Cephalometric Landmarks

An Atlas on
Cephalometric
Landmarks
An Atlas on
Cephalometric
Landmarks
Basavaraj Subhashchandra Phulari

BDS MDS (Ortho-TSMA-Russia) FAGE FRSH
Formerly
Faculty, Department of Orthodontics and
Dentofacial Orthopedics
Mauras College of Dentistry, Hospital and
Oral Research Institute
Republic of Mauritius
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An Atlas on Cephalometric Landmarks

First Edition: 2013
ISBN: 978-93-5090-324-7
Printed at
To
My dear parents Subhashchandra and Shivalingamma Phulari
brothers Sangamesh, Jagadish and manjunath
my beloved wife Dr Rashmi GS
and my dear sons Yashas and Vrishank
Preface
Cephalometrics has been used in orthodontics for diagnosis, treatment planning, to evaluate the dentofacial
changes during treatment and to assess the dentofacial growth and development. Cephalometrics makes use
of certain landmarks on the skull. The first important step in cephalometric analysis is accurate location and
tracing of cephalometric landmarks on the cephalogram. Any error in tracing the landmarks may result in incorrect
cephalometric analysis.
This book focuses on understanding the various cephalometric landmarks. Each cephalometric landmark is
explained in detail including its abbreviation, definition by various researchers, origin and radiographic anatomy of
the landmarks.
There are 20 chapters divided into 11 sections. Chapter two lists the different ways of classifying cephalometric
landmarks given in the literature. In addition, a new working classification has been given that lists the numerous
cephalometric landmarks logically which makes remembering easier.
This working classification is used as a blueprint to systemically explain the cephalometric landmarks from
chapter 3 through chapter 19. Chapter 20 explains application of all types of cephalometric landmarks in various
cephalometric analyses. In addition to the landmarks on lateral cephalogram, the landmarks on the posteroanterior
(P-A) cephalogram and submentovertex (S-V) radiographic projection are also dealt in this book.
I regret any deficiencies and shortcomings that might have crept in despite my best efforts. I would also welcome
comments and suggestions from both students and teachers for further improvement of the book.
Basavaraj Subhashchandra Phulari

[email protected]
Acknowledgments
I express my heartfelt gratitude to Dr Rajendrasinh Rathore MDS, Chairman of Manubhai Patel Dental College and
Hospital, Vadodara, Gujarat for his inspirational support during this endeavor and throughout my career. I also thank
Dr Yashraj Rathore, Trustee, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India for encouraging
me during this project.
I am indebted to my dear parents for all their love and sacrifices that have made me what I am. My special thanks
are due to my beloved wife for her valuable comments and suggestions, and my dear sons for being the constant
source of inspiration to set and reach new goals in life.
I would like to thank Anatomage Inc. for providing images in chapter 17 and for the cover.
Most of all I thank the Almighty for all His kindness and blessings showered upon me.
Contents
Section 1: Introduction and History

1. Cephalometry in Orthodontics....................................................................................................... 3
Technical Aspects 4
Cephalometric X-ray Tracing Techniques 4
Section 2: Classification of Cephalometric Landmarks

2. Classification of Cephalometric Landmarks................................................................................. 7
Classification of cephalometric landmarks (Points) 7
Section 3: Cephalometric Landmarks Related to Cranial Bones

3. Cephalometric Landmarks Related to Frontal Bone.................................................................. 15
Parts of Frontal Bone 15 Nasion 16
Articulation of Frontal Bone 15 Supra-Orbitale 17
Cephalometric Landmarks (Points) on Frontal Bone 15
Roof of the Orbital Cavity 17
Radiographic Anatomy of Frontal Bone 15
Frontonasal/Frontomaxillary Nasal Suture 18
4. Cephalometric landmarks related to ethmoid bone ............................................................... 21
Parts of Ethmoid Bone 21 Neck of Crista Galli 23
Articulation of Ethmoid Bone 21 Medio-orbitale 23
Cephalometric Landmarks (Points) on Ethmoid Bone 21
Sphenoethmoidal Point 24
Temporale 21
Ethmoidale 24
5. Cephalometric landmarks related to Nasal bone.................................................................... 26

Articulation of frontal bone 26 Frontonasal/Frontomaxillary Nasal Suture 28
Radiographic anatomy of nasal bone 26 Rhinion 29
Nasion 26
6. Cephalometric landmarks related to temporal bone ............................................................. 31

Articulation of Temporal Bone 31 Porion 32
Radiographic Anatomy of Temporal Bone 31 Zygomatic Arch 32
Cephalometric Landmarks (Points) on Temporal Bone 31
Mastiodale 33
7. Cephalometric landmarks related to sphenoid bone ............................................................. 35

Cephalometric Landmarks (Points) on Sphenoid Bone 35 Pterygoid point 40
Dorsum of Sella 36 Sella 41
Floor of Sella 37 Sella Entrance 41
Clinoidale 38 Sphenoethmoidal point 42
Spheno-Occipital Synchondrosis 39 Pterygomaxillary Fissure 44
xii
8. Cephalometric landmarks related to occipital bone .............................................................. 46

Cephalometric landmarks (Points) on occipital bone 46 Opisthion 48
Radiographic anatomy of Occipital bone 46 Bolton’s point 48
Basion 46 Spheno-occipital synchondrosis 50
9. Cephalometric landmarks related to Zygomatic bone ............................................................. 52

Radiographic Anatomy of Zygomatic Bone 52 Orbitale 52
Cephalometric landmarks (Points) on Zygomatic Temporale 54
bone 52
Section 4: Cephalometric Landmarks Related to Facial Bones and Dentition

10. Cephalometric Landmarks Related to Maxilla............................................................................ 59
Cephalometric Landmarks (Points) on Maxilla 59 Posterior Nasal Spine 64
Anterior Nasal Spine 59 Pterygomaxillary Fissure 65
Point A 61 Key Ridge 66
Prosthion 62 Orbitale 67
11. Cephalometric Landmarks Related to Dentition............................................................................ 70

Incision Superius Incisalis 71 Maxillary Central Incisor 79
Incision Superius Apicalis 73 Maxillary First Molar 79
Incision Inferius Incisalis 74 Mandibular Central Incisor 80
Incision Inferius Apicalis 75 Mandibular First Molar 81
Anterior Point of Occlusion 76 mi 82
Posterior Point of Occlusion 77 ms 83
12. Cephalometric Landmarks Related to Mandible............................................................................ 85

Cephalometric landmarks (Points) on Mandible 85 Gnathion 89
Parts of Mandible 85 dd 91
Nerve Supply to Mandible 85
Menton 92
Articulations 86
Gonion 93
Infradentale 86
Articulare 93
Point B 87
kk 94
Pogonion 88
Condylion 95
Section 5: Cephalometric Landmarks Related to Cervical Bones

13. Cephalometric landmarks related to hyoid bone ................................................................. 101
Parts of the Hyoid Bone 101 Cephalometric Landmarks (Points) on Hyoid Bone 101
Radiographic Anatomy of Hyoid Bone 101 Hyoid 101
14. Cephalometric landmarks related to Vertebrae......................................................................... 103

Radiographic anatomy of cervical vertebrae 103 cv2ip 104
Cephalometric Landmarks on Cervical Vertebra 103 cv2ap 104
Cephalometric Landmarks (Points) Related to Cervical cv2ia 106
Vertebra 103 cv3sp 106
xiii
cv3ip 107 cv5ip 113

cv3sa 107 cv5sa 113
cv3ia 109 cv5ia 115
cv4sp 109 cv6sp 115
cv4ip 110 cv6ip 116
cv4sa 110 cv6sa 116
cv4ia 112 cv6ia 118
cv5sp 112 Cervical Vertebrae as Indicators of Skeletal Maturity 118
Section 6: Cephalometric landmarks related to Pharynx

15. Cephalometric landmarks related to Pharynx........................................................................ 123
Nasopharynx 123 Posterior Pharyngeal Wall 124
Oropharynx 123 Superior Pharyngeal Wall 124
Laryngopharynx 123 Tip of the Uvula 124
Cephalometric Landmarks (Points) on Pharynx 123 Point on the Oral Side of the Soft Palate 124
Anterior Nasal Spine, Posterior Nasal Spine and Point on the Pharyngeal Side of the Soft Palate 124
Pterygomaxillary Fissure 123 Upper Point of Tongue 124
Anterior Pharyngeal Wall 123 Significance 124
Section 7: Soft Tissue Cephalometric Landmarks

16. Soft Tissue Cephalometric Landmarks.......................................................................................... 127
Contents
Soft Tissue Cephalometric Landmarks (Points) Related to Subnasale 131
Forehead 127 Soft Tissue Subspinale 133
Soft Tissue Glabella 127 Labrale Superius 134
Soft Tissue Nasion 128 Stomion 135
Nasal Crown 129 Labrale Inferius 136
Pronasale 129 Soft Tissue Submentale 136
Point “T” 130 Soft Tissue Pogonion 138
Alar Crease Junction 131 Soft Tissue Gnathion 139
Section 8: 3D Cephalometric Landmarks

17. 3D Cephalometric Landmarks.................................................................................................... 143
Vertex 143 Zygomatic Prominence 149
Soft Tissue Nasion 143 Zygion 149
Pronasale 144 Condylion 149
Subnasale 144 Gonion 150
Soft Tissue Subspinale 145 Ch 150
Labrale Superius 146 Cheilion 151
Stomion 146 Alare 151
Labrale Inferius 146 Exocanthion 151
Soft Tissue Submentale 147 Sella 152
Soft Tissue Pogonion 147 Sella entrance 153
Soft Tissue Gnathion 148 Basion 153
Orbitale 148 Anterior Nasal Spine 154
xiv
Section 9: PA Cephalometric Landmarks

18. PA Cephalometric Landmarks.................................................................................................... 159
Taking Pa Cephalogram 160 Maxillary First Molar 168
Structures Involved in Pa Cephalogram 160 Cuspid 169
Crista galli 160 Incision Inferius Incisalis 169
Top of nasal septum 161 Incision Inferius Apicalis 170
NC 162 Incision inferius frontale 171
Zyg-Zygoma 162 Mandibular First Molar 171
zygion 163 mi 172
Zygomatic arch 163 Mandibular molar 173
Zygomatic suture point 164 Menton 173
Jugal process 164 Articulare 174
Maxillare 165 malare 174
Incision Superius Incisalis 165 Antegonial Tubercles 175
Incision Superius Apicalis 166 Antegonion 175

Maxillary molar 167
Section 10: SV Cephalometric Landmarks

19. SV Cephalometric Landmarks.................................................................................................... 179
Basion 179 Maxillary Apical Base Midline 185
Opisthion 179 Mandibular Dental Midline 185
Foramina spinosa points 180 Mandibular Apical Base Midline 186
Foramina spinosum 180 First Molar Point 187
Odontoid 181 Gonion point 187
Pterygomaxillary fissure 182 Condylion medialis 188
Middle cranial fossa points 182 Condylion lateralis 188
Posterior Vomer point 182 Condylion Anterioris 189
Posterior Cranial vault points 183 Condylion posterioris 190
Angulare point 184
Section 11: Applications of Cephalometric Landmarks

20. Applications of Cephalometric Landmarks.............................................................................. 193
Bjork Cephalometric Analysis 193 Holdaway Cephalometric Analysis 197
Coben Craniofacial and Dentition Cephalometric Legan and Burstone Soft Tissue Cephalometric
Analysis 194 Analysis 198
Downs Cephalometric Analysis 195 Rickett’s Cephalometric Analysis 198
Farkas and Coworkers Soft Tissue Cephalometric Sassouni Cephalometric Analysis 199
Analysis 196 Di Paolo’s Quadrilateral Analysis 200
Harvold Cephalometric Analysis 196 Hasund (Bergen) Cephalometric Analysis 200
xv
Jarabak Cephalometric Analysis 201 Wit’s Cephalometric Analysis 206

Riedel Cephalometric Analysis 202 Basis Cephalometric Analysis 207
Schwartz Cephalometric Analysis 203 Cagliari Cephalometric Analysis 207
Wylie Cephalometric Analysis 203 Chieti Cephalometric Analysis 208
Steiner’s Cephalometric Analysis 204 McGann Cephalometric Analysis 209
Tweed’s Cephalometric Analysis 205
Index...................................................................................................................................................... 211
Contents
Section 1
Introduction and History
 Cephalometry in Orthodontics
Chapter
1 Cephalometry in
Orthodontics
Cephalometric radiographs are used in orthodontic diagnosis Types of Cephalogram

to evaluate the pre-treatment dental and facial relationship of a
patient, to evaluate changes during treatment and to assess tooth There are following two types of cephalograms
movement and facial growth at the end of treatment. On the 1. Lateral cephalogram: Lateral cephalogram provides a
cephalometric film, teeth can be related to one another, to the lateral view of the skull (Fig. 1.1). It is taken with the
jaw in which they reside, and to cranial structures. The maxilla head in a standardized reproducible position at a specified
and mandible can be related to one another and other structures distance from the source of the x-ray. Lateral cephalogram
into the cranium and the soft tissue profile can be evaluated. commonly is used for cephalometric analysis.
Cephalometric analysis is one among various diagnostic aids. 2. Frontal cephalogram: This provides an antero-posterior
An orthodontic diagnosis is not possible only on the basis view of the skull (Fig. 1.2).
of cephalometry. Cephalometric analysis is an important aid
in orthodontic diagnosis only if its findings are correctly and Uses of Cephalometric Analysis
wisely interpreted with the help of other diagnostic aids.
In the cephalometric assessment, certain carefully defined 1. Cephalometric analysis is routinely used for diagnostic
points are located on the radiographs, and linear and angular purpose to assess whether malocclusion dental or skeletal
measurements are made from these points. The expressions in origin.
of these measurements in various ways produce analysis of 2. It enables clinician to know accurately the extent to which
skeletal size and form. patient deviates from described norms.
Figure 1.1: Lateral cephalogram Figure 1.2: Frontal cephalogram

4
3. It is used to monitor the changes occurring due to growth traced. The anterior surface of the frontal and nasal bones are
or treatment or their combination. In other words, precise then traced followed by tracing the outline of the maxilla and
evaluation of patient’s response to treatment is made from the anterior nasal spine along the floor of the nasal cavity
possible. back to posterior nasal spine from posterior nasal spine.
4. Yet another use of cephalometrics is to predict changes
that should occur in future for patient after orthodontic Bibliography
treatment. An architectural plan / blueprint of orthodontic 1. Bennett GC, Kronman JH. A cephalometric study of mandibular
treatment. development and its relationship to the mandibular and occlusal planes.
Angle orthodont.1970;40:119-28.
2. Bjork A. Prediction of mandibular growth rotation. Am J Orthodont.
Technical Aspects 1969;55:585-99.
3. Broadbent BH. A new X-ray technique and its application to
The cephalometric radiographs are taken using an apparatus orthodontics, Angle Orthod. 1931;1:45-66.
that consists of an X-ray source and a head holding device 4. Brodie AG, Downs WB, Goldstein A, Myer E. Cephalometric appraisal of
called cephalostat. The cephalostat consists of two ear rods orthodontic results: A preliminary report. Angle orthodont. 1938;8:261-5.
that prevent the movement of the head in the horizontal 5. Downs WB, Variations if facial relationship: Their significance in
treatment and prognosis. Am J Orthod. 1948;34:812.
plane. Vertical stabilization of the head is brought about by 6. Downs WB. Analysis of the dentofacial profile. Angle Orthod. 1956;
an orbital pointer that contacts the lower border of the left 26:191.
orbit. The upper part of the face is supported by the forehead 7. Downs WB. Analysis of the dento-facial profile. Angle orthodont.
1956;26:191-212.
clamp positioned above the region of the nasal bridge. The
Section 1  Introduction and History
8. Houston WJB. The analysis of error in orthodontics measurements. AM

distance between the X-ray source and the mid-sagittal plane J Orthod. 1983;83:382-90
of the patient is fixed at 5 feet (152.4 cm). Thus the equipment 9. Jacobs. Introduction to Radiographic Cephalometry, Lea and Febiger,
helps in standardizing the radiographs by use of constant head Philadelphia. 1985.
10. Jacobson A. Radiographic cephelometry: From basics to video imaging,
position and source film distance so that serial radiographs Chicago 1995, Quintessence Pub Co.
can be compared. 11. Jacobson A. The appraisal of jaw disharmony. Am J Orthod. 1975;
There are many systems of cephalometric analysis, which 67:125-38.
utilize various points and outline on the lateral cephalogram 12. Jakobson S. Cephelometric evaluation of treatment effect on Class-
IIDivision I malocclusions. Amer J Orthodont. 1967;53:446-57.
radiograph. 13. Moorrees, CFA, Lebret L. The mesh diagram and cephalometricss.
Angle Orthodont. 1962;32:214-31.
14. Rickets RM, Bench RW, Hilgers JJ, Schulhof R. An overview of
Cephalometric X-ray Tracing Techniques computerized cephalometrics. Am J Orthodont. 1972;61:1-28.
Masking tape is used to attach the cephalometric X-ray to the 15. Steiner CC. The use of Cephalometrics as an aid in planning & assessing
orthodontic treatment. Am J Orthod. 1960;46:721.
acrylic acetate tracing paper sheet. Tracing is made on the 16. Subtelny JD. Cephalometric diagnoss, growth and treatment: something
frosted surface of acetate tracing sheet. old, something new? Am J Orthodont. 1970;57:262-86.
The tracing is begun by marking the hard and soft tissue 17. Susomi R. A cephalometric evaluation of dentofacial growth in mandi
points needed for the analysis on the tracing sheet. Soft tissue bular protrusion subjects. J Osaka Univer. Dent. CSch. 1969;9:25-35.
18. Thomas M Graber, Robert L Vanarsdall. Orthodontics current principles
profile is traced and then the sella turcica going forward to and techniques, Mosby year book Inc. 1994.
the planum sphenoidale along the floor of the anterior cranial 19. Tweed CH. The diagnosis facial triangle in the control of treatment
fossa of the shadows of the greater wings of sphenoid bone are objectives. Am J Orthodont. 1969;55:667.
Section 2
Classification of Cephalometric
Landmarks
 Classification of Cephalometric Landmarks

Chapter
2 Classification of
Cephalometric Landmarks
Cephalometry makes use of certain landmarks or points 1. Hard tissue cephalometric landmarks.
on the skull which are used for quantitative analysis and 2. Soft tissue cephalometric landmarks.
measurements. Flow chart 2.2: Cephalometric landmarks/points
Classification of cephalometric landmarks/points

The first two classifications given below are well-known in the
literature. In addition to these basic existing classifications,
the author has attempted to categorize the cephalometric
landmarks in various ways to simplify their understanding and
subsequent applications in various cephalometric analysis.
Hard tissue cephalometric landmarks
Classification of cephalometric landmarks
These landmarks represent the actual hard tissue structures of
based on Origin
the skull, such as nasal bone, ethmoidal bone, frontal bone,
Based on the origin, cephalometric landmarks/points are maxillary bone, mandible and hyoid, etc.
classified in the following two types (Flow chart 2.1):
Examples of hard tissue cephalometric landmarks—
1. Anatomic cephalometric landmarks/points.
• Nasion
2. Derived cephalometric landmarks/points.
• Neck of crista galli
Flow chart 2.1: Cephalometric landmarks/points • Temporale
• Sella
• Menton
• Gonion.
Soft tissue cephalometric landmarks

Cephalometric landmarks/points located on soft tissues are
Anatomic cephalometric landmarks/points categorized as soft tissue cephalometric landmarks/points.
These landmarks represent the actual anatomic structures of Soft tissues:
the skull, e.g. Nasion, point A, point B, ANS, PNS, etc. • Forehead
• Nose
Derived cephalometric landmarks/points • Lips
These are landmarks that have been obtained secondarily from • Chin.
anatomic structures in a lateral cephalogram, e.g. Gnathion,
Examples of soft tissues cephalometric landmarks—
Anterior Point of Occlusion, etc.
• Soft tissue nasion
• Subnasale
cephalometric landmarks Based on
• Subspinale
Structures Involved • Stomion
Based on structures involved, cephalometric landmarks/points • Soft tissue pogonion
can be classified as follows (Flow chart 2.2): • Soft tissue gnathion.
8
Cephalometric landmarks Based on the type • Point B

or Side Involved • Menton, etc.
Based on the side involved cephalometric landmarks/points Bilateral cephalometric landmarks

can be classified as follows (Flow chart 2.3):
1. Unilateral cephalometric landmarks. These are cephalometric landmarks found on both right and
2. Bilateral cephalometric landmarks. left side.
Examples
Flow chart 2.3: Cephalometric landmarks/points
• Gonion
• Articulare
• APOcc
• U6
• L 6, etc.
Hard or Soft Tissue cephalometric landmarks

Section 2  Classification of Cephalometric Landmarks
Cephalometric landmarks/points can be hard or soft tissue

Unilateral cephalometric landmarks landmarks. Hard tissue and soft tissue landmarks can be further
These are cephalometric landmarks or points situated in the classified into anatomic and derived and then subclassified
midline. into unilateral or bilateral (Flow chart 2.4).
Examples
• Nasion Cephalometric Landmarks/Points can be Found
• Neck of crista galli on lateral Cephalogram, PA Cephalogram and
• Point A SV Cephalogram (Flow Chart 2.5)

9
Types of Cephalometric Landmarks/Points Classification of Cephalometric Landmarks/

Cephalometric landmarks/points can be classified into follow- Points Based on their Location
ing three types (Flow chart 2.6) The detailed description of the cephalometric landmarks/
1. Cephalometric landmarks/points related to cranial bones points in this book follows this working classification (Flow
2. Cephalometric landmarks/points related to pharynx chart 2.7).
3. Cephalometric landmarks/points related to cervical vertebrae
Chapter 2  Classification of Cephalometric Landmarks

B C
10
Cephalometric landmarks/points related to Cephalometric landmarks/points related to zygomatic

cranial bones bone
Cephalometric landmarks/points related to frontal • Orbitale

• Temporale
bone
• Nasion Cephalometric landmarks/points related to
• Supra-orbitale Facial Bone and Dentition
• Roof of orbit
• Frontozygomatic suture Cephalometric landmarks/points related to maxilla
• Frontale
• Frontomaxillary nasal suture • Anterior nasal spine
• Point A
Cephalometric landmarks/points related to ethmoid • Anterior point of occlusion
bone • Prosthion
Section 2  Classification of Cephalometric Landmarks
• Posterior nasal spine

