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INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
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1899 – Edward Angle – Classification of Malocclusion 1915 – Van Loon – developed a method for 3D registration of face and dentition – Cubus Craniophorus 1922 – Simon – modified Van Loon’s inventon by using a face bow. 1922 – Pacini – Paved the way for standardized head radiography 1931 – Hofrath in Germany and Broadbent in United States – published their works in the ‘ Forschritte der Orthodontie’ and the Angle Orthodontist respectively. 1939 – Lucien de Coster – published his work on proportional relationships of the face.www.indiandentalacademy.com
Reserve Craniostat
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The Bolton Room in the Anatomical Laboratory of the Medical School at Western Reserve University, Cleveland.
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Cephalometric Equipment Cephalostat or head holder X-ray source Cassette holder Cassette www.indiandentalacademy.com
Two types of cephalostats
Broadbent – Bolton method
Higley method
Specifications: Distance from the midsagittal plane of the subject’s head to the X-ray tube = 60” (5ft) Distance from the midsagittal plane of the subject’s head to the film = 7” American convention – subject’s left side to the film European convention – subject’s right side to the film www.indiandentalacademy.com
Natural Head Position NHP is a standardized and reproducible orientation of the head in space when one is focusing on a distant point at eye level. 1884 – German Anthropological Society – Frankfort Agreement 1956 – William Downs – discrepancies in cephalometric facial typing and photographic facial typing – Analysis of dentofacial profile
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‘Discrepancies between cephalometric facial typing and photographic facial typing disappear when a correction is made for those persons who do not have a level frankfort plane.’ William Downs(1956)
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‘Intracranial landmarks are not stable points in the cranium, their vertical relationship to each other is therefore also subject to biologic variation.’ Bjerin (1957)
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Definition of terminology Anthropometry – Measurement of dimensions of the human body and it’s parts. Craniometry – Branch of anthropometry dealing with measurements of dimensions and angles of bony skull. Cephalometry – Scientific measurement of dimensions of the ‘living’ head. Cephalometric analysis – Process of evaluating the skeletal, dental, and soft tissue relationships of a patient by comparing measurements performed on the patient’s cephalometric tracing with population norms for respective measurements, to come to a diagnosis of the patient’s orthodontic problem. www.indiandentalacademy.com
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DOWN'S ANALYSIS
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Mean Reading : 87.5o
Range : 82o – 95o
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Mean Reading : 0o
Range : -8.5o – 10o
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Mean Reading : -4.6o
Range : 0o – - 9o
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Mean Reading : 21.9o
Range : 17o – 28o www.indiandentalacademy.com
Mean Reading : 59.4o
Range : 53o – 66o
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Mean Reading : 9.3o
Range : 1.5o – 1.4o
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Mean reading : 135.4o
Range : 130o – 150o
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Mean reading : 1.4o
Range : -8.5o – 7o
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Wriggle
Vorhies and Adams (1951)
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STEINER’ S ANALYSIS
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STEINER’S ANALYSIS SKELETAL ANALYSIS DENTAL ANALYSIS
SOFT TISSUE ANALYSIS
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Mean reading : 82o
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Mean reading : 80o
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ANB Mean reading : 2o
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Mean reading : 14o
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Mean reading : 32o
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Mean reading : 130o
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WITS ‘APPRAISAL ANALYSIS ’
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RIEDEL - 1952 ANB
University of Witwatersrand www.indiandentalacademy.com
Anteroposterior relationship of the jaws relative to cranium
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Rotational effect of the jaws relative to the anterior cranial base
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SHORTCOMINGS OF ANB ‘Use of the apical base should be replaced JENKINS – 1955 by a better method to determine sagittal TAYLOR – 1969 apical base difference. The WITS appraisal could be used a possible BEATTY – 1975 alternative.’
JARVINEN – 1985 (1985) JARVINEN www.indiandentalacademy.com
“ Measurements from the cranial base, however, do not provide a reliable expression of anteroposterior jaw relationship in the dentofacial complex.�
Jacobson www.indiandentalacademy.com
Is the ANB angle a reliable indicator of jaw discrepancy or not? www.indiandentalacademy.com
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McNAMARA ANALYSIS
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McNamara (1984) •
Lateral cephalogram of children comprising of the Bolton’s Standards •
Selected values from a group of untreated children from Burlington research center. •
Sample of young adults from Ann Arbor having excellent dental and facial pattern.
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Craniofacial skeleton has been divided into five sections
Maxilla to cranial base Maxilla to mandible Mandible to cranial base Dentition Airway www.indiandentalacademy.com
Maxilla to cranial base
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Nasiolabial angle : 102o + 8o
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Cant of the Upper lip : Women : 14o + 8o Men
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: 8o + 8 o
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Maxilla to mandible
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Maxillomandibular differential = Midfacial length – Effective mandibular length
Co
A
Gn www.indiandentalacademy.com
Ideal maxillomandibular differential
Small
-
20mm
Medium
-
25 – 27mm
Large
-
30 – 33mm
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Mandible to cranial base
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Mixed Dentition = 6-8mm behind nasion perpendicular Adult woman = 4-0mm behind nasion perpendicular Adult men = 2mm behind to 2mm ahead of nasion perpendicular
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Dentition
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1-3mm
4-6mm www.indiandentalacademy.com
Airway Analysis
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COGS ANALYSIS
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COGS – Cephalometrics for Orthognathic Surgery Charles J. Burstone – 1978
University of Connecticut www.indiandentalacademy.com
COGS Chosen landmarks and measurements can be altered by various surgical procedures. The appraisal includes all facial bones and a cranial base reference. Rectilinear measurements can be readily transferred to a study cast for mock surgery. www.indiandentalacademy.com
ď ą Critical facial components can be examined. ď ą Standards and statistics are available for variations in age and sex from 5 to 20 ď ą Consists of a series of measurements that can be computerised. www.indiandentalacademy.com
H-P line
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Cranial Base
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Horizontal Measurements
N-A-Pg www.indiandentalacademy.com
Vertical Measurements
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Maxilla and Mandible
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Dental Measurements
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TWEED’ S ANALYSIS
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HARVOLD ANALYSIS
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SASSOUNI’ S ANALYSIS (1969)
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JARABAK ANALYSIS
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Why do we have to think about Computer aided Cephalometrics Computers & Cephalometrics Videocephalometry?
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Conclusions: • Cephalometric analyses are merely aids in helping the clinician arrive at a diagnosis and treatment planning. • All anteroposterior skeletal discrepancies cannot be corrected to an ideal jaw relationship. • Cephalometric measurements are not to be regarded as final points or values and it is not necessary that values should exactly tally. www.indiandentalacademy.com
• Variation in biology is a rule, therefore a normal value is never a point so a mean is to be always considered. • Serial cephalograms taken during course of treatment helps us to ascertain whether our treatment goals are achieved. • The Wits appraisal is a linear measurement and not an analysis per se. It is simply an adjunctive diagnostic aid that may prove useful in assessing the extent of anteroposterior skeletal dysplasia and in determining the reliability of ANB angle. www.indiandentalacademy.com
• We should strive to develop cephalometric norms and values pertaining to an Indian background instead of using those meant for Caucasian norms.
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