Orthodontic Diagnosis

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 3

Contemporary orthodontic 5th
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CLINICAL EXAMINATION
TENTATIVE DIAGNOSIS
DIAGNOSIS
TREATMENT PLAN
LABORATORY TEST AND
RADIOGRAPH

Orthodontic diagnosis – rakosi , graber 7
DIAGNOSTIC AIDS

Classification of Diagnostic Aids
Supplemental Essential
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Essential Aids
Case History
Clinical Examination
Study casts
Radiographs-Peri apical, Bitewing,Panoramic.
Facial photographs
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Supplemental Aids
Special x-ray- lateral ceph ,occlusal
Electromyographic examination
Hand Wrist x-ray
Basal metabolic rate & Endocrine tests
Full Mouth radiographs
Shift cone technique
• Computerized tomography (CT)
• CBCT
• Magnetic resonanceimagin(MRI)
•
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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 psychological problems
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.
5)for identifying the priorities and the desires of the patient
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MEDICAL HISTORY
H/O of previous hospitalization.
H/O chronic diseases like diabetes, cardiac problems.
H/O allergy specially LATEX & NICKEL.
H/O blood transfusion.
Tonsillectomy/Adenoidectomy
Epilepsy
Handicapped childrens
arthritis
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Pre natal History
Delivery- Full term/ Premature
Type- Normal/ Forceps/ Caesarian
TMJ ankylosis due to prenatal trauma by forceps
delivery
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Medications during pregnancy

POST NATAL HISTORY (childhood history)
FEEDING METHODS-(Breast or Bottlle and Duration &
Frequency)
IMMUNIZATION
INJURIES- To Dento-Alveolar and Oro-Facial structures,
HABITS – ANY ABNORMAL ORAL HABITS.
HABITS like thumb sucking, tongue thrusting etc
Duration- Most important
Intensity
Frequency
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Thumb / finger
sucking
Placing of thumb/finger in various depth within the oral cavity

 Decreased or discontinued breast feeding
 Imitation
 Hunger
 Comfort and Compensation
 A sense of security
 Nervously imbalanced or physically subnormal
 Emotional tension
 As a teething device
Naa . . . my
thumb is so
tasty

Reddened
Clean
Chapped
Fibrous
roughened callus
Digits in Acute
Thumb suckers
Digits in Chronic
Thumb suckers
Hypotonic upper lip

Defects in Maxilla:
Increased
proclination of the maxillary
incisors
 Increased clinical crown length
of the maxillary incisors
 counterclockwise rotation of
the occlusal plane
trauma to maxillary central
incisors
Decreased
palatal arch width
Palatal plane angle
Defects in Mandible
Increased retroclination of mandibular
incisors
Increased mandibular intermolar
distance
Increased distal position of B point

Effects on the interarch relationship :
Decreased maxillary and mandibular incisal angle
Increased overjet
Decreased overbite
posterior cross-bite
unilateral or bilateral class II malocclusion

Tongue thrusting
Abnormal tongue posture during
swallowing/retained infantile swallow
It can be simple/complex
Clinical features includes
• anterior/posterior open bite
• proclined maxillary anteriors
• spacing in anterior region
•
􀁡 Delayed transition between the infantile and adult
swallowing pattern.
􀁡 Transition usually begins to happen around the age
of 2 years.
􀁡 By the age of 6 years, 50% have completed the
transition.
􀁡.
􀁡 Most cases (80%) will self correct by 12 years of
age

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Lip Sucking /lip biting Habit
􀁡In most instances lip sucking habit is a compensatory
activity that result from an excessive overjet and relative
difficulty of closing the lips properly during deglutition􀁡
Reddened and irritated lips, more severe in the winter
months
intendation on lower lips and
hypertrophic vermillion border
Proclined maxillary anterior teeth and
retroclined mandibular anterior teeth

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Mouth Breathing
Mouth breathing can be defined as habitual respiration
through mouth instead of nose(sassouni)
􀁡It can be caused by physiologic or anatomic conditions
True mouth breathing when the habit continues after the
obstruction is removed.

