diagnosis and treatment planning of malocclusion orthodontic department of xi'an jiaotong...

Diagnosis and Treatment planning Of Malocclusion

Orthodontic Department Of Xi'an Jiaotong

University Medical College Dental Hospital

Accurate diagnosis of Orthodontic problems comes from the detailed clinical examination, data analysis and comprehensive evaluation. The correct treatment program can be planed after an adequate diagnosis of malocclusion. Therefore, the correct diagnosis and treatment plan of Orthodontic problems play an important role in the whole treatment process.

Diagnosis Of Malocclusion

Interview

Clinical Exam

Analysis of Dx Records

Diagnosis (Problem list )Database Classification

Pathology (caries, perio, etc.)

Control before orthodontic treatment

Orthodontic problems

Priority order, A, B, C, D, etcpossible solution treatment plan

concept

Treatment plan details

Treatment goals

Patient parent Consult

Interaction compromise cost/benefit other factors

Patients with the general situation : Including the patient's name, sex, nationality, date of

birth, birthplace and occupation information.

Chief complaint and medical history Chief Complaint: Patient's chief complaint of all orthodontic treatment are the basic starting point, usually treatment plan begins to develop according to the chief complaints of patients.

History: including past history, present history and genetic history

1. Clinical examination

Chief complaint and medical history

1. The Jaw’s traumatic may cause temporomandibular joint adhesions, so it could be difficult for jaw to move and develop.

2. Dental trauma may cause the teeth adhere to the alveolar bone,

so it makes the tooth move difficult.

3. long-term Systemic chronic dyspepsia may affect the normal bone tissue reconstruction in the movement of the teeth, which may lead to the loosening of mobile teeth.

Clinical examination

Facial examination

Facial profile

from the Height of facial to points: a long face, short face, normal face. From the surface profile of the degree to sub-process: straight,

convex , concave . Symmetry To the hypothetical median sagittal plane for the evaluation of the baseline, normal, nasal ridge, nasal tip, upper lip beads, submental vertex, arch basically located in the center line on this plane. Right and left eyes, ears, zygomatic process, nose, mouth, mandibular angle and a corresponding symmetrical teeth are symmetrical.facial Ratio Vertical ratio

left and right ratio Evaluation of facial : photographs, body measurements, X-

cephalometry

Profile typeProfile type

The profile is divided into before and after the relative position according to the soft tissue glbella, the nose, pogonion of soft : straight type, concave type, convex type

Dentition examination

a, The development stage of occlusion: deciduous , dentition, permanent occlusion. The relationship between occlusion and age. Development of teeth and condition. Replacement of teeth, the tooth-loss situation.

b, the basic situation of dentition: the number, shape, size, color, developmental status and caries status of the teeth.

c, abnormal dentition parts: the part of crowded, misplaced, reversing, the open bite occlusion, lock bite occlusion and other malformations.

Dentition examination

d, molar relationship: Class I, II, III category of relations, also known as the neutroclusion, distoclusion and mesioclusion.

the two latter can be divided into full and cusp-cusp relationship

e, canine relationship: can also be divided into the

neutroclusion, distoclusion and mesioclusion.

f, anterior relationship: Overbite Over jet

Class I

Class II

Class III

OverbiteOverbite

normalnormal ：：1/31/3

1/2>I1/2>I 度度 >1/3>1/3

2/3>II2/3>II 度度>1/2>1/2

IIIIII 度度 >2/3>2/3

1/3 Over jetOver jet

Normal:3.0mmNormal:3.0mm

II 度度 3-5 mm3-5 mm

IIII 度度 5-8 mm5-8 mm

IIIIII 度度 > 8 mm> 8 mm

gg 、、牙周情况牙周情况 Slight periodontal lossSlight periodontal loss: loss of attachment < 1/4 : loss of attachment < 1/4

of the root length of the root length Moderate periodontal lossModerate periodontal loss: loss of attachment : loss of attachment

1/4 to 1/3 of the root length 1/4 to 1/3 of the root length Severe periodontal lossSevere periodontal loss: loss of attachment > : loss of attachment >

1/3 of the root length 1/3 of the root length Severe complicated periodontal lossSevere complicated periodontal loss: loss of : loss of

attachment > 1/3 of the root length combined attachment > 1/3 of the root length combined with intra -osseous defect.with intra -osseous defect.

hh 、、 Spee`sSpee`s 曲线曲线

牙列的检查牙列的检查

Spee`s 曲线

Oral function and temporomandibular joint

a, opening /closed type and the opening /closed degree

bb 、、 CR-CR-

COCOc, tongue function

d, masticatory function

e, swallowing function

f, the pain and Snapping of temporomandibular joints

Physical growth evaluationPhysical growth evaluation

We should have a clear understanding for each patient's growth and development status, as the same abnormal performance, when the growth and development status is not the same, the treatment methods used may be different.

Evaluation of growth and development mainly relies on the physiological characteristics of patients, such as the bone age, the dental age and the secondary sexual characteristics.

A radiograph of the hand and wrist

Far from the middle section of the

middle finger epiphysis

The medial sesamoid of thumb

Radial epiphysis

Body height

Body height

Psychological SituationPsychological Situation

In recent years, orthodontic patients at the psychological situation increase gradually. The patients which exist psychological situation usually exceed the normal requirements of the scope in the treatment, and he could be very sensitive about the existence of malocclusion, exaggerate in understanding the abnormal performance, be urgent for treatment and require a higher treatment sometimes exceeding the normal scope.

Oral health assessment (dental caries, gingivitis, periodontal disease, etc.)

