Orthodontic records /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL
ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


ORTHODONTIC
RECORDS


~ESSENTIAL
~SUPPLEMENTAL
~CONVENTIONAL
~CONTEMPORARY

~Records for evaluation of teeth & oral
structures
~Records for evaluation of occlusion
~Records for evaluation of facial and jaw
proportions
- William Proffit


ESSENTIAL
~Case History
~Study Model
~Wax bite records
~Photographs
~Radiographs
OPG
Occlusal radiograph
Intra-oral peri-apical radiograph

SUPPLEMENTAL
~Cephalometric radiographs
~3-D Cephalograms
~Cephalometric Laminagraphy
~Teleradiology
~Videocephalometry
~Stereophotogrammetry
~Hologram
~Occlusogram

~Arthrography
~MPI
~Mandibular Kinesiograph
~Electromyograph
~Polytomography
~Magnetic Resonance Imaging
~Computed tomographic Scan
~3-D Surface Laser Scanner
~Computerised Format

CASE HISTORY
~Written record
~The card is 4><6 “ or 5>< 8 “
History
Specific Disturbances causing
malocclusion
Past medical history
Past dental history

Genetic Influences
Family History
Environmental influences
Personal history
CLINICAL EXAMINATION
General examination
Shape of the body
Height Weight Gait Posture Body Tone
Extra Oral Examination
Skeletal Soft tissue inTransverse,Vertical
and antero posterior

INTRA-ORAL EXAMINATION
~Soft tissues
Oral hygiene, gingiva, brushing habits, MG
Junction, frenal attachment, Tongue(size,
shape, movement)
Oral mucosa
~Hard tissues
Number of teeth present
Number of unerupted teeth
Supernumerary teeth, size, form, texture,
caries, endodontically treated, occlusal wear

Arch Form
Shape, symmetry, alignment, crowding, spacing,
rotations
Maximum opening-freeway space, curve of spee
Mid-line relation
~A-P relationship
Molar relation, canine relation, incisor relation
Overjet
Vertical relationship-overbite
~Transverse relationship-cross-bite

DIAGNOSIS & TREATMENT PLAN
~Diagnosis & probable etiology
~Treatment objectives
~Treatment Plan
~Prognosis
~Type of Appliance
~Extra-oral anchorage
~Retention Plan

~Clinical Examination
~Determine Growth & development pattern
~Health of teeth & tissues
~Facial type
~Esthetic balance
~Dental age
~Posture & Function-lips & mandible
~Tongue function


~Type of Malocclusion
~Premature loss
~Prolonged retention of teeth
~General Medical Examination


RECORDS – SIGNIFICANCE
~Permanent record
~Growth changes
~Medico-legal
Requisite
~Eight years after appliance removal(UK)
~Until the patient attains 25
~10 years after the orthodontist releives from
practice (US)

IMPRESSION MAKING
~Maximum displacement to record
inclination and not just the location of the
teeth
~The upper lip is held and tray positioned
Tray is pushed upward and backward
(prevent trapping of air & saliva)
~Record muscle attachments


STUDY MODELS
-Graber
~Degree of Accuracy & completeness
~Time-linked record
~Longitudinal, three-dimensional record that
establishes the status of teeth & investing
tissues


MODEL-MAXILLARY


~Record of a particular condition at a specific
time
~Reasonable facsimile of occlusion
~Correlate Radiographs
~Permanent record for growth
~Measurements of arch length, lack of arch
length, tooth size discrepancy, available space,
total arch length –more precise
~Arch shape & symmetry

~Drifting, tipping, over-eruption, undereruption,
abnormal curve of Spee and prematurities
~Palatal depth & breadth
~Functional analysis & equilibration of occlusion
~Classification of Malocclusion
~Post-treatment stability


MODEL-MANDIBULAR


TWELVE BANKS WITH EIGHT COLUMNS & TIERS


BANK DIVIDED INTO FRONT,MIDDLE & BACK STACKS


BOX WITH THREE SETS OF MODELS


LOCATING MODELS WITH 4-DIGIT CO-ORDINATES


GRAPHIC DESIGNS

-JCO 1985, Raymond Howe


Disadvantages-plaster models
~Study casts are fragile
~Bulky & expensive to store & support


