Cephalometric Radiograph

A radiograph of the head taken in a Cephalometer (Cephalostat) that is a head-holding device introduced in 1931 by ! "! roadbent in the #$A and by "! "ofrath in %ermany! &he original design included t'o ear rods for insertion into the e(ternal auditory canals) an infraorbital pointer and a forehead clamp) to achieve parallelism of the *rankfort plane 'ith the floor! &he cephalometer is used to obtain standardi+ed and comparable craniofacial images on radiographic film!

,ateral Cephalometric Radiograph

A radiograph of the head taken 'ith the (-ray beam perpendicular to the patient-s sagittal plane! &he beam most commonly enters on the patient-s right side) 'ith the film cassette ad.acent to the patient-s left side (so that the patient-s head is oriented to the right on the radiograph)) but the reverse convention also is used! /atural head position is a standardi+ed orientation of the head that is reproducible for each individual and is used as a means of standardi+ation during analysis of dentofacial morphology both for photos and radiographs! &he concept of natural head position 'as introduced by C! *! A! 0oorrees and 0! R 1ean in 1923 and no' is a common method of head orientation for cephalometric radiography! &o accomplish natural head position) the patient is asked to look into a mirror placed in front of him4her at eye level (as if he4she 'ere looking at the hori+on)) 'ith the interpupillary line parallel to the floor! Advocates of this method maintain that registration of the head in its natural position 'hile obtaining a cephalogram has the advantage that an e(tracranial line (the true vertical or a line perpendicular to that) can be used as a reference line for cephalometric analysis) thus bypassing the difficulties imposed by the biologic variation of intracranial reference lines! &rue vertical is an e(ternal reference line) commonly provided by the image of a free-hanging metal chain on the cephalostat registering on the film or digital cassette during e(posure! &he true

vertical line offers the advantage of no variation (since it is generated by gravity) and is used 'ith radiographs obtained in natural head position!

5osteroanterior (5-A) cephalometric radiograph

A radiograph of the head taken 'ith the (-ray beam perpendicular to the patient-s coronal plane 'ith the (-ray source behind the head and the film cassette in front of the patient-s face! 5-A cephalograms are usually taken for evaluation and treatment planning of patients 'ith facial asymmetry!

Cephalometric &racing
A Cephalometric tracing is an overlay dra'ing produced from a cephalometric radiograph by digital means and a computer program or by copying specific outlines from it 'ith a lead pencil onto acetate paper) using an illuminated vie'-bo(! &racings are used to facilitate cephalometric analysis) as 'ell as in superimpositions) to evaluate treatment and gro'th changes !

Computeri+ed Cephalometrics
&he process of entering cephalometric data in digital format into a computer for cephalometric analysis! 6igiti+ation (of radiographs) is the conversion of landmarks on a radiograph or tracing to numerical values on a t'o- (or three-) dimensional coordinate system) usually for the purpose of computeri+ed cephalometric analysis! &he process allo's for automatic measurement of landmark relationships! 6epending on the soft'are and hard'are available) the incorporation of data can be performed by digiti+ing points on a tracing) by scanning a tracing or a conventional radiograph) or by originally obtaining computeri+ed radiographic images that are already in digital format) instead of

conventional radiographs! Computeri+ed cephalometrics offers the advantages of instant analysis7 readily available race-) se(- and agerelated norms for comparison7 as 'ell as ease of soft tissue change and surgical predictions!

*inite 8lement Analysis

*inite elemental analysis is used in digital imaging and is an engineering techni9ue of stress analysis) the basic concept of 'hich is the visuali+ation of a structure as an assemblage of a finite number of discrete structural elements connected at a finite number of points! &he finite elements are formed by figuratively :cutting the original structure into segments! : *or t'o-dimensional applications) triangles of various si+es and shapes usually are the finite elements of choice! 8ach element retains the mechanical characteristics of the original structure! $ome characteristics of the material have to be specified (depending on 'hether it is isotropic or not)! Additionally) a numbering system is re9uired to identify the elements and their connecting points) called :nodes! : A coordinate system also must be established to identify uni9uely the location of the nodal points! A large number of simultaneous linear e9uations are computergenerated) 'hich establishes compatibility 'ithin each element! &he techni9ue has some very distinct advantages as a research tool) among 'hich is the ability to obtain an estimate of the stresses throughout the structure under consideration! *urther) the inclusion of any type of anisotropy and inhomogeneity conceptually is possible by inserting the appropriate distribution of material properties at the nodes of the elements! "o'ever) 'hen it is applied to structures such as a tooth) there are some practical limitations) as relatively little is kno'n about the mechanical properties of dental and especially periodontal tissues!

