patient assessment Flashcards
parts of ortho pt assessment
history EO assessment IO assessment summary problem list tx aims tx plan
whats the ideal occlusion/ gold standard
Andrew 6 keys (1972)
- Molar relationship: the distal surface of the DB cusp of the U FPM occludes with the mesial surface of the MB cusp of L. 7.
- Crown angulation - mesio-distal tip
- crown inclination
- no rotations
- no spaces
- flat occlusal planes
C/O- aspect
RFA - specific thing?
level of concern
is pt concerned?
appearance
dental health
fct
aspects of MH that can affect ortho
epilepsy - avoid URAs
Recurrent aphthous ulcer - tend to manage
diabetes - diet
bisphosphonates - slow tooth movements and ext risk
latex allergy
Nickel allergy - NiTi arch wire ( not on the surface)
DH
regular attender? prev tx - coped? caries risk - stabilise prev ortho? - avoid retx if possible - RR history of trauma - RR OH
what habits are important to note in the history?
digit sucking
lower lip sucking
tongue thrust
nail biting
features of lip sucking
retroclination L incisors
eczematous appearance L lip
SH
prior knowledge from friends/siblings?
can they commit to tx - exams, travel, parents/work
wind instruments - can still play but will be more difficult
occlusal features of a digit sucking habit
proclination U incisors
retroclination L incisors
localised AOB or incomplete OB
narrow upper arch +/- unilateral posterior CB
but superimposed on existing skeletal pattern and incisor relationship
EO assessment
skeletal pattern - AP, V, T
STs
TMJ
ways of assessing AP skeletal pattern
visual
palpate skeletal bases
lateral cephalogram
how should the head be positioned for visually assessing the AP skeletal pattern?
Frankfort plane parallel to floor
natural head posture
AP class 1
mandible 2-3mm behind maxilla
AP class 2
mandible >3mm behind maxilla
AP class 3
mandible <2mm or in front
ways of assessing V skeletal pattern
FMPA
vertical facial proportions
lat ceph
how to assess FMPA clinically
Frankfort and mandibular planes
meet at occiput ideally
how to assess FMPA radiographically
porion to orbitale = Frankfort plane
gonion to menton = mandibular plane
meet at occiput ideally
landmarks for clinical vertical facial proportions
glabella
subnasale
menton
clinical vertical facial ideal proportions
50 %
glabella -subnasale / subnasale - menton
landmarks for cephalometric vertical facial proportions
nasion
Ant nasla spine
menton
cephalometric vertical facial ideal proportions
UAFH 45%
LAFH 55%
transverse skeletal pattern
assess symmetry
reference: mid sagittal reference line/ interpupillary line
view from front and above
occlusal cant?
ST features to assess
lips
- competent
- trap
- lower lip level & activity
tongue
- position
- habitual
- swallowing
nasolabial angle
smile line
competent lips
meet together at rest with relaxed mentalis muscle
lip form
full/thin
lip tonicity
hyperactive or little tone
what group of patients often have hyperactive lip tonicity?
class 2 div 2 - will retrocline L incisors
nasolabial angle
angle formed by tangents to the U lip and columella of the nose
what does the nasolabial angle indicate?
upper lip position
increased nasolabial angle
protrusive - good for ext
average nasolabial angle
100
decreased nasolabial angle
retrusive - avoid ext if possible
normal smile line
show whole height of U incisors with only the IP gingivae visible
at rest lips apart 3-4mm incisal tooth show
what are tongue thrusts usually and why?
adaptive (secondary)
to achieve an anterior oral seal when swallowing (AOB)
what is the problem with endogenous (primary) tongue thrusts?
harder to treat and more likely to relapse
TMJ assessment
ask re symptoms
palpate as open/closed and lateral movements
note any clicks/crepitus/locking
note range of movement inc max opening
if symptoms examine MofM
can tooth position/appliances cause TMD?
