Web viewUniversity of Jordan. Faculty of Dentistry. Fourth year – 2nd semester 2014-2015. Orthodontics. Sheet . Slides. Hand Out. 44. Date: Lecture No. Our website

Jumanah alzoubi

Dr. eyad

44

24/2/2015

University of JordanFaculty of Dentistry

Fourth year – 2nd semester 2014-2015

Orthodontics

Lecture No.

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Jumana al-zoubi lec. # 4 .orthodontic assessment and diagnosis 24-2-2015

Introduction:

We should make proper orthodontic assessment to formalize proper treatment plan ,which involve step by step approach to reach proper diagnosis in order to put accurate comprehensive treatment plan and this will be covered in 4 next lectures summarizing all things that we took . all things are interrelated in a way that to reach the diagnosis you have to use the etiology and classification .

Assessment done by gathering information in systemic way to avoid missing anything starting with history then clinical examination.

One of the main issues is to know how to assess and diagnose , to formalize proper treatment planning for your patient for orthodontic purposes .

So to achieve proper treatment plan we should go step by step approach and proper records taking.

o Step by step approach ,need to collect all the information through history and clinical examination then take records ,then we need to analyze the records ((making proper analysis + rapport for the records)).

Proper treatment plan : I. Records analysis

II. Problem lists : -you should know what is normal and what is abnormal -so you should think about what is the possible causes


-etiology of disease if we have abnormality

III. Objectives o Are we going to treat these causes or not?? o Are we able to treat these causes or not ??o What is a proper treatment planning??o To know if the patient need appliances or not (fixed ,removable,functional)??

#these are sequential steps ,each time we should follow them .

Summary:

Note: records involve:

*radiographs *study models *photographs

Treatment planning depends on: Analysis of diagnostic records Treatment options appliances used stability and retention

diagnostic data-base: o clinical examination: is very important ,this how to discover or inspect

the patient for the problem ,sometimes it is difficult to perform specific measurements , specific analysis ,specific diagnosis to the patient mouth

History clinical examination records data base

List of problems

Treatment planning


o orthodontic records : so we need records in order to get accurate diagnosis to the patients mouth .

**done by : -photographs

-dental casts ..how to perform the space analysis(precise objective space analysis)

-radiographs .. to help us to get most relative information as well

-other records

space analysis : for assessment of crowding

-development assessment of crowding by :1- inspection 2- space analysis using study model

space analysis : space available : - divides arch into segment -use brass wire space required: - MD width of all teeth .

-some study’s say that the crowding is the most common problems ,50 % of our patients have this problem

-crowding …lack of space *we need to know how much space is required *how are we going to provide a space? By extraction of teeth mainly

*How we can analyze if there is a space and what is the required space to provide it??

o Why do we need space in orthodontic?? A. To overcome skeletal problems B. 20-30 % of patients have increased overjet (protraction of upper

anterior teeth or retraction of lower anterior teeth.)…we need to correct it into class 1 .

*how much space we require??We will answer this question

Clinically, most practical way or method to measure crowding is to measure overlap between teeth (clinical examination visits just to measure the overlap.


*so the overlapping between the teeth will give how much the crowding in mm?

We have examination about 5-6 mm of lower arch crowding (rough estimation )

Know we should discuss the treatment options with the patient and provide the consultation, it is improper to do treatment to patient without any discussion the treatment options with providing the consultation

5-6 mm of crowding ,it is a moderate crowding (the patient is needing extraction to provide space)

So we should make proper space analysis by study models and discuss the treatment options with patient .


