ááŒááºáá¬ááá¯ááºáá¶ááœá¬ážááŸáá·áºáá¶ááœááºážááá¯ááºáá¬áá±ážáá±á¬ááºá á®á¥ááá±
Myanmar Dental Council Law 2018
ááœá¬ážááŸáá·áºáá¶ááœááºážááá¬áááºáá»á¬ážááá¯ááºáá¬áááºáá»áá·áºáááºáá»á¬áž
Ethics for Myanmar Dentists
ááŒááºáá¬ááá¯ááºáá¶ááœá¬ážááŸáá·áºáá¶ááœááºážááá¯ááºáá¬áá±ážáá±á¬ááºá á®á¥ááá±
Myanmar Dental Council Law 2018
ááœá¬ážááŸáá·áºáá¶ááœááºážááá¬áááºáá»á¬ážááá¯ááºáá¬áááºáá»áá·áºáááºáá»á¬áž
Ethics for Myanmar Dentists
4. á¡áá±ážááá¯á±ážááá±ážááœá±á¬á±ážá¡áá á¥á±á¬áºáᬠááá±á¬áºá¡áá á±á¬áºá¡ááœá±á á²á· ááááá±á¬áºá±ážáááá±á¬áºá±ážááá±ážááœá±á¬á±ážáá¬áá²á· áá±á¬áºá¡áááá±á¬áºá±ážá á²á· ááá±á¬áº
á¡á¡áá¬áá±á¬áºá±ážá¡ááœá± ááááá±á¬áºá±ážáááá±á¬áºá±ážá¡á á¬á²á·áá¬áá²á· áá±á¬áºá¡áááá±á¬áºá±ážááᯠá±áž (á) áá¯áá±á¬áºá±áž á¡ááœá±áœá¶á·á á«ááá±á¬áºá Ramus á á²á·posterior border
áᬠááá±á¬áºá¡áá á±á¬áºá¡ááœá±á á²á· ááá±ážááœá±á¬á±ážááŸá¯ááá±á¬áºááá á±á¬áºáᬠá«ááá±á¬áºá Ramus á á²á·anterior border áᬠááá±á¬áºá¡á¡áá¬áá±á¬áºá±ážá¡ááœá±
á¡ á¬áá±á¬áºááœá±áá±á¬áºáᬠá«ááá±á¬áºá Mental protuberance á á²á·
á¡ááá±á¬áºáᬠbone resorption ááá á±á¬áºáá¬áá²á·á¡áá« á¡á áá²á·á±á¬áºá¡áá±áž
ááá á±á¬áºáá¬áá¬ááᯠá¡ááœá±áœá¶á·á á«ááá±á¬áºá
ááœá±á¬á±ážáááá¯áá°áá¬á¡ááœá±ááᯠááá¯áááŸá¯á¡ á±ážáá²á·á¡áá« á¡áá¬áá á¬á±ážá¡áá±ážá á²á·
ááá±á¬áºá±ážáá¡áá±ážá¡ááœá±á á²á· growth spurt ááá¯
ááá¬á±ážááá²á·á±á¬áº á«ááá±á¬áºá
Boys Girls
⢠12.5 â 15 years old (average 14 year)
⢠Max velocity is 10 cm/ year
⢠Results in height increase of 20 cm and
weight increase of 20 kg
⢠Principal hormone is testosterone but
some estradiol may be converted from
testosterone
⢠10.5 â 13 years old (average 12 years)
⢠Max velocity is 8 cm/ year
⢠Results in height increase of 20 cm and
weight increase of 16 kg
⢠Principal hormone is estradiol but some
testosterone may be converted from
androstenedione
Note: Nutrition is the most important environmental determinant of growth. Mostly affected by
malnutrition is muscles and fat, then bones, then teeth.
áá¡áá±ážá¡ááœá±á á²á·
á¡ááá±á¬áºááᯠáá±á¬áºááᯠááá±á¬áºááá±á¬áºá áá±á¬áºá¡ááœá±á á²á· ááá²á·á±á¬áºááá¯áá±á¬áºáá?
