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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.
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.
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.
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.
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.
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
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.
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.
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.
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*.
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.