no evidence
parts of IO examination
general overview
arches in isolation
teeth in occlusion
features of IO general overview
chart erupted teeth
poor prognosis - need stabilisation before tx
OH
tooth quality - note any decal areas
PD condition
toothwear - sort erosion
how can PD condition affect ortho tx?
can accelerate recession
prev loss of support can give more chance of relapse post-tx
features of assessing the arches in isolation
crowded/aligned/spaced
incisors - proclined/average/retroclined
mild degree of crowding
<4mm space short in one arch
moderate degree of crowding
4-8mm space short in one arch
severe degree of crowding
> 8mm space short in one arch
methods to assess the degree of crowding
space available/space required
overlap technique (of contact points)
methods to assess the degree of crowding - space available/space required
arch length or space available
- M6 to D2, D2 to M1, M1 to D2, D2 to M6
sum of widths of teeth anterior to 6s (premolars - premolars)
methods to assess the degree of crowding - overlap technique
of contact points
add together
methods to assess the degree of crowding - mixed dentition analysis
need to use when permanent teeth still to erupt U arch need 22mm - 3 8mm - 4 7mm - 5 7mm L arch need 21mm - 3 7mm - 4 7mm - 5 7mm
incisor angulation
Frankfort plane to long axis of U incisor is about 110 degrees
things to assess when teeth in occlusion
incisor classification OJ OB centre lines molar relationship canine relationship crossbite mandibular displacement?
BSI class 1 incisors
lower incisor edges occlude with or lie immediately below the cingulum plateau of the U central incisors
BSI class 2 div 1 incisors
lower incisor edges lie posterior to cingulum plateau of upper central incisors. U centrals proclined or av inclination, increased OJ
BSI class 2 div 2 incisors
lower incisor edges lie posterior to cingulum plateau of U centrals
U centrals retroclined
OJ usually minimal but may be increased
BSI class 3 incisors
lower incisor edges lie anterior to cingulum plateau of U centrals
OJ reduced or reversed
what is OJ
horizontal distance between the labial surface of the tips of the U incisors and the labial surface of the L incisors
measuring the OJ
teeth in ICP usually
ruler held parallel to occlusal plane (horizontal)
usually measure the greatest OJ on the most prominent U incisor
overbite
vertical overlap of the incisor teeth
describing OB
- average, increased or decreased
- complete or incomplete
- complete to tooth/ ST
average OB
where the U incisors overlap the incisal 1/2 to 1/3 of the crowns of the L incisors
complete / incomplete OB
only for increased OB
- complete to tooth
- complete to ST
- incomplete
centre lines
look at rest and smiling describe U and L centre lines relative to - midline of face (ref point) - each other coincident, to right, to left look from above, behind and in front
whats the classification of buccal segment
- Angle’s classification
- class I, II, III
class 1 molars
MB cusp of U FPM occludes with MB groove of L FPM
class 2 molars
MB cusp of U FPM occludes anterior to MB groove of L FPM
class 3 molars
MB cusp of U FPM occludes posterior to the MB groove of L FPM
class 1 canines
U permanent canine occludes in the embrasure between the L permanent canine and L 4
class 2 canines
U permanent canine occludes anterior to the embrasure between the L permanent canine and L4
class 3 canines
U permanent canine occludes posterior to the embrasure between the L permanent canine and L4
assessing mandibular displacement
check if you see CB or centre line discrepancy
check path of closure
check for displacement - RCP/ICP discrepancy - curl tongue back as gradually close, stop when feel first tooth contact
assessing CB
describe teeth involved
check for mandibular displacement
kesling set ups
useful for pt to see
simulate position you think teeth will end up in
diagnostic records
radiographs study models Kesling set ups photographs sensibility tests CBCT
what radiograph could you use in ortho
- OPT
- maxillary anterior occlusal
- lateral cephalogram
indications for CBCT
UE teeth
multidisciplinary cases
bone for implants
when do you decide if radiographs are needed?
after clinical examination
what is always first in tx aims?
deal with pathology
what should be included at the end of the tx plan?
retention
