Parcial 2 Flashcards
Diagnostic records include:
-lateral X-ray
- panoramic X-ray
-Extra Oral and Intra Oral Photographs
- Dental Casts
To diagnose correctly all cases of malocclusion it’s necessary to know the normal occlusion or the ideal position of the dental organs and normal facial lines. This knowledge is the basis of science and the most important thing for the orthodontist
Edward Angle
Is essential to carry out the correct treatment planning. This must be done based on a thorough study of the pacient and the problems they present, both bone and dental.
The orthodontic diagnosis
The time dedicated to the diagnosis will be the best spent, since a correct diagnosis represents _______ of the success of an orthoodntic treatment
80%
Orthodontics take care of:
- diagnosis, prevention, interception and treatment of all malocclusions. The design, application and control of functional and corrective devices
- the guide of the eruption and its supporting structures to achieve and maintain optimal occlusal relationships, physiological and aesthetic harmony between cranio-facial structures
The orthodontic diagnosis deals with recognition of the various characteristics of the maloclussion. Based on:
- patient interview
- clinical examination
- evaluation of the diagnostic records
Diagnosis
- Interpretation and presentation of the results
- Carry out the necessary exploration
- Problem formulation
- Recognition of the problem
Clinic history
- Medical history
- Interrogation (orthodontic history) (dental history)
In the interrogation
Orthoodntic history and dental history
Medical history
- osteoporosis
- cancer
- diabetes
- reumatic feber
Dental history
- age at which the deciduous dental erupted
- age at with permanent dental organs erupted
- dental trauma
To make a adequate diagnosis in orthodontic it’s necessary to carry out a correct history and a correct clinical examination of the patient:
- On a first visit, you should listen to the patient/ parents to find out what things worry them or what they don’t like and would like to change
- The patient should be asked about the disease they suffer or have suffered, consider whether the patient is receiving prolonged pharmalogical Tx of any type and if so, determine the cause
- Perform an examination of the patients oral cavity focusing attention on the dental bad positions and bite problems
- Assess the possible presence of cavities or periodontal disease pathologies that must be resolved before beginning orthodontic treatment.
- Once the examination is completed the patient must be guided about what their main problems are and how we can solve them. “However until exhaustive study has been carried out with x-rays and models of the teeth, the treatment plan and its duration cannot be exactly determine”
Mention the 4 medical condicions that contraindicate the use of orthodontic appliances:
Osteoporosis
Cancer
Diabetes
Reumatic feber
Prior to start the orthodontic treatment a ______ must be made to know the patients dental health status. An overview is required, it must be exhaustive and it should not be focused only on one aspect since in many cases it can be a complex situation
Diagnosis
A diagnosis allows:
- the development of a treatment plan that addresses the patients chief complaint
- medical and dental history
- dental, facial, skeletal and functional problems
Diagnosis process
- interview
- clinical examination
- analysis of diagnostic records
- data base
- control before orthodontic treatment
- list of diagnosis problems
Diagnosis récords
- identify the problems
- formulate the diagnosis
- allow the correct development of the treatment
May include digital and video images to supplement the clinical findings
Extraoral and intraoral images (photographic analysis)
The assess the Inter- arch and intra- arch relationship of the teeth, to help determine arch length and to assess arch symmetry
Dental casts (digital models)
To assess the condition and development status of the teeth and associated structures, and to identify any dental anomalies or pathology
Panoramic X-ray
Allow the evaluation of the size, shape and positions of the craniofacial structures and dentition, and in the identification of a skeletal anomalies or pathology
Cephalometric X-ray
May be used as a alternative source to obtain dentofacial information, but is not rountinely required for orthodontic X-rays
Cone- Beam Computer tomography (CBCT)
Assess the general condition of the hard and soft tissues of the mouth (including the periodontium) and the functional status of the patients occlusion
Intraoral pictures
Determine facial shape, symmetry, soft tissue harmony and the state of the perioral muscles. This determines deviations from normal with respect to a patients sagittal, vertical and transverse maxillofacial relationship and evaluates the relationship of the dentition and facial structures
Extraoral pictures
Facial shapes:
Oval
Round
Square
Profile types:
Straight, convex, concave
Indicates a class II jaw relationship, which may result from the maxilla that projects too far forward or mandible too far back
Convex profile
Indicates that the relationship of the maxilla and mandible is in harmony
Straight profile
Indicates a class III relationship, which may result from the maxilla that is too far back or a mandible that protrudes forwards
