Radiology in Orthodontics

The integration of cutting-edge radiological innovations within the ever-evolving field of dentistry has transformed the way dental practitioners approach their patients’ needs. Orthodontics and radiology now go hand in hand. In recent years, orthodontics has drastically revolutionized, thanks to groundbreaking advances in radiology.

As clinicians, our ultimate goal is to achieve the best possible treatment outcomes for our patients and improve the quality of their lives and overall well-being. Regarding patient satisfaction and treatment success, one cannot stress the importance of a correct diagnosis enough. A correct diagnosis serves as the foundation for developing an effective treatment plan that adequately addresses the patient’s unique orthodontic needs. Without an accurate diagnosis, it is difficult to determine the underlying causes of the orthodontic problems, and almost impossible to create a treatment plan capable of producing optimal results.

This article discusses how various radiographic modalities play a role in making a correct diagnosis. Orthodontic radiographs, such as panoramic, cephalometric, and cone-beam computed tomography (CBCT) scans, enable the clinician to acquire a comprehensive picture of the three-dimensional relationship between hard and soft tissues. This holistic view of the patient empowers dentists and gives them the confidence to vest in their skills and knowledge.

The information rendered by radiographs is vital in diagnosing dental and skeletal abnormalities that may be contributing to malocclusion or improper bite alignment.

Discussed below are the various types of radiographic methods employed in orthodontics:

OPG (Orthopantomogram)

OPG radiographs show a panoramic view of the jaws, teeth, and related structures, including the maxillary sinuses, mandibular nerve, and TMJ. This information allows the clinician to evaluate the position and development of the teeth and jaws, identify any missing or impacted teeth, assess the level of bone density, and detect any abnormalities or pathologies. Based on this information, the clinician can develop a personalized treatment plan that addresses the patient’s unique needs and goals, and that takes into account any potential complications or risks.

Here are some ways that an OPG can help diagnose orthodontic abnormalities:

Detecting missing or extra teeth
An OPG can show the number and position of teeth in the patient’s mouth, which is essential for planning orthodontic treatment.
Evaluating tooth eruption patterns
An OPG reveals the position of unerupted teeth, which can help predict future orthodontic problems and determine the appropriate course of treatment.
Assessing jaw growth
It can show the size and shape of the patient’s jaws, which is essential for evaluating skeletal abnormalities such as underdevelopment or overdevelopment
Analyzing bone loss
An orthopantomogram can also show the level of bone support around the teeth. This is important information as the success of orthodontic treatment depends on the health of the teeth and supporting structures, including the bone. During orthodontic treatment, the forces applied to the teeth can cause temporary changes in the bone around the teeth. In cases of bone loss, it is essential to monitor these changes carefully to ensure that they do not exacerbate the existing bone loss or compromise the long-term stability of the teeth.
If there is significant bone loss around the teeth, it may be more challenging to achieve a stable and predictable outcome with orthodontic treatment alone.
In cases where there is extensive bone loss, it may be necessary to address the underlying periodontal condition before starting orthodontic treatment.
However, in some cases of mild to moderate bone loss, orthodontic treatment can be done with appropriate caution and careful monitoring. The clinician will need to evaluate the extent and severity of the bone loss and determine whether it is stable or progressive. If the bone loss is stable and well-controlled, orthodontic treatment may be possible.
Detecting other abnormalities
An OPG can reveal abnormalities such as cysts, tumors, and jaw fractures, which may impact orthodontic treatment.

Lateral Cephalogram

A lateral cephalogram radiograph shows a side view of the patient’s head, including the skull, teeth, and soft tissue. This radiograph is commonly used in orthodontics to diagnose and evaluate orthodontic abnormalities and plan treatment.

The lateral cephalogram provides information on several key aspects of the patient’s dental anatomy. One of the most important measurements is the angle of the patient’s jaw in relation to the rest of their face. This measurement, known as the ANB angle, helps the orthodontist determine whether the patient has a Class I, Class II, or Class III malocclusion (misalignment of the teeth and jaws). Additionally, the lateral cephalogram shows the position of each tooth in relation to the others and to the jawbone. This information can enable the clinician to determine which teeth need to be moved and how far they need to be moved to achieve proper alignment.

The radiograph also shows the position of the temporomandibular joint (TMJ), which connects the jaw to the skull. Problems with the TMJ can cause pain and discomfort, and the lateral cephalogram can help the orthodontist identify any issues with the joint.

Listed below are some ways that a lateral cephalogram radiograph can help diagnose orthodontic abnormalities:

Skeletal relationships
The radiograph can provide information on the position and relationships of the upper and lower jaws in relation to each other, which can help diagnose skeletal abnormalities such as Class I, Class II, or Class III malocclusions.
Dental relationships
The radiograph can show the positions of the teeth in relation to the jaws, including the degree of crowding or spacing, rotations, and any missing or impacted teeth.
Soft tissue analysis
The radiograph can show the position and relationship of the soft tissue structures of the face, such as the lips, chin, and nose, which can help in diagnosing and planning treatment for facial asymmetry or imbalances.
Growth prediction
The radiograph can provide information on the patient’s stage of dental and skeletal development, which can help predict future growth and plan treatment accordingly.
Airway assessment
The radiograph can show the size and shape of the upper airway, which can help diagnose obstructive sleep apnea and plan treatment to improve breathing.
TMJ analysis
The radiograph can show the position and relationship of the temporomandibular joint (TMJ) and can help diagnose any abnormalities or disorders affecting the joint.

