This document outlines the steps involved in orthodontic diagnosis and treatment planning. It discusses the importance of a thorough clinical examination, including extraoral and intraoral assessments. Diagnostic records such as photos, casts, and radiographs are also highlighted. The document emphasizes developing a problem list and treatment plan that identifies the treatment aims, details of tooth movement/appliances, estimated time, and prognosis. Overall, it provides an overview of the full orthodontic diagnosis and treatment planning process.
2. STEPS IN ORTHODONTIC DIAGNOSIS
• History taking: Chief complaint, Medical history, Dental history
• Clinical examination: Extraoral examination, intraoral examination
• Diagnostic records: Casts, photographs, Radiographs
• Analysis: Facial, Dental, functional, soft tissue, Habits
Problem list: Developmental / Orthodontic problems, Pathologic problems
Treatment plan
Treatment alternatives
Interact with those involved, discuss treatment plans and options, clarify
sequence, and obtain patient acceptance
Develop a final treatment plan.
3. CLINICAL EXAMINATIONS
Essentially, there are three principal reasons why patients seek orthodontic
treatment;
1. To improve dentofacial appearance.
2. To correct the occlusal function of the teeth.
3. To eliminate occlusion that could damage the long-term health of the teeth
and periodontium.
These should be assessed thoroughly during clinical examination and evaluated
with additional diagnostic records that are available.
Clinical assessment involves both extra and intra oral features.
4.
5. Frontal Examination
• Shape of the head: Dolicocephaly (craniofacial anomaly with narrow
and long head anteroposteriorly); Brachycephaly (head is short and
broad); Mesocephaly (head of medium proportion).
• Symmetry of the mouth, nose and eyes. (?? Syndrome or craniofacial
anomalies).
• Vertical facial third examination (face can be divided into 3 equal
parts
• Facial symmetry (minor deviation is usual, but noticeable deviations
may suggest unilateral ankylosis, unilateral condylar hyperplasia,
congenital defects, hemifacial hypertrophy/atrophy
6. Vertical thirds
Face can be
divided into -
line to the
midpoint
between the
eyebrow.
From this point to the
junction of the lip and
nose and from the
junction of the lip and
nose to the lower
border of the chin.
9. Asymmetry of faceA small degree of bilateral
asymmetry is present in all individuals. (normal
asymmetry)
However, severe asymmetry should be noted and the
cause of asymmetry should be looked for.
Eg, developmental, specific pathology, dental crowding and
mandibular displacement.
Face may be asymmetric due to skeletal (skeletal
asymmetry) or dental (dental asymmetry).
10. Coincidence of facial midline with dental midline
-Check whether the mid-facial line is coincide
with the dental midlines.
-Check whether the upper and lower dental
midlines are coincide.
-Centre line should be measured by placing a ruler
down the patient’s facial midline and measuring
how far away from this the center lines deviate.
The amount of deviation should be recorded.
11. Saggital examination
• This is examination of the side of the head with the patient looking at
a distant object and the Frankfort plane is parallel to the floor – also
known as with the patient in profile
12. • Profile:
Patients can have a straight , concave or convex profile
If the face is straight, then it is normal. If concave suspect a class III and
if convex then a class IIor bimaxillary situation
This is obtained by a line joining the forehead to the soft tissue point A
and from A to soft tissue Pogonion.
• Facial divergence
This can either be posteriorly divergent or anteriorly divergent. It is
obtained by a line drawn from the forehead to the chin.
14. Antero Posterior Relationship - The relative size of the mandible and maxilla to
each other will determine the skeletal pattern.
Ideally, the maxilla should be about 2-3mm ahead of the mandible for a class I
skeletal pattern
The smaller the mandible or the larger the maxilla the more the patient will be
Class II.
Conversely with a bigger mandible or smaller maxilla the patient will be more
Class III.
The bigger the size discrepancy between the maxilla and mandible, the more
difficult treatment becomes and the less likely it is that orthodontics alone will
be able to correct the malocclusion.
15. Vertical
• This dimension gives some
indication of the degree of
overbite.
The vertical dimension is usually
measured in terms of facial height
And the shorter the anterior facial
height the more likely it is that
the patient will have a deep
overbite.
Conversely the longer the facial
height the more the patient is likely
to have an anterior open bite.
Examination of face in vertical plane
can also be examined from the
profile view.
16. INTRA-ORAL EXAMINATION
Evaluate oral health.
Oral health of both hard and soft tissues of the mouth must be assessed for
potential orthodontic patients.
It is important that all pathologies e.g. caries or pulpal pathologies be treated
before orthodontic treatment is commenced .
A thorough periodontal evaluation (oral hygeine/gingivitis/periodontitis) is an
important part of orthodontic assessment as it may have a direct effect on the
orthodontic treatment plan.
Any carious tooth should be identified and charted .