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Mouth Breathing Habit
􀁡 Adenoid Facies
• Long narrow face
• Narrow nose and nasal airway
• Flaccid lips with short upper lip
• Upturned nose exposing nares
frontally
• Skeletal Open Bite or “Long Face
Syndrome”
• Excessive eruption of posteriors
• Constricted maxillary arch
• Excessive overjet
• Anterior openbite

DENTAL HISTORY
H/O trauma
H/O any restorations, periodontal treatment etc.
H/O previous orthodontic treatment.
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FAMILY HISTORY
H/O cleft lip & palate
Hereditary dysgnathias include-
- Class II Div 2
- Skeletal open bite
- Bimaxillary protrusion
Skeletal classIII
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PHYSICAL GROWTH EVALUATION
Note general physical development like height & weight.
History related to growth spurts like rapid increase in
height, change in voice, menarche.
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There are two goals of the Orthodontic clinical examination:
1) to evaluate and document oral health, jaw function, and
facial esthetics; and
2) to decide which diagnostic records are required.
Consists of
General examination
Extra-oral examination
Functional examination
Intra-oral examination - Soft tissues
Hard tissues
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GENERAL EXAMINATION
BUILD : SLIGHT MODERATE WELL
POSTURE
It is a reflection of body’s efficiency to maintain joints in
relationship which require least energy for functions
imposed on them.
Head posture altered in mouth breathers.
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GAIT
The way patient walks.
Altered in neuromuscular disorders
eg. polio
BODY TYPE
Classified as-
Aesthetic
Atheletic
Plethoric
SHELDON classification-
Ectomorphic
Mesomorphic
Endomorphic
Ectomorph Mesomorph Endomorph34
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HEAD/CEPHALIC SHAPE
MARTIN & SALLER-1957
Cephalic Index = Max skull width
Max skull length
DOLICOCEPHALIC- LONG SKULL (x – 75.9)
MESOCEPHALIC- AVERAGE SKULL (76.0 – 80.9)
BRACHYCEPHALIC- BROAD SKULL (81.0 – 85.4)
HYPERBRACHYCEPHALIC (> 85.5)
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FACIAL INDEX
Defined as ratio between
morphological facial height &
bizygomatic distance.
Given by Martin & Saller in 1957.
Morphologic facial index
= Morphologic facial height
Bizygomatic width
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MESOPROSOPIC (MESOFACIAL) -(84 – 87.9)
EURYPROSOPIC (BRACHYFACIAL)- (79 – 83.9)
SHORT & BROAD
LEPTOPROSOPIC (DOLICOFACIAL)- (88 – 92.9)
LONG & NARROW
HYPERLEPTOPROSOPIC - (> 93)
Europrosopic
Mesoprosopic
Leptoprosopic
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FACIAL SYMMETRY
RIGHT LEFT
ASYMMETRY DUE TO TRAUMA
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Orthodontics – current principles and technique 5th
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Rule of Fifth
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41Orthodontics – current principles and technique 5th
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INTERLABIAL GAP
Normally lips are in contact in relaxed state.
Interlabial gap is assessed by degree to which lips are
apart at rest.
Large gap indicates-
Vertically short lips
Excessive anterior facial height
NORMAL 0 to 2 mm
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PROFILE ANALYSIS
Called as Poorman’s Cephalometric Analysis.
Patient is placed in physiologic natural head position.
Incorrect Correct
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N’
Sn
Pg’
Straight Profile Convex Profile Concave Profile
Convex Profile- Skeletal class II
Concave Profile- Skeletal class III
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Term coined by Milo Hellman.
Defined as an anterior or posterior inclination of
lower face relative to forehead.
If it slopes anteriorly- Anterior Divergence
If it slopes posteriorly- Posterior Divergence
DIVERGENCE
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Both planes meet at occipital region.
If they meet beyond it- Low angle or horizontal growth
pattern.
If they meet anterior- High angle or Vertical growth
pattern.
Horizontal
Vertical
MANDIBULAR PLANE ANGLE
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Horizontal growth

