The document outlines the history, diagnosis, and problem list for orthodontic cases as presented by Dr. Mehrunisa, emphasizing the importance of a comprehensive case history and various diagnostic aids such as clinical examinations and radiographs. It details the assessment procedures for facial and cephalic symmetry, soft tissue examination, and clinical evaluations of dentition. Additionally, the document includes a problem list identifying pathologic and developmental issues to guide necessary orthodontic treatment.

1. History, Diagnosis And Problem List
Presented by: Dr Mehrunisa

2. Contents
1. Introduction
2. Diagnostic Aids
3. Case History
 Chief Complaint
 Medical History
 Dental History
 Family History
4. Diagnosis In Orthodontics
 Cephalic And Facial Symmetry
 Assessment Of Facial Symmetry
 Facial Profile
 Facial Divergence
 Assessment Of Anteroposterior Relationship
 Assessment Of Vertical Skeletal Relationship

3. Contents
 Examination Of Soft Tissue
 Clinical Examination Of Dentition
 Functional Examination
 Reference
5. Problem List

4. Introduction
• Treatment is secondary step, the primary task for the
clinician is to identify the problem and find its etiology.
• Diagnosis involves the development of a comprehensive
and concise database of information sufficient to
understand patient’s problem

5. Diagnostic Aids
• They are clinical aids that are considered very important
for all cases.
• The following are essential diagnostic aids:
1. Case history
2. Clinical examination
3. Study models

6. 4. Certain radiographs:
Periapical
Bitewing
Panoramic
5. Facial photographs

7. Case History
• Case history involves eliciting and recording of relevant
information from the patient and parent to aid in overall
diagnosis of the case.
• Personal details: Name, age, sex, address and
occupation.

8. Chief Complaint
• The patient’s chief complaint should be recorded in
his/her own words.
• This help the clinician in identifying the priorities and the
desires of the patient.

9. Medical History
• Full medical history is recorded before orthodontic
treatment.
• Few medical conditions contraindicate the use of
orthodontic appliances such as:
1. Epilepsy
2. Diabetic patient
3. Physically and mentally handicapped children
• Include information on drug usage.

10. Dental History
• Dental history includes information on the following:
1. Age of eruption of the deciduous and permanent teeth.
2. Tooth decay.
3. History of extraction.
4. Restoration.
5. Trauma to dentition.
• Past Dental History helps in evaluation of patient and
parent’s attitude towards treatment.

11. Family History
• Family history should record details of malocclusion
existing in other members of the family.

12. Diagnosis In Orthodontics
• The goal of orthodontic clinical examination to evaluate
and document oral health, jaw function, facial proportion
and smile characteristics.
General examination:
1. Cephalic and facial examination.
2. Assesment of facial symmetry.
3. Facial profile.
4. Facial divergence.

13. Assesment of anteroposterior relationship.
Assesment of vertical skeletal relationship.
Examintion of soft tissue:
1. Extraoral.
2. Intraoral.
Clinical examination of dentition .
Functional examination:
1. Functional occlusion
2. Examination of TMJ.

14. Cephalic And Facial Symmetry
• Cephalic and facial index included that the shape of the
HEAD may be:
1. Mesencephalic: Average skull proportion.
2. Dolicocephalic: Long narrow skull.
3. Brachycephalic: Short broad skull.

15. Cephalic And Facial Symmetry
• The shape of the FACE may be:
1. Euryprosopic: Low facial seketal.
2. Mesoprosopic: Average facial skeletal.
3. Leptoprosopic: High facial skeletal.

16. Assesment Of Facial Symmetry
• The face should be examine in the transverse and vertical
planes to detetrmine a greater degree of asymmetry.
• Gross facial asymmetries may be seen in patients with:
1. Hemifacial hypertrophy/atrophy.
2. Congenital defects.
3. Unilateral condylar hyperplasia.
4. Unilateral ankylosis.

17. Facial Profile
• Three types of profiles are shown:
1. Straight/Orthognathic Profile:
Ideal profile.
2. Convex profile:
Form an accute angle.
Seen in class II Div I due to either protruded maxilla or
retruded mand.

18. Facial Profile
3. Concave profile:
Form an obtuse angle.
Seen in class III either due to protruded mandible or
retruded maxilla.

19. Facial Divergence
• It is define as anterior or posterior inclination of lower face
relative to forhead.
• A line is drawn from the forehead to the chin to determine
whether the face is:
1. Anterior divergent: line inclined anteriorly.
2. Posterior divergent: line inclined posteriorly.
3. Straight/Orthognathic: straight line, no slant seen.