• Temporale • Pterygomaxillary fissure
• Neck of crista galli • Key ridge
• Medio-orbitale • Orbitale
• Sphenoethmoidal point
• Ethmoidale Cephalometric landmarks/points related to dentition
Cephalometric landmarks/points related to nasal bone • Incision superius incisalis
• Incision superius apicalis
• Nasion • Incision inferius incisalis
• Rhinion • Incision inferius apicalis
• Frontonasal/frontomaxillary nasal suture • Anterior point of occlusion
• Posterior point of occlusion
Cephalometric landmarks/points related to temporal • Maxillary central incisor
bone • Maxillary first molar
• Porion • Mandibular central incisor
• Zygomatic arch • Mandibular first molar
• Mastiodale • Mi
• Ms
Cephalometric landmarks/points related to sphenoid
bone Cephalometric landmarks/points related to mandible
• Dorsum sella • Infradentale
• Floor of sella • Point B
• Clenoidale • Pogonion
• Spheno-occipital synchondrosis • Gnathion
• Pterygoid point • dd
• Pterygomaxillary fissure • Menton
• Foramen spinosum point • Gonion
• Sella • Articulare
• Sphenoethmoidal point • kk
• Condylion
Cephalometric landmarks/points related to occipital bone
Cephalometric landmarks/points related to Cervical
• Basion
bones
• Opisthion
• Bolton’s point Cephalometric landmarks/points related to hyoid bone
• Spheno-occipital synchondrosis • Hyoid.
11
Cephalometric landmarks/points related to vertebrae • Nasal crown

• cv2ap • cv4ia • Pronasale
• cv2ip • cv5sp • Point T
• cv2ia • cv5ip 3. Soft tissue cephalometric landmarks or points related to lips
• cv3sp • cv5sa Upper lip
• cv3ip • cv5ia • Soft tissue subspinale
• cv3sa • cv6sp • Labrale superius
• cv3ia • cv6ip • Philtrum
• cv4sp • cv6sa • Cuspid bow
• cv4ip • cv6ia • Vermilion border of upper lips
• cv4sa Lower lip
• Labrale inferius
Soft tissue cephalometric landmarks/points • Soft tissue point B
Soft tissue cephalometric landmarks or points can be classified Upper and lower lips
Chapter 2  Classification of Cephalometric Landmarks

as follows (Flow chart 2.8): • Stomion
1. Soft tissue cephalometric landmarks or points related to - Stomion superius
forehead - Stomion inferius
• Trichion 4. Soft tissue cephalometric landmarks/points related to chin
• Soft tissue glabella. • Soft tissue pogonion
2. Soft tissue cephalometric landmarks or points related to nose • Soft tissue menton
• Soft tissue nasion • Soft tissue gnathion.
Flow chart 2.8: Soft tissue cephalometric landmarks/points

Section 3
Related to Cranial Bones
 Cephalometric Landmarks Related to Frontal Bone

 Cephalometric Landmarks Related to Ethmoid Bone
 Cephalometric Landmarks Related to Nasal Bone
 Cephalometric Landmarks Related to Temporal Bone
 Cephalometric Landmarks Related to Sphenoid Bone
 Cephalometric Landmarks Related to Occipital Bone
 Cephalometric Landmarks Related to Zygomatic Bone
ChApTER
3 Related to Frontal Bone
The frontal bone (Fig. 3.1) (Os frontale in Latin), is a Table 3.1: Cephalometric landmarks (points) related to frontal bone
membranous bone that forms the anterior part of the cranial
vault. The frontal is like half a shallow, irregular cap forming Cephalometric landmarks Abbreviation Type Origin
the forehead or form on each side a horizontal orbital part roof Nasion N or Na Unilateral Anatomic
of most of an orbital cavity. The frontal bone is thick with Supra-orbitale SOr Bilateral Anatomic
trabecular tissue between compact laminae, trabecular being Roof of orbit RO Bilateral Anatomic
absent near the frontal sinuses.
Frontomaxillary nasal FMN Unilateral Anatomic
suture
Parts of Frontal Bone
Parts of frontal bone are listed below:
Radiographic Anatomy of Frontal Bone (Fig. 3.2)
• Squamous part
• Orbital plates On lateral cephalogram, the inner and outer cortical plates
• Nasal process of frontal bone appear as two parallel radio-opaque lines
• Zygomatic process. descending downwards from coronal suture. Anterio-inferiorly,
these two radio-opaque lines diverge to encase the frontal sinus,
Articulation of Frontal Bone which appears radiolucent area.
The frontal bone articulates with 12 bones in total and is listed The outer radio-opaque line representing outer cortical
below: plates meets nasal bone at frontonasal suture, while the inner
• Parital bone • Sphenoid bone radio-opaque line representing inner cortical plate meets
• Ethmoid bone • Maxillary bone
• Nasal bone • Lacrimal bone
• Zygomatic bone • Temporal bone
Cephalometric Landmarks (Points)

on Frontal Bone
Cephalometric landmarks seen on the frontal bone are of
anatomic origin and are as follows (Table 3.1):
Figure 3.2: Radiographic anatomy of the frontal bone on the

Figure 3.1: Frontal bone lateral cephalogram
16
ethmoid bone at frontoethmoidal suture. Above the horizontal Nasion

part of the internal cortical plate, there are two radio-opaque
lines. The upper radio-opaque line represents endocranial
surface of the frontal bone, which forms the base for anterior Abbreviation
cranial fossa, and the other radio-opaque line represents the N–Nasion is abbreviated using English alphabet and is
exocranial surface of the frontal bone which forms the roof of expressed as capital letter or upper case N.
the orbit.
Definition
Nasion (Figs 3.3A to D) is the most anterior point of the
frontonasal suture in the middle.1
Section 3  Cephalometric Landmarks Related to Cranial Bones
A B
C D
Figures 3.3A to D: (A) Nasion on lateral cephalogram; (B) Magnified image showing nasion on the lateral cephalogram;
(C) Nasion on graphic illustration; and (D) Magnified image of nasion on graphic illustration
17
According to Willam B Downs • Relationship of anterior and posterior cranial base is

assessed using N-S-Ar angle.
Nasion is the suture between the frontal and nasal bones.1
According to TM Graber Supra-Orbitale

Nasion is the junction of the nasal and frontal bone as seen on
the profile of the cephalometric roentgenogram.2 Abbreviation
SOr–Supra-orbitale is abbreviated using English alphabets
According to B Holly Broadbent and is expressed as capital or upper case S, O followed by
Nasion is the craniometric point where the midsagittal plane lower case r and is written continuously without any space
intersects the most anterior point of the frontonasal suture, the between the alphabets.
anterior termination of the Bolton’s plane.3
Definition
Chapter 3  Cephalometric Landmarks Related to Frontal Bone

According to Leslie G Farkas
According to Viken Sassouni
Nasion is the point in the midline of both the nasal root and
Supra-orbitale (Figs 3.4A to D) is the most anterior point of
the frontonasal suture.4
the intersection of the shadow of the roof of the orbit and its
Type lateral contour.5
Nasion is a unilateral, anatomic, hard tissue cephalometric Type

landmark (Point).
Supra-orbitale is a bilateral, hard tissue lateral cephalometric
Origin landmark (point).
Nasion is a hard tissue cephalometric landmark of anatomic Origin

origin.
Supra-orbitale is a hard tissue cephalometric landmark of
Tracing of Nasion on the Lateral Cephalogram anatomic origin.
The outer cortical plate of frontal bone, nasal bone and Tracing the Supra-Orbitale on the Lateral
frontonasal suture appears as radio-opaque line on the lateral
Cephalogram
cephalogram. The outer cortical plate of frontal bone is denser
radio-opaque than compared to other two bony structures. Supra-orbitale, the point on the orbital margin where it turns
Trace outer cortical plate of frontal bone, nasal bone and onto the upper roof of the orbital cavity, is comparatively easy
frontonasal suture, the point in the midline where all three to trace.
structures meet is the point of nasion. In other way nasion is
the most anterosuperior point on the frontonasal suture in the Significance (Ref to Chapter 20)
midline.
• Supra-orbitale is useful reference point for anteroposterior
Significance (Ref to Chapter 20) differences and vertical differences between the right and
left sides when the orbits are traced.
Nasion is used as one of the reference points in the construction • Supra-orbital landmark is used as a landmark in Sassouni
of angles and planes for the assessment of following: cephalometric analysis.
• Relationship of maxilla to cranial base is assessed using
SNA angle.
• Relationship of mandible to cranial base is assessed using Roof of the Orbital Cavity
SNB angle.
• Maxillo-mandibular relationship with anterior cranial
Abbreviation
base is assessed using ANB angle.
• Inclination upper incisors are assessed using NA-Upper RO–Roof of the orbital cavity is abbreviated using English
incisor angular and NA-Upper incisor linear. alphabets and is expressed as capital or upper case R, O
• Inclination lower incisors are assessed using NB-Lower and is written continuously without any space between the
incisor angular and NB-Lower incisor linear. alphabets.
18
A B
C D
Figures 3.4A to D: (A) Supra-orbitale on lateral cephalogram; (B) Magnified image showing supraorbitale on the lateral cephalogram;
(C) Supra-orbitale on graphic illustration; and (D) Magnified image of supra-orbitale on graphic illustration
Definition Frontonasal/Frontomaxillary
The roof of the orbital cavity is formed by the bone between Nasal Suture
the anterior cranial fossa above and the orbital cavity below.

Abbreviation
The roof of the orbit is the uppermost point of the orbit.5
FMN–Frontomaxillary suture is abbreviated using English
Type alphabets and is expressed as capital or upper case F, M and
N and are written continuously without any space between the
Roof of the orbital cavity (Figs 3.5A to D) is a bilateral,
alphabets.
anatomic hard tissue lateral cephalometric landmark.
Tracing the Roof of Orbit on the Lateral Cephalogram Definition

On the cephalogram, both right and left roofs of the orbital Frontomaxillary nasal suture (Figs 3.6A to D) is the most
cavity are superimposed and reveal as a radio-opaque line superior point of the suture, where the maxilla articulates with
anteriorly and posteriorly leading to pituitary fossa. the frontal and nasal bones.
19
A B
Chapter 3  Cephalometric Landmarks Related to Frontal Bone

C D
Figures 3.5A to D: (A) Roof of orbit on lateral cephalogram; (B) Magnified image showing roof of orbit on the lateral cephalogram;
(C) Roof of orbit on graphic illustration; and (D) Magnified image of roof of orbit on graphic illustration
A B
C D
Figures 3.6A to D: (A) Frontomaxillary suture on lateral cephalogram; (B) Magnified image showing frontomaxillary suture on the lateral
cephalogram; (C) Frontomaxillary suture on graphic illustration; and (D) Magnified image of frontomaxillary suture on graphic illustration;
20
Type References
Frontomaxillary nasal suture is a unilateral, anatomic, hard 1. Downs WB. Variations in facial relationships. Their significance in
treatment and prognosis. Am J of Ortho. 1948;34:812-39.
tissue cephalometric landmark. 2. Graber TM. New horizons in case analysis-clinical cephalometrics. Am
J of Ortho.1952;38:603-24.
Significance (Ref to Chapter 20) 3. Broadbent BH Sr. Bolton’s standards of dentofacial developmental
growth. The CV Mosby Company. 1975;133-5.
Frontomaxillary nasal suture is situated/located on anterior 4. Farkas LG. Anthropometry of the head and face in medicine—Elsevier
North Holland, Inc. 1981;9-14.
cranial base, unlike N and can therefore also be used for 5. Sassouni V. Orthodontics in dental practice. The CV Mosby Company.
measurement or defining the cranial base (Moyers 1988). 1971;330-7.
Chapter
4 Cephalometric landmarks
related to ethmoid bone
The ethmoid bone (Fig. 4.1) (Os ethmoidale in Latin). The • Lacrimal bone – (2)
Ethmoid bone is cuboidal and fragile, lies anterior in the • Palatine bone – (2)
cranial base and is involved in the structure of the orbital walls • Vomer
and nasal septum, the roof and lateral walls of the nasal cavity. • Maxillary bone – (2)
It is described as a heavy horizontal cribriform plate, a median • Inferior nasal concha – (2)
plate and two total labyrinths. • Nasal bone – (2).
Parts of Ethmoid Bone Cephalometric Landmarks (Points) on

Parts of ethmoid bone are listed below: Ethmoid Bone
• Cribriform plate Cephalometric landmarks seen on the ethmoid bone are of
• Crista galli anatomic origin and are as follows (Table 4.1):
• Perpendicular plate.
Table 4.1: Cephalometric landmarks (points) related to ethmoid bone
Articulation of Ethmoid Bone Cephalometric landmarks Abbreviation Type Origin
The ethmoid bone articulates with 13 bones in total and is Temporale Te Bilateral Anatomic
listed below:
Neck of the crista galli NC Unilateral Anatomic
• Sphenoid bone
• Frontal bone Medio-orbitale mo Bilateral Anatomic
Sphenoethmoidal point SE Unilateral Anatomic
Ethmoidale Eth Unilateral Anatomic
Radiographic Anatomy of Ethmoid bone (Fig. 4.2)

On the lateral cephalogram, the cribriform plate of the ethmoid
bone is seen, which appears as a radio-opaque line below the
horizontal part of the internal cortical plate of the frontal bone.
The intersection of the shadows of the ethmoid and the anterior
wall of the infratemporal fossa is identified as temporal and is a
bilateral hard tissue cephalometric landmark. The intersection
of the shadows of the greater wing of the sphenoid and the
cranial floor is identified as Sphenoethmoidal (SE).
Temporale
Abbreviation
Te–Temporale is abbreviated using English alphabets and is
Figure 4.1: Ethmoid bone expressed as capital or upper case T followed by small letter
22
or lower case e and is written continuously without any space

between the alphabets.
Definition
Temporale (Figs 4.3A to D) is the intersection of the shadows
of the ethmoid and the anterior wall of the infra-temporal
fossa.

Intersection of the shadows of the ethmoid and anterior wall
of the infra-temporal fossa.1
Type
Temporale (Figs 4.3A to D) is a bilateral, anatomic, hard
tissue cephalometric landmark.
Figure 4.2: Radiographic anatomy of ethmoid bone
A B
C D
Figures 4.3A to D: (A) Temporale on lateral cephalogram; (B) Magnified image showing temporale on the lateral cephalogram;
(C) Temporale on graphic illustration; and (D) Magnified image of temporale on graphic illustration
23
Neck of Crista Galli • Crista galli lies behind the frontal sinuses on the lateral
cephalogram and in the central part of the cranium on the
posteroanterior cephalogram.
Abbreviation
NC–Neck of Crista Galli is abbreviated using English alpha Tracing Neck of Crista Galli on The Lateral
bets and is expressed as capital or upper case N and C and is Cephalogram
written continuously without any space between the alphabets.
It is difficult to identify on the lateral cephalogram whereas it
can be easily identified on the PA cephalogram.
Definition
According to Viken sassouni Medio-orbitale

Neck of the crista galli (Figs 4.4A and B) is the most
Chapter 4  Cephalometric Landmarks Related to Ethmoid Bone

constricted point of the projection of the perpendicular lamina Abbreviation
of the ethmoid (almost at the level of planum).1
mo–Medio-orbitale is abbreviated using English alphabets
and is expressed as lower case m, o and written continuously
Type without any space between the alphabets.
Neck of crista galli is an anatomic, unilateral, hard tissue
cephalometric landmark. Definition
Significance (Ref to chapter 20) According to Athanasios E Athanasiou

• The crista galli is an important landmark of the midline Medio-orbitale (Figs 4.5A and B) is the point on the medial
for the analysis of bilateral symmetry in a posteroanterior orbital margin that is closest to the median plane.2
cephalogram.
Figures 4.4A and B: (A) Neck of crista galli on frontal

cephalogram; (B) Magnified image showing neck of
A B crista galli on the frontal cephalogram
Figures 4.5 A and B: Medio-orbitale on the lateral

cephalogram; (B) Magnified image showing
medio-orbitale on the lateral cephalogram A B
24
Type According to SN Bhatia and BC Leighton

Medio-orbitale is an anatomic, bilateral, hard tissue cephalo The point of intersection between the greater wings of the
metric landmark. sphenoid and the anterior cranial base.4
Sphenoethmoidal Point Type

Sphenoethmoidal point is an anatomic, unilateral, hard tissue
Abbreviation cephalometric landmark.
SE–Sphenoethmoidal point is abbreviated using English

alphabets and is expressed as upper case S, E and written Ethmoidale
continuously without any space between the alphabets.
Definition Abbreviation
Eth–Ethmoidale is abbreviated using English alphabets and
According to Robert E Moyers is expressed as capital or upper case E and small alphabets
The intersection of the shadows of the grater wing of or lower case th and written continuously without any space
the sphenoid and the cranial floor as seen in the lateral between the alphabets.
cephalogram3 (Figs 4.6A to D).
A B
C D
Figures 4.6A to D: Sphenoethmoidale: (A) Sphenoethmoidale on the lateral cephalogram; (B) Magnified image
showing sphenoethmoidale on the lateral cephalogram; (C) Sphenoethmoidale on graphic illustration; and
(D) Magnified image of sphenoethmoidale on graphic illustration
25
Chapter 4  Cephalometric Landmarks Related to Ethmoid Bone

A B
C D
Figures 4.7A to D: Ethmoidale: (A) Ethmoidale on the lateral cephalogram; (B) Magnified image showing
ethmoidale on the lateral cephalogram; (C) Ethmoidale on graphic illustration; and (D Magnified image
of ethmoidale on graphic illustration
Definition References
According to Arne Bjork 1. Viken Sassouni—Orthodontics in dental practice. The CV Mosby
Company. 1971:330-7.
The deepest median point of the anterior cranial fossa, corres 2. Athanasios E Athanasiou, Helmut Drioschk, Charles Bosch. Data
ponding to the cribriform plate of the ethmoid bone.5 and patterns of transverses dentofacial structure of 6 to 15 years–old
children; A posteroanterio cephalometric study.
3. Robert M Moyers. Handbook of Orthodontics. Year Book medical
According to SN Bhatia and BC Leighton Publishers, inc. 1988:251-9.
Ethmoidale (Figs 4.7A to D) is the lowest point on the anterior 4. Bhatia SN, Leighton BC. A manual of facial growth–Oxford University
press. 1993:10-5.
cranial fossa or the outline of the cribriform plate.4 5. A Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.
Type
Ethmoidale is an anatomic, unilateral, hard tissue cephalo
metric landmark.
CHAPTER
5 Cephalometric Landmarks
Related to Nasal Bone
The nasal bone (Fig. 5.1) (Os nasale in Latin), are paired Radiographic Anatomy of Nasal Bone (Fig. 5.2)
bones that lie in the midline above the nasal fossae between
the frontal processes of the maxilla. They articulate superiorly On lateral cephalogram, the nasal bone appears as a
with the frontal bone at the fronto-nasal suture. triangular radio-opaque area. Its apex points to the tip of the
nose and its base faces the frontonasal suture which appears
as an oblique radiolucent line between frontal and nasal
Articulation of Frontal Bone
bones. The posterior part of the inner surface of the nasal
The nasal bone articulates with four bones in total and is listed bone merges with the radio-opaque line of the cribriform
below: plate of the ethmoid bone. The anteromedial point of the
• Maxilla frontonasal suture is identified as nasion and posteroinferior
• Frontal bone point is identified as FMN.
• Ethmoid bone
• Nasal bone of opposite side. Nasion
Cephalometric Landmarks (Points)
on Nasal Bone Abbreviation
Cephalometric landmarks seen on the nasal bone are of N–Nasion is abbreviated using English alphabet and is
anatomic origin and are as follows (Table 5.1): expressed as capital letter or upper case N.
Table 5.1: Cephalometric landmarks related to nasal bone

Cephalometric landmarks Abbreviation Type Orgin
Nasion N OR Na Unilateral Anatomic
Frontonasal/frontomaxillary FMN Unilateral Anatomic
nasal suture
Rhinion Rh Unilateral Anatomic
Figure 5.1: Nasal bones Figure 5.2: Radiographic anatomy of nasal bone
27
Definition According to William B Downs

Nasion (Figs 5.3A to D) is the most anterior point of the Nasion is the suture between the frontal and nasal bone.3
frontonasal suture in the middle.
According to TM Graber Type

Nasion is the junction of the nasal bone and frontal bones as Nasion is a unilateral, anatomic, hard tissue cephalometric
seen on the profile of the cephalometric roentgenogram.1 landmark.
According to B Holly Broadbent

Origin
Nasion is the craniometric point where the midsagittal plane
intersects the most anterior point of the frontonasal suture; the Nasion is a hard tissue cephalometric landmark of anatomic
anterior termination of the Bolton plane.2 origin.
Chapter 5  Cephalometric Landmarks Related to Nasal Bone

A B
C D
Figures 5.3A to D: (A) Nasion on lateral cephalogram; (B) Magnified image showing nasion on the lateral cephalogram; (C) Nasion on
graphic illustration; and (D) Magnified image of nasion on graphic illustration
28
Significance (Ref to Chapter 20) A is a positive value and a posterior position of point A
is a negative value.
Nasion is used as one of the reference point in the • In Rickett’s cephalometric analysis, the positioning of
construction of angles and planes for the assessment of the the chin is determined by the angle formed between
following: the Ba-N plane and plane from foramen rotundum (PT)
• Relationship of maxilla to cranial base is assessed using to Gn. The normal value of this angle is 90 degree. A
SNA angle. larger angle suggests a protrusive or forward growing
• Relationship of mandible to cranial base is assessed chin whereas a lesser angle suggests a retropositioning
using SNB angle. of the chin.
• Maxillo-mandibular relationship with anterior cranial
• Inclination upper incisors are assessed using NA-Upper Frontonasal/Frontomaxillary Nasal
incisor angular and NA-Upper incisor linear. Suture
• Inclination lower incisors are assessed using NB-Lower
incisor angular and NB-Lower incisor linear.

