Clinical examination in orthodontics.pdf
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Clinical examination in orthodontics by DrNayAung PhD
![Clinical examination in Orthodontics
(compiled by Dr. Nay Aung, BDS, PhD)
Orthodontic examination áááŻáᏠáá°ááŹáá
áşáááŹááşáááąá¸áááşáąá¸áá˛ááᯠáááşááŹááááşáąá¸á á
áááşááŤáááşá
áá°ááŹáᲠá˛áˇgeneral stage of development, height, presence of secondary sexual characteristics á
ááŹááá˝áąáááŻ
áááá˛áˇáşáážáŻá
á
áşáááąá¸áááąá¸ ááťááşááááááŻááşá áąá¸áá˛á˛áˇ amount of growth remaining ááᯠáááşáąá¸ááááŻááşááŤááá˛áˇáşáááşá ááĄáááşáąá¸ááŹ
orthodontic clinical examination áĄááááŹááşáąá¸ááᯠáĄááááşáąá¸ááťáĽáşáąá¸ áááąáŤáş áá á˝áąáŹáąá¸áᏠááá
áşááŤáááşá
Extra-oral assessment Intraoral assessment
1. Assessment of skeletal pattern
⢠Antero-posterior
⢠Vertical
⢠Transverse
2. Assessment of soft tissues
⢠Lips
⢠Nasolabial angle
3. TMJ
⢠Oral hygiene
⢠Dental development
⢠Dental/mucosal pathology
⢠Tongue
⢠Tooth position within and in between the
arches
Extra-oral assessment áĄáááᲠá˛áˇ áá°ááŹáᲠá˛áˇ áĄáááąáŤáş áᲠá˛áˇ
ááĄáŹááşáááąá¸áááŻáąá¸ááá˝áąáᲠá˛áˇ áĄááááşáĄáááşáááşá
ááşáážáŻáááŻ
skeletal pattern assessment áááŻááşáááŤáááşá Antero-posterior, vertical, transverse relationship ááá˝áąáááŻ
áááá˛áˇáşáááŤáááşá Lips, nasolabial angle á
áá˛á˛áˇ soft tissues ááá˝áąáááŻáááşáąá¸ assessment áááŻááşáááá˛áˇáşáááŤáááşá
á˝áąáŹáąá¸áááᯠáážáŻááááźáŻáááŻááşáááşááááşáąá¸á TMJ áᲠá˛áˇáĄááááĄááááᯠááŹáąá¸áááŤáááşá
Intra-oral assessment áĄáááᲠá˛áˇ áá°ááŹáᲠá˛áˇ á˝áąáŹáąá¸ááá˛áˇáşááśáá˝áąááşáąá¸ááťááşáąá¸ááŹáááąá¸áĄááááĄááá áĄáááŹáąá¸ á˝áąáŹáąá¸ááá˛áˇáşááśáá˝áąááşáąá¸
áááŹááŤááťáŹáąá¸ á-ááá áááąá¸áááŻáąá¸áá
áşáááŻááťááşáąá¸á
ááŹááá˛á˛áˇ á˝áąáŹáąá¸ááá˝áąáᲠá˛áˇáĄáááĄááŹáąá¸á áĄáááąáŤáş áᲠá˛áˇ
ááĄáŹááşáááąá¸áááŻáąá¸ááŹááá˛á˛áˇ á˝áąáŹáąá¸ááá˝áą
áᲠá˛áˇ
áĄááááşáĄáááşáĄáááĄááŹáąá¸ááá˝áąááᯠá
á
áşáááąá¸áááá˛áˇáşáááŤáááşá áá°áąá¸áááŹáąá¸ááťááşááá˝áąááááş ááŹá˛áˇááááŹáá˛áˇáşáá˛á ááŹááá
áşááᯠá˛áˇ
áá˛
á
áááá˛áˇáş ááĄáŹááşáááŻááşááŹáąá¸áááąá¸ áááşáááşáąá¸áááşááŹáąá¸áááŻááşááŤáááşá áá°ááŹáᏠá˝áąáŹáąá¸ááá˛áˇáşááśáá˝áąááşáąá¸ááᯠááááŻááşáá
áááŻááşáá˛á˛áˇ
áĄáá°áĄááťáá˛áˇáşá áĄááá˛áˇáĄááťáá˛áˇáşááá˝áąá-áááááŻáááşáąá¸ ááŹáąá¸ áá˛áˇáşááŤáááşá áá°ááŹáᏠáááşáá
ááŻááşáááşáá˛á˛áˇáĄááťáá˛áˇáşááááş
