ORTHODONTICS

IV
LECTURE 1
ORTHODONTIC PATIENT
EXAMINATION

Mohammed jaradat
BDS,MSc(ortho),Jord-Board, Pal-Board
THE PATIENT INTERVIEW/CONSULTATION :

• The three main areas that need to be addressed during the

patient interview/consultation appointment are:-
• 1- the chief complaint
• 2- medical and dental history,
• 3- and growth potential prediction.
CHIEF COMPLAINT:-

• Chief Complaint:- The clinician must identify the main reason why the patient is seeking treatment,
and this should be noted and documented in the chart in the patient’s own words.
• The list of chief concerns should be established and noted in order of importance .
A good Orthodontic treatment planning should not only achieve
the orthodontic treatment goal but also should satisfy the
patient’s primary needs.
MEDICAL AND DENTAL HISTORY:-

• Medical and Dental History:- A careful and full medical and dental history is necessary to provide
a thorough background on the patient’s overall health status .
• It is important to discuss any medications the patient may be taking, since some may have an effect
on orthodontic treatment.
uncontrolled diabetes,
Bisphosphonates
chronic use of high-dose prostaglandin inhibitors for
management of arthritis in adults may interfere with
orthodontic tooth movement.

Extractions may be contraindicated in patients with hemophilia.

latex allergic patients must be identified.

IDENTIFY
LATEX
ALLERGIC
PATIENTS
3- GROWTH POTENTIAL PREDICTION

• Growth Potential Prediction The patient (or accompanying adult(s)) should be asked questions
about recent changes in clothes/shoe sizes, signs of sexual maturity (achievement of menarche in
girls) and age of sexual maturation in older siblings.
• Look for signs of secondary sexual characteristics, and take note of the patient’s height and weight
compared to siblings and parents, as this will tell you whether the patient has reached the onset of
puberty, is at the peak of his or her growth spurt, or if the growth spurt has ceased altogether.
• Orthodontic correction can benefit from rapid growth during adolescence, whereas growth
modification may not be feasible if a child is over the peak of the growth spurt.
EXTRAORAL EXAMINATION

• Extraoral Examination
• The facial analysis is conducted with the patient either sitting upright or standing, not reclining in a
dental chair. The analysis must consider the frontal plane, facial midlines and lip competency.
• Frontal Plane The proportional relationship between facial height and width is the first step in
facial evaluation. The three characteristic categories of facial type are :-
• dolichofacial (facial height > facial width, long faces),
• mesofacial (facial height proportional to width)
• and brachyfacial (facial width > facial height, square faces).
PATIENT
SHOULD
NOT BE
RECLINING
IN A DENTAL
CHAIR.
• The facial one-fifths are determined by
vertical lines going through the helix of the
outer ear, the outer canthus of the eye and
the inner canthus of the eye.
• The line through the inner canthus of the eye
should pass through the lateral aspect of the
alar base of the nose, and all five segments
should be one eye distance in width. This
can also aid in evaluation of facial symmetry
 THE FACIAL THIRDS ARE DETERMINED BY
EVALUATING THE DISTANCES FROM THE HAIRLINE
(TRICHION) TO THE PROMINENT RIDGE BETWEEN THE
EYEBROWS (GL = GLABELLA), THE GLABELLA TO THE
BOTTOM OF THE NOSE (SN = SUBNASALE), AND THE
BOTTOM OF THE NOSE TO THE CHIN POINT (ME =
MENTON) .

THESE DISTANCES SHOULD BE EQUAL.

THE MOUTH SHOULD BE A THIRD OF THE WAY

BETWEEN THE BASE OF THE NOSE AND THE CHIN .
LIP COMPETENCY :THE UPPER AND LOWER LIPS SHOULD IDEALLY BE TOUCHING OR REMAIN APART UP TO 3-4 MM WHILE THE PATIENT IS IN A RELAXED POSITION (I.E., WITH NO STRAINING OF LIPS OR CHIN TO CLOSE THE
MOUTH).

PATIENTS WITH A SHORT UPPER LIP (SHORT PHILTRUM) TEND TO “STRAIN” THEIR LIPS IN ORDER TO CLOSE THEM AND HAVE AN INTERLABIAL GAP OF MORE THAN 4 MM AT REST. BESIDES INDICATING A SHORT PHILTRUM,
THIS CAN ALSO BE INDICATIVE OF PROTRUSIVE INCISORS (WHILE JAWS ARE IN THEIR NORMAL POSITION), NORMALLY INCLINED TEETH BUT MANDIBULAR RETROGNATHISM (THE MANDIBLE BEING FARTHER BACK THAN
THE MAXILLA), NORMALLY INCLINED TEETH BUT MAXILLARY PROGNATHISM (THE MAXILLA BEING FARTHER FORWARD THAN MANDIBLE), A COMBINATION OF BOTH MANDIBULAR RETROPROGNATHISM AND MAXILLARY
PROGNATHISM, OR A LONGER THAN NORMAL LOWER FACE WITH OR WITHOUT AN ANTERIOR OPEN BITE. IN ADDITION TO LIP STRAIN, THESE PATIENTS CAN PRESENT WITH A DEEP MENTOLABIAL SULCUS AND AN
ACCOMPANYING HYPERACTIVE MENTALIS. HYPERACTIVE MENTALIS TYPICALLY SHOWS UP AS AN “ORANGE PEEL” APPEARANCE OF THE SOFT TISSUE AROUND THE CHIN POINT.
SMILE LINE AND GINGIVAL DISPLAY.

