Periapical or Panoramic

Periapical and panoramic radiographs must be of diagnostic quality for each level of evaluation. If a panoramic radiograph is submitted, periapical radiographs of the maxillary and mandibular incisors are highly recommended. All films must be oriented correctly with right and left sides clearly marked. The name of the doctor should be covered with tape. The patient's name and date should be visible. Supplemental radiographs, such as occlusal, additional periapicals or tangential radiographs may be included as needed in the case report. Digital requirements are discussed under Electronic Guidelines.

For patients 18 years of age and over, as well as for younger patients with signs/symptoms of periodontal involvement, and where pretreatment records were produced on or after March 1, 2007, the examinee must document that the patient's periodontal status was amenable to orthodontic treatment prior to initiating care. Under these conditions, the examinee will utilize one or more of the following methodologies:

1. Full mouth periodontal probing recorded by the examinee prior to initiating orthodontic therapy
2. Written documentation of pretreatment periodontal status, including a full periodontal charting, received from a periodontist, general or pediatric dentist
3. Pretreatment panoramic, vertical or conventional bitewings, and maxillary and mandibular periapical radiographs
4. Full mouth series of periapical and bitewing radiographs

Post-treatment documentation of similar format must be submitted for comparison of the patient's initial and final periodontal status.

Cephalograms

Cephalograms must show as much anatomy as possible, especially in vital landmark areas, for each level of evaluation. They should be properly standardized, oriented and processed. The patient's name and date should be visible. Tape over the doctor's name if it appears on the radiograph. The soft tissue profile should be visible on lateral cephalograms. Posterior-Anterior (PA) or sub-mental vertex cephalograms may be included if pertinent to the case. Digital requirements are discussed under Electronic Guidelines.

ABO Policy Statement Regarding Lateral Head Film Radiographs

With the advent of three dimensional technologies, the inherent inaccuracies of traditional radiographs have come into question. While no person has ever believed that cephalometric data collection was an exact science, orthodontics has continuously placed a high degree of importance on superimpositions as an accurate way of:

1. Determining changes in growth and development and treatment.
2. Ascertaining the amount and direction of tooth movement.

Three dimensional volumetric assessments produce exact measurements.^{1. 2.} When this type of data is compared to traditional cephalometric information (analogue and digital technology), indiscriminant errors in the actual location of vital landmarks necessary to establish superimpositions are found.

In spite of this problem, the Board encourages the continued use of "like" cephalograms (i.e. cephalograms produced on the same machine), and expects examinees to produce high quality cephalometric radiographs using the ABO measurements to determine diagnostic approaches for patient care and to reveal the final treatment results. Use of these accurately traced cephalograms will give the examinee very valuable information about tooth movement, amount and direction of growth, or lack thereof.

While the Board recognizes that magnification errors will always be present unless three dimensional volumetric radiographs are utilized, it does not dismiss the examinee's responsibility:

1. to inform the Board the conditions under which the initial, progress, and final cephalometric radiographs were obtained.
2. to create radiographic superimpositions demonstrating the highest degree of accuracy possible

^1. Adams G.L. GSA, Miller A.J.,Harrell Jr. W.E., and Hatcher D.C. Comparison between traditional 2-dimensional cephalometry and a 3-dimensional approach on human dry skulls. Am J Orthod Dentofacial Orthop 2004; 126:397-409

^2. Harrell WE, Jr., Hatcher DC, Bolt RL. In search of anatomic truth: 3-dimensional digital modeling and the future of orthodontics. Am J Orthod Dentofacial Orthop 2002;122:325-330.