ORTHO LEC 2

ORTHODONTIC DIAGNOSIS

It deals with recognition of the various characteristics of the malocclusion.

Orthdodontic diagnosis

It involves collection of pertinent data in a systemic manner to help in the identifying the nature and cause of the probleM

Orthodontic diagnostic aids are of two types namely:

1. Essential diagnostic aids

2. Supplemental diagnostic aids

ESSENTIAL DIAGNOSTIC AIDS

A. CASE HISTORY

B. GENERAL EXAMINATION

C. PLASTER STUDY CASTS

D. RADIOGRAPHS (PERIAPICAL, BITEWING, OCCLUSAL AND PANORAMIC)

E. FACIAL PHOTOGRAPHS

SUPPLEMENTAL DIAGNOSTIC AIDS

1. Cephalometric radiographs

2. Electromyographic examination of muscle activity

3. Wrist x-ray to assess bone

4. Basal metabolic rate and other endocrine tests

ORTHODONTIC DIAGNOSIS PROCESS

• Recognition

• Patient Data

• Nature & Cause

Orthodontic diagnosis begins by recognizing the characteristics and

pattern of a patient’s malocclusion.

RECOGNITION

It should collects persistent information such as the history, clinical findings, photographs, casts, and radiographs

PATIENT DATA

The collected findings are used to Identify the nature of the problem and

determine possible causes that may influence treatment

NATURE & CAUSE

It provides information about patient’s dental, medical, and developmental background.

CASE HISTORY

it evaluates the patient’s overall condition and looks for facial, oral, and other findings that may be related to malocclusion

General Examination

provide three dimensional models of the teeth and arches, allowing the clinician or dentist to assess alignment, spacing, arch form, and occlusion

PLASTER STUDY CASTS

provide images of the teeth and supporting structures that cannot be fully examined during a routine clinical examination

RADIOGRAPH

it records the patient’s facial apperance and proportions and also provide a useful baseline for diagnosis and treatment planning

FACIAL PHOTOGRAPHS

It shows the entire tooth, including the root and sorrounding bone, and it is useful

for evaluating individual teeth

Periapical

It mainly shows the crowns of the upper and lower teeth and is

useful for detecting interproximal caries and assessing the bone level

BITE-WING

It gives a broader view of an entire dental arch and can help locate unerupted,

impacted or displaced Teeth.

OCCLUSAL

Provides a broad view of both jaws and is useful for assessing developing teeth,

missing or impacted teeth and general jaw structures

Panoramic

It complement the clinical examination and document facial relationships

FACIAL RADIOGRAPHS

are standardized skull and facial radiographs used to evaluate skeletal and dental relationships and facial growth patterns

CEPHALOMETRIC RADIOGRAPHS

It records muscle activity and can help evaluate the function of muscles involved in mastication and facial movement.

ELECTROMYOGRAPHIC EXAMINATION

can be used to estimate skeletal maturity and help determine the stage of

growth in a developing patient

WRIST XRAYS

It may be considered when a systemic or hormonal condition could be contributing to abnormal growth or development.

Basal Metabolic Rate and Endocrine Test

involves eliciting and recording of relevant information from the patient and parent to aid in overall diagnosis of the case

CASE HISTORY

Case history includes

1. Name

2. Age

3. Sex

4. Address & Occupation

the patient's name should be recorded for the purpose of

communication and identification.

Name

the patients chronological age should be recorded. Age consideration

helps in diagnosis as well as treatment planning.

Age

This is important in planing treatment,as the timing of growth events such as growth spurts is different in males and females

Sex

helps in evaluation of socio-economic status of the patient and the

parents

Address and occupation

the patient's chief compliant should be recorded in his/ her on words. This help the clinician in identifying the priorities and the desires of the patient

CHIEF COMPLIANT

an account obtained during the interview with the patient of the onset, duration, and character of the present illness, as well as of any acts or factors that aggravate or ameliorate the symptoms. The patient is asked what he or she considers to be the cause of the symptoms and whether a similar condition has occurred in the pas

HISTORY PRESENT ILLNESS

In obtaining the medical history, the orthodontist or assistant must always ask a few important questions: as the last time a physician was seen any hospitalizations any medications currently being taken information regarding allergies, especially latex or nickel sensitivity history of blood transfusions heart problems such as mitral valve prolapse or rheumatic fever

MEDICAL HISTORY

Few medical conditions contraindicate the use of orthodontic appliances such as: Epilepsy, History of blood dyscrasias, Diabetic patient, Rheumatic fever, Cardiac anomalies, Physically and mentally handicapped children

MEDICAL HISTORY

Few medical conditions contraindicate the use of orthodontic appliances such as:

• Epilepsy

• History of blood dyscrasias

• Diabetic patient

• Rheumatic fever

• Cardiac anomalies

• Physically and mentally handicapped children

The history of the patient should include: age of eruption of the deciduous and permanent teeth history of extraction, decay, restorations history of trauma to the dentition

DENTAL HISTORY

A type of history helps in evaluation of patient and parent's attitude towards treatment

DENTAL HISTORY

It include information on the condition of the mother during pregnancy and the type of delivery.

Prenatal History

Forceps delivery predispose to TMJ injuries that can result mandibular growth retardation.

Prenatal History

Drugs like thalidomide or affectation with some infection during pregnancy like german measles can results in congenital deformities o child.

Prenatal History

it includes information on the type of feeding, presence of habits and on the milestones of normal development.

Postnatal Hostory

Class I| ,class Ill malocclusions and congenital conditions such as clefts of lip & palate are inherited.

