5. Angle classification extension
Class II division 1:
Narrowing of the upper arch, lengthen and protruding UC.
Abnormal function of the lips, nasal obstruction, mouth
breathing.
Class II division 1 subdivision: class I on one side.
Class II division 2:
Crownding, overlaping and lingual inclination UC
Normal nasal and lip function
Class II division 2 subdivision: class I on one side.
Class III subdivision: class I on one side.
Mild class II: between class I and class II
Mild class III: between class I and class III
5
13. Six keys Andrew
1. Molar relationship :
Class I Angle
Cusp‐embrasure relationship buccally
Cusp‐fossa relationship lingually
2. Crown angulation:
All tooth crowns are angulated mesially (mesio‐distal tip)
3. Crown inclination:
Incisors are inclined labially
Upper posterior teeth are inclined lingually, similarly from
the canine to the premolars; upper molars are inclined
slightly more than the canine and the premolars.
13
15. Lower posterior teeth are inclined lingually,
progressively from canine to molars
4. Rotations:
Rotations are not present
5. Spaces
Spaces are not present between teeth
6. Curve of Spee
The plane is either flat or slightly curve
15
36. DIAGNOSIS
Collect data
Orthodontic questionaire
Clinical examination
X‐rays : POG and CEP
Models
Pictures
Cephalometric analysis
Model anlysis
→ Diagnosis: problem list
36
40. Medical conditions to be considered in
orthodontic treatment
Medical condition Implications Action
Asthma Root resorption Monitor every 6 mo for evidence
of EARR
Allergies Allergic reaction Determine materials causing
allergy
Coagulation disorders Bleeding risk Extraction?
Diabetes Periodontal disease Monitor adequate control of
diabetes
Epilepsy, High blood Gingival Plaque control, gingivectomy if
pressure hypertrophy necessary
Heart valve conditions Endocarditis Premedication when extraction,
fitting bands
Rheumatoid arthritis TMJ degeneration Monitor TMJ
Xerostomia Caries Fluoride supplement
40
42. GROWTH STATUS: (child patients only)
Height__________ cm Weight _________kg
Females: Has the patient started her menstruation?
__ Yes __ No. If yes, at what age? ________
Males: Voice changes? __ Yes __ No
Facial hair growth? __ Yes __ No
Has the patient had any recent rapid growth? ___________
If so, how much?_______________
42
43. Rational for Orthodontic questionaire
Chief complaints
Determine patient’s motivation, expectation
Medical and Dental history
Reveal the causes of problems
Relation between the patient’s conditions and
orthodontic treatment
Growth and development
Timing of orthodontic treatment
43
44. CLINICAL EXAMINATION
Esthetic analysis
Macro esthetics: facial proportion
Mini esthetics: tooth – lip relationships
Micro esthetics: dental appearance
Functional analysis
TMJ
Occlusion
Periodontal health
Bad habit
44
45. Macro esthetics: facial proportion
General view
Dolicofacial, brachyfacial, mesiofacial →
Frontal view
Vertical
Proportion
Chin height
Lower face height
Horizontal
Proportion: rule of fifth
Midline asymmetry
45
48. The lower third @
A. Increase face height:
Dolicofacial pattern
Vertical maxillary excess (VME) ♦
High lip line: anterior teeth display too much
Gummy smile
Lip length: normal
≠ Short lip ♦
Excesssive chin height ♦
B. Decrease face height
Brachyfacial pattern
Vertical maxillary deficiency
Mandibular defienciency ♦
Short chin height ♦
48
80. Open bite
Principle: Teeth erupt until they hit something.
Open bite: the lower
incisor does not contact
the upper incisor. There
are obvious open bite
cases where the teeth are
separated in the anterior.
In some class II cases
where the amount of
overlap of the upper
incisor vs. the lower
incisor is normal (1/3
coverage), but the lower
incisor does not contact
the tooth nor the palate.
80
81. Tongue thrust
A test for anterior tongue thrust is to:
Take a small sip of water.
Close the teeth together with the lips open.
Swallow.
A patient with an anterior tongue thrust will either:
Not be able to keep his/her lips open.
Will tilt his/her head back for gravity to keep the water from squirting
forward.
Will squirt the water between the teeth forward onto their shirt (child
patient).
A good exercise to give a patient with an anterior tongue thrust
(especially in the presence of open bite or excess anterior overjet) is:
Take a small sip of water.
Close the teeth together with the lips open.
Swallow with the throat muscles. Tell the patient to hold their hand
on their throat as they learn this exercise to feel the muscle
contraction.
