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DOWNS Variations in Facial

cefalometria

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Mayra Alejandra Ramírez Pinzón
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72 views11 pages

DOWNS Variations in Facial

cefalometria

Uploaded by

Mayra Alejandra Ramírez Pinzón
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Variations In Facial Relationshi Their Significance In Treatment and Prognosis! Wiasiam B. Downs, D.D.S., MLS. Aurora, [linois A large proportion of the orthodontist’s problems stem from the well known biological fact of variations within the species. This variation is particularly evident in the human face. The differences are noted in size, proportion, relationship of parts and even in growth rates. These varia- tions have been recognized and have lead to classification of facial types, but there are no sharp demarcations. The gradations from one extreme to the other in type are innumerable. To complicate further the problem, the various t) present functional and esthetic harmony and balance, or they may ent degrees of disharmony and imbalance, depending on the relationship of the component parts of the face, namely, the bones of the head, the denture and overlying soft tissue. ‘This paper presents the finding of a study which has been pursued by the author for the past five years. Tt was undertaken to determine the range of the skeletal and dental pattern within which one might expect to find the normal and further to discover whether any usnable correla- tion existed in such normals. The method employed in the study was roentgenographie cephalometry and the technie was that deseribed in various papers familiar to all ortho- dontists. The control material studied was derived from twenty living individ- uals, ranging in age from 12 - 17 years and about equally divided as to sex. Models, photographs and cephalometric and intraoral roentgenograms were taken of each. All individuals possessed clinically excellent occlusions. Tracings were made of all lateral head x-rays taken with the teeth in occlusion and the Bolton triangle outlined on each tracing according to Broadbent's technique, which consists of eonnceting the following points: (Fig. 1) Nasion to the center of sella tureiea, and sella to the Bolton point, whieh is the superior point on the concavity behind the occipital condyles. Continuing from the Bolton point back fo nasion completes the Bolton triangle, which represents the area at the base of the eranium to which the face is joined. It is believed by Broadbent to be the most stable area from which to make serial comparisons. This area itself must, of course, increase as the head grows, so Broadbent has located a point within the triangle by taking the mid-point of a perpendienalr from the Bolton plane to the center of sella turcica. He calls this the registration point. When serial tracings are studied they may be registered on this point with their Bolton planes parallel, ‘The other landmarks and planes used in this study are shown in Fig. 1. 1 From the Graduate Department of Orthodontia, University of Illinois, Chicago. First prizewinner, Essay Contest of the Ainerican Association of Orthodontia, 1948. Published in American Jnl. Orthodontics, Oct. 1948 (34:812-40), and reprinted with permission. 145 146 W. B. DOWNS July, 1949 Fre. 1. The skeletal pattern—serial pictures are superimposed at R with the Bolton planes parallel. Fic.2. A diagrammatic breakdown of the areas of the head. For the purpose of this study the head was divided into eranium and face. (Fig. 2) The face was further divided into (1) upper face, (2) teeth and alveolar area and (4) lower face or mandible. As the investigation progressed two objectives developed, to appraise: (1) the pattern of the facial skeleton exclusive of the teeth and alveolar process. (2) The relationship of the teeth and alveolar process to the facial skeleton. OBSERVATIONS 1. The Skeletal Pattern In Norma-Lateralis ‘The skeleton pattern of the face is determined by the maxillary bones and the mandible. While the teeth and alveolar process also influence facial form, they will be considered separately as the denture. ‘The skeletal pattern can be laid out on lateral cephalometric x-rays as a polygon and its form or pattern deseribed by the angular relationships of various planes. (Fig. 3) Those to be described in this study are the Facial angle, Angle of convexity, the antero-posterior relationship of the denture bases, Mandibular plane angle and the Y axis. It. is customary for orthodontists to classify facial types according to the degree of recession or protrusion of the mandible. As this attribute of facial form is determined by a skeletal foundation, it would obviously be an advantage to classify skeletal pattern in a manner consistent wit facial type as this is appraised by examination of the individual or their photographs. So far it has been found that this can best be accomplished by relating certain planes of the pattern to the Frankfort horizontal plane. Facial Angle (Fig. 4) This angle is an expression of the degree of recession or protrusion of the chin. It is determined by drawing a line from nasion to pogonion, this plane being called the Facial plane. The inferior inside angle of its Hee with the Frankfort horizontal is designated as the Facial angle. The mean value for the series was 87.8. The range was from 82° representing a recessive chin approaching the facial type usually associated with Class IT malocclusion to 95° indieating a protrusive chin. Vol. XIX, No. 3 FACIAL VARIATION 147 ee y ~

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