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TEMPLATE ANALYSIS

Guided byDr. Mridula Trehan


(Prof. & H.O.D.)
Dept. of Orthodontics
& Dentofacial
Orthopaedics

Presented byDr. Jatin Sahwal


P.G. 2nd Year

CONTENTS
INTRODUCTION
MOOREES MESH DIAGRAM
TEMPLATE ANALYSIS
REGIONAL SUPERIMPOSITION
PROPORTIONATE TEMPLATE
CONCLUSION
REFERENCES

INTRODUCTION The cephalometric technique has


been used in the field of orthodontics
for over 60 years and has become an
important diagnostic aid in the
formulation of diagnosis and
treatment plan as of today.

Many a times clinicians take


statistical mean as the norm and tend
to treat the patients according to
them which in all cases may not be
the ideal treatment.
To overcome this a template analysis
was developed.

A cephalometric template is a set of


oriented rulers that permit size and
position to be measured in terms of
years of development.

T he "Moorees mesh which was


developed in the 1960s, presents the
patient's disproportions as the
distortion of a grid.

Athanasiou AE. Orthodontic Cephalometry, Mosby-Wolfe Publications.

The Moorees mesh can be used to


compare growth changes in
longitudinal studies where
proportions can be visualized rather
than the amount of growth.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

In recent years, direct comparison of


patients with templates derived from
the various growth studies has
become a reliable method of analysis
with the considerable advantage that
compensatory skeletal and dental
deviations within an individual can be
observed directly.

Athanasiou AE. Orthodontic Cephalometry, Mosby-Wolfe Publications.

Standardized lateral head radiographs of


46 men and 47 women from the greater
Boston area, representing a broad range
of normal occlusal variation, were used to
construct male and female norms for the
mesh diagram.
These radiographs were obtained as part
of the Longitudinal Studies of Child Health
and Development by the Department of
Maternal and Child Health, School of
Public Health, Harvard University.

Moorrees, Coenraad. Normal Variation and Its Bearing on the Use of Cephalometric
Radiographs in Orthodontic Diagnosis. Am. J. Orthodontics. 1953;39:942950.

TEMPLATE ANALYSISEach template is a compact set of


oriented rulers graduated in years (6 to 16
years). So a single template can be used
for the analysis.
There are no millimeter measurements or
degrees.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Male and female dianostic templates. The incisor


long axis (1/1) and Downs occlusal plane (DOP)
are depicted of 3 ages and articulare (Ar) for two.
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

The lines perpendicular to DOP represent maxillary and


mandibular 1st molar (M) terminal planes (distal of E and mesial
of 6) and the dots represent the position of averaged mesial
contact point of upper first permanent molars from ages 6 to 16.
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

One of the objectives of any analytic


approach is to reduce the practically
infinite set of possible cephalometric
measurements to a manageably small
group that can be compared with specific
norms and thereby provide useful
diagnostic information.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

From the beginning it was recognized that


the measurements for comparison with
the norms should have several
characteristics.
The following were specifically desired:
(1) The measurement should be useful
clinically in differentiating patients with
skeletal and dental characteristics of
malocclusion;

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

(2) The measurements should not be


affected by the size of the patient (i.e.,
proportions should be preserved
between small and large individuals).
This means an emphasis on angular
rather than linear measurements; and
(3) The measurements should be
unaffected, or at least minimally affected
by the age of the patient. Otherwise, a
different table of standards for each age
would be necessary to overcome the
effects of growth.
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Any individual cephalometric tracing


easily can be represented as a series of
coordinate points on a (x,y) grid (which is
done when a radiograph is digitized for
computer analysis).
But cephalometric data from any group
also could be represented graphically by
calculating the average coordinates of
each landmark point, then connecting the
points.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

The anatomically complete template, a


different one for each age, are particularly
convenient for direct visual comparison of
a patient with the reference group while
accounting for age.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

CRANIAL BASE
SUPERIMPOSITIONThe best plan usually is
to select the reference
template initially so that
the length of the
anterior cranial base is
approximately the same
for the patient and the
template and then to
consider developmental
age
by
William R. Proffit, Contemporary Orthodontics, 4
2007.

th

Edition, Elsevier Publications,

moving forward or
backward in the
template age if the
patient is
developmentally
quite advanced or
retarded.

William R. Proffit, Contemporary Orthodontics, 4th Edition, Elsevier Publications,


2007.

In almost all instances, correcting for


differences between developmental
and chronologic age also leads to the
selection of a template that more
nearly approximates the anterior
cranial base length.

William R. Proffit, Contemporary Orthodontics, 4th Edition, Elsevier Publications,


2007.

The sequence of superimpositions follows:


1. Cranial base superimposition, which allows
the relationship of the maxilla and mandible
to the cranium to be evaluated.

William R. Proffit, Contemporary Orthodontics, 4th Edition, Elsevier Publications,


2007.

The most useful approach is to


superimpose on the SN line,
registering the template over the
patient's tracing at nasion rather than
sella if there is a difference in cranial
base length.

William R. Proffit, Contemporary Orthodontics, 4th Edition, Elsevier Publications,


2007.

