0
ORTHODONTIC DIAGNOSIS
Clinical Examination
Aim
 Causative factors of mal occlusion
 Skeletal factor ( most important )
...
Evaluation of Skeletal relationship
The Pt. should sit in upright position
in a comfortable state ( why ? )
Three planes o...
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.
 ...
Facial Divergence
Anterior or posterior inclination of lower face to •
forehead determined by a line drawn

* straight (or...
B- Palpation method
placing Index & Middle fingers

if :* index finger anterior to middle finger ( Cl ll )
* middle finger...
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...
Clinically :*** The angle between these lines ranged
between 28 – 30 ( normal )

Radiographically :-by measured the angle
...
Assessment of Transverse law relationship
** facial symmetry
** facial Asymmetry
may be seen in Pt. with

1) hemifacial at...
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 whe...
There are many Ways to assess the facial
asymmetry :1/ bird look
2/ composite photograph
3/ Tongue spatula
4/ Radio graphi...
Evaluation of facial proportion
**Four horizontal planes : hairline
(trichion) , ridge between eyebrows
(glabella) , subna...
Ideal proportion :* Upper , lower and middle third should be equal.
* vertical facial measurement is compromised with
the ...
** Width of the nose should be near to the
inner inter – canthal distance
** Width of the mouth is equal to the distance
b...
Lips :The following should be considered:
***The form, tonicity, and fullness of the lips.
For example, are they full or
t...
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
relat...
** Ideally the two lips should meet at the center of
the upper central crown >>>>> lip line
** in skeletal Cl ll & high lo...
Ricketts , Esthetic line (E-line)
** connect the tip of the nose with soft tissue pogonion
** passes about 4 mm in front o...
Clinical extraoral examination
Clinical extraoral examination
Upcoming SlideShare
Loading in...5
×

Clinical extraoral examination

810

Published on

Seminar about Extra oral clinical examination in orthodontics

0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
810
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
46
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Transcript of "Clinical extraoral examination"

  1. 1. 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 
  2. 2. 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
  3. 3. ANTEROPOSTERIOR ( SAGITTAL ) JAWS RELATIONSHIP Assessed by one of the following : A- Facial profile * Two reference lines
  4. 4. Three types of profiles exists based on these two lines : * Straight * Convex * Concave
  5. 5. 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 .
  6. 6. 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
  7. 7. 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)
  8. 8. C – Cephalometric Analysis Based on :* ANB angle : difference between SNA angle & SNB angle
  9. 9. if * ANB = 2-4 ……. Skeletal Cl l * ANB > 4 …….. Skeletal Cl ll * ANB < 4 …… Skeletal Cl lll
  10. 10. 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 )
  11. 11. 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
  12. 12. Assessment of Transverse law relationship ** facial symmetry ** facial Asymmetry may be seen in Pt. with 1) hemifacial atropy / hypertrophy ( hemi hyperplasia)
  13. 13. 2) congenital defects 3) Unilateral condylar Hyperplasia 4) unilateral Ankylosis
  14. 14. 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.
  15. 15. There are many Ways to assess the facial asymmetry :1/ bird look 2/ composite photograph 3/ Tongue spatula 4/ Radio graphically ( OPG or PA )
  16. 16. 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)
  17. 17. 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)
  18. 18. ** 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.
  19. 19. 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.
  20. 20. Classification of lips :  Competent  Incompetent  potentially incompetent  Everted lips
  21. 21. **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
  22. 22. ** 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
  23. 23. 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
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×