X-Rays: If You Take Them, Read Them!

By Dr. Greg Jorgensen
Rio Rancho, NM – www.gregjorgensen.com

Radiographs, whether the oldest film-based bitewing or the newest digital 3-D cone beam scan, are important diagnosis and treatment planning tools for orthodontists. They allow us to visualize anatomic structures and relationships that cannot be examined in any other way. The American Association of Orthodontists suggests that its members follow the ALARA principal (As Low As Reasonably Achievable) when it comes to the amount of radiation to which they expose their patients.

The value of radiographs as a diagnostic tool is indisputable. X-rays allow orthodontists to see pathology, monitor development, and diagnose skeletal and dental relationships that are at the root of malocclusion. Not a day goes by in my office where I don’t find something of importance in a radiograph that was not visible to me clinically. I believe that most orthodontists diligently read radiographs taken before treatment and between phases because they are in their “diagnostic mode.”

Dental radiographs are also essential to doctors during the treatment planning phase. The number, condition, and position of unerupted teeth affect the timing and scope of orthodontic treatment. The skeletal relationships revealed by lateral cephalograms help orthodontists select the appropriate treatment plan and biomechanics. While many orthodontists routinely evaluate radiographs taken specifically for treatment planning, others delegate the tracing of “cephs” to staff members who are not trained to recognize pathology. Many doctors study the results of the cephalometric analysis without actually seeing the film from which it was derived.

The data set created during a cone beam scan is useful not only for the evaluation of disease and the localization of important structures, it can also be used in the fabrication of orthodontic appliances before, during, and after orthodontic treatment. Examples of such appliances include digital models, indirect bonding set-ups, custom arch wires, and retainers. Some would argue that exposing patients to additional radiation solely to avoid taking alginate impressions is a clear violation of the ALARA principle. Some technology however uses the CBCT scan not only to fabricate an appliance, but also to visualize the current position of the roots in the alveolar bone and predict the effects that specific movements will have on the health of the teeth and the bone. That is revolutionary! Doctors using this technology would argue that this use of radiographs provides patients with the most accurate and healthy results currently available at a reasonably low radiation level.

Another timepoint just as important as before and during treatment is at the end of treatment. “Final records” are too often considered a mere legal record of what was accomplished during treatment. These records however also provide the orthodontist with information about wisdom teeth, changes in root length and bone support that occurred during treatment, as well as other non-treatment related pathologies that may arise while the braces were in place. Final records should be analyzed as carefully as initial ones.

Whether you take an x-ray to look at developing teeth, evaluate jaw growth, or as part of the diagnosis, treatment planning, and appliance fabrication process, you have a responsibility as a doctor to review all images and inform patients of any abnormalities present. A formal chart entry should always be made to document that you did review the radiographs taken whether or not you found anything out of the ordinary. While most of us are very comfortable evaluating routine panoramic and cephalometric films, today’s CBCT scans oft times include expanded field of views that include areas of the craniofacial complex with which we are not as familiar. The AAO’s Council on Insurance recommends that we seek the opinion of a qualified dental radiologist anytime we are not comfortable interpreting a diagnostic film.

Dental radiographs are important diagnostic tools. They not only help us diagnose and treatment plan orthodontic problems, they can also save teeth, bone, and even lives. They are useful however only if they are read. If you take an x-ray, make sure you read it!

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