2. The second superimposition is on


the maximum contour of the maxilla
to evaluate the relationship of the
maxillary dentition to the maxilla.

William R. Proffit, Contemporary Orthodontics, 4th Edition, Elsevier Publications,


2007.

3. The third superimposition is on the


symphysis of the mandible along the
lower border, to evaluate the
relationship of the mandibular
dentition to the mandible.

William R. Proffit, Contemporary Orthodontics, 4th Edition, Elsevier Publications,


2007.

lf the shadow of the mandibular canal


is shown on the templates a more
accurate orientation can be obtained
by registering along this rather than
the lower border posteriorly.
Both the vertical and the
anteroposterior positions of the
anterior and posterior teeth should be
noted.

William R. Proffit, Contemporary Orthodontics, 4th Edition, Elsevier Publications,


2007.

REGIONAL
SUPERIMPOSITION The template is placed
over the cephalogram or a
tracing of the
cephalogram, and the pair
of points that define the
measurement is compared
with the template scales at
symmetric ages (6 and 6,
8 and 8, 10 and 10, etc)
until a match is achieved.
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

1. Cranial base
length Anterior - Register
on S, read age at
N
Posterior Register at S, read
age at Ba
Total - Ba to N
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

2. Facial height Upper anterior ANS to N


Upper posterior PNS to S
Lower anterior ANS to Gn
Anterior - N to Gn
Posterior - S to Go
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Maxillary size Length - PNS to


ANS or point A
Effective length Ar to point A

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Mandibular Size Ramus height -Ar


to Go
Body length -Go to
Gn/ Pog/ or point B
Overall - Ar to Gn/
Pog/ or point B
Effective length - Ar
to Gn
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Dental position Maxillary dentition - Orient


on palatal plane, register
at A, read molar position
at upper contact-point
dots (M) and incisor
position at 1 /1
Mandibular dentition Orient on mandibular
plane (GoGn), register at
point B, estimate molar
position by interpolation at
lower terminal planes (M)
and incisor position at 1 /1
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Dental Extrusion Maxillary: Palatal


plane registered at
A to Downs
occlusal plane
(DOP)
Mandibular:
Mandibular plane
(Go-Gn) registered
at B to DOP or 1/1
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

PROPORTIONATE TEMPLATE

The proportionate template is based on the


principle of the visual comparison of lateral
cephalometric tracings with average normal
tracings.
A single template cannot be used for all
individuals because of variations in body
height.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

To compare lateral head film tracings


of persons with craniofacial skeletal
dysplasia, a template having average
skeletal proportions was developed
from the data of Broadbent and
coworkers.
These data were based on the
recordings of 5,000 individuals.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

To accommodate variations in skull


size, four templates were designed.
The average template was
developed by averaging
geometrically the dimensions of the
sample.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

The large template was intended for


larger than average persons, and the
small template for persons with
smaller than average craniums and
jaws.
In addition, an extra-large template
was designed for much larger than
average individuals.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Cephalometric Landmarks and


Planes-

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Method of Application Selection of the


appropriate template.
1. The mid S-J point of
the template is
superimposed on the
tracing, and the
template is adjusted
to the point where the
Ba-N lines on the
template and the
tracing are parallel to
each other.
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

2. Points basion and nasion in the


correctly selected template will
approximately overlie the same points
on the tracings.
When superimposing Ba-N, both S-J
lines will be parallel to each other. The
template is then raised or lowered,
keeping the Ba-N lines parallel until
both of the mid S-J points are
equidistant from the Ba-N line.
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Interpretation
The following can be interpreted by the
proportionate analysis The relative spatial position of maxilla
and mandible.
Length of maxilla.
Length of mandible.
Vertical dimensions Incisor inclination.
Cant of mandibular plane.
Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

TEMPLATE ANALSIS FORM

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Jacobson A. Radiographic Cephalometry, Quintessence Publications, 1995.

Relative position of maxilla and


mandible State whether maxilla and mandible are
anteroposteriorl protrusive or retrusive.
Whether the mandibular plane is steep
or low.
Measure the distance between the
incisal edge of upper teeth and lower
border of upper lip. On an average the
lip embrasure is 2-3 mm above the
incisal egde.

Soft Tissues Lips- comment on thickness,


competence and strain.
Nose- comment on size and shape.
Chin- comment on thickness,
prominence and deficiency.

CONCLUSION
The expanding scope of orthodontic
treatment would seem to demand
meaningful diagnostic procedures.
Template analysis provides a simple
and flexible alternative to the
conventional methods.

It demands the active participation of


the clinician and forms more of a
decision tree when compared to the
conventional numerical analysis.

REFERENCES
Proffit WR. Contemporary Orthodontics, 4th Edition,
Elsevier Publications, 2007.
Jacobson A. Radiographic Cephalometry, Quintessence
Publications, 1995.
Athanasiou AE. Orthodontic Cephalometry, MosbyWolfe Publications.
Moorrees, Coenraad. Normal Variation and Its Bearing
on the Use of Cephalometric Radiographs in
Orthodontic Diagnosis. Am. J. Orthodontics.
1953;39:942950.

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