Skeletal age = based on ossification of bones [mostly assessed by radiographs of the hands and wrists
compared to an atlas of radiographs that covers the entire developmental period]
Dental age = based on tooth formation + eruption [degree of cusp/root calcification, development of
the roots, closure of the apical foramen, emergence (penetration of the gingiva), eruption (contacting
the opposing tooth) is assessed]
Simplest way to determine age is to look for the number of teeth erupted and the sequence of eruption
Morphological age = based on height
Sexual = based on development of sexual features
15. Extra-oral Assessment
Assessment of skeletal pattern
Anteroposterior dimension
áááá¥á±ážáá¶áá¯á±áž áá°áá¬ááᯠnatural head position (standardized and reproducible) áᬠáá¬á±ážáááá²á·áºááá«áááºá
Natural head position ááá¯áᬠáá°áá¬ááᯠáááºáááºááá¯ááºááá¯ááºá±ážá ááºá á¬áá²á·áº áẠá¬áááá ááá±áž áá°áá¬áá² á²á·
áá»ááºáá¶áá¯á±ážáá² á²á·
áá áºáááºá±ážáááºá±áž áááŸá±á·áááºáá¬ááááá²á²á· point áá áºááá¯ááᯠáááá²á·áºááá¯ááºá±ážáá¬á±ážáᬠááá áºáá«áááºá áœá±á¬á±ážáááœá±ááá¯áááºá±áž
á¡á¶ááááºáááá¬áá»áŒá¯á±ážáááá¯ááºáá² áá¶áá¯áááºá¡ááá¡áá¬á±áž áá¬á±ážááá«áááºá (Teeth should be slightly in occlusion.)
áá°áá¬áá² á²á· á¡ááá±á«áº áá² á²á·
áá¡á¬ááºááá±ážááá¯á±ážáááœá±áá² á²á· áááŸá±á·áááºá¡áá»áá¶áá¯á±ážá¡áááºáááœá±ááᯠá¡ááá±á«áºááŸá¯ááºáááºá±ážáá² á²á· áá¡á¬ááº
ááŸá¯ááºáááºá±ážáááœá±áá² á²á·
á¡áááááááá²á·áº áá¶áá¯áᬠáááá¬á±ážáá²á²á·á¡ááá¯ááºá±áž á ááºá±ážáááá²á·áºááá¯ááºáá«áááºá
Class I The mandible lies 2-3 mm posterior to the maxilla [the straight profile]
Class II The mandible lies retrusive to the maxilla [convex profile]
Class III The mandible lies protrusive to the maxilla [concave profile]
áá°áá¬áá² á²á·anterior limit of cranial base ááᯠááá¯ááºá á¬á±ážáááŒá¯áá²á²á· zero meridian line ááœá±á²áááá²á·áºááá±áž soft tissue A
point, soft tissue B point áááœá±áá² á²á·ááŸá¯ááºá±ážáá¥áºáááá²á·áºááá¯ááºáá«áááºá áá¶áá¯áááºááá¯ááẠsoft tissue A point á álineáá² á²á·áááŸá±á·áááº
2-3mmá¡ááœá±á¬áᬠáááá±áž soft tissue B point á álineáá² á²á·ááá¬ááºááẠ0-2mmá¡ááœá±á¬áᬠááááááºáá«áááºá
(a) The Ricketts zero-meridian line is a constructed vertical line dropped perpendicular to the Frankfort Plane (or horizontal) from Nâ. It
gives an indication of the antero-posterior position of Pgâ, which will lie behind the line in class II cases with mandibular retrusion (b) and
in front in cases with mandibular prognathism (c).
18. Lip fullness and tone
Lip competency
