Diagnosis-orthodontic /certified fixed orthodontic courses by Indian dental academy

ORTHODONTIC DIAGNOSIS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

DIAGNOSIS &TREATMENT
PLANNING IS A SERIES OF
LOGICAL STEPS


DIAGNOSIS is a comprehensive
procedure focused on broad overview of
the patients situation

TREATMENT PLANNING is to
maximize benefit for the patient

The field of orthodontics
is
in the midst of a
knowledge
explosion.

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.

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.


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.

Orthodontic
Consultation
Clinical
Examination

Data
Base

Diagnostic
Records

Provisional
Diagnosis

ORTHODONTIC CONSULTATION


CHIEF COMPLAINT
• Impaired dentofacial esthetics
• Impaired function

Objective is to find out what is
important to the patient?

CASE HISTORY
 NAME
 AGE
 SEX
 ADDRESS & OCCUPATION
 CHIEF COMPLAINT
 MEDICAL HISTORY
 DENTAL HISTORY
 POST NATAL HISTORY
 FAMILY HISTORY

CLINICAL EXAMINATION
 FACIAL
 OCCLUSAL
FUNCTIONAL


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

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


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.

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

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
In Transverse plane








Hereditary?
Environmental?
Trauma?
Chronic diseases?
Habits?
etc………

EVALUATION OF ORAL HEALTH

• Health of oral hard and soft tissues
• Dental caries
• Periodontal evaluation


Evaluation of
individuals’ physical
growth status


ASSESSMENT OF DEVELOPMENTAL AGE
• Physical development
• Chronologic age
• Dental age
• Sexual maturity

By
Clinical examination
Hand wrist radiograph
CVMI
Calcification of canine

SOCIAL AND BEHAVIORAL EVALUATION

 Motivation

External
Internal

 Expectations
 Co-operation

• STUDY MODELS
• OPG
• PHOTOGRAPHS
• CEPHALOGRAMS
• OTHER ADVANCED DIAGNOSTIC
AIDS

STUDY MODELS
 Proclination of teeth
 Width of the arch
 Symmetry of the arch
 Crowding/ Rotations/ Spacing
 Arch length discrepancy
 Bolton’s analysis
 Classification of malocclusion

ORTHOPANTAMOGRAPH


PHOTOGRAPHS


HARD TISSUE
ANALYSES

MAND A-AXIS(LINEAR)
PLANE ANGLE
CANT 1 Y-FMIA(Angle)
INTERINCISAL ANGLE
U U to toANB
1 OFOFSNA
ANGLEtoOCCLUSAL PLANE
CONVEXITY
FACIALPOG
FMPA
IMPA
ANGLE
L 1 SNB
N-A
N-B


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.


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.


WITS ANALYSIS

In the Wits analysis, points A & B are projected to the
functional occlusal plane, and the AB difference is
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.

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

SOFT CHINLABIAL ANGLE
TISSUE CHIN
NASO MENTAL ANGLE
LOWER LIPLINE THICKNESS
UPPER LIP PROMINENCE
PROMINENCE
H PROMINENCE
S
E
(Bell et al)
(Bell et al)


FUNCTIONAL
ANALYSES

EFFECTIVE1
UPPERJARABAKANGLELENGTH
& LOWER SN
EFFECTIVE PLANE ANGLE
ANGLE OFMANDIBULAR ANGLES
POSTERIOR toANGLELENGTH
ANTERIOR FACE HEIGHT
BASALPOSTERIOR
ARTICULAR GONIAL ANGLE
SADDLE RATIO
INCLINATION
ANGLE
SUMGONIALFACE HEIGHT
OFU MAXILLARY
N′


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


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

TO SUMMARIZE
WE SHOULD HAVE…
 An interview data i.e., case history
 Clinical examination
 Complete analyses of all diagnostic
record
 Orthodontic classification
 Problem list

Orthodontic
Problems
In priority
order

Possible
Solution
To
Individual
problem

Optimal
Treatment
plan

Mechano
therapy

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

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.

TREATMENT PLANNING
Clinical examination / Diagnostic records
Data base
Complete analyses
Classification
Problem list
Treatment objectives
Step by step progression of treatment
Biomechanics
Appliance design

Appliance use

CONCLUSION

CONCLUSION

Leader in continuing dental education


Diagnosis-orthodontic /certified fixed orthodontic courses by Indian dental academy

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