Tag Archive for: ceph analysis

Increased Demand for CBCT

During the past months the dental market has been buzzing about CBCT Scanners and Ceph images. This is mainly due to the increased demand for CBCT scanners, and the superior imaging quality yet lower radiation doses it delivers. Initially, this new technology was only used to evaluate jaw bones (for implants or surgery), but quickly advanced to panoramic and Cephalometric imaging capabilities CBCT


What is CBCT (Cone Beam Computed Tomography Scanners)?

A medical imaging technique where the x-rays are divergent, forming a cone. The 3D technology and panoramic imaging enables very high resolution pictures, yet through low radiation. Cone-Beam Computed Tomography (CBCT) is a new technology which is dedicated to imaging change from a two dimensional to a three dimensional capability and has created a revolution as it enables substantial improvement in operative and surgical procedures.
Some of the advantages of this new technology include: more rapid acquisition of data, shorter examination time, reduced image distortion, and best of all – one quarter to one fifth of the price of the standard CT machine. In addition, during the last decade manufacturers were able to produce small enough machines to be used inside dentals offices.

According to recently conducted research (*Transparency Market Research), the Global cone beam computed Tomography (CBCT) market expected to reach US$ 960.8 million in 2023. This demonstrates a clear high demand from clinics, and provides an increased incentive for further technology development and improvements. There are currently various leading manufacturers, but overall the demand for CBCT is sometimes said difficult to fulfill.

What about radiation??

Zero x-rays carry zero radiation! But, that’s almost impossible when treating patients these days. Saying that, the average radiation exposure for individual, panoramic and Cephalometric images have decreased. This is mainly due to improved protocol and procedures established for both clinicians and patients. It is also due to advancements in technological solutions such as the CBCT scanners. Comparison with patient dose reported for maxillofacial imaging by conventional CT (approximately 2000 mSv) indicates that CBCT provides **substantial dose reductions of between 98.5% and 76.2%.

What are common uses for Dental Cone-Beam CT?

The technology is normally used for treatment planning of orthodontic issues. These include surgical teeth implantation planning and placement, disorders diagnostics, tumor detection and treatments, pain locations, reconstructive surgery, and Cephalometric analysis.
Depending on the procedure type the patient is normally required by the practitioner to sit in an exam chair, while the scanner is used. Afterwards, once the results are ready, they will be discussed with the patient and proceed to the proper treatment.

Regardless of the technology used at dental clinics, CephX still provides the prime analysis and reports with the highest accuracy and substantially lower processing time. CephX is a fully-featured cloud system, where you can create patient records, upload X-Ray and profile photos, and be sure you can always access past records, photos and analyses as they are stored, secured and backed-up daily!

CephX online cephalometric trace & analysis is available at https://cephx.com/

For more information please contact info@cephx.com or 1-800-992-1499

Read more about Interview with Dr. Greenfield – Non extraction technique

Interview with Dr. Greenfield – Non extraction technique

Dr. Greenfield is the author of “Nonextraction Orthodontics, 98.5% Nonextraction Therapy using Coordinated Arch Development®“, a textbook that has been published in four different languages, and is now in its 2nd edition, with over 1,100 pages and 7,000 images.

During the making of his textbook Dr. Greenfield made extensive use of CephX.com services to get unbiased Cephalometric analyses, and through that we came to learn about his 98.5% nonextraction treatment philosophy entitled; “Coordinated Arch Development®.”


Dr. Greenfield was invited to present his philosophy at the 1996, 2003, 2004 and 2005 scientific sessions of the American Association of Orthodontics, and was asked to defend his Nonextraction approach at numerous sessions, including:

  • The 1992 and 2002 College of Diplomates of the American Board of Orthodontics annual sessions
  • The 1993 Southern Association of Orthodontists’ annual session
  • The 1998 Northeastern Society of Orthodontists’ annual meeting
  • The 1999 American Academy of Pediatric Dentistry annual session
  • The 2001 Japanese Orthodontic Society Annual session.



Let’s start with your background information

I am a graduate with honors from Howard University College of Dentistry in 1971.  After receiving my Master of Science in Orthodontics from Boston University in 1973, I continued as a Clinical Instructor until 1976.  In 1984 I became a Diplomate of the American Board of Orthodontics and was invited to exhibit my board cases at the A.A.O. meeting that same year.