áĄá˛á˛áˇááááşáááťáŹááşáąá¸áááąá¸áᏠcallus ááᯠá˛áˇ
áááąáŤáşáá˛á˛áˇ ᥠáŹáąá¸ááŹááśááŻá
áśáááąá¸ ááááááşááŤáááşá áááş ááşáąá¸áááŻááşáááşáá˛á˛áˇ
áá°ááŹááá˝áąáᲠá˛áˇáááş ááşáąá¸áᲠá˛áˇ
ááśááŻá
áśáááŻáááşáąá¸ á
á
áşáááąá¸áááá˛áˇáşáááŻááşááŤáááşá
Habits
Lower lip biting â retroclined lower incisors [Class II division 1]
Nail biting â tooth wear + root resorption](https://image.slidesharecdn.com/clinicalexaminationinorthodontics-220629143216-8121118d/85/Clinical-examination-in-orthodontics-pdf-1-320.jpg)
![Extra-oral Assessment
Assessment of skeletal pattern
Anteroposterior dimension
ááááĽáąá¸ááśááŻáąá¸ áá°ááŹááᯠnatural head position (standardized and reproducible) áᏠááŹáąá¸áááá˛áˇáşáááŤáááşá
Natural head position áááŻáᏠáá°ááŹááᯠáááşáááşáááŻááşáááŻááşáąá¸á ááşá áŹáá˛áˇáş ááş áŹáááá
áááąá¸ áá°ááŹáᲠá˛áˇ
ááťááşááśááŻáąá¸áᲠá˛áˇ
áá
áşáááşáąá¸áááşáąá¸ ááážáąáˇáááşááŹááááá˛á˛áˇ point áá
áşáááŻááᯠáááá˛áˇáşáááŻááşáąá¸ááŹáąá¸áᏠááá
áşááŤáááşá á˝áąáŹáąá¸ááá˝áąáááŻáááşáąá¸
áĄáśááááşááááŹááťáźáŻáąá¸ááááŻááşáᲠááśááŻáááşáĄáááĄááŹáąá¸ ááŹáąá¸áááŤáááşá (Teeth should be slightly in occlusion.)
áá°ááŹáᲠá˛áˇ áĄáááąáŤáş áᲠá˛áˇ
ááĄáŹááşáááąá¸áááŻáąá¸ááá˝áąáᲠá˛áˇ ááážáąáˇáááşáĄááťááśááŻáąá¸áĄáááşááá˝áąááᯠáĄáááąáŤáşáážáŻááşáááşáąá¸áᲠá˛áˇ ááĄáŹááş
áážáŻááşáááşáąá¸ááá˝áąáᲠá˛áˇ
áĄáááááááá˛áˇáş ááśááŻáᏠááááŹáąá¸áá˛á˛áˇáĄáááŻááşáąá¸ á
ááşáąá¸áááá˛áˇáşáááŻááşááŤáááşá
Class I The mandible lies 2-3 mm posterior to the maxilla [the straight profile]
Class II The mandible lies retrusive to the maxilla [convex profile]
Class III The mandible lies protrusive to the maxilla [concave profile]
áá°ááŹáᲠá˛áˇanterior limit of cranial base ááᯠáááŻááşá
áŹáąá¸áááźáŻáá˛á˛áˇ zero meridian line áá˝áąá˛áááá˛áˇáşáááąá¸ soft tissue A
point, soft tissue B point ááá˝áąáᲠá˛áˇáážáŻááşáąá¸ááĽáşáááá˛áˇáşáááŻááşááŤáááşá ááśááŻáááşáááŻáááş soft tissue A point á álineáᲠá˛áˇááážáąáˇáááş
2-3mmáĄáá˝áąáŹáᏠááááąá¸ soft tissue B point á álineáᲠá˛áˇáááŹááşáááş 0-2mmáĄáá˝áąáŹáᏠááááááşááŤáááşá
(a) The Ricketts zero-meridian line is a constructed vertical line dropped perpendicular to the Frankfort Plane (or horizontal) from Nâ. It
gives an indication of the antero-posterior position of Pgâ, which will lie behind the line in class II cases with mandibular retrusion (b) and
