OrthodonticCaseAnalysis正课件

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1、Orthodontic Case AnalysisDr.PerucchiniDr.FeatheringhamDent 657.THE PROBLEM-ORIENTED APPROACH Comprehensive way of looking at patients problem Involves development of a database Patient interview/questionnaire Clinical exam Diagnostic records.I.QUESTIONNAIRE/PATIENT INTERVIEW.I.QUESTIONNAIRE/PATIENT

2、INTERVIEW Chief complaint Patients subjective assessment of problem Impaired function vs.impaired esthetics Establish relative importance of each to the patient.Medical/Dental HistoryOrthodontic problems are typically a developmental problem,not a pathological problemImportant points on medical hist

3、ory:Medical problems?Medications?Need for prophylaxis?History of previous trauma?Important points on dental history:Hereditary component to malocclusion?Dental/Orthodontic IQI.QUESTIONNAIRE/PATIENT INTERVIEW.I.QUESTIONNAIRE/PATIENT INTERVIEW Physical Growth EvaluationWhy do we want to evaluate patie

4、nts growth status?Appropriate referral if problemsGrowth modification therapy(headgear)Rapid growth during adolescence facilitates tooth movementHow can you evaluate a patients growth?Growth chartsSerial cephsHand-wrist radiographEvaluation of 2 sex characteristics.I.QUESTIONNAIRE/PATIENT INTERVIEW

5、Physical Growth EvaluationWhy do we want to evaluate patients growth status?Appropriate referral if problemsGrowth modification therapy(headgear)Rapid growth during adolescence facilitates tooth movementHow can you evaluate a patients growth?Growth chartsSerial cephsHand-wrist radiographEvaluation o

6、f 2 sex characteristics.I.QUESTIONNAIRE/PATIENT INTERVIEW Physical Growth EvaluationWhy do we want to evaluate patients growth status?Appropriate referral if problemsGrowth modification therapy(headgear)Rapid growth during adolescence facilitates tooth movementHow can you evaluate a patients growth?

7、Growth chartsSerial cephsHand-wrist radiographEvaluation of 2 sex characteristics.I.QUESTIONNAIRE/PATIENT INTERVIEW Physical Growth EvaluationWhy do we want to evaluate patients growth status?Appropriate referral if problemsGrowth modification therapy(headgear)Rapid growth during adolescence facilit

8、ates tooth movementHow can you evaluate a patients growth?Serial cephalogramsHand-wrist radiographEvaluation of 2 sex characteristics.I.QUESTIONNAIRE/PATIENT INTERVIEW Social/Behavioral Evaluation Motivation Internal vs.External Expectation Realistic?Cooperation Some forms of treatment are cooperati

9、on-dependent May delay treatment altogether,or modify treatment plan to decrease need for patient compliance.II.CLINICAL EXAM.II.CLINICAL EVALUATION Evaluation of Oral Health Medical and dental problems under control before ortho Treatment of active caries and perio problems done before ortho Defini

10、tive restorations(crowns)usually not placed until after ortho Check for mucogingival problems Often dealt with prior to ortho.II.CLINICAL EVALUATION Evaluation of Jaw/Occlusal Function TMJ evaluation History or TMD?TMD signs/symptoms?Evaluation for CR-CO shifts Presence of shift may alter diagnosis.

11、COCR.II.CLINICAL EVALUATION Evaluation of Facial Esthetics Evaluate facial proportions and symmetry Disproportion/asymmetry contribute to esthetic problems FRONTAL VIEW Symmetry Dental vs.skeletal midlines Width of eyes,nose,mouth Lip competence,gingival display,etc.II.CLINICAL EVALUATION Evaluation

12、 of Facial Esthetics Evaluate facial proportions and symmetry Disproportion/asymmetry contribute to esthetic problems FRONTAL VIEW Symmetry Dental vs.skeletal midlines Width of eyes,nose,mouth Lip competence,gingival display,etc.SYMMETRY.II.CLINICAL EVALUATION Evaluation of Facial Esthetics Evaluate

13、 facial proportions and symmetry Disproportion/asymmetry contribute to esthetic problems FRONTAL VIEW Symmetry Dental vs.skeletal midlines Width of eyes,nose,mouth Lip competence.MIDLINES.II.CLINICAL EVALUATION Evaluation of Facial Esthetics Evaluate facial proportions and symmetry Disproportion/asy

14、mmetry contribute to esthetic problems FRONTAL VIEW Symmetry Dental vs.skeletal midlines Width of eyes,nose,mouth Lip competence.WIDTHS.II.CLINICAL EVALUATION Evaluation of Facial Esthetics Evaluate facial proportions and symmetry Disproportion/asymmetry contribute to esthetic problems FRONTAL VIEW

15、Symmetry Dental vs.skeletal midlines Width of eyes,nose,mouth Lip competence,gingival display,etc.LIP INCOMPETENCE,GINGIVAL DISPLAY.II.CLINICAL EVALUATION Evaluation of Facial Esthetics PROFILE VIEW Compare vertical thirds Evaluate position of maxilla and mandible in the anterior-posterior plane Eva

16、luate lip posture/prominence.II.CLINICAL EVALUATION Evaluation of Facial Esthetics PROFILE VIEW Compare vertical thirds Evaluate position of maxilla and mandible in the anterior-posterior plane Evaluate lip posture/prominence.II.CLINICAL EVALUATION Evaluation of Facial Esthetics PROFILE VIEW Compare

