Lecture 2

Study models and OPG

Dr. Aiser Kareem Al-Kaabi 5th stage

Diagnostic Aids
1-Study Models:
Orthodontic study models are essential diagnostic
records, which help to study the occlusion and
dentition from all three dimensions. They are
accurate plaster reproductions of the teeth and their
surrounding soft tissues.

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IDEAL REQUIREMENTS OF ORTHODONTIC STUDY MODELS

1. Models should accurately reproduce

the teeth and their surrounding soft
tissues.
2. Models are to be trimmed so that they
are symmetrical and pleasing to the eye
and so that an asymmetrical arch form
can be readily recognized.

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3. Models are to be trimmed in such a way that the dental occlusion shows by
setting the models on their backs.
4. Models are to be trimmed such that they replicate the measurements and
angles proposed for trimming them.
5. Models are to have clean, smooth, bubble-free surfaces with sharp angles
where the cuts meet.
6. The finished models should have a glossy mar-proof finish.
 WHY WE MAKE STUDY MODELS?
1. They are the only three dimensional records of the patient's
dentition.
2. Occlusion can be visualized from the lingual aspect.

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3. They provide a permanent record of the intermaxillary
relationships and the occlusion at the start of therapy; this is
necessary for medical considerations.
4. They are a visual aid for the dentist as he monitors changes
taking place during tooth movement.
5. Help motivate the patient, as the patient can visualize the
treatment progress.
6.They are needed for comparison at the end
of treatment and act as a reference for post-
treatment changes.
7.They serve as a reminder for the parent and
the patient of the condition present at the
start of treatment.
8.In case the patient has to be transferred to
another clinician, study models are an
important record.
 USES OF STUDY MODELS
1. Assess and record dental anatomy
2. Assess and record intercuspation
3. Assess and record arch form
4. Assess and record the curves of occlusion
5. Evaluate occlusion with the aid of articulators
6. Measure progress during treatment
7. Detect abnormality, e.g. localized enlargements, distortion of arch form, etc.
8. Calculate total space requirements/discrepancies
9. Provide record before, immediately, after and several years following
treatment for the purpose of studying treatment procedures and stability.
Assess and record the curves of
occlusion
 Calculate total space
requirements/discrepancies
DIS ADVANTAGES OF STUDY MODELS
Liable to fracture
Takes too much space in storing

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PARTS OF THE STUDY MODELS

The study models can be divided into two parts for the purpose of description:
The anatomic portion
The artistic portion

The anatomic portion is that part which is the actual impression of the dental arch and its
surrounding soft tissue structures. This is the part, which must be preserved when trimming
the model.
The artistic portion is the stone base supporting the anatomic portion. This portion is
trimmed in a manner, which depicts, in a general way, the dental arch form and is pleasing
to the eye.
 STUDY MODEL FABRICATION AND TRIMMING

Preliminary procedures in the fabrication of study models are:

1. Remove any excess flash or obviously excessive bulk on the periphery

of the models
2. Remove any nodules that may be present on the occluding surfaces of
the teeth
3. Remove any extensions in the posterior areas that prevent occluding of
the models
4. Using the wax bite, occlude the models.

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This video
on
YouTube
Dental modal base

