Orthodontic diagnosis /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


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Diagnosis involves development of a
comprehensive & concise database of
pertinent information, sufficient to
understand the patients problem.


Diagnostic- aids
Essential

•Case history
•Clinical examination
•Study models
•Radiographs
•OPG
•Lateral Ceph
•Facial photographs


Supplemental

•Specialized radiographs
•P-A Ceph
•Occlusal
•Periapical and bitewing
•TMJ radiographs
•Hand and wrist X-ray
•Electromyography

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Case history
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Personal details
Chief complaint
Past Medical history
Past Dental history
Pre-natal history
Post-natal history
Family history
History of habits

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Personal details

-name
-age & sex
-address
-occupation


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Chief complaint:
two main concerns:
-Impaired dentofacial esthetics
-Impaired function
-priorities
-desires/expectations


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Past Medical history

-H/o of trauma to the orofacial region
-H/o allergies to medications or medical
products
-H/o past illness or treatment
-H/o past and present medications
-Chronic medical problems e.g. diabetes,
arthritis or osteoporosis

Special concerns:
-H/o Condylar fractures
- H/o Long term medications
-H/o allergy to latex or nickel sensitivity
- H/o blood transfusions
-H/o heart problems


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Past Dental history

- Caries
-Restorative treatment
-Extraction of deciduous / permanent
teeth
- Periodontal problems
- history of trauma to the teeth and jaws
- H/o pain or clicking in TMJ
- H/o bleeding gums

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Pre-natal and Natal history
Placental transfer of drugs
Forceps injury,
Caeserian surgical complications
Congenital anomalies

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Post-natal history
Milestones in development
Childhood diseases

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Family history :

H/o malocclusion in parents or siblings
and type of malocclusion
H/o of previous familial orthodontic
treatment
Heriditary/Genetic influence on
malocclusion


History of habits :
- Thumb sucking
-tongue thrusting
-lip and nail biting
-mouth breathing .
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Physical Growth Evaluation

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Growth Charts
Hand – wrist radiographs
Cervical vertebral development
Serial cephalometric radiographs

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Social and Behavioral Evaluation

-Patient’s motivation for treatment
–Internal or External
- Expectations
- Co-operation: more of concern with
children:
-Benefits of T/t as seen by the child
-Degree of parental control

•Ht & wt
•Gait
•Posture
•Body-build

•Head shape
•Facial form
•Facial symmetry
•Facial proportion
•Facial profile
•Facial divergence
•Growth pattern
•Examination of lip,
nose & chin


•Tongue
•Palate
•Gingiva
•Frenal attachment
•Tonsils & adenoids
•Assessment of dentition
•Functional examination

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General examination :
Gait
Posture
Body type
Height
Weight


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Body-build (physique)
 Aesthetic-THIN: narrow dental arches.
 Pletoric -OBESE: large square dental
arches
 Athletic –NORMAL: normal sized dental
arches

•Sheldon's classification:

•Ectomorphic - tall and thin physique
•Mesomorphic - average physique
•Endomorphic- short and obese physique

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Shape of the head
 Mesocephalic: average shape of
head- normal dental arches.
 Dolicocephalic: long and narrow
head- narrow dental arches.
 Brachycephalic: broad and short
head- broad dental arches.

Cephalic Index :

I= maximum skull
width/maximum skull
length


CLASSIFICATION:
Dolichocephalic(long skull) x – 75.9
Mesocephalic
76 – 80.9
Brachycephalic (short skull) 81 – 85.4
Hyperbrachycephalic
85.5 – x

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Facial form
› Mesoprosopic: normal face form
› Euryprosopic: broad & short
› Leptoprosopic: long & narrow.


Morphologic Facial Index
Morphologic face height
Bizygomatic width
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Martin and Saller (1957)
 Hypereuryprosop
 Euryprosop
 Mesoprosop
 Leptoprosop
 Hyperleptoprosop


x-78.9
79-83.9
84-87.9
88-92.9
93-x

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Facial symmetry
› the facial proportion in

transverse and vertical planes.
› Example:
 Congenital defects
 Hemifacial hypertrophy
 Unilateral condylar ankylosis
 Unilateral condylar hyperplasia.

