ORTHODONTIC

DIAGNOSIS
PART II
GUIDED BY,
DR. AVINASH MAHADEV
DR.AJEESHA NAIR
DR.MUHAMMED ASLAM
SUBMITTED BY,
MEENAKSHI. J. H
160020335
FINAL YEAR PART I
CONTENTS
• ORTHODONTIC STUDY MODELS
• DIAGNOSTIC SETUP
• FACIAL PHOTOGRAPH AS A DIAGNOSTIC AID
• ELECTROMYOGRAPHY
• RADIOGRAPHS USED IN ORTHODONTIC DIAGNOSIS
• INTRAORAL RADIOGRAPHS
• EXTRAORAL RADIOGRAPHS
• OTHER RADIOGRAPHS
• RECENT ADVANCES IN DIAGNOSTIC AIDS
• CONE BEAM COMPUTED TOMOGRAPHY
• CONCLUSION
• REFERENCE
INTRODUCTION
• Diagnosis is the study and interpretation of data
concerning a clinical problem in order to determine the
presence or absence of abnormality
• To treat any malocclusion well, one must recognize it
in all its forms and stages of development, such recognition
constitutes the diagnosis.
• Orthodontic diagnosis is systematic, tentative,
accurate guessing directed to two ends, classification and
planning consequent action made necessary by its recognition
• Some diagnosis are easy, some difficult and a few are
impossible – yet all are important, for diagnosis is the turning
factor in providing orthodontic care.
INTRODUCTION
• Diagnosis is the study and interpretation of data
concerning a clinical problem in order to determine the
presence or absence of abnormality
• To treat any malocclusion well, one must recognize it
in all its forms and stages of development, such recognition
constitutes the diagnosis.
• Orthodontic diagnosis is systematic, tentative,
accurate guessing directed to two ends, classification and
planning consequent action made necessary by its recognition
• Some diagnosis are easy, some difficult and a few are
impossible – yet all are important, for diagnosis is the turning
factor in providing orthodontic care.
The digital models are obtained by laser scanning of the impressions or the plaster study models.
Once the scanning is done, the digital models are obtained by using computer aided designing and manufacturing
(CAD/CAM) technology where it is transformed into a digital 3D image of the dentition.
Software enable the digital models to be viewed from all aspects and manipulated.
The softwares are also capable of performing various model analysis
Advantages
• Reduction in space needed to store the models.
• Easy retrieval and transmission of the image to other computers.
• Measurement on the dental cast can be carried out on the digital model without the cumbersome use
of caliper.
• The digitized models can be viewed from any angle and also opened to allow upper and lower models to
be viewed separately.
• Possibility of viewing digital models at multiple locations from any office computer linked to the
practice’s central server, allowing patients to be treated at multiple sites with easy access to their records.
GNATHOSTATIC MODELS
Orthodontic study models where the base of maxillary cast is trimmed to correspond to the Frankfort horizontal plane.
First attempt made by which the teeth can be oriented to a reference plane of the cranial base.
It enables visualizing the dentition to three anthropometric planes (Frankfort horizontal plane, orbital plane, mid sagittal
plane).
Not routinely used.
Difficult to make
Very bulky compared to regular orthodontic study models.

DIAGNOSTIC SETUP
Made from an extra set of trimmed and polished study models.
Individual tooth and associated alveolar processes are sectioned and replaced on the model base in the desired position.
Helps in simulating various tooth movements that are planned for patients.
USES
• Useful in visualizing and testing the effect of complex tooth movements and extractions on the occlusion.
• Patient can be motivated by simulating the various corrective procedures on the cast.
• Tooth size- arch length discrepancies can be visualized by means of a setup.
FACIAL PHOTOGRAPHS AS A DIAGNOSTIC AID
Photographs should be taken in a standardized manner so that they can readily be compared with similar photographs
taken during or after the treatment.
Extra oral views
 Frontal view
 Profile view
 Oblique facial view
Intraoral photographs
 Left and right lateral view
 Frontal view
 Maxillary and mandibular occlusal view

