Ortho

1. ANALYSIS OF RECORDS
Dr. Zafar Ul Islam
Assistant Professor Orthodontics

2. Analysis of Records
 Cast analysis
 Radiographic Analysis

3. Cast Analysis
 Symmetry
 Arch form
 Alignment
 Dental relations
 Space analysis
 Bolton ratio

4. Arch Symmetry
 Transparent ruled grid
placed on maxillary cast
and oriented to mid
palatal raphe

5. Computer Software
 Alternately we can use
software program to see
asymmetry of the dental
arch

6. Arch Form
 Tapered
 Squarish
 Ovoid

7. Alignment
 Buccoversion
 Plato/lingo version
 Torsi version

8. Dental Relations
 Class I
 Class II
 Class III
 Overjet
 Overbite
 Cross bite
 Midlines

9. Molars and Canine Relations
class I
Class II
Class III

10. Incisor Class II Relations
Class II div 1 Class II div 2

11. Overjet
 Horizontal overlap of the
lower incisors by upper
incisors
 Positive overjet
 Reverse overjet

12. Overbite
 Vertical overlap of the
lower incisors by upper
incisors
 Normal overbite is 1 to
3mm
 Openbite
 Deepbite

13. Crossbite
 Transverse discrepancy
of the position of upper
and lower teeth
 May be unilateral or
bilateral
 Anterior crossbite
 Posterior crossbite
 Single tooth crossbite

14. Midlines
 Upper dental midline to
midpalatal raphae
 Lower midline to lingual
frenum
 Upper midline to lower
midline

15. SPACE ANALYSIS

16. Space Analysis
 Space available
 Space required
 Space available – space required = crowding/spacing

17. Space Available
 Also called arch
perimeter
 Extends between mesial
of first permanent
molars of either side of
arch
 Measured by two
methods
1. Brass wire
2. Varnier caliper/divider

18. Space Available
 Use of brass wire
 Adapt along arch from mesial of first molar on one
side to other

19. Space Available
 Use of vernier caliper
 Measured in 4 quadrants

20. Space Required
 Space required is the combined mesiodistal widths of
premolars, canines and incisors

21. Mixed Dentition Analysis

22. Mixed Dentition Analysis
 Space available
 Space required

23. Space Available
 Measured from mesial of first permanent molars to
mesial of deciduous canine

24. Space Required
 Three methods to find out mesiodistal width of
unerupted canine and premolars
1. Tanaka and Johnston
2. Moyer’s predictability table
3. Radiographic

25. Tanaka and Johnston
 Measure mesiodistal width of mandibular incisors
 Sum the mesiodistal widths of mandibular incisors
and divide by 2
 For mandibular canine and premolars MD width add
10.5
 For maxillary canine and premolars MD width add 11

26. Tanaka and Johnston

27. Moyer’s Methods
 Measure the mesiodistal width of mandibular
incisors
 See for the value of premolars and canine at 75% in
the table

28. Moyer’s Table

29. Moyer’s Table

30. Radiographic Method
 Dental cast and patient radiograph is required
 Radiograph may be periapical or OPG
 Mesiodistal width of teeth is measured on cast and
radiograph
 Calculate with formula x = x’y/y’
 X is unerupted tooth
 Y is erupted tooth on cast
 X’ is unerupted tooth on radiograph
 Y’ is erupted tooth on radiograph

31. Radiographic Method

32. Total space required
 I + 2X + ceph correction + curve of Occlusion
 I is the MD width of permanent incisors
 2X is the combined MD width of canines and
premolars
 Ceph correction is Proposed FMIA – Actual FMIA ×
0.8
 Curve of occlusion is depth of curve of spee
bilaterally/2 + 0.5

33. Total Space Required
 FMIA  Measure curve of
Occlusion

34. Bolton Analysis
 Tooth size discrepancy of maxillary and mandibular
arch
 More than 2mm discrepancy need revision and
diagnostic setup
 7th key of occlusion
 Discrepancy will not allow perfect class I occlusion

35. Bolton Analysis
 Measure mesiodistal width of all teeth in maxilla and
mandible from first molar to first molar
 Add the widths of teeth in mandible and maxilla
separately

36. Bolton Analysis
 Overall Ratio (X)
 X = Sum of mandibular 12/sum of maxillary 12 ×100
 Normal value is 91.3
 If X is more than 91.3
 Desired sum of mand 12 = actual sum of max 12×91.3
100
 Overall mandibular tooth excess =
Actual sum of man 12 - desired sum of man 12 = ------mm

37. Bolton Analysis
 If X is less than 91.3
 Desired sum of max 12 = actual sum of mand 12 × 100
91.3
 Overall maxillary tooth material excess =
Actual sum of max 12 – desired sum of max 12 = ------mm

38. Bolton Analysis
 Anterior Ratio (Y)
 Y = Sum of mandibular 6/sum of maxillary 6 ×100
 Normal value is 77.2
 If Y is more than 77.2
 Desired sum of mand 6 = actual sum of max 6×77.2
100
 Anterior mandibular tooth excess =
Actual sum of man 6 - desired sum of man 6 = ------mm

39. Bolton Analysis
 If Y is less than 77.2
 Desired sum of max 6 = actual sum of mand 6 × 100
77.2
 Anterior maxillary tooth material excess =
Actual sum of max 6 – desired sum of max 6 = -------mm

