Tournée de l’Ordre 2012             •   Dr Jean-Marc Retrouvey             •   Dr Donald Taylor
Objectives of the Day• Discuss the different modalities necessary to  obtain an adequate diagnosis• Revisit the basic prin...
Orthodontic      Diagnosis       Dr Donald TaylorDr Jean-Marc Retrouvey
Objectives1. Review the fundamental principles of   diagnosis2. How to prepare proper orthodontic record3. The importance ...
1. Review of fundamental principles• Screenings of  malocclusions (children  and adults)• Orthodontic evaluation   1. Obse...
Brief History of Diagnosis in                  Orthodontics                           Akerman Profitt 1970-     New approa...
Diagnosis-Differential Diagnosis• Important to differentiate the severity of the  malocclusion
Orthodontic Record• It is imperative to create an orthodontic record for                      each patient!
The orthodontic record is        composed of two sections1. Collection of Information  1. Medical and Dental History  2. 2...
Orthodontic Record: 2nd Section2. Interpretation of the findings  The collection of the findings is not sufficient.   You ...
1. Collection of Information  1. Medical and Dental History  2. Extraoral Examination  3. Functional Patient’s History    ...
History• Chief complaint:  – It is really important to write the reason for the    visit in the terms described by the pat...
1. Collection of Information  1. Medical and Dental History         2.Extra-oral Examination  2. Extraoral Examination  3....
WHY PERFORM AN EXTRAORAL      EXAMINATION ?
•   Determine the harmony of facial structures•   Judge facial symmetry•   Analyze the smile•   Evaluate the position of t...
Facial TypeHas an important influence on the    prognosis of the result of     orthodontic treatment
Normocephalic       • The length and width of         the face are in ideal         proportions       • The growth pattern...
Brachycephalic               Dolychocephalic           Facial Types deviate from             ideal and the growth         ...
Brachycephalic          DolichocephalicTendency for a deep bite    Tendency for an open bite
Analysis of the Profile            The angle Glabella,            Subnasale et Pogonion            gives a good idea of th...
Facial profile and soft tissuesA pleasant profile is not measurable: It is an esthetic judgment
1. Collection of Information  1. Medical and Dental History  2. Extraoral Examination      3. Functional Examination  3. F...
1. Verify the medical and dental history
2. Palpate the TM Joints and Perioral             musculature
3. Record mandibular movements and            excursions
Functional ExaminationA malocclusion whoseorigin is skeletal withjoint degeneration.It can be seen that thecondyle on the ...
1.    Collection of Information        1. Medical and Dental History        2. Extraoral Examination4. Intra oral examinat...
Intra-oral Photographs(obligatory and of diagnostic quality)
Study modelsStudy models must be of goodquality to allow proper study
When to mount a case in CR
1. Molar Classification• Angle determined that this relationship was  essential in order to have a functional  occlusion a...
Is there a problem with this       classification?           Even though Class I is very           important , it does not...
Two malocclusions which present with  a Class I malocclusion (or almost)   Are the problems skeletal or dento alveolar?   ...
2. Overbite1. Etiology of exaggerated deep   bite  –   Over eruption of the incisors   The chief complaint  –   Under erup...
The etiology greatly helps to determine the modalities                     of treatment• Supra erupted incisors    • Intru...
2.Open Bite• Possible etiologies of open bite   – Anterior position of the tongue( habits)   – Genetic factors   – Sleep a...
3.Overjet     • The etiology was       multifactorial            • Dentoalveolar            • Skeletal            • A comb...
Overjet     The incisors seem to      be very protrusive     Equally, the mandible is very    retrusive
4. Midlines• Skeletal• Dental
Midlines• We use the reference line                                 Reference  to determine the different                 ...
Midlines1. Midline reference line2. Maxillary midline3. Mandibular midlineIf there is a facial deviation,     how is it co...
6. Tooth size/Arch sizeSmall lateral incisors       Large teeth
Width of the teeth                     Bolton analysis – Normal: 77%Tooth             Upper right   Upper left   IdealCent...
The Boley Gauge of             Dr. RetrouveyHe as developed a computer program to calculate Bolton                     Dis...
