This document provides information about the steps involved in orthodontic diagnosis and treatment planning. It discusses essential diagnostic aids like case history, clinical examination including extra-oral and intra-oral examination, study casts, radiographs, and facial photographs. Supplemental diagnostic aids like specialized radiographs and electromyography are also mentioned. The conclusion restates that orthodontic diagnosis involves systematically collecting data to identify the nature and cause of a malocclusion.

1. K.SANTOSHI
II MDS
ORTHODONTIC DIAGNOSIS

2. CONTENTS
Introduction
Steps in diagnosis and treatment planning
Diagnostic aids
Essential Aids
Case history
Clinical examination
General examination
Extra-oral examination
Intra-oral examination
Functional analysis
Study casts
Radiographs-Periapical, Bitewing,Panoramic.
Facial photographs

3. Supplemental Aids
The supplemental diagnostic aids include;
1-Specialized radiographs ex;
a-cephlometric radiographs
b-occlusal intra-oral films
c-selected lateral jaw views
d-cone shift technique
2.Electromyographic examination of muscle activity
3. Hand wrist radiographs to assess bone age or
maturation age
Conclusion
References

4. INTRODUCTION
Orthodontic diagnosis deals with recognition of the various
characteristics of the malocclusion.
It involves collection of data in a systematic manner to
help in identifying the nature and cause of the problem.
Orthodontic diagnosis should be based on sound scientific
knowledge combined at times with clinical experience and
common sense.
A proper diagnosis is essential for better treatment plan .
Orthodontic diagnosis – rakosi , graber

5. 3
Contemporary orthodontic 5th edition proffit

6. Orthodontic diagnosis – rakosi , graber 7
DIAGNOSTIC AIDS

7. 11

8. NAME OF THE PATIENT: For identification, For better communication and Medicolegal
legal records.
AGE : Chronologica age – Growth modification procedures
SEX : Timing of growth spurt and esthetics
OCCUPATION: Economic status , Occupational hazards
ADDRESS: for correspondance , to know the endemic and pandemic outburts
ETHENIC ORIGIN: ethnic facial charecteristics
CONTACT NUMBER:

9. CHIEF COMPLAINT: recorded in patients own words and in order
of preference & priority.
Most common logical reasons for orthodontic treatment will be
1)Impaired dento-facial esthetics leading to psychologicalproblems
2)Impaired function (chewing, speech and oral hygiene
maintenance) 3)Concern about alignment & occlusion of teeth.
4)Desire to enhance esthetics to improve quality of life.
Contemporary orthodontic 4th edition proffit
9

10. Medical history
H / O of previoushospitalization.
H / O chronic diseases like diabetes, cardiacproblems.
H / O allergy specially LATEX &NICKEL.
H / O bloodtransfusion & drugs
Tonsillectomy/Adenoidectomy
Epilepsy
PRENATAL HISTORY
Medications during pregnancy
Delivery- Full term/ Premature
Type - Normal/ Forceps/Caesarian
TMJ ankylosis due to prenatal trauma by
forceps delivery
POST NATAL HISTORY
FEEDING METHODS-(Breast or Bottlle
and
INJURIES- To Dento-Alveolar and Oro-Facial
structures,
HABITS ANY ABNORMAL ORAL HABITS.

11. ORAL HABITS

12. THUMB SUCKING
EXTRA ORAL EXAMINATION
Digits in acute thumb suckers Digits in chronic thumb
suckers
Reddens Fibrous
,rounghened
Clean , chapped Hypotonic upper lip

13. EFFECTS OF DIGIT- SUCKING
1. MAXILLA-
Proclination of maxillary incisors
Increased arch length
Increased anterior placement of apical base
of maxilla
Constricted maxilla
Increased clinical crown length of incisors
Counter-clockwise rotation of occlusal plane
Atypical root resorption of primary incisors
Trauma to the incisors

14. MANDIBLE -
Retroclination of lower incisors
Increased inter-molar width
Distal placement of mandible
INTER-ARCH RELATIONSHIP –
Decreased inter-incisal angle
Increased overjet
Posterior cross-bite
Anterior open-bite
Narrow nasal floor

15. TONGUE THRUSTING
Placement of the tongue tip forward between incisors during swallowing
Proffit
SIMPLE TONGUE THRUST
Contraction of lips, mentalis and mandibular elevators
Teeth are in occlusion as tongue protrudes into open bite
Open bite
Hypertrophy of tonsils which are not enlarged enough
Diminishes with the age
Treatment is simple
Good prognosis

