Introduction to Orthodontics Fifth Year

1. 11th Lecture
Orthodontic Examination
and Diagnosis-II

2. Orthodontic Examination and
Diagnosis-I

I.
Definitions:
History:
Personal history:
Chief Complain:
Past History:
Past medical history:
Past dental history:
April 28, 2012
Dr. Ahmed Basyouni
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3. Orthodontic Examination and Diagnosis-I
II. Clinical examination:
General Examination:
Extra-Oral Examination:
Intra-Oral Examination:
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Dr. Ahmed Basyouni
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4. III. Study Casts
Their value in orthodontic diagnosis includes:
i. They make it possible to view occlusion from every
aspect & make direct measurement.
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Dr. Ahmed Basyouni
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5. III. Study Casts
ii. They are helpful in explaining treatment plan to
patient and parents
iii. They may be used for assessment of treatment
progress
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Dr. Ahmed Basyouni
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6. III. Study Casts
iv. They can be used for construction of diagnostic
setup for simulation of proposed treatment plan
v. They can be used for consultation with another
Orthodontist to whom patient may be transferred.
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Dr. Ahmed Basyouni
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7. OrthoCAD Digital Study Models:
 With OrthoCAD Digital Study Models, you
can easily store, retrieve, and communicate
cases electronically, dispensing with the
hassles associated with plaster casts. All files
are instantly at fingertips—24-hours-a-day,
no matter where you are.
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Dr. Ahmed Basyouni
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8. April 28, 2012
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9. Digital Modeling: Benefits
 Storage – Information is stored electronically, freeing up valuable office
space.
 Quality – Accepted for certification purposes.
 Affordable – No upfront investment is required. Simply pay as you go.
 Retrieval – Files are accessed instantly, saving valuable time.
 Diagnostics – A set of user-friendly diagnostic tools, enabling betterinformed clinical decisions.
 Communication – 3-D data can be printed, faxed or e-mailed
effortlessly.
 Convenience – Use the same alginates, wax bites, trays and office
procedures.
 Access – Retrieve digital models in home, office, or while on the road.
 Backup – Copies are kept in service center for a period of ten years.
 Marketing – Show patients that the office is at the forefront of
technology.
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Dr. Ahmed Basyouni
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10. April 28, 2012
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11. e-Model
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12. Study Cast Analysis
I.
II.
III.
IV.
V.
Intra-arch Analysis:
Inter-arch Analysis:
Arch Length:
Width of Arch:
Mixed Dentition Analysis:
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Dr. Ahmed Basyouni
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13. Study Cast Analysis
I. Intra-arch Analysis:
A. Curve of Spee:
Upper
Normal
Flat
Reverse moderate
Reverse Excessive
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Dr. Ahmed Basyouni
Lower
Normal
Flat
Moderate
Excessive
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14. Study Cast Analysis
B. Arch Form:
Maxillary
Square
Ovoid
Tapered
Mandibular
C. Teeth Present:
Specify__________________________
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Dr. Ahmed Basyouni
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15. Study Cast Analysis
D. Individual Tooth Malposition:
_______________________________
E. Dental Age:
_______________________________
_______________________________
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Dr. Ahmed Basyouni
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16. Study Cast Analysis
II. Inter-arch Analysis:
Anteroposterior relation:
A. Angel’s Classification:
Class I
Class III
Class II division 1
division 2
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17. Study Cast Analysis
B. Overjet:
mm.
Increased
decreased
Negative (Anterior crossbite)
Vertical relation:
A. Overbite:
Increased
B. Openbite:
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%
decreased
Anterior
Dr. Ahmed Basyouni
Edge to edge
Edge to edge
Posterior
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18. Study Cast Analysis
Transverse relationship:
A. Posterior crossbite:
Right
B. Incisor midline:
Upper
Left
Lower
Correct
To right
To left
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Dr. Ahmed Basyouni
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19. Study Cast Analysis
III. Arch Length (perimeter):
A. Maxill. Tooth material:
Available space:
Crowding:
mm./ Spacing:
B. Mand. Tooth material:
Available space:
Crowding:
mm./ Spacing:
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Dr. Ahmed Basyouni
mm.
mm.
mm.
mm.
mm.
mm.
