 1 - SN)
60	Dental Assessment Max 1 - NA (degrees)
61	Dental Assessment Max 1 - NA (mm)
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63	Dental Assessment L1-GoGn (Man 1 - GoGn)
64	Dental Assessment Man 1 - NB (degrees)
65	Dental Assessment Man 1 - NB (mm)
66	Dental Assessment U1-L1 (Max 1 - Man 1)
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68	Soft Tissue Soft tissue profile position of teeth and jaws affect position of soft tissue drape normal changes from childhood to adulthood Airway (or lack of it) may affect growth & positioning of jaws and teeth
69	Soft Tissue Assessment: E Plane
70	Soft Tissue Assessment
71	Composite Tracing
72	Computerized Tracing
73	Melded View
74	Cephalometric Values
75	Standard Deviations
76	Cases
77	Objectives Gain familiarity with interpretation of cephalometric tracings Recognize Class I, II, and III skeletal arrangements Recognize vertical skeletal arrangements Recognize the variations of incisor angulation and the effect this has on crowding
78	Patient One Class II skeletal Open bite Flared upper incisors Normal lower incisors Protrusive profile Normal airway
79	Patient Two Class III skeletal Normal vertical Retroclined upper incisors Normal lower incisors Retrusive profile Normal airway
80	Patient Three Class I skeletal Normal vertical Proclined upper incisors Retroclined lower incisors Straight profile Restricted airway