Cephalometrics I

Cephalometrics: the interpretation of skull/face radiographs taken under standardized

conditions
o Originally used in craniometry (longitudinal studies measuring the skull)
Cephalograph: head radiograph used as a diagnostic tool in orthodontics
o Cranial base, jaws, and teeth are all related to each other
o Compare patients normal to a reference group
o Landmarks: defined locations on the human skull and face
Very useful because similar dental malocclusions may have very different
skeletal patterns (or different dental malocclusions have similar skeletal
structures)
o Growth analysis (spinal analysis) and orthodontic changes can be performed
o Not good as a pathologic screening tool
o 2 types
Lateral ceph (typical one used)
Anterior-posterior ceph
Taken from posterior to anterior so that the film is closer to the film,
making it clearer
Overview of function
o If same posture can be obtained, images can be overlapped to look at growth
o Soft tissue can be investigated
o Look at vertebrae for growth velocity/growth status
o Good resolution of the airway
Lateral Ceph Standard arrangement
o Left side of patient closest to the film
o Central ray extends through the external auditory meatus
Ear rods are used placed in the EAM and are the center of the x-ray
o 5 feet from the x-ray source to the mid-sagittal of the patient
Head hold helps keep head steady and can mark the midline
o Have eye sight directed forward
o Get patient into Natural Head position by having patient moving head up and down in
small movements until they feel comfortable (reproducible to 1 to 2 degrees)
Try and get Frankfort horizontal plane parallel to the floor (the top of the EAM
lines up with the inferior portion of the orbitale)
Magnification occurs due to the difference in distances to the film
o Right side is further away from the film than the left, so it appears more magnified and
slightly less clear than the left
o For inferior border of the mandible, the right side is more inferior than the left side. For
the superior, the right side will be slightly more superior.
o If patients head is not perpendicular to the x-ray source, midline structures will most
likely not be affected (EAM), but further out structures (like nose and chin) will be more
affected
o Patients with asymmetry may end up with more overlapping cepahlographs
 Any malocclusion is the result of an interaction between jaw position and the position the teeth
end up in as they erupt
o For the most part teeth position is affected by the jaw relationship, and the teeth
compensate for the discrepancies
Cephalometric goals
o Evaluate the relationship of the 5 major functional components of the face(both
horizontal and vertical)
Skull and cranial base
Nasomaxillary area
Maxillary dento-alveolar component
Mandibular dento-alveolar component
Mandible
o Relate to population norms, or itself over time
o Evaluate treatment results and biomechanical outcomes
o Assess growth
Importance of cephalometrics
o Dental casts have limitations
Only show teeth
Incisor inclination cannot be determined from just a cast
o Skeletal relationships can be determined
Can visualize the contribution of dental and skeletal proportions to malocclusion
Treating skeletal problems are much more different than treating dental
problems
o Can determine the underlying etiology of the malocclusion
In relation to the cranial base, is the maxilla prognathic or in a normal position?
Maxillary differences are often due to the cranial base
What is the size and plane angle of the mandible in relation to the rest of the
face
o Provides an indication of the future pattern of craniofacial growth
A steep mandibular plane angle correlates with a long anterior facial vertical
dimension and anterior open bite malocclusion.
o Predication on timing of maximal growth
Vertebral assessment
Superimposition
o Completion of growth: serial cephalographs taken at least 6 months apart show the
Nasion-Menton (bridge of nose to angle of chin) has remained unchanged
Cephalometrics analysis
o Many different analyses exist, some are better for comparing patients to a population,
while others are better at monitoring changes due to growth or a combination of
growth and treatment
o General notes
Dont be a slave to the numbers (shouldnt always dictate your treatment)
Look for trends
 Very important to take into account standard deviations when planning
treatment
95% of population should be within 2 SD of a measurement
Use as an adjunct for treatment planning, shouldnt dictate everything
o 3 main components of cephalometric analysis
Soft tissue: facial contour, proportions, and lip position
Skeletal: maxillary and mandibular basal arches, A-P and vertical relationships,
Mn plane, and facial proportions
Dental: incisor and molar position, A-P and vertical angulation, occlusal plane
angulation, overjet and overbite
o Information that can be gathered from a ceph
Lateral
A-P dysplasia
Vertical dysplasia
Incisor position and inclination
Balance of soft tissue and facial contours
Frontal
Transverse dysplasia
Asymmetries
o What Cephas can be used for
Diagnosis
Analysis of treatment results
Longitudinal studies of growth
3D technology has allowed orthodontists to start including root alignment with the functional
occlusal table. Makes it more difficult to align, but should allow better loading