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radiography
Cephalometric radiography is a standardized and Ch. 6). Indications and selection criteria for
reproducible form of skull radiography used exten- Cephalometric radiographs are clearly identified
sively in orthodontics to assess the relationships of in the Faculty of General Dental Practitioners
the teeth to the jaws and the jaws to the rest of the Selection Criteria in Dental Radiography booklet
facial skeleton. Standardization was essential for published in the UK in 1998 and in the British
the development of cephalometry — the measure- Orthodontic Society's booklet Guidelines for the
ment and comparison of specific points, distances Use of Radiographs in Clinical Orthodontics, pub-
and lines within the facial skeleton, which is now lished in the UK in 2001. These guidelines are
an integral part of orthodontic assessment. The designed to assist in the justification process so as
greatest value is probably obtained from these to avoid the use of unnecessary radiographs.
radiographs if they are traced or digitized and this
is essential when they are being used for the
Orthognathic surgery
monitoring of treatment progress.
• Preoperative evaluation of skeletal and soft
tissue patterns
Main indications • To assist in treatment planning
• Postoperative appraisal of the results of
The main clinical indications can be considered surgery and long-term follow-up studies.
under two major headings — orthodontics and
orthognathic surgery.
Equipment
Orthodontics
Several different types of equipment are available
• Initial diagnosis — confirmation of the for Cephalometric radiography, either as separate
underlying skeletal and/or soft tissue units, or as additional attachments to dental
abnormalities panoramic units. In some equipment, the patients
• Treatment planning are seated, while in others they remain standing.
• Monitoring treatment progress, e.g. to assess Despite these variables the essential requirements
anchorage requirements and incisor inclination for this type of equipment are the same and
• Appraisal of treatment results, e.g. 1 or 2 include:
months before the completion of active
• Cephalostat (or craniostaf) (see Fi| 13.1)
treatment to ensure that treatment targets have
comprising:
been met and to allow planning of retention.
Head positioning and stabilizing apparatus
When considering these indications, it should with ear rods to ensure a standardized
be remembered that all radiographs must be patient position (some units also have infra-
clinically justified under current legislation (see orbital guide rods)
145
146 Essentials of dental radiography and radiology
Fig. 13.1 A typical cephalostat (craniostat) containing a patient with the main features indicated. Note that this design of
cephalostat has the aluminium wedge filter positioned between the patient and the anti-scatter grid. The Frankfort plane is
marked on the patient's face.
— Fixed anti-scatter grid — to stop photons • X-ray generating apparatus that should be:
scattered within the patient reaching the — In a fixed position relative to the cephalostat
film and degrading the final image (see (approx. 2 m) and the film (see Fig. 13.2)
Ch. 12) so that successive radiographs are
— Cassette holder. reproducible and comparable
Cassette (usually 18 x 24 cm) containing — Capable of producing an X-ray beam that
intensifying screens and indirect-action film is:
Aluminium wedge filter. This is either part of the * Sufficiently penetrating to reach the film
cephalostat and positioned between the patient * Parallel in nature to minimize
and the anterior part of the cassette, as shown magnification between R and L sides of
in Figure 13.1, or it is attached to the the mandible and to ensure that the
tubehead, covering the anterior part of the midline points S, N and A are as sharp as
emerging beam. Its function is to attenuate the possible
X-ray beam selectively in the region of the * Collimated to an approximately
facial soft tissues because these tissues are not triangular shape to restrict the area of the
dense enough on their own to produce a patient irradiated to the required cranial
visible radiographic shadow. This added base and facial skeleton, so avoiding the
attenuation enables the soft tissue profile to be skull vault and cervical spine (see Figs
seen on the final radiograph. 13.2 and 13.3).
Cephalometric radiography 147
Fig. 13.2A Positioning for the true cephalometric lateral skull projection. Note the
X-ray tubehead and cephalostat are in fixed positions (approximately 2 m apart) and
the patient's head is stabilized within the cephalostat with the Frankfort plane
horizontal. The triangular collimator (C) is indicated by the arrow. B Diagram of the
positioning from the front — the sagittal plane of the head is parallel to the film, and
the X-ray beam is horizontal and perpendicular to the sagittal plane and the film.
148 Essentials of dental radiography and radiology
Fig. 13.3 An example of a true cephalometric lateral skull radiograph. Note the images of the ear rods should ideally appear
superimposed on one another. The various shadows of the cephalostat equipment and the collimator are indicated.
B
Fig. 13.6A Positioning for the cephalometric PA jaws projection. The patient is in the forehead—nose position, with the
radiographic baseline (marked on the face) horizontal and perpendicular to the film. B Diagram of the patient positioning and
showing the X-ray beam horizontal and centred through the rami.
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