INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com


Diagnosis involves development of a
comprehensive & concise database of
pertinent information, sufficient to
understand...
www.indiandentalacademy.com
Diagnostic- aids
Essential

•Case history
•Clinical examination
•Study models
•Radiographs
•OPG
•Lateral Ceph
•Facial phot...


Case history









Personal details
Chief complaint
Past Medical history
Past Dental history
Pre-natal histo...


Personal details

-name
-age & sex
-address
-occupation

www.indiandentalacademy.com


Chief complaint:
two main concerns:
-Impaired dentofacial esthetics
-Impaired function
-priorities
-desires/expectation...


Past Medical history

-H/o of trauma to the orofacial region
-H/o allergies to medications or medical
products
-H/o pas...
Special concerns:
-H/o Condylar fractures
- H/o Long term medications
-H/o allergy to latex or nickel sensitivity
- H/o bl...


Past Dental history

- Caries
-Restorative treatment
-Extraction of deciduous / permanent
teeth
- Periodontal problems
...


Pre-natal and Natal history
Placental transfer of drugs
Forceps injury,
Caeserian surgical complications
Congenital ano...


Family history :

H/o malocclusion in parents or siblings
and type of malocclusion
H/o of previous familial orthodontic...
History of habits :
- Thumb sucking
-tongue thrusting
-lip and nail biting
-mouth breathing .


www.indiandentalacademy.c...


Physical Growth Evaluation



Growth Charts
Hand – wrist radiographs
Cervical vertebral development
Serial cephalometr...


Social and Behavioral Evaluation

-Patient’s motivation for treatment
–Internal or External
- Expectations
- Co-operati...
•Ht & wt
•Gait
•Posture
•Body-build

•Head shape
•Facial form
•Facial symmetry
•Facial proportion
•Facial profile
•Facial ...


General examination :
Gait
Posture
Body type
Height
Weight

www.indiandentalacademy.com


Body-build (physique)
 Aesthetic-THIN: narrow dental arches.
 Pletoric -OBESE: large square dental
arches
 Athletic ...


Shape of the head
 Mesocephalic: average shape of
head- normal dental arches.
 Dolicocephalic: long and narrow
head- ...
Cephalic Index :

I= maximum skull
width/maximum skull
length

www.indiandentalacademy.com
CLASSIFICATION:
Dolichocephalic(long skull) x – 75.9
Mesocephalic
76 – 80.9
Brachycephalic (short skull) 81 – 85.4
Hyperbr...


Facial form
› Mesoprosopic: normal face form
› Euryprosopic: broad & short
› Leptoprosopic: long & narrow.

www.indiand...
Morphologic Facial Index
Morphologic face height
Bizygomatic width


www.indiandentalacademy.com
Martin and Saller (1957)
 Hypereuryprosop
 Euryprosop
 Mesoprosop
 Leptoprosop
 Hyperleptoprosop

www.indiandentalaca...


Facial symmetry
› the facial proportion in

transverse and vertical planes.
› Example:
 Congenital defects
 Hemifacia...
“Vertical thirds of
face”

www.indiandentalacademy.com


Vertical facial proportions:

The ideal face is divided into equal thirds
by horizontal lines adjacent to the
hairline ...


“Rule of fifths”
› Middle fifth
› Medial two fifths
› Outer two fifths

www.indiandentalacademy.com


Transverse facial proportions:

Describes the ideal transverse relationships
of the face.
The face is divided sagitally...


The middle fifth of the face – delineated by
inner canthus of the eye.A line from the
inner canhus should be coincident...


Facial profile
 Straight
 Convex
 concave

www.indiandentalacademy.com


The profile is evaluated in the natural
head position which is determined by
the visual axis – the patient is asked to
...


Facial divergence
› Facial angle. i.e. angle

bw N- Pog line to FHplane.
 Straight/ orthognathic
face :90
 Anterior d...


Facial Divergence:

An anterior or posterior inclination of the
lower face relative to the forehead.
Divergence of the ...


Assessment of vertical skeletal
relationship:
Growth pattern
› FMPA- Frankfurt mandibular plane angle

www.indiandental...


Evaluated by measuring the Frankfurt
mandibular plane angle ( FMA) depending
upon the point where the two planes –
“Fra...


Examination of lips

Incompetent

Potentially incompetent

www.indiandentalacademy.com

Competent


Lip incompetence –
-excessive seperation of the lips at rest
-teeth protrude excessively
-the lips are prominent and ev...


Lip posture : evaluated by viewing the
profile with the lips relaxed. This is done
by relating the upper lip to a true ...


Lip length: The length of the lips can
be examined by gently parting the
lips. Usually the upper lip covers the
entire ...


Texture and color:-usually both the lips are of same color.
-Less active or hypoactive upper lip is
chapped and lighter...


Mento-labial sulcus:a fold of the soft
tissue between the
lower lip and the
chin

www.indiandentalacademy.com


affected by- lower incisor position,the
vertical height of the lower face & chin
projection
-Upright lower incisors ten...


Examination of nose

Radix-soft tissue nasion
Nasofrontal angle
Nasal dorsum
Nasal tip
Columella
Nasolabial angle-102

...


Nasal dorsum:



Bony dorsum- onethird to onehalf of
nasal dorsum formed by the confluence
of nasal bones
Cartilagenou...








Nasal tip: most anterior point of the nose
Supratip - just cephalic to the nasal tip
Supratip break- area jus...


Columella:
portion of the
nose between
the base of the
nose and the
nasal tip

www.indiandentalacademy.com


Naso-labial angle:
- the angle between the lower border of
the nose to the upper lip.
-Average - 90 to 120
-reduced in ...


Fomon and Bell-three major categories of
nasal features according to racial
background.

1.

Leptorrhine – Usually foun...
www.indiandentalacademy.com


Examination of chin:

www.indiandentalacademy.com


Chin projection:
-two factors
1. the amount of anteroposterior bony
projection of the anterior inferior border
of the m...





The amount of bone projecting past the
cephalometric NB line
NB-Pg: linear measurement
Normal- 2±2 mm
Retrusive/pr...


Throat form:
Contour of the submental tissues



Lip chin throat angle:-The angle between the lower lip, chin
and R po...
www.indiandentalacademy.com


An obtuse Lip chin throat angle
which is unaesthetic reflects the
following:

•

Chin deficiency

•

Lower lip procumbe...


Chin neck angle:



It is also termed cervicomental angle.



Vistness and Souther stressed that the normal
cervico m...


Soft tissue examination



Oral hygiene status



Gingiva:
-size & shape
-texture & colour
-width of attached gingiva...
www.indiandentalacademy.com


Periodontal status:
-tooth mobility
-periodontal pockets
-bleeding on probing

www.indiandentalacademy.com


Frenal attachments:
-upper & lower labial and buccal freni
-In infant, upper labial frenum extends
from the upper lip t...


