Basic undergraduate cephalometric radiography

1. Cephalometric
Analysis
Mohanad Elsherif
BDS (U of K), MFD RCSI, MFDS RCPS(Glasg), MSc (Orthodontics), M.Orth. RCSEd
‫الرحيم‬‫الرحمن‬‫هللا‬ ‫بسم‬
Ibn Sina University
Faculty of Dentistry
Department of Orthodontics

2. • Cephalo: Head Metric: Measurement
• Cephalometric radiography is a specialized
radiographic technique concerned with
imaging the craniofacial region in a
standardized and reproducible manner.
• A cephalometric analysis identifies defined
anatomical landmarks on the film and
measures the angular and linear
relationships between them.
• This numerical assessment can provide
detailed information on the relationship of
skeletal, dental and soft tissue elements
within the craniofacial region.

3. 1. Standardized and reproducible.
2. Shows the soft tissues.

4. 1. Frontal (posterio-anterior): for
assessment of facial symmetry.
2. Lateral: for assessment of vertical
and sagittal (anterio-posterior)
relationship.

7. 1. Study craniofacial growth.
2. Help in diagnosis.
3. Help in treatment planning.
4. Evaluation of treated cases.
5. Help in classification of skeletal &
dental abnormalities & establishing
the facial type.
6. Detect certain pathology.
7. Helpful in research work.

8. 1. The patient should be in the natural
head position (i.e. the Frankfort
plane should be horizontal parallel
to the floor).
2. Ear rods of the cephalostat(head
holding device) should be in the
external auditory canal and thereby
prevent the movement of the head
in Horizontal plane and the central
beam should be directed toward
them.
3. Orbital pointer should contact the
lower border of the left orbit for
vertical stabilization.

9. 4. Upper part of the forehead is
supported by the forehead clamp
positioned above the region of the
nasal bridge.
5. Teeth in centric occlusion.
6. X-ray source is at fixed distance to
the mid-sagittal plane (5 feet or 150
cm) and to the film (6 feet or 180
cm).
6. Collimate beam to reduce radiation
exposure.
7. Aluminum wedge filter or barium
paste to enables the soft tissues to be
demonstrated.

10. 1 feet5 feet
X-ray Source
Patient in Head
Positioning Device
Mid-saggital Plane
Film Plane
X-ray Film in
Cassette

15. Evaluating relationships, both
horizontal and vertical of 5
major functional components of
the face:
• the cranial base.
• the maxilla.
• the mandible.
• the maxillary dental base.
• mandibular dental base.

16. It is the transformation of
information from the cephalometric
radiograph into tracing sheet using
manual or digital tracing.

20. Sella
Porion
Gonion
PNS
Menton Gnathion
Pogonion
B Point
A Point
ANS
Orbitale
Nasion
Articulare

21. • Sella (S):
The center of the sella turcica.
• Orbitale (Or):
The most anterior inferior point on the infra-
orbital margin.
• Nasion (N):
The most anterior point on the frontonasal
suture.
• Anterior nasal spine (ANS):
The tip of the anterior nasal spine.
• Posterior nasal spine (PNS):
The tip of the posterior nasal spine of the
palatine bone in the hard palate.

22. • Point A or Subspinale:
The point of deepest concavity on the anterior
profile of the maxilla between the anterior
nasal spine and the alveolar crest. This
point represent the anterior limit of the
maxilla and it is liable to change with tooth
movement and growth.
• Point B or supramentale:
The point of deepest concavity on the anterior
surface of the mandibular symphysis between
the chin point and the alveolar crest. It
represent the anterior limit of the mandible and
also liable to change by tooth movement and
growth.

23. • Pogonion (Pog):
The most anterior point of the bony
chin.
• Gnathion (Gn):
The most anterior and inferior point
on the bony outline of the chin.
• Menton(Me):
The lowest point on the bony outline
of the mandibular symphysis.

24. • Gonion (Go):
The most posterior inferior point in the
angle of the mandible.
• Note:
The gonion is found by bisecting the
angle formed by line (tangent) passing
throw the posterior border of the
mandible and a line (tangent) passing
throw the inferior border of the
mandible.

25. • Articulare(Ar):
intersection of posterior border of the neck of the
mandibular condyle and the lower margin of
the posterior cranial base.
• Porion(Po):
The uppermost outermost point of the bony
external auditory meatus. It’s location can be
obstructed by the ear rod of the cephalostat.
• Basion (BA):
The most inferior posterior point of the occipital
bone at the anterior margin of the occipital
foramen (it is a unilateral landmark)

26. SN Plane
Frankfort Plane
Maxillary (Palatal)
Plane
Occlusal Plane
Mandibular Plane

27. • Frankfort plane:
It is a line joining porion (Po) and
orbitale (Or). It should be parallel to
the floor when you are taking
cephalometric radiograph.
• Maxillary (palatal) (nasal) plane:
It is a line joining the anterior nasal
spine (ANS) and the posterior nasal
spine (PNS).

