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

Radiographs used in
Orthodontics

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
www.indiandentalacademy.com


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.

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.

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.

Classification
1.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


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.
.


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.

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.


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.

Bitewing radiographs

 Bitewing radiographs are used primarily to
record the coronal portion of the maxillary and
mandibular posterior dentition along with their
supporting stuctures.
.


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

Occlusal Radiographs
Indicated when a requirement to visualize
a relatively large segment of a dental arch,
including the palate or floor of the mouth.


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.

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.


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.


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.

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.

Interpretation of normal anatomy


Soft tissue anatomical structure


Maxillary bony anatomical structures


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.

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.Phalanges

Anatomy of skeleton of Hand


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.


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

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 .


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


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-7 Fifth finger-Middle Phalanx
Fusion of Epiphysis and Diaphysis
SMI-8 Third finger-Distal Phalanx
SMI-9 Third finger-Proximal Phalanx

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.


Sesamoid
 Sesamoid is usually attained during the
acceleration period of the pubertal growth
spurt [onset of peak height velocity]


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.


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.


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.


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.


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.


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.


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] .


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

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