Diagnostic records /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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  • Diagnostic records /certified fixed orthodontic courses by Indian dental academy

    1. 1. www.indiandentalacademy.com
    2. 2. INDIAN DENTAL ACADEMY • Leader in continuing dental education • www.indiandentalacademy.com www.indiandentalacademy.com
    3. 3. www.indiandentalacademy.com
    4. 4. Introduction…… Duncan says in Shakespear’s Macbeth, “THERE’S NO ART TO FIND THE MIND,S CONSTRUCTION IN THE FACE… www.indiandentalacademy.com
    5. 5. Orthodontic Diagnosis www.indiandentalacademy.com
    6. 6. Diagnostic Database in orthodontics ESSENTIAL • CASE HISTORY • CLINICAL EXAMINATION • STUDY MODELS • CERTAIN RADIOGRAPHS - IOPA - BITE WING - PANORAMIC • FACIAL PHOTOGRAPHS SUPPLEMENTAL . SPECIALISED RADIOGRAPHS - CEPHALOMETRIC RADIOGRAPHS - HAND WRIST RADIOGRAPHS - OCCLUSAL RADIOGRAPHS - CONE SHIFT TECHNIQUE - DIGIGRAPH - CRANIOFACIAL IMAGING . ELECTROMYOGRAPHY . BASAL METABOLIC RATE . DIAGNOSTIC SET UP . PHYSIOPRINTS . OCCLUSOGRAMS www.indiandentalacademy.com
    7. 7. Case history Case history can be divided in to Medical history Dental history Family history patient history Prenatal Postnatal www.indiandentalacademy.com
    8. 8. Clinical examination 1. General examination. 2. Extraoral examination. 3. Intraoral examination. www.indiandentalacademy.com
    9. 9. General examination  State of development: Age related/ overdeveloped/ underdeveloped, mentally normal/early/late developer, lively/quiet/nervous/phlegmatic  Body height……..cm  Body weight………kg  Stature: strong/tall/average/short/adipose  Nutritional status: good/ bad  Dental age:…….years  Skeletal age:…….years www.indiandentalacademy.com
    10. 10. Extra oral examination • Facial asymmetry: shift of maxillary midline relative to the facial midline. • Head form/ cephalic index: dolichocephalic/ mesocephalic/ brachycephalic/ hyperbrachycephalic. www.indiandentalacademy.com
    11. 11. Facial index: It is assessed using distance between nasion and gnathion, the bizygomatic width. • Euryprosopic type : patient exhibits wider face with wider apical based jaws in transverse dimension. • Leptoprosopic type : patient exhibits narrow face with narrowing of coronal arch and the apical base in transvers dimensions. www.indiandentalacademy.com
    12. 12. Facial profile:• straight profile • Convex profile • Concave profile www.indiandentalacademy.com
    13. 13. Frontal view:• Facial symmetry -vertical midsagittal plane. -upper horizontal plane. that is bipupillary plane -Lower horizontal plane, through the stomion. -Bilateral marking of orbital point. • Facial asymmetry www.indiandentalacademy.com
    14. 14. Lips - posture and nasolabial angle • According to korkhaus; Different variations of lip profiles & the lip step are:. positive lip step ,a symptom of class III profile. . slightly negative lip step seen in normal profile. . marked negative lip step, a symptom of class II profile.  Nasolabial angle; . Decreased due to maxillary prognathism. . normal ( 1020 ) . Increased due to maxillary retrognathism. www.indiandentalacademy.com
    15. 15. Lips - dysfunctions A • A- competent lips ;-Lips in contact when the musculature is relaxed. • B- Incompetent lips ;Anatomically short lips with a wide gap between the upper and lower lip in relaxed state. • C- Potentially incompetent C lips;-labialy placed upper incisors interpose between the lips and prevent the normal lip D • seal. D- Everted lips ;- This is a lip seal with weak tonicity of lip musculature, often with bimaxillary dental www.indiandentalacademy.com protrusion. B
    16. 16. Intra oral examination Dental findings;• No of teeth present should be recorded. • Patients oral hygine status should be evaluated. • Measurement of overjet and overbite. www.indiandentalacademy.com
    17. 17. Soft tissue examination:• Maxillary, mandibular labial frenal attachment and lingual frenal attachment should be examined. www.indiandentalacademy.com
    18. 18. • Gingiva:-inflamed / hyperplastic / recession • Periodontal diseases:- periodontal status should be recorded in periodontal chart form. • Oral mucosa:- examined for pathologic changes. • Palate:- high / average / flat • Apical base examination In transvers and sagittal direction . www.indiandentalacademy.com
    19. 19. Tongue posture, length and width & swallow pattern :A broad and low lying tongue, as seen in class lll cases, will extend over the dental arches and will have lateral indentations and in case of a long tongue it reach the tip of the nose . www.indiandentalacademy.com
    20. 20. Types of swallow Normal matured somatic swallow Infantile swallow in neonates www.indiandentalacademy.com Habitual tongue thrust swallow
    21. 21. TMJ dysfunction.. Diagnosis of the general systemic disease and local pathology which is the causative factor in TMJ disorder is very critical in management of TMJ disorders. The TMJ disorder may be due to, • Developemental or Functional disturbance of the musculoskeletal system of TMJ. • ENT disease • Adenopathy • Disorders of neural origin • Collagenous disease • Bone dyscrasias • Traumatic disorders • Arthritis • Psychogenic factors….etc www.indiandentalacademy.com
    22. 22. Functional examination • Examination of the postural rest position and maximum intercuspation. • Examination of the temporomandibular joint. • Muscle palpation. • Examination of mandibular movements. • Examination of orofacial dysfunctions. www.indiandentalacademy.com
    23. 23. Examination of the postural rest position and maximum intercuspation www.indiandentalacademy.com
    24. 24. Examination of the temporomandibular joint www.indiandentalacademy.com
