Ortho EnD Flashcards
Types of History to Ask for
C/O
Mx: Medical Conditions, Medications, Allergies
Dental Hx: Last visit, relevant past tx, OH regimen, Hx of Trauma, Hx of Ortho
Social Hx: Smoking, Drinking
Familial Hx
Habits
Physical Growth Status: Pre-pubertal, Pubertal, Post-pubertal, Adult
Attitude to treatment
Important family history to check for
Craniofaical syndromes (Cleft Lip/Palate)
Inherited Jaw Proportions
- Retrognathic facial
proportions
- Mandibular Prognathism
- Vertical Jaw Proportions
Congenitally Missing Teeth
Important Habits to check for
Digit Sucking, Pacifier Use, Non-nutritive sucking habits
Forward resting tongue posture/Tongue thrust
Mouth Breathing
How to check for physical growth status
- Change in height/clothes/shoe size
- Peak Growth:
Facial hair on upper lip (M)
1-1.5 years prior to first menarche (F) - End of growth spurt:
Facial hair on lips and chin (M)
First menarche (F) - Chronological Age
- Dental Age
- Radiographs CVM
E/O: Frontal Facial Analysis
11
- Bigonial width is 30% less than Bizygomatic dimension
- Height to width:
1.3:1 (F)
1.35:1 (M) - Facial form: Tapered, Ovoid, Square
- Vertical Proportions:
1:1:1 - Lower facial vertical proportions
1:2 - Facial symmetry - Deviation of nasal septum, shape/size of left and right, Chin point deviation
- Facial, dental and chin midlines relative to each other
- Equal horizontal fifths
- Centered nose and chin in central fifth
- Width of nose =/> central fifth
- Inter-pupillary distance = width of mouth
- Occlusal plane cant
E/O: Profile Analysis
- Soft tissue facial profile: Convex, Straight, Concave
- Skeletal profile: Class I (165-175), Class II (<), Class III (>)
E/O: Soft tissue evaluation
7
Smile Aesthetics
Tongue
Circumoral muscles
- Lip line at rest (Ant tooth displace with rested upper lip)
- Lip competence
- Lower lip trap
- Lip protrusion (relative to Subnasale (Sn) and Pogonion (Pg))
- Nasolabial angle: Acute, 90, Obtuse
- Labiomental fold: Shallow, Average, Deep/Accentuated
- Incisor Display at rest
Smile Aesthetics:
- Incisor and gingival display on smiling (ideal = full incisor to 2mm gingiva)
- Smile Arc consonent with lower lip line
- Buccal corridors: Wide/Ideal/Narrow
Tongue:
- Resting tongue position
- Active tongue position
Circumoral muscles:
- Tone
- Swallow activity - present as adaptation in AOB or upper incisor protrusion
TMJ Examination
6
- Sound
- ROM
- Deviation on opening/closing
- Occlusal interferences
- CR-MI slide (direction, magnitude, initial contact point)
- Pain
Why is CR-MI slide important
Can cause pseudo class III
I/O: Soft Tissue
- Anomalies
- Frenal attachments: Cleft in alveola, Median Diastema, Ankyloglossia, Proximity to gingival margins (recession?)
I/O: Dentition
- Type
- Teeth present
- OH
- Caries activity
- Anomalies in crown morphology: Severe attrition/erosion, Dens Evaginatus, Talon cusp, Peg-shaped, Microdontia, etc,
I/O: Periodontal Status
6
- Biotype
- Width of keratinised gingiva
- Gingival recession: Generalised or localised - tooth number, magnitude, surface
- Probing depths
- Gingival Inflammation
- Tooth mobility
I/O: Endodontic status
- Pulpal/Periapical pathology
Intra-arch analysis
- Arch form
- Arch symmetry
- Occlusal description: Displacement, Rotation, Tilt/Angulation, Inclination, Vertical position (Infraocclusion/Supraeruption), Impacted/Ectopic
Crowding/Spacing
- Location
- Magnitude:
Mild: 1-4
Moderate: 5-8
Severe: >8
Mixed Dentition analysis
- Tanaka and Johnston 1974
Used to estimate MD width of permanent 3,4,5 before eruption
Lower 345 = 1/2 of man incisors + 10.5
Upper 345 = 1/2 man incisors + 11
- Use contralateral tooth
Measuring lower curve of spee
Average of depth of curve from premolar cusps (deepest) to flat plane on distal cusp of 7 to incisors
Interarch: AP
- OJ (British Standards Institute Classification)
- Class I, II, III -Molars and Canines (Angle’s Classification)
- Anterior crossbite
Definition of Incisor Class I
Lower incisors occlude with or lie immediately below the cingulum plateau of upper central incisors
Definition of Incisor Class II
Lower incisor edges lie posterior to cingulum plateau of upper incisors
Div 1: Upper central incisors are proclined or of average inclination, Increase in OJ
Div 2: Upper central incisors are retroclined, Minimal or may be increase in OJ
Definition of Incisor Class III
Lower incisor edges lie anterior to cingulum plateau of upper incisors, Reduced or Reversed OJ
Definition of Molar Class I
Mesiobuccal cusp of upper first molar occludes with mesiobuccal groove of lower first molar
Definition of Molar Class II
Mesiobuccal cusp of lower first molar occludes distal to Class I position
Definition of Molar Class III
Mesiobuccal cusp of lower first molar occludes mesial to Class I position
Interarch: Vertical
- Deep overbite
- AOB
- POB
Points to note:
- Location
- Magnitude
- Complete/Incomplete (Is there contact)
- Presence of Soft tissue trauma
Interarch: Transverse
- Crossbites - A/P, Uni/Bilateral, Localised/Generalised, Dental/Skeletal
- Scissorbites
- Midline Deviations - Direction and Magnitude
Purpose of Cervical Vertebral Maturation
Assessment of Mandibular Growth/Skeletal maturation
Peak: Between CVMS II and III/ One year after CVMSII
DPT Uses
8
- Bone pathology (eg. clefts)
- Missing/Supernumerary teeth
- Dental age
- Root morphology/length anomalies (eg. dilacerations, narrow spindly roots, blunting of roots, root resorption)
- Impacted teeth
- Alveolar bone loss
- Ankylosis
- PA pathology
Orthodontic problem list
- Skeletal
- Dental: Interarch, Intraarch
- Soft Tissue
IOTN
Three planes:
AP (Sagittal) - Class
Vertical
Transverse
Skeletal Problem List
- AP
- Class I/II/III
- Retrusive/protrusive max
- Retrognathic/Prognathic man
- Bimax retrusion/protrusion - Vertical
- Hypo/Hyperdivergent
- Increased/Reduced LAFH - Transverse
- Maxillomandibular width discrepancy: Eg. Constricted maxilla
- Facial asymmetry
- Occlusal plane cant
Dental Problem List: Interarch
- AP
- Functional shift
- Incisor Class I/II/III Malocclusion
- Increased/Reduced OJ
- Anterior Crossbite - Vertical
- Deep/Shallow OB
- AOB/POB - Transverse
- Crossbite
- Scissorbite
- Midline deviation
Dental Problem List: Intraarch
- Crowding/Spacing: Mild/Moderate/Severe
- Missing/Additional teeth
- Ectopic/.Impacted teeth
- Anomalies in crown morphology
- Existing root resorption
Soft Tissue Problem List
- Habits
- Lips
- Tongue
- Frenal Attachments
- Periodontium: Thin, reduced width of keratinized gingiva, Gingival recession
