Sie sind auf Seite 1von 10

COGS ANALYSIS

Cephalometric for orthodontic surgery usually have facial asks well as tooth
positions that must be modified by a combined orthodontic and surgical treatment. For
this reason a specialized Cephalometric appraisal system called Cephalometric for
orthognathic surgery (COGS).
The cogs system describe the Horizontal and vertical positions of the facial bones
by use of constant co-ordinate system, the sizes of bones are represented by direct linear
dimensions and their shapes, by angular measurements. COGS analysis describes dental,
skeletal, and soft tissue variations.

The land marks used are


1. Sella (S) - the center of the pituitary fossa.
2. Nasion (N) - The most anterior point of the nasofrontal suture in the
Mid-sagittal plane.
3. Articular (Ar) - The intersection of basisphenoid and the posterior border of
the condyle mandibularis.
4. Pterygomaxillary fissure (PTM) - The most posterior point on the anterior contour of
the maxillary tuberosity.

5.Subspinale (A) - The deepest point in the mid-sagittal plane between the
Anterior nasal spine and prosthion usually around the level
of and anterior to the apex of the maxillary central
incisors.
6. Pogonion (Pg) - The most anterior point in the mid-sagittal plane of the
contour of the chin.
7. Supramentale - Mid-sagittal plane between infradental and Pg. usually
anterior to and slightly below the apices of the mandibular
incisors.
8. Anterior Nasal spine (ANS)- the most anterior point of the contour of the mandibular
symphysis.
9. Menton (Me) - The lowest point of the contour of the mandibular
symphysis.
10. Gnathion (Gn) - The mid-point between Pg and Me located by bisecting the
facial line. N-Pg and the mandibular plane (lower bordor).
11. Posterior Nasal Spine (PNS) - The most posterior point on the contour of the palate.
12. Mandibular plane (MP) - A plane constructed from Me to the angle of the mandible
(GO).
13. Nasal floor (NF) - A plane constructed from PNS to ANS.
14. Gonion (GO) - Located by bisecting the posterior ramal plane and the
mandibular plane angle.

Horizontal plane (HO)


It is the constructed base line for comparison of most of the data in this analysis.
Constructed by drawing a line from the line S to N. mopst measurements will be made
from projections either parallel to HP (11HP) or perpendicular to HP (L HP).
CRANIAL BASE – Ar TO N parallel to HP – It denotes the length of the cranial base.
Ar – Ptreygomaxillary fissure (Ar-Ptm) parallel to HP
Horizontal distance between the posterior aspects of the mandible and maxilla.
The greater the distance between Ar-Ptm the more the mandible will lie posterior
to the maxilla assuming that all other facial dimensions are normal. Therefore one casual
factor for prognathism or retrognathism can be evaluated by this measurement of the
crtanial base.

Horizontal Skeletal Profile


Marked as +ve
All the measurements made are parallel to horizontal plane. This measurements
are very important as most surgical corrections are primarily made in antero-posterior
direction.

Marked as –ve
Angle of skeletal convexity
The angle formed by the line N – A and a line A to Pg. the N – A – Pg angle gives
an indication of the overall facial convexity.

Convex face : +ive angle


Concave face : -ve angle

A clockwise angle is +ive and a counter wise angle is negative –ve.

PROGNATHIC AND RETROGNATHIC MAXILLA AND MANDIBLE IN THE


HORIZONTAL PLANE
It is foundout in the following method:
A perpendicular line from HP is dropped through N.
If this line passes behind the point –B – it is called mandibular prognathism and it
is marked as +ve.
If this line passes infront of point B – it is called mandibular retrognathism and it
is marked as –ve.
N – A is the horizontal distance of the maxilla from point – A to the N line
(perpendicular line from HP at N).
This measurements are related measurements are useful in the planning of
treatment of anterior mandibular and maxillary horizontal advancement or reduction.

CHIN PROMINENCE
Perpendicular line from the horizontal plane is dropped from the point – N.
Distance from pogonion to this line is N – Pg.
This indicates the prominence of the chin.
Any unusually large or small value that is obtained must be compared with N – B
and B – Pg (the distance from B point to a line perpendicular to MP through Pg) to
determine if discrepancy is in the –alveolar process, the chin or the mandibular proper.
These measurements help to determine if there is a horizontal genial hyperplasia
or hypoplasia. After all these measurements are considered the surgeon has a quantitative
skeletal Cephalometric facial description of the horizontal anterior facial discrepancy.

