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Extra oral examination /certified fixed orthodontic courses by Indian dental academy


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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.

Extra oral examination /certified fixed orthodontic courses by Indian dental academy

  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. Extra oral examination INTRODUCTION The purpose of examination is to record the information about the frontal view, profile view and functional analysis of the facial structure, which helps as a guideline during orthodontic therapy also to improve the esthetic appearance of the face. I. FRONTAL ANALYSIS 1. Shape of the head (Cephalic index) 2. Facial form (Facial index) 3. Facial proportions 4. Facial symmetry 5. Forehead examination 6. Nose examination 7. Lip examination a. Interlabial gap b. Lip posture & tonicity c. Lip step d. Lip thickness & height proportions
  4. 4. SHAPE OF THE HEAD Classification & index values according to martin & Saller (1957) The index is basedon the anthropometrix determination of the maximum width of the head & the maximum length. Dolichocephalic patient have long and narrow dental arch Mesocephalic patient have paraboloid or average dental arch Brachycephalic and Hyperbrachycephalic patient have broad dental arch
  5. 5. FACIAL FORM The morphologic facial height is defined as the distance between nasion & gnathion, the bizygomatic width as the distance between the zygomatic points. Morphologic facial height – Nasion – Gnathion (gn) Bizygonmatic width – Zygoma – Zygoma This type of facial morphology has a certain relationship to the shape of the dental arch. Euryprosopic face type have broad, square arches. leptorposopic face types have narrow apical base / arches.
  6. 6. Euryprosopic Face Leptoprosopic face Mesoprosopic face
  7. 7. FACIAL PROPORTIONS TRANSVERSE FACIAL PROPORTIONS The central fifth of the face The middle two fifth of the face The Outer two fifth of the face VERTICAL FACIAL PROPORTIONS Upper third of the face Middle third of the face Lower third of the face upper 1/3rd lower 2/3rd
  8. 8. NORMATIVE VALUES FOR FACIAL DIMENSIONS Dimension Distance Inter pupaillary 65 mm 35 mm (adult) 30.3 mm (age9) 31.6 mm (age 16) 9.8 cm. Inter canthal Outer canthal.
  9. 9. FACIAL SYMMETRY Facial Symmetry Facial Asymmetry
  10. 10. STRUCTURAL CLASSIFICATION OF DENTOFACIAL ASYMMETRIES  Dental asymmetries  Skeletal Asymmetries  Muscular and soft tissue asymmetries  Functional Asymmetries
  13. 13. NOSE EXAMINATION Size of the nose NOSTRILS
  14. 14. Leptorrhine nose On profile leptorrhine nose have more nasal projection On frontal view it is narrow and has more nasal height
  15. 15. Mesorrhine nose Platyrrhine nose Mesorrhine nose is most common to Asians and it frontally characterized by lack of dorsal height and dorsal and alar wideness Platyrrhine nose is most common in black populations. Frontally it is characterized by broad alar base and nostrils.
