PSYCHOLOGICAL

EXAMINATION
1. Eysenck Personality Questionnaire
2. Brief Symptom Inventory
Eysenck
Personality
Questionnaire
RADIOGRAPHIC
EXAMINATION
• Lateral cephalography • Hand wrist radiograph
• PA cephalography (for asymmetry) • Bone scan of TMJ (for asymmetry)
• Panelipse (OPG) • Cone beam CT
• Periapicals (if necessary)
 PA Cephalography (for asymmetry)

PA cephalograms + frontal facial

= cost-effective tools for determining the presence and
extent of facial asymmetry

Ko, E. W.-C., Huang, C. S., & Chen, Y. R. (2009). Characteristics and Corrective Outcome of Face Asymmetry by Orthognathic Surgery. Journal of Oral
and Maxillofacial Surgery, 67(10), 2201–2209. doi:10.1016/j.joms.2009.04.039 
 Fitting skeletal landmarks to the
treatment goal of a double-cross grid in
PA cephalometric tracing
• Ideal symmetry:
• Planned surgical prediction of the frontal occlusal
plane - parallel to the orbital plane
• Central contact of maxillary incisors  in
midsagittal plane
• Chin point (menton)  in midsagittal plane
• Axis of the front teeth  parallel the midsagittal
plane

As long as the face and skeleton are fitted in the “double-cross grid,” the
remaining outer contour asymmetry can simply be corrected by cosmetic
shaping

Ko, E. W.-C., Huang, C. S., & Chen, Y. R. (2009). Characteristics and Corrective Outcome of Face Asymmetry by Orthognathic Surgery. Journal of Oral and Maxillofacial Surgery,
67(10), 2201–2209. doi:10.1016/j.joms.2009.04.039 
 Cephalometric Measurement of
PA Films
Orbital Line connecting the bilateral Lo points
plane
Rf Midsagittal plane

Sm Vertical distance of the upper first molar to the

orbital plane in the shorter side of the face

Lm Vertical distance of the upper first molar to the

orbital plane in the longer side of the face

GS Horizontal distance of the gonion to midsagittal

plane in the shorter side of the face

GL Horizontal distance of the gonion to the midsagittal

plane in the longer side of the face

Chin-mid Horizontal distance from the menton to the

midsagittal plane
Ko, E. W.-C., Huang, C. S., & Chen, Y. R. (2009). Characteristics and Corrective Outcome of Face Asymmetry by Orthognathic Surgery. Journal of Oral and Maxillofacial Surgery,
67(10), 2201–2209. doi:10.1016/j.joms.2009.04.039 
HAND
WRIST
Bjork System
 Hand Wrist Radiograph

The hand and wrist radiograph help in estimating the skeletal age of bone for
determining the physical maturation status of the child

The bone age is of great help to the orthodontist in coordinating the orthodontic
therapy with the growth process

Hashim, H. A., Mansoor, H., & Mohamed, M. H. H. (2018). Assessment of skeletal age using hand-wrist radiographs following Bjork
system. Journal of International Society of Preventive & Community Dentistry, 8(6), 482.
 Different methods to assess the skeletal
maturity
Height Weight Chronological age Sexual maturation

Biological age or Hand-wrist

Frontal sinus Cervical vertebrae
physiological age maturity

Dental eruption
and dental Biomarkers
calcification stages

Hashim, H. A., Mansoor, H., & Mohamed, M. H. H. (2018). Assessment of skeletal age using hand-wrist radiographs following Bjork
system. Journal of International Society of Preventive & Community Dentistry, 8(6), 482.
 Different methods to assess the skeletal
maturity
Height Weight Chronological age Sexual maturation

Biological age or Hand-wrist

Frontal sinus Cervical vertebrae
physiological age maturity

Dental eruption
and dental Biomarkers
calcification stages

Hashim, H. A., Mansoor, H., & Mohamed, M. H. H. (2018). Assessment of skeletal age using hand-wrist radiographs following Bjork
system. Journal of International Society of Preventive & Community Dentistry, 8(6), 482.
 Indications for hand wrist radiographs
• In patients who exhibit major discrepancy between dental and chronologic age
• To predict the pubertal growth spurt
• Prior to the treatment of skeletal malocclusion such as skeletal C II or III in a
growing patient
• Indicated in patient with skeletal malocclusion needing orthognathic surgery, if
undertaken between 16 – 20 years – to assess growth status
• To study the role of heredity, environment and nutrition on the skeletal
maturation pattern
 Hand Wrist Radiograph
• Skeleton in hand and wrist region is made of several small bones

