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Orhtodontic Examination & Diagnosis II
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  • 1. 11th Lecture Orthodontic Examination and Diagnosis-II
  • 2. Orthodontic Examination and Diagnosis-I  I. Definitions: History: Personal history: Chief Complain: Past History: Past medical history: Past dental history: April 28, 2012 Dr. Ahmed Basyouni 2
  • 3. Orthodontic Examination and Diagnosis-I II. Clinical examination: General Examination: Extra-Oral Examination: Intra-Oral Examination: April 28, 2012 Dr. Ahmed Basyouni 3
  • 4. III. Study Casts Their value in orthodontic diagnosis includes: i. They make it possible to view occlusion from every aspect & make direct measurement. April 28, 2012 Dr. Ahmed Basyouni 4
  • 5. III. Study Casts ii. They are helpful in explaining treatment plan to patient and parents iii. They may be used for assessment of treatment progress April 28, 2012 Dr. Ahmed Basyouni 5
  • 6. III. Study Casts iv. They can be used for construction of diagnostic setup for simulation of proposed treatment plan v. They can be used for consultation with another Orthodontist to whom patient may be transferred. April 28, 2012 Dr. Ahmed Basyouni 6
  • 7. OrthoCAD Digital Study Models:  With OrthoCAD Digital Study Models, you can easily store, retrieve, and communicate cases electronically, dispensing with the hassles associated with plaster casts. All files are instantly at fingertips—24-hours-a-day, no matter where you are. April 28, 2012 Dr. Ahmed Basyouni 7
  • 8. April 28, 2012 Dr. Ahmed Basyouni 8
  • 9. Digital Modeling: Benefits  Storage – Information is stored electronically, freeing up valuable office space.  Quality – Accepted for certification purposes.  Affordable – No upfront investment is required. Simply pay as you go.  Retrieval – Files are accessed instantly, saving valuable time.  Diagnostics – A set of user-friendly diagnostic tools, enabling betterinformed clinical decisions.  Communication – 3-D data can be printed, faxed or e-mailed effortlessly.  Convenience – Use the same alginates, wax bites, trays and office procedures.  Access – Retrieve digital models in home, office, or while on the road.  Backup – Copies are kept in service center for a period of ten years.  Marketing – Show patients that the office is at the forefront of technology. April 28, 2012 Dr. Ahmed Basyouni 9
  • 10. April 28, 2012 Dr. Ahmed Basyouni 10
  • 11. e-Model April 28, 2012 Dr. Ahmed Basyouni 11
  • 12. Study Cast Analysis I. II. III. IV. V. Intra-arch Analysis: Inter-arch Analysis: Arch Length: Width of Arch: Mixed Dentition Analysis: April 28, 2012 Dr. Ahmed Basyouni 12
  • 13. Study Cast Analysis I. Intra-arch Analysis: A. Curve of Spee: Upper Normal Flat Reverse moderate Reverse Excessive April 28, 2012 Dr. Ahmed Basyouni Lower Normal Flat Moderate Excessive 13
  • 14. Study Cast Analysis B. Arch Form: Maxillary Square Ovoid Tapered Mandibular C. Teeth Present: Specify__________________________ April 28, 2012 Dr. Ahmed Basyouni 14
  • 15. Study Cast Analysis D. Individual Tooth Malposition: _______________________________ E. Dental Age: _______________________________ _______________________________ April 28, 2012 Dr. Ahmed Basyouni 15
  • 16. Study Cast Analysis II. Inter-arch Analysis: Anteroposterior relation: A. Angel’s Classification: Class I Class III Class II division 1 division 2 April 28, 2012 Dr. Ahmed Basyouni 16
