Ceph tracing allows for quantitative analysis of dental and skeletal structures to describe morphology, diagnose deviations, plan treatment, and evaluate changes over time. Key aspects of cephalometric analysis include identification of anatomical landmarks, angular and linear measurements of cranial structures, maxilla, mandible, and dentition. Several common analyses were described, including Steiner, Downs, Tweed, Bjork, Jarabak, Ricketts, and McNamara analyses, each with their own sets of angular measurements and norms. Ceph tracing is useful for orthodontic diagnosis and treatment planning.

1. Dr Abelrahman Mosaad , BDS

2. Ceph tracing allows
 1) Describe the subject’s dento-facial morphology
 2) Quantitative description of morphological
deviations
 3) Make diagnostic and treatment planing
decisions
 4) Evaluate change over time - treatment induced
and growth process

3.  Skeletal analysis
 Dental analysis
 Vertical analysis

4. Cephalometric evaluation
 Identification of anatomic landmarks
 Landmarks: stable reference structures and maxillary
and mandibular skeletal and dental
 Graphically relating the dento-facial elements to these
reference structures
 Angular and or linear measurements

5.  Evaluating relationships, both horizontal and vertical
of 5 major functional components of the face:
 the cranial base
 the maxilla
 the mandible
 the maxillary dento-alveolus
 mandibular dento-alveolus

6. Landmarks
(A)
Deepest concavity on anterior profile of
maxilla
(B)
Deepest concavity on anterior surface of
mandibular symphysis
Anterior nasal spine (ANS)
Tip of anterior process of maxilla
Posterior nasal spine (PNS)
Tip of posterior nasal spine of maxilla
Pogonion (Pg)
Most anterior point on bony chin
Nasion (N)
Deepest point on frontonasal suture

7. Sella (S)
Midpoint of sella turcica
Orbitale (Or)
Most inferior point on orbital margin
Porion (Po)
Upper and outermost point on bony external
auditory meatus
Condylion
Most superior posterior point on the
condylar head
Gnathion (Gn)
The most anterior inferior point on the
mandibular symphysis
Menton (Me)
Lowest point on mandibular symphysis
Gonion (Go)
The most posterior inferior point on the
angle of the mandible

8. Condylion
Most superior posterior point on the
condylar head
Articulare
Intersection of the posterior border of the
neck of the mandibular
condyle and the lower margin of the
posterior cranial base
Basion
Posterior limit of midline cranial base

9. Planes SN line
A line joining sella(S) and nasion(N)
representing the anterior cranial base
FH Frankfort horizontal plane
A line joining porion(Po) and orbitale(Or)
OP Functional occlusal plane
A line drawn between the cusp tips of the
permanent molars and the premolars or
deciduous molars
Md Mandibular plane
A line joining gonion(Go) and menton(Me)
Mx maxillary plane
A line joining ANS &PNS
E Ricketts ’ E - line
A soft tissue line tangential to chin(Pg soft
tissue ) and nasal tip

10. SNA
SNB
ANB
MMPA
Y-axis (growth) Angle between Frankfort
H. plane and line from sella turcica and
Gnathion
Mandibular plane angle (MPA) SN-Go.Me
U1-L1 angle (interincisal angle)
L1-MP

11. Types of tracing
 Manual
 Digital or computerized : eg (dolphin) software for
Windows , (quick ceph ) software for MAC

12. Analyses (analytic approaches) by
various authors
 Many authors have their analytical approaches to
analize the cephalometric radiograph , each approach
has its characteristics and values

13. *Steiner analysis
- developed Steiner Analysis in 1953. He used S-N plane
as his reference line in comparison to FH plane due to
difficulty in identifying the orbitale(Or) and
porion(Po)
- drawbacks : reliability on N point , S-N plane rather
than cranial base
-

14.  Skeletal : SNA , SNB , ANB , SN-OP , SN-MdP
 Dental : U1-NA , U1-NA mm , L1-NB , L1-NB mm , U1-
L1 , L1-chin mm
 Soft tissue : S.line ,, Line formed by connecting Soft Tissue
Pogonion and middle of an S formed by lower border of the nose

16. Skeletal
SNA 82
SNB 80
ANB 2
SN-OP 14
SN-MdP 32

17. U1-NA
U1
inclination
*= 22
*= 4mm
L1-NB
L1 inclination
*= 25
*= 4mm
Could Evaluates
the chin also
U1-L1 angle
*= 130
Dental analysis