17、 vertical thirds Evaluate position of maxilla and mandible in the anterior-posterior plane Evaluate lip posture/prominence.RETROGNATHICPROGNATHIC.II.CLINICAL EVALUATION Evaluation of Facial Esthetics PROFILE VIEW Compare vertical thirds Evaluate position of maxilla and mandible in the anterior-poste

18、rior plane Evaluate lip posture/prominence.III.ANALYSIS OF DIAGNOSTIC RECORDS.III.ANALYSIS OF DIAGNOSTIC RECORDS-CAST ANALYSIS-CEPH ANALYSIS.CAST ANALYSIS Asymmetry Often due to early loss of primary tooth on 1 side of arch.CAST ANALYSIS Molar Classification.CAST ANALYSIS Space available vs.space re

19、quired Permanent Dentition Measure the M-D width of teeth and compare to arch length Mixed Dentition Need width of unerupted canines and premolars Tanaka-Johnston or Moyers AnalysisUse width of erupted lower incisors to predict.CEPH ANALYSIS To identify pathology To define anatomic basis for maloccl

20、usion To evaluate changes due to treatment and growth.CEPH ANALYSIS To identify pathology To define anatomic basis for malocclusion To evaluate changes due to treatment and growth.CEPH ANALYSIS To identify pathology To define anatomic basis for malocclusion To evaluate changes due to treatment and g

21、rowth.IV.ORTHODONTIC CLASSIFICATION SYSTEMS.ORTHODONTIC CLASSIFICATION SYSTEMS Angle First system to define normal occlusion Defined three classes of malocclusion Weakness:No information about transverse or vertical relationships Ackerman/Proffit Describes five major characteristics of malocclusion.

22、ACKERMAN PROFFIT CATEGORIES Facial Proportions and Esthetics Alignment and Symmetry Transverse skeletal/dental relationships A-P skeletal/dental relationships Vertical skeletal/dental relationships.ACKERMAN PROFFIT CATEGORIES Facial Proportions and Esthetics Clinical exam and photos Look at frontal

23、and profile views Check facial symmetry,A-P and vertical proportions,lip prominence.ACKERMAN PROFFIT CATEGORIES Alignment and Symmetry Occlusal view of casts Symmetry and space.ACKERMAN PROFFIT CATEGORIES Transverse skeletal/dental relationships Casts in occlusion(frontal view)Check for posterior cr

24、ossbites.ACKERMAN PROFFIT CATEGORIES A-P skeletal/dental relationships Casts in occlusion(buccal views),Ceph Molar and canine class,overjet,anterior crossbite.ACKERMAN PROFFIT CATEGORIES Vertical skeletal/dental relationships Casts in occlusion(frontal view),Ceph Check for open bite,deep bite.V.DEVE

25、LOPMENT OF A PROBLEM LIST.DEVELOPMENT OF A PROBLEM LIST Separate pathology vs.developmental Classify developmental problems into 5 Ackerman-Proffit categories Classify problems as mild-moderate-severe Write prioritized problem list from most to least severe.CASE ANALYSISLABORATORY EXERCISE.CC:“Mouth

26、 is too small for all his teeth.Protruding teeth.”.Facial symmetry:Symmetric.Profile:ConvexMaxilla(AP):ProtrusiveMandible(AP):RetrusiveLip competency:Yes.Nasolabial Angle:Obtuse.Mandibular Plane Angle:Increased.Lower Face Height:Increased.Overbite:Deep(50%)Anterior Crossbite:#7 and#27Dental midlines

27、:Maxillary right 3mm.Overjet:2 mmMolar class:Angle class ICanine class:UnidentifiableAnt.crossbite:#7 and#27Overjet:2 mmMolar class:Angle class ICanine class:Angle class I.Max.Arch:CrowdingArch Shape:U-formMand.Arch:CrowdingArch Shape:U-form.StandardDylanSNA82+/-286 NA to FH90+/-391SNB80+/-282N-Pog

28、to FH88+/-687ANB2+/-24Y-axis59+/-665FMA22+/-528%LFH55%Interincisal130+/-5139U1 to FH110+/-3104U1 to NA2214U1 to NA(mm)4mm3mmL1 to NB2524L1 to NB(mm)4mm3mmL1 to MP91+/-692Lo lip to E plane-2+/-2mm1mmNasolabial Angle102+/-8109.Space Analysis:-6 mm (crowding)Space Analysis:-7 mm(crowding).ACKERMAN PROF

29、FIT CATEGORIES Facial Proportions and Esthetics Alignment and Symmetry Transverse skeletal/dental relationships A-P skeletal/dental relationships Vertical skeletal/dental relationships.DEVELOPMENT OF A PROBLEM LIST Separate pathology vs.developmental Classify developmental problems into 5 Ackerman-P

30、roffit categories Classify problems as mild-moderate-severe Write prioritized problem list from most to least severe.Prioritized Problem List1.Pathology:generalized gingivitis,poor OH2.Alignment/SymmetryMx/Md moderate crowdingMx midline right 3 mm3.Anteroposterior Skeletal/DentalReclined and recumbe

31、nt U/L incisorsAnterior crossbiteSlight retrognathic mandible/convex profile4.Vertical Skeletal/DentalDeep biteIncreased LAFH.Prioritized Problem List(continued)5.Transverse Skeletal/DentalNo problems6.Facial Proportions/EstheticsNo problems.Diagnostic SummaryDylan is a 14y 3m Causasian male who presents with moderate maxillary and mandibular crowding,ectopic eruption of canines,anterior crossbite,deep bite,maxillary midline 3mm to the right,and a convex profile.