A. Competent lips: a lip seal is produced with minimal muscular effort when the mandible is at
rest position
B. Potentially competent: positioning of the upper incisors prevents a comfortable lip seal
C. Incompetent: excessive muscular activity is required to achieve lip seal [the interlabial distance
at rest is >4mm]
Signs of excessive muscular activity
Flattening of the labio mental fold when the lips are held together
Puckering of the skin overlying the chin [due to the mentalis muscle contraction]
Method of achieving anterior oral seal at rest and at swallowing
á¡ááá±á«áºááŸá¯ááºáááºá±ážáá² á²á·áá¡á¬ááºááŸá¯ááºáááºá±ážáááœá±áᬠRickettâs esthetic line [E-line]áá² á²á·áááºááá¬ááºá¡ááœá±á¬á¡ááá±áž
áᬠááááá²ááá¯áá¬ááá¯áááºá±áž ááá¯ááºá±ážáááá²á·áºááá¯ááºáá«áááºá áá¶áá¯áááºááá¯ááẠupper lip áᬠE-lineáá² á²á·
ááá¬áẠ4mmá¡ááœá±á¬áá á²á·
áº
áᬠááá áá²á·áºááá±áž lower lip áᬠE-lineáá² á²á·
ááá¬áẠ0-2mmá¡ááœá±á¬áá á²á·
áºáᬠááá áá²á·áºáá«áááºá
áá°áá¬áá² á²á·upper lipáᬠáááºááá¯á¡ááá¡áá¬á±ážáá² á²á·
ááááá²ááá¯áá¬ááᯠáááá¯ááºááᯠá²á·Nasolabial angle ááá¯áááºá±áž
ááá¯ááºá±ážáááá²á·áºááá¯ááºáá«áááºá
Normal Nasolabial angle=102±8 Acute = <90 Obtuse = >90
21. Lateral cephalometric radiograph (LCR)ááᯠáááºááá¯áá±ááŸá¬áááœá±ááŸá¬ á¡áá¯á°ážáááŒá¯ááááá ááŸá¬á²á·á¡ááœá±ááº
á¡áá¯á°ážáááŒá¯ááááá Orthodontic diagnosis and treatment planning, To know whether it is dental or skeletal
or both, To monitor treatment progress, In research á ááááá²á·áº áááºááœá±ááºáá»ááºá¡áá»ááŒá¯á°ážáá»ááŒá¯á°ážá± á²á·á¡áá¯á°ážáááŒá¯áááá«áááºá
Frontal cephalogramáá«ááºáá±áºáá áºáá»ááŒá¯á°ážááá¯áááºá°áž áá±áŸá¬á á²á·antero-posterior view of skull ááᯠáááá²á·áºááᯠá²á·á¡áá¯á°ážáááŒá¯áá
áá«áááºá
24. Deep overbite correction áá¯ááºááŸá¬á°ážááá°ážáá²á·á¡áá« ááá±áºáá°áž relapse ááá áºááá¯ááºááá°ážááŸá¬ááᯠááŸá¬ááœá±ááºááááááá¯ááºááᯠá²á·
interincisal angleá á¡ááá°ážáá«ááŸá¬ááᯠá²á·ááá¯ááºá°ážáááá²á·áºááá¯ááºáá«áááºá
Soft tissue analysis
Maxillary á± á²á·mandibular prominence áááœá±ááᯠáá¡áŸá¬ááºááŸá¬ááááŸá¬á°ážáá²á·áá¯á¡ááá¯ááºá°áž ááá¯ááºá°ážáááá²á·áºááá²á·áááá«áááºá
Nasolabial angle, Lip position relative to Ricketts E-lineáááœá±ááá¯áááºá°áž ááá¯ááºá°ážáááá²á·áºááá¯ááºáá«áááºá
ááŸááºáá¬á¬ážá áá¬á¡áá»ááºáá»á¬á¬áž
Anterior cranial base ááŸá¬ ááááá»á¡áŸá¬á°ážáááá²á·áº á¡áááº(á)áá áºá¡ááœá±ááºááŸá¬ á¡ááááŸá¬ááºá°ážá¡ááááá constant
ááá áºááœá±áŸá¬á°ážáá«áááºá áá« á²á·
ááááŸá¬áá²á·áº ááááŸá¬á°áž facial structure áááœá±ááᯠááŸá¯áááºá°ážáá¥áºáááá²á·áºáá²á·á¡áá« áááºá°ážááᯠstable point áá áºáá¯
á¡áá±á± á²á·á¡áá¯á°ážáááŒá¯áááá«áááºá Sella turcica ááᯠanterior cranial base á á²á·reference á¡ááá Ạá¡áá¯á°ážáááŒá¯áááá«áááºá
