Notes (1/17)

You cannot mark on analog films

-but you can on digital extra oral films

Digital panos are not to be used to take measurements

-laminagraph(sp)

The benefits of using a pano is to look at the sizes, shapes, and positions of the roots

Don’t look at the teeth, look at the condylar heads to see if they are flat or missing

On everybody, up the age of 8 - take images!!!!

-especially if everything looks beautiful, you must confirm there is nothing missing

In the mid-teens, when all teeth are in the mouth

-take another image on everyone

Imaging machine today;

-usually last around 5-10 years
-around 75K
-technique is higher

Imaging positioning - relatively technique sensitive

-squashed = invalid

Mandibular canal:
-2/3 the distance from the ___ to the ramus
-major landmark because it’s a neurotrophic i.d. marker relative to the _______.

3-D Imaging
-CBCT
-used by ortho, major restorative dentist doing implants, and surgeon

We no longer take intra-oral films

-CBCT is use as a substitute
-You can measure anything
-After new tooth movement, you can’t pick up calcified bone, it’s all developing bone
-Means you have to take these 6 months later

Pediatric intraoral series

-you can’t see the roots of the succedaneous teeth
-which is why we don’t use these
-We can’t take long pole PA under the age of 12 because of ……..

Earlier the permanent tooth comes in, the more immature the root is, and vise versa

Nobody knows the cause of tooth eruption

-actual cause unknown
-The cause of eruption is root long - statement is NOT correct
-However it is related to genetics
Restorative implant is an ankylosed tooth
-if male under 20, no one should be doing restorative implants
-If you try, then it’ll sink
-Girls - 2 lateral ceps films 1 year apart with no change = growth and development is done

Goneal (sp) angle ???

Goneal (sp) notch?? - look out!

Ceph

Number one mistake is not biting down correctly

Been using EAM landmark since 1884 in Frankfort, Germany

-Frankfort Horizontal plane = 3 marks (2 EAM, Left orbit)

Posterior superior part is the Ear canal

White circle is machine corion (sp)?

-need to use anatomical coria (sp) when tracing

Superior part of the fossa - or condylar head is on the same plane as EAM

Ear
-can identify between male and female
-Pinna, EAM

Sometimes can see the IAM

-smaller
-up and back

Also see Mastoid Air cells

-children don’t have a lot because it’s too immature
-we can see IAM, EAM

Hyoid - Around C4
-gets taller and concave at the bottom
-helps determine bone age
-needs to see this, which is why we don’t use a thyroid collar

Need to always look at the airway to see if there are problems

-most times it’s not related to malocclusion
-multifactorial cause (biggest is weight)

Saggital - front to back

In front of the ear - you’re in the face

-posterior vertical face (straight down)
-anterior vertical face (in front of that)
-theses are inversely related (test question)*****
One image not on cephs is the transverse plane (test question)********
-it’s not needed as much because it develops early
-Can’t do side to side

Lateral Cephalometric Radiograph

-standardized distance film

Look at the back of the head:

-Internal table
-External table

-difference between endoosteal and periosteal surfaces

Occiptal protuberance - mine is huge!

-it’s a secondary sex characteristic
-won’t see in children, comes in later on

Two different ways to read films:

Landscape field
-this is what we use
Portrait view
Negative: cut off back of head
Think the positions of the upper incisor and forehead should match

Microcephalic - little heads

-can happen when you don’t calibrate

If you can’t see the soft tissue

-this is a major problem!

Lateral cephs films studies - 1927

Anulized (sp) films from 1-40

Soft tissues:
-over forehead
-nasion (around eye brows)

Soft tissue does not match the underlining hard tissue bone!!
-which is why you can’t just use hard tissue measurements

Frontal sinus:
-More common in males
-Secondary sex characteristics
-Why eyes look set back
-Asian - this set back

Bottom part of lower jaw on ceps

-outer surface
-inner surface - when you superimpose, this doesn’t change overtime
-this is a great landmark
Very difficult to pick up the condylar head on ceph images

Articulara (sp)
-not trying to find condylar head
-…….?

Front tooth - usually central lower incisor

Back tooth - usually lower 1st molar (around age 6) (or primary 2nd molar)

Maxilla:
-palatal plane/or maxillary plane, there is white line that goes up (White, dense bone)
-thats the back part of the maxilla

-you will see a teardrop - opening

-this is the pterygomaxillary fissure

-Can’t move the maxillae back farther than this even with surgery, or you’re dead

-Maxilla grows in the back and up

-but projected down and forward
-grows in direction and is actually pushed away in opposite

PNS - Posterior Nasal spine

-pterygomaxillary fissure - back part drops down to _________ plane

ANS - Anterior Nasal spine

-this why is hurts when you get hit in the nose
-shows up as a little projection

Deepest part of the arch (concave area)

-A point (above upper incisors)
-junctions of the alveolar and basal bone

-B point (below lower incisors)

Orbit:
-Orbitaly = bottom notch of orbit
-shows up on 3 or 4 images, needs to pick out which one is correct
-Used with Frankfort horizontal measurements

-Cranial base measurements are for you personally, but can’t be used against
others like Frankfort measurements can

Where is the junction of the nasal and frontal bones?

-suture
-near deepest concavity
-This is called “Nasion”

Cranial base in the middle section:

-3 aspects:
 -N = anterior point of anterior cranial base
-Middle:
-front part - come off the anterior clenoid processes
-back part - posterior clenoid
=Sella Turica (sp)
-sella - mid-point of the processes

Greater wings of the sphenoid

-left and right
-Junction between middle and anterior cranial base
-when doing superimposition over time, these are landmarks to see the change

Basion - sella - nation

-triangle
-cranial base flecture (angle)
-angle doesn’t change even though extension grow out
-implications since we all have different angles but average around 130

4 major curves in growth

1. schematic
2….
3….
4…

More common in males to have an FMA

-for the need of oxygen in the skeletal muscular system
-in girls it general doesn’t grow as much in the back as it does in the front

-more common to have a low fnma

Notes for Tracing Errors:

Facial angle is from frankfort, not SN

Angle of convexity needs a valance, even if it’s positive
-Don’t make the vertex of the angle at N, make it at A

SNA - SNB = ANB

-Do not measure ANB (must have a valance, even if it’s positive)

The FMA is the same measurement in the triangle as it is in the skeletal

IMPA
-the dental measurements =lower incisor to mandibler planes = these are the same
measurement

*Do the Triangle first!!!! (Take the two above values and move them up)
-there’s only 3 values in a triangle that equal 180 degrees

Upper 1/ to NA
lower 1 to NB
-These are for the facial surfaces of the teeth!!
 -Line needs to be perpendicular from most facial aspect of indoors

lower incisal to A-Pog

-measured to incisal edge
-must have a valance!!!

Next time:
-Turn in both sheets to get graded
-Look at pg 65

Things that needs a valance:

Angle of convexity
ANB
(Anything that needs valance)

should have 8

plus .5 or minus .5 = 0.5

GoGn/SN