Orthodontic appliance will reduce the function of self-cleaning, the existed dental caries, gingivitis, etc must be treated before the appliance fixed to the teeth, otherwise the development of the disease may be aggravated.

the role of study cast at orthodontic treatment: 1. Record real teeth, alveolar bone, the palate and the base bone morphology and location. 2.Dentofacial deformity analysis conducted 3. Comparison in the course of treatment

4. Compared the efficacy before and after treatment 5.One of the essential legal basis

The requirements for study cast 1. The cast should be extent possible, the extension of the maximum displacement of the soft tissue can reflect the situation in bone matrix. Generally it doesn’t carry out amendments to the soft tissue. The cast should include teeth, alveolar process, based bone, transitional fold, hard palate and lace cap, backwards be included maxillary tuberosity and molar pad nodule. 2.Cast must be accurate, clear and beautiful, and be able to reflect the patient's occlusion.

Second, cast analysis

Cast Analysis

Cast analysis

Arch Length analysis: arch length is divided into three sections, the previous length, the middle of the length and

posterior segment length. Arch Perimeter

dental space Analysis : Arch Required Arch Available

Arch space= Arch Required - Arch Available

·

A

B

A the previous length,B the middle of the length and

Cast Analysis

Cast analysis

Mixed dentition space analysis

prediction of Arch Required

estimation from radiographs estimation from Moyertables

Tanaka-Johnston prediction method

Arch Available measurement

Estimation from radiographs

The space between the demand for the four incisor according

to their distance from mesial to distal .

Uneruption of canine, premolar measurements

x =

y₁

y x₁

Conventional space analysis does not include the location of lateral incisor and profile.Analysis only shows the lack of coordination, do not reveal the location of coordination.

Moyer prediction table

Use four mandibular incisor to estimate the distance of lower , the maxillary canine, premolar from mesial to distal .But this estimate has a tendency to over-estimate.

Low incisor 19.5 20.0 20.5 21.0 21.5 22.0Low incisor 19.5 20.0 20.5 21.0 21.5 22.0 maxillary 20.6 20.9 21.2 21.3 21.8 22.0 mandibular 20.1 20.4 20.7 21.0 21.3 21.6

Tanaka and Johnston 预测法

Mandibular canine and premolars in one quadrant

can be calculated by adding 10.5 mm to half of the

measured mesiodistal width of the four mandibular

incisors. 下颌： 2112+10.5 = 345

Maxillary canine and premolars in one quadrant can

be determined by adding 11.0 mm to half of the

measured mesiodistal width of the four mandibular

incisors. 上颌： 2112+11.0 = 345

Tanaka and Johnston 预测法

Mandibular canine and premolars in one quadrant can be calculated by adding 10.5 mm to half of the measured mesiodistal width of the four mandibular incisors. manibular ： 2112+10.5 = 345

Maxillary canine and premolars in one quadrant can be

determined by adding 11.0 mm to half of the measured

mesiodistal width of the four mandibular incisors.

maxillary ： 2112+11.0 = 345

Cast Analysis

Bolton Index Bolton index refers to the former upper and lower teeth crown width ratio of the sum of all relations and with the upper and lower dental arch crown width ratio of the sum. Bolton index used to diagnose patients with upper and lower teeth do not tune the width of the problem.

Anterior than = 6 mandibular anterior teeth crown width / 6 maxillary anterior teeth crown width

all teeth than = 12 mandibular tooth crown width / 12 maxillary teeth crown width × 100%

The discrepancy of Bolton index may cause the malocclusion of anterior teeth, such as overcrowding, deep overbite ,deep over jet and so on.

Bolton Analysis

Model Analysis

curves of Spee

Measurement Methods: The ruler placed on the side of mandibular incisor teeth with the last mandibular molar on the cuspal, measure the distance between the lowest point and the ruler. Both sides of the measured value divided by the sum of two, plus 0.5mm is the correct curve of Spee `s required by the space.

Spee`s 曲线

Curve of Spee

Flat Deep

Model Analysis

Analysis of dental arch symmetry

Palate wrinkle method: In the first wrinkle on the palate and the last one to take the midpoint, make the connection between the two points and extended to measure both sides of the dental arch distance from this line to diagnose the dental arch symmetry.

Coordinate Measuring : Coordinates the center line of plate aligned with the palate raphe, then measures both sides of the teeth before and after the location of buccolingual position.

Model Analysis

Width evaluation

Arch width can be divided into three parts:

The preceding width (inter-canine width)

Middle arch width (first premolar width of the central inter-nest)

Posterior segment arch width (the first permanent molars between the width of the central nest)

the preceding width

Middle arch width

Posterior segment arch width

Model Analysis

Pont's index

1909 Pont made an ideal arch width of the prediction methods. with the sum of four maxillary incisors divided by first premolar and first permanent molars, in the multiplied by 100, to arrive at a fixed index.

Pont's index is Obtained as follow

（ S ） ×100 /80 = Ideal interpremolar width（ S ） ×100 /64 = Ideal intermolar width （ S ） =sum of the diameters of the four maxillary incisors

上和四个切牙宽度之和

理想第一前磨牙间宽度

理想磨牙间宽度

上和四个切牙宽度之和

理想第一前磨牙间宽度

理想磨牙间宽度

18 22.5 28.1 28.5 35.5 44.5

20 25 31.94 29 36 45.3

20.5 25.5 32 29.5 37 46

21 26.25 32.82 30 37.5 46.87

21.5 27 33.27 30.5 38 47.6

22 27.5 34 31 39 48.4

22.5 28 35 31.5 39.5 49.2

23 28.75 35.94 32 40 50

23.5 29.5 36.88 32.5 40.5 50.8

24 30 37 33 41 51.5

24.5 30.5 38 33.5 42 52.3

25 31 39 34 43 53

25.5 32 39.8 34.5 43.5 53.9

26 32.5 40.9 35 44 54.5

26.5 33 41.5 36 45 56.4

27 33.5 42.5 37 46.25 57.8

27.5 34 42.96

28 35 44

Pont `s indexPont `s index

Model Analysis

alveolar bone Analysis :

Base bone: mandibular arch formed, namely, dental periapical alveolar arch. base bone is stable based alveolar bone, and won’t change due to the tooth’s movement or loss.