How and when did you develop your NON-extraction technique?

“Coordinated Arch Development®“ is a nonextraction philosophy more than a technique.   Its roots were formed in the early 1940’s from the work of my mentor Dr. Norman Cetlin, arguably one of the greatest orthodontic clinicians in the modern era.  The Tweed extraction philosophy was very popular at the time and consequently Cetlin’s early efforts were overshadowed.   In the 1970’s and 1980’s, long term nonextraction cases were exhibited at the AAO meetings which aroused great interest in the philosophy. Cases 25 years out of retention were also submitted to the University of Michigan for evaluation of the technique’s long term stability.

Please explain “Coordinated Arch Development®” philosophy

Achieving long term stability requires controlled upper and lower 1st molar movements, simultaneously, in all three planes.  Light continuous forces of similar magnitude are utilized to “coordinate” these movements.  The final orientation of the molars creates occlusal forces through the long axes with the absence of deflective contacts during function.  The molars are placed well within cancellous bone and the “neutral zone” to enhance their compatibility with the periodontium and soft tissue envelope.  The resultant position of the anterior segment provides proper incisal guidance and maximizes facial and dental aesthetics. nextortho-sample1
nextortho-sample3 nextortho-sample2a

What has changed in the industry since the book was written?

The pendulum has definitely swung towards a nonextraction treatment approach the last several years.   People want a full radiant smile rather than seeing dark corridors at the corners of a smile.   However, there is high quality nonextraction treatment and there is quick nonextraction treatment.   The new generation of orthodontists must lean towards quality in this delicate balance.   The Doctor must remember that the treatment decisions they make today will impact the patient’s health for the rest of their life.   Throughout the Textbook, the principles for attaining long term stability for their patients are explained in vivid detail, and must never be compromised for the sake of “efficiency.”

What can you tell us about the book writing process?

The writing of the Textbook took approximately 4 years.   Without the encouragement of my wife, the project would never have been completed.   She typed and proof read the entire manuscript while I compiled long term records on my patients.  In fact, my youngest daughter whose a graphic artist, designed the cover – it truly was a family effort.   I had 3 contributing editors write 3 chapters in the textbook, and CephX , under the expert direction of Danny Abraham, traced every cephalometric x-ray in the textbook.  CephX unbiased data not only made my job easier, but it contributed greatly to the success of the publication.   We also included 10 cases  from my study club in Japan.   I specifically chose Japanese cases since they are considered to be among the most difficult nonextraction cases in the world.  It was my way of confirming the versatility of this philosophy no matter how difficult the case. nextortho

When and where was the book distributed thus far?

The textbook has been published in four different languages, and is distributed throughout the world. It is available in hard copy (Amazon), and in digital (Downloadable) format.  The information contained in the Textbook is NOT available anywhere else, so Doctors that have purchased the Textbook are very appreciative of its content.  I constantly receive hundreds of emails from Doctors around the world thanking me for sharing this information – it has prevented the unnecessary extraction of teeth in thousands of children and adults.

My ultimate goal is to create optimum LONG TERM function and radiant smiles for our patients worldwide.

Can you share with us feedback you received about it?

The feedback has been extremely positive – beyond my wildest imagination.  Doctors have emailed me thousands of photos of their cases treated successfully with the information contained within the textbook.   Many Doctors wished they had this knowledge earlier in their career.  In fact, my Japanese study club recently won 1st place for their case presentation at the American Association of Orthodontists Annual session.

Do you plan to publish a follow up book to extend the technique?

The textbook is now in its 2nd edition and still very popular.   The Chinese publication has just been released in December, 2015.

Instead of publishing a 3rd edition, we have now expanded our FREE WEBSITE, NEXTORTHO.COM to include VIDEOS of all the techniques in the textbook, and 100 nonextraction cases illustrated in vivid detail in our “library of cases.”  By making the website FREE, we have made the “Coordinated Arch Development®” nonextraction philosophy accessible to students and clinicians in every country.   This will expedite my goal of preventing unnecessary extractions in children worldwide.

How do you feel about CephX – how relevant is the online tool for the industry – what is the added value you see in Cephx to the industry

The value of CephX to me as a clinician, author and researcher is extremely valuable for different reasons.   First, it removes all bias from my cephalometric measurements.   This is very important in the minds of Doctors who purchase my Textbook.  If I traced the X-ray, they may be concerned that the measurements were skewed in my favor.

