A standard orthodontic record set has four parts: an OPG, a lateral cephalogram, standardised clinical photographs, and study models or intraoral scans. Each answers a different question, so no single record can replace the others.
OPG: what it shows
The OPG shows the number and stage of development of the teeth, impacted, missing and supernumerary teeth, root length and root parallelism, the condylar region, and any pathology or retained roots. It gives an overview. It is not a replacement for periapical films when you need fine detail.
Lateral cephalogram: the skeletal picture
The lateral cephalogram shows the sagittal relationship of the jaws (in Steiner's analysis the average SNA, SNB and ANB are about 82, 80 and 2 degrees, and norms differ between populations), the vertical pattern through the mandibular plane, the inclination of the incisors and the soft tissue profile. Tracing it by hand or with software forces you to look at every landmark. Remember that it is a two dimensional image of a three dimensional structure.
Photographs: the baseline and the record
Take extra oral photographs (frontal at rest, frontal smiling and profile) and intra oral photographs (frontal, right and left buccal, upper and lower occlusal). They document the starting point, support case presentation to the patient, and serve as a clinical record. Photographs also reveal things that are easy to miss chairside, such as a canted occlusal plane or an asymmetric smile.
Models and scans: the dental arches
Study models or intraoral scans let you measure arch length discrepancy, tooth size, arch form, overjet and overbite without the patient in the chair, and they support Bolton analysis and digital setups.
Reading the records together
Each record can mislead when read alone. A crowded lower arch on the model may look like an extraction case until the cephalogram shows retroclined incisors that could be advanced. Use the records to confirm one another, then write the problem list described in the diagnosis guide. Justify every radiograph clinically and follow the radiation protection guidelines that apply to your clinic.
Key takeaways
- The OPG shows the teeth and surrounding structures, the cephalogram shows the skeletal pattern.
- Photographs and models or scans document the starting point and measure the arches.
- Read the records together, since each one can mislead on its own.
Frequently asked questions
Is a lateral cephalogram necessary for every braces case?
A lateral cephalogram is advised for most cases where skeletal pattern, incisor position or anchorage matters, and extraction, retraction and growth related cases are hard to plan responsibly without one. Very simple cases may need less. The decision follows clinical judgement and local radiation guidelines.
Which photographs are needed for orthodontic records?
A standard set has frontal at rest, frontal smiling and profile extra oral photographs, and frontal, right buccal, left buccal, upper occlusal and lower occlusal intra oral photographs.