CEPHALOMETR

ICS
CONTENTS
• INTRODUCTION
• DEFINITION
• USES OF CEPHALOGRAM
• PRINCIPLES OF CEPHALOMETRIC ANALYSIS
• GOALS OF CEPHALOMETRICS
• TYPES OF CEPHALOGRAMS
• CEPHALOMETRIC IMAGING TECHNIQUES
• CEPHALOMETRIC LANDMARKS
• CEPHALOMETRIC PLANES
 INTRODUCTION
• Origin:
Cephalo = Head
Metric = Measurement

• DISCOVERY OF X-RAYS: x-rays were discovered by WILHELM CONRAD ROENTGEN

in 1885.
Measurement of the head from shadows of bony and soft tissue landmarks
on the roentgenographic image ,known as the ROENTGENOGRAPHIC
CEPHALOMETRY.
• PACINI in 1922 demonstrated the basic procedure of cephalometrics.

• In 1931, HOFRATH of Germany and BROADBENT of United States, published

articles in which they had refined the technique and applied these principles to
orthodontics.
DEFINITION
• “The scientific measurement of the bones of the cranium and face, utilizing a
fixed, reproducible position for lateral radiographic exposure of skull and facial
bones”-- Moyers

• “ A scientific study of the measurements of the head with relation to specific

reference points; used for evaluation of facial growth and development,
including soft tissue profile” -- Grabers
CEPHALOMETRIC IMAGING SYSTEM
CEPHALOSTAT

X- RAY APPARATUS

IMAGE RECEPTOR
USES OF CEPHALOGRAM

• In orthodontic diagnosis & treatment planning.

• In classification of skeletal & dental abnormalities.
• In establishing facial types.
• In evaluation of treatment results.
• In predicting growth related changes & changes associated with surgical
treatment.
• Valuable aid in research work involving the cranio-dentofacial region.
PRINCIPLE OF CEPHALOMETRIC ANALYSIS

• To compare the patient with a normal reference group, so that differences

between the patient’s actual dentofacial relationships and those expected for
his/her racial or ethnic groups are revealed.
GOALS OF CEPHALOMETRICS

To evaluate the relationships, both horizontally and vertically, of the five

major functional components of the face:
• The cranium and the cranial base
• The skeletal maxilla
• The skeletal mandible
• The maxillary dentition and the alveolar process
• The mandibular dentition and the alveolar process
TYPES OF CEPHALOGRAMS

There are two types of cephalograms:

• Lateral cephalogram
• Posterior anterior cephalogram.
 LATERAL CEPHALOGRAM

• Also referred to as lateral “cephs”.

• Taken with head in a standardized reproducible
position at a specific distance from X-ray source.
USES

• Important in orthodontic growth analysis.

• Diagnosis & Treatment planning.
• Monitoring of therapy.
• Evaluation of final treatment outcome.
POSTEROANTERIOR (P-A) CEPHALOMETRIC RADIOGRAPH

Image Receptor and Patient Placement:

• Image receptor is placed in front of the patient,
perpendicular to the midsagittal plane and
parallel to the coronal plane.

• The patient is placed so that the canthomeatal line

is perpendicular to the image receptor.
Position of The Central X-Ray Beam:
Central beam is perpendicular to the image receptor, directed from the
posterior to anterior parallel to the patient’s midsagittal plane and is centered at
the level of bridge of the nose.

• Resultant Image:
The midsagittal plane should divide the image into two symmetric halves.
USES

• Provides information related to skull width.

• Skull symmetry.
• Vertical proportions of skull, craniofacial complex
& oral structures.
• For assessing growth abnormalities & trauma.
CEPHALOMETRIC LANDMARKS

A conspicuous point on a cephalogram that serves as a guide for

measurement or construction of planes.
There are 2 types :
• Anatomic: Represent actual anatomic structure of the skull.
eg – N, ANS, pt A, Pr, Id, pt B, Pog, Me.

• Constructed: Constructed or obtained secondarily from anatomic

structures in the cephalogram.
eg– Gn, Go, Ptm, S.
REQUISITES FOR A LANDMARK

• Should be easily seen on the roentgenogram.

