Lateral cephalometric tracing (CEPH)

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What is CEPH?

CEPH (Cephalometry) is a type of dental imaging that is used to produce a radiographic image of the head and face, including the teeth, jaws, and facial structures. CEPH is an X-ray scan similar to OPG (panoramic) scan, and it produces a detailed 2D image of the full skull and neck. The difference in image acquisition between CEPH and OPG is that CEPH is captured using a side-to-side sweeping motion, whereas panoramic uses a full 360-degree non-stop motion.

CEPH, short for cephalometric radiograph, is an essential diagnostic tool in orthodontics. It allows for the evaluation of the growth and development of the jaws and teeth and enables precise planning and monitoring of treatment. The cephalometric radiograph provides a side view of the head, revealing a detailed profile of the face and skull. This allows orthodontists to assess the position and relationship of the teeth and jaws, identify any problems with bite or jaw alignment, and plan appropriate treatment to correct these issues. CEPH is also useful in detecting jaw tumors and indications of Obstructive sleep apnea. It allows for a precise diagnosis, and when performed regularly, monitoring treatment progress to ensure the most optimal results.

What does CEPH mean in dentistry?

CEPH is an abbreviation that stands for cephalometric. The term “cephalometric” is derived from the Greek words “kephali” meaning “head” and “metron” meaning “measure,” and is used to refer to the measurement and analysis of the head. A Cephalometric Radiograph (CEPH) is a specialized type of X-ray image taken of the head and face that is used to study the bones of the skull and face. The image is used to measure and study the various structures of the head, including the jaws, teeth, and skull, and is commonly used in orthodontics for diagnosis, treatment planning and monitoring.

What is CEPH (cephalometric) tracing?

Cephalometric tracing refers to “head measuring”, and is a technique used to analyze cephalometric radiographs. The term “tracing” refers to the process of creating a hand-drawn representation of the dental and skeletal structures seen on standardized radiographs. The tracing is often done manually, on a transparent sheet, which is placed onto a cephalometric radiograph. Tracing lines and points are hand-drawn on the image, along with the specific anatomical landmarks. Alternatively, the tracing can be done digitally with dedicated software apps, and automatically with AI (artificial intelligence) tools.

CEPH tracing is used to analyze position and relationship of the teeth, jaws, and facial bones, to measure specific angles and distances, to identify and evaluate dental and skeletal structures, and to plan orthodontic treatment. Cephalometric tracing allows for a precise and accurate analysis of the patient’s anatomy and is helpful in treatment planning. Dental malocclusions and skeletal discrepancies are the two most common conditions where cephalometric tracings are done. The traced image can show the position of various structures, such as the teeth and jaws, and then can be used to do the measurements for malocclusions and other skeletal issues.

What is Lateral CEPH tracing?

Lateral CEPH (cephalometric) tracing refers to the process of analyzing a lateral cephalogram, which is a specialized X-ray image taken from the lateral (side) view of the head. It is a widely used diagnostic tool in orthodontics, allowing for the precise measurement and analysis of dental and skeletal structures. The tracing process involves placing a transparent film over the radiographic image and making markings along specific anatomical points. This traced image is then used to evaluate the position and relationship of the teeth, jaws and other facial structures.

Lateral cephalometric tracing is a crucial tool in the planning and treatment of orthodontic cases. It enables orthodontists to determine the appropriate course of treatment and monitor the progress of treatment. It allows for the measurement of numerous cephalometric variables, that provide key information that can be used to evaluate malocclusion, crowding, overbite, and underbite, to identify craniofacial abnormalities, to measure soft tissue structures, to predict treatment outcomes and to monitor treatment progress over time. Overall, lateral cephalometric tracing is an important diagnostic tool that provides crucial information for orthodontic treatment and ensures the best possible outcome for the patient.

What are the types of cephalograms?

A cephalogram is a radiographic image of the head and face that is used to study the bones of the skull and face, including the teeth and jaws. There are several different types of cephalograms that are used in dentistry, mostly in orthodontics, each with their own specific indications and advantages.

Here are some common types of cephalograms:

Lateral cephalogram: This is a side (lateral) view of the head and face, rather than the front or back. It is commonly used by orthodontists to assess the position of the teeth and jaw in relation to the rest of the face.
Frontal cephalogram: This is a frontal view taken to assess the position of the structures falling in the front side of the face and their relationships with each other such as the front teeth, the front part of the jaw, and the nasal bones.
Posteroanterior cephalogram (PA CEPH): This is a front-to-back (posteroanterior) view of the head and face, taken with the patient facing the X-ray source, which can be helpful in evaluating the anterior teeth, the jaw joint, and the airway.
Basal cephalogram: This view of the head is taken from the base of the skull. It is used to assess the position of the structures falling in the basal side of the head and their relationship with each other including the lower jaw and its relation to the rest of the face.
Standard cephalogram: This view is used for assessing the overall shape and size of the face and skull.
Profile cephalogram: This is an essential view for assessing the profile and the overall shape and size of the face, and is commonly used during any orthodontic treatment or orthognathic surgery.
3D cephalogram: This type of cephalogram is a three-dimensional image of the head and face that is created using advanced imaging techniques such as CT, MRI scans, or CBCTs. It provides a highly detailed image of the head and face which can be used to study and assess the position and shape of the teeth, jaw, and skull with accuracy. 3D cephalograms are often used for planning orthognathic surgeries, as they provide detailed information about the patient’s dental and skeletal anatomy.

In conclusion, there are several types of cephalograms that are used in orthodontics, each with their own specific indications and advantages. Lateral cephalograms are the most commonly used, but other types such as frontal, posteroanterior, basal, standard, profile and 3D cephalograms can also be used to evaluate the head and face. The choice of cephalogram will depend on the specific condition being evaluated and the goal of the examination.

What is poor man’s cephalometric?

Poor man’s cephalometric is a term used to describe a simplified and low-cost method for analyzing cephalometric radiographs. It is used as an alternative to the more complex and expensive process of cephalometric tracing. It is a popular technique in the areas of resource-limited practices, or for teaching purposes.

Poor man’s cephalometric is often done to establish:

Are the jaws proportionately placed in A-P (anteroposterior) plane
Profile convexity or concavity
The lip posture and incisor prominence
Bimaxillary protrusion

Here are some key aspects of poor man’s cephalometry:

Simplified method: Instead of creating a detailed hand-drawn tracing of the radiographic image, poor man’s cephalometry utilizes basic measurements and observations of the radiograph to analyze dental and skeletal structures.

Measurement of key landmarks: In poor man’s cephalometry, the radiograph is analyzed by measuring key landmarks such as the position and relationship of the teeth, jaws, and skull.

No specialized equipment needed: Unlike cephalometric tracing, poor man’s cephalometry does not require any specialized equipment, such as tracing paper and pencils, making it more accessible in terms of cost and resources.

User-friendly: Poor man’s cephalometry is easy to learn and can be used by dental professionals with minimal training.

Cost-effective: Poor man’s cephalometry is a cost-effective alternative to cephalometric tracing and digital cephalometry

Limitations: Despite its advantages, poor man’s cephalometry has certain limitations. It is not as accurate as traditional cephalometric tracing, and it is less able to measure the subtle changes that occur during orthodontic treatment.

