Here you will find everything related to cephalometric analysis, digital radiography, Dental imaging basically everything ceph-related.

History of Cephalometric Analysis – Using Our Heads

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Interest in measuring the human form and skull has been around for millennia. The history of cephalometric analysis stems from Egyptian and Greek attempts at human body measurement (anthropometrics).

The term cephalometric is sometimes confused with craniometric. The former refers to measurement of the skull. The latter refers to measurement of the head including the soft tissue be it living or dead.

History of Cephalometric Analysis/Pre-Roentgen

4000 (BC) Egyptians: Canon of Proportions was a mathematical system developed to give idealistic proportions to the human form. Artistic forms were generated using a grid system.

Evidence of attempts at orthodontics and tooth “bridging systems” using wires have been found among the human remains of ancient civilizations. The idea that modern day orthodontics may have originated thousands of years ago, is certainly intriguing. This remaining ancient physical evidence of attempts at orthodontics indicates that the dentition and facial appearance were as important then as they are today.

* Although not strictly related to cephalometric contributions, attempts down through time have been made to qualify and quantify the human form by type. *

  • (c.460-c.370) Hippocrates: described two body types.
    Habitus phithicus: Long thin body
    Habitus apoplecticus: Short thick body
  • (1921) Kretschmer:
    Pyknic: Fat and stocky
    Asthenic: Weak, small and thin
    Athletic: Muscular and large boned
  • (1954) Sheldon:
    Endomorph: tending toward body fat
    Mesomorph: tending toward musculature
    Ectomorph: tending toward undeveloped muscle
  • (1452-1519) DaVinci: Arguably the first to try and systematically measure the head.

  • (1528) Albrecht Durer: A treatise on cranial measurements was the first published work in which anthropometry was applied to aesthetics.
  • (1678-1761) Pierre Fouchard: Published the “Surgeon Dentist” in 1728. Some consider him to be the “inventor” of orthodontics. Some of the “less than modern” methods of straightening teeth included finger pressure, metal plates lashed to abutment teeth, extractions and the use of a surgical instrument of the time called “The Pelican”. This instrument was used to make large forceful lingual to buccal tipping movements. If possible, it would have been interesting to talk to some of his teenage patients!
  • (1722-1789) Petrus Camper: introduced the facial angle, facial line and horizontal plane.
  • (1847) Joachim LaFoulon: Coined the term
  • (1796-1860) Anders Retzius: Credited with introducing the terms orthognathic, prognostic and the cephalic index.

Kingsley and Farrar are credited with being the “Fathers of Orthodontics”. Both wrote definitive books on orthodontics during the late 1800s.

Edward Angle was a paramount figure in orthodontics. His work in the early part of the twentieth century remains an influence in present day orthodontics.

Roentgen Leads The Way

(1895) Roentgen discovered X-rays in 1895 and submitted the paper, “On a New kind of Rays, a Preliminary Communication”. The following year Koening and Walkhoff simultaneously made the first dental X-ray of a tooth.

(1922) AJ Pacini is credited with making the first standard lateral view radiograph in 1922.

(1922) Paul Simon (Germany) becomes the first to use planes and angles in the diagnosis of dental anomalies

(1922-1931) During this period, various researchers reported on the use of radiographs in the practice of orthodontics. These contributions included the discovery of new radiographic landmarks and various attempts to incorporate and improve methods of diagnostic measurement including attempts to obtain a standardized practical method for obtaining radiographs.

(1931) Holly Broadbent along with Todd Wingate (United States), H. Hofrath (Germany) simultaneously developed the cephalostat. Broadbent occupies a special place in the evolution of cephalometrics as many of his principles and ideas have been accepted practice since their inception. Broadbent used a metric scale and reproducible head positioning of the cephalostat to eliminate the problems associated with previous unstandardized radiographic analysis.

(1937-1947) Much of the evolution of cephalometric analysis during this period was associated with investigating the craniofacial growth factors affecting orthodontic treatment (down and forward, Brodie 1941) and other factors relating to the dentation in its relationship to various craniofacial factors, (Margolis 1943, inclination of incisors).