• Be uniform in outline.
• Easily reproducible.
• Should permit valid quantitative measurement of lines and angles.
• Lines and planes should have significant relationship to the vectors of
growth.
• Nasion (N,Na) : the most anterior on the frontonasal sutures in the midsagittal
plane

• Orbitale (Or) : the lowest point on the inferior margin of the orbit.

• Porion (Po): the most superior point on the outline of the external auditory
meatus (anatomic). The superior most point of the ear rods (machine porion)
sometimes is used.
• Gonion (Go): the most posterior inferior point on the outline of the angle of the
mandible.
• Pogonion(pog): its is the most anterior point of the bony chin in the median
plane.
• Gnathion (Gn) : the most anterior inferior point on the bony chin in the
midsagittal plane.
• Menton (Me) : the most inferior point of the mandibular symphysis in the
midsagittal plane.
• A-point (Point A, Subspinale, SS) : the most posterior midline point on the
concavity between the ANS and prosthion.
• Anterior nasal spine (ANS): the anterior tip of the sharp bony process of maxilla
at he lower margin anterior nasal opening.
• Articulare (Ar) a point at the junction of the posterior border of ramus of
mandible and inferior border of posterior cranial base (occipital bone).
• B-point (Point B, Supramentale, sm): the most posterior midline point in the
concavity of the mandible between the most superior point on the alveolar bone
overlying the mandibular incisors (infradental) and Pog.
• Basion (Ba): the lowest point on the anterior rim of the foramen magnum.
• Bolton (Bo): the intersection of the outline of the occipital condyle and the
foramen magnum at the highest point on the notch posterior to the occipital
condyle.
• Pterygo-maxillary fissure (PTM) : bilateral inverted tear drop shaped
radiolucency whose anterior border represents the posterior surfaces of the
tuberosities of the maxilla.
• Sella (S) : the geometric centre of the pituitary fossa (sella turcica), determined
by inspection – a constructed point in the midsagittal plane.
LATERAL CEPHALOGRAM

• HARD TISSUE LANDMARKS

SOFT TISSUE LANDMARKS
TRACING TECHNIQUE

Tracing supplies & equipments

• Lateral ceph, usual dimensions of 8 x 10 inches (patients with facial

asymmetry requires antero posterior head film)

• Acetate matte tracing paper (0.003 inches thick, 8 X 10 inches)

• A sharp 3H drawing pencil or a very fine felt-tipped pen.

• Masking tape.
• A few sheets of cardboard (preferably black), measuring
approximately 6 x 12 inches, and a hollow cardboard tube.
• A protractor and tooth-symbol tracing template for drawing the teeth
(optional).
• Dental casts trimmed to maximal intercuspation of the teeth in occlusion.
• Viewbox (variable rheostat desirable, but not essential).
• Pencil sharpener and an eraser.
STEPWISE TRACING TECHNIQUE

• Section 1 : soft tissue profile, external cranium, vertebrae

Soft tissue profile

External cranium

Vertebrae
Section 2: Cranial base, internal border of cranium, frontal sinus, ear
rods.
internal border of
cranium
Trace orbital roofs

Planum sphenoidale Sella

turcica

Floor of middle cranial

fossa
Dorsum sella

Ear rods

Superior, midline of occipital

bone
Section 3 : Maxilla & related structures& pterygomaxillary
fissures including nasal bone
Bilateral pterygomaxillary
fissures PNS
nasal bone

Thin nasal maxillary bone

surrounding piriform aperture

Lateral orbital

margins Bilateral key

ridges
Superior outline of nasal
Maxillary first molars

Outline of maxillary incisors

Section 4 : The mandible

Mandibular condyles

Mandibular notches & coronoid process

Posterior aspect of rami

Anterior aspect of rami

Mandibular first molars

Mandibular incisors

Anterior border,
symphysis

Marrow space of symphysis

Inferior border of
Averaging of bilateral images on tracing using a broken line
CEPHALOMETRIC PLANES

Are derived from at least 2 or 3 landmarks

Used for measurements, separation of anatomic divisions, definition of anatomic
structures of relating parts of the face to one another
Classified into horizontal & vertical planes
Horizontal planes

