a to z orthodontics vol 7 radiographs1

7/27/2019 A to z Orthodontics Vol 7 Radiographs1

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A to Z

ORTHODONTICS

Volume: 07

Dr. Mohammad Khursheed AlamBDS, PGT, PhD (Japan)

RADIOGRAPHS


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First Published August 2012

Dr. Mohammad Khursheed Alam

All rights reserved. No part of this publication may be reproduced stored in a retrieval system,

or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording orotherwise, without prior permission of author/s or publisher.

ISBN: 978-967-5547-96-6

Correspondance:

Dr. Mohammad Khursheed Alam

Senior Lecturer

Orthodontic Unit

School of Dental Science

Health Campus, Universiti Sains Malaysia.

Email:

[email protected]

[email protected]

Published by:

PPSP Publication

Jabatan Pendidikan Perubatan, Pusat Pengajian Sains Perubatan,

Universiti Sains Malaysia.

Kubang Kerian, 16150. Kota Bharu, Kelatan.

Published in Malaysia


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Contents

1. Dental Xray..................................3-5

2. Types of radiographs....................................5-7

3. Hand wrist radiographs....................................7-8

4. Panoramic radiographs........... ..9-10

5. Intra oral occlusal radiographs.11

6. Bite wing radiographs12

7. Periapical radiographs...13-15


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Orthodontic treatment for malocclusion moves faster during growth spurts.

In general, children have a pattern of fast growth, followed by slow growth

in late childhood, and then another growth spurt in the teen years. Because

children start this pattern at different ages.

WHAT IS A DENTAL X-RAY?

The term x-ray is actually referring to the radiation that is used to make the

image on the film. A radiograph is an extremely important diagnostic tool.

Without the proper use of it, an inferior examination and inferior treatment

will result.

WHY THE NEED?

Dental X-rays help the dentis t to:

Determine presence of unusually shaped roots

Determine the existence of an abscess

Study root involvement and location in relationship with your sinuses

Find hidden decay

Locate the presence of cysts

Locate hidden calculus


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Determine the presence of tumors

Examine area being considered for a bridge

Study primary teeth

Locate a fistula

Determine if all permanent teeth are present

Determine presence and location of foreign objects

Determine condition of root canal filled teeth

Determine presence of a fracture

Determine condition of deep restorations

Determine reasons for pressure sensitivity

Determine if decay is located in abnormal areas

Determine presence of ill-fitting restorations and overhangs

Determine condition of supporting bone

Determine amount of bone destruction in gum disease

Study impacted teeth

Determine health of teeth being considered to support a fixed

Determine if extra teeth are present

Determine sinus condition


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Transparent : These are objects through which X-ray

passes freely. They appear black in a

radiographic film.

Radiolucent : These are objects through which X-rays pass

without much resistance. They appear

different shades of gray in a radiographic film.

Radio-opaque : These are objects through which X-rays do

not pass. They appear white in a radiographic

film.

Types of Radiographs

Intraoral radiograph

1 Intraoral periapical radiograph

2 Bite wing radiograph

3. Occlusal radiograph


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Extraoral radiographs

1. Panoramic radiographs

2. Others-

Cephalometric radiographs

Lateral cephalogram

Postero-anterior cephalogram

Lateral oblique cephalogram

Method of parallax

Hand-wrist radiograph

Cervical vertebrae radiograph

Intra Oral Periapical Radiograph

There are done to view single or small number of teeth and their supporting

structures.

There are two techniques-

Paralelling or Right angle or Long cone technique

In this technique, the X-ray film is placed parallel to the long axis of the

teeth and the central ray of the X-ray beam is directed at right angles to the

teeth and film. This technique reduces geometric distortions.


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Bisecting Angle Technique

In this technique, the central ray is directed at right angles to a plane

bisecting the angle between the long axis of the teeth and the film. This

technique produces a clear image of the teeth and periapical tissues.

The hand-wrist radiograph

The hand-wrist radiograph, or X-ray image of the wrist bones, can help

pinpoint a child's skeletal age. Wrist bones develop to adult size in a clear

pattern. This has allowed experts to make a picture atlas of wrist bones in

various development stages. Orthodontists can compare a hand-wrist

radiograph with the atlas and find out a childs skeletal age.

Importance:

Carpal bones, epiphysis, phalanges and metacarpals provide a

clue to bone growth of the body.

Ossification in these bones occurs after birth and before maturity.

The growth can be evaluated by:

Shape of the carpal bones

Degree of ossification

Time and order of appearance of carpal bones.


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Position of the patient:

o Patient is sitted with the forearm on a table on the line parallel to the

shoulder.

o X-ray film is placed below the hand on the table.

o The ray is directed perpendicular to the line passing between the

hands.

If one hand then ray is directed at the center of the carpals.

Interference:

1. The beginning of ossification of sesamoid bone is a reliable indicator

of onset of puberty.

2. Absence of sesamoid bone at the absence of puberty in a female

means, there is retardation of pubertal growth.