in front in cases with mandibular prognathism (c).](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Clinical examination in orthodontics.pdf
- 1. Clinical examination in Orthodontics (compiled by Dr. Nay Aung, BDS, PhD) Orthodontic examination áááŻáᏠáá°ááŹáá áşáááŹááşáááąá¸áááşáąá¸áá˛ááᯠáááşááŹááááşáąá¸á á áááşááŤáááşá áá°ááŹáᲠá˛áˇgeneral stage of development, height, presence of secondary sexual characteristics á ááŹááá˝áąááᯠáááá˛áˇáşáážáŻá á áşáááąá¸áááąá¸ ááťááşááááááŻááşá áąá¸áá˛á˛áˇ amount of growth remaining ááᯠáááşáąá¸ááááŻááşááŤááá˛áˇáşáááşá ááĄáááşáąá¸áᏠorthodontic clinical examination áĄááááŹááşáąá¸ááᯠáĄááááşáąá¸ááťáĽáşáąá¸ áááąáŤáş áá á˝áąáŹáąá¸áᏠááá áşááŤáááşá Extra-oral assessment Intraoral assessment 1. Assessment of skeletal pattern ⢠Antero-posterior ⢠Vertical ⢠Transverse 2. Assessment of soft tissues ⢠Lips ⢠Nasolabial angle 3. TMJ ⢠Oral hygiene ⢠Dental development ⢠Dental/mucosal pathology ⢠Tongue ⢠Tooth position within and in between the arches Extra-oral assessment áĄáááᲠá˛áˇ áá°ááŹáᲠá˛áˇ áĄáááąáŤáş áᲠá˛áˇ ááĄáŹááşáááąá¸áááŻáąá¸ááá˝áąáᲠá˛áˇ áĄááááşáĄáááşáááşá ááşáážáŻááᯠskeletal pattern assessment áááŻááşáááŤáááşá Antero-posterior, vertical, transverse relationship ááá˝áąááᯠáááá˛áˇáşáááŤáááşá Lips, nasolabial angle á áá˛á˛áˇ soft tissues ááá˝áąáááŻáááşáąá¸ assessment áááŻááşáááá˛áˇáşáááŤáááşá á˝áąáŹáąá¸áááᯠáážáŻááááźáŻáááŻááşáááşááááşáąá¸á TMJ áᲠá˛áˇáĄááááĄááááᯠááŹáąá¸áááŤáááşá Intra-oral assessment áĄáááᲠá˛áˇ áá°ááŹáᲠá˛áˇ á˝áąáŹáąá¸ááá˛áˇáşááśáá˝áąááşáąá¸ááťááşáąá¸ááŹáááąá¸áĄááááĄááá áĄáááŹáąá¸ á˝áąáŹáąá¸ááá˛áˇáşááśáá˝áąááşáąá¸ áááŹááŤááťáŹáąá¸ á-ááá áááąá¸áááŻáąá¸áá áşáááŻááťááşáąá¸á ááŹááá˛á˛áˇ á˝áąáŹáąá¸ááá˝áąáᲠá˛áˇáĄáááĄááŹáąá¸á áĄáááąáŤáş áᲠá˛áˇ ááĄáŹááşáááąá¸áááŻáąá¸ááŹááá˛á˛áˇ á˝áąáŹáąá¸ááá˝áą áᲠá˛áˇ áĄááááşáĄáááşáĄáááĄááŹáąá¸ááá˝áąááᯠá á áşáááąá¸áááá˛áˇáşáááŤáááşá áá°áąá¸áááŹáąá¸ááťááşááá˝áąááááş ááŹá˛áˇááááŹáá˛áˇáşáá˛á ááŹááá áşááᯠá˛áˇ áᲠá áááá˛áˇáş ááĄáŹááşáááŻááşááŹáąá¸áááąá¸ áááşáááşáąá¸áááşááŹáąá¸áááŻááşááŤáááşá áá°ááŹáᏠá˝áąáŹáąá¸ááá˛áˇáşááśáá˝áąááşáąá¸ááᯠááááŻááşáá áááŻááşáá˛á˛áˇ áĄáá°áĄááťáá˛áˇáşá áĄááá˛áˇáĄááťáá˛áˇáşááá˝áąá-áááááŻáááşáąá¸ ááŹáąá¸ áá˛áˇáşááŤáááşá