28. • Mandibular plane:
There are several definitions:
1- A line joining Menton (Me) and Gonion
(Go).
2- A line joining Gnathion (Gn)and Gonion
(GO).
3- A tangent to the lower border of the
mandible

29. • SN plane:
A transverse plane through the skull
represented by the line joining Sella
(S) and Nasion (N). It represent the
anterior cranial base and it shows little
changes after age of 7 years. it is the
most stable line of them.
• Functional occlusal plane:
A line bisecting the occlusal surface (i.e.
passing between cusp tips) of molars
& premolars (or deciduous molar in
mixed dentition) it can be changed
with growth andor treatment.

30. It assess the sagittal relation between
maxillary apical base and the base of the skull.
If increased (prognathic maxilla) (i.e
tendency to skeletal class II) if decreased
(retrognathic maxilla) (i.e. tendency to
skeletal class III) .
82S
N
A

31. It assess the sagittal relation between
mandibular dental base and the base of the
skull. If increased (prognathic mandible) (i.e
tendency to skeletal class III) if decreased
(retrognathic mandible) (i.e. tendency to
skeletal class II) .
79S
N
B

32. N
A
B
It assess the sagittal relation between the
maxilla and mandible. If increased it indicates
skeletal class II malocclusion , and if
decreased it indicates skeletal class III
malocclusion

33. Frankfort mandibular plane angle: for Vertical
Skeletal Assessment. if increased => tendency
to open bite, if decreased => tendency to deep
bite.
28

34. Maxillo-mandibular plane angle: It is the
vertical relationship between the maxilla
and mandible if increased => tendency to
open bite, if decreased => tendency to
deep bite.
27

35. Upper incisor to maxillary plane: it
measure the degree of inclination of the
maxillary incisors if increased => incisor
proclination, if decreased => incisor
retroclination.
108

36. Lower incisors to mandibular plane: it
measure the degree of inclination of the
mandibular incisors if increased => incisor
proclination, if decreased => incisor
retroclination.
92

37. It is associated with the depth of the
overbite. if increased deep bite, if
decreased open bite.
133

38. CHANGES
WITH AGE!
This the line join the soft tissue chin and the
tip of the nose. In balanced person the lower
lip should lie 2mm (± 2mm) anterior to this
line and the upper lip should be a little
further posteriorly.

39. CHANGES
WITH AGE!
Extend from the soft tissue chin to the
upper lip in well proportioned face this line
– if extended- it should bisect the nose.

40. Extend from the Nasion to the soft tissue
chin (i.e. soft tissue overlying the
pogonion) in well proportioned face this
line should bisect the Frankfort plane at 86
degree.
CHANGES
WITH AGE!86

42. Declaration
 The author wish to declare that; these presentations are his original work,
all materials and pictures collection, typing and slide design has been
done by the author.
 Most of these materials has been done for undergraduate students,
although postgraduate students may find some useful basic and advanced
information.
 The universities title at the front page indicate where the lecture was first
presented. The author was working as a lecturer of orthodontics at Ibn
Sina University, Sudan International University, and as a Master student in
Orthodontics at University of Khartoum.
 The author declare that all materials and photos in these presentations
has been collected from different textbooks, papers and online websites.
These pictures are presented here for education and demonstration
purposes only. The author are not attempting to plagiarize or reproduced
unauthorized material, and the intellectual properties of these photos
belong to their original authors.

43. Declaration
 As the authors reviews several textbooks, papers and other
references during preparation of these materials, it was impossible to
cite every textbook and journal article, the main textbooks that has
been reviewed during preparation of these presentations were:
 Contemporary Orthodontics 5th edition; Proffit, William R, Henry W.
Fields, and David M. Sarver.
 Handbook of Orthodontics. 1st edition; Cobourne, Martyn T, and
Andrew T. DiBiase.
 Essentials of orthodontics: Diagnosis and Treatment; Robert N. Staley,
Neil T. Reske
 Orthodontics: Current Principles & Techniques 5th edition; Graber, Lee
W, Robert L. Vanarsdall, and Katherine W. L. Vig
 Orthodontics: The Art and Science. 3rd Edition. Bhalajhi, S.I.

44. Declaration
 For the purposes of dissemination and sharing of knowledge,
these lectures were given to several colleagues and students. It
were also uploaded to SlideShare website by the author.
Colleagues and students may download, use, and modify these
materials as they see fit for non-profit purposes. The author
retain the copyright of the original work.
 The author wish to thank his family, teachers, colleagues and
students for their love and support throughout his career. I also
wish to express my sincere gratitude to all orthodontic pillars
for their tremendous contribution to our specialty.
 Finally, the author welcome any advices and enquires through
his email address: Mohanad-07@hotmail.com

45. ‫هللا‬ ‫بحمد‬ ‫تم‬