2024-2025 Orthodontic Diagnostic Records PDF

Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin Diagnostic Records Diagnosis may be defined as: a. The act or process of identi...

Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin Diagnostic Records Diagnosis may be defined as: a. The act or process of identifying or determining the nature and cause of a disease or injury through evaluating patient history and examining and reviewing laboratory data. b. The opinion derived from such an evaluation. Diagnosis in orthodontics, as in other disciplines of dentistry and medicine, necessitates the collection of a comprehensive database of patient information and distilling a clearly stated list of the patient's problems. It's crucial to emphasize that both the patient's perceptions and the doctor's observations are vital in formulating the problem list. This collaborative approach ensures that the treatment plan is a synthesis of the possible solutions to these specific problems, tailored to provide maximum benefit for this particular patient. In diagnosis, whether in orthodontics or other areas of dentistry or medicine, it's crucial not to focus so narrowly on one aspect of the patient's overall condition that other significant problems are missed. The problem-oriented approach to diagnosis and treatment planning, widely endorsed in medicine and dentistry, ensures a comprehensive database of pertinent information, leaving no problems overlooked. This thorough approach provides reassurance that all aspects of the patient's condition are considered. For orthodontic purposes, the databases are derived from three primary sources: (I) Interview data from questions (written and oral) of the patient and parents, (II) Clinical examination of the patient, and (III) Evaluation of diagnostic records, Orthodontic diagnostic records may be required for several possible purposes: Diagnosis and treatment planning Monitoring growth Monitoring treatment Medico-legal record Patient communication and education Audit and research Orthodontic diagnostic records include: 1- Radiographs 2- Photographs 3- Study model. 1- RADIOGRAPHS Any radiograph carries a low but identifiable risk, so each radiograph must be clinically justified. A radiograph is only prescribed after a full clinical examination to ensure that Page 1 of 9 Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin information cannot be gained by a less invasive method. When considering interceptive or active orthodontic treatment, a radiograph may provide additional information on: presence or absence of teeth stage of development of permanent dentition root morphology of teeth, including root length and any existing root resorption presence of ectopic or supernumerary teeth presence of dental disease relationship of the teeth to the skeletal dental bases and their relationship to the cranial base. Radiographs commonly used in orthodontic assessment: Dental panoramic tomograph (DPT) or Orthopantomograph (OPG) Cephalometric lateral skull radiograph Upper standard occlusal radiograph Periapical radiographs Bitewing radiographs. A- Orthopantomograph (OPG): The orthopantomogram is considered an essential diagnostic aid and should be examined before undertaking any orthodontic treatment (Figure 1). Orthopantomographs (OPG) are recommended for the following reasons: 1- Detection of pathologies associated with the teeth in particular and the jaws in general. These may include caries, periapical pathologies, odontomas, etc. 2- To determine the number, size and shape of the teeth. ` 3- To determine the exact eruption status of the succedaneous teeth, including placement and path of eruption. 4- For the calculation of total tooth material. The mesiodistal dimensions of the permanent teeth. 5- For medicolegal purposes. Advantages: 1. A large anatomic area is visualised. 2. Low radiation exposure. 3. Ability to be used in patients unable to open their mouths. 4. Patient cooperation is rarely a problem. 5. Interoperator variation is minimal. Disadvantages: 1. Specialized equipment is required. Page 2 of 9 Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin 2. Distortions, magnifications and overlapping of structures are a problem. 3. High cost. 4. Precise measurements are not possible. 5. It is not standardised. 6. Intraoral periapical radiograph (lOPA) may still be required. Figure 1. B- Cephalometric lateral skull radiograph: Sometimes referred to as a ‘lateral ceph.’ C- Intraoral radiographs: Intraoral radiographs are still frequently used as all centres may not possess the OPG. They are also recommended for specific regions where doubt remains regarding the clarity of the OPG. The most frequently used intraoral views in orthodontics include: Intraoral periapical radiographs (IOPA). Bitewing radiographs. Occlusal radiographs. Intraoral periapical radiographs: They are still ideal for detecting anomalies related to changes in the size, shape and content of the tooth structure and/or the lamina dura and/ or the periapical region (Figure 2). Page 3 of 9 Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin Figure 2. Bitewing radiographs: Bitewing radiographs are ideal for the detection of proximal caries and the study of interdental bone height. They may also help in the detection of secondary caries under restorations or overhanging margins of proximal restorations (Figure 3). Figure 3. Occlusal radiographs: This gives a view of the incisor region and is used to assess the root form of incisors, detect the presence of supernumerary teeth, and locate ectopic canine teeth. The location of teeth on radiographs often requires views to be taken at different angles using a technique known as parallax (Figure 4). Figure 4. Page 4 of 9 Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin D-Cone beam computed tomography (CBCT) Conventional computed tomography (CT) imaging involves the use of rotating X-ray equipment combined with a digital computer to obtain images of the body. Using CT imaging, cross-sectional images of body organs and tissues can be produced. CBCT is a faster, more