Comparison: The measurements obtained by poor man’s cephalometry can be compared to established standards, such as cephalometric norms, to identify any discrepancies.

No angle measurement: Poor man’s cephalometry does not measure angles between different structures of the craniofacial complex, which can be useful for diagnosis and treatment planning.

Less detailed than traditional cephalogram: The information obtained through poor man’s cephalometry is less detailed than that obtained through a traditional cephalogram, as the poor man’s cephalogram lacks the precision of a traced cephalogram.

Poor man’s cephalometric is useful in identifying gross discrepancies in dental and skeletal structures, in resource-limited practices, or for teaching purposes. However, it should be considered as an adjunct, rather than a replacement, to traditional cephalometric tracing and analysis.

What is the difference between cephalometric and panoramic?

Cephalometric and panoramic radiographs are both types of dental radiographs, but they serve different diagnostic and treatment planning purposes.

Cephalometric radiography is a type of dental imaging technique designed to produce a detailed image of the head from the side or the frontal view, where the position of the teeth and jaws and their relationship with each other can be viewed. The most common usage of cephalometric is in the field of orthodontics and to some extent orthognathic surgery, where the assessment of the position and alignment of the teeth, jaws, and facial bones are crucial for treatment planning and for the follow-up afterwards.

Panoramic radiography is a type of dental imaging technique that produces a wide image (circular view) of the entire mouth, including the patient’s jaw bones, the temporomandibular joint (TMJ) and all the teeth and the surrounding tissues in one view. Such images are used by dentists for numerous purposes including pathologies of teeth, jaws, sinuses, and other facial bone, traumatic injuries, assessment of the overall health of the teeth and jaws, and for treatment planning.

Thus, cephalometric radiography is specifically meant for treatment planning where only head and facial bones are involved, while panoramic radiography can be used for the entire mouth. Here are some detailed key differences between cephalometric and panoramic radiographs:

Purpose: Cephalometric radiographs are used to study the position and relationship of the teeth, jaws, and skull, while panoramic radiographs are used to evaluate the entire jaw and all the teeth.

View: Cephalometric radiographs are often taken from a side (lateral) view, while panoramic radiographs are taken from a circular view, which means it captures an image of the entire jaw and all of the teeth.

Angles: Cephalometric radiographs are used to measure specific angles and distances between different structures of the craniofacial complex and for the diagnosis of malocclusions and other craniofacial abnormalities, while panoramic radiographs are primarily used to detect missing, erupted, or impacted teeth, cysts, tumors, and jawbone fractures.

Diagnostic use: Cephalometric radiographs are primarily used in orthodontics, while panoramic radiographs are used in both general dentistry and orthodontics. They can be used for diagnosis of dental issues, such as cavities, periodontal disease, and jaw tumors, as well as for planning treatment for dental extractions, dental implants, and orthodontic treatment.

Positioning: Cephalometric radiographs require the patient to be positioned in a specific way, with the head positioned in the center of the X-ray beam, while panoramic radiographs require the patient to rotate their head around an axis, to capture the entire jaw in one image.

Image Quality: Cephalometric radiographs provide a detailed view of the craniofacial complex and its different structures, while panoramic radiographs may not provide the same level of detail, but it can show all teeth and jawbones in one image.

In conclusion, cephalometric and panoramic radiographs are both types of dental radiographs, but they serve different diagnostic and treatment planning purposes. Cephalometric radiographs are used to study the position and relationship of the teeth, jaws, and skull, while panoramic radiographs are used to evaluate the entire jaw and all the teeth. They can be used together to provide a comprehensive analysis of the patient’s dental and skeletal anatomy, leading to more accurate diagnosis and treatment planning.

2D CEPH versus 3D CEPH

The cephalogram (CEPH) is one the most important standardized tools in orthodontics, used for assessing the dental, soft tissue, and skeletal relationships in patients. Cephalometric analysis can also be a key diagnostic tool before and after a craniomaxillofacial surgery. Cephalometric variables which are important for orthodontic treatment and orthognathic surgeries can be measured either by using two-dimensional (2D) cephalometric analysis of lateral or frontal cephalogram, or by using three-dimensional (3D) imaging.

2D CEPH is a traditional method of cephalometry that uses a single lateral radiographic image to capture a two-dimensional (2D) image of the head and face, in one plane (one view angle). This method provides a detailed view of the craniofacial complex and its different structures, and it can be used to measure specific angles and distances between different structures of the craniofacial complex and for the diagnosis of malocclusions and other craniofacial abnormalities.

3D CEPH, on the other hand, uses advanced imaging techniques such as CT, MRI scans, or cone-beam CT scans to capture a three-dimensional (3D) image of the head and face. The 3D image (often a DICOM file) can be rotated and viewed from any angle, providing a more accurate and detailed view of the head and facial bones, which can be used to study and assess the position and shape of the teeth, jaw, and skull with higher accuracy. 3D CEPH are often used for planning orthognathic surgeries, as they provide detailed information about the patient’s dental and skeletal anatomy that can be used to ensure the best possible outcome of the surgery.

Here is a summary of the main differences between 2D CEPH and 3D CEPH

Dimension: 2D CEPH is a two-dimensional image, while 3D CEPH is a three-dimensional image

Imaging Method: 2D CEPH originated from traditional film-based radiography, while 3D CEPH is done using advanced imaging techniques such as CT, MRI scans, or CBCTs.

Detail level: 3D CEPH provides a higher level of detail of than 2D CEPH

Use: 2D CEPH is primarily used for diagnosis and treatment planning for malocclusions, while 3D CEPH is more useful for diagnosis and treatment planning more complex situations, such as overlaid teeth, hidden nerve channels, impacted teeth, airway analyses, and concealed roots or anomalies in the temporomandibular joint, where accuracy is the key to a successful treatment.

Range: 3D CEPH provide more accurate information, as well as clear image of both sides of the head. To gain similar clarity for both sides of the head, two 2D CEPH scans will often be needed, each covering only one side.

Safety: 2D CEPH requires less radiation dose since it only scans one plane (2D) whereas 3D CEPH via CBCT scans multiple layers. Therefore, the usage of 3D CEPH is often restricted to patients who need a detailed diagnosis (for example, in order to analyze an impacted tooth).

Cost: 3D CEPH is generally more expensive than 2D CEPH.

To summarize: Both 2D and 3D CEPH have their advantages and disadvantages and the choice of which one to use depends on the clinical situation and the clinician’s preference. While 3D CEPH provides a higher level of detail it is also more expensive and involves higher exposure to radiation. On the other hand, 2D CEPH is more traditional and less costly but less detailed and comprehensive.

How do you trace a cephalogram?

Tracing a cephalogram is the process of creating a (usually hand-drawn, and sometimes digital) representation of the radiographic image, which can be used to analyze and measure various dental and skeletal structures, including the relevant position of teeth and jaws, using various anatomical landmarks.

The tools required to trace a lateral cephalogram include:

A clear transparent sheet
A sharp pencil
A straight edge or ruler
Optional: a magnifying glass

The process of tracing a cephalogram typically involves the following steps:

Acquiring the radiographic image: The first step in tracing a cephalogram is to acquire the radiographic image. This can be done using a variety of methods, including traditional film-based radiography or digital radiography.

