Exam 1 Flashcards
What are the 3 steps in the systemic exam of Facial and Dental Appearance?
- Facial Proportions in all 3 planes (macro-esthetics)
- Dentiiontion in relation to the face (mini-esthetics)
- The teeth in relation to one another (micro-esthetics)
Frontal Exam
1st step in facial appearance
Look for:
* Bilateral Symetry in the fifths of the face
* Proportions of the of eyes, nose and mouth width
* Facial Index, Vertical Facial thirds
Bilateral Symmetry in the fifths of the face
Ideal proportional face can be divided into fifths
Central Fifth:
*determined by space b/w eyes
* Nose & chin are centered
* nose width is equal or slightly wider
Medial Fifth:
* determined by eye width
Lateral Fifth
Interpupillary line=width of mouth
Anthropometric analysis
Facial Measurements during clinical exam
* made with: Bow or Straight calipers
Used before Cepalometric radiography
Facial Index
Facial Height to Width ratio
* can’t eval height unless width is known
Establishes:
* overall facial type
* Basic proportions of face
Vertical Facial Thirds
Upper 1/3:
* hairline to base of nose
Middle 1/3:
* Base of nose to bottom of nose
Lower 1/3:
* Bottom of nose to chin
* Mouth=1/3 b/w bottom of nose and chin
* 1/3 above mouth
* 2/3 below mouth
Excessive Display of maxillary Gingiva
- Eval postion of the Lips & teeth relative to vertical 1/3s of face
- Common cause=Long Lower 1/3
What is another name for Profile Analysis
Aka Poor Man’s Cephalometric analysis
What are the 3 Goals of Profile Analysis?
- Establish whether the jaws are proportionately positioned in the AP plane of space
- Evluation of Lip Posture & Incisor Prominence
- Re-evaluation of Vertical Facial Porportions & eval mandibular plane angle
Establish whether the jaws are proportionately in the AP plane of space?
Place pt in physiologic NHP
* head position w/o other cues
* sitting upright or standing; Not reclines
* Look at horizon or distant object
2 Lines:
* Bridge of nose to base of upper lip
* base of upper lip to chin
Straight Profile=Ideal
* Skeletal Class I
Convex Profile
* Large angle (> 10)
* prominent upper jaw relative to chin
* Skeletal clas 2
* maxilla projects to far forward
* Mandible projects to far back
Concave Profile
* Upper Jaw behind chin
* Skeletal Class 3
* maxilla to far back
* mandible protrudes to far forward
What does Concave or Conex Profiles result from?
Disproportion in Jaw size
Incisor Prominence
Incisor Protrusion or retrusion
* effects dental arch space
* protrusion=more space; alleviates crowding
* Retrusion=Less space; worse crowding
Bimaxillary Dentoalveolar Protrusion
aka Bimaxillary Protrustion
Extreme Incisor Protrusion w/ideal alignment
Must meet 2 conditions:
* Lips are prominent and everted
* Lip incompetence (Lips seperated at rest by > 3-4mm)
Lip Incompetence
- Lips seperated are rest >3-4mm
Lip Prominence Eval
Distance that each lip projects forward from a true vertical line through the depth of the concavity at its base
* Forward of line=Prominent
* Behind line=retrusive
Helpful to Draw E-line (Esthetic)
* nose to chin
* Lips should be on e-line
Consider size of nose and chin:
Larger the nose
* more prominent the chin needs to be to balance
* greater amount of lip prominence accepted
Nasolabial Angle
* Normal=Mild obtuse
What defines facial Attractiveness?
Smile
What are the 2 types of smile?