Hand-wrist Radiograph

A hand-wrist radiograph is a useful diagnostic tool for evaluating skeletal maturity in orthodontic treatment. It is an X-ray of the hand and wrist, which allows the orthodontist to assess the stage of growth and development of a patient’s bones.

The bones in the hand and wrist have a predictable growth pattern, and by comparing the X-ray to standardized growth charts, a clinician can determine a patient’s skeletal age. This information is vital in orthodontic treatment planning, as it helps determine the optimal treatment timing and duration.

For example, if a patient’s hand-wrist radiograph shows that they are still growing rapidly, the orthodontist may choose to delay treatment until the patient has reached a more stable skeletal maturity. Alternatively, if a patient’s skeletal maturity is advanced, the clinician may choose to start treatment earlier to take advantage of the patient’s growth potential.

Peri-apical Radiograph

A periapical radiograph is an X-ray that shows the entire tooth, from the tip of the root to the crown. It is often used in dentistry and orthodontics to evaluate the health of the tooth and surrounding bone.

Periapical radiographs are commonly used in orthodontic treatment for several purposes.

Periapical radiographs allow clinicians to assess the position and orientation of teeth within the jawbone. This can help them identify any abnormalities, impactions, or other issues that may need to be addressed during treatment.
Periapical radiographs can be relied on to monitor the progress of orthodontic treatment. Taking periodic radiographs can equip the clinician with substantial information to help evaluate the movement of teeth, assess the position of the roots, and monitor the development of new bone in response to orthodontic forces.
They can reveal valuable findings to identify potential complications or issues that may arise during treatment. For example, they can help the clinician identify root resorption, a condition where the teeth’ roots become shorter due to orthodontic treatment. By recognizing these issues early, dental professionals can take the required steps to prevent or minimize their impact on the patient’s overall treatment outcome.

Antero-occlusal Radiograph

An antero-occlusal radiograph, also known as an occlusal radiograph or a “top-down” view of the teeth and surrounding structures, can prove to be helpful for orthodontic diagnosis in certain situations.

This type of radiograph can provide a view of the entire arch of teeth, including the positions and angulations of the teeth and their roots. It can also show the presence of any impacted teeth, cysts, or other abnormalities that may affect orthodontic treatment planning.

In cases of significant crowding or overlap of the teeth, an antero-occlusal radiograph can be particularly helpful. It can provide a clear view of the position and orientation of the teeth, which can help the clinician determine the most appropriate treatment approach.

However, it’s worth noting that antero-occlusal radiographs are not always necessary or useful for making an orthodontic diagnosis. In many cases, other types of radiographs, such as periapical or panoramic radiographs, may be more appropriate. The decision to use an antero-occlusal radiograph or any other type of radiograph should be made based on the individual needs of the patient and the specific goals of orthodontic treatment.

Cone-Beam Computed Tomography (CBCT)

Cone beam computed tomography (CBCT) is an advanced imaging technique that utilizes a cone-shaped X-ray beam to produce a three-dimensional (3D) image of the craniofacial region. In orthodontics, CBCT has become an invaluable tool for diagnosis, treatment planning, and monitoring of treatment outcomes.

One of the primary advantages of CBCT in orthodontics is its ability to provide detailed 3D information about the patient’s teeth and supporting structures, which is not possible with traditional 2D radiographs. This allows clinicians to visualize the anatomy of the patient’s teeth and jaws in much greater detail, which is particularly useful in complex cases where the exact location and orientation of the teeth and supporting structures are critical for treatment planning.

Some of the ways in which CBCT can help with orthodontic diagnosis include:

Evaluating the position and orientation of teeth
CBCT images can provide a detailed view of the position and orientation of each tooth within the jaw, which can help the orthodontist to plan the most effective treatment approach.
Evaluating the skeletal discrepancies and asymmetries
CBCT is particularly useful in the evaluation of skeletal discrepancies and asymmetries, as it allows the clinician to accurately measure the size, shape, and position of the patient’s jaws and facial bones. This information can be used to determine the optimal treatment plan and to monitor the progress of treatment over time.
Identifying the presence of impacted teeth
CBCT can be used to assess the location and position of impacted teeth, which is important for planning their removal or orthodontic treatment.
Assessing bone quality
It can also be used to evaluate the volume and quality of bone in the area of the planned implant placement, which is essential for successful implant treatment.

In conclusion, CBCT can be a handy tool in orthodontic diagnosis. It can provide a wealth of essential information to aid the clinician in planning the most effective treatment approach and achieving the best possible outcome for the patient.

The Bottom Line

Radiographs are an indispensable tool in orthodontic treatment planning and monitoring, providing a wealth of diagnostic information that cannot be obtained through a clinical examination alone. These images allow the clinician to assess the patient’s skeletal and dental relationships, predict growth patterns, identify any airway obstructions, and evaluate the temporomandibular joint (TMJ).

With this information, the clinician can develop a comprehensive and personalized treatment plan that addresses the patient’s unique needs and goals. Radiographs also enable dental professionals to monitor the progress of treatment and make any necessary adjustments, ensuring that the teeth are moving in the desired direction and that treatment is proceeding as planned.

Additionally, radiographs also help assess the risk of potential complications, such as root resorption or tooth impaction and take necessary steps to mitigate these risks. Conclusively, radiographs play a critical role in achieving optimal orthodontic treatment outcomes and promoting the long-term health and functionality of the patient’s teeth and jaw.