lateral ceph.points

8/15/2019 Lateral Ceph.points

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Seminar 2Seminar 2

records processingrecords processing

LATERAL CephalometricLATERAL Cephalometric

AnalysisAnalysis



Cephalometic Points Used forCephalometic Points Used for

POS AnalysisPOS Analysis

• refer to notesrefer to notes

for denitionsfor denitions

of each pointof each point



Tips to nd points Tips to nd points



A Review of Cranial Anatomy as it A Review of Cranial Anatomy as itrelates to Cephalometric Tracingrelates to Cephalometric Tracing

Presented by Dr Jeffery Taylor



POS Cephalometric PointsPOS Cephalometric Points(n the order in which they appear in DentalCad!PSoft"(n the order in which they appear in DentalCad!PSoft"

•NasionNasion (N):(N): The most The most

anterior point of the naso-anterior point of the naso-frontal suture on thefrontal suture on the

midsagittal plane.midsagittal plane.

Refer to slide #$% Seminar #&



N point



POS Cephalometric PointsPOS Cephalometric Points

• asionasion !"# The most anterior point of the!"# The most anterior point of thenaso-frontal suture on the midsagittal plane.naso-frontal suture on the midsagittal plane.

•SellaSella (S):(S): The center of the The center of the

contour of Sella Tursica $ycontour of Sella Tursica $yinspection.inspection.



S point





• Sella !S"# The center of the contour of SellaSella !S"# The center of the contour of Sella

Tursica $y inspection. Tursica $y inspection.

•PorionPorion (Por):(Por): The most The mostsuperior point of %&ternalsuperior point of %&ternal

Auditory 'eatus.Auditory 'eatus.



Porion





• SellaSella !S"# The center of the contour of Sella!S"# The center of the contour of Sella

Tursica $y inspection. Tursica $y inspection.

• PorionPorion !Por"# The most superior point of!Por"# The most superior point of%&ternal Auditory 'eatus.%&ternal Auditory 'eatus.

•OrbitaleOrbitale (O):(O): (o)ermost(o)ermost

point of the contour of thepoint of the contour of the$ony or$it$ony or$it..



Orbitale




• asionasion !"# The most anterior point of the naso-!"# The most anterior point of the naso-

frontal suture on the midsagittal plane.frontal suture on the midsagittal plane.

• SellaSella !S"# The center of the contour of Sella Tursica!S"# The center of the contour of Sella Tursica

$y inspection.$y inspection.

• PorionPorion !Por"# The most superior point of %&ternal!Por"# The most superior point of %&ternal

Auditory 'eatus.Auditory 'eatus.

• Or$italeOr$itale !O"# (o)ermost point of the contour of the!O"# (o)ermost point of the contour of the$ony or$it.$ony or$it.

•Posterior Nasal SpinePosterior Nasal Spine (PNS):(PNS):

The most posterior point of the The most posterior point of thenasal *oor. +unction of the hardnasal *oor. +unction of the hard

and soft palate.and soft palate.



PNS

OS CPOS C h l t i P i t





• SellaSella !S"# The center of the contour of Sella!S"# The center of the contour of Sella Tursica $y inspection. Tursica $y inspection.

• PorionPorion !Por"# The most superior point of!Por"# The most superior point of%&ternal Auditory 'eatus.%&ternal Auditory 'eatus.

• Or$italeOr$itale !O"# (o)ermost point of the contour!O"# (o)ermost point of the contour

of the $ony or$it.of the $ony or$it.• Posterior asal SpinePosterior asal Spine !PS"# The most!PS"# The most

posterior point of the nasal *oor. +unction ofposterior point of the nasal *oor. +unction ofthe hard and soft palate.the hard and soft palate.

• Anterior Nasal SpineAnterior Nasal Spine (ANS):(ANS): The most anterior point of the The most anterior point of thenasal *oor. Tip of the pre-ma&illanasal *oor. Tip of the pre-ma&illaon the midsagittal plane.on the midsagittal plane.



