Cephalometry in orthodontics 2d and 3d 19mb

Cephalometry in Orthodontics: 2D and 3D www.ajlobby.com Kula_FM.indd 6/20/18 8:44 AM Dedication I dedicate this book to two important people in my life: my father, James A Miller, Sr, who taught me the importance of hard work and the strength to persevere, and my husband, Theodore J Kula, Jr, who taught me to question and to solve problems using the scientific method –KK I dedicate this book to my late father and mother for the encouragement they blessed me with my entire life I also dedicate it to my lovely wife and daughters for their continuous love and support Lastly, a special thanks to many of my students whom I have had the pleasure of teaching and supervising –AG Library of Congress Cataloging-in-Publication Data Names: Kula, Katherine, editor | Ghoneima, Ahmed, editor Title: Cephalometry in orthodontics : 2D and 3D / edited by Katherine Kula and Ahmed Ghoneima Description: Batavia, IL : Quintessence Publishing Co,Inc, [2018] | Includes bibliographical rewferences and index Identifiers: LCCN 2018021619 | ISBN 9780867157628 (hardcover) Subjects: | MESH: Cephalometry methods | Orthodontics methods | Cephalometry instrumentation | Cone-Beam Computed Tomography Classification: LCC RK310.C44 | NLM WU 141.5.C3 | DDC 617.6/4307572 dc23 LC record available at https://lccn.loc.gov/2018021619 97% © 2018 Quintessence Publishing Co, Inc Quintessence Publishing Co, Inc 411 North Raddant Road Batavia, IL 60510 www.quintpub.com All rights reserved This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher Editor: Leah Huffman Design: Erica Neumann Production: Kaye Clemens Printed in China www.ajlobby.com Kula_FM.indd 6/20/18 8:44 AM Edited by Katherine Kula, MS, DMD, MS Professor Emeritus Department of Orthodontics and Oral Facial Genetics Indiana University School of Dentistry Indianapolis, Indiana Ahmed Ghoneima, BDS, PhD, MSD Chair and Associate Professor, Orthodontics Hamdan Bin Mohammed College of Dental Medicine Dubai, United Arab Emirates Adjunct Faculty Department of Orthodontics and Oral Facial Genetics Indiana University School of Dentistry Indianapolis, Indiana Berlin, Barcelona, Chicago, Istanbul, London, Milan, Moscow, New Delhi, Paris, Prague, São Paulo, Seoul, Singapore, Tokyo, Warsaw www.ajlobby.com Kula_FM.indd 6/20/18 8:44 AM PREFACE Successful orthodontic treatment of a patient depends on accurate diagnosis and treatment planning The purpose of this book is to provide an updated use of clinical cephalometrics, an important part of diagnosis and treatment planning An effort was made to minimize esoteric parameters that are not frequently used in clinical orthodontics and to introduce and broaden the aspects of the role of cephalometrics in diagnosis and treatment planning Currently, clinical orthodontics is transitioning from the two-dimensional (2D) world to the three-dimensional (3D) world The use of cone beam computed tomography (CBCT) has changed from a rather myopic view that the use of 3D CBCTs could be unethical to a far broader acceptance This has happened not only because of radiation and cost reduction but also as a result of research showing the benefits of 3D CBCTs The unknown became the known As equipment starts to break down, the clinician also evaluates the cost and benefit of new equipment and what his or her technologically savvy market expects However, 2D cephalometrics is still the standard for clinical orthodontics, although many practices and orthodontic programs currently take 3D CBCTs In reality, many practices and orthodontic programs globally are using 2D cephalometric measures with the 3D CBCTs Thus, 2D cephalometrics is still very pertinent to patient treatment In order to teach cephalometrics, some history of cephalometrics is necessary but not to the degree that clinicians become lost in it Cephalometric software programs make a plethora of analyses available for use because many clinicians not restrict their analysis to those of individual treatment camps Indeed, many of the cephalometric analyses are based on research or writings of multiple authors In order to teach cephalometrics, both 2D and 3D cephalometry with their advantages and limitations need to be discussed, not as a philosophy but related to the craniofacial structures and their relationships As research and product development increase, use of 3D measures might negate the use of 2D measures The addition of 3D CBCTs to cephalometry presents another dimension to the identification of skeletal and soft tissue landmarks The transverse dimension is inherently integrated with the lateral dimension and is available for almost instant review without the viewer having to stitch separate images together The internal structures of the face, skull, and airways can be reviewed for structural abnormalities and pathologies The internal potentially driving structures of facial morphology can be viewed and measured more precisely in 3D The authors integrate these possibilities with cephalometry and present currently evolving concepts and processes within cephalometry that the clinician needs to be aware of Cephalometry, a measure of straight lines and angles of the hard and soft tissue of the face and cranium, is evolving into measures of areas and volumes that will need to be interpreted for clinical decisions and evaluation of outcomes However, clinicians need to understand 2D cephalometry to be able to apply it better in 3D cephalometry Acknowledgments Our sincere appreciation to our administrative assistant, Shannon Wilkerson, for providing assistance with typing and copying as well as allowing us to focus on our writing by running interference; to the clinical supervisor and dental assistants, Gayle Massa, Brenda McClarnon, Darlene Arnold, Shelley Pennington, and all the others, who helped us with patient records; and to the business office supervisor and other personnel, Monica Eller, Karen Vibbert, and others, for helping with patient contacts Note on Terminology The hyphenation standards for cephalometric terms and landmarks used in the literature are not consistent, and many publications rely on jargon that is not universally accepted For the sake of consistency and understanding in this book, hyphens are only used when referring to angles or landmarks that require the hyphen for clarity Every effort has been made to remove unnecessary jargon and use clinically relevant terms and landmarks www.ajlobby.com Kula_FM.indd 6/20/18 8:44 AM CONTENTS Contributors vi 10 11 12 13 14 Introduction to the Use of Cephalometrics Katherine Kula / Ahmed Ghoneima 2D and 3D Radiography Edwin T Parks Skeletal Landmarks and Measures