Preparing the tracing materials: Once the radiographic image has been acquired, the next step is to prepare the tracing materials. This typically involves obtaining a transparent film and a pencil or other tracing instrument.

Placing the film on the radiograph: The transparent film is placed over the radiographic image, making sure that it is properly aligned with the image.

Identifying key landmarks: The next step is to identify the key landmarks on the radiographic image. This typically includes identifying the position and relationship of the teeth, jaws, and skull.

Marking key landmarks: Once the key landmarks have been identified, they are marked on the transparent film, using the tracing instrument.

Tracing the key landmarks: The key landmarks are then traced onto the transparent film, creating a hand-drawn representation of the radiographic image. This step is done using a ruler as a guide, while making sure that all the important details and structures on the cephalogram (e.g.- the cranial base, cranial suture lines, teeth, and facial landmarks) are included.

It is important to be precise and accurate when tracing a cephalogram, as the tracing will be used for diagnostic and treatment planning purposes. A magnifying glass or other magnification devices can be used to see the details more clearly.

Measuring cephalometric variables: After the cephalogram is traced, the cephalometric variables are measured using cephalometric analysis software, or by manually with a cephalometric ruler. The traced cephalogram can also used as a tracing template to create a more permanent drawing on paper which can be used to measure and analyze specific features of the cephalogram.

Interpreting and using the traced cephalogram: Once the cephalogram is traced, the traced cephalogram is used to evaluate the patient’s dental and skeletal anatomy, and to plan and monitor orthodontic treatment.

It is important to note that cephalogram tracing is a skill that requires practice and training to master. The accurate identification of landmarks and the accurate tracing and measurement of cephalometric variables is a key aspect of orthodontic diagnosis and treatment planning.

CEPH tracing landmarks

The CEPH tracing landmarks are very important to be identified correctly and accurately to achieve a good analysis. They can be divided into two types – hard tissue landmarks and soft tissue landmarks.

Hard tissue landmarks include:

Sella (S): the midpoint of the sella turcica (pituitary fossa).
Nasion (N): the most anterior point on the frontonasal suture in the midline.
Porion (Po): the upper- and outermost point on the external auditory meatus.
Orbitale (Or): the most inferior and anterior point on the orbital margin.
Condylion (Cd): the most posterior and superior point on the mandibular condyle.
Articulare (Ar): the point of intersection of the posterior margin of the ascending mandibular ramus and the outer margin of the posterior cranial base.
Gnathion (Gn): the most anterior and inferior point on the bony chin.
Menton (Me): the most inferior point of the mandibular symphysis in the midline.
Pogonion (Pog): the most anterior point on the bony chin.
Gonion (Go): the most posterior and inferior point on the angle of the mandible.
Point A (subspinale): the deepest point on the curved profile of the maxilla between the anterior nasal spine and alveolar crest.
Point B (supramentale): the deepest point on the curved profile of the mandible between the chin and alveolar crest.
Upper incisor apex (UIA): the root apex of the most anterior maxillary central incisor.
Incisor superius (Is): the tip of the crown of the most anterior maxillary central incisor.
Incisor inferius (Ii): the tip of the crown of the most anterior mandibular central incisor.
Lower incisor apex (LIA): the root apex of the most anterior mandibular central incisor
Anterior nasal spine (ANS): the tip of the bony anterior nasal spine in the midline.
Posterior nasal spine (PNS): the tip of the posterior nasal spine in the midline (located as a continuation of the base of the pterygopalatine fossa where it intersects with the nasal floor).

Soft tissue landmarks include:

Soft tissue Glabella (G’)
Soft tissue Nasion (N’)
Tip of Nose (P)-Pronasale
Subnasale (Sn)
Soft tissue A-point (SLS)
Labialis Superior (Ls)
Stomium Superior (Stms)
Stomium Inferior (Stmi)
Labialis Inferior (Li)
Soft tissue B-point (ILS)
Soft tissue Pogonion (Pog’)
Soft tissue Menton (Me’)

How do you trace lateral CEPH?

A lateral CEPH (or cephalogram( is an x-ray image of the head that involves taking a lateral (side) view of the head, a vital diagnostic tool in orthodontics. For tracing the lateral cephalogram, a transparent film is placed onto it and then marking is done along the specific anatomical points. The traced image is an assessment of the position and relationship of the teeth, jaws, and other facial structures which is very helpful to analyze various cephalometric variables.

Lateral cephalometric tracing is typically used in the planning and treatment of orthodontic cases. It helps to determine the appropriate course of treatment and to monitor the progress of treatment.

The tools required to trace a lateral cephalogram include:

A clear transparent sheet
A sharp pencil
A straight edge or ruler
Optional: a magnifying glass

Step-by-step procedure

Step 1: tracing paper is aligned on the lateral cephalogram, then two crosses are drawn about 3 cm apart on the top-left corner of the radiograph. A transparent sheet for tracing is then superimposed on the radiograph and attached to the top edge with adhesive tape. The two crosses make it easier to keep proper position the sheet while tracing.

Step 2: Identification and tracing of the following hard tissue (HT) landmarks:

cranial base
upper and lower central incisors following the correct long axes
upper and lower first permanent molars in relationship to each other
mandible and maxilla
mid-point of sella turcica (S)
Nasion (N)
Porion (Po)
Top of external auditory meatu
Orbitale (Or)
inferior border of orbit
pterygomaxillary Assure (Pt)
Condylion (Cd)
articulate (Ar)
posterior nasal spine (PNS)
anterior nasal spine (ANS)
A-point, B-point, pogonion (Pog)
gonion (Go), gnathion (Gn)
menton (Me).

Step 3: Identification and tracing of the following soft tissue (ST) landmarks:

Soft tissue Glabella (G’)
soft tissue Nasion (N’)
tip of Nose (P)-Pronasale
Subnasale (Sn)
soft tissue A-point (SLS)
labialis Superior (Ls)
stomium Superior (Stms)
stomium Inferior (Stmi)
labialis Inferior (Li)
soft tissue B-point (ILS)
soft tissue Pogonion (Pog’)
soft tissue Menton (Me’).

Step 4: Connect the following landmarks

Sella and Nasion – SN line.
Porion and Orbitale (Frankfurt Horizontal plane-FH).
Mesiobuccal cusp of maxillary first molar and cusp of the first premolar – (Occlusal plane).
A straight line through Gnathion(Gn) and Gonion (Go) [MP -Mandibular plane].
Sella and Gnathion (Y-axis).
Nasion and A-point (NA– line).
Nasion and B-point (NB-line).
Nasion and Pogonion (N-Pog).
A-point and Pogonion (APo-line).