“Vertical thirds of
face”


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Vertical facial proportions:

The ideal face is divided into equal thirds
by horizontal lines adjacent to the
hairline ,the nasal base , the bottom of
the nose and menton .
The lower third of the face is further divided
into -upper one third comprise the upper
lip and the lower lip to the chin comprise
the lower two thirds.

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“Rule of fifths”
› Middle fifth
› Medial two fifths
› Outer two fifths


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Transverse facial proportions:

Describes the ideal transverse relationships
of the face.
The face is divided sagitally into five equal
fifths from helix to helix of the outer ears.
Each of the segment equals one eye
distance in width

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The middle fifth of the face – delineated by
inner canthus of the eye.A line from the
inner canhus should be coincident with the
ala of the nose.

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The medial two fifths of the face – A line
from the outer canthus of the eye should be
coincident with the gonial angle of the
mandible.

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The outer two fifths of the face – measured
from the base of the ear to the helix of the
ear,which represents the width of the ears.

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Facial profile
 Straight
 Convex
 concave


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The profile is evaluated in the natural
head position which is determined by
the visual axis – the patient is asked to
look straight forwards.

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Three soft tissue points are taken into
consideration – most prominent point on
the forehead,base of the upper lip and
pogonion.


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Facial divergence
› Facial angle. i.e. angle

bw N- Pog line to FHplane.
 Straight/ orthognathic
face :90
 Anterior divergent
face: more than 90
 Posterior divergence:
less than 90

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Facial Divergence:

An anterior or posterior inclination of the
lower face relative to the forehead.
Divergence of the face -coined by the
eminent orthodontist – anthropologist
Milo Hellman
The facial angle,which is the angle formed
by the nasion-pogonion sot tissue line
and the frankfurt horizontal line is used to
define the facial divergence.

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Assessment of vertical skeletal
relationship:
Growth pattern
› FMPA- Frankfurt mandibular plane angle


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Evaluated by measuring the Frankfurt
mandibular plane angle ( FMA) depending
upon the point where the two planes –
“Frankfurt horizontal plane and the
mandibular plane” meet to form the FMA
angle.

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Average FMA angle cases – two planes
meet at the occipital region.

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Low angle cases – two planes meet
beyond the occipital region.

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High angle cases – the two planes meet in
the mastoid region in front of the ear.

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Examination of lips

Incompetent

Potentially incompetent


Competent

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Lip incompetence –
-excessive seperation of the lips at rest
-teeth protrude excessively
-the lips are prominent and everted
-lips separated at rest by more than 3
to 4 mm

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Lip posture : evaluated by viewing the
profile with the lips relaxed. This is done
by relating the upper lip to a true vertical
line passing through the concavity at the
base of the upper lip (soft tissue point A)
and by relating the lower lip to a similar
true vertical line through the concavity
between the lower lip and chin( soft
tissue point B ).

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Lip length: The length of the lips can
be examined by gently parting the
lips. Usually the upper lip covers the
entire labial surface of upper anteriors
except the incisal third or 2 to 3 mm
and the lower lip extends on to the
incisal one third of the upper anterior
teeth.

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Texture and color:-usually both the lips are of same color.
-Less active or hypoactive upper lip is
chapped and lighter in
color.

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Tonicity: Normal lip – minimal tonicity,
Hypertonic lip – tend to be firm and
redder, Hypotonic lip is flaccid.

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Mento-labial sulcus:a fold of the soft
tissue between the
lower lip and the
chin


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affected by- lower incisor position,the
vertical height of the lower face & chin
projection
-Upright lower incisors tend to result in
a shallow mentolabial sulcus.
-Excessive lower incisor proclination
deepens the mentolabial sulcus.