7.Number of teeth and sequence of          dental eruption• What is normal?• Can we take advantage of the sequence of  eru...
Curve of spee• Flat (normal)        • Deep. Probably a skeletal                         malocclusion
8.Curve of Spee                 Very important to evaluate• Flat or moderate: good prognosis• Accentuated curve: Prognosis...
9. Amount of Crowding• There are different factors  to consider• Difference between the  mixed dentition and the  permanen...
Is this crowding a concern?
Mixed dentitionThe control and utilization of theLeeway space is really important
The Boley Gauge of           Dr. RetrouveyHe has developed a computer program to calculate E space
If leeway space is not adequate• Normally, extractions  will be required• Sometimes we can  expand the arches• Depends on ...
1. Collection of Information  1. Medical and Dental History  2. Extraoral Examination  3. Functional examination          ...
Analysis of Pantographic radiograph
Analysis and interpretation of the cepalogramMandatory when contemplating all orthodontic treatment!Analysis:   – Skeletal...
Cephalometric analysis                                     Angles         Ceph.         Normal                            ...
Diagnosis of the malocclusion• Write the most significant  elements• Example   – Class II division I     malocclusion   – ...
Problem listProblem                Resolution                     CommentsClass II molar         x   Maintain             ...
ConclusionsIdentify the malocclusion presented and arrive to a proper   diagnosis is the most important aspect in orthodon...
1.odq. diagnositic short  oct 17  slideshare english.pptx
1.odq. diagnositic short  oct 17  slideshare english.pptx
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A short presentation on orthodontic diagnosis for the general practitioner

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1.odq. diagnositic short oct 17 slideshare english.pptx

  1. 1. Tournée de l’Ordre 2012 • Dr Jean-Marc Retrouvey • Dr Donald Taylor
  2. 2. Objectives of the Day• Discuss the different modalities necessary to obtain an adequate diagnosis• Revisit the basic principles of interceptive orthodontics and understand the importance of early intervention• Determine the importance of the use of orthodontics to optimize the dental health of adults• Discuss Invisalign
  3. 3. Orthodontic Diagnosis Dr Donald TaylorDr Jean-Marc Retrouvey
  4. 4. Objectives1. Review the fundamental principles of diagnosis2. How to prepare proper orthodontic record3. The importance of differential diagnosis4. The selection of cases that can be treated in your office
  5. 5. 1. Review of fundamental principles• Screenings of malocclusions (children and adults)• Orthodontic evaluation 1. Observation-Reevaluation 2. Intervention 3. Treatment 4. When to refer to the orthodontist
  6. 6. Brief History of Diagnosis in Orthodontics Akerman Profitt 1970- New approach Angle’s Classification 1980: more information1920’s. Based on molar based on skeletal and “Outside in ”: relationship dento-alveolar Importance of facial relationships harmony
  7. 7. Diagnosis-Differential Diagnosis• Important to differentiate the severity of the malocclusion
  8. 8. Orthodontic Record• It is imperative to create an orthodontic record for each patient!
  9. 9. The orthodontic record is composed of two sections1. Collection of Information 1. Medical and Dental History 2. 2.Extraoral Examination Extraoral Examination 3. Functional examination (TMJ, orofacial muscles, tongue position, respiration, habits) 4. Intraoral Examination and Study Models 5. Radiographs • panoramic • cephalometric
  10. 10. Orthodontic Record: 2nd Section2. Interpretation of the findings The collection of the findings is not sufficient. You must Interpret these findings to allow you to arrive at a precise diagnosis. This interpretation must be written in the chart and must be in a logical order that can be understood by others.
  11. 11. 1. Collection of Information 1. Medical and Dental History 2. Extraoral Examination 3. Functional Patient’s History 1. examination (TMJ, orofacial muscles, tongue position, respiration, habits) 4. Intraoral Examination and Study Models 5. Radiographs • panoramic • cephalometric
  12. 12. History• Chief complaint: – It is really important to write the reason for the visit in the terms described by the patient • Ex: I have an overbite…. • Ex: My teeth are crooked..• Medical, Dental and Familial History – This allows you to detect problems which are environmental and or genetic
  13. 13. 1. Collection of Information 1. Medical and Dental History 2.Extra-oral Examination 2. Extraoral Examination 3. Functional examination (TMJ, orofacial muscles, tongue position, respiration, habits) 4. Intra-oral Examination and Study Models 5. Radiographs • panoramic • cephalometric
  14. 14. WHY PERFORM AN EXTRAORAL EXAMINATION ?
