orthodontic diagnosis

1. ORTHODONTIC DIAGNOSIS

2. DIAGNOSIS
• Definition- “The act / process of identifying or determining the nature and
cause of a disease or injury through evaluation of patient history ,
examination and review of laboratory data.”
INTRODUCTION

3. Orthodontic diagnosis deals with recognition of the various characteristics
of the malocclusion. It involves collection of pertinent data in a systemic
manner to help in the identifying the nature and cause of the problem

4. Diagnostic aids
• Comprehensive orthodontic diagnosis is established by use of certain clinical
implements called diagnostic aids
• Classification of diagnostic aids
Essential
• Simple and do not require expensive equipment
Supplementary
• Require specialized equipment

5. I. Essential diagnostic aids
i. Case history
ii. Clinical examination
iii. Study models
iv. Certain radiographs – Periapical radiograph, bite wing,
Panoramic radiograph
v. Facial radiographs

6. • Supplemental diagnostic aids
Specialized radiographs –
 Cephalometric radiographs
 Occlusal intraoral films
 Selected lateral jaw views
 Cone shift technique
1. Electro myographic examination of muscle activity
2. Hand – wrist radiograph
3. Endocrine tests
4. Estimation of basal metabolic rate
5. Diagnostic Set up
6. Occlusograms

7. • CASE HISTORY- Case History involves eliciting and recording of relevant
information from the patient and the parent to aid in overall diagnosis of the
case.
• PERSONAL DETAILS
1. NAME: Purpose of communication and identification. Addressing the patient
by his/her name has a beneficial psychological effect. Patient feels that the
clinician is interested in his well being. In case of children, it is better to record
their pet names too
DIAGNOSTIC PROCESS

8. • AGE
• Diagnosis and treatment planning
• Identification of transient malocclusions and explaining the development
• Growth modification procedures – during period of growth
• Surgical resective procedures – after cessation of growth

9. • SEX – Treatment planning e. g. the timing of growth events such as growth
spurts are different in males and females, Females precede males in onset of
growth spurts, puberty and termination of growth
• ADDRESS AND OCCUPATION –
Evaluation of socio – economic status
For selection of an appropriate appliance
Future correspondence for appointments

11. • CHIEF COMPLAINT
• The patient’s chief complaint should be recorded in his/her own words.
• This helps the clinician in identifying the priorities and desires of the patient
• There are three major reasons for patient concern about the alignment and
occlusion of the teeth:
1. impaired dento-facial esthetics that can lead to psychosocial problems
2. impaired function, and a desire to enhance dento-facial esthetics and
3. thereby the quality of life.

12. • MEDICAL HISTORY
• In obtaining the medical history, the orthodontist or assistant must always ask a
few important questions, as the last time a physician was seen, any
hospitalizations, any medications currently being taken. Information regarding
allergies, especially latex or nickel sensitivity; history of blood transfusions must
be recorded.
• Patients having rheumatic fever or cardiovascular conditions should be given
antibiotic coverage prior to certain orthodontic procedures
• Medical history should include information on drug usage. Drugs like aspirin
impede orthodontic tooth movement

13. • DENTAL HISTORY :- The dental history of the patient should include , age of
eruption of the deciduous and permanent teeth, history of extraction, decay,
restorations and history of trauma to the dentition
• PRE NATAL HISTORY :- It includes – The condition of the mother during
pregnancy and the type of delivery. The use of certain drugs like thalidomide.
• Information should be recorded on type of delivery. Forceps delivery predispose
to TMJ injuries which directly affects mandibular growth retardation

14. • POST NATAL HISTORY
• It include – The type of feeding, Presence of habits and The milestones of
normal development.
• Extended or excessive frequency of feeding times (from the breast or bottle)
is discouraged and appropriate oral hygiene measures for infants and
toddlers is advised.

15. • FAMILY HISTORY :- Congenital conditions like cleft lip and palate, skeletal
Class II and Class III malocclusion are hereditary in nature

16. • CLINICAL EXAMINATION
• GENERAL EXAMINATION
a. Height and Weight – They provide a clue to the physical growth and maturation
of the patient
b. Gait – It is the manner of walking. Abnormalities of gait are usually associated
with neuro-muscular disorders
c. Posture – Posture refers to the way a person stands. Abnormal postures can
predispose to malocclusion due to alteration in maxillo- mandibular relationship

17. • BODY BUILD(PHYSIQUE)
a. Aesthetic – they have a thin physique and usually posses narrow dental
arches.
b. Plethoric – they are obese and have large, square dental arches.
c. Athletic – they are normally built and have normal sized dental arches.

