8/12/2019 Cep Halo Metrics
1/58
8/12/2019 Cep Halo Metrics
2/58
DEPARTMENT OF
PEDODONTICS
8/12/2019 Cep Halo Metrics
3/58
CEPHALOMETRIC DIAGNOSIS
Submitted to : Dr. RITU JINDAL
Head o f the department
Submitted by: Sharanjit walia
Roll no. 57BDS Finalprof.
8/12/2019 Cep Halo Metrics
4/58
CONTENTS
Introduction History Equipment Technical aspect Positioning of the patient Exposure parameters Types Uses Landmarks and planes Analysis
8/12/2019 Cep Halo Metrics
5/58
Introduction
Craniometry can be said to be theforerunner of cephalometry.
Craniometry involved measurements ofcranio facial dimensions of skulls of deadpersons.
This method was not practical in livingindividual due to soft tissue envelope thatmade direct measurement difficult and farreliable.
8/12/2019 Cep Halo Metrics
6/58
History
Cephalometry was a modification ofanthropological studies andcraniometry.
PACINI in 1922 published the firstpaper on cephalometry.But it was BOARDBENT(USA) and
HOFRATH(Germany) who introduced
and popularized in 1931.Clinical application of cephalometry was
introduced by DOWNS.
8/12/2019 Cep Halo Metrics
7/58
EQUIPMENT
BOARDBENT bolton type Uses two x ray sources and two
film holders.
Lateral and AP cephalogramscan be taken without moving thesubject.
More precise results can beobtained..
8/12/2019 Cep Halo Metrics
8/58
BOARDBENT boltontype
8/12/2019 Cep Halo Metrics
9/58Bjork, 1951Thurow, 1951
Marcolis, 1940Waldo, 1938
8/12/2019 Cep Halo Metrics
10/58
Technical aspect
Cephalometric radiographs are taken usingan apparatus that consist of an x raysource and an head holding device calledcephalostat.
Cephalostat consists of two ear rodspreventing movement of head.
Vertical stabilisation of head is by orbitalpointer contacting lower border of orbit.
8/12/2019 Cep Halo Metrics
11/58
8/12/2019 Cep Halo Metrics
12/58
POSITIONING OF THE PATIENT
F.H. plane should be parallel tofloor.
Ear rods stabilize the patient on the
horizontal plane. Patient is made to close the mouth
in centric occlusion.
Orbital pointer should be fixed forvertical plane stabilization ofpatient.
8/12/2019 Cep Halo Metrics
13/58
head
holding
device
X-ray
sourc
e
:
Cephalostat:
Consist of:
8/12/2019 Cep Halo Metrics
14/58
Uses
Helps in orthodontic diagnosis. Helps in classification of skeletal
and dental abnormalities.
Helps in planning treatment of anindividual.
Helps in evaluation of treatment
results. Helps in predicting growth related
changes.
8/12/2019 Cep Halo Metrics
15/58
8/12/2019 Cep Halo Metrics
16/58
APoint A: the deepest point in the curvature
of the maxillary alveolar process
BPoint B: the deepest point in the curvatureof the mandibular alveolar process
Pg
Pogonion: the extreme anterior point of thechin
MeMenton: the extreme inferior point of the
chin Gn
Gnathion: the midpoint between pogonion andmenton
8/12/2019 Cep Halo Metrics
17/58
8/12/2019 Cep Halo Metrics
18/58
Gonion(GO)-:It is constructed point at thejunction of ramal plane and themandibular plane.
Porion (p)-:The highest bony point on theupper margin of external auditorymeatus.
Sella-:point representing pituitary fossa
or sella turcica. . Orbitale-:lowest point on the inferior bony
margin of the orbit. Nasion-:most anterior point midway
between frontal and nasal bones on thefrontonasal sutures.
8/12/2019 Cep Halo Metrics
19/58
8/12/2019 Cep Halo Metrics
20/58
Planes used incephalometrics Horizontal planes:
S.N. Plane sella to nasion.F.H. Plane orbitale to porion.
Occlusal plane plane bisectingposterior occlusion.Palatal plane ANS to PNS of
palatine bone.Mandibular plane gonion tognathion.
8/12/2019 Cep Halo Metrics
21/58
8/12/2019 Cep Halo Metrics
22/58
sella nasion
porion orbitale
Reference Lines
8/12/2019 Cep Halo Metrics
23/58
VERTICAL PLANES:
A-Pog line point A on maxilla topogonion on mandible.
