Points and Landmarks

POINTS AND LANDMARKS

Cephalometric points and landmarks are of the following kinds:

1. True anatomic points.

2. Implants.
3. External points
4. Intersections of edges of regression, and
5. Intersection of constructed lines.

1. TURE ANATOMIC POINTS:

Anatomic points are really small regions which might be located on the
solid skull even better than in the cephalogram. Each point has its own scale and
its own uncertainty in one or two dimensions. Examples include the Anterior
Nasal Spine (ANS), Infradentale (ID), cups tips or incisal edges (IS) or Nasion
(Na).

2. IMPLANTS
Implants are artificially inserted radio-opaque markers, usually made of an
inert metal. They are “private points”, their position from subject to subject is not
homologous, making cross – sectional studies very difficult. They may be located
more precisely than traditional points and provide precise superimposition, but
they can not be used to measure accurately any aspect of the single form.

3. EXTERNAL POINTS
External points are points characterized by their properties relative to the entire
outline;
A. Points which are extreme of curvature.
e.g.: Incison superius (Is)
B. Points whose co-ordinates are largest or smallest of all points on specific
outline.
e.g. : “A Point”, “B Point”, Gnathion (Gn), or Condylion (Co).
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These points have less precision of location than true anatomic points.
C. Points defined in pairs:
e.g. The two Gonions used to measure mandible within the PA projection.

4. INTERSECTION OF EDGES OF REGRESSION AS “POINTS”:

“Points” defined as the inter section of images are really lines looked at
down their length. For instance, Articulare (Ar) and Pterygomaxillary fissure
(PTM) are not points at all and are in no way part of the soiled skull. Such
“Points” exist only in projections and are dependent on subject positioning.

5. INTERSECTION OF CONSTRUCTED LINES:

Intersection of constructed lines is used as “Points”, e.g. “Gonion”
sometimes is defined as the intersection of the ramal and mandibular lines.

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CEPHALOMETRIC LANDMARKS RELATED

TO THE FRONTAL BONE

 F- point F (constructed) – this point approximates the foramen caecum

and represents the anatomic anterior limit of the cranial base, constructed
as the point of intersection of a line perpendicular to the S-N plane from the
point of crossing of the images of the orbital roofs and the internal pate of
the frontal bone (Coben);

 FMN – fronto-maxillary nasal suture – the most superior point of the

suture, where the maxilla articulates with the frontal and nasal bones
(unilateral); FMN is on the anterior cranial base, unlike Na, and can
therefore also be used for measuring o defining the cranial base (Moyers,
1988).

 Na- Nasion – the most anterior point of the frontonasal suture in the
median plane (unilateral);

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 Points and Landmarks

 SE – sephenoethmoidal – the intersection of the shadows of the greater

wing of the sphenoid and the cranial floor as seen in the lateral
cephalogram;

 Sor – supraorbitale – the most anterior point of the intersection of the

shadow of the roof of the orbit and its lateral contour (bilateral) (Sassouni).

 RO – roof of orbit – this marks the uppermost point on the roof of the orbit
(bilateral) (Sassouni).

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CEPHALOMETRIC LANDMARKS RELATED

TO THE OCCIPITAL BONE

 Ba – basion – the median point of the anterior margin of the foramen

magnum can be located by following the image of the slope of the inferior
border of the basilar part of the occipital bone to its posterior limit
(unilateral) (Coben);

 Bo – Bolton point – the highest point in the upward curvature of the retro
condylar fossa (unilateral) (Broadbent);

 Op – opisthion – the posterior edge of foramen magnum (unilateral).