  15. 15. • Determine the harmony of facial structures• Judge facial symmetry• Analyze the smile• Evaluate the position of the teeth in relation to the soft tissue of the face
  16. 16. Facial TypeHas an important influence on the prognosis of the result of orthodontic treatment
  17. 17. Normocephalic • The length and width of the face are in ideal proportions • The growth pattern is most probably favorable
  18. 18. Brachycephalic Dolychocephalic Facial Types deviate from ideal and the growth pattern is not favorable
  19. 19. Brachycephalic DolichocephalicTendency for a deep bite Tendency for an open bite
  20. 20. Analysis of the Profile The angle Glabella, Subnasale et Pogonion gives a good idea of the relationship of the skeletal bases in relationship to the soft tissues of the face
  21. 21. Facial profile and soft tissuesA pleasant profile is not measurable: It is an esthetic judgment
  22. 22. 1. Collection of Information 1. Medical and Dental History 2. Extraoral Examination 3. Functional Examination 3. Functional examination (TMJ, orofacial muscles, tongue position, respiration, habits) 4. Intraoral Examination and Study Models 5. Radiographs • panoramic • cephalometric
  23. 23. 1. Verify the medical and dental history
  24. 24. 2. Palpate the TM Joints and Perioral musculature
  25. 25. 3. Record mandibular movements and excursions
  26. 26. Functional ExaminationA malocclusion whoseorigin is skeletal withjoint degeneration.It can be seen that thecondyle on the left isactively resorbing
  27. 27. 1. Collection of Information 1. Medical and Dental History 2. Extraoral Examination4. Intra oral examination and 3. Functional examination (TMJ, orofacial muscles, study models tongue position, respiration, habits) 4. Intraoral Examination and Study Models 5. Radiographs panoramic cephalometric
  28. 28. Intra-oral Photographs(obligatory and of diagnostic quality)
  29. 29. Study modelsStudy models must be of goodquality to allow proper study
  30. 30. When to mount a case in CR
  31. 31. 1. Molar Classification• Angle determined that this relationship was essential in order to have a functional occlusion and optimal esthetics…….with a full compliment of teeth• One of the goals of orthodontic treatment is to achieve a class I molar relationship. There are exceptions
  32. 32. Is there a problem with this classification? Even though Class I is very important , it does not take into account the denture position in relation to facial structures It is not guaranteed that a Class I molar relationship is the only mark of success of orthodontic treatment It is vertical problems which cause us miseries
  33. 33. Two malocclusions which present with a Class I malocclusion (or almost) Are the problems skeletal or dento alveolar? The Angle classification has nothing to do with the complexity of the cases
  34. 34. 2. Overbite1. Etiology of exaggerated deep bite – Over eruption of the incisors The chief complaint – Under eruption of the molars of the patient was: « I have a crooked – Skeletal dysplasia tooth » – Deep Curve of Spee
  35. 35. The etiology greatly helps to determine the modalities of treatment• Supra erupted incisors • Intrusion with fixed• Under erupted molars braces• Deep Curve of Spee • Level Curve of Spee• Hypoplastic Mandible • Orthognathic surgery
  36. 36. 2.Open Bite• Possible etiologies of open bite – Anterior position of the tongue( habits) – Genetic factors – Sleep apnea
  37. 37. 3.Overjet • The etiology was multifactorial • Dentoalveolar • Skeletal • A combination of the above
  38. 38. Overjet  The incisors seem to be very protrusive  Equally, the mandible is very retrusive
  39. 39. 4. Midlines• Skeletal• Dental
  40. 40. Midlines• We use the reference line Reference to determine the different line midlines- maxillary and mandibular
  41. 41. Midlines1. Midline reference line2. Maxillary midline3. Mandibular midlineIf there is a facial deviation, how is it corrected?If a dental deviation is it skeletal or functional?