ANS



POS Cephalometric Points% Section $POS Cephalometric Points% Section $

• SubspinaleSubspinale (A):(A): The deepest The deepestpoint on the midsagittal planepoint on the midsagittal plane$et)een AS and Prosthion,. A$et)een AS and Prosthion,. Apoint is the most anterior point ofpoint is the most anterior point of

the ma&illary denture $ase. t isthe ma&illary denture $ase. t isusually located around the leel ofusually located around the leel ofand anterior to the ape& of theand anterior to the ape& of theupper central incisors. /int# traceupper central incisors. /int# trace

the upper incisorthe upper incisor beforebefore selectingselectingA point.A point.

,,prosthionprosthion (noun)(noun) - 1. craniometric point that is the most anterior point in the- 1. craniometric point that is the most anterior point in themidline on the alveolar process of the maxillamidline on the alveolar process of the maxilla



A point



Not here



No

Yes



Dental Cad' Place incisor with tip on edge of incisor



Dental Cad' ove root over p)lp

radiol)cency )sing root*tip +handle,-



Dental Cad' .ow place A point )sing

/nowledge of the anatomy,



Dental Cad' .ow ret)rn bac/ the list of Points and Conto)rs

and place the a0illa if desired, (1$ /ey to advance"




• Su$spinaleSu$spinale !A"# The deepest point on the!A"# The deepest point on themidsagittal plane $et)een AS and Prosthion.midsagittal plane $et)een AS and Prosthion.

•SupramentaleSupramentale (B):(B): The The

deepest point on thedeepest point on the

midsagittial plane $et)eenmidsagittial plane $et)een

infradentale and Pogoion.infradentale and Pogoion.

Usually anterior to and slightlyUsually anterior to and slightly$elo) the apices of the lo)er$elo) the apices of the lo)er

incisors.incisors.



B point




• Su$spinaleSu$spinale !A"# The deepest point on the!A"# The deepest point on themidsagittal plane $et)een AS and Prosthion.midsagittal plane $et)een AS and Prosthion.

• SupramentaleSupramentale !0"# The deepest point on the!0"# The deepest point on the

midsagittial plane $et)een infradentale andmidsagittial plane $et)een infradentale and

Pogoion. Usually anterior to and slightly $elo)Pogoion. Usually anterior to and slightly $elo)

the apices of the lo)er incisors.the apices of the lo)er incisors.

•PoonionPoonion (P):(P): The most The most

anterior point on theanterior point on the

midsagittal plane of themidsagittal plane of the

contour of the chin.contour of the chin.



Pogoion




• Su$spinaleSu$spinale !A"# The deepest point on the!A"# The deepest point on the

midsagittal plane $et)een AS and Prosthion.midsagittal plane $et)een AS and Prosthion.

• SupramentaleSupramentale !0"# The deepest point on the!0"# The deepest point on the

midsagittial plane $et)een infradentale andmidsagittial plane $et)een infradentale and

Pogoion. Usually anterior to and slightly $elo) thePogoion. Usually anterior to and slightly $elo) the

apices of the lo)er incisors.apices of the lo)er incisors.

• PogonionPogonion !P"# The most anterior point on the!P"# The most anterior point on themidsagittal plane of the contour of the chin.midsagittal plane of the contour of the chin.

•!nathion!nathion (!n):(!n): The point on the The point on the

anterior symphsis closest to theanterior symphsis closest to theintersection of -Po line and theintersection of -Po line and the

inferior $order of the mandi$le.inferior $order of the mandi$le.



Gnathion



POS Cephalometric Points% Section $POS Cephalometric Points% Section $• Su$spinaleSu$spinale !A"# The deepest point on the!A"# The deepest point on the

midsagittal plane $et)een AS and Prosthion.midsagittal plane $et)een AS and Prosthion.

• SupramentaleSupramentale !0"# The deepest point on the!0"# The deepest point on themidsagittial plane $et)een infradentale andmidsagittial plane $et)een infradentale andPogoion. Usually anterior to and slightly $elo)Pogoion. Usually anterior to and slightly $elo)the apices of the lo)er incisors.the apices of the lo)er incisors.

• PogonionPogonion !P"# The most anterior point on the!P"# The most anterior point on themidsagittal plane of the contour of the chin.midsagittal plane of the contour of the chin.

