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A radiograph of the head taken in a Cephalometer (Cephalostat) that is a head-holding device introduced in 1931 by B. H. Broadbent in the USA and by H. Hofrath in Germany. The original design included two ear rods for insertion into the external auditory canals, an infraorbital pointer and a forehead clamp, to achieve parallelism of the Frankfort plane with the floor. The cephalometer is used to obtain standardized and comparable craniofacial images on radiographic film.
vertical line offers the advantage of no variation (since it is generated by gravity) and is used with radiographs obtained in natural head position.
Cephalometric Tracing
A Cephalometric tracing is an overlay drawing produced from a cephalometric radiograph by digital means and a computer program or by copying specific outlines from it with a lead pencil onto acetate paper, using an illuminated view-box. Tracings are used to facilitate cephalometric analysis, as well as in superimpositions, to evaluate treatment and growth changes.
Computerized Cephalometrics
The process of entering cephalometric data in digital format into a computer for cephalometric analysis. Digitization (of radiographs) is the conversion of landmarks on a radiograph or tracing to numerical values on a two- (or three-) dimensional coordinate system, usually for the purpose of computerized cephalometric analysis. The process allows for automatic measurement of landmark relationships. Depending on the software and hardware available, the incorporation of data can be performed by digitizing points on a tracing, by scanning a tracing or a conventional radiograph, or by originally obtaining computerized radiographic images that are already in digital format, instead of
conventional radiographs. Computerized cephalometrics offers the advantages of instant analysis; readily available race-, sex- and agerelated norms for comparison; as well as ease of soft tissue change and surgical predictions.
Moire Diffraction
This is a technique with many applications in medicine, is used mainly to
map three-dimensional contour. In orthodontics it has been used for evaluation of facial asymmetry. The technique uses a series of lines produced by a transparent grid. The grid is placed in front of the object that is to be contour-mapped. A light source is offset from the viewing angle. The light passes through the diffraction grading twice: firstly on its way from the source to the object and secondly after it has been reflected off the object. It then is recorded by a film or viewed by an investigator. An interference pattern of light and dark lines or fringes is created; each fringe represents a set of equidistant points from the grid. The fringes appear superimposed on the object as a series of contour plots of similar elevation. The method is limited by the viewing angle of the system to the object. Areas of rapid elevation change on the object are difficult to characterize because of inability to distinguish the line separation. This requires evaluation of the object from different viewing angles.
Occlusogram
An occlusolgram is a graphic representation of the arches from the occlusal view. Occlusograms are mainly used as treatment planning aids to assist in defining the specific tooth movements required within and between arches (in the sagittal and transverse planes) to achieve treatment goals. An occlusogram is essentially a two-dimensional diagnostic setup and is directly correlated with the Visual Treatment Objective (VTO). It can be constructed from tracings of radiographs or photographic or photostatic copies of the occlusal aspects of the maxillary and mandibular study casts. The tracings of the teeth of both arches are superimposed on each other to reproduce the existing occlusal relationship, using index points that are marked on the images or models and subsequently transferred to the tracings. Anticipated movements of individual teeth as well as the need for extractions then can be determined, to simulate the desired treatment goal.
Superimposition
Superimposition is the process of placing two images upon each other, registering on structures that remain relatively stable during the time period separating the two images, to evaluate the changes brought about by growth and/or treatment. In orthodontics, most commonly applies to cephalometric tracings or occlusograms.
Reference Lines
A reference line is a line that is used as a basis for superimposition, or for comparison when several measurements are performed. Reference lines ideally should be stable with time and should not be affected by treatment. Because the cant or inclination of all intracranial reference lines is subject to biologic variation, it often is claimed that they are unsuitable for meaningful cephalometric analysis. Registration of the head in its natural position has the advantage that an extracranial "true" vertical or horizontal line can be used as a reference line for cephalometric analysis.
Cephalometric landmarks
Readily recognizable points on a cephalometric radiograph or tracing, representing certain hard or soft tissue anatomical structures (anatomical landmarks) or intersections of lines (constructed landmarks). Landmarks are used as reference points for the construction of various cephalometric lines or planes and for subsequent numerical determination of cephalometric measurements. In the definitions of the specific landmarks the following convention is used: "midsagittal" identifies landmarks lying on the midsagittal plane, "unilateral" identifies landmarks corresponding to unilateral structures and "bilateral" applies to landmarks corresponding to bilateral structures.