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CEPHALOMETRIC LANDMARKS RELATED

TO THE SPHENOID BONE

 Cl – clinoidale – the most superior point on the contour of the anterior

clinoid (unilateral);

 Ptm – pterygomaxillary fissure – a bilateral teardrop – shaped area of

radiolucency, the anterior shadow of which represents the posterior
surfaces of the tuberosities of the maxilla; the landmark is taken where the
two edges, front and back, appear to merge inferiorly’

 S – Sella – this is the point representing the midpoint of the pituitary fossa
(Sella turcica); it is a constructed point in the median plane;

 Sc – midpoint of the entrance to the Stella – this point represents the

midpoint of the line connecting the posterior clinoid process and the
anterior opening of the Sella turcica; it is at the same level as the jugum
sphenoidale and it is independent of the depth of the Sella (Schwarz) ;

 SE – sphenoethmoidal – the intersection of the shadows of the great wing

of the sphenoid and the cranial floor as seen in the lateral cephalogram;

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 Si – floor of the Sella – the lowermost point on the internal contour of the
Sella turcica (unilateral);

 Sp – dorsum Sella – the most posterior point on the internal contour of the
Sella turcica (unilateral).

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CEPHALOMETRIC LANDMARK RELATED

TO THE TEMPORAL BONE

 Po – Porion (anatomic) – the superior point of the external auditory meatus

(the superior margin of the temperomandibular fossa, which lies at the
same level, may be substituted in the construction of Frankfort horizontal)
(bilateral).

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CEPHALOMETRIC LANDMARK RELATED

TO THE ETHMOID BONE

 SE – sphenoethmoidal – the intersection of the shadows of the greater wing

of the sphenoid and the cranial floor as seen in the lateral cephalogram.

 Te – temporale – the intersection of the shadows of the ethmoid and the

anterior wall.

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CEPHALOMETRIC LANDMARKS RELATED

TO THE NASAL BONE

 FMN – frontomaxillary nasal suture – the most superior point of the suture
where the maxilla articulates with the frontal and nasal bones (unilateral);
unlike Na, FMN is on the anterior cranial base, and it can therefore also be
used for measuring or defining the cranial base (Moyers).

 Na – Nasion – the most anterior point of the frontonasal suture in the

median plane (unilateral).

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CEPHALOMETRIC LANDMARKS RELATED

TO THE MAXILLA

 A – Point A (or ss, subspinale) – the point at the deepest midline concavity
on the maxilla between the anterior nasal spine and Prosthion (unilateral)
(Downs).

 ANS – anterior nasal spine (or sp) spinal point – this is the tip of the bony
anterior nasal spine, in the median plane (unilateral) ; it corresponds to the
anthropological point acanthion;

 APMax – anterior point for determining the length of the maxilla – this is
constructed by dropping a perpendicular from point A to the palatal plane
(Rakosi);

 KR – the key ridge – the lowermost point on the contour of the shadow of
the anterior wall of the infratemporal fossa (bilateral) (Sassouni).

 Or – orbitale – the lowest point in the inferior margin of the orbit, midpoint
between right and left images (bilateral);

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 PNS – posterior nasal spine – the intersection of a continuation of the

anterior wall of the pterygopalatine fossa and the floor of the nose, marking
the dorsal limit of the maxilla (unilateral); the point pterygomaxillary
(pm),which represents the dorsal surface of the maxilla at the level of the
nasal floor, also resembles landmark Pns.

 Pr – Prosthion (or superior Prosthion or supradental) – the lowest and most

anterior point on the alveolar portion of the premaxilla, in the median
plane, between the upper central incisors (unilateral);

 Ptm – pterygomaxillary fissure- a bilateral teardrop – shaped area of

radiolucency, the anterior shadow of which represents the posterior
surfaces of the tuberosities of the maxilla; the landmark is taken where the
two edges, front and back, appears to merge inferiorly.

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CEPHALOMETRIC LANDMARKS RELATED

TO THE ZYGOMATIC BONE

 Or – orbitale – the lowest point in the inferior margin of the orbit, midpoint
between right and left images (bilateral).

 Te – temporale – the intersection of the shadows of the ethmoid and the

anterior wall of the temporal fossa (bilateral) (Sassouni).

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CEPHALOMETRIC LANDMARKS RELATED

TO THE MANDIBLE

 AP Man – anterior landmark for determining the length of the mandible –

it is defined as the perpendicular dropped from Pog to the mandibular plane
(Rakosi).