Alveolar bone: It is the bone tissue which is on the top of the base bone surrounding the teeth. It is between the teeth crown and the base bone. Alveolar bone may change due to the tooth’s movement or loss.

Model Analysis

Diagnostic set -up

Cutting down each tooth which will be on the malocclusion crowded model and arrange with an ideal location in order to diagnose if the adequacy of base bone length to accommodate existing teeth. And then decide whether or not to extract tooth and predict the location of tooth movement and direction, showing efficacy.

Model Analysis

The step of diagnostic set –up

1) Make an accurate record of occlusal relations, marking a centerline. 2) Marked all the teeth with pencil . 3) To saw along the contact point, not damage tooth crown width. 4) To saw all the teeth at the same level of the root side. 5) Rearrange the sawed teeth according to dental arch size and shape of the teeth as the treatment plan says, and fix with sticky wax.

Three, X-cephalometry

X-cephalometry is a study method by the United States of Broadbent and Germany in the 30's .The method used to study Hofrath Craniofacial Growth and malocclusion combined with bone disorders. The modern theory about growth and development comes from the majority study of x-cephalometry.

X- 线头影测量的发展 1920, 1920, Dr B.Holly Broadbent SrDr B.Holly Broadbent Sr interesting in the interesting in the

face change by Angle`s treatment. face change by Angle`s treatment. Dr T Wingate Dr T Wingate

ToddTodd had collected many skulls and had used had collected many skulls and had used Todd Todd

craniostatcraniostat to measure human face. to measure human face. 19241924, , BroadbentBroadbent transformed Todd craniostat into transformed Todd craniostat into

first craniometer byfirst craniometer by adding a metric scale. adding a metric scale. Todd emphasized investigation must be performed Todd emphasized investigation must be performed

on health living children.on health living children. During these years of skeletal study, lateral jaw and During these years of skeletal study, lateral jaw and

craniofacial radiographs were made by Todd, Hill craniofacial radiographs were made by Todd, Hill and Thomas, while and Thomas, while Broadbent Broadbent used it in clinic.used it in clinic.

Craniofacial growth and development in the study, based on the method will soon be used to evaluate the craniofacial morphology, the proportion of the anatomical distinction between basic mistake occlusion. Through the x-cephalometry study, it is recognized that most of the mistake occlusion jaw position and the teeth are compensatory or the result of the interaction between adaptation. The location of possible jaw disorders through the teeth to achieve the normal compensatory .

X-cephalometry applications.


Normal bone was found on the teeth can also occur malocclusion. Moderate bone disorders with moderate dental disorders can become a serious malocclusion , therefore, in the tooth model on the same mistake appears malocclusion , probably completely different in the x-ray analysis, the patient may have a completely different facial type.


X-cephalometry study are the clinical treatment course of teeth, jaw, face changes in the primary means of treatment before, during and after filming ,a series of x-ray film to overlap to study changes in the location of mandibular teeth. However, such changes include the both parts about growth ,development and treatment .At present , it is very difficult to determine which are part of the growth and development, which are treatment according to the current knowledge and technology.


In addition to analyzing the relationship between different periods of time outside of the craniofacial, x-cephalometry also the prediction for the growth and development, it is estimated that the future growth of the facial trend-type. If the prediction and treatment of unforeseen changes in the framework will result in combined treatment plan, or blueprint known as the orthodontic treatment - VTO, become a specific therapeutic purposes. Thus promote the development of x-rays cephalometry analysis.


In order to achieve X-cephalometry individuals comparing with similar groups, it is necessary to establish the same race, same sex, same age the average measured value. Downs suggest a x-cephalometry analysis methods in 1948, and set up a normal average.


X - cephalometry analysis can be divided into five functional parts: cranial, skull base, maxillary bony maxillary dentition, mandible and mandibular dentition. Analysis of the five parts of each other in the horizontal, vertical upward relations. Modern X-cephalometry is a method designed to describe the relationship between these functional units. It is generally believed that there are two ways to analyze a measurement and analysis.


General There are three main types of view measurement method. Linear measured : measured cephalometric tracing film ⑴or the distance between two points and compare the distance directly or in the proportion way. angle measured: measured the angles between ⑵intersecting lines, the advantages of this measurement is it doesn't use the ratio to avoid the individual differences.

⑶ arc measurements: draw a series of arc to evaluate the location of anatomical structures.


Another way is to use graphics to express the normal data, rather than a series of measurements. Directly to the patient's, edentulous patients with normal graphics through the template for comparison. The early x-cephalometry consider a normal graphics more easily recognizing the type of relationships. Dr. Moorrees `s Mesh are raised in the 60's with the performance of the grid to the patient's disorder. However, at that time because this method does not clearly establish normal relations, while not widely accepted. However, in recent years, with the development of the computer application, the normal template set up, such a direct comparison of the template has been adopted as an analytical method.

X- 线投影测量的基本知识

Lateral and frontal head radiographs

1 Head in a fixed position in a cephalometer

2 Head hold by ear rods.

3 X-ray direction is at right angle to sagittal plane of the head when profile film taken.

4 PA view, frontal plane of the head is perpendicular to the x-ray beam.

5 The film cassette is as close as possible to the face.

Lateral and frontal head radiographs

A standard distance of 60 inch from

source of radiation to midsagittal plane.

Film to midsagittal plane according

head size, they used vernier scales to

correct enlargment.

the basic knowledge of X-cephalometry

basic components of X-cephalometry system's : X-ray equipment,

X-ray film devices, the head positioning device.

The basic knowledge of X-cephalometry

X-ray device (tube)

Components: X-ray tube, transformers, filters, parallel-ray tube, cooling system.

X-ray have the three basic conditions, cathode, anode and power

Cathode composition: tungsten target, Copper Rods

Cathode composition: tungsten wire, condenser Cup

阴极阴极

阳极阳极

聚光杯聚光杯

乌丝乌丝乌靶乌靶

铝盘铝盘

铅隔板铅隔板

变压器（高压）变压器（高压）

变压器（低压）变压器（低压）

Minimize error when serial films of same individual are taken at different times.

to permit universal use of cephalometric data obtained from many different source.