INDESTRUCTIBLE MODELS


Disadvantages-plaster models
~Air bubbles on occlusal surfaces and incisal
edges of models
~Fracturing of incisor teeth
Technique
~Teeth portion-Crystalline acrylic resin(TRIM)
~Anatomic & Base – Plaster of paris
-AJO 1973,Erwin Lubit

WAX BITE RECORDS
~Relates the upper & lower cast in full
occlusion
~Bite should be registered
~Done in open-bite, partially edentulous
when occlusion of casts ?
~Wax prevents fracturing of anterior teeth
~Centric occlusion
~Lateral shift is significant
~CR-CO difference

CLINICAL PHOTOGRAPHS
-Graber
~A permanent record for the operator
~Forehead slant affects facial balance
~Hair style
~Facial type & arch form(hereditary & functional
forces)


MEASUREMENTS-FACIAL PHOTOGRAPHS


-AJO 1995, Bishara

MOUNTING PHOTOGRAPHS


INSTANT PHOTO RECORD SYSTEM
~Polaroid photographs
~moisture proof plastic envelopes
~Treatment sticker
-JCO 1994, J.Hickham


RADIOGRAPHS
~Resorption
~Presence/absence of permanent teeth
~Congenital absence
~Alveolar bone
~Morphology & inclination
~Root development,path of eruption,cysts,
impaction, #, caries, ankylosis, supernumerary
teeth

IOPA


ORTHOPANTOMOGRAM


BEFORE

AFTER

-JCO 1996, Starnes

CEPHALOMETRIC RADIOGRAPHS
~Growth & Development
~Craniofacial abnormalities
~Facial type
~Case analysis & diagnosis
~Progress reports
~Functional analysis


LATERAL CEPHALOMETRIC RADIOGRAPH


LIMITATIONS
~Assumptions
-Symmetry
-Occlusal position
-Orientation to transmeatal axis
-Adequacy of one/two planar projections
~Fallicies
-False precision
-Ignoring the patient
-Superpositioning
-Using chronological age
-Handbook –Ortho.
-Ideal
1988 , Moyers

OTHER SPECIAL X-RAY VIEWS
~A-P View
~45 Degree Lateral Projection
Proper tooth relationships
~Occlusal films
~Hand-wrist films


OCCLUSAL RADIOGRAPH


A-P VIEW


A-P VIEW TRACING


HOLODENT SYSTEM


VERTICALLY ORIENTED UNIT


HOLOGRAPHIC RECORDING
HOLOGRAPHIC PLATE


PRINCIPLES OF EVALUATION

-AJO 1982, Ryden

~Holography uses laser light to reproduce a
high quality, three dimensional image of a cast
-AJO 1990, Harradine
Holodent (He-Ne)
~Observe the dentitions at the same time
~Changes in tooth position
~Superimposition
~Produce Hog. on films

Advantages
~Reduced storage space
~Resistant to damage
~Can be transported
-AJO 1992 Ryden


METAL OBJECT-SUPERIMPOSITION


CAST

PRINCIPLES OF EVALUATION

-AJO 1992, Ryden


HOLOGRAPH CAMERA


HOLOGRAPHIC VIEWER


DOUBLE CHASIS FOR EXTERNAL VIBRATION


AUTOMATIC DEVELOPER


HOLOGRAM IN MEASUREMENT UNIT


3-D CEPHALOGRAM
~Similar to the Broadbent-Bolton orientator
to simulate stereophotogrammetry
~Usual landmarks, normative data base for
semi-automatic analysis
~Lateral & Postero-anterior views
~Only disadvantage-does not produce curving
form in three dimension
- AJO 1988, Orayson

3-D CEPHALOGRAM


OCCLUSOGRAM
~Developed by Burstone in 1961
~Actual sized photographs of occlusal surfaces
of dental casts
~Tracings are done –used in treatment
planning


OCCLUSOGRAM


TRACINGS


OCCLUSOGRAM

-AJO 1991, Parker


~Record maintenance
~Treatment planning & progress
~Customized prescriptions
~3-D Models & virtual set-up
~Digital study models, e-models
~Documentation & case progress
~Cephalograms
~Photographs


, 1. Record duplication can be performed in
office.
2. Minimal expense of time and materials
required.
3. Records can be archived as needed,
considering space and timeliness.
4. Compactness. Many patient records sets
can be put on one floppy disk.
5. Stored records are extremely portable and
durable.

