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Orthodontic diagnosis:Orthodontic diagnosis:The development of a Problem ListThe development of a Problem ListOperator:Zhou LingSupervisor:Prof.Li Date:2013.6.61行业进步Orthodontic diagnosis:1534Development of a Problem List The Problem-Oriented approachClinical EvaluationAnalysis of Diagnostic RecordsOrthodontic ClassificationChapter outline22行业进步1534Development of a Problem LAnalysis of Diagnostic RecordsTwo partsCephalometric analysis of dentofacial relationshipsDental cast analysisto evaluate space excess or deficiency and symmetry within the dental arches3行业进步Analysis of Diagnostic Recordsv Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis4行业进步 SymmetryDental cast analysis4Symmetryv Transparent ruled grid placed over dental castv Oriented to the midpalatal raphe v Spot asymmetries in arch form,and tooth position5行业进步Symmetry Transparent ruled gri Lateral drift of incisors (Crowding,C lost 3 blocked out)SymmetryDrift of posterior teeth（Early loss of E)6行业进步 Lateral dPendulum7行业进步Pendulum7行业进步v Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis8行业进步 SymmetryDental cast analysis8Alignment(Crowding):SpaceAnalysis9行业进步Alignment(Crowding):9行业进步vDental castv Computer algorithmSpace Analysis10行业进步Dental cast Computer algorith Measuring arch perimeter from the mesial of one first molar to the other,over the contact points of posterior teeth and incisal edge of anteriors.Step one:Calculation of available space片段法铜丝法11行业进步 Measuring arch perimeter fStep two:Calculation of required spaceMeasure the mesiodistal width of each erupted tooth from contact point to contact point.12行业进步Step two:Calculation of requiSpace Analysis13行业进步Space Analysis13行业进步 01 The space available will not change because of growth.02All the teeth are normal in size03Correct anteroposterior position of incisors Three assumptions14行业进步 01 02All the teeth ar InteractionProtrusionRetrusionCrowding15行业进步 InteractionProv Crowding and protrusion are different aspects of the same phenomenon.vIf there is not enough room to properly align the teeth,the result can be crowding,protrusion,or(most likely)some combination of the two.16行业进步16行业进步17行业进步17行业进步18行业进步18行业进步19行业进步19行业进步01 The space available will not change because of growth.02All the teeth are normal in size03Correct anteroposterior position of incisors Three assumptions20行业进步01 02All the teeth are normalv In a child with a well-proportioned face,there is little or no tendency for the dentition to be displaced relative to the jaw during growth.vBut the teeth often shift anteriorly or posteriorly in a child with a jaw discrepancy.21行业进步 In a child with a well-propor22行业进步22行业进步01 The space available will not change because of growth.02All the teeth are normal in size03Correct anteroposterior position of incisors Three assumptions23行业进步01 02All the teeth are normalv Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis24行业进步 SymmetryDental cast analysis2 Mix Dentition Estimating of Unerupted Permanent Teeth25行业进步 Mix Estimating of Unerupted Permanent TeethRadiograghicPrediction table methodsCombination26行业进步 Estimating of Unerupted PeUndistorted radiographic image Compensate for enlargementPeriapical radiographsPanoramic radiographs.Measurement of the teeth on radiographs27行业进步Undistorted radiographic image True width of primary molarApparent width of primary molarMeasurement of the teeth on radiographs True width of unerupted PremolarApparent width of unerupted premolar=28行业进步 True width of primary molav Accuracy is fair to good depending on the quality of the radiographs and their position in the arch.v The technique can be used in maxillary and mandibular arches for all ethnic groups.Measurement of the teeth on radiographs29行业进步 Accuracy is fair to good depe Estimating of Unerupted Permanent Teeth RadiograghicPrediction table methodsCombination30行业进步 