VERTICAL SKELETAL AND DENTAL


Vertical skeletal discrepancy may reflect an anterior, posterior or complex
dysplasia of the face. Therefore the vertical skeletal Cephalometric measurements are
divided into anterior and posterior components. The anterior component is sub-divided
into
1. Middle third facial height
- Measured distance from N to ANS – perpendicular to horizontal plane.
2. Lower third facial height
- Measured distance from ANS to Gn
- Perpendicular to horizontal plane.
Posterior component is sub-divided into:
1. Posterior maxillary height
- is the length of a perpendicular line dropped from HP intersecting the PNS.
2. Posterior Divergence of the Mandible
- It is shown by the MP angle. It is the angle formed between a line from Go-Gn
(mandibular plane) and HP as it intersects at Gn.

This angle relates the posterior facial divergence with respect to anterior facial
height. Posterior maxillary height and the MP angle define the vertical dysplasia of the
posterior components.
Vertical skeletal measurements of the anterior and posterior components of the
face will help in the diagnosis of anterior, posterior or total vertical maxillary hyperplasia
or hypoplasia, and clockwise or counter clockwise o\rotations of the maxilla and the
mandible.
The typical surgical correction of these problems includes total maxillary vertical
advancement or reduction, anterior maxillary vertical augmentation or reduction,
posterior maxillary vertical augmentation or reduction, combinations of anterior and
posterior maxillary vertical augmentation or reduction and mandibular ramus rotation and
ramus height reduction.

VERTICAL DENTAL DYSPLASIA


It is divided into anterior and posterior components.

ANTERIOR MAXILLARY DENTAL HEIGHT


Perpendicular line is dropped from the incisal edge of mandibular central incisor
to MP – and the linear measurement is taken.
The total vertical dimension of the premaxilla from the MP perpendicular to the
tip of the maxillary incisor crown is represented by perpendicular ∟1 – NF.
The total vertical dimension of the anterior mandible from the MP perpendicular
to the tip of the mandibular incisors crown is represented by ┌1 to MP.
These two measurements define how far the incisors have erupted in relation to
NF and MP respectively.
POSTERIOR DENTAL MEASUREMENT
It is sub-divided into
1. 6 – NF is the perpendicular length of a line through the maxillary first molar
mesiobuccal tip of the cusp constructed to MP.
2. 6 – MP is a similar line through the mandibular 1st molar mesiobuccal tip of the
cusp constructed to MP.
The posterior dental mandibular vertical height or molar eruption is represented
by ┌6 – MP.
These values should be related to ANS-GN and MP-HP to establish whether the
origin of maxillary and mandibular discrepancies is skeletal, dental or a combination of
both.

MAXILLA AND MANDIBLE

Total effective length of the maxilla:

Is the distance from ANS to PNS that is projected on a line parallel to the HP.

ANS – PNS distance – N – ANS and PNS – N give a quantitative description of the
maxilla in the skull complex.

MANDIBLE

Ar to GO - length of the mandibular ramus.


Go – Pg - Length of the mandibular body.
Ar – Go- Gn - Is the gonial angles that represents the relationship between
the ramal plane and mandibular plane.
B – Pg - Is the distance between from B point to a line perpendicular
to MP through Pg. This short line describes the prominent
of the chin related to the mandibular denture base.

These measurements are helpful in the diagnosis of variat ons in ramus height that
effect open bite or deep bite problems increased or diminished mandibular body length
acute or obtuse Go angles that also contribute to skeletal open or closed bite and finally
as an assessment of chin prominence. These mandibular problems may be isolated or may
occur in any combination.

DENTAL
The occlusal plane is a line drawn from the buccal groove of both first permanent
molars through a point 1 mm apical of the incisal edge of the central incisor in each
respective arch. The OP angle is the angle formed between this plane and HP. If the teeth
overlap anteriorly to produce an over bite the OP can be drawn as a single line. If an
anterior open bite is present according to the criteria listed previously two OP must be
drawn and measured separately to establish the angles formed with HP. Each OP is
assessed as to its steepness or fitness. Vertical facial and dental heigj\hts should be
considered to determine which OP should be corrected.
An increased OP-HP may be associated with skeletal open bite, lip incompetence,
increased facial height, retrognathia or increased M.P. angle.

A decreased OP – HP may be associated with a deep bite, decreased facial height


or lip redundancy.

The measurement AB-OP is constructed by dropping a perpendicular line to OP


from points A and B respectively and then measuring the distance between these two
linear intersections. This distance is the relationship of the maxillary and mandibular
apical base to the OP. If the A.B distance is large with point B projected posteriorly to
point A (a negative number) mandibular denture base discrepancy that predisposes to a
cl.II occlusion is present. A linear measurement is used in this analysis rather than the
more familiar ANB angular measurement because it enables the surgeon to better
visualize the discrepancy along the lines he may use in planning surgical correction.

LU1 –NF(angle) - constructed from a line drawn from the incisal edge of the
incisors through the tip of the root to the point of intersection with NF.

LL1 – MP - the angulation of the mandibular central incisor to


mandibular plane.

