Orthodontic Assessment Flashcards
what entails taking a history?
take medical history, dental history, previous trauma history
what do you have to consider with the patient and their family?
what are the patients concerns and their parents concern
do both concerns match up or is it just the patient?
are the concerns reasonable and with realistic expectations
what should the patient expect with braces?
- they may be fixed
- they may be on for 2 years on avg
- appts will be every 6-8 weeks
- need good OH and diet
what should you consider regarding medical history?
- cardiac issues
- bleeding disorders
- psychological concerns
- epilepsy
- diabetes
- childhood malignancies
- autoimmune disorders
- allergies
- bisphosphonates
- smoking medication
what should be considered with the social history?
- is the px motivated to look after braces
- are they good to attend appts
- what is the occupation
- is there family history with malocclusions such as hypodontia
- who has the right to consent with children
what should be considered with the dental history?
- regular attendee
- any current dental issues?
- awaiting any tx?
- tx in the past
- trauma
- TMJD’s
- developmental abnormalities
- habits - thumb sucking, nail biting
what comes under the EO exam for ortho assessment?
- view patients head from the front, side and above
- assess in 3 planes - antero-posterior, vertical and transverse
- TMJ - deviations, clicks
what are the 3 planes to assess? describe them.
antero-posterior - from front to back
- class I - face is well balanced, mandible = 2-4mm < maxilla
- class II - overbite, mandible is posterior
- class III - underbite, mandible is anterior
vertical plane - average, increased or decreased
transverse plane - from side to side, symmetrical or asymmetrical
how would you assess the antero-posterior plane?
- in the natural head position
- how a px looks at themselves in a mirror
- can use the Frankfort Plane but this cannot be done clinically due to vast anatomical variances
- can use Kettle’s method - using reference points, A - most concave part on maxilla and B - most concave point on mandible, palpate and measure
what is maxillary retrognathia?
paranasal hollowing
infra-orbital margins look flat
- severe cases, can see the sclera below the iris
what is the Zero Meridian Line? / True Vertical Line?
drop vertical from soft tissue nation - where the forehead meets the nose
perpendicular to the floor
how do you measure the Vertical Plane?
FMPA - Frankfort Mandibular Plane Angle
use: the alar-tragal line
- the Frankfort plane on a radiograph - from bony infra-orbital margin to external auditory meatus
- the mandibular plane
- if it is average = will meet at the occiput
- if it is increased = meets before the occiput
- if it is decrease = meets behind the occiput
describe how you would determine average, increased or decreased lower anterior face height would be.
face is split into equal thirds
1. Trichion-Glabella (hairline-eyebrows)
2. Glabella-Subnasale (eyebrow-base of nose) = UAFH
3. Subnasale-Menton (base of nose-bottom of chin) = LAFH
average = LAFH = UAFH
increased = LAFH>UAFH
decreased = LAFH<UAFH
with transverse symmetries, what do you consider? and how do you assess it?
the mandible
the nose
the maxilla
the entire face
the facial midline - through the eyebrows, tips of nose and philtrum of upper lip
stand infront and behind the patient
what is the neutral zone?
the region intra-orally where muscular forces, generated by the lips anterior and the tongue posteriorly are balances
e.g. important in dentures to make sure they fit well
- any deviation from the normal = affects the position of the teeth
what do you look at with the lips?
- if theyre competent - if you naturally bring your lips together or incompetent
- the length
- nasio-labial angle - angle between the columella and upper lip - between 90 and 110 degrees
- relationship of lower lip to upper incisors
- relationship of upper lip to upper incisors
- smile aesthetics
tone - if theyre flaccid or strap-like lower lip
describe how the relationship between the lower lip to the upper incisors
lower lip trap
- class II, div I malocclusion - upper incisors stick out
- lower lip behind the upper incisor at rest, swallowing, eating, smiling, speaking
higher lower lip lip
- class II, div II malocclusion - upper incisors are retroclined
what should you consider with the tongue?
- its position at rest - is it against the teeth or hard/soft palate
- if it sits forward, can lead to anterior open bite, proclination, spacing and lisps§
- its size - is it too big
what is an adaptive tongue thrust and a endogenous tongue thrust?
adaptive tongue thrust
- lips are incompetent
- tongue thrust forward to contact lips and create oral seal
= AOB
endogenous tongue thrust
- habitual
- high risk of release if you try to correct it
what is crowding?
the space required for teeth:the space available
0-4mm crowding = mild
>4-8mm = medium
>8mm = severe
Describe these Incisor Relationship
- Class I
- Class II, Div I
- Class II, Div II
- Class III
Class I- lower incisor edge occludes below the cingulum plateau of the uppers
Class II, Div I - lower incisors edge lies posterior to the cingulum plateau of the uppers, uppers stick out = overjet
Class II, Div II - lower incisor edge lies posterior to the cingulum plateau, uppers are retroclined
Class III - lower incisor edge lies anterior to the cingulum plateau = reverse overjet
how do you measure the overjet?
use a metal ruler and horizontal plane
- the distance between the upper and lower incisors
- normal = 2-4mm
what are the types of overbite
normal - 1/3-1/2 of lower incisors covered
increased - >1/2 lower incisors covered
reduced - <1/3 lower incisors covered
increased and complete
decreased and complete
what are the two types of open bites?
lateral/posterior
anterior
what are the 3 classes of buccal relationship under Angle’s Molar Classification? how can it be used for canines?
class I - upper MB cusp sits in the anterior buccal groove = direct intercuspation
class II - UR6 MB cusp tip = mesial to groove
class III - UR6 MB cusp tip = distal to groove
CANINES
class I - direct intercuspation
class II - U3 tip mesial to embrasure
class III - U3 tip distal to embrasure
define cross bite.
define buccal and lingual crossbites
a transverse discrepancy in the buccolingual relationship of the upper and lower teeth - always check for mandibular displacement
buccal cross bite
- the lower buccal cusps
- occlude buccal to upper buccal
= the lower arch is usually bigger
lingual cross bite/scissor bite
- the lower buccal cusps
- occlude lingual to the palatal cusps of upper
= narrow lower arch
describe digit sucking and the effect it has orally.
sucking on fingers for approx 6 hrs a day will affect tooth position
- its a problem if it persists into the permanent dentition
= increased overjet - proclined upper, retroclined lower
= AOB
= narrow upper arch - from the constant buccinator muscle force
what is a PARALLAX?
intra-oral radiograph
- shows the displacement of one object in relation to another when viewed from 2 Dif positions
SLOB
- if object moves in the same direction = lingual
- if object moves in the opp direction = buccal
- if no change, objects in the same plane
what can a Lateral Cephalogram show?
the skeletal position
incisor position
monitor growth and tx progress
what would a CT show?
more accurate assessment of unerupted teeth
- TMJ
- airway analysis
describe the Index of Orthodontic Treatment Needed.
rank malocclusion on severity
from 1-5, 5 = severe
MOCDO
Missing teeth
Overjet and reverese
Crossbite
Displacement of contact points
Overbite and open bite
