Cephalometric

Analysis
Unit 3
Latanya Williams
Sydoni Young
 Objectives
A. Cephalometric
structures
B. Cephalometric
landmarks
 Definitions
Cephalometry- This is measurement the head by using specific reference points

and sufficient standardization to allow reproducible results.

Cephalometric analysis- This is study of the skeletal and dental relationship with

the human skull

 Cephalometric structures
These would include teeth,

Bones (the cranium,mandible,maxilla…)

Sinuses
 Overview
● The primary aim of cephalometric analysis is to localize malocclusion within a
tracing of facial bone and soft tissue structures.
● The analysis is done by using standard cephalometric landmarks to construct
lines, angles, and imaginary planes. This permits linear and angular
assessments of dental and facial relationships as seen on the radiographic
films.
 Cont’d
● These findings are compared with established normal values, and an
individualized treatment plan is developed.
 Uses
● Aids in orthodontic diagnosis
● Helps in classification of the skeletal and dental abnormalities and also helps in
establishing facial type
● Helps in treatment planning
● Helps in predicting the growth related changes associated with surgical treatment.
● Identify fractures and other injuries to the teeth and jawbone.
● Determine specific measurements prior to the creation and placement of dental
implants.
 How it is done
● The head is placed between the mechanical rotating arm and the film holder,
which is placed on another arm. The arm rotates around the head capturing
images of the face, mouth and teeth.
● The clarity and sharpness of these images will depend on the positioning of
the body. The images are usually magnified up to 30%, so any signs of decay,
disease or injury can be seen and treated.
 Types of cephalograms
Lateral- provides a lateral view of the skull. It is taken with the head in a standard
reproducible position at a specified distance from the source of the X ray

Frontal - This provides an anteroposterior view of the skull

Lateral
Frontal
CEPHALOMETRIC
LANDMARKS
What are cephalometric landmarks?
● Recognizable points on a cephalometric tracing or radiograph

● Focuses on anatomical structures of both hard and soft tissues

● It is important to be familiar with the landmarks

There are two types of cephalometric
landmarks
● Anatomical- These help with orientation

● Derived- Landmarks obtained secondarily from anatomic structures in a

cephalogram
Landmarks on a cephalometric radiograph
There are two types of landmarks
● Soft tissue

● Hard Tissue
Soft Tissue Landmarks
● Soft Tissue Glabella- most prominent
point in the med-sagittal plane of the
forehead

● Pronossale- Most prominent point in the

nose

● Columella- Point on the lower surface of

nose
Soft Tissue Landmarks
● Subnasale- Intersection of the lower border
of the nose and the outer contour of the
upper lip
Hard Tissue Landmarks
These include:

● Nasion (N) - Most anterior point midway

between the frontal and nasal bones on
the frontonasal suture
● Sella (S) - Point representing the midpoint
of the pituitary fossa or sella turcica.
Located in the mid sagittal plane
Calculation using cephalometric radiograph
● X and Y coordinates are used

● Mean value considered

● Assessed variation in measurements

Errors identifying landmarks
● Incorrect positioning of patient

● Measurements should be repeated

● Do both hand tracing and digitizing the landmarks

Envelope of error associated with
cephalometric point identification. (Redrawn
from Baumrind and Frantz, 1971a).
References
(PDF) Cephalometric analysis: Manual tracing of a lateral cephalogram. (n.d.). Retrieved from

https://www.researchgate.net/publication/336715258_Cephalometric_analysis_manual_tracing_of_a_lateral_cephalogram

Cephalometric analysis. (n.d.). Retrieved from https://dentagama.com/news/cephalometric-analysis

Cephalometric landmark variability among orthodontists and dentomaxillofacial radiologists: A comparative study. (n.d.). Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697005/

Cephalometrics evaluation and interpretation. (2016, October 23). Retrieved from

https://www.slideshare.net/BanavathSameer/cephalometrics-evaluation-and-interpretation

Cephalometrics. (2017, July 11). Retrieved from https://slideplayer.com/slide/3897917/

 References
https://www.colgate.com/en-us/oral-health/x-rays/what-is-a-cephalometric-x-ray

https://www.dentalprotection.org/uk/articles/a-beginners-guide-to-lateral-cephalom
etric-radiographs

https://www.thefreedictionary.com/cephalometric#:~:text=(s%C4%95f%E2%80%B2
%C9%99%2Dl%C5%8Fm%E2%80%B2,the%20assessment%20of%20facial%20grow
th.
Cephalometric
Planes and
Angles
Destanae Sinclair
Christopher Boswell
Cephalometric Planes & Lines
When two landmarks are “connected” cephalometric planes and lines are
produced.