(1948) William Downs is credited with developing the first cephalometric analysis. Over the ensuing years multiple cephalometric analysis methods have been established,

  • (1953) Steiner
  • (1954) Tweed
  • (1955) Sassouni
  • (1974) Harvold
  • (1975) Wits
  • (1979) Ricketts
  • (1985) McNamara
  • (1972) Jaraback

Technologies

Initially, cephalometric analysis was performed manually using acetate tracing paper and a lighted view box. Tracings of pertinent diagnostic lines using established orthodontic anatomical landmarks were drawn using a #3 lead pencil. This method of performing an analysis brings in problems of accurate analysis due to human error and differences of experience and expertise of the analyst.

Digital radiographs

(1960s) The proposition of digitalized radiographs as a vehicle for cephalometric analysis came into play and technologies have evolved since that time to make the process faster, easier and more accurate. Types of digital radiographs include:

  • Indirect digital
  • Direct
  • Semi-direct

Computed Tomography (CT) MRI, PET, PET/CT

(1971) First used in the United Kingdom. Technology improvements included reduction in time for the procedure due to increased number of slices produced in the same rotational period and increases in image size. Other imaging modalities followed.

  • (1980) Magnetic Resonance Imaging (MRI)
  • (1985) Positron Emission Tomography (PET)
  • (2000) Positron Emission Tomography/ Computed Tomography (PET/CT)

Initial dental use of CT was necessarily restricted due to the size and expense of the equipment. However, this technology was the basis and cornerstone of today’s use of CBCT in the science of cephalometric analysis.

Cone Beam Computed Tomography (CBCT)

(1995) Tacconi and Mazzo develop a system to utilize CBCT technology for dental purposes.

(2001) CBCT was first introduced in the United States after the “New Tom 9000” machine was approved by the FDA. Using a cone beam rather than a fan beam along with other innovations allowed the equipment for CBCT to be reduced in size enough to be installed in the average dental setting and at a (comparably) affordable price.

(2007) Kodak introduces Ultra CBCT ILUMA scanner

(2007-present) Competition has resulted in different brands of CBCT machines offering their own design, branding advantages, etc. Most often these differences are related to field of view (FOV) and improvements in image resolution.

The increased use of CBCT has resulted in the necessity of a parallel technology improvement in rendering cephalometric analyses. Technology has resulted in computerized software models for in-office and online cephalometric analysis.

Founded in 2001, the online company Cephx has been at the forefront of developments in CBCT cephalometric analysis rendering technology. These developments in technology allow Cephx to provide orthodontists and other dental practitioners with cutting edge solutions regarding analyses, cloud storage and patient records management.

For more information please contact info@cephx.com or 1-800-992-1499

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and Unveiling Complex Orthodontics: How AI Transforms Diagnosis and Treatment Planning

Orthodontic Adverse Effects – Helping Patients Understand Them

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A discussion of orthodontic adverse effects and the signing of an informed consent document are important steps prior to the initiation of clinical orthodontic treatment procedures.

It has been demonstrated that patients may listen to an outline of possible dental or medical deleterious side effects, not really understand them, respond negatively when asked if they have any questions and then just routinely sign the consent form as a matter of habit.

This type of scenario invites misunderstandings down the orthodontic treatment “road” and experience shows there are usually at least a few bumps along this road for both patient and practitioner.

Clinical explanations of adverse effects may be met with nodding heads, but in many cases patients will have hardly a clue what the implications of say, “termination of treatment due to unexpected root resorption” or “exacerbation of temporo-mandibular joint disorder symptoms” may mean. Better to smooth out the road before traveling down it.

“I remind students that most of them possess the same limited understanding of medical language as many of their future patients, and I encourage them to always remember those feelings of confusion, uncertainty and anxiety.”  Dr. Frank R. Serrecchia, Midwestern University

While practitioners may not use the sterile clinical language as mentioned above when talking about adverse effects of orthodontic treatment or dentistry in general to their patients, making sure the patient has at least a reasonable layman’s understanding may help both parties know that they are “on the same page”. This approach can help mitigate later misunderstandings if treatment or patient expectations come into question.

If there is doubt that informed consent may be misunderstood or only partly understood by a layman, a practitioner need only look at the American Association of Orthodontists informed consent (1) form.  Although an excellent well thought out document, it informs the patient using dental jargon for the most part. Granted, this dental “language” may be required for legal purposes.

