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Cephalometrics /certified fixed orthodontic courses by Indian dental academy
1. SEMINAR ON
CEPHALOMETRICS IN ORTHOGNATHIC
SURGERY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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5. ANCIENT
-
TIMES
Historically human form measurements.
1 - self portrayal in sculpture, drawing and
painting.
2 - relation of physique - health, temperament and
behavioral traits.
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7. The ancient Egyptians developed an intricate
quantitative system that defined the proportions of
the human body. It became the CANON.
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9. RENAISSANCE TO
2 0 TH C E N T U R Y
Leonardo da Vinci
(1451 – 1519)
Albrecht Durer
Petrus Camper
Spix
Welcker
Hellman
Korkhaus
Bjork
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10. 2 0 TH C E N T U R Y
Craniometry to Cephalometry
Van Loon
Paul Simon
Paccini
1922
1931
Carrera
Broadbent
Hofrath
Lucien de Coster
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11. 15"
5 feet
Film Plane
Source Plane
X-ray Source
Mid-saggital
Plane
X-ray Film in
Cassette
Patient in Head
Positioning Device
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17.
Radiograph with good resolution
Matte Acetate Tracing paper (non glossy side for the
tracing) – 0.003 inches thick & 8 x 10 inches thick
Sharp 3H fine drawing pencil
Protractor
Viewbox
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29.
Metric approach - use of selected linear and angular
measures
Graphic approach - “overlay” of individual’s tracing on a
reference template and visual inspection of degree of
variation
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34. Length of cranial base is measured from Articulare
to nasion parallel to HP
Ar-Ptm
Ptm-N
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35.
Ar-PTM is measured
parallel to HP to determine
the horizontal distance
between the posterior
aspects of mandible and
maxilla.
Male – 37.1 +/- 2.8
Female – 32.8+/-1.9
Increase or decrease in
these values indicates
prognathism/retrognathism
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37.
In this analysis all measurements are made
parallel to HP
N-A-Pg(angle)
N-A (Linear)
N-B (Linear)
N-Pg (Linear)
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38.
This measurement
indicates the degree of
skeletal convexity
Male – 3.9 +/- 6.4o
Female – 2.6 +/- 5.1o
+ ve angle indicates
convex face
-ve angle indicates
concave face
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39.
Here apical base of maxilla is
related to N.
Used to determine if anterior
part of maxilla is
protrusive/retrusive.
Male – 0.0 +/- 3.7
Female - -2 +/- 3.7
+ve indicates prognathism
-ve indicates retrognathism
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40.
Here apical base of
mandible is related to
N.
Male : -5.3 +/- 6.7
Female : -6.9 +/- 4.3
This quantitates the
AP position of
mandible and degree of
mandibular horizontal
dysplasia
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42.
In this analysis all measurements are made
perpendicular to HP.
Reflects the anterior, posterior or complex dysplasia
of face.
N-ANS(Linear)
ANS-GN(Linear)
PNS-N(Linear)
MP-HP(Angle)
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43.
It signifies the
middle third facial
height.
Male – 54.7 +/3.2
Female – 50 +/- 2.4
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49.
It signifies the posterior
divergence of mandible
shown by MP angle.
The angle relates the
posterior facial divergence
with respect to anterior
facial height
Male - 23o +/- 5.9o
Female – 24.2o +/- 5o
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51.
Measurements for this analysis
UI perpendicular to NF
LI perpendicular to MP
U6 perpendicular to NF
L6 perpendicular to MP
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52.
It denotes the anterior
maxillary dental height.
Aids to evaluate the total
vertical dimensions of
premaxilla from approximate
piriform aperture
perpendicular to tip of
maxillary incisor crown.
Signifance: indicates how far
the incisor have erupted in
relation to nasal floor.
Male - 30.5 +/- 2.1
Female – 27.5 +/- 1.7
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53.
This measures the anterior
mandibular dental height.
Determines the total
dmensions of anterior
mandible from MP
perpendicular to tip of
mandibular incisor crown.
Signifance: denotes how
far the incisor have
erupted in relation to MP
Male - 45 +/- 2.1
Female – 40.8 +/- 1.8
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60.
Aids in establishing the length of mandibular body
Male – 83.7 +/- 4.6
Female – 74.3 +/- 5.8
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61.
This measurements denotes prominence of chin related
to mandibular denture base
Male - 8.9 +/- 1.7
Female – 7.2 +/- 1.9
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62.
This angle denotes relationship between ramal plane and
MP.
Aids in diagnosis of skeletal open/closed bite problems.
Male – 119.1o +/- 6.5o Female – 122o +/- 6.9o
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63. Measurements for this analysis
OP – HP (Angle)
A – B(Linear)
U6 – NF(Angle)
L1 – MP(Angle)
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64.