0oire 6iffraction
&his is a techni9ue 'ith many applications in medicine) is used mainly to

map three-dimensional contour! ;n orthodontics it has been used for evaluation of facial asymmetry! &he techni9ue uses a series of lines produced by a transparent grid! &he grid is placed in front of the ob.ect that is to be contour-mapped! A light source is offset from the vie'ing angle! &he light passes through the diffraction grading t'ice< firstly on its 'ay from the source to the ob.ect and secondly after it has been reflected off the ob.ect! ;t then is recorded by a film or vie'ed by an investigator! An interference pattern of light and dark lines or fringes is created7 each fringe represents a set of e9uidistant points from the grid! &he fringes appear superimposed on the ob.ect as a series of contour plots of similar elevation! &he method is limited by the vie'ing angle of the system to the ob.ect! Areas of rapid elevation change on the ob.ect are difficult to characteri+e because of inability to distinguish the line separation! &his re9uires evaluation of the ob.ect from different vie'ing angles!

=isual treatment ob.ective (=&>)

A treatment planning and communication aid that may be used to define the tooth movements and4or surgical changes re9uired to achieve the desired facial goals! 8ssentially it consists of the patient-s pretreatment lateral cephalometric tracing) modified to demonstrate the changes that are anticipated in the course of treatment! &his can be accomplished 'ith the help of a computer program! A =&> of a gro'ing child is an estimate of the gro'th of a gro'ing patient 'ith the orthodontic treatment outcome) and is a very helpful tool in arriving at a final treatment plan! =isual treatment ob.ectives performed for orthognathic surgical treatment planning are sometimes referred to as $&>s ($urgical &reatment >b.ectives)! &he construction of a =&> can be very helpful in e(ploring various treatment options) but it is important) once a plan is determined) that the clinician goes back and makes sure that it is the product of a logical and practical approach to the problem! &he =&> can be linked directly to) and evaluated in con.unction 'ith) the occlusogram!

>cclusogram
An occlusolgram is a graphic representation of the arches from the occlusal vie'! >cclusograms are mainly used as treatment planning aids to assist in defining the specific tooth movements re9uired 'ithin and bet'een arches (in the sagittal and transverse planes) to achieve treatment goals! An occlusogram is essentially a t'o-dimensional diagnostic setup and is directly correlated 'ith the =isual &reatment >b.ective (=&>)! ;t can be constructed from tracings of radiographs or photographic or photostatic copies of the occlusal aspects of the ma(illary and mandibular study casts! &he tracings of the teeth of both arches are superimposed on each other to reproduce the e(isting occlusal relationship) using inde( points that are marked on the images or models and subse9uently transferred to the tracings! Anticipated movements of individual teeth as 'ell as the need for e(tractions then can be determined) to simulate the desired treatment goal!

$uperimposition
$uperimposition is the process of placing t'o images upon each other) registering on structures that remain relatively stable during the time period separating the t'o images) to evaluate the changes brought about by gro'th and4or treatment! ;n orthodontics) most commonly applies to cephalometric tracings or occlusograms!

Reference ,ines
A reference line is a line that is used as a basis for superimposition) or for comparison 'hen several measurements are performed! Reference lines ideally should be stable 'ith time and should not be affected by treatment! ecause the cant or inclination of all intracranial reference lines is sub.ect to biologic variation) it often is claimed that they are unsuitable for meaningful cephalometric analysis! Registration of the head in its natural position has the advantage that an e(tracranial :true: vertical or hori+ontal line can be used as a reference line for cephalometric analysis!

Frontal plane (Coronal plane)

Any plane passing longitudinally through the body from side to side, at right angles to the median plane and dividing the body into front and back parts.

Transverse plane (Hori ontal plane)

Any plane passing through the body at right angles to both the median and the frontal plane, dividing the body into upper and lo!er parts.

0edian plane (0idsagittal plane)

The imaginary plane passing longitudinally through the middle of the body, dividing it into left and right halves.

$agittal plane (5arasagittal plane)

Any vertical plane that passes through the body parallel to the median plane and divides the body into left and right parts.

