Cephalometrics

 
Aneel  Kumar  Bherwani  
Department  of  Orthodon9cs  
Ziauddin  University  
      Cephalometrics  is  a  technique  employing  
oriented  radiographs  for  the  purpose  of  
making  head  measurements.  
 Historical Review
         Great importance of sagittal apical base relationship in
orthodontic diagnosis and treatment planning.
Ballard 1951, Moorrees 1953, Mills 1970.

 Clinically by the overall profile view of the patient.

Barnett 1975
 Palpation of anterior surfaces of the basal
part of the jaw. Mills 1987
 Better assessment with lateral skull radiograph.
 Pacini 1922 – Cephalometrics
 Broadbent (USA), Hofrath (Germany) 1934 –
Standardization and Popularization
 Introduc9on  of  Cephalometrics  
• Introduced  in  1934  
• By  Hofrath  in  Germany  and  Broadbent  in  the  
United  States  
 Why  do  it?  
• Research  
• E9ology  of  malocclusion  
• Prognosis  
• Predic9on  (VTO)  
 60"   15"  
Film Plane  
Source Plane  

X-ray Source  
X-ray Film in
Mid-saggital
Cassette  
Plane  
Patient in Head
Positioning Device  
      Simply calling a dimension ‘large’ or ‘small’ or
‘good’ or ‘bad’ does not mean the same to
everyone. In order to be critical or descriptive
it is more useful to express dimensions in
terms of angles or linear measurements.
BUT
Cephalometrics is not an exact science
 Purpose  in  Diagnosis/TP  
Find  out  skeletal  classifica9on    
• anteroposterior    
• ver9cal    
Find  out  angula9on  of  incisors    
Consider  soW  9ssue    
• facial  profile    
• airway  considera9ons  
Structures  to  trace  
 Structures  to  trace  
• Sella  
• Orbit  
• Nasal  bone  
 Structures  to  trace  

 Maxilla
 Long axis U1
 Labial U1  
 Structures  to  trace  
 Mandible
 Permanent 1st
molars
 Long axis L1
 Labial L1  
Reliability  of  Landmark  Iden9fica9on  
 GOALS  OF  CEPHALOMETRIC  ANALYSIS  
       Evalua9ng  rela9onships,  both  horizontal  and  
ver9cal  of  5  major  func9onal  components  of  
the  face:    
•  the  cranial  base;  
• the  maxilla;  the  mandible,    
• the  maxillary  and  mandibular  dento-­‐alveolus  
 Cephalometric  Analysis  
• Measurement  Analysis  
• Template  Analysis  
 Measurement  Analysis  
• Downs  analysis  
• Steiner's  analysis  
• Wits  analysis  
• Sassouni’s  analysis  
• McNamara  analysis  
• Tweed  analysis  
• Jarabak’s  analysis  
 Downs  Analysis  
• 20  white  subjects  
• Age  range  12  to  17  years  
• Equally  distributed  among  boys  and  girls  
• Excellent  occlusions  
Downs  Analysis  
 Skeletal  Pajern  

Facial angle Angle of Convexity

AB Plane Angle Mandibular plane & Y axis
 Dental  Pajern  

Inter-Incisor, Incisor-Occlusal & Incisor Mandibular Plane Angle

Protrusion of Maxillary Incisors
Polygon  or  Wiggle  
 Measurement  Analysis  
• Downs  analysis  
• Steiner's  analysis  
• Wits  analysis  
• Sassouni’s  analysis  
• McNamara  analysis  
• Tweed  analysis  
• Jarabak’s  analysis  
 Steiner’s  Analysis  
• Cecil  C.  Steiner  
• Relates  the  Jaws  to  the  Cranium  and  to  each  
other  
• Relates  the  Den99on  to  their  Respec9ve  Bases  
and  to  each  other.  
Skeletal Analysis:
SNA = 82
SNB = 80
ANB = 02
Occ Plane to SN= 14
GoGn to SN = 32

Dental Analysis:
I to NA (mm) = 4
I to NA (angle) = 22
I to NB (mm) = 4
I to NB (angle) = 25
I-I (angle) = 131
Po and LI to NB distance =
Equal

Soft Tissue Analysis:

S line: 0mm
SNA SNB
ANB
 Measurement  Analysis  
• Downs  analysis  
• Steiner's  analysis  
• Wits  analysis  
• Sassouni’s  analysis  
• McNamara  analysis  
• Tweed  analysis  
• Jarabak’s  analysis  
WITS  Analysis  
Effect  of  Cranial  Base  Length  on  ANB  
Effect  of  Rota9ons  on  ANB  
 Shortcomings  of  ANB  
• Posi9on  of  Nasion  is  variable  
• Point  A  is  a  Alveolar  landmark  
• Point  B  is  a  Dentoalveolar  landmark  
• ANB  angle  is  affected  by  Rota9ons  of  jaws  
 Measurement  Analysis  
• Downs  analysis  
• Steiner's  analysis  
• Wits  analysis  
• Sassouni’s  analysis  
• McNamara  analysis  
• Tweed  analysis  
• Jarabak’s  analysis  
 Measurement  Analysis  
• Downs  analysis  
• Steiner's  analysis  
• Wits  analysis  
• Sassouni’s  analysis  
• McNamara  analysis  
• Tweed  analysis  
• Jarabak’s  analysis  
 McNamara  Analysis  
• Maxilla  to  cranial  base  
• Maxilla  to  Mandible  
• Mandible  to  cranial  base  
• Den99on  
• Airway  
SoW  Tissue  
 Hard  Tissue  

Point A to Nasion Perpendicular

TWEED  ANALYSIS  
JARABAK  ANALYSIS