• Relationship of anterior and posterior cranial base Abbreviation
assessed using N-S-Ar angle. FMN–Frontomaxillary suture is abbreviated using English
• In McNamara cephalometric analysis, the cant of the alphabets and is expressed as capital F, M and N and is written
upper lips is evaluated by constructiong an angle using continuously without any space between the alphabets.
a line tangent to the upper lip and the nasion. The nasion
perpendicular is a vertical line drawn perpendicular to Definition
Frankfort horizontal plane.
• Anteroposterior orientation of the maxilla to the cranial Frontomaxillary nasal suture (Figs 5.4A to D) is the most
base is assessed by the linear distance between nasion superior point of the suture, where the maxilla articulates
perpendicular and point A. An anterior position of point with the frontal and nasal bones.
A B
C
D
Figures 5.4A to D: (A) Frontomaxillary nasal suture on lateral cephalogram; (B) Magnified image showing frontomaxillary nasal suture
on the lateral cephalogram; (C) Frontomaxillary nasal suture on graphic illustration; and (D) Magnified image of frontomaxillary nasal
suture on graphic illustration
29
According to Robert M Moyers Rhinion

According to Robert M Moyers, frontomaxillary nasal suture
is the most superior point of the suture, where the maxilla Abbreviation
articulates with the frontal and nasal bones.4 Rh–Rhinion is abbreviated using English alphabets and is ex-
pressed as capital or upper case R followed by lower case h, and
Type is written continuously without any space between the alphabets.
Frontomaxillary nasal suture is a unilateral, hard tissue cephalo
metric landmark. Definition
Origin According to Spiro J Chaconas

Frontomaxillary nasal suture is a hard tissue cephalometric According to Spiro J Chaconas, Rhinion (Figs 5.5A to D) is
landmark of anatomic origin. the most anterior-inferior point on the tips of the nasal bones
Chapter 5  Cephalometric Landmarks Related to Nasal Bone

as seen from norma lateralis.5
Significance (Ref to Chapter 20)
Type
Frontomaxillary nasal suture is situated/located on anterior
cranial base, unlike N and can therefore also be used for measure Rhinion is an anatomic, unilateral, hard tissue cephalometric
ment or defining the cranial base (Moyers 1988). landmark.
A B
C D
Figures 5.5A to D: (A) Rhinion on lateral cephalogram; (B) Magnified image showing Rhinion on the lateral cephalogram; (C) Rhinion
on graphic illustration; and (D) Magnified image of Rhinion on graphic illustration
30
Tracing Rhinion on the Lateral Cephalogram bone, especially its inclination that affects the soft tissue
profile.
Tracing the rhinion is difficult in few cases, where there is faded
image of nasal bone in the tip region, in such cases the margin
of the piriform aperture will be helpful in identifying the point References
rhinion. In most of the cases it is easy to identify on the lateral 1. Graber TM. New horizons in case analysis-clinical cephalometrics. Am
cephalogram. Trace the nasal bone from the frontonasal suture J of Ortho. 1952;38:603-24.
till the tip, the tip of the nasal bone is the point of rhinion. 2. Broadbent BH Sr. Bolton’s standards of dentofacial developmental
growth. The C V Mosby Company. 1975;133-5.
3. Downs WB. Variations in facial relationships. Their significance in
Significance (Ref to Chapter 20) treatment and prognosis. Am J of Ortho. 1948;34:812-39.
4. Moyers RM. Handbook of Orthodontics–Year Book Medical Publishers,
Position of rhinion differs from individual to individual. Inc. 1988;251-9.
As we learnt in anatomy, there are several types of nasal 5. Spiro J Chaconas. Orthodontics-PSG Publishing Company. 1980;37-45.
Chapter
related to temporal bone
Each temporal bone consists of following two portions bone. The other side of the triangle, which appears as a vertical
(Fig. 6.1): line, represents the anterior limit of the posterior cranial fossa.
• Squamous portion
• Petrous portion. Radiographic Anatomy of Temporal Bone
Squamous portion of the temporal bone is large and flat (Fig. 6.2)
that forms the lateral wall of the cranium. Petrous portion of
temporal bone is an irregular bone which forms the inferior The major part of the temporal bone that can usually be identified
part of the temporal bone. from the lateral cephalogram is the endocranial surface of the
petrous portion. It appears as a triangular radio-opaque area with
Articulation of Temporal Bone its apex pointing upwards and backwards.The side of the triangle
that appears as the anterosuperior radio-opaque line represents
Superiorly temporal bone articulates with parietal bone at the posteroinferior limit of the middle cranial fossa. This radio-
squamoparietal suture. Inferiorly, it articulates with mandibular opaque line continues anteriorly to the endocranial surface of the
condyle at genoid fossa. Zygomatic process of temporal bone squamous portion of the temporal bone. The other side of the
articulates wih zygomatic bone at zygomaticotemporal suture. triangle, which appears as a vertical line, represents the anterior
The major part of the temporal bone that can usually be limit of the posterior cranial fossa.
identified from the lateral cephalogram is the endocranial
surface of the petrous portion. It appears as a triangular radio- Cephalometric Landmarks (Points) on
opaque area with its apex pointing upwards and backwards. Temporal Bone
The side of the triangle that appears as the anterosuperior
radio-opaque line represents the posteroinferior limit of Cephalometric landmarks seen on the temporal bone are of
the middle cranial fossa. This radio-opaque line continues anatomic origin and are as follows (Table 6.1):
anteriorly to the endocranial surface of the squamous portion
of the temporal bone and the greater wing of the sphenoid
Figure 6.1: Temporal bone Figure 6.2: Radiographic anatomy of temporal bone
32
Table 6.1: Cephalometric landmarks related to temporal bone Type

Cephalometric Abbreviation Type Origin Porion (Figs 6.3A to D) is a bilateral, hard tissue cephalometric
landmarks
landmark.
Porion Po Bilateral Anatomic
Zygomatic arch Zyg Bilateral Anatomic
Mastoidale Ma Bilateral Anatomic Origin
Porion is a hard tissue cephalometric point of anatomic
Porion origin.
Abbreviation Significance (Ref to Chapter 20)

Po–Porion is abbreviated using English alphabets and is ex- 1. Porion is used as one of the reference points in the
pressed as capital letter or upper case P followed by lower construction of Frankfort horizontal plane and is used
case o, and is written continuously without any space between for the assessment of horizontal growth pattern using
the alphabets. following angles:
• FH-Mandibular plane angle (Go-Me)
Definition • FH-Palatal plane angle (ANS-PNS)
Porion is the most superior point of the external auditory meatus • FH-Occlusal plane (APOcc – PPOcc)
(the superior margin of the TMJ fossa, which lies at the same 2. Porion is also used as one of the reference points in the
level may be substitute in the construction of the FH). construction of angle and is used for the assessment of upper
incisors torque using FH—long axis of upper incisors.
According to Arne Bjork
The midpoint of the upper edge of the porous acoustics externus Zygomatic Arch
located by wings of the metal rods on the cephalometer. This
is the cephalometric reference point.1
Abbreviation
According to Willam B Downs
Zyg–Zygomatic arch is abbreviated using English alphabets
The highest point on the superior surface of the soft tissue of and is expressed as capital or upper case Z followed by lower
the external auditory meatus.2 case y and g, and is written continuously without any space
According to LB Higley
The highest point on the roof of the left external auditory meatus.3 Definition
According to Robert E Moyers According to Robert M Ricketts
The top of the ear rods Shadows the external auditory meatus.4 According to Robert M Ricketts, the Zygomatic arch is the
center of zygomatic arch by inspection for frontal.7
Type
Point on the upper margin of the porus acusticus externus the two
poria and left orbitale defined the Frankfort horizontal plane.5 Zygomatic arch is bilateral, hard tissue landmark.
According to Leslie G Farkas Origin

Porion (soft) is the highest point on the upper margin of the Zygomatic arch is a hard tissue cephalometric landmark of
cutaneous auditory meatus.6 anatomic origin.
33
Chapter 6  Cephalometric landmarks related to temporal bone

A B
C D
Figures 6.3A and D: (A) Porion on lateral cephalogram; (B) Magnified image showing porion on the lateral cephalogram;
(C) Porion on graphic illustration; and (D) Magnified image of porion on graphic illustration
Mastiodale Definition
According to Viken sassouni

Abbreviation
According to Viken Sassouni, the mastiodale is the lowest
Ms–Mastiodale is abbreviated using English alphabets and is point on the contour of the mastoid process.8
expressed as capital or upper case M followed by lower case
s, and is written continuously without any space between the Type
alphabets.
Mastiodale (Figs 6.4A and B) is bilateral, cephalometric landmark.
34
A B
Figures 6.4A and B: (A) Mastiodale on lateral cephalogram; (B) Magnified image showing mastiodale on the lateral cephalogram
Origin References
Mastiodale is a hard tissue landmark of anatomic origin. 1. Arne Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.
2. Downs WB. Variations in facial relationships; Their significance in
treatment and prognosis. Am J of Orthod. 1948;34:812-39.
Tracing of Mastiodale on the Lateral 3. Higley LB. Cephalometric standards for children 4-8 years of age-Am J
of orthod. 1954;40:51-9.
Cephalogram 4. Moyers RM. Handbook of Orthodontics. Year Book Medical Publishers,
Trace the mastoid process, which is located between the Inc. 1988;251-9.
5. Broadbent BH Sr. Bolton’s standards of dentofacial developmental
temporal bone and cranial base region. The lowest point of growth. The CV Mosby Company. 1975;133-5.
the mastoid process in the P-A cephalogram is the point of 6. Farkas LG. Anthropometry of the head and face in medicine—Elsevier
mastiodale. As we learnt in anatomy, the mastoid process is north Holland Inc. 1981;9-14.
not so visible in the childhood, but it increases in size with the 7. Ricketts RR. Provocations and perceptions in cranio-facial orthopedics
–dental science and facial art. Rocky Mountain inc. 1989;797-803.
age and readily visible in both P-A cephalogram and lateral 8. Viken Sassouni. Orthodontics in Dental Practice. The CV Mosby
cephalogram. Company. 1971;330-7.
Chapter
Cephalometric landmarks
7 related to sphenoid bone
The sphenoid bone (Fig. 7.1) is in the base of the skull,

wedged (as its name implies) between the frontal, temporal
and occipital bones. It has a central body paired greater and
lesser wings of separating laterally from it and two pterygoid
processes descending from the junction of the body of the
greater wing.
Cephalometric Landmarks (Points) on

Sphenoid Bone
Cephalometric landmarks seen on the sphenoid bone are as
follows (Table 7.1):
Table 7.1: Cephalometric landmarks related to sphenoid bone
Cephalometric Abbreviation Type Origin
landmarks Figure 7.1: sphenoid bone
Dorsum of sella Sp Unilateral anatomic
Floor of sella Si Unilateral anatomic
Clinoidale Cl Bilateral anatomic
Spheno-occipital SOS Unilateral anatomic
synchondrosis
pterygoid point pt Bilateral anatomic
Sella S Unilateral anatomic
Sella entrance Se Unilateral anatomic
Sphenoethmoidal point Se Unilateral anatomic
Foramen spinosum Fsp Bilateral anatomic
point
pterygomaxillary ptm Bilateral anatomic Figure 7.2: radiographic anatomy of sphenoid bone
fissure
The vertical line terminates at the center of the
pterygomaxillary fissure, which on lateral cephalogram appears
Radiographic anatomy of Sphenoid Bone (Fig. 7.2) as inverted teardrop radiolucent area bounded anteriorly by radio-
The frontal bone, ethmoidal bone and sphenoid bone meet opaque line of the maxillary tuberosity and posteriorly by the
at frontosphenoethmoidal suture, which radiographically radio-opaque line of the anterior surface of the pterygoid process
appears as a radiolucent line. At the frontosphenoethmoidal of the sphenoid bone. The sella turcica appears as elliptical
suture, these are two radio-opaque lines, one vertical and the shape radiolucent area surrounded medially radio-opaque line
other horizontal. The vertical radio-opaque line represents the of medial surface of the sella and most inferiorly radio-opaque
anterior border of the sphenoid body whereas horizontal line line of floor of sella anterosuperiorly curved radio-opaque line of
represents the planum sphenoidale, or the superior surface of anterior clenoid process and posterosuperiorly radio-opaque line
the sphenoid body. of posterior border of the clenoid process.
36
The center of sella turcica is identified as sella abbreviated by small letter or lower case p and is written continuously
using English alphabet as upper case S and the mid-entrance without any space between the alphabets.
point of the sella turcica is the sella-entrance (Se). Most
inferior point of the curved radio-opaque line of floor of sella Definition
is identified as Si (Floor of sella ), and the most posterior point
on the internal continuation of the sella turcica is identified as Dorsum of sella is the most posterior point on the internal contour
dorsum sellae. The most superior point on the contour of the of the sella turcica or hypophyseal fossa or pituitary fossa.
anterior clenoid is identified as clenoidale (Cl).
according to Viken Sassouni
Dorsum of Sella Most posterior point on the internal contour of the sella
turcica.1
abbreviation Type
Sp–Dorsum of sella is abbreviated using English alphabets Dorsum of sella (Figs 7.3A to D) is a unilateral, hard tissue
and is expressed as capital letter or upper case S followed cephalometric landmark.
A B
C D
Figures 7.3A to D: (A) Dorsum of sella on lateral cephalogram; (b) Magnified image showing dorsum of sella on the lateral
cephalogram; (C) Dorsum of sella on graphic illustration; (D) Magnified image of dorsum of sella on graphic illustration
37
Origin letter or lower case i and is written continuously without any

space between the alphabets.
Dorsum of sella is an anatomic hard tissue cephalometric
landmark.
Definition
Floor of sella is the lower most point on the inner contour of
Floor of Sella the sella turcica or hypophyseal fossa or pituitary fossa.
abbreviation Type
Si–Floor of sella is abbreviated using English alphabets and is Floor of sella (Figs 7.4A to D) is a unilateral, hard tissue
expressed as capital letter or upper case S followed by small cephalometric landmark.
Chapter 7  Cephalometric Landmarks Related to Sphenoid Bone

A B
C D
Figures 7.4A to D: (A) Floor of sella on lateral cephalogram; (b) Magnified image showing floor of sella on the lateral
cephalogram; (C) Floor of sella on graphic illustration; (D) Magnified image of floor of sella on graphic illustration
38
Origin Definition
Floor of sella is an anatomic hard tissue cephalometric Clinoidale is the most superior point on the contour of the
landmark. anterior clinoid.
according to Viken Sassouni

Clinoidale
The most superior point on the contour of the anterior clenoid.1
abbreviation Type
Cl–Clinoidale is abbreviated using English alphabets and is Clinoidale (Figs 7.5A to D) is a unilateral, hard tissue
expressed as capital C followed by lower case l.l cephalometric landmark.
A B
C D
Figures 7.5A to D: (A) Clinoidale on lateral cephalogram; (b) Magnified image showing clinoidale on the lateral
cephalogram; (C) Clinoidale on graphic illustration; (D) Magnified image of clinoidale on graphic illustration
39
Origin according to arne Bjork

Clinoidale is a unilateral, anatomic, hard tissue cephalometric According to Arne Bjork, the opisthion is the posterior margin
landmark. of the occipital foramen.2
according to TM Graber
Spheno-Occipital Synchondrosis
According to TM Graber, the opisthion is the most posterior
point on the posterior margin of the foramen magnum.3
abbreviation
Type
SOS–Spheno-occipital synchondrosis abbreviated using English
alphabets and is expressed as capital letter or upper case S, O Spheno-occipital synchondrosis (Figs 7.6A to D) is a unilateral,
and S and is written continuously without any space between hard tissue cephalometric landmark.

the alphabets.
Origin
Definition
Spheno-occipital synchondrosis is a unilateral, anatomic, hard
Opisthion is the posterior edge of the foramen magnum. tissue cephalometric landmark.
A B
C D
Figures 7.6A to D: (A) spheno-occipital synchondrosis on lateral cephalogram; (b) Magnified image showing spheno-occipital
synchondrosis on the lateral cephalogram; (C) spheno-occipital synchondrosis on graphic illustration; (D) Magnified image of spheno-
occipital synchondrosis on graphic illustration
40
Significance (Ref to Chapter 20) lower case t, and is written continuously without any space
The spheno-occipital synchondrosis is very important struc-
ture in growth and development of the cranial base in the
Definition
growing child.
According to Robert M Ricketts, the pterygoid point is the
Tracing Spheno-Occipital Synchondrosis on lower lip of the foramen rotundum (represents the position of
the sphenoid bone). Most posterior point on the outline of the
the Lateral Cephalogram
pterygopalatine fossa.4
Tracing of SOS is very easy, if it is before the ossification and
very difficult if it is after the ossification. Type
Pterygoid point (Figs 7.7A to D) is a bilateral, hard tissue
Pterygoid Point cephalometric landmark.
abbreviation Origin
Pt–Pterygoid point abbreviated using English alphabets and Pterygoid point is a bilateral, hard tissue cephalometric land-
is expressed as capital or upper case P followed by small or mark.
A B
C D
Figures 7.7A to D: (A) Pterygoid point on lateral cephalogram; (b) Magnified image showing pterygoid point on the lateral
cephalogram; (C) Pterygoid point on graphic illustration; (D) Magnified image of pterygoid point on graphic illustration
41
Tracing Pterygoid Point on the Lateral according to arne Bjork

Cephalogram The center of sella turcica (the midpoint of the horizontal
Trace the pterygopalatine fossa point usually located immedi- diameter).2
ately behind the posterior part of the fossa.
Type
Significance (Ref to Chapter 20) Sella (Figs 7.8A to D) is a unilateral, hard tissue cephalometric
• Pterygoid point is a useful point for Rickett’s cephalometric landmark.
analysis.
• Pterygoid point is the intersection border of the foramen Origin
rotundum and the posterior wall of pterygopalatine fossa Sella is a unilateral anatomic hard tissue cephalometric
in the lateral cephalogram. landmark point.

Sella Tracing of Sella on the Lateral Cephalogram
The pituitary fossa is round and bottle shaped hollow space,
abbreviation situated in the upper body of the sphenoid bone. This fossa
contains pituitary gland. This fossa is bounded anterioly
S–Sella is abbreviated using English alphabets and is expressed and posteriorly by anterior and posterior clinoid processes.
as capital or upper case S. Both anterior and posterior clinoid process appears as
radio-opaque line on the lateral cephalogram. First trace
Definition the anterior and posterior cliniod process followed by
inferior border of the pituitary fossa. Center point of the
Sella is the midpoint of sella turcica or hypophyseal fossa or fossa is the point of sella.
pituitary fossa.
according to Robert E Moyers
Sella is used as one of the reference points in the construction
The center of the hypophyseal fossa (sella turcica). It is of angles and planes for the assessment of following:
selected by the eye since that producer as been shown to be as • Relationship of maxilla to cranial base is assessed using
reliable as a constructed center.4 SNA angle, S-N-Pr angle and saddle angle (N-S-Ar).
• Relationship of mandible to cranial base is assessed using
according to TM Graber SNB angle and S-N-Id angle.
• Relationship of anterior and posterior cranial base assessed
The center of pituitary fossa.3 using N-S-Ar.
according to B Holly Broadbent Sella Entrance

Sella turcica (Turkish saddle): The landmark is the center
of the sella as seen in the lateral radiograph and located by
inspection.5 abbreviation
Se–Sella entrance is abbreviated using English alphabets and

according to LB Higley is expressed as capital letter or upper case S followed by small
The center of sella turcica: The midpoint of the sella turcica letter or lower case e and is written continuously without any
orbitrarily determined.6 space between the alphabets.
according to Willam B Downs Definition

The center of sella turcica: Located by inspection of the profile Sella entrance is the mid entrance point of sella turcica or
image of the fossa.7,8 hypophyseal fossa or pituitary fossa.
42
A B
C D
Figures 7.8A and B: (A) sella on lateral cephalogram; (b) Magnified image showing sella on the lateral
cephalogram; (C) sella on graphic illustration; (D) Magnified image of sella on graphic illustration
Type E and written continuously without any space between the

alphabets.
Sella entrance (Figs 7.9A to D) is a unilateral, hard tissue
cephalometric landmark.
Definition
Origin
according to Robert E Moyers
Sella entrance is a constructed, hard tissue cephalometric
landmark. The intersection of the shadows of the greater wing of
the sphenoid and the cranial floor as seen in the lateral
Sphenoethmoidal Point cephalogram.4
abbreviation according to SN Bhatia and BC Leighton

SE–Sphenoethmoidal point (Figs 7.10A to D) is abbreviated The point of intersection between the greater wings of the
using English alphabets and is expressed as upper case S, sphenoid and the anterior cranial base.9
43

A B
C D
Figures 7.9A to D: (A) sella entrance on lateral cephalogram; (b) Magnified image showing sella entrance
on the lateral cephalogram; (C) sella entrance on graphic illustration; (D) Magnified image of sella entrance
on graphic illustration
A B
Figures 7.10A and B: (A) sphenoethmoidal point on lateral cephalogram; (b) Magnified image showing
sphenoethmoidal point on the lateral cephalogram
44
C D
Figures 7.10C and D: (C) sphenoethmoidal point on graphic illustration; (D) Magnified image of
sphenoethmoidal point on graphic illustration
Type the anterior margin of the pterygoid process of the sphenoid

bone and the profile outline of the posterior surface of the
Sphenoethmoidal point is a unilateral, hard tissue cephalomet- maxilla.
ric landmark.
according to Robert M Moyers

Pterygomaxillary Fissure
According to Robert M Moyers, the pterygomaxillary fissure
abbreviation is tear drop shaped radiolucency, the anterior shadow of
which represents the posterior surface of the tuberosity of the
Ptm–Pterygomaxillary fissure is abbreviated using English maxilla; the landmark itself is at the most inferior confluences
alphabets and is expressed as capital or upper case P followed of the curvatures.
by small or lower case t and m, written continuously without
any space between the alphabets.
according to Clifton T Forceberg
PTM–According to Robert M Moyers, Pterygomaxillary
fissure is abbreviated using English alphabets and is expressed According to Clifton T Forceberg, Pterygomaxillary fissure is
as capital or upper case P followed by capital or upper case T the most medial and posterior point of each pterygomaxillary
and M, written continuously without any space between the fissure. The ptm line connects right and left ptm points. The
alphabets. ptm access is the perpendicular bisector of the ptm line.
PTMS–According to Michael L Riolo, Pterygomaxillary
fissure is abbreviated using English alphabets and is expressed according to Holly Broadbent
as capital or upper case P,T,M,S, written continuously without Inverted, elongated, tear drop-shaped area formed by the
any space between the alphabets. divergence of the maxilla from the pterygoid process of the
sphenoid. The posterior nasal spine and staphylion are gener-
Definition ally located beneath the lower pointed end of this area.
Pterygomaxillary fissure (Figs 7.11A to D) is a bilateral tear
drop shaped area of radiolucency, the anterior shadow of according to LB Higley
which represents the posterior surface of the tuberosity of the
maxilla; the landmark is taken where the two edges, front and Junction of the Frankfort plane and a line perpendicular to it
back, appear to merge inferiorly. from the pterygomaxillary fissure.
according to TM Graber Type

