Radiographs used in orthodontics /certified fixed orthodontic courses by Indian dental academy

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  • 1. Radiographs used in Orthodontics INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. Introduction Essential in orthodontic diagnosis Wilhelm conrad roentgen discovered X-rays in 1895. Two kinds of radiograph required for orthodontic diagnosis:1. Those taken to provide information regarding the condition of teeth,the periodontium and the bony structures.2. Assessment of the malocclusion in relation to the facial skeletal structure. www.indiandentalacademy.com
  • 3. Uses of radiographs in orthodontics To asses general development of dentition ,presence absence and state of eruption of the teeth. Detection of any pathologies associated with the teeth and jaws. To determine the number, size and shape of the teeth. To determine the extent of root resorption of deciduous teeth and root formation of permanent teeth. www.indiandentalacademy.com
  • 4. Uses of radiographs in Orthodontics To study the character of alveolar bone. Valuable aid in cranio-dentofacial analysis. For the calculation of total tooth material[mesiodistal dimension of permanent teeth] To confirm the axial inclination of the roots of teeth. www.indiandentalacademy.com
  • 5. Classification1.Intra oral radiograph 2.Extra oral radiograph -Periapical projection a.Panoramic -Bitewing projection b.Lateral oblique -Occlusal projection -Mandibular ramus projection -Mandibular body projection c.Skull projection -PosteroAnterior -Lateral skull -Water’s[occipitomental] -Reverse-towne[Open mouth] -Submento-vertex www.indiandentalacademy.com
  • 6. Intra oral periapical radiograph Periapical radiograph are intended to show all of a tooth including its surrounding bone. A full series of IOPA [10-16 films] is required for assesment of the periodontal state.. www.indiandentalacademy.com
  • 7. Uses of IOPA To confirm the presence or absence of supernumerary teeth. To asses the extent of calcification and root formation of teeth. To study the extent of periapical pathology and root fractures. To study the alveolar bone and periodontal ligament space. To asses axial inclination of roots. To determine the size and shape of unerupted teeth. www.indiandentalacademy.com
  • 8. Advantage of IOPA Low radiation dose Possible to obtain localised views of the area of interest. They offer excellent clarity of teeth and their supporting stuctures. www.indiandentalacademy.com
  • 9. Disadvantage of IOPA Assesment of entire dentition requires too many radiographs. Children may not allow placement of intraoral film Cannot be used in patients having high gag reflex and trismus. www.indiandentalacademy.com
  • 10. Bitewing radiographs Bitewing radiographs are used primarily to record the coronal portion of the maxillary and mandibular posterior dentition along with their supporting stuctures.. www.indiandentalacademy.com
  • 11. Used To detect Interproximal caries in early stage of development. Secondary caries below restorations. Height and contour of interdental alveolar bone. Calculus deposits in interproximal areas. Over hanging proximal restorations www.indiandentalacademy.com
  • 12. Occlusal RadiographsIndicated when a requirement to visualize a relatively large segment of a dental arch, including the palate or floor of the mouth. www.indiandentalacademy.com
  • 13. Uses of occlusal radiographs To precisely locate roots, supernumerary, unerupted and impacted teeth. To localize foreign bodies in the jaws and stones in the ducts of salivary glands. To evaluate the integrity of the anterior, medial and lateral outline of the maxillary sinus. In providing information relative to the location, nature, extent and displacement of fractures of maxilla and mandible. To determine the medial and lateral extent of pathoses and detect their presence in the palate. www.indiandentalacademy.com
  • 14. Extra Oral Radiographs Panoramic Radiography: Pantomography or Rotational radiography Radiographic procedure that produces a single image of the facial structures, including both maxillary and mandibular arches and their supporting structures. www.indiandentalacademy.com
  • 15. Advantages of OPG Broad anatomic region imaged. Relatively low patient radiation dose. Relative convenience, ease and speed with which the procedure may be performed. Performed on patient who are unable to open the mouth. Inter-operator variation is minimal. www.indiandentalacademy.com
  • 16. Disadvantage of OPG Specialized equiment is required. The cost is two to four times that of intraoral X-ray machine. Geometric distortion, Magnifications and Overlapping of structures. Objects whose recognition may be important for the interpretation may be situated outside the plane of focus called the focal trough. www.indiandentalacademy.com
  • 17. Indications of OPG Evaluation of trauma, third molars,extensive or unique pathoses. Tooth development in mixed dentition analysis. Developmental anomalies. Broad coverage of the jaws is desirable. Contra indication Panoramic films are not suitable for diagnostic examination requiring high image resolution. www.indiandentalacademy.com