• Sella nasion plane

S N
• Frankfort horizontal plane

P O
• Basion-Nasion plane:
N

• Palatal plane:
PNS ANS
Ba
• Occlusion plane:
• Mandibular plane: Different definitions are given in different analysis
1. Tweed analysis- Tangent to lower border of the mandible
2. Downs analysis – extends from Go to Me
3. Steiner’s anlaysis –extends from Go to Gn

GO
GN
ME
Vertical planes
• Facial plane
• A-Pog line
• Facial axis
• E. plane (Esthetic plane) N
PTM

A
E PLANE

GN POG
MEASUREMENT ANALYSIS

DOWN’S ANALYSIS
• Given by WB Downs, 1948.
• One of the most frequently used cephalometric analysis.

• Based on findings on 20 caucasian individuals of 12-17 yrs age group belonging

to both the sexes.

• Consists of 10 parameters of which 5 are skeletal & 5 are dental.

Skeletal parameters :

FACIAL ANGLE
• Average value is 87.8°, Range-82-95°. N

• Gives an indication of anteroposterior FH PLANE

positioning of mandible in relation to upper face.

• Magnitude increases in skeletal class 3 cases,
decreases in skeletal class 2 cases. POG
Angle of convexity

• Reveals convexity or concavity of skeletal

profile N
• Average value 0°, Range = -8.5 to 10°
• Positive angle or increased angle –
A
prominent maxillary denture
base relative to mandible
POG
• Decreased angle , negative angle –
prognathic profile
A-B plane angle

• Mean value = -4.6°, Range= -9 to 0°

• Indicative of maxillary mandibular
relationship in relation to facial plane.
• Positive angle in class 3 malocclusion.
Mandibular plane angle

• Mean value = 21.9°, Range= 17 to 28°

• Increased mandibular plane angle FH PLANE

Suggestive of vertical grower with

hyperdivergent facial pattern.
• Decreased angle suggestive of horizontal
GO
Growth pattern.
ME
Y- axis (growth axis)
• Mean value = 59° , range = 53 to 66°
• Angle is larger in class 2 facial patterns
than in class 3 patterns. S
• Indicates growth pattern of an individual.
FH PLANE
• Angle greater than normal – vertical growth of
Mandible.
• Angle smaller than normal – horizontal growth
of mandible. GN
DENTAL PARAMETERS
• Cant of occlusal plane
 Mean value = 9.3° , Range = 1.5 to 14°
 Gives a measure of slope of occlusal plane
relative to FH plane. FH PLANE
Inter- incisal angle

• Average reading = 135.4° , range = 130 to 150.5°.

• Angle decreased in class 1 bimaxillary protrusion
& class 2 div 1 malocclusion.
• Increased in class 2 div 2 case.
Incisor occlusal plane angle

• Average value = 14.5°, range =3.5 to 20°

• Increase in the angle is suggestive

of increased lower incisor proclination.
Incisor mandibular plane angle

• Mean angulation is 1.4, range= -8.5 to 7°

• Increase in angle is indicative
of lower incisor proclination
Upper incisor to A-Pog line

• Average distance is 2.7mm (range -1 to 5 mm)

• Measurement is more in patients
with upper incisor proclination.
LIMITATIONS OF DOWNS ANALYSIS

Too many landmarks.

Too many measurements.
Time consuming.
STEINER ANALYSIS

Developed by Steiner CC in 1953 with an idea of providing maximal

information with the least number of measurements.

Divided the analysis into 3 parts

• Skeletal
• Dental
• Soft tissue
SKELETAL ANALYSIS

S.N.A angle
• Indicates the relative antero-posterior
positioning of maxilla in relation to cranial base.
• >82° - prognathic maxilla (Class 2)
• < 82°- retrognathic maxilla (class 3)
S.N.B angle

• Indicates antero-posterior
positioning of the mandible in relation
to cranial base.
• > 80°-- prognathic mandible
• < 80°-- retrusive mandible
A.N.B angle
Denotes relative position of maxilla
& mandible to each other.
• > 2° –- class 2 skeletal tendency
• < 2°–- skeletal class 3 tendency
Mandibular plane angle(GO-Gn)

• Gives an indication of growth pattern of an

Individual.
• Mean is 320
• < 32° - horizontal growing face.
• > 32°– vertical growing individual.
Occlusal plane angle

• Mean value = 14.5°

• Indicates relation of occlusal plane to the

cranium & face.
• Indicates growth pattern of an individual.
• Increased in vertical growers.
• Decreased in horizontal growers.
Dental analysis

Upper incisor to N-A(angle)

• Normal angle = 22°

• Angle indicates relative
inclination of upper incisors.
• Increased angle seen in
class 2 div 1 malocclusion.
Upper incisor to N-A ( linear)

It helps in assessing the upper incisor inclination.