Occasionally, the frenum will persist and
this may be associated with midline
diastema. In these cases, the palatine
pa...
www.indiandentalacademy.com
www.indiandentalacademy.com


Tongue:
-Size and shape
-symmetry
-posture
-presence or absence of indentations
or tooth impression on the sides of the...
www.indiandentalacademy.com


Oral mucosa:
-ulcerations
-tori or bony protuberences
-submucosal clefts or swelings

www.indiandentalacademy.com
www.indiandentalacademy.com


Palate:
-palatal contour
-depth and width of the palate
-other developmental abnormalities
like torus palatinus and cle...
www.indiandentalacademy.com


Tonsils/adenoids:
-size and degree of inflammation
-alteration in tongue and jaw posture
-adenoid facies

www.indianden...
Faucial pillars and throat

www.indiandentalacademy.com


Hard tissue examination:



Examination of teeth:
-developmental status of dentition
-teeth present
-carious teeth
-en...
-congenitally missing teeth
-variations in size of teeth
microdontia
macrodontia
-variations in shape of teeth
peg shaped ...
-variations in normal eruption sequence
-restorations
-discoloured teeth
-hypoplastic teeth
-occlusal wear facets/bruxism
...


Examination of arches:
-shape: ovoid/tapered/square
-symmetry
-alignment:
crowding/spacing/rotation
-curve of spee:
fla...


Malpositioning of individual teeth:
-mesial/distal inclination
-buccal/lingual inclination
-mesial/distal /lingual disp...


Examination of occlusion:
A. antero-posterior relationship:

1.molar relation-Angle’s classification
2.canine relation
...


Overjet:
-Horizontal overlapping of upper and lower
teeth

-Normal- 2 to 3 mm.


Variations in overjet :
-decreased
- ...
www.indiandentalacademy.com


B. Vertical relationship:



Over bite:
-vertical overlapping of anterior teeth
-Normal- 2 to 3 mm.
-Overbite percenta...


Variations in overbite:



Deep bite – overbite > 2 to 3 mm.



Complete deep bite – lower anteriors
contact either t...
C. Transverse relationship:
-posterior cross bite
-buccal non-occlusion/ Scissors bite
-lingual non-occlusion

D. Midline
...


Macro-esthetics -Face in all three
planes of space

-asymmetry
-excessive or deficient face height
-mandibular deficien...


Mini-esthetics -smile framework

-excessive gingival display on smile
-inadequate anterior tooth display
-inappropriate...


Micro-esthetics –the teeth

-tooth proportion in height and width
-gingival shape and contour
-connectors and embrasure...


Facial esthetics vs. Facial proportions



Frontal examination:
1.Bilateral Facial symmetry in the
fifths of face
2.Pr...


anthropometric measurements



Vertical facial proportions
-vertical facial thirds
-artists of the Renaissance period
...
www.indiandentalacademy.com


Saggital facial proportions
-Rule of fifths
-seperation of the eyes-equal the width of
the eyes
-nose & chin- centred w...
www.indiandentalacademy.com


Profile analysis

Poorman’s cephalometric analysis
3 goals:
 Evaluation of Proportionality of jaws in
the A-P plane
 ...




Physiologic NHP
Profile convexity or concavity
Divergence of face

www.indiandentalacademy.com




Lip promienence
Lip incompetence
Bimaxillary dentoalveolar protrusion
-reflected in facial appearance in 3 ways
1.e...
www.indiandentalacademy.com
www.indiandentalacademy.com
Short facial height-everted and
protrusive lips
 Throat form:
-submental fat deposition and low tongue
posture
-stepped t...
www.indiandentalacademy.com


Vertical facial
proportions

www.indiandentalacademy.com


Mandibular plane angle:

steep MPA:
-long anterior vertical facial dimensions
-skeletal open bite tendency
 flat MPA:
...
-Relationship of the dentition to the face
1.Examination of symmetry
-relationship of dental midline of each
arch to the s...




Excessive incisor display1.long lower third of the face
2.short upper lip
-lip height at philtrum and the comissures...
www.indiandentalacademy.com
Two types
1.posed/social smile
-focus of the orthodontic diagnosis
-reproducible
2.Unposed/emotional smile


www.indiande...
www.indiandentalacademy.com


Extent of the smile is outlined by
 Curvature of the upper & lower lip
 Position of the angle of mouth
 Degree of ex...
Three views:
1.Obligue or ¾ view
2.Frontal view
3.Profile view


www.indiandentalacademy.com
Three points
1.Amount of icisor and gingival display
2.Transverse dimensions of the smile
relative to the upper arch
-bucc...


Amount of incisor and gingival
display:

-elevation of the upper lip on smile should
stop at or near gingival margin
-<...
www.indiandentalacademy.com


Buccal corridors:

-distance between the maxillary posterior
teeth and inside of the cheek
-excessively wide buccal cor...
www.indiandentalacademy.com


Smile arc:
-contour of the incisal edges of the
maxillary anterior teeth relative to the
curvature of the lower lip dur...
www.indiandentalacademy.com


Tooth proportions:

-tooth widths in relation to each other
-height-width proportions of individual
teeth
-width relati...
www.indiandentalacademy.com


Height-width relationships:

-width of the tooth should be about 80% of
its height- 8:10
-disproportions in height-widt...
www.indiandentalacademy.com


Gingival height , shape & contour:

Gingival height:
-proportional gingival heights
-central incisor-highest gingival l...
www.indiandentalacademy.com
Gingival shape:
-curvature of gingiva at the margins of
tooth
-Max. Lateral Incisorsymmetrical half-oval/half circle
-Max....
Gingival zenith:
-most apical point of the gingival tissue
- Max. Central Incisor & CanineDistal to long axis of the tooth...
www.indiandentalacademy.com


Connectors and embrasures:



Connectors:

-area where adjacent teeth appears to
touch
-extends apically or occlusally...
www.indiandentalacademy.com
-diminishes from CI to posterior teeth
-moves apically in progression from CI to
PMs & Ms

www.indiandentalacademy.com


Embrasures:

-triangular spaces incisal or gingival to the
contact area


Black triangles:

-open gingival embrasures ...
www.indiandentalacademy.com


Tooth shade & color:

-Max. Central Incisor -brightest in smile
-Max. Lateral Incisor- less than CI
-Max. Canine- least...






Assessment of Postural rest position and
interocclusal space
Evaluation of path of closure
Examination of TMJ
E...

-

Examination of orofacial Dysfunctions
Respiration
Deglutition/Swallowing
Speech
Peri-oral muscle tone

www.indiandent...


Postural rest position and
interocclusal space:

-the position of mandible when the
muscles which elevates and depress
...
www.indiandentalacademy.com
Methods of assessing Postural rest
position:
1.Phonetic method
2.Command method
3.Non-command method


www.indiandentalac...


Interocclusal clearance/space:

-distance between the occlusal or incisal
surfaces of the maxillary and mandibular
teet...
Methods to measure interocclusal
space:
1.Direct intra-oral procedure
2.Direct extra-oral procedure
3.Indirect extra-oral ...