18. Soft tissue analysis

19. Egyptian Norms

20. Wits analysis :
- jacobson 1975 in soutthafrica Witwaterssand
university
- it measured the AP positions of the jaw to each other

21. Wits
Aprasial
*average jaw
relationship is -1 mm
in Males (AO is behind
BO by 1mm) & zero
mm in Females (AO
and BO coincide)

22. • Its clinical significance is that :
• in a Class 2 skeletal patient, AO is located ahead of
BO
• In skeletal Class 3 patient, BO is located further ahead
of AO
• Therefore, the greater the witts reading, the greater
the jaw discrepancy

23.  Drawbacks to Wits analysis includes:
Left and Right molar outlines may not always coincide
Occlusal plane may differ in mixed vs permanent
dentition
If curve of spee is deep then it may be difficult to
create a straight occlusal plane
Angulation of functional occlusal plane
to pterygomaxillary vertical plane was shown to
decrease from age 4 to 24

24. *Down Analysis
 by Downs in 1948
 It is one of the most frequently used cephalometric
analysis.
 Downs analysis consists of – 10 parameters (5 skeletal ,
5 dental )

25.  according to down “balance of face is determined by
position of mandible”.
 in order to find this balance downs use frankfurt
horizontal plane (FH)as a reference plane i.e. line from
anatomic porion(po) to orbitale(or)
 Downs elected to use this plane as a reference base
from which he determine the degree of retrognathism,
orthognathism, or prognathism

27.  Skeletal parametters :
- facial angle :Angle between Nasion-Pogonion and Frankfurt
Horizontal Line (N-Pg & FH )
- angle of convexity : Angle between Nasion - A point and A point -
Pogonion Line (N-A & A-Pg)
- Mand plane angle : Angle between Frankfort horizontal line and
the line intersecting Gonion-Menton(FH &Go-Me)
- y (growth) axis : Sella Gnathion to Frankfurt Horizontal Plane (S-
Gn & FH)
- AB plane angle : Point A-Point B to Nasion-Pogonion Angle (A-B
& N-Pg)

28. Facial Angle
*FH&N-Pg
* Mean = 88
(82-95)
*Mandibular
prominance
Angle of convexity
* N-A & A-Pg
* Mean = 0
(-8 - 10 )
*+ve suggest prominent
maxilla
* -ve suggests prognathic
profile
Mand. Plane angle
*Go-Me & FH
* Mean = 25
(17-28)
* >28 , suggests
prominence , retrusion ,
LAFH ? , lower
prognosis vlaues , ….

29. Y (growth) axis angle
* S-Go & FH
* Mean =58
( 53-66 )
* Downward forward
position of chin to FH
* Derease = horizontal
growth rather than
vertical
A-B plane angle
* A-B & N-Pg
* Mean = -4
(-9 to 0 )
* Usually –ve except class 3 &
class 1 prominent chin
* High –ve values suggest
class 2

30.  Dental parameters :
- occlusal plane cant angle : angle between OP & FH
- U1 - L1 angle :
- L1 - Occlusal Plane Angle :
- L1 - Mandibular Plane Angle :
- U1 to A-Pog Line (mm) :

31. occlusal plane angle
* OP & FH
* Mean = 9
(1-14 )
* slope of occlusal
plane
*Decrease in long rami
* Increase in class 2
facial
U1-L1
* Mean 135
(130-150)
* < 130 = protruded
anteriors , stability ??
L1 – Occ.Plane
* Mean = 14.5
(3.5-20)
* > 20 suggests
proclined L1

32. L1 – Mand.Plane
*Mean = 90
(85-95)
* > 95 suggests
proclined L1
U1 – (A-Pg)
*Mean 2.7
( -1 to 5 )
*> 5 suggests proclined U1

33. * Tweed Analysis
 Charles H. Tweed developed his analysis in the year
1966
 In this analysis, he tried describing the lower incisor
position in relation to the basal bone and the face.
 This is described by 3 planes. He used Frankfurt
Horizontal plane as a reference line
 Useful in extraction planning and dertermine the
position of lower anteriors after ttt , so the prognosis
could be predicted