3. Initial ossification of pisiform is and hook of hamate indicates peak

growth in most boys and girls.

4. Initial ossification of thumb and advanced ossification of hook of

hamate indicates peak growth in most boys and it is true for only half

of the girls.


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Panaromic radiograph

Panaromic radiograph enable viewing of both maxillary and mandibular

arches with their supporting structures. Thus a single image covers a major

part of the facial region.

Use of Panaromic radiograph includes;

1. They are useful in assessing the dental development by studying

deciduous root resorption and root development of permanent teeth.

2. They can be used to view ankylosed and impacted teeth.

3. To study the path of eruption of teeth.

4. To diagnose the presence and extent of pathology fractures of the jaw.

5. To diagnose the presence or absence of multiple supernumerary teeth.

6. They are useful in the mixed dentition period to study the status of

erupting teeth.

7. They are useful in the mixed dentition period to study the status of

unerupted teeth.


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The advantages of Panoramic radiograph includes;

1. The patient radiation exposure is low.

2. A broad anatomic area can be visualized.

3. It can be used in patients who are unable to tolerate intra-oral films or

unable to open the mouth.

The following are the disadvantage s of panoramic radiograph

includes;

1. Distortions; magnifications and overlapping of the structures occur.

2. The teeth and the supporting periodontal structures are not as clear as

in periapical films.

3. Inclination of anterior teeth cannot be visualized.

4. Requires equipments that are expensive.

5. Whenever details of a particular area needed they have to be

supplemented by other radiographs.


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Intraoral occlusal radiograph

Intraoral occlusal radiographs enable viewing of a relatively large segment

of the dental arch, including the palate or floor of the mouth.

Uses:

1. To locate impacted or unerupted teeth.

2. To locate supernumerary teeth.

3. To locate foreign bodies in the jaws and stones in salivary ducts.

4. To study buccolingual expansions of cortical plate due to pathology of

the jaw.

5. To diagnose the presence and extent of fractures.

6. They are useful in orthodontics to study the effects of arch expansion

procedures.


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Bite wing radiographs

Bite wing radiographs record the coronal part of the upper and lower

dentition along with their supporting structures.

BITEWING X-rays highlight the crowns of the teeth. On each radiograph,

the upper and lower teeth in one portion of the mouth are shown, from the

crown to about the level of the jaw. These require patients to hold or bite

down on a piece of plastic with X-ray film in the center.

Uses:

1. To detect proximal caries.

2. To study the height and contour of inter-dental alveolar bone.

3. To detect secondary caries below restorations.

4. To detect overhanging proximal restorations.

5. To detect periodontal changes.

6. To detect interproximal calculus.

Bitewing X-rays typically determine the presence of decay in between

teeth, while periapical X-rays show root structure, bone levels, cysts and

abscesses. They are also used to help diagnose cavities between the

teeth, as these areas are not visible when looking directly in the mouth.


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Intraoral Periapical radiographs

They are radiographs that are used to view the teeth and their supporting

structures.

Uses

1. To confirm the presence or absence of teeth.

2. To establish the presence or absence of supernumerary teeth.

3. To assess the extent of calcification and root formation of teeth.

4. To confirm the presence and study the extent of periapical

pathology and root fractures .

5. To study the alveolar bone periodontal ligament space.

6. To study the height and contour of alveolar bone crest.

7. To assess the axial inclination of roots.

8. To detect retained root fragments and roots stumps.

9. To determine the size and shape of unerupted teeth.


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Advantages

1. Low radiation dose

2. Possible to obtain localized views of the area of interest

3. They offer excellent clarity of teeth and their supporting structures

Disadvantages:

1. Assessment of the entire dentition requires too many radiographs.

2. Children may not allow placement of intra-oral films

3. They cannot be used in patients having high gag reflex and trismas

Determining tipper or Lower from a Radioqraph

The dot of film should be downwards during exposing, so that it will

be placed epically for lower teeth and occlusally for upper teeth.

If the dot is not placed accurately upper or lower may be detected

from other landmarks like number, shape and size of teeth, carious,

filled or missing teeth, outline of sinuses, inferior dental canal, mental,

incisive and mandibular foramen, nasal cavity outline, maxillary

tuberosity, etc.


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Determining Front and Back from a Radiograph

Elevated side of dot is front and depressed side is back for the

operator

Determining Right and left from a Radiograph

If the film is exposed and viewed accurately the dot wilt be on the

right when the long axis of the film is horizontal arid on the left when

the long axis of the film is vertical.

If the dot is not properly, placed right or left side can be determined by

comparing the patient face after determining the front and upside of the

film.


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Bibilography:

1. Bhalajhi SI. Orthodontics The art and science. 4th edition. 2009

2. Gurkeerat Singh. Textbook of orthodontics. 2nd edition. Jaypee, 2007

3. Houston S and Tulley, Textbook of Orthodontics. 2nd Edition. Wright, 1992.

4. Iida J. Lecture/class notes. Professor and chairman, Dept. of Orthodontics, School of dental

science, Hokkaido University, Japan.