Step 5: Measure the following angles

The angle between SN line and FH line.
The angle between SN line and Occlusal plane.
The angle between SN line and Mandibular plane.
The angle between FH line and Sella – Gnathion (Y- axis).
The angle between SN and NA line (SNA°).
The angle between SN line and NB line (SNB°).
Difference between SNA and SNB = (ANB°).
The angle between FH and NPog line (Facial angle).
The angle between long axis of U1 and NA line.
The angle between long axis of L1 and NB line.
The angle between long axis of U1 and L1 (Interincisal angle).
Total facial angle (TFA) — G’-P-Pog’: the angle formed by the intersection of the line soft tissue glabel-la-pronasale and the extended line soft tissue pogonion-pronasale to form the contained angle for measurement.
Soft tissue facial angle (FA) – G’-Sn-Pog’-angle formed by the intersection of lines subnasale-glabel-la and pogonion-subnasale extended (measured at the upper contained angle).
Soft tissue facial angle (STFA) – N’-Pog’ and FH: angle formed by the intersection of the line soft tissue pogonion-soft tissue nasion and the Frankfort Horizontal plane, measured as the lower contained angle.
Merrifield’s Z angle (ZA) – Pog’ to most protrusive lip, extended to FH: the angle between the “profile line” and the Frankfort horizontal plane.
Nasolabial angle (NA) – Cm-Sn-Ls: Angle between the intersection of lines tangent to the columella and upper lip.
Pogonion-labial angle (MLA) – Li-ILS-Pog’: Angle between the intersection of the line labialis inferius-to inferior labial sulcus and a line tangent to the soft tissue pogonion, passing through labialis inferior.
Pogonion-menton angle (PMA) – Pog’ -Me’: Angle between the intersection of lines tangent to the soft tissue pogonion and soft tissue menton
Holdaway angle (HA): Angle formed between the soft tissue facial plane line (soft tissue nasion-pogonion) and the H line8 (soft tissue pogonion to labialis inferior).

Step 6: Measure the following linear measurements (mm):

SN length.
NB line to A-point (Convexity).
Most anterior point of labial U1 to NA-line.
Most anterior point of labial L1 to NB-line.
APog-line to incisal edge of L1.
Distance between A and B perpendicular points on the occlusal plane (Wits analysis).
Upper lip length (ULL): Discrepancy in the vertical dimension, the extent of upper incisor visibility in resting position.9 (upper stomium to ST subnasale).
Lower lip length (LLL): Discrepancy in the vertical dimension, the extent of the lower lip curl, presence or absence of labio-mental fold.9 (lower stomium to ST pogonion).
Upper lip prominence (ULP-B line): Protrusive/ retrusive upper lip relative to the B Line.
Lower lip prominence (LLP-B line): Protrusive/ retrusive lower lip relative to the B Line.
Lower lip position (LLP-H): Retruded or protruded lower lip relative to H line.
Interlabial gap (ILG): The space between the upper and lower lips when they are relaxed, with the head in a normal upright position and the teeth in centric relation.
Hard tissue pogonion to soft tissue pogonion (Pog-Pog’): Soft tissue thickness measured between the hard tissue pogonion and soft tissue pogonion.
Hard tissue menton to soft tissue menton (Me-Me’): Soft tissue thickness measured between the hard tissue menton and soft tissue menton.
Measure the distance between perpendicular anterior facial height lines – (Nasion to ANS and ANS to menton).

Step 7: The values obtained are placed in a table where pre and post-treatment values are added and then compared with the reference values based on which analysis is done.

As mentioned before, cephalogram tracing is a skill that requires practice and training to master. The accurate identification of landmarks and the accurate tracing and measurement of cephalometric variables is a key aspect of orthodontic diagnosis and treatment planning.

What is the purpose of a cephalometric analysis?

Cephalometric analysis is a diagnostic tool used to study the position and relationship of the teeth, jaws, and skull, to help in the planning and monitoring of treatment for orthodontic or craniofacial conditions.

Here are some key purposes of cephalometric:

Diagnosis: Cephalometric analysis can be used to diagnose and classify different types of malocclusions, such as Class I, Class II, or Class III malocclusions, which can help guide treatment planning. It can help in diagnosing tooth and jaw fractures, and in assessing the causes of the excessive tooth or jaw misalignment.

Measuring: Cephalometric analysis can be used to accurately teeth and their root systems on details

Treatment planning: Cephalometric analysis can be used to plan the most appropriate course of orthodontic and other types of treatment for each patient, based on their individual dental and skeletal anatomy.

Orthodontic treatment: Cephalometric analysis can be used to monitor the progress of orthodontic treatment, by measuring changes in the position and relationship of the teeth, jaws, and skull. This can be used to identify any adjustments that need to be made to the treatment plan to ensure the best possible outcome.

Orthognathic surgery: Cephalometric analysis can be used to plan and evaluate the outcome of orthognathic surgeries, which are done to correct jaw malformations and to improve the occlusion and facial balance.

TMJ disorders: Cephalometric analysis can be used to evaluate the temporomandibular joint (TMJ) to identify any disorders, such as TMJ dysfunctions or dislocations.

Airway assessment: Cephalometric analysis can be used to evaluate the size and shape of the airway, which can be useful for diagnosis and treatment planning of sleep apnea and other airway disorders.

Craniofacial growth and development: Cephalometric analysis can be used to evaluate the growth and development of the craniofacial complex, which can be useful for assessing the risk of developing orthodontic problems.

Research: Cephalometric analysis can also be used in research studies to evaluate the changes in the craniofacial complex over time and to compare different treatment methods or techniques.

It is important to note that cephalometric analysis should always be performed by a trained and experienced professional, such as an orthodontist or oral and maxillofacial surgeon.

Why is cephalometric (CEPH) important?

Cephalometric (CEPH) analysis is an important diagnostic tool in orthodontics and craniofacial surgery, as it helps to evaluate the position and relationship of the teeth, jaws, and skull, and to plan and monitor treatment for various dental and craniofacial conditions.

Cephalometry is a valuable diagnostic tool that enables orthodontists to gain crucial information that can help understand the underlying causes of dental problems and determine the best suited treatment plan.

Cephalometric analysis is also of great importance for orthognathic surgeons. The analysis can be used pre-operatively to understand the deficiencies and prominences in the jaws based on standard values and to plan the surgery accordingly. It is also used post-operatively, when pre-operative and post-operative results can be compared, to evaluate the outcome of the surgery. This information is crucial for the success of the surgery and the satisfaction of the patient.

Another less obvious though important aspect of cephalometric analysis is its use in airway assessment. Patients with malocclusion or who are undergoing treatment for malocclusion often suffer from sleep apnea. In such cases, orthodontists use cephalometric analysis to specifically evaluate factors such as the relationship between the airway and the facial type, the shape of the airway, and the volume of the airway. This information is essential for the diagnosis and treatment planning of sleep apnea and other airway disorders.

Overall, cephalometric analysis is a vital diagnostic tool that provides important information about the craniofacial complex, which can be used to diagnose, treat, and monitor a wide range of dental and craniofacial conditions.

Why would a dentist prescribe a cephalometric radiograph?

A cephalometric radiograph (CEPH) or a lateral cephalometric projection, is an extraoral radiograph that is taken to view the bones of the head and neck.

Dentists may prescribe a cephalometric radiograph for a variety of reasons, including:

Evaluation: Cephalometric radiographs can be used to evaluate the position and development of the teeth, jaws, and facial bones, and to determine the relationship between the teeth, jaws, and facial bones.

Diagnosis: Cephalometric radiographs can be used to diagnose and classify different types of malocclusions, such as Class I, Class II, or Class III malocclusions, which can help guide treatment planning. For example, CEPH analysis can help in diagnosing the deficiencies and prominences in the jaws before the orthognathic surgeries. It can also help in ruling out any fractures in the trauma cases.