35.  Angles ( of the triangle ):
 L1-MP
 L1-FH
 FH-MP

36.  FH-MP > 25 vertical growing
 FH-MP < 25 horizontal growing
 Prognosis is good when FH-MP 16-28
 Prognosis is fair when FH-MP 28-35
 Prognosis is bad when FH-MP > 35 extraction will
worsen the results
 Tweed stressed the importance of the FH-L1 angle
recommending that it be maintained at 65° to 70°

37. Bjork analysis
 Arne Bjork was developed in 1947 based on 322
Swedish boys and 281 conscripts
 a facial polygon which was based on 5 angles
 7 structural signs which indicates the mandibular
rotator type
 The analysis is based on 5 points: Nasion (Na), Sella
(S), Menton (Me), Go (Gonion) and Articulare (Ar)

38.  5 angles (facial polygon) :
- Nasion Angle : Formed by line connecting ANS to Nasion to
Sella (ANS-N & N-S )
- Saddle or Cranial Base Angle : Formed by line connecting
Nasion to Sella to Articulare ( N-S & S-articulare )
- Articular Angle : Formed by line connecting Sella to Articulare
to Gonion ( S-articular & articular-Go)
- Gonial Angle : Formed by line connecting Articulare to Gonion
to Gnathion (Art-Go & Go-Gn)
- Chin Angle : Formed by line connecting Infradentale to
Pogonion to the Mandibular Plane ( infradental –pog & pog-
MandP )

40.  7 structural signs :
1.Inclination of the Condylar head
2.Curvature of the Mandibular canal
3.Shape of the lower border of mandible
4.Inclination of the Symphysis
5.Interincisal angle
6.Intermolar or Interpremolar angles
7.Lower Anterior face height

41. Jarabak Analysis
 developed by Joseph Jarabak in 1972
 The analysis interprets how the craniofacial growth
may affect the pre and post treatment dentition
 The analysis is based on 5 points: Nasion (Na), Sella
(S), Menton (Me), Go (Gonion) and Articulare
(Ar). They together make a Polygon on a face when
connected with lines

42.  These points are used to study the anterior/posterior
facial height relationships and predict the growth
pattern in the lower half of the face.
 Three important angles used in his analysis are:
- 1. Saddle Angle - Na, S, Ar
- 2. Articular Angle - S-Ar-Go,
- 3. Gonial Angle - Ar-Go-Me.

44.  In a patient who has a clockwise growth pattern, the
sum of 3 angles will be higher than 396 degrees.
Posterior & anterior face height ratio:

45. Ricketts analysis
 Aim:
- to clarify the science of cephalometrics and free it
from some of the confusion and misuse pervading the
discipline. he also wanted to point out that the use of
cephalometrics to describe and classify a malocclusion
was one thing (analysis) and the act of treatment
planning as a result of this classification and
description was another thing (synthesis)

46. # CC= Center of cranium
point of intersection of
the basion Nasion plane
and the facial axis.
#DC=Point in the center of
condylar neck along the
Ba- Na Plane
# PM= Suprapogonion/
protrubrance menti , The
point at which the
symphysis mentalis
changes from convex to
Concave
# Ptv= point of
intersection of thedistal
outline of ptm fissure and
perpendicular to the F-
Hplane.
#Xi= Geometric center of
the ramus

47.  1960
 Superficial Analysis:
- 1.Facial Angle
- 2. Facial axis( x-y axis)
- 3.Facial Convexity( A- Pog)
- 4. Lower Incisor position and angulation.
- 5. Upper Incisor position
- 6. Esthetic Plane
 Deep Structure Analysis:
- 1. Cranial Base Angle
- 2. Cranial Base Length
- 3. Condyle or Fossa position
- 4. Condyle Axis
- 5. Mandibular Plane Angle

48.  1981
 I. Lateral Analysis
- 1.Facial Axis
- 2.Facial Angle
- 3.Mandibular Plane Angle
- 4.Mandibular arc( Mandibular Bend)
- 5.Point A to Facial plane
- 6.Palatal Plane to Frankfort horizotal plane
- 7.Denture Height /lowerfacial height/ Oral Gnomom
- 8.Lower incisor to Apog line(mm) and (Angulation)
- 9.Upper Incisor to Apog(1960)
- 10.Upper molar to Ptv
- 11.Interincisal Angle
- 12.Lower Lip to E Line

