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