compact version of traditional CT with a lower radiation dose. Through the use of a cone-shaped X-ray beam, the size of the scanner, radiation dosage, and time needed for scanning are all dramatically reduced. The three-dimensional (3D) views produced may be helpful in certain orthodontic cases: Accurate location of impacted teeth and a more accurate assessment of any associated pathology, particularly resorption of adjacent teeth (Figure 5). Assessment of alveolar bone coverage. Cleft palate. Assessment of alveolar bone height and volume. TMJ or airway analysis. Planning of some complex combined orthodontics and orthognathic surgery cases. Although the radiation dose is considerably smaller than that of conventional CT scanning, the dose is still higher than that of conventional radiographs. Therefore, CBCT should only be used when conventional radiography has failed to give or is very unlikely to give the necessary diagnostic information, for example, in cases of impacted teeth. Figure 5. 2- PHOTOGRAPHS: Photographs provide immense information to the clinician as well as the patient. Photographs can be, Extraoral photographs. Page 5 of 9 Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin Intraoral photographs. Extraoral Photographs: Extraoral photographs are considered essential records and should be taken before starting treatment and after completion of treatment. It is recommended that at least three extraoral photographs be taken for all patients. This includes: Frontal facial with lips relaxed. Frontal facial, smiling. Facial profile with lips relaxed. (Figure 6) Figure 6. We can also take the three-quarter view with smiling or lips at rest for more details. (Figure 7). Figure 7. Page 6 of 9 Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin All extraoral photographs should be taken in the natural head position (Frank Fort horizontal plane parallel to the floor), preferably without any shadows appearing in the background. The ears should be exposed (for the purpose of orientation), and the patient should not be wearing eyewear. Uses of extraoral photographs: 1. Evaluation of craniofacial relationships and proportions before and after treatment. 2. Assessment of soft tissue profile. 3. Proportional facial analysis and/or photographic analysis. 4. Monitoring of treatment progress (if standardised). 5. Important for conducting space analysis. 6. Detecting and recording facial asymmetry and muscle imbalance. 7. Identifying patients. Intraoral Photographs: Intraoral photographs are helpful in explaining and motivating the patient. They are also used to monitor treatment progress and results. They are also helpful in medicolegal cases involving the texture and colour of teeth. We should take five intra-oral views: One frontal photograph with the teeth in maximum intercuspation. Two lateral views-right and left. Two occlusal views-maxillary and mandibular, with the tongue retracted posteriorly for the mandibular view (Figure 8). Figure 8. Page 7 of 9 Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin Uses of intraoral photograph: 1. Record the structure and colour of the enamel. 2. Patient motivation. 3. Assessing and recording health or disease of the teeth and soft tissue structures. 4. Monitoring of treatment progress. 5. Study of relationships before, immediately following and several years after treatment to improve treatment planning. 3- Orthodontic Study Models (Dental Casts): Orthodontic study models are essential diagnostic records that help study occlusion and dentition from all three dimensions. They are accurate plaster reproductions of the teeth and their surrounding soft tissues (Figure 9). Ideal requirements of orthodontic study models: 1. Models should accurately reproduce the teeth and their surrounding soft tissues. 2. Models are to be trimmed to be symmetrical so that an asymmetrical arch form can be readily recognised. 3. Models are to be trimmed so that the dental occlusion shows by setting the models on their backs. 4. Models are to have clean, smooth, bubble-free surfaces. Figure 9. Page 8 of 9 Fourth stage Orthodontics 5/11/2024 Lecture 1 2024-2025 Diagnostic Records Dr Anwar Ahmad Amin Why do we make study models? 1. They are invaluable in planning treatment, as they are the only three-dimensional patient dentition records. 2. Calculate total space requirements/discrepancies. 3. They provide a permanent record of the intermaxillary relationships and the occlusion at the start of therapy; this is necessary for medicolegal considerations. 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 visualise 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. 8. Study models are an important record if the patient has to be transferred to another clinician. Technological advances in orthodontic records and treatment Digital photography and radiography have, of course, been available for many years. Computer software can be used to combine the two-dimensional hard and soft tissues information obtained from the photographs and radiographs to morph images to simulate the outcomes of orthodontic and/or surgical treatment. This aids treatment planning and can also help communication and providing informed consent for patients. More recently, there has been a move towards 3D digital records for orthodontic patients. Instead of traditional impressions, intra-oral scanning can now be used to produce virtual study models. Software can be used to efficiently measure arch lengths and tooth size discrepancies, as well as provide ‘virtual treatment set-ups’ offering predictions of the likely occlusion at the end of treatment. When combined with the information gained from CBCT, this may allow a better 3D understanding of the relationships of the crowns to the roots and surrounding alveolar bone, helping to define the biological bony limits of any orthodontic treatment. As technology improves, it will also help in predicting the effect of orthodontic treatment on the relationships of the teeth to the surrounding soft tissues (smile aesthetics), and the likely effect on facial appearance. Page 9 of 9