WHAT IS BASIC CEPHALOMETRIC

ANALYSIS?

Cephalometrics is a systemic analysis of a

patient’s dentition and supporting denture
base ( the base of the alveolar ridges that
support the teeth) as they relate to the
facial bones and the cranial base of the
skull.
The cephalometric analysis is always made
by tracing certain bony tissue features as
visualized in a lateral or P-A radiograph of
the entire head. The lateral head film
must be of sufficient quality to enable one
to distinguish certain bony points, or
landmarks, on the film.
1. Start by placing the cephalogram on the
viewbox with the patients’s image facing
to the right.
2. Fasten the acetate tracing paper to the
radiograph with scotch tape on the top
portion
A clear sheet of acetate tracing material is
fastened to the radiograph, dull side out.
Against an x-ray viewer, the pertinent
dental and bony structures are carefully
traced on the acetate sheet with a sharp
lead pencil.
3. With a fine felt-tipped black pen, draw
three crosses on the radiograph,
two within the cranium and one over the
area of the cervical vertebrae.
Draw the three registration crosses
on radiograph
These registration crosses allow for re-
orientating the acetate tracing on the film
for later verification or in the event the
film becomes displaced during the tracing
procedure which is a common occurrence.
4. Place the matte acetate film over the
radiograph and tape it securely to the
radiograph and the viewbox.
(The shiny side of the acetate film is
placed down, against the radiograph).
5. After firmly affixing the acetate film, trace
the three registration crosses.
6. Write the following:
a) patient’s name
b) age in years and months
c) date the cephalogram was traced
d) your name in the bottom left hand
e) corner of the acetate tracing
Erinne Grace F. Orlina Catherine Grace F. Orlina
10 years old, Female 8/ 6/2013
8. Trace the soft tissue profile.
9. Trace the external contour of the cranium.
10. Trace the outline of the atlas and the axis
( first and second vertebrae respectively).
When the outline of all necessary
structures are traced, the anatomical
landmarks or points are located and
marked with a pencil.
Lines that serve as planes are drawn
through the various points; as the planes
intersect each other, they form accurately
measurable angles.
By the analysis of these angles comparing
them to a series of norms, the dentist can
complete a basic cephalometric analysis for
an individual.
The most important clinical use of
Cephalometrics is in recognizing and
evaluating changes brought about by
orthodontic treatment. By superimposing
the before and after radiographs.
HOW CAN A CEPHALOMETRIC ANALYSIS
AID IN DIAGNOSING A PATIENT’S
MALOCCLUSION ?
When the series of angles (or distance in
millimeters in some cases) is measured,
the patient’s angles are compared against
a list of those determined by researchers
to be the norm for children or adults after
studying hundreds of individuals.
After comparison with the norm, the
difference between the patient’s and the
norm angle is noted by the person doing
the analysis, and a plus or minus is placed
in the column noting differences.
Some small deviations from the norm are
seen to be of little significance; but once a
difference greater than a standard
deviation from the norm is noted, it may
be considered a skeletal malocclusion.
This means that there is such a vast
dysplasia of the bony skeleton that, even
though orthodontic treatment may correct
the patient’s dental malocclusion, the
underlying bony dysplasia may only be
disguised through treatment and not truly
normalized.
If the pattern of differences in the angles
of a cephalometric analysis does not stray
too far from the norm, the patient’s
problem is more of a dental malocclusion.
Usually this means that there is little
osseous dysplasia of the denture bases
and supporting bony tissue and the
malocclusion problem is within the dental
arches and due essentially to a
malposition of dental units only.
CEPHALOMETRIC LANDMARKS
As one views a lateral skull radiographic
projection, two kinds of landmark maybe
seen:
One kind is found in hard tissue (bone)
and the other in soft tissue (facial profile).
The hard tissue landmarks are the
preferred ones and will be used here.
Soft tissue landmarks are named
identically to the hard tissue points, but
geographically they are located on the
margin of the soft tissue immediately
adjacent to the hard tissue point in
question.
1) SELLA TURCICA (S)

The center of the

pituitary fossa of the
sphenoid bone.
 2) NASION (N)

The intersection of the

internasal suture with
the nasofrontal suture
in the midsagittal
plane.
3) PORION (Por)

The most superior

point of the external
auditory meatus.
 4) ORBITALE (Or)

The most inferior point

on the lower margin of
the bony orbit.
5.) GONION (Go)

The most inferior,

posterior, and outwardly
directed point of the
angle of the mandible.
6) GNATHION (Gn)

The most anterior and

inferior point of the chin
– usually best found by
determining the
midpoint between
Pogonion and Menton.
7) A POINT (A) -
Subspinale
The deepest point
in the curve of the
anterior maxillary
border between
anterior nasal spine
and dental alveolus.
8) B POINT (B) -
Supramentale

The deepest point in

the curve along the
anterior border of the
symphysis of the
mandible.
9) POGONION (Po)

The most anterior point

in the contour of the
chin.
10) MOLAR POINT
(Mp)

The bisection of the

overlap of the maxillary
and mandibular first
molars.
11) UR POINT (UR)

