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
Dental cast analysis
•Space analysis
oa comparison between the amount of space ____ for the alignment of the teeth and the amount of space ____ to align them properly
•Estimating the size of ____ permanent teeth
oMeasurement of the teeth on ____
oEstimation from ____; Moyers, Tanaka and Johnston
- available space greater > ____ space; if require more space > ____
- measure available space
- mesial of ____ to mesial ____
- can use a brass wire to measure the length of the ____
available required unerupted radiographic x-ray proportionality tables excess crowding
first molar
first molar
arch
tables are using the ____ width.
MOYERS
TANAKA
- more ____
- take one half of the MD width of the four lower inciosrs and add ____ for the estimated width of mandiblar canines/premolars in one quadrant
- or, add ____ for the estimated width of the maxillary canine and premolars in one quadrant
comparing tanaka and moyers, the values are very ____
lower incisor
simple
10.5
11
similar
BOLTON RATIO
Measure the mesiodistal width of each permanent tooth
•Overall Analysis = sum of mesiodistal width of all ____ (first molar to first molar) Mn teeth
/ sum of mesiodistal width of ____ Mx teeth
•91.3%
- Anterior analysis = sum of mesiodistal width of front ____ Mn teeth / sum of mesiodistal width of front ____ Mx teeth
- 77.2%
•An overall ratio of more than 91.3% means that the mandibular teeth are ____ or maxillary teeth are ____ compared to normal.
– same applies for the anterior analysis
- if patient has ____, then the bolton anterior ratio will certainly be off
12
12
6
6
larger
smaller
peg laterals
DENTAL ANALYSIS •Angle Cl I, II, III •Overjet •Overbite •Open bite/Deep bite •Crossbite
can see all of these on dental casts
Angle classification
- most common malocclusion, universally: ____
- next most common in america: ____
- in asia? ____
class I class II class III
ANGLE CLASSIFICATION
§Molar Angle Class I: The ____ cusp of the maxillary ____ rests in the ____ of the mandibular ____
§Canine Angle Class I:
The cusp of the maxillary canine rests slightly ____ to the embrasure between the mandibular ____ and mandibular ____
mesiobuccal
first molar
buccal groove
first molar
mesial
canine
first premolar
Overjet
Overjet is a measurement between two antagonistic anterior teeth (lateral or central incisors) comprising the greatest overjet and is measured from the ____ of the most lingual mandibular tooth to the ____ of the ____ of the more facially positioned maxillary tooth.
facial surface
middle
incisal edge
Overbite - VERTICAL
Overbite is a measurement between two ____ teeth (lateral or central incisors) comprising the greatest overbite.
- measures the ____ distance between upper incisors and lower incisor tip
antagonistic
vertical
Deep bite - VERTICAL
100% overbite - you will not see the ____
- lower incisor is touching the ____
lower incisor
palate
Open bite - VERTICAL
can have an ____ or a ____ open bite
anterior
posterior
Crossbite - TRANSVERSE
- lingual crossbite
- the ideal is that the upper posteiorr is slightly ____ of the lower. lingual crossbite is the opposite.
- buccal crossbite
- the upper is a little bit too far to the ____. sometimes called the ____.
outside
outside
scissor
Cephalometric analysis
____ analysis
skeletal
GLOSSARY OF TERMS
Cephalometric radiograph
A ____, extraoral projection, either in a lateral or frontal view, that shows the relationships between the jaws and other skeletal structures, usually used for orthodontic evaluation.
standardized
CEPHALOSTAT
An instrument developed originally from the anthropologic cephalostat, used now on patients to obtain ____ and ____ craniofacial images on X-ray film.
- can compare ____ and ____ treatment; or can compare ____ growth
standardized oriented pre post patient
CEPHALOSTAT
Natural Head positioning
instruct patients to sit upright and look straight ahead to a point at ____ level on the wall in front of them
The ____ point on the inferior bony border of the left orbit, indicated by the orbital marker, is at the level of the ____ parts of the ear-rods.
The superior borders of the ____ resting on the upper parts of the two ear-rods.
- use the FHL to the ____ point of the orbit
- FHL should be ____ to the floor when head is in natural head positioning
eye lowest upper EAM lowest parallel
RADIOGRAPHIC ANATOMY
& CEPHALOMETRIC LANDMARKS
Craniofacial Skeleton Cranial base and other structures Maxilla Mandible Dentition Soft tissue profile Pharynx and cervical vertevrae
- with lateral ceph can do a ____
CVM
Landmarks
- Nasion (Na)
- The most ____ point of the ____ suture in the median plan
- SN connects the ____ to nasion
- FH and SN are the most common ____ landmark links
anterior
frontonasal
sella
horizontal
Landmarks
- Orbitale (Or)
- the ____ point in the inferior margin of the ____, midpoint between right and left images. - The key ridge (KR)
- the lowermost point on the contour of the shadow of the ____ wall of the ____ fossa.