Concave profile
The radiologic projections indicated for the orthodontic diagnosis are divided into two categories:
Intraoral
Extraoral
X-ray to assess dental anomalies
Intraoral
X-ray to assess the dental condition and adjacent structures
Extraoral
Radiologic study: intraoral
- periapical
- occlusal
Radiologic study: extraoral
- lateral X-ray
- panoramic X-ray
- Carpal X-ray
- Postero- Anterior
Intraoral X- ray
- chronology of the eruption
- the degree of apical formation
- Shape, number, and size of roots
- agenesis
- Supernummerary
- Presence, position of third molars
- presence of retained teeth
Occlusal X-rays
- location of impacted tooth
- extension and shape of fissure
- Control of disjunctions
It allows the examination of the intraoral dental status (in case of suspicion of pathological processes detected in the panoramic X-rays)
Periapical X-ray
Periapical X-ray
- the degree of apical formation
- Shape, number and size of roots
- Agenesis
- Supernumerary
Extraoral X-rays
- Skull and face growth
- growth direction according to age
- clinical diagnosis of anomalies
- evaluation of results
Panoramic X-ray
- chronology of the eruption
- eruptive trajectory
- agenesis, supernumeraries
- TMJ morphology
- Ramify morphology
- Different types of pathologies
- Fracture lines
Lateral X-ray
- skull and face growth
- direction of growth according to age
- clinical diagnosis of anomalies
- comparison of changes caused: due to treatment with appliances, patient growth
- evaluation of results
The information that must be analyzed in a lateral X-ray:
- craniofacial anatomy
- relationship between the jaws
- relationship of the axes of the incisors
- Assessment of profile morphology (soft tissues)
- Growth trend and direction
- Possibilities and limitations of Tx
Once the lateral X-ray has been obtained to perform the cephalometric analysis the cephalogram is delimited on it, which will be composed of the anatomical drawing and the set of linear and angular measurements. It’s interpretation will allow us to understand the malocclusion and carry out the orthodontic treatment plan
V o F
V
This consists of two basic elements: ________, which determines the main anatomic structures and ________ that are made through the union of the points located previously and composed of lines and planes that define various cephalometric magnitudes
The anatomical drawings, the orientation drawings
Determines the main anatómical structures
Anatomical drawings
Are made through the union of the points located previously and composed of lines and planes that define various cephalometric magnitudes
Orientation drawings
Anatomic drawings
Soft profile
Dental structures
Bone structures
Orientation trace
Lines
Planes
Linear and angular magnitudes
Studies the craniofacial growth patterns is mainly used to assess dentofacial proportions and to evaluate the anatomical bases of malocclusion
Cephalometry
It’s responsible to study the horizontal and vertical relationships of the most important functional components:
The skull and cranial base, the maxilla, the dentition and the upper alveolar processes, the mandible, the dentition and the lower alveolar processes
Is a procedure designed to obtain a description of the relationships that exist between these units
The cephalometric analysis
Consist on tracing cephalometric points on acetate paper and from these points the desired angular and linear values are measured to obtain a concise and understandable description of the craneofacial pattern and classify the patient, this is going to helps us to identify what the objectives of the study will be, choose the treatment modality and predicting it’s success
Cephalometric analysis
Another clinical application of _________ is the establishment of changes induced during orthodontic treatment
Cephalometric analysis
______ obtained before, during and after treatment can be superimposed to study changes in the position of the jaws and teeth
Serial cephalometric X-rays
It is the most used diagnostic method to determine the level of bone maturation
Carpal X- ray
It is a study that is used to evaluate the patients bone age and establish a relationship with their chronological age in order to determine the level of development and maturation
Carpal X-ray
It conincide with the beginnig of the pubertal outbreak, and is ideal for the beginning of orthodontic treatment
Ossification of the sésamos de bone of the thumb
Ossification of the sesamoid bone of the thumb: indications
- in patients who show a severe discrepancy between dental age and chronological age
- determination of the state of skeletal maturity before performing orthodontic treatment
- predict the onset of pubertal growth
- patients between 16 and 20 years old who need orthognathic surgery
It allows the assessment of asymmetries of the skull, face and jaws as well as the frontal position of the dental organs
Postero anterior X-ray
Indications of the postero anterior x-ray
- diagnosis for latero- deviations/ laterognathia
- severe midline deviation
- diagnosis of malpositions that affect different structures
- studies that transverse anomalies
It is a technology that provides high-resolution images of the craniofacial complex in three dimensions (3D). This vision goes with the movements made to correct malocclusion or facial asymmetries.
