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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:
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.