áá°ááŹáᏠáááşáá ááŻááşáááşáá˛á˛áˇáĄááťáá˛áˇáşááááş áĄá˛á˛áˇááááşáááťáŹááşáąá¸áááąá¸áᏠcallus ááᯠá˛áˇ áááąáŤáşáá˛á˛áˇ ᥠáŹáąá¸ááŹááśááŻá áśáááąá¸ ááááááşááŤáááşá áááş ááşáąá¸áááŻááşáááşáá˛á˛áˇ áá°ááŹááá˝áąáᲠá˛áˇáááş ááşáąá¸áᲠá˛áˇ ááśááŻá áśáááŻáááşáąá¸ á á áşáááąá¸áááá˛áˇáşáááŻááşááŤáááşá Habits Lower lip biting â retroclined lower incisors [Class II division 1] Nail biting â tooth wear + root resorption
- 2. Extra-oral Assessment Assessment of skeletal pattern Anteroposterior dimension ááááĽáąá¸ááśááŻáąá¸ áá°ááŹááᯠnatural head position (standardized and reproducible) áᏠááŹáąá¸áááá˛áˇáşáááŤáááşá Natural head position áááŻáᏠáá°ááŹááᯠáááşáááşáááŻááşáááŻááşáąá¸á ááşá áŹáá˛áˇáş ááş áŹáááá áááąá¸ áá°ááŹáᲠá˛áˇ ááťááşááśááŻáąá¸áᲠá˛áˇ áá áşáááşáąá¸áááşáąá¸ ááážáąáˇáááşááŹááááá˛á˛áˇ point áá áşáááŻááᯠáááá˛áˇáşáááŻááşáąá¸ááŹáąá¸áᏠááá áşááŤáááşá á˝áąáŹáąá¸ááá˝áąáááŻáááşáąá¸ áĄáśááááşááááŹááťáźáŻáąá¸ááááŻááşáᲠááśááŻáááşáĄáááĄááŹáąá¸ ááŹáąá¸áááŤáááşá (Teeth should be slightly in occlusion.) áá°ááŹáᲠá˛áˇ áĄáááąáŤáş áᲠá˛áˇ ááĄáŹááşáááąá¸áááŻáąá¸ááá˝áąáᲠá˛áˇ ááážáąáˇáááşáĄááťááśááŻáąá¸áĄáááşááá˝áąááᯠáĄáááąáŤáşáážáŻááşáááşáąá¸áᲠá˛áˇ ááĄáŹááş áážáŻááşáááşáąá¸ááá˝áąáᲠá˛áˇ áĄáááááááá˛áˇáş ááśááŻáᏠááááŹáąá¸áá˛á˛áˇáĄáááŻááşáąá¸ á ááşáąá¸áááá˛áˇáşáááŻááşááŤáááşá Class I The mandible lies 2-3 mm posterior to the maxilla [the straight profile] Class II The mandible lies retrusive to the maxilla [convex profile] Class III The mandible lies protrusive to the maxilla [concave profile] áá°ááŹáᲠá˛áˇanterior limit of cranial base ááᯠáááŻááşá áŹáąá¸áááźáŻáá˛á˛áˇ zero meridian line áá˝áąá˛áááá˛áˇáşáááąá¸ soft tissue A point, soft tissue B point ááá˝áąáᲠá˛áˇáážáŻááşáąá¸ááĽáşáááá˛áˇáşáááŻááşááŤáááşá ááśááŻáááşáááŻáááş soft tissue A point á álineáᲠá˛áˇááážáąáˇáááş 2-3mmáĄáá˝áąáŹáᏠááááąá¸ soft tissue B point á álineáᲠá˛áˇáááŹááşáááş 0-2mmáĄáá˝áąáŹáᏠááááááşááŤáááşá (a) The Ricketts zero-meridian line is a constructed vertical line dropped perpendicular to the Frankfort Plane (or horizontal) from Nâ. It gives an indication of the antero-posterior position of Pgâ, which will lie behind the line in class II cases with mandibular retrusion (b) and in front in cases with mandibular prognathism (c).