  • 17. Study Cast Analysis B. Overjet: mm. Increased decreased Negative (Anterior crossbite) Vertical relation: A. Overbite: Increased B. Openbite: April 28, 2012 % decreased Anterior Dr. Ahmed Basyouni Edge to edge Edge to edge Posterior 17
  • 18. Study Cast Analysis Transverse relationship: A. Posterior crossbite: Right B. Incisor midline: Upper Left Lower Correct To right To left April 28, 2012 Dr. Ahmed Basyouni 18
  • 19. Study Cast Analysis III. Arch Length (perimeter): A. Maxill. Tooth material: Available space: Crowding: mm./ Spacing: B. Mand. Tooth material: Available space: Crowding: mm./ Spacing: April 28, 2012 Dr. Ahmed Basyouni mm. mm. mm. mm. mm. mm. 19
  • 20. Study Cast Analysis Space Analysis: Total teeth size – Available space = +Ve means crowding or -Ve values (means spacing) April 28, 2012 Dr. Ahmed Basyouni 20
  • 21. Study Cast Analysis IV. Width of Arch: Maxillary Mandibular ____mm. Bicanine ____mm. ____mm. Bimolar ____mm. April 28, 2012 Dr. Ahmed Basyouni 21
  • 22. Study Cast Analysis V. Mixed Dentition Analysis: A. Space left for 3+4+5 after alignment of the incisors: Upper arch:__mm. Lower arch:____mm. B. Estimated size of 3+4+5 : Upper arch:__mm. Lower arch:___ mm. C. Space left for molar adjustment: Upper arch:__mm. Lower arch:____mm. April 28, 2012 Dr. Ahmed Basyouni 22
  • 23. Study Cast Analysis  Summary: This is a Class___malocclusion with ___mm. overjet and ___ overbite. There is ___mm. crowding or / spacing in upper and /or lower arch. The midlines are correct or shifted to Rt. Or Lt. by ___ mm. April 28, 2012 Dr. Ahmed Basyouni 23
  • 24. IV. Radiographic Examination Intra-Oral Radiographs: Extra-Oral Radiographs: April 28, 2012 Dr. Ahmed Basyouni 24
  • 25.  Intra-Oral Radiographs:  Periapical  Bite wing  Occlusal April 28, 2012 Dr. Ahmed Basyouni 25
  • 26. IV. Radiographic Examination  Extra-Oral Radiographs:  Panoramic  Cephalometric:  Lateral Cephalometric  P-A Cephalometric Hand &wrist X-ray April 28, 2012 Dr. Ahmed Basyouni 26
  • 27.  Intra-oral radiographs are essential aids for the following reasons: 1. To determine amount of root length. 2. To determine degree of root resorption and its pattern on primary teeth. 3. To determine pattern of eruption of unerupted permanent teeth. April 28, 2012 Dr. Ahmed Basyouni 27
  • 28. Intra-Oral Radiographs: Intra-oral radiographs are essential aids for the following reasons: 4. To ascertain presence of permanent teeth. 5. To study nature of supporting alveolar bone and thickness of periodontal ligament. 6. To determine axial inclination of permanent teeth. 7. To diagnose pathological conditions including caries, periodontal diseases. April 28, 2012 Dr. Ahmed Basyouni 28
  • 29. Cephalometric Radiography  Cephalogram is standardized radiograph of head and face for the purpose of making head measurements. Standardization is accomplished by means of head holder (Cephalostat) by Two ear rods inserted into external auditory meatus and one nasal rod fixed into junction of frontal & nasal bones on midline (Soft tissue Nasale), and constant distance from central ray of the X-ray source and midsagittal plane of the patient (60 Inches). April 28, 2012 Dr. Ahmed Basyouni 29
  • 30. Cephalostat April 28, 2012 Dr. Ahmed Basyouni 30
  • 31.  Cephalometric Landmarks: Nasion (N): most anterior point of the suture between frontal and nasal bones. Sella Turcica (S): center of sella turcica Orbitale (Or): Lowest point on the infraorbital margin Porion (Po): Highest point on upper margin of external auditory meatus April 28, 2012 Dr. Ahmed Basyouni 31
