DIAGNOSTIC AIDS IN

ORTHODONTICS

Presented By

Guided By

Dr. Santosh Chavan

Dr. (Mrs.) W.A. Bhad

P.G. Student

Assoc. Prof. & Head

Department of Orthodontics & Dentofacial Orthopedics

Government Dental College & Hospital, Nagpur

 Introduction
Diagnostic aids
Essential diagnostic aids
Supplemental diagnostic aids
Recent advances in diagnostic aids
Xeroradiography
Digi graph
Magnetic resonance imaging (MRI)
Ultra sonography
Computed tomography
Occlusograms
Digital substraction radiography
Laser holography
Photo cephalometry
Cineradiography
Electromyography
Finite element method

INTRODUCTION
Orthodontic diagnosis deals with recognition of the various
characteristics of the malocclusion. It involves collection of pertinent data
in a systematic manner to help in identify the nature and cause of the
problem.
Diagnosis involves development of a comprehensive data base of
pertinent information. The data is derived from case history, clinical
examination and other diagnostic aids such as study casts, radiographs
and photographs. Orthodontic diagnostic aids are of two types. They are
the essential diagnostic aids and the supplemental diagnostic aids.
DIAGNOSTIC AIDS
a) Essential diagnostic aids
They are clinical aids that are considered very important for all
cases.
They are
1. Case history
2. Clinical examination
3. Study models
4. Certain radiographs
5. Facial photographs
b) Supplemental diagnostic aids
They are certain aids which are not essential in all cases. They may
require specialized equipment that an average dentist may not possess.
They are
1) Specialized radiographs
a. Cephalometric radiographs
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b. Occlusal intra-oral films

c. Cone shift techniques
2) Electromyographic examination of muscle activity.
3) Hand-wrist radiographs
4) Endocrine tests
5) Estimation of basal metabolic rate.
6) Occlusograms
RECENT ADVANCES IN DIAGNOSTIC AIDS
Orthodontics is a rapidly growing field with developments
occurring almost every day. Recent innovation sin medical imagings have
been adapted to dentistry and find some applications in orthodontics as
well.
Xeroradiography
Xeroradiography is a, completely dry, non-chemical process which
makes use of the electrostatic process as in Xerox machines. It was
invented by Chester F. Carlson in 1937.
Xeroradiography makes use of an aluminum plate that is coated
with a layer of vitreous selenium. The selenium particles are given a
uniform electrostatic charge. The charged plate is placed in a light tight,
airtight cassette. When the film is exposed it causes a selective discharge
of the selenium depending upon the amount of radiation used and relative
density of the object. This pattern of electric discharge on the plate is
called latent image.
The latent image is then converted into a visible image by a
process called development in a unit called processor. The plate is
exposed to charged particles called toner. The image is now transferred to
a special kind of paper called xerox opaque paper.
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The unique feature of xeroradiography is that it is possible to have

both positive and negative image. Once a latent image is converted to a
real image on to a paper the selenium plate can be discharged, cleaned
and used again.
Advantages
1. Reduction in exposure time.
2. Ease in manipulation. No need of dark rooms for developing.
3. Ease of viewing. No special light source is required.
4. Edge enhancement effect.
5. Cephalometric landmarks are easily identified.
6. Reconstruction of the cephalometric planes and points can be made
directly on paper.
Digi graph
The digi graph is a synthesis of video imaging, computer
technology and sonic digitizing. Cephalometric landmarks are digitized
by light touching the sonic digitizing probe to a point on the patients skin
corresponding to it. This emits a sound, which is then recorded by the
microphone and monitored as X, Y and Z co-ordinates. The system
allows cephalometric evaluation and treatment progress as often as
necessary without radiation exposure.
Features of digi graph system included:
1. A land-mark can be identified as a point in three dimensions.
2. A cephalometric analysis can be made independently of head
position.
The Digi graph work stations hardware and software enable the
performance of cephalometric analyses, tracing, superimposition and
visual treatment objectives. The digi graph allows all patients models,
radiographs, photographs, cephalograms and tracings to be stored on one
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small disk, thereby reducing storage requirements. It is also a valuable