16. COMPLEX TONGUE THRUST
Contractions of lips , facial and mentalis muscles
Lack of contractions of mandibular elevators
Teeth apart during swallow
History of chronic nasorespiratory disease and allergies
More diffuse open bite
Inflamed tonsils
Does not diminish with age
Poor prognosis

17. RETAINED INFANTILE SWALLOW
Strong contractions of lips and facial musculature
especially
buccinator.
Anterior and lateral thrusting
Inexpressive face
Difficulty in mastication
Poor prognosis

18. MALOCCLUSION
Proclination of upper anteriors
Anterior or posterior open bite
Protrusion of anterior segment of both arches
Constricted maxillary arch
Posterior cross bite
Spacing

19. MOUTH BREATHING
CLINICAL FEATURES
• Long and narrow face ( Adenoid
face)
• Narrow nose and nasal passage
• Short and flaccid upper lip
• Contracted upper arch with possibility
of posterior cross bite
• Excessive eruption of posteriors
• Constricted maxillary arch
• Excessive overjet
• Anterior openbite
• Marginal gingivitis

20. LIP HABITS
BRUXISM

21. FAMILY HISTORY
H / O cleft lip &palate
Hereditary dysgnathias include-
 Class II Div 2
 Skeletal open bite
 Bimaxillary protrusion
 Skeletal classIII

22. PHYSICAL GROWTH EVALUATION
 The best clinical effects are achieved in good growers and
poorest results are achieved in poor growers.
 By good growers, clinicians mean a patient with an amount,
rate, direction and pattern of growth that facilitates treatment.
 The most favourable time to attack many orthodontic problems
with skeletal manifestation is during growth acceleration in
puberty.
CONTEMPORARY ORTHODONTICS WILLIAM. R. PROFFIT 5TH
EDITION

23.  Thus, predicting nature and timing of onset of pubertal growth is
important in planning orthodontic therapy.

25. GENERAL EXAMINATION
1.BUILT :
Asthetic: thin built and usually possess narrow dental arches
Pletoric: obese built & generally have broad dental arches
Atheletic: neither thin nor obese normally built and normal dental
arches.

26. GENERAL EXAMINATION
2. BODY TYPE:
Sheldon in 1940 described body build as :
 Endomorphs- short and obese.
 Ectomorphs- long and thin.
 Mesomorphs- between endo and ectomorphs.

27. GENERAL EXAMINATION
 3.GAIT :
This is examined as the patient walks in the clinic. Any
neuromuscular defects should be made out in this
evaluation.
 4.POSTURE:
While evaluation of posture; look for kyphosis, lordosis or
scoliosis. There has been association of vertebral
abnormalities with facial disharmonies.
 5.HEIGHT AND WEIGHT:
They give a clue to physical maturation and growth of the
patient which may have dentofacial correlation.

28. 28

29. SHAPE OF THE HEAD:
This should be assessed from above the head. It is calculated
by:
Anthropological index= width of cranium X 100
length of cranium
 Index value > 81 is termed Brachycephalic.
 Value < 76 is termed Dolichocephalic.
 Values between 76 and 81 is termed Mesocephalic.
DOLICHOCEPHALY BRACHYCEPHA
LY
MARTIN & SALLER-1957

30. Martin, R., and K. Saller (1957). Lehrbuch der
anthropologie. Gustav Fischer Verlag, Stuttgart

31. FACIAL INDEX
Defined as ratio between
morphological facial height &
bizygomatic distance.
Given by Martin & Saller in1957.
Morphologic facial index
=Morphologic facial height
Bizygomatic width
Contemporary orthodontic 4th edition proffit
31

33. FACIAL SYMMETRY
 The patient’s facial symmetry is examined to determine
disproportions of the face in transverse and vertical planes.
Gross facial asymmetry can occur as a result of:
 A. congenital defects
 B.hemi-facial atrophy/hypertrophy
 C.unilateral condylar ankylosis and hyperplasia

34. Vertical facial symmetry
• hair line to
midbrow,midbr
ow to
subnasale
,and
subnasale to
soft tissue
menton.
• 55 to 65 mm.
• Variation in facial
thirds may be due
to vertical
maxillary excess and
deficiency,open
bite,deep bite etc

35. Middle fifth of the face - a line
from inner canthus should be
coincided with ala of nose.
Medial two fifths of the face- a line
from the outer canthus of the eye
should be coincided with the gonial
angle of the mandible
Outer two fifths of the face-
measured from the base of the ear
to the helix of the ears
TRANSVERSE FACIAL PROPORTIONS
35