Katherine Kula / Ahmed Ghoneima Frontal Cephalometric Analysis Katherine Kula / Ahmed Ghoneima 17 47 Soft Tissue Analysis 63 Ahmed Ghoneima / Eman Allam / Katherine Kula A Perspective on Norms and Standards Katherine Kula / Ahmed Ghoneima 75 The Transition from 2D to 3D Cephalometrics: Understanding the Problems of Landmarks and Measures 89 Manuel Lagravère / Connie P Ling Cephalometric Airway Analysis Ahmed Ghoneima / Katherine Kula 101 Radiographic Superimposition: From 2D to 3D Mohamed Bazina / Juan Martin Palomo 113 Growth and Treatment Predictions: Accuracy and Reliability Achint Utreja 123 Measuring Bone with CBCT 131 Leena Palomo / Tarek Elshebiny / Ali Z Syed / Juan Martin Palomo Common Pathologic Findings in Cephalometric Radiology Paul C Edwards / James Geist The Cost of 2D Versus 3D Radiology Eric Dellinger 145 157 Clinical Cases 161 Ahmed Ghoneima / Katherine Kula Index 197 www.ajlobby.com Kula_FM.indd 6/20/18 8:44 AM CONTRIBUTORS Eman Allam, bds, phd, mph Manuel Lagravère, dds, msc, phd Postdoctoral Fellow Department of Orthodontics and Oral Facial Genetics Indiana University School of Dentistry Indianapolis, Indiana Associate Professor Division of Orthodontics Faculty of Medicine and Dentistry University of Alberta Edmonton, Alberta Mohamed Bazina, bds, msd Connie P Ling, dds, msc Assistant Clinical Professor Department of Orthodontics University of Kentucky Private Practice Limited to Orthodontics Toronto, Ontario Adjunct Assistant Professor Department of Orthodontics School of Dental Medicine Case Western Reserve University Cleveland, Ohio Juan Martin Palomo, dds, msd Professor and Residency Director Department of Orthodontics Director of the Craniofacial Imaging Center School of Dental Medicine Case Western Reserve University Cleveland, Ohio Eric Dellinger, dds, msd Private Practice Limited to Orthodontics Angola, Indiana Leena Palomo, dds, msd Professor Department of Oral Pathology, Medicine & Radiology Indiana University School of Dentistry Indianapolis, Indiana Associate Professor Department of Periodontology School of Dental Medicine Case Western Reserve University Cleveland, Ohio Tarek Elshebiny, bds, msd Edwin T Parks, dmd, ms Paul C Edwards, dds, msc Clinical Assistant Professor Department of Orthodontics School of Dental Medicine Case Western Reserve University Cleveland, Ohio Professor Department of Oral Pathology, Medicine & Radiology Indiana University School of Dentistry Indianapolis, Indiana James Geist, dds, ms Assistant Professor Director of Radiology School of Dental Medicine Case Western Reserve University Cleveland, Ohio Ali Z Syed, bds, mha, ms Professor Department of Biomedical and Diagnostic Sciences Director, Oral and Maxillofacial Imaging Center University of Detroit Mercy Detroit, Michigan Achint Utreja, bds, ms, phd Assistant Professor and Director, Pre-Doctoral Orthodontics Director, Mineralized Tissue and Histology Research Laboratory Department of Orthodontics and Oral Facial Genetics Indiana University School of Dentistry Indianapolis, Indiana Ahmed Ghoneima, bds, phd, msd Chair and Associate Professor, Orthodontics Hamdan Bin Mohammed College of Dental Medicine Dubai, United Arab Emirates Adjunct Faculty Department of Orthodontics and Oral Facial Genetics Indiana University School of Dentistry Indianapolis, Indiana Katherine Kula, ms, dmd, ms Professor Emeritus Department of Orthodontics and Oral Facial Genetics Indiana University School of Dentistry Indianapolis, Indiana vi www.ajlobby.com Kula_FM.indd 6/20/18 8:44 AM Introduction to the Use of Cephalometrics Katherine Kula, MS, DMD, MS Ahmed Ghoneima, BDS, PhD, MSD for a cephalometric radiograph; however, the routine use of a CBCT is not generally required in orthodontics, so cephalometric radiographs are the current standard The AAO Clinical Practice Guidelines1 also recommend evaluating the patient’s treatment outcome and determining the efficacy of treatment modalities by comparing posttreatment records with pretreatment records Posttreatment records may include dental casts; extraoral and intraoral images (either conventional or digital, still or video); and intraoral, panoramic, and/or cephalometric radiographs depending on the type of treatment and other factors Many orthodontists also take progress cephalograms to determine if treatment is progressing as expected In addition, board certification with the American Board of Orthodontics requires cephalograms and an understanding of cephalometry to explain the decisions for diagnosis, treatment, and the effects of growth and orthodontic treatment Therefore, it is paramount that orthodontists understand how to use cephalometrics in their practice Cephalometrics refers to the quantitative evaluation of cephalograms, or the measuring and comparison of hard and soft tissue structures on craniofacial radiographs It is an evolving science and art that has been woven into orthodontics and the treatment of patients Cephalograms are an integral part of orthodontic records and are typically used for almost all orthodontic patients The cephalometric analysis or evaluation helps to confirm or clarify the clinical evaluation of the patient and provide additional information for decisions concerning treatment The American Association of Orthodontists (AAO) developed the current Clinical Practice Guidelines for Orthodontics and Dentofacial Orthopedics,1 which recommend that initial orthodontic records include examination notes, intraoral and extraoral images, diagnostic casts (stone or digital), and radiographic images These radiographic images include appropriate intraoral radiographs and/or a panoramic radiograph as well as cephalometric radiographs A three-dimensional cone beam computed tomograph (3D CBCT) can be substituted www.ajlobby.com Kula_Chap_01.indd 6/20/18 8:45 AM Introduction to the Use of Cephalometrics a b Fig 1-1 (a and b) Lateral and frontal cephalograms Basics of Cephalometrics be viewed independently While the worldwide transition from 2D to 3D imaging is occurring quickly, it is still important for clinicians to understand what has been used for decades (2D), what additional 3D information is needed, and the limitations and potential of 3D imaging The general purpose of this book is to introduce the orthodontic clinician to the use and interpretation of cephalometrics, both 2D and 3D, and to show the potential benefits of using 3D CBCTs The purpose of this chapter is to provide the background for the current and future use of cephalometrics Cephalometrics is used to assist in (1) classifying the malocclusion (skeletal and/or dental); (2) communicating the severity of the problem; (3) evaluating craniofacial