    25. 25. Auscultation & palpation of the T M J Auscultation of T M J Lateral palpation of T M J www.indiandentalacademy.com posterior palpation of T M J
    26. 26. Examination of masticatory muscles of T M J  Palpation of lateral pterygoid muscle.  Palpation of temporalis muscle.  Palpation of masseter muscle.  Recording the maximum interincisal distance. www.indiandentalacademy.com
    27. 27. Electro-myographic examination (EMG) • EMG is occasionally used to confirm a clinical diagnosis of muscle dysfunction. • For ex.: In sever class ll division l malocclusion, the mentalis muscle is hyperactive, upper lip is hypo functional and in addition , buccinator contracts excessively and the posterior fibers of temporalis exerts considerable influence to above muscle activity. this muscular imbalance can be assessed by using EMG. www.indiandentalacademy.com
    28. 28. Examination of mandibular movements during functional maneuvers • Left:-opening and closing paths in sagittal plane. • Middle:-opening & closing arcs in horizontal plane • Right:-opening and closing paths in frontal plane. www.indiandentalacademy.com
    29. 29. • Articulators & mounted diagnostic models are used to determine if the bite is in a proper relationship to the TM joint. www.indiandentalacademy.com
    30. 30. Diagnostic records includes… • • • • • • • Study models Facial photographs Intraoral photographs panoramic & intraoral radiographs. Cephalometric radiographs. Digital imaging:- Digital photography - Digital radiography - Digital cephalometry / digigraph - Digital video cephalometry - Digital study models / OrthoCAD a) Conventional craniofacial imaging:- Traditional CT scan [ CT ] - Magnetic resonance imaging [ MRI ] b) contemporary and evolving imaging techniques:- Cone beam Volumetric tomography [ CBCT ] - Surface mapping with Structured light - Laser scaning - Stereophotogrammetry www.indiandentalacademy.com
    31. 31. Study cast analysis:- Gnathostatic model by SIMON, 1926 • These plaster models are oriented to the midpalatal raphe, tuberosity plane and the occlusal plane for study cast analysis .these model analysis helps in a three dimensional assessment of the maxillary and mandibular dental arches and there occlusal relationships. • The upper surface of the maxillary study model corresponds to frankfurt horizontal plane. www.indiandentalacademy.com www.indiandentalacademy.com
    32. 32. • • • • • • • • • Study models are used for To calculate total space analysis. To assess and record the dental anatomy. To assess and record the intercuspation. To assess and record arch form. To assess and record curves of occlusion. To evaluate occlusion, with aid of articulator. To measure progress during treatment. To detect abnormalities ( distorted arch form) To provide a record before, immediately after, and several years following treatment for the purpose of studying treatment procedures. www.indiandentalacademy.com
    33. 33. Permanent & mixed dentition model analysis Permanent Dentition: 1. Pont’s index. 2. Korkhaus analysis. 3. Linder harth index. 4. Arch perimeter analysis. 5. Bolton tooth size ratio. 6. Ashley Howe’s analysis. 7. Peck and Peck index. 1. 2. 3. 4. 5. Mixed dentition : Moyers mixed dentition analysis. Huckaba’s analysis. Hixon & old father method. Nance carey’s analysis. Total space analysis. www.indiandentalacademy.com
    34. 34. Pont’s analysis (1909 ) • It is used to determine the ideal dental arch width from combined mesiodistal width of the maxillary ( 2 1/ 1 2 )=X • The ideal arch width in premolar region is calculated by (X/80)×100 • The ideal arch width in molar region is calculated by, (X/64)×100 www.indiandentalacademy.com
    35. 35. Palatal height analysis • Palatal height is measured in the midsagittal plane in the region of the upper 1st molars on the level of the occlusal plane using korkhaus three dimensional orthodontic divider. • Palatal = Palatal height × 100 height posterior arch width index • The average index value is 42% • Inference:- If >42% high palate. - If <42% shallow palate., www.indiandentalacademy.com
    36. 36. Ashley howe’s analysis • According to howe’s , crowding is not only due to tooth size, but it can also result when there is inadequate apical base. • It can be calculated by determining , -- TTM (tooth material) - PMD (premolar diameter) - PMBAW (premolar basal arch width) - BAL (basal arch length) • Compare PMD & PMBAW • Calculate PMBAW% =PMBAW × 100 TTM • Results compared with howe’s measurements table. www.indiandentalacademy.com
    37. 37. Inference 1.The patient values should fall with in the suggested range. 2. If PMD>PMBAW, expansion is contraindicated. If PMBAW>PMD, expansion is indicated. 3. If PMBAW × 100 TM - Less than 37% basal arch deficiency case requiring extraction of teeth. - If >44% Ideal case & dose not need extraction. - If between 37% to 44% Borderline case, which may/ may not require extraction. www.indiandentalacademy.com
    38. 38. Arch perimeter analysis • It use to find the difference between the basal bone and tooth material • It is used to evaluate - tooth material (space required) - arch perimeter (space available) -arch length discrepancy Arch perimeter analysis done on lower arch is called carey’s analysis. www.indiandentalacademy.com
    39. 39. Boltans analysis www.indiandentalacademy.com
    40. 40. Table of average values for the overall and anterior ratio’s of maxillary and mandibular tooth width according to boltan www.indiandentalacademy.com
    41. 41. Photography ABO Requirements 1. 2. 3. 4. 5. 6. 7. 8. 9. Quality prints either in black and white or color. Head should be oriented accurately in all 3 planes of space and in F-H plane. 1Lateral view- facing to the right , serious expression ,lips closed lightly. 1Anterior view- serious expression Background free of distractions. 1lat view ,1ant view- (optional) with lips apart. 1 ant view- (optional) smiling. Quality lighting with no shadows. Ears exposed for purpose of orientation. 10.Eyes opened, looking straight ; glasses removed . www.indiandentalacademy.com
