Clinical Assessment of Dentofacial
Deformity
Victoria Beale MRCS FDS RCS
Specialist Registrar in Oral and Maxillofacial Su...
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Introduction
• Identify problems
– Functional
– Aesthetic

• Highlight variations from ‘normal’
• Clinical diagnosis
• Sur...
Positioning
• Patient sitting upright
• Pupillary plane
parallel to the floor
• Frankfort plane
parallel to the floor
• Ex...
www.indiandentalacademy.com
Vertical Analysis

www.indiandentalacademy.com
Vertical analysis

www.indiandentalacademy.com
Lateral View

www.indiandentalacademy.com
Frontal View
• Upper
– Eyes
– Orbits
– Ears

• Middle
– Nose

www.indiandentalacademy.com
Frontal View
• lips
–
–
–
–
–

length
competence
muscle activity
vermilion
teeth rest/smiling

• Chin
– asymmetry
– mental...
Smile
• Upper lip vermillion at
gingival margin
• Max 1-2mm gingival
show

www.indiandentalacademy.com
Symmetry

www.indiandentalacademy.com
Oral examination
•
•
•
•
•
•
•
•
•

Occlusal relationship
AOB
Overbite / Overjet
Crossbites
Incisor inclination
Crowding /...
Record keeping
•
•
•
•

Notes
Photographs
Study models
Radiographs
–
–
–
–
–

OPG
Lat Ceph
Periapical
PA Ceph
CT
www.india...
Examination Pitfalls
• Incorrect patient
positioning
• Posturing
– Habitual
– Occlusal interference

• Over closure
– Skel...
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

Clinical assessment of dentofacial deformity /certified fixed orthodontic courses by Indian dental academy

1,046 views

Published on


The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

Published in: Education, Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,046
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • This talk will cover features of the normal face and a scheme for examining patients with dentofacial deformity.
  • Compensatory positioning may be appropriate for patients with orbital dystopia, can eg use ears to establish a parallel plane
    Clinical Frankfort plane – line from tragus of the ear to the bony infraorbital rim.
    Reproducible position that mimics the ‘natural’ standing head postures of most individuals with a normal jaw structure
    Patients with dentofacial deformities often assume alternative head postures to improve function or make the deformity look less obvious. It is important to eliminate this by correctly orientating the patient. Ensuring the correct head position aids proper clinical diagnosis as well as evaluation of post treatment results.
    Lips should be relaxed and not forced together to allow evaluation of tooth lip relationship, chin position and lip competence
  • Face divided into thirds:
    Upper third – hairline to glabella
    Middle third – glabella to subnasale
    Lower third – subnasale to soft tissue menton
    Orthognathic surgery most commonly alters the lower third of the face, with some influence on the middle third
  • The facial thirds should all be equally proportioned
    In addition the lower third of the face can be further divided, with , with the distance from subnasale to upper lip stomion equalling one third, and the lower lip stomion to soft tissue menton equalling two thirds. This ratio provides the optimum vertical facial balance in the lower third of the face.
  • Evaluation of the profile is usually the most valuable assessment in determining vertical and AP Jaw problems
    As mentioned previously the middle and lower face heights should be equal
    The ideal chin projection is 3+/-3mm behind a line perpendicular to the Frankfort plane through subnasale provided the AP position of the maxilla is normal
    Midface
    maxillary hypoplasia
    nasolabial angle
    Lower face
    mandibular angle
    mandibular length
    chin projection
    labiomental groove
  • Symmetry
    Size
    Deformity
    Upper
    Orbits
    pupillary level
    palpebral fissures
    dystopia
    hypoglobus
    For normal facial balance the intercanthal, alar base and palpebral fissure width (C) should all be equal
    Normal intercanthal distance (A) for Indians 31 +/- 3
    Slight variation male to female
    Slightly lower values than other races
    Interpupillary distance (B) 65 +/- 3
    The alar base should lie within 2mm of a vertical line through the medial canthus which is perpendicular to the pupillary plane
    Nose
    root
    dorsum
    alar base
    tip projection
    septum
    air entry
  • The normal upper lip length measured from stomion to subnasale is 22 +/- 2mm for males and 20 +/- 2mm for females. The measurement should be taken with the lip relaxed.
    Normal tooth show at rest is 2-3 mm. Provides a good gauge or vertical maxillary height in the presence of normal lip length.
  • Frequently the smile is one of the patient’s main concerns. With a natural smile the vermillion of the upper lip should fall at the gingival margin with no more than 1-2mm of gingival show.
    Factors influencing the amount of upper lip elevation during smiling may be include:
    Clinical crown length
    Angulation of the anterior alveolus
    Degree of overjet and overbite
    AP position of the mandible and maxilla
    Neuromuscular function
    Unnatural smile – tell the patient a joke or ask them to think of a happy memory
    These factors must be taken into account to ensure inaccuracies are not introduced when evaluating the proper vertical maxillary position.
  • The facial midlines are assessed including nasal, maxillary and mandible dental midlines, and the relationship of the chin midpoint to the facial midline
    Left to right facial symmetry should also be evaluated.
    Transversely, the colossal plane should be parallel to the pupillary plane, providing there is no orbital dystopia
  • Clinical assessment of dentofacial deformity /certified fixed orthodontic courses by Indian dental academy

    1. 1. Clinical Assessment of Dentofacial Deformity Victoria Beale MRCS FDS RCS Specialist Registrar in Oral and Maxillofacial Surgery www.indiandentalacademy.com
    2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    3. 3. Introduction • Identify problems – Functional – Aesthetic • Highlight variations from ‘normal’ • Clinical diagnosis • Surgical prediction www.indiandentalacademy.com
    4. 4. Positioning • Patient sitting upright • Pupillary plane parallel to the floor • Frankfort plane parallel to the floor • Examiner at same level as patient www.indiandentalacademy.com
    5. 5. www.indiandentalacademy.com
    6. 6. Vertical Analysis www.indiandentalacademy.com
    7. 7. Vertical analysis www.indiandentalacademy.com
    8. 8. Lateral View www.indiandentalacademy.com
    9. 9. Frontal View • Upper – Eyes – Orbits – Ears • Middle – Nose www.indiandentalacademy.com
    10. 10. Frontal View • lips – – – – – length competence muscle activity vermilion teeth rest/smiling • Chin – asymmetry – mentalis www.indiandentalacademy.com
    11. 11. Smile • Upper lip vermillion at gingival margin • Max 1-2mm gingival show www.indiandentalacademy.com
    12. 12. Symmetry www.indiandentalacademy.com
    13. 13. Oral examination • • • • • • • • • Occlusal relationship AOB Overbite / Overjet Crossbites Incisor inclination Crowding / Spacing Occlusal interferences Tongue size / mobility Dental health www.indiandentalacademy.com
    14. 14. Record keeping • • • • Notes Photographs Study models Radiographs – – – – – OPG Lat Ceph Periapical PA Ceph CT www.indiandentalacademy.com
    15. 15. Examination Pitfalls • Incorrect patient positioning • Posturing – Habitual – Occlusal interference • Over closure – Skeletal class III www.indiandentalacademy.com
    16. 16. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

    ×