asymmetry

Question 1

FACIAL ASYMETRY
* The face is never?
* Severe asymmetric development of the jaws to cause a problem is?
* How important is a patient’s frontal symmetry evaluation?
* Even the most esthetic faces are associated with?
* The individuals seeking orthodontic treatment, are often associated?

Answer 1

• The face is never totally symmetrical.
• Severe asymmetric development of the jaws to cause a problem is relatively rare.
• A patient’s frontal symmetry evaluation is one of the most critical
  aspects in orthodontic diagnosis.
• Even the most esthetic faces are associated with mild forms of facial
  asymmetry.
• The individuals seeking orthodontic treatment, are often associated with facial asymmetries that may be greater that the acceptable norms

Question 2

symmetric?

Answer 2

yes

Question 3

symmetry?

Answer 3

no, canted occlusal plane

Question 4

what pt type has more facial asymmetries?

Answer 4

more prevalent in ortho pts

Question 5

Classification of Facial
Asymmetries

Answer 5

Question 6

mandibular asymmetry cause

Answer 6

hyper/hypoplastic mandible/condyle

Question 7

presentation of man asymmetries

Answer 7

typically a crossbite with nn-aligned dental midlines.
chin is deviated as well towards side without hyperplasia

Question 8

Answer 8

hyperplastic condyle likely

Question 9

etiologies of man asymmetry

Answer 9

• PRENATAL CAUSES
• GENETIC: Facial cleft syndromes- Unilateral cleft lip – cleft palate
• CONGENITAL
• POSTNATAL CAUSES
• ENVIRONMENTAL

Question 10

congential etiologies of man asym

Answer 10

• Hemi-facial microsomia
• Neurofibromatosis
• Birth trauma
• Intra-uterine pressure during pregnancy

Question 11

hemi-facial microsomia

Answer 11

unequal growth patterns of face, one side WNL the other is absent

Question 12

Answer 12

hemifacial microsomia

Question 13

• ENVIRONMENTAL cause man asymmetry

Answer 13

• Trauma & infection
• Muscle dysfunction
• Functional deviations
• TMJ derangements
• Hemi-mandibular hypertrophy
• Pathologies

Question 14

diagnosing asymmetry

Answer 14

• Patient Medical History
• Clinical examination: Extra-oral examination and Intra-oral examination
• Para-clinical examination
• • Radiographic examination
• • Photographic analysis
• • Digital videography
• • Articulated study models

Question 15

frontal horizontal extra oral eval of symmetry

Answer 15

divide face into fifths
1/5=intra-alar distance
2nd portion: ala to lateral canthus
3rd portion: lateral canthus to ear

Question 16

EXTRA-ORAL EVALUATION
* Vertical

Answer 16

face divided into thirds
supraorbital rim to tricium=1/3, also the most superior third
2nd portion: supraorbital rim to base of nose
3rd portion: base of nose to chin

Question 17

EXTRA-ORAL EVALUATION
* Sub-Mento Vertex

Answer 17

can eval septum

Question 18

EXTRA-ORAL EVALUATION
pupils

Answer 18

• The pupils are assessed for level with the horizon
• If level, then use as horizontal reference line
• Inter-pupillary plane

Question 19

intra oral exam components:
* functional?
* Evaluation of ?
* crossbites?
* occlusal evaluation?
* Transverse cant of?

Answer 19

• FUNCTIONAL EXAMINATION
• Evaluation of the dental midlines.
• Unilateral cross bites.
• Vertical occlusal evaluation.
• Transverse cant of maxilla.

Question 20

functional exam components

Answer 20

• Maximal opening.
• Postural rest position.
• CR-CO discrepancy.
• Motor & sensory evaluation

Question 21

CR

Answer 21

• A musculoskeletal stable position, with the condyles forward, as far upward as possible, centered transversely and with the articular disc properly interposed

Question 22

CO

Answer 22

A dental determined position, Tooth morphology and position are the primary influences determining the mandibular position and movements. The condylar position is strongly determined by the dental contacts and intercuspation through muscles and ligaments

Question 23

CR and CO relation

Answer 23

may not be coincident, moving from CO to CR in some cases can approximate the midlines closer

Question 24

non-functional cases

Answer 24

• No CR-Co Shift.
• There is a dental or skeletal asymmetry

Question 25

radiographic exam

Answer 25

* Taking an accurate radiograph is crucial as the head position is an important factor in radiographic assessment. * We can use different radiograph to evaluate asymmetry, such as: * Lateral cephalogram * Panoramic radiograph * Sub-mento vertex view * CBCT. (Best

Question 26

Asymmetric occlusion req what occlusion mechanics

Answer 26

asymm mechanics

Question 27

Lower midline deviations will usually have an effect on? importance?

Answer 27

Lower midline deviations will usually have an effect on the occlusion. It is important to diagnose the deviation properly and plan the adequate correction.

Question 28

symmetric?

Answer 28

yes, sym occ

Question 29

SKELETAL ASYMMETRIES * Asymmetry Treatment in? * what is used to help improve or correct the developing imbalance? examples?

Answer 29

* Asymmetry Treatment in Growing Individuals * Orthopedic appliances in conjunction with orthodontics are used to help improve or correct the developing imbalance: Hybrid Functional Appliances and Distraction Osteogenesis

Question 30

Answer 30

hybrid functional appliance for skeletal asymmetry

Question 31

Asymmetry (skeletal) Treatment in Non-Growing Individuals. (Adults)

Answer 31

* Surgical Conditions with severe skeletal asymmetries are not able to be corrected by orthodontic camouflage and growth modification so surgical procedures are used to correct the deformities or asymmetries. * Distraction Osteogenesis * Surgical Osteotomy: BSSO, Le Fort, genioplasty, etc.

Question 32

# mild and moderate tx FUNCTIONAL ASYMMETRIES * Deviations caused by functional shifts

Answer 32

* Mild => minor occlusal adjustments. * Moderate to Severe deviations => orthodontic treatment to align the teeth

Question 33

important note for tx of asymmetries caused by func shift

Answer 33

Because functional shift can also be the result of a skeletal asymmetry, rapid maxillary expansion, orthognathic surgery, and orthodontic treatment may be indicated in the management of these cases

Question 34

Occlusal Splints/Deprogrammers

Answer 34

* Occlusal splints may be necessary to properly evaluate the presence and extent of the functional shift by eliminating the habitual posturing and de-programming the musculature.

Question 35

SOFT TISSUE ASYMMETRIES

Answer 35

* Deformities caused by soft tissue imbalance can be treated by either augmentation or reduction surgery. * Augmentations include the use of bone grafts and silicone implants to re-contour the desired areas of the face.