Diagnostic Records (Dr. Ahmed)

Dr. Ahmed AL-Mayali B.D.S M.Sc. Ortho.
Kufa university Dr. Ahmed AL-Mayali

Dentistry College
Orthodontic department B.D.S M.Sc. Ortho.
5th stage
Lec: 4
Diagnostic Records
Which Diagnostic Records Are Needed?
Orthodontic diagnostic records are taken for two purposes:
1-Document the starting point for treatment.
2-Add to the information gathered on clinical examination.
It is important to remember that the records are supplements to, not
replacements for, the most important source of information which is
clinical diagnoses & examination.
Among the essential diagnostic aids, study model, radiographs, and
photographs, play an important role in the diagnosis of a particular case.
1-STUDY CAST
Orthodontic cast & Digital cast (Figure 1 A&B)
Evaluation of the occlusion requires impressions for dental arch, and a
record of the occlusion.
There are two reasons for doing trimmed and polished cast:
1- If the casts are viewed with a symmetric base that is oriented to the
midline of the palate, it is much easier to analyze arch form and detect
asymmetry within the dental arches.
2-They are more acceptable for presentation to the patient, as will be
necessary during any consultation about orthodontic treatment.
Direct scans of the arches into computer memory are just becoming
possible for digitization into computer memory.
Ideal requirements of orthodontic study model

1. Models should accurately reproduce the teeth and their surrounding
soft tissues.
2. Models are to be trimmed so that they are symmetrical and pleasing to
the eye and so that an asymmetrical arch form can be readily recognized.
3. Models are to be trimmed in such a way that the dental occlusion
shows by setting the models on their backs.
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Fig. 1 A, Orthodontic casts B, Digital casts, produced from laser scans of impressions
4. Models are to be trimmed such that they replicate the measurements

and angles.
5. Models are to have clean, smooth, bubble-free surfaces with sharp
angles where the cuts meet.
6. The finished models should have a glossy finish.
Why We make study model?

1. They are valuable in planning treatment, as they are the only three
dimensional records of the patient's dentition.
2. Occlusion can be visualized from the lingual aspect.
3. They provide a permanent record of the intermaxillary relationships
and the occlusion at the start of therapy.
4. They are a visual aid for the dentist as he monitors changes taking
place during tooth movement.
5. Help motivate the patient, as the patient can visualize the treatment
progress.
6. They are needed for comparison at the end of treatment and act as a
reference for post treatment changes.
7. They serve as a reminder for the parent and the patient of the condition
present at the start of treatment.
Symmetrical Cast Analysis (Figure 2)

An asymmetric position of an entire arch should
have been detected already in the facial
examination. An asymmetry of arch form also
may be present even if the face looks symmetric.
A transparent ruled grid placed over the upper
dental arch and oriented to the mid palatal raphe
can make it easier to see a distortion of arch form. Fig.2 Transparent grid
The ruled grid also helps in seeing where drift of
teeth has occurred.
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Example 1
Lateral drift of incisors occurs frequently in patients with severe
crowding, particularly if a primary canine was lost prematurely on one
side. This often results in one permanent canine being blocked out of the
arch while the other canine is nearly in its normal position, with all the
incisors shifted laterally.
Example 2
Drift of posterior teeth is usually caused by early loss of a primary molar,
but sometimes develops even when primary teeth were exfoliated on a
normal schedule.
2-RADIOGRAPHS
Intra Oral Radiographs
The intraoral radiographs are the easiest to take for most orthodontic
patients. They are also recommended for specific regions in all cases
where a doubt remains regarding the clarity of the orthopantomogram.
The most frequently used views include:
A• Intraoral periapical radiographs (IOPA)
B• Bitewing radiographs
C• Occlusal radiographs.
A-Intra Oral Periapical Radiographs

Advantages
1-They covered all the present teeth and the adjacent structures.
2-They are ideal for localized views in relatively small areas of interest
because of the excellent clarity that they allow.
3-They are still ideal for the detection of anomalies related to changes in
the size, shape and content of the tooth structure and / or the lamina dura
and / or the periapical region.
Disadvantages
1-increased radiation that a person has to undergo to cover the full
complement of his/her teeth.
2-Also at times the patient is not cooperative, and may not allow the
repeated placement of films in the desired manner in his/her mouth.
B- Bite wing Radiographs

1-It used primarily to record the coronal portion of the maxillary and the
mandibular posterior dentition.
2-ideal for the detection of proximal caries and the study of interdental
bone height in these areas.
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3-They may also help in the detection of the secondary caries under
restorations or overhanging margins of proximal restorations.
C-Occlusal Radiographs
Occlusal radiographs are of special interest to an orthodontist when
dealing with impacted teeth or for the study of the labio-lingual position
of the root apices in the anterior segments of the maxillary and the
mandibular dentition.
EXTRA ORAL RADIOGRAPHS (ORTHOPANTOMOGRAM )