Treatment planning: Cephalometric radiographs can be used to plan the most appropriate course of treatment for each patient, based on their individual dental and skeletal anatomy. This can include orthodontic treatment, orthognathic surgery, or other types of interventions.

Orthodontic treatment: Cephalometric radiographs can be used to monitor the progress of orthodontic treatment, by measuring changes in the position and relationship of the teeth, jaws, and skull. This can be used to identify any adjustments that need to be made to the treatment plan to ensure the best possible outcome.

Orthognathic surgery: Cephalometric radiographs can be used to plan and evaluate the outcome of orthognathic surgeries, which are done to correct jaw malformations and to improve the occlusion and facial balance.

TMJ disorders: Cephalometric radiographs can be used to evaluate the temporomandibular joint (TMJ) to identify any disorders, such as TMJ dysfunctions or dislocations.

Airway assessment: Cephalometric radiographs can be used to evaluate the size and shape of the airway, which can be useful for diagnosis and treatment planning of sleep apnea and other airway disorders.

Craniofacial growth and development: Cephalometric radiographs can be used to evaluate the growth and development of the craniofacial complex, which can be useful for assessing the risk of developing orthodontic problems.

Research: Cephalometric radiographs can also be used in research studies to evaluate the changes in the craniofacial complex over time and to compare different treatment methods or techniques.

To summarize, a cephalometric radiograph is an important diagnostic tool for orthodontists, oral and maxillofacial surgeons, and other dental professionals as it provides detailed information on craniofacial structures, allowing them to diagnose various dental conditions and plan or review results of various dental procedures.

What would an orthodontist use a cephalometric (CEPH) tracing for?

Orthodontists use cephalometric (CEPH) tracings to study the relationship between the head and teeth, and to diagnose and plan treatment for orthodontic problems such as misalignment of the teeth or jaws.

Cephalometric tracings are done on a piece of transparent film by marking various landmarks on the cephalogram, then the tracing is used to measure angles and distances between different points on the head and teeth to produce an analysis. This analysis can be used to help the orthodontist diagnose and plan treatment for misaligned teeth and jaws.

Additionally, cephalometric tracings are also used by orthodontists to assess the upper airways in patients with malocclusion or who are under the treatment for malocclusion and suffer from sleep apnea, and to plan the appropriate treatment.

Why do you need a lateral cephalometric radiograph?

A lateral cephalometric radiograph is a type of X-ray image that shows the side view of the head and neck to view the bones of the skull and face. It is often used in the field of orthodontics to help diagnose and treat dental and jaw abnormalities. The image allows orthodontists to measure the position and size of various structures in the head and neck, including the teeth, jaw bones, and nasal cavities. This information can be used to help plan treatment for misaligned teeth, overbite, underbite, and other problems.

Here are several specific reasons why a lateral cephalometric radiograph may be needed:

Diagnosis of malocclusions: Lateral cephalometric radiographs are often used to diagnose and classify different types of malocclusions, such as Class I, Class II, or Class III malocclusions, which can help guide treatment planning.

Treatment Planning: A lateral CEPH is an important diagnostic tool that can be used to determine the most appropriate course of treatment for each patient, based on their individual dental and skeletal anatomy. The radiograph allows the orthodontist to analyze the patient’s craniofacial structure, including the position of the teeth, jaw, and skull, which can help determine if orthodontic treatment, orthognathic surgery, or other types of interventions are needed.

Orthodontic treatment: Lateral cephalometric radiographs can be used to monitor the progress of orthodontic treatment by measuring changes in the position and relationship of the teeth, jaws, and skull. This can be used to identify any adjustments that need to be made to the treatment plan to ensure the best possible outcome.

Orthognathic surgery: A lateral CEPH radiograph can be used to plan and evaluate the outcome of orthognathic surgeries, which are done to correct jaw malformations and improve occlusion and facial balance.

Airway assessment: A lateral CEPH radiograph can be used to evaluate the size and shape of the upper airway, which can be useful for diagnosis and treatment planning of sleep apnea and other airway disorders.

Craniofacial growth and development: Lateral CEPH radiographs can be used to evaluate the growth and development of the craniofacial complex, which can be useful for assessing the risk of developing orthodontic problems.

Research: Lateral CEPH radiographs can also be used in research studies to evaluate the changes in the craniofacial complex over time and to compare different treatment methods or techniques.

Overall, a lateral CEPH radiograph is a valuable diagnostic tool that provides important information about the craniofacial complex, which can be used to diagnose, treat, and monitor a wide range of dental and craniofacial conditions.

CEPH requirements

The basic requirement for a CEPH analysis is to evaluate the relationships both horizontally and vertically of the five major functional components of the face, which are as follows:

The cranium and the cranial base.
The skeletal mandible
The skeletal maxilla
The maxillary dentition and the alveolar process
The mandibular dentition and the alveolar process

There are certain requirements that must be met in order to obtain a quality cephalometric radiograph and perform a proper cephalometric analysis:

Patient positioning: The patient must be positioned correctly in order to obtain an accurate cephalometric radiograph. This includes ensuring that the head is in a neutral position and is level, and that the Frankfort horizontal plane (a reference plane used in cephalometry) is parallel to the floor.

Film or sensor size: A standard film or sensor size must be used in order to ensure that the entire craniofacial complex is captured on the radiograph.

Image quality: The radiograph must be of sufficient quality and contrast in order for the landmarks and structures to be easily identified and analyzed. This may require adjusting the x-ray technique or using a specialized image processing software.

Radiographic technique: The radiographic technique used to obtain the cephalometric radiograph must be appropriate for the patient’s age and the specific diagnostic or treatment needs.

Expertise: A qualified and trained professional, such as an orthodontist or oral and maxillofacial radiologist, must perform the cephalometric analysis and interpretation.

Patient protection: Adequate radiation protection must be provided for the patient, including the use of lead aprons and thyroid collars, and ensuring that the patients are protected from radiation exposure.

Meeting these requirements is important to ensure the accuracy and reliability of the cephalometric analysis, and ultimately the success of the treatment.

How is lateral CEPH (cephalogram) taken?

A lateral cephalogram, also known as a lateral cephalometric radiograph, is a type of medical imaging test that produces a two-dimensional image of the head and neck from the side (lateral view). It is commonly used in the field of orthodontics to assess the alignment of the teeth and jaw and to plan treatment.

The process of taking a lateral cephalogram typically includes the following steps:

Patient protection: Adequate radiation protection must be provided for the patient, including the use of lead aprons and thyroid collars, and ensuring that the patient’s eyes are protected from radiation exposure.
Film positioning: the film is held vertically against the patient’s cheek and centered so that the entire skull along with the facial skeleton can be seen as a resultant.
Patient positioning: The patient should be seated in a chair, or reclining on a table, with the head placed straight, facing the film. Then, the patient is being asked to hold the breath for a few seconds while the image is being taken. The patient must be positioned correctly in order to obtain an accurate cephalogram. This includes having the patient stand with the head in a neutral position and level, with the Frankfort horizontal plane (a reference plane used in cephalometry) parallel to the floor.
Imaging device preparation: The imaging device should be prepared and calibrated before the radiographic exposure. The x-ray machine is positioned in such a way that the beam passes through the side of the head, producing an image that shows the side view of the head and neck.
Radiographic technique: The radiographic technique used to obtain the cephalogram must be appropriate for the patient’s age, size and the specific diagnostic or treatment needs.
Image acquisition: Radiographic exposure is taken of the head.
Image development: After the radiographic exposure, the film or sensor is processed and developed, to produce the lateral cephalogram image.