Estimating of Unerupted PeMoyersprediction Estimation from proportionality tablesMeasuring the mesiodistal width of the lower incisors Prediction the size of both the lower and upper unerupted canines and premolars31行业进步Moyers prediction Estimatio Estimation from proportionality tables32行业进步 Estimation from proportionavNorthern European white childrenvNo radiographs are required,used for the upper or lower arch.Estimation from proportionality tables33行业进步 Estimation from proportion Estimation from proportionality tables34行业进步 Estimation from proportiona Estimating of Unerupted Permanent TeethRadiograghicPrediction table methodsCombination35行业进步 Estimating of Unerupted PeCombination of radiographic and prediction tableIt depends!36行业进步Combination of radiographic anComparison1Radiograghic2Most practicalNorthern European white childrenNo radiograghsNo reference table3MoyersTakana&JohnstonNorthern European white childrenNo radiographsDepending on the quality of the radiographs and their position in the archFor all ethnic groups.37行业进步Comparison1Radiograghic23Moyerv Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis38行业进步 SymmetryDental cast analysis3v Although the natural teeth match very well in most individuals,approximately 5%of the population have some degree of disproportion among the sizes of individual teeth.-Tooth Size Discrepancy(TSD)Tooth Size Analysis39行业进步 Although the natural teeth maTooth Size Analysis40行业进步Tooth Size Analysis40行业进步Bolton RatioTooth Size Analysis(78.8 1.72)%(91.5 1.51)%41行业进步Bolton RatioTooth Size Analysi A quick check for.v Anterior tooth size discrepancy:2 2v Posterior tooth size discrepancy：5=5v A tooth size discrepancy of less than 1.5mm is rarely significant.Tooth Size Analysis42行业进步 Tooth Size Analysis42行v Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis43行业进步 SymmetryDental cast analysis4Analysis of Diagnostic RecordsTwo partsCephalometric analysis of dentofacial relationshipsDental cast analysisto evaluate space excess or deficiency and symmetry within the dental arches44行业进步Analysis of Diagnostic Records The introduction of radiographic cephalometrics is in 1934 by Hofrath in Germany and Broadbent in USA.Cephalometric analysis45行业进步 The introduction of radiogra Function v Original purposev Evaluating dentofacial proportions and clarify the anatomic basis for a malocclusion v Observing pathologic changes(Sometimes)Researching on growth patterns in the craniofacial complex.46行业进步 Function Original purpose 46This patient has fusion of the 1st and 2nd cervical vertebrae,with the odontoid process extending into the margin of foramen.Function 47行业进步This patient has fusion of the Function v Original purposev Evaluating dentofacial proportions and clarify the anatomic basis for a malocclusion v Observing pathologic changes(Sometimes)v Recognizing and evaluating changes brought about by orthodontic treatment.Researching on growth patterns in the craniofacial complex.48行业进步 Function Original purpose 48 Function 49行业进步 Function 49行业进步 The goal of cephalometric analysis is to evaluate the relationships,both horizontally and vertically,of the five major functional components of the face.Cephalometric analysis50行业进步 The goal of cephalometric aCephalometric analysis51行业进步Cephalometric analysis51行业进步vCranial Base S，N，Po，Ba,Bov Maxilla Or，Ptm，ANS，PNS，A，UIv Mandibular Co，Go，B，LI，Pog，Me，GnCephalometric Landmarks52行业进步Cranial BaseCephalometric Landv S.sellav N.nasion v Po.porion v Ba.basion v BoS S S SN N N NPoPoPoPoBaBaBaBaBoBoBoBoCephalometric Landmarks53行业进步SNPoBaBoCephalometric Landmarkv Or.orbitale v Ptm.v ANS.Anterior nasal spine v PNS Posterior nasal spine v A.subspinale v UI.Upper IncisorOrOrOrOrANSANSANSANSUIUIUIUIA A A APtmPtmPtmPtmPNSPNSPNSPNSCephalometric Landmarks54行业进步 Or.orbitale OrANSUIAPtmPNSCv Co.condylionv Go.gonionv Pog.pogonionv Me.menton v Gn.gnathionv