OP denotes its
steepness/flatness
Increased angle: assess
skeletal open bite, lip
incompetence,increased
facial height,
retrognathia.
Decreased angle: assess
deep bite, decreased facial
height, lip redundancy.
Male - 6.2o+/- 5.1o
Female – 7.1o+/-2.5o
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67.
This linear measurements
represents the relationship
of maxillary and
mandibular apical base to
OP
Male - -1.1 +/- 2
Female - -0.4 +/- 2.5
Significance: if A-B
distance is large with
point B projected
posteriorly to point A
denotes class II occlusion
and vice versa
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68.
Represents angulations of
maxillary central incisors to
NF
Male - 111o +/- 4.7o
Female – 112o +/- 5.3o
Signifance: aids to
determine the
procumbency/recumbency of
incisor
Vital in assessing long term
stability of dentitionwww.indiandentalacademy.com
69.
Denotes angulation of
mandibular incisors to MP
Male - 95.9o+/- 5.2o
Female – 95.9o+/-5.7o
Significance: determines the
procumbency/recumbency of
lower incisor.
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71. VARIOUS SOFT TISSUE CEPHALOMETRIC ANALYSES
HAVE BEEN PUT FORTH…….
Steiner
Ricketts
McNamara
Merrifield’s Z angle
Holdaway
Burstone – COGS
Arnett, Bergman et al - STCA
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74. This analysis describes overall horizontal soft tissue profile.
The following analysis is used:
Facial convexity angle(G-Sn-Pg)
Maxillary prognathism(G-Sn)
Mandibular prognathism(G-Pg)
Vertical height ratio(G-Sn/Sn-Me)
Lower face throat angle(Sn-Gn-C)
Lower vertical height depth ratio(Sn-Gn/C-Gn)
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75. FACIAL CONVEXITY ANGLE
MEAN VALUE : 12 ⁰ +/- 4
POSITIVE VALUE –
CONVEX PROFILE
NEGATIVE VALUE CONCAVE PROFILE
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G – Sn - Pog
76. ANTERO - POSTERIOR
MAXILLARY (Mean value 6+/-3) AND
MANDIBULAR (Mean value 0+/-4) MEASUREMENTS
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,
77. (G-Sn To Sn-Me)
Mean value 1:1
Inference: Ratio <1
denotes
disproportionality and
there is large lower 3rd
face height and viceversa
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78. LOWER FACE THROAT
ANGLE (Sn-Gn –C)
MEAN VALUE – 100 DEGREES
DECREASE IN VALUE INDICATES
PROMINENT CHIN
LOWER FACIAL HEIGHT TO
DEPTH RATIO
Mean value 1.2:1
Inference
Ratio>1 indicates short neck
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79. The following analysis is used
Nasolabial angle(Cm-Sn-Ls)
Upper lip protrution(Ls to Sn-Pg)
Lower lip position(Li to Sn-PG)
Mento labial sulcus(Si to Li-Pg)
Vertical lip chin ratio(Sn-Stms/Stmi-Me)
Maxillary incisor exposure(Stm-U1)
Interlabial gap(Stms-Stmi)
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80. NASOLABIAL ANGLE
(Cm – Sn – Ls)
Mean Value - 102o +/- 8o
Obtuse angle indicates
maxillary hypoplasia and
vice-versa
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81. UPPER AND LOWER LIP PROTRUSIO
Sn
Ls
Li
Pog
Mean Values
Ls – Sn Pog
3 ± 1mm
Li – Sn Pog
2 ± 1mm
LIP POSITION AND FORM
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83. VERTICAL LIP : CHIN RATIO
(Sn-Stms /Stmi-Me)
Mean Value - 1:2
INTER LABIAL GAP
Mean Value - 2 ± 2 mm
MAXILLARY INCISOR EXPOSURE
Mean Value- 2 mm
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84. By Epker and Fish (1980 JCO)
adopted in part from the mechanics developed by Ricketts for
cephalometric analysis, growth prediction and visual treatment
objective construction as presented by Bench, Gugino, and Hilgers.
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92.
Burstone CJ, Legan HL: Cephalometrics for orthognathic surgery, J Oral
Surg 1978;36:269-277
Text book of Radiographic Cephalometry by Alexander Jacobson.
Textbook of Essentials of orthognathic surgery by Johan P Reyneke
Text book of Orthodontic Cephalomerty by Athanasios E Athanasiou
A colour atlas and manual of Three Dimentional cephalometry by GRJ
Swennen
Textbook of Orthognathic surgery by Raymond Fonseca
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93. Thank you
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