Abstract
Objectives: Although the Frankfort Horizontal (FH) and sella-nasion were routinely used as craniofacial reference planes, the inter-individual orientations were changeable when related to true horizontal (HOR). Natural head position (NHP) is a reproducible, standardized position, with the head in an upright posture and eyes focused on a point in the distance at eye level so that the visual axis is horizontal. The natural head position has importance in anthropological as well as in orthodontic fields, as this position has a relatively fixed relationship to the true horizontal and vertical planes. However, NHP is clinically not simple and it takes long time to be recorded, in addition to a deficiency in the tools utilized in the NHP and lack in the staff training. This paper aims to shed the light on different methods of NHP registration and reproduction. Data and Sources: A literature review of English articles was performed using PubMed, Scopus, and Google Scholar to search for natural head position in orthodontics. Conclusions: NHP is affected by many factors, and it is different in walking state than in static state. There are various cephalometric or photographic methods for NHP recording. Keywords: Reproducibility of natural head position, True horizontal, True vertical plane.
 
Highlights
When a person is looking at a far point at eye level with a standardized orientation of the head in space, this is called natural head position (NHP),(1) or at the distant objects like the light source at eye level or one's eyes reflection in a mirror. (2) The functional position of the head that differs in the sitting and standing subject and it oscillates around the individual’s mean
Von Baer (1861)(12) described the first method for recording NHP, which was early work in the mirror guided visual technique of obtaining NHP. It seemed to be an accepted technique. In this method the persons sit on a chair comfortably and relaxed, they were asked to look into a mirror to see the image of their eyes, this mirror was founded at the same level with the pupils of their eyes
The use of NHP as a craniofacial system represents a correct alteration of classical craniofacial reference planes since it truly represents the head orientation, registered and it has good intra-individual reproducibility
Summary
When a person is looking at a far point at eye level with a standardized orientation of the head in space, this is called natural head position (NHP),(1) or at the distant objects like the light source at eye level or one's eyes reflection in a mirror. (2) The functional position of the head that differs in the sitting and standing subject and it oscillates around the individual’s mean. When a person is looking at a far point at eye level with a standardized orientation of the head in space, this is called natural head position (NHP),(1) or at the distant objects like the light source at eye level or one's eyes reflection in a mirror. NHP is known as natural head posture. Lundström and Lundström(4) defined it as when the doctor assists the subject to orient his head, according to the clinical expertise, when body of the person is relaxed and he is looking at a distant point at level of the vision. Leonardo da vinci (1452- 1519) and Albrecht Dürer (14711528) used scaffoldings of horizontal and vertical lines on drawings of models positioned in ''natural pose'' to allow more precise scientific and artistic replication of the human head.(5) Sella– nasion (SN) plane is a commonly used craniofacial reference plane.(6) This plane represented the anterior cranial base; so it is reliable, biologically meaningful and when concerned to vertical plane it has large inter-individual standard deviations.(4)
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