Cephalometric landmarks

"eadily recogni able points on a cephalometric radiograph or tracing, representing certain hard or soft tissue anatomical structures (anatomical landmarks) or intersections of lines (constructed landmarks). #andmarks are used as reference points for the construction of various cephalometric lines or planes and for subse$uent numerical determination of cephalometric measurements. %n the definitions of the specific landmarks the follo!ing convention is used& 'midsagittal' identifies landmarks lying on the midsagittal plane, 'unilateral' identifies landmarks corresponding to unilateral structures and 'bilateral' applies to landmarks corresponding to bilateral structures.

()*T+",(& A-point (.oint A, (ubspinale, ss) Anterior nasal spine (A/() Articulare (Ar) *-point (.oint *, (upramentale, sm) *asion (*a) *olton (*o) Condylion (Co) Crista galli 0acryon 1labella (1) 1nathion (1n) 1onion (1o) %ncision inferius (%i) %ncision superius (%s) %nfradentale (%d, %nferior prosthion) #-point ,enton (,e) /asion (/, /a) 2pisthion (2p) 2rbitale (2r) .ogonion (.og, ., .g) .orion (.o) .osterior nasal spine (./() .rosthion (.r, (uperior prosthion, (upradentale) .terygoma3illary fissure (.T,, .terygoma3illare) "-point ("egistration point) (ella (() Cervical point (C) %nferior labial sulcus (%ls) #abrale inferior (#i) #abrale superior (#s) .ronasale (.n) (oft tissue glabella (14) (oft tissue menton (,e4) (oft tissue nasion (/4, /a4) (oft tissue pogonion (.g4, .og4) (tomion ((t) (tomion inferius ((ti) (tomion superius ((ts) (ubnasale ((n)

(uperior labial sulcus ((ls) Trichion (Tr) (oft tissue gnathion (1n4)

"icketts Anatomical Tracing

"icketts .oints and .lanes

"icketts Frontal Anatomy

A-point (Point A, Subspinale, ss)

The deepest (most posterior) midline point on the curvature between the ANS and prosthion. Its vertical coordinate is unreliable and therefore this point is used mainly for anteroposterior measurements. The location of A-point may change

somewhat with root movement of the ma illary incisor teeth. (midsagittal)

Anterior nasal spine (ANS) The tip of the bony anterior nasal spine at the inferior margin of the piriform aperture! in the midsagittal plane. It corresponds to the anthropological point acanthion and often is used to define the anterior end of the palatal plane (nasal floor). (midsagittal)

Articulare (Ar) A constructed point representing the intersection of three radiographic images"

the inferior surface of the cranial base and the posterior outlines of the ascending rami or mandibular condyles. It was meant to substitute condylion when the latter is not readily discernible. Any movement of the mandible (i.e. opening or closing) will change the location of articulare. (bilateral)

B-point (Point B, Supramentale, sm) The deepest (most posterior) midline point on the bony curvature of the anterior mandible! between infradentale and pogonion. (midsagittal)

Basion (Ba) The most anterior inferior point on the margin of the foramen magnum! in the midsagittal plane. It can be located by following the image of the slope of the inferior border of the basilar part of the occipital bone to its posterior limit! superior to the dens of the a is. (midsagittal)

Bolton (Bo) The highest points on the outlines of the retrocondylar fossae of the occipital bone! appro imating the center of the foramen magnum. Named after #. $. $olton. (bilateral)

CC Point (CC) Ricketts (#ranial #enter) #rossing of the facial a is with the $aN plane

Cervical point (C) The innermost point between the submental area and the nec% in the midsagittal plane. &ocated at the intersection of lines drawn tangent to the nec% and submental areas. (midsagittal)

Condylion (Co) The most superior posterior point on the head of the mandibular condyle. (bilateral)

Crista galli A vertically elongated! diamond-shaped radiopacity! appearing between the orbital outlines on postero-anterior cephalometric radiographs. Its location is used to establish a midsagittal reference plane. (midsagittal)

Dacryon The point of intersection of the frontoma illary! lacrimoma illary and frontolacrimal sutures. An anatomic reference point used to record interorbital distance. (bilateral) 'rbital hypertelorism The increased distance between the medial orbital walls! reflecting an increased distance between the orbits (greater than ( standard deviations from the norm). The anatomic landmar%s used commonly for the measure-ment of interorbital distance are the dacryon points (bilaterally). )ypertelorism is described on the basis of s%eletal measurements! because the presence of epicanthal folds or strabismus (e otropia)! or other soft-tissue variations such as increased distance between the medial canthi (telecanthus) clinically may give a false impression of hypertelorism. 'rbital hypertelorism is common in a number of craniofacial malformations such as #rou*on syndrome and frontonasal dysplasia. #ompare with Telecanthus