The tracings are performed by a well-trained 3rd party who does it all day long.   Thus the quality of the tracings and measurements are consistently excellent.   Our diagnoses & treatment plans are certainly enhanced by their quality & consistency.

CephX has all the popular cephalometric analyses on their website.   Therefore, the Doctor can refer to any of the analyses for a specific measurement to aid his diagnosis – how important is that!   In fact, Doctors who purchased my textbook were allowed to contact CephX to gain access to any of my case measurements if they wanted to view their favorite analysis online.   Finally, I cannot say enough about the excellent support of CephX I received for the past 15 years.   Anytime there was an issue, it was resolved the same day in a courteous and professional manner via email.

The Doctor does not have to train a staff member to perform this task, nor train another staff member should the original employee leave the office.   This is a real time saver in a busy office.

An author or researcher can focus on their research rather than worry about the accuracy of their tracings.   Placing this task in the hands of an expert improves the overall quality of the final product.

Finally, CephX may not have invented cephalometric tracing, but CephX certainly defines it.

Dr. Greenfield’s textbook is available at www.nextortho.com

CephX online cephalometric trace & analysis is available at https://cephx.com/

For more information please contact info@cephx.com or 1-800-992-1499

Read more about Increased Demand for CBCT

How do patients choose their Orthodontist

Choosing an orthodontist carries great responsibility, as it has a very clear effect on a person’s aesthetics and health. The majority of orthodontic patients are children, leaving the responsibility on parents to choose the right caregiver and treatment type. This task is taken very seriously, and followed by weeks of research.

In this article, we have gathered the considerations that help parents and patients in general make up the final decision – who to choose as their Orthodontist.



Awareness and knowledge – of the treatment’s importance, orthodontist’s existence

Acknowledgement of orthodontists and their expertise is a vital first step. A patient must distinguish between a dentist’s role and an orthodontist’s role, while choosing whom to approach for treatment.

Awareness can be achieved through schools and teachers, family physicians, governmental programs and the media.

Need and Treatment Motivation

Today, aesthetics is very important. Our role models showcase perfect smiles in the media and we want our kids and ourselves to have that too. In addition, there is also the element of healthcare when it comes to orthodontics (sleep disorders, painful teeth misalignment).

The patient’s need has to be there, either from the healthcare or aesthetics sides, in order to turn to a specialist. If the problem isn’t troubling enough, the condition may be left untreated.

Credibility, References and Trust – of the Practice and Orthodontist

Education is part of the credibility Orthodontists have. Patients normally check their physician’s education, and certification, while also want to ensure they are a Board Certified. This demonstrates a higher commitment and dedication, given the standards requirements.

References (recommendations by experienced friends) are also an important element patients look for. Word-of-mouth, recommendation, testimonials all act as great reference for a patient. 

Technologically Equipped Clinic

People expect to receive leading treatment and to also fully understand it. The technology is available through improved software, larger screens, full images, laser innovations, advanced treatment materials, online Cephalometric analysis…etc. Orthodontists willing to ensure their clinic is staffed with leading technology and able to showcase it, are more likely to gain the customer.

Personal Connection

Trusting the doctor from an education perspective isn’t enough – if the personal connection isn’t there. Each patient looks for an assuring and easy-going caregiver, who is willing to listen to their questions, concerns and fears. Many doctors today may be very well educated, with lots of experience, but are less attentive to the emotional side of the treatment.  In situations as such, the patient will prefer to seek a different doctor, especially if there is a larger choice available nearby.

Affordable Costs & Payments

Affordable treatment prices are an important part of the patient’s decision making process, however it’s normally mentioned after overcoming the barriers mentioned earlier. It’s vital for the patient to first check their treatment type, and only then find out if they can afford it, considering various payment/finance options.

Many practices provide different payment terms, specifically since the actual orthodontic care is normally spread out through several months or even years.

Availability and Location

A treatment plan may be laid out over months and years, which is why patients tend to also choose their orthodontist according to the practice’s location and ease of travel.  Ensuring they can make the appointments, without loosing too much work or school days, due to traffic or parking issues is  important.