  • 18. Interpretation of normal anatomy www.indiandentalacademy.com
  • 19. Soft tissue anatomical structure www.indiandentalacademy.com
  • 20. Maxillary bony anatomical structures www.indiandentalacademy.com
  • 21. Hand Wrist Radiographs Assessment of the skeletal age is often made with the help of a hand radiograph which can be considered the Biological clock. Hand wrist region is made up of numerous small bones. These bone show a predictable and scheduled pattern of appearance, ossification and union from birth to maturity. Hence, this region is one of the most suited to study growth. www.indiandentalacademy.com
  • 22. Anatomy of Hand-Wrist The hand wrist region is made of four groups of bones 1.Distal ends of long bones of forearm. 2.Carpal 3.Metacarpals 4.Phalangeswww.indiandentalacademy.com
  • 23. Anatomy of skeleton of Hand www.indiandentalacademy.com
  • 24. Indication Of Hand Wrist Radiographs In patients who exhibit major discrepancy between dental and chronologic age. Determination of skeletal maturity status prior to treatment of skeletal malocclusion. To assess the skeletal age in a patient whose growth is affected by infections, neoplastic or traumatic conditions. Help to predict future skeletal maturation rate and status. To predict the pubertal growth spurt. www.indiandentalacademy.com
  • 25. Methods Of Assessing Skeletal Age Bjork ,Grave and Brown method Fishman’s skeletal maturity indicators Hagg and Taranger method Atlas method by Greulich and Pyle www.indiandentalacademy.com
  • 26. Fishman Skeletal Maturity Indicators  Proposed by Leonard S Fishman in 1982.  Make use of anatomical sites located on thumb, third finger, fifth finger and Radius . www.indiandentalacademy.com
  • 27. The Fishman’s system of interpretation Uses four stages of bone maturation 1.Epiphysis equal in width to diaphysis 2.Appearence of adductor sesamoid of thumb 3.Capping of epiphysis. 4.Fusion of epiphysis www.indiandentalacademy.com
  • 28. Fishman method –Eleven SMIs Width of Epiphysis equal to Diaphysis SMI-1 Third finger-Proximal Phalanx SMI-2 Third finger-Middle Phalanx SMI-3 Fifth finger-Middle Phalanx SMI-4 Appearance of adductor sesamoid of the thumb Capping of Epiphysis SMI-5 Third finger –Distal Phalanx SMI-6 Third finger-Middle Phalanx SMI-7 Fifth finger-Middle Phalanx Fusion of Epiphysis and Diaphysis SMI-8 Third finger-Distal Phalanx SMI-9 Third finger-Proximal Phalanx www.indiandentalacademy.com SMI-10 Third finger-Middle Phalanx
  • 29. Maturation Assessment by Hagg and Taranger Analyzed from radiograph taken between the ages of 6 and 18 years, by assessing of the ossification of the ulnar sesamoid of the metacarpophalangeal joint of first finger. Certain specified stages of 3 epiphyseal bone -Middle and distal phalanges of third finger [MP3 and DP3] and distal epiphysis of Radius. www.indiandentalacademy.com
  • 30. Sesamoid Sesamoid is usually attained during the acceleration period of the pubertal growth spurt [onset of peak height velocity] www.indiandentalacademy.com
  • 31. Third Finger Middle Phalanx MP3-F Stage  Start of the curve of pubertal growth spurt .  Epiphysis is as wide as metaphysis  End of epiphysis are tapered and rounded.  Radiolucent gap [cartilageous epiphyseal growth plate] between epiphysis and metaphysis is wide. www.indiandentalacademy.com
  • 32. MP3-FG Stage  Acceleration of the curve of pubertal growth spurt.  Epiphysis is as wide as metaphysis.  Distinct medial and lateral border of epiphysis forms line of demarcation at right angle to distal border.  Metaphysis begins to show slight undulation.  Radiolucent gap between metaphysis and epiphysis is wide.www.indiandentalacademy.com
  • 33. MP3-G Stage  Maximum point of pubertal growth spurt.  Sides of epiphysis have thickened and cap its metaphysis, forming sharp distal edge on one or both the sides.  Marked undulations in metaphysis give it “Cupid’s bow’’ appearance.  Radiolucent gap is moderate.www.indiandentalacademy.com
  • 34. MP3-H Stage  Deceleration of the curve of pubertal growth spurt.  Fusion of epiphysis and metaphysis begins.  Side of epiphysis form obtuse angle to distal border.  Epiphysis is beginning to narrow.  Slight convexity in metaphysis.  Typical Cupid’s bow appearance is absent .  Radiolucent gap is narrow.www.indiandentalacademy.com
  • 35. MP3-HI Stage  Maturation of the curve of pubertal growth spurt.  Superior surface of epiphysis shows smooth concavity.  Metaphysis shows smooth, convex surface, almost fitting into reciprocal concavity of epiphysis.  No undulation present in metaphysis.  Radiolucent gap is insignificant.www.indiandentalacademy.com
  • 36. MP3-I Stage  End of pubertal growth spurt  Fusion of epiphysis and metaphysis complete.  No radiolucent gap.  Dense, radiopaque epiphyseal line forms integral part of proximal portion of middle phalanx.www.indiandentalacademy.com
  • 37. Third finger distal phalanx DP3-1:Fusion of Epiphysis and Metaphysis is completed. -This is attained during the deceleration period of pubertal growth spurt [ end of PHV] . www.indiandentalacademy.com
  • 38. THANK YOU FOR WATCHINGFOR MORE DETAILS PLEASE VISIT www.indiandentalacademy.com www.indiandentalacademy.com