81
98. Cephalometric analysis – Skeletal
Description Measurement Mean Range
Pal. plane to Md. Plane: Skeletal ANS‐PNS to Md. plane 280 Closed 240 – 330 Open
Open/closed
Md. Plane angle: Skeletal Open/closed FH – MA: Child 260 Closed 200 – 300 Open
Adult 220 240 – 330
Y – Axis Vert/Hor Growth SGN ‐ FH 590 Hor. 570 – 620 Vertical
Maxilla to Cranium N ⊥ A +1mm Retruded ‐1 to +3 Protruded
Maxilla to Cranium SNA 820 Retruded 760 – 830 Protruded
Mandible to Cranium N ⊥ Po : Child ‐7mm Retruded ‐10 to ‐4 Protruded
Adult ‐1mm ‐4 to ‐1
Mandible to Cranium SNB 790 Retruded 750 – 830 Protruded
Maxilla to Mandible ANB 20 Class I : + 20 to +4.50
Class III tendency: +0.50 to +1.50
Wits A, B ⊥ Occlusal plane 0 mm Class I : ‐1 to +2
98
111. DETERMINE THE PROBLEMS
Kind of problems:
Dental problems
Skeletal problems
Facial problems
Occlusal problems
TMJ problems
Periodontal problems
Causative factors
Degree of problems
111
112. Ackerman and Proffit diagram
Aligment (spacing and crowding)
Profile (convex, straight, concave)
Sagittal deviation (Angle class)
Vertical deviation (deep bite, open bite)
Transsagittal deviation (combine Angle class and cross
bite)
Sagittovertical deviation (combine Angle class and deep
bite or open bite)
Verticotransverse deviation (combine cross bite and deep
bite or open bite)
Transsagittovertical deviation (combine of problems in
three planes of space)
112
115. Intra‐arch problems
Position :
Protrusion or retrusion of incisors
Malposition
Impaction
Rotation
Angulation
Inclination:
Procline or recline
Spaces:
Spacing or crowding
Curve of Spee
115
116. Inter‐arch problems
Molar relationship
Class I, II, III
Canine relationship
Class I, II, III
Vertical relationship:
Overbite, deep bite, open bite
Horizontal relationship:
Overjet, end‐to‐end, anterior crossbite.
Posterior crossbite
Upper and lower incisor angulation
Inter‐arch discrepancy
Midline relationship:
Midline asymmetry
116
117. Causative factors
Spacing
Large jaw
Small teeth
Missing teeth
Lateral over‐expansion of arches or forward proclination of
anterior teeth.
Crowding
Small or constricted arches
Large teeth
Retroclination
Mesial drift of posterior teeth
117
118. Openbite
Bad habit: thumb sucking, finger sucking or pacifier
using, tongue thrush, lip habit.
High tongue posture
Airway obstruction: allergies, enlarged tonsils,
adenoids, septum problem…
Intracapsular TMJ problems
Skeletal growth abnormalities
118
119. Diagnosis of Impacted Teeth
Impacted Teeth : not erupted for 2 years following the
normal eruption age.
The eruption path is blocked, or if the eruption stops after
the tooth strays to a position labial or lingual to another
tooth.
The most common impaction: the upper canine.
DIAGNOSIS OF AN UPPER IMPACTED CANINE
Panoramic x‐ray: Any overlap of the canine crown with the
lateral incisor roots → impaction?.
Palatal or labial?
Palpate the labial tissue
Occlusal x‐ray
119
120. Crowding and impacted tooth
The "impacted tooth" may be BLOCKED OUT of the
arch because of crowding: in a good position but
cannot erupt due to a lack of space →blocked out.
Evaluate the root formation to determine eruption
potential: incomplete root formation → eruption
potential.
Tx: space is made with open coils or extraction and a
deadline # 12 months is set to wait for its eruption.
120
122. Degree of problems:
Diagnostic Parameters
1. Canine and molar relationships: RM, RC, LM, LC
2. Angle classification
3. Overbite
4. Overjet
5. Stage of dental development
6. Presence of crossbite: with or without functional
shift
7. Space analysis
8. POG interpretation
9. CEP interpretation
122
123. 1. Canine and molar relationships: RM, RC, LM, LC
a. Class I
b. Class II*
c. Class III*
d. Not fully erupted
2. Angle classification
a. Class I malocclusion
b. Class II malocclusion, division 1, 2 and subdivision*
c. Class III malocclusion, subdivision*
123
124. 3. Overbite
a. Normal (5 % ‐ 20%)
b. Moderate deep bite (20% ‐ 50%)
c. Severe deep bite ( > 50%)*
d. Edge to edge
e. Anterior open bite
4. Overjet
a. Normal (1 – 3mm)
b. Excessive ( > 3mm)*
c. Edge to edge
d. Underjet (negative overjet)
124
125. 5. Stage of dental development
a. Deciduous dentition
b. Early Mixed dentition
c. Late Mixed dentition
d. Permanent dentition
6. Presence of cross bite: with or without functional shift
a. None
b. Anterior
c. Posterior
d. Both
125
126. 7. Space analysis
a. Adequate arch length ( +1 to ‐1mm)
b. Mild crowding (‐2 to ‐3mm)
c. Moderate crowding (‐4 to ‐6mm) or Severe (> ‐6mm)
d. Mild spacing (1 – 3mm)
e. Moderate spacing (4 to 6mm) or Severe (> 6mm)
8. POG interpretation
a. Normal
b. Abnormal: missing, supernumerary, ectopic, impacted
tooth)
9. CEP interpretation
a. Normal
b. Beyond the normal range: 1 SD
c. Beyond the normal range: 2 SD
d. Beyond the normal range: 3 SD
126