Possible errors:

1 a lack of perpendicularity of the X-beam to midsagittal plane and the film surface.

2 The film is not in closest place to head and face for minimizing enlargement.


Safety feature of the cephalometric techniqueSafety feature of the cephalometric technique

- Use of the 90-kv peak to minimize softer x-rays.

- The beam is filtered to remove softer x-rays

- The film is a double-emulsion film

- A cassette with compatible intensifying screens.

- Patient and operating personnel protection


X-ray protection

Utilization of Utilization of high speed filmhigh speed film and and intensifying screenintensifying screen in order to reduce the in order to reduce the dose of radiation and exposure time dose of radiation and exposure time

FiltrationFiltration of secondary radiation of secondary radiation Collimation by a Collimation by a diaphragm diaphragm Proper exposure Proper exposure techniquetechnique and and

processingprocessing The patient`s wearing a The patient`s wearing a lead apronlead apron

Landmarks and TracingLandmarks and Tracing

Three components of analysis are analysis of Three components of analysis are analysis of the the skeletal featuresskeletal features of the patient, the of the patient, the dental dental featuresfeatures and the and the profileprofile of the patient. of the patient.

Tracing stepsTracing steps 11 Soft profile, external cranium, vertebra Soft profile, external cranium, vertebra three crosses for registration. three crosses for registration. 22 cranial base, internal border of cranium, cranial base, internal border of cranium, frontal sinus, and ear rods.frontal sinus, and ear rods. 33 Maxilla and related structures. Maxilla and related structures. 44 Mandlbe Mandlbe

NotesNotes

1 Tracing as much anatomy as possible, 1 Tracing as much anatomy as possible,

especially in skull base area. especially in skull base area.

2 Know definition of the landmarks clearly2 Know definition of the landmarks clearly

3 Know the variation of some landmarks3 Know the variation of some landmarks

location. location.

4 When left and right are two lines, trace the4 When left and right are two lines, trace the

two lines and use the average with brokentwo lines and use the average with broken

line. line.

5 repeat of the tracing as same for severe times.5 repeat of the tracing as same for severe times.


Sella (S)Sella (S)

The geometric center of The geometric center of

the pituitary fossa (sella the pituitary fossa (sella

turcica), determined by turcica), determined by

inspection constructed inspection constructed

point in the midsagittal point in the midsagittal

plane. (midsagittal)plane. (midsagittal)


Nasion (N, Na)Nasion (N, Na)The intersection The intersection of the internasal of the internasal and frontonasal and frontonasal sutures, in the sutures, in the midsagittal plane. midsagittal plane. (midsagittal)(midsagittal)



Porion (Po)Porion (Po)The most superior point of The most superior point of the outline of the external the outline of the external auditory meatus auditory meatus ("anatomic porion"). ("anatomic porion"). When the anatomic When the anatomic porion cannot be located porion cannot be located reliably, the superior-most reliably, the superior-most point of the image of the point of the image of the ear rods ("machine ear rods ("machine porion") sometimes is porion") sometimes is used instead. (bilateral)used instead. (bilateral)


Anterior nasal spine (ANS)Anterior nasal spine (ANS)

The tip of the bony The tip of the bony anterior nasal spine at the anterior nasal spine at the inferior margin of the inferior margin of the piriform aperture, in the piriform aperture, in the midsagittal plane. It midsagittal plane. It corresponds to the corresponds to the anthropological point anthropological point acanthion and often is acanthion and often is used to define the anterior used to define the anterior end of the palatal plane end of the palatal plane (nasal floor). (midsagittal)(nasal floor). (midsagittal)


A-pointA-point (Point A, Subspinale, ) (Point A, Subspinale, ) The deepest (most posterior) midline The deepest (most posterior) midline

point on the curvature between the ANS point on the curvature between the ANS and prosthion. Its vertical coordinate is and prosthion. Its vertical coordinate is unreliable and therefore this point is used unreliable and therefore this point is used mainly for anteroposterior mainly for anteroposterior measurements. The location of A-point measurements. The location of A-point may change somewhat with root may change somewhat with root movement of the maxillary incisor teeth. movement of the maxillary incisor teeth. (midsagittal)(midsagittal)


B-pointB-point (Point B, Supramentale, sm) (Point B, Supramentale, sm)

The deepest (most posterior) midline The deepest (most posterior) midline

point on the bony curvature of the point on the bony curvature of the

anterior mandible, between infradentale anterior mandible, between infradentale

and pogonion. (midsagittal)and pogonion. (midsagittal)


Pogonion (Pog, P, Pg)Pogonion (Pog, P, Pg)

The most anterior point on The most anterior point on the contour of the bony the contour of the bony chin, in the midsagittal chin, in the midsagittal plane. Pogonion can be plane. Pogonion can be located by drawing a located by drawing a perpendicular to perpendicular to mandibular plane, tangent mandibular plane, tangent to the chin. (midsagittal)to the chin. (midsagittal)


Gnathion (Gn)Gnathion (Gn)

The most anterior The most anterior inferior point on the inferior point on the bony chin in the bony chin in the midsagittal plane. midsagittal plane. (midsagittal)(midsagittal)


Menton (Me)Menton (Me)

The most inferior The most inferior point of the point of the mandibular mandibular symphysis, in the symphysis, in the midsagittal plane. midsagittal plane. (midsagittal)(midsagittal)


Gonion (Go)Gonion (Go) The most posterior inferior The most posterior inferior

point on the outline of the point on the outline of the angle of the mandible. It angle of the mandible. It may be determined by may be determined by inspection or it can be inspection or it can be constructed by bisecting constructed by bisecting the angle formed by the the angle formed by the intersection of the intersection of the mandibular plane and the mandibular plane and the ramal plane and by ramal plane and by extending the bisector extending the bisector through the mandibular through the mandibular border. (bilateral)border. (bilateral)


Orbitale (Or)Orbitale (Or)

The lowest point on the The lowest point on the inferior orbital margin. inferior orbital margin. (bilateral)(bilateral)

Soft tissue landmarksSoft tissue landmarks


Soft tissue glabella (G)Soft tissue glabella (G) The The mostmost

prominent point of prominent point of the soft tissue drape the soft tissue drape of the forehead, in of the forehead, in the midsagittal the midsagittal plane. plane.