5. Lamiya C. Lecture/class notes. Ex Associate Professor and chairman, Dept. of Orthodontics,

Sapporo Dental College.

6. Laura M. An introduction to Orthodontics. 2nd edition. Oxford University Press, 2001

7. McNamara JA, Brudon, WI. Orthodontics and Dentofacial Orthopedics. 1st edition, Needham

Press, Ann Arbor, MI, USA, 2001

8. Mitchel. L. An Introduction to Orthodontics. 3 editions. Oxford University Press. 2007

9. Mohammad EH. Essentials of Orthodontics for dental students. 3rd edition, 2002

10.Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4th edition, Mosby Inc., St.Louis,

MO, USA, 2007

11.Sarver DM, Proffit WR. In TM Graber et al., eds., Orthodontics: Current Principles and

Techniques, 4th ed., St. Louis: Elsevier Mosby, 2005

12.Samir E. Bishara. Textbook of Orthodontics. Saunders 978-0721682891, 2002

13.T. M. Graber, R.L. Vanarsdall, Orthodontics, Current Principles and Techniques, "Diagnosis and

Treatment Planning in Orthodontics", D. M. Sarver, W.R. Proffit, J. L. Ackerman, Mosby, 2000

14.Thomas M. Graber, Katherine W. L. Vig, Robert L. Vanarsdall Jr. Orthodontics: Current Principles

and Techniques. Mosby 9780323026215, 2005

15.William R. Proffit, Raymond P. White, David M. Sarver. Contemporary treatment of dentofacial

deformity. Mosby 978-0323016971, 2002

16.William R. Proffit, Henry W. Fields, and David M. Sarver. Contemporary Orthodontics. Mosby

978-0323040464, 2006

17.Yoshiaki S. Lecture/class notes. Associate Professor and chairman, Dept. of Orthodontics, School

of dental science, Hokkaido University, Japan.

18.Zakir H. Lecture/class notes. Professor and chairman, Dept. of Orthodontics, Dhaka Dental

College and hospital.


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Dedicated To

My Mom, Zubaida Shaheen

My Dad, Md. Islam

&

My Only Son

Mohammad Sharjil


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Acknowledgments

I wish to acknowledge the expertise and efforts of the various

teachers for their help and inspiration:

1. Prof. Iida Junichiro Chairman, Dept. of Orthodontics,

Hokkaido University, Japan.

2. Asso. Prof. Sato yoshiaki Dept. of Orthodontics, Hokkaido

University, Japan.

3. Asst. Prof. Kajii Takashi Dept. of Orthodontics, Hokkaido

University, Japan.

4. Asst. Prof. Yamamoto Dept. of Orthodontics, Hokkaido

University, Japan.

5. Asst. Prof. Kaneko Dept. of Orthodontics, Hokkaido

University, Japan.

6. Asst. Prof. Kusakabe Dept. of Orthodontics, Hokkaido

University, Japan.

7. Asst. Prof. Yamagata Dept. of Orthodontics, Hokkaido

University, Japan.

8. Prof. Amirul Islam Principal, Bangladesh Dental college9. Prof. Emadul Haq Principal City Dental college

10. Prof. Zakir Hossain Chairman, Dept. of Orthodontics,Dhaka Dental College.11. Asso. Prof. Lamiya Chowdhury Chairman, Dept. of

Orthodontics, Sapporo Dental College, Dhaka.

12. Late. Asso. Prof. Begum Rokeya Dhaka Dental College.13. Asso. Prof. MA Sikder Chairman, Dept. of Orthodontics,

University Dental College, Dhaka.

14. Asso. Prof. Md. Saifuddin Chinu Chairman, Dept. ofOrthodontics, Pioneer Dental College, Dhaka.


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Dr. Mohammad Khursheed Alamhas obtained his PhD degree in Orthodontics from Japan in 2008.

He worked as Asst. Professor and Head, Orthodontics

department, Bangladesh Dental College for 3 years. At the sametime he worked as consultant Orthodontist in the Dental office

named Sapporo Dental square. Since then he has worked in

several international projects in the field of Orthodontics. He is

the author of more than 50 articles published in reputed journals.

He is now working as Senior lecturer in Orthodontic unit, School

of Dental Science, Universiti Sains Malaysia.

Volume of this Book has been reviewed by:

Dr. Kathiravan Purmal

BDS (Malaya), DGDP (UK), MFDSRCS (London), MOrth

(Malaya), MOrth RCS( Edin), FRACPS.

School of Dental Science, Universiti Sains Malaysia.

Dr Kathiravan Purmal graduated from University Malaya 1993.

He has been in private practice for almost 20 years.

He is the first locally trained orthodontist in Malaysia withinternational qualification. He has undergone extensive

training in the field of oral and maxillofacial surgery and

general dentistry.

a to z orthodontics vol 7 radiographs1

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