- 3. Vertical dimension áá°ááŹáᲠá˛áˇ vertical skeletal dimension á the degree of vertical incisor overlap, overall facial esthetics, lip competency á áá˛á˛áˇáĄááťááşááá˝áąáááąáŤáşáᏠáá˝ážááşáąá¸áááŻáąá¸áážáŻááááŻááşááŤáááşá Vertical dimension ááᯠlower anterior facial height (LAFH) áᲠá˛áˇFrankfort mandibular plane angle (FMPA)ááá˝áąááᯠᥠáśááŻáąá¸áááźáŻáááąá¸ á á áşáááąá¸áááá˛áˇáşáááŻááşááŤáááşá LAFH ááᯠáááŻááşáąá¸áááá˛áˇáşáá˛á˛áˇáĄá፠upper and lower facial heights ááá˝áąáᏠááťážáááááąá¸ááŤáąá¸ ááá áá˛áˇáşááŤáááşá FMPA ááᯠáááŻááşáąá¸áááá˛áˇáşááááşáąá¸áĄáŹáąá¸áááá˛áˇáş LAFH áᲠá˛áˇposterior facial height (ramus height)ááᯠá˛áˇ áᲠá˛áˇáĄááááşáĄáááşáááşáá˝áąááş áážáŻááᯠáááŻááşááŤáááşá FMPA áᏠááśááŻáááşáááŻáááş Frankfort plane áᲠá˛áˇMandibular plane ááᯠá˛áˇááśááŻáááşáᏠocciput region áᏠáááááŤáááşá FMPA á ááśááŻáááşáááşááťáŹáąá¸áááááş ááśááŻáááşáᏠocciput ááážáąáˇá ááśááŻáááşáááşáááşáąá¸áááááş ááśááŻáááşáᏠocciput áááŹááşáááşáᏠáááŹááşááááŤááá˛áˇáşáááşá Transverse dimension áá°ááŹáᲠá˛áˇ transverse dimension ááᯠáśááŻáąá¸ ááşáááŻááşááᯠá˛áˇfacial symmetry á-ááá áĄáááąáŤáş áᲠá˛áˇ ááĄáŹááşáááąá¸áááŻáąá¸ááá˝áąáᲠá˛áˇ arch width ááá˝áą áááŻááşáááťáŹáááá˝áąáąá¸áážáŻá-ááááᯠá á áşáááąá¸áááá˛áˇáşáááŻááşááŤáááşá
- 4. Facial symmetry ááᯠá á áşáá˛á˛áˇáĄá፠soft tissue nasion á middle part of the upper lip at the vermilion border áᯠá˛áˇáááşááŹáąá¸áá˛á˛áˇ facial midline (FM)áá áşáááŻááᯠáá˝áąá˛áááŻááşááŤáááşá ááśááŻáááşáááŻáááş áĄá˛á˛áˇááááşáá˝áąá˛ááŹáąá¸áá˛á˛áˇááťáĽáşáąá¸áᏠáááąá¸á áᲠá˛áˇ áĄáááşáĄáááşááᯠááááş á˝áąáŹáąá¸ áá˛áˇáşááŤáááşá ááááşááᯠá˛áˇááááşá á˝áąáŹáąá¸áá°áąá¸áááŻáááş áá°ááŹáᏠmaxillary occlusal plane canting (compensatory canting) á-áá á á áşáááá˛áˇáş áá˛áˇáşááŤáááşá Occlusal interference ááááááş á˝áąáŹáąá¸á áá˛á˛áˇ áĄá፠lateral displacement of the mandible ááááŹáá˛áˇáş asymmetries in the chin point ááᯠááá áşáá áááŻááşááŤáááşá Arch width ááᯠááá˛áˇááŹáááá˛áˇáşáááş áĄáááąáŤáşáááąá¸áááŻáąá¸áᏠááĄáŹááşáááąá¸áááŻáąá¸áááş áĄáááşáąá¸áááşáááŻááťááşááŹááᯠááá˝áąážáąáˇ áááŻááşááŤáááşá áá áşááŤáá áşááśáᏠáĄáááąáŤáşáááąá¸áááŻáąá¸áᲠá˛áˇááĄáŹááşáááąá¸áááŻáąá¸ááá˝áąáᲠá˛áˇáĄááťááşá ááśááŻáááşáááááááá˛áˇáş