Diagnosis in Orthodontics
Dr. Zuber Ahamed Naqvi
Objectives
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Introduction
Diagnostic aids
Case history
Clinical examination
Introduction
• Diagnosis in orthodontics is based
on collection of adequate database
of information about the patient.
 Case history (questions of the
patient written and/ or oral)
 Clinical examination
 Diagnostic aids
DIAGNOSIS
INTERVIEW
CLINICAL EXAMINATION
ANALYSIS OF DIAGNOSTIC
RECORDS
PATHOLOGY( CARIES, PERIO)
CONTROL BEFORE ORTHO
TREATMENT
OPTIMAL
TREATMENT
PLAN
INTERACTION
COMPROMISE
COST-RISK / BENEFIT
DATA BASE
CLASSIFCATION
PROBLEM LIST
ORTHODONTIC PROBLEMS
( IN PRIORITY ORDER) AND
THE POSSIBLE SOLUTIONS
TO INDIVIDUAL PROBLEMS
MECHANOTHERAPY
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Diagnostic aids
Essential
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Case history
Clinical examination
Study models
Radiographs periapical
 Bitewing
 panoramic
• Facial photographs
Supplemental
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Specialized radiographsCephalometric radiographs
Occlusal intraoral radiograph
Cone shift technique
Electromyography
Hand wrist radiograph
Endocrine test
Estimation of BMR
Diagnostic set up
Occlusogram
CT-Computerized tomography
CBCT- cone beam computerized
tomography
Case history
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Personal details
Name
Age
Sex
Address
Occupation
Patient's chief complaint (major reason for seeking consultation and
treatment) .
There are three major reasons for patient concern about the alignment and
occlusion of the teeth:
1.
impaired dentofacial esthetics that can lead to psychosocial problems
2.
impaired function, and
3.
desire to enhance dentofacial esthetics and thereby the quality of life
Case history
Information should be sought in three major areas:
1.
2.
3.
Medical and dental history
Physical growth status
Motivation, expectations, and other sociobehavioral factors
A careful medical and dental history is needed for orthodontic patients both:
- provide a proper background for understanding the patient's overall
situation -to evaluate specific orthodontically related concerns
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early fractures of the condylar neck of the mandible
trauma to the teeth
long-term medication
Osteoporosis , uncontrolled diabetes contraindicates orthoodntic
treatment
Physical Growth Evaluation
This is important for a number of reasons:
• Growth spurt – growth modification
• Signs of sexual maturation
• Recording height and weight
• Calculation of skeletal age ( skeletal maturity) from the vertebrae
 hand-wrist radiographs
 serial cephalometric radiographs
 Mesomorphic
 Endomorphic
 Ectomorphic
Social and Behavioral Evaluation
Social and behavioral evaluation should explore several
related areas
• The patient's motivation for treatment
• What he or she expects as a result of treatment
• How cooperative or uncooperative the patient is likely to be.
• External motivation.
• Internal motivation.
Clinical Evaluation
There are two goals of the orthodontic clinical
examination:
1. to evaluate and document oral health, jaw
function,facial proportions and smile
characteristics; and
2. to decide which diagnostic records are required.
The clinical examination can be devided to:
– Morphological (extraoral and intraoral)
– Functional
Extraoral examination
• Facial Proportions: Macro-Esthetics
• Assessment of Developmental Age
• Facial Esthetics versus Facial Proportions
Whether a face is considered beautiful is greatly
affected by cultural and ethnic factors, but
whatever the culture, a disproportionate face
becomes a psychosocial problem.
Distorted and asymmetric facial features – not
esthetic
Proportionate features are acceptable if not always
beautiful.
Frontal Examination
Frontal view- one looks for bilateral symmetry and for
proportionality of the widths of the eyes/nose/mouth
Low set ears, or hypertelorism ---syndrome or a microform of a
craniofacial anomaly.
If a syndrome is suspected, the patient's hands should be
examined for syndactyly.
Facial index
The proportional relationship of facial height to width (the facial index).
Index Measurements Male
Female
Facial n-gn/zy-zy
88.5 (5.1) 86.2 (4.6)
• Mesoprosopic- average
• Euryprosopic - broad and short
• Leptoprosopic – long and narrow
vertical facial thirds
• Distance from
• the hairline to the
base of the nose,
• base of nose to
bottom of nose,
• and nose to chin
should be the same.
Profile Analysis
Goals of facial profile analysis:
1.
Establishing whether the jaws are proportionately
positioned in the anteroposterior plane of space.
2.
Evaluation of lip posture and incisor prominence
3.
Re-evaluation of vertical facial proportions and
evaluation of mandibular plane angle.
Evaluation of lip posture and incisor prominence
The teeth protrude excessively (1) the lips are prominent and everted, and
(2) the lips are separated at rest by more than 3 to 4mm (lip
incompetence)
Intraoral examination
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Evaluation of Oral Health
The health of oral hard and soft tissues must be
assessed for potential orthodontic patients as for
any other.
It includes:
• medical problems- osteoporosis, uncontrolled
diabetes.
• dental caries or pulpal pathology
• periodontal disease
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Permanent dentition- count the number of teeth
In mixed dentition the orthopantomogram is
necesary .
Periodontal evaluation
-indications of active periodontal disease and
potential or actual mucogingival problems
Aggressive juvenile periodontitis
Attached gingiva around crowded incisors
Insertion of the frenulum
The evaluation of the malocclusion :
• Angle´s classification
• malposition of individual teeth
• overjet
• ovebite
• examination of symmetry
Evaluation of Jaw and Occlusal Function
Three aspects of function require evaluation:
1. Mastication (including but not limited to swallowing),
2. Speech, and
3. the presence or absence of temporomandibular (TM)
joint problems.
Patients with severe malocclusion often have difficulty in
normal mastication, not so much in being able to chew their
food (though this may take extra effort) but in being able to
do so in a socially acceptable manner.
Speech problems
Can be related to malocclusion
Speech difficulties in a child
If a child has a speech problem and the type of
malocclusion related to it, a combination of
speech therapy and orthodontics may help.
Evaluation of the TM joints
Restricted movement - indicates a functional problem.
The most important single indicator of joint function is
the amount of maximum opening.
Palpating the muscles of mastication and TM joints
Note any signs of TM joint problems such as joint pain,
noise, or limitation of opening.
The path of closure- the final part must be examined
and any occlusal interferences with functional
mandibular movements recorded.
Orthodontic diagnostic records
Orthodontic diagnostic records are taken for two
purposes:
• to document the starting point for treatment
• and to add to the information gathered on
clinical examination
Orthodontic records fall into three major
categories.
Those for evaluation of the:
1. health of the teeth and oral structures
2. alignment and occlusal relationships of the
teeth
3. facial and jaw proportions
Radiographs
A panoramic radiograph
The panoramic image has two significant
advantages over a series of intraoral
radiographs:
• broader view - to show any pathologic lesions
and supernumerary or impacted teeth and
• the radiation exposure is much lower
• view of the mandibular condyles,.
• periapical and bitewing radiographs only
when greater detail is required.
• Occlusal radiographs
Cephalometric radiograph
It is important in evaluation of the skeletal and
dental relationship.
Radiographs of the temporomandibular joint
should be reserved for patients who have
symptoms of dysfunction .
Evaluation of the occlusion requires impressions
for dental casts and a record of the occlusion.
The rutine examination involves also the
intraoral and extraoral photographs.