• Normal value is 4 mm.
• Increase in measurement –proclined
upper incisors.
Inter-incisal angle

• < 130 to 131° -- class 2 div 1 malocclusion

or a class 1 bimax.
• > 130 to 131° – class 2 div 2 malocclusion.
Lower incisor to N-B (angle)

• Indicates inclination of lower central

incisors
• >25 °-- proclination of lower incisors
• < 25 °– retroclined incisors
Lower incisor to N-B (linear)

• Helps in assessing lower incisor inclination.

• Increase in measurement indicates
proclined lower incisors.
• Normal value– 4mm
Soft tissue analysis

• S line
TWEED ANALYSIS

Given by Tweed CH, 1950

Used 3 planes to establish a diagnostic triangle --
• Frankfurt horizontal plane
• Mandibular plane
• Long axis of lower incisor determines position of lower incisor.
• FMPA = 25 °
FH
• IMPA = 90 ° plane

• FMIA = 65 ° Mand
plane
WITS APPRAISAL

• Given by ALEXANDER JACOBSON in 1975.

• It is a measure of the extent to which maxilla & mandible are related to
each other in antero- posterior or sagittal plane.
• Used in cases where ANB angle is considered not so reliable due to factors such
as position of nasion & rotation of jaws.
• In males point BO is
ahead of AO by 1mm.
• In females point AO & BO
Coincide.
• In skeletal class 2
tendency BO is usually
behind AO( positive reading).
• In skeletal class 3 tendency
BO is located ahead
of AO ( negative reading).
LIMITATIONS OF ANB AND WITS APPRAISAL

• ANB – Nasion position not fixed

-rotation of jaws by growth or orthodontic treatment
can change ANB.
• WITS- Accurate identification of occlusal plane not easy or accurately
reproducible.
- Angulation of functional occlusal plane caused by normal development of
dentition or orthodontic intervention can influence wits appraisal.
BETA ANGLE

• Given by CHONG YO BAIK, MARIA VERVERIDOU – AJO 2004.

• A new angle is developed as a diagnostic aid to evaluate sagittal jaw
relation.
• If it’s Between 27- 35 degree-
class 1 Skeletal pattern
• Less than 27 degree – class 2
• Greater than 35 degree – class 3
RICKETTS ANALYSIS

• Also known as Ricketts’ summary

descriptive analysis
• Given by RM Ricketts in 1961
• The mean measurements given
are those of a normal 9 year old child
• The growth dependent variables
are given a mean change value that is to be expected
and adjusted in the analysis.
Landmarks

This is a 11 factor summary analysis that employs specific measurements to

• Locate the chin in space

• Locate the maxilla through the convexity of the face
• Locate the denture in the face
• Evaluate the profile
This analysis employs somewhat less traditional measurements & reference
points
• En = nose
• DT = soft tissue
• Ti = Ti point
• Po = Cephalometric
• Gn = Gnathion
• A6 = upper molar
• B6 = Lower molar Go = gonion
• C1 = condyle
• DC = condyle
• CC = Center of cranium
• CF = Points from planes at
pterygoid
Xi point -
Planes

Frankfurt horizontal -- Extends from

porion to orbitale

Facial plane -- Extends from

nasion to pogonion

Mandibular plane – Extends

from cephalometric gonion to
cephalometric gnathion
Pterygoid vertical -- A vertical line drawn
through the distal radiographic outline
of the pterygo maxillary fissure
& perpendicular to FHP
Ba-Na plane -- Extends
from basion to the nasion.
Divides the face and cranium.
Occlusal plane -- Represented by line
extending through the
first molars & the premolars.

