Lateral X-Ray of the Head (Cephalogram)
For the lateral X-ray of the skull internationally the term cephalogram (ceph) is used, while in Germany the term „Fernröntgenbild seitlich“, which means lateral teleradiograph is preferred.
With a ceph, the position of the jaws to the skull in the sagittal plane can be measured along with the location and inclination of the teeth. This form of diagnosis is interesting for educating young orthodontists as well as for scientific research, but it doesn’t contribute much to the planning of conventional orthodontic treatments. While a ceph is standard during post-graduate education orthodontics, this record is not usually required by experienced orthodontists. Unfortunately, in the course of orthodontic treatment it’s of common use to take at least two cephs, which is questionable because they don’t contribute to the treatment planning in many cases. Moreover, the radiation protection of the patients should be considered.
Occasionally it even happens that we plan orthodontic treatments without a ceph, but an expert commissioned by the health insurance company subsequently demands the preparation of it. As a rule, we do not follow such unfounded requests.
That is the reason why in our practices a ceph is only used in 20% of our treatments. For example, we will only consider using a ceph in cases when there is uncertainty whether or not permanent teeth should be removed. Similarly, we use cephs in case of strong positional deviations of the jaws. Moreover, cephs are helpful for planning tooth movement with mini-screws as skeletal anchors. We also take a ceph when orthognathic surgery is to be carried out.
A ceph with modern, digital x-ray equipment causes a radiation exposure of about 5 microsievert, which is about the equivalent exposure to radiation at sea level in about a day. Thus, it is a small radiation dose.
In 2015, Dr. Madsen has published a scientific review on the use of cephs in orthodontics, which can be downloaded here: www.madsen.de/2015/12/20/benoetigen-wir-ein-ceph-zur-behandlungsplanung/