  42. 42. 6. Tooth size/Arch sizeSmall lateral incisors Large teeth
  43. 43. Width of the teeth Bolton analysis – Normal: 77%Tooth Upper right Upper left IdealCentral incisor 8.85Lateral incisor 6.9Canine 7.88Tooth Lower right Lower left IdealCentral incisor 5.5Lateral incisor 6Canine 6.95 • UA (Σ 13-23) = mm • LA (Σ 33-43) = mm • ( 35.3 / 43.3 ) x 100 = %
  44. 44. The Boley Gauge of Dr. RetrouveyHe as developed a computer program to calculate Bolton Discrepancy
  45. 45. 7.Number of teeth and sequence of dental eruption• What is normal?• Can we take advantage of the sequence of eruption? Yes (E space)• Is the timing early or late? Patient age 16 years: slow eruption and multiple impacted teeth
  46. 46. Curve of spee• Flat (normal) • Deep. Probably a skeletal malocclusion
  47. 47. 8.Curve of Spee Very important to evaluate• Flat or moderate: good prognosis• Accentuated curve: Prognosis les positive – Do we level? – How much space is necessary? – We need to analyze the cephalogram. Helps with differential diagnosis
  48. 48. 9. Amount of Crowding• There are different factors to consider• Difference between the mixed dentition and the permanent dentition (Leeway Space)• Inclination of the lower incisors (Curve of Spee)• Non-apparent available space ( non anatomic restorations)
  49. 49. Is this crowding a concern?
  50. 50. Mixed dentitionThe control and utilization of theLeeway space is really important
  51. 51. The Boley Gauge of Dr. RetrouveyHe has developed a computer program to calculate E space
  52. 52. If leeway space is not adequate• Normally, extractions will be required• Sometimes we can expand the arches• Depends on the amount of attached gingiva at labial of the lower incisors and facial features
  53. 53. 1. Collection of Information 1. Medical and Dental History 2. Extraoral Examination 3. Functional examination 5.Radiographs (TMJ, orofacial muscles, tongue position, respiration, habits) 4. Intraoral Examination and Study Models 5. Radiographs • panoramic • cephalometric
  54. 54. Analysis of Pantographic radiograph
  55. 55. Analysis and interpretation of the cepalogramMandatory when contemplating all orthodontic treatment!Analysis: – Skeletal (values as normal as possible) – Dentoalveolar – Pearl: The cases where the mandibular plane angle is normal typically gives the best prognosis
  56. 56. Cephalometric analysis Angles Ceph. Normal Values The skeletal measurements giveus the relationship of the osseous Skeletal Measurementsbases relative to the cranial base SNA 79.5 81 ± 3 SNB 75.0 78 ± 3 ANB 4.5 3±2 Witts -4.0 2 mm ± 2mm Facial 86.0 88 ± 4 MPAST 38.0 32 ± 3 Y axis 60.0 60 ± 4 Dental Measurements (UI,NA) 16.0 23 ±6 (LI,NB) 23.0 27.5 ±5 (UI,LI) 135.0 130 ± 7 (LI,MP) 91.0 91.4 ± 4 Pre-Treatmen
  57. 57. Diagnosis of the malocclusion• Write the most significant elements• Example – Class II division I malocclusion – Severe retrusion of the mandible – Increased overbite – Moderate crowding of the upper arch – Upper right canine palatally impacted
  58. 58. Problem listProblem Resolution CommentsClass II molar x Maintain There are potential Correct skeletal problems ImproveMandibular retrusion x Correct Reevaluate in 6 monthsOverjet Maintain Correct x ImproveImpacted canine Consultation with surgeon May need to be su Wait 6 months x Surgically exposedCrowding Rapid palatal expansion Extraction Arch development
  59. 59. ConclusionsIdentify the malocclusion presented and arrive to a proper diagnosis is the most important aspect in orthodontic treatment.Then the formulation of the objectives and establishment of a feasible treatment plan are indispensable in establishing the path to follow in treatmentObserve, wait, treat or refer, but above all be sure that you inform the patient and parent of the diagnosis and options of treatment so that THEY make an informed decision to chose the best course for the to follow.
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