Every Orthodontist can play a major role in every single part of the listed items. Awareness creation, motivation, market education

  • Marketing plan – Maintain an online and social marketing plan, as that’s where most Patients start their research nowadays! Be sure to be listed on local/online directories, community organizations, healthcare programs.
  • Keep up to date – with new technologies, innovations, and treatment types. This will ensure your market competitiveness positioning.
  • Have your references, case studies, education easy to find. These can be publicized on the web, social media channels, and reviews by local/national magazines.
  • Make sure you choose a friendly staff with a welcoming and warm attitude.
  • Give back to the community – It’s always great to provide some pro-bono help. The community appreciates it, and increases your clinic’s credibility
  • Be ready for lots of questions, even if they sound repetitious or obvious.
  • Position your clinic in a good location, with good access to public transportation and parking.




Read more about A Brilliant Way to Minimize Metal Artifacts in CBCT Scans
and New Dental Technology

Orthodontics – 2015 Summary

2016 already started, holding promises for another year of growth in the fields of dentistry and orthodontics. But it’s always important to look back to get an overview of trends and changes in the business, and conclude insights that may help us down the road.



According to a survey conducted in the USA on 2015, Orthodontists spend a weekly average of 30-40 hours  with patients This does not include time spent on practice management, staff recruitment and training, marketing and general business management, which most of it can outsourced.


The demand for orthodontics in the USA is comparatively higher than the rest of the world.
According to the WFO (World Federation of Orthodontists), in 2015 the number of orthodontist in USA is over 9,000. The European countries have additional 10,000 orthodontists (500 in Belgium, 350 in Czech, 200 in Denmark, 150 in Finland, 2500 in France, 3000 in Germany, 450 in Greece, 150 in Ireland, 1300 in Italy, 250 in Norway, 1100 in Poland, 300 in Sweden, 300 in Netherlands, and 1,200 in the UK). Due to lack of oral health awareness, lack of literacy, poor economic condition the demand for orthodontics in Asia is significantly lower compared to the rest of the world. Market research shows that only 1,500 orthodontists are working around Asia, leading to a low ratio to the large Asian population.



History demonstrates that during the past couple of decades it was normally children and teenagers were the main target patients of orthodontics. But now in 2015, this situation has changed for adult population – significantly more are concerned with correcting or improving the position of their teeth and correcting any malocclusion.

Recent study shows that over 1 million North Americans are taking orthodontics treatment by wearing braces in present days. 


The way forward for orthodontics is challenging yet promising bright. Challenges are primarily characterized with barriers for new entry, lack of awareness to new techniques and high cost of advanced treatments. For emerging markets, mainly around Asia, increasing demand for orthodontics is held back by less professional, with many of registered ones actually working in governmental hospitals.

Nevertheless, the bright future of Orthodontics is driven by new era of dental science, mainly clear aligners, rising dental aesthetic standards, rapid GDP growth in Asian markets and new technologies enabling less manpower for running Orthodontic practice, such as cloud services.Despite of greater competition, higher patient expectations, and increased legislative involvements, 5 years from now expect to see an increased usage trend of digital orthodontics including Laser technology, x-rays, White light, 3D printing, Intraoral Scanners, and Digital Photography which is expected to have the market size around $3.6 billion in the global dental market


Are you ready to attain excellence to brace yourselves for 2016?

Read more about Case study – using CephX in imaging centers
and Best Orthodontic Marketing Ideas

Cephalometric Analysis

What is Cephalometric Analysis?

Cephalometric analysis is commonly used by dentists and orthodontist to study skeletal relationships in the craniofacial complex. However, cephalometric analysis also has many other uses. They can be uses to predict future changes, study the success of ongoing treatment plans, evaluate a patient’s dentofacial proportions and help doctors recognize abnormalities.

For these reasons, cephalometric analysis is paramount when developing and evaluating proper treatment plans for patients. Yet understanding how to do a cephalometric analysis properly is often the most difficult obstacle for many doctors.


Before learning how to do a cephalometric analysis, it is important to understand the basics of the procedure. A cephalometric analysis consists of two parts: the initial x-ray examination and the post-examination reading. The reading uses angular, linear, coordinate, and arcial relationships to reveal critical information about the maxillary position, mandibular position, facial proportions/vertical relationships, and incisor positions (both maxillary and mandibular) of a patient.

By using a comparative set of angles and distances, measurements can be related to one another and to normative values to determine variations in a patient’s facial structure. So, here’s how to do a cephalometric analysis of your own.

