Ce;ph has given us us a different prespective of interpreting various skeletal problems in the

dentofacial complex. However, the promise of the cephalometrics as a diagnostic and prognostic tool is
yet to be fulfilled.

Limitations of ceph: Errors of projection: Magnification Distortion  Errors of identification Radiograph

quality Reproducibility  Unpredictability of growth  Limitations in suerimpositioning

Errors due to intracranial reference planes

patient positioning in the cephalostat

intracranial reference planes: indv. variations in reference lines - different interpretation of subjects
with similar profiles.

Campers line: first orientation plane to orient cranium on a horizontal from the middle of EAM to ANS

SN:The S & N points move only minimally when head deviates from the true profile position & even
when head is rotated in the cephalostat

Bjork AO 1951 – earliest to report unreliability Drawbacks of S-N plane: Downward- facial angles
decrease Upward- facial angles increase

ANT skull base SN is unstable in growing persons. • Nasion - landmark on an actively growing suture, -
moves forward, upward, or downward in growing children • Sella- its geometric center is unstable since
the pituitary gland enlarges during growth.

may therefore rotate slightly over time - results in a considerable back or forward swing of the chin.

Sella is unrelated to the structures of the face and therefore cannot be used to measure facial
development.

FH Plane: plane through left and right porion and left orbitale , (in 1884 by craniologists), - the best
compromise for orientation of crania.

Drawbacks: Downs(1956) - the discrepancies between Cephalometric and photographic facial typing
disappear when a correction is made for those persons in whom the "Frankfurt plane" is not horizontal.

Machine porion Anatomic porion Individual variation Vertical relationships with other intracranial
landmarks – biologic variation.

Occlusal plane: drawn the region of overlapping cusps of I premolar & I molars (Jacobson Wit’s
Appraisal) • To eliminate the effect of rotation of the jaws • Variation in the A-P relation of the jaws with
respect to cranium.

Dsadv: affected by occlusal plane angle & vertical alveolar relationships • Affected by vertical distance
between points A & B.

Any change in occlusal plane during treatment allows variation • Growth related changes cannot be
determined.

Patient positioning in a cephalogram: Patient aligned within ear rods of the cephalostat exerting
moderate pressure on EAM. Patient’s FH placed parallel to the floor canthomeatal line placed 10
degrees to floor Locking nasal positioner against bridge of nose .
Dadv of ear rods: Greenfield et.al. AJO 1989 Fixed position of cephalostat - cannot be adjusted
forward, backward, sidewise, or rotated. - The subject moves his head to fit the ear rods, ( altering the
angulation of the head and neck )

NHP Moorrees - A standardized and reproducible position of the head, in an upright posture, the eyes
focused on a point in the distance at eye level, which implies that the visual axis is horizontal.

Adv: provides the use of an extracranial reference line (true vertical or horizontal) for cephalometric
analysis. NHP should be the preferred for profile evaluation as it reflects the everyday true life
appearance of people. (COOKE 1986)

NHP is relatively constant over time. (MOORREES &KEAN 1958) Facial photograph and cephalometric
radiograph in NHP - direct correlation bet. real-life appearance and tracing.

Natural
head position (NHP) provides the key for meaningful cephalometric analysis because an extracranial reference
line is used instead of intracranial reference lines, known to be subject to considerable iological variation in
theirinclination.
NHP has been found to be highly reproducible in adults and children, males and females, Caucasians and non-
Caucasians, with a variance of only about 4°.
Natural head posture is a physiologic position -"orthoposition" - characteristic for a person and
reproducible, but differs among persons.

Posture control of head head is influenced by Resistance to gravity Respiration Deglutition Sight
(visual axis) Vestibular balance mechanism Hearing .

For ceph analysis the standardized NHP is preferable to natural head posture (MOORREES)

Natural head orientation: The head orientation of the subject perceived by the clinician, based on
general experience, as the NHP in a standing, relaxed body and head posture, when the subject is
looking at a distant point at eye level. Natural head orientation is defined as the head position
estimated by a trained clinician as the natural one.

The NHO related horizontal line standardized to a line through Sella is the best reference for clinical
cephalometric analysis when head positions registered at NHP are unnaturally flexed

NHP registration:

MIRROR METHOD

SELF BALANCE METHOD

instructing the subject standing or sitting in the cephalostat to look at a point on the wall in front,
exactly at eye level. A small mirror (diameter no more than 10 cm), the midpoint of which also at eye
level, can be used also for head orientation.

WIRE PLUMB LINE: record the true vertical Plumb line bisects the reflection of the subject's face in the
mirror and minimize lateral head rotation.

Rehersal phase:patient placed facing a neutral wall (nothing to distract ). • Carefully observe the
patient's posture before the actual rehearsal takes place, • The patient walks from the waiting area to
the radiographic room.

BODY POSTURE: most reproducible natural standing position is the orthoposition Small children - to
place heels together and let the arms hang. Older and tense patients - "walk on the spot'' & to raise and
drop shoulders to ease tension.
HEAD POSTURE: two methods (SOLOW 1971)  The subject's own feeling of a natural head position
―the self-balance position.‖  Based on visual cues from external reference.

POSITIONING ACC TO EXTERNAL REFERENCE: carried out only after the head has been placed in the
self-balance position.  In adults the head is kept, on the average, 3 degrees higher in the mirror
position than in the self-balance position.

BODY POSIYIONING AND HEAD POSITIONING: pt instructed to ''hold your head so that you can look into
your own eyes in the miror". ADJUSTMENT FOR SYMMETRY. carried out with guidance by the light-beam
cross

FLUID LEVEL DEVICE

INCLINOMETRE

DISADV OF NHP: 1980 Frankel  Functional appliance treatment- changes in posture ( functional and
physiologic)- distorts data base  Fu.A. alters muscle form and function. Adjoining muscle groups
experience reciprocal changes and treatment-related head posture changes could result.