structures for potential and actual treatment using orthodontics, implants, and/ or surgery; and (4) evaluating growth and treatment changes of individual patients or groups of patients In general, a lateral cephalogram shows a two-dimensional (2D) view of the anteroposterior position of teeth, the inclination of the incisors, the position and size of the bony structures holding the teeth, and the cranial base (Fig 1-1a) A cephalogram can also provide a different view of the temporomandibular joint than a panoramic radiograph and a view of the upper respiratory tract In addition, cephalograms aid in the identification and diagnosis of other problems associated with malocclusion such as dental agenesis, supernumerary teeth, ankylosed teeth, malformed teeth, malformed condyles, and clefts, among others They have also been used to identify pathology and can give some indication of bone height and thickness around some teeth However, they are not very useful in identifying dental caries, particularly initial caries, and periodontal disease, so bitewing radiographs and periapical radiographs are needed for patients who are caries susceptible or show signs of periodontal disease While some asymmetry can be diagnosed using a lateral cephalogram, an additional frontal cephalogram (Fig 1-1b) is needed to better identify which hard tissue structures are involved in the asymmetry Of course all of these conventional radiographs are 2D images A 3D CBCT can replace multiple 2D radiographs and can allow the entire craniofacial structure to be viewed from multiple aspects (x, y, z format) with one radiograph (Fig 1-2) Intracranial and midline facial structures can be viewed without overlying confounding structures, and bilateral structures can History of Cephalometrics Prior to the use of radiographs, growth and development of the craniofacial complex was essentially a study of skull measurements (craniometry) (Fig 1-3) or soft tissue Craniometry2 dates back to Hippocrates in the 4th century BC and is still used today in physical anthropology, forensics, medicine, and art It is used to determine the size of cranial bones and teeth, their relationship to each other, potential differences among groups of people, and evolutionary changes in the cranium and face Some of the current cephalometric landmarks, planes, and angles have their origin in craniometry For example, the Frankfort plane was established in 1882 during a meeting of the German Anthropological Society as a standardized method of orienting the skull horizontally for measurements.2 The anthropologists agreed to define the Frankfort plane as a plane from the upper borders of the auditory meati (external auditory canals) to the inferior margins of each orbit Later, this plane was modified for cephalometry to indicate that the right and left porion and left orbitale would be used to define the horizontal plane to minimize problems that asymmetry caused www.ajlobby.com Kula_Chap_01.indd 6/20/18 8:45 AM History of Cephalometrics a b c d Fig 1-2 Software screen showing (a) coronal slice (green line in b and c), (b) sagittal slice (red line in a and c), (c) axial slice (blue line in a and b), and (d) 3D CBCT reconstruction of the same study Craniometry, however, had limitations Each skull represented a one-time peek or snapshot at the development of one individual—in other words, a cross-sectional data point There was little hope of a longitudinal study Frequently, the reason for the death of the individual was unknown, resulting in an unknown effect on the growth and development of the skull Thus, craniofacial development was interpreted based on the skulls of children who died because of trauma, disease, starvation, abuse, or genetics Todd,3 the chairman of the Department of Anatomy at Case Western Reserve University School of Medicine, considered the measuring of these children’s skulls as studying defective growth and development; the longitudinal effect of orthodontic treatment on growth and development could not be assessed Animal studies using dyes were obviously limited in providing interpretation of the effect of various factors on human growth and development Soft tissue studies, particularly longitudinal, were also limited by the lack of reproducible data Radiographs, however, provided the opportunity to study and compare multiple patients over decades The use and standardization of cephalograms continually evolved from their early beginnings in the late 1800s Similarly, during that time, orthodontics had its inception as a dental specialty Edward Hartley Angle classified malocclusion in 1899 and was recognized by the American Dental Association for making orthodontics a dental specialty.4 Angle established the first school of orthodontics (Angle School of Orthodontia in St Louis) in 1900, the first orthodontic society (American Society of Orthodontia) in 1901, and the first dental specialty journal (American Orthodontist) in 1907 Fig 1-3 An original Broadbent craniostat used to standardize skull position and measurement (Courtesy of Dr Juan Martin Palomo, Case Western Reserve University.) Shortly after the discovery of x-rays by Wilhelm Conrad Roentgen in 1895,5 the use of the first facial and cranial radiographs was reported as early as 1896 by Rowland6 and later by Ketcham and Ellis.7 By 1921, B H Broadbent was using lateral cephalograms in his private practice.7 In 1922, Spencer Atkinson reported to the Angle College of Orthodontia that he used lateral facial radiographs to identify the position of the first molar below the maxilla’s key ridge.7 Because the radiographs also showed soft tissue, Atkinson suggested that these lateral radiographs had the potential of relating the mandible and the maxilla to the face and to the cranial base Initially, the comparison of cephalometric radiographs to show the effects of growth and treatment was difficult because head position and distance from the cephalometric film were not standardized In an attempt to standardize head position, in 1921 Percy Brown designed a head holder for taking radiographic images of the face.7 In 1922, A J Pacini reported standardizing head position for lateral radiographs by using a gauze bandage to hold the film to the head.8 Ralph Waldron followed in 1927 by constructing a cephalometer to measure the gonial angle on a roentgenogram taken 90 degrees from the profile.9 Martin Dewey and Sidney Riesner held the patient’s head in a clamp and took a profile view with the film cassette placed against the head.10 However, for several decades there was no universal standardization of cephalometric technique, meaning that identical radiographs