DC Point (Ricketts) #enter of the nec% of the condyle on the $asion Nasion line.

labella ( ) The most prominent point of the anterior contour of the frontal bone in the midsagittal plane. (midsagittal)

nat!ion ( n) The most anterior inferior point on the bony chin in the midsagittal plane. (midsagittal)

onion ( o) The most posterior inferior point on the outline of the angle of the mandible. It may be determined by inspection or it can be constructed by bisecting the angle formed by the intersection of the mandibular plane and the ramal plane and by e tending the bisector through the mandibular border. (bilateral)

"n#ra$entale ("$) "n#erior prost!ion Pr The most superior anterior point on the mandibular alveolar process! between the central incisors. (midsagittal)

"ncision in#erius ("i) or B% (Ricketts)

The incisal tip of the most labially placed mandibular incisor. (unilateral)

"ncisian "n#erius Root or BR (Ricketts)

"ncision superius ("s) or A% (Ricketts) The incisal tip of the most labially placed ma illary central incisor. (unilateral)

"ncision Superious Root or AR (Ricketts)

&-point A point located in the anterior surface of the cortical plate! labial to the apices of the ma illary central incisors. Introduced by +. ,. -. .. van der &inden! as a point representing the anterior border of the ma illary apical area. (midsagittal) &abrale in#erior (&i) The point denoting the vermilion border of the lower lip! in the midsagittal plane. (midsagittal)

&abrale superior (&s) The point denoting the vermilion border of the upper lip! in the midsagittal plane. (midsagittal)

'enton ('e) The most inferior point of the mandibular symphysis! in the midsagittal plane. (midsagittal)

'olar (pper )irst (Ricketts) ,oint on the occlusal plane perpendicular to the distal surface of the crown of the upper first molar.

'olar &o*er )irst (Ricketts)

,oint on the occlusal plane perpendicular to the distal surface of the crown of the lower first molar.

Nasion (N, Na) The intersection of the internasal and frontonasal sutures! in the midsagittal plane. (midsagittal

+pist!ion (+p) The most posterior inferior point on the margin of the foramen magnum! in the midsagittal plane. (midsagittal)

+rbitale (+r) The lowest point on the inferior orbital margin. (bilateral)

Pogonion (Pog, P, Pg)

The most anterior point on the contour of the bony chin! in the midsagittal plane. ,ogonion can be located by drawing a perpendicular to mandibular plane! tangent to the chin. (midsagittal)

Porion (Po) The most superior point of the outline of the e ternal auditory meatus (/anatomic porion/). 0hen the anatomic porion cannot be located reliably! the superior-most point of the image of the ear rods (/machine porion/) sometimes is used instead. (bilateral)

Posterior nasal spine (PNS) The most posterior point on the bony hard palate in the midsagittal plane1 the meeting point between the inferior and the superior surfaces of the bony hard palate (nasal floor) at its posterior aspect. It can be located by e tending the anterior wall of the pterygopalatine fossa inferiorly! until it intersects the floor of the nose. (midsagittal)

Pronasale (Pn)

The most prominent point of the tip of the nose! in the midsagittal plane. (midsagittal)

Prost!ion (Pr, Superior prost!ion, Supra$entale) The most inferior anterior point on the ma illary alveolar process! between the central incisors. (midsagittal)

Protruberance 'enti (Pm) or Supra pogonion (Ricketts) A point where the curvature of the anterior border of the symphysis changes from concave to conve !

Pterygoi$ Point (Pt) Ricketts &ower lip of foramen rotundum (2epresents the position of the sphenoid bone) posterior superior tangent of the pterygoma illary fissure

Pterygoi$ Root (Pr) Ricketts .ost posterior point on the outlines of the pterygopalatine fossa

Pterygoma,illary #issure (P-', Pterygoma,illare) A bilateral! inverted teardrop-shaped radiolucency! whose anterior border represents the posterior surfaces of the tuberosities of the ma illa. The landmar% is ta%en at the most inferior point of the fissure! where the anterior and the posterior outline of the inverted teardrop merge with each other. (bilateral)

R-point (Registration point) A cephalometric reference point for registration of superimposed tracings!

introduced by $. ). $roadbent! Sr. ! in his original presentation of the cephalometric techni3ue. It is the midpoint on a perpendicular drawn from sella to the $olton-nasion line. (midsagittal)

Sella (S) The geometric center of the pituitary fossa (sella turcica)! determined by inspection4a constructed point in the midsagittal plane. (midsagittal)

So#t tissue glabella ( .) The most prominent point of the soft tissue drape of the forehead! in the midsagittal plane. (midsagittal)

So#t tissue menton ('e.)