Arguably however, it is understandable that a patient might have some difficulties answering an honest  “yes” to the signature acknowledgement, “I hereby acknowledge that I have read and fully understand the treatment considerations and risks presented in this form.”.

As mentioned earlier, patients routinely glance over these types of consent forms and sign them without really knowing the contents. They generally rely and trust what the orthodontist has told them and leave it as that.

Explaining Orthodontic Adverse Effects – Analogies, Metaphors and Similes

A common strategy when attempting to explain complex problems (2)  in meaningful layman’s terms is the use of metaphors, similes and especially, analogies.

  • Analogy: compares things so that a relationship between them can be understood.
  • Simile: compares things by using “like” or “as”, e.g., an implant is like the root of a tooth.
  • Metaphor: compares by saying “is”, e.g., An implant is a “tooth root replacer”.

These methods may be helpful when outlining the nature of orthodontic treatment adverse effects during informed consent discussions.

While each practitioner will have preferences for creating unique analogies (3), similes or metaphors for their own patients and case situations, some examples of possible analogies involving some adverse effects are offered as a starting point.

  • Enamel decalcification – A suggested analogy is a comparison of how household products containing acid may erode, discolor or otherwise damage surfaces. This analogy can be combined with an explanation of how proper oral hygiene practices prevent acid from plaque and food debris from remaining in contact with the enamel around bracket edges, etc., causing “white spots”. Further, that in most cases any damage is usually temporary or can be easily treated micro –abrasion (“sanding”).
  • Periodontal problems – A visual comparison of the attached gingival with a shirt sleeve may help patients understand the progression and damage of periodontal disease from poor oral hygiene practices. A normal attached gingiva equated with a tight sleeve around the wrist, a looser sleeve compared with inflammation and more of the wrist showing – gingival recession.
  • Loss of pupal vitality – A plant may serve as an analogy where the pulp and periapical foramen blood vessels are compared with a plant. Pressure, crushing or cutting of the root (periapical vessels) causes eventual wilting and “death” of the plant.
  • Temporomandibular Disorders (TMD) – Many patients are likely to have suffered a “sore jaw”. However, it might be helpful to relate the Temporomandibular Joint (TMJ) to a door hinge with a spring where repeated opening and closing of the hinge (TMJ) may cause the spring (muscles) to malfunction.
  • Root resorption – Although the exact reasons for root resorption are not understood, a comparison of an icicle shrinking with warmer temperature may be a good visual for a layman’s understanding.
  • Soft tissue damage – Any comparison of a hard object rubbing against a softer object could serve as an appropriate analogy for this adverse effect. One example might be how a carpet is damaged (traumatic ulcer) by excessive foot traffic.
  • Occlusal adjustment – Regarding the need for occlusal equilibration, any analogy that relates sanding an object so that it fits together correctly with another object would be apt.

Another suggestion for appointments that involve informed consent is to have patients repeat back in their own words their “take” on what has been discussed regarding informed consent and adverse effects.

Use of Images

“A picture is worth a thousand words” is certainly true when attempting to explain dental terminology and procedures to laymen patients.  The use of images and/or drawings combined with verbal analogic explanations may increase the chances for understanding by the patient.

If patients are having a difficult time understanding a concept, the use of photos (4), pictures and/or drawing a sketch may often be very helpful.  No art degree is required here. A simple pencil drawing of a tooth root followed by shorter and shorter shrinking tooth root images should suffice to demonstrate root resorption.

A notebook, tablet or computer containing selected photos and/or pictures from the orthodontist’s own practice or internet sources might be worth a small investment in time and a larger later investment not only in patient education, but helping to prevent future patient misinterpretations.

The approach of using analogies, similes and metaphors for helping patients understand  orthodontic adverse effects can be applied to other areas of treatment such as cephalometric analysis, wisdom tooth extraction etc.

Some practitioners may find this analogy, simile and metaphor patient communication method comes naturally to them, while others may find it difficult, cumbersome, seemingly unnecessary or awkward. However, the idea that good communication does enhance patient rapport (5), possible choice of an orthodontist (6) and/or prevent future “difficulties” may be a worthwhile incentive to practice a bit and give these ideas a “dental…….college” try.