of the same patient could not be reproduced It was obvious to Broadbent11 that accurate and reliable longitudinal measurements of the head and face in three dimen3 www.ajlobby.com Kula_Chap_01.indd 6/20/18 8:45 AM Case Table 14-8 (cont) Case posttreatment cephalometric values Group/measurement Value Norm SD Dev norm Upper lip to E-plane (mm) –7.4 –3.0 2.0 –2.2** Lower lip to E-plane (mm) –5.8 –2.5 2.5 –1.3* –0.7 Soft tissue ILG (HP) (mm) 0.6 2.0 2.0 115.8 102.0 8.0 1.7* 5.7 10.0 4.0 –1.1* 108.1 125.0 4.7 –3.6*** UFH (G’Sn’) (mm) 61.0 63.0 3.0 –0.7 LFH (Sn’Me’) (mm) 61.9 63.0 3.0 –0.4 UFH (N-ANS) (mm) 47.5 50.0 2.5 –1.0* LFH (ANS-Me) (mm) 57.0 65.0 4.5 –1.8* UFH (N-ANS/[N-ANS+ANS-Me]) (%) 45.4 45.0 5.0 0.1 LFH (ANS-Me/[N-ANS+ANS-Me]) (%) 54.6 57.0 5.0 –0.5 Posterior face height (ArGo) (mm) 50.2 48.1 4.5 0.5 PFH:AFH (CoGo:NMe) (%) 59.7 60.0 1.0 –0.3 3.0 5.1 3.0 –3.4*** 89.7 88.6 3.0 Nasolabial angle (CoLSnUL) (degrees) H-angle (Pg’UL-Pg’N’) (degrees) Face height (N’Me’) (mm) Facial proportions (hard tissue) Profile Convexity (NA-APg) (degrees) Facial angle (FH-NPg) (degrees) 0.4 Dev norm, deviation from the norm; PP, palatal plane; OP, occlusal plane; MP, mandibular plane; U1, maxillary incisor; L1, mandibular incisor; ILG (HP), interlabial gap (horizontal plane); CoL, condylion lateral; UL, upper lip; UFH, upper face height; LFH, lower face height; PFH:AFH, posterior face height to anterior face height *Each asterisk represents a standard deviation (SD) u t Fig 14-4 (cont)  (t) Posttreatment cephalogram (u) Superimposition of pretreatment and posttreatment cephalometric tracings 189 www.ajlobby.com Kula_Chap_14.indd 189 6/20/18 8:52 AM 14 Clinical Cases a b c d e f g h Fig 14-5 (a to h) Pretreatment extraoral and intraoral photographs Case A 12-year-old Caucasian girl presented for comprehensive orthodontic treatment with unremarkable medical and dental histories Her chief complaint was that her teeth were not straight The etiology of her malocclusion was most likely due to genetic factors The patient presented in the mixed dentition with a Class III malocclusion The mandibular incisors were retroclined, and she had a shallow overbite (1.2 mm) and a 1.1-mm overjet (Figs 14-5d to 14-5h) The maxillary right lateral incisor was in anterior crossbite, and the primary first and second molars were in posterior crossbite She had a short mandible with an excessive curve of spee and a mild curve of Wilson The maxillary midline was deviated mm to the right, and the mandibular midline was deviated mm to the left in relation to the facial midline Photographic evaluation Cephalometric evaluation The patient had a straight facial profile with normal chin development (Fig 14-5a) The lips were competent with a slightly retrusive upper lip, slightly deviated nose, increased lower anterior face height, and a nonconsonant smile arc (Figs 14-5b and 14-5c) The skeletal base was in Class I relationship with a deficient maxilla and mandible anteroposteriorly Vertically the patient had a hyperdivergent skeletal pattern (Fig 14-5i and Table 14-9) Initial medical history and chief complaint 190 www.ajlobby.com Kula_Chap_14.indd 190 6/20/18 8:52 AM Case i j Fig 14-5 (cont)  (i) Pretreatment cephalogram (j) Pretreatment panoramic radiograph Table 14-9 Case pretreatment cephalometric values Group/measurement Value Norm SD Dev norm SNA (degrees) 72.1 82.0 3.5 –2.8** SN-PP (degrees) 10.9 8.0 3.0 1.0* SN-OP (degrees) 22.3 14.4 2.5 3.2*** A-N perp (mm) –7.6 0.0 2.0 –3.8*** SNB (degrees) 69.8 80.9 3.4 –3.3*** SNPg (degrees) 70.7 80.0 3.5 –2.6** FMA (MP-FH) (degrees) 35.6 24.6 4.5 2.5** SN-MP (degrees) 41.6 32.9 5.2 1.7* MP-OP (degrees) 22.9 16.6 5.0 1.3* B-N perp (mm) –17.1 –6.0 8.0 –1.4* Pg-N perp (mm) –16.7 –5.0 3.0 –3.9*** 75.7 67.0 5.5 1.6* 2.3 1.6 1.5 0.5 34.3 25.0 6.0 1.5* Maxilla to cranial base Mandible to cranial base y-axis (SGnSN) (degrees) Maxilla to mandible ANB (degrees) PP-MP (degrees) Wits appraisal (mm) 0.8 –1.0 1.0 Maxillary length (ANS-PNS) (mm) 49.8 51.6 4.3 –0.4 1.8* Mandibular length (CoGn) (mm) 108.5 118.1 4.0 –2.4** (cont) Panoramic evaluation Treatment plan The panoramic radiograph confirmed the late mixed dentition stage and showed the presence of all permanent teeth except the maxillary right third molar (Fig 14-5j) The treatment plan involved comprehensive orthodontics The patient was given and accepted a nonextraction treatment plan with fixed orthodontic appliances to correct the malocclusion and finish in Class I molar and canine occlusion An 191 www.ajlobby.com Kula_Chap_14.indd 191 6/20/18 8:52 AM 14 Clinical Cases Table 14-9 (cont) Case pretreatment cephalometric values Group/measurement Value Norm SD Dev norm 136.0 130.0 5.0 1.2* U1-SN (degrees) 90.1 102.6 5.5 –2.3** U1-NA (degrees) 18.0 22.8 5.7 –0.8 2.1 4.3 2.7 –0.8 101.0 110.0 5.0 –1.8* L1-MP (degrees) 83.8 95.0 7.0 –1.6* L1-NB (degrees) 19.8 25.3 6.0 –0.9 L1-NB (mm) 4.0 4.0 1.8 0.0 L1 protrusion (L1-APg) (mm) 1.9 1.0 2.3 0.4 139.9 130.0 6.0 1.7* Overjet (Mx1-Md1) (mm) 1.1 3.2 0.4 –4.8**** Overbite (Mx1-Md1) (mm) 1.2 3.2 0.7 –4.1**** Upper lip to E-plane (mm) –4.9 –3.0 2.0 –0.9 Lower lip to E-plane (mm) –0.8 –2.5 2.5 0.7 0.5 2.0 2.0 –0.8 114.7 102.0 8.0 1.6* 13.0 10.0 4.0 0.8 123.2 125.0 4.7 –0.4 UFH (G′Sn′) (mm) 64.3 63.0 3.0 0.4 LFH (Sn′Me′) (mm) 69.1 63.0 3.0 2.0** UFH (N-ANS) (mm) 53.1 50.0 2.5 1.2* LFH (ANS-Me) (mm) 66.8 65.0 4.5 0.4 UFH (N-ANS/[N-ANS+ANS-Me]) (%) 44.3 45.0 5.0 –0.1 LFH (ANS-Me/[N-ANS+ANS-Me]) (%) 55.7 57.0 5.0 –0.3 Posterior face height (ArGo) (mm) 40.0 45.4 4.5 –1.2* PFH:AFH (CoGo:NMe) (%) 43.7 60.0 1.0 2.9 6.6 3.0 –1.2 * 81.3 87.9 3.0 –2.2 ** Cranial base BaSN (degrees) Upper incisors to maxilla U1-NA (mm) U1-PP (degrees) Lower incisors to mandible Incisors to each other Interincisal angle (U1-L1) (degrees) Soft tissue ILG (HP) (mm) Nasolabial angle (CoLSnUL) (degrees) H-angle (Pg′UL-Pg′N′) (degrees) Face height (N′Me′) (mm) Facial proportions (hard tissue) –16.3 ******* Profile Convexity (NA-APg) (degrees) Facial angle (FH-NPg) (degrees) Dev norm, deviation from the norm; PP, palatal plane; OP, occlusal plane; MP, mandibular plane; U1, maxillary incisor; L1, mandibular incisor; ILG (HP), interlabial gap (horizontal plane); CoL, condylion lateral; UL, upper lip; UFH, upper face height; LFH, lower face height; PFH:AFH, posterior face height to anterior face height *Each asterisk represents a standard deviation (SD) appliance with 0.022-inch 3M brackets with MBT prescription was used with bands on the maxillary and mandibular molars and brackets bonded to all maxillary and mandibular teeth The teeth were leveled and aligned and then detailed with finishing archwires 192 www.ajlobby.com Kula_Chap_14.indd 192 6/20/18 8:52 AM Case k l m n o p q r s Fig 14-5 (cont)  (k to r) Posttreatment extraoral and intraoral photographs (s) Posttreatment panoramic radiograph Final evaluation No significant changes were observed in the esthetics of the facial profile (Fig 14-5k) The maxillary midline is coincident with the facial midline, and there is an improvement in the alignment of the teeth with minimal buccal corridors and a consonant smile arc (Figs 14-5l to 14-5r) Figure 14-5s shows the posttreatment panoramic radiograph 193 www.ajlobby.com Kula_Chap_14.indd 193 6/20/18 8:52 AM 14 Clinical Cases t u Fig 14-5 (cont)  (t) Posttreatment cephalogram.  (u) Superimposition of pretreatment and posttreatment cephalometric tracings Table 14-10 Case posttreatment cephalometric values Group/measurement Value Norm SD Dev norm SNA (degrees) 72.1 82.0 3.5 –2.8** SN-PP (degrees) 10.6 8.0 3.0 0.9 SN-OP (degrees) 23.4 14.4 2.5 3.6*** A-N perp (mm) –6.8 0.0 2.0 –3.4*** SNB (degrees) 68.9 80.9 3.4 –3.5*** SNPg (degrees) 70.1 80.0 3.5 –2.8** FMA (MP-FH) (degrees) 39.4 23.9 4.5 3.5*** SN-MP (degrees) 46.3 32.9 5.2 2.6** Maxilla to cranial base Mandible to cranial base MP-OP (degrees) 26.1 17.4 5.0 1.7* B-N perp (mm) –17.0 –6.0 8.0 –1.4* Pg-N perp (mm) –16.3 –1.0 3.0 –5.1***** 77.4 67.0 5.5 y-axis (SGnSN) (degrees) 1.9* (cont) Cephalometric analysis SNA remained the same, and SNB decreased by about degree Consequently, ANB changed from 2.3 to 3.2 degrees to correct the skeletal discrepancy between the jaws (Fig 14-5t and Table 14-10) The hyperdivergency of the mandible increased significantly as SN-MP changed from 41.6 to 46.3 degrees Proclination of the maxillary incisors increased from 90.1 to 94.4 degrees, while the inclination of the mandibular incisors remained the same (Fig 14-5u) 194 www.ajlobby.com Kula_Chap_14.indd 194 6/20/18 8:52 AM Case Table 14-10 (cont) Case posttreatment cephalometric values Group/measurement Value Norm SD Dev norm 3.2 1.6 1.5 1.0* 38.9 25.0 6.0 2.3** Maxilla to mandible ANB (degrees) PP-MP (degrees) Wits appraisal (mm) 1.6 –1.0 1.0 2.6** Maxillary length (ANS-PNS) (mm) 43.2 51.6 4.3 –2.0** Mandibular length (CoGn) (mm) 108.3 122.3 4.0 –3.5*** 134.3 130.0 5.0 0.9 U1-SN (degrees) 94.4 102.8 5.5 –1.5* U1-NA (degrees) 22.3 22.8 5.7 –0.1 Cranial base BaSN (degrees) Upper incisors to maxilla U1-NA (mm) 3.6 4.3 2.7 –0.3 104.9 110.0 5.0 –1.0* L1-MP (degrees) 83.8 95.0 7.0 –1.6* L1-NB (degrees) U1-PP (degrees) Lower incisors to mandible 23.6 25.3 6.0 –0.3 L1-NB (mm) 5.5 4.0 1.8 0.8 L1 protrusion (L1-APg) (mm) 2.6 1.0 2.3 0.7 Incisors to each other Interincisal angle (U1-L1) (degrees) 131.0 130.0 6.0 0.2 Overjet (Mx1-Md1) (mm) 2.4 3.2 0.4 –2.0** Overbite (Mx1-Md1) (mm) 1.5 3.2 0.7 –2.4** Upper lip to E-plane (mm) –6.8 –3.0 2.0 –1.9* Lower lip to E-plane (mm) –1.5 –2.5 2.5 0.4 1.9 2.0 2.0 0.0 112.2 102.0 8.0 1.3* Soft tissue ILG (HP) (mm) Nasolabial angle (CoLSnUL) (degrees) H-angle (Pg′UL-Pg′N′) (degrees) 11.6 10.0 4.0 0.4 121.0 125.0 4.7 –0.8 UFH (G′Sn′) (mm) 62.3 63.0 3.0 –0.2 LFH (Sn′Me′) (mm) 77.8 63.0 3.0 4.9**** UFH (N-ANS) (mm) 52.5 50.0 2.5 1.0* LFH (ANS-Me) (mm) 69.7 65.0 4.5 UFH (N-ANS/[N-ANS+ANS-Me]) (%) 43.0 45.0 5.0 LFH (ANS-Me/[N-ANS+ANS-Me]) (%) 57.0 57.0 5.0 0.0 Posterior face height (ArGo) (mm) 39.8 48.5 4.5 –1.9* PFH:AFH (CoGo:NMe) (%) 40.4 60.0 1.0 4.3 4.9 3.0 –0.2 81.6 88.6 3.0 –2.3 ** Face height (N′Me′) (mm) Facial proportions (hard tissue) 1.0* –0.4 –19.6 ******* Profile Convexity (NA-APg) (degrees) Facial angle (FH-NPg) (degrees) Dev norm, deviation from the norm; PP, palatal plane; OP, occlusal plane; MP, mandibular plane; U1, maxillary incisor; L1, mandibular incisor; ILG (HP), interlabial gap (horizontal plane); CoL, condylion lateral; UL, upper lip; UFH, upper face height; LFH, lower face height; PFH:AFH, posterior face height to anterior face height *Each asterisk represents a standard deviation (SD) 195 www.ajlobby.com Kula_Chap_14.indd 195 6/20/18 8:52 AM www.ajlobby.com Kula_Chap_14.indd 196 6/20/18 8:52 AM XX Index Index X Page references followed by “f” denote figures, and those followed by “t” denote tables A A to N perp to FH, 29t AB plane, Acetate tracing paper, 20, 20f Arcial growth of mandible, 126, 126f Adenoid facies, 102 African Americans cephalometric studies of, 80t–82t children, 81–82 Airway, upper See Upper airway; see also specific anatomy Alare, 66t Alveolar bone cone beam computed tomography assessment of, 133–135, 134f–135f dehiscences of, 133–134, 137f fenestrations of, 133–134 thickness of, 134f, 134–135, 137f American Association of Orthodontists Clinical Practice Guidelines, Foundation Legacy Collection, 76 American Board of Orthodontics, 2, 115 Analog to digital conversion, 12 Anatomical porion, 27t Angle of convexity, Angles, 29t Antegonion, 25t, 53, 53t Anterior border of ramus, 25t Anterior clinoid process, 22 Anterior Downs point, 25t Anterior nasal spine, 25t, 30, 33f Antral pseudocyst, 148–149, 149f A-point, 26t, 30–31 AP growth axis, 29t Articulare, 25t, 32 As low as reasonably achievable (ALARA), 15 Atheromas, carotid artery, 153f, 153–154 B Basion, 22, 25t, 30, 33f Basion-nasion, 29t, 114 Benefit, risk versus, 10–11 Bifid condyle, 151, 152f Bolton cephalostat, 4f Bolton plane, 29t, 36 Bolton point, 25t Bolton registration point, 27t Bolton standards, 77, 77t Bolton-nasion plane, 4, 5f, Bone density cone beam computed tomography assessment of, 135–138, 136f–137f miniscrew stability affected by, 140 B-point, 27t, 31 Bridge of nose, 66t Broadbent craniostat, 3, 3f–4f Broadbent-Bolton Study, 76–77, 77t, 84 C Calcifications carotid artery atheromas, 153f, 153–154 intracranial, 146–147, 147f sinus, 149 tonsillar, 153, 153f Canines impaction of, 49f landmarks for, 96t Carotid artery atheroma calcifications, 153f, 153–154 Case studies, 161–195 Caucasian American adults, 79–80, 80t–82t Caucasian American children norms and standards Broadbent-Bolton Study, 76–77, 77t, 84 Fels Longitudinal Study, 78–79 Forsyth Institute Twin sample, 79 Hixon Oregon Growth Study, 79 Iowa Facial Growth Study, 79 Krogman Philadelphia Growth Study, 79 Michigan study, 78 University of Oklahoma Denver Growth Study, 78 University of Toronto Burlington Growth Study, 78 UOP Mathews Growth Study, 79 CBCT See Cone beam computed tomography CCD See Charge-coupled device Cephalograms comparison of, lateral See Lateral cephalogram posteroanterior See Posteroanterior cephalogram standardization of, 3–4 Cephalometric analysis, 89 Cephalometrics basics of, clinical uses of, definition of, history of, 2–6 reference parameters for, See also Planes, reference values, Cephalometry, 18, 24 See also 2D cephalometry Cephalostat, Cervical