The most inferior point of the soft tissue chin! in the midsagittal plane. (midsagittal)

So#t tissue nasion (N., Na.) The deepest point of the concavity between the forehead and the soft tissue contour of the nose in the midsagittal plane. (midsagittal)

So#t tissue pogonion (Pg., Pog.) The most prominent point on the soft tissue contour of the chin! in the midsagittal plane. (midsagittal)

Stomion (St) The most anterior point of contact between the upper and lower lip in the

midsagittal plane. 0hen the lips are apart at rest! a superior and an inferior stomion point can be distinguished. (midsagittal) Stomion in#erius (Sti) The highest midline point of the lower lip. (midsagittal) if lips are apart Stomion superius (Sts) The lowest midline point of the upper lip. (midsagittal) if lips are apart

Subnasale (Sn) The point in the midsagittal plane where the base of the columella of the nose meets the upper lip. (midsagittal)

Superior labial sulcus (Sls) So#t -issue Point A The point of greatest concavity on the contour of the upper lip between subnasale and labrale superius! in the midsagittal plane. (midsagittal)

So#t -issue B or "n#erior labial sulcus ("ls) The point of greatest concavity on the contour of the lower lip between labrale inferius and menton! in the midsagittal plane. (midsagittal)

-ric!ion (-r) An anthropometric landmar%! defined as the demarcation point of the hairline in the midline of the forehead. (midsagittal) No Picture

/i Point (/i) appro,imate #or "n#erior alveolar #oramen (Ricketts) A constructed point located at the geographic center of the ramus as indicated

below.

Cephalometric lines (planes)

Most analyses utilize one or more cephalometric lines that are joining t o landmar!s, are tangent to an outline from a landmar!, or are perpendicular to another line from a landmar!.

$# &8R0$< A"# plane #asion"$asion line (#a"$) #olton plane Campers base plane %e Coster line &"line (&"plane, &sthetic line of 'ic!etts) (acial a)is of 'ic!etts (acial plane ((*, (acial line) (ran!fort horizontal plane ((+, (ran!fort horizontal line, Auriculo"orbital plane, &ye"ear plane) +"line (+armony line of +olda ay) ,ntergonial line Mandibular plane (M*, Mandibular line, M-) $asion"perpendicular .cclusal plane (.*) *alatal plane (A$/"*$/, **, $asal line, $asal floor, /pinal plane) 'ees esthetic plane 'eference line 'iedel plane /"line (&sthetic plane of /teiner) /ella"$asion line (/$, $asion"/ella line, $/-) True horizontal line True vertical line 0"a)is (1ro th a)is) 2"line (*rofile line of Merrifield)

A-

plane

A line joining points A and #. As part of the %o ns analysis, the superior angle formed by the intersection of the A"# plane and the facial line ($"*og) is measured to evaluate the relation of the anterior limit of the apical bases to each other, relative to the facial line. This angle is negative in patients ith s!eletal Class ,, and positive in patients ith s!eletal Class ,,, malocclusions.

asion-/asion line ( a-/)

A line considered by some to represent the cranial base more accurately than the /$ line or the #olton plane.

olton plane
A line connecting points #olton and nasion3 an alternate representation of the cranial base.

Camper4s base plane

An anthropometric line connecting the center of the bony e)ternal auditory meatus and the anterior nasal spine. ,t as used as a horizontal reference line for evaluation of prognathism on dry s!ulls, prior to establishment of the (ran!fort horizontal plane.

$o *icture

6e Coster line
A reference line proposed by -. %e Coster as a stable area for cephalometric superimposition. ,t e)tends from the image of the anterior clinoid process along the planum sphenoidale and the anterior cranial edge of the sphenoethmoidal synchondrosis to the cranial aspect of the cribriform plate, terminating at the internal osseous line of the frontal bone above the crista frontalis.

&-line

(8-plane) 8sthetic line of Ricketts)

A line tangent to the chin and nose, introduced by '. M. 'ic!etts for assessment of lip fullness. According to him, the lo er lip should fall slightly ahead of the upper lip hen related to this line.