According to TM Graber, the pterygomaxillary fissure is an Pterygomaxillary fissure is an anatomic, bilateral, hard tissue
oval-looped radiolucency resulting from the fissure between cephalometric landmark.
45

A B
C D
Figures 7.11A to D: (A) Pterygomaxillary fissure on lateral cephalogram; (b) Magnified image showing
pterygomaxillary fissure; (C) Pterygomaxillary fissure on graphic illustration; (D) Magnified image of
pterygomaxillary fissure on graphic illustration
Significance (Ref to Chapter 20) 4. Robert R. Ricketts–Provocations and perceptions in cranio-facial

orthopedics–dental science and facial art. Rocky Mountain Inc. 1989;
Pterygomaxillary fissure is used as one of the reference 797-803.
point in Cox cephalometric analysis and is used to assess the 5. Moyers RM. Handbook of Orthodontics–Year Book Medical Publishers,
Inc. 1988;251-9.
posterior limit of the maxilla.
6. Holley Broadbent B, Sr. Bolton’s standards of dentofacial develop-
mental growth. The CV Mosby Company. 1975;133-5.
References 7. Higley LB. Cephalometric standards for children 4-8 years of age.Am J
1. Viken Sassouni. Orthodontics in dental practice. The CV Mosby of Ortho. 1954;40:51-9.
Company. 1971;330-7. 8. Downs WB. Variations in facial relationships. Their significance in
2. Arne Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3. treatment and prognosis. Am J of Ortho.1948;34:812-39.
3. Graber TM. New horizons in case analysis-clinical cephalometrics. 9. Bhatia SN, Leighton BC. A manual of facial growth–Oxford University.
Am J of Ortho.1952;38:603-24. 1993;10-5.
CHAPTER
8 Cephalometric Landmarks
Related to Occipital Bone
The occipital bone (Fig. 8.1) forming much of the back and The inner and outer cortical plates of the occipital bone
base of the cranium and is trapezoidal and concave internally. appear as two radio-opaque lines, which descend parallely
and meet together at formen magnum, where the hard tissue
Cephalometric Landmarks (Points) on cephalometric point opisthion is identified.
Occipital Bone The exocranial and endocranial surfaces of the occipital
bone appear as two radio-opaque lines, the point where these
Cephalometric landmarks seen on the occipital bone are of two surfaces meet is the point of basion, which is an important
anatomic origin and are as follows (Table 8.1): hard tissue cephalometric landmark.
Table 8.1: Cephalometric landmarks related to occipital bone
Cephalometric landmarks Abbreviation Type Origin Basion
Basion Ba Unilateral Anatomic
Opisthion Op Unilateral Anatomic Abbreviation
Bolton’s point Bo Unilateral Anatomic
Ba–Basion is abbreviated using English alphabets and is
Spheno-occipital SOS Unilateral Anatomic denoted as capital letter or upper case B followed by small
synchondrosis
letter or lower case a and is written continuously without any
Radiographic Anatomy of Occipital Bone
(Fig. 8.2) Definition
The occipital bone joins the parietal bone at lambdoid suture, Basion is the median point of the anterior margin of the
which on lateral cephalogram appears as a radiolucent line. foramen magnum can be located by following the images of
the slope the inferior border of the basilar part of the occipital
bone to its posterior limit.
Figure 8.1: Occipital bone Figure 8.2: Radiographic anatomy of occipital bone
47
According to Robert M Ricketts According to Clifton T Forsberg

Point at the center of the anterior border of the foramen The most anterior point relative to the interspinosum line, on
magnum at the base of the occipital bone.1 the border of the foramen magnum.5
According to TM Graber Type

Basion (Figs 8.3A to D) is a unilateral, hard tissue cephalo-
The most inferior point on the anterior margin of the foramen
metric landmark.
magnum in the midsagittal plane.2
Origin
According to Robert E Moyers
Basion is a anatomic hard tissue cephalometric landmark.
The most inferior posterior point in the sagittal plane on the
anterior rim of the foramen magnum.3 Tracing Basion on the Lateral Cephalogram
Chapter 8  Cephalometric Landmarks Related to Occipital Bone

• To identify basion on the lateral cephalogram, following
According to Arne Bjork structures need to be traced.
Normal projection of the anterior border of the occipital • Trace from the posterior clinoid process, down the upper part
foramen (endobasion) on the occipital foramen line.4 of the clivus, and past the region of the spheno-occipital syn-
chondrosis to the anterior margin of the foramen magnum.
A B
C D
Figures 8.3A to D: (A) Basion on lateral cephalogram; (B) Magnified image showing basion on the lateral
cephalogram; (C) Basion on graphic illustration; (D) Magnified image of basion on graphic illustration
48
• Trace the cranial aspect of the greater wing of the sphenoid According to Clifton T Forsberg
one, the inferior, ectocranial aspect of the base of the
occipital bone, and the anterior margin of the foramen The most posterior point, relative to the inter-spinosum line
magnum. These are separate lines and should not be drawn on the border of the foramen magnum.5
a one continuous line.
• Trace carefully from the base of the occipital bone Type
to the compact bone of the occipital condyles. The Opisthion (Figs 8.4A to D) is a unilateral, hard tissue
anterior margins of the occipital condyle and basion are cephalometric landmark.
radio-opaque on the lateral cephalogram and should be
differentiated. Basion is usually behind the anterior part of Origin
the occipital condyle.
Opisthion is an anatomic, hard tissue cephalometric landmark.
Opisthion Tracing Opisthion on Lateral Cephalogram

Trace both the outer, ectocranial surface of the external occipital

Abbreviation protuberance and the inner, endocranial surface of the occipital
Op–Opisthion is abbreviated using English alphabets and is bone. Follow the surfaces anteroinferiorly until the two lines
expressed as capital letter or upper case O followed by small merge as the radio-opaque point, which is opisthion.
letter or lower case p and is written continuously without any
space between the alphabets. Bolton’s Point
Definition
Abbreviation
Opisthion is the posterior edge of the foramen magnum.
Bo–Bolton’s point is abbreviated using English alphabets and
is expressed as capital letter or upper case B followed by small
According to Arne Bjork letter or lower case o and is written continuously without any
Posterior margin of the occipital foramen.4 space between the alphabets.
According to TM Graber Definition

The most posterior point on the posterior margin of the Bolton’s point is the highest point in the upward curvature of
foramen magnum.2 the retrocondylar fossa.
A B
Figures 8.4A and B: (A) Opisthion on lateral cephalogram; (B) Magnified image showing opisthion on the
lateral cephalogram
49

C D
Figures 8.4C and D: (C) Opisthion on graphic illustration; (D) Magnified image of opisthion
on graphic illustration
According to B Holly Broadbent According to Viken Sassouni

Point in space, about the center of foramen magnum, that is Highest point in the upward curvature of the retrocondylar
located on the lateral cephalometric radiograph by the highest fossa. In uncertain cases it may be located as the midpoint
point in the profile image of the postcondylar notches of the between opisthion (Op), and basion (Ba); in other words, at
occipital bone.5 the center of foramen magnum.7
According to Arne Bjork According to TM Graber

The deepest point of the notch in the shadow behind condylus The most superior point in the uppet curvature of the
occipitalis.3 retrocondylar fossa. It is just posterior to the occipital condyle.2
According to William B Downs Type

The highest point on the concavity behind the occipital Bolton’s point (Figs 8.5A to D) is a unilateral, hard tissue
condyles.6 cephalometric landmark.
A B
Figures 8.5A and B: (A) Bolton’s point on lateral cephalogram; (B) Magnified image showing Bolton’s point on the
lateral cephalogram
50
C D
Figures 8.5C and D: (C) Bolton’s point on graphic illustration: (D) Magnified image of Bolton’s point on
graphic illustration
Origin and is written continuously without any space between the

alphabets.
Bolton’s point is an anatomic hard tissue cephalometric
landmark/point.
Type
Tracing Bolton’s Point on the Lateral
Spheno-occpital synchondrosis (Figs 8.6A to D) is a unilateral,
Cephalogram
hard tissue cephalometric landmark.
Bolton’s point is the midway between the point basion and
opisthion. Trace the basion and opisthion and bisect the distance Origin
between these two points to establish the Bolton’s point. Spheno-occipital synchondrosis is an anatomic hard tissue
cephalometric landmarks.
Spheno-Occipital Synchondrosis
Tracing Spheno-Occipital Synchondrosis on
Abbreviation the Lateral Cephalogram
SOS–Spheno-occipital synchondrosis abbreviated using Tracing of SOS is very easy, if it is before the ossification and
English alphabets and is expressed as capital S, O and S very difficult, if it is after the ossification.
A B
Figures 8.6A and B: Spheno-occipital synchondrosis on lateral cephalogram; (B) Magnified image
showing spheno-occipital synchondrosis on the lateral cephalogram
51

C D
Figures 8.6C and D: (C) Spheno-occipital synchondrosis on graphic illustration; (D) Magnified image of
spheno-occipital synchondrosis on graphic illustration
Significance (Ref to Chapter 20) 3. Moyers RM. Handbook of Orthodontics. Year Book Medical Publishers,
Inc. 1988;251-9.
The spheno-occipital synchondrosis is very important structure in 4. Arne Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.
growth and development of the cranial base in the growing child. 5. Clifton T Forsberg. Diagnosis and treatment planning of skeletal
asymmetry with the sub-mental vertical radiograph. Am J of Ortho.
1984;85:224-37.
References 6. Downs WB. Variations in facial relationships; Their significance in
1. Ricketts RR. Provocations and perceptions in cranio-facial orthopedics treatment and prognosis. Am J of Ortho.1948;34:812-39.
–dental science and facial art. Rocky Mountain Inc. 1989;797-803. 7. Viken Sassouni. Orthodontics in dental practice. The CV Mosby
2. Graber TM. New horizons in case analysis-clinical cephalometrics. Am Company. 1971;330-7.
J of Ortho. 1952;38:603-24.
Chapter
related to Zygomatic bone
Each zygomatic bone (Figs 9.1A and B) consists of a process of the zygomatic bone. This line extends posteriorly
diamond-shaped body and following four processes: and merges with the horizontal part of the zygomatic process
• Frontal process articulates with the frontal bone at of the maxilla.
zygomaticofrontal suture forming the lateral wall of the
orbit. Cephalometric landmarks (Points) on
• Temporal process articulates with the zygomatic process Zygomatic bone
of the temporal bone, forming the zygomatic arch.
• Maxillary process articulates with the zygomatic process Cephalometric landmarks seen on the zygomatic bone are of
of the maxilla at the zygomaticomaxillary suture, forming anatomic origin and are as follows (Table 9.1):
the infraorbital rim and the orbital floor. Table 9.1: Cephalometric landmarks related to zygomatic bone
• Jugular process articulates the maxilla at the lateral wall of
the maxillary sinus. Cephalometric landmarks Abbreviation Type Origin
Orbitale Or Bilateral Anatomic
Radiographic Anatomy of Zygomatic Bone Temporale Te Bilateral Anatomic
The frontal process of the zygomatic bone appears as two
radio-opaque lines on the lateral cephalogram, one anterior Orbitale
and the other posterior. The anterior line is curved line
representing the anterior border of the lateral wall of the orbit.
Abbreviation
The posterior line is a vertical line that extends downward
from the junction with the cribriform plate and merges with Or–Orbitale is abbreviated using English alphabets and is
the posterior border of the zygomatic process of the maxilla. denoted as capital letter or upper case O followed by small
Between the inferior parts of the two lines, there is another letter or lower case r and is written continuously without any
horizontal radio-opaque line, which represents the maxillary space between the alphabets.
A B
Figures 9.1A and B: Zygomatic bone

53
Definition According to Leslie G Farkas

Orbitale is the lowest point in the inferior margin of the orbit, Orbitale is the lowest point on the lower margin of each
midpoint between right and left images. orbit.It is identified by palpation and is identical to the
bony orbitale.4
According to William B Downs
Orbitale is the lowest point on the left infraorbital margin.1
In the lateral cephalogram, the outlines of the orbital rims
overlap. Usually, the lowest point on the averaged outline is
According to TM Graber
used for the construction of Frankfort plane.5
Orbitale is the most inferior point on the lower border of the
left orbit.2 Type
Chapter 9  Cephalometric landmarks related to Zygomatic bone

Orbitale (Figs 9.2A to D) is a bilateral, hard tissue cephalometric.l
Orbitale is the left orbital point used in conjunction with the Origin
poria to orient the skull on the Frankfort horizontal plane.3 Orbitale is an anatomic hard tissue cephalometric landmarks.
A B
C D
Figures 9.2A to D: (A) Orbitale on lateral cephalogram; (B) Magnified image showing orbitale on the lateral cephalogram;
(C) Orbitale on graphic illustration; (D) Magnified image of orbitale on graphic illustration
54
Tracing of Orbitale on Lateral Cephalogram • FH-Mandibular plane angle (Go- Me)

• FH- Palatal plane angle ( ANS-PNS)
Normally, right and left infra-orbital margins are superimposed • FH-Occlusal plane ( APOcc – PPOcc).
on the lateral cephalogram, then they reveal radio-opaque
line on the lateral cephalogram, when patient is positioned
accurately on the cephalostat during the radiographic taking Temporale
procedure.
If the patient is inaccurately positioned then in such cases, Abbreviation
the infra-orbital margins appear as two different radio-opaque
lines on the lateral cephalogram making difficult to identify Te–Temporale is abbreviated using English alphabets and is
the point. In such cases, the orbitale is identified as the mid expressed as capital or upper case T followed by small letters
point of right and left infra-orbital margins. or lower case e and is written continuously without any space
Definition
Orbitale is used as one of the reference points in the construction
of Frankfort horizontal plane and is used for the assessment of Temporale (Figs 9.3A to D) is the intersection of the shadows of
horizontal growth pattern using following angles: the ethmoid and the anterior wall of the infratemporal fossa.
A B
C D
Figures 9.3A to D: (A) Temporale on lateral cephalogram; (B) Magnified image showing temporale on the lateral cephalogram;
(C) Temporale on graphic illustration; (D) Magnified image of temporale on graphic illustration
55
According to Viken Sassouni References

Intersection of the shadows of the ethmoid and anterior wall 1. Downs WB. Variations in facial relationships; Their significance in
of the infra-temporal fossa.6 2. Graber TM. New horizons in case analysis-clinical cephalometrics. Am
J of Ortho. 1952;38:603-24.
Type 3. Broadbent BH, Sr. Bolton’s standards of dentofacial developmental
growth. The CV Mosby Company. 1975; 133-5.
Temporale is a bilateral, hard tissue cephalometric landmark. 4. Farkas LG. Anthropometry of the head and face in medicine. Elsevier
north Holland inc. 1981;9-14.
5. Moyers RM. Handbook of Orthodontics—Yearbook medical publishers
Origin inc. 1988;251-9.
6. Viken Sassouni. Orthodontics in dental practice. The CV Mosby
Temporale is an anatomic hard tissue cephalometric landmark. company. 1971;330-7.
Chapter 9  Cephalometric landmarks related to Zygomatic bone

Section 4
Related to Facial Bones
and Dentition
 Cephalometric Landmarks Related to Maxilla

 Cephalometric Landmarks Related to Dentition
 Cephalometric Landmarks Related to Mandible
ChapteR
10 Related to Maxilla
The maxilla (Fig. 10.1) consists of a large hollow body that

houses the maxillary sinus and the four prominent processes.
• The frontal process
• The zygomatic process
• The palatine process
• The alveolar process.
Cephalometric Landmarks (Points) on Maxilla

Cephalometric landmarks seen on the maxilla are as follows
(Table 10.1):
Table 10.1: Cephalometric landmarks related to maxilla
Cephalometric landmarks Abbreviation Type Origin
anterior nasal spine aNS Unilateral anatomic
point a a Unilateral anatomic
anterior point of maxilla apMax Unilateral anatomic
prosthion pr Unilateral anatomic
posterior nasal spine pNS Unilateral anatomic
Pterygomaxillary fissure • Ptm Bilateral anatomic
Figure 10.1: Maxillary bone
• PTM
• PTMS
Key ridge KR Unilateral anatomic
Orbitale Or Bilateral anatomic The most anterior point of the nasal floor tip of pre-maxilla on
mid-sagittal plane.1
Anterior Nasal Spine According to B Holly Broadbent

Sharp median process formed by the forward prolongation of
Abbreviation the anterior aperture of the nose.2
ANS–Anterior nasal spine is abbreviated using English
alphabets and is expressed as capital or upper case A, N According to TM Graber
and S, written continuously without any space between the The tip of the anterior nasal spine as seen on the X-ray film in
alphabets. norma lateralis.3
Definition According to Robert E Moyers

Anterior nasal spine (Figs 10.2A to D) is the tip of bony The most anterior point on the maxilla at the level of the
anterior nasal spine in the midline or median plane. palate. The ANS is of limited use for analysis in the posterior-
60
Section 4  Cephalometric Landmarks related to Facial Bones and Dentition
A B
C D
Figures 10.2A to D: (A) Anterior nasal spine on lateral cephalogram; (B) Magnified image showing anterior nasal spine on the lateral
cephalogram; (C) Anterior nasal spine on graphic illustration; and (D) Magnified image of Anterior nasal spine on graphic illustration
anterior projection as the actual spine often cannot be seen Tracing of Anterior Nasal Spine on Lateral
and its location varies considerably according to radiographic Cephalogram
exposure.4
There is an individual variation exists in length and width of
ANS. In some individuals ANS are long and thin; while in
Type other are short and thick.
Anterior nasal spine is a unilateral, hard tissue cephalometric
landmark. Radiographic Appearance
• ANS appears slightly posterior to the anatomic spine.
Origin • In cases with thin ANS: In such cases, on the cephalogram,
ANS will be unclear because it can superimpose by nasal
Anterior nasal spine is an anatomic hard tissue cephalometric cartilage.
landmark. • In cases with thick ANS: In such cases, on the cephalogram,
ANS is clear and will be ease in tracing.
61
Significance (Ref to Chapter 20) Definition

Anterior nasal spine is used as one of the reference points Point A (Figs 10.3A to D) is the deepest point on the curved
in the construction of occlusal plane and is used for the bony outline between the anterior nasal spine (ANS) and
assessment of horizontal growth pattern using FH-palatal prosthion (Pr).
plane angle (ANS-PNS).
According to Willian B Downs
The deepest midline point on the premaxilla between the
Point A anterior nasal spine and prosthion.5
Abbreviation According to Robert M Ricketts

Point A: Point A is abbreviated using English alphabets and is Deepest point on the curve of the bone between the anterior
expressed as A itself. nasal spine and dental alveolus. Also termed SS or subspinale
(below the spine).6
Chapter 10  Cephalometric Landmarks related to Maxilla

A B
C
D
Figures 10.3A to D: (A) Point A on lateral cephalogram; (B) Magnified image showing point A on the lateral cephalogram; (C) Point A
on graphic illustration; and (D) Magnified image of point A on graphic illustration
62
According to Viken Sassouni • To establish A point, draw a line between ANS and
prosthion. Then draw a line parallel to the ANS–Pr line,
Deepest point on midsagittal plane between ANS and tangent to the deepest point between ANS and Pr. This is
prosthion, mesially around the level of and anterior to the point A.
apex of the upper central incisors.1
Point A is used as one of the reference points in the construction
The most posterior point on the pre-maxilla above prosthion of angles and planes for the assessment of the following:
and immediately lateral to the contour of projection of the • Relationship of maxilla to cranial base is assessed using
anterior nasal spine. It is the junction of the alveolar and basal SNA angle.
of the maxilla.3 • Maxillo-mandibular relationship with anterior cranial

According to Alex Jacobson and W Caufield • Inclination upper incisors are assessed using NA-Upper
Using a line perpendicular to FH locate the most posterior incisor angular and NA-Upper incisor linear.
point in the concavity between ANS and maxillary alveolar • Point A is useful indicator of the anteroposterior
process.7 relationship between the basal bone of the maxilla and the
malocclusion.
Or • In Mc Namara cephalometric analysis, anteroposterior
orientation of the maxilla to the cranial base is assessed
The most posterior midline point in the concavity between the by the linear distance between nasion perpendicular and
ANS and prosthion (The most inferior point on the alveolar point A. An anterior position of point A is a positive value
bone overlying the maxillary central incisor). and a posterior position of point A is a negative value.
• Mid facial length is measured from condylion to Point A
According to Robert E Moyers in McNamara analysis.
The most posterior point on the curve between ANS and PR • In Mc Namara cephalometric analysis, method of
“A” point usually is found approximately 2 mm anterior to determining of position of maxillary incisor relative to
the apices of the maxillary central incisor roots. A is not an point A. Draw vertical line through the nasion called NP
anatomic point, of course.4 (Nasion perpendicular) and A vertical line constructed
through the point A parallel to the Nasion perpendicular
line called the parallel to nasion perpendicular through
According to JR Jarabak
point A (PNP). The anteroposterior distance from maxi-
Maxillary denture base, point A is 2 mm labial to the apices of llary incisor to point A.
the central incisors.8 • In Mc Namara cephalometric analysis, to determine the
anteroposterior position of the mandibular incisors, the
Type distance is measured between the edge of the incisor and
a line drawn from point A to Pog. In a well-balanced face,
Point A is a unilateral, hard tissue cephalometric landmark. this distance should be 13 mm.
Origin
Prosthion
Point A is an anatomic hard tissue cephalometric landmark.
Tracing Procedure for Point A Abbreviation

Pr: Prosthion is abbreviated using English alphabets and is
• First trace the palatal bone, the anterior nasal spine, the
expressed as capital letter or upper case P followed by small
marginal bone of the alveolar process and the anterior
letter or lower case r and is written continuously without any
facial surface of the alveolar process.
• Thereafter, trace the outline of maxillary central incisor
which includes tracing of incisal edge, apex of the root outer
Definition
surface of the crown and root of maxillary central incisor.
• Note:The most important factor which helps in location of Prosthion (Figs 10.4A to D) is the lowermost anterior point
point A is that it is at almost the same height as the apex of alveolar process of pre-maxilla in the midline between two
of the incisor. maxillary central incisors.
63

