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4. ~Records for evaluation of teeth & oral
structures
~Records for evaluation of occlusion
~Records for evaluation of facial and jaw
proportions
- William Proffit
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5. ESSENTIAL
~Case History
~Study Model
~Wax bite records
~Photographs
~Radiographs
OPG
Occlusal radiograph
Intra-oral peri-apical radiograph
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8. CASE HISTORY
~Written record
~The card is 4><6 “ or 5>< 8 “
History
Specific Disturbances causing
malocclusion
Past medical history
Past dental history
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9. 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
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10. 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
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15. 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
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practice (US)
16. 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
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18. STUDY MODELS
-Graber
~Degree of Accuracy & completeness
~Time-linked record
~Longitudinal, three-dimensional record that
establishes the status of teeth & investing
tissues
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20. ~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
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21. ~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
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35. 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
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36. 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
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57. 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.
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-Ideal
1988 , Moyers
58. OTHER SPECIAL X-RAY VIEWS
~A-P View
~45 Degree Lateral Projection
Proper tooth relationships
~Occlusal films
~Hand-wrist films
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68. ~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
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77. 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
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81. OCCLUSOGRAM
~Developed by Burstone in 1961
~Actual sized photographs of occlusal surfaces
of dental casts
~Tracings are done –used in treatment
planning
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88. , 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.
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89. 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.
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90. 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.
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91. 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.
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98. ~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
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100. ~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
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system
131. 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
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133. 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
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135. INFORMATION RETREIVAL SYSTEM
~Record chart has 944 features. It includes
-Clinical data
-Evaluation of study models
-Radiographic cephalometry
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149. MANDIBULAR POSITON INDICATOR
~SAM articulator & MPI enables the clinician
determine, record & compare positional changes
of condyle between CR and CO
- AJO 1995, Meyers
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151. 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
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155. 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 .
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166. 1. A higher level of communication.
2. More precision in this communication.
3. This communication is more effective
and less time consuming.
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167. 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.
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178. 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.
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179. 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.
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180. 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.
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181. 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).
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182. 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
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186. 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.
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-JCO 1984, Bernard
187. 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
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191. 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.
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192. 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
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194. 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
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195. ~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
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196. ~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
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201. 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
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209. 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
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