  • 32. Sella Turcica o Porion Nasion Orbitale Point A Gonion Point B Pogonion Menton April 28, 2012 Dr. Ahmed Basyouni 32
  • 33. Cephalometric Landmarks: Pogonion (Pog): The most anterior point on bony chin of the mandible Gonion (Go): The most posterior and inferior point on the angle of the mandible Point A (Subspinale): The deepest point in midline between anterior nasal spine and alveolar crest of the maxilla Point B (Supramentale): The deepest point in midline between alveolar crest of the mandible and pogonion Menton (Me): The lowest point on cross section of the mandibular symphysis April 28, 2012 Dr. Ahmed Basyouni 33
  • 34. Landmarks • Sella Turcica (S): midpoint of the pituitary fossa • Orbitale (Or): lowest point on lower margin of orbit April 28, 2012 Dr. Ahmed Basyouni 34
  • 35. • Nasion (N): junction of nasal and frontal bones • Basion (Ba): anterior margin of foramen magnum April 28, 2012 Dr. Ahmed Basyouni 35
  • 36. • Porion (Po): superior point of external auditory meatus • Machine Porion: landmark created by ear post of cephalostat April 28, 2012 Note: anatomic porion is commonly used in ceph analysis Dr. Ahmed Basyouni 36
  • 37. • Anterior Nasal Spine (ANS): tip of anterior nasal spine of maxilla • Posterior Nasal Spine (PNS): tip of posterior spine of palatine bone April 28, 2012 Dr. Ahmed Basyouni 37
  • 38. • A point: most concave portion of premaxilla • B point: most concave portion of symphysis April 28, 2012 Dr. Ahmed Basyouni 38
  • 39. • Gonion (Go): most inferior posterior portion of the angle of the mandible • Gnathion (Gn): most anterior inferior portion of symphysis April 28, 2012 Dr. Ahmed Basyouni 39
  • 40. • Pogonion (Pog): most anterior portion of symphysis • Menton (M): lowermost portion of symphysis April 28, 2012 Dr. Ahmed Basyouni 40
  • 41. • PT point: the most posterior-superior point on the pterygomaxillary fissure • PTM: the point at the base of the pterygomaxillary fissure where the anterior and posterior walls meet April 28, 2012 Dr. Ahmed Basyouni 41
  • 42. • 1: most anterior upper central incisor __ • 1: most anterior lower central incisor • 6: upper permanent first molar __ • 6: lower permanent first molar April 28, 2012 Dr. Ahmed Basyouni 42
  • 43. April 28, 2012 Dr. Ahmed Basyouni 43
  • 44.  Cephalometric Planes used in cephalometric analysis: Frankfort Horizontal plane (FH): It passes from orbitale and Porion Mandibular plane (Md): passes from menton to gonion. Facial plane (N-Pog): passes from nasion to pogonion April 28, 2012 Dr. Ahmed Basyouni 44
  • 45. Frankfort Horizontal Plane April 28, 2012 Dr. Ahmed Basyouni 45
  • 46. Mandibular Plane  Line drawn from Gnathion (Gn) to Gonion (Go) April 28, 2012 Dr. Ahmed Basyouni 46
  • 47. Occlusal Plane April 28, 2012 Dr. Ahmed Basyouni 47
  • 48. Sella-Nasion Plane (SN) April 28, 2012 Dr. Ahmed Basyouni 48
  • 49. Esthetic Plane (E-plane)  Tip of nose to tip of soft tissue chin  Lower lip should fall 0-4 mm behind line April 28, 2012 Dr. Ahmed Basyouni 49
  • 50. April 28, 2012 Dr. Ahmed Basyouni 50
  • 51.  Cephalometric Angles used in cephalometric analysis: FH-Md plane angle: vary between 17-28 degrees in normal occlusion cases, and may vary from 9-40.5 degrees in all cases. As angle increases, the ascending ramus and length of the face increases. April 28, 2012 Dr. Ahmed Basyouni 51
  • 52. Cephalometric Radiography SNA, SNB, and ANB angles: Average for SNA angle is 82, for SNB angle 80 degrees, and the mean for ANB difference 2 In Class II ANB may reach to 12 degrees, while in Class III ANB angle less than 2 and may be even negative value. April 28, 2012 Dr. Ahmed Basyouni 52