Part 1: The Cephalostat 

The first step is to examine patients in a cephalostat according to the worldwide standard measurements for a cephalometric analysis. Following the standards ensure that all radiographs have the same diagnostics. Position the patient’s skull at a 90-degree angle to the X-ray beam, at a five foot distance from the tube, and place the film 15 inches from the patient’s head.

Although many doctors place emphasis on the post-examination analysis, it’s important to remember that if the X-rays are not accurate, it will be impossible to generate a correct analysis!

Part 2: Post-examination analysis

The analysis of the radiographs is one of the significant and difficult parts of the cephalometric analysis. After taking an X-ray of the skull, it is necessary to trace the film at multiple angles using either the computer’s drawing tool or a small diameter (0.5mm) pencil or pen. Tracings must be at a 1:1 ratio to the radiograph.
When tracing, ensure all lights are turned off and areas around the radiograph are darkened so that the reading is clear. Marking anatomical structures clearly and accurately is of paramount importance, because the angles and reference lines depend on their accuracy.

Outline the following areas carefully:

  • The soft tissue profile of the patient’s face (from forehead to chin)
  • The sella turcica
  • The frontal bone and nasal bone
  • The orbital floor
  • The external auditory meatus
  • The maxilla (both the upper first molar and the upper central incisor)
  • The mandible, mandibular symphysis (the lower first molar and lower central incisor).

After outlining all the designated areas, designate the lines and planes and compare these to normal values to determine the patient’s deviation from the standard. Additionally, doing multiple cephalometric analysis with one patient over time allows you to understand the change and growth in a patient as well as diagnose how a patient is responding to treatment.

This can also reveal vital responses before, during, and after orthodontic treatment as well as be used to observe pathologic changes. It is typically recommended to perform two to three cephalometric analyses over 6-12 month intervals when assessing a patient’s readings over time.

Cephalometric Measurements

Cephalometrics aims to better understand how structures of the skull work by comparing a patient’s specific measurements with general averages. Measurements are an extremely important part of the cephalometric process, because an individual patient’s measurements are compared to population norms to spot deviations and assess where dental and orthodontic issues are occurring.

During a cephalometric x-ray, doctors must adhere to protocols to ensure that a patient’s results can be accurately compared with the general mean. While there is one standard for measurement during the x-ray, there are many different points of measurement for the radiograph during the post x-ray analysis.

The points of measurement have been popularized throughout time by different cephalometric experts, and some sets of analyses are now more commonly used than others. Steiner’s, Downs, Tweeds, and Ricketts analyses are among some of the most popular. Each of these use different sets of measurements following specific landmarks in the bony and soft tissues of the skull to create angles of comparison.

In cephalometrics, the landmarks, or points of measurement, often demonstrate the relationship of the maxillary teeth and mandibular teeth, the jaws to the teeth and the jaws to one another, and the jaws to the cranial base. By drawing a complex series of angle and plane values, doctors are able to create values to compare for each measurement series.

What do cephalometric measurements do?

  • Point out the location of imbalances or irregularities
  • Demonstrate whether malocclusions are due to skeletal or alveolar deviations
  • Show whether dysplastic development or dento-alveolar compensation causes skeletal discrepancy in patients
  • Identify possible areas of asymmetry
  • Show relationship between facial structures
  • Help doctors gain understanding causes of facial issues (if any)
Correctly identifying cephalometric measurements can make or break an analysis, which is why many medical professionals have turned to electronic help to ensure that measurements are drawn accurately. Additionally, by locating measurements digitally, doctors can easily compare a patient’s ceph to normative values across gender, sex, and other demographic averages. Digitally tracing cephalometric radiographs ensures measurements have no mistakes and is a great tool for medical professionals today.

Cephalometric Analysis and Remote Tracing

Tracing a cephalometric radiograph has traditionally been one of the most tedious and time consuming parts of any cephalometric exam. While the initial x-ray can be completed within minutes, the post X-ray analysis can take much longer. A cephalometric tracing can be produced either by digital means or by the more traditional hand-drawing method, and it results in a superimposed drawing over the original cephalometric radiograph. Cephalometric tracings outline the particular measurements, landmarks, and angles that medical professionals need to use a ceph in treatment.

