Asociación Mexicana de Ortopedia Maxilar A.C.
Dr. Med. Dent. Hans-Joachim Müller
Do we need always Cefalometric lateral X
Resumen Conferencia, 4ta. Reunión Anual AMOM,1999 Manzanillo Col., 235-28 Nov.
Recently patients or their parents an questioning whether long distance X-rays are really neccessary to achieve orthodontic tratment.
This for us was reason enough to consider ways of Diagnostic which could substitute Xrays.
But firts let us see, what long distance X-rays can inform us about.
1. Positions of the teeth relating to the jaws
2. Positions of the teeth relating to eachother
3. Positions of the jaw relating to the scull
4. Positions of the jaw relating to each other
5. Direction of growth of the jaws relating to the scrull (growth-prediction).
Various methods to detect the growth direction of the jaws have been introduced by Schwarz, Korkhaus, Björk, Jarabak, Ricketts. Steiner, Hasund and others. They all use specific angles to determine the growth direction.
Even though the importance of lateral (and frontal) long distance-X-ray is evident, we need more information to achieve a correct Diagnosis which can lead us to the optimum therapy.
I. There are of course the Anannesis questions we have to ask to complete our clinical picture of our patient.
II. Then we have to do a detailed clinical examination of our patient.
III. Whe have to do impressions in order to be able to make masurements of the size of the teeth as well the width and the length of the jaws.
IV. Because most of our patients are mixed dentition cases we have to know which teeth still have to be expected. We have to get information about the position and the form of the roots of the permanent teeth. For this reason we use panorama K-rays.
V. In order to detect the state of grovth of our patients in some cases an X-ray of the hand will be necessary.
VI. Last not least we need lateral land frontal fotos and may be a foto that shows our patient smiling liven infraoral fotos are helpful to show the colour of the teeth, the gingiva and the state of oral hygien.
Now let us return to what has been stated at the beginning:
Which of these diagnostics are really neccessary in order to prepare an individual tratmentplan on whitch our t`ea ment for the next years is based on?
I. Annammestic questioning YES
II. Clinical examination YES
III. Impressions and modells YES
IV. Panorama X-ray Not in
every case. If we have to treat a lateral
cross-bite in a milch-dentition in order to
avoid asymmetrical devellopement of the
face we do not X-ray.
V. X-ray of the hand Some
We can as well ask the paren how much growth tookplace in the last theree mounth and wether growth increased was stable or bas decresed.
By using the curve of growth it is possible to find the approximate stadium of growth the child is in.
VI. Lateral an frontal long distante X-ray Not in every case
How-you will ask- can an Orthodontist make a statement like this?
But we have mentioned FOTOS.
The have to be taken froon the same distance as the corresponding X-rays and the head has to be positioned equally.
Schwarz and Simon Have alrcady introduced a method to position the patient correctly dapted from the foto chuiques in police stations.
By using the Frankfurt-Horizontal, the po-line, the Pn-line and kpf= Kieferprofiled = profilefield they evalated the tipe of the face.
But are other measurements possible which can give us more information connerning growth direction.
Does a foto deliver such findings? Yes it can to a certain degree
So what about the position of the teeth?
In order to correct this we shoulc look at the modells being angulated to a certain degree from the horizontal.
This angulation normally is seer in a lateral X-ray byusing the angle between the line spa-spp and the bite-plane.
In order to proceed we took a pieces of 10 mm stainless steel wire, straightened it and melted it into the waxbite taken from the patient in central relation parellel to the bite-plane. It ends distall, of the first molar and has a length of about 20cm.
Then we put the waxbite togetner with the wire back into the moute of the patient and took a lateral foto.
Bey extending the line of the wire distally we could see the angulation of the bite-plane in relation to the face.
All these findings brought as to the conclusion, that a lateral long distance X-ray can be avoided in many patiens and be substituted by correctely take and analysed lateral foto using the described stainless steel wire to demostrate the angulation of the bite plane.
Together with the modells we can achieve a correct diagnosis even though it takes a bit more tome for preparation.