 Ar – Articulare – the point of intersection of the images of the posterior

border of the condylar process of the mandible and the inferior border of
the basilar part of the occipital bone (bilateral) (redefined by Coben after
Bjork).

 B –Point B (or sm, supramentale) – the point at the deepest midline

concavity on the mandibular symphysis between infradentale and Pogonion
(unilateral) (Downs);

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 Co, Condylion (or cd) – the most superior point on the head of the condylar
head (bilateral);

 Gn – Gnathion – this is the most anteroinferior point on the symphysis of

the chin, and it is constructed by intersecting a line drawn perpendicular to
the line connecting Me and Pog; however, it has been defined in a number
of ways, including as the lowest point of the chin, which synonymous with
mention;

 Go – Gonion – the constructed point of intersection of the ramus plane and

the mandibular plane;

 Id – infradentale – the highest and most anterior point on the alveolar

process, in the median plane, between the mandibular central incisor
(unilateral);

 m – the most posterior point on the mandibular symphysis (unilateral);

 Me – Menton – the most inferior midline point on the mandibular

symphysis (unilateral);

 Pog – Pogonion – the most anterior point of the bony chin in the median
plane (unilateral);

 Pog’ Pogonion prime – the point of tangency of a perpendicular from the

mandibular plane to the most prominent convexity of the mandibular
symphysis (Coben).

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CEPHALOMETRIC LANDMARKS RELATED

TO THE HYOID BONE.

 Hy – hyoid – the most superoanterior point on the body of the hyoid bone
(unilateral).

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CEPHALOMETRIC LANDMARKS OF CRANIOFACIAL SKELETON

 A – point A (or ss, subspinale) – the point at the deepest midline concavity
on the maxilla between the anterior nasal spine and prosthion (unilateral)
(Downs);

 Ans, anterior nasal spine (or sp, spinal point) – the tip of the bony anterior
nasal spine, in the median plane (unilateral); it corresponds to the
anthropological point acanthion;

 APMan – anterior landmark for determining the length of the mandible –

this is defined as the perpendicular dropped from Pog to the mandibular
plane (Rakosi);

 APMax – anterior point for determining the length of the maxilla – this is
constructed by dropping a perpendicular from point A to the palatal plane
(Rakosi).

 Ar – articulare – the point of intersection of the images of the posterior

border of the condylar process of the mandible and the inferior border of

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 Points and Landmarks

the basilar part of the occipital bone (bilateral) (redefined by Coben after
Bjork).

 B – Point B (or sm, supramentale) – the point at the deepest midline

concavity on the mandibular symphysis between infradentale and pogonion
(unilateral) (Downs);

 Ba – basion – the median point of the anterior margin of the foramen

magnum, located by following the image of the slope of the inferior border
of the basilar part of the occipital bone to its posterior limit (unilateral)
(Coben);

 Bo – Bolton point – point in space (roughly at the center of the foramen

magnum) that is located on the lateral cephalometric radiograph by the
highest point in the profile image of the post-condylar notches of the
occipital bone; since did, postcondylar notches are close to the medial
sagittal plane, their shadows generally register on the lateral film as a
single image (unilateral) (Broadbent);

 Cl – clinoidale – the most superior point on the contour of the anterior

clinoid (unilateral);

 Co – Condylion (or cd) – the most superior point on the head of the
condylar head (bilateral);

 F – Point F (constructed) – the point approximating foramen caecum and

representing the anatomic anterior limit of the cranial base, constructed as
the point of intersection of a perpendicular to the S-N plane from the point
of crossing of the images of the orbital roofs and the internal plate of the
frontal bone (Coben);

 FMN – frontomaxillary nasal suture – the most superior point of the suture,
where the maxilla articulates with the frontal and nasal bones (unilateral);

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 Points and Landmarks

unlike Na, FMN is on the anterior cranial base, and it can therefore also be
used for measuring or defining the cranial base (Moyers);

 Gn – Gnathion – the most anterioinferior point on the symphysis of the

chin; it is constructed by intersecting a line drawn perpendicular to the line
connecting Me and Pog; however, it has been defined in a number of ways,
including as the lowest point of the chin, which is synonymous with
mention;

 Go – Gonion – the constructed point of intersection of the ramus plane and

the mandibular plane;

 Hy – hyoid – the most superoanterior point on the body of the hyoid bone
(unilateral);

 Id – infradentale – the highest and most anterior point on the alveolar

process, in the median plane, between the mandibular central incisors
(unilateral);

 KR – the key ridge – the lowermost point on the contour of the shadow of
the anterior wall of the infrantemporal fossa (bilateral).