    42. 42. Facial photographs. • For ideal photographic representation of the face, the camera should be positioned in the “portrait” position to maximize use of the photographic field. Orienting camera in “landscape” position captures much of the background and diminishes the size of the face in the picture. www.indiandentalacademy.com
    43. 43. Extra oral photographic views • Acc. to Proffit :– Frontal view with lips relaxed – Frontal view with lips together – Profile view with lips relaxed – Profile view with lips together – Smile (Angular or frontal) www.indiandentalacademy.com
    44. 44. Extra oral photographic views • According to T M. Graber and R L. Vanarsdall 1.Frontal view - at rest with lips repose. - at maximal intercuspation, with lips closed. - a Dynamic (smile) - a close-up image of posed smile. 2.Oblique ( three-quarter, 45-degree ) view - Oblique at rest - Oblique on smile - Oblique close-up smile 3.Profile view - Profile at rest with lips relaxed - Profile smile 4.Optimal Submental view www.indiandentalacademy.com
    45. 45. Commonly used extra oral photographs Frontal view Frontal dynamic (smile) view Oblique three quarter view Profile view www.indiandentalacademy.com
    46. 46. ABO requirments for intraoral photographs.  Quality, standardized intraoral prints in colour.  Patient’s dentition oriented accurately In all three planes of space.  One frontal view in maximum intercuspation.  Two lateral views – right and left.  Optional: Two occlusal views- maxillary and mandibular.  Free of distractions – cheek retractors, labels and fingers.  Quality lighting revealing anatomical contours and free of shadows  Tongue retracted.  Free of saliva and/or bubbles  Dentition clean. www.indiandentalacademy.com
    47. 47. Intra oral photographic views Right lateral view Frontal view left lateral view • The occlusal Maxillary occlusal view photograph should be taken using a front surface mirror to permit 90° view of the occlusal surface. Mandibular occlusal view www.indiandentalacademy.com
    48. 48. Uses of intra oral photographs, • It enable orthodontist to review the hard and soft tissue findings from the clinical examination during analysis of all the diagnostic data. • To record hard and soft tissue conditions as they exist before treatment. • Photographs helps to record white-spot lesions of enamel, hyperplastic areas and gingival clefts to document that such preexisting conditions are not caused by orthodontic treatment. www.indiandentalacademy.com
    49. 49. Radiography www.indiandentalacademy.com
    50. 50. Topographic anatomy of the skeleton of the hand.. www.indiandentalacademy.com
    51. 51. Maturation indicators of hand bones for determining skeletal age .. There are 3 stages of ossification of the phalanges .. • 1st stage - Epiphysis shows the same width as the diaphysis . • 2nd stage - In capping stage, the epiphysis surrounds the diaphysis like a cap. • 3rd stage – In U-stage bony fusion of epiphysis and diaphysis occur. www.indiandentalacademy.com
    52. 52. Analysis of hand radiographs according to Bjork, Grave and Brown: • 1st stage of maturation PP2 =stage Epiphysis of the index finger (PP2) has the same width as the diaphysis. • 2nd stage: MP3= stage Epiphysis of the middle finger (MP3) is of the same width as the diaphysis • 3rd stage : pisi-,H1 and R = stage this stage has 3 distinct ossification areas, Pisi- stage = Visible ossification of the Pisiform. H1- stage = ossification of the hamular process of the hamatum. R stage = same width of epiphysis and diaphysis of the radius. www.indiandentalacademy.com
    53. 53. 4th stage: S- and H2-stage S-stage = First mineralisation of the sesamoid bone of the metacarpophalanngeal joints of the thumb. H2-stage = Progressive ossification of the hamular process of the hamatum.  5th stage: MP3, PPI and R stage In this stage the diaphysis is covered by the cap shaped epiphysis at the middle phalanx, proximal phalanx, and radius. www.indiandentalacademy.com
    54. 54. 6th stage: DP3 – stage Visible union of epiphysis at the distal phalanx of the middle finger. 7th stage: PP3 – stage Visible union of epiphysis and the proximal phalanx of the little finger. 8th stage: MP3 – stage Union of epiphysis at the middle phalanx of the middle finger is clearly visible. 9th stage: R- stage Complete union of epiphysis and diaphysis of the radius. The ossification and skeletal growth is finished. www.indiandentalacademy.com
    55. 55. Julian singer’s method of Hand wrist radiograph assessment (1980) According to singer’s There are 6 stages to determine the maturational status of the patient, • Stage one (early):- Absence of pisiform, absence of hook of hamate & epiphysis of proximal phalanx of second finger being narrower than its diaphysis. • Stage two (prepubertal):- Initial ossification of hook of hamate, initial ossification of the pisiform and proximal phalanx of second finger being equal to its epiphysis. • Stage three (pubertal onset):- There is beginning of calcification of ulnar sesamoid, increased width of epiphysis of proximal phalanx of 2nd finger & increased calcification of hook of hamate & pisiform. www.indiandentalacademy.com
    56. 56. • Stage four (pubertal):-characterized by calcified ulnar sesamoid and capping of the diaphysis of the middle phalanx of 3rd finger by its epiphysis. • Stage five (pubertal deceleration):-characterized by fully calcified ulnar, sesamoid, fusion of epiphysis of distal phalanx of third finger with its shaft, & epiphysis of radius and ulna not fully fused with respective shafts. • Stage six (growth completion):- No remaining growth sites seen. www.indiandentalacademy.com