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20. Study Cast Analysis
Space Analysis:
Total teeth size – Available space = +Ve means
crowding or
-Ve values (means spacing)
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Dr. Ahmed Basyouni
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21. Study Cast Analysis
IV. Width of Arch:
Maxillary
Mandibular
____mm. Bicanine ____mm.
____mm. Bimolar ____mm.
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Dr. Ahmed Basyouni
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22. Study Cast Analysis
V. Mixed Dentition Analysis:
A. Space left for 3+4+5 after alignment of the
incisors:
Upper arch:__mm. Lower arch:____mm.
B. Estimated size of 3+4+5 :
Upper arch:__mm. Lower arch:___ mm.
C. Space left for molar adjustment:
Upper arch:__mm. Lower arch:____mm.
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Dr. Ahmed Basyouni
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23. Study Cast Analysis
 Summary:
This is a Class___malocclusion with ___mm.
overjet and ___ overbite. There is ___mm.
crowding or / spacing in upper and /or lower
arch. The midlines are correct or shifted to
Rt. Or Lt. by ___ mm.
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24. IV. Radiographic Examination
Intra-Oral Radiographs:
Extra-Oral Radiographs:
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25.  Intra-Oral Radiographs:
 Periapical
 Bite wing
 Occlusal
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26. IV. Radiographic Examination
 Extra-Oral Radiographs:
 Panoramic
 Cephalometric:
 Lateral Cephalometric
 P-A Cephalometric
Hand &wrist X-ray
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27.  Intra-oral radiographs are essential
aids for the following reasons:
1. To determine amount of root length.
2. To determine degree of root resorption and
its pattern on primary teeth.
3. To determine pattern of eruption of
unerupted permanent teeth.
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28. Intra-Oral Radiographs:
Intra-oral radiographs are essential aids for the following reasons:
4. To ascertain presence of permanent teeth.
5. To study nature of supporting alveolar
bone and thickness of periodontal ligament.
6. To determine axial inclination of
permanent teeth.
7. To diagnose pathological conditions
including caries, periodontal diseases.
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29. Cephalometric Radiography
 Cephalogram is standardized radiograph of head
and face for the purpose of making head
measurements. Standardization is accomplished by
means of head holder (Cephalostat) by Two ear rods
inserted into external auditory meatus and one nasal
rod fixed into junction of frontal & nasal bones on
midline (Soft tissue Nasale), and constant distance
from central ray of the X-ray source and midsagittal
plane of the patient (60 Inches).
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30. Cephalostat
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31.  Cephalometric Landmarks:
Nasion (N): most anterior point of the suture between
frontal and nasal bones.
Sella Turcica (S): center of sella turcica
Orbitale (Or): Lowest point on the infraorbital margin
Porion (Po): Highest point on upper margin of external
auditory meatus
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32. Sella Turcica
o
Porion
Nasion
Orbitale
Point A
Gonion
Point B
Pogonion
Menton
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33. Cephalometric Landmarks:
Pogonion (Pog): The most anterior point on bony chin of
the mandible
Gonion (Go): The most posterior and inferior point on the
angle of the mandible
Point A (Subspinale): The deepest point in midline
between anterior nasal spine and alveolar crest of the maxilla
Point B (Supramentale): The deepest point in midline
between alveolar crest of the mandible and pogonion
Menton (Me): The lowest point on cross section of the
mandibular symphysis
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34. Landmarks
• Sella Turcica (S):
midpoint of the
pituitary fossa
• Orbitale (Or): lowest
point on lower margin
of orbit
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35. • Nasion (N): junction of
nasal and frontal bones
• Basion (Ba): anterior
margin of foramen
magnum
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36. • Porion (Po): superior
point of external
auditory meatus
• Machine Porion:
landmark created by ear
post of cephalostat
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Note: anatomic porion is
commonly used in
ceph analysis
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37. • Anterior Nasal Spine
(ANS): tip of anterior
nasal spine of maxilla
• Posterior Nasal Spine
(PNS): tip of posterior
spine of palatine bone
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38. • A point: most concave
portion of premaxilla
• B point: most concave
portion of symphysis
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39. • Gonion (Go):
most inferior posterior
portion of the angle of
the mandible
• Gnathion (Gn):
most anterior inferior
portion of symphysis
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40. • Pogonion (Pog):
most anterior portion
of symphysis
• Menton (M):
lowermost portion
of symphysis
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41. • PT point: the most
posterior-superior
point on the
pterygomaxillary fissure
• PTM: the point at the base
of the pterygomaxillary
fissure where the anterior
and posterior walls meet
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42. • 1: most anterior upper
central incisor
__
• 1: most anterior lower
central incisor
• 6: upper permanent
first molar
__
• 6: lower permanent
first molar
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44.  Cephalometric Planes used in cephalometric
analysis:
Frankfort Horizontal plane (FH): It passes from
orbitale and Porion
Mandibular plane (Md): passes from menton to
gonion.