SNA á± á²á· SNB ááŸá¬ ááŸá¬ááᯠáááºááœáŸá±áºá°ážááŸá¬á? áááºá°ážááᯠá²á·
ááŸá¬ cranial base á± á²á· anterior position of
maxilla/mandibleááᯠá²á·
á á²á· áááºááœá±ááºááŸá¯ááᯠááá¯ááºá°ážááŸá¬áááá²á·áºááŸá¬áá«á á¡ááá±á«áºááá°ážááá¯á°áž/áá¡áŸá¬ááºááá°ážááá¯á°ážá
25. áááŸá±á·áááºáááŸá¬ááºááœá±á±áºá°ážáá±ááŸá¬á°ážá áá±áŸá¬ááºáááºááᯠá²á· ááá¯á±ááºáá±áááŸá¬á°ážá áá¯áá±áºá¡áá±á¡ááŸá¬á°ážáááŸá¬á°ážááá¯ááŸá¬ááá¯
ááá¯ááºá°ážááŸá¬ááᯠá²á·
ááá²á· áá±áºááá¯á°ážáááœá±á¡ááááŸá¬ ááááŸá¬á°ážclinical records áááœá±á¡ááááŸá¬ ááá²á·ááŸá¬ááááááá¯ááºáá«áááá²á·áºáááºá Skeletal
pattern á class I or class II or class III ááá¯ááŸá¬ááᯠANB angle á á²á·
áá±áºááá¯á°ážááᯠáááá²á·áºáá°áž ááááá»áááºáááºááá¯ááºáá«
áááºá ááá¯ááá¯áááá»áŸá¬áá¡áŸá¬áẠWits analysisá± á²á·ááááŸá¬á°ážclinical recordsáááœá±ááá¯áá« á¡áá¯á°ážáááŒá¯ááá°áž ááá¯ááºá°ážááŸá¬ááá¯ááºáá«áááºá
Incisal positions áááœá±ááᯠáá¯á°ážááááºááᯠá²á·áááºangleááᯠá¡áá¯á°ážáááŒá¯áá? Axis of the maxillary incisors (UInc)
á± á²á· maxillary plane ááᯠá²á·
ááᯠááœá±áááá²á·áºáááºá Axis of the mandibular incisors (Linc)á± á²á· mandibular plane ááᯠá²á·
ááá¯
ááœá±áááá²á·áºáááºá á¡á²á·áááá¯ááœá±áááá²á·áºáá²á·á¡áá« ááá áºááá±á«áºááŸá¬áá²á·áááŸá¬áá²á·áºáááœá±á á²á·á¡áá»á¥áºá°ážáá¡áá»ááºááᯠááœá±ááºáá»ááºááá°áž á¡ááá±á«áº á± á²á·
áá¡áŸá¬áẠáááŸá±á·ááœá±áŸá¬á°ážáááœá±ááŸá¬ áá¯áá±áºáááŸá¬á°ážá áááŸá±á·ááœá±ááºááœá±á±áºá°ážáá±áááŸá¬á°ážá á¡áááᯠáá¯ááºá±ááºáá±áááŸá¬á°ážááá¯ááŸá¬ááᯠááááá¯ááºáá«
áááá²á·áºáááºá áá« á²á·
á¡áááẠááá áºááá±á«áºááŸá¬áá²á· inter-incisal angle ááᯠáááá²á·áºáá»ááºá°ážá¡áŸá¬á°ážáááá²á·áº overbite á á²á· á¡áááá¡áá±ááá¯
ááááá¯ááºáá«ááá°ážáááºá Interincisal angle áá»áŸá¬á°ážááœá±á±áºá°ážááá»ááºááœá±á±áºá°ážááẠáá±áŸá¬ááŸá¬ deep overbite áááá±áá«áááá²á·áºáááºá
áá±áŸá¬á á²á· vertical dimension ááᯠááá¯ááºá°ážááŸá¬ááŸá¬ááŸá¬ Maxillary-mandibular plane angle(MMPA) ááá¯
ááá¯ááºá°ážááŸá¬ááá²á· áááá«áááºá
Increased MMPA â backward pattern of mandibular growth and a decreased overbite
Decreased MMPA â forward pattern of mandibular growth and increased overbite
26. Soft tissue analysis
(compiled by Dr. Nay Aung, BDS, PhD)
áá»ááºááŸá¬ááᯠFrontal 3rd
, Nasal 3rd
, Gnathic 3rd
ááá¯áá®áž á¡áá»áŸá¬á®ážááá¯áẠá¡ááá¯ááºá®áž(á)ááá¯ááºá®áž ááœá²ááááºááá¯ááºáááá¯
á á±á«ááºááá¯ááºááá¯ááẠá¡ááá¯ááºá®áž(á )ááá¯ááºá®áž ááœá²ááááºááá¯ááºáá±á«áááºá Golden Ratio ááᯠá¡ááá¯á®ážáááŒá¯ááá®áž ááá¯ááºá®ážáááŸá¬á®ážááááºááááºá®áž
ááŒá áºáá±á«áááºá
Using the Golden Ratio, we analyze the face in horizontal thirds, and vertical fifths.
