Cephalometry A Color Atlas and Manual - part 5 docx

Virtual Definition of the Lower Molar Cusp Landmarks Step 1: Define Lower Molar Cuspr and Lower Molar Cusplon the profile views of the 3-D hard sue surface representation Figs.. and Lower

Lower Molar Cusp: LMcusp r – LMcusp l

Definition of the Lower Molar Cusp Landmarks

Lower Molar Cusp (LMcusp) is the most superior point

of the mesial cusp of the crown of each first lower

molar in the profile plane

Virtual Definition of the Lower Molar Cusp Landmarks

Step 1: Define Lower Molar Cuspr and Lower Molar

Cusplon the profile views of the 3-D hard sue surface representation (Figs 4.57, 4.58)

tis-Step 2: Verify and correct the position of Lower

Mo-lar Cusprand Lower Molar Cusplon the

virtu-al latervirtu-al (Fig 4.59) cephvirtu-alogram linked to the3-D hard tissue surface representation

Fig 4.55 Lower Molar Cuspr Profile view right (cadaver skull) Fig 4.56 Lower Molar Cuspr Profile view right (3-D CT, cadaver skull)

Fig 4.57 Lower Molar Cuspr Profile view right (3-D CT, patient K.C.) Fig 4.58 Lower Molar Cuspl Profile view left (3-D CT, patient K.C.)

Fig 4.59 Lower Molar Cuspr and Lower Molar Cuspl.Virtual lateral cephalogram linked to the 3-D hard tissue surface representation (3-D CT, patient K.C.)

Fig 4.60 Virtual frontal cephalogram linked

to the 3-D hard tissue surface representation

shows an overview of dental landmarks

(3-D CT, patient K.C.)

Menton: Men

Definition of the Menton Landmark

Menton is the most inferior midpoint of the chin on the

outline of the mandibular symphysis

Virtual Definition of the Menton Landmark

Step 1: Define Menton on the virtual lateral

cephalo-gram (Figs 4.65, 4.66)

surface representation (patient K.C.)

Step 2: The position of Menton is verified on the right

(Fig 4.67) and left (Fig 4.68) profile views ofthe 3-D hard tissue surface representations

Step 3: Verify the midline position of Menton on the

base view of the 3-D hard tissue surface resentation (Fig 4.69) Note that Menton isthe skeletal midline point of the chin and can therefore be out of the midplane

rep-Fig 4.67 Menton Profile view right (3-D CT, patient K.C.) Fig 4.68 Menton Profile view left (3-D CT, patient K.C.)

Fig 4.69 Menton Base view (3-D CT, patient K.C.)

Fig 4.70 Menton.Virtual lateral and frontal

cephalograms linked to the 3-D hard tissue

sur-face representation (3-D CT, patient K.C.)

Gonion: Go r – Go l

Definition of the Gonion Landmarks

Gonion (Go) is the point at each mandibular angle that

is defined by dropping a perpendicular from the

inter-section point of the tangent lines to the posterior

margin of the mandibular vertical ramus and inferior

margin of the mandibular body or horizontal ramus

Virtual Definition of the Gonion Landmarks

Step 1: Define Gonionr and Gonionl on the right

(Fig 4.73) and left (Fig 4.74) profile views ofthe 3-D hard tissue surface representation

Step 2: Verify the correct transversal position of

Go-nionrand Gonionlon the base view (Fig 4.75)

of the 3-D hard tissue surface representation

Fig 4.73 Gonionr Profile view right (3-D CT, patient K.C.) Fig 4.74 Gonionl Profile view left (3-D CT, patient K.C.)

Fig 4.75 Gonionrand Gonionl Caudal view (3-D CT, patient K.C.)

Fig 4.76 Gonionrand Gonionl.Virtual lateral and frontal cephalograms linked to the 3-D hard tissue surface representation (3-D CT, patient K.C.)

Frontozygomatic Point: Fz r – Fz l Definition of the Frontozygomatic Landmarks

Frontozygomatic (Fz) is the most medial and anteriorpoint of each frontozygomatic suture at the level of thelateral orbital rim

Fig 4.77 Frontozygomaticrand Frontozygomaticl Frontal view (cadaver skull)

Fig 4.78 Frontozygomaticr and Frontozygomaticl Frontal view (3-D CT,

cadaver skull)

Virtual Definition of the Frontozygomatic Landmarks

Step 1: Define Frontozygomaticr and

Frontozygo-maticl on the frontal view (Fig 4.79) of the 3-D hard tissue surface representation

Step 2: Verify the sagittal position of

Frontozygo-maticr and Frontozygomaticl on the virtuallateral cephalogram linked to the 3-D hardtissue surface representation (Fig 4.81)

Fig 4.79 Frontozygomaticr and Frontozygomaticl Frontal view (3-D CT,

patient K.C.)