*acial a(is of Ricketts

A line connecting gnathion ith cranial point 5*t,5 defined as the lo er border of the foramen rotundum and appro)imated by the most posterosuperior point of the outline of the pterygoma)illary fissure.

*acial plane (*5) *acial line)

A line e)tending from nasion to pogonion.

*rankfort hori+ontal plane (*") *rankfort hori+ontal line) Auriculo-orbital plane) 8ye-ear plane)
An anthropological horizontal plane described on dry s!ulls as passing through the lo est point in the floor of the left orbit and the highest point on the margins of the e)ternal auditory meati. The plane as adopted at the 67th 1eneral Congress of1erman Anthropologists in (ran!fort, 1ermany in 6889 and later as endorsed by the ,nternational Agreement for the :nification of Craniometric Measurements in Monaco (6;<=) as a plane appro)imating the true horizontal line hen the head is in an upright position. .n a lateral cephalometric radiograph, the (ran!fort horizontal plane is represented by a line connecting the cephalometric landmar!s porion and orbitale.

"-line ("armony line of "olda'ay)

A line tangent to the soft tissue chin and the upper lip, introduced by '. A. +olda ay for assessment of the soft tissue profile.

;ntergonial line
A line on a *"A cephalogram or tracing, connecting the gonion points to each other.

0andibular plane (05) 0andibular line) 0,)

A line representing the plane passing through the mandibular borders (bilaterally). ,t can be dra n in t o different ays> by joining points gonion and gnathion, or by dra ing a tangent to the posterior aspect of the lo er mandibular border from menton. Cephalometric measurements

/asion-perpendicular
A line dra n perpendicular to the (ran!fort horizontal from nasion. A reference line for anteroposterior measurements in the Mc$amara analysis.

>cclusal plane (>5)

A line on the cephalometric radiograph representing an imaginary plane at the level of the occlusion! &here are various different definitions<

1!

isected occlusal plane

A line passing through the cusp tips of the ma(illary and mandibular first permanent molars andmid'ay bet'een the incisal edges of the ma(illary and mandibular central incisors (bisecting the overbite)!

?! *unctional occlusal plane

A line dra'n through the occlusal surfaces of the ma(illary and mandibular first permanent molars and first and second premolars (or first and second deciduous molars)!

3! 0andibular occlusal plane

A line .oining the cusp tips of the mandibular first permanent molars to the incisal edge of the mandibular central incisors!

@! 0a(illary occlusal plane

A line .oining the cusp tips of the ma(illary first permanent molars to the incisal edge of the ma(illary central incisors!

Ricketts >cclusal 5lane

$lavicek >cclusal 5lane and 65>

5alatal plane (A/$-5/$) 55) /asal line) /asal floor) $pinal plane)
A line joining *$/ and A$/.

Rees esthetic plane

A line tangent to the nasal tip and upper lip, introduced by T. %. 'ees for assessment of the soft tissue profile. According to him, it should pass near the bony pogonion hen the face is ell balanced.

Riedel plane
A line on hich the upper lip, lo er lip and chin should fall in esthetic profiles, according to '. A. 'iedel. A concept similar to the esthetic plane of /teiner, although not ta!ing into account the nasal prominence.

$-line (8sthetic plane of $teiner)

A line connecting the midpoint of the columella of the nose to the soft

tissue pogonion. According to C. C. /teiner, the lips should fall on this line and any deviation sho s prominence or flatness of the lips.

$ella-/asion line ($/) /asion-$ella line) /$,)

A fre?uently used cephalometric reference line representing the anterior cranial base. A line joining points / and $a.

&rue vertical line

&rue vertical is an e(ternal reference line) commonly provided by the image of a free-hanging metal chain on the cephalostat registering on the film or digital cassette during e(posure! &he true vertical line offers the advantage of no variation (since it is generated by gravity) and is used 'ith radiographs obtained in natural head position! $o *icture

&rue hori+ontal line

An e(ternal reference line constructed by dra'ing a perpendicular to the true vertical!

$o picture

A-a(is (%ro'th a(is)

A line connecting points sella and gnathion. ,n the %o ns analysis, the anteroinferior angle bet een the 0"a)is and the (ran!fort horizontal ((+) plane is measured as an indication of the direction of mandibular gro th.

B-line (5rofile line of 0errifield) A line tangent to pogonion from the most prominent of the lips, introduced by -. -. Merrifield for soft tissue profile assessment. According to him, in ell"balanced faces the upper lip should fall on the line and the lo er lip should be slightly behind.

