Dr.K.
George Varghese
Consultant Oral & Maxillofacial Surgeon
Pushpagiri Institute of Medical Sciences, Tiruvalla
1
Why this topic ?
2
Science and art of diagnosis,
treatment planning, and execution
of treatment to correct dentofacial
deformities (musculoskeletal, dento-
osseous and soft tissue)
3
Skeletal ,Dental, Soft tisse
4
5
Middle third: lower third- 5:6
Tr- trichion
G-glabella
Sn-subnasale
Me’ -soft tissue menton
The lower third can bedivided into
an upper third (from Sn to
stomion superius [Sts]) and a lower
two-thirds (from stomion inferius
[Sti] to Me’).
6
Mesocephalic /Brachycephalic/ Dolicocephalic
7
“Rule of fifth”
8
Trichion
Upper third
Glabella
Middle third
Subnasale
Lower third
Menton
9
Aid to clinical assessment- not a sole
diagnostic tool
It should be critically weighed against
clinical finding and the individual needs
of the patient.
“The aesthetic desires of the patient should
be given the priority”
10
Cephalometric analyses are primarily
designed ( in Orthodontics) to evaluate
the position of the teeth with the
existing skeletal pattern. In patients
undergoing orthognathic surgery,
usually facial bones as well as teeth
positions are altered
11
Cephalometric Land mararks
Hard tissue land marks
Soft tissue land marks
Cephalometric values
Hard tissue values
Soft tissue values
12
-7 degree from SN intersecting at N
- Measurements made either parallel or perpendicular
to HP
13
1. Cranial base
2. Horizontal measurements- Skeletal
3. Vertical measurements- Skeletal & Dental
4. Maxilla and Mandible
5. Dental measurements
14
Landmarks considered- Ar, PTM , N
Ar- N - Length of cranial base- 50/52
Ar-PTN- Horizontal distance from post.maxilla-32/37
15
1) N A
(-2/0)
2) N B
(-6.9/5.3)
3) N Pg
(-6.5/4.3)
4) N-A-Pg
(2.6/3.9)
16
Skeletal A. Anterior
B. Posterior
Dental A. Anterior
B. Posterior
17
Skeletal
50.6/53.9 50/54.7
2 Anterior
Components
N-ANS
ANS-Gn
2 Posterior
Components 61.3/68.6
N-PNS
MP-HP Angle
24.2/23
18
Dental
2 Anterior
2 Posterior Components
Components U1-NF
U1-NF L1-MP
L1-MP
23/26.2 27.5/30.5
30.1/35.8
40.8/45
19
1)PNS- ANS
52.6/57.7
2)Ar- Go
46.8/52 3)Go Pg
122/123
4)Ar-Go-Gn
74.3/83.7
5)B- Pg
7.2/8.9
20
112/111
-0.4/1.1
7.1/6.2
1)HP-OP Angle
2) AB- OP
3)U1-NF Angle
4)L1-MP Angle
112/111
21
22
Incomplete in providing details of
facial form
Ceph analysis may be sometimes
misleading
Soft tissue covering teeth and bone is
variable in thickness
23
Angle of convexity/
Anterior facial plane
Perpendicular
dropped
from glabella
to subnasion
and then
pogonion
24
Convex Straight Concave
Naso labial angle
Normal range- 85 to105
degrees
Acute angle -treated by
retracting the maxilla or
incisors or both
Obtuse angle- suggests
maxillary hypoplasia-
treated by maxillary
advancement or orthodontic
proclination
26
Lower lip chin contour should have an S curve
Depth of labiomental sulcus – 4mm
Angulation – 130 degrees
Acute – CL II div I
Flattened - CL III
27
Chin throat angle provides
chin definition.
Normal - 110 degrees.
Distance between neck-
throat angle to soft tissue
pogonion should be
approx. 42mm.
28
Soft Tissue
1. Cranial base
1. Angle of
2. Horizontal measurements-
Skeletal convexity/facial form
3. Vertical measurements-
2. Naso labial angle
Skeletal & Dental
4. Maxilla and Mandible
3. Labio mental sulcus
5. Dental measurements 4. Chin throat angle
29
1. Includes all of the facial bones and a cranial
base reference.
2. Landmarks and measurements can be
altered by surgical procedures.
3. Measurements can be readily transferred to
a study cast for mock surgery.
4. For variations in age & sex- standards and
statistics are available.
30
31
Vertical excess of lower third of face
Visibility of upper teeth by more than 2-3mm
with lips in repose
Gummy smile
Difficulty in apposing the lips
Acute nasolabial angle
Convexity of facial profile
Increased overjet and/or deep overbite
32
Concave facial profile
Nasolabial angle acute or obtuse
depending on the combination of
defects
Reduced vertical dimension of lower
third of face
Dishing of upper third of face
Prominent lower lip
Narrow upper arch
33
Prognathism of mandible
Anterior cross bite
Elongated face
Lower third of face is relatively longer
Face appears concave
Lower lip and chin are much
anteriorly placed than normal
Class III relationship of occlusion
34
Bird face appearance
Severe overjet
Class II relationship
Crowding of lower teeth
Flaring of lower anterior teeth
Face appears small
Lower third of face is short
Stomion- menton is proportionately short
Chin neck angle is obtuse
35
36
Thank You
37
38