EXAMINATION OF LIPS :
Size :NormalShortThinThickEverted
Posture : CompetentIncompetentPotentially Incompetent
Competent
lips
Potentially incompetent
lips
Incompetent
lips
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Positive
lip step
Slightly
Negetive lip
step
Negetive
lip step
Given by korkhaus
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ACUTE ANGLE NASO-LABIAL ANGLE OBTUSE ANGLE
Decreased angle- Protrusive upper lip
Proclined upper anteriors
Prognathic maxilla
Increased angle- Retrusion of upper lip
Retroclined upper
anteriors
Retrognathic maxilla
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Normal 110

Mentolabial Sulcus
It is a fold of soft tissue between lower lip & chin.
Affected by- Facial Height
Overjet
Chin Projection.
Normal Shallow Deep
Deep sulcus – Class II Div 1
Shallow sulcus – Bimaxillary protrusion
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Hyperactive
mentalis activity
produces puckering
effect in chin region
called as GOLF
BALL APPERANCE
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NOSE EXAMINATION
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
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Overdevelopment of chin height alters position of
lower lip & Interferes with lip closure.
Causes hyperactivity of mentalis.
Influence on profile-
-Protruding chin with deep mentolabial sulcus-
Retrusive lip profile.
-Negative chin formation with absence of sulcus-
Protrusive lip profile.
CHIN
Projection- Depends on
Bone over inferior border of mandible
Soft tissue over chin
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Adequate
chin
Excessive
chin
Recessive
chin
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FUNCTIONAL EXAMINATION
Speech/Articulation
Breathing/Respiration
Swallowing
Path of closure
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SPEECH/ARTICULATION
Basic units- 25 consonants, 14 vowels.
Ask patient to count 1 to 10 or 20.
Watch closely adaptation of lips & tongue.
Listen to how sounds are produced.
TESTSTest Consonants Vowels
One w,n h
Two t oo
Three th,r ee
Four f,r o
Five f,v i
Six s,ks(x) i
Seven s,v,n e
Eight t a
Nine n,n i
Ten t,n e 57Contemporary orthodontic 4th
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SPEECH DEFECTS
SOUND PROBLEM MALOCCLUSION
S,z Lisp Spacing
T,d Dif. in production Irregular position
F,v Distortion Sk class III
Th,sh,ch Distortion Open bite
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Methods of Examination
VISUAL EXAMINATION
size,shape and activity of external nares are observed
while breathing
Ask patient to close lips & take deep breath.
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In mouth breathers the alar muscles are
inactive
BREATHING/RESPIRATION

Mirror test
Butterfly test
Water Test
Rhinomanometry 60Contemporary orthodontic 4th
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1) Retracted
Tongue tip withdrawn from all anterior teeth.
Usually associated with posterior open bite.
May be associated with bilateral loss of several posterior
teeth.
2) Protracted-
2 forms- a) Endogenous- Retention of infantile postural pattern
Results in open bite.
b) Acquired- Transitory adaptation enlarged tonsils, pharyngitis or
tonsillitis.
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Dentistry of child mcdonald
Tongue Postures

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Vertical plane
Hotz & Muhlemann
True deep overbite- large freeway space caused by
infraocclusion of molars.
Pseudo deep overbite- small freeway space caused by
over eruption of incisors
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Occlusal Interferences
 It can be studied by as follows-
Dots are placed at selected points on midline &
patient is asked to open & close gently.
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In first picture jaw is wide open, dots are well
aligned.
In middle picture mandible is in rest position, dots
are still well aligned.
In last picture teeth are in occlusion, mandible is
guided by cuspal interferences into functional cross
bite & is forced to swing to left on closure.
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Orthodontic diagnosis – rakosi , graber

LATERAL PALPATION OF T.M.J
POSTERIOR PALPATION OF T.M.J
AUSCULTATION OF T.M.J
TMJ EXAMINATION-
INSPECTION
PALPATION
AUSCULTATION
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The first step in functional analysis is to examine the
patients maximum jaw opening
For adults – 45 mm
Children - < 45 mm
.. Many authorities consider
less than 40 mm to represent
restricted jaw opening. Brandt
considers this an artificially
high threshold for determining
restricted jaw movements,
suggesting that 35 mm is
more appropriate for children
and adolescents.
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MOUTH OPENING