References:

(1) http://www.columbia-ortho.com/Informed.pdf

(2) https://www.researchgate.net/profile/Gwinyai_Masukume/publication/221868357_Analogies_and_metaphors_in_clinical_medicine

(3) http://www.dentaleconomics.com/articles/print/volume-89/issue-3/features/clinical-scripts-for-effective-communication.html

(4) http://www.medicinenet.com/script/main/mobileart.asp?articlekey=120284

(5) http://www.jyi.org/issue/trust-in-the-dentist-patient-relationship-a-review/

(6) https://ceph-x.com/hlow-do-patients-choose-their-orthodontist/

Save time and effort analyzing your cephalometric radiographs while helping your patients better understand their own treatment plans by visiting Cephx.

Discover the advantages of online cephalometric analysis in this area of patient care and more at Cephx.

For more information please contact info@cephx.com or 1-800-992-1499

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Reticent Orthodontic Patients – What’s On Their Minds?

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A consultation, a new referral, the elementary school child, the “whatever” teenager, the adult patient, what goes through their minds about orthodontics that they don’t vocalize to their practitioner for whatever reason.

What are the common concerns, worries and problems of these quiet and reticent orthodontic patients that may remain unspoken and lead to referral patients declining initial treatment, misunderstandings about adverse effects, unrealistic expectations or general poor patient rapport? It’s true that patients are seen over a period years, but with increased competition, auxiliaries performing more procedures and time management appointment philosophies limiting time to really talk to a patient, opportunities to initiate a real patient/doctor dialogue may be missed. There are numerous studies on healthcare patient interactions linking perceived “good” communication and positive trust issues ¹ as a major factor driving patient satisfaction, rather than other parameters of clinical treatment.

Reticent Orthodontic Patients – Great Expectations?

Informed consent is one of the primary standards of care in healthcare. Usual orthodontic consent and treatment plan discussions center around final cosmetic and functionality aspects, possible risks and limitations of treatment, special case considerations as well as patient responsibilities for ensuring optimum treatment.
Unfortunately, it is not unusual for patients to sign medical and dental consent forms as a matter of routine behavior without reading them, understanding them, or asking any questions. This occurs even after participating in treatment discussions and responding negatively when asking about any questions. This can result in later misunderstanding especially for those patients who feel that questioning a dentist is “inappropriate” or they subscribe to the “dentist/doctor knows best” philosophy.

Meeting Expectations

Areas where adults, teenagers, children and parents may have difficulties in articulating their concerns, communicating adequately, are embarrassed, socially awkward or a myriad of other reasons, fall into some common categories.

  • Economic difficulties are a major concern of parents and adults undergoing treatment. Orthodontic treatment is a large investment of time and money.  Many patients do worry about the cost and may be hesitant to reveal certain personal details concerning family finances e.g., whether they should delay treatment until they save enough money; will it be worth it and so on.
    Making concrete, sympathetic and reasonable individualized payment arrangements helps to allay financial concerns, affect choosing an orthodontist and may open a dialogue making a difference in starting or rejecting treatment.  A sub economic issue concerns transportation problems associated with taking children out of school, missing work, driving the child to appointments etc. Coordinating appointments as best as possible with individual patient situations allows them to voice their concerns rather than bottling them up.
  • Pain issues may not be brought up prior to treatment. Children may be afraid to ask. Orthodontic advertising tends to minimize any references to pain.  Adults may “tough it out” without notifying the practitioner, but inwardly resent having pain. Being upfront, sympathetic and providing information on pain management encourages patients to be vocal about their pain so that this side effect of treatment is not “stuffed” and then comes out later as a misunderstanding.
  • Appearance issues with braces have become less of a problem with orthodontics becoming more popular and accepted. Colored rubber bands, shaped brackets, ceramic materials and Invisalign treatment have minimized some of the “metal mouth” caricatures, especially for the child. However, bullying of children with braces can remain a problem ² and efforts on both the dentist and parent should be directed toward encouraging reporting of bullying.
  • Speech and diet concerns become an issue when patients experience real problems giving up foods that are detrimental to braces. Some patients may also experience speech problems with some appliances i.e., palatal expansion devices. Patients should be encouraged to report problems with maintaining dietary restrictions and feel empowered by dental staff to verbally report problems and seek advice without fear of “rebuke”.
  • Duration of treatment resentments may crop up at any point even though this parameter of treatment supposedly is universally understood as a core part of “having your teeth straightened”. Patients may grow tired of the length of treatment and lose their commitment to hygiene, internally complain and resent treatment. Rather than asking perfunctory questions like, “How are you doing?” or “Any questions?” and exiting the operatory for the next patient, a better approach may be to periodically take a few minutes and encourage the patient to talk about themselves and have a real conversation.