36. PROFILE ANALYSIS
Drop two lines
 A line joining the forehead and the
soft tissue point A (deepest point in
the curvature of upper lip)
 A line joining point A and the soft
tissue pogonion (most anterior point
of the chin)
N’
Sn
Pg’

37. PROFILE ANALYSIS
 Depending on the angle formed
Straight-Class I Convex-Class II Concave-Class III

38. FACIAL DIVERGENCE
 This term was coined by Milo Hellman in 1921.
 It is the anterior or posterior inclination of lower face relative to
forehead
 The facial angle formed by Nasion-Pogonion soft tissue line
and the frankfort horizontal line is used to define as facial
divergance.

39. FACIAL DIVERGENCE
STRAIGHT/ ORTHOGNATHIC-(90)
ANTERIOR DIVERGANCE-(more than 90)
POSTERIOR DIVERGANCE-(less than 90)

40. ASSESSMENT OF ANTERO- POSTERIOR JAW RELATIONSHIP
 Estimation is done by placement of the index and the middle
fingers at point A and point B respectively.
40
SKELETAL PATTERN

41. ASSESSMENT OF VERTICAL SKELETAL
RELATION
1. Average FMA angle- Two planes
meet at the occipital region.
2. Low angle- Two planes meet beyond
the occipital region.
3. High angle- Two planes meet at the
mastoid region in front of the ear.
41
 By the angle formed between Lower
border of the mandible and Frankfort
horizontal plane.

42. MANDIBULAR PLANE ANGLE
Both planes meet at occipitalregion.
I f they meet beyond it- Low angle or horizontal growth pattern.
I f they meet anterior- High angle or Vertical growth pattern.
Vertical grower Horizontal grower

43. SOFT TISSUE EXAMINATION
ACCORDING TO BURSTONE(AJO APRIL 1967)
LIP LENGTH
Upper lip length:
From: subnasale to
upper lip inferior
(19 to 22mm)
Lower lip length:
From: lower lip superior to
Menton
(38 to 44mm)

44. LIP MORPHOLOGY
ACCORDING TO BURSTONE(AJO APRIL 1967)
 Lips might be full,
thick(12 to 20mm) or
might be thin(6 to 10
mm).
 Full and everted are
usually associated with
proclined upper and
lower labial segments.
 Lips that are thin are
usually associated with
retroclined upper and
lower labial teeth.

45. KORKHA’S LIP STEPS-HORIZONTAL LIP ANALYSIS
POSITIVE LIP STEP NORMAL LIP STEP MARKED NEGATIVE
LIP STEP

46. LIP COMPETENCE
• In child patient, it is common for lips to be apart at rest.
• As the child progresses through to teens, increase in soft tissue maturation
means lips become competent.
• If older child or certainly adults have incompetent lips they may demonstrate
increased contraction of circumoral musculature to habitually keep lips
together.
• This can be seen as puckering in the skin over the chin caused by excessive
contraction of mentalis muscle

47. EXAMINATION OF LIPS :
47
Size :NormalShortThinThickEverted
Posture : CompetentIncompetentPotentially Incompetent
Competent
lips
Potentially incompetent
lips
Incompetent
lips
Contemporary orthodontic 4th edition proffit

48. NASOLABIAL ANGLE
Normal (90-100)/ Acute/Obtuse
ACUTE ANGLE NASO-LABIAL ANGLE OBTUSE ANGLE
Proclined upper anteriors
Prognathic maxilla
Increased angle-
Retrusion of upper lip
Retroclined upper anteriors
Retrognathic maxilla
Contemporary orthodontic 4th edition proffit
Normal 110
Protrusive upper lip
Decreased angle-

49. MENTOLABIAL SULCUS
49
 It is a fold of soft tissue between lower lip &
chin.
 Affected by- Facial Height
Overjet
Chin Projection.
Deep sulcus – Class II Div 1
Shallow sulcus – Bimaxillary protrusion
NORMAL SHALLOW DEEP

50. Hyperactive
mentalis activity
produces
puckering effect in
chin region called
as GOLF BALL
APPERANCE
Contemporary orthodontic 4th edition proffit
51

51. NOSE EXAMINATION
51
Size- One third of total face height.
Microrhinic
Macrorhinic
Nostrils- Oval & bilaterally symmetrical
Types of nose…1.leptorhine 2.mesorhine3.platyrhine
 STRAIGHT BRIDGE CONVEX BRIDGE CROOKED NOSE