 M – the most posterior point on the mandibular symphysis (unilateral);

 Me – Menton – the most inferior midline point on the mandibular

symphysis (unilateral);

 Na – Nasion – the most anterior point of the frontonasal suture in the

median plane (unilateral);

 Op – opisthion – the posterior edge of foramen magnum (unilateral);

 Or – orbitale – the lowest point in the inferior margin of the orbit, mid
point between right and left images (bilateral);

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 Points and Landmarks

 Pns – posterior nasal spine – the intersection of a continuation of the

anterior wall of the pterygopalatine fossa and the floor of the nose, marking
the dorsal limit of the maxilla (unilateral): the point pterygomaxillary (pm),
which represents the dorsal surface of the maxilla at the level of the nasal
floor, also resembles landmark Pns;

 Po – Porion (anatomic) – the superior point of the external auditory meatus

(superior margin of temporamandibular fossa which lies at the same level
maybe substituted in the construction of Frankfort horizontal) (bilateral);

 Pog – Pogonion – the most anterior point of the bony chin in the median
plane (unilateral);

 Pog’ – pogonionprime – the point of tangency of a perpendicular from the

mandibular plane to the most prominent convexity of the mandibular
symphysis (Coben);

 Pr – Prosthion (or superior Prosthion or supradental) – the lowest and most

anterior point on the alveolar portion of the premaxilla; it is in the median
plane, between the upper central incisors (unilateral);

 Ptm – pterygomaxillary fissure – a bilateral teardrop – shaped area of

radiolucency, whose anterior shadow represents the posterior surfaces of
the tuberosities of the maxilla; the landmark is taken where the two edges,
front and back, appear to merge inferiorly;

 RO – roof – of orbit – the uppermost point on the roof of the orbit

(bilateral) (Sassouni);

 S – Sella – the point representing the midpoint of the pituitary fossa (sella
turcica); it is a constructed point in the median plane;

 Sc – midpoint of the entrance to the Sella – this point represents the

midpoint of the line connecting the posterior clinoid process and the

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 Points and Landmarks

anterior opening of the Sella turcica; it is at the same level as the jugum
sphenoidale and is independent of the depth of the Sella (Schwarz);

 SE – sphenoethmoidal – the intersection of the shadows of the great wing

of the sphenoidal and the cranial floor, as seen in the lateral cephalogram;

 Si – floor of Sella – the lowermost point on the internal contour of the Sella
turcica (unilateral);

 SOr – supraobitale – the most anterior point of the intersection of the

shadow of the roof of the orbit and its lateral contour (bilateral) (Sassouni);

 Sp – dorsum sellae – the most posterior point on the internal contour of the
sella turcica (unilateral):

 Te – temporale- the intersection of the shadows of the ethmoid and the

anterior wall of the anterior wall of the intratemporal fossa (bilateral)
(Sassouni).

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CEPHALOMETRIC LANDMARKS RELATED

TO THE SOFT TISSUE PROFILE

 G – glabella – the most prominent point in the midsagittal plane of

forehead;

 Hs- Inferior labial sulcus – the point of greatest concavity in the midline of
the lower lip between labale inferius and Menton;

 Li – labrale inferius – the median point in the lower margin of the lower
membranous lip;

 Ls – labrale superius – the median point in the upper margin of the upper
membranous lip;

 Ms – menton soft tissue – the constructed point of intersection of a vertical

co-ordinate from menton and the inferior soft tissue contour of the chin;

 Ns – Nasion soft tissue – the point of deepest concavity of th soft tissue

contour of the root of the nose;

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 Points and Landmarks

 Pn – pronasale – the most prominent point of the nose;