Soft tissue nasion (N, Na)Soft tissue nasion (N, Na) The deepest point of

the concavity between the forehead and the soft tissue contour of the nose in the midsagittal plane. (midsagittal)


Pronasale (Pn)Pronasale (Pn) The most prominent

point of the tip of the nose, in the midsagittal plane. (midsagittal)


Subnasale (Sn)Subnasale (Sn)

The point in the The point in the midsagittal plane midsagittal plane where the base of the where the base of the columella of the nose columella of the nose meets the upper lip. meets the upper lip. (midsagittal)(midsagittal)


Superior labial sulcus Superior labial sulcus (Sls)(Sls)

The point of greatest The point of greatest concavity on the concavity on the contour of the upper contour of the upper lip between subnasale lip between subnasale and labrale superius, and labrale superius, in the midsagittal in the midsagittal plane. (midsagittal)plane. (midsagittal)


Stomion (St)Stomion (St) The most anterior point The most anterior point

of contact between the of contact between the upper and lower lip in upper and lower lip in the midsagittal plane. the midsagittal plane. When the lips are apart When the lips are apart at rest, a superior and an at rest, a superior and an inferior stomion point inferior stomion point can be distinguished. can be distinguished. (midsagittal)(midsagittal)


Labrale inferior (Li)Labrale inferior (Li) The point denoting The point denoting

the vermilion border the vermilion border of the lower lip, in of the lower lip, in the midsagittal plane. the midsagittal plane. (midsagittal)(midsagittal)


Labrale superior (Ls)Labrale superior (Ls) The point denoting The point denoting

the vermilion border the vermilion border of the upper lip, in of the upper lip, in the midsagittal plane. the midsagittal plane. (midsagittal)(midsagittal)


Inferior labial sulcus (Ils) The point of greatest

concavity on the contour of the lower lip between labrale inferius and menton, in the midsagittal plane. (midsagittal)


Soft tissue pogonion Soft tissue pogonion

(Pg, Pog)(Pg, Pog) The most prominent The most prominent

point on the soft tissue point on the soft tissue

contour of the chin, in contour of the chin, in

the midsagittal plane. the midsagittal plane.

(midsagittal)(midsagittal)

Reference line

A line that is used as a basis for

superimposition, or for comparison.

Reference lines ideally should be stable stable

with timewith time and should not be affected by be affected by

treatmenttreatment.

Intracranial reference lines

Extracranial reference lines


Basion-Nasion line (Ba-N)

A line considered by A line considered by some to represent the some to represent the cranial base more cranial base more accurately than the SN accurately than the SN line or the Bolton plane.line or the Bolton plane.

Intracranial referencelines Frankfort horizontal plane (FH, Frankfort Frankfort horizontal plane (FH, Frankfort

horizontal line, Auriculo-orbital plane, Eye-ear horizontal line, Auriculo-orbital plane, Eye-ear plane)plane)

The plane was adopted at the 13th General The plane was adopted at the 13th General Congress of German Anthropologists in Congress of German Anthropologists in Frankfort, Germany in 1882. On a lateral Frankfort, Germany in 1882. On a lateral cephalometric radiograph, the Frankfort cephalometric radiograph, the Frankfort horizontal plane is represented by a line horizontal plane is represented by a line connecting the cephalometric landmarks porion connecting the cephalometric landmarks porion and orbitale.and orbitale.

Intracranial reference lines Sella-Nasion line Sella-Nasion line

(SN, Nasion-Sella (SN, Nasion-Sella line, NSL)line, NSL)

A frequently used A frequently used cephalometric cephalometric reference line reference line representing the representing the anterior cranial anterior cranial basebase. A line joining . A line joining points S and Na.points S and Na.


Bolton planeBolton plane

A line connecting points Bolton and A line connecting points Bolton and nasion; an alternate representation of the nasion; an alternate representation of the cranial base.cranial base.

Reference plane

The above-mentioned reference plane are considered to be intracranial reference plane, or intracranial reference lines. Between them in the literature there is a lot of controversy, but it seems that less than to resolve. Each type of system, the existence of the advantages and disadvantages of a greater or lesser extent, a way there is another way than the good side, there are insufficient places. Because of the existence of large individual changes, there is no reference plane is absolutely stable, that is to say there is no analytical method is reliable.

Reference plane

How to eliminate this problem? There is only one way to select different reference plane set up on the analysis, expectations of the advantages of using a method to compensate for the shortcomings of another way to eliminate the different reference plane of the individual differences in change, as the average of the parameter error.

Reference plane

Completely solve the problem of reference plane, only the introduction of extracranial reference line, also known as the "true vertical line " Modern X-cephalometry should be in the natural head position under the shooting, which was really the horizon. Natural position have been suggested by some scholars that its level is also known as the "true level" line in the 60's and 70's at the end of the beginning.

SKELETAL VERTICAL

F H

S

G NM E

G O

FH TO GOGN 22 ± 5 deg

Y AXIS 59 ± 6 deg

LFH 55% OF TFH

FH TO GOGN 22 ± 5 deg

Y AXIS 59 ± 6 deg

LFH 55% OF TFH

Reference plane

At this location set up on the physiological status of the foundation, rather than on anatomical structure. Most patients with FH plane really close to the horizon. However, some patients also show significantly different. SN same plane with the horizontal angle of 7 degrees. Natural posture can place at 1-2 repetition range.