  16. 16. LIP EXAMINATION In Competent lips Competent lips Potentially in competent lips Everted lips
  17. 17. LIP STEP Positive lip Slightly negative Marked negative lip step (normal lip step Step cases)
  18. 18. PROFILE ANALYSIS  Facial profile  Facial divergence  Nasolabial angle  Nose examination in profile  Lip examination in profile  Mentolabial sulcus  Chin examination  Maxilla / Mandibular vertical proportions  Mandibular plane angle  Visualized treatment objective (VTO)
  19. 19. FACIAL PROFILE The evaluation is based upon 3 reference Planes 1. Eye –ear plane (Frankfurt horizontal plane) 2. Skin nasio perpendicular, according to dreyfuss 3. Orbital perpendicular, according to simon
  20. 20. Straight jawed profile Backward slanting profile Forward slanting profile
  21. 21. FACIAL DIVERGENCE 1. Straight 2. Convex 3. Concave 1 1 2 3 2 3
  22. 22. NASOLABIAL ANGLE Acute Obtuse
  23. 23. NOSE EXAMINATION IN PROFILE Straight nose Convex nose
  24. 24. LIP EXAMINATION IN PROFILE Protrusive upper & lower lip Retrusive lip profile Method of evaluation
  25. 25. THE MENTO LABIAL SULCUS is defined simply as the fold of soft tissue between the lower lip and the chin; it may vary greatly in form and depth. It is affected by lower incisor position and by the vertical height of the lower face. Upright lower incisors tend to result in a shallow mentolabial sulcus because of lack of lower lip projection. A deep mentolabial sulcus is common in patient with short faces & class II relationship because the lower lip is averted against the upper incisors & lip redundancy in caused by the short lower face. The patient with a long face has a tendency to have a flat mentolabial sulcus because of the flattening of the mantalis muscle to attain lip closure. The deep mentolabial sulcus in characteristic of a hyperactive mentalis muscle.
  26. 26. MENTOLABIAL SULCUS Mentolabial sulcus Deep mentolabial sulcus Shallow mentolabial sulcus
  27. 27. Hyper activity of mentalis muscle
  28. 28. CHIN EXAMINATION Protruing chin with mentolabial sulcus Normal chin Negative chin Configuration of chin projection is determined by two factors The amount of bony projection. The amount of bony projection. tissue overlap the
  29. 29. Maxilla & Mandibular vertical proportion
  30. 30. MANDIBULAR PLANE ANGLE FRANK FURT MANDIBULAR PLANE ANGLE It depending upon the point where two planes meet. Frank furt horizontal plane Mandibular plane Clinical FMA
  32. 32. FUNCTIONAL EXAMINATION 1. Respiration 2. Mastication 3. Deglutition 4. Speech 5. Centric relation / Centric occlusion discrepancy, protrusive & lateral excursions, freeways space. 6. Maximum mouth opening 7. Smile analysis 8. Peri oral muscle activity (Muscles of mastication) 9. Tempro mandibular joint (TMJ) a. Pain b. Sound c. Path of closure / opening
  33. 33. EXAMINATION OF BREATHING MODE Mirror Test Nasal respiration – observation of nostrils Oro Nasal respiration – alar muscles or inactive nares do not change their size
  34. 34. DEGLUTITION Collecting stage Transporting stage 1st part Transporting stage 2nd part
  35. 35. Transporting stage 3rd part Third swallowing stage Fourth swallowing stage Final swallowing stage
  36. 36. SPEECH Speech sound Problem Related malocclusion /S/, /Z/ (sibilants) Lips Anterior open bite, large gap between incisors. /T/, /D/ (lingualveolar stops) Difficulty in production /F/, /V/ (labio dental fricatives) Distortion Irregular incisors, especially gingival position of maxillary incisor. Skeletal class II Th,sh,ch (lingodental fricatives) (voice or voiceless) Distortion Anterior open bite
  37. 37. CENTRIC OCCLUSION : Condyles in the centre of the articular discs and against the examinatia, as high up as anatomically possible and contred transversely. CENTRIC RELATION : A maxillo mandibular relationship in which the condyles articulate with the thinnest a vascular position of their respective disc with the condyle in antero superior position against the slopes of articular eminences. This position is independent of tooth contact. This position is clinically as discernible when the mandible is directed superiorly and anteriorly and restricted to a purely rotary movement about the transverse horizontal axis. IMPORTANCE OF CENTRIC RELATION IN ORTHODONTICS Diagnosis and treatment planning should be performed by an evaluation of the occlusion with mandible in centric relation in order to obtain the maxillary and mandibular skeletal and dental relation ship. If this is overlooked, an in correct diagnosis and treatment plan of the actual mal occlusion, along with its unfavourable consequences may result.