A B
C D
Figures 10.4A to D: (A) Prosthion on lateral cephalogram; (B) Magnified image showing prosthion on the lateral cephalogram;
(C) Prosthion on graphic illustration; and (D) Magnified image of prosthion on graphic illustration
According to Arne Bjork Type

The transition point between the crown of the most prominent Prosthion is a unilateral, hard tissue cephalometric landmark.
medial maxillary incisor and the alveolar projection.9
According to TM Graber Origin

The point of the maxillary alveolar process in the midline that Prosthion is an anatomic hard tissue cephalometric landmark.
projects most anteriorly.3
The most anterior inferior point on the maxillary alveolar Prosthion is used as one of the reference points in the
process usually found near the cementoenamel junction of the construction of angles for the assessment of relationship of
maxillary central incisor.4 maxilla skeletal base to cranial base using S-N-Pr angle.
64
Posterior Nasal Spine According to TM Graber

The bony posterior projection of the horizontal portion of the
Abbreviation palatine bone at the midline.3
PNS: Posterior Nasal Spine is abbreviated using English

alphabets and is expressed as capital letter or upper case P, N
and S and is written continuously without any space between Process formed by the united projecting medial ends of the
the alphabets. posterior borders of the two palatine bones.2
Definition
Posterior Nasal Spine (Figs 10.5A to D ) is the intersection of

Most posterior point on the contour of the bony palate.1
a continuation of the anterior wall of the pterygopalatine fossa
and the floor of the nose.
According to Alex Jacobson and W Caufield
According to Michael L Riolo
Using a line perpendicular to FH, locate PNS at the most
The most posterior point at the sagittal plane on the bony hard posterior aspect of the palatine bone.7
palate.10
A B
C D
Figures 10.5A to D: (A) Posterior nasal spine on lateral cephalogram; (B) Magnified image showing posterior nasal spine on the lateral
cephalogram; (C) Posterior nasal spine on graphic illustration; and (D) Magnified image of posterior nasal spine on graphic illustration
65
According to Robert M Ricketts which represents the posterior surface of the tuberosity of the
maxilla; the landmark is taken where the two edges, front and
Midpoint of the base of the palatine bone at the posterior back appear to merge inferiorly.
margin of the hard palate.6
Type
According to TM Graber, the pterygomaxillary fissure is an
Posterior nasal spine is a unilateral, hard tissue cephalometric
oval-looped radiolucency resulting from the fissure between
landmark.
the anterior margin of the pterygoid process of the sphenoid
bone and the profile outline of the posterior surface of the
Origin maxilla.3
Posterior nasal spine is an anatomic hard tissue cephalometric
landmark. According to Robert M Moyers
According to Robert M Moyers, the pterygomaxillary fissure

Tracing of Posterior Nasal Spine on the is tear drop shaped radiolucency, the anterior shadow of
Lateral Cephalogram which represents the posterior surface of the tuberosity of the
• Like ANS, PNS also has variation in length and width. maxilla; the landmark itself is at the most inferior confluences
• PNS is difficult to trace on the cephalogram when there of the curvatures.4
is unerupted teeth, in these cases the PNS can be located
between the floor of nasal cavity and the inferior surface According to Clifton T Forsberg
of the palatine bone. According to Clifton T Forsberg, pterygomaxillary fissure is
• Usually, it is found that PNS is located below the Ptm. the most medial and posterior point of each pterygomaxillary
fissure. The Ptm line connects right and left Ptm points. The
Ptm access is the perpendicular bisector of the Ptm line.11
Posterior nasal spine is used as one of the reference points
in the construction of occlusal plane and is used for the According to Holly Broadbent
assessment of horizontal growth pattern using FH-Palatal
plane angle (ANS-PNS). Inverted, elongated, tear drop-shaped area formed by the
divergence of the maxilla from the pterygoid process of
the sphenoid. The posterior nasal spine and staphylion are
Pterygomaxillary Fissure generally located beneath the lower pointed end of this area.2
Abbreviation According to LB Higley

Ptm: Pterygomaxillary fissure is abbreviated using English Junction of the Frankfort plane and a line perpendicular to it
alphabets and is expressed as capital or upper case P followed from the pterygomaxillary fissure.12
by small or lower case t and m, written continuously without
any space between the alphabets. Type
PTM: According to Robert. M. Moyers, Pterygomaxillary fissure
is abbreviated using English alphabets and is expressed as capital Pterygomaxillary fissure is bilateral, hard tissue cephalo-
or upper case P followed by capital or upper case T and M, metric landmark.
written continuously without any space between the alphabets.4
Origin
PTMS: According to Michael L Riolo, Pterygomaxillary
fissure is abbreviated using English alphabets and is expressed Pterygomaxillary fissure is an anatomic hard tissue cephalo-
as capital or upper case P, T, M, S, written continuously metric landmark.
without any space between the alphabets.9
Definition Pterygomaxillary fissure is used as one of the reference
Pterygomaxillary fissure (Figs 10.6A to D) is a bilateral tear points in Cox cephalometric analysis and is used to assess the
drop shaped area of radiolucency, the anterior shadow of posterior limit of the maxilla.
66
A B
C D
Figures 10.6A to D: (A) Pterygomaxillary fissure on lateral cephalogram; (B) Magnified image showing pterygomaxillary
fissure on the lateral cephalogram; (C) Pterygomaxillary fissure on graphic illustration; and (D) Magnified image of
pterygomaxillary fissure on graphic illustration
Key Ridge According to Viken Sassouni

Lowermost point on the contour of the shadow of the anterior
wall of the infratemporal fossa.1
Abbreviation
KR: Key ridge is abbreviated using English alphabets and is According to Robert E Moyers
expressed as capital or upper case K, and R, and is written The lowest point on the outline of the zygoma.4
Definition The most inferior point on the zygomatic ridge.3
The key ridge (Figs 10.7A to D) is the lowermost point on
Type
the contour shadow of the anterior wall of the infratemporal
fossa. Key ridge is a bilateral, hard tissue cephalometric landmark.
67

A B
C D
Figures 10.7A to D: (A) key ridge on lateral cephalogram; (B) Magnified image showing key ridge on the lateral cephalogram; (C) key
ridge on graphic illustration; and (D) Magnified image of key ridge on graphic illustration
Origin Definition
Key ridge is an anatomic hard tissue cephalometric landmark. According to Arne Bjork
The deepest point on the infraorbital margin.The midpoint, or
is used where double projection gives rise to two points, or 1
Orbitale and or 2.9
Abbreviation According to William B Downs

Or: Orbitale is abbreviated using English alphabets and is ex- The lowest point on the left infra-orbital margin.5
pressed as capital or upper case O, followed by small or lower
case r and both alphabets are written continuously without any According to TM Graber
space between them. The most inferior point on the lower border of the left orbit.3
68
According to B Holly Broadbent Type

The left orbital point is used in conjunction with poria to Orbitale is a bilateral (Figs 10.8A to D), anatomic, hard tissue
orient the skull on the Frankfort horizontal plane.2 cephalometric landmark.
Leslie G Farkas Origin

Orbitale is the lowest point on the lower margin of the each orbit. Orbitale is an anatomic hard tissue cephalometric landmark.
It is identified by palpation and is identical to the bony orbitale.13
Orbitale is used as one of the reference points in the construction

In the lateral cephalogram, the outlines of the orbital rims of angles and planes for the assessment of following:
overlap. Usually, the lowest point on the averaged outline is • Growth pattern is assessed using FH plane-Mandibular
used for the construction of Frankfort plane.4 plane.
A B
C D
Figures 10.8A to D: (A) Orbitale on lateral cephalogram; (B) Magnified image showing orbitale on the lateral cephalogram;
(C) Orbitale on graphic illustration; and (D) Magnified image of orbitale on graphic illustration
69
• Upper incisor torque is assessed using FH-long axis of 2. Broadbent BH Sr. Bolton’s standards of dentofacial developmental
growth. The CV Mosby Company. 1975;133-5.
upper incisor. 3. Graber TM. New horizons in case analysis. Clinical cephalometrics.
Am J of Ortho. 1952;38:603-24.
Tracing of Orbitale on the Lateral Cephalogram 4. Moyers RM. Handbook of Orthodontics.Year book medical publishers,
Inc. 1988;251-9.
Normally, right and left infra-orbital margins are superimposed 5. Downs WB. Variations in facial relationships. Their significance in
on the lateral cephalogram, and then they reveal radio-opaque
6. Ricketts RM. Provocations and perceptions in cranio-facial orthopedics.
line on the lateral cephalogram, when patient is positioned Dental science and facial art. Rocky Mountains, Inc. 1989;797-803.
accurately on the cephalostat during the radiographic taking 7. Alex Jacobson, Caufield W. Introduction to radiographic cephalometry.
procedure. Lea and Febiger. 1985;37-40.
8. Jarabak JR. Technique and treatment with light wire appliance. The CV
If the patient is inaccurately positioned then in such cases,
Mosby company. 1963;132-3.
the infra-orbital margins appear as two different radio-opaque 9. Arne Bjork. The face in profiles. Sven. Tandlak Tidskr. 1947;40:32-3.
lines on the lateral cephalogram making difficult to identify 10. Riolo ML. An atlas of craniofacial growth. Cephalometric standards from
the point. In such cases, the orbitale is identified as the mid- the university school growth study, the university of Michigan.Center for

human growth and development. The University of Michigan. 1974;12-21.
point of right and left infra-orbital margins.
11. Forsberg CT. Diagnosis and treatment planning of skeletal asymmetry
with submental. Vertical radiograph. Am J of Ortho. 1984;85:224-37.
References 12. Higley LB. Cephalometric standards for children 4-8 years of age.Am J
of Ortho. 1954;40:51-9.
1. Viken Sassuoni. Orthodontics in dental practice. The CV Mosby 13. Farkas LG. Anthropometry of the head and face in medicine. Elsevier
company. 1971;330-7. north Holland, Inc. 1981;9-14.
Chapter
11 Related to Dentition
Dental occlusion undergoes significant changes from birth of all the primary teeth is usually complete by two and half
until adulthood and beyond. This continuation of changes in years by which age, the deciduous dentition is in full function.
the dental relationship during various stages of the dentition Root formation of primary teeth is usually completed by three
can be divided into four stages: years of age.
1. Gum pad stage—0–6 months Although considerable variation is seen in the eruption
2. Deciduous dentition—6 months–6 years timing of deciduous teeth, there appears to be no significant
3. Mixed dentition—6–12 years gender differences. The chronology of primary teeth is
4. Permanent dentition—12 years and beyond. presented in the Table 11.1.
The sequence of eruption of primary teeth may also show
Gum Pad Stage (0–6 Months) some variation. However, in most of the cases, the lower
central incisors are the first teeth to erupt, followed by the
Usually jaws are devoid of teeth at birth. Gum pad stage upper central incisors. Usually the lateral incisor, first molar
extends from birth up to the eruption of first primary tooth and canine tend to erupt earlier in maxilla than in the mandible.
usually the lower central incisors at around 6 months of age. Deciduous dentition generally shows the following orders of
The gum pads are pink in color and firm in consistency. The eruption:
maxillary gum pad is U/square shaped, and the mandibular
gum pad is horse-shoe shaped. AB D C E
The gum pads develop in two portions—buccal and A B D CE
lingual portions which are separated by the dental groove.
The gum pads in both the arches show certain elevations and • Central incisors
grooves that outline the portion of the various primary teeth • Lateral incisors
that are still developing in the alveolar ridges. These grooves • First molars
are called as transverse grooves. The prominent transverse • Canines
groove separating canine and first deciduous molar segments • Second molars
in both the arches is called the lateral sulcus. The lateral sulcii By 3 years of age, the occlusion of deciduous dentition
are often used to judge the inter-arch relationship at a very is completely established and dental arches remain relatively
early stage. The gingival groove separates the maxillary and constant with no significant changes up to 6 years of age.
mandibular gum pads from the palate and floor of the mouth
respectively.
Mixed Dentition Stage (6–12 Years)
Deciduous Dentition Stage Mixed dentition stage is a transition stage when primary
(6 Months to 6 Years) teeth are exfoliated in a sequential manner, followed by the
eruption of their permanent successors. This stage spans from
The deciduous dentition stage spans from the time of eruption 6 to 12 years of age, beginning with the eruption of the first
of primary teeth until the eruption of the first permanent tooth permanent tooth, usually a mandibular central incisor or a first
around 6 years of age. molar. It is completed at the time the last primary tooth is shed.
Significant changes in occlusion are seen in mixed dentition
Eruption Chronology of Primary Teeth period due to the loss of 20 primary teeth and eruption of their
Eruption of the primary teeth begins by 6 months of age when successor permanent teeth. Most malocclusions are developed
primary mandibular incisors erupt into oral cavity. Eruption at this stage.
71
Permanent Dentition Stage Table 11.1: Cephalometric landmarks related to dentition
Permanent dentition stage is pretty well established by about Cephalometric Abbreviation Type Origin
landmarks
13 years of age, with the eruption of all permanent teeth
except the 3rd molars. Permanent successors develop from Incision superius Isi Unilateral Anatomic
incisalis
lingual extension of the dental lamina (successional lamina)
and the permanent molar develop from the posterior extension Incision superius Isa Unilateral Anatomic
apicalis
of the dental lamina. The permanent incisors develop lingual
to the primary incisors and move labially as they erupt. The Incision inferius Iii Unilateral Anatomic
incisalis
premolars develop below the divergent roots of the primary
molars. Incision inferius Iia Unilateral Anatomic
apicalis
Permanent dentition begins to form at birth, at which time,
Anterior point of APocc Unilateral Anatomic
calcification of the 1st permanent molars becomes evident.
occlusion
Chronology of permanent dentition is depicted in Table 11.1.
Chapter 11  Cephalometric Landmarks Related to Dentition

Posterior point of PPocc Unilateral Anatomic
Sequence of eruption of permanent dentition is more
occlusion
variable than that of the primary dentition. In addition, there
Maxillary central U1 Unilateral Anatomic
are significant differences in the eruption sequences between incisor
the maxillary and the mandibular arch.
Maxillary first molar U6 Bilateral Anatomic
Mandibular central L1 Unilateral Anatomic
Most Common Eruption Sequence in Maxilla incisor
6-1-2-4-3-5-7-8 or Mandibular first L6 Bilateral Anatomic
6-1-2-4-5-3-7-8 molar
mi mi Bilateral Anatomic
Most Common Eruption Sequence for ms ms Bilateral Anatomic
Mandibular Arch
(6-1)-2-3-4-5-7-8 or is–Incision Superius is abbreviated using English alphabets
(6-1)-2-4-3-5-7-8 and is expressed as small letters or lower case i and s and is
These are also the most favorable sequences for the prevention
of malocclusion. It must be noted that, there is a difference
in eruption timing of the canines in the two arches. In the Definition
mandibular arch, the canine erupts before the premolars, Incision superius Incisalis (Figs 11.1A to D) is the incisal
whereas in the maxillary arch the canine generally erupts after edge of the maxillary central incisor.
the premolars.
When second molars erupt before the premolars are fully According to Arne Bjork
erupted significant shortening of the arch perimeter occurs,
increasing the likelihood of malocclusion. Incision superius incisalis is the mid-point of the incisal edge
of the most prominent upper central incisor.1
Cephalometric Landmarks on Dentition
Cephalometric landmarks seen on the Dentition are of
Incision superius incisalis is the incisal tip of the most anterior
anatomic origin and are as follows (Table 11.1):
maxillary central incisor.2
Incision Superius Incisalis Type

Incision superius incisalis is a unilateral, hard tissue cephalo
Abbreviation metric landmark.
Isi–Incision Superius Incisalis is abbreviated using English
Origin
alphabets and is expressed as Capital or upper case I followed
by small letters or lower case s and i and is written continuously Incision superius incisalis is a unilateral, anatomic, hard tissue
without any space between the alphabets. cephalometric landmark.
72
A B
C D
Figures 11.1A to D: (A) Incision superius incisalis on lateral cephalogram; (B) Magnified image showing incision
superius Incisalis on the lateral cephalogram; (C) Incision superius incisalis on graphic illustration; (D) Magnified
image of incision superius Incisalis on graphic illustration
Tracing of Incision Superius Incisalis • Inclination of upper incisor is assessed using angle drawn
on Lateral Cephalogram between the long axis of upper incisor plane and the FH plane.
• In Arnett’s analysis, the upper incisor torque is assessed
The labial and lingual outline of the crown of the maxillary using the angle drawn between long axis of upper incisor
permanent central incisor appears as radio-opaque line on and occlusal plane.
the lateral cephalogram. Trace these two outlines of crown of • Inter-incisal relationship of upper and lower incisors are
the maxillary permanent central incisor. The tip of the incisal assessed using the angle drawn between the long axis of
edge or the intersection of the labial and lingual outline is the upper and lower permanent central incisor.
point of Incision Superius Incisalis. • Anteroposterior positioning of maxillary central incisor is
assessed using the distance between the incision Superius
Significance (Ref to Chapter 20) Incisalis and the NA plane.
Incision superius incisalis is used as one of the reference points • Anteroposterior positioning of maxillary central incisor is
in the construction of angles and planes for the assessment of assessed using the distance between the incision Superius
following: Incisalis and the A-Pog plane.
73
Incision Superius Apicalis According to Michael L Riolo

The upper incisor apex is the root tip of the maxillary central
Abbreviation incisor. In cases where the root is not yet completed, the
midpoint of the growing root tip is marked.3
Isa–Incision Superius Apicalis is abbreviated using English
alphabets and is expressed as capital or upper case I followed According to SN Bhatia and BC Leighton
by small letters or lower case s and a and is written continuously
without any space between the alphabets. The upper incisor apex is the root apex of the most prominent
UIA–Upper incisor apex is abbreviated using English upper incisor.4
alphabets and is expressed as capital or upper case U, I and
A and is written continuously without any space between the Type
alphabets.
Incision superius apicalis is a unilateral, anatomic, hard tissue

Definition
Incision superius apicalis (Figs 11.2A to D) is the root apex
Origin
of the most anterior maxillary central incisor; if this point
is needed only for defining the long axis of the tooth, the Incision superius apicalis is an anatomic hard tissue cephalo
midpoint on the bisection of the apical root width can be used. metric landmark.
A B
C D
Figures 11.2A to D: Incision superius apicalis

74
Tracing of Incision Superius Apicalis • Inter-incisal relationships of upper and lower incisors are
on Lateral Cephalogram assessed using the angle drawn between the long axis of
upper and lower permanent central incisor.
The labial and lingual outline of the root of the maxillary
permanent central incisor appears as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of root of the Incision Inferius Incisalis
maxillary permanent central incisor. The point of intersection
of labial and lingual outlines of the root of maxillary permanent Abbreviation
central incisor is the point of incision superius apicalis.
Iii–Incision inferius incisalis is abbreviated using English
Significance (Ref to Chapter 20) alphabets and is expressed as capital or upper case I followed
by small letters or lower case i and i and is written continuously

Incision superius apicalis is used as one of the reference points without any space between the alphabets.
in the construction of angles and planes for the assessment of
following: ii–Incision inferius is abbreviated using English alphabets and
• Inclination of upper incisor is assessed using angle drawn is expressed as small letters or lower case i and i and is written
between the long axis of upper incisor plane and the FH continuously without any space between the alphabets.
plane.
Definition
• In Arnett’s analysis, the upper incisor torque is assessed
using the angle drawn between long axis of upper incisor Incision inferius incisalis (Figs 11.3A to D) is the incisal edge
and occlusal plane. of the most prominent mandibular central incisor.
A B
C D
Figures 11.3A to D: Incision inferius incisalis (A and B) on lateral cephalogram, (C and D) on graphic illustration
75
According to Arne Bjork by small letters or lower case i and a and is written continuously
without any space between the alphabets.
The incision inferius is the incisal point of the most prominent
medial mandibular incisor.1 LIA–lower incisor apex is abbreviated using English
alphabets and is expressed as capital or upper case L, I and
According to Robert E Moyers A and is written continuously without any space between the
alphabets.
The incision inferius is the incisal tip of the most labial mandi
bular central incisor.2
Definition
Type Incision inferius apicalis (Figs 11.4A to D) is the root apex
Incision inferius incisalis is a unilateral, anatomic, hard tissue of the most anterior mandibular central incisor; if this point
cephalometric landmark. is needed only for defining the long axis of the tooth, the
midpoint on the bisection of the apical root width can be

used.
Tracing of Incision Inferius Incisalis
on Lateral Cephalogram
According to SN Bhatia and BC Leighton
The labial and lingual outline of the crown of the mandibular
permanent central incisor appears as radio-opaque line on the The lower incisor apex is the root apex of the most prominent
lateral cephalogram. Trace these two outlines of crown of the lower incisor.4
mandibular permanent central incisor. The tip of the incisal
edge or the intersection of the labial and lingual outline is the Type
point of incision inferius incisalis.
Incision inferius apicalis is a unilateral, anatomic, hard tissue
Significance (Ref to Chapter 20) cephalometric landmark.
Incision inferius incisalis is used as one of the reference point

in the construction of angles and planes for the assessment of
Tracing of Incision Inferius Apicalis
following: on Lateral Cephalogram
• Inclination of lower incisor is assessed using angle drawn The labial and lingual outline of the root of the mandibular
between the long axis of lower incisor plane and the permanent central incisor appears as radio-opaque lines on the
mandibular plane. lateral cephalogram. Trace these two outlines of root of the
• In Arnett’s analysis, the lower incisor torque is assessed mandibular permanent central incisor. The point of intersec-
using the angle drawn between long axis of lower incisor tion of labial and lingual outlines of the root of mandibular
and occlusal plane. permanent central incisor is the point of incision inferius
• Inter-incisal relationship of upper and lower incisors are apicalis.
assessed using the angle drawn between the long axis of
upper and lower permanent central incisor.
• Anteroposterior positioning of mandibular central incisor
is assessed using the distance between the incision inferius Incision inferius apicalis is used as one of the reference points
incisalis and the NB plane. in the construction of angles and planes for the assessment of
• Anteroposterior positioning of maxillary central incisor is following:
assessed using the distance between the incision inferius • Inclination of lower incisor is assessed using angle drawn
incisalis and the A-Pog plane. between the long axis of upper incisor plane and the
mandibular plane.
Incision Inferius Apicalis • In Arnett’s analysis, the lower incisor torque is assessed
using the angle drawn between long axis of lower incisor
and occlusal plane.
Abbreviation
• Inter-incisal relationship of upper and lower incisors are
Iia–Incision inferius apicalis is abbreviated using English assessed using the angle drawn between the long axis of
alphabets and is expressed as capital or upper case I followed upper and lower permanent central incisors.
76
A B
C D
Figures 11.4A to D: Incision inferius apicalis
Anterior Point of Occlusion Tracing of Anterior Point of Occlusion

