1.odq. diagnositic short oct 17 slideshare english.pptx
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 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
Orthodontic Diagnosis Dr Donald TaylorDr Jean-Marc Retrouvey
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
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
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
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.Extraoral Examination Extraoral Examination 3. Functional examination (TMJ, orofacial muscles, tongue position, respiration, habits) 4. Intraoral Examination and Study Models 5. Radiographs • panoramic • cephalometric
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.
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
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
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
Functional ExaminationA malocclusion whoseorigin is skeletal withjoint degeneration.It can be seen that thecondyle on the left isactively resorbing
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
Intra-oral Photographs(obligatory and of diagnostic quality)
Study modelsStudy models must be of goodquality to allow proper study
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
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
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
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
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
2.Open Bite• Possible etiologies of open bite – Anterior position of the tongue( habits) – Genetic factors – Sleep apnea
3.Overjet • The etiology was multifactorial • Dentoalveolar • Skeletal • A combination of the above
Overjet The incisors seem to be very protrusive Equally, the mandible is very retrusive
Midlines• We use the reference line Reference to determine the different line midlines- maxillary and mandibular
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?
6. Tooth size/Arch sizeSmall lateral incisors Large teeth
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 = %
The Boley Gauge of Dr. RetrouveyHe as developed a computer program to calculate Bolton Discrepancy
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
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 les positive – Do we level? – How much space is necessary? – We need to analyze the cephalogram. Helps with differential diagnosis
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)
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 the amount of attached gingiva at labial of the lower incisors and facial features
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
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
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
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
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
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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