Cast – Radiograph Evaluation: Case E

Case E CR-Eval Calibration

Alignment

2

PresenterPresentation NotesAlways view the entire model for alignment errors before measuring. Visualize the central grooves and lingual-incisal edges of the incisors. The upper appears pretty well aligned except for the UR7.

2UR7

>1mm

1

2

1

2

1

PresenterPresentation NotesBefore scoring, always view the model and teeth to identify rotated teeth. Visualize the cusp tips. The overall view reveals a number of alignment errors. The three teeth that stand out the most are the LR3-4, LR7 and LL5, and the LL2-3.

>1mm

>0.5mm2

1

1>0.5mm

PresenterPresentation NotesThe LL2 is rotated out on the distal. It measures greater than 0.5mm so 1 pt should be scored.The LL4 is rotated out on the distal more than 0.5mm. Score 1pt.The LL5 is rotated out on the distal more than 1mm. Score 2pts.

0

1

2 > 1mm

= 0.9 to 1.1mm

=0.5 to 0.6mm

< 0.5mm0

PresenterPresentation NotesThe LR3 is rotated to the lingual on the distal. The mesial of the LR6 is lingual 0.5-0.6mm. It is close enough to 0.5mm that it is not scored. It is understandable if you scored 1pt.The LR7 is lingual =1 to 1.2mm. Since it is not noticeably greater than 1mm the score is 1. It is understandable if you scored 2pts.

Alignment (9 pts)

2

2

1

1 21

0

Marginal Ridges

00

UR7

UL7

=0.5mm

LL6

LL61

1

= 1 to 1.1mm

Feels slightly > 1mm

PresenterPresentation NotesThe LL6 is almost exactly 1mm, but it is too close to say that it is greater than 1mm. It should be scored as 1pt. Since the ruler is 1mm tall it can be used as shown to verify the measurement. There is a slight bump when you press the stepped edge of the ruler against the LL6 indicating it is slightly greater than 1mm. The Directors decided collectively decided this should be scored as 1pt. It is understandable if you scored this as 2pts.

LR6

LR61

1

= Not > 1mm

> 0.5mm, < 1mm

PresenterPresentation NotesThe LR6 is just under 1mm but greater than 0.5mm so 1pt is scored.

Marginal Ridge (2 pts)

1 1

Buccolingual Inclination

X X

R

PresenterPresentation NotesBuccolingual inclination can be first viewed from this angle. Visually drawing an imaginary line gives you an idea of which maxillary teeth might not have adequate lingual crown torque. The buccal cusps of the first molars appear to be within 1mm of a line crossing through the lingual cusps. The second molars have less adequate torque and may not be. Measuring them will determine whether they are within 1mm.

1UR7

UL7

0

PresenterPresentation NotesThis is the traditional way of scoring buccolingual inclination. It is difficult to get the edge of the ruler to sit on both cusp tips properly. Each step on the ruler is 1mm. The UR7 is greater than 1mm but less than 2mm. 1pt should be scored on the UR7

UR7

UR7

1

1

PresenterPresentation NotesThis slide shows two additional ways of measuring buccolingual inclination. The top photo shows the measurement taken using the opposing model as a plane that is touching the lingual cups of the second molars. The lower photo shows a second ruler being used as the plane. The ruler easily slides past the cusp tip. The UR7 is close to 2mm off the plane; however, it is not greater than 2mm. The score should be 1pt.

UL70

Does not slide through freely

PresenterPresentation NotesThe UL7 is not greater than 1mm. The ruler does not slide past the cusp tip.

X X

PresenterPresentation NotesThe lower first molars and second premolars appear to have reasonable torque; however, the LR7 does not appear to be within 1mm of the line between the mesiobuccal cusps.

10

LL7

0

PresenterPresentation NotesThis is the traditional way of scoring. The LL7 is scored as 1pt. The cusp tip does appear to be fractured; however, it obviously has more lingual crown torque. The LR7 is within 1mm so no points are scored.

Buccolingual Inclination (2 pts)

11

Overjet

01 0 0

0

Difficult to prove there is NO contact

Obvious overjet but not >1mm

PresenterPresentation NotesThe red dots mark the points of contact. The UL2 may not be in contact; however, it is so close that you should not score it. The examiner is not looking to prove it IS in contact. The examiner is looking to prove it is NOT in contact. It is understandable if you scored 1pt for the UL2.Only the distal of the UR7 is scored with overjet. The remaining lower posterior teeth are reasonably centered within the central fossa of the upper posterior teeth.

Overjet (1 pt)

1

Occlusal Contacts

L

L

1

1

X X

No contact

May be out of contact but difficult to prove

Contacts on lingual aspect of cuspR

R

PresenterPresentation NotesDon’t score diminutive cuspsThe ML cusp of the UL7 is out of contact. And DB cusp of LL7.The LL7 distobuccal cusp is definitely not in contact. The mesiobuccal cusp is very close and may not be in contact, but it is close enough that it should not be scored.The same is true for the LL4&5, mesiobuccal cusp of the LL6, and mesiobuccal cusp of the LR6. All of these may not actually be contacting on the digital model; however, they are very close and it is impossible to know for sure without loupes or additional measuring devices (eg. shim-stock).The DB cusp of the LR7 contacts the UR7 on the lingual aspect of the cusp tip.

Occlusal Contacts (2 pts)

11

2 11 2 1 1

Occlusal Relationship

2 210

>2=1+/- >1,2

PresenterPresentation NotesThe UR7 is exactly 1mm. You can’t determine for sure that it is greater than 1mm so 0pts. It’s ok if you scored 1pt. UR5 is slightly over 2mm so 2pts.UR4 is exactly 2mm, but you can’t determine for sure that it is greater than 2mm. Score 1pt. Note that the cusp tip (not visible in this photo) is slightly distal to the center of the tooth.UR3 is greater than 2mm, so score 2pts.

1 11

>1,1,1,

Occlusal Relationship (8 pts)

1 1 1 122

Root Angulation

1 1

1 1

PresenterPresentation NotesThe UL2 appears to be more dilacerated so no points were scored.The L4s do appear to have dilacerations; however, there is excess distal crown tip (mesial root tip). 1pt is scored for each. We don’t score 2pts on the L4s even if it appears they are contacting the roots of the canines because of distortions in the canine region.The radiograph is not clear enough to know that the UR5 is contacting the root of the UR4 so only 1pt is scored.

2 11

1 4

11

8

2

1

1

1 1

2

1

2

2 12

928

1

1 1

011 2

1 1 2

1

Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Alignment (9 pts)Slide Number 9Slide Number 10Slide Number 11Marginal Ridge (2 pts)Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Buccolingual Inclination (2 pts)Slide Number 20Overjet (1 pt)Slide Number 22Occlusal Contacts (2 pts)Slide Number 24Slide Number 25Slide Number 26Occlusal Relationship (8 pts)Slide Number 28Slide Number 29