52. Projection- Depends on
Bone over inferior border ofmandible
Soft tissue overchin
Overdevelopment of chin height alters position o
f
l
o
wer lip &
Interferes with lip closure.
Influence on profile-
-Protruding chin with deep mentolabial sulcus- Retrusive lip
profile.
-Negative chin formation with absence of sulcus- Protrusive lip
profile.
Orthodontics – current principles and technique 5th edition
CHIN

53. Adequate
chin
Excessive
chin
Recessive
chin
54
Orthodontics – current principles and technique 5th edition

54. VISUALIZED TREATMENT OBJECTIVE
This examination help s us deciding whether any functional
appliance that postures the mandible forward will improve the facial
profile and appearance.
Patient is instructed to swallow ,lick the lips and then relax. His profile
with teeth in habitual occlusion is observed . He is then asked to
bring the mandible forward into a correct sagittal relationship
reducing the overjet

55. Profile doesnot improve when
Excess anterior facial height
Deficient symphyseal development
Steep mandibular plane
Improved profile seen in
Anteriorly rotated growth patterns
Functional retrusion
Deep overbites
Excessive inter occlusal clearence with
normally positioned maxilla

56. It helps in predicting treatment changes that would occur in the future for
the patient.
The accuracy of prediction is a combination of the effect of treatment
procedures and accuracy of predicting future growth
They are not very accurate but may act as rough estimate of acurate
outcome

57. INTRA-ORAL EXAMINATION
 In general any investigation of the teeth and jaws aims to
determine 3 p’s
 Presence
 Position
 Pathology
Other features of teeth needed to be ascertained are
 Shape
 Size
 Developmental stage (if this is related to patient’s age)

58. PRESENCE
 In mixed dentition mobility of deciduous teeth must be
tested .
 At beginning of intra oral examination it is essential to
count the teeth as it is easy to overlook developmental
absence.
 Symmetry in components of occlusion must be determined
i.e., if a primary tooth is mobile on one side then other side
must be checked for.

59. POSITION
 Position of erupted and unerupted teeth
 Unerupted teeth -location.
 Darkened toothand if infarction line is on a tooth found on
transillumination, then special investigation like electric pulp
testing should be done.
 Also presence of large restorations, crowns, bridges,
implants, root canal fillings, ankylosed teeth and other dental
anomalies should be noted.

60. Attrition on incisal edge and a displacement is a functional
indication of orthodontic treatment.
Other health considerations also to look for are:
 Dental caries
 Periodontal disease
 Traumatic injury to teeth
 Tonsils
 The patient is asked to say A-a-h and the tongue is
depressed with a mouth mirror, it is possible to examine size
colour and form of pharyngeal tonsils.

61. EXAMINATION OF TONGUE
Abnormalities Of Tongue Can Upset The
Muscle Balance And Equilibrium Leading To
Malocclusion.
A Patient Whose Tongue Can Reach The Tip
Of The Nose Is Said To Have A Long Nose.
The Lingual Frenum Should Be Examined
For Tongue Tie

62. EXAMINATION OF THE PALATE
1. Dolicofacial patients have deep palate.
2. Presence of swellings in the palate
3. Mucosal ulcerations and indentations are a
feature of traumatic deep bite.
4. Presence of cleft in the palate.
5. The third rugae is usually in line with canines.
This is useful in the assessment of maxillary
anterior proclination.

63. EXAMINATION OF GINGIVA
Gingiva Should Be Examined For
1. Inflammation
2. Recession
3. Mucogingival Lesions
Anterior Gingivitis Common In Mouth Breathers
Due To Dryness Of Mouth Caused By Open Lip
Posture.

64. EXAMINATION OF FRENAL ATTACHMENTS
The maxillary labial frenum sometimes be thick
fibrous and attached relatively low.
This may lead to midline diastema.
Abnormal frenal attachment are diagnosed by
blench test.