- above the ____
lowest orbit anterior infratemporal maxillary first molar
- Sella (S)
- the point representing the midpoint of the ____ (sella turcica); it is a constructed point in the median plane.
pituitary fossa
MIDDLE & POSTERIOR CRANIOFACIAL BONES
Landmarks
- Porion (Po)
- the ____ point of the ____. - Basion (Ba)
- the median point of the anterior margin
of the ____. - Bolton Point (Bo)
- the ____ point in the upward curvature of the ____. - Opisthion (Op)
- the ____ edge of ____. - Pterygoid point (Pt)
- the point where pterygomaxillary fissure meets ____, midpoint between right and left images. - Pterygomaxillary fissure (Ptm) - a bilateral tear- drop shaped radiolucency, the anterior shadow of which represents the posterior surfaces of the ____ of the maxilla; the landmark is taken where the two edges, front and back, appears to merge inferiorly.
superior
EAM
foramen magnum
highest
retrocondylar fossa
posterior
foramen magnum
foramen rotundum
tuberosities
MAXILLA
- Anteior nasal spine (ANS)
- the ____ of the bony anterior nasal spine, in the median plane. - Posteior nasal spine (PNS)
- the intersection of a continuation of the anterior wall of the ____ and floor of the nose, marking the dorsal limit of maxilla. - A Point (A), subspinale
- the point at the deepest midline concavity on the maxilla between the ____ and ____. - Prosthion (Pr), supradentale
- the ____ and most ____ point on the alveolar portion of the premaxilla;
it is in the median plane, between the upper central incisors.
tip pterygopalatine fossa ANS prosthion lowest anterior
MANDIBLE
- Infradentale(Id)
- the ____ and most ____ point on the alveolar process, in the median plane, between the mandibular central incisors. - B point (B), supramentale
- the point at the deepest midline concavity on the
mandibular symphysis between ____ and ____.
2-1. Pm (Suprapogonion)
- the point at which shape of symphysis changes from
convex to ____ - Pogonion (Pog)
- the most ____ point of the bony chin in the median
plane. - Gnathion (Gn)
- the most ____ point on the symphysis of the chin. - Menton (Me)
- the most ____ midline point on the mandibular symphysis. - Gonion (Go)
- the most ____r point of the mandible. - Articulare (Ar)
- the point of intersection of the images of the posterior border of ____ of the mandible and the inferior border of the ____ part of the occipital bone. - Condylion (Co)
- the most ____ point on the condylar head
highest anterior infradentale pogonion concave anterior anteroinferior posteroinferior inferior posterioinferior superior condylar processes basilar superior
DENTITION
- U1E
- the incisal edge of the ____. - L1E
- the incisal edge of the ____. - U1A
- the root apex of the ____. - L1A
- the root apex of the ____. - U6
- the tip of the mesiobuccal cusp of the ____. - L6
- the tip of the mesiobuccal cusp of the ____.
- mark the incisal teeth root to tip; then we can see the torque - the ____, the ____
max CI man CI max CI man CI max M1 man M1
angulation
inclination
SOFT TISSUE PROFILE - UPPER
Glabella (G)
- the most ____ point in the midsagittal plane of the head.
Soft tissue Nasion(Na’)
- the point of deepest concavity of the soft tissue contour of the ____ of the nose.
Pronasale (Pn)
- the most ____ point of the nose.
Subnasale (Sn)
- the point where the ____ border of the nose meets the outer contour of the ____ lip.
Superior labial sulcus (Sls), soft tissue A point
- the point of greatest concavity in the midline of ____ between subnasale and labrale superius.
Labrale superius (Ls) - the median point in the upper margin of the upper membranous \_\_\_\_. the vermillion border of the upper lip in the midsagittal plane.
Upper lip (UL) - the most \_\_\_\_ point of the upper lip.
