Orthodontic assessment Flashcards
How do we history take?
- MH
- PDH
- trauma history
- how old/ mature is pt?
- their concerns and parents concerns
- does family members concerns match with pt
what other factors do we need to consider before examining the pt?
- does pt know what to expect
- will the pt be able to tolerate braces: 2 yrs wear average, fixed or removable, appts every 6-8 weeks, excellent OH and safe diet
What things do we need to consider when taking social history/ family history?
- are they/ family motivated to have tx
- are they willing to wear braces
- are they able to attend regular appts
- what do they do? (school, uni, job)
- family history for certain malocclusions eg. hypodontia, class 3
- have other family members had orthodontist tx
- for children, find out if they have right to consent
what things do we need to consider when taking dental history ?
- regular attender?
- any current dental issues
- awaiting any dental tx?
- past tx eg. extractions/ restorations = can tell if they can tolerate oath
- trauma
- TMJDS
- developmental anomalies eg. hypodontia
- habits eg. nail biting, pen chewing, = need to stop as it can damage teeth
other than teeth what else are we looking at?
extraoral
do the teeth look good within the pts face
how do we do an extra oral ortho assessment?
- view pts head from front and sides
- assessing hard and soft tissues in 3 planes of space= antereo-posterior, vertical and transverse
- TMJ = pain, clicks, locking, deviation of mandible on opening and closing
- skeletal = AP, class 1,2,3, symmetry, vertical (average, decreased, increased),
- soft tissues
- habits
how do we assess antero-posteriorly ?
- natural head position (eye looking straight into mirror)
- Frankfort plane (can be seen in xrays) maybe used as a substitute
(anthropological measurement) we use ALR tarsal plane clinically - assessed AP visually or by kettle method
what is the zero meridian line?
- vertical imaginary point dropped from soft tissue nasion
- should be perpendicular to the floor if pt in natural head position
what is the ideal AP relationship?
- AP class1
- face appears well balanced
- mandible 2-4mm posterior to maxilla
how do we use kettles method to check skeletal pattern and its severity
- palpate soft tissues A and B
- A= most concave bit of maxilla when you’re looking you’re looking AP
- B= most concave bit of mandible
class 1 class 2 class 3
what are the cons of using kettle method?
- very arbitrary eg. depends of length of fingers
what is class 2 AP 3?
- mandible more posterior (retruded) than class 1 cases
- due to: maxilla being too far forward or more commonly mandible being too far back (retrognathia)
what is class 3 AP?
- mandible is further anterior (protruded) than the maxilla
- maybe due to: mandible being too large (prognathic), maxilla being too far back (retrognathic)/ too small (hypo plastic) or combination of 2
what is maxillary retrognathia/ hypo plastic ?
- paranasal hollowing (hollowing on sides of face )
- flat infraorbital margins, flat zygoma (cheekbones)
- severe cases whites of eyes (sclera) visible below iris
How do we measure vertically?
Frankfort mandibular plane angle
how do we measure FMPA?
- from bony infra orbital margin to external auditory meatus; visible on radiograph (clinically = alar-tragal line)
- mandibular plane runs along the lower border of the mandible
- we are seeing where the 2 points intersect
what is classed as average vertical FMPA?
meet at occiput
what is classed as increased FMPA ?
meet before occiput
what is classed as decreased FMPA?
meet behind occiput
what are the other ways in which w can measure vertically ?
- face split into thirds
- in well balanced face thirds are of equal measurement
- Lower anterior face height (LAFH) is assessed in relation to upper anterior face height (UAFH)
- Average: LAFH=UAFH
- increased: LAFH>UAFH
- decreased: LAFH<UAFH
what is transverse measurements?
- symmetry
how do we assess transversely?
- asses form above, below and in front
- comparison to facial midline
- companions between bilateral structures eg. eyes, ears
- need to look at whole face (panfacial)
- imagine drawing line in facial midline = if upper face symmetrical then identify mid point of chin if it censicdes with facial midline = mandible is symmetrical
what is the neutral zone?
- bit in mouth in between lips tongue cheek and where the teeth naturally rest
what things affect neutral zone ?
thumb sucking
tongue thrust
sucking cheeks in
affects palate, development of teeth and neutral zone
how do we measure lips orthodontically?
1.are they competent (can bring lips together) or incompetent, children can but as they get older they can
2. lip length = from nasal to lip and lower lip
3. nasolabial angle = angle between nose and lip
4. relationship between lower lip and upper incisors
5. relationship between upper lip and upper incisors - at rest max 3mm incisor show, older you get less incisor show
6. tone = flaccid or strap like lower lip usually seen in class 2 div 2 (top teeth pushed back)
7. smile aesthetic = slight gingiva display in full smile considered attractive
what does habitual competent lips mean?
- puckering of the skin over the mentalis muscle is a sign of muscular activity to keep lips together
how do we measure naso-labial angle?
between 90 to 110 degrees
what is the lower lip trap ?
what is a strap like lower lip?
why is gingival show important?
- can make person look older if not showing
what can lip tone be described as?
questions we ask when tongue is at rest?
- does it rest against teeth or palate
- If sits forward between the incisors can lead to = anterior open bite (AOB)
- if it pushes against the palatal surfaces of the incisors can lead to = proclination and spacing
questions we ask about the position of tongue when speaking ?
- can you see tongue protruding when the patient is speaking?
- if thrusts forwards between the teeth - can also lead to proclamation, spacing, AOB and lisping
what is an adaptive tongue thrust?
- when lips are incompetent, tongue thrusts forward to contact the lips and create an oral seal
- can lead to reduced overbite/ anterior open bite
- if tx can aid lip competence this usually ceases
what is an endogenous tongue thrust?
- habitual - correcting the Mal occlusion unlikely to change this
- high risk of relapse even with retention
- can’t always distinguish from adaptive
tongue size
- large tongues/ small arches may have similar implications to tongue thrust - look from crenelations (indentations along the borders
- not a lot that can be done
how do we examine TMJ in relation to ortho?
- examine as normal - not any abnormal findings
- assess signs and symptoms of TMD
- ideally treat symptoms conservatively prior to orthodontist tx: refer for specialist advice if cons management ineffective
- no strong evidence that ortho tx can either cause or cure TMJDS
IOE esp in paeds pts
- know eruption dates
- know root formation
- calcification dates
- be aware of missing teeth and supernumeraries
dental overview
what are we looking for when assessing lower and upper arches ?
- crowding/ spacing/ rotating
- proclaimed/ retroclined
- arch form
what are we looking for when assessing occlusion?
crowding
what is class 1 ?
what is class 2 div 1?
what is a class 2 div 2?
what is a class 3 ?
what is an overjet?
overbite?
describe increased and complete Bite
describe decreased and complete
- increased overbite 2. average overbite 3. decreased overbite
what are the different types of open bites ?
- anterior can be due to habits such as thumb sucking or just skeletal development
definition of centrelines and how we measure
what is a buccal segment relationship ?
what is the molar relationship ?
What is angle’s molar classification: class 1 ?
what is angle’s molar classification: class 2?
what is angle’s molar classification:class 3?
what is half unit class 2?
how do we describe canine relationship?