  38. 38. Moreover during every appointment the patient has to be monitored in centric relation if monitoring is not done in this manner the treatment may finish with the mandible in centric occlusion, with several prematuraties. This may later cause trauma from occlusion and TMJ disorder. FREE WAY SPACE The space between the teeth when mandible is at rest position it is usually 2-3mm referred as freeway space or inter occlusal clearance. METHODS TO DETERMINE Phonetic method Command method Non- command method Combined method
  39. 39. MAXIMUM MOUTH OPENING Deflection Deviation
  40. 40. SMILE ANALYSIS Smile mesh by Ackerman
  41. 41. EXCESSIVE MAXILLARY INCISOR SHOWS Gender Male Maxillary incisor 1.91 mm Female central 3.40 mm Mandibular central incisor 1.23 mm 0.49 mm Excessive maxillary incisors shows due to  Short upper lip philtrum height  Excessive vertical growth of the maxilla can cause excessive incisor display  Excessive crown height Detorqued maxillary incisors
  42. 42. INADEQUATE INCISOR DISPLAY  Excessive upper lip philtrum height  Inadequate growth of the maxilla may result in inadequate incisor show  Inadequate crown height  Flared maxillary incisors.  High frenum attachment
  43. 43. GINGIVAL DISPLAY ON SMILE Gummy Smile  Short philtrum  Vertical maxillary excess  Excessive “Curtain” on smile  Short incisal crown height  Upright maxillary incisors  High frenal attachment.
  44. 44. TEMPRO MANDIBULAR JOINT EXAMINATION Ausculation Lateral Palpation of TMJ Posterior palpation of TMJ
  45. 45. Lateral pterygoid M. Palpation Temporalis M. Palpation Messater M. Palpation
  46. 46. FUNCTIONAL MANIPULATION Muscle Contracting Inferior lateral pterygoid muscle Protruding resistance, pain Superior lateral pterygoid muscle Clenching on increase pain Medial muscle pterygoid Stretching against increase Clenching on teeth, increase pain Clenching on separator, no pain teeth, Clenching on teeth, increase painClenching on separator, increase painOpening mouth, no pain Clenching on teeth, increasing pain Clenchingon separator, increasing pain Opening mouth, increasing pain.
  48. 48. UPPER LIP LENGTH FROM VARIOUS STUDIES (MM) Male Female Burstone 23.6±1.5 20.1 ±1.9 Farkas et al. 21.8 ±2.2 19.6 ±2.4 Powell, Humphreys 23.8 ±1.5 20.1 ±1 Wolford 22 ±2 20 ±2 Peck et al. 23.4 ±2.5 21.2 ±2.4 Arnet, Bergman (Male and female combined) 19-22
  49. 49.
  50. 50. Patient with low lip line due to vertical maxillary deficiency Patient with gingival smile, over bite, and short clinical crowns
  51. 51. Lip line with reduced incisor display due to proclined maxillary incisors Patient with reverse smile arc
  52. 52.
  53. 53.
  54. 54. Patient with arch asymmetry due to peg-shaped lateral incisor. Symmetrical arch after extraction of peg lateral and orthodontic space closure
  55. 55. CONCLUSION The modern orthodontics includes a series of different types of treatment requiring precise diagnosis techniques in order to produce a positive out come. The careful and complete extra oral examination of patient will guide in proper treatment plan.
  56. 56.  REFERENCES 1. Colour Atlas of Dental Medicine Orthodontic diagnosis Thomas Rakosi 2. Orthodontics current principles and techniques, 3rd Ed. Graber, Vanarsall 3. Dento facial orthopedics with functional appliance, 3rd Ed. Graben Rakosi Petrovic 4. Contemporary orthodontics, 3rd Ed. William R. Proffit 5. Esthetic Orthodontics & Orthognathic surgery David M. Sarver 6. Management of TMJ Disorder & Occlusion Jeffery P. Okeson 7. Contemporary treatment of dento facial deformity Proffit, White, Sarver
  57. 57. Leader in continuing dental education