40. Radiographic Analysis
 OPG
 Lateral cephalograph

41. OPG
 Number of teeth
 Carious teeth
 Impacted teeth
 Eruption of teeth
 Root parallelism
 Alveolar bone loss

42. OPG

43. Adjunctive Radiographs
 Periapical
 Bite wing
 Occlussal
 CBCT

44. Guidelines for Radiographs

45. Periapical Radiograph
 Periapical pathology
 Root resorption
 Root development
 Fillings/RCTs
 Bone loss
 Ankylosis
 Dilacerations

46. Bite wing Radiograph
 Primarily used for
detection of multiple
crown caries

47. Occlussal Radiographs
 Impacted teeth
 Dilacerations

48. CBCT
 More complex relations
of the structures can be
seen
 Cleft lip palate
 Multiple
supernumeraries
 Impactions difficult to
locate with other
radiographs

49. Lateral Cephalograph
 Standardization
 Soft tissue visible
 Used for skeletal, dental
and soft tissue relations
 Growth prediction
 Treatment planning

50. Ceph Tracing
 Trace the lateral ceph
landmarks on acetate
paper

51. Ceph Tracing

52. Ceph Analysis
 Sagittal skeletal analysis
 Vertical skeletal analysis
 Dental analysis
 Soft tissue analysis

53. Sagittal skeletal analysis
 SNA
 SNB
 ANB
 Witt’s value

54. SNA
 Anteroposterior relation
of maxilla to cranial base
 Normal value is 82 ± 2

55. SNB
 Anteroposterior relation
of mandible to cranial
base
 Normal value 80 ± 2

56. ANB
 Difference of SNA and
SNB
 Normal value is 2 ± 2

57. Witt’s Value
 Anteroposterior relation
of maxilla and mandible
 Confirmation of the
angle ANB
 Normal value is -1 – 0

58. Interpretation
 Class I : ANB 0 – 4
 Class II : ANB > 4
 Class III : ANB < 0

59. Vertical Skeletal Analysis
 SN-MP
 FMA
 SN-PP
 PP-MP
 Y axis
 Inclination angle
 Gonial angles
 Facial height ratios

60. SN-MP
 Vertical mandibular
relation to cranial base
 Normal value is 32 ± 4

61. FMA
 Frankfort to mandibular
plane angle
 Normal value is 25±4

62. SN-PP
 Vertical relation of
maxilla to cranial base
 Normal value is 8 ± 3

63. PP-MP
 Rotation of maxilla to
mandible
 Normal value is 21±5

64. Y axis
 Rotation of the mandible
 Normal value is 60±4

65. Inclination angle
 Rotation of the maxilla
 Normal value is 84±4

66. Gonial angles
 Rotation of the mandible
 Normal value 124±3
 Upper gonial angle
 Normal value 50±2
 Lower gonial angle
 Normal value 74±2

67. Face height ratios
 Anterior face height ratio
 Normal value 54±4%
 Posterior face height
ratio
 Normal value 65±4%

68. Vertical skeletal interpretation
 Normal angle case
 Low angle case
 High angle case

69. Linear Measurement
 Anterior cranial base
 Maxilla length
 Mandible length
 Ramus height

70. Anterior cranial base
 Sella entrance to nasion
 Assess the proportional
lengths of maxilla and
mandible
 Mean value at age 8 is
68.6mm for males and
65.9mm for females
 Incremental increase of
.7mm/year for males and
.5mm/year for females
up to age 18

71. Maxillary Length
 From PNS to Point A
perpendicular on Palatal
plane
 Mean value is 45mm at
age 8
 Annual increase of
1.2mm for males and
.8mm for females up to
age 16

72. Mandibular Length
 Measured from gonion to
perpendicular from
pogonion on mandibular
plane
 Mean value is 68mm at
age 8
 Annual increase of 2mm
for males and 1.4mm for
females up to age 16

73. Ramus Height
 Measured from condylon
to gonion
 Mean value is 46mm at
age 8
 Annual increase is 2mm
for males and 1.2mm for
females up to age 16

74. Dental Analysis
 UI-NA distance
 UI-NA angle
 LI-NB distance
 LI-NB angle
 UI-SN
 IMPA
 Holdaway ratio

75. UI-NA
 Position of the upper
incisor to maxilla
 Normal distance is 4mm
 Normal angle is 22
degrees

76. LI-NB
 Position of the lower
incisor to mandible
 Normal distance is 4 mm
 Normal angle is 25
degrees

77. UI-SN
 Inclination of maxillary
incisor
 Normal value is 102±5
 Proclined
 Retroclined

78. IMPA
 Lower incisor inclination
 Normal value is 90±4
 Proclined
 Retroclined

79. Holdaway Ratio
 Balance of lower incisor
and bony chin for
stability
 Normal ratio is 1:1

80. Soft Tissue Analysis
 Rickets' E plane
 Nasolabial angle

81. Rickets’ E Plane
 Shows the position of
upper and lower lip to
chin and nose
 Normal value for upper
lip is -3±2mm
 Normal value for lower
lip is -2±2
 Recumbent lips
 Procumbent lips

82. Nasolabial Angle
 Shows the position of the
upper lip
 Normal ranges from 90
degrees to 110 degrees
 Obtuse
 Acute

83. THANK YOU