Facial plane nasion to pogonion,
Facial axis ptm point to gnathion.
E-plane esthethic plane is a linebetween the most anterior point of softtissue nose to soft tissue chin.
8/12/2019 Cep Halo Metrics
24/58
Downs analysis;
It is one of the most frequentlyused cephalometric analysis.
Downs analysis consists of tenparameters of which five areskeletal and five are dental.
8/12/2019 Cep Halo Metrics
25/58
Skeletal parameters;
Facial angle;it is the inside inferior angle formed
by intersection of nasion-pogonionplane and F.H. plane.
average value; 87.8 ( 82 95)significance; indication of antero-
posterior positioning of mandible inrelation to upper face. Angle is
increased in skeletal class III withprominent chin while decreased inskeletal class II.
8/12/2019 Cep Halo Metrics
26/58
SKELETAL HORIZONTAL -
MAXILLA
s n
a
F H
8/12/2019 Cep Halo Metrics
27/58
Angle of convexity;
Nasion-point A to point A pogonion.
Average value; 0 ( -8.5 to 10).Significance; A positive angle suggest a
prominent maxillary denture base in
relation to mandible.Negative angle is indicative of
prognathic profile.
8/12/2019 Cep Halo Metrics
28/58
8/12/2019 Cep Halo Metrics
29/58
A-B plane angle;
point A point B to nasion pogonion.
Average value; -4.6 ( -9 to 0)
Significance; indicative of maxillomandibular relationship in relation tofacial plane.Negative since point B is positioned
behind point A.
Positive in class III malocclusion.
ANB 2 2 deg
8/12/2019 Cep Halo Metrics
30/58
SKELETAL HORIZONTAL -
MAXILLA TO MANDIBLE
N
A
B
ANB 2 2 deg
8/12/2019 Cep Halo Metrics
31/58
Mandibular plane angle;Intersection of mandibular plane with
F.H. Plane.Average value; 21.9 ( 17 to 28)
Y-Axis;Sella gnathion to F.H. plane.Average value; 59 ( 53 to 66)Angle is larger in class II facial patterns.
Indicates growth pattern of a individual.
8/12/2019 Cep Halo Metrics
32/58
SKELETAL VERTICAL
F H
S
G NM E
G O
8/12/2019 Cep Halo Metrics
33/58
DENTAL PARAMETERS
Cant of occlusal plane;OCCLUSAL PLANE TO F.H. PlaneAverage value; 9.3 ( 1.5 to 14) Gives a
measure of slope of occlusal plane relative toF.H. Plane.
Inter incisal angle;Angle between long axes of upper and lower
incisors.
Average value: 135.4 ( 130 to 150.5)increased in class I bimaxillary protrusion.
8/12/2019 Cep Halo Metrics
34/58
8/12/2019 Cep Halo Metrics
35/58
Incisor occlusal plane angle;This is the inside inferior angle formed by the
intersection between the long axis of lower central
incisor and the occlusal plane and is read as a plusor minus deviation from a right angleAverage value: 14.5 ( 3.5 to 20)An increase in this angle is suggestive of increased
lower incisor proclination.
Incisor mandibular plane angle:This angle is formed by intersection of the long
axis of the lower incisor and the mandibular plane.
Average value: 1.4(-8.2 to 7)An increase in this angle is suggestive of increasedlower incisor proclination.
8/12/2019 Cep Halo Metrics
36/58
DENTAL - UPPER TO LOWER
INCISOR
8/12/2019 Cep Halo Metrics
37/58
Upper incisor to A-pog line:
This is a linear measurement betweenthe incisal edge of the maxillarycentral incisor and the line joiningpoint A to pogonion. This distance is onan average 2.7 mm(rang-1 to 5 mm)The measurement is more in patients
presenting with upper incisor
proclination.
8/12/2019 Cep Halo Metrics
38/58
8/12/2019 Cep Halo Metrics
39/58
Steiners analysis
SNA (Maxillary position) 82.0
SNB (Mandibular position) 80
ANB (Maxillary/Mandibular relation) 2
l to NA (Upper incisors to NA mm) 4mm
l to NA (Upper incisors to NA degree) 22
l to NB (Lower incisors to NB mm) 4mm
l to NB (Lower incisors to NB degree) 25l to l (lnter-incisal angle) 131
SN to GoGn (Mandibular plane angle 32
SN to occlusal plane 14
8/12/2019 Cep Halo Metrics
40/58
SKELETAL
ANALYSIS
S.N.AAngle formed by intersection
of s.n.plane and a line joining nasion
and point A.