Based on their orientation these planes and lines are classified as being either
horizontal or vertical.
Horizontal Planes
● Sella-Nasion Plane
● Frankfort Horizontal Plane
● Occlusal Plane
● Palatal Plane
● Basion-Nasion Plane
● Mandibular Planes: Tweed Analysis, Downs
Analysis and Steiner’s Analysis
Sella-Nasion Plane
It is a cranial line which lies between
the Sella (centre of the sella turcica)
and the Nasal (anterior portion of the
frontonasal suture).
Occlusal Plane
A plane which bisects the occlusion of
the maxillary and mandibular molars
and premolars of the permanent
dentition. It then extends anteriorly.
Frankfort Horizontal Plane
A plane which passes through the
orbitale (the lower aspect of the orbit)
and the superior aspect of the
external auditory meatus.
Basion-Nasion Plane
A plane which connects the nasion
(the most anterior point of the
frontonasal suture in the midsagittal
plane) and the basion (the anterior
border of the foramen magnum). It
signifies the base of skull.
Mandibular Planes
1. Steiner’s Analysis - Extends from
Gonion (Go) to Gnathion (Gn)
2. Down’s Analysis - Extends from
Gonion to Menton (Me)
3. Tweed’s Analysis - Tangent to
lower border of the mandible
Palatal Plane
Extends beyond the anterior nasal
spine (ANS) and posterior nasal spine
(PNS) of the palatal bone.
Vertical Planes and Line
● Facial Plane
● Facial Axis
● A-Pog Line
● Esthetic Plane (E. plane)
Facial Plane
Extends from the nasion (N) to the
pogonion (Pog).

Necessary for :

1. Maxilla and facial plane

relationship
2. Chin position
A Pog line
Also known as Dental Plane/
Subnasale pogonion Line

● Line from point A of maxilla to

pogonion on the mandible

Used to:

● measure the location of the

anterior teeth, protrusion of lower
arch
● Ideally lower incisors should be
located 1mm ahead of the A-Pog
line
Esthetic Plane
AKA Ricketts esthetics line

A line that extends from the tip of the

nose to soft tissue pogonion

For Esthetics the lips should be

slightly behind the line
Cephalometric Angles
 Cephalometric types of angles
Angles Describing Skeletal relationship Angles for Dental Relationships
Facial Angle

Facial angle tells the anteropostero position of the

mandible in relation to the face. (The degree of protrusion
or retrusion of the mandible)

Formed by the intersection of the N-Pog plane and the F-H

plane

Average value of 87.8° (82°-95°)

<87.8° - Reclusive chin

>87.8° - Protrusive chin

Angle of Convexity
The angle of convexity tells the degree of convexity
or concavity of the skeletal profile.

It is formed by the intersection of a line from naison

to point A, and a line from Point A to pogonion.

The average value is 0° (-8.5° - 10°)

<0° - negative angle - indicates prognatic profile

>0° - positive angle - indicates a prominent maxillary

dental base
A-B angle
A-B plane angle measures the angle between
N-Pog and A-B line, as a means to assess the
maxillo madibular relationship to the face.

The average value is -4.6° (-9° - 0°)

< -4.6 -

> -4.6 - class III malocclusion or class I

malocclusion with mandibular prominence
Y-axis
Also known as the growth axis, it measures the acute
angle formed by the intersection of a line from the sella
Turkica to gnathion with the Frankfort horizontal plane

. Average Value- 59.4 ° (53°-66°)

. Increased angle- vertical growth of the mandible

. Decreased angle - horizontal growth of the mandible

Mandibular Plane Angle

- Formed by the intersection of the Frankfort

horizontal plane and the mandibular plane.

- Mean value = 21.9° (17°-28°)

- High angle: open bite, vertically growing mandible

- Low angle: deep bite, horizontally growing

mandible
Dental Related
Angles
Cant of Occlusal Plane
This angle is formed between the occlusal plane
and the F.H plane and is important as it gives a
measure of the slope of the occlusal plane
(relative to the F.H plane)

The average value is 9.3° (1.5° - 14°)

>9.3° - indicates a class 2 malocclusion

Interincisal Angle
This angle is a measure of the degree of
procumbency of the incisor teeth and is the
angle formed by the intersection of the long axes
of the maxillary and mandibular central incisors.

The average value is 135.4° (130°-150-5°)

<135.4° - Reduced angles indicates a class II

division 2 malocclusion

>135.4° - Increased angle indicates a class II

division 2 malocclusion
Incisal Occlusal Plane
The incisal occlusal plane angle is the angle
formed between the long axes of the lower
(mandibular) central incisors, and the occlusal
plane.

The average value is 14.5° (3.5° - 20°)

>14.5° - suggestive of increased lower incisor

proclination.
Incisor Mandibular Angle
The angle formed by the intersection of the
mandibular plane and the long axes of the
mandibular incisor.

The average value is 1.4° (-8.2° - 7°)

>1.4° - suggestive of increased lower incisor

proclination
Maxillary Incisor to A-Pog
This is the linear measurement of the space
between the incisal edge of the maxillary central
incisors, and the line joining point A to pogonion.

The average value is 2.7mm (-1mm -5mm)

>2.7mm - Increased measurements are

correlated to upper incisor proclination.
Reference
The South African Dental Association. (2019). Cephalometric analysis: manual
tracing of a lateral cephalogram. Retrieved from:
http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162019000600
009
Shetty, S, Zagar, N.M, Shenoy, K, Rekha,V. (2013). Occlusal plane location in
edentulous patients: a review. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732734/
Bhalajhi, S. L. (n.d.) Orthodontics, The Art and Science (7th ed.). ARYA.