Clinical assessment of dentofacial deformity /certified fixed orthodontic courses by Indian dental academy
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078
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Clinical assessment of dentofacial deformity /certified fixed orthodontic courses by Indian dental academy
- 1. Clinical Assessment of Dentofacial Deformity Victoria Beale MRCS FDS RCS Specialist Registrar in Oral and Maxillofacial Surgery www.indiandentalacademy.com
- 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
- 3. Introduction • Identify problems – Functional – Aesthetic • Highlight variations from ‘normal’ • Clinical diagnosis • Surgical prediction www.indiandentalacademy.com
- 4. Positioning • Patient sitting upright • Pupillary plane parallel to the floor • Frankfort plane parallel to the floor • Examiner at same level as patient www.indiandentalacademy.com
- 9. Frontal View • Upper – Eyes – Orbits – Ears • Middle – Nose www.indiandentalacademy.com
- 10. Frontal View • lips – – – – – length competence muscle activity vermilion teeth rest/smiling • Chin – asymmetry – mentalis www.indiandentalacademy.com
- 11. Smile • Upper lip vermillion at gingival margin • Max 1-2mm gingival show www.indiandentalacademy.com
- 13. Oral examination • • • • • • • • • Occlusal relationship AOB Overbite / Overjet Crossbites Incisor inclination Crowding / Spacing Occlusal interferences Tongue size / mobility Dental health www.indiandentalacademy.com
- 14. Record keeping • • • • Notes Photographs Study models Radiographs – – – – – OPG Lat Ceph Periapical PA Ceph CT www.indiandentalacademy.com
- 15. Examination Pitfalls • Incorrect patient positioning • Posturing – Habitual – Occlusal interference • Over closure – Skeletal class III www.indiandentalacademy.com
- 16. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com
Hinweis der Redaktion
- This talk will cover features of the normal face and a scheme for examining patients with dentofacial deformity.
- Compensatory positioning may be appropriate for patients with orbital dystopia, can eg use ears to establish a parallel plane Clinical Frankfort plane – line from tragus of the ear to the bony infraorbital rim. Reproducible position that mimics the ‘natural’ standing head postures of most individuals with a normal jaw structure Patients with dentofacial deformities often assume alternative head postures to improve function or make the deformity look less obvious. It is important to eliminate this by correctly orientating the patient. Ensuring the correct head position aids proper clinical diagnosis as well as evaluation of post treatment results. Lips should be relaxed and not forced together to allow evaluation of tooth lip relationship, chin position and lip competence
- Face divided into thirds: Upper third – hairline to glabella Middle third – glabella to subnasale Lower third – subnasale to soft tissue menton Orthognathic surgery most commonly alters the lower third of the face, with some influence on the middle third
- The facial thirds should all be equally proportioned In addition the lower third of the face can be further divided, with , with the distance from subnasale to upper lip stomion equalling one third, and the lower lip stomion to soft tissue menton equalling two thirds. This ratio provides the optimum vertical facial balance in the lower third of the face.
- Evaluation of the profile is usually the most valuable assessment in determining vertical and AP Jaw problems As mentioned previously the middle and lower face heights should be equal The ideal chin projection is 3+/-3mm behind a line perpendicular to the Frankfort plane through subnasale provided the AP position of the maxilla is normal Midface maxillary hypoplasia nasolabial angle Lower face mandibular angle mandibular length chin projection labiomental groove
- Symmetry Size Deformity Upper Orbits pupillary level palpebral fissures dystopia hypoglobus For normal facial balance the intercanthal, alar base and palpebral fissure width (C) should all be equal Normal intercanthal distance (A) for Indians 31 +/- 3 Slight variation male to female Slightly lower values than other races Interpupillary distance (B) 65 +/- 3 The alar base should lie within 2mm of a vertical line through the medial canthus which is perpendicular to the pupillary plane Nose root dorsum alar base tip projection septum air entry
- The normal upper lip length measured from stomion to subnasale is 22 +/- 2mm for males and 20 +/- 2mm for females. The measurement should be taken with the lip relaxed. Normal tooth show at rest is 2-3 mm. Provides a good gauge or vertical maxillary height in the presence of normal lip length.
- Frequently the smile is one of the patient’s main concerns. With a natural smile the vermillion of the upper lip should fall at the gingival margin with no more than 1-2mm of gingival show. Factors influencing the amount of upper lip elevation during smiling may be include: Clinical crown length Angulation of the anterior alveolus Degree of overjet and overbite AP position of the mandible and maxilla Neuromuscular function Unnatural smile – tell the patient a joke or ask them to think of a happy memory These factors must be taken into account to ensure inaccuracies are not introduced when evaluating the proper vertical maxillary position.
- The facial midlines are assessed including nasal, maxillary and mandible dental midlines, and the relationship of the chin midpoint to the facial midline Left to right facial symmetry should also be evaluated. Transversely, the colossal plane should be parallel to the pupillary plane, providing there is no orbital dystopia