These angulations determine the procumbancy of the incisor and are vital is assessing the
long term stability of the dentition.
BJORK-JARABAK’S ANALYSIS
Bjork had a very outstanding performance as investigator in the field of
Cephalometric analysis. In several papers published between 1947 and 1963 he studied
the behavior of craniofacial structures during growth. His observations are based on a
study of approximately 300 children aged 12 and a similar number of soldiers whose ages
ranged from 21 to 23 in whom almost 90 measurements were determined.
In this chapter we will refer to Bjork’s polygon, analyzing the measurements we
consider most important for the study of the two aspects mentioned above:
 Direction and amount of growth potential.
 Supplement to the study of the facial type.
This subject will be developed in the following order.
1. Tracing of the polygon – planes and angles.
2. Interpretation of angle measurements.
3. Angle measurements ratio. Total sum.
4. Linear measurements.
5. Relationship among linear measurements.
6. Posterior to anterior facial height ratio.

POINTS OF REFERENCE:
Na (Nasion): a point in the anterior bordor of the frontonasal suture.
S (Sella turcica): geometric center of the sella turcica.
Ar (Articulare): point where the posterior bordor of the neck of the condyle intersects the
inferior contour of the spheno occipital bones.
Go (Gonion): intersection of the tangent to the posterior bordor of the ramus and the
tangent to the inferior bordor of the body of the mandible.
Me (Menton): most inferior point of the symphysis mandible.

TRACING OF THE POLYGON


Planes:
1. S – Na. Anterior cranial base.
2. S – Ar. Posterior cranial base.
3. Ar – Go. Ramus height.
4. Go – Me. Mandibular body length.
5. Na – Me. Anterior facial height.
6. S – Go. Posterior facial height.
7. Go – Na. It divides the gonial angle in two halves, a upper and an inferior one.
Lines Na – Pog and S – Gn shown on standard tracings have been omitted since they
are not considered useful in our approach to Bjork’s polygon.

Angles of the polygon:


1. Saddle angle Na – S – Ar
2. Articular angle S – Ar – Go
3. Gonial angle Ar – Go – Me
4. Upper gonial angle Ar – Go - Na
5. Lower gonial angle Na – Go – Me
INTERPRETATION
Interpretation of angle measurements
Saddle angle
Also called seat angle, it is formed by the union of the anterior cranial base with
the posterior cranial base.
The anterior cranial base is represented by the line between nasion (the most
anterior on the nasofrontal fissure) to point s (geometric center of the sella turcica).
The posterior cranial base is represented by the line traced between point S and
point Ar.

The norm for this saddle angle is 122*.


A high angle indicates a more horizontal S – Ar line while a lower angle indicates
that the line is more vertical. This variation also results in a different location of the
glenoid cavity thus influencing the mandible position anteroposteriorly.
As regards growth, in cases of angles lower than the norm, there will be a
downwards and slightly backwards displacement of the joint cavity resulting in a more
distal implantation of the mandible.
In other words, a mandible implanted more distally than the norm, will have to
grow more to reach an orthognathic profile; on the other hand, a forward implantation of
the condyle might cause, even with a normal growth of the mandible, a class III skeletal
profile.
This angle might be larger or lower than the norm in the three facial types. In
general, open angles are frequent in dolichofacial subjects, while closed angles are
usually seen in brachyfacial and mesofacial subjects.
Although the saddle angle cannot be modified by an orthodontic treatment, it is a
structural factor that should be taken into account in growth forecast, because mandibular
projection might result in different angulations.

Articular angle
Formed by the posterior cranial base (S-Ar) and the tangent to the posterior
bordor of the mandibular ramus (Ar-Go). The norm established by Bjork is 143*.
The position of the ramus is affected during growth and development by the
muscular environment and dentoalveolar growth.
Patients with vertically oriented rami will have high articular angles while lower
angles are correspondent with backward and upward rami projected forwardly and
downwardly.
A lower angle tends to favor mandibular prognathism, conversely, a higher angle
will favor retrognathism.
This is one of the two polygon angles that can be modified by treatment.

Gonial angle:
It is formed by the tangents to the posterior border of the mandibular ramus (Ar-
Go) and inferior border of the body of the mandible (Go-Me).
The norm for this angle according to Bjork is 130*.

It might be analyzed in terms of:


- Its total measure and then relating it to the two angles previously studied by
adding all three of them. This will later be explained.
- Its two parts, an upper and a lower part.

The upper gonial angle (or Ar-Go-Na) is formed by the tangent to the posterior border
of the ramus (Ar-Go) and by a line traced between the gonial angle and nasion (Go-Na).
The lower angle is formed by the union of the Go-Na line with the tangent to the inferior
border of the corpus (Go-Me), the angle is called Na-Go-Me.

The norm for the upper gonial angle is 70* to 75*.