After the image is taken, it is processed and analyzed by a dentist or radiologist to assess the alignment of the teeth and jaw and to plan treatment. A trained professional such as an orthodontist or oral and maxillofacial radiologist will analyze the cephalogram and interpret it.

It is important to note that taking a lateral cephalogram requires the expertise of a qualified radiologic technologist and interpretation by a qualified orthodontist or radiologist. The process should be done in accordance to the recommended guidelines and regulations to minimize the radiation exposure to the patient and produce accurate diagnostic images.

Lateral CEPH radiograph

The term “CEPH” comes from the Greek word “kephali”, which means “head”. Lateral CEPH, also known as lateral cephalometric radiograph, is a type of extraoral radiograph (image) that is taken from the side (lateral) of the head to view the bones of the skull and face. It is commonly used in orthodontics to evaluate the growth and development of the jaws and teeth, and to plan and monitor treatment. The image taken is a profile view of the face and skull, which can be useful in identifying any problems with the bite or jaw alignment, and in planning treatment to correct these issues.

Lateral CEPH radiographs are typically quick and painless to perform and used for cephalometric analysis. Lateral CEPH radiographs can also be combined with other imaging techniques such as CT or MRI to provide a more detailed image of the head and face.

Lateral cephalometric image

A lateral cephalometric image is a radiographic image of the side view of the head, including the teeth and bones of the face. The image is created by taking an X-ray of the head from the side. It is most commonly used in the field of orthodontics where it can provide information to identify problems with the bite, the alignment of the teeth, and the overall shape of the face.

Lateral cephalometric images can assist in diagnosing problems with the teeth and jaw and planning their treatment. Lateral cephalometric images are often used in conjunction with other diagnostic tools such as dental casts and photographs, which can provide additional valuable information for the treatment plan.

What does a lateral CEPH show?

A lateral cephalometric (CEPH) radiograph, also known as a lateral cephalometric projection, shows a side view of the head, including the bones of the skull and face. It is a detailed, two-dimensional picture of the teeth and bones of the face in a side view. The image can show a variety of structures and abnormalities in the development of the teeth and jaws. It provides information that can assist in the diagnosis and treatment of various dental and craniofacial conditions.

Here are some of the things that a lateral CEPH can show:

Skeletal structures: The CEPH shows the relationship between the skull and jaw bones, including the size and shape of the maxilla (upper jaw) and mandible (lower jaw).

Dental structures: The CEPH shows the position of the teeth and their relationship to one another and to the jaws.

Soft tissue structures: The CEPH can also show the position and shape of the soft tissues of the face, such as the nose, lips, and cheeks.

Airway analysis: The image can also be used to assess the upper airway, by analyzing the relationship between the airway and the facial type, airway shape and/or airway volume.

Angles and measurements: The CEPH can be used to measure angles and distances between different points on the head and teeth, which can provide information about the alignment of the jaws and teeth.

Malocclusion: The CEPH can be used to identify malocclusion (misaligned teeth) which is a common orthodontic problem.

Lateral CEPH anatomy

A lateral cephalogram is a type of X-ray that is taken from the side of the head. It is used to examine the skeletal and dental structures of the head and face, as well as the soft tissue profile. Lateral cephalogram allows the orthodontist to evaluate the patient’s facial structure, dental occlusion (bite), and the position of the teeth and jaw bones. It can also be used to diagnose problems such as jaw discrepancies, and facial imbalances.

Lateral CEPH can give a detailed 2D image of the hard palate, nasal bone, paranasal sinuses, nasopharyngeal soft tissues, nasopharyngeal airways, mandible, cervical spine, and hyoid bone which can be used to evaluate their normal anatomy or any discrepancies if present.

Here are some of the structures and landmarks that can be visible on a lateral CEPH radiograph:

Cranial base: The base of the skull, which forms the foundation for the rest of the head and face.

Maxilla: The upper jaw bone, which forms the roof of the mouth and holds the upper teeth.

Mandible: The lower jaw bone, which forms the lower part of the face and holds the lower teeth.

Zygomatic arches: The bones that form the cheeks and form the top part of the orbits, which hold the eyes.

Nasal bone: The bone that forms the bridge of the nose.

Anterior cranial base: The front part of the cranial base, between the upper jaw and the forehead.

Posterior cranial base: The back part of the cranial base, between the upper jaw and the base of the skull.

Hard palate: The bony roof of the mouth.

Soft palate: The fleshy part of the roof of the mouth, which separates the mouth from the nasal cavity.

Sphenoid bone: A large bone in the center of the skull, which forms the base of the skull and has important anatomical landmarks, such as the sphenoid sinus and the sella turcica.

Occipital bone: The bone at the base of the skull that forms the back of the head.

Cervical vertebrae: The bones of the neck, visible on the lateral cephalometric radiograph.

Landmarks: Nasion, Pogonion, Menton, Point A, Point B, Point Pg.

A lateral CEPH radiograph can provide a wealth of information about the craniofacial structures, their relationships and the overall shape of the face and head. To gain the most out of the CEPH radiograph, it’s best to consult an orthodontist or radiologist, who has expertise in interpreting the image and drawing accurate conclusions from it.

Lateral CEPH tracing points

For tracing a lateral cephalogram it is very important to identify the various tracing points accurately. The analysis which is established using these tracing points, forms the basis of the diagnosis and treatment planning which is very critical for the outcome of the treatment.

Following basic tracing, the point should be identified:

A point (A) The point of the deepest concavity anteriorly on the maxillary alveolus
B point (B) The point of the deepest concavity anteriorly on the mandibular symphysis
Sella (S) The midpoint of the sella turcica (pituitary fossa)
Nasion (N) The most anterior point on the fronto-nasal suture
Orbitale (Or) The most anterior, inferior point on the infraorbital rim
Porion (Po) The upper midpoint point on the external auditory meatus
Anterior Nasal Spine (ANS) The tip of the anterior nasal spine
Posterior Nasal Spine (PNS) The tip of the posterior nasal spine
Gonion (Go) The most posterior, inferior point on the mandibular angle
Gnathion (Gn) The most anterior, inferior point on the mandibular symphysis
Menton (Me) The most inferior point on the mandibular symphysis
Pogonion (Pog) The most anterior point on the mandibular symphysis

Lateral CEPH measurements

A lateral cephalometric radiograph (CEPH) provides a wealth of information about the craniofacial structures and their relationships. To gain the most out of the image, orthodontists use various measurements to analyze the CEPH radiograph, often in order to evaluate the growth and development of the head and face.

While performing the measurement, orthodontists identify specific points on the hard and soft tissue of the head and measure various parameters such as the width of the face, the position of the jaw, and the relationship between the upper and lower jaws. These measurements can help identify problems with the bite, the alignment of the teeth, and the overall shape of the face, and plan the appropriate course of treatment.

