Orthodontic Diagnosis

By: Assist.Prof Aly Osman

MSc. Ph.D
Dr Orthodontic Diagnosis
Orthodontic diagnosis deals with recognition of the various characteristics
of the malocclusion.
Orthodontic diagnosis should be based on scienti c knowledge combined
with clinical experience.

Diagnostic Flowchart:
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1- History

2- Clinical Examination
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Diagnostic records
1- Photographs
2- Study Models
3- Radiographs

3- Study Cast Analysis

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4- Cephalometric Analysis
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Database of information

Analysis of information

Problem List
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Treatment Plan

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Dr I- History

This includes:
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Personal data
Name
Age (Dental - Skeletal - Chronological)
Sex
Occupation
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Chief Complaint
Patient’s own words

Medical History
Any medical conditions & taking medications
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Dental History
Previous extractions or trauma

Family History
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Hereditary

Childhood History
Any history of habits

Social & Behavior Evaluation

Patient’s motivation & cooperation
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Dr
Eruption Dates
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Dr II - Clinical Examination
.A Extra-oral Examination

Frontal Facial Analysis Smile Analysis Pro le

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!- Facial type 1- Incisor show 1- Pro le type
Mesocephalic At rest (2mm) Straight (Class I))
(average face) Smile ( Full crown) Convex (Class II)
Brachycephalic Concave (Class III)
(short & wide) 2- Smile arc
Dolichocephalic convex (esthetic) 2- Nose
(long & narrow) Normal
Upturned
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2- Facial Symmetry 3- Buccal corridors Downturned
Vertical symmetry
upper 1/3 of face 4- Facial midline 3- Naso-labial angle
Middle 1/3 of face Normal (90-110)
Lower 1/3 of face To obtain optimal aesthetics,
Transverse the facial midline must
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(face divided coincide with the maxillary 4- A-P lips
into 5 equal parts) and mandibular central Protruded lower lip
incisor midline or minimally Normal lip pro le
3- Lip morphology these line must be parallel Retruded lower lip
competent lips
Incompetent lips 5- Chin
Everted lips Orthognathic (Normal)
Tense lower lip Prognathic
Retrognathic
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6- Mandibular plane
Steep mandibular
plane —> increase
V.D
Flat mandibular plane
—> decreased V.D

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Dr Intra-oral Examination

1- Gingiva
The gingiva should be examined for in ammation, recession & other mucogingival
lesions.
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2- Tongue
Presence of excessively large tongue indicated by scalloping on the lateral margins of
the tongue.
The lingual frenum should be examined for tongue tie as it alters the resting tongue
position & affects tongue movement.

3- Labial frenum
A thick, brous, low labial frenum prevents upper central incisors from approximating
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each other leading to a midline diastema.
A frenectomy is indicated when the frenum is inserted deeply with ber extensions into
the interdental papilla.

4- Dental Classi cation

Class I
Class II
Class III
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5- Overbite

6- Overjet
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7- Crossbite
Posterior or Anterior

Functional Examination

1- TMJ
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Any tenderness, clicks, crepitus and locking should be noted

2- Respiration
Habitual mouth breather or True mouth breather

3- Swallowing
Atypical type of swallowing —> tongue protrudes anteriorly —> tongue thrust

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Dr III-Study Cast Analysis
Importance:
1.Occlusion can be visualized from the lingual aspect.
2.They provide a permanent record of the intermaxillary relationships and the occlusion at the
start of therapy; this is necessary for medico-legal considerations.
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3. They are a visual aid for the dentist as he monitors changes taking place during tooth
movement.
4. They are needed for comparison at the end of treatment and act as a reference for post
treatment changes.
5. They serve as a reminder for the parent and the patient of the condition present at the start
of treatment.

