Malocclusion Assessment PDF

Assessment of Malocclusion Occlusion: A manner in which the upper and lower teeth intercuspate between each other in all mandibular positions and movements. It is a result of neuromuscular control of the components of the mastication systems...

Assessment of Malocclusion Occlusion: A manner in which the upper and lower teeth intercuspate between each other in all mandibular positions and movements. It is a result of neuromuscular control of the components of the mastication systems namely: Teeth Periodontal structures, Maxilla and mandibular Temporomandibular joints and their associated muscles and ligaments An ideal occlusion Is a theoretical concept based on the anatomy of the teeth & rarely found in nature. The concept is applied to a condition when the skeletal bases of maxilla and mandible are of the correct size relative to each other, and the teeth should be in correct relationship in all three plane of space at rest Bene ts of orthodontic treatment A. Caries Researches have failed to demonstrate a signi cant association b/w malocclusion and caries Clinical experience suggests that in susceptible children with a poor diet, malalignment may reduce the potential for natural tooth-cleansing and increase the risk of decay B. Periodontal disease The association between malocclusion and periodontal disease is weak Its seems logical that irregular teeth would hinder e ective brushing Certain occlusal anomalies may prejudice periodontal support such as : - Crowding - Traumatic overbites - Class III malocclusion An increased dental awareness in patients following orthodontic treatment, may be of long- term bene t C. Trauma to the anterior teeth Researches con rm the association between increased overjet and trauma Individuals with an overjet in excess of 3 mm had more than double the risk of injury Risk is greater in patients with incompetent lips. Patient is more prone to trauma if they have a severe overjet D. Masticatory function Patients with anterior open bites or overjets often complain of di culty with eating Patients with anterior open bites complain that they must avoid sandwiches containing lettuce or cucumber. E. Speech Speech is little a ected by malocclusion IT is multi factorial If a patient cannot attain contact between the incisors anteriorly, this may contribute to the production of a lisp 1 of 5 fi fi fi ff fi ff ffi F. Psychosocial well-being Research has shown that an unattractive dentofacial appearance does have a negative e ect on the expectations of teachers and employers A patient's perception of the impact of dental variation upon his or her self-image, is subject to enormous diversity Some individuals are unaware of marked malocclusions, while others complain bitterly about very minor irregularities Questionnaire/Interview: Patient’s chief complaint Medical and dental history Physical growth status Motivation and expectation Notes: * Be a good listener and give the patient time to talk. * Exact documentation of the patient’s own words. Diagnosis: Collection of information and formation of a problem list. The goal is “Truth” Treatment Planning: Possible solution to the problems that bene t for the patient. The goal is “Wisdom” We asses occlusion in 3 dimensions: - Sagittal - Transverse - Vertical Skeletal: A. Anterior posterior of the : - (Maxilla = Protrusion, retrusion) - (Mandible= retrognathic, prognathic B. Vertical - Maxilla: short or long facial height) - Mandible: (Skeletal open/deepbite) C.Transverse - Buccal/scissor crossbite - Palatal crossbite In class 3, not all of the patient can be diagnosed when it is on a palatial crossbite, we have to take a scans and impression to con rm 2 of 5 fi fi ff Dental: Classifying malocclusion 1. Qualitative assessment of malocclusion A. Molar relationship (most common Angle classi cation) B. Incisor relationship (British standards institute) 2. Quantitative assessment of malocclusion A. Each feature of a malocclusion is given a score - The summed total is then recorded —> PAR Index B. The worst feature of a malocclusion is recorded —> IOTN Index Angle's classi cation - Based on the rst permanent molars which could be used to assess the anteroposterior relationship of the arches Class I or neutrocclusion — the mesiobuccal cusp of the upper rst molar occludes with the mesiobuccal groove of the lower rst molar. In practice discrepancies of up to half a cusp width either way were also included in this category. Class II or distocclusion — the mesiobuccal cusp of the lower rst molar occludes distal to the Class I position. This is also known as a postnormal relationship. (Division 1,the upper central incisors are proclined or of average inclination and there is an increase in overjet. Division 2 ,The upper central incisors are retroclined. The overjet is usually minimal or may be increased.) Class III or mesiocclusion — the mesiobuccal cusp of the lower rst molar occludes mesial to the Class I position. This is also known as a prenormal relationship. 3 of 5 fi fi fi fi fi fi fi British Standards Institute classi cation (will not be asked about this classi cation) Based on incisor relationship and is the most widely used in UK and the commonwealth Class I — the lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors. Class II — the lower incisor edges lie posterior to the cingulum plateau of the upper incisors. There are two subdivisions of this category: Division 1 — the upper central incisors are proclined or of average inclination and there is an increase in overjet. Division 2 — The upper central incisors are retroclined. The overjet is usually minimal or may be increased. Class III — The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed. IOTN index can be used to: Screen Ministry of Health patients for orthodontic treatment Direct the governmental resources to those who need it the most Re-evaluate the accepting criteria according to the available resources Evaluate manpower requirement to treat Ministry of Health patients Peer Assessment Rating (PAR) Developed primarily to measure the success of treatment Scores are recorded using study models Unlike IOTN, the scores are cumulative Scores: crowding — by contact point displacement (×1) buccal segment-in anteroposterior, vertical, and transverse planes (×1) overjet (×6) overbite (×2) centrelines (×4) 1. Angle classi cation - Class I - Class II - Class III 2. Proclination of U/L incisors A. Upper Incisor to SN B. Lower incisor to MP 3. Overjet 4. Crowding: - Space Analysis —> Available space – Required space - Results: - Negative # —> Crowding - Positive # —> Spacing 5. Crossbite 4 of 5 fi fi fi SOFT TISSUE: Anteroposterior, we want two things - Nasolabial angle - Esthetic line Transverse —> Symmetry Vertical: - Facial thirds ( we have to make sure they’re equal) - Incisal show at rest - Upper midline 5 of 5