Some Psychology

A New York Times blog ³ with supporting research about the difficulties of speaking up at the medical doctor’s office readily reflects the same dynamics regarding the dental practitioner. There is a well-known dynamic where people may feel vulnerable or intimidated in a medical/dental setting. The prospect of speaking up, viewed as complaining, or asserting their views for some patients represents a possibility for negative consequences impacting their care.

This dynamic along with the ones listed under the heading above have resulted in various recommendations 4 to improve patient/practitioner communication.

L.A.S.T. is an acronym outlining a four-point list that might be used by busy orthodontists to help their patients feel better about “opening up” and lead to better patient rapport.

  1. Listen: Take a few extra minutes to really connect with patients.
  2. Apologize: “I’m sorry, next time let’s try and communicate better concerning your worries about your child being teased while wearing braces”.
  3. Speak: Encourage patients to speak their mind without fear of judgement.
  4. Thank: Let patients know you appreciate it when they are vocal about their concerns.

Busy orthodontists need as much time as possible to devote toward direct patient care and communication. Manual cephalometric analysis and tracing are time consuming and one area where extra time can be freed up for important communication aspects of practice management including more time understanding reticent orthodontic patients. Computerized cephalometric analysis now allows for multiple analyses and cloud storage within seconds.

References:

1: http://www.jyi.org/issue/trust-in-the-dentist-patient-relationship-a-review/

2: http://www.nymetroparents.com/article/why-are-some-kids-with-braces-bullied-and-how-to-boost-their-self-esteem

3:  http://well.blogs.nytimes.com/2012/05/31/afraid-to-speak-up-at-the-doctors-office/?_r=0

4: http://www.nature.com/bdj/journal/v187/n5/full/4800251a.html

Discover the advantages of online cephalometric analysis in this area of patient care and more at Cephx.

For more information please contact info@cephx.com or 1-800-992-1499

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How do patients choose their Orthodontist

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Choosing an orthodontist carries great responsibility, as it has a very clear effect on a person’s aesthetics and health. The majority of orthodontic patients are children, leaving the responsibility on parents to choose the right caregiver and treatment type. This task is taken very seriously, and followed by weeks of research.

In this article, we have gathered the considerations that help parents and patients in general make up the final decision – who to choose as their Orthodontist.

 

Awareness and knowledge – of the treatment’s importance, orthodontist’s existence

Acknowledgement of orthodontists and their expertise is a vital first step. A patient must distinguish between a dentist’s role and an orthodontist’s role, while choosing whom to approach for treatment.

Awareness can be achieved through schools and teachers, family physicians, governmental programs and the media.

Need and Treatment Motivation

Today, aesthetics is very important. Our role models showcase perfect smiles in the media and we want our kids and ourselves to have that too. In addition, there is also the element of healthcare when it comes to orthodontics (sleep disorders, painful teeth misalignment).

The patient’s need has to be there, either from the healthcare or aesthetics sides, in order to turn to a specialist. If the problem isn’t troubling enough, the condition may be left untreated.

Credibility, References and Trust – of the Practice and Orthodontist

Education is part of the credibility Orthodontists have. Patients normally check their physician’s education, and certification, while also want to ensure they are a Board Certified. This demonstrates a higher commitment and dedication, given the standards requirements.

References (recommendations by experienced friends) are also an important element patients look for. Word-of-mouth, recommendation, testimonials all act as great reference for a patient.

Technologically Equipped Clinic

People expect to receive leading treatment and to also fully understand it. The technology is available through improved software, larger screens, full images, laser innovations, advanced treatment materials, online Cephalometric analysis…etc. Orthodontists willing to ensure their clinic is staffed with leading technology and able to showcase it, are more likely to gain the customer.