    57. 57. Cervical vertebral maturation as a predictor of the growth www.indiandentalacademy.com
    58. 58. The five stages of cervical vertebral maturation used to predict the phases of growth. by Baccetti and colleagues CVMS I: The lower borders of the first three cervical vertebrae are flat, with the possible exception of a concavity at the lower border of C2 in almost half of the subjects. The bodies of both C3 and C4 are trapezoidal in shape. www.indiandentalacademy.com
    59. 59. • CVMS II: A concavity is present at the lower borders of both C2 and C3. The bodies of C3 and C4 may be either trapezoidal or rectangular horizontal in shape. • CVMS III: A concavity is now present at the lower borders of C2, C3, and C4. The bodies of both C3 and C4 are rectangular horizontal in shape. www.indiandentalacademy.com
    60. 60. • CVMS IV: The bodies of C3 and /or C4 are square in shape. If not square, one of the two cervical vertebrae is still rectangular horizontal. • CVMS V: The bodies of C3 and. / or C4 are rectangular vertical in shape. If not rectangular vertical,- one of the two cervical vertebrae is still square. www.indiandentalacademy.com
    61. 61. Full mouth radiographs.. • Full mouth radiographs before commencement of orthodontic treatment is of a valuable aid in accurate assessment of the periodontal condition and the apices of the roots. • These diagnostic records will help in assessment of areas of root resorption at the completion of mechanotherapy. www.indiandentalacademy.com
    62. 62. Occlusal radiographs • occlusal radiographs r the diagnostic aids wihich help to locate supernumerary teeth at midline, and to ascertain accurately the position of unerupted maxillary cuspids www.indiandentalacademy.com
    63. 63. Orthopantomogram (opg) • The panoramic radiograph gives a survey of the T M J, entire dental condition and abnormalities of the mixed dentition in one single exposure. • Radiologic findings like hypoplasia, impacted teeth, narrow tooth germ posistion, root canal filling, root resorptions, amount of bone loss, bony trabecular pattern, bony pockets, any root fragments, third molars, supernumerary teeth and pathological lesions at root apex and other findings can be evaluated using panoramic radiographs. www.indiandentalacademy.com
    64. 64. Shift cone technique / clarks technique • For locating position of impacted canines . www.indiandentalacademy.com
    65. 65. cephalometrics www.indiandentalacademy.com
    66. 66. Cephalometric records • Cephalometric analysis is a 2D representation and analysis of a 3D patient ,using a numerous reference points and lines made on patients lateral cephalogram. • These reference points and lines are located in the skeletal, dentoalveolar and soft tissue regions of the headfilm. www.indiandentalacademy.com
    67. 67. The information that can be ascertained from the cephalometric analysis are...  Classification of the facial patterns.  Relationship of jaw bases before treatment.  Monitoring of skeletodental relationships during treatment  Relationship of the axial inclination of incisors.  Assessment of the soft tissue morphology.  To predict Growth pattern and direction of growth.  Localization of the malocclusion.  Treatment possibilities and limitations.  Determination of mandibular rest position.  Assessment of trauma after facial injuries. www.indiandentalacademy.com
    68. 68. Cephalometric reference points www.indiandentalacademy.com
    69. 69. Cephalometric reference planes www.indiandentalacademy.com
    70. 70. Purpose of different cephalometric analysis  For diagnosis – Ex:- Down’s analysis.  For treatment planning - Ex:- Steiner’s analysis.  For growth predictions – Ex:- Serial cephalograms, visual treatment objective of Holdaway, Ricketts analysis…etc  For surgical orthodontics - Ex:- Burstone’s analysis (COGS)  For Soft tissue evaluation - Ex:- Arnett analysis, Holdaway, Meredith analysis, Burstone analysis…etc  For studying symmetry – Ex:- Rickett’s analysis.  For airway evaluation – Ex:- McNamara analysis. www.indiandentalacademy.com
    71. 71. Frontal cephalogram • To evaluate facial asymmetry. - Grummon’s analysis. - Rocky mountain analysis. • To diagnose malocclusion in transverse plane. www.indiandentalacademy.com
    72. 72. Structural Classification of Dentofacial Assymetries Broadly classified into Dental, Skeletal, Muscular and functional. • A. Dental Asymmetries: can be due to Local factors such as loss of deciduous teeth, congenitally missing teeth, habits and lack of exactness in genetic expression.  B. Skeletal Asymmetries: Their deviation may involve one bone such as maxilla or mandible or it may involve a no. of skeletal and muscular structures on one side of the face. www.indiandentalacademy.com
    73. 73. • C) Muscular Asymmetries : Hemifacial atrophy or cerebral palsy, abnormal muscle functional • D) Functional Asymmetry: can result from the mandible being deflected laterally or antero - posteriorly, if occlusal interferences prevent proper intercuspation in centric relation. www.indiandentalacademy.com
    74. 74. occlusograms • Occlusogram is a 1:1 reproduction of the occlusal surfaces of plaster models on a sheet of tracing paper or they are the direct positive photographs in negative form of plaster study cast. Clinical significance:• It is a reliable way of determining minute changes in the arch form & position of teeth before, during and after orthodontic treatment. • This method provides a simplified method for measurements to determine the arch length discrepancy. www.indiandentalacademy.com