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Examination of nose

Radix-soft tissue nasion
Nasofrontal angle
Nasal dorsum
Nasal tip
Columella
Nasolabial angle-102


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Nasal dorsum:

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Bony dorsum- onethird to onehalf of
nasal dorsum formed by the confluence
of nasal bones
Cartilagenous/septal dorsum
On profile, the septal cartilage protrudes
infront of the pyriform aperture

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Nasal tip: most anterior point of the nose
Supratip - just cephalic to the nasal tip
Supratip break- area just cephalic to
nasal tip where the lobule meets the
dorsal portion of the nose
On esthetic nose, a slight depression is
present on the Supratip – more
pronounced in females
Double break-angular formation of nasal
tip created by Supratip, tip and infratip

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Columella:
portion of the
nose between
the base of the
nose and the
nasal tip


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Naso-labial angle:
- the angle between the lower border of
the nose to the upper lip.
-Average - 90 to 120
-reduced in cases of proclined maxillary
anterior teeth, maxillary prognathism
-Increased in cases of maxillary
retrognathism, retroclined maxillary
anterior teeth

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Fomon and Bell-three major categories of
nasal features according to racial
background.

1.

Leptorrhine – Usually found in whites and
characterized by a long, high, narrow nose
and nostrils.

2.

Mesorrhine – Usually found in Asians and
characterized by lack of dorsal height and
collumellar support.

3.

Platyrrhine – Usually found in blacks and
characterized by a flat broad nose and
wide nostrils.

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Examination of chin:


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Chin projection:
-two factors
1. the amount of anteroposterior bony
projection of the anterior inferior border
of the mandible
2. the amount of soft tissue that overlays
that bony projection


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The amount of bone projecting past the
cephalometric NB line
NB-Pg: linear measurement
Normal- 2±2 mm
Retrusive/protrusive


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Throat form:
Contour of the submental tissues

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Lip chin throat angle:-The angle between the lower lip, chin
and R point ( the deepest point along the
chin neck contour) should be
approximately 90 degrees.

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An obtuse Lip chin throat angle
which is unaesthetic reflects the
following:

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Chin deficiency

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Lower lip procumbency

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Excessive sub-mental fat

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Retropositioned mandible

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Low hyoid bone position.

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Chin neck angle:

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It is also termed cervicomental angle.

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Vistness and Souther stressed that the normal
cervico mental angle is approximately 90
degrees.

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Soft tissue sag due to ageing is one of the
contributors for less than ideal sub mental
form.

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Weight gain also plays an important role.

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Soft tissue examination

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Oral hygiene status

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Gingiva:
-size & shape
-texture & colour
-width of attached gingiva
-in young healthy patients 2 –3 mm of
attached gingiva is apparent.
-gingival recession

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Periodontal status:
-tooth mobility
-periodontal pockets
-bleeding on probing


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Frenal attachments:
-upper & lower labial and buccal freni
-In infant, upper labial frenum extends
from the upper lip to the incisive papilla.
-As the incisors erupt, the frenum usually
migrates and gets attached to the labial
surface of the alveolar process.

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Occasionally, the frenum will persist and
this may be associated with midline
diastema. In these cases, the palatine
papilla will blanch, if the lip is pulled
forward.- Blanch test

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Lower lingual frenum is examined for
tongue tie or ankyloglossia.


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Tongue:
-Size and shape
-symmetry
-posture
-presence or absence of indentations
or tooth impression on the sides of the
tongue
-large tongue or macroglossia.

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Oral mucosa:
-ulcerations
-tori or bony protuberences
-submucosal clefts or swelings


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Palate:
-palatal contour
-depth and width of the palate
-other developmental abnormalities
like torus palatinus and clefts
-scar tissue formation


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Tonsils/adenoids:
-size and degree of inflammation
-alteration in tongue and jaw posture
-adenoid facies


Faucial pillars and throat


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Hard tissue examination:

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Examination of teeth:
-developmental status of dentition
-teeth present
-carious teeth
-endodontically treated teeth
-impacted/unerupted teeth
-supernumerary/ supplementory teeth

-congenitally missing teeth
-variations in size of teeth
microdontia
macrodontia
-variations in shape of teeth
peg shaped lateral incisor
mulbery molars
-variations in no. of teeth

-variations in normal eruption sequence
-restorations
-discoloured teeth
-hypoplastic teeth
-occlusal wear facets/bruxism
-traumatic/fractured teeth


