Clinical extraoral examination

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Seminar about Extra oral clinical examination in orthodontics

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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

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