area, 2D cephalometry tracing of, 20, 22, 22f Cervical spine, 152, 153f Cervical vertebral maturation, 125, 125f Charge-coupled device description of, 12 receptors, 13 Cheilion, 66t Children African American, 81–82 Caucasian American See Caucasian American children cross-sectional studies of, 83 Chinese Americans, 80t–81t Clivus, 22 Collimation, 11 Complementary metal oxide semiconductors (CMOS) description of, 11 receptors, 13 Compound odontomas, 150, 150f Computational fluid dynamics (CFD), 111, 111f Computed tomography, cone beam computed tomography versus, 14 Concha bullosa, 148, 148f Condyle, bifid, 151, 152f Condyle (landmark), 25t, 31 Condylion, 25t, 31, 53t Cone beam computed tomography accuracy of, 132–133 advantages of, 131, 138 alveolar bone assessments using, 133–135, 134f–135f bone density assessments description of, 135–138, 136f–137f for miniscrew placement, 139–140 for temporary anchorage device placement, 138–141 computed tomography versus, 14 197 www.ajlobby.com Kula_Index.indd 197 6/20/18 8:52 AM C Index description of, history of, 14, 131 image reconstruction, 16 landmarks in reliability of, 90–91 as superimposition references, 91 types of, 91–92 lateral cephalograms, 15f multiplanar reformation, 14, 14f patient positioning and preparation for, 16 scanning protocol for, 15 selection criteria for, 15 soft tissue analysis using, 71–72, 72f spatial resolution of, 132–133 3D See 3D cone beam computed tomography x-radiation dosage, 10 Constructed gonion, 32 Coronoid process anatomy of, 21f as landmark, 25t, 32 Cortical bone, 139 Cranial base anatomy of, 113–114, 114f anterior, 114f embryology of, 113 landmarks for description of, 28–30, 30f 3D imaging, 93t, 98t mandible to, landmarks for, 38–39, 39f maxilla to, landmarks for, 37–38, 38f posterior, 30 2D cephalometry tracing of, 22f, 22–23 Cranial bones, 21f Craniocervical angulation, 104, 106t, 107f Craniofacial region bone density assessments in, 137 fibrous dysplasia, 150, 150f growth in, 83, 123 sickle cell anemia, 150–151, 151f Craniometry history of, limitations of, Craniostat, 3–4, 3f–4f Crista galli, 53t, 93t CVM See Cervical vertebral maturation Dental agenesis, 54 Dental plane, 42 Dental to jaw midline measurement, 59, 59f Dentigerous cyst, 149, 149f Dentition See also Teeth; specific teeth landmarks for, 32, 42–45, 43f–44f, 95t–96t 2D cephalometry tracing of, 23, 24f Descriptive statistics, DICOM, 24, 117, 133 Digital cephalometry, 14 Digital receptors, 12–13 Digital systems advantages of, 12t disadvantages of, 12t film-based systems versus, 14 Dorsum foramen magnum, 94t Downs analysis, 86 Downs occlusal plane, 29t, 36 Dual-energy x-ray absorptiometry (DXA), 135 E-line, 70, 70f Endocanthion, 66t Endochondral ossification, 113 Esthetic values, 86 Ethmoid registration point, 26t Ethnic groups African Americans cephalometric studies of, 80t–82t children, 81–82 Caucasian Americans See Caucasian American adults; Caucasian American children cephalometric parameters differences in interpretation based on, 85 selection of, 86 Exocanthion, 66t Exposure factors kilovoltage peak, 11 milliamperage, 11 Exposure time, 11 External auditory meatus anatomy of, 21f–22f as landmark, 95t D F Darkroom procedures, 12 Deep bite, 44 Degenerative joint disease, 151 Dehiscences alveolar bone, 133–134, 137f definition of, 133 Dens bicornis, 152, 152f Facial angle, 6, 29t, 39 Facial asymmetries, 47–48 Facial axis, 29t, 39 Facial axis angle, 41 Facial bones, 21f Facial convexity, 67–68 Facial height index, 41 E Facial plane, 29t, 37 Facial profile, 68–69 Facial proportions, 64, 64f Facial symmetry, 64, 65f Falx cerebri calcification, 147f Fels Longitudinal Study, 78–79 Fenestrations alveolar bone, 133–134 definition of, 133 Fibrous dysplasia, 150, 150f Field of view for cone beam computed tomography, 15 Film processors, 12 Film-based systems digital systems versus, 14 image receptors, 11–12, 12f Fishman maturational analysis, 128 Foramen ovale, 94t, 97 Foramen rotundum, 94t Foramen spinosum, 94t Forsyth Institute Twin sample, 79 FOV See Field of view Frankfort horizontal plane definition of, description of, 29t, 35–36, 115 development of, Downs’s use of, in frontal analysis, 51f illustration of, 36f Frankfort mandibular angle, 36, 39, 40f Frontal analysis anatomy in, 51f digital cephalograms in, 52 extraoral examination in, 48 frontal cephalograms for, 48f head position standardization for, 50, 51f intraoral examination in, 48 landmarks used in, 52–54, 53t, 54f lateral cephalograms for, 48f overview of, 47–49 3D cone beam computed tomography, 60f–62f, 60–61 2D cephalometry conventional, 50–52 dental to jaw midline measurement, 59, 59f horizontal symmetry, 56 intercanine width, 57, 58f intermolar width, 57, 58f landmarks used in, 52–54, 53t, 54f maxillomandibular width, 57–58, 58f measures, 54–60, 55f–60f molar relation, 57, 57f molar to jaws measurement, 59, 59f nasal width measurement, 59, 59f occlusal plane tilt measurement, 59, 59f 198 www.ajlobby.com Kula_Index.indd 198 6/20/18 8:52 AM Index M postural asymmetry measurement, 59, 59f symmetry, 54–56, 55f–56f transverse discrepancies, 59–60 vertical symmetry, 55–56, 55f–56f Frontal bone anatomy of, 21f, 23f 2D cephalometry tracing of, 23, 23f Frontal cephalogram, 2f Frontal sinus, 124 Functional occlusal plane, 29t, 37 Functional occlusal plane point, 26t G Ganglion cysts, 151 Glabella, 26t, 66t Gnathion, 26t, 31, 33f Gonial intersection, 26t Gonion, 26t, 31, 33f, 53t Greater palatine foramen, 93t, 97 Growth-prediction studies cephalometric templates for, 126–127 heredity, 124 mandible arcial growth, 126, 126f rotation during, 127f, 127–128 skeletal Class II cases, 128 skeletal maturity, 124–125, 125f 3D, 128 visual treatment objective predictions, 128 y-axis, 125, 125f digital systems, 12–13 fast, 10 film-based systems, 11–12, 12f photostimulable phosphor plates, 13 Incisal angle, 44, 44f Incisor mandibular plane angle, 75 Incisors mandibular See Mandibular incisors maxillary, 44f proclination of, 43, 86 Inferior alveolar nerve canal, 141f Inferior labial sulcus, 66t Infradentale, 26t, 31 Infraorbital foramen anatomy of, 21f as landmark, 93t, 97 Intensifying screens, 11 Intercanine width, 57, 58f Interlabial gap, 64 Intermolar width, 57, 58f Internal angle of the mandible, 29t Internal carotid artery calcifications, 146 Intracranial findings calcifications, 146–147, 147f sella turcica, 146 Iowa Facial Growth Study, 79 J Japanese Americans, 80t–81t Jaw lesions, 149–150 Jugal process, 53t H K Haller cells, 147–148, 148f Hand-wrist radiographs, 124 H-angle, 70f, 70–71 Height, 86–87 Hixon Oregon Growth Study, 79 Holdaway lip analysis, 70f, 70–71 Hounsfield