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


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

  1. 1. Radiographs used in Orthodontics INDIAN DENTAL ACADEMY Leader in Continuing Dental Education
  2. 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.
  3. 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.
  4. 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.
  5. 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
  6. 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..
  7. 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.
  8. 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.
  9. 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.
  10. 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..
  11. 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
  12. 12. Occlusal RadiographsIndicated when a requirement to visualize a relatively large segment of a dental arch, including the palate or floor of the mouth.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 18. Interpretation of normal anatomy
  19. 19. Soft tissue anatomical structure
  20. 20. Maxillary bony anatomical structures
  21. 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.
  22. 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
  23. 23. Anatomy of skeleton of Hand
  24. 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.
  25. 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
  26. 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 .
  27. 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
  28. 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 SMI-10 Third finger-Middle Phalanx
  29. 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.
  30. 30. Sesamoid Sesamoid is usually attained during the acceleration period of the pubertal growth spurt [onset of peak height velocity]
  31. 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.
  32. 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
  33. 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
  34. 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
  35. 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
  36. 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
  37. 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] .