SUBTERMS: A-point (Point A, Subspinale, ss) Anterior nasal spine (ANS) Articulare (Ar) B-point (Point B, Supramentale, sm) Basion (Ba) Bolton (Bo) Condylion (Co) Crista galli Dacryon Glabella (G) Gnathion (Gn) Gonion (Go) Incision inferius (Ii) Incision superius (Is) Infradentale (Id, Inferior prosthion) L-point Menton (Me) Nasion (N, Na) Opisthion (Op) Orbitale (Or) Pogonion (Pog, P, Pg) Porion (Po) Posterior nasal spine (PNS) Prosthion (Pr, Superior prosthion, Supradentale) Pterygomaxillary fissure (PTM, Pterygomaxillare) R-point (Registration point) Sella (S) Cervical point (C) Inferior labial sulcus (Ils) Labrale inferior (Li) Labrale superior (Ls) Pronasale (Pn) Soft tissue glabella (G) Soft tissue menton (Me) Soft tissue nasion (N, Na) Soft tissue pogonion (Pg, Pog) Stomion (St) Stomion inferius (Sti)
Stomion superius (Sts) Subnasale (Sn) Superior labial sulcus (Sls) Trichion (Tr) Soft tissue gnathion (Gn)
Anterior nasal spine (ANS) The tip of the bony anterior nasal spine at the inferior margin of the piriform aperture, in the midsagittal plane. It corresponds to the anthropological point acanthion and often is used to define the anterior end of the palatal plane (nasal floor). (midsagittal)
Articulare (Ar)
A constructed point representing the intersection of three radiographic images: the inferior surface of the cranial base and the posterior outlines of the ascending rami or mandibular condyles. It was meant to substitute condylion when the latter is not readily discernible. Any movement of the mandible (i.e. opening or closing) will change the location of articulare. (bilateral)
B-point (Point B, Supramentale, sm) The deepest (most posterior) midline point on the bony curvature of the anterior mandible, between infradentale and pogonion. (midsagittal)
Basion (Ba) The most anterior inferior point on the margin of the foramen magnum, in the midsagittal plane. It can be located by following the image of the slope of the inferior border of the basilar part of the occipital bone to its posterior limit, superior to the dens of the axis. (midsagittal)
Bolton (Bo) The highest points on the outlines of the retrocondylar fossae of the occipital bone, approximating the center of the foramen magnum. Named after C. B. Bolton. (bilateral)
CC Point (CC) Ricketts (Cranial Center) Crossing of the facial axis with the BaN plane
Cervical point (C) The innermost point between the submental area and the neck in the midsagittal plane. Located at the intersection of lines drawn tangent to the neck and submental areas. (midsagittal)
Condylion (Co) The most superior posterior point on the head of the mandibular condyle. (bilateral)
Crista galli A vertically elongated, diamond-shaped radiopacity, appearing between the orbital outlines on postero-anterior cephalometric radiographs. Its location is used to establish a midsagittal reference plane. (midsagittal)
Dacryon The point of intersection of the frontomaxillary, lacrimomaxillary and frontolacrimal sutures. An anatomic reference point used to record interorbital distance. (bilateral) Orbital hypertelorism The increased distance between the medial orbital walls, reflecting an increased distance between the orbits (greater than 2 standard deviations from the norm). The anatomic landmarks used commonly for the measure-ment of interorbital distance are the dacryon points (bilaterally). Hypertelorism is described on the basis of skeletal measurements, because the presence of epicanthal folds or strabismus (exotropia), or other soft-tissue variations such as increased distance between the medial canthi (telecanthus) clinically may give a false impression of hypertelorism. Orbital hypertelorism is common in a number of craniofacial malformations such as Crouzon syndrome and frontonasal dysplasia. Compare with Telecanthus
DC Point (Ricketts) Center of the neck of the condyle on the Basion Nasion line.