Fig 4.80 Frontozygomaticr and Frontozygomaticl Virtual frontal gram (3-D CT, patient K.C.)

cephalo-Fig 4.81 Frontozygomaticrand

Frontozygo-maticl.Virtual lateral and frontal cephalograms

linked to the 3-D hard tissue representation

(3-D CT, patient K.C.)

Zygion: Zy r – Zy l

Definition of the Zygion Landmarks

Zygion (Zy) is the most lateral point on the outline of

each zygomatic arch

Fig 4.82 Zygionrand Zygionl Exocranial skull base view (cadaver skull) Fig 4.83 Zygionrand Zygionl Exocranial skull base view (3-D CT, cadaver

Virtual Definition of the Zygion Landmarks

Step 1: Define Zygionrand Zygionlon the exocranial

skull base view (Fig 4.86) of the 3-D hard

tis-sue surface representation If marked

amal-gam artefacts are present (Fig 4.90), Zygion

can be defined on the endocranial skull base

view by inclining medially until the complete

zygomatic arch is visualized (Figs 4.91, 4.92)

Step 2: Verify the vertical position of Zygionr and

Zygionlon the frontal (Figs 4.87, 4.93) and/or

profile (Figs 4.88, 4.89, 4.94, 4.95) views of the

3-D hard tissue surface representation

Fig 4.86 Zygionrand Zygionl Exocranial skull base view (3-D CT, patient K.C.) Fig 4.87 Zygionrand Zygionl Frontal view (3-D CT, patient K.C.)

Fig 4.88 Zygionr Profile view right (3-D CT, patient K.C.) Fig 4.89 Zygionl Profile view left (3-D CT, patient K.C.)

Fig 4.90 Due to amalgam artefacts, definition of Zygionrand Zygionl

land-marks is not possible on the exocranial skull base view (3-D CT, patient A.G.)

Fig 4.91 Zygionl Close-up zygomatic arch, endocranial skull base view (3-D

CT, patient A.G.)

Fig 4.92 Zygionl Close-up zygomatic arch, endocranial skull base view (3-D

CT, patient A.G.)

Fig 4.94 Zygionr Profile view right (3-D CT, patient A.G.) Fig 4.95 Zygionl Profile view left (3-D CT, patient A.G.)

A-Point: A

Definition of the A-Point Landmark

A-Point is the point of maximum concavity in the

mid-line of the alveolar process of the maxilla

Virtual definition of the A-Point Landmark

Step 1: Define A-Point on the virtual lateral

cephalo-gram (Figs 4.98, 4.99)

Step 2: The position of A-Point is verified on the right

(Fig 4.100) and left (Fig 4.101) profile views

of the 3-D hard tissue surface representations

Step 3: Verify the midline position of A-Point on the

maxillary dento-alveolar process on thefrontal view of the 3-D hard tissue surfacerepresentation (Fig 4.102) The virtual frontalcephalogram (Fig 4.103, 4.104) is helpful todefine the midline position of A-Point

Fig 4.98 A-Point.Virtual lateral cephalogram (patient K.C.) Fig 4.99 A-Point Virtual lateral cephalogram linked to the 3-D hard tissue

surface representation (patient K.C.)

Fig 4.100 A-Point Profile view right (3-D CT, patient K.C.) Fig 4.101 A-Point Profile view left (3-D CT, patient K.C.)

Fig 4.102 A-Point Frontal view (3-D CT, patient K.C.)

Fig 4.103 A-Point.Virtual frontal cephalogram

linked to the 3-D hard tissue surface tion (3-D CT, patient K.C.)

representa-Fig 4.104 A-Point.Virtual frontal cephalogram (patient K.C.)

B-Point: B

Definition of the B-Point Landmark

B-Point is the point of maximum concavity in the

mid-line of the alveolar process of the mandible

Fig 4.106 B-Point Profile view right (3-D CT, cadaver skull) Fig 4.105 B-Point Profile view right (cadaver skull)

Virtual Definition of the B-Point Landmark

Step 1: Define B-Point on the virtual lateral

cephalo-gram (Figs 4.107, 4.108)

Step 2: The position of B-Point is verified on the right

(Fig 4.109) and left (Fig 4.110) profile views

of the 3-D hard tissue surface representations

Step 3: Verify the midline position of B-Point on the

mandibular dento-alveolar process on thefrontal view of the 3-D hard tissue surfacerepresentation (Fig 4.111) The virtual frontalcephalogram (Figs 4.112, 4.113) is helpful todefine the midline position of B-Point

Fig 4.107 B-Point.Virtual lateral cephalogram (patient K.C.) Fig 4.108 B-Point Virtual lateral cephalogram linked to the 3-D hard tissue

surface representation (patient K.C.)