B.supramentalv LI.lower incisor CoCoCoCoGoGoGoGoB B B BLILILILIPog/Pog/Pog/Pog/GnGnGnGn/MeMeMeMeCephalometric Landmarks55行业进步 Co.condylionCoGoBLIPog/Gn/Me56行业进步56行业进步Two methodsContemporary measurement approachCephalometric analysis via direct comparison with reference templateCephalometric analysis57行业进步Two methodsContemporary measurContemporary measurement approachv Choice of a Horizontal(Cranial)Reference Line.v Steiner Analysisv Sassouni Analysisv Wits Analysis58行业进步Contemporary measurement approChoice of a Horizontal Reference LineAn international congress was held in Frankfort,Germany in 1882.with the choice of a horizontal reference line for orientation of skulls59行业进步Choice of a Horizontal Referen“Machine porion :The upper surface of the ear rod of the cephalometric Anatomic porion”:The upper surface of the shadow of the auditory canal.Choice of a Horizontal Reference Line60行业进步“Machine porion :Choice of a61行业进步61行业进步NHP(natural head position):Relaxed individuals look at a distant obiect or into their own eyes in a mirror and incline their heads up and down in increasingly smaller movements until they feel comfortably positioned.Choice of a Horizontal Reference Line62行业进步NHP(natural head position):CChoice of a Horizontal(Cranial)Reference Line.Steiner AnalysisSassouni AnalysisWits AnalysisContemporary measurement approach63行业进步Choice of a Horizontal(CraniaSteiner AnalysisSteiner Analysisv SNA:Maxilla to the cranial base 82 2 v SNB：Mandible to the CB 78 2v ANB:skeletal jaw discrepancy.v SN-MP(mandiblar plane):Vertical position of the mandible.64行业进步Steiner Analysis SNA:MaxillaANB angle is influenced by two factors:vVertical height of the face.vAnteroposterior position of nasion.Steiner AnalysisSteiner Analysis65行业进步ANB angle is influenced by two66行业进步66行业进步Steiner AnalysisSteiner Analysisv U1-NA（mm)v U1-NA v L1-NB（mm)v L1-NB67行业进步Steiner Analysis U1-NA（mm)6 Holdaway Ratio:Holdaway Ratio:The balance between the prominence of the chin and the prominence of the lower incisor:the more prominent the chin,the more prominent the incisor can be。Steiner AnalysisSteiner Analysis68行业进步 Holdaway Ratio:Steiner AnalysisSteiner Analysis69行业进步Steiner Analysis69行业进步70行业进步70行业进步Steiner AnalysisSteiner Analysis71行业进步Steiner Analysis71行业进步Choice of a Horizontal(Cranial)Reference Line.Steiner AnalysisSassouni AnalysisWits AnalysisContemporary measurement approach72行业进步Choice of a Horizontal(Craniaskeletal open bite SN FH PP OP MP Sassouni Analysis73行业进步skeletal open bite SN FH PP 74行业进步74行业进步Choice of a Horizontal(Cranial)Reference Line.Steiner AnalysisSassouni AnalysisWits AnalysisContemporary measurement approachContemporary measurement approach75行业进步Choice of a Horizontal(CraniaWits Analysis Wits analysis（overcome the limitations of ANB as an indicator of jaw discrepancy)It is based on a projection of points A and B to the occlusal plane,along which the linear difference between these points is measured.76行业进步Wits Analysis Wits analysiocclusal plane（OP）77行业进步occlusal plane（OP）77行业进步Female:0Male:-178行业进步Female:078行业进步79行业进步79行业进步v First step:pick the correct template from the set of age-different ones that represent the reference data.v Two things must be kept in mind:(1)the patients physical size (2)his or her developmental ageTemplate AnalysisTemplate Analysis80行业进步 First step:pick the correcS Sequence of superimpositionequence of superimpositionCranial base superimpositionMaximum contour of the maxilla Symphysis of themandible81行业进步Sequence of superimpositionCraCranial base superimpositionCranial base superimposition82行业进步Cranial base superimposition8 Maximum Maximum contour of the maxilla contour of the maxilla 83行业进步 Maximum contour of the maxillSymphysis of the mandibleSymphysis of the mandible84行业进步Symphysis of the mandible84行业Thank you!Thank you!85行业进步Thank you!85行业进步
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