This document discusses normal occlusion versus malocclusion and the diagnostic aids used to assess them. It outlines essential diagnostic aids like case history, clinical examination, study models, radiographs, and photographs. Supplementary diagnostic aids include specialized radiographs, EMG, TMJ imaging, and hormonal tests. A thorough case history and clinical examination involving extraoral soft tissue analysis, TMJ assessment, and intraoral evaluation of the teeth, gingiva and occlusion are essential to diagnosis. Radiographs like lateral cephalograms aid in determining underlying skeletal discrepancies.

1. DR CHANDRIKA KATTI
Reader, Dept Of Orthodontics.
Navodaya Dental College, Raichur.

4. NORMAL OCCLUSION VS. MALOCCLUSION
The first step towards cure is to know what the
disease is.

5. • Definition –
Is the study and interpretation of the data
concerning a clinical problem in order to
determine the presence or absence of abnormality.

7. DIAGNOSTIC AIDS:
1. Essential
2. Supplementary

8. Essential Diagnostic Aids
1. Case history

9. 2. Clinical Examination

10. 3. Study Models

11. 4. Mandatory radiographs

12. 5. Photographs

13. SUPPLEMENTAL DIAGNOSTIC AIDS
1. Specialized radiographs –
2. EMG
3. TMJ – Arthroscopy, MRI, CT
4. Hormonal assays/ Endocrine tests
5. Occlusograms
6. Diagnostic set-up

14. CASE HISTORY
• Name
• Age – general status of patient
- chronologic age = dental age?
- growth modulation
• Sex – Different timings of pubertal growth spurt
- For girls – 10 – 15 years of age.
- For boys – 12 - 17 years of age.

15. • Address and occupation
• Chief complaint – patient priorities and desires
• Medical history –childhood diseases retard growth
- cleft palate
- naso-respiratory obstruction
- medications, allergies

16. • Prenatal history
- Consanguinous marriage between parents
- Health of mother during pregnancy
- Placental transfer of drugs
• Natal history
- Forceps injury,
- Congenital anomalies

17. • Post natal history:
- Milestones
- General health
- Dental development
- History of fall - Condylar fracture

18. • History of habits :
- Thumb sucking
- Tongue thrusting
- Lip and nail biting
- Mouth-breathing .

19. • Family history :
Genetic influence on malocclusion

20. • Maturational status :
- Increase in height ,
- Change of voice in males ,
- Menarche in females .
• Past dental history :
- Caries, Restorative treatment
- Extraction of deciduous / permanent teeth
- Periodontal problems
- History of trauma

21. CLINICAL EXAMINATION
1. General examination
2. Extra-oral examination
- Frontal
- Profile
- Functional
3. Intra-oral examination
- Soft-tissue
- Hard-tissue

22. General examination :
1. Gait - Neuromuscular status
2. Posture - Mouth-breathers
3. Height, weight

23. 1. Body type – SHELDON’S SOMATOTYPES
Ectomorphic : tall & thin
Mesomorphic : average build
Endomorphic : short and fat

24. Extra-oral examination
A. FACIAL PROPORTIONS
B. FACIAL FORM

25. Cephalix Index
Maximum skull width
CI =
Maximum skull length

26. Morphologic facial index
• The form of the facial morphology has a certain
relationship to the shape of the dental arch.
Morphologic facial height
MFI =
Bizygomatic width.

27. Classification
• Leptoprosopic : long & narrow
face
• Mesoprosopic : Average
face/Normal face
• Euryprosopic : Broad & short
face

28. Analysis of facial form
1. FRONTAL EXAMINATION :
2. PROFILE EXAMINATION

29. ANALYSIS OF FACIAL FORM
ASYMMETRY
Frontal view
SYMMETRY

30. Vertical proportion

31. Lips
• Lip length
• Width
• Curvature

32. COMPETENT LIPS
CONSCIOUSLY
COMPETENT LIPS
CONFIGURATION OF LIPS

33. POTENTIALLY
COMPETENT LIPS
INCOMPETENT LIPS
EVERTED LIPS

34. Drop two lines
• One from the bridge of
the nose to the base of
the upper lip.
• Second from the that
point downward to the
chin.

35. Depending on the angle formed
Straight - Class I Convex – Class II Concave - Class III

36. KORKHAUS’ LIP STEPS-HORIZONTAL LIP ANALYSIS
POSITIVE LIP
STEP
NORMAL LIP
STEP
MARKED
NEGATIVE LIP
STEP

37. NASOLABIAL ANGLE
Angle between the tangents
subnasale-anterior most point of
columella and subnasale- labrale
superius
Less naso
labial angle
Enlarged naso
labial angle

38. LIP SUCKING
LIP THRUST
LIP HABITS

39. MENTO-LABIAL SULCUS
Normal Shallow Deep

40. Chin

41. • TEMPOROMANDIBULAR JOINT
EXAMINATION :
TMJ movements , clicking , tenderness
• MANDIBULAR MOVEMENTS :
Opening , protrusion , lateral excursions ,
deviations
• MUSCLE EXAMINATION :
Temporalis , masseter , medial and lateral
pterygoids

42. LATERAL PALPATION OF T.M.J
POSTERIOR PALPATION OF T.M.J
AUSCULTATION OF T.M.J

43. PALPATION OF LATERAL
PTERYGOID MUSCLE
PALPATION OF
TEMPORALIS MUSCLE
PALPATION OF
MASSETER MUSCLE

44. The first step in functional analysis
is to examine the patients
maximum jaw opening
For adults – 45 mm
Children - < 45 mm


45. INTRA ORAL EXAMINATION :
• Oral hygiene
• Teeth present
• Arch form

46. • In occlusion :
Incisor , canine , molar relationships
Overjet and overbite

47. • Frenal attachment
• Gingiva
• Visible pathology , missing teeth , over-
retained deciduous teeth

48. SUPPLEMENTARY
DIAGNOSTIC AIDS

49. • Specialized radiographs

50. LATERAL CEPHALOGRAMS
• TRACING

51. OTHER RADIOGRAPHS :
• PA cephalogram
Facial asymmetry
• TMJ radiographs
• Specific Intra-oral
radiographs

52. • EMG
• TMJ

53. FACTORS INFLUENCING TREATMENT
PLANNING
AGE
TREATMENT
MODALITY
Growth Modulation
Orthodontic
Surgical