Glabella (G) The most prominent point of the anterior contour of the frontal bone in the midsagittal plane. (midsagittal)
Gnathion (Gn) The most anterior inferior point on the bony chin in the midsagittal plane. (midsagittal)
Gonion (Go) The most posterior inferior point on the outline of the angle of the mandible. It may be determined by inspection or it can be constructed by bisecting the angle formed by the intersection of the mandibular plane and the ramal plane and by extending the bisector through the mandibular border. (bilateral)
Infradentale (Id) Inferior prosthion Pr The most superior anterior point on the mandibular alveolar process, between the central incisors. (midsagittal)
The incisal tip of the most labially placed mandibular incisor. (unilateral)
Incision superius (Is) or A1 (Ricketts) The incisal tip of the most labially placed maxillary central incisor. (unilateral)
L-point A point located in the anterior surface of the cortical plate, labial to the apices of the maxillary central incisors. Introduced by F. P. G. M. van der Linden, as a point representing the anterior border of the maxillary apical area. (midsagittal) Labrale inferior (Li) The point denoting the vermilion border of the lower lip, in the midsagittal plane. (midsagittal)
Labrale superior (Ls) The point denoting the vermilion border of the upper lip, in the midsagittal plane. (midsagittal)
Menton (Me) The most inferior point of the mandibular symphysis, in the midsagittal plane. (midsagittal)
Molar Upper First (Ricketts) Point on the occlusal plane perpendicular to the distal surface of the crown of the upper first molar.
Point on the occlusal plane perpendicular to the distal surface of the crown of the lower first molar.
Nasion (N, Na) The intersection of the internasal and frontonasal sutures, in the midsagittal plane. (midsagittal
Opisthion (Op) The most posterior inferior point on the margin of the foramen magnum, in the midsagittal plane. (midsagittal)
Orbitale (Or) The lowest point on the inferior orbital margin. (bilateral)
The most anterior point on the contour of the bony chin, in the midsagittal plane. Pogonion can be located by drawing a perpendicular to mandibular plane, tangent to the chin. (midsagittal)
Porion (Po) The most superior point of the outline of the external auditory meatus ("anatomic porion"). When the anatomic porion cannot be located reliably, the superior-most point of the image of the ear rods ("machine porion") sometimes is used instead. (bilateral)
Posterior nasal spine (PNS) The most posterior point on the bony hard palate in the midsagittal plane; the meeting point between the inferior and the superior surfaces of the bony hard palate (nasal floor) at its posterior aspect. It can be located by extending the anterior wall of the pterygopalatine fossa inferiorly, until it intersects the floor of the nose. (midsagittal)
Pronasale (Pn)
The most prominent point of the tip of the nose, in the midsagittal plane. (midsagittal)
Prosthion (Pr, Superior prosthion, Supradentale) The most inferior anterior point on the maxillary alveolar process, between the central incisors. (midsagittal)
Protruberance Menti (Pm) or Supra pogonion (Ricketts) A point where the curvature of the anterior border of the symphysis changes from concave to convex,
Pterygoid Point (Pt) Ricketts Lower lip of foramen rotundum (Represents the position of the sphenoid bone) posterior superior tangent of the pterygomaxillary fissure
Pterygoid Root (Pr) Ricketts Most posterior point on the outlines of the pterygopalatine fossa
Pterygomaxillary fissure (PTM, Pterygomaxillare) A bilateral, inverted teardrop-shaped radiolucency, whose anterior border represents the posterior surfaces of the tuberosities of the maxilla. The landmark is taken at the most inferior point of the fissure, where the anterior and the posterior outline of the inverted teardrop merge with each other. (bilateral)
R-point (Registration point) A cephalometric reference point for registration of superimposed tracings,
introduced by B. H. Broadbent, Sr. , in his original presentation of the cephalometric technique. It is the midpoint on a perpendicular drawn from sella to the Bolton-nasion line. (midsagittal)
Sella (S) The geometric center of the pituitary fossa (sella turcica), determined by inspectiona constructed point in the midsagittal plane. (midsagittal)
Soft tissue glabella (G) The most prominent point of the soft tissue drape of the forehead, in the midsagittal plane. (midsagittal)
The most inferior point of the soft tissue chin, in the midsagittal plane. (midsagittal)
Soft tissue nasion (N, Na) The deepest point of the concavity between the forehead and the soft tissue contour of the nose in the midsagittal plane. (midsagittal)
Soft tissue pogonion (Pg, Pog) The most prominent point on the soft tissue contour of the chin, in the midsagittal plane. (midsagittal)
Stomion (St) The most anterior point of contact between the upper and lower lip in the
midsagittal plane. When the lips are apart at rest, a superior and an inferior stomion point can be distinguished. (midsagittal) Stomion inferius (Sti) The highest midline point of the lower lip. (midsagittal) if lips are apart Stomion superius (Sts) The lowest midline point of the upper lip. (midsagittal) if lips are apart
Subnasale (Sn) The point in the midsagittal plane where the base of the columella of the nose meets the upper lip. (midsagittal)
Superior labial sulcus (Sls) Soft Tissue Point A The point of greatest concavity on the contour of the upper lip between subnasale and labrale superius, in the midsagittal plane. (midsagittal)
Soft Tissue B or Inferior labial sulcus (Ils) The point of greatest concavity on the contour of the lower lip between labrale inferius and menton, in the midsagittal plane. (midsagittal)
Trichion (Tr) An anthropometric landmark, defined as the demarcation point of the hairline in the midline of the forehead. (midsagittal) No Picture
Xi Point (Xi) approximate for Inferior alveolar foramen (Ricketts) A constructed point located at the geographic center of the ramus as indicated
below.
