Orthodontic Diagnosis I Flashcards
QUESTIONS OF THE PATIENT
§____;
o“Do you think you need braces? Tell me what bothers you about your face or your
teeth.”
§____
oOld condylar injury; the most probable cause of facial asymmetry
oLong-term medication or chronic medical problems; i.e. diabetes, prostaglandin inhibitors or resorption-inhibiting agents
§____
oSerial cephalometric radiographs – most accurate way to determine whether growth has stopped or is continuing
chief complaint
medical and dental history
physical growth evaluation
Growth Potential Prediction
- evaluate growth potential
- check where in growth curve by taking a ____, or via ____ or ____
- sesamoid bone ossification
- PHV > means growth peak occurs right after ____
CVM
- if patient bt ____ and ____, patient is at peak height growth potential
- phase I - ____ before growth peak
- phase II - growth peak ____
- phase III - growth peak ____
- phase IV - ____ after growth peak
- phase V - ____ after growth peak
serial ceph radiograph
hand wrist-xray
CVM
sesamoid ossification
cat II cat III 1 year start ends 1 year 2 years
EVALUATION OF ORAL HEALTH
§Any problems of disease or pathology MUST be under control before ____ begins.
§Periodontal evaluation
o____ indicates active disease
o____ around crowded incisors indicates the possibility of tissue dehiscence developing when the teeth are aligned, especially with nonextraction (arch expansion) treatment.
orthodontic treatment
bleeding on probing
inadequate attached gingiva
EVALUATION OF JAW AND OCCLUSAL FUNCTION
§____- most
important single indicator of joint function
§Any sign of TM joint problems §\_\_\_\_ §Crepitation §Limited \_\_\_\_ §Deviation on opening/closing §\_\_\_\_ to manipulation §Pain/tenderness in muscles of mastication §Pain localized in/referred to the \_\_\_\_
crepitus
- bone-bone contact between the condyle and ____.
amount of maximum opening clicking range of motion resistance TMJ complex glenoid fossa
TMD
- affects ____ growth
- the mandible goes ____ and ____
- posterior and anterior facial height is ____
- ____ bite
mandibular downward backward low open
MANDIBULAR SHIFT ON CLOSURE
§Lateral or anterior shifts of the mandible on closure
oA child with an apparent unilateral crossbite usually has a ____ narrowing of the maxillary arch with a shift to the ____ crossbite position
oClass II - position the Mn forward in a “____”, making the occlusion look better that it really is.
oClass III – results from a forward shift to escape incisor interferences in what is really an end-to-end relationship (____)
- need to take care of TMJ prior to treatment
bilateral
unilateral
sunday bite
pseudo-class II malocclusion
Pseudo-class III Malocclusion
- in CR, the centric relation is ____.
- touching in the anterior, and in order to avoid interference the patient advances his ____ forward, so it looks like class III but it’s NOT
edge to edge
mandible
CENTRIC RELATION (CR) VS CENTRIC OCCLUSION (CO)
§Centric Relation (CR): the most orthopedically ____ joint position when the condyles are in their most ____ position in the articular fossa, resting against the posterior slopes of the articular eminence with the discs properly interposed
§Centric Occlusion (MIC): the position of ____ when viewing a patient intraorally, or as the fit of hand-held maxillary and mandibular models with a thin maximum intercuspation wax registration interposed
- for treatment, always treat patient based on the ____ position
- CO and CR are usually ____
stable superoanterior maximum intercuspation CR similar
CO-CR discrepancy
- if made a treatment for CO based on the pseudo-class III, it would be totally off. it looks like class II, but the patient is actually a skeletal ____
class I
MOUNT CASTS ON ARTICULATORS
- Record and document any discrepancy between the occlusal relations at the ____ of the teeth and the relations at the patient’s ____ occlusion
- Record the ____ paths of the mandible
- Needed for surgical treatment planning
initial contact
full or habitual
lateral and excursive
CLASSIFICATION BY THE CHARACTERISTICS OF MALOCCLUSION
- STEP 1: Evaluation of ____ Proportions and Esthetics.
- STEP 2: Evaluation of ____ Within the Dental Arches.