Uses
• Useful in assessment of facial symmetry, profile and type.
• Serve as diagnostic records.
• Help in assessing the progress of treatment.
ELECTROMYOGRAPHY
Procedure used for recording the electrical activity of muscle
Electromyograph is a machine used to receive, amplify and record the action potential during muscle activity.
Electromyogram is a record obtained by such a procedure.
The action potential is picked up by electrodes that are of two types
 Surface electrodes: Used when the muscle is superficially placed just below the skin.
 Needle electrodes: Used when muscle is placed deep inside.
Used to detect abnormal muscle activity
• In severe class II, division 1 malocclusion the upper lip is hypofunctional.
• Abnormal buccinators activity in class II, Division 1.
• Over closure of jaws associated with accentuated temporalis muscle activity.
• Children with cerebral palsy.
• EMG can be carried out after orthodontic therapy to see if muscle balance is achieved
RADIOGRAPHS USED IN ORTHODONTIC DIAGNOSIS
Radiographs have established themselves as a valuable tool in orthodontic diagnosis.
Uses
• To assess general development of the dentition, presence, absence and state of eruption of teeth.
• To establish the presence or absence of supernumerary tooth
• To determine the extent of root resorption of deciduous tooth.
• To study the extent of root formation of the permanent teeth.
• To confirm the presence and extend of pathological and traumatic conditions.
• To study the character of alveolar bone.
• Valuable aid in cranio-dento-facial analysis.
• To confirm the axial inclination of the roots of the teeth.
• To assess teeth that are morphologically abnormal.
Radiographs routinely used for orthodontic diagnosis
1. Intraoral radiographs.
2. Extraoral radiographs.
INTRAORAL RADIOGRAPHS
Commonly used projections
1. Periapical
2. Bitewing
3. Occlusal
INTRAORAL PERIAPICAL RADIOGRAPH
Used to view teeth and their surrounding structures.
 Two intraoral projection techniques
• Paralleling technique
• Bisecting angle technique
Uses
Full mouth intraoral periapical radiographs are routinely taken prior to initiation of orthodontic treatment.
o To confirm the presence or absence of teeth
o To establish the presence or absence of supernumerary teeth.
o To assess the extent of calcification and root formation of teeth
o Study of periapical pathology and root fractures.
o Axial inclination
o Size and shape of unerupted teeth.
Disadvantages of IOPA
o Assessment of the entire dentition requires too many radiographs.
o Children may not allow placement of intraoral films
o They cannot be used in patients having high gag reflex and trismus.

Advantages of IOPA
o Low radiation dose
o Possible to obtain localised views of the area of interest
o Excellent clarity of teeth and their supporting structures

BITEWING RADIOGRAPHS
Bitewing radiographs record the coronal part of the upper and lower dentition along with their supporting
structures.

Uses
o Detect proximal caries
o To study the height and contour of interdental alveolar bone
o To detect secondary caries
o Overhanging restorations
o Detect interproximal calculus
OCCLUSAL RADIOGRAPHS
Intraoral occlusal radiographs enable viewing of a relatively large segment of the dental arch, including the palate or
floor of the mouth.
Uses
o To locate impacted tooth
o To locate supernumerary teeth
o To locate foreign bodies in the jaws and stones in salivary ducts.
o To study buccolingual expansions of cortical plate due to pathology of the jaws,
o To diagnose the presence and extent of fractures.
EXTRAORAL RADIOGRAPHS

PANORAMIC RADIOGRAPHS
Enable viewing of both maxillary and mandibular arches with their supporting structures.
Uses
• In assessing the dental development by studying deciduous root resorption and root development of
permanent teeth.
• To view ankylosis and impacted teeth.
• To study the path of eruption of teeth
• To diagnose the presence of pathology and fractures of tooth.
• Useful aid in serial extraction procedures.
Advantages
• Broad anatomical area cannot be visualized
• Patient radiation exposure is low.
• Patients unable to open the mouth.
• Disadvantage
• Distortions, magnification, overlapping
• Inclination of anterior teeth cannot be visualized
• Equipment is expensive
CEPHALOMETRIC RADIOGRAPHS.
They are specialised skull radiographs in which the head is positioned in a specially designed head holder called
cephalostat by means of ear rods.
Two types;
 Lateral cephalogram
 Poster anterior cephalogram

OTHER RADIOGRAPH
Hand wrist radiograph
Radiographs of the hand and wrist are useful in estimating the skeletal age of a person
Useful in assessing growth for planning growth modification procedures and surgical respective procedures.
RECENT ADVANCES IN DIAGNOSTIC AIDS
XERORADIOGRAPHY
Completely dry non chemical process that make use of electrostatic process as in Xerox machine.
Advantages
• Reduction in exposure time
• Ease in manipulation
• No need of dark room for developing.
• No special light source is required
• Boundary between structures is clear
Cephalometric landmarks are easily identified .