FAMILY HISTORY

history should record details of malocclusion existing in other members of the family as well as other diseases which can be inherited

FAMILY HISTORY

A history should explore several related areas: The patient's motivation for treatment, Expectations from treatment, Compliance of the patient

Social and Behavioral History

THEY PROVIDE CLUE TO THE PHYSICAL GROWTH AND MATURATION OF THE PATIENT.

Height & Weight

(WAY A PERSON WALKS) ABNORMALITIES WHICH ARE USUALLY ASSOCIATED WITH NEUROMUSCULAR DISORDERS THAT MAY HAVE A DENTAL CORRELATION

Gait

- (WAY A PERSON STANDS) ABNORMAL POSTURES CAN PREDISPOSE TO MALOCCLUSION DUE TO ALTERATION IN MAXILLO-MANDIBULAR RELATIONSHIP

POSTURE

Enumerate the Body Build (Physique)

A. Aesthetic

B. Plethoric

C. Athletic

A THIN PHYSIQUE AND NARROW DENTAL ARCHES.

Aesthetic

OBESE WITH LARGE SQUARE DENTAL ARCHES

Plethoric

-NORMALLY BUILT, NEITHER THIN NOR OBESE, NORMAL SIZED DENTAL ARCHES.BODY

Athletic

Enumerate the Body Build Types (Sheldon Classification)

A. Ectomorphic

B. Mesomorphic

C. Endomorphic

tall and thin physique

Ectomorphic

average physique

Mesomorphic

short and obese physique

Endomorphic

focuses specifically on facial aesthetics, skeletal relationships, growth patterns, and soft tissue proportions to guide structural diagnosis and treatment planning

Extra-oral examination

What are the 3 different shape of the head

• Mesocephalic

• Dolicocephalic / Dolichocephalic

• Brachycephalic

an average, well-balanced head shape and facial pattern that falls between long and short types.

Mesocephalic

Mesocephalic index ranges from

75.0 to 80.0

posses normal dental arches

MESOCEPHALIC

facial pattern that falls between long and short types.

Mesocephalic

having a head shape that is longer from front to back than it is wide from side to side.

Dolichocephalic

It possess narrow dental atches

Dolicocephalic

What is the index range of dolichocephalic

Less than 75

having a relatively short and wide skull

Brachycephalic

It posses broad dental arches

Brachycephalic

What is the index range of bracycephalic?

Over 80-85

Enumerate the 3 types of facial form

A. Mesoprosopic

B. Euryprosopic

C. Leptoprosopic

a face of medium or average width and round-to-oval proportions

Mesoprosopic

facial height is roughly 84% to 90% of its total width

Mesoprosopic

having a broad, short face

Euryprosopic

Defined by a prosporic index value

roughly between 80% and 85%

Euryprosopic

comes from the Greek roots eurys (wide) and prosopo (face)

Euryprosopic

a morphological facial type characterized by being vertically tall and transversely narrow

Leptoprosopic

Index value for women in leptoprosopic

85.0 % - 89.9 %

Index value for men in leptoprosopic

88.0 % - 92.9%

examined to determine disproportions of the face in transverse and vertical planes

Facial symmetry

Gross facial asymmetry can occur as a result of:

A. congenital defects

B. hemi-facial atrophy/hypertrophy

C. unilateral condylar ankylosis and hyperplasia

examined by viewing the patient from the side. The facial profile helps in diagnosing the gross deviation of maxillo-mandibular relationship

Facial profile

The facial profile is assessed by joining the following two reference lines, these are the_______

Point A & Pogonion

A line joining the forehead and the soft tissue

Point A

-deepest point in curvature of upper lip).

Point A

A line joining point A and the soft tissue

Pogonion

Types of Facial Profile

• Straight Profile (Mesognathic / Orthognathic)

• Convex Profile (Retrognathic)

• Concave Profile (Prognathic)

THE TWO REFERENCE LINES FORM AN ANGLE WITH CONVEXITY

TOWARDS TISSUE

Concave Profile

Concave profile is associated with what ty

PROGNATHIC MANDIBLE OR RETROGNATHIC MAXILLA

AS IN CLASS III MALOCCLUSION

What is the type of malocclusion for concave profile

CLASS 3 MALOCCLUSION

Protruded jaws that gives the facial outline flat appearance

Mesognathic (straight profile)

Prominent maxilla and a mandible posterior to its normal relationship

Retrognathic

Prominent, protruded mandible and normal maxilla

Prognathic

THE TWO LINES FORM NEARLY STRAIGHT LINE

Straight Profile

THE TWO LINES FORM AN ANGLE WITH CONCAVITY FACING THE TISSUE

Convex Profile

THIS KIND OF PROFILE OCCURS AS A RESULT OF PROGNATHIC MAXILLA RETROGNATHIC MANDIBLE AS SEEN IN CLASS II, DIVISION 1 MALOCCLUSION

Convex Profile

What is class of malocclusion for Convex Profile

Class 2, Div 1 Malocclusion

What type of facial profile occur if it is a convex (Class 2, Div 1 Maloocclusion)

Retrognathic

-Most anterior part of the chin

Pogonion

DEFINED AS ANTERIOR OR POSTERIOR INCLINATION OF THE LOWER FACE RELATIVE TO THE FOREHEAD.

Facial Divergence

3 types of Facial Divergence

1. Anterior Divergence

2. Posterior Divergence

3. Straight Divergence

A LINE DRAWN BETWEEN THE FOREHEAD AND CHIN IS INCLINED ANTERIORLY TOWARDS THE CHIN

Anterior Divergence

A LINE DRAWN BETWEEN THE FOREHEAD AND CHIN SLANTS POSTERIORLY TOWARDS THE CHIN

Posterior Divergence

THE LINE BETWEEN THE FOREHEAD AND CHIN IS

STRAIGHT OR PERPENDICULAR TO THE FLOOR

Straight Divergence