Mixed dentition stage:

Patient presented with crowding of primary teeth with deviation .(e.g) So how do you estimate the size of space for erupted teeth. We should make estimation whether there is a space tooth or not ,soit is

important to do proper estimation . If you are going to do space analysis ,we should do specific

measurements ,to get specific records Occlusal planes should be flat or slightly curve of spee in order to have

sufficient space for the erupted teeth So space is required to level of the curve ( flat occlusal plane …anteriorly

Curve of spee …posteriorly)

*so again the assessment of crowding which is done by proper analysis and determine of space required *when you want to classify the crowding you have to determine :

The severity (mild /moderate /severe ) according to space present and space required

The location ( generalized/ localized)

We always start our description with lower arch When we analyze ,we always consider PM unit ..equal to 7mm o Incisor A/P change :

Increased overjet Allow 2mm space for each 1mm change Assess lower arch first Aim to reduce the overjet to 2mm

e.g: 10 mm overjet

the amount of increased overjet is 10-2=8mm

1mm change in overjet …we should leave 2mm as space, and this is applied per arch.1mm per quadrant .


*so we have 8mm of overjet ,amount of space that is needed per area

8*2 ..16mm per arch .

*1mm per quadrant the change

*this to achieve normal overjet

*5mm overjet

-3mm is increased

-we neen 3mm of space per quadrant /3*2=6mm space per arch to get normal overjet

How to measure the overjet :

Proper size ruler with proper measurement

Highest record we take

From labial surface of upper incisal edges …to labial surface of lower incisors

Dental centerline :

For teeth alignment …the upper midline should coincide with lower midline

Ideally we should diagnose in the pts mouth

*clinically not in the models


*so any center line shift need to be corrected by providing space .

*so we should observe molars movement occurred (anterior or posterior )

* how much space we need??

Study models:

A. Pre-treatment record (study models ) B. 3D-assessment of occlusion from all aspects (digital method ,we take

impression by alginate then use ct scanner laser scanners to give an accurate method design (very accurate method )

C. Considered as reference to assess treatment progress D. For space analysis (most important one)

Standardized study models Digital: -2D…have distortion ,it is difficult to do measurements -3D…we use it (laser scanners/ct-scan/photographs) We can perform precise and accurate measurement on models

Casts: we look for alignment /space /tooth size analysis and shape of teeth.

Compare between space available inarch+ space required to accommodate the teeth .

*also we need to compare if we have : excess of space or space shortage (crowding).

*we also need to compare the size of teeth/shape of teeth ..so we should have proper molarand incisor relation

*we should make proper space analysis to consider size of the teeth


* the study model can be either : - plaster ( conventional ) . - digital studying model (3D) : taking the impression send it to a company which pour it and scan it by laser scanner and then keep it as a digital record which is very accurate and solve a storage problem because according to ethics you have to keep the records for at least 10 years , and for teenager until they become adult so you will end up having thousands of records. It is also give you 3D on the screen with automated measurements , faster and time saver

so study models are very important to take , keep and use them .

space analysis ideally at the end of clinical examination and assessment of study model you have to determine whether the arch has adequate space to accommodate all teeth , shortage of space or excess of space . for permanent dentition 1- the average numbers according to Weller anatomy we use the average width of the teeth ( for example the premolar width = 7 mm , the canine width = 8 mm ) . if the canine is unerupted and we need to be sure that the available space will be enough for eruption without crowding we measure the available


space then compare it with average width and accordingly we decide if there is any need for intervene or use a space maintainer . this method only acceptable for quick clinical examination and consultation , but it is not used for treatment plan . 2- the cast use it for space analysis for permanent dentition either the arch as whole or each individual tooth by 1- gauge with two sharp pointed peaks from the distal of the five ( mesial of the 6 ) on one side to the distal of the 5 on the other side then compare it with arch shape by segments or arch as whole . 2- brace soft wire used from the mesial of the 6 in one side to the mesial of the 6 on the other sidethen we compare it with clinical arch space .inter-molar width not very important .