Personal Connection

Trusting the doctor from an education perspective isn’t enough – if the personal connection isn’t there. Each patient looks for an assuring and easy-going caregiver, who is willing to listen to their questions, concerns and fears. Many doctors today may be very well educated, with lots of experience, but are less attentive to the emotional side of the treatment.  In situations as such, the patient will prefer to seek a different doctor, especially if there is a larger choice available nearby.

Affordable Costs & Payments

Affordable treatment prices are an important part of the patient’s decision making process, however it’s normally mentioned after overcoming the barriers mentioned earlier. It’s vital for the patient to first check their treatment type, and only then find out if they can afford it, considering various payment/finance options.

Many practices provide different payment terms, specifically since the actual orthodontic care is normally spread out through several months or even years.

Availability and Location

A treatment plan may be laid out over months and years, which is why patients tend to also choose their orthodontist according to the practice’s location and ease of travel.  Ensuring they can make the appointments, without loosing too much work or school days, due to traffic or parking issues is  important.

Recommendation

Every Orthodontist can play a major role in every single part of the listed items. Awareness creation, motivation, market education

  • Marketing plan – Maintain an online and social marketing plan, as that’s where most Patients start their research nowadays! Be sure to be listed on local/online directories, community organizations, healthcare programs.
  • Keep up to date – with new technologies, innovations, and treatment types. This will ensure your market competitiveness positioning.
  • Have your references, case studies, education easy to find. These can be publicized on the web, social media channels, and reviews by local/national magazines.
  • Make sure you choose a friendly staff with a welcoming and warm attitude.
  • Give back to the community – It’s always great to provide some pro-bono help. The community appreciates it, and increases your clinic’s credibility
  • Be ready for lots of questions, even if they sound repetitious or obvious.
  • Position your clinic in a good location, with good access to public transportation and parking.
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Orthodontics – 2015 Summary

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2016 already started, holding promises for another year of growth in the fields of dentistry and orthodontics. But it’s always important to look back to get an overview of trends and changes in the business, and conclude insights that may help us down the road.

AVERAGE NUMBER OF WORKING HOURS

According to a survey conducted in the USA on 2015, Orthodontists spend a weekly average of 30-40 hours  with patients This does not include time spent on practice management, staff recruitment and training, marketing and general business management, which most of it can outsourced.

THE NUMBER OF ORTHODONTISTS WORLDWIDE

The demand for orthodontics in the USA is comparatively higher than the rest of the world.
According to the WFO (World Federation of Orthodontists), in 2015 the number of orthodontist in USA is over 9,000. The European countries have additional 10,000 orthodontists (500 in Belgium, 350 in Czech, 200 in Denmark, 150 in Finland, 2500 in France, 3000 in Germany, 450 in Greece, 150 in Ireland, 1300 in Italy, 250 in Norway, 1100 in Poland, 300 in Sweden, 300 in Netherlands, and 1,200 in the UK). Due to lack of oral health awareness, lack of literacy, poor economic condition the demand for orthodontics in Asia is significantly lower compared to the rest of the world. Market research shows that only 1,500 orthodontists are working around Asia, leading to a low ratio to the large Asian population.

POTENTIAL MARKET

History demonstrates that during the past couple of decades it was normally children and teenagers were the main target patients of orthodontics. But now in 2015, this situation has changed for adult population – significantly more are concerned with correcting or improving the position of their teeth and correcting any malocclusion.

Recent study shows that over 1 million North Americans are taking orthodontics treatment by wearing braces in present days.

FUTURE PROSPECTS

The way forward for orthodontics is challenging yet promising bright. Challenges are primarily characterized with barriers for new entry, lack of awareness to new techniques and high cost of advanced treatments. For emerging markets, mainly around Asia, increasing demand for orthodontics is held back by less professional, with many of registered ones actually working in governmental hospitals.

Nevertheless, the bright future of Orthodontics is driven by new era of dental science, mainly clear aligners, rising dental aesthetic standards, rapid GDP growth in Asian markets and new technologies enabling less manpower for running Orthodontic practice, such as cloud services.Despite of greater competition, higher patient expectations, and increased legislative involvements, 5 years from now expect to see an increased usage trend of digital orthodontics including Laser technology, x-rays, White light, 3D printing, Intraoral Scanners, and Digital Photography which is expected to have the market size around $3.6 billion in the global dental market

 

Are you ready to attain excellence to brace yourselves for 2016?

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