tool for improving communication among clinician, patient and staff.
Magnetic resonance imaging (MRI)
MRI uses non-ionizing radiation from the radiofrequency band of
the electromagnetic spectrum. To produce an MR image, the patient is
placed inside a large magnet, which induces a relatively strong external
magnetic field. This causes nuclei of many atoms in the body including
hydrogen, to align themselves with the magnetic field. After application
of RF signal, energy is released from the body, detected and used to
construct the MR image by the computer.
Advantages
1. Best resolution of tissue of low inherent contrast.
2. No ionizing radiation is involved.
3. Because the region of body imaged in MRI is recorded
electronically, direct multiplanar imaging is possible without
reorienting the patient.
Disadvantages
1. Relatively imaging times.
2. Expensive procedure.
3. Crowns or bridges may cause artifacts because of its excellent soft
tissue contrast resolution.
MRI has proved useful in a variety of circumstances in
orthodontics particularly in the study of TMJ.
a. To study the mandibular condylar position.
b. To correlate TMJ sounds recorded by sonography with
condyle / disk relations on MRI.
c. TMJ disorders in juvenile patients.
d. TMJ internal derangement and craniofacial morphology.
e. Estimate tongue volume and correlate with body weight.
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Ultra sonography
Ultrasound can be defined as a coherent, mechanical vibration at
high frequency. Ultrasound waves are longitudinal in nature. The particles
of the elastic medium move in the direction parallel to that of the wave
propagation of the ultrasound is a sequence of compression and
rarefaction of waves, which are transmitted by virtue of the elastic forces
between adjacent tissue particles.
Ultrasound assumes a constant speed of 1540 M/S in the body.
Ultrasound comprises of
a) Transducer
b) Transmitter
c) Receiver
d) Scan converter
e) Monitor
Applications
1. For assessment of TMJ dysfunctions.
2. To determine the position of mandibular condyle.
3. For evaluation of masseter muscle thickness.
Computed tomography
Tomography is a image of a layer of tissue.
Computed tomography is use of a computer to aid in generating the
image.
In 1972, Godfrey Hounsefield announced the invention of a
revolutionary imaging technique which he referred to as computerized
axial transverse scanning. In its simplest form, a CT scanner consists of a
radiographic tube that emits a finely collimated, fan shaped X-ray beam
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that is directed to a series of scintillation detectors or ionization

chambers.
Depending on the scanners mechanical geometry both the
radiographic tube and detectors may move synchronously about the
patient or the detectors may form a continuous ring about the patient and
the X-ray tube may move in a circle within the detector ring.
The CT image is reconstructed by the computer, which
mathematically manipulates the transmission on data obtained from
multiple projections.
If one projection is made every third of a degree, then 1080 images
result from a 3600 rotation of the scanner. The CT image is a composite of
these 1080 projections. The CT image is recorded and displayed as a
composite of individual blocks called voxels. The block is rectangular
with square face called as pixel. The length of block is analogous to the
thickness of plane of section scanned.
On the CT image each pixel is assigned a CT number or
Hounsefield units. These numbers range from 1000 to +1000, each
constituting a different level of optical density. This scale of relative
density is base on air (-1000) water (0) and dense bone (+1000).
Advantages
1. Completely eliminates superimposition.
2. Because of high contrast resolution of CT, differences between
tissues that differ in physical density by less than 1% can be
distinguished.
3. Data from a single CT image can be viewed as axial, coronal or
sagittal planes.
Disadvantages
1. Radiation risk, which is greater in children.
2. It is expensive.
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Applications
1. Localization of impacted canines.
2. Evaluation of condylar position in glenoid fossa in skeletal Class
III malocclusions.
3. Measurement of joint spaces of TMJ.
4. Resorption of roots of maxillary canines after ectopic eruption of
maxillary canines.
5. Assessment of maxillary movements induced by rapid maxillary
expansion.
6. Assessment of nasopharyngeal airway and cleft palate deformities.
7. Evaluation of ossification and closure of various structures in
craniofacial complex.
8. Ct reconstruction of tongue and airway in cases of obstructive
sleep apnea.
Occlusograms
It is a tracing of a photograph or a photocopy of a dental arch.
Occlusograms are used for the following purposes.
a. To estimate occlusal relationships.
b. To estimate arch length and width.
c. To estimate the tooth movements required in all three planes
of space.
d. To estimate spacing and crowding.
e. To estimate anchorage requirements.
f. To see arch form.
Digital substraction radiography
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Digital substraction radiography is an image enhancement method