    75. 75. Diagnostic set-up by H.D. kesling • It is valuable in, • • • • Borderline cases to know, -whether to extract or not. -whether to extract 1st premolar or 2nd premolar. Possibility of aligning incisors, whenever incisor extraction is planned as at of treatment plane. All possible types of occlusal arrangement for patients with abnormal occlusal problems like, missing teeth, badly broken teeth etc… www.indiandentalacademy.com
    76. 76. Diagnostic records in case of fixed mechanotherapy…. www.indiandentalacademy.com
    77. 77. Stage 1 - Pre treatment records ……Date:-……………. • Extra oral photographs. • Intra oral photographs. • Diagnostic study models. Am J Ortho Dentofacial Orthop, October 2004 www.indiandentalacademy.com
    78. 78. Pretreatment lateral cephalogram and its cephalometric tracing for diagnosis,and pretreatment panoramic rodiograph. Am J Ortho Dentofacial Orthop, October 2004 www.indiandentalacademy.com
    79. 79. Stage 2- Progress treatment records . Date:-……… • Progressive Mid treatment photograpic records. • Mid treatment intra oral photographs. • Progressive treatment diagnostic study models. Am J Ortho Dentofacial Orthop, October 2004 www.indiandentalacademy.com
    80. 80. Progress lateral cephalogram, and the progress cephalometric tracing superimposed on the pre treatment tracing. • Progress panoramic radiograph... Am J Ortho Dentofacial Orthop, October 2004 www.indiandentalacademy.com
    81. 81. Stage 3 - Post treatment records. Date:-………….. • Post treatment photographic records. • Post treatment intra oral photographic records. • Post treatment study models records. Am J Ortho Dentofacial Orthop, October 2004 www.indiandentalacademy.com
    82. 82. Post treatment lateral cephalogram and its cephalometric tracing superimposed with pretreatment lateral cephalometric tracing records to evaluate the results achieved at the end of the tratment. e • Post treatment panoramic radiogram. Am J Ortho Dentofacial Orthop, October 2004 www.indiandentalacademy.com
    83. 83. Technobytes and Digital imaging • The transition from film to digital has been happening at a faster pace in the fields of Orthodontics,where the photographic & radiographic images (periapical, occlusal, OPG, cephalometric, and skull radiographs) are being acquired digitally, stored as a diagnostic record with in a server locally, and eventually accessed for diagnostic purposes, along with the rest of the patient data via the patient management www.indiandentalacademy.com software.
    84. 84. Goals and principles of craniofacial imaging:General imaging goals: Image the entire region of interest.  View the entire region of interest in at least 2 planes at right angles to each other ( 3D )  Obtain images with maximum detail, minimal distortion & minimal superimposition. Clinically determined imaging goals: To identify normal & abnormal anatomy.  Determine root length & root alignment.  Determination of the status of TMJ.  Determine the relationship b/w tooth space requirement and jaw dimensions.  Determine maxillomandibular spatial relationships.  Determine past, present & expected craniofacial growth magnitude and direction.  Determine effects of treatment on the craniofacial anatomy.  Identify and localize supernumeraries and impacted teeth. www.indiandentalacademy.com
    85. 85. Digital imaging records includes.. • Digital photography • Digital radiography • Digital cephalometry- Digigraph • Digital study models www.indiandentalacademy.com
    86. 86. Digital photography • Pixel (Picture element) • Voxel (Volume element) • Spoxel (Space element) • • CCD - Charged Couple Device (Charge Coupled Device?) CMOS – Complementary Metal Oxide Semiconductor ADC – Analog to Digital Converter • Light • Sensor Electric charge storage of digital images in Memory www.indiandentalacademy.com ADC
    87. 87. Digital Photography Advantages Disadvantages - Instant viewing of pictures -cameras prices are still - mistakes can be rectified high. immediately -As digital images can be - No film or processing is retouched , they can’t be required useful for medico-legal - Manipulation of data on requirements as computer, easy duplication traditional negatives. - Organization of data - No rolls – saves money , no aging of photos. - Decreas storage problems & easy retrieval in need. - Immediate Transmission of data www.indiandentalacademy.com
    88. 88. Digital Radiography RadioVisuoGraphy (RVG)  Imaging done with a CCD  very high resolution  optimal shape and size of the sensor  sensor thickness 4 mm www.indiandentalacademy.com
    89. 89. Digital Radiography Data collection: Electric al charge Image • CCDs • Amorphous Selenium • Amorphous Silicon • Phosphor plates www.indiandentalacademy.com Sensor digitizer X-ray
    90. 90. Structure of sensor Scintillator CCD Fiber optic layer X-ray imaging with CCD • Scintillator converts x-rays to photons. (light) • Fibro optic layer Conducts photons to CCD and stops radiations. • CCD converts photons tgo electrons(charges). • Electric circute amplifies the signal and converts the analog signal in to digital. www.indiandentalacademy.com pixels
    91. 91. • Imaging cycle 1.Load intraoral or panoramic imaging plate 5. Erase imaging plates for reuse 2. Take X ray Image on computer 3. Mount imaging plates in carousel 4. Place in scanner & Scan images www.indiandentalacademy.com
    92. 92. [Storage phosphour imaging plates] Advantages of digital radiography - Images can be manipulated using softwear filters (brightness, contrast and saturation can be altered which make identification of anatomic tissues easy) - Alternative to conventional film - Same machine and settings used for DenOptix & regular cephalograms and OPGs. - No chemicals or dark room is required . - Environment friendly- no heavy metal wastage - Can be reused thousands of times -Immediate Transmission of images - Image is instantly www.indiandentalacademy.com obtained Saving clinic staff time.