Evaluation of path of closure:

-movement of mandible from rest position
to habitual occlusion
1.Forward path of closur...
2.Backward path of closure:
-class II div 2
3.Lateral path of closure:
-occlusal prematurities
-narrow maxillary arch

www...


Early symptoms of TMJ problems include:

•

Clicking and crepitus

•

Sensitivity in the condylar region and
masticator...
1.Jaw movements, path of closure and
joint sounds:
-range of motion:
a)Maximum opening-40 mm
b)Right and left lateral excu...
-path of closure:
-amount, direction, timing of any deviation
-clicks:
-disclose a loss of intimacy of condyle and
meniscu...
www.indiandentalacademy.com
2.Occlusal interferences:
-retruded contact position
-intercuspal position
-protrusive and lateral occlusal contacts

3.Mu...
www.indiandentalacademy.com
Muscles of mastication


Morphologic Examination:
Palpation of each jaw muscle at rest
and in function - useful to reveal...
www.indiandentalacademy.com
Muscles of neck and head
support


Pain and tenderness:Myalgia of the neck muscles may be
associated with



tempero man...
www.indiandentalacademy.com


Assessment of Respiration:

-breathing- three types
a)Nasal
b)Oral
c)Oro-nasal
-alteration in the posture of head, tong...
Methods of examination:
1.Study the patients breathing unobserved:
2.Ask the patient to take a deep breath
3.Ask the patie...
Nasal breathers:
-lips touch lightly at rest
-good reflex control of the alar muscles
-dilate the external nares on inspir...

1.
2.
3.

Other tests to diagnose the mode of
respiration:
Mirror test
Cotton test
Water test

www.indiandentalacademy.c...
www.indiandentalacademy.com


Examination of Swallowing:

-patient seated upright
-Normal mature swallow:-mandible rises as the teeth are brought
tog...
-Differential diagnosis:
1. Normal infantile swallow
2. Normal mature swallow
3. Simple tongue thrust swallow
4. Complex t...
Normal infantile swallow:
-tongue lies between gum pads
-mandible is stabilized by contraction of
facial muscles
-strong b...
www.indiandentalacademy.com
Normal mature swallow:
-very little lip and cheek activity
-contraction of mandibular elevators
bringing the teeth into oc...
Complex tongue thrust swallow:
-tongue thrust with teeth apart swallow
-combined contraction of lips, facial
muscles and m...
Retained infantile swallow:
-persistence of the infantile swallowing
reflex after the arrival of permanent
teeth
-contract...


Assessment of Speech:

1.Lisping with sibilant sound(S,Z):
-large gap between incisors
-missing incisors or open bite
-...
3.Distortion of labio-dental fricatives(t,v):
-excessive protrusion of mandible
4.Distortion of linguo-dental
fricatives(t...


Peri-oral muscle tone:

-mentalis
-orbicularis oris

www.indiandentalacademy.com


Two purposes:
- to document the patient’s initial
condition
- to supplement information obtained
from interview and cli...


Three major categories:
-for evaluation of-

A. The health of the teeth and oral
structures
1.
2.
3.
4.
5.

Intraoral p...
B. The alignment & occlusal relationship
of the teeth
1.
2.

Study casts
Occlusal records

C. The face & jaw proportions
1...


Intraoral photographs:

-to document the initial condition of hard
and soft tissues
-five standard views
1. Frontal/ant...
www.indiandentalacademy.com
www.indiandentalacademy.com


Panoramic radiographs:

-advantages:
1. Yields a broader view
2. Pathological lesions and supernumerary
or impacted tee...
www.indiandentalacademy.com


Periapical & bitewing radiographs:

-supplemental to OPG when greater detail
is required
-children & adolescent-root re...


Occlusal radiographs:

-to locate impacted teeth in combination
with periapical radiograph


Cone-beam computed tomogr...


CT or MRI scans:

-screening for TMJ internal joint pathology

www.indiandentalacademy.com


Frontal :

-natural head position
-four views:
a) Frontal at rest:
-lip incompetence-lips in repose and
mandible in res...
b) Frontal with teeth in maximal
intercuspation:
-lips closed
-lip strain and its esthetic effect
-lip incompetence-lips t...
c) Frontal dynamic(smile):
-the amount of incisor display
-excessive gingival display

d) Close-up view of the posed smile...
www.indiandentalacademy.com
2. oblique(three-quarter; 45 degree):
-three views:
a) Oblique at rest:
-examination of midface
-midfacial deformities
-na...
-prominence of gonial angle
-length and definition of the border of
mandible
-lip fullness and vermilion display
-facial a...
b) Oblique on smile:
-anteroposterior cant of OP
c) Oblique close-up smile:
-more precise evaluation of lip relationships
...
www.indiandentalacademy.com
3. Profile:
-orientation of the head to the visual axis
-inferior border: slight above the scapula,
at the base of the nec...
www.indiandentalacademy.com
-two views:
a) Profile at rest:
-lips relaxed
b) Profile smile:
-angulation of maxillary incisors

4. Submental view:
-man...
www.indiandentalacademy.com
www.indiandentalacademy.com
Study casts are
oriented in
3 planes:

-Midpalatal raphe
-Tuberosity plane
-Occlusal plane

www.indiandentalacademy.com


Cast analysis:

-Symmetry and space
1.Symmetry:
-trasparent ruled grid
-oriented to midpalatine raphe
-asymmetry within...
2.Alignment (crowding): space analysis
-to quantify the amount of crowding within
the dental arches
-comparison between th...
Mixed Dentition Analysis:
-Estimation of the size of unerupted
permanent teeth
-three basic approaches
1. Radiographic met...
2. Proportionality tables:
-Moyer’s prediction tables
-Tanaka & Johnston prediction values
3. Combination of radiographic ...
-Radiographic cephalometry
-1934 by Hofrath in Germany & Broadbent
in United States
 Uses:
 Research on growth patterns ...
Recognizing and evaluating changes
brought about by orthodontic treatment
by superimposition of serial radiographs
 Scree...


www.indiandentalacademy.com

TRACING
www.indiandentalacademy.com




Case history and clinical examination
are the two important tools in the
process of diagnosis which can be
supplemen...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Orthodontic diagnosis /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.

