The clinical value of X-ray images of the teeth and jaws

X-ray images of the teeth and jaws are required for a variety of diagnostic purposes to supplement a clinical examination, and are invaluable for providing pictorial information about the structures that cannot be examined with direct vision. They can be acquired using traditional film systems which produce analogue images, or using a variety of alternative image receptors which result in a digital image. Irrespective of the method of image acquisition they are utilised by the dental surgeon in order to benefit their patients’ management. Numerous disease processes can affect the teeth and jaws, in addition to a range of developmental abnormalities. These can be classified according to a radiological sieve, which also includes artefactual and iatrogenic features. The key components of the classification are: developmental, inflammatory, traumatic, cystic, neoplastic, osteodystrophies and systemic disorders. This paper will utilise examples of radiographic images of patients to illustrate components of this classification which are unique to the teeth and jaws

Immediate effects of rapid maxillary expansion on the naso-maxillary facial soft tissue using 3D stereophotogrammetry

Background: Rapid maxillary expansion (RME) is used to expand the narrow maxilla. Dental and skeletal affects have previously been reported but few studies have reported on the overlying soft tissue changes. This study reports on the immediate effects of RME on the naso-maxillary facial soft tissue using 3D stereophotogrammetry. Methods: Fourteen patients requiring upper arch expansion using RME as part of their full comprehensive orthodontic plan were recruited. Cone beam CT scans and stereophotogrammetry images were taken for each patient; pre-RME activation (T0) and immediately post-RME expansion (T1). Based on twenty-three landmarks, 13 linear and 3 angular measurements were made from each of the stereophotogrammetry images. A linear measurement at ANS was taken from each CBCT image. Using a Wilcoxon signed rank test, the pre-RME and post-RME measurements were compared. Results: The mean separation of the anterior nasal spine was 3.8 mm ± 1.2 mm. The largest median increase was in nasal base width (1.6 mm), which was statistically significant (p = 0.001). Changes in the nasal dorsum height, nasal tip protrusion, philtrum width, and upper lip length were not statistically significant (p < 0.05). No significant differences were observed in the nostril linear measurements, expect for columella width (p = 0.009). Naso-labial angle decreased but was not statistically significant (p = 0.276). The only statically significant angular change was an increase in the nasal tip displacement angle (p = 0.001). Conclusion: Rapid maxillary expansion produces subtle changes in the naso-maxillary soft tissue complex. There is an increase in nasal base width, retraction and flattening of the nasal tip. These changes are small, less than 2 mm and variable between patients