  • 53. Cephalometric Angles used in cephalometric analysis: Occlusal – FH plane angle: vary from 14 to 1.5 degrees, usually greater in Class II and smaller in Class III. ( Occl. Plane is taken as a straight line connecting the bisection of both first molar cusp height and incisor overbite) April 28, 2012 Dr. Ahmed Basyouni 53
  • 54. Cephalometric Angles used in cephalometric analysis: Inter-incisal angle: measured by continuing their long axes through the crown until these lines meet at an angle which can be used as indication of their prominences. Usually vary between 130-150 degrees April 28, 2012 Dr. Ahmed Basyouni 54
  • 55.  Value of Cephalometrics in Orthodontic diagnosis: 1. Skeletal pattern of patient including cranial base, maxilla and mandible 2. Soft tissue morphology of lips, tongue, soft palate and pharynx 3. Serial head plates to study growth and treatment changes 4. Relationship of the teeth to each other and to bones of the skull. April 28, 2012 Dr. Ahmed Basyouni 55
  • 56.  Panoramic X-ray: Provides larger field of dentition, alveolar bone, basal bones and the condyles in one view, with less cooperation (avoid discomfort of the intra-oral films). April 28, 2012 Dr. Ahmed Basyouni 56
  • 57.  Hand and wrist X-ray: usually left hand & wrist x-ray gives diagnostic criteria for skeletal age by observing degree of calcification of ossification centers of the hand and fusion of the epiphysis. April 28, 2012 Dr. Ahmed Basyouni 57
  • 58. April 28, 2012 Dr. Ahmed Basyouni 58
  • 59. V. Facial Photographs April 28, 2012 Dr. Ahmed Basyouni 59
  • 60.  Extra-Oral Photos:  Lateral view  Frontal view  Intra-Oral Photos:  Right side  Left side  Frontal view  Upper arch  Lower arch April 28, 2012 Dr. Ahmed Basyouni 60
  • 61. Clinical Cases April 28, 2012 Dr. Ahmed Basyouni 61
  • 62. Case 1:This 20 years old female presented with a Class I moderately crowded malocclusion and a 70% anterior deep bite. April 28, 2012 Dr. Ahmed Basyouni 62
  • 63. Case 2: This 13 years old male Class I presented with severe upper crowding and a full tooth overbite. The upper first bicuspids were removed. April 28, 2012 Dr. Ahmed Basyouni 63
  • 64. Case 3: This 23 years old female presented with a severely crowded Class I malocclusion. April 28, 2012 Dr. Ahmed Basyouni 64
  • 65. Case 4:This 11 years old female presented with a Class II div. 1 moderately crowded malocclusion with 8 mm of excess overjet. April 28, 2012 Dr. Ahmed Basyouni 65
  • 66. Case 5: This 24 years old male presented with severely crowded arches and a tendency toward a Class III malocclusion with cross bites. April 28, 2012 Dr. Ahmed Basyouni 66
  • 67. Orthodontic Examination and Diagnosis  I. Definitions: History: Personal history: Chief Complain: Past History: Past medical history: Past dental history: April 28, 2012 Dr. Ahmed Basyouni 67
  • 68. Orthodontic Examination and Diagnosis II. Clinical examination: General Examination: Extra-Oral Examination: Intra-Oral Examination: April 28, 2012 Dr. Ahmed Basyouni 68
  • 69. Orthodontic Examination and Diagnosis III. Study Casts: Study Cast Analysis I. Intra-arch Analysis: II. Inter-arch Analysis: III. Arch Length: IV. Width of Arch: V. Mixed Dentition Analysis: April 28, 2012 Dr. Ahmed Basyouni 69
  • 70. Orthodontic Examination and Diagnosis IV. Radiographic Examination Intra-Oral Radiographs: Extra-Oral Radiographs: V. Facial Photographs April 28, 2012 Dr. Ahmed Basyouni 70
  • 71. April 28, 2012 Dr. Ahmed Basyouni 71