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

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Orthodontic diagnosis /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2.  Diagnosis involves development of a comprehensive & concise database of pertinent information, sufficient to understand the patients problem. www.indiandentalacademy.com
  3. 3. www.indiandentalacademy.com
  4. 4. Diagnostic- aids Essential •Case history •Clinical examination •Study models •Radiographs •OPG •Lateral Ceph •Facial photographs www.indiandentalacademy.com Supplemental •Specialized radiographs •P-A Ceph •Occlusal •Periapical and bitewing •TMJ radiographs •Hand and wrist X-ray •Electromyography
  5. 5.  Case history         Personal details Chief complaint Past Medical history Past Dental history Pre-natal history Post-natal history Family history History of habits www.indiandentalacademy.com
  6. 6.  Personal details -name -age & sex -address -occupation www.indiandentalacademy.com
  7. 7.  Chief complaint: two main concerns: -Impaired dentofacial esthetics -Impaired function -priorities -desires/expectations www.indiandentalacademy.com
  8. 8.  Past Medical history -H/o of trauma to the orofacial region -H/o allergies to medications or medical products -H/o past illness or treatment -H/o past and present medications -Chronic medical problems e.g. diabetes, arthritis or osteoporosis www.indiandentalacademy.com
  9. 9. Special concerns: -H/o Condylar fractures - H/o Long term medications -H/o allergy to latex or nickel sensitivity - H/o blood transfusions -H/o heart problems www.indiandentalacademy.com
  10. 10.  Past Dental history - Caries -Restorative treatment -Extraction of deciduous / permanent teeth - Periodontal problems - history of trauma to the teeth and jaws - H/o pain or clicking in TMJ - H/o bleeding gums www.indiandentalacademy.com
  11. 11.  Pre-natal and Natal history Placental transfer of drugs Forceps injury, Caeserian surgical complications Congenital anomalies  Post-natal history Milestones in development Childhood diseases www.indiandentalacademy.com
  12. 12.  Family history : H/o malocclusion in parents or siblings and type of malocclusion H/o of previous familial orthodontic treatment Heriditary/Genetic influence on malocclusion www.indiandentalacademy.com
  13. 13. History of habits : - Thumb sucking -tongue thrusting -lip and nail biting -mouth breathing .  www.indiandentalacademy.com
  14. 14.  Physical Growth Evaluation  Growth Charts Hand – wrist radiographs Cervical vertebral development Serial cephalometric radiographs    www.indiandentalacademy.com
  15. 15.  Social and Behavioral Evaluation -Patient’s motivation for treatment –Internal or External - Expectations - Co-operation: more of concern with children: -Benefits of T/t as seen by the child -Degree of parental control www.indiandentalacademy.com
  16. 16. •Ht & wt •Gait •Posture •Body-build •Head shape •Facial form •Facial symmetry •Facial proportion •Facial profile •Facial divergence •Growth pattern •Examination of lip, nose & chin www.indiandentalacademy.com •Tongue •Palate •Gingiva •Frenal attachment •Tonsils & adenoids •Assessment of dentition •Functional examination
  17. 17.  General examination : Gait Posture Body type Height Weight www.indiandentalacademy.com
  18. 18.  Body-build (physique)  Aesthetic-THIN: narrow dental arches.  Pletoric -OBESE: large square dental arches  Athletic –NORMAL: normal sized dental arches •Sheldon's classification: •Ectomorphic - tall and thin physique •Mesomorphic - average physique •Endomorphic- short and obese physique www.indiandentalacademy.com
  19. 19.  Shape of the head  Mesocephalic: average shape of head- normal dental arches.  Dolicocephalic: long and narrow head- narrow dental arches.  Brachycephalic: broad and short head- broad dental arches. www.indiandentalacademy.com
  20. 20. Cephalic Index : I= maximum skull width/maximum skull length www.indiandentalacademy.com
  21. 21. CLASSIFICATION: Dolichocephalic(long skull) x – 75.9 Mesocephalic 76 – 80.9 Brachycephalic (short skull) 81 – 85.4 Hyperbrachycephalic 85.5 – x www.indiandentalacademy.com
  22. 22.  Facial form › Mesoprosopic: normal face form › Euryprosopic: broad & short › Leptoprosopic: long & narrow. www.indiandentalacademy.com
  23. 23. Morphologic Facial Index Morphologic face height Bizygomatic width  www.indiandentalacademy.com
  24. 24. Martin and Saller (1957)  Hypereuryprosop  Euryprosop  Mesoprosop  Leptoprosop  Hyperleptoprosop www.indiandentalacademy.com x-78.9 79-83.9 84-87.9 88-92.9 93-x
  25. 25.  Facial symmetry › the facial proportion in transverse and vertical planes. › Example:  Congenital defects  Hemifacial hypertrophy  Unilateral condylar ankylosis  Unilateral condylar hyperplasia. www.indiandentalacademy.com
  26. 26. “Vertical thirds of face” www.indiandentalacademy.com
  27. 27.  Vertical facial proportions: The ideal face is divided into equal thirds by horizontal lines adjacent to the hairline ,the nasal base , the bottom of the nose and menton . The lower third of the face is further divided into -upper one third comprise the upper lip and the lower lip to the chin comprise the lower two thirds. www.indiandentalacademy.com
  28. 28.  “Rule of fifths” › Middle fifth › Medial two fifths › Outer two fifths www.indiandentalacademy.com
  29. 29.  Transverse facial proportions: Describes the ideal transverse relationships of the face. The face is divided sagitally into five equal fifths from helix to helix of the outer ears. Each of the segment equals one eye distance in width www.indiandentalacademy.com
  30. 30.  The middle fifth of the face – delineated by inner canthus of the eye.A line from the inner canhus should be coincident with the ala of the nose.  The medial two fifths of the face – A line from the outer canthus of the eye should be coincident with the gonial angle of the mandible.  The outer two fifths of the face – measured from the base of the ear to the helix of the ear,which represents the width of the ears. www.indiandentalacademy.com
  31. 31.  Facial profile  Straight  Convex  concave www.indiandentalacademy.com
  32. 32.  The profile is evaluated in the natural head position which is determined by the visual axis – the patient is asked to look straight forwards.  Three soft tissue points are taken into consideration – most prominent point on the forehead,base of the upper lip and pogonion. www.indiandentalacademy.com
  33. 33.  Facial divergence › Facial angle. i.e. angle bw N- Pog line to FHplane.  Straight/ orthognathic face :90  Anterior divergent face: more than 90  Posterior divergence: less than 90 www.indiandentalacademy.com
  34. 34.  Facial Divergence: An anterior or posterior inclination of the lower face relative to the forehead. Divergence of the face -coined by the eminent orthodontist – anthropologist Milo Hellman The facial angle,which is the angle formed by the nasion-pogonion sot tissue line and the frankfurt horizontal line is used to define the facial divergence. www.indiandentalacademy.com
  35. 35.  Assessment of vertical skeletal relationship: Growth pattern › FMPA- Frankfurt mandibular plane angle www.indiandentalacademy.com