"ard &issue 0easurements

$# &8R0$< A$# angle Angle of conve)ity ($A*og) #olton triangle Cranial base angle ($/#a, /addle angle, Angle of fle)ure) (acial angle ((+"$*og) (acial a)is angle of 'ic!etts (#a"*t"1n) (acial height, Anterior3 *osterior3 and Total (ran!fort"mandibular incisor angle ((M,A) (ran!fort"mandibular plane angle ((MA) 1onial angle (Angle of the mandible, Condylar angle) +olda ay ratio (-,"$#@*g"$#) ,ncisor"mandibular plane angle (,M*A) ,nterincisal angle -,"to"A* distance Mandibular plane angle /$A angle /$# angle :,"to"A* distance Aits appraisal Angle of facial conve)ity (1B/n"/n*gB) +"angle (of +olda ay) ,nterlabial gap -o er face"throat angle (/n*gC"CMeC) -o er lip length $asolabial angle ($-A) :pper lip length 2"angle (of Merrifield)

Angle of conve(ity (/A5og)

.ne of the measurements of the %o ns cephalometric analysis, assessing the degree of conve)ity (or concavity) of the s!eletal profile. The angle is formed by the lines $A and A"*og and has a positive value in conve) and negative value in concave profiles, hereas in patients ith a straight profile the angle is appro)imately <.

A/

angle

The difference bet een angles /$A and /$#, as introduced by '. A. 'iedel, aiming at providing an evaluation of the anteroposterior relationship bet een the ma)illary and mandibular apical bases. The measurement is not specific as to the location of the deformity.

$/A angle
A commonly used measurement (of the /teiner analysis) introduced by '. A. 'iedel for assessment of the anteroposterior position of the ma)illa ith regards to the cranial base. The inferior posterior angle formed by the intersection of lines /$ and $A is measured.

$/

angle

A measurement introduced by '. A. 'iedel to evaluate the anteroposterior

position of the mandible in relation to the cranial base (also part of the /teiner analysis). The inferior posterior angle formed by the intersection of lines $A and $# is measured.

olton triangle
A triangle formed by connecting points #olton, nasion and sella, representing the area of the cranial base to hich the face is joined. ,t as believed by #. +. #roadbent, /r. to be the most stable reference for superimposition of serial cephalograms.

Cranial base angle (/$ a) $addle angle) Angle of fle(ure)

The angle bet een the anterior and posterior cranial base, recorded as the inferior angle formed by the intersection of the lines #a/ and /$. A large cranial base angle is thought to signify a posterior condylar and glenoid fossa position and a mandible that is positioned posteriorly ith respect to the cranial base and the ma)illa, unless it is compensated by a larger gonial angle and an increased mandibular length.

*acial angle (*"-/5og)

The inferior posterior angle formed by the intersection of the (ran!fort horizontal and the facial plane ($"*og). ,ntroduced by A. #. %o ns to provide an assessment of the anteroposterior position of the chin in relation to the (ran!fort horizontal plane.

*acial a(is angle of Ricketts ( a-5t-%n)

The inferior angle formed by the intersection of the facial a)is of 'ic!etts and the #a"$ line. This angle on the average appro)imates ;<D. A value smaller than ;<D indicates facial gro th primarily in the vertical direction and@or a Class ,, pattern, hereas a value greater than ;< degrees indicates a horizontal gro th pattern and@or a Class ,,, tendency.

*acial height) Anterior7 5osterior7 and &otal

An appraisal of the face in the vertical dimension. The anterior lo er facial height is e)pressed by the linear millimetric distance bet een the A$/ and menton, measured directly, or along the true vertical line. The percent ratio of the previous linear measurement (A$/"Me) over the total anterior facial height ($"Me)Emeasured in the same ayEprovides an assessment of the relative proportionality of the anterior face in the vertical dimension. The measurement is obviously not specific as to the location of the deformity. /imilarly, the linear measurement from / to 1o on the lateral cephalometric radiograph provides an assessment of posterior facial height. The ratio of posterior face height ) 6<<@anterior face height, according to the recommendations of F. '. Faraba! and F. A. (izzel, can give an estimate of gro th direction.