Reasons for blood transfusion
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Infections transmitted through blood
transfusion
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1.HIV
2.HEPATITIS B and C
3.HUMAN HERPES VIRUS
4.SYPHILIS
5.MALARIA

Sign and Symptoms of nickel allergy
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1.Gingiva
gingivitis in the absence of plaque
gingival hyperplasia
2tongue
burning sensation in the mouth
metallic taste
soreness in the lateral side of tongue
3.Lips
labial swelling
labial desquamation
angular cheilitis
4.Exta orally
localized dermatitis

Diagnosis of nickel allergy
1.Trial appliance
2.Test using 5%nickel sulphate in a
petrollium gelly substrte
3.Needle prick
4.Blood test
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Orthodontic consideration for patient with
diabetes mellitus.
 1.periodontal health is to be evaluated regularly
 2.strict oral hygiene measures are adopted
 3.orthodontic forces kept to minimum
 4.peripheral microangiopathy related tooth pain
 5.management of hypoglycemic attack
 Clinical symptoms of hypoglycaemia include sweating, hunger, tremor,
agitation.With progression drowsiness, confusion and coma.
 Management
 Conscious patients can usually be treated with rapid acting oral
carbohydrates,
 e.g. fruit juice, packets of granulated sugar, glucose powder neat or dissolved
inwater.
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Measurement of cranial width and length(POINTS)
Width of skull
 EURION TO EURION
Length
 NASION TO OPISTHOCRANION
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Tongue :
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Cheek sucking/Cheek biting.
Soft tissue interposition- Lateral open bite or deep
bite.
Increased pressure by cheek musculature impedes
transverse development of jaw-Buccal nonocclusion.
CHEEK-
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Positive Blanch test
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Enlarged Gingiva
Healthy Gingiva
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Palate
Pathological swelling- Cyst, Displaced tooth germs
Ulceration- Traumatic deep bite
Scar tissue after surgery for clefts
Vault- High arched in syndromes eg. Pierre Robin
syndrome
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HIGH PALATE BIFID UVULA
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CLASS II DIV I
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Dentition
Assess dental status
Recording of dental & occlusal anomalies
Midline of face & coincidence with dental arches
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Dental Status
Caries
Structure anomalies like enamel hypoplasia
Number of teeth
Wear facets
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Occlusion
Malposition of individual teeth
Malposition of group of teeth
Malocclusion
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Individual Teeth
Rotation
Inclination/ Tipping- Buccal/Labial
Lingual
Mesial
Distal
• Total displacement
• Transposition
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Mesial inclination or tipping Distal inclination or
tipping
Lingual inclination or
tipping
Labial/buccal
inclination or tipping

Infra-occlusion
Supra occlusion Rotations

CROWDING
Etiology
 Primary- Hereditary
 Secondary- Acquired
 Tertiary- Unknown
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Spacing
Causes-
 Oral habits
 Altered morphology
 Supernumerary teeth
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MALRELATION OF DENTAL ARCHES
SAGITTAL PLANE MALOCCLUSION
VERTICAL PLANE MALOCCLUSION
TRANSVERSE PLANE MALOCCLUSION

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

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

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

ANGLE’S CLASSIFICATION
Edward Angle in 1899 classified
malocclusion based on the mesiodistal relation
of the teeth, dental arches and jaws
He considered the maxillary 1st
permanent
molar as a fixed anatomical point in the jaws &
the key to occlusion (but it is not so)
Most frequently used classification system and
the only internationally recognized classification
of malocclusion

CLASSIFICATION OF MALOCCLUSION
It is grouping of clinical cases of similar appearance for ease in
handling & discussion but not a system of diagnosis, method
for prognosis or a way of defining treatment.
Purpose
Helps in diagnosis
Aids in comparison
Ease of reference
Self communication
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ANGLE’S CLASSIFICATION…
Classified into three broad categories and
are designated as “Classes” and are
represented by Roman numerals – I, II, and III
Class I malocclusion
Class II malocclusion
Class II division 1
Class II division 2
Class II subdivision
Class III malocclusion
true class III
pseudo class III