• 1nathion1nathion !1n"# The point on the anterior!1n"# The point on the anteriorsymphsis closest to the intersection of -Posymphsis closest to the intersection of -Poline and the inferior $order of the mandi$le.line and the inferior $order of the mandi$le.

•"enton"enton ("e):("e): The lo)ermost The lo)ermostpoint on the contour of thepoint on the contour of thesymphysis.symphysis.



Menton

POS C h l t i P i t S ti 2



POS Cephalometric Points% Section 2POS Cephalometric Points% Section 2

•!onion!onion (!o):(!o): The point on The point onthe posterior mandi$le, closestthe posterior mandi$le, closest

to the erte& of the gonialto the erte& of the gonial

angleangle..• ote#ote# "c!ann pre#ers"c!ann pre#ers using the mostusing the most

inferior point of the ramus 3'enton for theinferior point of the ramus 3'enton for the

mandi$ular plane !as in 4o)n5s analysis"mandi$ular plane !as in 4o)n5s analysis"

• ote# Steiner analysis used 1onion-1nathionote# Steiner analysis used 1onion-1nathionfor mandi$ular planefor mandi$ular plane



True denition of True denition of 1onion1onion



Gonion

POS C h l t i P i t S ti 2POS C h l t i P i t S ti 2




• 1onion1onion !1o"# The point on the posterior!1o"# The point on the posterior

mandi$le closest to the erte& of the gonialmandi$le closest to the erte& of the gonial

angle.angle.

•ArticulareArticulare (Ar):(Ar): The point of The point of

intersection $et)een theintersection $et)een theposterior $order of theposterior $order of the

mandi$le and the occipitalmandi$le and the occipital

$one !$ase of the $ony s6ull."$one !$ase of the $ony s6ull."



Articulare

POS C h l t i P i t S ti 2POS C h l t i P i t S ti 2




• 1onion1onion !1o"# The point on the posterior!1o"# The point on the posterior

mandi$le closest to the erte& of the gonialmandi$le closest to the erte& of the gonial

angle.angle.

• ArticulareArticulare !Ar"# The point of intersection!Ar"# The point of intersection

$et)een the posterior $order of the mandi$le$et)een the posterior $order of the mandi$le

and the occipital $one !$ase of the $ony s6ull."and the occipital $one !$ase of the $ony s6ull."

•Con$ylionCon$ylion (Co):(Co): The most The most

superior and distal point on thesuperior and distal point on the

head of the condyle.head of the condyle.



POS Cephalometric Points Section 2POS Cephalometric Points Section 2




• 1onion1onion !1o"# The point on the posterior mandi$le!1o"# The point on the posterior mandi$le

closest to the erte& of the gonial angle.closest to the erte& of the gonial angle.

• ArticulareArticulare !Ar"# The point of intersection $et)een!Ar"# The point of intersection $et)een

the posterior $order of the mandi$le and thethe posterior $order of the mandi$le and the

occipital $one !$ase of the $ony s6ull."occipital $one !$ase of the $ony s6ull."

• CondylionCondylion !Con"# The most superior and distal!Con"# The most superior and distalpoint on the head of the condyle.point on the head of the condyle.

•SubnasaleSubnasale (simpli%e$):(simpli%e$): The The

$isection of the angle formed $y a$isection of the angle formed $y a

line on the inferior $order of theline on the inferior $order of the

nose and a line on the ltrumnose and a line on the ltrum

area.area.



Subnasale



p

• 1onion1onion !1o"# The point on the posterior!1o"# The point on the posteriormandi$le closest to the erte& of the gonialmandi$le closest to the erte& of the gonial

angle.angle.• ArticulareArticulare !Ar"# The point of intersection!Ar"# The point of intersection

$et)een the posterior $order of the mandi$le$et)een the posterior $order of the mandi$leand the occipital $one !$ase of the $ony s6ull."and the occipital $one !$ase of the $ony s6ull."

• CondylionCondylion

!Con"# The most superior and distal!Con"# The most superior and distal

point on the head of the condyle.point on the head of the condyle.

• Su$nasaleSu$nasale !simplied"# The $isection of the!simplied"# The $isection of theangle formed $y a line on the inferior $order ofangle formed $y a line on the inferior $order ofthe nose and a line on the ltrum area.the nose and a line on the ltrum area.

•StomionStomion:: The point )here the The point )here theinferior of the upper lip !at rest"inferior of the upper lip !at rest"and the central incisor meet.and the central incisor meet.



Stomion

Planes used in the POSPlanes used in the POS



Planes used in the POSPlanes used in the POS

AnalysisAnalysis

• man$ibular planeman$ibular plane# 'enton-lo)er# 'enton-lo)er$order of ramus$order of ramus

• Occlusal planeOcclusal plane# ntersection of cusp# ntersection of cusptips upper and lo)er 7s8 $isection oftips upper and lo)er 7s8 $isection ofincisors oer$ite or open $iteincisors oer$ite or open $ite

• Palatal PlanePalatal Plane# AS-PS# AS-PS

• &ran'#urt oriontal&ran'#urt oriontal# Por-Or$itale# Por-Or$itale

• SNSN# Cranial 0ase# Cranial 0ase

Planes used in thePlanes used in the



Planes used in the "c!ann analysis"c!ann analysis

• S lineS line

• 9ran6furt /ori:ontal9ran6furt /ori:ontal

• Palatal planePalatal plane• Occlusal planeOcclusal plane

• 'andi$ular plane'andi$ular plane

(ocate the points(ocate the points



(ocate the points(ocate the points



S6eletal AnalysisS6eletal Analysis

4etermine if the patient is4etermine if the patient is

s6eletal open8 aerage8 ors6eletal open8 aerage8 or

closedclosed

'easurement ;'easurement ;



'easurement 2'easurement 2



4ropping a Parallel !to 9/"4ropping a Parallel !to 9/"

• Planes intersect o< the pagePlanes intersect o< the page

• Only needed )hen doing a manualOnly needed )hen doing a manual

tracingtracing• Use parallel lines on the ormacephaUse parallel lines on the ormacepha

measuring instrumentmeasuring instrument

• OT needed )hen doing a computerOT needed )hen doing a computertracing=tracing=

4ou$le 'easurements#4ou$le 'easurements#



determine s6eletal open8determine s6eletal open8

aerage8 or closedaerage8 or closed• Palatal-'and. planePalatal-'and. plane • 9'A9'A



>-a&is >-a&is

Politically correct# 1PPolitically correct# 1P

understands gro)th?understands gro)th?



S6eletal analysisS6eletal analysis

4etermine if the ma&illa is4etermine if the ma&illa is

protrusie8 aerage8 orprotrusie8 aerage8 or

retrusieretrusie



perpendicular At A perpendicular At A

manual measuringmanual measuringUse parallel lines and theUse parallel lines and the

outside edge of theoutside edge of the

ormacepha !@ deg" to createormacepha !@ deg" to create

the reference linethe reference line



Appliances to alter theAppliances to alter the



Appliances to alter theAppliances to alter the

ma&illama&illa

• Cerical headgearCerical headgear• Beerse headgearBeerse headgear



S6eletal analysisS6eletal analysis

4etermine if the mandi$le is4etermine if the mandi$le is

protrusie8 aerage8 orprotrusie8 aerage8 or

retrusieretrusie



S6eletal AnalysisS6eletal Analysis

4etermine if the upper and4etermine if the upper and

lo)er a)s are )ell related !orlo)er a)s are )ell related !or

not"not"



A0# manualA0# manual

measurementmeasurement4o not measure this angle84o not measure this angle8

su$tract the num$ers S0 fromsu$tract the num$ers S0 from

SASA



DitDit



DitsDits

• The $est measurement to predict The $est measurement to predict

s6eletal resistance in class casess6eletal resistance in class cases

!not A0"!not A0"

• ot sensitie to changes in theot sensitie to changes in the

ertical dimension !as is A0"ertical dimension !as is A0"