The root apex of

the maxillary
central incisor.
12) UI POINT (UI)

The incisal tip of the

maxillary central
incisor.
13) LR POINT (LR)

The root apex of the

mandibular central
incisor.
14) LI POINT (LI)

The incisal tip of the

mandibular central
incisor.
Chin (Dt)
- The most anterior
point on the curve of
the soft tissue chin.
Upper Lip (Ul)
- The most anterior
point on the curve of
the upper lip.
 Lower lip (LI)
- the most anterior
point on the curve of
the lower lip.
 CEPHALOMETRIC PLANES
A plane is defined as a flat surface
determined by the position of at least
three points in space. In the lateral
cephalometric head plate each plane is
depicted as a line drawn through two
points, or landmarks.
The two types of plane in common use are
those which are more horizontally oriented
and those which are essentially vertically
oriented.
 Horizontal planes
 Sella – Nasion plane
 Frankfort Horizontal plane
 Occlusal Plane
 Mandibular plane
 Vertical Planes
 Facial Plane (Sim’s 10 angle analysis)
 Y axis (Sim’s 10 angle analysis)
 N-A plane
 N-B plane
 1 / SN
1/1
 ELLP (Steiner’s analysis)
1) SELLA – NASION
PLANE (S-N)

The plane connecting

Sella Turcica (S) and
Nasion (N). This is
also known as the
cranial base.
2) FRANKFORT PLANE
(FH)- EYE- EAR
PLANE

The plane connecting

Porion (Po) and
Orbitale (Or). This
plane is relatively
parallel to the horizon
when the patient is
looking straight
ahead.
3) OCCLUSAL PLANE (Op)

The plane connecting

Molar point (Mp) to
the point that
represents one-half of
the incisal overlap (or
the open bite) of the
maxillary and
mandibular central
incisors.
4) MANDIBULAR PLANE
(Mp)

The plane connecting

Gonion (Go) and
Gnathion (Gn).
5) N-A PLANE (N-A)
The plane connecting
Nasion (N) and A
Point (A). This plane
aids in judging the
protrusiveness of the
maxilla when
compared to S-N.
6) N-B PLANE (N-B)

The plane connecting

Nasion (N) and B
Point (B). This plane
aids in judging the
protrusiveness of the
mandible when
compared S-N.
8) MAXILLARY INCISOR
LONG AXIS

The plane connecting the

root apex (UR) and the
incisal tip (UI) of the
maxillary central incisor.
It is used to judge the
relative angulation of this
tooth as seen in the
lateral projection
compared to the cranial
base. (S-N plane).
9) MANDIBULAR
INCISOR LONG
AXIS
The plane connecting
the root apex (LR) and
the incisal tip (LI) of
the mandibular central
incisor.
It is used to judge the relative angulation
of this tooth as compared to the
mandibular plane.
This plane is usually extended to
intersect with the Frankfort Horizontal
Plane.
10) Y-AXIS

The plane connecting

Sella Turcica and
Pogonion.
CEPHALOMETRIC ANGLES
SIM’S 10 ANGLE
ANALYSIS
 The 10 angle analysis was developed to
aid in diagnosing the child who is within
the Class I malocclusion range and not the
major Class II and Class III malocclusion.

 It is to aid dentist in treating minor, not

major malocclusions.
ANGLE NORM RANGE BELOW ABOVE INTERPRETATION
degree degrees
s
SNA 84.5 79.2 – 89.8 Retruded Protruded Maxilla

SNB 82 77.1 - 86.9 Retruded Protruded Mandible

ANB 2.5 0-5 Class III Class II Skeletal Pattern

FH/NP 85.1 82.1 – 88.1 Retruded Protruded Mandible

1/SN 103 98 - 108 Linguoverted Labioverted Upper incisors

1/1 122.8 122.8 – 139.2 Acute angle Obtuse Dental Pattern

labioverted Linguoverted

IMPA 96 88.6 – 103.4 Linguoverted Labioverted Lower incisors

FMIA 55.2 48.1 -61.9 Labially tipped Lingually tipped Lower incisors

FMA 28.7 22.9 - 34.5 Forward, Downward, Growth Pattern of the Mandible
horizontal Vertical

Y-AXIS 65 62.2 – 67.8 Flat steep Occlusal Plane/ Growth Pattern

1) S-N-A
The angle formed by the
intersection of the S-N Plane
and the N-A plane.

It determines the
protrusiveness of the
maxillary bone or maxillary
denture base in relation to
the cranial base.
2) S-N-B
The angle formed by
the intersection of the
S-N Plane and the
N-B Plane.
It measures the
protrusiveness of the
mandibular bone.
3) A-N-B
The angle found by
subtracting SNB from SNA.
(SNA minus SNB = ANB)
• The angle formed by
the intersection of the S-
N Plane and the N-B
Plane.
• Measures the
protrusiveness of the
mandibular bone.
4) FH/NP ( facial angle)
 It is measured at the
intersection of
Frankfort horizontal
plane and facial
plane.
 It determines the
protrusiveness of the
chin point as
compared to the
cranial base
5) U1 – S-N
The angle formed by the
intersection of the
maxillary incisor long axis
and Sella Nasion (SN)
Plane.