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Examination of arches:
-shape: ovoid/tapered/square
-symmetry
-alignment:
crowding/spacing/rotation
-curve of spee:
flat/average/exaggerated/reverse

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Malpositioning of individual teeth:
-mesial/distal inclination
-buccal/lingual inclination
-mesial/distal /lingual displacement
-infraversion/supraversion
-rotations
-transposition

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Examination of occlusion:
A. antero-posterior relationship:

1.molar relation-Angle’s classification
2.canine relation
3.incisor relation


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Overjet:
-Horizontal overlapping of upper and lower
teeth

-Normal- 2 to 3 mm.
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Variations in overjet :
-decreased
- increased
-reverse overjet or anterior cross bite
-edge to edge bite.

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B. Vertical relationship:

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Over bite:
-vertical overlapping of anterior teeth
-Normal- 2 to 3 mm.
-Overbite percentage –
overbite/ clinical crown length x 100
Normal value – 33 %.

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Variations in overbite:

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Deep bite – overbite > 2 to 3 mm.

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Complete deep bite – lower anteriors
contact either the cingulum of upper
anteriors or the palatal mucosa.

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Closed bite –upper anteriors overlap the
lower anteriors completely – class II div 2
malocclusion.

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Open bite – lack of vertical overlapping of
teeth.

C. Transverse relationship:
-posterior cross bite
-buccal non-occlusion/ Scissors bite
-lingual non-occlusion

D. Midline
-upper and lower midline
-skeletal midline
-mid sagittal plane


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Macro-esthetics -Face in all three
planes of space

-asymmetry
-excessive or deficient face height
-mandibular deficiency or excess


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Mini-esthetics -smile framework

-excessive gingival display on smile
-inadequate anterior tooth display
-inappropriate gingival heights
-excessive buccal corridors


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Micro-esthetics –the teeth

-tooth proportion in height and width
-gingival shape and contour
-connectors and embrasures
-black triangular holes
-tooth shade


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Facial esthetics vs. Facial proportions

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Frontal examination:
1.Bilateral Facial symmetry in the
fifths of face
2.Proportionality of width of
eyes/nose/mouth
-composite photographs-Rt/Lt
- Facial index: proportional relationship
of facial height to width

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anthropometric measurements

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Vertical facial proportions
-vertical facial thirds
-artists of the Renaissance period
da Vinci and Durer
-Farkas-modern Caucasians of
European descent-lower third is
slightly longer


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Saggital facial proportions
-Rule of fifths
-seperation of the eyes-equal the width of
the eyes
-nose & chin- centred within central fifth
-width of the nose-same as or slightly wider
than the central fifth
-interpupillary distance-equal the width of
mouth

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Profile analysis

Poorman’s cephalometric analysis
3 goals:
 Evaluation of Proportionality of jaws in
the A-P plane
 Evaluation of lip posture and incisor
prominence
 Re-evaluation of vertical facial
proportions and Evaluation MPA

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Physiologic NHP
Profile convexity or concavity
Divergence of face


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Lip promienence
Lip incompetence
Bimaxillary dentoalveolar protrusion
-reflected in facial appearance in 3 ways
1.excessive seperation of the lips at rest
i.e. >4mm -lip incompetance
2.excessive efforts to bring lips in closure
-lip strain
3. Lip promienence

Short facial height-everted and
protrusive lips
 Throat form:
-submental fat deposition and low tongue
posture
-stepped throat contour
-”double chin” appearence
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Vertical facial
proportions


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Mandibular plane angle:

steep MPA:
-long anterior vertical facial dimensions
-skeletal open bite tendency
 flat MPA:
-short AFH
-deep bite tendency



-Relationship of the dentition to the face
1.Examination of symmetry
-relationship of dental midline of each
arch to the skeletal midline
2.Vertical relationship of the teeth to the
lips-at rest and on smile
-amount of incisor display

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Excessive incisor display1.long lower third of the face
2.short upper lip
-lip height at philtrum and the comissures
Transverse cant of occlusal plane
-transverse roll of the esthetic line of
dentition
-up-down transverse rotation of the
dentition on smiling or when the lips are
seperated at rest

Two types
1.posed/social smile
-focus of the orthodontic diagnosis
-reproducible
2.Unposed/emotional smile
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Extent of the smile is outlined by
 Curvature of the upper & lower lip
 Position of the angle of mouth
 Degree of exposure of both anterior &
posterior teeth, gingiva
 width of the buccal corridor.