• %rrors in the occlusal plane are%rrors in the occlusal plane are

signicant and may ma6e thissignicant and may ma6e this

measurement inalidmeasurement inalid

Dit A0Dits ersus A0



Dits ersus A0Dits ersus A0

• Use A0 in Class diagnosis !notUse A0 in Class diagnosis !not

)its")its"

• Use Dits in Class diagnosis !notUse Dits in Class diagnosis !notA0"A0"

• Use Dits in s6eletal open $ite casesUse Dits in s6eletal open $ite cases

!A0 is sensitie to ertical!A0 is sensitie to erticaldimension"dimension"



4ental Analysis4ental Analysis

4etermine the antero-4etermine the antero-

posterior position andposterior position and

inclination of the incisor teethinclination of the incisor teeth



The lo)er incisor The lo)er incisor

E measurementsE measurements



The upper incisor The upper incisor

F measurementsF measurements



9acial Analysis9acial Analysis



Guic6 !manual" tracingGuic6 !manual" tracing



gmethodmethod

• Trace anatomy and choose points Trace anatomy and choose points

• 4ra) lines and planes as you thin6 of them4ra) lines and planes as you thin6 of them

• 'easure as you Hremem$erI locations of'easure as you Hremem$erI locations of

measurementsmeasurements• Drite the num$er on the tracingDrite the num$er on the tracing

• Transfer the measurements to the form Transfer the measurements to the formafter you cannot remem$er any moreafter you cannot remem$er any more

• Beturn to the tracing to complete forgottenBeturn to the tracing to complete forgottenmeasurements.measurements.



/ead positioning error/ead positioning error

(ateral ceph Htilt the headI(ateral ceph Htilt the headI

2 structures2 structuresporion or$itale gonion molarsporion or$itale gonion molars



porion8 or$itale8 gonion8 molarsporion8 or$itale8 gonion8 molars



HH TiltI the head positioning TiltI the head positioning



error correctionerror correction

• Trace the dou$le structures on the Trace the dou$le structures on the

same side of the facesame side of the face

• The most superior or$itale is the The most superior or$itale is theeasiest to see. Therefore8 choose theeasiest to see. Therefore8 choose the

most superior porion8 mandi$le8 andmost superior porion8 mandi$le8 and

molars to $e consistent.molars to $e consistent.

True s6eletal asymmetry True s6eletal asymmetry



2 mandi$les2 mandi$les

True s6eletal asymmetry True s6eletal asymmetry9rontal ceph num$ers9rontal ceph num$ers



9rontal ceph num$ers9rontal ceph num$ers

• 'andi$ular plane cant is at least E'andi$ular plane cant is at least Edegreesdegrees

• Jertical height di<erence !antegonialJertical height di<erence !antegonial

notch to :ygomatic plane"notch to :ygomatic plane"

The headholder is not cali$rated The headholder is not cali$rated

correctlycorrectly



correctlyco ec y

Hloo6ing to the sideI head positioningHloo6ing to the sideI head positioning

errorerror

ConseKuences of Hloo6ing toConseKuences of Hloo6ing to



the sideI positioning errorthe sideI positioning error

• 4iLcult to trace the molars84iLcult to trace the molars8especially )hen comparing &-raysespecially )hen comparing &-rays$efore and after treatment !oerlay"$efore and after treatment !oerlay"

• Occlusal plane is OT e<ectedOcclusal plane is OT e<ected

• 4ou$le Bamus is of no conseKuence4ou$le Bamus is of no conseKuence

• Or$itale is OT e<ectedOr$itale is OT e<ected

• Porion leel to 9ran6furt /ori:ontal isPorion leel to 9ran6furt /ori:ontal isOT e<ectedOT e<ected

OerlaysOerlays



OerlaysOerlays

• Comparing ceph &-rays ta6en on theComparing ceph &-rays ta6en on the

same patient8 at di<erent times8 onsame patient8 at di<erent times8 on

the SA'% machine.the SA'% machine.

• On Adult patient M Treatment e<ectOn Adult patient M Treatment e<ect

onlyonly

• On 1ro)ing patient M 1ro)th plusOn 1ro)ing patient M 1ro)th plustreatment.treatment.