posterior crossbite ááá áşááááŹááťáźáŻáąá¸ááᯠááááşááá˝áąážáąáˇáááá˛áˇáááŤáááşá áĽááᏠ- ááĄáŹááşáááąá¸áááŻáąá¸á ááážáąáˇáááşááᯠáááŹááşáá˝áąááşáąá¸áááááş ááĄáŹááşáááąá¸áááŻáąá¸áᲠá˛áˇ áááŻááťááşáá˛á˛áˇáááŹááşáááşáááŻááşáąá¸á ááážáąáˇáááŹááşáá˝áąááşáąá¸ááááŹááᯠá˛áˇ áĄáááąáŤáşáááąá¸áááŻáąá¸áᲠá˛áˇ ááťááşáááá˛áˇáşáá˛á˛áˇáĄá፠posterior crossbite ááśááŻá áś ááá áşáááááşááŤáááşá Assessment of soft tissues Lips áážáŻááşáááşáąá¸áᲠá˛áˇ áááş ááşáááąá¸ ááá˛áˇááŹáá˛á˛áˇáĄá፠lower lip lineáᲠá˛áˇáááşáááśááŻááᯠááá˛áˇááŹáááŤáááşá ááśááŻáááş at rest áĄááááĄáááᏠlower lip áᲠá˛áˇmaxillary incisors áááŹáąá¸á vertical relationship ááᯠááá˛áˇááŹááááşáąá¸ááᯠá˛áˇ áááşáąá¸ áááŻáááŻááş ááŤáááşá ááśááŻáááşáĄáááĄááŹáąá¸áááŻáááş lower lip áᏠupper central incisor crownáᲠá˛áˇ middle 3rd áĄáááŻááşáąá¸áááąáŤáşáᏠááá áá˛áˇáşááŤáááşá ááááşááᯠá˛áˇáĄá˛á˛áˇáleveláĄáááşá áááŹááşáááááş maxillary incisor retroclination [class II div 2]ááá áşáááŻááşáááąá¸ áĄá˛á˛áˇálevelááĄáŹááşááᯠáááŹááşáááááş maxillary incisor proclination [class II div 1] ááá áşáááááŻááş ááŤáááşá ( áááŹáąá¸áááş - class II div 1 áá°ááŹááᯠá˝áąáŹáąá¸áááᯠáážáŻáááąá¸áĄáááąá¸ overjet correction áááŻááşááąá¸ á˝áąáŹáąá¸áááş áááŹááşá lower lip á maxillary central incisor áᲠá˛áˇincisal 3rd áááŹááşáááŻá áááśááŻáąá¸ááááááş áááááşáᏠstability áááá áá ááťáŹáá°áąá¸ááᯠá˛áˇáááŻááááŤáááşá) áĄááťáźáŻáąá¸ ááąá¸ááá˝áąáᲠá˛áˇlip length = 20-22 mm ááááąá¸ áĄááťáźáŻáąá¸ áŹáąá¸ááá˝áąáᲠá˛áˇlip length = 22-24 mm áá á˛áˇ áş ááááŻááşááŤáááşá áážáŻááşáááşáąá¸áᲠá˛áˇlip fullness and tone, lip competency, method of achieving anterior oral seal at rest and at swallowing ááᯠá˛áˇ áááŻáááşáąá¸ á á áşáááąá¸áááá˛áˇáşáááŤáááşá lip competency á-ááááᯠáááá˛áˇáşáá˛á˛áˇáĄá፠áá°ááŹá áĄáŹáąá¸á ááŻááşáááŻááşáááááşáąá¸áááá˛áᲠá˛áˇáĄáááąáŤáş áᲠá˛áˇ ááĄáŹááşáážáŻááşáááşáąá¸ááťááşáąá¸áááąá¸ lip seal ááááááş competent lips ááᯠá˛áˇ ááşáááşááŤáááşá Upper incisors ááá˝áąáᲠá˛áˇ áĄáááĄááŹáąá¸ááááŹáá˛áˇáş lip seal áááᯠá˛áˇáĄáááŹáá˛áˇáşáĄáááşááá áşááááŹááťáźáŻáąá¸ááᯠpotentially competent ááᯠá˛áˇ ááşáááşááŤáááşá áĄáááąáŤáş áᲠá˛áˇ ááĄáŹááşáážáŻááşáááşáąá¸áááᯠá˛áˇáážáŻááşáááşáąá¸áááŻáĄáááşáąá¸á ááŻáááąá¸ áááşá áááş incompetent lip ááᯠá˛áˇ ááşáááşáááąá¸ áĄá˛á˛áˇááááŻáĄááááĄáááᏠexcessive mentalis muscle contraction ááááŹáá˛áˇáş áá°ááŹáᲠá˛áˇ áááąá¸á áᏠáĄáááąá¸áĄááááŹááşáąá¸ááĄáá˝áąá á˛áˇ áşáĄáááŹááşááśááŻá áśáááąá¸ááá˝áą ááááááşááŤáááşá