  36. 36.  Evaluated by measuring the Frankfurt mandibular plane angle ( FMA) depending upon the point where the two planes – “Frankfurt horizontal plane and the mandibular plane” meet to form the FMA angle.  Average FMA angle cases – two planes meet at the occipital region.  Low angle cases – two planes meet beyond the occipital region.  High angle cases – the two planes meet in the mastoid region in front of the ear. www.indiandentalacademy.com
  37. 37.  Examination of lips Incompetent Potentially incompetent www.indiandentalacademy.com Competent
  38. 38.  Lip incompetence – -excessive seperation of the lips at rest -teeth protrude excessively -the lips are prominent and everted -lips separated at rest by more than 3 to 4 mm www.indiandentalacademy.com
  39. 39.  Lip posture : evaluated by viewing the profile with the lips relaxed. This is done by relating the upper lip to a true vertical line passing through the concavity at the base of the upper lip (soft tissue point A) and by relating the lower lip to a similar true vertical line through the concavity between the lower lip and chin( soft tissue point B ). www.indiandentalacademy.com
  40. 40.  Lip length: The length of the lips can be examined by gently parting the lips. Usually the upper lip covers the entire labial surface of upper anteriors except the incisal third or 2 to 3 mm and the lower lip extends on to the incisal one third of the upper anterior teeth. www.indiandentalacademy.com
  41. 41.  Texture and color:-usually both the lips are of same color. -Less active or hypoactive upper lip is chapped and lighter in color.  Tonicity: Normal lip – minimal tonicity, Hypertonic lip – tend to be firm and redder, Hypotonic lip is flaccid. www.indiandentalacademy.com
  42. 42.  Mento-labial sulcus:a fold of the soft tissue between the lower lip and the chin www.indiandentalacademy.com
  43. 43.  affected by- lower incisor position,the vertical height of the lower face & chin projection -Upright lower incisors tend to result in a shallow mentolabial sulcus. -Excessive lower incisor proclination deepens the mentolabial sulcus. www.indiandentalacademy.com
  44. 44.  Examination of nose Radix-soft tissue nasion Nasofrontal angle Nasal dorsum Nasal tip Columella Nasolabial angle-102 www.indiandentalacademy.com
  45. 45.  Nasal dorsum:  Bony dorsum- onethird to onehalf of nasal dorsum formed by the confluence of nasal bones Cartilagenous/septal dorsum On profile, the septal cartilage protrudes infront of the pyriform aperture   www.indiandentalacademy.com
  46. 46.      Nasal tip: most anterior point of the nose Supratip - just cephalic to the nasal tip Supratip break- area just cephalic to nasal tip where the lobule meets the dorsal portion of the nose On esthetic nose, a slight depression is present on the Supratip – more pronounced in females Double break-angular formation of nasal tip created by Supratip, tip and infratip www.indiandentalacademy.com
  47. 47.  Columella: portion of the nose between the base of the nose and the nasal tip www.indiandentalacademy.com
  48. 48.  Naso-labial angle: - the angle between the lower border of the nose to the upper lip. -Average - 90 to 120 -reduced in cases of proclined maxillary anterior teeth, maxillary prognathism -Increased in cases of maxillary retrognathism, retroclined maxillary anterior teeth www.indiandentalacademy.com
  49. 49.  Fomon and Bell-three major categories of nasal features according to racial background. 1. Leptorrhine – Usually found in whites and characterized by a long, high, narrow nose and nostrils. 2. Mesorrhine – Usually found in Asians and characterized by lack of dorsal height and collumellar support. 3. Platyrrhine – Usually found in blacks and characterized by a flat broad nose and wide nostrils. www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com
  51. 51.  Examination of chin: www.indiandentalacademy.com
  52. 52.  Chin projection: -two factors 1. the amount of anteroposterior bony projection of the anterior inferior border of the mandible 2. the amount of soft tissue that overlays that bony projection www.indiandentalacademy.com
  53. 53.    The amount of bone projecting past the cephalometric NB line NB-Pg: linear measurement Normal- 2±2 mm Retrusive/protrusive www.indiandentalacademy.com
  54. 54.  Throat form: Contour of the submental tissues  Lip chin throat angle:-The angle between the lower lip, chin and R point ( the deepest point along the chin neck contour) should be approximately 90 degrees. www.indiandentalacademy.com
  55. 55. www.indiandentalacademy.com
  56. 56.  An obtuse Lip chin throat angle which is unaesthetic reflects the following: • Chin deficiency • Lower lip procumbency • Excessive sub-mental fat • Retropositioned mandible • Low hyoid bone position. www.indiandentalacademy.com
  57. 57.  Chin neck angle:  It is also termed cervicomental angle.  Vistness and Souther stressed that the normal cervico mental angle is approximately 90 degrees.  Soft tissue sag due to ageing is one of the contributors for less than ideal sub mental form.  Weight gain also plays an important role. www.indiandentalacademy.com
  58. 58.  Soft tissue examination  Oral hygiene status  Gingiva: -size & shape -texture & colour -width of attached gingiva -in young healthy patients 2 –3 mm of attached gingiva is apparent. -gingival recession www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com
  60. 60.  Periodontal status: -tooth mobility -periodontal pockets -bleeding on probing www.indiandentalacademy.com
  61. 61.  Frenal attachments: -upper & lower labial and buccal freni -In infant, upper labial frenum extends from the upper lip to the incisive papilla. -As the incisors erupt, the frenum usually migrates and gets attached to the labial surface of the alveolar process. www.indiandentalacademy.com
  62. 62.  Occasionally, the frenum will persist and this may be associated with midline diastema. In these cases, the palatine papilla will blanch, if the lip is pulled forward.- Blanch test  Lower lingual frenum is examined for tongue tie or ankyloglossia. www.indiandentalacademy.com
  63. 63. www.indiandentalacademy.com
  64. 64. www.indiandentalacademy.com
  65. 65.  Tongue: -Size and shape -symmetry -posture -presence or absence of indentations or tooth impression on the sides of the tongue -large tongue or macroglossia. www.indiandentalacademy.com
  66. 66. www.indiandentalacademy.com
  67. 67.  Oral mucosa: -ulcerations -tori or bony protuberences -submucosal clefts or swelings www.indiandentalacademy.com
  68. 68. www.indiandentalacademy.com
  69. 69.  Palate: -palatal contour -depth and width of the palate -other developmental abnormalities like torus palatinus and clefts -scar tissue formation www.indiandentalacademy.com
  70. 70. www.indiandentalacademy.com
  71. 71.  Tonsils/adenoids: -size and degree of inflammation -alteration in tongue and jaw posture -adenoid facies www.indiandentalacademy.com
  72. 72. Faucial pillars and throat www.indiandentalacademy.com
  73. 73.  Hard tissue examination:  Examination of teeth: -developmental status of dentition -teeth present -carious teeth -endodontically treated teeth -impacted/unerupted teeth -supernumerary/ supplementory teeth www.indiandentalacademy.com