Here are some of the common measurements that can be made from a lateral CEPH radiograph:

SNA (Sella-Nasion-A Point) angle – this measurement is used to evaluate the relationship between the upper jaw (maxilla) and the lower jaw (mandible). It measures the angle between the sellion (the midpoint of the sella turcica), the nasion (the midpoint of the nasofrontal suture) and Point A (most anterior point of the maxilla). It gives an idea about the maxillary position in relation to the cranial base.

SNB (Sella-Nasion-B Point) angle – similar to the SNA angle, this measurement evaluates the relationship between the upper jaw and the lower jaw, but with a different reference point. It measures the angle between the sellion, the nasion and Point B (most inferior point of the mandibular plane) and gives an idea about the mandibular position in relation to the cranial base.

ANB (A Point-Nasion-B Point) angle – this measurement is used to evaluate the relationship between the upper jaw and the lower jaw, specifically focusing on the position of the upper jaw in relation to the lower jaw. It measures the angle between Point A, the nasion and Point B, which gives an idea about the relationship between the maxilla and the mandible.

GoGn (Gonion-Gnathion) distance – this measurement is used to evaluate the position of the lower jaw and its relationship to the rest of the facial structure.

Wits appraisal – This measurement is used to evaluate the position of the lower jaw, specifically, the position of the mandibular plane in relation to the cranial base plane. It measure the distance between Point A and the Sella turcica, which gives an idea about the position of the maxilla in relation to the cranial base.

FMA (Frankfurt Mandibular plane angle) – This measurement is used to evaluate the angle between the mandibular plane and the plane of the Frankfurt cranial base.

Facial angle: measures the angle between the line from the nasion to the gnathion (most inferior point on the mandible) and the line from the nasion to the subspinale (most inferior point on the midline of the mandible), giving an idea of the overall shape of the face.

Other measurements: the Overjet, Overbite, Molar relationship, Lower facial height.

These measurements can be used alone or in combination to analyze the craniofacial structures and plan the appropriate course of treatment. The interpretation of these measurements requires the expertise of a qualified orthodontist or radiologist, who can take into account the patient’s specific needs and goals.

Lateral CEPH values

The analysis can be achieved on the lateral CEPH based on the planes and relationships which are established using the previously mentioned lateral CEPH tracing points.

The Lateral CEPH values with their standard deviation are as follows:

SNA (81˚±3˚) This angle represents the relative anterioposterior position of the maxilla to the cranial base.

SNB (78˚±3˚) This angle represents the relative anterioposterior position of the mandible to the cranial base.

ANB (3˚±2˚) This angle represents the relative anterioposterior position of the maxilla to the mandible and can be used to determine skeletal class.

Maxillary Incisal Inclination/UInc to MxPl (109˚±6˚) The angle between the maxillary plane (MxPl) and the axis of the maxillary incisors (UInc)

Mandibular Incisal Inclination/Inc to MnPl (93˚±6˚) The angle between the mandibular plane (MnPl) and the axis of the mandibular incisors (LInc)

Maxillary-mandibular plane angle/MMPA (27˚±4˚) The angle formed between the Maxillary Plane and Mandibular Plane

Facial proportion – 55%±2%

Lateral cephalometric tracing values

The various cephalometric variables used for tracing and their values are given below.

Anteroposterior skeletal pattern

The anteroposterior position of the maxilla is calculated by measuring the angle SN to point A (SNA) (81° ± 3°)
The anteroposterior position of the mandible is calculated by measuring the angle SN to point B (SNB) (78° ± 3°)
The relative difference in the anteroposterior relationship of the maxilla and mandible is measured by the difference between the SNA and SNB angles, or ANB angle (3° ± 2°).

Assessing the vertical skeletal relationship

Maxillary–mandibular plane angle (MMPA) – The MMPA is a common method for evaluating the vertical jaw relationship, with horizontal reference planes that are easily located. The mean value is 27° ±5°.
Frankfort–mandibular plane angle (FMPA)- The FMPA uses the Frankfort plane as a horizontal reference to the mandibular plane. The mean value is 27° ±5°.

Anterior and posterior face heights

Anterior and posterior face heights are also used as a measure of vertical facial relationships

Total anterior face height (TAFH) extends from nasion to menton, with both lines constructed perpendicular to the maxillary plane (mean 119 mm in an adult male).

TAFH is further subdivided into:

- Upper anterior face height (UAFH); nasion to a maxillary plane (mean 54 mm)
- Lower anterior face height (LAFH); maxillary plane to menton (mean 65 mm)
  LAFH should be approximately 55% of the TAFH.

Total posterior face height (TPFH) extends from sella to gonion, with both lines constructed perpendicular to the maxillary plane (mean 79 mm in an adult male).

TPFH is therefore subdivided into:
- Upper posterior face height (UPFH); sella to the maxillary plane (mean 46 mm)
- Lower posterior face height (LPFH); maxillary plane to gonion (mean 33 mm)
  TPFH should be approximately 65% of the TAFH.

Assessing the dental relationship

Several methods of assessment are available for positioning the maxillary and mandibular dentition in relation to the jaws and face:

Maxillary incisor relationship
The inclination of the most prominent maxillary incisor is constructed using a line through UIA–Is and measured in relation to the maxillary plane. The mean value is 109° ± 6°.

Mandibular incisor relationship
The inclination of the most prominent mandibular incisor is constructed using a line through LIA–Ii and measured in relation to the mandibular plane. The mean value is 93° ± 6°.

Interincisal angle
The interincisal angle is the angle formed between the most prominent maxillary and mandibular incisors. The mean value is 135° ± 10°.

Soft tissue cephalometric analysis

The soft tissue profile can also be seen on a lateral skull cephalometric radiograph, methods for measuring are:

Ricketts’ E-line
Ricketts’ E-line is a line drawn from tip of the nose to the soft tissue pogonion. The upper lip should be 4 mm and the lower lip 2 mm behind this line. This line is age-related, as the lips tend to become more retrusive with age.

Nasolabial angle
The nasolabial angle can also be identified from the soft tissue profile on a cephalometric radiograph. The mean value is 100° ± 8°.

What is the most stable landmark in the cephalometric radiograph?

When analyzing a cephalometric radiograph, landmarks serve as reference points for measuring the various angles and distances between different structures in the head and face. The stability of these landmarks is critical for ensuring the accuracy and reliability of the analysis.

Multiple studies have been conducted to identify the most stable landmarks for cephalometric radiographs. The majority of these studies have found that the lower incisor border is the most consistent landmark, while points such as Co, Gn, Or, and the anterior nasal spine are considered to be the least reliable.

What dimension is not evaluated in the lateral Cephalogram?

In orthodontic assessments, 3 planes are assessed: Anteroposterior, Vertical, and Transverse relationships.

The Anterioposterior and Vertical relationship can be assessed using a lateral cephalogram, but the transverse relationships is not evaluated in the lateral cephalogram. However, transverse relationship can be assessed by posteroanterior cephalogram or by using CBCT.

The third dimension missing from the cephalometric radiograph, the transverse plane or x-axis in the 3D coordinate system, can be evaluated using CBCT and 3D software. The advent of advanced technologies has made it possible for the orthodontist and surgeon to visualize, evaluate, and simulate hard and soft tissue changes in all three dimensions of the craniofacial structure at the same time, which is useful to make an accurate diagnosis of a transverse discrepancy in the dental and skeletal components and to establish a better treatment plan.