21. Assesment Of Anterioposterior Relationship
• It can be obtained clinically by placing the index and
middle finger at approximate point A and B.
• Ideally the maxilla is 2 to 3mm anterior to the mandible in
centric occlusion.

22. Assesment Of Vertical Skeletal Relationship
• A normal vertical rerlationship is on where the distance
between the glabella and subnasale is equal to the
distance from the subnasale to the underside of the chin.

23. Examination Of The Soft Tissues
• Extraoral Examination
1. Forhead:
For face to be harmonious, the height of the forhead
(distance from hairline to glabella) should be as long as
the middle third (glabella to subnasale)and the lower
third (subnasale to menton)
Dental bases are more prognathic
with steep forhead than with a flat forhead.

24. Examination Of The Soft Tissues
2. Nose:
Size, shape and position of the nose determines the
appearance of the face.
3. Lips:
Lip length,width and curvature should be assessed.
The upper incisal edge exposure with the upper lip at rest
should be normally 2mm.

25. Examination Of The Soft Tissues
• Lips can be classified into:
1. Competent Lips: Upper and lower lip meet at rest.
2. Incompetent Lips: The lips are separated at rest by
more than 3 to 4mm.
3. Potentially Competent Lips: Lips have ability to meet
but due to some factor lips are separated.

27. Examination Of The Soft Tissues
4. Incisor Prominence:
Bimaxillary dentoalveolar protusion means that both
upper and lower jaws are proclined.
Lips are prominent.
Lips are incompetent.
Lips prominence of >2 to 3 mm in presence of lip
incompetence indicates dentoalveolar protusion.

29. Examination Of The Soft Tissues
5. Nasolabial Angle:
• This is the angle form between a tangent to the lower
boarder of the nose and a line joining the subnasale with
the tip of the upper lip.
• Normal value is 110 degree.

30. Examination Of The Soft Tissues
6. Mandibular Plane Angle:
• It is visualized by placing a mirror handle along the lower
border.
1) Steep plane indicates long anterior facial height and a
skeletal open bite.
2) Flat plane indicates short anterior facial height and deep
bite malocclusion.

32. Examination Of The Soft Tissues
7. Incisor Stomion:
The amount of incisor display at rest.
8. Smile Line:
The harmony between the curvature of the incisal edges
of the maxillary anterior teeth and the upper border of the
lower lip.

33. Examination Of The Soft Tissues
9. Smile Arc:
Contour of incisal edges of maxillary anterior teeth relative
to the curvature of lower lip during social smile.
a. Consonant smile
b. Non consonant smile

34. Examination Of The Soft Tissues
10.Buccal Corridor:
Buccal corridor is the distance between maxillary
posterior teeth(premolars) and the inside of the cheek on
a smile.

35. Examination Of The Soft Tissues
11.Gum Show:
 Up to 4mm of gingival display or up to 4mm of lip
coverage of incisor crown is acceptable.
12.Chin:
Symmetry and asymmetry.

36. Examination Of The Soft Tissues
• Intraoral Examination
• It includes:
1. Oral hygiene.
2. Periodontal status.
3. Labial frenum attachment.

37. Clinical Examination Of Dentition
• The dentition is examined for:
1. Type of dentition.
2. The dental status.
3. Occlusion ( over jet , over bite , cross bite)
4. Molar , incisor and canine relationship.
5. Curve of spee ( normal, flat and deep )
6. Dental midline.
7. Open bite ( anterior and posterior open bite)

38. Functional Examination
1. Functional occlusion:
a. Mouth opening.
b. Path of closure.
c. Chewing pattern.
d. CO-CR discrepancy.

39. Functional Examination
2. TMJ examination:
a. Clicking.
b. Crepitus.
c. Pain of masticatory muscles.
d. Limitation of jaw movement.
e. hyper mobility.
f. morphological abnormalities.

40. Problem List
• The problem list includes two types of problems.
1. Pathologic problems
Mild gingivitis, mild gingival overgrowth.
Hypoplastic area maxillary left premolar.

41. Problem List
2. Developmental problems
Mandibular deficiency.
Maxillary incisors tipped lingually, short crowns.
Moderate maxillary incisor crowding.
Class II buccal segments, minimal overjet.
Deep bite, excessive eruption of mandibular incisors.

43. Reference
• William R. Profit., Henry W. Fields., Brent E. Larson.,
David M. Sarver.(2019-2020). Contemporary
Orthodontics. Elsevier,Inc.