DIGIGRAPH
Synthesis of video imaging, computed technology and sonic digitizing
Enables the clinician to perform non-invasive and non-radiographic Cephalometric analysis
Features
• Landmark can be identified as a point in 3-D a Cephalometric analysis can be made independently of head
position.
• Allows all patients models, radiographs, photographs, cephalograms and tracing to be stored on one small
disc thereby reducing storage requirements.
MAGNETIC RESONANCE IMAGING
Make use of two fundamental properties of protons i.e. spin and small magnetic movements

Advantages
• It does not have a hazard as it use of non-ionizing electromagnetic radiation
• Anatomical details are good
• Imaging of blood vessels, blood flow visualization of thrombus if possible
Disadvantages
• Time consuming
• Not used in patients with cardiac pacemakers
TOMOGRAPHY
Conventional radiographs are images in which all objects between the xray source and film are superimposed
Tomography can be conventional or computed

Conventional
Process by which a layer of image within the body is produce while the images of structures above and below that layer
are made invisible by blurring.
Principle of tomography can be mechanically implemented in two ways
1.The x-ray tube and film can move synchronously in opposite direction in parallel planes
2.The x-ray tube and film can move synchronously and in opposite direction in parallel planes but with motions other
than straight line i.e. circular and spiral .

Computed tomography
They are complex imaging systems which use thin beams of x-ray that move in synchronous manner with an array of
detectors which calculate and attenuate the x-ray beams at different angles in different planes.
Advantages
• Accurate visualization
• Computer programing make it possible to view the image in different shapes and density
OCCLUSOGRAMS
It is a tracing of photograph of photocopy of a dental arch
Uses
• Estimate occlusal relationship
• Estimate arch length and width
• Estimate the tooth movements
• Estimate spacing and crowding
• Estimate anchorage requirements

DIGITAL SUBTRACTION RADIOGRAPHY

This is an image enhancement method that removes the structured noise from
the images . The result is the area of change clearly displaced either against a
neutral grey background or is superimposed on the original radiograph itself. It
selectively enhances the difference between two images
LASER HOLOGRAPHY
Holography is a photographic technique for recording and reconstructing images in such a way that the 3-D aspect
of an object can be obtained
The recorded image is called hologram

Uses
• Measurement of incisor intrusions
• To study the effects of class II elastics
• To study the effect of cervical pull head gear to assess the facial and dental arch symmetry

PHOTOCEPHALOMETRY
3 radiopaque metallic markers with holes are placed on the patient skin with adhesives and standard lateral and
anterioposterior cephalograms are taken. Using the same position lateral and frontal photographs are taken.
Photographs are printed to the same size as the radiograph and are superimposed over the radiographic tracing
taking the metallic markers as the guide.

CINERADIOGRAPHY
Basically a radiograph motion picture
Diagnostic aid used to visualize the swallowing pattern of the patient.
CONE BEAM COMPUTED TOMOGRAPHY

Advantages
• Low radiation exposure
• Improved special resolution
• Compact design
• Less space requirement
• Lower cost
Disadvantages
• Limited information on soft tissue structures
• Image distortion due to streak artifacts, truncation artifacts, motion artifacts
• Application in orthodontics
• Assessment of impacted teeth
• Assessment of planning Orthognathic surgery.
• Assessment of cleft palate.
CONCLUSION

The problem oriented approach to diagnosis and treatment planning has been widely advocated in medicine
and dentistry as a way to overcome the tendency to concentrate on only one part of a patient’s problem.
The essence of the problem oriented approach is the development of a comprehensive data base of the
pertinent information so that no problems will be overlooked.
From this data base the list of problems i.e. the diagnosis is abstracted
REFERENCE
Bhalajhi. S. L - Orthodontics The art and science -7 th Edition.
THANKYOU