Stomion superius (Sts) - the \_\_\_\_point of the \_\_\_\_ lip.
prominent root prominent lower upper upper lip lip prominent lowest upper lip
SOFT TISSUE PROFILE - LOWER
- Stomion Inferius (Sti)
- the ____ point of the lower lip. - Lower lip (UL)
- the most ____ point of the lower lip. - Labrale Inferius (Li)
- the median point in the ____ margin of the lower membranous lip. - Inferior labial sulcus (Ils), soft tissue B point
- the point of greatest ____ in the midline of lower lip between labrale inferius and soft tissue pogonion. - Soft tissue Pogonion (Pog’)
- the most ____ point on the soft tissue contour of the chin. - Soft tissue Menton (Me’)
- the constructed point of intersection of a vertical co-ordinate from ____ and the inferior soft tissue contour of the chin.
highest prominent lower concavity prominent menton
STEINER ANALYSIS - AP (SKELETAL)
§SNA § NORM: § (Caucasian) 82 +/- 2 § (African American) 85 +/- 2 §Mx AP position §If above, Mx \_\_\_\_ §If below, Mx \_\_\_\_
§SNB § NORM: § (Caucasian) 80 +/- 1 § (African American) 79 +/- 2 §Mn AP position §If above, Mn \_\_\_\_ §If below, Mn \_\_\_\_
§ANB § NORM: § (Caucasian) 2 +/- 1 § (African American) 6+/- 2 §Skeletal pattern §If above, \_\_\_\_ §If below, \_\_\_\_
- ANB is the difference between ____ and ____
prognathism
retrognathism
prognathism
retrognathism
Cl II
Cl III
SNA
SNB
STEINER ANALYSIS -AP (DENTAL)
§1/ to NA ◦ §Norm: § (Caucasian) 22 +/-2 ◦ § (African American) 24 +/- 2 §Axial position of upper incisors § If above, \_\_\_\_ §If below, \_\_\_\_
§1/ to NA mm* §Norm: § (Caucasian) 4 +/-1 mm § (African American) 7 +/-1 mm §Sagittal position of upper incisors § If above, \_\_\_\_ §If below, \_\_\_\_ §*Measured from the incisal tip to line NA
proclined
retroclined
procumbent
retruded
STEINER ANALYSIS -AP (DENTAL)
§/1 to NB◦ §Norm:
§ (Caucasian) 25 +/-2 ◦
§(African American) 37 +/-2 ◦ §Axial position of lower incisors § If above, ____
§If below, ____
§/1 to NB mm
◦ §Norm:
§ (Caucasian) 4 +/-1 ◦
§(African American) 11 +/-1 ◦ §Sagittal of lower incisors § If above, ____
§If below, ____
- measured from the incisal tip to the link NB
proclined
retroclined
procumbent
retruded
STEINER ANALYSIS -VERTICAL
§GoGn to SN
§Norm: § (Caucasian) 32+/-5 ◦ § (African American) 38+/-5 ◦ §Vertical Skeletal Pattern §If above, \_\_\_\_ Bite Skeletal Pattern §If below, \_\_\_\_ Bite Skeletal Pattern
- GoGn is ____ plane
open
deep
manidbular
TWEED EVALUATION
Reference Plane: Frankfort Horizontal Plane (FH)
- FMA talks about the ____ and the IMPA talks about the ____
skeletal vertical
lower incisor torque
TWEED EVALUATION
§FMA
§Norm: § (Caucasian) 25+/-4 ◦ § (African American) 31+/-4 ◦ §Vertical Skeletal Pattern §If above, \_\_\_\_ Bite Skeletal Pattern §If below, \_\_\_\_ Bite Skeletal Pattern
open
deep
TWEED EVALUATION
§IMPA
§Norm: § (Caucasian) 87+/-3 ◦ § (African American) 100+/-3 ◦ §Lower Incisor Inclination §If above, \_\_\_\_ lower Incisors §If below, \_\_\_\_ lower Incisors
proclined
retroclined
WITS APPRAISAL
§Draw a perpendicular to the occlusal plane from point A and also from point B
§Calculate the distance between AO and BO
§If point BO is ahead of AO, then the difference is a ____
§NORM
§-1 mm for Caucasian male §0 mm for Caucasian female
- positive value is a ____; a negative value is more ____
negative class II class III
Ricketts Analysis
- Nasal cavity width : ____
- Mn. Width : ____
- Mx. Width : ____ J
- Symmetry : ____ ZA~ZA
- Intermolar width: buccal
surface of ____ - Intercuspid width : width between the tips of the ____
- Denture symmetry
- Upper to lower molar relationship
NC~NC Ag~Ag Z~Ag crista galli first perm molar lower cuspid
Deep curve of spee
- shorter distance - could have more ____
Flat curve of spee
- longer distance - more ____ for teeth
____ is normal
crowding
space
1mm
- Andrew Analysis is another way to measure the ____; measure how many mm we need for a maxilla expansion.
- There are several ways to do this. Sometimes people use Andrew Analysis; you can also use ____ widths. There are some norms based on patient age, then we can compare.
- The third way to do this is using ____
transverse
inter-molar
PA cephs
Can have different class in molar and in canine!
just FYI
TAD expander in children; in adults, more difficult, would require ____
surgery
