Clinical extraoral examination
Upcoming SlideShare
Loading in...5
×
 

Clinical extraoral examination

on

  • 696 views

Seminar about Extra oral clinical examination in orthodontics

Seminar about Extra oral clinical examination in orthodontics

Statistics

Views

Total Views
696
Views on SlideShare
696
Embed Views
0

Actions

Likes
2
Downloads
24
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Clinical extraoral examination Clinical extraoral examination Presentation Transcript

  • ORTHODONTIC DIAGNOSIS Clinical Examination Aim  Causative factors of mal occlusion  Skeletal factor ( most important )  Soft tissue factor  Dental factor  Combination of one or more in one or more than one plane of space 
  • Evaluation of Skeletal relationship The Pt. should sit in upright position in a comfortable state ( why ? ) Three planes of spaces :  Anteroposterior ( Sagittal ) jaws relationship  Vertical jaws relationship  Transverse jaws relationship
  • ANTEROPOSTERIOR ( SAGITTAL ) JAWS RELATIONSHIP Assessed by one of the following : A- Facial profile * Two reference lines
  • Three types of profiles exists based on these two lines : * Straight * Convex * Concave
  • Class I — the mandible is 2–3 mm posterior to maxilla.  Class II — the mandible is retruded relative to the maxilla.  Class III — the mandible is protruded relative to the maxilla. Note :this classification only gives the position of the mandible and the maxilla relative to each other and does not indicate where the discrepancy lies. So we need a lateral cephalograph .
  • Facial Divergence Anterior or posterior inclination of lower face to • forehead determined by a line drawn * straight (orthognathic) when the line • perpendicular to the floor * Anterior or posterior divergence when the • line inclined anteriorly or posteriorly
  • B- Palpation method placing Index & Middle fingers if :* index finger anterior to middle finger ( Cl ll ) * middle finger anterior to index finger * Even level ( Cl l ) ( Cl lll)
  • C – Cephalometric Analysis Based on :* ANB angle : difference between SNA angle & SNB angle
  • if * ANB = 2-4 ……. Skeletal Cl l * ANB > 4 …….. Skeletal Cl ll * ANB < 4 …… Skeletal Cl lll
  • Assessment of Vertical jaws relationship * Normally distance between glabella to sub nasale and sub nasale to underside of the chin(lower facial height) is equal . ** reduced lower facial height…… deep bite ** increased lower facial height …. Ant. Open bite *** its also can be assessed by studying angle between - lower border of mandible - Frankfort horizontal plane (from auditory meatus to lowest point of infra – orbital margin )
  • Clinically :*** The angle between these lines ranged between 28 – 30 ( normal ) Radiographically :-by measured the angle ** Frankfort horizontal plane between porion to orbitale ** lower border of mandible between gonion to menton
  • Assessment of Transverse law relationship ** facial symmetry ** facial Asymmetry may be seen in Pt. with 1) hemifacial atropy / hypertrophy ( hemi hyperplasia)
  • 2) congenital defects 3) Unilateral condylar Hyperplasia 4) unilateral Ankylosis
  • The characteristics of condylar hyperplasia are: 1- Posterior open bite or canting of occlusal plane depending on time when hyperplasia develops. 2- Asymmetry of lower facial third.
  • There are many Ways to assess the facial asymmetry :1/ bird look 2/ composite photograph 3/ Tongue spatula 4/ Radio graphically ( OPG or PA )
  • Evaluation of facial proportion **Four horizontal planes : hairline (trichion) , ridge between eyebrows (glabella) , subnasale , chin point (menton) ** upper lip occupies one third of distance ( mouth – nose – chin relationship)
  • Ideal proportion :* Upper , lower and middle third should be equal. * vertical facial measurement is compromised with the width to give normal facial index if ** facial height > facial width ….. Long face (dolichofacial) **facial height proportional to width ….. (mesofacial ) ** facial width > facial height …… square faces (brachyfacial)
  • ** Width of the nose should be near to the inner inter – canthal distance ** Width of the mouth is equal to the distance between the irises ** facial symmetry : all five segments should be one eye distance in width.
  • Lips :The following should be considered: ***The form, tonicity, and fullness of the lips. For example, are they full or thin, hyperactive, or with little tone? ***Lip competence. Competent lips meet together at rest without any muscular activity They should be touch each other or remain apart up to 3-4 mm in relaxing position. * Normally the upper lip cover the upper incisors except the incisal 2-3 mm , while lower lip cover entire labial surface of lower incisor and the upper incisal 2-3mm.
  • Classification of lips :  Competent  Incompetent  potentially incompetent  Everted lips
  • **Separated lips at rest ** Closed lips at rest >>>>>> negroid *** The sagittal plane of lips determined entirely by relationship between basal bone & jaws. Instances :* low lip line >>> Skeletal discrepancy not severe lip functioning partly behind Upper C incisor >>>> Cl ll div l * Skeletal discrepancy very severe >>> lip functioning compeletly behind Upper C incisor >>> no effect
  • ** Ideally the two lips should meet at the center of the upper central crown >>>>> lip line ** in skeletal Cl ll & high lower lip line >>>> lip functioning entirely in front of upper C incisor >>>>> Retroclination >>>>> CL ll div ll
  • Ricketts , Esthetic line (E-line) ** connect the tip of the nose with soft tissue pogonion ** passes about 4 mm in front of upper lip . about 2 mm in front of lower lip . ** Bimaxillary dentoalveolar protrusion ** Nasolabial angle NLA : between lower Border of the nose and line joining subnasale And tip of the upper lip (labiale superius)>>> The angle = 110 normally It reduced in Pt. with proclined upper incisor or Prognathic maxilla