Tournée de l’Ordre 2012 • Dr Jean-Marc Retrouvey • Dr Donald Taylor Drag picture to placeholder or click icon to add Drag picture to placeholder or click icon to add Note: For the sake of privacy, real patients’ faces have been replaced by royaltee free pictures
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Tournée de l’Ordre 2012
• Dr Jean-Marc Retrouvey• Dr Donald Taylor
Drag picture to placeholder or click icon to add
Drag picture to placeholder or click icon to add
Note: For the sa
ke of
privacy, re
al patients’
faces have been re
placed
by royalte
e free pictures
Objectives of the Day
• Discuss the different modalities necessary to obtain an adequate diagnosis
• Revisit the basic principles of interceptive orthodontics and understand the importance of early intervention
• Determine the importance of the use of orthodontics to optimize the dental health of adults
• Discuss Invisalign
OrthodonticDiagnosis
Dr Donald TaylorDr Jean-Marc Retrouvey
1. Review the fundamental principles of diagnosis
2. How to prepare proper orthodontic record3. The importance of differential diagnosis4. The selection of cases that can be treated in
your office
Objectives
1. Review of fundamental principles
• Screenings of malocclusions (children and adults)
• Orthodontic evaluation1. Observation-Reevaluation2. Intervention3. Treatment4. When to refer to the
orthodontist
Brief History of Diagnosis in Orthodontics
Angle’s Classification 1920’s. Based on molar
relationship
Akerman Profitt 1970-1980: more information
based on skeletal and dento-alveolar relationships
New approach “Outside in ”:
Importance of facial harmony
Diagnosis-Differential Diagnosis
• Important to differentiate the severity of the malocclusion
• It is imperative to create an orthodontic record for each patient!
Orthodontic Record
The orthodontic record is composed of two sections
1. Collection of Information 1. Medical and Dental History2. Extraoral Examination3. Functional examination
Intra-oral Photographs (obligatory and of diagnostic quality)
Study modelsStudy models must be of good quality to allow proper study
When to mount a case in CR
• Angle determined that this relationship was essential in order to have a functional occlusion and optimal esthetics…….with a full compliment of teeth
• One of the goals of orthodontic treatment is to achieve a class I molar relationship. There are exceptions
1. Molar Classification
Is there a problem with this classification?
Even though Class I is very important , it does not take into account the denture position in relation to facial structures
It is not guaranteed that a Class I molar relationship is the only mark of success of orthodontic treatment
It is vertical problems which cause us miseries
Two malocclusions which present with a Class I malocclusion (or almost)
Are the problems skeletal or dento alveolar?
The Angle classification has nothing to do with the complexity of the cases
2. Overbite1. Etiology of exaggerated deep
bite– Over eruption of the incisors– Under eruption of the molars– Skeletal dysplasia– Deep Curve of Spee
The chief complaint of the patient was: « I have a crooked
tooth »
The etiology greatly helps to determine the modalities of treatment
• Supra erupted incisors• Under erupted molars• Deep Curve of Spee
• Hypoplastic Mandible
• Intrusion with fixed braces
• Level Curve of Spee
• Orthognathic surgery
2.Open Bite• Possible etiologies of open bite
– Anterior position of the tongue( habits)– Genetic factors– Sleep apnea
3.Overjet
• The etiology was multifactorial
• Dentoalveolar• Skeletal• A combination of the
above
Overjet
The incisors seem to be very protrusive
Equally, the mandible is very retrusive
4. Midlines
• Skeletal• Dental
Midlines
• We use the reference line to determine the different midlines- maxillary and mandibular
4. Intraoral Examination and Study Models 5. Radiographs
• panoramic • cephalometric
5.Radiographs
Analysis of Pantographic radiograph
Analysis and interpretation of the cepalogramMandatory when contemplating all orthodontic treatment!
Analysis:– Skeletal (values as normal as possible)– Dentoalveolar – Pearl: The cases where the mandibular plane angle is
normal typically gives the best prognosis
Cephalometric analysisAngles Ceph.
ValuesNormal
Skeletal Measurements
SNA 79.5 81 ± 3
SNB 75.0 78 ± 3
ANB 4.5 3 ± 2
Witts -4.0 2 mm ± 2mm
Facial ∠ 86.0 88 ± 4
MPAST 38.0 32 ± 3
Y axis 60.0 60 ± 4
Dental Measurements
(UI,NA) 16.0 23 ±6
(LI,NB) 23.0 27.5 ±5
(UI,LI) 135.0 130 ± 7
(LI,MP) 91.0 91.4 ± 4
Pre-Treatment
The skeletal measurements give us the relationship of the osseous bases relative to the cranial base
Diagnosis of the malocclusion
• Write the most significant elements
• Example– Class II division I
malocclusion– Severe retrusion of the
mandible– Increased overbite – Moderate crowding of the
upper arch– Upper right canine
palatally impacted
Problem listProblem Resolution Comments
Class II molar Maintain Correct Improve
There are potential skeletal problems
Mandibular retrusion Correct Reevaluate in 6 months
Overjet Maintain Correct Improve
Impacted canine Consultation with surgeon su Wait 6 months
May need to be Surgically exposed
Crowding Rapid palatal expansion Extraction Arch development
x
x
x
x
ConclusionsIdentify the malocclusion presented and arrive to a proper
diagnosis is the most important aspect in orthodontic treatment.
Then the formulation of the objectives and establishment of a feasible treatment plan are indispensable in establishing the path to follow in treatment
Observe, wait, treat or refer, but above all be sure that you inform the patient and parent of the diagnosis and options of treatment so that THEY make an informed decision to chose the best course for the to follow.