units, 137 Huxley’s plane, 36 Hyoid bone position, 106t, 107f Hypoglossal canal, 95t Hypopharynx anatomy of, 101, 102f segmentation of, 110 Key ridge, 23, 23f Kilovoltage peak (kVp), 11 Krogman Philadelphia Growth Study, 79 I Image distortion, 11 Image receptors charge-coupled device, 13 complementary metal oxide semiconductors, 13 L Labial of the upper incisor, 27t Labrale inferior, 66t Labrale superius, 66t Lacrimal bone, 21f Landmarks airway analysis, 103t Broadbent’s creation of, for canines, 96t cranial base 3D, 93t–95t, 98t 2D, 28–30, 30f on curve, 18f definition of, 17 dentition, 42–45, 43f–44f, 95t–96t development of, 4–5 facial proportions assessed using, 64, 64f history of, identification of description of, 24–32, 25f, 25t–29t errors in, 89–91 importance of, mandible to cranial base, 38–39, 39f mandibular, 31–32 maxilla to cranial base, 37–38, 38f maxillary, 30–31, 30f–31f maxillomandibular, 93t molars, 42–45, 43f–44f for molars, 42–45, 43f–44f, 95t–96t overview of, 17–19 for premolars, 96t reliability of, 90–91 for Ricketts analysis, 28t soft tissue analysis, 66, 66t superimposition of, 116 3D cone beam computed tomography, 32, 33f–34f, 92, 97, 98t 2D cephalometry, 17–19 cranial base, 28–30, 30f dentition, 32 description of, 18 identification of, 24–32, 25f, 25t–29t mandibular, 31–32 maxillary, 30–31, 30f–31f 3D cephalometry use of, Lap apron, 11 Lateral cephalogram cone beam computed tomography, 15f illustration of, 2f patient positioning for, 9, 10f Lateral nasal, 53t Lateral orbit, 53t Lingual symphyseal point, 26t Lip incompetence, 64, 70 Lips, soft tissue analysis of, 69–70, 70f Long face syndrome, 102 Longitudinal studies, 76 Lower central incisors, 53t Lower facial height, 29t Lower first molar, 27t Lower incisor apex, 26t Lower incisor incisal edge, 26t Lower incisor lingual bony contact, 26t Lower molars, 53t M Machine porion, 27t Magnification description of, 11 differences in, 83–84 Magnification error, 199 www.ajlobby.com Kula_Index.indd 199 6/20/18 8:52 AM M Index Malocclusion Angle’s classification of, problems associated with, Mandible arcial growth of, 126, 126f anatomy of, 21f growth of arcial, 126, 126f rotation in, 127f, 127–128 height measures for, 41f inclination of, 127 landmarks for to cranial base, 38–39, 39f maxilla to mandible, 40f–41f, 40–41 3D cone beam computed tomography, 98t 2D cephalometry, 31–32 protrusion of, 39, 39f superimposition of, 120–121, 120f–121f 2D cephalometry tracing of, 23, 24f Mandibular incisors alveolar bone loss around, 134 inclination of, 44f proclination of, 43 protrusion of, 42 Mandibular notch, 21f Mandibular plane, 29t, 36, 36f Mandibular plane angle, 6, 39, 41 Mandibular symphysis, 24f Mastoid process, 21f, 53t Maxilla anatomy of, 21f fibrous dysplasia of, 150, 150f landmarks for to cranial base, 37–38, 38f to mandible, 40–41, 40f–41f 3D cone beam computed tomography, 98t 2D cephalometry, 30–31, 30f–31f protrusion of, 37 superimposition of, 119f, 119–120 2D cephalometry tracing of, 23, 23f Maxillare, 53t Maxillary incisors, 44f Maxillary sinuses, 110 Maxillary sinusitis, 147 Maxillomandibular width, 57–58, 58f Mean, Measures of central tendency, Measures of dispersion, Median, Mental foramen anatomy of, 21f as landmark, 93t, 97 Mentolabial depth, 69f Menton, 26t, 31, 34f, 53t Merrifield profile line, 70, 70f Michigan study, of Caucasian American children, 78 Middle turbinate pneumatization, 148 Midsagittal plane, 53t Milliamperage, 11, 14 Molar(s) landmarks for, 42–45, 43f–44f, 95t–96t relations, in frontal cephalogram, 57, 57f Molar to jaws measurement, 59, 59f Multiplanar reformation, 14, 14f N Nasal angle, 68, 69f Nasal bone, 26t Nasal cavity, 147–149 Nasal polyps, 148 Nasal width measurement, 59, 59f Nasion, 26t, 28, 34f Nasion perpendicular, 29t Nasion-basion plane, 36 Nasofacial angle, 68, 69f Nasolabial angle, 68, 69f Nasopalatine foramen, 93t, 97 Nasopharynx anatomy of, 101, 102f pathologic changes in, 147–149 segmentation of, 110 National Health and Nutrition Examination Survey, 86 National Health Examination Survey, 86 Natural head position, 104 NHANES, 86 Norms age effects on, 84–85 for Caucasian American adults, 79–80, 80t–82t for Caucasian American children See Caucasian American children norms and standards definition of, 75 esthetic values and, 86 ethnic population changes and, 84 height changes and, 86–87 longitudinal studies, 76 magnification differences and, 83–84 nutrition effects on, 84 population differences and, 86 research design problems in, 83 sex differences in, 85 Nose, soft tissue analysis of, 68, 69f Nutrition, 84 O Obstructive sleep apnea, 102 Occipital bone, 21f, 22 Occlusal plane, 29t, 36f, 37 Occlusal plane tilt measurement, 59, 59f Odontoma, 150, 150f “One-shot” image capture system, 13 Open bite, 45 Opisthion, 26t, 33f Oral-antral fistula, 149 Orbitale, 26t, 34f, 53t, 66t Oropharynx anatomy of, 101, 102f segmentation of, 110 Orthodontic treatment influences on, 75 reasons for seeking, 72 soft tissue analysis use in, 66–71, 67f–71f Ostiomeatal complex, 147 Overbite, 44, 44f Overjet, 42 P Palatal plane, 29t, 36f, 37 Paranasal sinuses calcifications of, 149 malignant neoplasms of, 149 pathologic findings in, 147–149 Parietal bone, 21f Pathologic findings cervical spine, 152, 153f craniofacial bones, 149–151, 150f intracranial, 146–147, 147f nasal cavity, 147–149 nasopharynx, 147–149 paranasal sinuses, 147–149 soft tissue lesions, 153–154, 154f temporomandibular joint, 151, 152f Patient positioning for cone beam computed tomography, 16 for lateral cephalogram, 9, 10f for posteroanterior cephalogram, 10, 10f for 2D cephalometry, 9–10, 10f Patient protection, 10–11 Peak, 11 Pg to N perp to FH, 29t Pharyngeal airway space, 103t, 104f, 105t Pharynx, 101, 102f Photostimulable phosphor description of, dosage for, 10 plates, 13 Planes, reference See Reference planes Planum sphenoidale, 22 200 www.ajlobby.com Kula_Index.indd 200 6/20/18 8:52 AM Index T PM vertical, 29t Pogonion, 26t, 31, 34f Point A, 26t, 34f Point B, 27t, 35f Point R, 27t Polyps, nasal, 148 Ponticulus lateralis, 152, 153f Ponticulus posticus, 152, 153f Porion, 27t, 32 Posterior border of the ramus, 27t Posterior nasal spine, 27t, 31, 33f Posterior vidian canals, 94t, 97 Posteroanterior cephalogram cone beam computed tomography-derived, 15f example of, 12f patient positioning for, 10, 10f Posttreatment records, Postural asymmetry measurement, 59, 59f Pronasale, 66t Prosthion, 27t, 30 Protrusion of mandible, 39, 39f of mandibular incisors, 42, 43f of maxilla, 37 of maxillary incisors, 42–43, 43f Protuberance menti, 27t PSP See Photostimulable phosphor Pterygoid point, 27t, 31 Pterygoid vertical, 