that removes the structured noise from the images. The result is the
images. The result is the area of change clearly displayed either against a
neutral gray background or is superimposed on the original radiograph
itself. The substraction of original two. Radiographs are termed an image
rather than a radiograph because it does not directly result from exposure
of a radiographic film.
It selectively enhances the differences between two images.
Laser holography
A hologram is a photographic film, slide or plate upon which is
recorded the interference pattern produced by the reinforcement or
cancellation of 2 different intersecting light wave fronts. Holography is
the science of recording the reflected light waves from an object on to a
hologram and subsequently reconstructing the stored image of the object
in the space where the original object had been.
The term holo mean complete and gram means message. As in
photography, a shutter is used to determine the holographic exposure. A
beam splitter divides the laser beam into two components; the
holographic film plate simultaneously records the reflected light from the
object and an additional reference light directly coming from the laser.
The reference beam and object beam light waves intersect and reinforce
or cancel one another producing a series of light and dark bands which
constitute the interference pattern produced on hologram. The hologram
is thus the recording of the interference of the wave pattern of the
reference beam with the wave pattern of the object beam.
Applications
1. Storage of study model images.
2. Measurement of incisor intrusions.
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3. To see effect of headgear.

4. To determine the center of rotation produced by orthodontic forces.
5. For lower incisor space analysis.
6. To assess the facial and dental arch symmetry.
Photo cephalometry
Thomas in 1978 developed photo cephalometry to better visualize
the soft tissue of the patient, three radiopaque metallic markers with holes
are placed on the patients skin with adhesives and standard lateral and
frontal photographs are taken. The photo size as the radiographs and are
superimposed over the radiographic tracing taking the metallic marker as
the guide.
Cine radiograph
This is basically a radiographic motion picture. The subject is
oriented properly and stabilized in a modified cephalostat. An X-ray
motion picture is obtained using a cine camera which runs at 240 frames
per second. This diagnostic aid is used to visualize the swallowing pattern
of the patient. The X-ray motion picture is studied using a movie
projector.
Electromyography
Electromyography is concerned with the detection, recording and
interpretation of electrical activity in skeletal muscle.
Application
1) To see neuromuscular adaptations following mandibular
forward positioning induced by functional appliances.
2) To see the functional changes in masticatory muscles during
treatment.
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Finite element method

This method is mainly used in civil engineering to study the stress
produced and propagation of cracks in fixed structures.
In dentistry it was initially used to analyze the same in restorative
materials and prosthetic post and core restorations. Finite element method
was developed in 1956 by Turner, Clough, Martin and Topp.
The basis of the finite element method is the representation of a
body or a structure by an assemblage of subdivisions called finite
element. These elements are interconnected at joints called as nodes or
nodal points. Simple functions are chosen to approximate the distribution
or variation of the actual displacement over each finite element. Such
assumed functions are called displacement models.
Applications
1. To determine the physiological stress values in the natural tooth
and alveolar bone.
2. To investigate relation ship of moment to force ratios and centers
of rotation.
3. Stresses produced in PDL by removable and fixed appliances.
4. To see the stress and strain distribution around the implant.
5. To locate the center of resistance of teeth and maxilla and
mandible.

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