  74. 74. -congenitally missing teeth -variations in size of teeth microdontia macrodontia -variations in shape of teeth peg shaped lateral incisor mulbery molars -variations in no. of teeth www.indiandentalacademy.com
  75. 75. -variations in normal eruption sequence -restorations -discoloured teeth -hypoplastic teeth -occlusal wear facets/bruxism -traumatic/fractured teeth www.indiandentalacademy.com
  76. 76.  Examination of arches: -shape: ovoid/tapered/square -symmetry -alignment: crowding/spacing/rotation -curve of spee: flat/average/exaggerated/reverse www.indiandentalacademy.com
  77. 77.  Malpositioning of individual teeth: -mesial/distal inclination -buccal/lingual inclination -mesial/distal /lingual displacement -infraversion/supraversion -rotations -transposition www.indiandentalacademy.com
  78. 78.  Examination of occlusion: A. antero-posterior relationship: 1.molar relation-Angle’s classification 2.canine relation 3.incisor relation www.indiandentalacademy.com
  79. 79.  Overjet: -Horizontal overlapping of upper and lower teeth -Normal- 2 to 3 mm.  Variations in overjet : -decreased - increased -reverse overjet or anterior cross bite -edge to edge bite. www.indiandentalacademy.com
  80. 80. www.indiandentalacademy.com
  81. 81.  B. Vertical relationship:  Over bite: -vertical overlapping of anterior teeth -Normal- 2 to 3 mm. -Overbite percentage – overbite/ clinical crown length x 100 Normal value – 33 %. www.indiandentalacademy.com
  82. 82.  Variations in overbite:  Deep bite – overbite > 2 to 3 mm.  Complete deep bite – lower anteriors contact either the cingulum of upper anteriors or the palatal mucosa.  Closed bite –upper anteriors overlap the lower anteriors completely – class II div 2 malocclusion.  Open bite – lack of vertical overlapping of teeth. www.indiandentalacademy.com
  83. 83. C. Transverse relationship: -posterior cross bite -buccal non-occlusion/ Scissors bite -lingual non-occlusion D. Midline -upper and lower midline -skeletal midline -mid sagittal plane www.indiandentalacademy.com
  84. 84.  Macro-esthetics -Face in all three planes of space -asymmetry -excessive or deficient face height -mandibular deficiency or excess www.indiandentalacademy.com
  85. 85.  Mini-esthetics -smile framework -excessive gingival display on smile -inadequate anterior tooth display -inappropriate gingival heights -excessive buccal corridors www.indiandentalacademy.com
  86. 86.  Micro-esthetics –the teeth -tooth proportion in height and width -gingival shape and contour -connectors and embrasures -black triangular holes -tooth shade www.indiandentalacademy.com
  87. 87.  Facial esthetics vs. Facial proportions  Frontal examination: 1.Bilateral Facial symmetry in the fifths of face 2.Proportionality of width of eyes/nose/mouth -composite photographs-Rt/Lt - Facial index: proportional relationship of facial height to width www.indiandentalacademy.com
  88. 88.  anthropometric measurements  Vertical facial proportions -vertical facial thirds -artists of the Renaissance period da Vinci and Durer -Farkas-modern Caucasians of European descent-lower third is slightly longer www.indiandentalacademy.com
  89. 89. www.indiandentalacademy.com
  90. 90.  Saggital facial proportions -Rule of fifths -seperation of the eyes-equal the width of the eyes -nose & chin- centred within central fifth -width of the nose-same as or slightly wider than the central fifth -interpupillary distance-equal the width of mouth www.indiandentalacademy.com
  91. 91. www.indiandentalacademy.com
  92. 92.  Profile analysis Poorman’s cephalometric analysis 3 goals:  Evaluation of Proportionality of jaws in the A-P plane  Evaluation of lip posture and incisor prominence  Re-evaluation of vertical facial proportions and Evaluation MPA www.indiandentalacademy.com
  93. 93.    Physiologic NHP Profile convexity or concavity Divergence of face www.indiandentalacademy.com
  94. 94.    Lip promienence Lip incompetence Bimaxillary dentoalveolar protrusion -reflected in facial appearance in 3 ways 1.excessive seperation of the lips at rest i.e. >4mm -lip incompetance 2.excessive efforts to bring lips in closure -lip strain 3. Lip promienence www.indiandentalacademy.com
  95. 95. www.indiandentalacademy.com
  96. 96. www.indiandentalacademy.com
  97. 97. Short facial height-everted and protrusive lips  Throat form: -submental fat deposition and low tongue posture -stepped throat contour -”double chin” appearence  www.indiandentalacademy.com
  98. 98. www.indiandentalacademy.com
  99. 99.  Vertical facial proportions www.indiandentalacademy.com
  100. 100.  Mandibular plane angle: steep MPA: -long anterior vertical facial dimensions -skeletal open bite tendency  flat MPA: -short AFH -deep bite tendency  www.indiandentalacademy.com
  101. 101. -Relationship of the dentition to the face 1.Examination of symmetry -relationship of dental midline of each arch to the skeletal midline 2.Vertical relationship of the teeth to the lips-at rest and on smile -amount of incisor display www.indiandentalacademy.com
  102. 102.   Excessive incisor display1.long lower third of the face 2.short upper lip -lip height at philtrum and the comissures Transverse cant of occlusal plane -transverse roll of the esthetic line of dentition -up-down transverse rotation of the dentition on smiling or when the lips are seperated at rest www.indiandentalacademy.com
  103. 103. www.indiandentalacademy.com
  104. 104. Two types 1.posed/social smile -focus of the orthodontic diagnosis -reproducible 2.Unposed/emotional smile  www.indiandentalacademy.com
  105. 105. www.indiandentalacademy.com
  106. 106.  Extent of the smile is outlined by  Curvature of the upper & lower lip  Position of the angle of mouth  Degree of exposure of both anterior & posterior teeth, gingiva  width of the buccal corridor. www.indiandentalacademy.com
  107. 107. Three views: 1.Obligue or ¾ view 2.Frontal view 3.Profile view  www.indiandentalacademy.com
  108. 108. Three points 1.Amount of icisor and gingival display 2.Transverse dimensions of the smile relative to the upper arch -buccal corridor 3.The smile arc  www.indiandentalacademy.com
  109. 109.  Amount of incisor and gingival display: -elevation of the upper lip on smile should stop at or near gingival margin -<100% incisor display-less attractive smile -decrease in amount incisor display over time www.indiandentalacademy.com
  110. 110. www.indiandentalacademy.com
  111. 111.  Buccal corridors: -distance between the maxillary posterior teeth and inside of the cheek -excessively wide buccal corridors i.e. negative space- unesthetic -widening of the upper arch www.indiandentalacademy.com
  112. 112. www.indiandentalacademy.com
  113. 113.  Smile arc: -contour of the incisal edges of the maxillary anterior teeth relative to the curvature of the lower lip during a social smile -consonant smile arc -flattened smile arc www.indiandentalacademy.com
  114. 114. www.indiandentalacademy.com
  115. 115.  Tooth proportions: -tooth widths in relation to each other -height-width proportions of individual teeth -width relationship & the “Golden proportion” -the ratio of recurring 62% from central incisor to posterior teeth i.e.1.0:0.62:0.38:0.24 etc www.indiandentalacademy.com