The orthopantomogram is considered an essential diagnostic aid and
should be examined prior to undertaking any orthodontic treatment. The
biggest advantage of this radiograph is that it provides visualization of a
large area of interest to an orthodontist using a single radiograph.
Advantages of an orthopantomogram
1. A large anatomic area is visualized
2. The radiation exposure is low.
3. Patient cooperation is rarely a problem
4. Inter-operator variation is minimal
Disadvantages of an orthopantomogram
1. Specialized equipment is required
2. Distortions, magnifications and overlapping of structures are a problem
3. Definition of structures is not so good.
4. lOPAs may still be required.
How to get information from orthopantomogram?
Step 1
Orient the radiograph as when looking at the patient, i.e. with the patient's
left side positioned on the clinician's right. The radiograph is then placed
on a view box.
Step 2
Start examining from the right condylar head and follow the outline along
the neck and the posterior border of the ramus. Continue following the
outline of the mandibular body to the symphyseal region anteriorly along
the lower border of the mandible to the left condyle. Compare the outline
for discontinueties, radiopacities or radiolucencies and symmetry.
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Step 3
Examine the medullary bone of the mandible for the usual anatomic
landmarks and note anything suggestive of pathology, especially in the
periapical regions of the teeth.
Step 4
Next, examine the cortical outline of the maxilla starting on the right side.
Trace the pterygo-maxillary fissure, hard palate with the anterior nasal
spine. Examine the nasal cavities and the nasal septum followed by the
maxillary sinuses. It is advisable to compare the right and left sides
especially of the nasal cavities and the maxillary sinuses. Radiopacities in
these regions could be suggestive of pathology or sometimes the presence
of foreign body. These might reflect upon the breathing pattern of the
patient.
Step 5
Margins of a number of soft tissue structures may be seen on the
orthopantomogram. These include:
Tongue, soft palate, nose and earlobes also, sometimes seen, though not
as clearly, are the lip lines and the nasolabial folds.
Step 6
Radiopaque shadows, which superimpose on normal anatomic structures
are called "ghosts" and are actually artifacts. These can sometimes pose
a problem in radiographic interpretation. These are created when the X-
ray beam projects through a dense object, e.g. the spinal cord and the
opaque shadow of the object projects onto the opposite side of the
radiograph.
Step 7
Finally evaluate the teeth for-presence, stage of development, state of
eruption unerupted or impacted teeth, placement, root morphology and
position, cavities, fractures, contacts, and/or any pathology .These
findings have to be clinically correlated and/or with PA's or bitewing
radiographs.
3-FACIAL PHOTOGRAPHS
Facial photographs are the easiest to store, occupy the least amount of
space and provide a lot of information to the clinician and to the patient.
Photographs can be:
• Extra oral photographs
• Intra oral photographs
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Extra oral photographs

Extra oral photographs are considered essential records and should be
taken before starting treatment and after completion of treatment. The
information provided by these photographs is valuable.
Uses of extra oral photographs:

1. Identifying patients
2. Detecting of facial asymmetry
3. Detection of muscle imbalances
4. Assessment of soft tissue profile
5. Facial analysis and/or photographic analysis.
6. Monitoring of treatment progress
7. Evaluation of craniofacial relationships & proportions before and after
treatment.
8. Valuable for longitudinal study of treatment & post retention follow-up
The Extra oral photographs for all patients are includes:

1-Frontal facial with lips relaxed (Figure 3 A).
2-Frontal facial smiling (Figure 3 B).
3-Facial profile with lips relaxed (Figure 3 C&D).
A B C D
Fig. 3 Extra oral photographs
Intra Oral Photographs

These are helpful in explaining and motivating the patient. They are also
used to monitor treatment progress and results. They are also helpful in
medico legal cases involving the texture and color of teeth.
Uses of intraoral photographs

1. Record the structure and color of enamel.
2. Patient motivation.
3. Monitoring of treatment progress.
4. Recording health or disease of the teeth and soft tissue structures.
5. Study of relationships before, immediately following and several years
after treatment, to improve treatment planning.
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The Intraoral photographs for all patients are includes:

1- One frontal photograph in maximum intercuspation (Figure 4 A).
2-Two lateral views-right and left (Figure 4 B&C).
3-Two occlusal views-maxillary and mandibular (Figure 4 D&E).
Fig. 4 Intraoral photograph
Digital video
With the advent of digital records, it is easy now to obtain a short
segment of digital video as the patient smiles and turns from a frontal to a
profile view. The resulting set of images allows a detailed analysis of
facial relationships at rest and in function and provides the preferred
photographic record set.
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Dr. Ahmed AL-Mayali B.D.S M.Sc. Ortho.

Kufa university Dr. Ahmed AL-Mayali

Ideal requirements of orthodontic study model

4. Models are to be trimmed such that they replicate the measurements

Why We make study model?

Symmetrical Cast Analysis (Figure 2)

A-Intra Oral Periapical Radiographs

B- Bite wing Radiographs

EXTRA ORAL RADIOGRAPHS (ORTHOPANTOMOGRAM )

How to get information from orthopantomogram?

Extra oral photographs

Uses of extra oral photographs:

The Extra oral photographs for all patients are includes:

Fig. 3 Extra oral photographs

Intra Oral Photographs

Uses of intraoral photographs

The Intraoral photographs for all patients are includes:

Fig. 4 Intraoral photograph

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