none

1. Patient evaluation
for Orthodontic
treatment

2. ◊ Importance of evaluating :
To provide the best treatment and patient
satisfaction , through clinical history , examination
investigation and diagnostic aids.
◊ Clinical history / History taking :
1. Patient’s particulars
(Name, Age, Sex, Occupation , Contact info. )
2 . Chief complaints
3. History of present illness

3. 4. Dental history
previous exposure & attitude of the patient
towards the dentistry, previous experience of
extraction, any incidence of fainting, bleeding
time etc.
5. Medical history
Asthma , Repeated cold, Rhinitis etc . That
persist major obstruction before orthodontic
treatment.
6. Family history
skeletal class 2 & class 3 , cleft lip & palate,
median diastema.

4. 7. Pre-dental history and Birth history
Birth injury, forceps delivery , measles on 1st
trimester causes cleft lip & palate. Accidental
injury causes facial asymmetry & other
anomalies. Drug induced deformity leads to
Down syndrome.
8. Socio-economical condition

5. ●Clinical Examination
Extra oral Examination
1. Head form
a. Mesocephalic : Average
b. Dolichocephalic : Long & narrow
c. Brachycephalic : Broad & Short
2. Face Form
a. Mesoprospic : Average
b. Dolichoprospic : Long & Narrow
c. Euryprospic : Broad & short

6. Figure : Head form

7. Figure : Face form

8. 3. Facial symmetry
Following factors causes facial asymmetry
Facial paralysis
Hemifacial atropy
Hemifacial hyperplasia
TMJ ankylosis
4. Face profile
a. Straight , resemble Class I
b. Convex , resemble Class II
c. Concave , resemble Class III

9. Figure : Facial symmetry

10. Figure : Face profile
Figure : Facial height

11. 5. Facial height
a. Upper facial height – from bridge of the nose to
lower border of the nose. Proportion 50%
b. Lower facial height – from lower border of the nose
to the lower border of the chin.
6. Skeletal pattern
a. Class I : Filtrum slightly ahead
b. Class II: Filtrum moderately ahead
c. Class III : Middle finger bend
To examine it, Two finger test is used. Middle finger in mental
depression and index finger in filtrum.

12. 7. Lip
(Competency , Tonicity , Size , Vermillion border , Color.)
8. Nose
a. Nose size
b. Nasal contour
c. Nostrils
Competency :
a. Competent lip
● Habitually together
●Habitually apart
●Potentially competent
b. Incompetent lip
c. Everted lip
d. Strap like lower lip

13. 9. Chin
a. Mentolabial sulcus : It is a concavity seen below the
lower lip.
●Normal
●Shallow : Bi-maxillary proclaination
●Deep : Class II Division I
b. Chin button : In incompetent lip chin button
produced.

14. Figure : Chin button

15. Intra oral examination
1. Oral hygiene status
2. Gingival condition
3. Periodontal condition
4. Tongue
● Position
● Shape : Bilateral symmetrical or not
● Size : True Macroglossia
Relative Macroglossia
Microglossia
5. Frenal attachments

16. 7. Teeth
Presence or absence of teeth
Caries , fracture , mobility
Angles classification
Over jet , Over bite
Cross bite , Lock bite
Curve of spee
Free way space
6.Palate
 Depth of vault
 Swelling , ulcer
 Cleft palate
 Tori

17. 9.Breathing pattern
Nasal breather
Mouth breather
8. Functional examination
○ Maximum mandibular protrusion & retraction
○ Maximum mouth opening : 40 – 45 mm

18. Model analysis : The study models
provide a three dimensional view of maxillary &
mandibular dental arches. Model analysis involves
the study of the maxillary & mandibular dental
arches in all three planes of spaces ( sagital , vertical ,
transverse planes ).

19. Carey’s analysis :
 Arch length anterior to the first permanent molars : _ _ _ mm
 Sum of mesio-distal width of teeth anterior to the first molars
(tooth material ) : _ _ _ mm
 Discrepancy between tooth material & arch length : _ _ _ mm
Discrepancy Inference
0 – 2.5 mm Proximal stripping
2.5 – 5 mm Extraction of 2nd premolars
> 5 mm Extraction of 1st premolars

22. ◊ Investigation :
1. Cephalometry
2. OPG
3. Hand-wrist radiograph
Cephalometry : It is a method of assessing the
relationship of cranial, facial and dental structure o radiograph
which is taken in a standardized manner.
Technique :
1. Patient F-H plane should be parallel to floor.
2. Ear rod fix the position of the head.
3. Orbital pointer is placed for vertical positioning.
4. The distance from mid sagital plane of the patient head to the X-ray
tube is fixed at 60 inches or 5 feet.
5. The distance from the mid sagital plane to the X-ray plate is fixed 7
inches.

23. Figure : Cephalometry

24. OPG : It is used to see the presence or absence of
the tooth, position, size , impaction of any tooth ,
deciduous tooth , supernumerary tooth etc.
Figure : OPG

25. Hand-wrist radiograph : It is used
to see the growth pattern and also used to
compare with the dento-facial growth.
Figure : Hand-wrist radiograph

26. Here are the information required
for the patient evaluation for a
better orthodontic treatment.
● Reference :
http://www.uobabylon.edu.iq/uobcoleges/action_lect.aspx?fid
=4&depid=6&lcid=6745
Orthodontics: The art and science by S. I. Bhalajhi, 3rd ed.
 Textbook of orthodontics by M.S. Rani, 3rd ed.
 https://www.google.com/

27. Thank you