Abbreviation • The labial and lingual outline of the crown of the maxillary
permanent central incisor appears as radio-opaque line on
APocc–Anterior point of occlusion is abbreviated using the lateral cephalogram. Trace these two outlines of crown
English alphabets and is expressed as capital or upper case A of the maxillary permanent central incisor.
and P followed by small letters or lower case o, c and c and • The labial and lingual outline of the root of the maxillary
written continuously without any space between the alphabets. permanent central incisor appears as radio-opaque lines
on the lateral cephalogram. Trace these two outlines of
Definition root of the maxillary permanent central incisor.
Anterior point of occlusion (Figs 11.5A to D) for the occlusal • The labial and lingual outline of the crown of the mandibular
plane–A constructed point, the midpoint of the incisor overbite permanent central incisor appears as radio-opaque line on
in occlusion. the lateral cephalogram. Trace these two outlines of crown
of the mandibular permanent central incisor.
• The labial and lingual outline of the root of the mandibular
Type
permanent central incisor appears as radio-opaque lines
Anterior point of occlusion is a unilateral, constructed, hard on the lateral cephalogram. Trace these two outlines of
tissue cephalometric landmark. root of the mandibular permanent central incisor.
77

A B
C D
Figures 11.5A to D: Anterior point of occlusion
• Locate the point where there is maximum intercuspation Posterior Point of Occlusion
of maxillary and mandibular permanent central incisors,
which is the point of anterior point of occlusion.
Abbreviation
Significance (Ref to Chapter 20) PPocc–Anterior point of occlusion is abbreviated using
English alphabets and is expressed as capital or upper case
Anterior point of occlusion is used as one of the reference
P and P followed by small letters or lower case o, c and c
points in the construction of angles and planes for the
and are written continuously without any space between the
assessment of the following:
alphabets.
• Growth pattern is assessed using angle drawn between the
occlusal plane and mandibular plane. Definition
• Growth pattern is assessed using angle drawn between the
occlusal plane and FH plane. Posterior point of occlusion (Figs 11.6A to D) for the occlusal
• In Arnett’s analysis, the upper incisor torque is assessed plane—the most distal point of contact between the most
using the angle drawn between long axis of upper incisor posterior molars in occlusion (Rakosi).
and occlusal plane.
• In Arnett’s analysis, the lower incisor torque is assessed Type
using the angle drawn between long axis of lower incisor Posterior point of occlusion is a bilateral, anatomic hard tissue
and occlusal plane. cephalometric landmark.
78
A B
C D
Figures 11.6A to D: Posterior point of occlusion
Tracing of Posterior Point of Occlusion • Locate the point where there is maximum intercuspation
on Lateral Cephalogram of maxillary and mandibular permanent first molars,
which is the point of anterior point of occlusion.
• The labial and lingual outline of the crown of the maxillary
permanent first molar appears as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of crown of
the maxillary permanent first molar. Posterior point of occlusion is used as one of the reference
• The labial and lingual outline of the root of the maxillary points in the construction of angles and planes for the
permanent first molar appears as radio-opaque lines on the assessment of following:
lateral cephalogram. Trace these two outlines of root of • Growth pattern is assessed using angle drawn between the
the maxillary permanent first molar. occlusal plane and mandibular plane.
• The labial and lingual outline of the crown of the • Growth pattern is assessed using angle drawn between the
mandibular permanent first molar appears as radio-opaque occlusal plane and FH plane.
lines on the lateral cephalogram. Trace these two outlines • In Arnett’s analysis, the upper incisor torque is assessed
of crown of the mandibular permanent first molar. using the angle drawn between long axis of lower incisor
• The labial and lingual outline of the root of the mandibular and occlusal plane.
permanent first molar appears as radio-opaque lines on the • In Arnett’s analysis, the lower incisor torque is assessed
lateral cephalogram. Trace these two outlines of root of using the angle drawn between long axis of lower incisor
the mandibular permanent first molar. and occlusal plane.
79

A B
C D
Figures 11.7A to D: Maxillary central incisor
Maxillary Central Incisor Tracing of Maxillary Central Incisor

Abbreviation The labial and lingual outline of the crown of the maxillary
permanent central incisor appears as radio-opaque line on the
U1–Maxillary central incisor is abbreviated using English lateral cephalogram. Trace these two outlines of crown of the
alphabets and numeric and is expressed as Capital or maxillary permanent central incisor. The most labial point
upper case U followed by English numeric 1 and is written on the crown of the maxillary central incisor is the point of
continuously without any space between them. maxillary central incisor.
Definition Maxillary First Molar

Maxillary central incisor (Figs 11.7A to D) is the most labial
point on the crown of the maxillary central incisor.
Abbreviation
Type U6–Maxillary first molar is abbreviated using English
alphabets and numeric and is expressed as capital or upper case
Maxillary central incisor is a unilateral, anatomic, hard tissue U followed by English numeric 6 and is written continuously
cephalometric landmark. without any space between the alphabets.
80
A B
C D
Figures 11.8A to D: Maxillary first molar
Definition Mandibular Central Incisor

Maxillary first molar (Figs 11.8A to D) is the tip of the
mesiobuccal cusp of the maxillary first permanent molar. Abbreviation
L1–Mandibular central incisor is abbreviated using English
Type alphabets and numeric and is expressed as capital or upper case
Maxillary first molar is a bilateral, anatomic, hard tissue L followed by English numeric 1 and is written continuously
cephalometric landmark. without any space between the alphabets.
Definition
Tracing of Maxillary First Molar
on Lateral Cephalogram Mandibular central incisor (Figs 11.9A to D) is the most labial
point on the crown of the mandibular central incisor.
The labial and lingual and cuspal outlines of the crown of the
maxillary permanent first molar appears as radio-opaque lines on
Type
the lateral cephalogram. Trace these outlines of crown of the max-
illary permanent first molar, the tip of the mesiobuccal cusp of the Mandibular central incisor is a unilateral, anatomic, hard
maxillary permanent molar is the point of maxillary first molar. tissue cephalometric landmark.
81

A B
C D
Figures 11.9A to D: Mandibular central incisor
Tracing of Mandibular Central Incisor Definition

Mandibular first molar (Figs 11.10A to D) is the tip of the
The labial and lingual outlines of the crown of the mandibular mesiobuccal cusp of the mandibular first permanent molar.
permanent central incisor appear as radio-opaque lines on the
lateral cephalogram. Trace these two outlines of crown of the Type
mandibular permanent central incisor. The most labial point
on the crown of the mandibular central incisor is the point of Mandibular first molar is a bilateral, anatomic, hard tissue
mandibular central incisor. cephalometric landmark.
Tracing of Mandibular First Molar

Mandibular First Molar on Lateral Cephalogram
The labial and lingual and cuspal outlines of the crown of the
Abbreviation mandibular permanent first molar appears as radio-opaque
L6–Mandibular first molar is abbreviated using English lines on the lateral cephalogram. Trace these outlines of
alphabets and numerical and is expressed as capital or crown of the mandibular permanent first molar, the tip of the
upper case L followed by English numeric 6 and is written mesiobuccal cusp of the mandibular permanent molar is the
continuously without any space between the alphabets. point of maxillary first molar.
82
A B
C D
Figures 11.10A to D: Mandibular first molar
mi Type
mi is a bilateral, hard tissue cephalometric landmark.
Abbreviation
Tracing of mi on Lateral Cephalogram
mi–mi is abbreviated using English alphabets and is expressed
as lower case m and i and written continuously without any The labial and lingual and cuspal outlines of the crown of the
space between the alphabets. mandibular permanent first molar appears as radio-opaque
lines on the lateral cephalogram. Trace these outlines of
Definition crown of the mandibular permanent first molar, the tip of the
mesiobuccal cusp of the mandibular permanent molar is the
mi (Figs 11.11A to D) is the mesial contact of the lower molar point of maxillary first molar. mi is the mesial contact of the
projected normal to the plane of occlusion. lower molar projected normal to the plane of occlusion.
83

A B
C D
Figures 11.11A to D: mi
Significance (Ref to Chapter 20) Definition

mi is used as one of the reference points in the construction of ms (Figs 11.12A to D) is the mesial contact of the upper molar
plane and angle in the Bjork cephalometric analysis. projected normal to the plane of occlusion.
ms Type
ms is a bilateral hard tissue cephalometric landmark.
Abbreviation
Tracing of ms on Lateral Cephalogram
ms–ms is abbreviated using English alphabets and is expressed
as lower case m and s and written continuously without any The labial and lingual and cuspal outlines of the crown of the
space between the alphabets. mandibular permanent first molar appears as radio-opaque
lines on the lateral cephalogram. Trace these outlines of
84
A B
C D
Figures 11.12A to D: ms
crown of the mandibular permanent first molar, the tip of the References
mesiobuccal cusp of the mandibular permanent molar is the 1. Arne Bjork. The face in profiles-Sven. Tandlak Tidskr. 1947;40:32-3.
point of maxillary first molar. ms is the mesial contact of the 2. Robert M Moyers. Handbook of Orthodontics–Year Book Medical
upper molar projected normal to the plane of occlusion. Publishers, Inc. 1988;251-9.
3. Michael L Riolo. An atlas of craniofacial growth: Cephalometric
standards from the university school growth study, the University of
Significance (Ref to Chapter 20) Michigan. Center for human growth and development. The University
of Michigan. 1974;12-21.
ms is used as one of the reference point in the construction of 4. Bhatia SN, Leighton BC. A manual of facial growth. Oxford University
plane and angle in the Bjork cephalometric analysis. Press. 1993;10-5.
Chapter
12 Related to Mandible
The mandible (Fig. 12.1 ) (from Latin mandibula—jawbone) • Mandibular foramen, paired, in the inner (medial) aspect
or inferior maxillary bone forms the lower jaw and holds the of the mandible, superior to the mandibular angle in the
lower teeth in place. middle of the ramus.
• Mental foramen, paired, lateral to the mental protuberance
Cephalometric landmarks (Points) on Mandible on the body of mandible.
Cephalometric landmarks on mandible are as follows (Table Nerve Supply to Mandible
12.1):
Inferior alveolar nerve, branch of the mandibular division
Table 12.1: Cephalometric landmarks related to mandible of trigeminal (V) nerve, enters the mandibular foramen and
runs forward in the mandibular canal, supplying sensation to
Cephalometric Abbreviation Type Origin the teeth. At the mental foramen the nerve divides into two
landmarks
terminal branches: Incisive and mental nerves. The incisive
Infradentale Id Unilateral anatomic nerve runs forward in the mandible and supplies the anterior
point B part B Unilateral anatomic teeth. The mental nerve exits in the mental foramen and
pogonion pog Unilateral anatomic supplies sensation to the lower lip.
Gnathion Gn Unilateral anatomic
dd dd Unilateral anatomic
Menton Me Unilateral anatomic
Gonion Go Unilateral anatomic
Articulare ar Bilateral anatomic
kk kk Unilateral anatomic
Condylion Cd Bilateral anatomic
Parts of Mandible
The mandible consists of:
• A curved, horizontal portion, the body.
• Two perpendicular portions, the rami, which unite with
the ends of the body nearly at right angles.
• Alveolar process, the tooth bearing area of the mandible.
• Condyle, superior (upper) and posterior projection from
the ramus, which makes the temporomandibular joint with
the temporal bone.
• Coronoid process, superior and anterior.
• Projection from the ramus. This provides attachment to
the temporalis muscle. Figure 12.1: Mandible
86
Articulations Definition
The mandible articulates with the two temporal bones at the According to Arne Bjork
temporomandibular joints.
The infradentale (Figs 12.2A to D) is the point of transition
from the crown of the most prominent mandibular medial
Infradentale incisor to the alveolar projection.
Abbreviation
According to Robert M Moyers
Id–Infradentale is abbreviated using English alphabets and is
expressed as capital or upper case I followed by lower case The infradentale is the most anterior superior point on the
Section 4  Cephalometric Landmarks Related to Facial Bones and Dentition
or small letters d and written continuously without any space mandibular alveolar process, usually found near cement-
between the alphabets. enamel junction of the mandibular incisors.
A B
C
D
Figures 12.2A to D: Infradentale

87
According to SN Bhatia and BC leighton Significance (Ref to Chapter 20)

The infradentale is the most anterosuperior point on the labial Infradentale is used as one of the reference points in the
crest of the mandibular alveolar process. construction of plane and angle for the assessment of mandibular
prognathism in the anterior region using S-N-Id angle.
Type
Infradentale is a unilateral, anatomic hard tissue landmark. Point B
Tracing of Infradentale on the lateral Abbreviation
Cephalogram
Point B–Point B is abbreviated using English alphabets and is
The alveolar crest between two mandibular permanent expressed as capital or upper case B.
central incisors in the midline appears as radio-opaque lines
on the lateral cephalogram. Trace these radio-opaque lines.
Chapter 12  Cephalometric Landmarks Related to Mandible

The intersection of radio-opaque lines of interdental cortical
plate in the alveolar crest region between two mandibular The point B (Figs 12.3A to D) is the deepest midline point on
permanent central incisors, is the point of infradentale. the mandible between infradentale and pogonion.
A B
C D
Figures 12.3A to D: Point B

88
According to TM Graber Definition

The point B is an arbitrary measure point on the anterior profile According to KKK lew
curvature from the mandibular anthropometric landmark
pogonion to the crest of the alveolar process. This most posterior Most anterior point of mandibular symphysis.
point usually falls just anterior to the apices of the incisor teeth.
According to Alex Jacobson and W Caufield Pogonion (Figs 12.4A to D) is the most anterior point on the
Point B is on a line perpendicular to FH, point B is the mandible in the midline.
most posterior point in the concavity between the chin and
mandibular alveolar process. According to TM Graber

The most anterior point on the symphysis of the mandible.
The point B is the most posterior point of the bony curvature According to Robert M Ricketts
of the mandible below infradentale and above pogonion. B
point usually is found near the apical third of the roots of the Most anterior point on the mental protuberance.
mandibular incisors and may be obscured during eruption
of these teeth, when the profile of the chin is not concave, B According to B Holly Broadbent
point cannot be determined. Most anterior point on the symphysis of the mandible in the
median plane when the head is viewed in Frankfort relation.
Type
According to leslie G Farkas
Point B is a unilateral, anatomic, hard tissue cephalometric
landmark. Pogonion is the most anterior midpoint of the chin, located on
the skin surface in front of the identical bony landmark of the
mandible.
Tracing of Point B on the lateral Cephalogram
The labial cortical plate of mandible in the anterior symphysis Robert E Moyers
region appears as vertical shaped radio-opaque line. Trace this The most anterior point on the contour of the chin, pogonion
line from the infradentale to the point of pogonion. usually is located by drawing a tangent perpendicular to the
It’s been tough task to establish the precise location of mandibular plane or by a tangent dropped to the chin from nasion.
point B on the lateral cephalogram. To make it easy, try to
locate infradentale and pogonion and then the mid deepest
Alex Jacobson and W Caufield
point is the point B.
Move the perpendicular line to FH forward then back to where
Significance it first touches the chin. This is pogonion.
Point B is used as one of the reference points in the construction

Type
of plane and angle for the assessment of anteroposterior
relationship of the mandible in relation to anterior cranial base Pogonion is a unilateral, anatomic, hard tissue cephalometric
using S-N-B angle. landmark.
Pogonion Tracing of Pogonion on the lateral Cephalogram

The labial cortical plate of mandible in the anterior symphysis
region appears as vertical shaped radio-opaque line. Trace
Abbreviation
the labial cortical plate from the alveolar crest between two
Pog–Pogonion is abbreviated using English alphabets and is permanent mandibular incisors in the midline to the point
expressed as capital or upper case P followed by lower case or anteroinferior point on the mandible. Below the point B follows
small letters o and g and are written continuously without any the convex outline of labial cortical plate of mandible, the most
space between the alphabets. prominent point is the point of pogonion.
89

A B
C D
Figures 12.4A to D: Pogonion
Significance Definition
Pogonion is used as one of the reference points in the con- Gnathion (Figs 12.5A to D) is a point on the chin determined by
struction of plane and angle for the assessment of anteroposte- bisecting the angle formed by the facial and mandibular plane.
rior relationship of the mandible in relation to anterior cranial
base using S-N-Pog angle (Facial angle). According to TM Graber
Gnathion is the most outward and everted point on the profile
Gnathion curvature of the symphysis of the mandible.
Abbreviation According to Robert E Moyers

Gn–Gnathion is abbreviated using English alphabets and is The most anterior inferior point in the lateral shadow of the
expressed as capital or upper case G followed by lower case or chin. Ganthion usually is best determined by selecting the
small letters n and is written continuously without any space midpoint between pogonion and menton on the contour of the
between the alphabets. chin.
90
A B
C D
Figures 12.5A to D: Gnathion
According to Viken Sassouni Tracing of Gnathion on the lateral

Midpoint between pogonion and menton can be located at the Cephalogram
intersection of the facial; line (Na-Pog) and the mandibular
plane (lower border). The labial cortical plate of mandible in the anterior symphysis
region appears as vertical shaped radio-opaque line. Trace the
Alex Jacobson and W Caufield labial cortical plate from the alveolar crest between two per-
A point located by taking the point between the anterior manent mandibular incisors in the midline to the point antero-
(Pogonion) and inferior (Menton) points of the bony chin. inferior point on the mandible. Below the point B follows the
convex outline of labial cortical plate of mandible, the most
Arne Bjork prominent point is the point of pogonion.The anteroinferior
Lowest point of the mandibular symphysis. point of inferior border of the mandible in the midline is the
point of menton. The ganthion is a constructed or derived hard
Type tissue cephalometric point. Draw a line joining the point of
Gnathion is a unilateral, constructed or derived, hard tissue pogonion to the menton, the midpoint of this line is the point
cephalometric landmark. of gnathion.
91

A B
C D
Figures 12.6A to D: dd
Gnathion is used as one of the reference points in the dd (Figs 12.6A to D) is the most prominent point of the chin
construction of plane and angle for the assessment of growth in the direction of measurement.
pattern using N-S-Gn angle.
In Rickett’s cephalometric analysis, the positioning of the Type
chin is determined by the angle formed between the Ba-N
dd is a unilateral, anatomic, hard tissue cephalometric
plane and plane from foramen rotundum (PT) to Gn. The
landmark.
normal value of this angle is 90 degree. A larger angle suggests
a protrusive or forward growing chin whereas a lesser angle
Tracing of dd on the lateral Cephalogram
suggests a retropositioning of the chin.
The labial cortical plate of mandible in the anterior symphysis
dd region appears as vertical shaped radio-opaque line. Trace
the labial cortical plate from the alveolar crest between two
permanent mandibular incisors in the midline to the point
Abbreviation
anteroinferior point on the mandible. Below the point B
dd–dd is abbreviated using English alphabets and is expressed follows the convex outline of labial cortical plate of mandible,
as lower case or small letters d and d and written continuously the most prominent point is the point of pogonion. The
without any space between the alphabets. anteroinferior point of inferior border of the mandible in the
92
midline is the point of menton. The gnathion is a constructed According to Viken Sassouni
or derived hard tissue cephalometric point. Draw a line joining
the point of pogonion to the menton,the midpoint of this line Lower most point of the contour of the chin.
is the point of gnathion. dd is the most prominent point of the
chin in the direction of measurement. According to Carl F Gugino
Menton (Figs 12.7A to D) is the point of the inferior border
Significance of the symphysis directly inferior to mental protuberance and
dd is used as one of the reference points in the construction of inferior to the center of trigoniun mentali.
plane and angle in the Bjork cephalometric analysis.
Type
Menton Menton (Figs 12.7A to D) is a unilateral, anatomic, hard

tissue landmark.
Abbreviation
Tracing of Menton on the lateral
Me–Menton is abbreviated using English alphabets and is
Cephalogram
expressed as capital or upper case M followed by lower case
or small letter e and is written continuously without any space The labial cortical plate of mandible in the anterior symphysis
between the alphabets. region appears as vertical shaped radio-opaque line. Trace the
A B
C D
Figures 12.7A to D: Menton

93
labial cortical plate from the alveolar crest between two radio-opaque lines and then draw a line tangent to inferior
permanent mandibular incisors in the midline to the point and posterior/ramus borders of the mandible; the point where
anteroinferior point on the mandible. Below the point B fol- these two intersects is the point of gonion.
lows the convex outline of labial cortical plate of mandible,the Improper positioning of head during cephalometric radio-
most prominent point is the point of pogonion.The anteroinfe- graphic projection procedure will result in superimposition
rior point of inferior border of the mandible in the midline is of right and left mandibular inferior border. In such cases,
the point of menton. there are two radio-opaque lines of right and left mandibular
inferior borders. Then trace these two radio-opaque lines and
Significance draw an imaginary line exactly middistance between right and
left inferior borders of the mandible. To establish the point
Menton is used as one of the reference points in the construction Gonion tangent line is drawn from the imaginary line and
of plane and angle for the assessment of following: posterior border/ramus border, the instersection of these two
• Constructions of mandibular plane, i.e. the line joining the lines is the point of Gonion.
point menton and gonion.

