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Recent advances in diagnostic aids /certified fixed orthodontic courses by Indian dental academy
1. Recent Advances in
Diagnostic Aids
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. History
Andreas Vesalius (1514-1564) published
his masterpiece De Humani Corporis
Fabrica in 1543.
Discovery of X rays- Roentgen
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4. History
Original Orthodontic diagnostic
records
- Study models
- Detailed clinical examination
- Plaster models of face
- Radiographs –
Cephalometric,panoramic
- Photographs
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13. Digital Photography
Storage of digital images
Compression –
JPEG (Joint Photographic Experts Group)
TIFF (Tag Image File Format)
Compression ratio – 3:1 almost no loss
20:1 clinically acceptable
Storage media- Magnetic disks
Optical or laser disks
Optical tape – 1 terabyte (1 million
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MB)
14. Digital Photography
Advantages of digital photography
- Instant viewing of pictures – mistakes
can be rectified immediately
- No film or processing is required
- Manipulation of data on computer
- Organization of data
- No rolls – saves money in long run
- Decreases storage needs
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- Transmission of data
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15. Digital Radiography
Digital radiography is possible since
Trophy introduced the first Charge coupled
device (CCD) in mid- 80’s
Patient radiation exposure can be reduced
by 30% - 98%
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16. Digital Radiography
X Ray
Sensor
Data collection:
Electrical
charge
digitizer
Image
• CCDs
• Amorphous Selenium
• Amorphous Silicon
• Phosphor plates
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17. Digital Radiography
RadioVisuoGraphy (RVG)
Imaging done with a CCD
view delay 1 - 4 s
very high resolution
optimal shape and size of the sensor
sensor thickness 4 mm
sensor cable diameter 3 mm
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19. X-ray imaging with CCD
Scintillator- converts x-radiation
to photons (light)
Fibre optic layer
- conducts photons to CCD
- stops x-radiation
pixels
CCD- converts photons
to electrons (charge)
Electronic circuit
- amplifies the signal
- converts the analog signal
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to digital
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20. Digital Radiography
DenOptix
- A radiographic technique which
eliminates silver halide film
- Instead uses Storage Phosphor imaging
plates
- Advantage over CCD - no rigid sensors
and wires,also less expensive
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23. Imaging cycle
1.Load intraoral or panoramic
imaging plate
5. Erase imaging plates
for reuse
2. Take X ray
Image on computer
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3. Mount imaging plates in carousel
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4. Place in scanner & Scan images
24. Digital images can be manipulated using
software filters
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25. Advantages
- Alternative to conventional film
- Same machine and settings used for DenOptix
and regular cephs & OPGs
- No dark room required
- Environment friendly- no heavy metal wastage
- Can be reused thousands of times
- Transmission of images
- Saving staff time
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26. Digital Cephalometry
Digitization is a process by which analog
information is converted into digital form
- Direct computer digitization of the ceph.
- Indirect computer digitization of the ceph.
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28. Digital Cephalometry
Digitizing tablet with cross hair cursor
Fine electronic grid- 0.009mm
Two wires arranged in a cross hair pattern
embedded in a glass window
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29. Digital Cephalometry
Digitization
Activated by pressing the button
Location of individual landmarks in a
predetermined sequential manner
Visual ceph generated by connecting
dots by lines and curves
Once digitization is complete,any
analysis can be performed in seconds
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30. Digigraph
Introduced by Dolphin imaging systems
Non radiographic system
Video imaging is also possible
VTO
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31. Digigraph
The Digigraph Workstation
5 feet long,3 feet wide,
7 feet high.
working area of 25 sq feet.
two video cameras –
permanently aimed and
focused
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35. Digigraph
The Digigraph Workstation
Attached video monitor –
can be moved
Images,text,numerical data
can be displayed,stored,
modified using a light pen or
computer keyboard
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36. Digigraph
The Digigraph Workstation
Output devices
Sony video imager – makes 5”X
7” colour prints in 60 seconds
Polaroid freeze frame camera –
polaroid prints in 10 seconds
Hewlett Packard paintjet printermakes 8”X10” colour copies in
4-8 minutes
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37. Digigraph
The Digigraph Workstation
Digitizing handpiece with
removable,sterilizable tips
Landmark location is recorded
in 3 dimensional coordinates(x,y,z)
The time it takes the sound to
reach each of the microphones
determines the landmark location.
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40. Digigraph
Procedure
Digitizing done in order –
1.Facial landmarks
2.Mouth closed intraoral landmarks
3.Intraoral landmarks requiring a
disposable bite opener to be
inserted
Indirect digitization –
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4.Extrapolated landmarks
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41. Digigraph
Cephalometric analysis display
- Any of the 14 cephalometric analyses
• Downs
• Rickets lateral
• Burstone
• Rickets frontal
• McNamara
• Vari-Simplex
• Tweed
• Holdaway
• Grummons frontal
• Alabama
• Standard lateral
• Jarabak
• Standard frontal
• Steiner
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42. Digigraph
Tracing display
- Additional custom analyses
may be set up
- Observed value is shown with
patient norm- adjusted for age,
sex,race and head size – and
standard deviations from norm
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43. Digigraph
Visual Treatment Objective (VTO)
To move part of the picture,
simply touch the light pen
to two points on the screen,
at opposite extremes of the
area to be moved.
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44. Digigraph
The software automatically blends
skin tones and smoothes profile
lines so they are consistent with the
surrounding tissue.
“Before and after" format
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45. Digigraph
Finishing the Digigraph session
At this point the data is saved on two 3 ½ "
floppy disks – one given to pt. and the other
disk for office record.
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46. Computed Tomography
Introduced in medicine in early 70’s
Slice like images are referred to as tomograms
and a computer is necessary to generate the
pictures; hence the name – Computed
Tomography
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48. Computed Tomography
Principle
An image of a layer within
the body is produced
while the images of the
structures above and
below that layer are made
invisible by blurring
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53. Computed Tomography
Detector system
Two types of detector
i.Ionization chamber
(Gas filled chamber
with electrodes)
ii.Scintillation detectors
(Solid crystalline
dielectric)
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54. Computed Tomography
Clinical applications
High radiation exposure and high cost has
prevented its use in Orthodontics.
But in certain situations benefits outweigh risks.
In severe craniofacial deformities where 2D
diagnostic records are inadequate
Treatment predictions with 3D computer
tomographic skull models
TMJ examination
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CT image
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55. Computed Tomography
TMJ examination
CT for the evaluation of the TMJ was introduced
by Wegener and colleagues for
demonstrating bone abnormalities within the
TMJ.
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56. Computed Tomography
TMJ examination
Useful in determining changes
in bone density
Primary imaging method when
internal derangement or arthrosis
is suspected – clinical diagnosis
is not always sufficient.
Has advantages when planning
treatment or operations on jaws
and TMJ diseases and
deformities.
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57. Micro Computed Tomography
Principally the same as CT, except that the
reconstructed cross sections are confined to a
much smaller area.
Significantly reduces radiation dosage.
Used to measure bone connectivity in all 3
dimensions and even record anisotropy – till
now not possible even with histology
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58. Micro Computed Tomography
Clinically used to evaluate alveolar
remodelling (osteoblastic/osteoclastic activity)
as well as bone dehiscences and root
resorption
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