65. EXAMINATION OF TONSILS AND ADENOIDS
Abnormaly Inflamed Tonsils Cause Alterations In
Tongue And Jaw Posture There By Upsetting The
Oro-facial Balance Leading To Malocclusion

66. Hard tissue
 Teeth present
 Un-erupted teeth
 Supernumerary teeth
 Missing teeth
 Retained teeth
 Crowding
66

67.  Rotated teeth
 Spacing
 Texture
 Caries
 Endodontically treated teeth
 Occlusal warefacets
67

68. PALATAL CONTOUR
68
 PALATAL HEIGHT INDEX (Korkhaus)
 Palatal height X 100
Posterior arch width
 Normal value is 42
39.3 51.3

69. RELATION OF MANDIBULAR TO MAXILLARY
ARCH
 Maximum incisal opening
 Freeway space
 Curve of spee
 Midline
 Upper
 Lower
 At rest
 In occlusion
69

70. ANTERIO-POSTERIOR RELATIONSHIP
 Molar relation
 Canine relation
 Incisor relation
 Over Jet & Bite
70
Class I Class II Class III

71. CANINE RELATION
71

72. INCISOR RELATIONSHIP
72
BSI1983 BSI198
3
BSI198
3
BSI198
3
Mageet AO. Classification of Skeletal and Dental Malocclusion:
Revisited. StomaEduJ. 2016;3(2)

73. SAGITTAL PLANE MALOCCLUSION
Pre-normal occlusion
-mandibular dental arch is
placed anteriorly in centric
occlusion
Post-normal occlusion
-mandibular dental arch is
placed more posteriorly in
centric occlusion

74. VERTICAL PLANE MALOCCLUSION
Deep bite
Vertical overlap between the
maxillary & mandibular teeth
is in excess than normal
Open bite
Exist in anterior or posterior

75. TRANSVERSE PLANE MALOCCLUSION
- includes various types of CROSS BITES
- mainly due to constriction of dental arches

76. INFRA-OCCLUSION
Supra occlusion Rotations

77. FUNCTIONAL EXAMINATION
 Improper functioning of the stomatognathic system can result in
various malocclusions.
 The functional examination should include :
 Assessment of postural rest position and inter occlusal space
 Path of closure
 Assessment of respiration
 Examination of TMJ
 Examination of swallowing
 Examination of speech
77

78. Assessment of postural rest position and inter – occlusal
clearance
 The postural rest position is the position of the mandible at which
the muscles that close the jaws and those that open them are in a
state of minimal contraction to maintain the posture of the
mandible.
 At the postural rest position, a space exist between the upper and
lower jaws. This space is called the inter occlusal clearance or
freeway space.
 Normally the freeway space is 3mm in canine regions.
78

79. Methods :
 Phonetics : ‘m’ or ‘c’ or ‘Mississippi’
 Command method : e.g. swallowing
 Non command method : e.g. visualize
 Measurement of inter occlusal clearance
 Direct intra oral procedure : vernier caliper
 Direct extra oral procedure
 Indirect extra oral procedure : e.g. radiographs,
Kinesiography
79

80. LATEROGNATHY
80
 Center of mandible is not aligned with facial midline in rest &
in occlusion
 True neuromuscular or anatomical asymmetry
 Lateral cross bite with laterognathy is True Cross bite.

81. LATERO OCCLUSION
81
 Skeletal midline shift of mandible can be observed only in
occlusion
 In postural position midlines are well aligned
 Deviation is due to tooth guidance.
 Known as Functional non true malocclusion.

82. EVALUATION OF PATH OF CLOSURE
Path of closure:
Movement of the mandible from Rest position  Habitual occlusion.
a. Forward path of closure : occurs in patients with mild skeletal
prenormalcy or edge to edge incisor contact.
b. Backward path of closure : Class II div 2 cases exhibit premature
incisor contact due to retroclined maxillary incisors.
c. Lateral path of closure : Associated with occlusal prematurity and
a narrow maxillary arch.
82

83. ASSESSMENT OF RESPIRATION
 Humans may exhibit 3 types of breathing :
-Nasal
-Oral
-Oro-nasal
 Tests to diagnose the type of respiration :
a) Mirror test
b) Cotton test
c) Water test
d) Observation
83

84. Mirror Test Cotton Test Water Test
84

85. EXAMINATION OF TMJ
 Patient is examined for symptoms of Temporomandibular joint
problems such as
 Clicking & Crepitus sounds
 Pain in the masticatory muscles
 Limitation of jaw movement
 Hyper mobility and morphological abnormalities.
 The maximum mouth opening (Normal: 40 – 45 mm)
85

86. SPEECH
-Certain malocclusions may cause defects in speech due to
interference with movement of the tongue and lips.
Speech sounds Problem Related malocclusion
/s/,/z/-sibilants Lisp Anterior open bite,
large gap between
incisors
/t/, /d/ linguoalveolar
stops
Difficulty in production Irregular incisors,
especially lingual
position of maxillary
incisors
/f/, /v/ labiodental
fricatives
Distortion Skeletal class III
th, sh, ch linguodental
fricatives
Distortion Anterior open bite
86