- STEP 3: Evaluation of ____ Relationships in the ____ Plane of Space
- STEP 4: Evaluation of ____ Relationships in the ____ Plane of Space
- STEP 5: Evaluation of ____ Relationships in the ____ Plane of Space
- the first one is always ____ first
facial alignment and symmetry skeletal and dental transverse skeletal and dental anteroposterior skeletal and dental vertical
- sagittal view
- -2 lines: one from nose to upper lip, and second from upper lip to chin
- this patient seems ____
- front view
- ____ width
- interpupillary lines should equal the width of the ____
- verticle lines
- should be ____ thirds
- when you sub-divide the bottom third, there should be a ____ ratio between the space above the upper lip to the space below the lower lip
convex
equal
mouth
equal
1:2
EVALUATION OF FACIAL AND DENTAL APPEARANCE
§Face in all three planes of space (____)
oasymmetry, excessive or deficient face height, mandibular deficiency or excess etc
§Smile framework (____)
obordered by the upper and lower lips on smile animation and includes such assessments as excessive ____ on smile, inadequate anterior tooth display, inappropriate gingival heights and excessive buccal corridors
§Teeth (____)
otooth proportions in height and width, gingival shape and contour, connectors and embrasures, black triangular holes and tooth shade
macro-esthetics
mini-esthetics
macro-esthetics
Face - profile
straight
convex
- typical ____
concave
- typical ____
class II class III
LIP POSTURE AND INCISOR PROMINENCE
•Bimaxillary dentoalveolar protrusion
– in both jaws the teeth ____
•Lip incompetence
- lips are separated at rest by more than ____ mm
- Pt must ____ to bring the lips together over the protruding teeth.
•Lip relation with the nose and chin
–The larger the nose, the more ____ the chin must be to balance it. ____ lip prominence will be acceptable.
protrude 3 to 4 strain prominent greater
SMILE ANALYSIS
1) Amount of Incisor and Gingival Display
oElevation of the upper lip on smile should stop at or near the ____. ALL ____ are seen.
oSome ____ looks esthetic and youthful appearing.
gingival margin
upper incisors
gingival display
SMILE ANALYSIS
2) Transverse Dimensions of the Smile Relative to the Upper Arch
o____ smile may be more attractive.
oAmount of buccal corridor; distance between Mx posterior teeth (PM) and the inside of the cheek
oWidening the ____ arch can improve the smile.
oTransverse width of dental arches should be related to the width of the ____.
- buccal corridor is the black space on either side of the end of the teeth in the smile
- narrow maxilla > ____ buccal corridor
broad
maxilla
face
wide
SMILE ANALYSIS
3) The Smile Arc
oContour of the incisal edges of the Mx anterior teeth relative to the curvature of the ____ during a social smile
o____ smile arc is important.
lower lip
consonant
TEETH– GOLDEN PROPORTION
- LI is ____ of the CI width
- canine is ____ of the LI width
- PM1 is ____ of the canine width
- these values are from the ____ view; they are not the ____ measurements of tooth widths
62% 62% 62% frontal actual
DENTAL APPEARANCE – HEIGHT/WIDTH RELATIONSHIP
Possible reasons for short crown
•Incomplete ____ in a child – further development
•Loss of crown height from ____ on an older pts –
restoration of the missing part of crown
•Excessive ____ – crown lengthening procedure
•An inherent distortion in ____ form – laminates or a complete crown
eruption
attrition
gingival height
crown
Diagnostic records
•Purposes
oDocument the ____ for treatment
oAdd to the information gathered on ____
starting point
clinical examination
WHICH DIAGNOSTIC RECORDS ARE NEEDED?
•____ photographs
•Dental casts or ____
•____ radiograph (+ periapical radiographs)
– adults: ____
– childrend: upper incisor, lower incisor and 2 ____
•Lateral cephalometric radiograph
•____ exam - adultpt
facial/intraoral digital scan panoramic FMX bite wings periodontal exam
Typical set of records
- ____
- central, side and occlusal
- ____
- central, three quarter view, profile view
- ____ x-ray
- ____ and PA ceph
intraoral
facial
panoramic
lateral ceph
Panoramic radiograph
- broad view > can see any pathologic ____, impacted teeth, ____ teeth, shape of the condyle, can see things in the ____
lesions
supernumerary
sinus
Analysis of diagnostic records
- Cast Analysis : Symmetry and Space - ____
- Cephalometric Analysis -____
dental
skeletal