Cone- beam computer tomography
_______ has led orthodontists to change their diagnostic imaging, including possible changes in orthodontic and orthodontic-surgical treatment planning
Cone-beam computer tomography
They are precise reproductions of the teeth and their surrounding soft tissues
Dental cast
Measurements of discrepancies are made between the dental arches and basal arches to obtain degree of crowding, lack of space, depth of curve of spee and midline
Dental casts
The study models allow us to observe:
- anomalies in shape and size and number of dental organs
- diastemas
- insertion of the braces
- midline discrepancy
- anterior or posterior crossbite
- openbite
- curve of spee
- morphology of interdental papillae
- shape and height of the palate
It allows the patient to compare before and after the treatment
Study models
Dental casts allow
- they allow the study of occlusion from all aspects
- it helps in the evaluation of treatment progress by the orthodontist and the patient
- helps in the evaluation and study of the severity of malocclusion
- helps in measuring arch length, and tooth size
Dental cast are used to see
- arch width
- arc length
- analysis of available space
- overjet and overbite
- molar and canine relationships
Dental cast type analysis
Transversal analysis
Sagittal analysis
Vertical analysis
Transversal analysis
- the coincidence or not of the dental midline
- the transverse symmetry of both sides
- the transversal interarch relationship
Sagittal analysis
Class 1, 2 and 3
Vertical analysis
Overjet
Overbite
For the complete study of model analysis, measurements are made to determine the relationship between the amount of space required for all dental organs to be correctly aligned so that we can determine the total of the space requirement
V o F
V
Model analysis divide in two
Mixed dentition
Permanent dentition
Analysis of the mixed dentition
- it aims to predict the size of the un erupted permanent dental organs and whether they will have space in the bone arch
- the upper and lower first permanent molars and the upper and lower permanent incisors must be present
This was an analysis created by doctors Lysle Johnston and Marvin Tanaka, it was obtained from 506 patients from Case Western Reseve University School of Dentistry. In this analysis the mesiodistal width of the upper and lower canines, first and second premolars is determined from the mesiodistal widths of the lower incisors
Tanaka and Johnson analysis
Tanaka and Johnson analysis was created by
Lysle Johnson and Marvin Tanaka
______ this is a simple quick method and has a reliability of _____
Tanaka and Johnson analysis/ 75%
Steps of the Tanaka and Johnson Analysis
- The mesiodistal width of the four lower incisors is measured
- The mesiodistal width of the four lower incisors is added and divided into two
- For the prediction of the mesiodistal width of the canine, first premolar and second premolar, 10.5 are added to the result of the division of the mesiodistal width of the incisors
- For the predilection of the mesiodistal widths of the canine, first and second upper premolars, 11 milimeters are added to the result obtained from the division of the mesiodistal width of the lower incisors
- Once the maxillary and mandibular predictions have been obtained it is known what is the space required to adjust the canine and premolars within the arch.
Next step is to compare this measurements with the available space in the arch. If the available space is greater that the canine and premolars within the arch. If the available space is less than required there will not be enough space for its location within the arch.
Analysis for permanent dentition
- The first step is lo calculate the space available, this is accomplished by measuring arch perimeter from mesial of one first molar to the other, over the contact points of posterior teeth incisal edge of anteriors
- The second step is to calculated the amount of space required for alignments of the teeth. This is done by measuring the mesio dental width of each erupted tooth from contact point to contact point, and then summing the widths of the individual teeth
Can be measured most easily by dividing the dental arch into four straight line segments, each segment is measured individually with sharppointed measuring instruments
Space available
Is the sum of the mesiodistal widths of all individual teeth, measured from contact point to contact point
Space required
If the sum of the permanent teeth is greater than the amount of space available, there is an __________
Arch perimeter space deficiency and crowding would occur
If available space is larger than the space requiered (excess space), gaps between some teeth would be ______
Expected
Model analysis: upper
Basal arch length (space available) 86 mm
Dental arch length (space require) 78 mm
Discrepancy -8mm
Statistical method. It is based on the great correlation that exists between groups of teeth making a size predilection of a group of dental organs knowing the size of another group of already erupted dental organs
Moteras analysis
It is responsible for predicting space that exists in both the upper arch and lower arch for the correct alignment of the canines and premolars
- mixed dentition stage
- predictive
- based on tables
Moyers analysis
Moyers analysis segments
Anterior arch: permanent incisors
Posterior arch: canines, first and second deciduous molars
Moyers analysis
- mixed dentition stage
- predictive
- based on tables
Anaterior available space: Steps
- One point of the compass is placed in the midline to mesial of the deciduous canine. The procedure is repeated on the opposite side.
- The greatest mesiodistal distance of each permanent incisors is measured
- The tip of the compass is placed of the first permanent molar and opened to the mesial of the deciduous canine. Doing the same on the opposite side.
From the sum of the width of the 4 incisors, the table is searched for the sum of the largest diameter MD of the canine and premolars that are still inrabone and multipled by 2.
Posterior required space