As many know, hand tracing is not only time consuming but runs an enormous risk of inaccuracies due to inevitable human errors. Many doctors have now turned to electronic tracing as a way to save time and reduce errors.

Now, you don’t have to worry about tracing or processing cephs in-house – let CephX do the work for you. CephX offers a complete solution to trace, analyze, store, and track your patients’ cephs.

With Remote Tracing Service (RTS), CephX ensures you can get the analysis you need without the hassle. Trust the experts to get your cephs traced accurately, quickly, and error free. How does it work?

  • Simply upload a new ceph to your account.
  • Within 2 business days, you will be receive your analysis.
  • You will be able to view, edit and print all standard cephalometric analysis.

What are the benefits of using RTS?

Instead of wasting precious time trying to analyze, upload, and track patients’ cephs yourself, send it to experts who are here to make your job easier. All of your cephs will be stored securely in the cloud, which means anyone with account access can view, edit, or print the analysis. No more chasing information around the office – simply provide CephX cloud account information, and anyone can access the cephs. You don’t have to worry about losing physical copies of ceph analysis, because a copy will be stored securely on the cloud. Furthermore, with CephX, you can request custom analysis beyond the 60 standard cephalometric analysis offered.

Cephalometric Analysis landmarks

Readily recognizable points on a cephalometric radiograph or tracing, representing certain hard or soft tissue anatomical structures (anatomical landmarks) or intersections of lines (constructed landmarks). Landmarks are used as reference points for the construction of various cephalometric lines or planes and for subsequent numerical determination of cephalometric analysis measurements.

In the definitions of the specific landmarks the following convention is used: “midsagittal” identifies landmarks lying on the midsagittal plane, “unilateral” identifies landmarks corresponding to unilateral structures and “bilateral” applies to landmarks corresponding to bilateral structures.

Cephalometric Analysis Analysis


A-point (Point A, Subspinale, ss)

Anterior nasal spine (ANS)

Articulare (Ar)

B-point (Point B, Supramentale, sm)

Basion (Ba)

Bolton (Bo)

Condylion (Co)

Crista galli


Glabella (G)

Gnathion (Gn)

Gonion (Go)

Incision inferius (Ii)

Incision superius (Is)

Infradentale (Id, Inferior prosthion)


Menton (Me)

Nasion (N, Na)

Opisthion (Op)

Orbitale (Or)

Pogonion (Pog, P, Pg)

Porion (Po)

Posterior nasal spine (PNS)

Prosthion (Pr, Superior prosthion, Supradentale)

Pterygomaxillary fissure (PTM, Pterygomaxillare)

R-point (Registration point)

Sella (S)

Cervical point (C)

Inferior labial sulcus (Ils)

Labrale inferior (Li)

Labrale superior (Ls)

Pronasale (Pn)

Soft tissue glabella (G’)

Soft tissue menton (Me’)

Soft tissue nasion (N’, Na’)

Soft tissue pogonion (Pg’, Pog’)

Stomion (St)

Stomion inferius (Sti)

Stomion superius (Sts)

Subnasale (Sn)

Superior labial sulcus (Sls)

Trichion (Tr)

Soft tissue gnathion (Gn’)

Ricketts Anatomical Tracing

Cephalometric Analysis - Ricketts Anatomical Tracing

Ricketts Points and Planes

Cephalometric Analysisi - Ricketts Points and Planes

Cephalometric Analysis - Ricketts Points and Planes

Ricketts Frontal Anatomy

Cephalometric Analysis - Ricketts Frontal Anatomy 1

Cephalometric Analysis - Ricketts Frontal Anatomy 2


The deepest (most posterior) midline point on the curvature between the ANS and prosthion. Its vertical coordinate is unreliable and therefore this point is used mainly for anteroposterior measurements. The location of A-point may change somewhat with root movement of the maxillary incisor teeth. (midsagittal)
cephalometric - A-POINT


The tip of the bony anterior nasal spine at the inferior margin of the piriform aperture, in the midsagittal plane. It corresponds to the anthropological point acanthion and often is used to define the anterior end of the palatal plane (nasal floor). (midsagittal)

Articulare (Ar)

A constructed point representing the intersection of three radiographic images: the inferior surface of the cranial base and the posterior outlines of the ascending rami or mandibular condyles. It was meant to substitute condylion when the latter is not readily discernible. Any movement of the mandible (i.e. opening or closing) will change the location of articulare. (bilateral)

