1、Orthodontic Case AnalysisDr. PerucchiniDr. FeatheringhamDent 657.第1頁，共85頁。THE PROBLEM-ORIENTED APPROACHComprehensive way of looking at patients problemInvolves development of a databasePatient interview / questionnaireClinical examDiagnostic records.第2頁，共85頁。.第3頁，共85頁。I. QUESTIONNAIRE / PATIENT INTE

2、RVIEW.第4頁，共85頁。I. QUESTIONNAIRE / PATIENT INTERVIEWChief complaintPatients subjective assessment of problemImpaired function vs. impaired estheticsEstablish relative importance of each to the patient.第5頁，共85頁。Medical / Dental HistoryOrthodontic problems are typically a developmental problem, not a p

3、athological problemImportant points on medical history: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.第6頁，共85頁。I. QUESTIONNAIRE / PATIENT

4、INTERVIEWPhysical 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 radiograph

5、Evaluation of 2 sex characteristics.第7頁，共85頁。.第8頁，共85頁。I. QUESTIONNAIRE / PATIENT INTERVIEWPhysical Growth EvaluationWhy do we want to evaluate patients growth status?Appropriate referral if problemsGrowth modification therapy (headgear)Rapid growth during adolescence facilitates tooth movementHow c

6、an you evaluate a patients growth?Growth chartsSerial cephsHand - wrist radiographEvaluation of 2 sex characteristics.第9頁，共85頁。.第10頁，共85頁。I. QUESTIONNAIRE / PATIENT INTERVIEWPhysical Growth EvaluationWhy do we want to evaluate patients growth status?Appropriate referral if problemsGrowth modificatio

7、n therapy (headgear)Rapid growth during adolescence facilitates tooth movementHow can you evaluate a patients growth?Growth chartsSerial cephsHand - wrist radiographEvaluation of 2 sex characteristics.第11頁，共85頁。.第12頁，共85頁。I. QUESTIONNAIRE / PATIENT INTERVIEWPhysical Growth EvaluationWhy do we want t

8、o evaluate patients growth status?Appropriate referral if problemsGrowth modification therapy (headgear)Rapid growth during adolescence facilitates tooth movementHow can you evaluate a patients growth?Serial cephalogramsHand - wrist radiographEvaluation of 2 sex characteristics.第13頁，共85頁。I. QUESTION

9、NAIRE / PATIENT INTERVIEWSocial / Behavioral EvaluationMotivationInternal vs. ExternalExpectationRealistic?CooperationSome forms of treatment are cooperation - dependentMay delay treatment altogether, or modify treatment plan to decrease need for patient compliance.第14頁，共85頁。II. CLINICAL EXAM.第15頁，共

10、85頁。.第16頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Oral HealthMedical 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 pri

11、or to ortho.第17頁，共85頁。.第18頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Jaw / Occlusal FunctionTMJ evaluationHistory or TMD?TMD signs / symptoms?Evaluation for CR - CO shiftsPresence of shift may alter diagnosis.第19頁，共85頁。COCR.第20頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Facial EstheticsEvaluate fac

12、ial proportions and symmetryDisproportion / asymmetry contribute to esthetic problemsFRONTAL VIEWSymmetryDental vs. skeletal midlinesWidth of eyes, nose, mouthLip competence, gingival display, etc.第21頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Facial EstheticsEvaluate facial proportions and symmetry

13、Disproportion / asymmetry contribute to esthetic problemsFRONTAL VIEWSymmetryDental vs. skeletal midlinesWidth of eyes, nose, mouthLip competence, gingival display, etc.第22頁，共85頁。SYMMETRY.第23頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Facial EstheticsEvaluate facial proportions and symmetryDispropor

14、tion / asymmetry contribute to esthetic problemsFRONTAL VIEWSymmetryDental vs. skeletal midlinesWidth of eyes, nose, mouthLip competence.第24頁，共85頁。MIDLINES.第25頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Facial EstheticsEvaluate facial proportions and symmetryDisproportion / asymmetry contribute to e

15、sthetic problemsFRONTAL VIEWSymmetryDental vs. skeletal midlinesWidth of eyes, nose, mouthLip competence.第26頁，共85頁。WIDTHS.第27頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Facial EstheticsEvaluate facial proportions and symmetryDisproportion / asymmetry contribute to esthetic problemsFRONTAL VIEWSymmet

16、ryDental vs. skeletal midlinesWidth of eyes, nose, mouthLip competence, gingival display, etc.第28頁，共85頁。LIP INCOMPETENCE, GINGIVAL DISPLAY.第29頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Facial EstheticsPROFILE VIEWCompare vertical thirdsEvaluate position of maxilla and mandible in the anterior - pos

17、terior planeEvaluate lip posture / prominence.第30頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Facial EstheticsPROFILE VIEWCompare vertical thirdsEvaluate position of maxilla and mandible in the anterior - posterior planeEvaluate lip posture / prominence.第31頁，共85頁。.第32頁，共85頁。II. CLINICAL EVALUATIONEva

18、luation of Facial EstheticsPROFILE VIEWCompare vertical thirdsEvaluate position of maxilla and mandible in the anterior - posterior planeEvaluate lip posture / prominence.第33頁，共85頁。.第34頁，共85頁。RETROGNATHICPROGNATHIC.第35頁，共85頁。II. CLINICAL EVALUATIONEvaluation of Facial EstheticsPROFILE VIEWCompare ve