Class I-Neutrocclusion
Normal AP relationship
Mesiobuccal cusp of upper first molar occludes with
mesiobuccal cusp of lower first molar.
Other dental irregularities like crowding, spacing,
deepbite may be present
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Class I
Class I with Bimaxillary Protrusion
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Class II-Distocclusion/Post normal
occlusion
Lower arch retruded
Distobuccal cusp of upper first molar occludes in
buccal groove of lower first molar.
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Class II Division 1
Maxillary incisors in labioversion
Deep bite
Upper lip hypotonic
Lip trap
Hyperactive mentalis
Narrow maxillary arch
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Class II Div 2
Maxillary centrals linguoversion & laterals in
labioversion.
Deep bite
Mandibular labial gingiva traumatised.
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Subdivision
When distocclusion occurs on one side only it is
called subdivision of its division.
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Class III- Mesiocclusion/Pre normal
occlusion
Mesiobuccal cusp of maxillary first molar
occludes in interdental space between mandibular
first & second molar or distal to buccal groove of
mandibular first molar.
2 Types-
True class III
Pseudo class III
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True Class III
It may be due to-
Excessively large mandible
Forwardly placed mandible
Smaller than normal maxilla
Retropositioned maxilla
Combination of above
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Pseudo Class III
Occlusal Prematurities
Premature loss of deciduous posteriors
Child with enlarged tonsils
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Dewey’s modification of Angle’s
classification
Angle’s Class I
Type I – Class I with crowded anteriors.
Type II – Class I with protrusive maxillary incisors.
Type III – Class I with anterior cross bite.
Type IV – Class I with posterior cross bite.
Type V – Mesially drifted permanent molars because
of early extraction of deciduous predecessors.

Lischer’ modification of Angle’s
classification
Lischer in 1933 further modified Angle’s classification by giving substitute names
for Angle’s class I,II, and III malocclusions
1) Neutro-occlusion → synonymous with Angle’s class I
2) Disto-occlusion → synonymous with Angle’s class II
3) Mesio-occlusion → synonymous with Angle’s class III
He proposed terms to designate individual tooth malpositions

classification
Lischer’s nomenclature for individual tooth
malpositions involved adding the suffix “version” to
a word to indicate the deviation from the normal
position
1) Mesioversion → mesial to normal position
2) Distoversion → distal to normal position
3) Labioversion → labial to normal position
4) Linguoversion → lingual to normal position

5) Infraversion → inferior or away from line of
occlusion
6) Supraversion → superior/extended past the line of
occlusion
7) Axiversion → axial inclination is wrong ie.tipped
8) Torsiversion → rotated on its long axis
9) Transversion → transposed or changes in the
sequence of position
classification

Drawbacks of Angle’s classification
Considered malocclusion in only AP plane.
First molar as fixed point in skull.
Classification cannot be applied if first molars are
missing.
Does not differentiate between skeletal & dental
malocclusion.
Does not highlight etiology of malocclusion.
Individual malpositions have not been considered.
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Incisor Classification
Described by Ballard &
Wayman
Formed by British
Standards Institute (1983)
Class I
Class II
Class III
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Ackermann-Profitt
classification
Based on five
characteristics
1. Alignment
2. Profile
3. Transverse
relationships
4. Class
5. Bite Depth
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4
5

1. Alignment
 Intra arch alignment and symmetry assessed when seen in
occlusal view.
 Dental arch is classified as ideal/crowded/spaced
2. Profile
 can be convex/straight/concave
Includes assessment of facial divergence ie. Anterior or posterior
divergence.
3. Transverse relationships
 Include transverse skeletal and dental relationships.
 Buccal and palatal cross bites are noted.
 Further classified as unilateral or bilateral.
 Distinction made between skeletal and dental cross bites.

4. Class
 Sagittal relationship of teeth is assessed using Angle’s
classification as Class I / II / III.
 Distinction made between skeletal and dental
malocclusions.
5. Bite Depth
 Assessed in the vertical plane
 Described as anterior open bite / posterior open
bite / anterior deep bite / posterior collapsed bite.
 Distinction made between skeletal and dental
malocclusions.