Fig 4.109 B-Point Profile view right (3-D CT, patient K.C.) Fig 4.110 B-Point Profile view left (3-D CT, patient K.C)

Fig 4.111 B-Point Frontal view (3-D CT, patient K.C.)

Fig 4.112 B-Point.Virtual frontal cephalogram

linked to the 3-D hard tissue surface tion (3-D CT, patient K.C.)

representa-Fig 4.113 B-Point.Virtual frontal cephalogram (patient K.C.)

Pogonion: Pog

Definition of the Pogonion Landmark

Pogonion is the most anterior midpoint of the chin on

the outline of the mandibular symphysis

Virtual Definition of the Pogonion Landmark

Step 1: Define Pogonion on the virtual lateral

ce-phalogram (Figs 4.118, 4.119)

Step 2: The position of Pogonion is verified on the

right (Fig 4.120) and left (Fig 4.121) profileviews of the 3-D hard tissue surface represen-tations

Step 3: Verify the midline position of Pogonion on

the base view of the 3-D hard tissue surfacerepresentation (Fig 4.122) Note that Pogo-nion is the most anterior skeletal midlinepoint of the chin and can therefore be out ofthe midplane

Fig 4.118 Pogonion.Virtual lateral cephalogram (patient K.C.) Fig 4.119 Pogonion.Virtual lateral cephalogram linked to the 3-D hard tissue

surface representation (patient K.C.)

Fig 4.120 Pogonion Profile view right (3-D CT, patient K.C.) Fig 4.121 Pogonion Profile view left (3-D CT, patient K.C.)

Fig 4.122 Pogonion Base view (3-D CT, patient K.C.)

Fig 4.123 Pogonion.Virtual lateral and frontal

cephalograms linked to the 3-D hard tissue face representation (3-D CT, patient K.C.)

sur-Basion: Ba

Definition of the Basion Landmark

Basion is the most anterior point of the great foramen

(foramen magnum)

Virtual Definition of the Basion Landmark

Step 1: Define Basion on the exocranial skull base

view (Fig 4.126) of the 3-D hard tissue

sur-face representation

Step 2: Verify the vertical position of Basion on the

virtual lateral cephalogram linked to the

3-D hard tissue surface representation (Figs

4.127, 4.128)

Fig 4.124 Basion Exocranial skull base view (3D-CT, cadaver skull) Fig 4.125 Basion Exocranial skull base view (3-D CT, cadaver skull)

Fig 4.126 Basion Exocranial skull base view (3-D CT, patient K.C.) Fig 4.127 Basion.Virtual lateral cephalogram (3-D CT, patient K.C.)

Fig 4.128 Basion.Virtual lateral cephalogram

linked to the 3-D hard tissue surface tion (3-D CT, patient K.C.)

representa-Condylion: Co r – Co l

Definition of the Condylion Landmarks

Condylion (Co) is the most postero-superior point of

each mandibular condyle in the sagittal plane

Virtual Definition of the Condylion Landmarks

Step 1: Define Condylionr and Condylionl on the

right (Fig 4.131) and left (Fig 4.132) profileviews of the 3-D hard tissue surface represen-tations

Step 2: Verify the transverse position of Condylionr

and Condylionl on the linked virtual frontalcephalogram (Fig 4.134)

Fig 4.129 Condylionr Profile view right (cadaver skull) Fig 4.130 Condylionr Profile view right (3-D CT, cadaver skull)

Fig 4.131 Condylionr Profile view right (3-D CT, patient K.C.) Fig 4.132 Condylionl Profile view left (3-D CT, patient K.C.)

Fig 4.133 Condylionrand Condylionl Virtual lateral cephalogram (3-D CT, patient K.C.)

Fig 4.134 Condylionrand Condylionl.Virtual

frontal cephalogram linked to the 3-D hard tissue

surface representation (3-D CT, patient K.C.)

allows verification of the transverse position of

the Condylion landmarks

4.2

Set-up of 3-D Cephalometric Hard Tissue Landmarks

Fig 4.135 a–d Set-up of 3-D cephalometric hard tissue landmarks (3-D CT, patient K.C.)

b a

Fig 4.136 Set-up of 3-D cephalometric hard

tis-sue landmarks.Virtual lateral cephalogram linked

to the 3-D hard tissue surface representation

(3-D CT, patient K.C.)