CLINICAL EVALUATION

There are two goals of the orthodontic clinical examination:(1) to evaluate and document oral health, jaw function,and facial esthetics .(2) to decide which diagnosticrecords are required.

Medical and dental problems under control before orthoTreatment of active caries and perio problems done before orthoDefinitive restorations (crowns) usually not placed until after orthoCheck for mucogingival problemsOften dealt with prior to ortho

Evaluation of Oral Health

Facial morphology, Occlusion and malocclusion:

Facial profiles can sometimes reveal underlying malocclusion problems. Anteroposterior relations between the maxilla and mandible are observed in the three basic types of profiles. Patients with a straight profile usually have normal occlusions or Class I malocclusions.

Those having convex profiles have an increased probability of having a Class II malocclusion associated with a retrusive mandible or perhaps a protrusive maxilla.

Patients with a concave profile have an increased probability of having a Class III malocclusion associated with a retruded maxilla, a protrusive mandible, or both. Facial profiles can also reveal growth problems in the vertical dimension. Excessive vertical growth of the face can lead to an anterior open bite malocclusion, lips apart at rest, a gummy smile, and an increased angle between the ramus and body of the mandible.

Insufficient vertical growth of the face can produce a deep overbite malocclusion, with redundant, overlapped lips and decreased angle between the ramus and body of the mandible, but the dentist should realize that the presence of a particular type of facial profile is not always indicative of the Angle malocclusion class.

Anteroposterior Dental Relations:

This can be assess by:

1.facial profile

2.facial divergenece

3.Palpation4.cephalome

tric

The lower face may be straight or inclined anteriorly / posteriorly relative to the forehead. This inclination is also termed as the facial divergence, which may be influenced by the patient's ethnic or racial background.

Facial Divergence

Vertical Dental Relations:

Overbite: is overlap of the incisors in vertical plane

Open bite: there is no vertical overlap of the incisors when the buccal segment teeth are in occlusion. Thumbsucking and abnormal tongue resting position, and abnormal facial growth (excessive vertical growth) may cause an open bite malocclusion.

ASSESSMENT OF VERTICAL SKELETAL

RELATIONSHIP

A normal vertical relationship is one where the distance between the glabella and subnasale is equal to the distance from the sub nasale to the under side of the chin .Reduced lower facial height is associated with deep bites while increased lower facial height is seen in anterior open bites.

Or clinically by rular or hand of mirror at the lower border of the mandibule and another one on Frankfort and measure it which is normal when ranged between 28_30

Thumb sucking

Horizontal dental relation:

Overjet: is the distance between the upper and lower teeth in horizontal plane.

normalcrossbite

Transverse Dental Relations:

Crossbite: a deviation from the normal bucco-ligual relationship. It may be anterior or posterior and\ or unilateral or bilateral.

Anterior crossbite:A malocclusion in which one or more of the upper anterior teeth occlude lingually to the mandibular incisors.

Posterior Crossbite:

Buccal cross bite: buccal cusp of lower posterior teeth occlude buccal to the buccal cusp of the upper posterior teeth.

Lingual cross bite: buccal cusp of lower posterior teeth occlude lingually to the palatal cusp of the upper posterior teeth.

A certain degree of asymmetry between the right and left sides of the face is seen in most individuals. The face should be examined in

the transverse and vertical planes to determine

a greater degree of asymmetry than is considered normal. Gross facial asymmetries

may beseen in patients with:

Assessment of Facial Symmetry

1 .Hemifacial hypertrophy Iatrophy

ii. Congenital defects.

iii. Unilateral condylar hyperplasia

iv. Unilateral Ankylosis, etc.

1.bird look(by looking from above and

behind) 2.compiste photogragh

this can be assess by:

3.radoigraph(opg)

4.tongue spatula

Or by divide approximately into fifths (each one the

width of the eye).

Lips Lip length, width and curvature should be assessed.

Lips can be classified into:

a. Competent lipsb. Incompetent lipsc. Potentially competent lips

The Nasolabial angle

The nasolabial angle is formed

between the upper lip and

base of the nose (columella) and

should be between 90° and 110. It gives an

indication of upper lip drape

in relation to the upper incisor

position.

cases

Lip competency:

Yes

Mandibular Plane Angle: Increased