The total gonial angle describes the shape of the mandible. This structure can be
considered as the center around which the rest of the face will adapt its growth; it also
determines the direction of growth of the lower half of the face.
Low angles characterize a square mandible, subtle antegonial notch, high
mandibular arch, brachyfacial type, and orthognathic profile.
Open gonial angles suggest a dolichofacial jaw, a low mandibular dental arch,
marked antegonial notch, convex profile and open facial axis.
The lower gonial angle describes the slant of the mandibular body. A high angle
indicates a downward inclination and a tendency for an open bite. A closed lower gonial
angle denotes a horizontal mandibular body and a tendency for an overbite.

Relationship between angles.


Total sum
All the angles mentioned in item 2 are closely related to each other because they
share sides.
For example, when line S-Ar (shared by both saddle angle and articular angle)
becomes more vertical it closes the saddle angle but opens the articular angle.
All the angles must be considered together because of their interdependence as
there are mechanisms of comparison that may lead isolated value to be misinterpretated
when it should actually be compensated with the value of an interdependent angle.
A practical way of three angles described (saddle angle, articulare angle and total
gonial angle). In doing so, compositions are eliminated and the “result” will show growth
direction.
The norm for the sum is 396* + 6*. A lower combined value suggests anterior
growth of the symphysis; a high angle predicts vertical growth and limited chin
advancement.

Linear measurements and their relationships


They are the measurements if the lines that form the 5 sides of the polygon:
 Anterior cranial base (S – Na)
 Posterior cranial base (S – Ar )
 Ramus height (Ar – Go)
 Length of the body of mandible (Go – Me)
 Anterior facial height (Na – Me)
 Posterior facial height (S – Go)

Relationship among linear measurements


Anterior cranial base – mandibular body length
The normal ratio is 1 to 1. for every 1 mm of growth of the anterior cranial base,
the mandibular body will grow 1 – 1.5 mm. where the mandibular body is longer than the
anterior cranial base by 3 – 5 mm, the mandible growth will be accelerated (higher than
1 : 1 ratio) and tend toward Class III.

Posterior cranial base – ramus height


According to Jarabak, a posterior cranial basetoramus height ratio of 3:4+
indicates a good vertical growth of the face. On the contrary, ratios closer to 1:1 indicate
deficient posterior facial height and probable retrognathism.

Posterior facial height / anterior facial height ratio


The facial axis indicates the direction of symphysis displacement as a result of
certain growth processes. It might result from mechanisms whose direction is
conditioned by the balance between the descent of glenoid cavities and vertical growth of
condyles (posterior part of the face) as opposed to the vertical downward displacement of
the maxilla and upward growth of the mandibular alveolar process (anterior part).
Bjork and Skieller, Luder, Teucher et. Al report that quotes by stockli are very useful to
understand how growth occurs in the anterior and posterior parts of the face and the
vertical and sagittal displacement brought about by such growth on the different facial
structures.
However, knowing the potential directions of growth, it is feasible to use this
information to design a treatment plan. From a descriptive standpoint, three types of
growth can be pointed out as regards direction.
A. Clockwise.
B. Downwards.
C. Counterclockwise.

Normal growth is counterclockwise because glenoid cavity and condyle growth


exceeds anterior vertical growth, pushing the symphysis forward.
In brachyfacial patients this imbalance between posterior growth / anterior growth, would
be even more pronounced, resulting in an increase of the posterior facial height and a
greater advancement of the symphysis, because there is a marked counterclockwise
growth. The direct relationship between posterior vertical growth and chin advancement
has been mentioned before.
Clockwise growth is characteristic of dolichofacial subjects. In this pattern
vertical growth of the maxilla and alveolar processes exceeds that of the posterior
structures, displacing the symphysis downward.
Direct downward growth will only occur when there is a balanced increase in
both areas, that is, when they are exactly alike.
One of the main objectives of treatment is to adapt to the patient’s growth. The
posterior facial height / anterior facial height ratio is critical for an accurate prospective
study on the type of potential growth the patient will have. Being one of the major
responses to treatment, this will be a valuable aid to accomplish treatment objectives.
When the posterior facial height (Na – Me), the face is retrognathic. There will be
less growth in the posterior sector than in an orthognathic face. This is a clockwise
growth, also called posterior rotational growth.
When the posterior facial height / anterior facial height ratio is 64 – 80%, the
growth of the mandible will undergo anterior rotation, counterclockwise growth, because
height increase will be greater in the posterior than in the anterior part of the face. This
can promote symphysis advancement as in Ricketts brachyfacial type.
In addition to the above mentioned ratios, that is 54 – 58% and 64 – 80%, the
intermediate value of 59 – 63% predicts neutral growth: cases growing directly
downward with neither clockwise nor counterclockwise rotation.
This is reflected in Roth’s directional spheres of craniofacial growth.

Das könnte Ihnen auch gefallen