 Pos – Pogonion soft tissue – the most prominent point on the soft tissue
contour of the chin;

 Sis – superior labial sulcus – the point of greatest concavity in the midline
of the upper lip between subnasale and labrale superius;

 Sn – subnasale – the point where the lower border of the nose meets the
outer contour of the upper lip;

 St – stomion – the midpoint between stomion superius and stomion

inferius;

 Sti – stomion inferius – the highest point of the lower lip;

 Sts – stomion superius – the lowest point of the upper lip’

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CEPHALOMETRIC LANDMARKS RELATED

TO THE DENTITION

 APOcc – anterior point for the occlusal plane – a constructed point, the
midpoint of the incisor overbite in occlusion;

 Iia – incision inferius apicalis – the root apex of the most anterior
mandibular central incisor, if this point is needed only for defining the long
axis of the tooth, the midpoint on the bisection of the apical root width can
be used;

 Iii – incision inferius incisalis – the incisal edge of the most prominent
mandibular central incisor;

 Isa – incision superius apicalis – the root apex of the most anterior
maxillary central incisor; if this point is needed only for defining the long
axis of the tooth, the midpoint on the bisection of the apical root width can
be used:

 Isi – incision superius incisalis – the incisal edge of the maxillary central
incisor.

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 Li – mandibular central incisor – the most labial point on the crown of the
mandibular central incisor;

 L6 – mandibular first molar – the tip of the mesiobuccal cusp of the

mandibular first permanent molar;

 PPOcc – posterior point for the occlusal plane – the most distal point of
contact between the most posterior molars in occlusion (Rakosi);

 UI – maxillary central incisor – the most labial point on the crown of the
maxillary central incisor;

 U6 – maxillary first molar – the tip of the mesiobuccal cusp of the

maxillary first permanent molar.

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CEPHALOMETRIC LANDMARKS RELATED

TO THE PHARYNX

 Ans – anterior nasal spine;

 Apw – anterior pharyngeal wall;
 Hy – hyoid
 Pns – posterior nasal spine;
 Ppw – posterior pharyngeal wall;
 Pt – posterior point of tongue;
 Ptm – pterygomaxillary fissure;
 Spw – superior pharyngeal wall;
 U – tip of uvula;
 Uo –point on the oral side of the soft palate;
 Up – point on the pharyngeal side of the soft palate;
 Ut – up-per point of tongue

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CEPHALOMETRIC LANDMARKS OF THE CERVICAL VERTEBRAE

 Cv2ap – the apex of the odontoid process of the second cervical vertebra;

 Cv2ip – the most inferoposterior point on the body of the second cervical
vertebra;

 Cv2ia – the most inferoanterior point on the body of the second vertical
vertebra;

 Cv3sp – the mostsuperoposterior point on the body of the third cervical

vertebra;

 Cv3ip – the most inferoposterior point on the body of the third cervical
vertebra;

 Cv3sa – the most superoanterior point on the body of the third cervical
vertebra;
 Cv3ia – the most inferoanterior point on the body of the third cervical
vertebra;

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 Cv4sp – the most superoposterior point on the body of the fourth cervical
vertebra;

 Cv4ip – the most infroposteiror point on the body of the fourth cervical
vertebra;

 Cv4sa – the most superonaterior point on the body of the fourth cervical
vertebra;

 Cv4ia – the most inferoanterior point on the body of the fourth cervical
vertebra;

 Cv5sp – the most superoposterior point on the body of the fifth cervical
vertebr;

 Cv5ip –the most inferoposterior point on the body of the fifth cervical
vertebra.

 Cv5sa – the most superoanterior point on the body of the fifth cervical
vertebra;
 Cv5ia – the most inferoanterior point on the body of the fifth cervical
vertebra;
 Cv6sp – the most superoposterior point on the body of the sixth cervical
vertebra;

 Cv6ip – the most inferoposterior point on the body of the sixth cervical
vertebra;

 Cv6sa – the most superoanterior point on the body of the sixth cervical
vertebra;

 Cv6ia – the most inferoanterior point on the body

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