Three views:
1.Obligue or ¾ view
2.Frontal view
3.Profile view
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Three points
1.Amount of icisor and gingival display
2.Transverse dimensions of the smile
relative to the upper arch
-buccal corridor
3.The smile arc
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Amount of incisor and gingival
display:

-elevation of the upper lip on smile should
stop at or near gingival margin
-<100% incisor display-less attractive smile
-decrease in amount incisor display over
time


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Buccal corridors:

-distance between the maxillary posterior
teeth and inside of the cheek
-excessively wide buccal corridors i.e.
negative space- unesthetic
-widening of the upper arch


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Smile arc:
-contour of the incisal edges of the
maxillary anterior teeth relative to the
curvature of the lower lip during a social
smile
-consonant smile arc
-flattened smile arc


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Tooth proportions:

-tooth widths in relation to each other
-height-width proportions of individual
teeth
-width relationship & the “Golden
proportion”
-the ratio of recurring 62% from central
incisor to posterior teeth
i.e.1.0:0.62:0.38:0.24 etc

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Height-width relationships:

-width of the tooth should be about 80% of
its height- 8:10
-disproportions in height-width ratio:
1.Incomplete eruption
2.Loss of crown height from attrition
3.Excessive gingival height
4.Inherent distortion in crown form

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Gingival height , shape & contour:

Gingival height:
-proportional gingival heights
-central incisor-highest gingival level
-lateral incisor-1.5 mm lower than CI
-canine-same as CI



Gingival shape:
-curvature of gingiva at the margins of
tooth
-Max. Lateral Incisorsymmetrical half-oval/half circle
-Max. Central Incisor & Caninemore elliptical



Gingival zenith:
-most apical point of the gingival tissue
- Max. Central Incisor & CanineDistal to long axis of the tooth
- Max. Lateral IncisorCoincide with the long axis
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Connectors and embrasures:



Connectors:

-area where adjacent teeth appears to
touch
-extends apically or occlusally from the
actual contact point
-Normal connector height –greatest
between CI

-diminishes from CI to posterior teeth
-moves apically in progression from CI to
PMs & Ms


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Embrasures:

-triangular spaces incisal or gingival to the
contact area


Black triangles:

-open gingival embrasures above the
connectors
-causes:
1.Loss of gingival tissue
2.Orthodontic correction of crowded and
rotated maxillary incisors



Tooth shade & color:

-Max. Central Incisor -brightest in smile
-Max. Lateral Incisor- less than CI
-Max. Canine- least bright
-First & second PMs-lighter and brighter
than canine


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Assessment of Postural rest position and
interocclusal space
Evaluation of path of closure
Examination of TMJ
Examination of muscles of mastication
Examination of muscles of neck and
head support



-

Examination of orofacial Dysfunctions
Respiration
Deglutition/Swallowing
Speech
Peri-oral muscle tone




Postural rest position and
interocclusal space:

-the position of mandible when the
muscles which elevates and depress
the jaw are in a state of minimum
tonic contraction to maintain the
posture of mandible


Methods of assessing Postural rest
position:
1.Phonetic method
2.Command method
3.Non-command method



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Interocclusal clearance/space:

-distance between the occlusal or incisal
surfaces of the maxillary and mandibular
teeth when the mandible is in the
physiologic rest position
-freeway space
-normal- 3mm in bicuspid region


Methods to measure interocclusal
space:
1.Direct intra-oral procedure
2.Direct extra-oral procedure
3.Indirect extra-oral procedure





Evaluation of path of closure:

-movement of mandible from rest position
to habitual occlusion
1.Forward path of closure:
-skeletal prenormalcy
-edge-to edge incisor contact


2.Backward path of closure:
-class II div 2
3.Lateral path of closure:
-occlusal prematurities
-narrow maxillary arch




Early symptoms of TMJ problems include:

•

Clicking and crepitus

•

Sensitivity in the condylar region and
masticatory muscles

•

Functional disturbances

•

Radiographic evidence of morphologic
and positional abnormalities.