Cephalometric Analysis - Articulare (Ar)

B-point (Point B, Supramentale, sm)

The deepest (most posterior) midline point on the bony curvature of the anterior mandible, between infradentale and pogonion. (midsagittal)

Chepalometric Analysis - B-point (Point B, Supramentale, sm)

Basion (Ba)

The most anterior inferior point on the margin of the foramen magnum, in the midsagittal plane. It can be located by following the image of the slope of the inferior border of the basilar part of the occipital bone to its posterior limit, superior to the dens of the axis. (midsagittal)

Bolton (Bo)

The highest points on the outlines of the retrocondylar fossae of the occipital bone, approximating the center of the foramen magnum. Named after C. B. Bolton. (bilateral)

Cephalometric Analysis - Bolton (Bo)

CC Point (CC) Ricketts

(Cranial Center) Crossing of the facial axis with the BaN plane

Cervical point (C)

The innermost point between the submental area and the neck in the midsagittal plane. Located at the intersection of lines drawn tangent to the neck and submental areas. (midsagittal)

CC Point (CC) Ricketts

Condylion (Co)

The most superior posterior point on the head of the mandibular condyle. (bilateral)

Condylion (Co)

Crista galli

A vertically elongated, diamond-shaped radiopacity, appearing between the orbital outlines on postero-anterior cephalometric radiographs. Its location is used to establish a midsagittal reference plane. (midsagittal)

Crista galli


The point of intersection of the frontomaxillary, lacrimomaxillary and frontolacrimal sutures. An anatomic reference point used to record interorbital distance. (bilateral) Orbital hypertelorism

The increased distance between the medial orbital walls, reflecting an increased distance between the orbits (greater than 2 standard deviations from the norm). The anatomic landmarks used commonly for the measure-ment of interorbital distance are the dacryon points (bilaterally). Hypertelorism is described on the basis of skeletal measurements, because the presence of epicanthal folds or strabismus (exotropia), or other soft-tissue variations such as increased distance between the medial canthi (telecanthus) clinically may give a false impression of hypertelorism. Orbital hypertelorism is common in a number of craniofacial malformations such as Crouzon syndrome and frontonasal dysplasia.

Compare with Telecanthus

DC Point  (Ricketts)

Center of the neck of the condyle on the Basion Nasion line.

Glabella (G)

The most prominent point of the anterior contour of the frontal bone in the midsagittal plane. (midsagittal)

Glabella (G)

Gnathion (Gn)

The most anterior inferior point on the bony chin in the midsagittal plane. (midsagittal)

 Gnathion (Gn)

Gonion (Go)

The most posterior inferior point on the outline of the angle of the mandible. It may be determined by inspection or it can be constructed by bisecting the angle formed by the intersection of the mandibular plane and the ramal plane and by extending the bisector through the mandibular border. (bilateral)

Infradentale (Id)  Inferior prosthion Pr

The most superior anterior point on the mandibular alveolar process, between the central incisors. (midsagittal)

Incision inferius (Ii) or B1 (Ricketts)

The incisal tip of the most labially placed mandibular incisor. (unilateral)

Incisian Inferius Root or BR (Ricketts)

Incision superius (Is) or A1 (Ricketts)

The incisal tip of the most labially placed maxillary central incisor. (unilateral)

Incision Superious Root or AR (Ricketts)


A point located in the anterior surface of the cortical plate, labial to the apices of the maxillary central incisors. Introduced by F. P. G. M. van der Linden, as a point representing the anterior border of the maxillary apical area. (midsagittal)

Labrale inferior (Li)

Labrale inferior (Li)

The point denoting the vermilion border of the lower lip, in the midsagittal plane. (midsagittal)

Labrale superior (Ls)

The point denoting the vermilion border of the upper lip, in the midsagittal plane. (midsagittal)

Menton (Me)

The most inferior point of the mandibular symphysis, in the midsagittal plane. (midsagittal)

Menton (Me)

Molar Upper First (Ricketts)

Point on the occlusal plane perpendicular to the distal surface of the crown of the upper first molar.

Molar Lower First (Ricketts)

Point on the occlusal plane perpendicular to the distal surface of the crown of the lower first molar.