LIMITATIONS
1. Possibly the main concern; computerized
records can be easily altered without a trace.
Records of this type would therefore not be
admissible as evidence in a court of law
unless a safekeeping system was devised.
2. Standardization of the capture procedure
for the images of study models will have to
be established to make such images
acceptable for all purposes.

3. Standardization of record formats and
recording procedures must be established
for storing radiographs and hard copy
records.
4. Equipment and software in common
use are not necessarily compatible.
5. Acceptable standards for record
reproduction would be needed.
6. Guaranteed record safety required.

6. Cataloging and rapid accessing of
records is simple, quick, and accurate.
7. Minimal storage space would be
required.
8. Instant hard copies can be produced with
ease, if needed.
9. Ease of record transmission for
consultation and case transfer would be
enhanced by these procedures.
10. Reduce insurance costs.

INTRA X-RAY UNIT

PANORAMIC & CEPH.

-PLANMECA


-PLANMECA

-JCO 1990, Schulhof


-JCO 1976, Callendar


~A data base(dBASE)is setup, each patient’s
unique chart number provides information on
-personal data
-diagnostic data
-treatment data
-cephalometric data
-post-treatment data
-Angle 1987, Weinberg


A DIFFERENT COMP. RECORD SYSTEM


~Software-Quick Ceph Image-a
computerised cephalometrics and imaging
system
~Two video cameras with a tripod stand with
good lighting(300 watt bulb)
~Charge-coupled Camera(CCD) –Fotovix
Is used to enhance picture quality
~In case of accidental erasure-it can be
retreived
~Image modifications cane be made in the
system

CROPPING IMAGES


CORRECTINGA FAULTY PHOTOGRAPH


A REVIEW OF THE PHOTOGRAPHS


TABLET PC


VIRTUAL ARTICULATOR


ROSY SIMULATOR-FUNCTIONAL ANALYSIS


CERTAIN AREAS CAN BE ENLARGED


RADIOGRAPHS


HIGHLIGHTING AREAS OF INTEREST


CCD CAMERA DEVICE


-AJO 1992, Sakuda

VIDEO PRINTING


VIDEO PRINT OF THE MODEL


TRIPOD MOUNTED CAM-CORDER

-JCO 1987, Francis Burke


B/W SURVEILLANCE CAMERA

VIDEO DUPLISCOPE
SLIDE PHOTO

DI-OPTER LENSES

MODEL SET-UP

PRINTS FROM
THERMAL-MEMORY
TYPEWRITER

SIX PHOTOS -MOUNTED

DIGIGRAPH
~A powerful clinical tool that offers
-Non radiographic Cephalometrics
-Video imaging
-Treatment planning
-Patient-parent counselling
-Digitized landmarks
-Cephalometric analysis display(14)
-Tracing display
-VTO

~Information storage
Two three & half hard disks
~Print-out
Can produce paper records, photographic &
slide records


DIGIGRAPH
WORKSTATION

PROFILE

CEPHALOMETRIC TRACING

CASTS IMAGE

HEAD-HOLDER

MODEL BOARD

HEAD HOLDER WITH LIGHTBOX

VIDEO MONITOR

PRINTER

DIGITIZING HANDPIECE


DIGIGRAPH RECORDS

DIGITISED LM


CEPHALOMETRIC ANALYSIS


BEFORE


AFTER

Advantages
~Diagnostic records can be taken more easily,
reliably & quickly
~No film processing time
~Storage space is reduced considerably
~No radiation exposure
-JCO 1990, Chaconas

-EJO 1999, Kenneth Tsang


COMPARSION OF CEPHALOMETRIC
ANALYSIS USING A NONRADIOGRAPHIC SONIC DIGITIZER
WITH CONVENTIONAL RADIOGRAPHY
~Repeated sonic digitization
~The radiographic measurements were not
accurate compared to the conventional
radiography
~Hence measurements should be interpreted
with caution