Posed/Social
* reproducible
* focus of ortho dx
Enjoyment (Duchenne)
* varies w/emotion
Smile Analysis consists of:
Amount of Incisor & Gingival Display
Transverse dimensions of smile relative to upper arch
* Buccal Corridors
Smile Arch
Amount of Incisor and gingival display
IDeal elevation of lip when smiling:
* slightly below gingival margin
* most of upper incisor can bve seen
Tooth Display:
* range: 1-4 mm of tooth coverage
* > 4 mm=less attractive
Gingival Display:
* ideal: 2.3 mm of tooth coverage
* Male: 0.5-1.0 mm
* Female: 0.5 mm
Amount of Incisor and gingival display
Tooth Display:
* range: 1-4 mm of tooth coverage
* > 4 mm=less attractive
Gingival Display:
* ideal: 2.3 mm of tooth coverage
* Male: 0.5-1.0 mm
* Female: 0.5 mm
Buccal Corridors
Distance b/w max posteriors (premolars) to inside of cheek
Another way to eval dental arch width
* Max dental arch width is proportional to midface width
* Broad smile=large midface/zygomatic arch width
* Narrow Smile=Narrow midface width
* ideal: 16%
* Male: 15-24%
* Female: 10-17%
Negative Space:
* Very Wide BC’s
* unesthic
* improve smile by: widen max arch
Minimal BCs:
* Females
No BCs:
* Unesthetic
* broad upper arch
Smile Arc
Incisal edge contours of max anterior teeth relative to lower lip curvature during a social smile
* Best apperance: Consonant-curvature of Lower lip is parallel to curvature of max incisors
* M/F: 1.8-3.8 mm K9 above incisal edge
Most important factor in smile esthetics
* only factor that can change smile to unesthetic by itself
Flat Smile Arc (non-consonant)
2 problems:
* less attractive
* Look oldder
Inclination of Upper teeth: Tip L or R
- > 2 mm from normal=Unesthic
What are 2 important components of appearance in Tooth Proportions
- Tooth widths in relation to one another
- Height-Width prooprtions of individual teeth
Ideal Tooth Width Proportion
Golden Proportion: 62%
* 1.0:0.62:0.38:0.24
* Lateral Incisor: 62% of central incisor width
* Through 1st premolar
Central Incisor Tooth Proportions
Max Central Incisors:
* Height: 10.4-11.2
* Width: 80% of Height (8.37-9.3)
If Maxillary Central Incisor Height is short, what are the possible causes? Possible Tx?
Possible Causes:
* Incomplete eruption in childhood=further development corrects
* Attrition in adults= restore missing part of crown
* Xs gingival height: Crown Lengthening
* Crown form distortion: facial Lamenette or complete crown
Connector
aka interdental contact
Where adjacent teeth appear to touch
Includes:
* contact point
* area above and below contact point
Decrease in size from centrals to posteiors
* moves apically
Short Connector=part of problem w/black triangles
Embrassures
Triangular spaces incial and gingival to contact
* ideal=larger than connectors
Gingival Embrasure:
* filled w/interdental papilla
Incisor Embrasure:
* Larger from central to premolars
* contact points move more gingival from central to premolars
Black Triangle
Short interdental papilla
* open gingival embrassure above connector
Adults: Due to:
* perio disease=loss of gingival tissue
* ortho corrects crowded and rotated max incisors; connetor moves incisal
Reshape teeth to correct
* move contact pt apically
* lengthen connector
Ideal Gingival Margin Levels for Centrals/Lateral/K9s
Centrals:
* highest gingival margin level
Lateral:
* 1.5 mm lower than centrals
K9:
* Same level as centrals
Gingival Contour of Centrals/Lateral/K9s
Centrals:
* Horizontal half ellipse
* zenith=distal to midline
Laterals:
* Half-circle
* Zenith=midline of tooth
K9:
* vertical half ellipse
* zenith=distal to midline
Norman Kingsley
- 1850s-1st text describing ortho
- 1st to use extraoral force
- Pioneer in cleft palate tx
Edward H. Angle
Father of Modern Ortho
* 1890: Concept of Occlusion
Angles Postulates
Upper 1st molars were the key to occlusion
* MB cusp of upper molar occlueds in B groove of lower molar
* Normal Occlusion=correct line of occlusion (caternary line) + normal molar relationship
Best esthetics were achieved when pt had ideal occlusion
Angles Classes of Malocclusion
Class 1:
* Normal relationship of molars
* Incorrect line of occlusion due to malposed teeth, rotations, other causes
Class 2:
* Lower molar distally positioned relative to upper molar
Class 3:
* Lower molar mesially positioned relative to upper molar
Soft Tissue Paradigm
Soft Tissue Relationships
* determine Goals & Treatment of modern ortho & orthognathic tx
* Not teeth and bones
Increased Focus on clinical exam
* instead of dental casts and radiographs
Compare Angle vs Soft Tissue Paradigm:
1. Primary Tx Goal
2. Secondary Tx Goal
3. Hard & Soft Tissue Relationships
4. Diagnostic emphasis
5. Treatment Approach
6. Functional emphasis
7. Stabliiity of result
Compare Angle vs Soft Tissue Paradigm:
1. Primary Tx Goal
2. Secondary Tx Goal
3. Hard & Soft Tissue Relationships
4. Diagnostic emphasis
5. Treatment Approach
6. Functional emphasis
7. Stabliiity of result
Posterior Cross Bite
Lingually positioned Max posterior teeth
* relative to mandibular teeth
Narrow max dental arch
What differences does soft tissue paradigm make in planning tx?