SIMON’S CLASSIFICATION
Simon (1930) – 1st
to relate dental arches to
the face & cranium in 3 planes of space
Three planes include,
1) Frankfort Horizontal plane
2) Orbital plane
3) Median sagittal plane (Midpalatal
raphe)

Frankfort Horizontal plane
Plane used to classify malocclusions in VERTICAL plane
ATTRACTION- dental arch closer to FH plane
ABSTRACTION-dental arch further away from FH plane
Straight line through lower
margin of bony orbit to the
upper margin of external
auditory meatus

Orbital plane
- Perpendicular to FH plane
-orbital plane passes through the
distal axial aspect of the maxillary
canine
- called as “SIMON’S LAW OF
CANINE”
Malocclusions described in antero-posterior relationship
PROTRACTION- teeth,dental arches,jaw bases that are too forward to orbital
plane
RETRACTION - teeth,dental arches,jaw bases that are too backward to orbital
plane

Median sagittal plane (Midpalatal raphe)
-Perpendicular to FH plane
-Malocclusions classified according to
transverse deviations from median sagittal
plane
CONTRACTION – a part or all of the dental arch is contracted towards the
median sagittal plane
DISTRACTION - a part or all of the dental arch is widened or placed at a
distance from the median sagittal plane

Canine Classification :
1) Class I canine relationship – the upper permenant canine
occludes in the embrasure between the lower permenant
canine and the first premolar.
2) Class II canine relationship – the canine occludes a whole
tooth width further anteriorly and lies in the embrasures
between the lower canine and lateral incisor.
3) Class III canine relationship – the upper canine occludes a
whole tooth width further posteriorly than normal and
occludes in the embrasure between the lower first and
second premolar.

Canine relationships:(a) class I, (b) ½ unit class II, (c) class II, (d) ½ unit class III,
(e) class III

Skeletal Classification
Class I- orthognathic maxilla and orthognathic
mandible.
Class II- orthognathic maxilla and retrognathic
mandible
Class III- orthognathic maxilla and prognathic
mandible
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Deep Bite
Excessive vertical overlap.
Considered excessive when incisors overlap by more
than half.
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Open bite
Lack of vertical overlap between maxillary & mandibular
teeth.
Classification – Skeletal
Dental
Causes for Open Bite-
Disturbance in eruption of teeth & alveolar growth
Mechanical interference with eruption of teeth
Vertical skeletal dysplasia
Abnormal oral habits
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Types
Anterior Open bite Lateral open bite

135
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Cross Bite
Causes
Narrow upper jaw
Broad lower jaw
B/L symmetric
B/L asymmetric
Unilateral
136
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Types
Anterior cross bite Posterior cross bite
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Buccal non-occlusion/Scissor Bite- Upper posterior
teeth occludes completely buccal to lower teeth.
Lingual non-occlusion- Upper posterior teeth
occludes completely lingual to lower teeth.
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139

140

Deviation of Midline
Midline Deviation
Maxilla Dentoalveolar
Mandible Skeletal
Combined Combined
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Dental Midline Shift
Skeletal Midline Shift
edition proffit

Smile Analysis
Facial attractiveness is defined more by smile than by
soft tissue.
2 types- Posed/social
Unposed/emotional
Posed smile Unposed smile
144
edition

Measurements of Smile
Amount of incisor display on smile
145
edition

Crown height & width
Ht:Width=10:8
146
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Smile Arc- Relationship of curvature of incisal edges
of incisors & canines to curvature of lower lip in posed
smile. Smile arc should track the lower lip curvature
edition

Incisor Display
Vertical characterstics of smile-
 Incisor Display
Gingival Display
edition

Gingival Display
Acceptable
Ideal
Least Desirable
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Transverse characteristics of smile
Buccal Corridor width
Distance between maxillary posterior teeth & inside
of cheek.
Ratio of Intercommisural width divided by distance
from first premolar to first premolar.
Ideal is 13% of
intercommissure width
150
edition

Arch Form
Important in transverse dimension of smile.
If arch form narrow- smile narrow
If expansion- smile improves
151
edition

Transverse cant
Asymmetric vertical
growth of mandible.
Results from
differential eruption &
placement of anterior
teeth.
152
edition

Dental appearance & Smile (Micro-
esthetics)
Golden Proportion
153
edition

Tooth height & width
relation-
154
edition

Connectors & Embrasures
155
edition

Black Triangles
edition

Recent advances in diagnosis and treatment
planning
Introduction
Original Diagnostic records consisted of
set of study models
and patient’s orthodontic problems
Discovery of X-rays by Roentgen in 1895.
Traditional 2-D cephalographs also known as
Roentgenographic cephalometry introduced by
Broadbent, 36 years later.

