patient evaluation for orthodontic treatment

Patient evaluation for Orthodontic treatment

Rd Dunia

◊ Importance of evaluating : To provide the best treatment and patient satisfaction , through clinical history , examination investigation and diagnostic aids.

◊ Clinical history / History taking :

1. Patient’s particulars (Name, Age, Sex, Occupation , Contact info. )

2 . Chief complaints

3. History of present illness

4. Dental history previous exposure & attitude of the patient

towards the dentistry, previous experience of extraction, any incidence of fainting, bleeding time etc.

5. Medical history Asthma , Repeated cold, Rhinitis etc . That

persist major obstruction before orthodontic treatment.

6. Family history skeletal class 2 & class 3 , cleft lip & palate,

median diastema.

7. Pre-dental history and Birth history

Birth injury, forceps delivery , measles on 1st trimester causes cleft lip & palate. Accidental injury causes facial asymmetry & other anomalies. Drug induced deformity leads to Down syndrome.

8. Socio-economical condition

● Clinical Examination Extra oral Examination

1. Head forma. Mesocephalic : Averageb. Dolichocephalic : Long & narrowc. Brachycephalic : Broad & Short

2. Face Forma. Mesoprospic : Averageb. Dolichoprospic : Long & Narrowc. Euryprospic : Broad & short

Figure : Head form

Figure : Face form

3. Facial symmetry Following factors causes facial asymmetry Facial paralysisHemifacial atropyHemifacial hyperplasiaTMJ ankylosis

4. Face profilea. Straight , resemble Class Ib. Convex , resemble Class IIc. Concave , resemble Class III

Figure : Facial symmetry

Figure : Face profile

Figure : Facial height

5. Facial heighta. Upper facial height – from bridge of the nose to

lower border of the nose. Proportion 50%b. Lower facial height – from lower border of the nose

to the lower border of the chin.

6. Skeletal patterna. Class I : Filtrum slightly aheadb. Class II: Filtrum moderately aheadc. Class III : Middle finger bend

To examine it, Two finger test is used. Middle finger in mental depression and index finger in filtrum.

7. Lip (Competency , Tonicity , Size , Vermillion border , Color.)

8. Nosea. Nose sizeb. Nasal contourc. Nostrils

Competency :a. Competent lip ● Habitually together ●Habitually apart ●Potentially competentb. Incompetent lipc. Everted lipd. Strap like lower lip

9. China. Mentolabial sulcus : It is a concavity seen below the

lower lip. ●Normal ●Shallow : Bi-maxillary proclaination ●Deep : Class II Division I

b. Chin button : In incompetent lip chin button produced.

Figure : Chin button

Intra oral examination1. Oral hygiene status2. Gingival condition3. Periodontal condition4. Tongue ● Position ● Shape : Bilateral symmetrical or not ● Size : True Macroglossia Relative Macroglossia Microglossia

5. Frenal attachments

7. TeethPresence or absence of teethCaries , fracture , mobilityAngles classificationOver jet , Over biteCross bite , Lock biteCurve of speeFree way space

6.Palate Depth of vault Swelling , ulcer Cleft palate Tori

9.Breathing patternNasal breatherMouth breather

8. Functional examination ○ Maximum mandibular protrusion & retraction ○ Maximum mouth opening : 40 – 45 mm

Model analysis : The study models provide a three dimensional view of maxillary & mandibular dental arches. Model analysis involves the study of the maxillary & mandibular dental arches in all three planes of spaces ( sagital , vertical , transverse planes ).

Carey’s analysis :

Arch length anterior to the first permanent molars : _ _ _ mm

Sum of mesio-distal width of teeth anterior to the first molars (tooth material ) : _ _ _ mm

Discrepancy between tooth material & arch length : _ _ _ mm

Discrepancy Inference

0 – 2.5 mm Proximal stripping

2.5 – 5 mm Extraction of 2nd premolars

> 5 mm Extraction of 1st premolars

Model

A

nalysis

◊ Investigation : 1. Cephalometry 2. OPG 3. Hand-wrist radiograph

Cephalometry : It is a method of assessing the relationship of cranial, facial and dental structure o radiograph which is taken in a standardized manner.

Technique :1. Patient F-H plane should be parallel to floor.2. Ear rod fix the position of the head.3. Orbital pointer is placed for vertical positioning.4. The distance from mid sagital plane of the patient head to the X-ray

tube is fixed at 60 inches or 5 feet.5. The distance from the mid sagital plane to the X-ray plate is fixed 7

inches.

Figure : Cephalometry

OPG : It is used to see the presence or absence of the tooth, position, size , impaction of any tooth , deciduous tooth , supernumerary tooth etc.

Figure : OPG

Hand-wrist radiograph : It is used to see the growth pattern and also used to compare with the dento-facial growth.

Figure : Hand-wrist radiograph

Here are the information required for the patient evaluation for a better orthodontic treatment.

● Reference : http://www.uobabylon.edu.iq/uobcoleges/action_lect.aspx?fid=4&depid=6&lcid=6745Orthodontics: The art and science by S. I. Bhalajhi, 3rd ed.

Textbook of orthodontics by M.S. Rani, 3rd ed. https://www.google.com/

Thank you