It describes the
protrusive relation of the
central incisors within the
maxillary bone.
6) INTERINCISAL
ANGLE (U1 – L1)
Angle formed by the
intersection of the
Maxillary Incisor Long
Axis and the Mandibular
Incisor Long Axis.
7) IMPA
The angle formed by
the intersection of
the Mandibular
Incisor Long Axis
and the Mandibular
Plane.
 8) FMIA

Frankfort Mandibular
Incisor Angle

 It determines the most

protrusive mandibular
central incisor in relation
to the Frankfort horizontal
plane.
9) FMA (FRANKFORT
MANDIBULAR ANGLE)

The angle formed by

the intersection of the
Frankfort Plane and the
Mandibular Plane.
Relates the steepness of the mandibular
plane when compared to the cranial base
represented by the FH plane. It is a fair
indication of the direction of growth
potential
An angle of 25 degrees is considered to be
average in children, with balanced horizontal
and vertical growth potential (Angle Class I
normal case).

A measurement of 30 degrees is
considered to indicate a “high” angle case,
which may pose difficulties in treatment
because of excessive vertical (predominantly
downward, instead of a balance between
downward and forward growth).
 An average of less 20 degrees, a “low”
angle case, indicates that the growth
potential is predominantly horizontal or
forward.
In general, children in the latter category are
better candidates for treatment in a general
practice. Most appliance therapy opens the bite,
so the child is better off if he is being treated
toward the norm rather than away from it.
12) Y- AXIS ANGLE
It is measured at the
Intersection of FH plane
and Y-axis (S-Gn), it
determines the direction
of growth potential of
the mandible in a child
and is considered 3
times more sensitive than
the FMA.
SNA– maxilla is forward

SNA – maxilla is back

SNB – prognathic mandible

SNB – less than normal

mandible is retruded
 If ANB is 2 degrees
- maxilla and mandible relate normally.
- tells relationship between maxilla
and mandible but could be forward
or backward.
If ANB is 10 degrees
- mandible is back as related to maxilla
If ANB is (-)5 in relation to maxilla,
mandible is forward.

Negative indicates Class III malocclusion.

If U1-SN is 103 degrees and U1- FH is 115
degrees it means normal inclination of
maxillary incisors.
S-N GoGn (Mandibular Angle)
FMA ( Frankfort Mandibular Angle)
OMA (Occlusal Mandibular Angle)

These 3 angles tells the growth pattern

Whether horizontal or vertical
High Y axis Angle – vertical growth
High FMA – vertical growth
Low FMA – horizontal growth
If FMIA is larger than 65 degrees lower
central incisors are vertical or lingually
tipped.

If FMIA is smaller than 65 degrees lower

incisors are tipped labially into a more
protrusive relation.
If IMPA is 7 degrees – lower incisors are
upright,
If IMPA is 98 degrees – low incisors are
flared,
If IMPA is 103 degrees with severe
crowding – this is an EXTRACTION case.
U1- L1 ( Interincisal Angle)
- tells about the flaring of upper or lower
incisors
STEINER’S ANALYSIS
 SNA  UI/ LI
 SNB  U1-NA
 ANB  L1-NB
 Occ-SN  Pog-NB
 GoGn SN  ELLP
Occ- SN
 SN plane and Occlusal
plane
GoGnSN

Mandibular plane and

SN plane

Go

GN
ELLP
 Esthetic Lip line plane
13. U1- N – A
(linear and angle)
The perpendicular
linear distance from
the facial surface of
the maxillary incisor
to the N- A Plane.
14) L1 – N- B
(linear and angle)
The perpendicular
linear distance from
the facial surface of
the mandibular incisor
to the N-B Plane.
15) L1 – A – Po

The perpendicular
linear distance from
the mandibular incisor
to the tip of the A- Po
Plane.
16) Po- N – B
The perpendicular
linear distance from
Pogonion to the N- B
Plane.
ANGLE MEAN RANGE BELOW ABOVE
degrees degrees
SNA 79.2- 89.8 retruded protruded Maxilla

SNB 86.977.1- retruded protruded Mandible

ANB 0-5 Class III Class II Antero posterior

Skeletal Pattern
Occ-SN 9-18 Flat Steep Occlusal plane/
Growth pattern
GoGnSN 24.4-38.2 low high Vertical growth
pattern
U1/L1 122.8-139.2 Acute Obtuse Dental pattern
labioverted linguoverted
U1-NA 7.6-31.8 linguoverted labioverted Upper incisor
inclination
3.5-9.3 mm Lingually Labially Upper incisor
positioned positioned position
L1-NB 23.2- 35.8 Linguoverted labioverted Lower incisor
inclination
5.2-9.8 mm Lingually Labially Lower incisor
positioned positioned position
Pog-NB -0.5- 1.9mm Deficient chin Prominent chin Chin position

ELLP Upper lip – 0 mm concave convex Facial profile

Lower lip - 0 mm