Nasion (N, Na)

The intersection of the internasal and frontonasal sutures, in the midsagittal plane. (midsagittal)

Cephalometric Analysis Analysis

Opisthion (Op)

The most posterior inferior point on the margin of the foramen magnum, in the midsagittal plane. (midsagittal)

Orbitale (Or)

The lowest point on the inferior orbital margin. (bilateral)

Pogonion (Pog, P, Pg)

The most anterior point on the contour of the bony chin, in the midsagittal plane. Pogonion can be located by drawing a perpendicular to mandibular plane, tangent to the chin. (midsagittal)

Porion (Po)

The most superior point of the outline of the external auditory meatus (“anatomic porion”). When the anatomic porion cannot be located reliably, the superior-most point of the image of the ear rods (“machine porion”) sometimes is used instead. (bilateral)

Posterior nasal spine (PNS)

The most posterior point on the bony hard palate in the midsagittal plane; the meeting point between the inferior and the superior surfaces of the bony hard palate (nasal floor) at its posterior aspect. It can be located by extending the anterior wall of the pterygopalatine fossa inferiorly, until it intersects the floor of the nose. (midsagittal)

Pronasale (Pn)

The most prominent point of the tip of the nose, in the midsagittal plane. (midsagittal)

Prosthion (Pr, Superior prosthion, Supradentale)

The most inferior anterior point on the maxillary alveolar process, between the central incisors. (midsagittal)

Protruberance Menti (Pm) or Supra pogonion (Ricketts)

A point where the curvature of the anterior border of the symphysis changes from concave to convex,

Pterygoid Point (Pt) Ricketts

Lower lip of foramen rotundum (Represents the position of the sphenoid bone) posterior superior tangent of the pterygomaxillary fissure


Pterygoid Root (Pr) Ricketts

Most posterior point on the outlines of the pterygopalatine fossa

Pterygomaxillary fissure (PTM, Pterygomaxillare)

A bilateral, inverted teardrop-shaped radiolucency, whose anterior border represents the posterior surfaces of the tuberosities of the maxilla. The landmark is taken at the most inferior point of the fissure, where the anterior and the posterior outline of the inverted teardrop merge with each other. (bilateral)

R-point (Registration point)

A cephalometric reference point for registration of superimposed tracings, introduced by B. H. Broadbent, Sr. , in his original presentation of the cephalometric technique. It is the midpoint on a perpendicular drawn from sella to the Bolton-nasion line. (midsagittal)

Sella (S)

The geometric center of the pituitary fossa (sella turcica), determined by inspectionóa constructed point in the midsagittal plane. (midsagittal)

Soft tissue glabella (Gí)

The most prominent point of the soft tissue drape of the forehead, in the midsagittal plane. (midsagittal)

Soft tissue menton (Meí)

The most inferior point of the soft tissue chin, in the midsagittal plane. (midsagittal)

Soft tissue nasion (Ní, Naí)

The deepest point of the concavity between the forehead and the soft tissue contour of the nose in the midsagittal plane. (midsagittal)

Soft tissue pogonion (Pgí, Pogí)

The most prominent point on the soft tissue contour of the chin, in the midsagittal plane. (midsagittal)

Stomion (St)

The most anterior point of contact between the upper and lower lip in the midsagittal plane. When the lips are apart at rest, a superior and an inferior stomion point can be distinguished. (midsagittal)

Stomion inferius (Sti)

The highest midline point of the lower lip. (midsagittal) if lips are apart

Stomion superius (Sts)

The lowest midline point of the upper lip. (midsagittal) if lips are apart

Subnasale (Sn)

The point in the midsagittal plane where the base of the columella of the nose meets the upper lip. (midsagittal)

Superior labial sulcus (Sls)  Soft Tissue Point A

The point of greatest concavity on the contour of the upper lip between subnasale and labrale superius, in the midsagittal plane. (midsagittal)

Soft Tissue B  or Inferior labial sulcus (Ils)

The point of greatest concavity on the contour of the lower lip between labrale inferius and menton, in the midsagittal plane. (midsagittal)

Trichion (Tr)

An anthropometric landmark, defined as the demarcation point of the hairline in the midline of the forehead. (midsagittal)

Xi Point (Xi) approximate for Inferior alveolar foramen (Ricketts)

A constructed point located at the geographic center of the ramus as indicated below.

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