Vertical fifths: Distance between eyes equals the width of nostrils which equals the width of eye which
equals the width of lateral face to lateral eye
Horizontal thirds: The length of nose equals the length of lower face (nose to chin) which equals the
length of upper face (mid-brow to hairline)
27. ááŸá¬ááá±á«ááºá®ážááœá² á¡áá±á¡ááŸá¬á®ážááᯠAngular Profile Analysis (Subtelny) á±áœá² ááá¯ááºá®ážááŸá¬ááááºááá¯ááºáá±á«áááºá Soft
tissue profile (N-Sn-Pog) á±áœá² ááá¯ááºá®ážááááºááá¯ááºáááᯠFull soft tissue profile (N-No-Pog)á±áœá²áááºá®áž
á á áºááááºááá¯ááºáá±á«áááºá á¡áœá² ááá¯ááá¯ááºá®ážááŸá¬ááœá²á¡áá±á« Anterior growth of the nose ááŸá¬ á¡áááºá¡áááºá±áœá²á¡áá»áŸ
ááá¯á®ážááŸá¬ááá¯ááºááŸá¬ááᯠáááœá±á·ááá±á«áááºá
ááŸá¯ááºáááºá®ážááááá¯áááºá®áž á¡áááºáááºáááŸá¬ááºááááœá²ááá¯ááŸá¬ ááá¯ááºá®ážááŸá¬ááááºááŸá¬áá»áŒá¯á®áž áááŒá¯ááá¯ááºááŸá¬á®ážáááá±á«
áááºá Length of the upper lip (Sn-Sto) á±áœá² Length of the lower lip (Sto-Gn)ááá¯ááᯠáá¡áŸá¬ááºááŸá¬ááááŸá¬á®ážááœá² ááá¯áá
ááŸá¬ ááááºááá¯ááºáá±á«áááºá
28. Class II Retraction of upper incisors â lower lip curls up and moves forward.
Class III Lingual tip of lower incisors â lip moves backward.
ááŸá¯ááºáááºá®ážááœá²á¡áá°ááá¯áááºá®áž ááá¯ááºá®ážááŸá¬ááááºááœá²á¡áá±á« á¡ááá±á«áºááŸá¯ááºáááºá®ážááá¯ááẠLabial surface of the maxillary
incisorááá± Labrale Superius pointá¡á ááá¯ááºá®ážááŸá¬ááá®áž áá¡áŸá¬ááºááŸá¯ááºáááºá®ážááá¯ááẠLabial surface of the
mandibular incisorááá± Labrale Inferius á¡á ááá¯ááºá®ážááŸá¬ááááºááá¯ááºáá±á«áááºá
ááá®ážá á±áœá²áááºáááºá®ážááá± ááá¯ááºá®ážááŸá¬ááá¯áááœá² lower face throat angle ááᯠááááºááá®áž ááá®ážá ááœá²á¡áá±á¡ááŸá¬á®ážááá¯
ááááŸá¬ááá¯ááºáá±á«áááºá Lower face throat angle áá»á¥áºá®ážáá ááá®ážá á áááºááŸá¬á®ážááá®áž áááœá±á·áááŸá¬ááºáá ááŒá áºáá±á«áááºá
Rickettâs lip analysis (E-line) ááᯠááá¯ááºá®ážááŸá¬áŒáá¯á¡ááẠtip of the nose á±áœá² pogonion ááá¯
á¡ááá¯á®ážáááŒá¯áá±á«áááºá á¡ááá±á«áºááŸá¯ááºáááºá®ážá E-lineááœá²áá±áŸá¬áẠ2-3mm á¡ááŸá¬á áá¡áŸá¬ááºááŸá¯ááºáááºá®ážá E-lineááœá²áá±áŸá¬áẠ1-
29. 2mmá¡ááŸá¬ááŸá¬ááá¯ááẠááá¯áá±áºá¡áá±á¡ááŸá¬á®ážááᯠááá¯ááá¯ááºáá±á«áááºá ááŸá¯ááºáááºá®ážá áááœá±á·áááºáááŸá¬ááºáá±áºá®ážáá±ááẠlip protrusion
ááŒá áºáá±ááá¯ááºááá®áž E-áá±áŸá¬ááºáááºááᯠáááŸá¬ááºáá±áºá®ážáá±ááẠlip retrusion ááŒá áºáá±ááá¯ááºáá±á«áááºá
Rickettâs lip analysis = The reference line used by Ricketts (esthetic line): top of nose to skin pogonion
⢠Upper lip 2-3 mm behind this line ⢠Lower lip 1-2 mm behind this line
Steinerâs lip analysis (S-line) ááᯠááá¯ááºá®ážááŸá¬áŒáá¯á¡ááẠcenter of the S-shaped curve between
tip of the nose and subnasale á±áœá² pogonion ááᯠá¡ááá¯á®ážáááŒá¯áá±á«áááºá ááŸá¯ááºáááºá®ážááŸá¬ S-line ááœá² áááœá±á·áááºááá¯
áááŸá¬ááºáá±ááẠlip protrusion ááŒá áºáá±ááá¯ááºááá®áž S-lineááœá²áá±áŸá¬ááºáááºááᯠáááŸá¬ááºáá±ááẠlip retrusion ááŒá áºáá±ááá¯ááºáá±á«áááºá
Steinerâs lip analysis = Reference line is center of (S) shape between tip of nose and upper lip and soft
tissue pogonion
⢠If lips behind this line â lips are too flat. ⢠If lips anterior to it â lips are too
prominent.