    93. 93. Digital Cephalometry • Digitization is a process by which analog information is converted into digital form Indirect digitization Digitizing tablet Electronic pen Direct digitization Mouse Cross hair cursor www.indiandentalacademy.com
    94. 94. Digital Cephalometry • Digitization – Activated by pressing the button – Location of individual landmarks in a predetermined sequential manner – Visual ceph generated by connecting dots by lines and curves – Once digitization is complete,any analysis can be performed in seconds using the reference points and planes. www.indiandentalacademy.com
    95. 95. Digigraph The Digigraph Workstation - It’s a non radiographic system. - Two video cameras permanently aimed & focused. - Head holder -Attached video monitor – Images,text,numerical data can be displayed, stored,modified using a computer keyboard. www.indiandentalacademy.com
    96. 96. Procedure for Digigraph www.indiandentalacademy.com
    97. 97. Digigraph • Cephalometric analysis display - Any of the 14 cephalometric analyses • Rickets lateral • Rickets frontal • Vari-Simplex • Holdaway • Alabama • Jarabak • Steiner • • • • • • • Downs Burstone McNamara Tweed Grummons frontal Standard lateral Standard frontal www.indiandentalacademy.com
    98. 98. Digigraph • Visual Treatment Objective (VTO) To move part of the picture, simply touch the light pen to two points on the screen, at opposite extremes of the area to be moved. www.indiandentalacademy.com
    99. 99. Digitalizing study models using OrthoCAD • OrthoCAD - It is a digital study model capture, assessment and storage system. • It provides a 3D record of the original malocclusion, any stages during treatment and the outcome of the www.indiandentalacademy.com treatment.
    100. 100. OrthoCAD & 3D digital study models • OrthoCAD software helps orthodontist to view, manipulate, measure & analyze 3Digital study models. • The penta-view of OrthoCAD ,enable us to view models from any direction in desired magnification on screen, thus lingual aspect of maxillary & mandibular teeth in occlusion can be clearly seen & assessed using OrthoCAD . www.indiandentalacademy.com • Journal of orthodontics- pubmed
    101. 101. OrthoCAD with diagnostic tools • a) Occlusogram can show inter-occlusal contacts using colour -coded scales. • b) overbite & overjet can be assessed by splitting the model in the midsagittal plane. • c) splitting can be done at any point & in any angle . • d) can measure mesiodistal width of teeth. • e) Space analysis in arch. f) can Measurement of arch widths in both the jaws . www.indiandentalacademy.com Journal of orthodontics- pubmed
    102. 102. Arch perimeter analysis using OrthoCAD • Similarly other model analysis can also be carried out using OrthoCAD software .this software is available with several diagnostic tools such as measurment analysis (e.g. Bolton analysis, arch width & length analysis ). www.indiandentalacademy.com
    103. 103. OrthoCAD virtual set-up based on straight wire philosophy • OrthoCAD virtual set-up needs to go through 7 steps to reach final plan. • Another addition to this is the OrthoCAD bracket placement system, which position brackets according to their planned position in 7 virtual Journal of orthodontics-www.indiandentalacademy.com pubmed treatment plan stages.
    104. 104. 3D study model by laser scanning • It helps to reveal accurate occlusal morphology. • This technique permits 360° views of study models with high accuracy, as the images are captured from several different angles & hence, it permit recording of undercut areas . www.indiandentalacademy.com • Journal of orthodontics- pubmed
    105. 105. Digital study models Advantages Disadvantages • Virtual casts can be kept in • If the plaster dental digital format & hence casts are poor, than eliminating storage problems. the obtained digitalized images will be altered • Immediate data transmission. during digitization . • Measurements on digital casts is easy, accurate & automatic. • Dental images in mixed dentition are difficult to • Digital images can be made recognize and measure. bigger and hence localizing • Digitalizing dental casts anatomic points easily. is a laborious process • Digital study casts can be that has always to be used for patient motivation. made under the same • Stores original malocclusion in conditions. 3D formate. www.indiandentalacademy.com Med oral patol oral cri bucal 2006- pubmed
    106. 106. Computed Tomography • Equipment - Scanner table +gantry - Computer movable X ray system - Display console www.indiandentalacademy.com
    107. 107. Computed Tomography  Principle…. X-ray tube (a) rotates in tandem with detectors (b) on opposite side to image 1 thin axial slice. Gantry is than advanced through CT machine for next slice. • An image of a layer within the body is produced while the images of the structures above and below that layer are made invisible by blurring www.indiandentalacademy.com Am J Ortho Dentofacial Orthop, MAY 2005
    108. 108. Working principle • Two spheres scanned at 3 different angles (0°, 60°, 120°) and graphs is obtained at each angle position which show absorption of x-rays as registered by detectors present in the tandem. At reconstruction phase by using mathematical algorithms, machine effectively back-project absorption graph data inside scanned volume. Thus 1D data registered at each rotational position are combined to produce 2D image of axial slice. Each axial slice is composed of pixels (small square elements aranged in rows and columns). Am J Orthowww.indiandentalacademy.comMAY 2005 Dentofacial Orthop,
    109. 109. www.indiandentalacademy.com
    110. 110. Difference between CT and CBCT • The type of imaging source –detector complex and the www.indiandentalacademy.com method of data acquisition.