FACIAL ASYMMETERY


-EJO 2001

INFORMATION RETREIVAL SYSTEM
~Record chart has 944 features. It includes
-Clinical data
-Evaluation of study models
-Radiographic cephalometry


~Glossary
-A-General
-B-Extraction
-C-Diagnosis
-D-Initial study models analysis
-F-Final Study Model analysis
-G-H-Radiographic Cephalometry
-J-Radiographic Cephalometry-dentition


INFORMATION RETREIVAL SYSTEM


OPTICAL COINCEDENCE FEATURE CHART


STORAGE TUB FOR THE CARDS

-JCO 1978, Hepburn

ORTHOSCAN CAMERA


CT SCAN


TMJ
NORMAL

Cl III


ANATOMIC LANDMARKS


CT ENABLES 3-D IMAGING


3-D RECONSTRUCTION-ASSYMETERY


POLYTOMOGRAPHY


HARDWARE FOR THE ANALYSIS


MANDIBULAR POSITON INDICATOR
~SAM articulator & MPI enables the clinician
determine, record & compare positional changes
of condyle between CR and CO
- AJO 1995, Meyers


MANDIBULAR POSITION INDICATOR


ROENTGEN STEREOPHOTOGRAMMETRY
~Based on measurements from metal bone
markers images on roentgenograms
~Two roentgen tubes simultaneously expose the
object
~Complication is the implantation of the bone
markers and loosening of the implants
-AJO 1986, Selvik

MRI

SCAN


1. Visual inspection of all slices to detect
possible structural bone changes.
2. Measurement of the disk condyle
relationship on tracings of the
parasagittal MRIs .
3. Measurement of condylar position
within the glenoid fossa on tracings of the
parasagittal MRIs .


MRI IMAGES-SUPERIOR DISK POSITION


ANTERIOR DISK DISPLACEMENT


PARTIAL DISK DISPLACEMENT


ROTATIONAL DISK DISPLACEMENT


MEDIAL DISK DISPLACEMENT


POSTERIOR DISK DISPLACEMENT


MRI - TMJ


VIDEO-CEPHALOMETRY


LEFORTE I OSTEOTOMY

MAXILLARY ADVANCEMENT


RESULT-MORPHING

MANDIBULAR REDUCTION


1. A higher level of communication.
2. More precision in this communication.
3. This communication is more effective
and less time consuming.


1. Improved visualization of the individual
treatment plans. This results in greater precision in
planning a desired outcome.
2. Greater participation by patients in helping in the
decision-making process of their final result.
3. In the surgical orthodontic patient, a mutual
template is provided for decision making among
patient, orthodontist, and oral surgeon.
In a study of our patients whose surgeries were
planned interactively with video imaging
technology, 90% of patients reported they thought
the final result was as good as or better than the
projected image.

CT SCAN –ALVEOLAR BONE


CT SCAN-BEFORE & AFTER RETRACTION


SINGLE PHOTON EMISSION - CT

-EJO 2003


PATIENT POSITION FOR OPTICAL SCANNER


OPTICAL SCANNER REPORT


SURFACE LASER SCANNER


OPTICAL SCAN COLOUR


OPTICAL SURFACE SCANNING-3-D DATA

-EJO 2001, J.P.Moss


Modern instruments that track mandibular
movement clearly show the proprioceptive
dominance of the occlusion over the
musculature. No matter how badly
malpositioned the occlusion or how much
torquing and twisting are required to occlude
the teeth, the muscles will proprioceptively
and instantaneously accommodate to pull the
mandible to that occlusal position and
maintain it there.

Measurement for the diagnosis of existing
musculoskeletal dysfunction in the
orthodontic patient provides a needed
additional functional diagnosis to
complement the conventional use of
cephalometric and TMJ x-rays. The
electromyograph (EM2) (Fig. 2) and
mandibular kinesiograph (MKG) (Fig. 3)
respectively measure electrical activity of the
muscles and the skeletal relation of the
mandible to the skull.

These data are essential for initial diagnosis,
monitoring of treatment progress, and
verification that a relaxed neuromuscular
environment— which is the goal of
functional orthodontic treatment— has been
obtained for the finished case.