• Ideally, there should be about 1-2 mm of soft tissue apparent

on smiling in this view with 75%- 100% of the upper
incisor’s crown.
LOW SMILE LINE
A below-average gingival display may indicate vertical maxillary deficiency or long philtrum.
THE SMILE ARC

• The smile arc is basically the contour of the incisal edges of the maxillary incisors relative to the
curvature of the lower lip while smiling.
• If these two lines match each other, the smile arc is called “consonant” It has been shown that lay
people prefer a consonant smile arc to one that is considered flat.
FACIAL MIDLINES

• -First and foremost, the presence of any nasal deviation must be identified because this will affect
your perception of dental midlines. If a deviation exists, then the midlines should be examined
relative to an imaginary straight line (or an actual piece of string held vertical in front of the face)
from the soft-tissue glabella. Ideally, this piece of string or imaginary line should pass through the
soft-tissue glabella, the philtrum of the upper lip and the soft-tissue chin point. This will aid in
determining any asymmetry of the face.
THE MAXILLARY DENTAL MIDLINE SHOULD COINCIDE WITH THE FACIAL MIDLINE AND THE
MAXILLARY AND MANDIBULAR DENTAL MIDLINES SHOULD COINCIDE WITH EACH OTHER.
THE MANDIBULAR DENTAL MIDLINE SHOULD COINCIDE WITH THE SOFT-TISSUE CHIN
POINT. DEVIATED CHIN POINTS MAY ALSO EXIST, AND THIS SHOULD BE TAKEN INTO
CONSIDERATION .
PROFILE

• The same three lines drawn on the frontal plane can be extended to this photograph. Additionally,
the Esthetic line of Ricketts (E-line) should be drawn from the tip of the nose to the chin. This helps
determine the positions of the upper and lower lip in relation to the E-line. Note that this relationship
is directly affected by the size of the nose and chin anteroposteriorly. Patients should be asked to
have their lips relaxed when taking this image. Typically, the upper lip should be 4 mm, and the
lower lip 2 mm, behind the E-line. The prominence of the incisors can affect the patient’s profile
appearance. Bimaxillary dentoalveolar protrusion explains the situation where the incisors are
protruded beyond their normal inclination, while the jaws are in their normal position
• To establish whether the jaws are proportionally positioned in the anteroposterior plane, a line is drawn on the
profile from the bridge of the nose to the base of the upper lip, and another one from that point down to the chin.
These two lines should form a straight line. If the angle formed between these is less than 180 degrees, the patient
has a convex profile with the chin being behind the bridge of the nose (posterior divergence), while a wider angle
indicates a concave profile (anterior divergence). Facial divergence is directly influenced by ethnic background, with
American Indians and Asians presenting with anteriorly divergent faces while Northern Europeans typically present
with posterior divergence. Vertical facial proportions can also be assessed with the profile image. By placing a finger
or an instrument along the lower border of the mandible, the mandibular plane angle (the angle formed by the
inclination of the mandibular plane to true horizontal) can be evaluated. Patients with long vertical facial dimensions
(dolichofacial) usually have steep mandibular plane angles and a skeletal open bite tendency. Conversely, patients
with short vertical facial dimensions (brachyfacial) usually have flat plane angles and deep bite malocclusions.
• The nasolabial angle (NLA) is very helpful in determining the final treatment plan customized for
the patient. This angle is produced by two lines: one tangential to the columella of the nose (the part
of the nose between the base of nose and the nasal tip) and the other tangential to the stomion
superius (the highest point on the upper lip). Wherever these two lines meet forms the NLA. This
angle relates the upper lip to the columella line. Typically, the measurement in a Caucasian patient is
between 90 and 110 degrees. Anything less than 90 degrees is considered an acute NLA and
anything greater than 90 degrees an obtuse NLA
INTRAORAL EXAMINATION

• Oral Health:
• Ascertain whether the patient is currently under a dentist’s care. The patient must have clearance from the
general dentist stating that a full clinical examination, including any needed X-rays, has been conducted;
that
• any dental caries has been treated;
• and that a cleaning as well as fluoride treatment, if needed, has been completed.
• All teeth must be accounted for to rule out any missing or supernumerary teeth.
• A thorough examination of the lips, oral mucosa, tongue and floor of the mouth and visual caries detection
must be performed for every patient.
INTRAORAL OCCLUSAL
• Overjet is the horizontal distance in millimeters between the facial surface of the lower anterior teeth
and the lingual surface of the upper anterior teeth .
• Based on the amount of overlap, you may get different overbite and overjet values, depending on
which incisor you do your measurement from. Typically, the largest number is recorded.
BSI CLASSIFICATION
.
.
FRONTAL VIEW

• In open-bite cases, the resulting number is negative.

TRANSVERSE RELATIONSHIP
Thank You
REFERENCES

• Contemporary orthodontics, 6th edition