49.  II. Frontal Analysis
- 1. Nasal width
- 2.Mandibular width
- 3.Maxillary width
- 4.Molar width
- 5.Actual intermolar width
- 6.Intercuspid width
- 7.Denture Symmetry
- 8. Upper to Lower Molar relation

51. Xi point

52.  Mandibular arc (Mandibular
Bend):
 It measures the angulation of
the condylar process to the
body of the mandible. It is the
angle between the Condyle
axis(Xi through center of
condyle neck) Posterior extent
of the corpus axis(pm to Xi)
 Norm = 26º+/- 2º A total
increase of 3º is seen every 5
year

53.  Fronatal analysis (PA)
1.Nasal cavity width
2.Mandibular width
3.Maxillary width
4.Symmetry
5.Intermolar width
6.Intercuspid width
7.Denture symmetry
8.Upper to lower molar
relation

54. McNamara analysis
 James Mcnamara 1984
 Analysis of craniofacial complex , via 5 major sections
which are :
- maxilla to cranial base
- mandible to cranial base
- maxilla to mandible
- dentition
- airway

55. Maxilla to cranial base

57. Mandible to cranial base

58. Maxilla to Mandible

59.  “small” , “medium” , “large” are used to describe the
size
 Maxillomandibular difference = midfacial length –
mandibular length
 In small individuals the difference should be between
20 and 23 mm
 In medium sized persons the difference should be
between 27 and 30mm
 In large individuals the difference should be 30 and
33mm

60.  If the discrepency is greater or smaller than the
normative values --------- Then next step is to
identify which jaw is small or large or both

61. # Lower face height in the mixed dentition with a midface length of
85mm should be 60 -62mm
# Lower face height in medium – sized individuals with a midface
length of 94 mm should be 65 -67 mm
# Lower face height in large individuals with midface length of
100mm should be 70 -73mm
Vertically

62. Mandibular plane angle :
• It is the angle between frankfort horizontal and the line drawn
along the lower border of the mandible through constructed gonion
and menton.
• Mandibular plane angle is 22º ±4º

63. Facial axis angle :
•Angle between a line from
basion to nasion and the facial
axis (PTM to Gn)
•In a balanced face , the facial axis
angle is 90 º
•< 90º (- ve value ) indicates
excessive vertical development
•> 90º (+ ve value) indicates
deficient vertical development

64.  Dentition
 We need to know the relationship between
dentition ( mainly anteriors ) in the both
jaws to the underlying basal bone .
 The dentition can be neutral , protrusive or
retrusive

65. MAXILLARY INCISOR POSITION
:
•To measure the position of the
maxillary incisors in relation to its
apical base
•A vertical line is drawn through
point A parallel to nasion
perpendicular
•The distance from point A to facial
surface of incisor is measured .
• It should be 4-6 mm

66. 11 mm severe U1 protrusion

67. MANDIBULAR INCISOR
POSITION :
•The distance is measured between
the edge of the mandibular incisor
and a line drawn from point A to
pogonion (A – Pog line)
•In well balanced face, the distance
should be 1-3 mm.

68.  Assessment of vertical position of lower incisor:
- If the curve of spee is excessive , a decision must be made
whether the lower incisor should be intruded or molars to
be extroded.
- The determining factor is the lower anterior facial height.
- If the lower facial height is normal or excessive the lower
incisor should be intruded.
- If the lower anterior facial height is deficient then the lower
incisor should be extruded or the buccal segments further
erupted.

69. Air way
UPPER PHARYNX:
 Width is measured from a point
on the posterior outline of the soft
palate to the closest point on the
pharyngeal wall
 Average : 15 – 20 mm in width
 A width of 2mm or less in this
region may indicate airway
impairment.

70.  LOWER PHARYNX :
 Its width is measured
from the point of
intersection of the
posterior border of the
tongue and the inferior
border of the mandible to
the closest point on the
posterior phanyngeal wall
 Average : 11 – 14 mm

71. Conclusion
 Lateral ceph analysis is not a must in orthodontics it is
a supplemental diagnostic aid
 Keep your analysis as simple as you can
 Focus on what you need and pick it up

72. Eg.
(A-P)
*SNA *SNB *ANB i.e. class I , II , III
Vertical
*MMPA i.e high , average , low i.e. vertical growing
*facial height i.e. LAFH
Dental
*(upper1-Max) i.e. proclined , average , retroclined
*(lower1-Mand) i.e. proclined , average , retroclined

74. Thanks a lot