    111. 111. Rendering axial slice in to 3D image Axial slices of maxilla showing impacted tooth. 3D Volume composed of voxels. Some voxels are rendered transparent to show object inside by using transfer function. 2D cephalogram front and edge on view showing front row of pixels. By extending a flat pixels image in 3rd dimension using computer algorithm, will yield a 3D volume. www.indiandentalacademy.com Am J Ortho Dentofacial Orthop, MAY 2005
    112. 112. Computed Tomography • Clinical applications High radiation exposure and high cost has prevented its use in Orthodontics. But in certain situations benefits outweigh the risks and are used in certain situations like,  In severe craniofacial deformities where 2D diagnostic records are inadequate  Treatment predictions with 3D computer tomographic skull models  TMJ examination www.indiandentalacademy.com CT image
    113. 113. • Parallel X-ray beam is sent through the patient. www.indiandentalacademy.com
    114. 114. • 3-D cephalometric hard tissue landmarks. www.indiandentalacademy.com
    115. 115. • 3-D cephalometric hard tissue landmarks. virtual lateral and frontal cephalograms linked to the 3D hard tissue representation. www.indiandentalacademy.com
    116. 116. • Set-up of 3-D cephalometri c hard tissue landmarks linked lateral and frontal cephalogram s. www.indiandentalacademy.com
    117. 117. Potential use of 3D data obtained from CT scan . 1.Impacted tooth position • The exact position of impacted tooth and their relationship to adjacent roots and there resorption & their proximity to any anatomical structures can be easily diagnosed. www.indiandentalacademy.com
    118. 118. 2. CT scan of maxillofacial region • CT scan of the maxillofacial region can be used to visualize both bony structures and teeth in three dimensions , and used as an supplemental to 2D cephalometric diagnostic records. Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    119. 119. 3.Simulation of torque movements • 3D evaluation of axial inclination of teeth can provide information to supplement the records obtained from models. • It is possible to change the torque of a single tooth or a group of teeth & evaluate the amount of bone before fenestration is evident. Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    120. 120. 4. 3D digital modeling and setup of orthodontic tooth movement & space closure using CT scan A B • Separation of anatomic teeth, including roots from CT scan. • 3D setup simulating extraction of 2 first premolars. Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    121. 121. C • Simulation of Subsequent space closure following orthodontic tooth movement. Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    122. 122. D • Simulation of subsequent tooth alignment at the completion of orthodontic tooth movement. • Aligned crowns & roots and their anatomic relationship with surrounding bone with E possible fenestrations. • Helps in assessment of width of available bone for buccolingual Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com movement of teeth.
    123. 123. 5.C T scan for T M J examination. • Computed tomogram of the right & left T M J in habitual occlusion . • Computed tomograms of the right & left T M J in maximum openmouth position. www.indiandentalacademy.com
    124. 124. TMJ examination  Useful in determining changes in bone density  Primary imaging method when internal derangement or arthrosis is suspected – clinical diagnosis is not always sufficient.  Has advantages when planning treatment or operations on jaws and TMJ diseases and deformities. www.indiandentalacademy.com
    125. 125. 6.Airway volume assessment in pt. with mouth breathing, adenoid hypertrophy, or sleep apnoea, by application of transfer function to 3D CT scan 7.Bone rendering with transparent soft tissues by application of transfer function ,which render soft tissue invisible on 3D CT scan. 7. Visualization of internal anatomic structures by removal of cranium by box cut to peek inside a 3D volume by use of transfer function. www.indiandentalacademy.com Am J Ortho Dentofacial Orthop, MAY 2005
    126. 126. Volume rendering • Set up of 3-D cephalometric reference system in conjugation with FH plane, maxillary plane, occlusal plane, mandibular plane.(3-D hard tissue & transperent soft tissue surface representation) • Set up of 3-D cephalometric reference system in conjugation with FH plane, maxillary plane, occlusal plane, mandibular plane.(3-D soft tissue surface representation) www.indiandentalacademy.com
    127. 127. www.indiandentalacademy.com
    128. 128. Cone-Beam CT Device images • A key feature of CBCT images is the ability to navigate through the volumetric data set in any orthogonal slice window [ axial, sagittal, coronal and panoramic views], instead of just analyzing 2D crosssectional images from a 3D patient, and help clinicians think in 3D directions instead of 2D directions. www.indiandentalacademy.com Am J Ortho Dentofacial Orthop, MAY 2006
    129. 129. 3D Cone-Beam CT virtual models • A. Can be Used In case of Surgical patients and those with developmental anomalies like hemi facial microsomia where in case ,if the working condyle is missing, it can be replaced with costocondral graft by proper planning of surgery using 3D cone beam CT virtual models . • B. can be used to evaluate significant facial asymmetry and missing articular fossa. www.indiandentalacademy.com Am J Ortho Dentofacial Orthop, MAY 2006
    130. 130. 3D Cone-Beam CT models • Can render bone transparent which allows visualization of developing permanent teeth & It can also be used to determine the position of the surgical pins or implants in bone, that might be impairing tooth eruption . Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    131. 131. Angular measurements with CBCT • Sagittal slice of CBCT showing angular measurement . • Linear & angular measurements between anatomical reference points (inter canine width) using axial view of CBCT images. www.indiandentalacademy.com
