1. Diagnosis in Orthodontics
Dr. Zuber Ahamed Naqvi

2. Objectives Introduction Diagnostic aids Case history
Clinical examination

3. 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

4. DIAGNOSIS INTERVIEW CLINICAL EXAMINATION DATA BASE
ANALYSIS OF DIAGNOSTIC
RECORDS CLASSIFCATION
PROBLEM LIST PATHOLOGY( CARIES, PERIO)
CONTROL BEFORE ORTHO
TREATMENT
OPTIMAL INTERACTION ORTHODONTIC PROBLEMS
TREATMENT COMPROMISE ( IN PRIORITY ORDER) AND
PLAN COST-RISK / BENEFIT THE POSSIBLE SOLUTIONS
TO INDIVIDUAL PROBLEMS
MECHANOTHERAPY

5. Diagnostic aids Supplemental Essential Specialized radiographs-
Cephalometric 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
Essential
Case history
Clinical examination
Study models
Radiographs-
periapical
Bitewing
panoramic
Facial photographs

6. Case history 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:
impaired dentofacial esthetics that can lead to psychosocial problems
impaired function, and
desire to enhance dentofacial esthetics and thereby the quality of life

7. Case history Information should be sought in three major areas:
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
early fractures of the condylar neck of the mandible
trauma to the teeth
long-term medication
Osteoporosis , uncontrolled diabetes contraindicates orthoodntic treatment

8. 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

9. 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.

10. Clinical Evaluation
There are two goals of the orthodontic clinical examination:
to evaluate and document oral health, jaw function,facial proportions and smile characteristics; and
to decide which diagnostic records are required.
The clinical examination can be devided to:
Morphological (extraoral and intraoral)
Functional

11. 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.

12. 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.

13. Facial index
The proportional relationship of facial height to width (the facial index).
Index Measurements Male Female
Facial n-gn/zy-zy (5.1) (4.6)
Mesoprosopic- average
Euryprosopic - broad and short
Leptoprosopic – long and narrow

14. 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.

15. Profile Analysis Goals of facial profile analysis:
Establishing whether the jaws are proportionately positioned in the anteroposterior plane of space.
Evaluation of lip posture and incisor prominence
Re-evaluation of vertical facial proportions and evaluation of mandibular plane angle.

16. Evaluation of lip posture and incisor prominence
The teeth protrude excessively -
the lips are prominent and everted, and
the lips are separated at rest by more than 3 to 4mm (lip incompetence)

17. Intraoral examination
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
Permanent dentition- count the number of teeth
In mixed dentition the orthopantomogram is necesary .

18. 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

19. Evaluation of Jaw and Occlusal Function
Three aspects of function require evaluation:
Mastication (including but not limited to swallowing),
Speech, and
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.

20. 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.

21. 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.

22. 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

23. Orthodontic records fall into three major categories.
Those for evaluation of the:
health of the teeth and oral structures
alignment and occlusal relationships of the teeth
facial and jaw proportions

24. 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

25. 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.