  116. 116. www.indiandentalacademy.com
  117. 117.  Height-width relationships: -width of the tooth should be about 80% of its height- 8:10 -disproportions in height-width ratio: 1.Incomplete eruption 2.Loss of crown height from attrition 3.Excessive gingival height 4.Inherent distortion in crown form www.indiandentalacademy.com
  118. 118. www.indiandentalacademy.com
  119. 119.  Gingival height , shape & contour: Gingival height: -proportional gingival heights -central incisor-highest gingival level -lateral incisor-1.5 mm lower than CI -canine-same as CI  www.indiandentalacademy.com
  120. 120. www.indiandentalacademy.com
  121. 121. Gingival shape: -curvature of gingiva at the margins of tooth -Max. Lateral Incisorsymmetrical half-oval/half circle -Max. Central Incisor & Caninemore elliptical  www.indiandentalacademy.com
  122. 122. Gingival zenith: -most apical point of the gingival tissue - Max. Central Incisor & CanineDistal to long axis of the tooth - Max. Lateral IncisorCoincide with the long axis  www.indiandentalacademy.com
  123. 123. www.indiandentalacademy.com
  124. 124.  Connectors and embrasures:  Connectors: -area where adjacent teeth appears to touch -extends apically or occlusally from the actual contact point -Normal connector height –greatest between CI www.indiandentalacademy.com
  125. 125. www.indiandentalacademy.com
  126. 126. -diminishes from CI to posterior teeth -moves apically in progression from CI to PMs & Ms www.indiandentalacademy.com
  127. 127.  Embrasures: -triangular spaces incisal or gingival to the contact area  Black triangles: -open gingival embrasures above the connectors -causes: 1.Loss of gingival tissue 2.Orthodontic correction of crowded and rotated maxillary incisors www.indiandentalacademy.com
  128. 128. www.indiandentalacademy.com
  129. 129.  Tooth shade & color: -Max. Central Incisor -brightest in smile -Max. Lateral Incisor- less than CI -Max. Canine- least bright -First & second PMs-lighter and brighter than canine www.indiandentalacademy.com
  130. 130.      Assessment of Postural rest position and interocclusal space Evaluation of path of closure Examination of TMJ Examination of muscles of mastication Examination of muscles of neck and head support www.indiandentalacademy.com
  131. 131.  - Examination of orofacial Dysfunctions Respiration Deglutition/Swallowing Speech Peri-oral muscle tone www.indiandentalacademy.com
  132. 132.  Postural rest position and interocclusal space: -the position of mandible when the muscles which elevates and depress the jaw are in a state of minimum tonic contraction to maintain the posture of mandible www.indiandentalacademy.com
  133. 133. www.indiandentalacademy.com
  134. 134. Methods of assessing Postural rest position: 1.Phonetic method 2.Command method 3.Non-command method  www.indiandentalacademy.com
  135. 135.  Interocclusal clearance/space: -distance between the occlusal or incisal surfaces of the maxillary and mandibular teeth when the mandible is in the physiologic rest position -freeway space -normal- 3mm in bicuspid region www.indiandentalacademy.com
  136. 136. Methods to measure interocclusal space: 1.Direct intra-oral procedure 2.Direct extra-oral procedure 3.Indirect extra-oral procedure  www.indiandentalacademy.com
  137. 137.  Evaluation of path of closure: -movement of mandible from rest position to habitual occlusion 1.Forward path of closure: -skeletal prenormalcy -edge-to edge incisor contact www.indiandentalacademy.com
  138. 138. 2.Backward path of closure: -class II div 2 3.Lateral path of closure: -occlusal prematurities -narrow maxillary arch www.indiandentalacademy.com
  139. 139.  Early symptoms of TMJ problems include: • Clicking and crepitus • Sensitivity in the condylar region and masticatory muscles • Functional disturbances • Radiographic evidence of morphologic and positional abnormalities. www.indiandentalacademy.com
  140. 140. 1.Jaw movements, path of closure and joint sounds: -range of motion: a)Maximum opening-40 mm b)Right and left lateral excursion c)Protrusion www.indiandentalacademy.com
  141. 141. -path of closure: -amount, direction, timing of any deviation -clicks: -disclose a loss of intimacy of condyle and meniscus relationship -crepitus: -early arthritic symptoms www.indiandentalacademy.com
  142. 142. www.indiandentalacademy.com
  143. 143. 2.Occlusal interferences: -retruded contact position -intercuspal position -protrusive and lateral occlusal contacts 3.Muscle tenderness(myalgia): -masseter, lateral pterygoid and temporalis www.indiandentalacademy.com
  144. 144. www.indiandentalacademy.com
  145. 145. Muscles of mastication  Morphologic Examination: Palpation of each jaw muscle at rest and in function - useful to reveal asymmetries of muscle size and placement.  Functional Examination: Functional analysis of the jaw musculature is best carried out with each particular synchronized function in mind. www.indiandentalacademy.com
  146. 146. www.indiandentalacademy.com
  147. 147. Muscles of neck and head support  Pain and tenderness:Myalgia of the neck muscles may be associated with  tempero mandibular dysfunction  spondylitis  other functional disorders of the region. www.indiandentalacademy.com
  148. 148. www.indiandentalacademy.com
  149. 149.  Assessment of Respiration: -breathing- three types a)Nasal b)Oral c)Oro-nasal -alteration in the posture of head, tongue and mandible www.indiandentalacademy.com
  150. 150. Methods of examination: 1.Study the patients breathing unobserved: 2.Ask the patient to take a deep breath 3.Ask the patient to close the lips and take a deep breath through the nose  www.indiandentalacademy.com
  151. 151. Nasal breathers: -lips touch lightly at rest -good reflex control of the alar muscles -dilate the external nares on inspiration  Mouth breathers: -lips are parted -maintain the size and shape of external nares or contract the nasal orifices  www.indiandentalacademy.com
  152. 152.  1. 2. 3. Other tests to diagnose the mode of respiration: Mirror test Cotton test Water test www.indiandentalacademy.com
  153. 153. www.indiandentalacademy.com
  154. 154.  Examination of Swallowing: -patient seated upright -Normal mature swallow:-mandible rises as the teeth are brought together, lips touch lightly and temporal muscle contracts -Teeth apart swallow:-no conraction of temporal muscle -strong mentalis and lip contractions www.indiandentalacademy.com
  155. 155. -Differential diagnosis: 1. Normal infantile swallow 2. Normal mature swallow 3. Simple tongue thrust swallow 4. Complex tongue thrust swallow 5. Retained infantile swallow www.indiandentalacademy.com
  156. 156. Normal infantile swallow: -tongue lies between gum pads -mandible is stabilized by contraction of facial muscles -strong buccinator muscle -disappears with eruption of buccal teeth in primary dentition  www.indiandentalacademy.com
  157. 157. www.indiandentalacademy.com
  158. 158. Normal mature swallow: -very little lip and cheek activity -contraction of mandibular elevators bringing the teeth into occlusion  Simple tongue thrust swallow: -contraction of lips, mentalis and mandibular elevators -teeth in occlusion  www.indiandentalacademy.com