• 27 small bones

• Distal ends of long bones radius and ulna

• The development of these bones from the appearance of calcification centres to

epiphyseal plate’s closure occurs throughout the entire postnatal growth
period

• Therefore provides a useful means of assessing skeletal maturity

Hashim, H. A., Mansoor, H., & Mohamed, M. H. H. (2018). Assessment of skeletal age using hand-wrist radiographs following Bjork
system. Journal of International Society of Preventive & Community Dentistry, 8(6), 482.
 Hand Wrist Radiograph
• Growth prediction can be estimated utilizing physiological parameters which
include the peak of the growth velocity in standing height, pubertal markers,
dental development, and radiological finding of skeletal maturation

• It was reported that the evaluation of skeletal maturation with the help of
radiographs is considered to be the more reliable approach.

• The most preferred method is the use of hand‑wrist radiographs

Hashim, H. A., Mansoor, H., & Mohamed, M. H. H. (2018). Assessment of skeletal age using hand-wrist radiographs following Bjork
system. Journal of International Society of Preventive & Community Dentistry, 8(6), 482.
 Purpose of hand and wrist radiograph analysis

• Determine parameters:
• Patient’s skeletal age

• Amount of growth left

• Functional appliance use or to wait until growth ceased

• Performed extraction or surgery

Hashim, H. A., Mansoor, H., & Mohamed, M. H. H. (2018). Assessment of skeletal age using hand-wrist radiographs following Bjork
system. Journal of International Society of Preventive & Community Dentistry, 8(6), 482.
 Bjork system
• Used 4 stages of bone maturation

• All found at 5 anatomical sites located on

the thumb, second finger, third finger, and
radius

• However, 8 discrete adolescent skeletal

maturity indicators covering the entire
period of adolescent development are found
on these 5 sites
 The skeleton of the hand and
wrist is made of the following:

• Distal ends of long bones of

the forearm (radius and ulna)
• Carpals
• Metacarpals
• Phalanges
 The main components of
hand and wrist are as
follows:
• Joint between radius and navicular
(Scaphoid) bones (radiocarpal joint)
• Joint between the trapezium and first
metacarpal bones (carpometacarpal joint)
• First metacarpophalangeal joint
• Interphalangeal joint of the thumb
• Proximal interphalangeal joint
• Middle inter‑phalangeal joint
• Distal interphalangeal joint.
 Epiphysis &
Diaphysis
• The development of the epiphysis and
diaphysis of growing child differs in:
• The timing & sequence of the
maturational events

Width Ossification Capping Fusion

 In Bjork system, the
developmental maturity
indicators are in the following
order
1. Width of epiphysis as wide as diaphysis
located at:
• Proximal phalanx of the second finger
(PP2)
• Middle phalanx of the third finger (MP3)
2. Ossification of adductor sesamoid located at
the thumb(S)
3. Capping of epiphysis located at middle
phalanx of the third finger (MP3 Cap)
4. Fusion of epiphysis and diaphysis located at:
• Distal phalanx third finger fusion (DP3F)
• Proximal phalanx third finger fusion (PP3F)
• Middle phalanx of third finger fusion (MP3F)
• Radius (R)
In Bjork system, the
developmental maturity
indicators are in the following
order
Width of epiphysis as wide as diaphysis located at:
• Proximal phalanx of the second finger (PP2)
• Middle phalanx of the third finger (MP3)
Ossification of adductor sesamoid located at the thumb(S)
Capping of epiphysis located at middle phalanx of the third
finger (MP3 Cap)
Fusion of epiphysis and diaphysis located at:
• Distal phalanx third finger fusion (DP3F)
• Proximal phalanx third finger fusion (PP3F)
• Middle phalanx of third finger fusion (MP3F)
• Radius (R)
Fusion of epiphysis and diaphysis located at:
• Distal phalanx third finger fusion (DP3F)
• Proximal phalanx third finger fusion (PP3F)
• Middle phalanx of third finger fusion (MP3F)
• Radius (R)
Fusion of epiphysis and diaphysis located at:
• Distal phalanx third finger fusion (DP3F)
• Proximal phalanx third finger fusion (PP3F)
• Middle phalanx of third finger fusion (MP3F)
• Radius (R)
Fusion of epiphysis and diaphysis located at:
• Distal phalanx third finger fusion (DP3F)
• Proximal phalanx third finger fusion (PP3F)
• Middle phalanx of third finger fusion (MP3F)
• Radius (R)
 In Bjork system, the
developmental maturity
indicators are in the following
order