Measurement plane

Make measurements with the reference plane constitutes a point of view Commonly used measurement plane are: Mandibular plane, Go-Gn, mandibular tangent, Me-mandibular tangent

plane, anatomical type planar, functional plane Flat facial

Mandibular plane angle

Measurement items and measurement methods

Angle, line segment and the ratio of

Normal range

Evaluation of the impact of factors

SKELETAL HORIZONTAL - MAXILLA

SNA 82 ± 2 deg

NA TO FH 90 ± 3 deg

SNA 82 ± 2 deg

NA TO FH 90 ± 3 deg

S N

A

F H

SKELETAL HORIZONTAL - MANDIBLE

S N

BP g

F H

SNB 80 ± 2 deg

N-PG TO FH

88 ± 6 deg

SNB 80 ± 2 deg

N-PG TO FH

88 ± 6 deg

SKELETAL HORIZONTAL - MAXILLA TO MANDIBLE

N

A

B

ANB 2 ± 2 degANB 2 ± 2 deg

DENTAL - UPPER TO LOWER INCISOR

INTERINCISAL 130 ± 5 deg

INTERINCISAL 130 ± 5 deg

DENTAL - MAXILLARY INCISOR

F H

N

A

U1 TO FH 110 ± 5 deg

U1 TO NA 22deg

U1 TO NA 4mm

U1 TO FH 110 ± 5 deg

U1 TO NA 22deg

U1 TO NA 4mm

DENTAL - MANDIBULAR ANTERIOR

GO

GN

B

N

L1 TO NB 25deg

L1 TO NB 4mm

L1 TO GOGN 91 ± 6deg

L1 TO NB 25deg

L1 TO NB 4mm

L1 TO GOGN 91 ± 6deg

Facial angle (FH-NPog)

Facial axis angle of RickettsFacial axis angle of Ricketts (Ba-Pt-Gn)(Ba-Pt-Gn)

Facial height,

Anterior; Posterior; and Total

Gonial angle (Angle of the mandible, Condylar

angle)

Frankfort-mandibular incisor angle Frankfort-mandibular incisor angle (FMIA)(FMIA)

Frankfort-mandibular plane angleFrankfort-mandibular plane angle

(FMA)(FMA)

Incisor-mandibular plane angle Incisor-mandibular plane angle

(IMPA)(IMPA)

UI-to-AP distanceUI-to-AP distance

Wits appraisal

H-angle (of Holdaway)H-angle (of Holdaway)

Angle of facial convexity (Gn-SnPg ）

Interlabial gap

Lower face-throat angle

(SnPg'-CMe')

Lower lip length

Upper lip length

Nasolabial angle (NLA)

Z-angle (of Merrifield)

Commonly used analytical methodsCommonly used analytical methods

– Downs Analysis Downs Analysis – Steiner AnalysisSteiner Analysis – Sassouni Analysis Sassouni Analysis – Harvold Analysis Harvold Analysis – Wylie AnalysisWylie Analysis– Wits AnalysisWits Analysis– Ricketts AnalysisRicketts Analysis– McNamara Analysis McNamara Analysis – Template Analysis Template Analysis – Mesh AnalysisMesh Analysis– Computerized Cephalometric Analysis Computerized Cephalometric Analysis ？？？？

Measurement items and measurement methods

··

·

··

·

·

·

·

·

·

·

Steiner 分析

SNA

SNBANBSND1-NA∠1-NA1-NB∠1-NBPo-NB1-1OP-SNGoGn-SNSLSE

sN

A

B

LE

Go

Gn

Po

Downs Analysis

FH-NPo

NA-PA

AB-NPo

FH-Me

FH-Y

FH-OcclP

1-1

1-MP

1-OcclP

1-AP

Mesh Analysis Mesh Analysis

pretreatmentpretreatment

After treatmentAfter treatment

※ ※ Cited the extracranial reference Cited the extracranial reference line, perpendicular really.line, perpendicular really.

1/21/2 1/21/2

1/21/2

1/21/2

True VerticalTrue Vertical

Through the glbella ,subnasale ,pogonion of soft tissue ,the point is divided into before and after the relative position: straight type, concave type, convex type.

X-cephalometric analysis of soft tissueX-cephalometric analysis of soft tissue

Profile type

the line segment facial profile

Richetts definited the aesthetic plane (E-Line): nose and chin over the tangent plane.

Normal adult white: the lower lip after the plane is located at 2 ± 2mm, is located in the lower lip after lip slightly.

Children: the lower lip is located in the plane, or slightly after the plane is located, because the development of chin and nose of some of the development of a more slow.

African-American and Chinese: is located in the lower lip aesthetic plane before the 1-3mm.

Steiner used "S" line to evaluated the lip’s position: the lower and upper lip is located after this line.

through the nose shape of the mid-point to do mental tangent is S line

H-line (Harmony line of H-line (Harmony line of Holdaway)Holdaway)

A line tangent to the soft A line tangent to the soft tissue chin and the upper lip, tissue chin and the upper lip, introduced by R. A. introduced by R. A. Holdaway for assessment of Holdaway for assessment of the soft tissue profile.the soft tissue profile.

H-angle (of Holdaway)

The superior angle formed by the intersection of the H-line of Holdaway and the (bony) NB line. It provides a measurement of soft tissue protrusion or retrusion and is evaluated in conjunction with the ANB angle. The amount of deviation of the ANB angle from the average (1to3) is added or subtracted from the H-angle for appropriate assessment of the lip and chin projection. The H-angle takes the skeletal relationship into account, but does not consider nasal contour and projection.

Merrifield's "Z" lines, through the most mental process tangent of

the upper lip, lower lip should be in line or slightly after this point. Adult white horizontal line and the angle is 80 ± 5 º ,11-15-year-old the "Z" angle is 78 ± 5 º.