SUBTERMS: A-B plane Basion-Nasion line (Ba-N) Bolton plane Campers base plane De Coster line E-line (E-plane, Esthetic line of Ricketts) Facial axis of Ricketts Facial plane (FP, Facial line) Frankfort horizontal plane (FH, Frankfort horizontal line, Auriculo-orbital plane, Eye-ear plane) H-line (Harmony line of Holdaway) Intergonial line Mandibular plane (MP, Mandibular line, ML) Nasion-perpendicular Occlusal plane (OP) Palatal plane (ANS-PNS, PP, Nasal line, Nasal floor, Spinal plane) Rees esthetic plane Reference line Riedel plane S-line (Esthetic plane of Steiner) Sella-Nasion line (SN, Nasion-Sella line, NSL) True horizontal line True vertical line Y-axis (Growth axis) Z-line (Profile line of Merrifield)
A-B plane
A line joining points A and B. As part of the Downs analysis, the superior angle formed by the intersection of the A-B plane and the facial line (N-Pog) is measured to evaluate the relation of the anterior limit of the apical bases to each other, relative to the facial line. This angle is negative in patients with skeletal Class II and positive in patients with skeletal Class III malocclusions.
Bolton plane
A line connecting points Bolton and nasion; an alternate representation of the cranial base.
No Picture
De Coster line
A reference line proposed by L. De Coster as a stable area for cephalometric superimposition. It extends from the image of the anterior clinoid process along the planum sphenoidale and the anterior cranial edge of the sphenoethmoidal synchondrosis to the cranial aspect of the cribriform plate, terminating at the internal osseous line of the frontal bone above the crista frontalis.
E-line
A line tangent to the chin and nose, introduced by R. M. Ricketts for assessment of lip fullness. According to him, the lower lip should fall slightly ahead of the upper lip when related to this line.
Frankfort horizontal plane (FH, Frankfort horizontal line, Auriculo-orbital plane, Eye-ear plane)
An anthropological horizontal plane described on dry skulls as passing through the lowest point in the floor of the left orbit and the highest point on the margins of the external auditory meati. The plane was adopted at the 13th General Congress ofGerman Anthropologists in Frankfort, Germany in 1882 and later was endorsed by the International Agreement for the Unification of Craniometric Measurements in Monaco (1906) as a plane approximating the true horizontal line when the head is in an upright position. On a lateral cephalometric radiograph, the Frankfort horizontal plane is represented by a line connecting the cephalometric landmarks porion and orbitale.
Intergonial line
A line on a P-A cephalogram or tracing, connecting the gonion points to each other.
Nasion-perpendicular
A line drawn perpendicular to the Frankfort horizontal from nasion. A reference line for anteroposterior measurements in the McNamara analysis.
Palatal plane (ANS-PNS, PP, Nasal line, Nasal floor, Spinal plane)
A line joining PNS and ANS.
Riedel plane
A line on which the upper lip, lower lip and chin should fall in esthetic profiles, according to R. A. Riedel. A concept similar to the esthetic plane of Steiner, although not taking into account the nasal prominence.
tissue pogonion. According to C. C. Steiner, the lips should fall on this line and any deviation shows prominence or flatness of the lips.
No picture
Z-line (Profile line of Merrifield) A line tangent to pogonion from the most prominent of the lips, introduced by L. L. Merrifield for soft tissue profile assessment. According to him, in well-balanced faces the upper lip should fall on the line and the lower lip should be slightly behind.