A-pog line -- Also known as

the dental plane.

E-line -- Extends from

soft tissue tip of nose to
the soft tissue chin point.
Facial Axis

PTM

GN

Facial axis
Condylar axis

Condylar axis
Corpus axis
INTERPRETATION

This consists of analyzing:

Chin in space
Convexity at point A
Teeth
Profile
Chin in Space

•This is determined by :
Facial axis angle
Facial (depth) angle
Mandibular plane angle
Facial axis angle

• Mean value is 90˚ ± 3˚

• Does not changes with growth
• Indicates growth pattern of the
mandible & also whether the chin is
upward & forward or downward
& backwards.
Facial (depth) angle
• Changes with growth.
• Mean value is 87˚± 3
with an increase of 1˚ every 3 years.
• Indicates the horizontal position
of the chin & therefore suggests whether
Class II or class III pattern is due to
the position of the mandible.
Mandibular plane angle

• Mean -- 26˚± 4˚at 9 yrs

with 1˚decrease every 3 yrs.
• High angle -open bite – vertically growing
mandible.
• Low angle – deep bite –
horizontally growing mandible.
• Also gives an indication
about ramus height.
CONVEXITY AT POINT A

This gives an indication about

the skeletal profile.
Direct linear measurement from
point A to the facial plane.
Normal at 9 yrs of age is 2mm &
becomes 1mm at 18 yrs of age,
since mandible grows more than maxilla
High convexity – Cl II pattern

Negative convexity – Cl III pattern

DENTAL

Lower incisor to A-Pog

 Referred to as denture plane
 Useful reference line to measure
position of anterior teeth.
 Ideally lower incisor should be
located 1 mm ahead of A-Pog line.
 Used to define protrusion of lower arch.
Upper molar to PtV

• Measurement is the distance

between pterygoid vertical to
the distal of upper molar.
• Measurement should equal
the age of the patient+3.0mm
• Determines whether the
malocclusion is due to
position of upper or lower molars
• Useful in determining
whether extractions are necessary.
Lower incisor inclinations

 Angle between long axis of

lower incisors & the A-Pog plane
 On average this angle this
angle should be 28 degrees
 Measurement provides
some idea of lower incisor
procumbency
Profile

Lower lip to E plane

 Distance between lower lip &
esthetic plane is an indication
of soft tissue balance between
lips & profile
 Average measurement is
-2.0mm at 9 yrs of age
 Positive values are those ahead of E- line
Mc NAMARA ANALYSIS

• Given By Mc Namara JA, 1984

• In an effort to create a clinically useful analysis, the craniofacial skeletal complex

is divided into five major sections.

1. Maxilla to cranial base

2. Maxilla to mandible
3. Mandible to cranial base
4. Dentition
5. airway
Soft tissue evaluation

Nasolabial angle
• Acute nasolabial angle – dentoalveolar protrusion, but can also occur
because of orientataion of base of nose.
Cant of upper lip

• Line is drawn from nasion

perpendicular to upper lip
• 14 degree in females
• 8 degree in males
Hard tissue evaluation

• Anterior position of point A = +ve value

• Posterior position of point A= -ve value
• In well-balanced faces, this measurement is
0 mm in the mixed dentition and 1 mm in adult. Maxillary skeletal protrusion

Maxillary skeletal retraction

Maxilla to mandible

Anteroposterior relationship
• Linear relationship exists between
effective length of midface & that of mandible.
• Any given effective midfacial
length corresponds to effective
mandibular length within a
given range
 To determine maxillomandibular differential midfacial length
measurement is subtracted from mandibular length
Small individuals (mixed dentition stage) :20-23mm
Medium-sized: 27-30mm
Large sized : 30-33mm
Vertical relationship

 Vertical maxillary excess–

downward & backward rotation of mandible,
increasing lower anterior facial height.
 Vertical maxillary deficiency –
upward & forward rotation of mandible, decreasing
lower anterior facial height.
Lower Anterior Face Height
(LAFH)

• LAFH is measured from ANS to Me.