Angle of facial convexity

Describe the overall convexity (or concavity) of the soft tissue profile. The inferior angle formed by the intersection of lines GSn and SnPg is measured. The measurement does not take nasal projection into account. Norm 12

Legan 1980

Burstone : nose angle, male 114 º, female 118 º. Submental neck angle, male 114 º, female 106 º.

Upper lip lengthUpper lip length

A linear measurement A linear measurement (in mm) from (in mm) from subnasale to stomion subnasale to stomion superius, measured superius, measured along the true vertical along the true vertical line.line.

Lower lip lengthLower lip length

A linear measurement A linear measurement from soft tissue menton from soft tissue menton to stomion inferius, to stomion inferius, measured along the true measured along the true vertical line.vertical line.

For optimal esthetics, it is considered desirable that approximately 2 to 4 mm of the maxillary central incisors be uncovered by the upper lip at rest.

Similarly, in an esthetically pleasing smile, the upper lip is raised approximately to the level of the cementoenamel junction of the incisors, so that the full crowns of the maxillary incisors are shown.

Posteroanterior Cephalometry

Elements of the Posteroanterior diagnosis

Soft tissue, through clinical examination and photographic examination Teeth and jaws, through the anterior and posterior cephalometric Dentition , through the tooth model, occlusion map and occlusion bite piece

Technical Features Piece of equipment in line with the lateral The first fixed or natural head position Tip of the nose and forehead lightly with the film cartridge contacts Exposure than the larger number of lateral films

Posteroanterior

1 the lateral skull plate 2 mastoidectomy 3 occipital 4, nasal septum, crest, the end of nose5 orbital 6 temporal fossa lateral sphenoid pterygoid constitute a large slash 7 petrous bone above 8 amount of zygomatic process of the lateral temporal Section 9 the zygomatic arch District 10 the nodules following temporal mandibular 11 mandible, body, sticks, coronoid process 12 teeth

前后位Grummons AnalysisPosteroanterior

the limitations of X-cephalometry analysis

confliction between X-ray measurement and clinical examination

When the SNA had to besmaller after the reduction, but not clinical performance. So S points to be considered.

Variability of the reference plane, S - N plane, FH plane . After the introduction of the real vertical extracranial correction. Natural head position in patients with the photos of the X-ray film

corrective.

X-ray film shooting would be good to have a benchmark mm to correct the magnification. Repetition, especially when the evaluation is even more important.

··

S S 点较低点较低

The existence of magnification

Cephalometric analysis of computer systems

⑴ save time, rather time-consuming manual measurement. ⑵ computer cephalometric points used in the logo is established,

eliminating manual measurement error. The signs point is still rely on manual identification completly.

⑶ easyly storage, extract the measurement. ⑷ integrate with the management systems Office for easy queries. ⑸ integrate with the document of photographs and model to

establish a patient database. ⑹ forecasting and simulation of orthodontic treatment,

orthognathic surgery treatment results. ⑺ model and predicte the growth and development. ⑻ facilitate exchanges between doctors and patients.

Other X-ray film applications

1, surface fault-chip 2, periapical film 3, occlusal film 4, temporomandibular joint films

V. The standard of malocclusion diagnostic

Individual Normal OcclusionIdeal Normal Occlusion

six elements of normal Occlusion

Molar relationshipAnterior inclination Inclination of posterior teethContact pointsReverse toothless Normal Spee `s curve

Occlusion and malocclusion

The main three objectives of orthodontic treatment good function ① acceptable form of facial ② stability after treatment ③

All of these are closely related to occlusionOnly understanding the expression of normal occlusion, the diagnosis of malocclusion, design, and formulate appropriate treatment plan can be obtained

Six elements of normal occlusion

Elements one: the relationship between dental arch

1. Maxillary first molar buccal tip bite on the maxillary first permanent molars in the buccal groove of the past. 2. Maxillary first molar distal marginal ridge of teeth in the mandibular the first permanent molars near the ridge on the edge. 3. Maxillary first molar teeth of the tongue bite on the mandibular first permanent molars in the central fossa.


4. Between maxillary premolar cheek tip and mandibular premolar , there have relations with a sharp concave. 5. Maxillary premolar of the tongue and lower jaw between the premolars relations have pointed Waterloo. 6. Maxillary canine and mandibular canine teeth and lower jaw together before grinding between teeth, canine in a bit more recent. 7. Maxillary incisor and mandibular canine cover contacts, from top to bottom arch center line in line.


Elements two: crown axis All the crown has a positive angle, but the clinical crown to clear the long axis of the lip surface of the tooth with the real axis there are still some differences in the crown of each tooth with the anatomical point of view on the long axis of tooth point of view has not been entirely uniform. In his research found maxillary 123,456, respectively, the angle is 5 ° 9 ° 11 ° 2 ° 2 ° 5 ° 5 °, the angle of the mandibular teeth were 2 ° 2 ° 5 ° 2 ° 2 ° 2 ° 2 °.


Three elements: crown inclination 1. The vast majority of maxillary incisor crown with a positive inclination, the mandibular incisor crown inclination slightly negative. , 2. Maxillary central incisor crown inclination of the crown slightly larger than the lateral incisor, canine and premolar is similar to a slight negative angle. 3. Mandibular incisor teeth from molar to the second negative angle, and gradually increase


Four elements: reverse of the teeth

generally,there is no reverse teeth in normal occlusion, the arch circumference would be shorter if there has reverse anterior teeth, the reverse posterior teeth in the dental arch will occupy more space, which will affect the existence of normal occlusion.