%onial angle (Angle of the mandible) Condylar angle)

Ricketts

The anterior angle formed by the intersection of a line tangent to the posterior border of the ramus and the mandibular plane. ,t determines the degree of inclination of the ramus to the mandibular plane and may give an indication about mandibular gro th direction. (Alternatively measured as the angle bet een Ar"1o and 1o"1n. )

"olda'ay ratio (,;-/ 45g-/ )

A measurement introduced by '. A. +olda ay to evaluate the relative prominence of the mandibular incisors, as compared to the size of the bony chin. ,t is calculated as the ratio of the linear distance from the labial surface of the mandibular central incisor to the $# line, over the linear distance of the chin to the same line.

;nterincisal angle
A measurement of the degree of procumbency of the incisor teeth, introduced by A. #. %o ns as the (posterior) angle formed by the intersection of the long a)es of the ma)illary and mandibular central incisors.

,;-to-A5 distance
The perpendicular distance (in mm) of the incisal edge of the mandibular central incisors to the A"*og line. A measurement of the %o ns analysis, e)pressing the degree of protrusion of the mandibular incisors.

0andibular plane angle

A measurement introduced by C. C. /teiner for assessment of the steepness of the mandibular plane in relation to the cranial base. The anterior angle formed by the intersection of /$ and 1o1n is measured. A. #. %o ns defined the mandibular plane angle as the anterior angle formed by the intersection of the (ran!fort horizontal plane and a tangent to the lo er border of the mandible and symphysis.

;nterlabial gap
The vertical distance bet een the upper and lo er lip, measured ith the lips at rest.

,o'er face-throat angle ($n5gC-C0eC)

The posterior superior angle formed by the intersection of the subnasale" pogonion line and the menton"cervical line, as described by +. -. -egan. This measurement is used hen mandibular surgery is contemplated to evaluate the potential esthetic impact of the procedure on the profile.

,o'er lip length

A linear measurement from soft tissue menton to stomion inferius, measured along the true vertical line.

#pper lip length

A linear measurement (in mm) from subnasale to stomion superius, measured along the true vertical line.

$asolabial angle ($-A)

The anterior inferior angle formed by the intersection of a line tangent to the columella of the nose and a line dra n from subnasale to the mucocutaneous border of the upper lip. ,t evaluates the degree of protrusion or retrusion of the upper lip, in reference to the columella of the nose. The nasolabial angle can influence the decision for e)tractions as part of the orthodontic treatment plan, as it is partially dependent on the anteroposterior position of the ma)illary incisors.

#;-to-A5 distance
The perpendicular distance (in mm) of the incisal edge of thema)illary central incisors to the A"*og line. A measurement of the %o ns analysis, e)pressing the degree of protrusion of the ma)illary central incisors.

B-angle (of 0errifield)

The inferior posterior angle formed by the intersection of the profile line of Merrifield (2"line) and the (ran!fort horizontal plane.

&'eed cephalometric analysis A set of three angular measurements (which constitute what has come to be %nown as the Tweed triangle)! introduced by #. ). Tweed in 5678. The three angles that were originally described are the +.A (+ran%fort-mandibular plane angle)! the I.,A (Incisor-mandibular plane angle) and the +.IA (+ran%fort-mandibular incisor angle). Their norms! as advocated by Tweed! were based on a sample of 69 individuals (some of whom were orthodontically treated) who according to him had good balance of facial outline! rather than ideal. The reference plane for the analysis is the +ran%fort hori*ontal plane. Tweed:s entire philosophy of diagnosis and treatment was built around the relationship of the mandibular incisors to the mandibular plane of 6; degrees (I.,A angle).

Dits appraisal
A measurement introduced by A. Facobson, designed to avoid the shortcomings of the A$# angle in evaluating anteroposterior ja disharmonies. The method entails dra ing perpendicular lines on a tracing of a lateral cephalogram from points A and #, ontothe functional occlusal plane ( hich is dra n through the region of the overlapping cusps of the first premolars and molars) and subse?uently measuring the distance bet een the t o points of intersection of the t o perpendicular lines ith the functional occlusal plane, along the latter. The greater the deviation of this reading from < mm in females and 6.< mm in males, the greater the degree of sagittal discrepancy bet een the ma)illa and mandible. The Aits appraisal is a linear measurement and not an analysis, per se. ,t is simply an adjunctive diagnostic aid that can be useful in assessing the e)tent of anteroposterior s!eletal dysplasia and in determining the reliability of the A$# angle. GThe name is an abbreviation for 5:niversity of Ait atersrand,5 in Fohannesburg, /outh Africa, here this appraisal as developed.

"icketts Anatomical Tracing

"icketts .oints and .lanes

"icketts Frontal Anatomy

*rontal ,andmark 5oints