This document discusses the process of evaluating a dental patient, including collecting diagnostic records. It involves questioning the patient, clinically examining them, reviewing diagnostic records, dental casts, radiographs, photographs and supplemental images. Key areas of evaluation include facial proportions, dental and oral health, jaw and occlusion function, and orthodontic treatment goals. Diagnostic records aid in documenting the initial dental condition, occlusion, and facial proportions to inform treatment planning.

1. GLO ARBY ARGUELLES, DMD

2. QUESTIONNAIR
E INTERVIEW
CLINICAL
EXAMINATION
ANALYSIS OF
DIAGNOSTIC
RECORDS
DATA BASE
PROBLEM LIST =
DIAGNOSIS
QUESTIONNAIR
E INTERVIEW
CLINICAL
EXAMINATION
ANALYSIS OF
DIAGNOSTIC
RECORDS
DATA BASE
PROBLEM LIST =
DIAGNOSIS

3.  PATIENT QUESTIONNING
 CLINICAL EXAMINATION OF A PATIENT
 EVALUATION OF DIAGNOSTIC RECORDS
 DENTAL CASTS
 RADIOGRAPHS – CEPH, PANO
 PHOTOGRAPHS -- INTRAORAL, EXTRAORAL
 SUPPLEMENTAL – PA, HANDWRIST
 TRANSCRANIAL XRAYS

4. 1. CHIEF COMPLAINT
“Tell me what bothers you about your teeth”.
a. Impaired dentofacial esthetics leading to psychosocial problems.

5. 2. MEDICAL AND DENTAL HISTORY
a. Facial asymmetry due to trauma
b. Condylar fractures
c. Controlled Diabetes – periodontal breakdown
d. Arthritis – high doses of Prostaglandin inhibitors may impede orthodontic movement
e. Rheumatic Fever or Cardiac Anomalies – antibiotic coverage
f. Any manipulation that would cause gingival bleeding
g. Rheumatoid Arthritis –
avoid functional appliances, elastics, TMJ manipulation and mandibular
advancement

6. 3. PHYSICAL GROWTH EVALUATION
a. Rapid growth during adolescent growth spurt facilities tooth movement.
b. Significant growth modification
- may not be possible in a child who is beyond the peak of growth spurt.
c. Normal youths approaching puberty

7. 4. SOCIAL AND BEHAVIORAL EVALUATION
Patients motivation for treatment.
 Internal
 External

8. GOALS:
To document and evaluate facial, occlusal and functional characteristics
To decide which diagnostic records are required

9. 1. Evaluation of facial proportions
a. Facial esthetics / Facial Proportions

10. 1. Evaluation of facial proportions
a. Facial esthetics / Facial Proportions

11. 1. Evaluation of facial proportions
a. Facial esthetics / Facial Proportions
b. Assessment or developmental Age: Hand wrist Radiograph

12. HAND WRIST RADIOGRAPH
3 BONES
1. Epiphysis & Diaphysis of Middle Phalanges
2. Sesamoid Bone - ‘dot-shaped’ bone
3. Radius - wrist bone

13. HAND WRIST RADIOGRAPH
PRE-PUBERTY
middle finger, middle phalanges has a diaphysis smaller than epiphysis.
PUBERTY IS STARTING
sesamoid bone presents in the thumb.
PUBERTY IS PEAKING
epiphysis of middle phalanges of middle finger caps the diaphysis
PUBERTY ALMOST COMPLETE
fusion occurs between epiphysis and diaphysis of the middle phalanges of the middle finger in absence of fused radius bone.
PUBERTY COMPLETE
complete union of epiphysis and diaphysis radius. Last bone to ossify.
ossification of all hand bones is completed and skeletal growth is finished.

14. HAND WRIST RADIOGRAPH

15. 1. Evaluation of facial proportions
a. Facial esthetics / Facial Proportions
b. Assessment or developmental Age: Hand wrist Radiograph
c. Profile Analysis
GOALS:
To establish whether the jaws are proportionally positioned
To evaluate lip posture and incisor placement
To evaluate vertical facial proportions and mandibular plane angle

16. 1. Evaluation of facial proportions
a. Facial esthetics / Facial Proportions
b. Assessment or developmental Age: Handwrist Radiograph
c. Profile Analysis
2. Evaluation of Oral Health
3. Evaluation of Jaw and Occlusal Function

17. FRONTAL VIEW
 Width of base of NOSE =INNER INTERCANTHAL DISTANCE

18. FRONTAL VIEW
 Width of MOUTH = Distance between Irises

19. FRONTAL VIEW
 Width of MANDIBLE at Gonial Angles = Width of the Orbits

20. TWO PURPOSES:
1. To document the starting point for orthodontic treatment.
2. To add the information gathered from the interview and clinical examination.

21. 3 MAJOR CATEGORIES:
1. Records for the evaluation of teeth and oral structures
2. Records for the evaluation of occlusion
3. Records for evaluation of facial and jaw proportions

22. 1. Records for the evaluation of teeth and oral structures.
 INTRAORAL PHOTOS - documents the initial condition of the hard and soft tissues; requires
maximum retraction of cheeks and lips

23. 2. Records for the evaluation of occlusion
 DENTAL STUDY CAST
- record of occlusion; provide “reasonable” facsimile of the occlusion of the patient

24. INFORMATION TO BE TAKEN FROM DENTAL STUDY CASTS:
1. Malocclusion classification
2. Overbite, overjet, crossbites
3. Condition of curve of spee
4. Bolton’s Analysis
5. Midline discrepancies
6. Tooth fracture
7. Premature loss, inadequate space, rotation
8. Individual Tooth Malposition
9. Frenum Diastemas
10. Muscle attachments
11. Morphology of interdental papillae
12. Anomalies in size, shape and position
13. Arch shape and symmetry
14. Thickness of Alveolar bone over the teeth

25. 2. Records for the evaluation of occlusion
 POLYSILOXANE or WAX BITE Record
- Permits the dentist to relate the upper & lower casts correctly in full occlusion.
- Assists in holding the upper & lower casts when trimming

26. 3. Records for evaluation of facial and jaw proportions
 DENTAL STUDY CAST
 trimmed for orthodontic purposes, so that the bases are
symmetric and polished.
- easier to analyze arch form to detect asymmetry within the
dental arches.
 Neatly trimmed and polished cast models are more acceptable
for presentation to the patient.

27. 1. Can measure more easily.
2. Objectivity is greater.
3. Drifting can be appreciated better.
4. Tipping can be observed better.
5. Over- eruption can be seen more clearly.
6. Under eruption can be seen more clearly.
7. Abnormal curve of spee is appreciated better.
8. Prematurities seen more clearly.
9. Palatal breadth, depth and figuration are observed better.