87. EVALUATION OF SWALLOWING
 The persistence of the infantile swallowing can be a cause for
Malocclusion
 Retained infantile swallow is indicated by the presence of
the following features :
a. Protrusion of the tip of the tongue.
b. Teeth occlude on only one molar in each quadrant
c. Violent contraction of perioral muscles during swallowing.
87

88. Infantile swallow (Visceral swallow)
 Jaws are apart, with the tongue between the gum pads
 Mandible is stabilized by contraction of the facial muscles and the
interposed tongue
 Swallow is guided & controlled by sensory interchange between the
lips and the tongue.
88

89. Mature swallow (Somatic swallow)
 Teeth are together
 Mandible is stabilized by contraction of the mandibular elevators.
 Tip of the tongue is held against the palate, above and behind the
incisors
89

90. METHODS OF EXAMINATION
 Electronic recording
 Electromyographic examination
 Recording of pressure exerted by the tongue
intraorally
 Roentgenocephalometric analysis
 Cineradiography
 Palatography
 Neurophysiologic examination
90

91. PALATOGRAPHIC EXAMINATION
91

92. STUDY CASTS
Orthodontic study models are accurate plaster reproductions of teeth and their
surrounding soft tissues .that are essential diagnostic aid that make it possible
to study the arrangement of teeth and the occlusion from all directions .

93. Uses of study model include:
a) They enable study of occlusion from all aspects
b) Enable accurate measurements to be made in dental arch.they help in
the measurement of arch length, arch width,and tooth size
c) Help in assessment of treatment progress by dentist as well as by patient
d) Help in assessing the nature and severity of malocclusion
e) Helpful in motivation of patient and to explain the treatment plan as well
as progress to patient and parents
g) Useful to transfer records in case patient is treated by another clinician

94. RADIOGRHIC ANALYSIS
94

95. LATERAL CEPHALOMETRY
95
CVMI
Degree of proclination of maxillary and mandibular
Incisors
Soft tissue analysis
Supplementary diagnostic aid
Types
Lateral cephalogram:
This is taken with the head in a standardized reproducible
position at a specified distance from x ray source
Frontal cephalogram
Provides the Anterior – Posterior view of skull
It helps in diagnosing Anterio posterior jaw relation
Growth pattern
Details of maxilla and mandible

96. CVMI
96
Vertrebral growth takes place from the cartilagenous layer on
the superior and inferior surfaces of the vertrebra..
Hassel and Farman (1995) found that the shapes of cervical
vertebrae werefound to differ with different level of skeletal
development
Cervical vertrebra maturation indices were determined
based on the presence of curvature in the inferior border,
shapes of bodies of the dens, C3 and C4 and intervertrebral
spacing.

98. PANORAMIC RADIOGRAPGH
Helps in diagnosing
presence of any impacted teeth
TMJ problems
any pathology
Enlarged Panoramic-
Accurate imaging in
anterior region.
Distortion in posterior
region.
Contemporary orthodontic 4th edition proffit
98

99. OCCLUSAL VIEW
Supplementary projection to locate malposed
unerupted teeth.
Palatal cleft
Expansion
Contemporary orthodontic 4th edition proffit 99

100. MP3
168

101. CONCLUSION
The patient assessment forms the essential basis of orthodontic
treatment. It is taken in steps starting from a
history/questionnaire and proceeding to a clinical examination
that includes extra-oral and intra-oral examination. The extra-
oral examination is carried out first as this can fundamentally
influence the treatment options. The skeletal pattern, soft tissue
form and the presence or absence of habits must all be
considered. The intra-oral assessment examines the oral health,
individual tooth positions and inter-occlusal relationships. When
this has been completed in conjunction with the extra-oral
examination, a treatment plan can then be formulated

102.  Contemporary orthodontic 4thedition proffit
 Orthodontic diagnosis – rakosi , graber
 Orthodontics – current principles and technique 5th edition
 Dentistry of child mcdonald
 Šidlauskienė M. Relationships between Malocclusion,
Body Posture, and Nasopharyngeal Pathology in Pre-
Orthodontic Children. Med Sci Monit. 2015;21:1765-
1773.
 Martin,R., and K.saller (1957). Leherbuch der
anthropologie. Gustav Fisher Verlag, Stuttgart.
REFERENCES