Start !age E2" 9inalStart !age E2" 9inalC h



CephCeph

S6eletal oerlayS6eletal oerlay



S6eletal oerlayS6eletal oerlay

4ental Oerlays4ental Oerlays



4ental Oerlays4ental Oerlays

Prediction ActualPrediction Actual



Prediction ActualPrediction Actual

1ro)th1ro)th)hat happens )ithout)hat happens )ithout



)hat happens )ithout)hat happens )ithout

treatmenttreatment• 9ace# gro)s do)n and for)ard8 not9ace# gro)s do)n and for)ard8 not

necessarily in the same directionnecessarily in the same direction

each yeareach year

• Upper molar# do)n and for)ardUpper molar# do)n and for)ard

• Upper incisor# do)n and slightly $ac6Upper incisor# do)n and slightly $ac6

• (o)er molar# up and for)ard(o)er molar# up and for)ard• (o)er incisor# up and slightly $ac6(o)er incisor# up and slightly $ac6

S6eletal oerlay#S6eletal oerlay# start age ;;start age ;;



femalefemale

4ental oerlays4ental oerlays



4ental oerlays4ental oerlays



ose oerlayose oerlay



Oerlay &-ray 73EOerlay &-ray 73E

N-ray E M female age ;N-ray E M female age ;

N-ray 7 M same female8 age ;EN-ray 7 M same female8 age ;E

Pu$ertal gro)th spurt for girls age ;;-Pu$ertal gro)th spurt for girls age ;;-;E;E

Ceph for BeconstructionCeph for Beconstruction



Ceph for BeconstructionCep o eco s uc o

Tutorials Tutorials



Tutorials

• Study at homeStudy at home

• Bun Tscc.e&e le to ie) HaiI ideoBun Tscc.e&e le to ie) HaiI ideo

les. Only one time installation ofles. Only one time installation ofthis programthis program

4igital Ceph cali$ration4igital Ceph cali$ration



4igital Ceph cali$rationg p

• 4igital cephs are typically cali$rated4igital cephs are typically cali$rated

)rong8 $eing saed as 2dpi peg)rong8 $eing saed as 2dpi peg

instead of @7dpi tif or $itmap.instead of @7dpi tif or $itmap.

• The resulting image of the head is The resulting image of the head is

smaller5 than actual si:e.smaller5 than actual si:e.

Same patientSame patientDrong CorrectDrong Correct



gg

/o) to determine if ceph is/o) to determine if ceph is

cali$rated correctlycali$rated correctly



cali$rated correctlycali$rated correctly

• f there is a millimeter ruler in thef there is a millimeter ruler in the

image8 then import the ceph intoimage8 then import the ceph into

dentalcad and measure using Co 3 Adentalcad and measure using Co 3 A

points !ma&illary length" on the ruler8points !ma&illary length" on the ruler8

Fmm may measure 2mm in aFmm may measure 2mm in a

typical out-of-cali$ration machine.typical out-of-cali$ration machine.

• (ineal measurements are )rong8(ineal measurements are )rong84ental to is distorted.4ental to is distorted.

Same patientSame patient

)rong correct)rong correct



)rong correct)rong correct

f no cali$ration rulerf no cali$ration ruler



• Ta6e an &-ray )ith a metal o$ect of Ta6e an &-ray )ith a metal o$ect of

6no)n length !piece of )ire8 endo6no)n length !piece of )ire8 endo

le" taped to the machine at thele" taped to the machine at the

nose or on the &-ray cassettenose or on the &-ray cassette

• 'easure after importing into'easure after importing into

dentalcad or directly on a printeddentalcad or directly on a printed

imageimage

Dhat to do if out ofDhat to do if out of

cali$rationcali$ration




• As6 manufacturer to ma6e theAs6 manufacturer to ma6e the

soft)are5 correction !update"soft)are5 correction !update"

• mport into ado$e photoshop andmport into ado$e photoshop andresi:e Himage-si:eI8 change pi&els toresi:e Himage-si:eI8 change pi&els to

; as a starting point8 and chec6; as a starting point8 and chec6


lateral ceph.points

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