Cephalometric analysis

Cephalometric analysis is a method used in orthodontics and oral surgery to evaluate and measure the size, shape, and relationship of the craniofacial structures, including the skull, jaws, and teeth. It is commonly used to diagnose and plan treatment for orthodontic problems such as malocclusion (misalignment of the teeth) and skeletal discrepancies in the jaws.

There are two main ways to perform cephalometric analysis: hand-tracing and computer-based analysis:

Hand-traced cephalometric analysis: done on a lateral skull radiograph which is hand-traced in a darkened room, on tracing paper attached to the radiograph, using a hard pencil. The peripheral regions of the radiograph should be masked so that they can highlight the cranial base and facial complex. Bilateral structures should be traced independently and then averaged. This method is considered to be time-consuming and can have a higher margin of error.

Computer-based cephalometric analysis: uses commercial and freely available software, which allows the user to import the radiograph and digitally identify and measure various landmarks. Identification of landmarks is done by the user and the rest of the measurement and analysis is done by the software. This method is considered to be more efficient and accurate, as the software performs the majority of the measurement and analysis, thus reducing the margin of error. Additionally, computer-based analysis offers versatility and allows the user to generate different analyses or customize their own, as well as predict treatment outcomes.

Cephalometric analysis interpretation

Cephalometric analysis interpretation is the process of analyzing and interpreting the measurements and data obtained from a lateral cephalogram. The goal of cephalometric analysis interpretation is to evaluate the growth and development of the head and face, identify any dental or skeletal problems, and plan an appropriate course of treatment.

There are several ways in which cephalometric analysis can be interpreted, some common methods include:

Norm-referenced analysis: This method compares the patient’s measurements to a standard or norm, typically established by a large population study. This allows the clinician to identify any deviations from normal growth and development.

Objective analysis: This method focuses on the measurement of specific angles, distances, and ratios. These measurements can be used to evaluate the position of the jaws, the relationship between the upper and lower teeth, and the overall shape of the face.

Subjective analysis: This method involves evaluating the overall appearance of the radiograph, including the position of the jaw, the shape of the face, and the relationship between the upper and lower jaws. This method is highly dependent on the experience and expertise of the clinician.

Computer-assisted analysis: Computer-assisted cephalometric analysis is a widely used method that involves using software to digitize and analyze the radiograph. This method provides a more accurate and efficient way of performing cephalometric analysis, it can be used to produce standardized measurements and analyses, which are not affected by the personal bias of the clinician.

Treatment outcome prediction: This method uses the cephalometric data to predict the outcomes of different treatment options and plan the best course of treatment for the patient.

After establishing CEPH analysis, the next step is to interpret it so that it can help with diagnosis and treatment planning.

In orthodontic assessments, 3 planes are interpreted: Anteroposterior, Vertical, and Transverse relationships:

The Anterioposterior and Vertical relationship can be assessed using a lateral cephalogram.
The transverse relationship can be assessed by posteroanterior cephalogram (this method is not common).

Anteroposterior Relationship

SNA and SNB determine the anteroposterior relationship of the mandible or maxilla relative to the cranial base. If this is increased/decreased compared to the mean values, it means the jaws are positioned more anteriorly or posteriorly.
The skeletal pattern can be assessed by the difference between SNA and SNB, which is also defined as ANB. If the angle ANB is between 2-4 degrees, the anteroposterior skeletal pattern is largely considered to be Class I. If ANB is less than 2degree, it is Class III and if it is greater than 4 degrees then this is considered to be Class II.
The incisal position is determined using the angles UInc to MxPl (see average values above), LInc to MnPl, and the Inter-incisal angle. These show whether the incisors are average, retroclined, or proclined. The inter-incisal angle shows how deep the overbite is.

Vertical Relationship

This is generally assessed by looking at the MMPA (see average values above).
An increased MMPA indicates a backward pattern of mandibular growth and a decreased overbite.

Once the analysis has been completed the type of malocclusion can be defined, along with its cause based, a treatment plan can be made.

Cephalometric analysis in Orthodontics

Cephalometric analysis is performed on a specialized radiograph known as a lateral cephalogram. This radiograph provides a detailed image of the side view of the face. To perform the analysis, a transparent sheet is placed over the cephalogram, and important cephalometric landmarks are traced on it. After identifying the landmarks, the associated planes and angles are calculated, and their values are used to establish an analysis. The resulting analysis provides detailed information about the craniofacial structures, which orthodontics can use to identify problems with the bite, the alignment of the teeth, and the overall shape of the face.

Cephalometric analysis is a key tool used in orthodontics to evaluate and plan treatment for patients with malocclusion or misaligned teeth. Based on this analysis, the type of malocclusion is diagnosed, and an appropriate orthodontic treatment plan is decided.

There are several different cephalometric analysis techniques used in orthodontics, each with its own set of measurements and landmarks. Some of the most commonly used techniques include:

Standard cephalometric analysis: This technique uses a set of standardized measurements and landmarks to evaluate the craniofacial structure, including the position of the jaws, the dental arches, and the relationship between the upper and lower teeth.

Steiner analysis: This technique uses a set of measurements and landmarks developed by Dr. Ralph Steiner to evaluate the craniofacial structure and plan treatment for malocclusion.

McNamara analysis: This technique uses a set of measurements and landmarks developed by Dr. Thomas McNamara to evaluate the craniofacial structure and plan treatment for malocclusion.

Tweed analysis: This technique uses a set of measurements and landmarks developed by Dr. Tweed to evaluate the craniofacial structure and plan treatment for malocclusion.

Lateral CEPH tracing software

Lateral cephalometric radiograph (CEPH) tracing software is a computer-based tool used by orthodontists and other dental professionals to analyze cephalometric radiographs. The software allows users to digitize cephalometric radiographs and then perform various measurements and analyses on the images.

Many CEPH tracing software solutions are available for the dental specialist, including, for example:

Key features of lateral CEPH tracing software include:

Landmark identification: The software allows users to identify key landmarks on the cephalogram, including points on the hard and soft tissue of the head, and to measure various parameters such as the width of the face, the position of the jaw, and the relationship between the upper and lower jaws.

Measurement tools: Lateral CEPH tracing software includes tools for measuring angles, distances, and other parameters on the cephalogram, providing accurate and reproducible measurements that can be used in diagnosis and treatment planning.

Automated analysis: Many lateral CEPH tracing software programs include built-in analysis tools, which automatically calculate important measurements and angles based on the landmarks identified by the user.

Customizable templates: Some software allows you to create custom templates, which you can use in future cases.

Treatment simulation: With the use of this software, orthodontists can plan and simulate different treatment options with virtual setups and preview the outcome before even starting the treatment.

Advanced AI (Artificial Intelligence) solutions are enhancing these capabilities and improve the quality of automatic analysis even further and is becoming very prevalent in orthodontics. These AI solutions are primarily used to measure and analyze cephalometric landmarks, and result in a cephalometric analysis which is very accurate and informative for decision-making related tooth extraction and prediction of orthognathic surgery. Lateral CEPH tracing software solutions enhanced by AI systems has evolved into a valuable tool in orthodontics, and enables to improve speed, consistency, and accuracy in Cephalometric analysis.

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