  159. 159. Complex tongue thrust swallow: -tongue thrust with teeth apart swallow -combined contraction of lips, facial muscles and mentalis -lack of contraction of mandibular elevators -mouth breathers and chronic nasorespiratory disease  www.indiandentalacademy.com
  160. 160. Retained infantile swallow: -persistence of the infantile swallowing reflex after the arrival of permanent teeth -contraction of buccinator muscle  www.indiandentalacademy.com
  161. 161.  Assessment of Speech: 1.Lisping with sibilant sound(S,Z): -large gap between incisors -missing incisors or open bite -tongue thrust habit 2.Difficulty in production of linguo-alveolar stops(t,d): -irregular incisors -lingually positioned maxillary incisors www.indiandentalacademy.com
  162. 162. 3.Distortion of labio-dental fricatives(t,v): -excessive protrusion of mandible 4.Distortion of linguo-dental fricatives(th,sh,ch): -anterior open bite or missing incisors 5.Cleft palate- nasal tone www.indiandentalacademy.com
  163. 163.  Peri-oral muscle tone: -mentalis -orbicularis oris www.indiandentalacademy.com
  164. 164.  Two purposes: - to document the patient’s initial condition - to supplement information obtained from interview and clinical examination www.indiandentalacademy.com
  165. 165.  Three major categories: -for evaluation of- A. The health of the teeth and oral structures 1. 2. 3. 4. 5. Intraoral photographs Panoramic radiographs TMJ radiographs Periapical & bitewings Occlusal radiographs www.indiandentalacademy.com
  166. 166. B. The alignment & occlusal relationship of the teeth 1. 2. Study casts Occlusal records C. The face & jaw proportions 1. 2. a. b. Facial photographs Cephalometric radiographs lateral ceph P-A ceph www.indiandentalacademy.com
  167. 167.  Intraoral photographs: -to document the initial condition of hard and soft tissues -five standard views 1. Frontal/anterior 2. Right lateral 3. Left lateral 4. Maxillary occlusal 5. Mandibular occlusal www.indiandentalacademy.com
  168. 168. www.indiandentalacademy.com
  169. 169. www.indiandentalacademy.com
  170. 170.  Panoramic radiographs: -advantages: 1. Yields a broader view 2. Pathological lesions and supernumerary or impacted teeth 3. Much lower radiation exposure 4. Views of mandibular condyles 5. Screening image to determine if other TMJ radiographs are needed www.indiandentalacademy.com
  171. 171. www.indiandentalacademy.com
  172. 172.  Periapical & bitewing radiographs: -supplemental to OPG when greater detail is required -children & adolescent-root resorption or aggressive periodontal disease www.indiandentalacademy.com
  173. 173.  Occlusal radiographs: -to locate impacted teeth in combination with periapical radiograph  Cone-beam computed tomography: -to evaluate position of impacted tooth and extent of damage to roots of other teeth www.indiandentalacademy.com
  174. 174.  CT or MRI scans: -screening for TMJ internal joint pathology www.indiandentalacademy.com
  175. 175.  Frontal : -natural head position -four views: a) Frontal at rest: -lip incompetence-lips in repose and mandible in rest position www.indiandentalacademy.com
  176. 176. b) Frontal with teeth in maximal intercuspation: -lips closed -lip strain and its esthetic effect -lip incompetence-lips together picture www.indiandentalacademy.com
  177. 177. c) Frontal dynamic(smile): -the amount of incisor display -excessive gingival display d) Close-up view of the posed smile: -analysis of smile relationships www.indiandentalacademy.com
  178. 178. www.indiandentalacademy.com
  179. 179. 2. oblique(three-quarter; 45 degree): -three views: a) Oblique at rest: -examination of midface -midfacial deformities -nasal deformity -chin neck area www.indiandentalacademy.com
  180. 180. -prominence of gonial angle -length and definition of the border of mandible -lip fullness and vermilion display -facial asymmetry-oblique views of both sides www.indiandentalacademy.com
  181. 181. b) Oblique on smile: -anteroposterior cant of OP c) Oblique close-up smile: -more precise evaluation of lip relationships to the teeth and jaws www.indiandentalacademy.com
  182. 182. www.indiandentalacademy.com
  183. 183. 3. Profile: -orientation of the head to the visual axis -inferior border: slight above the scapula, at the base of the neck -superior border: slight above the top of head -right border: slight ahead of the nasal tip -left border: stops just behind the ear/ full head shot www.indiandentalacademy.com
  184. 184. www.indiandentalacademy.com
  185. 185. -two views: a) Profile at rest: -lips relaxed b) Profile smile: -angulation of maxillary incisors 4. Submental view: -mandibular asymmetry www.indiandentalacademy.com
  186. 186. www.indiandentalacademy.com
  187. 187. www.indiandentalacademy.com
  188. 188. Study casts are oriented in 3 planes: -Midpalatal raphe -Tuberosity plane -Occlusal plane www.indiandentalacademy.com
  189. 189.  Cast analysis: -Symmetry and space 1.Symmetry: -trasparent ruled grid -oriented to midpalatine raphe -asymmetry within the dental arch  Lateral drift of incisors  Drift of posterior teeth on one side www.indiandentalacademy.com
  190. 190. 2.Alignment (crowding): space analysis -to quantify the amount of crowding within the dental arches -comparison between the amount of space available for alignment of the teeth and the amount of space required to align them properly www.indiandentalacademy.com
  191. 191. Mixed Dentition Analysis: -Estimation of the size of unerupted permanent teeth -three basic approaches 1. Radiographic method: -true width of primary molar/apparent width of primary molar = true width of unerupted premolar/apparent width of unerupted premolar  www.indiandentalacademy.com
  192. 192. 2. Proportionality tables: -Moyer’s prediction tables -Tanaka & Johnston prediction values 3. Combination of radiographic & prediction table method: -Hixon & Oldfather prediction graph -Staley & Kerber prediction graph www.indiandentalacademy.com
  193. 193. -Radiographic cephalometry -1934 by Hofrath in Germany & Broadbent in United States  Uses:  Research on growth patterns in the craniofacial complex  To evaluate dentofacial proportions and clarify the anatomic basis for malocclusion www.indiandentalacademy.com
  194. 194. Recognizing and evaluating changes brought about by orthodontic treatment by superimposition of serial radiographs  Screening of pathology: -anomalies in the cervical spine -degenerative changes in the cervical vertebrae -other pathological changes in the skull, jaws or cranial base  www.indiandentalacademy.com
  195. 195.  www.indiandentalacademy.com TRACING
  196. 196. www.indiandentalacademy.com
  197. 197.   Case history and clinical examination are the two important tools in the process of diagnosis which can be supplemented with other diagnostic records such as radiographs and study casts to obtain proper diagnosis A comprehensive diagnosis is necessory for proper treatment planning and the success of orthodontic treatment www.indiandentalacademy.com
  198. 198. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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