Cephalometric Radiographs and Analysis Techniques
- Cephalometric analysis relies on cephalometric radiography to study relationships between bony and soft tissue landmarks.
- Cephalometric radiographs are taken using a Cephalometer, a head-holding device invented by Holly Broadbent Sr. in 1931.
- The Cephalometer ensures standardised and comparable craniofacial images on radiographic films.
- Cephalometry requires positioning the X-ray source five feet away from the mid sagittal plane.
- The film is placed 15 cm from the mid sagittal plane for accurate measurements.
- Distance affects cephalometric image magnification, with a shorter object-to-film interval reducing magnification.
- Lateral and frontal cephalograms are two-dimensional projections of three-dimensional structures, which can cause challenges in analysis.
- Traditional radiography can introduce magnification and distortion, blurring important details.
- Lateral cephalometric radiographs are taken with the X-ray beam perpendicular to the patient's sagittal plane.
- Natural head position is a standardised orientation used during analysis of dentofacial morphology.
- Natural head position allows for the use of an extracranial reference line, such as the true vertical line.
- The true vertical line is generated by gravity and offers a consistent reference for cephalometric analysis.
- Radiographs obtained in natural head position provide accurate measurements and reference points.
- Posteroanterior (P-A) cephalometric radiographs are taken with the X-ray beam perpendicular to the patient's coronal plane.
- Various analyses have been developed for evaluating P-A cephalograms, such as Grummon, MSR, Hewitt, Svanholt-Solow, and Grayson analysis.
- P-A cephalograms provide valuable information about the skeletal relationship between the maxilla and mandible.
- The P-A cephalometric radiograph is taken with the X-ray source positioned behind the head and the film cassette in front of the patient's face.
- Cephalometric tracing involves overlaying a drawing onto a cephalometric radiograph.
- Tracings are created digitally or by copying outlines onto acetate paper.
- Tracings facilitate cephalometric analysis and can be used for superimpositions to evaluate treatment and growth changes.
- Tracings are typically done on matte acetate paper using a lead pencil.
- Anatomical structures are traced, and bilateral structures are represented by an average line.

Analysis Techniques
- Holdaway Ratio (Wits Analysis): States that chin prominence should be as far away as the farthest point of the lower incisor should be. Measures the AP positions of the jaw to each other. Clinical significance: in Class 2 skeletal patient, AO is located ahead of BO; in Class 3 skeletal patient, BO is located ahead of AO.
- Delaire Analysis: Based on reciprocal proportion and balance. Does not use standard deviation. Gives the ideal architecture the patient should have based on skull shape, posture, and functions.
- Downs Analysis: Based on 5 angles and 7 structural signs indicating mandibular rotator type. Provides measurements and standard deviations for various skeletal and dental angles.
- Tweed Analysis (Triangle): Describes lower incisor position in relation to basal bone and face. Uses Frankfurt Horizontal plane as reference line. Uses 5 points to study anterior/posterior facial height relationships and predict growth pattern in lower half of face.
- Harvold Analysis: Establishes standards for unit length of maxilla and mandible. Difference between unit lengths describes disharmony between jaws. Also examines lower facial height from upper ANS to Menton.

Superimposition Techniques
- Cephalometric radiographs can be superimposed to visualize growth and tooth movement.
- Superimposition is done on stable anatomical structures.
- The Structural Method is a commonly used superimposition method.
- Superimposition helps in orthodontic treatment planning and evaluation.
- The Structural Method divides superimposition into three categories: cranial base, maxillary, and mandibular.
- The Structural Method is based on studies by Arne Bjork, Birte Melsen, and Donald Enlow.
- It divides superimposition into cranial base, maxillary, and mandibular categories.
- Cranial base landmarks include the sella turcica and Walker point.
- Maxillary landmarks include the zygomatic process.
- Mandibular landmarks include the chin and mandibular symphysis.
- Landmarks for cranial base superimposition include the sella turcica and middle cranial fossa.
- Other landmarks include the cribriform plate and fronto-ethmoidal crests.
- Superimposition also considers the trabecular system in the anterior cranial fossa.
- The cerebral surfaces of the orbital roofs are important for cranial base superimposition.
- Mandibular superimposition considers the contour of the chin.
- Inner cortical structures and trabecular structures at the inferior border of the mandibular symphysis are important landmarks.
- Trabecular structures related to the mandibular canal are considered in mandibular superimposition.
- The lower contour of a molar germ is used for mandibular superimposition.
- Maxillary superimposition involves the anterior contour of the zygomatic process.
- Maxillary superimposition helps assess changes and movement in the maxilla.
- Superimposition techniques are used to evaluate orthodontic treatment outcomes.
- Superimposition is an essential tool in cephalometric analysis and treatment planning.

Soft Tissue Cephalometric Analysis
- Published in September 1999 in the American Journal of Orthodontics and Dentofacial Orthopedics, Volume 116, Issue 3.
- Used for the diagnosis and treatment planning of dentofacial deformity.
- DOI: 10.1016/S0889-5406(99)70234-9
- PMID: 10474095

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