• Growth pattern is assessed using S-N to mandibular plane
Significance
angle.
• Growth pattern is assessed using FH to mandibular plane Gonion is used as one of the reference points in the construction
angle. of plane and angle for the assessment of following:
• Cant of occlusal plane is assessed using occlusal plane • Constructions of mandibular plane, i.e. the line joining the
(APocc-Ppocc) to mandibular plane (Me-Go) angle. point menton and gonion.
• Growth pattern is assessed using Go1 and Go2 angles. • Growth pattern is assessed using S-N to mandibular plane
angle.
• Growth pattern is assessed using FH to mandibular plane
Gonion angle.
• Cant of occlusal plane is assessed using occlusal plane
Abbreviation (APocc-Ppocc ) to mandibular plane (AvMe-Go) angle.
• Growth pattern is assessed using Go1 and Go2 angles.
Go–Gonion is abbreviated using English alphabets and is • Rotation of the mandible is also assessed using the S-Ar-
expressed as capital or upper case G followed by lower case Go angle.
or small letter o and is written continuously without any space • The length of the mandible is measured from condylion
between the alphabets. to gonion.
Definition
Articulare
According to Clifton T Forsberg
The midpoint mediolaterally on the posterior border of each Abbreviation
gonial angle. Ar–Articulare is abbreviated using English alphabets and is
expressed as capital or upper case A followed by lower case
According to KKK lew or small letter r and is written continuously without any space
The midpoint mediolaterally on the posterior most border of between the alphabets.
each gonial angle. Gonion is a bilateral structure.
Definition
Type Articulare (Figs 12.9A to D) is the point of intersection the
Gonion (Figs 12.8A to D) is a unilateral, anatomic, hard tissue dorsal contours of the processus articularis mandibulare and
cephalometric landmark. os tempoarle. The midpoint, a is used where double projection
gives rise to two points, a1 and a2.
Tracing of Menton on the lateral Cephalogram
Type
The inferior and posterior borders of the mandible appear as
radio-opaque lines on the lateral cephalogram.Trace these two Articulare is a bilateral, anatomic, hard tissue landmark.
94
A B
C D
Figures 12.8A to D: Gonion
Tracing of Articulare on the lateral kk

Cephalogram
The posterior or ramus border of the mandible appears as Abbreviation
radio-opaque line on the lateral cephalogram. Trace ramus
kk–kk is abbreviated using English alphabets and is expressed
border of the mandible. The point on the ramus border of the
as lower case or small letters k and k and written continuously
mandible at the neck region.
without any space between the alphabets.
Articulare is used as one of the reference points in the construction kk is the point of intersection between the base and ramus
of plane and angle for the assessment of the following: tangents to the mandible. The midpoint is used where double
• Construction of posterior/ramus border of the mandible, projections gives rise to two points.
i.e. the line joining the point Articulare and Gonion.
• Growth pattern is assessed using Go1 and Go2 angles. Type
• Rotation of the mandible is also assessed using the S-Ar- kk (Figs 12.10A to D) is a bilateral hard tissue cephalometric
Go angle. landmark.
95

A B
C D
Figures 12.9A to D: Articulare
Tracing of Menton on the lateral Cephalogram Condylion

The inferior and posterior borders of the mandible appear as
radio-opaque lines on the lateral cephalogram. Trace these Abbreviation
two radio-opaque lines and then draw a line tangent to inferior Cd–Articulare is abbreviated using English alphabets and is
and posterior/ramus borders of the mandible; the point where expressed as capital or upper case C followed by lower case
these two intersect is the point of gonion. kk is the point or small letter d and is written continuously without any space
of intersection between the base and ramus tangents to the between the alphabets.
mandible. The midpoint is used where double projections give
rise to two points. Definition
Significance
Condylion medialis (Figs 12.11A to D)–The tangent point to
kk is used as one of the reference points in the construction of each medial condylar border of a line drawn parallel to each
plane and angle in the Bjork cephalometric analysis. mandibular body line.
96
A B
C D
Figures 12.10A to D: kk
According to KKK lew According to Clifton T Forsberg

Condylion medialis–Most medial aspect of condyle. Bilateral Condylion anterioris–A point on the anterior of each condylar
structure. head which is chosen to represent the mandibular fossa of the
temporal bone.
Condylion lateralis–The tangent point in each condylar Condylion posterialis–The intersection of the mandibular
border of a line drawn parallel to each mandibular body line. body line with the posterior border of each condyle.
According to KKK lew Type

Condylion lateralis–Most lateral aspect of condyle. Bilateral Condylion is a bilateral, anatomic, hard tissue cephalometric
structure. landmark.
97

A B
C D
Figures 12.11A to D: Condylion
• Construction of posterior/ramus border of the mandible,

Tracing of Condylion on the lateral Cephalogram
i.e. the line joining the point Articulare and Gonion.
The posterior or ramus border of the mandible appears as • Growth pattern is assessed using Go1 and Go2 angles.
radio-opaque line on the lateral cephalogram. Condyle of the
mandible appears as a circular radio-opaque line on the lateral • Rotation of the mandible is also assessed using the S-Ar-
cephalogram. The highest point of superior curvature of the Go angle.
condyle of the mandible is the point of condylion. • Midfacial length is measured from condylion to point A in
McNamara analysis.
Significance
• The length of the mandible is measured from condylion
Condylion is used as one of the reference points in the construc- to gonion.
tion of plane and angle for the assessment of the following:
Section 5
Related to Cervical Bones
 Cephalometric Landmarks Related to Hyoid Bone

 Cephalometric Landmarks Related to Vertebrae
Chapter
related to hyoid bone
Like the mandible, the hyoid bone (Figs 13.1A and B) is also • In children, greater cornu is seen separately as it is not
a horse-shoe shaped bone suspended in the neck. fused to the body of hyoid but in adults both lesser and
greater cornu are fused to the body of hyoid bone.
Parts of the Hyoid Bone
Cephalometric Landmarks (Points) on Hyoid Bone
Hyoid bone consists of the following parts:
• A body. Cephalometric landmarks seen on the hyoid bone are of
• Lesser cornu/horn. anatomic origin and are as follows:
• Greater cornu/horn. Table 13.1: Cephalometric landmark related to hyoid bone
The lesser cornu fuses the body of the hyoid bone
superiorly whereas the greater cornu fuses the body of hyoid Cephalometric Abbreviation Type Origin
landmark
bone inferiorly.
Hyoid Hy or H Unilateral Anatomic
Radiographic Anatomy of Hyoid Bone
• The hyoid bone is well appreciated on the lateral cephalogram. Hyoid
• On the lateral cephalogram, the hyoid bone appears
boomerang-shaped radio-opaque area below the inferior
Abbreviation
to the middle of the mandibular body.
• The greater and lesser cornu of the hyoid bone appear as Hy–Hyoid is abbreviated using English alphabet and is
radio-opaque on the lateral cephalogram. expressed as capital or upper case H followed by lower case or
• The body of the hyoid bone on the lateral cephalogram small y, and both are written continuously without any space
appears as radio-opaque. between the alphabets.
A B
Figures 13.1A and B: Hyoid bone

102
Section 5  Cephalometric Landmarks Related to Cervical Bones
A B
C D
Figures 13.2A to D: Hyoid
H–Hyoid is abbreviated using English alphabet and is Type

expressed as capital or upper case H.
Hyoid is a unilateral, anatomic, hard tissue cephalometric
Note: Most widely and commonly used abbreviation for hyoid landmark.
is Hy.
Tracing of Hyoid on the Lateral Cephalogram
Definition The body, lesser and greater cornu of the hyoid bone appears
Hyoid (Figs 13.2A to D) is the most superoanterior point on as boomerang shaped radio-opaque area. The superioanterior
the body of the hyoid bone. point on the body of the hyoid bone is the point of hyoid. It
is a unilateral, anatomic hard tissue cephalometric landmark.
According to Robert M Ricketts Reference
According to Robert M Ricketts, the hyoid is the point at the 1. Ricketts RR. Provocations and perceptions in cranio-facial orthopedics–
anterior-superior margin of the body of the hyoid.1 dental science and facial art. Rocky Mountain Inc. 1989;797-803.
Chapter
14 related to Vertebrae
Radiographic anatomy of Table 14.1: Cephalometric landmarks related to cervical vertebra

cervical vertebrae (fig. 14.1) Cephalometric Abbreviation Type Origin
landmarks
Anteroinferior to the occipital condyle, which appears as a
curved radio-opaque line, the anterior arch of the atlas can be cv2ap cv2ap Unilateral Anatomic
identified as a small triangular radio-opaque area. The apex cv2ip cv2ip Unilateral Anatomic
of the triangle faces the posterior border of the mandibular
cv2ia cv2ia Unilateral Anatomic
ramus, while its base faces the odontoid process of the
axis. The central mass of the atlas, which appears as radio- cv3sp cv3sp Unilateral Anatomic
opaque area superimposed on the radio-opaque shadow of the cv3ip cv3ip Unilateral Anatomic
odontoid process. Posterosuperior to the inferior articular facet
cv3sa cv3sa Unilateral Anatomic
is the superior articular facet, which can be identified as radio-
opaque area. Its superior border is concave and corresponds cv3ia cv3ia Unilateral Anatomic
with the contour of the occipital condyle. Next to the superior cv4sp cv4sp Unilateral Anatomic
articular facet is the posterior arch with the posterior tubercle.
cv4ip cv4ip Unilateral Anatomic
At the superior border of the posterior arch is a groove for the
vertebral artery and the first cervical nerve. cv4sa cv4sa Unilateral Anatomic
The odontoid process and the body of the axis appear as a cv4ia cv4ia Unilateral Anatomic
triangular radio-opaque area. The odontoid process represents
cv5sp cv5sp Unilateral Anatomic
the apex of the triangular points toward the occipital condyle.
The spinous process of the axis appears as a radio-opaque cv5ip cv5ip Unilateral Anatomic
projection extending superiorly. cv5sa cv5sa Unilateral Anatomic
The radiographic appearance of the third cervical vertebra
cv5ia cv5ia Unilateral Anatomic
(C3) to the seventh cervical vertebra (C7) is similar. The body
of the each of these cervical vertebrae appears as wedge shaped cv6sp cv6sp Unilateral Anatomic
radio-opaque area situated behind the pharyngeal space. cv6ip cv6ip Unilateral Anatomic
Posterior to the body is the spinous process. The transverse
cv6sa cv6sa Unilateral Anatomic
processes, the superior articular process and the inferior
articular process appear as radio-opaque area superimposed cv6ia cv6ia Unilateral Anatomic
on the shadow of the body and the spinous process. The
body of each cervical vertebra is separated from the adjacent Cephalometric Landmarks (Points) Related to
ones by the intervertebral disc, which appears as radiolucent Cervical Vertebra
strip. At the midpoint between the third and fourth cervical
vertebrae is the hyoid bone, which is separated anteriorly. • cv2ap–The apex of the odontoid process of the second
cervical vertebra.
• cv2ip–The most inferoposterior point on the body of the
Cephalometric Landmarks on Cervical Vertebra
second cervical vertebra.
Cephalometric landmarks seen on the cervical vertebra are of • cv2ia–The most inferoanterior point on the body of the
anatomic origin and are as follows (Table 14.1): second cervical vertebra.
104
• cv6ip–The most inferoposterior point on the body of the

sixth cervical vertebra.
• cv6sa–The most superoanterior point on the body of the
• cv6ia–The most inferoanterior point on the body of the
cv2ip
Abbreviation
cv2ip–cv2ip is abbreviated using English alphabet and English
numeric and is expressed as small letters or lower case c,v
followed by English numeric 2 and then it is followed with
English alphabets lower case i and p and all of them are written
Definition
The most inferoposterior point on the body of the second
cervical vertebra.
Type
cv2ip (Figs 14.2A and B) is a unilateral, anatomic, hard tissue
Figure 14.1: Radiographic anatomy of cervical vertebra
Significance
• cv3sp–The most superoposterior point on the body of the
third cervical vertebra. This cephalometric landmark/point is used as a reference point
• cv3ip–The most inferoposterior point on the body of the in the cervical vertebrae maturity indicator (CMVI) method.
third cervical vertebra.
• cv3sa–The most superoanterior point on the body of the cv2ap
third cervical vertebra.
• cv3ia–The most inferoanterior point on the body of the Abbreviation
third cervical vertebra. cv2ap–cv2ap is abbreviated using English alphabet and
• cv4sp–The most superoposterior point on the body of the English numeric and is expressed as small letters or lower
fourth cervical vertebra. case c,v followed by English numeric 2 and then it is followed
• cv4ip–The most inferoposterior point on the body of the with English alphabets lower case a and p and all of them are
fourth cervical vertebra. written continuously without any space between the alphabets.
• cv4sa–The most superoanterior point on the body of the
fourth cervical vertebra. Definition
fourth cervical vertebra. The apex of the odontoid process of the second cervical
• cv5sp–The most superoposterior point on the body of the vertebra.
fifth cervical vertebra.
• cv5ip–The most inferoposterior point on the body of the Type
fifth cervical vertebra. cv2ap (Figs 14.3A and B) is a unilateral, anatomic, hard tissue
• cv5sa–The most superoanterior point on the body of the cephalometric landmark.
Significance
• cv6sp–The most superoposterior point on the body of the This cephalometric landmark/point is used as a reference point
sixth cervical vertebra. in the cervical vertebrae maturity indicator (CMVI) method.
105
Chapter 14  Cephalometric landmarks related to Vertebrae

A B
Figures 14.2A and B: cv2ip-The most inferoposterior point on the body of the second cervical vertebra
A B
Figures 14.3A and B: cv2ap-The apex of the odontoid process of the second cervical vertebra
106
cv2ia cv3sp
Abbreviation Abbreviation
cv2ia–cv2ia is abbreviated using English alphabet and English cv3sp–cv3sp is abbreviated using English alphabet and
numeric and is expressed as small letters or lower case c,v English numeric and is expressed as small letters or lower
followed by English numeric 2 and then it is followed with case c,v followed by English numeric 3 and then it is followed
English alphabets lower case i and a and all of them are written with English alphabets lower case s and p and all of them are
continuously without any space between the alphabets. written continuously without any space between the alphabets.
Definition Definition
The most inferoanterior point on the body of the second The most superoposterior point on the body of the third
cervical vertebra. cervical vertebra.
Type Type
cv2ia (Figs 14.4A and B) is a unilateral, anatomic, hard tissue cv3sp (Figs 14.5A and B) is a unilateral, anatomic, hard tissue
cephalometric landmark. cephalometric landmark.
Significance Significance
This cephalometric landmark/point is used as a reference point This cephalometric landmark/point is used as a reference point
in the cervical vertebrae maturity indicator (CMVI) method. in the cervical vertebrae maturity indicator (CMVI) method.
A B
Figures 14.4A and B: cv2ia-The most inferioanterior point on the body of the second cervical vertebra
107

A B
Figures 14.5A and B: cv3sp-The most superoposterior point on the body of the third cervical vertebra
cv3ip cv3sa
cv3ip–cv3ip is abbreviated using English alphabet and English cv3sa—cv3sa is abbreviated using English alphabet and
English alphabets lower case i and p and all of them are written with English alphabets lower case s and a and all of them are
The most inferoposterior point on the body of the third cervical The most superoanterior point on the body of the third cervical
vertebra. vertebra.
Type Type
cv3ip (Figs 14.6A and B) is a unilateral, anatomic, hard tissue cv3sa (Figs 14.7A and B) is a unilateral, anatomic, hard tissue
108
A B
Figures 14.6A and B: cv3ip-The most inferoposterior point on the body of the third cervical vertebra
A B
Figures 14.7A and B: cv3sa-The most superoanterior point on the body of the third cervical vertebra
109
cv3ia cv4sp
The most inferoanterior point on the body of the third cervical The most superoposterior point on the body of the fourth
vertebra. cervical vertebra.

Type Type
cv3ia (Figs 14.8A and B) is a unilateral, anatomic, hard tissue cv4sp (Figs 14.9A and B) is a unilateral, anatomic, hard tissue
A B
Figures 14.8A and B: cv3ia-The most inferioanterior point on the body of the third cervical vertebra
110
A B
Figures 14.9A and B: cv4sp-The most superoposterior point on the body of the fourth cervical vertebra
cv4ip cv4sa
cv4ip–cv4ip is abbreviated using English alphabet and English cv4sa–cv4sa is abbreviated using English alphabet and
numeric and is expressed as small letters or lower case English numeric and is expressed as small letters or lower
c,v followed by English numeric 4 and then it is followed case c,v followed by English numeric 4 and then it is
with English alphabets lower case i and p and all of them followed with English alphabets lower case s and a and
are written continuously without any space between the all of them are written continuously without any space
alphabets. between the alphabets.
The most inferoposterior point on the body of the fourth The most superoanterior point on the body of the fourth
Type Type
cv4ip (Figs 14.10A and B) is a unilateral, anatomic, hard cv4sa (Figs 14.11A and B) is a unilateral, anatomic, hard
tissue cephalometric landmark. tissue cephalometric landmark.
111

A B
Figures 14.10A and B: cv4ip-The most inferoposterior point on the body of the fourth cervical vertebra
A B
Figures 14.11A and B: cv4sa-The most superoanterior point on the body of the fourth cervical vertebra
112
cv4ia cv5sp
numeric and is expressed as small letters or lower case c,v English numerical and is expressed as small letters or lower
English alphabets lower case i and a and all of them are written with English alphabets lower case i and a and all of them are
DEFINITION Definition
The most inferoanterior point on the body of the fourth The most superoposterior point on the body of the fifth
Type Type
cv4ia (Figs 14.12A and B) is a unilateral, anatomic, hard cv5sp (Figs 14.13A and B) is a unilateral, anatomic, hard
A B
Figures 14.12A and B: cv4ia-The most inferoanterior point on the body of the fourth cervical vertebra
113

A B
Figures 14.13A and B: cv5sp-The most superoposterior point on the body of the fifth cervical vertebra
cv5ip cv5sa
The most inferoposterior point on the body of the fifth cervical The most superoanterior point on the body of the fifth cervical
vertebra. vertebra.
Type Type
114
A B
Figures 14.14A and B: cv5ip-The most inferoposterior point on the body of the fifth cervical vertebra
A B
Figures 14.15A and B: cv5sa-The most superoanterior point on the body of the fifth cervical vertebra
115
cv5ia cv6sp
The most inferoanterior point on the body of the fifth cervical The most superoposterior point on the body of the sixth
vertebra. cervical vertebra.

Type Type
Cv5ia (Figs 14.16A and B) is a unilateral, anatomic, hard cv6sp (Figs 14.17A and B) is a unilateral, anatomic, hard
A B
Figures 14.16A and B: cv5ia-The most inferoanterior point on the body of the fifth cervical vertebra
116
A B
Figures 14.17A and B: cv6sp-The most superoposterior point on the body of the sixth cervical vertebra
cv6ip cv6sa
The most inferoposterior point on the body of the sixth The most superoanterior point on the body of the sixth cervical
cervical vertebra. vertebra.
Type Type
117

A B
Figures 14.18A and B: cv6ip-The most inferoposterior point on the body of the sixth cervical vertebra
A B
Figures 14.19A and B: cv6sa-The most superoanterior point on the body of the sixth cervical vertebra
118
cv6ia Cervical Vertebrae as Indicators of Skeletal

Maturity
Abbreviation
Hand-wrist radiographs have been used conventionally as the
cv6ia–cv6ia is abbreviated using English alphabet and English standard method of evaluating skeletal maturity. Although
numeric and is expressed as small letters or lower case c,v accurate, this method necessitates additional radiation
followed by English numeric 6 and then it is followed with exposure to patients. Furthermore, the hand-wrist site is
English alphabets lower case i and a and all of them are written far removed from the jaw which is the site of orthodontic
continuously without any space between the alphabets. correction. In recent years, evaluation of cervical vertebrae
has been increasingly used to determine skeletal maturation.
Definition A new system of skeletal maturation assessment using the
cervical vertebrae was first developed by Hassel and Farman.
The most inferoanterior point on the body of the sixth cervical A number of subsequent stu dies have shown significant
vertebra.
correlation between developmental or maturational changes

occurring in the cervical vertebrae than that of the hand-wrist
Type region.
Cervical vertebrae maturity indicator (CMVI) method
cv6ia (Figs 14.20A and B) is a unilateral, anatomic, hard
is increasingly being used in the recent years instead of the
tissue cephalometric landmark.
conventional hand-wrist radiograph method. One of the main
reasons for the rising popularity of the method is that cervical
Significance vertebral maturation can be assessed on lateral cephalograms
This cephalometric landmark/point is used as a reference point in (Fig. 14.21), which is used regularly in orthodontic diagnosis,
the cervical vertebrae maturity indicator (CMVI) method. thus precluding the need for an additional radiograph.
A B
Figures 14.20A and B: cv6ia-The most inferoanterior point on the body of the sixth cervical vertebra
119