Facial plane (N-Pog): passes from nasion to
pogonion
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45. Frankfort Horizontal Plane
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46. Mandibular Plane
 Line drawn from Gnathion (Gn) to Gonion (Go)
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47. Occlusal Plane
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48. Sella-Nasion Plane (SN)
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49. Esthetic Plane (E-plane)
 Tip of nose to tip of soft tissue chin
 Lower lip should fall 0-4 mm behind line
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51.  Cephalometric Angles used in
cephalometric analysis:
FH-Md plane angle: vary between 17-28
degrees in normal occlusion cases, and may
vary from 9-40.5 degrees in all cases. As
angle increases, the ascending ramus and
length of the face increases.
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Dr. Ahmed Basyouni
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52. Cephalometric Radiography
SNA, SNB, and ANB angles:
Average for SNA angle is 82,
for SNB angle 80 degrees, and
the mean for ANB difference 2
In Class II ANB may reach to
12 degrees, while in Class III
ANB angle less than 2 and may
be even negative value.
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53. Cephalometric Angles used in cephalometric analysis:
Occlusal – FH plane angle: vary from 14 to 1.5
degrees, usually greater in Class II and smaller in
Class III.
( Occl. Plane is taken as a straight line connecting
the bisection of both first molar cusp height and
incisor overbite)
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54. Cephalometric Angles used in cephalometric analysis:
Inter-incisal angle: measured by continuing
their long axes through the crown until these
lines meet at an angle which can be used as
indication of their prominences. Usually vary
between 130-150 degrees
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55.  Value of Cephalometrics in Orthodontic diagnosis:
1. Skeletal pattern of patient including cranial base,
maxilla and mandible
2. Soft tissue morphology of lips, tongue, soft palate
and pharynx
3. Serial head plates to study growth and treatment
changes
4. Relationship of the teeth to each other and to
bones of the skull.
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56.  Panoramic X-ray:
Provides larger field of dentition,
alveolar bone, basal bones and the
condyles in one view, with less cooperation (avoid discomfort of the
intra-oral films).
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Dr. Ahmed Basyouni
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57.  Hand and wrist X-ray: usually left hand &
wrist x-ray gives diagnostic criteria for
skeletal age by observing degree of
calcification of ossification centers of the
hand and fusion of the epiphysis.
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59. V. Facial Photographs
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60.  Extra-Oral
Photos:
 Lateral view
 Frontal view
 Intra-Oral
Photos:
 Right side
 Left side
 Frontal view
 Upper arch
 Lower arch
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61. Clinical Cases
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62. Case 1:This 20 years old female presented with a Class I
moderately crowded malocclusion and a 70% anterior deep
bite.
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63. Case 2: This 13 years old male Class I presented with severe
upper crowding and a full tooth overbite. The upper first
bicuspids were removed.
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64. Case 3: This 23 years old female presented with a severely
crowded Class I malocclusion.
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65. Case 4:This 11 years old female presented with
a Class II div. 1 moderately crowded malocclusion
with 8 mm of excess overjet.
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66. Case 5: This 24 years old male presented with severely
crowded arches and a tendency toward a Class III
malocclusion with cross bites.
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67. Orthodontic Examination and
Diagnosis

I.
Definitions:
History:
Personal history:
Chief Complain:
Past History:
Past medical history:
Past dental history:
April 28, 2012
Dr. Ahmed Basyouni
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68. Orthodontic Examination and Diagnosis
II. Clinical examination:
General Examination:
Extra-Oral Examination:
Intra-Oral Examination:
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Dr. Ahmed Basyouni
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69. Orthodontic Examination and Diagnosis
III. Study Casts:
Study Cast Analysis
I. Intra-arch Analysis:
II. Inter-arch Analysis:
III. Arch Length:
IV. Width of Arch:
V. Mixed Dentition Analysis:
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70. Orthodontic Examination and Diagnosis
IV. Radiographic Examination
Intra-Oral Radiographs:
Extra-Oral Radiographs:
V. Facial Photographs
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