• In well balanced faces it correlates
• with the effective length of midface.
Mandibular plane angle

 On average, the mandibular plane angle

is 22 degrees ± 4 degrees
A higher value - excessive lower
facial height
A lesser angle- Lower facial height
The facial axis angle

 In a balanced face -90 degrees to

the basion- nasion line

A negative value - excessive vertical

development of the face

Positive values - deficient vertical

development of the face
MANDIBLE TO CRANIAL BASE

In the mixed dentition - pogonion on the average is located 6 to 8 mm posterior

to nasion perpendicular, but moves forward during growth

Medium-size face -pogonion is positioned 4 to 0 mm behind the nasion

perpendicular line

 Large individuals-the measurement of the chin position extends from

about 2 mm behind to approximately 2 mm forward of the nasion
perpendicular line
DENTITION

a) Maxillary incisor position

The distance from the point A to the facial surface

of the maxillary incisors is measured.

The ideal distance - 4 to 6 mm

b) Mandibular incisor position

• In a well-balanced face,
this distance should be 1 to 3 mm
AIRWAY ANALYSIS

Upper Pharynx
• Width measured from posterior
outline of the soft palate to a
point closest on the pharyngeal wall.

• The average nasopharynx is

approximately 15 to 20mm in width.

• A width of 2mm or less in this

region may indicate airway impairment.
Lower Pharynx

• Width – point of intersection of

posterior border of tongue &
inferior border of mandible to
closest point on posterior pharyngeal wall.

• The average measurement is 11 to 14 mm,

independent of age

• Greater than average lower pharyngeal width—

possible anterior positioning of the tongue.
SASSOUNI ANALYSIS
• The Sassouni analysis was the first to emphasize vertical as well as horizontal
relationships and the interaction between vertical and horizontal proportions.
• Sassouni pointed out that the horizontal anatomic plane, palatal plane, occlusal
plane, and mandibular plane- tend to converge towards a single point in well
proportioned faces.
• if the planes intersect relativity close to the face and diverge quickly as they pass
anteriorly, the facial proportions are long anteriorly and short posteriorly, which
predisposes the individual to an open bite malocclusion.
• If the planes are nearly parallel so that they converge far behind the face and
diverge only slowly as they pass anteriorly, there is a skeletal predisposition
toward anterior deep bite, and the condition is termed skeletal deep bite.
THE HOLDAWAY SOFT TISSUE
ANALYSIS

• Given by Dr. Reed Holdaway, 1984

• Dr. Reed Holdaway in series of two

articles outlined the parameter of
soft tissue outline

• Analysis consists of 11 measurement

Dr. Reed Holdaway

1. Facial Angle (90 degree)

 Ideally the angle should be 90

to 92 degrees

 >90 degree: mandible too

protrusive

 <90 degree: recessive lower

jaw
2. Upper lip curvature (2.5mm)
 Depth of sulcus from a line
drawn perpendicular to FH &
tangent to tip of upper lip

 Lack of upper lip curvature –

lip strain

Excessive depths could be

caused by lip redundancy or
jaw overclosure
3. Skeletal convexity at point A
(-2to 2mm)
Measured from point A to N’-
Pog’ line

Not a soft tissue measurement

but a good parameter to
assess facial skeletal convexity
relating to lip position

 Dictates dental relationships

needed to produce facial
harmony
4. H-Line Angle(7-15 degree)
 Formed between H-line & N’-
Pog’ line
Measures either degree of
upper lip prominence or
amount of retrognathism of soft
tissue chin
If skeletal convexity & H-line
angles donot approximate,
facial imbalance may be evident
5. Nose tip to H-line (12mm
maximum)
 Measurement should not
exceed 12mm in individuals
14 yrs of age

6. Upper sulcus depth (5mm)

 Short/thin lips -
measurement of 3 mm may
be adequate
 Longer/thicker lips- 7mm
may still indicate excellent
balance
• 7.Upper lip thickness
(15mm)
 Measured horizontally from
a point on outer alveolar
plate 2mm below point A to
outer border of upper lip
• 8. Upper lip strain
 Measured from vermillion
border of upper lip to labial
surface of maxillary CI

 Measurement should be approx

same as the upper lip thickness
(within 1mm)

