Professional Documents
Culture Documents
Analyzing Orthodontic Problems
Analyzing Orthodontic Problems
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Clinical evaluation
• Evaluation of facial proportion
– Assessment of developmental age
• Chronologic
g vs. maturational age:
g 12-year-old
y looks
15 or 15-year-old looks 12
– Facial esthetics vs. Facial proportions
– Frontal examinations
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Clinical evaluation
• Profile analysis
– Jaw proportionately positioned in the A-P plane
of space
p
– Lip posture and incisor prominence
– Vertical facial proportions and mandibular
plane angle
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Diagnostic Records Diagnostic Records
• Three major categories: • Records for evaluation of the teeth and oral
– Records for evaluation of the teeth and oral structures
structures – Intraoral photographs
– Records for occlusal evaluation – Panoramic radiographs
– Records for evaluation of facial and jaw • Periapical and bitewing radiographs
proportions
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Curve of Spee
• Depth of Curve of Spee - Unilateral
measurement of the deepest curve of Spee
on the mandibular cast. This is defined as a
vertical
i l measurement (millimeters)
( illi ) from
f a
horizontal plane resting on the most distal-
buccal molar cusp tip and the ipsilateral
central incisor edge to the most gingivally
positioned premolar or deciduous molar
buccal cusp tip.
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Enough room?
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m=
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Hixon and Oldfather prediction Hixon and Oldfather prediction graph
graph
• Combination of radiographic and prediction table
methods
• Only for mandibular arch
• Measure the width of #25, 26 from the cast
• Measure the width of unerupted #28, 29 from the
radiograph
• Sum of the above 2 and look up the graph for the
total width of unerupted canines and premolars
(#27,28,29)
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Treatment planning for the primary Treatment planning for the early
dentition mixed dentition
• Posterior and anterior crossbites: treat early • Space discrepancies
• Skeletal A-P and vertical problems: <4mm: non-extraction
treatment indicated only for the most severe 55-99 mm: non
non-extraction/
extraction/ extraction
discrepancies > 10 mm: extraction
• Serial extraction
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Treatment Planning for the Early
Growth modification
Mixed Dentition
• Skeletal problems • Facemask for Class III skeletal malocclusion
– Growth modification
• Dentofacial problems related to incisor
protrusion:
– Late mixed dentition or early permanent
dentition
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Treatment planning for the early mixed Treatment planning for the early
dentition mixed dentition
• Space problems: localized space loss (< • Generalized moderate crowding
3mm): space regaining – 2-4 mm of arch length discrepancy with no
– Premature loss of primary Mx or Md 2nd molar pprematurelyy missing
g pprimary
y teeth →
– Early loss of one Md primary canine eventually has moderately crowded permanent
incisors. → Expand the arches with either
– Unilateral space loss: regain up to 3mm
LLHA in lower arch or W-arch in upper arch
– Bilateral space loss: regain up to 4mm for total
arch/ 2mm per quadrant
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Treatment planning for the early
Mixed dentition
• Irregular/ Malpositioned incisors
– Spaced and flared maxillary incisors
– Maxillary midline diastema: “ugly
ugly duckling
stage”
• Space > 2mm: spontaneous closure is unlikely (early
frenectomy should be avoided)
– Mesioden?
– High frenum?
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Blue grass appliance Tongue crib
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Treatment planning for the early Treatment planning for the early
mixed dentition mixed dentition
• Over-retained primary teeth and ectopic • Premature removal of primary tooth: layer
eruption of dense bone and soft tissue
– Delayed eruption of permanent teeth if primary • Extraction of Mx primary canine when
predecessor retained too long permanent canines are overlapping the
– If a primary tooth still has considerable root permanent lateral incisor roots → positive
remaining, when ¾ of the root of the permanent influence on the permanent tooth’s eruption
successor has formed, the primary tooth should
path.
be extracted.
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Summary
• Questionnaire/Interview
• Clinic evaluation
• Diagnostic records
• Treatment plan
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