To determine the amount of crowding or spacing in an arch :Subtract the sum of widths of the teeth mesial to the first molars from sum of arch lengths mesial to the first molars

Arch length is measured from mesial surface of the first molar on the right side around arch to the mesial surface of the first molar on the left side by brass wire or by dividing arch into segments


The amount of crowding can be measured by summing the overlap between the contact points of the teeth anterior

So assessment of space requirement:

Crowding and spacing Leveling of occlusal planes Arch expansion and contraction


Incisor A/P change : assess the lower arch first and then correct the upper incisors to overjet 2mm

Angulation (mesiodistal tip)

Space analysis in mixed dentition:

In the mixed dentition ,the permanent incisors and first molars are erupted ,the permanent canines and premolars have not erupted. Their mesial-distal widths can be measured by one of the following :

a. Measurement of the teeth on radiograph *this requires an undistorted radiograph image ,which is more easily achieved with individual periapical radiograph than panoramic radiograph .

True width of primary molar/apparent width of primary molar = true width of unerupted premolar/apparent width of unerupted

premolar


we use the study model to measure the width of erupted tooth then we measure the width of the same tooth on the radiograph and use it to determine the magnification of the radiograph ( if the width of the tooth on the radiograph= width of the tooth on the study model then there is no magnification )

then we measure the width of unerupted tooth on the radiograph and according to magnitude of magnification we can predict the space needed for the tooth and compare it

with the actual space in the arch .we can't use the panoramic radiographs because the

magnification differ in different parts but we can use PA's .

using the average number for example the average space needed for permanent premolars and canine is 21 and the available arch space is 18 mm there is shortage of space so we expect crowding . **used only for consultation.


b. proportional tables*give good estimation and it is accurate problems with it:*race sensitive (different between races in the size of the teeth ))no correlation between sizes *female and male differences (gender differences))*in same individual (weak correlation between the teeth themselves (PMs differ from canines).

it is based on longitudinal studies on population to know the average of all teeth one of the most popular studies in America and Canada is Moyer 's study which use the space occupied by erupted permanent lower incisors ( centrals and laterals )- which erupted early - to predict the space needed for unerupted (3,4,5 )according to certain proportion. for example we measure the width of lower incisors then we look for the corresponding number in the table to know the estimated width of (3,4,5) . the problems of these tables that they are not friendly used , they based on estimation , it is race specific so all population need their own measurements .


3-estimation from equation:

Tanka and Johnson developed another way to use the width of the lower incisors to predict the size of unerupted canine and premolar as following :

½ of the mesiodistal width of the four lower incisrs + 10.5 =estimated width of mandibular canine and premolars in one quadrant

½ of the mesiodistal width of the four lower incisors +11=estimated width of maxillary canine and premolars in one quadrant

for example if the width of lower incisors is 20 mm then the space needed for upper permanent (3,4,5 )= (20/2) + 11 = 21 and the space needed for the lower ( 3,4,5 ) = (20/2 )+ 10.5 = 20.5we have our own version of Tanka and Johonston ( Jordanian study ) which is very close to Caucasian of American.

tooth size discrepancy The tooth size was important to ideal occlusion. In order to obtain the proper interdigitation and arch coordination when the molars and incisors are in a Class I relationship, the dimension of the lower teeth has to be proportional to the dimension of the upper teeth , if there is a tooth size discrepancy the teeth will not fit each other.Overall ratio: Sum of mesiodistal width of mandibular 12 teeth/ sumof mesiodistal width of maxillary 12 teeth Mean =91.3%

Anterior ratio:Sum of mesiodistal width of mandibular 6 teeth /sum of mesiodistal width of maxillary 6 teeth *100 %Mean=77.2%


If the ratio is more than mean then the mandibular tooth material is excessive

If the ratio is less than mean value ,then the maxillary tooth material is excessive

as a general dental practitioner you should be able to examine and diagnose orthodontics problem then summarize the case in systematic approach we start with history then chief complain( CC ) ,extra oral examination , intra oral examination , gingival condition , teeth condition ,teeth in occlusion ,describe the lower arch then the upper ( crowded or well aligned ) then problem list .

good luck sorry for any mistake jumanah alzoubi

Documents

Web viewUniversity of Jordan. Faculty of Dentistry. Fourth year – 2nd semester 2014-2015. Orthodontics. Sheet . Slides. Hand Out. 44. Date: Lecture No. Our website