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3D printer dental cast

 Finishing the Models
1. The surface must be made smooth, remaining at the same time absolutely
flat and at right angles to the bases of the models.
2. The finishing process should not change the dimensions or any of the
angulations of the models.
3. After the surfaces have been finished, and the exact dimensions achieved,
the model is set aside to dry for 48 hours or dried overnight in an
orthodontic oven.
4. At this point the model should be labeled with the patient's name and
date on the backs of both the upper and lower models.
5. The final glazing is put on the models by immersing them in a
commercial gloss. The models are allowed to remain in this solution for
half-one hour.
6. Holding each arch under cold water, the models are polished and soap
solution removed by buffing with cotton.
7. The models are set on their occlusal surfaces to dry for another twelve
hours, then buffed with a very light but rapid motion using cotton. The
models should assume a high, even luster which will then resist soiling
while handling.
 Handling of the study models:
The models should be placed on a flat surface with their backs down. They
should be picked up together and always returned together. Individual
handling of the models is more likely to result in damage to the models.
ORTHOPANTOMOGRAM
(OPG)
 2- ORTHOPANTOMOGRAM:
(Known as an orthopantomography (OPG),
pantomogram, OPT or panaromic radiograph). It is
a panoramic, two-dimensional (2-D) x-ray that
captures the entire mouth in a single image,
including the teeth, upper and lower jaws,
surrounding structures. It is often encountered in
dental practice and occasionally in the emergency
department; providing a convenient, inexpensive
and rapid way to evaluate the gross anatomy of
the jaws and related pathology.
The orthopantomogram is considered an essential diagnostic aid and
should be examined prior to undertaking any orthodontic treatment. OPG
was is not always available routinely in dental clinics and the patient may
require to be referred to special X-ray centers (in the past), nowadays, it
become more available and may be present in most of dental clinics.
Earlier, before the advent of the OPCs, the IOPAs (Intraoral peri apical
radiographs ) along with the bitewing radiographs were the main stay for
an orthodontist.
Advantages of an orthopantomogram
1-A large anatomic area is visualized in a single image
2-These are probably the most frequently preserved record of any orthodontic
case in areas where this facility is available
3-The radiation exposure is low, less than that for four IOPAs
4-Patient cooperation is rarely a problem
5-Inter-operator variation is minimal
Disadvantages of an orthopantomogram
•1. Specialized equipment is required, needs
extra space, so it is rather expensive than
periapical x-ray .
•2. Distortions, magnifications and
overlapping of structures are a problem
•3. lOPAs may still be required
•4. It provides less sharp images and less
accurate information about dental and oral
diseases than regular intraoral periapical or
bite-wing radiographs.
For any student of orthodontics, it is essential to be able to correctly read and interpret an
orthopantomogram. It is advised that while reading an orthopantomogram a correct
protocol must be followed so as not miss out any important diagnostic details. The most
convenient and simple method is presented below.
Step 1
Orient the radiograph as when looking at the patient, i.e. with the patient's left side
positioned on the clinician's right. The radiograph is then placed on a view box. It is
preferred to dim the remaining lights in the room.
Start examining from the right condylar head and follow the outline along the neck
and the posterior border of the ramus. Continue following the outline of the
mandibular body to the symphyseal region anteriorly along the lower border of the
mandible to the left condyle. Compare the outline for discontinueties, radiopacities
or radiolucencies and most importantly from an orthodontic perspective for
symmetry. Asymmetry may result from faulty positioning of the patient or that of
the cassette in its holder. Note the thickness and density of the mandibular cortex
and the other structures including the mandibular canals, mental foramina, and the
coronoid process.
Step 2
Examine the medullary bone of the mandible for the usual anatomic
landmarks and note anything suggestive of pathology, especially in the
periapical regions of the teeth. The third molar development and position
should definitely be noted as it may play an important role in determining
the type of retention planned and/or their enucleation if required.
Step 3
Next, examine the cortical outline of the maxilla starting on the right side. Trace the
pterygo-maxillary fissure, hard palate with the anterior nasal spine. Examine the
nasal cavities and the nasal septum followed by the maxillary sinuses. It is
advisable to compare the right and left sides especially of the nasal cavities and the
maxillary sinuses. Radiopacities in these regions could be suggestive of pathology
or sometimes the presence of foreign body. These might reflect upon the breathing
pattern of the patient.
Step 4
Margins of a number of soft tissue structures may be seen on the
orthopantomogram. These include the--- tongue, soft palate, nose and
earlobes the lip lines and the nasolabial folds
Step 5
Radiopaque shadows, which superimpose on normal anatomic structures
are called "ghosts" and are actually artifacts. These can sometimes pose a
problem in radiographic interpretation. These are created when the X-ray
beam projects through a dense object, e.g. the spinal cord and the opaque
shadow of the object projects onto the opposite side of the radiograph.
Step 6
Finally evaluate the teeth for-presence, stage of
development, state of eruption unerupted or
impacted teeth, placement, root morphology and
position, cavities, fractures, contacts, and/or any
pathology.
Teeth may appear to be magnified or minimized in the
horizontal dimension depending on their position. The
maxillary and mandibular cusp tips should be generally
separate (unless there is a change in the cant of
occlusion and there should be gentle curve to the
occlusal plane.
The orthopantomograrm may not be sufficient by
itself. If any doubt arises it is recommended that an
lOP A of the concerned region be taken