Lecture 2 Al Azhar University Faculty of oral and dental medicine fifth-year second semester By Lama El Banna

1. ‫الرحي‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬‫م‬

2. College of Dentistry
Orthodontic III
Diagnosis
Dr. Hazem El Ajrami
Master Degree in Orthodontic & Pedodontic

3. Problem list = Diagnosis
Database
Questionnaire
and interview
Diagnostic
records
Clinical
examination

4. • Examination of neuromuscular functions:
1) Respiration.
2) Swallowing.
3) Speech.
4) Jaw function.

5. 3. Speech:
• Speech problems can be related to
malocclusion, but normal speech is possible in
the presence of severe anatomic distortions.
Speech difficulties in a child, therefore, are
unlikely to be solved by orthodontic
treatment.
• Some malocclusions can be related to speech
problems for example anterior open bile, large
gap between incisors and skeletal Class III. In
these situations a combination of speech
therapy and orthodontics may help.

7. 4. Jaw function:
• An important part of the clinical examination
is to establish the path of closure of the
mandible and to determine if the maximum
intercuspal position (centric occlusion)
corresponds with the retruded contact
position (centric relation).
• During the clinical examination, the TMJs
should be palpated and any crepitus or pain in
the joints should be noted.

9. 3. Facial Examination:
• “Everything has beauty, but not everyone sees it”
Confucius
• Facial examination includes frontal and profile
analysis.
a) Frontal Examination (Dentofacial appearance)
Frontal examination should include evaluation of:
1. Facial symmetry.
2. Facial proportions.
3. Anterior tooth display.

10. 1. Facial symmetry:
• A small degree of bilateral facial asymmetry exists
in essentially all normal individuals.
• This "normal asymmetry," which usually results
from a small size difference between the two
sides, should be distinguished from a chain or
nose that deviates to one side, which can
produce severe disproportion and esthetic
problems.
• Gross asymmetry of the face may occur in
conditions like: hemifacial hypertrophy,
hemifacial atrophy, facial palsy and unilateral
ankylosis.

13. 2. Facial proportions:
Vertical proportions:
The ideal face is composed of equal fifths, all
approximately equal to one eye width. The
commissure width should also be coincident
with the medial limbus of the eyes, and the alar
width should be coincident with the intercanthal
width.

16. Horizontal proportions:
• The distance from the hairline to the base of the
nose, base of nose to
bottom of nose, and nose to chin should be
equal. In Caucasians, the lower third is very
slightly longer.
• In the lower third the mouth should be one-third
the way between the base of the nose and the
chin.
• Because of variation of the hairline, the face can
alternatively be divided into two parts, upper
and lower only.

18. Facial types:
• The facial type is indicated by the facial height
to width ratio (Facial index).
• There are three facial types:
A. Mesocephalic; average shape of the head,
usually individuals with mesocephalic face
posses' normal dental arches.

22. B. Dolicocephalic; they have long and narrow
head, and this is usually accompanied by
narrow dental arches.
C. Brachycephalic; the face is broad and short,
and accompanied with broad dental arches.

24. 3. Anterior tooth display (Maxillary incisor-lip
relationship):
• Examine the vertical relationship of the teeth
to the lips, at rest and on smiling.
• At rest, a 2 to 3 mm. of the maxillary incisors
can be displayed.
• Upon smiling, ideal exposure of upper incisors
is three quarter of the crown height to 2 mm.
of gingival.
• More than 2 mm of gingival exposure in full
smiling is referred to as gummy smile.

27. b) Profile Analysis:
There are three goals of facial profile analysis:
1. Establishing whether the jaws are
proportionately positioned in the
anteroposterior plane of space.
• Clinical assessment of anteroposterior jaw
relationship can be done by using the index and
middle fingers placed approximately at point A
and point B respectively.
• If index finger is slightly ahead of the middle
finger it indicates Class II skeletal base pattern.
• If the middle finger is ahead of the index finger it
indicates Class III skeletal base pattern.