ANB angle
The difference between angles SNA and SNB, as introduced by R. A. Riedel, aiming at providing an evaluation of the anteroposterior relationship between the maxillary and mandibular apical bases. The measurement is not specific as to the location of the deformity.
SNA angle
A commonly used measurement (of the Steiner analysis) introduced by R. A. Riedel for assessment of the anteroposterior position of the maxilla with regards to the cranial base. The inferior posterior angle formed by the intersection of lines SN and NA is measured.
SNB angle
A measurement introduced by R. A. Riedel to evaluate the anteroposterior
position of the mandible in relation to the cranial base (also part of the Steiner analysis). The inferior posterior angle formed by the intersection of lines NA and NB is measured.
Bolton triangle
A triangle formed by connecting points Bolton, nasion and sella, representing the area of the cranial base to which the face is joined. It was believed by B. H. Broadbent, Sr. to be the most stable reference for superimposition of serial cephalograms.
An appraisal of the face in the vertical dimension. The anterior lower facial height is expressed by the linear millimetric distance between the ANS and menton, measured directly, or along the true vertical line. The percent ratio of the previous linear measurement (ANS-Me) over the total anterior facial height (N-Me)measured in the same wayprovides an assessment of the relative proportionality of the anterior face in the vertical dimension. The measurement is obviously not specific as to the location of the deformity. Similarly, the linear measurement from S to Go on the lateral cephalometric radiograph provides an assessment of posterior facial height. The ratio of posterior face height x 100/anterior face height, according to the recommendations of J. R. Jarabak and J. A. Fizzel, can give an estimate of growth direction.
Ricketts
A measurement introduced by R. A. Holdaway to evaluate the relative prominence of the mandibular incisors, as compared to the size of the bony chin. It is calculated as the ratio of the linear distance from the labial surface of the mandibular central incisor to the NB line, over the linear distance of the chin to the same line.
Interincisal angle
A measurement of the degree of procumbency of the incisor teeth, introduced by W. B. Downs as the (posterior) angle formed by the intersection of the long axes of the maxillary and mandibular central incisors.
LI-to-AP distance
The perpendicular distance (in mm) of the incisal edge of the mandibular central incisors to the A-Pog line. A measurement of the Downs analysis, expressing the degree of protrusion of the mandibular incisors.
Interlabial gap
The vertical distance between the upper and lower lip, measured with the lips at rest.
A linear measurement from soft tissue menton to stomion inferius, measured along the true vertical line.
UI-to-AP distance
The perpendicular distance (in mm) of the incisal edge of themaxillary central incisors to the A-Pog line. A measurement of the Downs analysis, expressing the degree of protrusion of the maxillary central incisors.
Tweed cephalometric analysis A set of three angular measurements (which constitute what has come to be known as the Tweed triangle), introduced by C. H. Tweed in 1946. The three angles that were originally described are the FMA (Frankfort-mandibular plane angle), the IMPA (Incisor-mandibular plane angle) and the FMIA (Frankfort-mandibular incisor angle). Their norms, as advocated by Tweed, were based on a sample of 95 individuals (some of whom were orthodontically treated) who according to him had good balance of facial outline, rather than ideal. The reference plane for the analysis is the Frankfort horizontal plane. Tweeds entire philosophy of diagnosis and treatment was built around the relationship of the mandibular incisors to the mandibular plane of 90 degrees (IMPA angle).
Wits appraisal
A measurement introduced by A. Jacobson, designed to avoid the shortcomings of the ANB angle in evaluating anteroposterior jaw disharmonies. The method entails drawing perpendicular lines on a tracing of a lateral cephalogram from points A and B, ontothe functional occlusal plane (which is drawn through the region of the overlapping cusps of the first premolars and molars) and subsequently measuring the distance between the two points of intersection of the two perpendicular lines with the functional occlusal plane, along the latter. The greater the deviation of this reading from 0 mm in females and 1.0 mm in males, the greater the degree of sagittal discrepancy between the maxilla and mandible. The Wits appraisal is a linear measurement and not an analysis, per se. It is simply an adjunctive diagnostic aid that can be useful in assessing the extent of anteroposterior skeletal dysplasia and in determining the reliability of the ANB angle. [The name is an abbreviation for "University of Witwatersrand," in Johannesburg, South Africa, where this appraisal was developed.