Ricketts Cephalometric Superimposition

Ricketts cephalometric superimposition
Important Cephalometric Land Marks in Ricketts cephalometric analysis:
PT Point. Intersection of the inferior border of the formen rotundum with the posterior
wall of the pterygomaxillary fissure
Basion(BA): Most inferior posterior point of the occip-ital bone at the anterior margin of
the occipital foramen.
CC Point (Center of Cranium) :Cephalometric landmark formed by the intersection of
the two lines BA-NA and PT-GN.
Gnathion(GN): Cephalometric landmark formed by the intersection of the tangent to
the most inferior point on the inferior border of the symphysis and the most inferior point
of the gonial region, and the line connecting NA and PO.
XI point : a point located at the geographic center of the ramus .
Protuberaance menti or supra pogonion (PM) : A point selected where the curvature
of the anterior border of the symphysis changes from concave to convex.
DC point : Cephalometric landmark representing the center of the neck of the condyle on
the Basion Nasion line.
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The method of Ricketts was developed in order to provide a simple basis, orderly and
credible way, to view and verify the changes that occur during an orthodontic treatment.
This analysis is to superimpose the initial x ray on the final layout of the same patient in
five locations, to identify changes that are expected to occur due to growth, or due to
orthodontic mechanics. This helps to plan our treatment and select our mechanics and to
describe the alterations that occur. The five Superimposition areas are used to evaluate
the face in the following order:
The chin.
The maxilla.
The teeth in the mandible.
The teeth in the maxilla.
The facial profile.
Superimposition Area 1 (Evaluation Area 1) '

The first superimposition (Basion-Nasion at CC Point) establishes Evaluation Area 1,
within which we evaluate the amount of growth of the chin in millimeters; any change in
chin in an opening or closing direction that may result from our mechanics; and any
change in upper molar.
In normal growth, the chin grows down the facial axis and the six year molars also grow
down the facial axis.
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Normal Growth of mandible Patient under observation
During the facial growth of "normal" patients, ie those lacking functional problems such
as mouth breathing, swallowing, altered, disturbed habits (poor posture and habits of
sucking), among others, the growth direction of Facial axis changes very little, closing on
average 0.2 degrees per year.
The mandible increased on average 2.5 mm / year from 8 to 18 years along the axis
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Patient after three years of treatment
The patient age at baseline (9 years and 3 months) with probably a growth spurt during
this period. In the first area we can observe an increase in the growth of the mandible of
12 or 3.5 mm / year. Facial Axis closed 3 (counterclockwise spin of the jaw), from 86 º to
89 º even with all extrusive mechanics used during treatment (cervical traction with
headgear, and elastic Quad Class II).
Superimpostion Area 2 (Evaluation Area 2)

The second superimposition area (Basion-Nasion at Nasion) establishes Evaluation Area
2 to show any change in the maxilla (Point A). The Basion-Nasion-Point A Angle does
not change in normal growth. Therefore, any change in this angle would be due to the
effect of our mechanics. We evaluate the effect of headgear (force and type), Class II
elastics, Class III elastics, torque, activator, etc. on the convexity of the maxilla.
Normal Growth of maxilla
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we can observe a restriction in maxillary anterior displacement and the angle

basion-nasion with the center at nasion decreased from 63 to 60 degrees.
Superimposition Area 3 (Evaluation Areas 3 and 4)

The third superimposition area (Corpus Axis at PM) establishes Evaluation Area 3
and Evaluation Area 4, which together evaluate any changes that take place in the
mandibular denture.
The technique consists of superimposing the initial and final strokes on the plane
Xi-Pm with the center of the two paths in Pm. Thus we observe the changes in the
lower incisors and first molars, respectively, assessment areas three and four.
In Evaluation Area 3, we evaluate whether we are going to intrude, extrude,
advance or retract the lower incisors, which helps us determine what type of utility
arch we will use.
In Evaluation Area 4, we evaluate the lower molars to determine what type of
anchorage we need and whether we wish to advance, upright or hold the lower
molars.
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Normal development of incisors and first molars in untreated patients :
During normal growth the first molars are moving upward (0.5 mm / year) and
forward (0.3 mm / year) and up the incisors (0.5 mm / year) and back slightly (0.2
mm / year).
1. The first molars erupted 1.5 mm and 2mm moved mesially during treatment
and helped close the extraction space and the correction of Class II molar
relationship.
2. The lower incisors were extruded 3mm, and were retracted 5 mm, more than
would occur with normal development of teeth that helped close extraction space.
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Superimposition Area 4 (Evaluation Areas 5 and 6)
The fourth Superimposition area (Palate at ANS) establishes Evaluation Area 5 and
Evaluation Area 6, which together evaluate any changes that take place in the maxillary
denture.
The technique consists of superimposing the initial palatal plane (ANS-PNS) and the
final palatal plane (ANS-PNS) at the center of the two planes coincide in ANS
In Evaluation Area 5, we evaluate what we are going to do with the upper molars —
hold, intrude, extrude, distallize or bring them forward.
In Evaluation Area 6, we evaluate what we are going to do with the upper incisors —
intrude, extrude, retract, advance, torque or tip them.
Normal development of maxillary incisors and first molars in untreated patients : When
the palatal plane is superimposed, it becomes possible to observe the vertical
development of the upper teeth down and forward. The upper incisors erupt following his
own long axis 0.4 mm / year and the first molars erupted 0.7 mm / year down to 0.3 mm /
year ahead, following the path of Facial axis
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1. The first molars were distalized 2.5 mm, as a result of orthodontic mechanics in
Class II (headgear and Class II elastics). This distal movement of maxillary first
molars occurred in a direction opposite the normal development of the dental arch.
The first molars were also extruded 3mm.
2. The upper incisors also had a slight extrusion of 2 mm, ie 0.6 mm more than the
expected value and were retracted 8mm bodily. This move occurred because of the
mechanics used in the treatment .
Superimposition Area 5 (Evaluation Area 7)
The fifth Superimposition area (Esthetic Plane at the crossing of the Occlusal
Plane) establishes Evaluation Area 7 with which we evaluate the soft tissue
profile. uses the aesthetic plane formed by the union of the most anterior point of
the nose to the most anterior point of the chin and the functional occlusal plane,
passing between the cusps of the molars and premolars. This technique consists of
superimposing the initial and final aesthetic level with the center at the intersection
of these with the functional occlusal plane,We use Superimposition Area 5 and
Evaluation Area 7 to evaluate the effect of our mechanics on the soft tissue of the
face.
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In normal growth, the face
becomes less protrusive with reference to the esthetic plane due to the growth of
the nose and chin .
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The patient's facial aesthetics changed considerably after orthodontic treatment,
facial orthopedic as shown by the overlay ,providing a more harmonious face,
since the lips are behind the aesthetic line, as recommended by Ricketts. The
retraction of the upper and lower incisors, the growth of the nose and chin
positioning resulted in more and less prominent of the distal upper and lower lips.
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Ricketts Cephalometric Superimposition

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Ricketts cephalometric superimposition

Important Cephalometric Land Marks in Ricketts cephalometric analysis:

Superimposition Area 1 (Evaluation Area 1) '

Superimpostion Area 2 (Evaluation Area 2)

Normal Growth of maxilla

we can observe a restriction in maxillary anterior displacement and the angle

Superimposition Area 3 (Evaluation Areas 3 and 4)

Patient after three years of treatment

Patient after three years of treatment

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