29. • Another technique with the patient in the natural
head position; note the relationship between two
lines, one dropped from the bridge of the nose to
the base of the upper lip, and a second one
extending from that point downward to the chin.
These line segments should form a nearly straight
line. An angle between them indicates either
profile convexity (upper jaw prominent relative to
chin) or profile concavity (upper jaw behind chin),
A convex profile therefore indicates a skeletal
Class II jaw relationship, whereas a concave
profile indicates a skeletal Class III jaw
relationship.

31. 2. Evaluation of lip posture and incisor
prominence:
Examine excessive incisor protrusion or
retrusion. In extreme cases, incisor protrusion
can affect the position and function of the lips.
If incisor protrusion is seen in both jaws, this is
called bimaxillary dentoalveolar protrusion.

34. 3. Re-evaluation of vertical facial proportions and
evaluation of mandibular plane angle.
• Vertical proportions can be observed during the
full face examination but sometimes can be seen
more clearly in profile.
• In the clinical examination, the inclination of the
mandibular plane to the true horizontal should
be noted. The mandibular plane is examined by
placing a finger or mirror handle along the lower
border. This is important because a steep
mandibular plane angle usually indicates long
anterior facial vertical dimensions and a skeletal
open bite tendency, while a flat mandibular
plane angle often correlates with short anterior
facial height and deep bite malocclusion.

37. 4. Intra oral examination:
To describe any orthodontic condition,
these four aspects must be evaluated
carefully:
A. Alignment, arch form and symmetry.
B. Anteroposterior relationships.
C. Vertical relationships.
D. Transverse relationships.

38. A. Analysis of the alignment and intra-arch
symmetry:
• First identify and count the teeth, with the aid
of radiographs for unerupted teeth. Then
individual tooth malpositions are recorded.
• The symmetry within each dental arch is
examined. Finally, evaluate amount of
crowding or spacing present.

40. B. Evaluation of dental relationships in the
anteroposterior plane of space:
• In this dimension, the Angle classification is used
to examine whether patient has Class I, Class II or
Class III molar relation.
• Excessive overjet or reverse overjet of the incisors
is also noted.
• This is usually supplemented by cephalometric
radiograph to state whether a deviation is
skeletal, dentoalveolar, or both.
• The skeletal possibilities are normal, maxillary
prognathism, mandibular retrognathism, maxillary
hypoplasia, mandibular prognathism, or any
combination of these.

42. C. Vertical dimensions (Vertical plane of space).
• Bite depth is used to describe the vertical relationships.
• The possibilities are anterior open bite (failure of the
incisor teeth to overlap), anterior deep bite (excessive
overlap of the anterior teeth), posterior open bite
(failure of the posterior teeth to occlude, unilaterally or
bilaterally), or posterior collapsed bite in the case of a
mutilated dentition.

43. • Again, one must determine whether the problem
is skeletal, dentoalveolar, or a combination.
• As with all aspects of malocclusion, it is
important to ask, "Why does the open bite (or
other problem) exist?" Since vertical problems,
particularly anterior open bile, can result from
environmental causes or habits.

48. D. Evaluation of dental relationships in the
transverse plane of space:
• First examine upper and lower dental midlines
they should coincide together and coincide also
with the facial midline.
• Transverse anomalies could be posterior
crossbites or scissors bite.
• Posterior crossbite could be unilateral or bilateral
and often reflect some discrepancy in the widths
of the dental bases.

49. • When the arches are symmetrical and of equal
width, the mandible will usually be displaced to
one side in order to obtain maximal
intercuspation, producing a unilateral posterior
crossbite. When the unilateral crossbite is
observed without lateral displacement of the
mandible, this reflects an underlying skeletal
asymmetry.
• Bilateral crossbite is always associated with a
narrow maxillary dental base relative to the
mandibular base. However, scissors bite occurs
when the upper arch is too broad relative to the
lower.

54. 54
Thank You