19、rtical thirdsEvaluate position of maxilla and mandible in the anterior - posterior planeEvaluate lip posture / prominence.第36頁，共85頁。.第37頁，共85頁。III. ANALYSIS OF DIAGNOSTIC RECORDS.第38頁，共85頁。III. ANALYSIS OF DIAGNOSTIC RECORDS-CAST ANALYSIS-CEPH ANALYSIS.第39頁，共85頁。CAST ANALYSISAsymmetryOften due to ea

20、rly loss of primary tooth on 1 side of arch.第40頁，共85頁。CAST ANALYSISMolar Classification.第41頁，共85頁。.第42頁，共85頁。CAST ANALYSISSpace available vs. space requiredPermanent DentitionMeasure the M-D width of teeth and compare to arch lengthMixed DentitionNeed width of unerupted canines and premolarsTanaka -

21、 Johnston or Moyers AnalysisUse width of erupted lower incisors to predict.第43頁，共85頁。CEPH ANALYSISTo identify pathologyTo define anatomic basis for malocclusionTo evaluate changes due to treatment and growth.第44頁，共85頁。CEPH ANALYSISTo identify pathologyTo define anatomic basis for malocclusionTo eval

22、uate changes due to treatment and growth.第45頁，共85頁。.第46頁，共85頁。CEPH ANALYSISTo identify pathologyTo define anatomic basis for malocclusionTo evaluate changes due to treatment and growth.第47頁，共85頁。.第48頁，共85頁。IV. ORTHODONTIC CLASSIFICATION SYSTEMS.第49頁，共85頁。ORTHODONTIC CLASSIFICATION SYSTEMSAngleFirst

23、system to define normal occlusionDefined three classes of malocclusionWeakness: No information about transverse or vertical relationshipsAckerman / ProffitDescribes five major characteristics of malocclusion.第50頁，共85頁。ACKERMAN PROFFIT CATEGORIESFacial Proportions and EstheticsAlignment and SymmetryT

24、ransverse skeletal / dental relationshipsA-P skeletal / dental relationshipsVertical skeletal / dental relationships.第51頁，共85頁。ACKERMAN PROFFIT CATEGORIESFacial Proportions and EstheticsClinical exam and photosLook at frontal and profile viewsCheck facial symmetry, A-P and vertical proportions, lip

25、prominence.第52頁，共85頁。ACKERMAN PROFFIT CATEGORIESAlignment and SymmetryOcclusal view of castsSymmetry and space.第53頁，共85頁。ACKERMAN PROFFIT CATEGORIESTransverse skeletal / dental relationshipsCasts in occlusion (frontal view)Check for posterior crossbites.第54頁，共85頁。ACKERMAN PROFFIT CATEGORIESA - P ske

26、letal / dental relationshipsCasts in occlusion (buccal views), CephMolar and canine class, overjet, anterior crossbite.第55頁，共85頁。ACKERMAN PROFFIT CATEGORIESVertical skeletal / dental relationshipsCasts in occlusion (frontal view), CephCheck for open bite, deep bite.第56頁，共85頁。V. DEVELOPMENT OF A PROB

27、LEM LIST.第57頁，共85頁。DEVELOPMENT OF A PROBLEM LISTSeparate pathology vs. developmentalClassify developmental problems into 5 Ackerman - Proffit categoriesClassify problems as mild - moderate - severeWrite prioritized problem list from most to least severe.第58頁，共85頁。.第59頁，共85頁。CASE ANALYSISLABORATORY E

28、XERCISE.第60頁，共85頁。.第61頁，共85頁。CC: “Mouth is too small for all his teeth. Protruding teeth.”.第62頁，共85頁。.第63頁，共85頁。Facial symmetry: Symmetric.第64頁，共85頁。.第65頁，共85頁。Profile: ConvexMaxilla(AP): ProtrusiveMandible(AP): RetrusiveLip competency: Yes.第66頁，共85頁。Nasolabial Angle: Obtuse.第67頁，共85頁。Mandibular Pla

29、ne Angle: Increased.第68頁，共85頁。Lower Face Height: Increased.第69頁，共85頁。.第70頁，共85頁。Overbite: Deep (50%)Anterior Crossbite: #7 and #27Dental midlines: Maxillary right 3mm.第71頁，共85頁。.第72頁，共85頁。Overjet: 2 mmMolar class: Angle class ICanine class: UnidentifiableAnt. crossbite: #7 and #27Overjet: 2 mmMolar

30、class: Angle class ICanine class: Angle class I.第73頁，共85頁。.第74頁，共85頁。Max. Arch: CrowdingArch Shape: U-formMand. Arch: CrowdingArch Shape: U-form.第75頁，共85頁。.第76頁，共85頁。.第77頁，共85頁。StandardDylanSNA82+/-286 NA to FH90+/-391SNB80+/-282N-Pog to FH88+/-687ANB2+/-24Y-axis59+/-665FMA22+/-528%LFH55%Interincisa

31、l130+/-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.第78頁，共85頁。.第79頁，共85頁。Space Analysis: -6 mm (crowding)Space Analysis: -7 mm(crowding).第80頁，共85頁。ACKERMAN PROFFIT CATEGORIESFacial Proportions and EstheticsAlignment and SymmetryTransverse skeletal / dental relatio