18. SHELDON has classified the general body build into
three types
a. Ectomorphic – tall and thin physique
b. Mesomorphic – average physique
c. Endomorphic – short and obese physique

19. EXTRAORAL EXAMINATION
Shape of head
• Cephalic index
Max skull width X100
Max skull length

20. Dolichocephalic -long and narrow head
Mesocephalic – Average shape of head
Brachycephalic –broad and short head

21. Facial form
Mesoprosopic –Average or normal facial form
Euryprosopic- Broad and short
Leptoprosopic-Long and narrow

22. Assessment of facial symmetry
• Assessment in the frontal view helps one to
analyze the proportional widths of the nose
and mouth.
• It also helps to detect bilateral asymmetries.

23. • Gross facial asymmetries can occur as a result of
• Congenital defect
• Hemifacial atrophy
• Unilateral condylar ankylosis

24. Facial profile
Help in diagnosing gross deviation in the maxilla
mandibular relationship
Relation between 2 lines

25. • Straight profile- two lines nearly form a
straight line
• Convex profile- two lines form a angle with
the concavity facing the tissue
• Concave profile-two lines form a angle with the
convexity facing the tissue

26. Facial divergence
Facial divergence is defined as an anterior or
posterior inclination of the lower face relative to
the forehead

27. • A straight line (orthognathic)
• Mandible is posteriorly placed - ‘posterior
divergent’.
• Mandible is positioned anteriorly - ‘anterior
divergent

28. Anteroposterior Relationship Between the Maxilla and the Mandible:
• For assessing the anteroposterior pattern of the skeleton, the head
should be postured carefully in neutral horizontal position, i.e.
Frankfort plane horizontal to the floor.
• The patient is made to sit upright and asked to occlude the posterior
teeth gently.

29. Estimation is done by placing the index finger and
middle finger at the soft tissue point A and B
respectively
• Class II patients index finger is anterior to middle
finger or the hand points
• Class III patients the middle finger is ahead of the
forefinger or hand points downwards

30. Facial proportion
Well proportioned face be divided into
three equal thirds using four horizontal
planes
• Hairline
• Supra orbital ridge
• Bottom of nose
• Chin
Lower third also has thirds.

31. Transverse facial proportion
Divide into 5 equal fifths-
Central,2 Medial,2Lateral
halves
.
Nose and chin should be
centered in central half,
Interpupilary distance equals
the width of the mouth

32. • Competent lips- Lips in contact when the musculature is
relaxed
• Incompetent lips- Anatomically short lips with a wide gap
between the upper and lower lip in relaxed state.
• Potentially incompetent lips- they are normal lips that fail
to form lip seal due to proclined upper incisors.
• Everted lips – hypertrophied lips with redundant tissue
and weak muscle tonicity, often with bimaxillary dental
protrusion.
Examination of lips

33. • According to Proffit, lower lip should be at least as
prominent as the chin for best esthetics.
• Excess chin or deficient chin : not pleasing
Lip prominence

34. Nasolabial Angle (NLA)
• The nasolabial angle is the angle formed by the tangent to the base of the nose and a
tangent to the upper lip.
• Normal angulation is 110°.
• The NLA is acute or decreases with proclination of the upper incisors.
• The NLA is obtuse or increased in retroclination of the incisors.

35. EXAMINATION OF NOSE
Size of nose:
Normally the nose is one third of the total facial height
(from hair line to lower boarder of chin)

36. Nasal contour:
Straight nose
Convex nasal bridge
Crooked nose, from previous trauma

37. Nostrils:
• Normal: nostrils oval and bilaterally symmetrical
• Nostril stenosis result in disturbed nasal breathing

38. Examination of chin
Mentolabial sulcus
• The mentolabial sulcus is the fold of soft tissue between the lower lip and the chin.
• A deep or exaggerated mentolabial sulcus is common in patients with short faces
and Class II relationship.
• A deep mentolabial sulcus is associated with hyperactive or puckering of the
mentalis muscle.

39. Mentalis activity
Hyperactive mentalis activity is seen in some
malocclusion such as Class II

40. CHIN POSITION AND PROMINENCE
Prominent chin associated with Class III Malocclusion
Recessive chin are associated with Class II malocclusion

41. Thank you