 Measurement less than upper

lip thickness – lips are considered
to be strained
• 9. Lower lip to H-line(0mm)
 Measured from the most
prominent outline of the lower lip
 Negative reading – lips are behind
the H line
Positive reading – lips are ahead of
H line
 Range of -1 to +2mm is regarded
normal

• 10. Lower sulcus depth (5mm)

11. Soft tissue-chin thickness (10-
12mm)
• Measured as distance between
bony & soft tissue facial planes

• In fleshy chins, lower incisors

may be permitted to stay in a
more prominent position,
allowing for facial harmony
True vertical line

• The problem of a constant reference plane can be solved if the true vertical
plane is used. True vertical line is constant and perpendicular to the true
horizontal.
• The true vertical line(TVL) is established . The line was placed through subnasale
and is perpendicular to the natural horizontal head position.
• It may be used to quantify favourable or unfavorable changes in the profile after
overjet reduction and has a potential role in post treatment analysis and
research.
LIMITATIONS OF CEPHALOMETRICS

• It gives two dimensional view of a three dimensional object.

• It gives a static picture which does not takes time into consideration.
• The reliability of cephalometrics is not always accurate.
• Standardization of analytical procedures are difficult.
SOURCES OF ERROR IN CEPHALOMETRY
Error Causes of error How to minimize
Radiographic the error
projection errors

A) Magnification X ray beams are not By using a long focus-

: Enlargement parallel with all points of object distance & a short
the object object- film distance

B) Distortions: Landmarks & structures not May be overcome by

Head being 3D situated in the midsaggital recording the midpoint
causes different plane are usually bilateral & may of 2 images
magnifications at cause dual images in
different depths of radiographs
field

Rotation of patient’s head in any By standardized head

plane of space in cephalostat orientation using ear
may produce linear/angular rods, orbital pointer &
distortions forehead rest
Error : Causes of error How to minimize
Errors within the the error
measuring system

Error may occur in the Human error may creep in Use of computerized
measurement of various during the tracing plotters & digitizers to
linear & angular measurements digitize the landmarks &
measurements carry out the various linear
& angular measurements
has proved to be more
accurate
Error : Causes of error How to minimize the
Errors in landmarks error
identification

A) Quality of radiographic Poor definition of Recommended films should

image radiographs may occur due be used to avoid poor
to use of old films & definition radiographs
intensifying screen although
radiation dose is reduced

Movement of object, tube or Stabilizing the object, tube,

film may cause a motion blur film. By increasing the
current exposure time is
reduced, minimizing motion
blur

Blurring of radiograph due Can be reduced by use

to scattered radiation that of grids
fogs the film
Error : Causes of error How to minimize the
Errors in landmarks error
identification

B) Precision of landmark May occur if landmark is Landmarks have to be

definition & reproducibility not defined accurately, accurately defined. Certain
of landmark location causes confusion in landmarks may require
identification of landmark special conditions to
identify which should be
strictly followed

In general certain Good quality radiography

landmarks are difficult to
identify such as porion

C) Operator bias Variations in landmarks Advisable for the same

identification between person to identify & trace
operators the patients
 CONCLUSION
• There are numerable cephalometric analysis given by different
people each expressing their ideas and ways to analyse, classify,
and treat the face.

• All these analysis are still a two dimensional representation of

the three dimensional structure.

• Each has inherent deficiencies associated with the analysis itself

and those because of radiological errors and clinician’s
experience.
The future of cephalometrics depends on the three dimensional
analysis, their accuracy, validity and reproducibility

Still the value of the information and insight given by these

traditional analyses should not be ignored or taken lightly
REFERENCES
• Radiographic Cephalometrics – Alexander Jacobson
• Orthodontic Cephalometry – Athanasios E
Athanasiou
• Contemporary Orthodontics – William Proffit
• Practice Of Orthodontics, Volume 1 & Volume 2-
J.A. Salzmann
• Clinical Orthodontics, Volume 1 - Charles H
Tweed
• Down W.B “ analysis of Dentofacial profile”- angle orthod 1956
October.
• Tweed CH. Frankfort mandibular incisor angles in diagnosis, treatment
palnning and prognosis. Angle orthod 1954;24:121-69.
THANK U 