Figure 14.21: Cervical vertebral maturation can be assessed on
lateral cephalograms Figure 14.22: Hassel and Farman developed a method of skeletal
maturation assessment using cervical vertebrae in which there are
6 stages of development
In 1972, Lamparki stated that the cervical vertebrae were
as statistically and clinically reliable in assessing skeletal age
as the hand-wrist technique. Several authors (San-Roman et
al 2002) have reported a high correlation between cervical
vertebrae maturation and skeletal maturation of the hand-
wrist. It has been found that cervical vertebrae could offer an
alternative method for assessing maturity without the need of
hand-wrist radiographs and thus decreasing patient’s radiation
exposure.
Most methods of cervical vertebral maturation are based
on morphologic changes that occur in cervical vertebral bodies
as growth progresses. Hassel and Farman developed a method
of skeletal maturation assessment using cervical vertebrae in
which there are 6 stages of development (Fig. 14.22). They
take into account the morphologic characteristics of the
cervical (C2, C3 and C4) vertebrae such as:
• Shape of the vertebral bodies
• Height of the vertebral bodies
• Concavity of the lower border of the cervical bodies.
The shapes of the cervical vertebral bodies of C3 and C4
change at each level of skeletal development are assessed
(Fig. 14.23).
• At first they are wedge-shaped, then changed to rectangular,
next to square-shaped.
• The vertical dimensions of the cervical vertebral bodies
increase with increased skeletal maturity.
• It is also observed that the inferior borders of the cervical
vertebral bodies which are flat at the beginning become
concave as they mature.
• The concavity of the inferior vertebral borders is seen to
appear sequentially from C2 to C3 and then to C4 as the Figure 14.23: The shapes of the cervical vertebral bodies of C3
skeleton matures. and C4 change at each level of skeletal development are assessed
120
Depending on these changes observed in C2, C3 and Contd...
C4 cervical vertebrae, Hassel and Farman gave 6 stages of Stage Name Changes in vertebrae
development depicted in Table 14.2. Stage 5 Maturation • Cervical vertebrae attain maturity
Table 14.2: Assessment of skeletal maturity using cervical vertebrae • Concavities at lower borders of C2, C3 and
C4 become more accentuated
Stage Name Changes in vertebrae • C3 and C4 are more square in shape
• 5–10% pubertal growth remaining
Stage 1 Initiation • Marks the beginning of adolescent growth.
• The cervical vertebral bodies and C2, C3 and Stage 6 Completion • Adolescent growth is nearly complete
C4 are wedge-shaped with their superior • More accentuated concavities are seen at
borders tapering posteroanteriorly. lower borders of C2, C3 and C4.
• Their inferior borders are flat. • Shape of C3 and C4 is square with greater
• 80–95% of growth in remaining pubertal. vertical dimension than width
• Pubertal growth is complete with no more
Stage 2 Acceleration • Acceleration of growth occurs.
growth potential remaining.
• Concavities are developing on the lower
borders of C2 and C3
• Lower border of C4 vertebral body is flat
• C3 and C4 assume rectangular shape Bibliography
• 65–85% of pubertal growth remains
1. Anderson Dl, Thompson GW, Popovich F. Interrelationship of dental
Stage 3 Transition • Growth is accelerated to reach peak height maturity, skeletal maturity, height and weight from age 4 to 14 years,
velocity Growth. 1975;39:453-62.
• Distinct concavity seen in lower borders of 2. Bowden BD. Epiphyseal changes in the hand/wrist area as an indicator
C2 and C3. of adolescent. Aust Orthod J. 1976;4:87-104.
• Concavity is developing in the lower 3. Fishman LS. Radiographic evaluation of skeletal maturity. Angle
borders of C4. Orthodont. 1982;88-112.
• C3 and C4 are more rectangular in shape.
4. Grave, Brown. Skeletal ossification and adolescent growth spurt. Am J
• 25–65% pubertal growth is remaining
Orthod. 1976;69-80.
Stage 4 Deceleration • Deceleration of adolescent growth spurt 5. Houston WJB, Miller JC, Tanner JM. pRediction of the timing of the
begins adolescent growth spurt from ossification events in hand/wrist films,
• Distinct concavities seen at the lower borders Brit J Ortho. 1979;6:145-52.
of all three vertebrae, that is, C2, C3 and C4 6. Moore, Moyer, Dubois. Skeletal maturation and craniofacial growth.
• C3 and C4 are nearly square in shape Am J Orthod. 1990;33-40.
• 10–25% of pubertal growth is remaining 7. Revelo, Fishman. Evaluation of ossification of midpalatal suture. Am J
Contd... Orthod. 1994;288-92.
Section 6
related to Pharynx
 Cephalometric landmarks related to Pharynx

Chapter
related to Pharynx
The pharynx is a median fibromuscular tube that extends from Table 15.1: Cephalometric landmarks related to pharynx
the base of the skull. Pharynx opens into nasal cavity, the oral
Cephalometric Abbreviation Type Origin
cavity, and the larynx. Pharynx opens into the nasal cavity, landmarks
the oral cavity and the larynx are termed as nasopharynx, Anterior nasal spine ANS or ans Unilateral Anatomic
oropharynx and laryngopharynx respectively.
Posterior nasal spine PNS or pns Unilateral Anatomic
Anterior pharyngeal apw Unilateral Anatomic
Nasopharynx wall
The Nasopharynx is the upper part of the pharynx. It is situated Posterior pharyngeal ppw Unilateral Anatomic
behind the oral cavity above the soft palate. Its superior border wall
is the base of the skull. In the posterior part of the roof and Pterygomaxillary Ptm Unilateral Anatomic
the upper part of the posterior wall, there is an accumulation fissure
of lymphoid tissue—the adenoid or pharyngeal tonsil—which Superior pharyngeal spw Unilateral Anatomic
may be prominent in children but which becomes indistinct wall
in adulthood. In the lateral wall, 1.5 cm posterior to the Tip of uvula U Unilateral Anatomic
inferior nasal concha, is the opening of the auditory tube.The Point on the oral side Uo Unilateral Anatomic
nasopharynx extends downwards and is continuous with the of the soft palate
oropharynx at the level below the soft palate. Point on the Up Unilateral Anatomic
pharyngeal side of
the soft palate
Oropharynx
Upper point of ut Unilateral Anatomic
The oropharynx is the middle part of the pharynx situated tongue
between the soft palate and the superior border of the epiglottis.
Anteriorly, it opens to the oral cavity and is bordered by the
posterior one-third of the tongue. At the lateral boundaries of
Anterior Nasal Spine,
the opening of the oral cavity into the oropharynx, the palatine Posterior Nasal Spine
tonsils are lodged in the tonsilar fossae. and Pterygomaxillary Fissure
Laryngopharynx Anterior nasal spine, posterior nasal spine and pterygo
maxillary fissure are explained in detail in Chapter 10
The laryngopharynx is the lower part of the pharynx. It extends [Cephalometric Landmarks (Points) Related to Maxilla].
from the superior border of the epiglottis to the inferior border
of the sixth cervical vertebrae, where it becomes continuous Anterior Pharyngeal Wall
with the esophagus. The upper part of the laryngopharynx is
open anteriorly to the larynx via the patent inlet. Abbreviation
apw–Anterior pharyngeal wall is abbreviated using English
Cephalometric Landmarks (Points) on Pharynx
alphabet and is expressed as small letters or lower case, a, p
Cephalometric landmarks seen on the pharynx are of anatomic and w and written continuously without any space between
origin and are as follows (Table 15.1): the alphabets.
124
Posterior Pharyngeal Wall case U followed by small letter or lower case p and is written
Abbreviation
ppw–Posterior pharyngeal wall is abbreviated using English alpha- Upper Point of Tongue
bet and is expressed as small letters or lower case, p, p and w and
written continuously without any space between the alphabets. Abbreviation
ut—Upper point of tongue is abbreviated using English
Superior Pharyngeal Wall alphabet and is expressed as small letters or lower case u and
t and is written continuously without any space between the
Abbreviation alphabets.
spw–Superior pharyngeal wall is abbreviated using English alpha-
bet and is expressed as small letters or lower case, s, p and w and Significance
In Mc Namara Analysis
Section 6  Cephalometric Landmarks Related to Pharynx
Tip of the Uvula

Upper pharynx
Abbreviation
Upper pharyngeal width is measured from a point on the
U–Tip of the uvula is abbreviated using English alphabet and posterior outline of the soft palate to the closet point on the
is expressed as capital or upper case U. pharyngeal wall. This measurement is taken on the anterior
half of the soft palate outline. The average nasopharnyx is
Point on the Oral Side of the Soft Palate approximately 15–20 mm in width. A width of 2 mm or less in
this region indicates airway impairment.
Abbreviation
Uo–Point on the oral side of the soft palate is abbreviated Lower Pharynx
using English alphabet and is expressed as capital or upper
Lower pharyngeal width is measured from the point of
case U followed by small letter or lower case o and is written
intersection of the posterior border of the tongue and the
inferior border of the mandible to the closet point on the
posterior pharyngeal wall. The average measurement is 11
Point on the Pharyngeal Side of the Soft Palate
to 14 mm independent of age. Greater than average lower
Abbreviation pharyngeal walls is of possible anterior positioning of the
tongue, either as a result of habitual posture or due to tonsillar
Up–Point on the oral side of the soft palate is abbreviated enlargements A lower than average lower pharyngeal wall
using English alphabet and is expressed as capital or upper indicates the posterior positioning of the tongue.
Index
Page numbers followed by f refer to figure
a Condylion 95, 97f, 149, 150f g

anterioris 189, 189f
Alar crease junction 128, 131 Glabella 198
lateralis 188, 189f
on graphic illustration 132f Gnathion 89, 90f, 193, 196, 197, 201, 202, 204
medialis 188, 188f
on lateral cephalogram 132f Gonion 93, 94f, 150, 150f, 202
posterioris 190, 190f
Angle of convexity 197 point 187, 187f
Coronal suture 160
Angulare point 184, 184f
Cranial bones 10, 13
Antegonial tubercles 175, 176f h
Crista galli 160, 161f
Antegonion 176f
Cuspid 169 Harvold cephalometric analysis 196, 197f
Anterior
bow 11, 135, 135f Hassel and Farman developed method of skeletal
nasal spine 10, 59, 123, 155f, 174, 194, 196,
200, 202, 204, 208, 209 maturation 119f
d Hasund cephalometric analysis 200, 200f
on graphic illustration 60f
on lateral cephalogram 60f Deciduous dentition stage 70 Holdaway cephalometric analysis 197, 197f
pharyngeal wall 123 Dentition 71 Hyoid 101, 102f
point of occlusion 10, 76, 77f, 208, 209 Di Paolo’s quadrilateral cephalometric analysis bone 101, 101f
for occlusal plane 203, 205 200, 200f
Applications of cephalometric landmarks 191, 193, Dorsum of sella 10, 36 i
Articulare 93, 95f, 174, 175f, 193 on graphic illustration 36f
Incision
Articulation of on lateral cephalogram 36f
inferius 194, 201, 202, 203, 204, 205
ethmoid bone 21 Downs cephalometric analysis 195, 195f
apicalis 10, 75, 76f, 170, 170f
frontal bone 15, 26 e frontale 171, 171f
temporal bone 31 incisalis 10, 74, 74f, 169, 170f
Eruption chronology of primary teeth 70
superius 194, 201, 202, 203, 205
b Ethmoid bone 10, 15, 21, 21f, 22f, 26
apicalis 10, 73, 73f, 166, 167f
Ethmoidale 24, 25f
Basion 154f, 179f incisalis 10, 71, 72f, 165, 166f
on lateral cephalogram 25f
on graphic illustration 47f Infradentale 86, 194
on lateral cephalogram 47f Exocanthion 151, 152
Basis cephalometric analysis 207, 207f j
Bjork cephalometric analysis 193, 193f f Jarabak cephalometric analysis 201, 201f
Bolton’s point 10, 48, 196 Facial bone and dentition 10, 57 Jugal process 164, 164f
on graphic illustration 50f Farkas and coworkers soft tissue cephalometric
on lateral cephalogram 49f analysis 196, 196f l
First molar point 187, 187f Labrale
c Fissure 123 inferius 11, 136, 146, 147f, 198
Cagliari cephalometric analysis 207, 207f Floor of on graphic illustration 137f
Center of sella turcica 196, 204, 208, 209 nose 160 on lateral cephalogram 137f
Cephalometric sella 10, 37 superius 11, 134, 146, 146f, 198
analysis 3 on graphic illustration 37f on graphic illustration 134f
X-ray tracing techniques 4 on lateral cephalogram 37f
Cephalostat 4 Foramina
Lacrimal bone 15
Cervical spinosa points 180, 180f
Laryngopharynx 123
bones 10, 99 spinosum 180, 181f
Lateral cephalogram 3, 3f
point 198 Frontal
vertebra 103, 104f, 118 bone 10, 26, 15, 15f Legan and Burstone soft tissue cephalometric
vertebral maturation 119f on lateral cephalogram 15f analysis 198, 198f
Cheilion 151 cephalogram 3, 3f Lower
Chieti cephalometric analysis 208, 208f Frontomaxillary face height 197
Clinoidale 38 nasal suture 10 lip 11
on graphic illustration 38f on graphic illustration 28f pharynx 124
on lateral cephalogram 38f on lateral cephalogram 28f
Coben craniofacial and dentition suture on m
analysis 194f graphic illustration 19f Magnified image of anterior nasal spine on
cephalometric analysis 194 lateral cephalogram 19f graphic 60f
Columella point 198 Frontozygomatic suture 10 Malare 175f
212
Mandibular Philtrum 135f gnathion 11, 139, 148, 148f, 198

apical base midline 186, 186f Planed incisor position 136 on graphic illustration 139
central incisor 10, 80, 81f, 195, 202, 203 Planum sphenoidale 160 on lateral cephalogram 139f
dental midline 185, 186f Pogonion 88, 196, 197, 200, 201, 204 menton 11, 198
first molar 10, 81, 82f, 171, 171f, 195 Point nasal crown on graphic illustration 129f
length 197 A on nasion 128, 143, 143f
molar 173, 173f graphic illustration 61f on graphic illustration 128f
Mastiodale on lateral cephalogram 34f lateral cephalogram 61f on lateral cephalogram 128f
Mastoid processes 160 on oral side of soft palate 123, 124 pogonion 11, 138, 147, 198
Maxilla 26, 59 on pharyngeal side of soft palate 123, 124 on graphic illustration 138f
Maxillary T on on lateral cephalogram 138f
apical base midline 185, 185f graphic illustration 131 point B 147f
bone 15, 59f lateral cephalogram 131f on graphic illustration 137f
central incisor 10, 79, 79f, 195, 202, 203 Porion 32, 194-196 on lateral cephalogram 137f
first molar 10, 79, 80f, 168, 168f, 195 on lateral cephalogram 33f submentale 136, 147
molar 167, 168f Posterior subspinale 11, 133, 145, 145f
McGann cephalometric analysis 209, 209f cranial vault points 183, 184f Sphenoethmoidal point 10, 24, 42
Medio-orbitale on lateral cephalogram 23f nasal spine 10, 64, 123, 208, 209 on graphic illustration 44f
Mentolabial sulcus 198 on graphic illustration 64f on lateral cephalogram 43f
Menton 92, 92f, 173, 174f on lateral cephalogram 64f Sphenoethmoidale 24f
Middle cranial fossa points 182, 183f pharyngeal wall 123, 124 on graphic illustration 24f
Mixed dentition stage 70 point of occlusion 10, 77, 78f, 208, 209
Vomer point 182, 183f
Sphenoid bone 10, 15, 35, 35f
n Prognathion 197
Spheno-occipital synchondrosis 10, 39, 50
Nasal Pronasale 129, 144, 144f
on graphic illustration 39f, 51f
bone 10, 15, 26, 26f, 26f on graphic illustration 130f
on lateral cephalogram 39f, 50f
crown 128, 129 on lateral cephalogram 130f
Spina nasalis posterior 194, 200-202
on graphic illustration 129f Prosthion 62, 194
Spinal point 194
on lateral cephalogram 129f, 129f on graphic illustration 63f
Squamous part 15
process 15 on lateral cephalogram 63f
Pterygoid point 10, 40 Steiner’s cephalometric analysis 204, 205f
Nasion 16, 26, 194-196, 197, 200 Stomion
on graphic illustration 16f, 27f on graphic illustration 40f
on lateral cephalogram 40f inferius 11, 198
on lateral cephalogram 16f, 27f on graphic illustration 136f
Nasopharynx 123 Pterygomaxillary fissure 10, 44, 65, 123, 182,
182f, 195, 200 on lateral cephalogram 136f
Neck of crista galli 10, 23
on graphic illustration 45, 66f superius 11, 198
on frontal cephalogram 23f
on lateral cephalogram 45f, 66f Subnasale 131, 144, 198
Nerve supply to mandible 85
r on lateral cephalogram 132f
o
Rhinion 29 Subspinale 194
Occipital on graphic illustration 29f on graphic illustration 133f
bone 10, 46, 46f on lateral cephalogram 29f on lateral cephalogram 133f
condyles 160 Rickett’s cephalometric analysis 198, 199f Superior
Occlusomandibular angle 199 Riedel cephalometric analysis 202 pharyngeal wall 123, 124
Occlusopalatal angle 199 Roof of surface of floor of pituitary fossa 160
Odontoid 181, 181f orbit on Supra-orbitale 17
Opisthion 48, 179, 180f graphic illustration 19f on graphic illustration 18f
on graphic illustration 49f lateral cephalogram 19f on lateral cephalogram 18f
on lateral cephalogram 48f orbital cavity 17
Orbital plates 15 t
Orbitale 52, 67, 148, 148f, 194-196 s Temporal bone 10, 15, 31, 31f
on graphic illustration 53f, 68f Sassouni cephalometric analysis 199, 199f Temporale on
on lateral cephalogram 53f, 68f Schwartz cephalometric analysis 203, 203f graphic illustration 22f, 54f
Oropharynx 123 Sella 10, 41, 152, 195 lateral cephalogram 22, 54f
entrance 41, 153, 153f Temporomandibular joint 196
p on graphic illustration 43f Tip of uvula 123, 124
Palatocranial angle 199 on lateral cephalogram 43f Top of nasal septum 161, 161f
Palatomandibular angle 199 on graphic illustration 42f Tracing
Parital bone 15 on lateral cephalogram 42f basion on lateral cephalogram 47
Parts of Shapes of cervical vertebral bodies 119f Bolton’s point on lateral cephalogram 50
ethmoid bone 21 Soft tissue neck of crista galli on lateral cephalogram 23
frontal bone 15 cephalometric landmarks 11, 125, 127, 128, of anterior
hyoid bone 101 133, 138 nasal spine on lateral cephalogram 60, 155
mandible 85 glabella 127 point of occlusion on lateral cephalogram
Permanent dentition stage 71 on graphic illustration 127f 76
Pharynx 123 on lateral cephalogram 129f of articulare on lateral cephalogram 94, 174
213
of gnathion on lateral cephalogram 90 of pogonion on lateral cephalogram 88 pharynx 124

of hyoid on lateral cephalogram 102 of point B on lateral cephalogram 88 point of tongue 123, 124
of incision inferius of posterior Uses of cephalometric analysis 3
apicalis on lateral cephalogram 75, 171 nasal spine on lateral cephalogram 65
incisalis on lateral cephalogram 75 point of occlusion on lateral cephalogram v
of incision superius 78 Vermillion 135, 135f
apicalis on lateral cephalogram 74, 167 of sella on lateral cephalogram 41, 152 border of upper lips 11
incisalis on lateral cephalogram 72, 166 opisthion on lateral cephalogram 48 Vertex 143, 143f
of infradentale on lateral cephalogram 87 pterygoid point on lateral cephalogram 41
of mandibular rhinion on lateral cephalogram 30 w
central incisor on lateral cephalogram 81 roof of orbit on lateral cephalogram 18 Wit’s cephalometric analysis 206
first molar on lateral cephalogram 81, 172 spheno-occipital synchondrosis on lateral Wylie cephalometric analysis 203, 204f
of mastiodale on lateral cephalogram 34 cephalogram 40, 51
of maxillary supra-orbitale on lateral cephalogram 17 z
central incisor on lateral cephalogram 79 Trichion 196 Zygion 149, 149f, 163, 163f
first molar on lateral cephalogram 80, 168 Tweed’s cephalometric analysis 205, 206f Zygoma 162, 162f
of menton on lateral cephalogram 92, 93, 95, Types of cephalogram 3 Zygomatic
174 arch 10, 32, 163, 163f
of MI on lateral cephalogram 82, 172 u bone 10, 15, 52, 52f
of MS on lateral cephalogram 83 Upper process 15
of nasion on lateral cephalogram 17 and lower lips 11 prominence 149, 149f
of orbitale on lateral cephalogram 54 lip 11 suture point 164, 164f
Index

Cephalometric Landmarks

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An Atlas on

Basavaraj Subhashchandra Phulari

JAYPEE BROTHERS MEDICAL

Jaypee Brothers Medical Publishers (P) Ltd

© 2013, Jaypee Brothers Medical Publishers

Inquiries for bulk sales may be solicited at: [email protected]

An Atlas on Cephalometric Landmarks

Basavaraj Subhashchandra Phulari

Section 1: Introduction and History

Section 2: Classification of Cephalometric Landmarks

Section 3: Cephalometric Landmarks Related to Cranial Bones

5. Cephalometric landmarks related to Nasal bone.................................................................... 26

6. Cephalometric landmarks related to temporal bone ............................................................. 31

7. Cephalometric landmarks related to sphenoid bone ............................................................. 35

8. Cephalometric landmarks related to occipital bone .............................................................. 46

9. Cephalometric landmarks related to Zygomatic bone ............................................................. 52

Section 4: Cephalometric Landmarks Related to Facial Bones and Dentition

11. Cephalometric Landmarks Related to Dentition............................................................................ 70

12. Cephalometric Landmarks Related to Mandible............................................................................ 85

Section 5: Cephalometric Landmarks Related to Cervical Bones

14. Cephalometric landmarks related to Vertebrae......................................................................... 103

cv3ip 107 cv5ip 113

Section 6: Cephalometric landmarks related to Pharynx

Section 7: Soft Tissue Cephalometric Landmarks

Section 8: 3D Cephalometric Landmarks

Section 9: PA Cephalometric Landmarks

Incision Superius Apicalis 166 Antegonion 175

Section 10: SV Cephalometric Landmarks

Section 11: Applications of Cephalometric Landmarks

Jarabak Cephalometric Analysis 201 Wit’s Cephalometric Analysis 206

Cephalometric radiographs are used in orthodontic diagnosis Types of Cephalogram

Figure 1.1: Lateral cephalogram Figure 1.2: Frontal cephalogram

8. Houston WJB. The analysis of error in orthodontics measurements. AM

 Classification of Cephalometric Landmarks

Classification of cephalometric landmarks/points

Soft tissue cephalometric landmarks

Cephalometric landmarks Based on the type • Point B

Based on the side involved cephalometric landmarks/points Bilateral cephalometric landmarks

Hard or Soft Tissue cephalometric landmarks

Cephalometric landmarks/points can be hard or soft tissue

Flow chart 2.4: Cephalometric landmarks/points

Flow chart 2.5: Cephalometric landmarks/points

Types of Cephalometric Landmarks/Points Classification of Cephalometric Landmarks/

Flow chart 2.6: Cephalometric landmarks/points

Chapter 2  Classification of Cephalometric Landmarks

Cephalometric landmarks/points related to Cephalometric landmarks/points related to zygomatic

Cephalometric landmarks/points related to frontal • Orbitale

• Posterior nasal spine

Cephalometric landmarks/points related to vertebrae • Nasal crown

Chapter 2  Classification of Cephalometric Landmarks

Flow chart 2.8: Soft tissue cephalometric landmarks/points

 Cephalometric Landmarks Related to Frontal Bone

Cephalometric Landmarks (Points)

Figure 3.2: Radiographic anatomy of the frontal bone on the

ethmoid bone at frontoethmoidal suture. Above the horizontal Nasion

According to Willam B Downs • Relationship of anterior and posterior cranial base is

According to TM Graber Supra-Orbitale

Chapter 3  Cephalometric Landmarks Related to Frontal Bone

Nasion is a unilateral, anatomic, hard tissue cephalometric Type