Lecture 13. Introduction To Orthodontics II PDF

Introduction to Orthodontics II 1602305 Dental Occlusion and Temporomandibular Joint disorders December 2024 1st Semester – 2024/2024 Dr. Yousef Herzallah Week 13  ORTHODONTICS Occlusion and Malocclusion Important Terminology When To Treat...

Introduction to Orthodontics II 1602305 Dental Occlusion and Temporomandibular Joint disorders December 2024 1st Semester – 2024/2024 Dr. Yousef Herzallah Week 13  ORTHODONTICS Occlusion and Malocclusion Important Terminology When To Treat Indices Of Need Classifying Malocclusions Risks Of Orthodontic Treatment Orthodontic Patient Assessment O R T H O D O N T I C PAT I E N T A S S E S S M E N T History and Examination Records Concerns Study Models Information Photos Radiographs Analysis Problem List Pathology Skeletal  Dental  Soft Tissue   H I S T O R Y A N D C O N C E R N S Dental History Patients should be in excellent dental health Frequently visit general dental practitioners (GDPS) Details Re: Previous appliance therapy Previous extraction (timing, reason, difficulties or complications) Previous restorative or endodontic tx. GDPs and Orthodontists need to have a good working relationship and communication  H I S T O R Y A N D C O N C E R N S Medical Hx. Heart defects with a risk of Medical Conditions: infective endocarditis Epilepsy Bleeding disorders Latex allergy Asthma Nickel allergy Bisphosphonates Diabetes Learning difficulties or behavioural disorders Please refer to An Introduction to Orthodontics. Fifth Edition. Simon J. Littlewood and Laura Mitchell.  H I S T O R Y A N D C O N C E R N S Patient information and perception Patient age and physical growth status Social and behavioural factors (Ability to attend appointments for a long time, behavioural problems when at school  May mean compliance issues). Patient’s concerns (Expressed in their own words) Patient’s expectations out of tx. Patient concerns vs. Parent/GDP concerns  Will affect motivation Adult patients vs. children patients  Motivation and expectations C L I N I C A L E X A M I N AT I O N C L I N I C A L E X A M I N AT I O N  C L I N I C A L E X A M I N AT I O N E X T R A - O R A L – A P CONCAVE CONVEX Zero Meridian Facial Convexity Assessment Palpation ZM: true vertical line dropped Class II Class I Class III Clinically palpating A point and from soft tissue Nasion. Assesses maxillo-mandibular relationship by B point. Class I:  2-4mm in Class I:  lip: on or slightly exploring facial convexity, determining the angle front of  anterior. Chinpoint: slightly between the middle and lower thirds of the face behind Profile view  C L I N I C A L E X A M I N AT I O N E X T R A - O R A L – V E R T I C A L. Hairline. Glabella. Subnasale. Lowest point on the chin Rule of Thirds Mandibular Plane Angle Face divided into equal thirds: Hairline to Glabella Looking at the point of intersecting lines made up by between the eyebrows (upper third), glabella to the lower border of the mandible (green) and the subnasale (middle third), and subnasale to lowest part Frankfort horizontal plane (yellow) of the chin (lower third) Normal vertical relationship: Intersect at the occiput Decreased: Posterior Increased: Anterior Frontal View Profile View  C L I N I C A L E X A M I N AT I O N E X T R A - O R A L – T R A N S V E R S E Bird’s Eye View Rule of Fifths Comparing left and right halves of the patient’s face to In a face with normal transverse proportions, the face check if they are symmetrical can divided into approximately five equal sections— each the width of an eye Frontal View & Above Frontal View C L I N I C A L E X A M I N AT I O N  C l i n i c a l E x a m i n a t i o n I n t r a - o r a l – O r a l H e a l t h Teeth present need to be noted Pathology (Mucosal, Periodontal, Dental) needs to be identified Evidence of trauma needs to be recorded and further investigated Oral Hygiene needs to be optimal – no tx. can begin before that  C l i n i c a l E x a m i n a t i o n I n t r a - o r a l – E a c h D e n t a l A r c h Crowding or Spacing  C l i n i c a l E x a m i n a t i o n I n t r a - o r a l – E a c h D e n t a l A r c h Alignment Of Teeth (Displacements Or Rotations Of Teeth)  C l i n i c a l E x a m i n a t i o n I n t r a - o r a l – E a c h D e n t a l A r c h Inclination of the Labial Segments  C l i n i c a l E x a m i n a t i o n I n t r a - o r a l – E a c h D e n t a l A r c h Depth of Curve of Spee Affects Space needs when tx. planning  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – A P British Standards Institute Incisor Classification Class I Class II div 1 Class II div 2 Lower incisor edges lie Lower incisor edges lie Lower incisor edges posterior to the cingulum posterior to the cingulum occlude with or lie plateau of the upper plateau of the upper immediately below the incisors and the upper incisors and the upper central incisors are central incisors are cingulum plateau of the proclined or of average retroclined. The overjet is upper central incisors inclination and there is an usually minimal or may be increase in overjet. increased.  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – A P Overjet Horizontal distance between the upper and lower incisors Normal: 2–4 mm.  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – A P Canine Classification Class I: Maxillary canine occludes in the embrasure between mandibular canine and first premolar Class II: Occludes in front of the embrasure Class III: Occludes behind the embrasure  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – A P Molar Classification Class I: The mesiobuccal cusp of the upper first permanent molar falls within the groove between the mesial and middle cusps of the lower first permanent molar Class II: The groove is distal to the cusp Class II: The groove is mesial to the cusp  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – A P Anterior Crossbite An abnormal labiolingual relationship between one or more maxillary and mandibular incisor teeth  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – V E R T I C A L Overbite Vertical overlap of the upper and lower incisors when viewed anteriorly - Normal: One-third to one- half coverage of the lower incisors - Increased: Coverage greater than one-half - Reduced: Coverage less than one-third  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – V E R T I C A L Anterior Open Bite When there is lack of a vertical overlap of the upper and lower incisors when viewed anteriorly  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – V E R T I C A L Lateral Open Bite When there is lack of contact between the upper and lower teeth on only one side  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – T R A N S V E R S E Centrelines - The upper centreline should be coincident with the facial midline - The lower centreline should be coincident with the upper centreline  C L I N I C A L E X A M I N AT I O N I N T R A - O R A L – T R A N S V E R S E Posterior Crossbites A discrepancy in the buccolingual relationship of the upper and lower teeth.  D I A G N O S T I C R E C O R D S Study Models Produced using a technique known as Angle’s trimming  D I A G N O S T I C R E C O R D S Photographs Extra-oral (In Natural Head Position) + Intra- oral Serve as a medicolegal record Short videos may also be useful  D I A G N O S T I C R E C O R D S Dental/Oral Panoramic Radiographs Tomograph (DPT/OPT) To check for: o Presence or absence of teeth o Stage of development of permanent dentition o Root morphology of teeth (root length and existing root resorption) o Presence of ectopic or supernumerary teeth o Presence of dental disease o Relationship of teeth to skeletal dental bases, and the cranial base. Lateral Cephalometric Radiograph  P R O B L E M L I S T RECORDS EXAMINATION HISTORY CONCERNS Problem List Treatment Aims  P R O B L E M L I S T Problem List Treatment Aims Problem List #1 Treatment Aim #1 Problem List #2 Treatment Aim #2 Problem List #3 Treatment Aim #3  P R O B L E M L I S T Problem List Treatment Aims Treatment Plan #1 Treatment Treatment Plan #2 Delivery Treatment Plan #3 Thank you … … for your attention