1.Jaw movements, path of closure and
joint sounds:
-range of motion:
a)Maximum opening-40 mm
b)Right and left lateral excursion
c)Protrusion


-path of closure:
-amount, direction, timing of any deviation
-clicks:
-disclose a loss of intimacy of condyle and
meniscus relationship
-crepitus:
-early arthritic symptoms


2.Occlusal interferences:
-retruded contact position
-intercuspal position
-protrusive and lateral occlusal contacts

3.Muscle tenderness(myalgia):
-masseter, lateral pterygoid and temporalis


Muscles of mastication


Morphologic Examination:
Palpation of each jaw muscle at rest
and in function - useful to reveal
asymmetries of muscle size and
placement.



Functional Examination:
Functional analysis of the jaw
musculature is best carried out with
each particular synchronized function
in mind.

Muscles of neck and head
support


Pain and tenderness:Myalgia of the neck muscles may be
associated with



tempero mandibular dysfunction



spondylitis



other functional disorders of the
region.



Assessment of Respiration:

-breathing- three types
a)Nasal
b)Oral
c)Oro-nasal
-alteration in the posture of head, tongue
and mandible

Methods of examination:
1.Study the patients breathing unobserved:
2.Ask the patient to take a deep breath
3.Ask the patient to close the lips and take
a deep breath through the nose



Nasal breathers:
-lips touch lightly at rest
-good reflex control of the alar muscles
-dilate the external nares on inspiration
 Mouth breathers:
-lips are parted
-maintain the size and shape of external
nares or contract the nasal orifices




1.
2.
3.

Other tests to diagnose the mode of
respiration:
Mirror test
Cotton test
Water test




Examination of Swallowing:

-patient seated upright
-Normal mature swallow:-mandible rises as the teeth are brought
together, lips touch lightly and temporal
muscle contracts
-Teeth apart swallow:-no conraction of temporal muscle
-strong mentalis and lip contractions

-Differential diagnosis:
1. Normal infantile swallow
2. Normal mature swallow
3. Simple tongue thrust swallow
4. Complex tongue thrust swallow
5. Retained infantile swallow


Normal infantile swallow:
-tongue lies between gum pads
-mandible is stabilized by contraction of
facial muscles
-strong buccinator muscle
-disappears with eruption of buccal teeth
in primary dentition



Normal mature swallow:
-very little lip and cheek activity
-contraction of mandibular elevators
bringing the teeth into occlusion
 Simple tongue thrust swallow:
-contraction of lips, mentalis and
mandibular elevators
-teeth in occlusion



Complex tongue thrust swallow:
-tongue thrust with teeth apart swallow
-combined contraction of lips, facial
muscles and mentalis
-lack of contraction of mandibular
elevators
-mouth breathers and chronic
nasorespiratory disease



Retained infantile swallow:
-persistence of the infantile swallowing
reflex after the arrival of permanent
teeth
-contraction of buccinator muscle





Assessment of Speech:

1.Lisping with sibilant sound(S,Z):
-large gap between incisors
-missing incisors or open bite
-tongue thrust habit
2.Difficulty in production of linguo-alveolar
stops(t,d):
-irregular incisors
-lingually positioned maxillary incisors

3.Distortion of labio-dental fricatives(t,v):
-excessive protrusion of mandible
4.Distortion of linguo-dental
fricatives(th,sh,ch):
-anterior open bite or missing incisors
5.Cleft palate- nasal tone




Peri-oral muscle tone:

-mentalis
-orbicularis oris




Two purposes:
- to document the patient’s initial
condition
- to supplement information obtained
from interview and clinical
examination




Three major categories:
-for evaluation of-

A. The health of the teeth and oral
structures
1.
2.
3.
4.
5.

Intraoral photographs
Panoramic radiographs
TMJ radiographs
Periapical & bitewings
Occlusal radiographs