The fact that the patient can consistently
bring the teeth into full intercuspation with
seeming ease must no longer lull the
orthodontist into treating to an existing
occlusal position, because that position will
perpetuate, rather than correct, an
unrecognized musculoskeletal dysfunction
(Fig. 1).


KINESIOGRAPH
~Indirect method
~The position of small magnet attached to the
mand. Incisors is recorded on cathode-ray
tube by electronic transducer
~Physiologically compatible
~Relatively accurate
-AJO 1982, Epker

MANDIBULAR KINESIOGRAPH


The mandibular kinesiograph (MKG) electronically
tracks mandibular movement and position. It
displays three-dimensional spatial data on the CRT
screen at variable magnifications.
In the pretreatment orthodontic examination, the
MKG displays the direction and extent to which the
mandible deviates from its relaxed trajectory as the
muscles close the teeth to a malpositioned occlusion.
This skeletal relation information correlates with and
confirms the electromyographic data, shedding light
on the cause of increased electrical activity in various
muscles.

-JCO 1984, Bernard

ELECTROMYOGRAPH
~Delineates clinical & physiologic rest positions
of mandible
~Clinical rest position is the posture assumed
by the mandible following a swallow/after
phonetic sounds
~The CNS governs this adaptive holding
position to optimise masticatory function via
occlusal programming
- AJO 1982, Epker


ELECTROMYOGRAPH


EMG


STRONG MASSETRIC CONTRACTION

STRONG CIRCUM-ORAL CONTRACTION

The EM2 is an eight-channel electromyograph
that processes action potential levels derived from
electrodes placed over right and left middle
masseter, anterior temporalis, posterior
temporalis, and anterior digastric muscles. Action
potential levels, recorded during both rest and
function (clench), are graphically displayed as
they sweep across the CRT screen .The EM2
microprocessor senses, computes, and integrates
256 samples of data every five seconds; it
provides a printout documenting the status of the
patient's muscles, which then becomes a
permanent file record.

Pretreatment EMG data document the
direction and degree to which muscles are
being forced into sustained contracture as
they are proprioceptively directed to pull and
hold the mandible in a skeletal malrelation to
accomplish intercuspation of a malpositioned
occlusion
-JCO 1984, Bernard

CEPHALOMETRIC LAMINAGRAPHY
Review
~Gills & Reigner-Face resting on a cassette
~Distortion-trying to focus petrous parttemporal bone
~Reclining the head->clenching of teeth
~Lindbolm & Higleys-1936-Cassette holder
~Only rest position of the condyle can be taken
~The area did not cover fossa & buccal
segment of teeth www.indiandentalacademy.com

~Arthrography,Nagaard.
~Injection of a disclosing medium allowed
detailed outline of the joint cavities
~But, it altered the mobility of condyle and
concealed outline of bones
~Cephalometric reoentgenology, Broadbent,
~Complete image of head without distortion
~Fossa obscured & its relation to condyle
could not be determined

~Body sectioning roentgenography or
laminagraphy-Bleiker, tomography-Petrilli
Gave a clear picture of the fossa & condyle
~Position of the patient with clenching of
teeth
~Position of mandible necessary both in rest
and closed position
~One side of the joint can be studied
extensively
-AJO 1950, Ricketts


LAMINAGRAPHY

HEAD HOLDING APPARATUS

ANALYSIS OF MOVEMENT OF CONDYLE


CHANGES-IN SHAPE OF THE CONDYLE

TR

LAM

TELERADIOLOGY
~Teleradiology is the transmission of
radiographic images to distant sites
~Permits transfer of images between centres
and improves patient care and aid research

- Angle 1996, Forsyth

TELERADIOGRAPHS


GNATHOSTAT


-Salzmann

FACEBOW RECORD


FACEBOW TRANSFER


ARTICULATION


ARTICULATED MODELS


ELECTRO-PALATOGRAPHIY

--EJO 2000, Tindall


TREATMENT OUTCOME ASSESSMENT
~Score for inter-arch, intra-arch
and skeletal relationship was recorded
~Pre-treatment & post-treatment score was
calculated using scores

JCO 1996, Leo Starnes


THANK YOU


Orthodontic records /certified fixed orthodontic courses by Indian dental academy

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