17. Teeth – The intra arch teeth assessment : teeth erupted, teeth of poor
prognosis, DMF, first permanent molars erupted, dental anomalies
Inter arch (occlusion) relationship of each tooth in both anterior and posterior
segment when in centric occlusion should be assessed (molar intercuspation,
anteroposterior relationships of molars and cuspid teeth)
The overjet and overbite are also assessed.
Crossbite, rotations are also assessed.
18. Evaluation of arch spaces (Tooth: Bone Ratio)
It is important to evaluate the arch spaces available in both jaws to achieve the
desired tooth positions and occlusal correction. Upper and lower arches are
assessed for spacing/crowding
19. Soft tissues
The soft tissues comprise the lips, cheeks and tongue and these guide the crowns
of the teeth into position as they erupt.
Ultimately, the teeth will lie in a position of soft tissue balance between the
tongue on one side and the lips and cheeks on the other.
LIPS – Examination of lips covers 3 aspects;
(a) lip contour – Everted lips may be as a result of proclined teeth.
(b) lip line – The lip line is the amount of vertical tooth exposure in smiling--
in other words, the height of the upper lip relative to the maxillary central
incisors. Lip line can be defined as the vertical position of the lower border of the upper lip.
It is important to evaluate the lip line when smiling (smile line). The lip line is typically
categorized in high smile, average smile and low smile.
(c) lip seal – Assess patient at rest. Competent lips form an anterior seal at rest,
while incompetent lips only forms a seal following contraction of the circumoral
musculature resulting in slight dimpling over the chin area
20.
21.
22. • Tongue
• Tongue position can not be observed directly even tongue size cannot be
measured directly. It is only gross variations from the normal that are worthy
of record
• The size and frenal attachment of tongue should be assessed.
• Muscle of mastication
• Check for hyperactivity of those muscles especially the massetters. Also
buccinators and mentalis muscle
• – check if there is Palsy
• Habits
• Records of any oral habits is documented. In some individuals, a tongue
thrusting behavior on swallowing may be observed. This may be habitual
or caused by an inborn neuromuscular defect.
23. •ts glenoid fossa.
Centric occlusion(CO) and Centric relation(CR) discrepancy.
TMJ Examination: The joints are palpated and assessed clicking sound , crepitus . The path of
closure should be assessed as well. Patients who present with TMJ pain seeking an
orthodontic solution to correct the problems should be treated with caution. the
mandible at CR position.
24. Diagnostic records
1) Records for evaluation of teeth and oral
structures
e.g. Intra oral photographs, panoramic
radiographs, periapical, bitewing and
occlusal radiographs
• 2) Records for evaluation of occlusion
e.g. dental casts. Orthodontic study model
(Diagnostic model or Diagnostic cast) can
be defined as an essential diagnostic record.
It is a positive replica of the dentition and
surrounding structures(soft tissues) used as
a diagnostic aid and /or base for
construction of orthodontic appliances.
They facilitate three dimensional study of
the occlusion and the dentition. They are
accurate three dimensional replica of a
patients teeth that are made by pouring
dental stone into the dental impression of
the patient obtained in the clinic or obtained
from a 3D scan of the patients teeth.
(useful in space analysis)
3) Records for evaluation of facial and jaw
proportions
extra oral photographs- Frontal and
Profile views
Lateral and postero anterior
cephalometric radiograph
25.
26. Developing a problem list (orthodontic summary)
In developing a list, the problems should be divided into 2 groups;
1) Those relating to disease or pathologies.
2) Those relating to malocclusion.
For any patient, those relating to diseases or pathologies should receive priority.
Therefore, in treatment sequence orthodontic treatment must appear after
steps to control other pathologies. The orthodontic problem list should begin
with those more important being listed first and the less important ranked
lower down.
27. TREATMENT PLANNING
The treatment plan is an integral part of orthodontic management. It should be
divided into treatment aims (what do you want to do?), treatment details (how
are you going to do it?) and treatment time/Prognosis.
There are 3 stages to treatment planning;
Stage 1 - Treatment aims
• Decide whether to treat or accept the malocclusion
• Decide whether the objective of treatment should be ideal or compromise.
These will depend on factors such as (a) readiness of patient to be committed to
treatment, (b) Availability of materials/equipments, (c) finance
28. Stage 2 – Treatment details
• Estimation of space required.
Lower arch – choice of extractions e.g. teeth of poor prognosis, displaced teeth.
Upper arch – choice of extractions
The need for extractions depends on the degree of crowding. For mild crowding
in the anterior segment (2-3mm) interdental stripping/arch expansion will be
adequate. As the degree of crowding increases from 4-6 mm the need for
extractions increases and with more than 6 mm of crowding extractions are
nearly always required.
• Identification of tooth/teeth movement required and the appliance necessary to
achieve this.
• Determination of the final buccal occlusion and how this is to be obtained
• Estimation of the anchorage required and decision on how this is to be obtained.
29. Stage 3 – Treatment time and prognosis
• An estimation of the overall treatment time
• Choice of retention required
• An estimation of the prognosis for stability once the appliance is withdrawn.
