ORTHODONTIC DIAGNOSIS
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DIAGNOSIS &TREATMENT PLANNING IS A SERIES OF LOGICAL STEPS
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DIAGNOSIS is a comprehensive procedure focused on broad overview of the patients situation
TREATMENT PLANNING is to maximize benefit for the patient www.indiandentalacademy.com
The field of orthodontics is in the midst of a knowledge explosion. www.indiandentalacademy.com
DIAGNOSIS ? A good diagnosis is important to decide whether or not to treat ? What the preferable method is ? When it should be started ? Therefore, it should be done with fully developed power of observation and an analytical mind. www.indiandentalacademy.com
THE OBJECTIVES OF DIAGNOSIS Identify the normal and abnormal developmental changes in growing children. Identify the dysfunction of the soft tissues. Identify the relevant etiological factors. Identify the interference in occlusion.
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THE OBJECTIVES OF TREATMENT Render the treatment at an early age and create a suitable environment and functional pattern so that the development is nearly as perfect as possible. Render the treatment in deciduous and mixed dentition to intercept the developing problems by utilizing the growth. Render the treatment in permanent dentition to achieve optimum esthetics, functional efficiency and long term stability. Should be aware of limitations of treatment and the degree of compromise by weighing various factors. www.indiandentalacademy.com
Orthodontic Consultation Clinical Examination
Data Base
Diagnostic Records www.indiandentalacademy.com
Provisional Diagnosis
ORTHODONTIC CONSULTATION
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CHIEF COMPLAINT • Impaired dentofacial esthetics • Impaired function
Objective is to find out what is important to the patient? www.indiandentalacademy.com
CASE HISTORY NAME AGE SEX ADDRESS & OCCUPATION CHIEF COMPLAINT MEDICAL HISTORY DENTAL HISTORY POST NATAL HISTORY www.indiandentalacademy.com FAMILY HISTORY
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CLINICAL EXAMINATION FACIAL OCCLUSAL FUNCTIONAL
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CLINICAL EXAMINATION HEIGHT & WEIGHT GAIT POSTURE BODY TYPE ECTOMORPHIC MESOMORPHIC ENDOMORPHIC BUILD ASTHETIC PLETORIC ATHLETIC FACIAL DIVERGENCE ANTERIOR POSTERIOR STRAIGHT
FACIAL FORM
MESOPROSOPIC EURYPROSOPIC DOLICOPROSOPIC www.indiandentalacademy.com
EVALUATION OF FACIAL PROPORTIONS Esthetics is very much in the eye of the beholder
Profile view straight/convex/concave Front view Front view- for bilateral symmetry - for dental/skeletal midline
Facial index Cephalic index
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To establish facial type
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PROFILE ANALYSIS • Fore head- Profile of face is determined by slant of forehead and nose. • Nose- Future nasal growth must be taken into consideration. • Lips- Length/ Thickness/ Curvature/ Competency. • Chin-Normally soft tissue is 10 – 12 mm thick on chin area. www.indiandentalacademy.com
Profile analysis –yields almost the same information as from lat.ceph. Poor man’s cephalometric analysis
To establish whether jaws are proportionately placed in A-P Plane To establish profile convexity or concavity To establish lip posture & incisor prominence Bimaxillary protrusion www.indiandentalacademy.com
FUNCTIONAL ANALYSIS Determination of postural rest position and freeway space. Examination of TMJ and condylar position. Assessment of functional status of lips, cheek and tongue. Evaluation of path of closure from postural rest position to habitual occlusion; In AP plane In Vertical plane www.indiandentalacademy.com In Transverse plane
Hereditary? Environmental? Trauma? Chronic diseases? Habits? etc……… www.indiandentalacademy.com
EVALUATION OF ORAL HEALTH
• Health of oral hard and soft tissues • Dental caries • Periodontal evaluation
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Evaluation of individuals’ physical growth status
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ASSESSMENT OF DEVELOPMENTAL AGE • Physical development • Chronologic age • Dental age • Sexual maturity
By Clinical examination Hand wrist radiograph CVMI Calcification of canine www.indiandentalacademy.com
SOCIAL AND BEHAVIORAL EVALUATION
Motivation
External Internal
Expectations Co-operation www.indiandentalacademy.com
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• STUDY MODELS • OPG • PHOTOGRAPHS • CEPHALOGRAMS • OTHER ADVANCED DIAGNOSTIC AIDS www.indiandentalacademy.com
STUDY MODELS Proclination of teeth Width of the arch Symmetry of the arch Crowding/ Rotations/ Spacing Arch length discrepancy Bolton’s analysis www.indiandentalacademy.com Classification of malocclusion
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ORTHOPANTAMOGRAPH
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PHOTOGRAPHS
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HARD TISSUE ANALYSES www.indiandentalacademy.com
MAND PLANE ANGLE AXIS CANT OF OCCLUSAL PLANE INTERINCISAL ANGLE UU 1LFACIAL to APOG (LINEAR) ANGLE OF CONVEXITY FMIA FMPA IMPA ANGLE 1 1 Yto to N-A N-B (Angle) SNB ANB SNA
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The difference between SNA & SNB – the ANB angle indicates the magnitude of the skeletal jaw discrepancy. It is influenced by two factors: The vertical height of the face As the vertical distance between nasion & point A & B increases, the ANB angle decreases. The anteroposterior position of nasion.