    132. 132. CBCT of condylar head • CBCT can be used to establish a 3D setup of mandibular condyles . It helps to assess the size , shape and position of mandibular condyle in glenoid fossa. Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    133. 133. Dolphin 3D beta version imaging • A:- Lateral view of 3D virtual models with transparency of soft tissue. • B:- 2D cephalogram generated from 3D models with orthogonal projection. • C:- 2D maximum intensity projection cephalogram . Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    134. 134. 3D Digital modeling and setup A C B D E • 3D superimposition of the anatomic teeth, before treatment [A & B] and after [C & D] the setup to visualize the amount of teeth movement before and after treatment [ E ] by making use of 3D setup Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    135. 135. 3D digital modeling and setup using CT scan A B A – removal of crowns from CT scan. B – separation of roots. C C – merging of these roots with separated crowns acquired from models. Am J Ortho Dentofacial Orthop, MAY 2006 www.indiandentalacademy.com
    136. 136. Magnetic Resonance Imaging . Principle:MRI is a type of emission imaging of water in the tissues. When images are displayed; intense signals show as white and weak ones as black. Intermediate as shades of gray. Cortical bone and teeth with low presence of hydrogen are poorly imaged and appear black. www.indiandentalacademy.com
    137. 137. MRI  MRI can clearly differentiate the soft tissue components  Preferred imaging technique when information regarding the articular disc or the presence of adhesions,or joint effusion is desired  Indications  Assessing diseases of the TMJ  Cleft lip and palate  Tonsillitis and adenoiditis  Cysts and infections  Tumors www.indiandentalacademy.com
    138. 138. Structured light • principle behind structured light systems is the projection of a designed pattern on to a surface that is distorted & interpreted as 3D information to produce a surface map. • Because a pattern is projected on to the face, the colored surface map obtained can be distracting. For this reason a second image is often obtained with out the projected pattern. • In this way the surface map obtained from projected pattern is used with clean texture map to produce more realistic 3D images. www.indiandentalacademy.com
    139. 139. www.indiandentalacademy.com
    140. 140. Laser scan for 3D facial imaging • Laser scanner consists of a color camera which is registered to with the laser scanner. • Laser scanning provides only the surface map & can not provide color information of the texture map. • Prelabeled anthropometric landmarks can be used for facial analysis using laser scanning. www.indiandentalacademy.com World journal of orthodontics December 2006
    141. 141. Principal of laser scanner • A non contact 3D laser scanner utilize patterned light technique in the form of slit or grid projected on to subject and the reflected light is than viewed by CCD camera. The variable deflections of reflected light in the cameras field offer the depth information. This method is called optical triangulation method www.indiandentalacademy.com World journal of orthodontics December 2006
    142. 142. Craniofacial analysis using 3D laser scanning • The soft tissue landmarks identified on the face can be easily joined to reproduce 3D surface of the face I normal, class ll and class lll malocclusion patients. www.indiandentalacademy.com World journal of orthodontics December 2006
    143. 143. Clinical applications of laser scanning • Construction • Assessment • of facial of facial templates. asymmetry www.indiandentalacademy.com Orthod craniofacial reserch 2006 Difference in pre & post surgical facial morphology using facial templates .
    144. 144. Stereophotogrammetry • Similar to human visual process this technique uses 2 images separated in distance by a small distance, where in 2 cameras, configured as a stereopair are used to capture 3Ddistances of the surface of the face by means of triangulation. • It captures patients skin texture over the 3D model of face. Journal of orthodontics- pubmed www.indiandentalacademy.com 15° 50 cms
    145. 145. stereophotogrammetry • The 3D face is a composite of 2 halves, each half representing the image acquired from each camera. • Assessment of outcome can also be performed easily by visual comparison of pre- & post-treatment models placed side by side by using stereophotogrammetry scanning. www.indiandentalacademy.com • Journal of orthodontics- pubmed
    146. 146. Application of 3D imaging with stereophotogrammetry • 3D imaging of face enables us to evaluate face from any direction in different views with gradual rotations around yaxis from -90 to+90 & +30 to -30 around x-axis, for subjective clinical assessment of deformities with out the need of patient recall or the doctor being restricted by time of clinical assessment. www.indiandentalacademy.com Journal of orthodontics- pubmed
    147. 147. Photogrammetry applied to craniofacial skeletal reconstruction using multiple planar radiographs. • Hear the radiographs use common registration points to produce 3D coordinate system for axial and sequence of transaxial buccolingual crosssectional views. • Allow determination of -bone quality ,height & width in proposed implant site. -visualization of lingual fossa. -Localisation of mandibular canal. www.indiandentalacademy.com
    148. 148. conclusion • Orthodontic imaging has come a long way since the “ plaster era” during the times of Edward angle and Calvin case when plaster was the recording medium. Later with the advent of dental impression materials radiographs and photographic films the orthodontic patient record evolved in to “Film era”. Now we are in to evolving “Digital era” in which new digital technologies are being used to resolve previous limitations of patient records and hence the continuing evolution in orthodontic imaging of virtual patients will be a key to future orthodontic practice. www.indiandentalacademy.com
    149. 149. Bibliography • • • • • • • • • • • • • • • • 1. current principles and techniques in orthodontics- by Thomas.M.Graber & Robert.L.Vanarsdall. 2. colour Atlas of Orthodontic diagnosis- by Thomas Rokosi, Irmtrud Jonas & Thomas.M.Graber 3. Orthodontic principles and practice- by T.M.Graber 4. Contemporory Orthodontics – by William.R.Proffit 5. Orthodontic Diagnosis- by W.J.B.Houston 6. Handbook of Orthodontics- by Robert.E.Moyers 7 AJODO 2006; August ,volume130 ,no 2 : 257-65 8 AJODO 2006: may, volume 129 ,no 5; 605-617 9 World journal of orthodontics December 2006. 10 Orthod craniofacial reserch 2006 11 AJODO 2005volume 128: 157-60 12 AJODO 2006 volume 127: 627-637 13 AJODO 2005 volume 127 no 5 14 Journal of orthodontics 15 Med oral patol oral cri bucal 2006- pubmed 16 journal of orthodontics 2006- pubmed www.indiandentalacademy.com
    150. 150. • • www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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