Primary Goal of Tx=Soft tissue relationship and adaptations
* Major determinants of facial appearance
* Determine stability of ortho
Secondary Goal=Functional Occlusion
* TMJ Dysfunction: result of soft tissue injury around TMJ
* arrange occlusion to minimize
Reverse Thought process in solving the patients problems
* Past: Focus on Dental & Skeletal relationships and ST would take care of itself
* Now: Establish ST relationship then determine how teeth and jaws would have to arrange to meet goal
Overjet
Horizontal overlap of incisors
* Ideal AP incisor relationship=1/3 US pop
* Overjet + Class 2 malocclusion=more prevalent (Vs reverse overjet + class 3)
Normal: upper incisors ahead of lower by incisal edge thickness
* 2-3 mm
Reverse Overjet
* Aka anterior crossbit
* lower incisors are in front of upper incisors
Overbite
Vertical overlap of incisors
* Ideal Vertical Relatinship: 50% of US
* Deep bite is more prevlaent than open
Normal: Lower incisor edge contact lingual surface of upper
* 1-2 mm
Openbite:
* no vertical overlap
* quantify by measuring the seperation of incisors
Line of Occlusion:
Catenary Curve: passes through
Maxilla:
* molar=central fossa
* k9/incisors=cingulum
Mandible:
* Molar: B cusp
* Mandible: incisal edges
Irregularity index
incisor irregularity
* total mm distance from contact pt on each incisor to contact point it should have
* More prevalent in mandibular arch
* 1/3 US Pop have at least moderate irregular incisors
* 15% severe/extreme
Diastema
Space b/w adjacent teeeth
Maxillary Midline Diastema:
* common in mixed dentition
* disappears or decrease width when permanent K9 erupt
* Spontaneous correction if width < 2 mm
Girls Stages of Development:
3 stages: 3.5 years
Stage 1:
* start of growth spurt
* breast buds appear
* pubic hair appears
Stage 2: 1 year after stage 1
* Peak Velocity of Physical growth
* noticeable breast development
* Pubic hair: darker and widespread
* Axillary hair appears
Stage 3: 1-1.5 years after after stage 2
* Start of Menstruation=start of stage 3
* hips broaden
* Adult fat distribuiton
* Breast development is complete
* Growth spurt complete
Boys stages of development
4 stages: 5 years
Stage 1: Fat Spurt=initial sign
* Almost chubby-feminine fat distriubtion
* Appears Obese and Awkward
* Scrotum increase in size (pigmentation change)
Stage 2: 1 year later
* growth spurt starts
* redistribution/decrease in fat
* Pubic hair appears
* Penis growth begins
Stage 3: 8-12 months later
* Peak Velocity of Growth
* Axillary hair appears
* Facial hair appears-Upper lip only
* Muscle growth
* Decrease fat: harder/more angular body form
* Pubnic Hair: Adult distribution
* Penis & Scrotum near adult size
Stage 4: 15-24 months later
* Growth spurt ends
* Facial hair: Chin & Upper lip
* Increase muscle strength
* Pubic & Axillary Hari: Darker and widespread
Tooth Size Analysis
Aka Bolton Analysis
Assume comparable inclinations of teeth
Steps:
1. measure M-D width of every tooth
2. add each arch
3. Calculate overall and anterior ratios by dividing Mandibular/Maxillary
4. Compare to Table
Idea:
* overall ratio=0.913
* anterior ratio: 0.772
Tooth Size discrepancy
Tooth Size disproportion
* upper centrals=most common
* <1.5=not significant
Anterior Tooth size discrepancy
* compare upper and lower lateral incisors
* If uppers NOT wider than lowers=discrepancy
Posterior tooth size discrepancy:
* compare 2nd premolars
* should be equal
Speech difficulties related to malocclusion
Speech difficulties related to malocclusion
Class 2 Division 1: Could be caused by:
Maxillary teeth protrusion
* normal jaw relationship
Mandibular dficiency
* Normal relationship of teeth to jaws (Both arches)
Downward-backward rotations of mandible
* excessive vertical growth of maxilla