Radiological Examination
Lateral ceph.
Panoramic(OPG)
Periapical
Occlusal
Hand wrist radiograph
CBCT
CT
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Lateral cephalometry
162
It helps in diagnosing
 anterio posterior jaw relation
 Growth pattern
 Details of Maxilla and mandible
 CVMI
 Degree of proclination of maxillary and mandibular
incisors
 soft tissue analysis
IT IS A SUPPLEMENTARY DIAGNOSTIC AID
THE RADIOGRAPH OBTAINED IS CALLED CEPHALOGRAM
TYPES OF CEPHALOGRAMS
A) LATERAL CEPHALOGRAM
THIS IS TAKEN WITH THE HEAD IN A STANDARDIZED ,
REPRODUCIBLE POSITION AT A SPECIFIED DISTANCE FRON X-RAY
SOURCE .
THIS PROVIDES A LATERAL VIEW OF THE SKULL i.e
RIGHT LATERAL VIEW , LEFT LATERAL VIEW
B) FRONTAL CEPHALOGRAM
THIS PROVIDES THE ANTERO-POSTERIOR VIEW OF SKULL

CVMI
163
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
cirvical virtebrae 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.

Panoramic radiograpgh(OPG)
Helps in diagnosing
presence of any impacted teeth
TMJ problems
any pathology
Enlarged Panoramic-
Accurate imaging in anterior region.
Distortion in posterior region.
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edition proffit

Periapical X-ray
Assessment of periodontal status
 individual tooth defects
Peri apical pathology
165
edition proffit

Localization/ SLOB Technique- Used to localize
position of impacted teeth.
166
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Occlusal View
Supplementary projection to locate malposed
unerupted teeth.
Palatal cleft
Expansion
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edition proffit

CBCT(Cone-beam computed tomography)
169
The object to be evaluated is captured as the radiation
source falls on a 2- dimensional detector
 An entire region of interest can be obtained with a single
rotation of the X-ray source
 The cone beam produces a more focused beam, so less
scatter radiation
 Significant increase in X-ray utilisation and reduces tube
required for volumetric scanning
Total radiation exposure is approximately 20% of
conventional CT’s
 Nearly equal to a full mouth periapical radiographic
exposure
 Less expensive and smaller, so can fit in dental office
Impacted canines and
abnormalities
 Airway analysis
 Assessment of alveolar
bone height and volume
 TMJ morphology

Computerized Tomography
170
 Invented by Sir Godfrey Hounsfield who was
awarded a Nobel prize in 1979
 CT is an image display of the anatomy of a thin
slice of the body developed from multiple x- ray
absorption measurements made around the
body’s periphery
 ADVANTAGES
 Useful in determining changes in bone density
 Primary imaging method when internal
derangement or arthrosis is suspected – clinical
diagnosis is not always sufficient.
 Has advantages when planning treatment or
operations on jaws and TMJ diseases and
deformities.

MRI
171
 Indications
 Assessing diseases of the TMJ
 Cleft lip and palate
 Tonsillitis and adenoiditis
 Cysts and infections
 Tumors
Magnetic fields are caused by moving electrical
charges or rotating electric charges.
.
The technique is based on the presence of
specific magnetic properties found within
atomic nuclei containing protons and
neutrons,
The Gantry ;houses the patient. Patient is
surrounded by magnetic coils
Interpretation
When images are displayed;
intense signals show as
white and weak ones as
black..
Intermediate as shades of gray.
Cortical bone and teeth with low
presence of hydrogen are
poorly imaged and appear
black

conclusion
172

refences
Contemporary orthodontic 4th
edition proffit
Orthodontic diagnosis – rakosi , graber
Orthodontics – current principles and technique 5th
edition
Dentistry of child mcdonald
173

Orthodontic Diagnosis

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