It includes:
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1- Inter-arch Relationship 2- Intra-arch Relationship
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Classi cation Arch length analysis
Overbite Arch form
Overjet Symmetry
Crossbite Curve of Spee
Individual Malposition
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Dr Class I
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Class II Division 1
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Class II Division 2
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Class III

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Dr
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Overbite Overjet
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Anterior Crossbite
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Posterior Crossbite
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 Arch Symmetry
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Arch Form
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Square Ovoid V-shaped
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(U-shaped)

Curve of Spee
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 Arch Length Analysis
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Dr
IV- Lateral Cephalometric
Origin: Cephalo means head and Metric is measurement.
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Skeletal & Dental relationships are measured by references to
specific landmarks & planes drawn on the lateral cephalogram.

These can be either “Hand Traced” or “Digitalized” using

specialized cephalometric software.
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Importance of the Lateral Cephalometric
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Evaluating relationships, both anteroposterior and vertical of 5
major components of the face:
Cranial Base
Maxilla & Mandible
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Maxillary & Mandibular dento-alveolus
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Dr Anatomical Landmarks
Hard Tissue Points
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Sella (S): The center of sella tursica

Nasion (N): The junction of the nasal and frontal bones at the most
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posterior point on the curvature of the bridge of the nose
Point A (Subspinale): Most anterior point of the maxillary apical base
n

Point B (Supramentale): Innermost curvature from the chin to the

alveolar junction

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Pogonion (Pog): The most anterior point on the contour of the chin
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Menton (Me): Lowest point on the symphysis of the mandible
Gnathion (Gn): The most outward and everted point on the profile
curvature of the symphysis of the mandible, Located midway between
pogonion and menton
Anterior Nasal Spine (ANS): Most anterior point on the maxilla at the
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nasal bone
Posterior Nasal Spine (PNS): The tip of the posterior nasal spine of the
palatine bone
Gonion (Go): Angle of the mandible
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Porion (Po): Midpoint of the upper contour of the external auditory
canal
Orbitale (Or): Lowest point on the inferior margin of the orbit
Articular (Ar): A point at the junction of the posterior border of the
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ramus and the inferior border of the posterior cranial base.
Basion (Ba): The lowest point on the anterior rim of the foramen
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magnum.
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Reference Planes:
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Anterior Cranial Base (S-N Plane)

Posterior Cranial Base (S-Ba)

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Frankfort Horizontal Plane (Po-Or)

Palatal Plane (ANS-PNS)

Occlusal Plane
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Mandibular Plane (Go-Gn)

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 Angle Interpretation
Dr SKELETAL ANGLES
SNA (82o) Indicates horizontal position of
the maxilla to the cranial base

>82o : Prognathic maxilla

<82o : Retrognathic maxilla
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SNB (80o) Indicates horizontal position of
the mandible to the cranial
base
>80o : Prognathic mandible
<80o : Retrognathic mandible
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ANB (2o) Measures the relative position
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of the maxilla to the mandible
=2o : Class I
>2o : Class II
<2o : Class III
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Dr
McNamara Analysis
Point A to N I FH This measurement indicates the horizontal
0 mm in mixed dentition position of the maxilla.
+1 mm in adults
>1mm - protrusive or prognathic maxilla
<1 mm - de cient or retrognathic maxilla
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Point A to N I FH
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0 mm in mixed dentition This measurement indicates the horizontal
position of the maxilla.
+1 mm in adults
>1mm - protrusive or prognathic maxilla
<1 mm - de cient or retrognathic maxilla
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Dr
SN to mandibular plane (32o) Measures the vertical
dimension

>32o : High VD
(Hyperdivergent)
<32o : Low VD
(Hypodivergent)
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Jarabak Facial ratio (62%) Facial form
<62% : Dolicofacial
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>62% : Brachyfacial
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Dr DENTAL ANGLES
U1 to SN (105o) Measures the inclination of the
incisors to the anterior cranial
base
>105o : Labial inclined
<101o : Lingual inclined
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L1 to MP (90o) Measures the inclination of the
lower incisor to the inferior border
of the mandible
>92o : labial inclined
<88o : Lingual inclined
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U1 to L1 (134o) Determine the degree of labial
inclination of the incisors
Small interincisal angle —> more
labial inclined of incisors
Large interincisal angle—> more
lingual inclined incisors
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