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The ANB angle can be misleading when nasion is displaced anteriorly. The ANB angle is only 70, but the A-B difference projected to the true horizontal is 14mm. ANB, at best, is an indirect measurement of the A-B difference & must be used with full awareness of its limitation.
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WITS ANALYSIS
In the Wits analysis, points A & B are projected to the functional occlusal plane, and the AB difference is www.indiandentalacademy.com measured.
STEINER ’S COMPROMISE
If the ANB angle is different from 20, the different positioning of the incisors given by the inclination & protrusion figures will produce a dental compromise that leads to correct occlusion despite the jaw discrepancy. www.indiandentalacademy.com
TWEED′S METHOD OF CEPHALOMETRIC CORRECTION
When the FMA is between 210 to 290, the FMIA should be 680. When the FMA is 300 or greater, the FMIA should be 650. When the FMA is 200www.indiandentalacademy.com is less the IMPA should not exceed 920.
SOFT
TISSUE
ANALYSES www.indiandentalacademy.com
SOFT TISSUE CHIN THICKNESS NASO LABIAL MENTAL ANGLE ANGLE LOWER LIP PROMINENCE UPPER CHIN LIP PROMINENCE H S EPROMINENCE LINE (Bell (Bell et et al) al)
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FUNCTIONAL ANALYSES www.indiandentalacademy.com
EFFECTIVE LENGTH UPPER & OF LOWER GONIAL ANGLE EFFECTIVE MANDIBULAR LENGTH ANGLE POSTERIOR ANTERIOR BASAL ARTICULAR JARABAK GONIAL SADDLE PLANE INCLINATION FACE ANGLE ANGLE RATIO ANGLE ANGLE HEIGHT SUM OF ANGLES FACE HEIGHT UPOSTERIOR 1MAXILLARY to SN N′
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ORTHODONTIC CLASSIFICATION An ideal classification should summarize the diagnostic data and imply the treatment plan, it can viewed as reduction of data base.
Skeletal jaw relationship with where exactly is the abnormality present. e.g. Skeletal class II with mandibular deficiency.
Dentoalveolar relationship Molar relationship Canine relationship Position of anterior teeth
Growth pattern
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PROBLEM LIST It should include: Those relating to disease or pathologic process. e.g. caries, perio etc. Those relating to disturbances of development that created the patients malocclusion.
Example of problem list Mild gingivitis in upper anterior region Maxillary incisor proclination with lip protrusion Excessive overjet Class II molar relationship Skeletal class II with mandibular deficiency www.indiandentalacademy.com
TO SUMMARIZE WE SHOULD HAVE… An interview data i.e., case history Clinical examination Complete analyses of all diagnostic record Orthodontic classification Problem list www.indiandentalacademy.com
Orthodontic Problems In priority order
Possible Solution To Individual problem
Optimal Treatment plan
Mechano therapy www.indiandentalacademy.com
MAJOR STEPS A description of an orthodontic data base and its analysis. The development of patients problem list. Determination of general treatment goals with more specific treatment objectives. Design of the specific mechanotherapy needed to reach these goals www.indiandentalacademy.com
THREE DIMENSIONAL TREATMENT GOALS Thorough analyses of orthodontic data base. Creation of patients problem list. Orthodontic mechanotherapy to achieve treatment goals. If the additional variations of time (growth) and function are considered, the approach becomes five dimensional. www.indiandentalacademy.com
TREATMENT PLANNING Clinical examination / Diagnostic records Data base Complete analyses Classification Problem list Treatment objectives Step by step progression of treatment Biomechanics Appliance design www.indiandentalacademy.com
Appliance use
CONCLUSION
CONCLUSION www.indiandentalacademy.com
www.indiandentalacademy.com Leader in continuing dental education
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