Cephalometric And Esthetic Considerations

It is often helpful to take progress headfilms approximately halfway through orthodontic treatment to determine how the skeletal, dental, and soft tissue components are being managed. Progress headfilms allow for reassessment of anchorage factors and help revisions in treatment planning as treatment proceeds. For some patients, it is necessary to take a final cephalometric radiograph. These should be taken approximately 3 to 4 months before debanding, rather than after treatment. Taking headfilms after completion of treatment is useful from a learning standpoint for future cases, as well as to evaluate the success or failure of the treatment, but it provides no specific advantage for the patient. It is better to lake the headfilm before the appliances are removed, so that loolh positions can be corrected if necessary, relative to PIP and other treatment goals for the case (p. 166).

The most important factors to be evaluated with these progress and final cephalometric radiographs involve the soft tissue profile, the antero-posterior position of the incisors, the torque of the incisors, the changes in the mandibular plane of the patient, the degree to which vertical development of the patient has occurred or been restricted, and the success in correcting the horizontal, skeletal, and dental components of the problem. Evaluation involves superimposition of progress and final radiographs with (he initial cephalometric radiograph, to accurately determine the changes that occurred.

If treatment planning has been based on the Arnett3 analysis (p. 163), facial profile and the five dentoskeletal structures can be evaluated in the closing stages of treatment, before appliances are removed (Fig. 10.19). The Arnett dentoskeletal ideals are:

1

female

male

MxOP

95.6 ± 1.8

95.0 ± 1.4

Mx1 to MxOP

56.8 ± 2.5

57.8 ± 3.0

Md1 to MdOP

64.3 ± 3.2

64.0 ± 4.0

overjet

3.2 ± 0.4

3.2 ± 0.6

overbite

3.2 ± 0.7

3.2 ± 0.7

95

Fig. 10.19 During the final stages of treatment the Arnett analysis may be used to evaluate facial profile and dentoskeletal structures. The orthodontist can normally produce favorable change in incisor torque and overjet/overbite, if required, but may be less able to influence the position of the maxillary occlusal plane, relative to true vertical line (TVL).

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