Five elements: the relationship between tooth contacts

all the teeth have a good point of contact, and more closely, without space in the existence of dental arch


Six elements: Spee `s curves

The spee `s curves should have more flat, or slightly deeper


The six elements of the above-mentioned in the normal occlusion of the system is the six elements of interdependence, which formed the basis of evaluation of occlusion,the more important reason is that these six elements can be used as treatment goals in most patients. However, any establishment of a normal occlusion also depends on two factors: dental arch in the mouth of the balance of power in all ⑴directions; jaw and alveolar bone development and normal position.⑵

Individual Normal Occlusion Ideal Normal Occlusion

Usually there is slightly but does not affect the normal physiological functions of the individual referred to as the normal occlusion. Generally crowded into a small arch, slightly larger than the normal and not entirely consistent with the facial morphology of dental arch deformity that is acceptable, that is, allow individual normal occlusion performance of the deformity. our clinical goal is individual normal occlusion

Comprehensive space analysis

⑴ the solution of crowded - model analysis Anterior adductor - X-cephalometry ⑵ molar relationship adjustment - model + X + Clinical ⑶ Spee's curve corrected - model analysis + Clinical ⑷ Arch width coordination - model analysis ⑸ Bolton ratio - model analysis ⑹ midline correction - clinical examination⑺

the diagnosis basisthe diagnosis basis of malocclusion


Model Analysis

X-cephalometry analysis

Chief complaint classification of malocclusion

Clinical examination diagnosisdiagnosis

Data analysis Problem List

The diagnosis basisThe diagnosis basis of malocclusion

1 Angle Classification

2 Problem List

Profile –Facial type

(Sagittal Plane, Transverse Plane, Vertical Plane)


Abnormal dentition (the order according to the seriousness)

Crowding 、 Spacing 、 Rotation 、 Overjet

Overbite 、 Curve of Spee 、 Arch Form

Midlines 、 Ectopic eruptions, intraeruptions

Cross-bite,( anterior ,posterior , single, multrup)

Other (mandibular movement, TMJ, periodontal)


Treatment goals

The problem of pathological priorities:

1, chronic diseases, such as: rheumatoid arthritis, chronic diarrhea. 2, the impact of the local oral health diseases, such as: periodontal disease, such as dental caries. 3, the psychological barrier, especially for the treatment have failed to meet practical ideas.

Treatment goals

According to the chief complaint of patients with the problems and consider the possibility of treatment. For all listed issues, not have to carry out treatment, thus the possibility of the existence of which the question of deformity correction. Therefore, in the formulation of treatment plans in accordance with the problem of patients and the patients are listed in the specific circumstances to identify the goal of treatment should be carried out.

Treatment goals

1, normal facial morphology, the need for correction

2, the presence of bony deformity, bony deformities must be corrected

3, the need to correct the molar relationship, review spee’s cover whether or not to correct

4, anterior process of the correct degree

5, other issues considered at the same time to correct

Treatment PlanTreatment Plan

Treatment plan rely on the treatment goals , as much as possible set out detailed methods and steps.

First of all, clear the scope of treatment

Modification of GrowthOrthodontic treatmentOrthodontic-Surgery

Treatment Plan

Based on treatment goals and then to be considered for correction of deformity using the specific methods and steps to carry out the order in which they plan. At the same time, to be expected after the end of treatment to improve facial form and maintain the level of what kind of relationship between upper and lower jaw, it is necessary to consider the correction after the end of the molar relationship between the canine relationship, review occlusion, covering the relationship between dental arch axis and the inclination of the coordination.

Treatment Plan

In addition, we must also consider the stability of correction after treatment and the possibility of recurrence. In the choice of treatment should be considered when there is: the role of each other (the relationship between open ①occlusion and the surface high) the scope of concessions ② Analysis of the pros and cons ③ special reasons④

Treatment Plan

The issue treatment plan should consider

Oral Health Mandibular dentition Maxillary dentition The relationship between the posterior teeth Appliance choice

Treatment Plan

Oral Health Of the patient's oral health education, such as brushing, diet, use of fluoride toothpaste. Caries and periodontal disease treatment

Mandibular dentition Mandibular dentition should first carry out the plan, the size of the mandibular dentition and the form should not be changed in general, over-expansion of the cheek or to the forward incisors in most cases are due to the role of soft-tissue recurrence. Extraction depends on the analysis of whether the demand for space. Any dumping of deep overbite with appear abnormal, tooth extraction must be carefully decided.

Treatment Plan

Maxillary dentition Maxillary generally in accordance with the plan to carry out the plan of mandibular, mandibular maxillary tooth extraction should be under normal circumstances the extraction of symmetry. If the non-extraction of mandibular, maxillary gap was far from the teeth to move or the first premolar extraction to obtain.

The relationship between the posterior teeth Molar relationship is the treatment of the issue must be taken into account, is not it needs to be remedied? How to correct? Class I canine relationship is the one of the goals of treatment. Class I molar or completely far-China relations (II-type) is acceptable Of maxillary first premolar extraction.

Treatment Plan

Appliance choice Appliance activities Get rid of bad habits Tilted teeth Mobile Gap to maintain Retainer

Fixed appliance Conventional treatment, three-dimensional control of tooth movement Functional appliance To stimulate or limit the maxillary, mandibular growth and development

chief complaint and case history


Diagnostic data analysis

Diagnosis (list of questions )

Database Categories

Orthodontic treatment before the disease control (such as: caries, periodontal disease, etc.)

According to the priority order of questions, A, B, C, D, etc Questions for each

possible solution

Choice of treatment plan

Healing techniques

Treatment goals

Can be modified with special consideration

Choose the ideal and the sacrifice plan

How to assess the facial soft tissue? What is the dental arch length? What is the dental arch circumference? How to calculate the degree of dental arch crowding? Mixed dentition how far the forecast of nearly 345 gap between the two? X-cephalometry of the basic principles of what? X-cephalometry what the main purpose? What is the reference plane? Intracranial reference plane of the shortcomings of what? In the gap analysis of what issues should be considered? Dental abnormalities, including what the diagnosis? What is the treatment goal? What is the treatment plan?

Thinking Questions

diagnosis and treatment planning of malocclusion orthodontic department of xi'an jiaotong...

Documents

treatment process

development of teeth

replacement of teeth

patients chief complaint

correct diagnosis

basic situation of dentition

dentition examinationd

normal face