Mean value is 82
I. In class II value is larger.
II. In classIII value is smaller.
8/12/2019 Cep Halo Metrics
41/58
S.N.B ANGLE
S.N.B. ANGLE-angle between S.N
plane and a line joining nasion topoint B.
Shows anteroposterior postioning of
mandible to cranial base.Average value is 80.
8/12/2019 Cep Halo Metrics
42/58
A.N.B ANGLE-angle is formed by
intersection of
nasion to point A
and nasion to point
B.
Average value is 2.
8/12/2019 Cep Halo Metrics
43/58
MANDIBULARPLANE ANGLE-
Angle formedbetween S.N.
PLANE andmandibularplane(lineconnecting gonion
and gnathion).Average value is
32.
8/12/2019 Cep Halo Metrics
44/58
DENTAL ANALYSIS
Upper incisor to N-
A(ANGLE); angle
formed by intersection of
long axis of uppercentral incisor and line
joining nasion to point A.
Normal value is 22.
8/12/2019 Cep Halo Metrics
45/58
Upper incisor to N-A(linear)
Linear
measurement
between upper
central incisor andline joining nasion
to point A.
Normal value is
4mm.
8/12/2019 Cep Halo Metrics
46/58
LOWER INCISOR TO N
8/12/2019 Cep Halo Metrics
47/58
LOWER INCISOR TO N-
B(angle)
Angle formed
between N-B PLANE
and long axis of lower
incisor.Average value is 25.
Increased value
indicates proclination
of lower incisors.
8/12/2019 Cep Halo Metrics
48/58
Lower incisor to N-B (linear)
Linear distance
between lower central
incisor and line joining
nasion to point B. Normal value is 4mm.
8/12/2019 Cep Halo Metrics
49/58
INTER-INCISAL ANGLE
Angle formed betweenlong axis of upper and
lower central incisors.
Reduced interincisalangle in classII,div1.
Larger than normal in
classII,div2
malocclusion.
SOFT TISSUE ANALYSIS
8/12/2019 Cep Halo Metrics
50/58
SOFT TISSUE ANALYSIS
S LINE;- According to steiner lips shouldtouch line extending from soft tissuecontour of the chin to the middle of an Sformed by the lower border of the nose.
If lips are located behind this line thenlips are retrusive,and patient hasconcave profile.
If lips are located beyond this line thenlips are believed to be protrusive,and isconvex profile.
8/12/2019 Cep Halo Metrics
51/58
SOFT TISSUE
8/12/2019 Cep Halo Metrics
52/58
TWEED ANALYSIS
Tweedanalysis makes the use of 3planes that form triangle.:- Frankfort horizontal plane Mandibular plane
Long axis of lower incisorAngles formed by these planes are-: Frankfort horizontal Mandibular plane
(FMPA) Incisor mandiular plane angle (IMPA) Frankfort mandibular incisor angle
(FMIA)
8/12/2019 Cep Halo Metrics
53/58
TWEED ANALYSIS
FMA (Frankfort plane to
mandibular plane)25.0
.
FMIA (Frankfort plane to lower
incisor angulation)65.0
.
IMPA (Lower incisor to
mandibular plane)90.0
.
8/12/2019 Cep Halo Metrics
54/58
TWEEDS TRIANGLE
8/12/2019 Cep Halo Metrics
55/58
WITSAPPRAISAL
It determines the extent to whichmandible and maxilla are related toeach other.
Wits appraisal is used in cases wherethe ANB angle is considered not so
reliable due to factors such asposition of nasion or rotation of jaws.
8/12/2019 Cep Halo Metrics
56/58
Method
The method includes drawing an occlusalplane through overlapping cusps of firstpremolars and molars.
Then perpendiculars are drawn to occlusalplane from point A and point B.
The point of contact are termed as AO and
BO. Distance between AO and BO gives antero
posterior relationship between two jaws.
8/12/2019 Cep Halo Metrics
57/58
WITS APPRAISAL
8/12/2019 Cep Halo Metrics
58/58
Top Related