29t Pterygomaxillary fissure, 23, 27t, 31 Pterygomaxillary fissure inferior, 27t Pterygomaxillary fissure superior, 27t Q Quantitative computed tomography, 135 R Radiation dose, 10 Ramal plane, 29t Range, Reference planes creation of, description of, 35 Frankfort horizontal plane See Frankfort horizontal plane illustration of, 36f for lip profile analysis, 70 mandibular plane, 36f occlusal plane, 36f, 37 palatal plane, 36f, 37 2D cephalometry, 29t Regional superimposition, 119–121, 119f–121f Registration point, 4, 5f Respiratory diseases, 102 Ricketts analysis, landmarks for, 28t Ricketts E-line, 70, 70f Risk benefit versus, 10–11 radiation dose and, 10 S Scatter radiation, 11 Selection criteria, 15 Sella turcica anatomy of, 21f, 28, 146 as landmark, 27t pathologic changes in, 146 Sella-basion, 29t Sella-nasion plane, 29t, 35, 36f Sella-nasion/Frankfort plane, 29t Sella-nasion/palatal plane, 29t Sella-nasion/ramal plane, 29t Shielding, 10 Sickle cell anemia, 150–151, 151f Sinonasal papillomas, 149 Sinonasal polyposis, 148 Sinonasal polyps, 148 Sinuses See Paranasal sinuses Sinusitis, 147 Skeletal maturity, 124–125, 125f Skeletal profile convexity, 67–68 S-line, 70, 70f Soft palate size, 106t Soft tissue analysis cone beam computed tomography for, 71–72, 72f description of, 63 facial profile, 68–69 facial proportions, 64, 64f facial symmetry, 64, 65f importance of, 66 landmarks used in, 66, 66t lips, 69–70 nose, 68, 69f orthodontic applications, 66–71, 67f–71f profile convexity, 68, 68f 2D cephalometry for description of, 71–72 tracings, 20, 20f–21f vertical fifths method of, 64, 64f Soft tissue filtration, 11 Soft tissue gnathion, 66t Soft tissue lesions, 153–154, 154f Soft tissue menton, 66t Soft tissue nasion, 66t Soft tissue pogonion, 66t Soft tissue thickness, 71 Source of radiation to the image receptor, 11 Source to object of interest, 11 Spatial resolution, of cone beam computed tomography, 132–133 Sphenoid bone, 21f Sphenoidethmoidal suture, 28 Sphenoidethmoidal synchondrosis, 28 Spheno-occipital synchondrosis, 22, 30 Standard deviation, Standards, 75 See also Norms Steiner cephalometric analysis, 128 Steiner lip analysis, 70, 70f Stereophotogrammetry, 71, 72f Stomion, 66t Styloid process, 21f Subnasale, 66t Superimposition cranial base anatomy of, 113–114, 114f 3D, 116–119, 116f–119f 2D, 114–115, 115f description of, 113 mandibular, 120–121, 120f–121f maxillary, 119f, 119–120 regional, 119–121, 119f–121f surface-based, 116 3D cranial base, 116f–119f, 116–119 maxillary, 119f, 119–120 2D accuracy of, 115 cranial base, 114–115, 115f limitations of, 115 mandibular, 119 maxillary, 119 voxel-based description of, 116–117 of mandible, 120, 120f of maxilla, 120, 121f Superior labial sulcus, 66t Supradentale, 27t, 30 Suprapogonion, 27t Synchondroses, 113 T Teeth See also Dentition; specific teeth landmarks for, 32 2D cephalometry tracing of, 23, 24f Temporal bone, 21f Temporomandibular joint degenerative disease of, 151 developmental anomalies of, 151, 152f inflammatory conditions of, 151 neoplastic conditions of, 151 pathologic findings of, 151 201 www.ajlobby.com Kula_Index.indd 201 6/20/18 8:52 AM T Index 3D cone beam computed tomography of, 61, 61f trauma-acquired anomalies of, 151 3D Cartesian system, 92 3D cone beam computed tomography cranial base superimposition, 116–119, 116f–119f description of, 2–3 evolution of, example of, 18f frontal analysis, 60f–62f, 60–61 growth prediction methods, 128 history of, 6–7 landmarks for, 18, 32, 33f–34f, 92, 97, 98t software used in, 90 2D cephalometric radiographs and, comparison between, 90 Threshold, 10 Thyroid collar, 11 Todd’s craniostat, Tonsillar calcifications, 153, 153f Total facial height, 29t Tracing digital radiographs, 24 2D cephalometry cervical area, 20, 22, 22f cranial base, 22f, 22–23 description of, 19 frontal bone, 23, 23f mandible, 23, 24f manual, 19 materials for, 19–20 maxilla, 23, 23f procedure for, 20–24, 21f–24f soft tissue, 20, 20f–21f teeth, 23, 24f Tragion, 66t Tragus, 66t Trichion, 66t 2D cephalometry anatomy involved in, 20, 21f angles, 29t history of, intraoral examination before, 19 landmarks cranial base, 28–30, 30f dentition, 32 description of, 18 identification of, 24–32, 25f, 25t–29t mandibular, 31–32 maxillary, 30–31, 30f–31f 3D cephalometry use of, 7, 92, 97 limitations of, 91 magnification caused by, 18 patient positioning for, 9–10, 10f patient protection for, 10–11 planes, 29t superimposition accuracy of, 115 cranial base, 114–115, 115f limitations of, 115 mandibular, 119 maxillary, 119 3D cone beam computed tomography and, comparison between, 90 tracing of cervical area, 20, 22, 22f cranial base, 22f, 22–23 description of, 19 frontal bone, 23, 23f mandible, 23, 24f manual, 19 materials for, 19–20 maxilla, 23, 23f procedure for, 20–24, 21f–24f soft tissue, 20, 20f–21f teeth, 23, 24f U University of Oklahoma Denver Growth Study, 78 University of Toronto Burlington Growth Study, 78 UOP Mathews Growth Study, 79 Upper airway See also specific anatomy anatomy of, 101f cephalometric measures of, 103t, 103–108, 104f–106f cone beam computed tomography of, 108 definition of, 101 obstructive disorders of, 102 obstructive sleep apnea evaluations, 102 segmentation of, 109f–110f, 109–111 3D evaluation of, 102–103 2D evaluation of, 102–103 Upper central incisors, 53t Upper facial height, 29t Upper first molar, 27t Upper incisor apex, 27t Upper incisor incisal edge, 27t Upper incisor lingual bony contact, 27t Upper incisor tip, 32 Upper lip thickness, 71 Upper molars, 53t V Vertical fifths method, of soft tissue analysis, 64, 64f Vidian canal foramen orifice, 97 Visual treatment objective predictions, 128 Vomer, 21f Voxel-based superimposition description of, 116–117 of mandible, 120, 120f of maxilla, 120, 121f Voxels, 110 X Xi point, 126, 126f x-radiation, 10 X-rays, Y y-axis, 29t, 39, 125 Z Z-angle, 70, 70f Zygion, 27t, 66t Zygoma, 53t Zygomatic, 21f Zygomatic prominence, 66t Zygomaticofrontal suture, 51f, 53t, 59 202 www.ajlobby.com Kula_Index.indd 202 6/20/18 8:52 AM www.ajlobby.com ... plane include identifying landmarks on both sides of the skull, in actuality, the points are averaged in 2D to a single point and connected by a line In other words, a plane used in 2D cephalometry. .. three landmarks was less so In contrast, both intraexaminer and interexaminer reliability for all landmark identification was high in the x, y, and z coordinates using 3D reconstructed CBCTs Landmarks... the landmarks and measures used in 2D cephalometry can be used in 3D cephalometry as well as the clinical relevance and use of 3D cephalometry for all orthodontic patients The evolution of 3D cephalometry