- 5. Lip fullness and tone Lip competency A. Competent lips: a lip seal is produced with minimal muscular effort when the mandible is at rest position B. Potentially competent: positioning of the upper incisors prevents a comfortable lip seal C. Incompetent: excessive muscular activity is required to achieve lip seal [the interlabial distance at rest is >4mm] Signs of excessive muscular activity Flattening of the labio mental fold when the lips are held together Puckering of the skin overlying the chin [due to the mentalis muscle contraction] Method of achieving anterior oral seal at rest and at swallowing áĄáááąáŤáşáážáŻááşáááşáąá¸áᲠá˛áˇááĄáŹááşáážáŻááşáááşáąá¸ááá˝áąáᏠRickettâs esthetic line [E-line]áᲠá˛áˇáááşáááŹááşáĄáá˝áąáŹáĄáááąá¸ áᏠááááá˛áááŻááŹáááŻáááşáąá¸ áááŻááşáąá¸áááá˛áˇáşáááŻááşááŤáááşá ááśááŻáááşáááŻáááş upper lip áᏠE-lineáᲠá˛áˇ áááŹááş 4mmáĄáá˝áąáŹáá á˛áˇ áş áᏠááá áá˛áˇáşáááąá¸ lower lip áᏠE-lineáᲠá˛áˇ áááŹááş 0-2mmáĄáá˝áąáŹáá á˛áˇ áşáᏠááá áá˛áˇáşááŤáááşá áá°ááŹáᲠá˛áˇupper lipáᏠáááşáááŻáĄáááĄááŹáąá¸áᲠá˛áˇ ááááá˛áááŻááŹááᯠááááŻááşááᯠá˛áˇNasolabial angle áááŻáááşáąá¸ áááŻááşáąá¸áááá˛áˇáşáááŻááşááŤáááşá Normal Nasolabial angle=102Âą8 Acute = <90 Obtuse = >90
- 6. Assessment of the TMJ áá°ááŹáᲠá˛áˇTemporomandibular joint (TMJ)áᲠá˛áˇ áááş ááşáááąá¸áááŹá˛áˇáááşáąá¸ áá°áąá¸áááŹáąá¸ááŹá-áá á á áşáááąá¸áááá˛áˇáş áá˛áˇáşááŤáááşá Muscles of mastication ááá˝áą ááŹááááŹááťáźáŻáąá¸á ááŹáąá¸á Clicking or crepitus ᥠáśááá˝áą áááŹáąá¸áááŹáąá¸ á áááá˛áˇáş á á áşáááąá¸áááŻááşááŤáááşá Intra-oral Assessment á˝áąáŹáąá¸áááťááşáá˛á˛áˇáá°ááŹáá áşáááŹááşáᏠá˝áąáŹáąá¸ááá˛áˇáşááśáá˝áąááşáąá¸ááťááşáąá¸ááŹáááąá¸ááᯠá á ááťáŹááťáŹ ááááŻá ááŻááşáááş á° ááá áşááᯠá˛áˇ áááŻááŤáááşá á˝áąáŹáąá¸á ááťáŹááááŻááşáá˛á˛áˇ á°á á˝áąáŹáąá¸ á á˛áˇ áşáááşáąá¸áááąá¸áĄáŹáąá¸áááşáąá¸áá˛á˛áˇ á°ááᯠá˝áąáŹáąá¸áááᯠáážáŻáááŻááşáááąá¸ááááş áĄááťáźáŻáąá¸áááşáĄáááᲠá˛áˇ decalcifications, gingival hyperplasia, periodontal breakdown, removable appliance related stomatitis á áá˛á˛áˇáááŻáąá¸ááťáźáŻáąá¸ááá˝áąááᯠááśá áŹáąá¸ááááŻááşááŤáááşá ááśááŻáááşááááŻááşáá˛á˛áˇ dental developmentááá˝áąá abnormalities ááá˝áą á-áááááŻáááşáąá¸ á á áşáááąá¸áááŤáááşá áá°ááŹáᏠdental/mucosal pathology ááá˝áą á-áá á á áşáááá˛áˇáşááŤá á˝áąáŹáąá¸áááŻáąá¸á áŹáąá¸áááŹááŤá á˝áąáŹáąá¸ááśááŻáąá¸áááŹááŤá á˝áąáŹáąá¸á ááá˝ážáŹ áááźáŻááşáąá¸ááąá¸ááááááşáąá¸á á˝áąáŹáąá¸ááá˝áąáᲠá˛áˇ á á á˝áąáŹáąá¸áá˝ážáŹ ááśááŻáááşááááŻááşáᲠáááťáŹá˛áˇááááááşáąá¸ á ááşááᯠá˛áˇ á-ááááᯠá ááťáŹáááá˛áˇáşááŤá ááťážáŹáᏠááśááŻáááşááááŻááşáᲠáááąá¸áá˝áąááşáąá¸ááááŹááťáźáŻáąá¸áááşáąá¸ ááááşááŤáááşá ááťážáŹá áááąá¸áá˝áąááşáąá¸áááááąá¸ áĄá˛á˛áˇáááťážáŹáᲠá˛áˇ áááŻáąá¸áááşáá˛á˛áˇáĄááťáá˛áˇáşááááş á°áᲠá˛áˇ áááş ááşáá˛á˛áˇáĄááťáźáŻáąá¸áááşááá˝áąááᯠáá°ááŹáᏠááŹáááá˛áˇáşáááŻááşááŤáááşá áĄáááąáŤáş áᲠá˛áˇ ááĄáŹááş á˝áąáŹáąá¸ááá˝áąáᏠá áá˛áˇáşáá˛á˛áˇááááŹáᏠá-ááá ááááŹáá˝áąá˛ááááááşáąá¸ á-ááá áĄáááŹááşáąá¸ááśááŻáąá¸áĄáááĄááŹáąá¸áᏠá-ááááá˝áąááᯠá á áşáááá˛áˇáşááᯠá˛áˇáááŻááŤáááşá á˝áąáŹáąá¸ááá˝áąáᲠá˛áˇ áĄáááĄááŹáąá¸ááᯠá á áşáááá˛áˇáşáá˛á˛áˇáĄá፠Labial segment, canines, buccal segment áááŻáááąá¸ áĄáááŻááşáąá¸(á)áááŻááşáąá¸ áá˝áąá˛áááá˛áˇáşáááŻááşááŤáááşá á˝áąáŹáąá¸áááşááááŹááá˝áąá á˝áąáŹáąá¸ááťá˛ááááŹááá˝áąá á˝áąáŹáąá¸ááá˝áą áĄáá˝áąááşáąá¸áááş áááŻááşáá˝áąááşáąá¸ áá ááŹáąá¸á á˝áąáŹáąá¸ááá˝áą áĄááááşáááş áá˝áąááşáá˝áąááşáąá¸áá ááŹáąá¸á ááśááŻáááşááááŻááşáá˛á˛áˇ abnormal frenal attachment ááááŹáá˛áˇáş diastema ááá áşáá ááŹáąá¸ á áááá˛áˇáş á á áşáááá˛áˇáş áá˛áˇáşááŤáááşá Overjet, Overbite, Centerlines, Crossbites, Incisor relationship, Canine relationship, Molar relationship á áá˛á˛áˇ áá°ááŹáᲠá˛áˇstatic occlusion áĄáááĄááŹáąá¸ááᯠá á áşááááşá˛áˇáááŻááşááŤáááşá áá°ááŹáᲠá˛áˇdynamic occlusion áĄáááĄááŹáąá¸ááᯠáááŻááşááᯠá˛áˇ interferences in lateral excursionsááá˝áą á-ááááᯠá á áşáááąá¸áááá˛áˇáş áá˛áˇáşááŤáááşá áá°ááŹáᲠá˛áˇ á˝áąáŹáąá¸ááśááŻá áśá áááąá¸áááŻáąá¸ááśááŻá áśá ááťááşááŹááśááŻá áśááá˝áąáĄá ááááŹáąá¸ á á áşáááąá¸ááᯠá˛áˇ áááŻáĄááşáá˛á˛áˇáĄááťááşáĄáááşááá˝áąáááŻáááşáąá¸ á á ááťáŹááťáŹ á á áşáááąá¸áááá˛áˇáş áá˛áˇáşááŤáááşá