B. The alignment & occlusal relationship
of the teeth
1.
2.

Study casts
Occlusal records

C. The face & jaw proportions
1.
2.
a.
b.

Facial photographs
Cephalometric radiographs
lateral ceph
P-A ceph



Intraoral photographs:

-to document the initial condition of hard
and soft tissues
-five standard views
1. Frontal/anterior
2. Right lateral
3. Left lateral
4. Maxillary occlusal
5. Mandibular occlusal



Panoramic radiographs:

-advantages:
1. Yields a broader view
2. Pathological lesions and supernumerary
or impacted teeth
3. Much lower radiation exposure
4. Views of mandibular condyles
5. Screening image to determine if other
TMJ radiographs are needed



Periapical & bitewing radiographs:

-supplemental to OPG when greater detail
is required
-children & adolescent-root resorption or
aggressive periodontal disease




Occlusal radiographs:

-to locate impacted teeth in combination
with periapical radiograph


Cone-beam computed tomography:

-to evaluate position of impacted tooth
and extent of damage to roots of other
teeth




CT or MRI scans:

-screening for TMJ internal joint pathology




Frontal :

-natural head position
-four views:
a) Frontal at rest:
-lip incompetence-lips in repose and
mandible in rest position


b) Frontal with teeth in maximal
intercuspation:
-lips closed
-lip strain and its esthetic effect
-lip incompetence-lips together picture


c) Frontal dynamic(smile):
-the amount of incisor display
-excessive gingival display

d) Close-up view of the posed smile:
-analysis of smile relationships


2. oblique(three-quarter; 45 degree):
-three views:
a) Oblique at rest:
-examination of midface
-midfacial deformities
-nasal deformity
-chin neck area

-prominence of gonial angle
-length and definition of the border of
mandible
-lip fullness and vermilion display
-facial asymmetry-oblique views of both
sides


b) Oblique on smile:
-anteroposterior cant of OP
c) Oblique close-up smile:
-more precise evaluation of lip relationships
to the teeth and jaws


3. Profile:
-orientation of the head to the visual axis
-inferior border: slight above the scapula,
at the base of the neck
-superior border: slight above the top of
head
-right border: slight ahead of the nasal tip
-left border: stops just behind the ear/ full
head shot

-two views:
a) Profile at rest:
-lips relaxed
b) Profile smile:
-angulation of maxillary incisors

4. Submental view:
-mandibular asymmetry

Study casts are
oriented in
3 planes:

-Midpalatal raphe
-Tuberosity plane
-Occlusal plane




Cast analysis:

-Symmetry and space
1.Symmetry:
-trasparent ruled grid
-oriented to midpalatine raphe
-asymmetry within the dental arch
 Lateral drift of incisors
 Drift of posterior teeth on one side

2.Alignment (crowding): space analysis
-to quantify the amount of crowding within
the dental arches
-comparison between the amount of
space available for alignment of the
teeth and the amount of space required
to align them properly


Mixed Dentition Analysis:
-Estimation of the size of unerupted
permanent teeth
-three basic approaches
1. Radiographic method:
-true width of primary molar/apparent
width of primary molar = true width of
unerupted premolar/apparent width of
unerupted premolar



2. Proportionality tables:
-Moyer’s prediction tables
-Tanaka & Johnston prediction values
3. Combination of radiographic &
prediction table method:
-Hixon & Oldfather prediction graph
-Staley & Kerber prediction graph


-Radiographic cephalometry
-1934 by Hofrath in Germany & Broadbent
in United States
 Uses:
 Research on growth patterns in the
craniofacial complex
 To evaluate dentofacial proportions and
clarify the anatomic basis for
malocclusion

Recognizing and evaluating changes
brought about by orthodontic treatment
by superimposition of serial radiographs
 Screening of pathology:
-anomalies in the cervical spine
-degenerative changes in the cervical
vertebrae
-other pathological changes in the skull,
jaws or cranial base






TRACING





Case history and clinical examination
are the two important tools in the
process of diagnosis which can be
supplemented with other diagnostic
records such as radiographs and study
casts to obtain proper diagnosis
A comprehensive diagnosis is necessory
for proper treatment planning and the
success of orthodontic treatment

Thank you
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