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Ortho Exam 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the 3 steps in the systemic exam of Facial and Dental Appearance?

A
  1. Facial Proportions in all 3 planes (macro-esthetics)
  2. Dentiiontion in relation to the face (mini-esthetics)
  3. The teeth in relation to one another (micro-esthetics)
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2
Q

Frontal Exam

A

1st step in facial appearance
Look for:
* Bilateral Symetry in the fifths of the face
* Proportions of the of eyes, nose and mouth width
* Facial Index, Vertical Facial thirds

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3
Q

Bilateral Symmetry in the fifths of the face

A

Ideal proportional face can be divided into fifths
Central Fifth:
*determined by space b/w eyes
* Nose & chin are centered
* nose width is equal or slightly wider

Medial Fifth:
* determined by eye width
Lateral Fifth

Interpupillary line=width of mouth

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4
Q

Anthropometric analysis

A

Facial Measurements during clinical exam
* made with: Bow or Straight calipers

Used before Cepalometric radiography

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5
Q

Facial Index

A

Facial Height to Width ratio
* can’t eval height unless width is known

Establishes:
* overall facial type
* Basic proportions of face

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6
Q

Vertical Facial Thirds

A

Upper 1/3:
* hairline to base of nose

Middle 1/3:
* Base of nose to bottom of nose

Lower 1/3:
* Bottom of nose to chin
* Mouth=1/3 b/w bottom of nose and chin
* 1/3 above mouth
* 2/3 below mouth

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7
Q

Excessive Display of maxillary Gingiva

A
  • Eval postion of the Lips & teeth relative to vertical 1/3s of face
  • Common cause=Long Lower 1/3
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8
Q

What is another name for Profile Analysis

A

Aka Poor Man’s Cephalometric analysis

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9
Q

What are the 3 Goals of Profile Analysis?

A
  1. Establish whether the jaws are proportionately positioned in the AP plane of space
  2. Evluation of Lip Posture & Incisor Prominence
  3. Re-evaluation of Vertical Facial Porportions & eval mandibular plane angle
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10
Q

Establish whether the jaws are proportionately in the AP plane of space?

A

Place pt in physiologic NHP
* head position w/o other cues
* sitting upright or standing; Not reclines
* Look at horizon or distant object

2 Lines:
* Bridge of nose to base of upper lip
* base of upper lip to chin

Straight Profile=Ideal
* Skeletal Class I

Convex Profile
* Large angle (> 10)
* prominent upper jaw relative to chin
* Skeletal clas 2
* maxilla projects to far forward
* Mandible projects to far back

Concave Profile
* Upper Jaw behind chin
* Skeletal Class 3
* maxilla to far back
* mandible protrudes to far forward

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11
Q

What does Concave or Conex Profiles result from?

A

Disproportion in Jaw size

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12
Q

Incisor Prominence

A

Incisor Protrusion or retrusion
* effects dental arch space
* protrusion=more space; alleviates crowding
* Retrusion=Less space; worse crowding

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13
Q

Bimaxillary Dentoalveolar Protrusion

A

aka Bimaxillary Protrustion
Extreme Incisor Protrusion w/ideal alignment

Must meet 2 conditions:
* Lips are prominent and everted
* Lip incompetence (Lips seperated at rest by > 3-4mm)

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14
Q

Lip Incompetence

A
  • Lips seperated are rest >3-4mm
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15
Q

Lip Prominence Eval

A

Distance that each lip projects forward from a true vertical line through the depth of the concavity at its base
* Forward of line=Prominent
* Behind line=retrusive

Helpful to Draw E-line (Esthetic)
* nose to chin
* Lips should be on e-line

Consider size of nose and chin:
Larger the nose
* more prominent the chin needs to be to balance
* greater amount of lip prominence accepted
Nasolabial Angle
* Normal=Mild obtuse

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16
Q

What defines facial Attractiveness?

A

Smile

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17
Q

What are the 2 types of smile?

A

Posed/Social
* reproducible
* focus of ortho dx

Enjoyment (Duchenne)
* varies w/emotion

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18
Q

Smile Analysis consists of:

A

Amount of Incisor & Gingival Display

Transverse dimensions of smile relative to upper arch
* Buccal Corridors

Smile Arch

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19
Q

Amount of Incisor and gingival display

A

IDeal elevation of lip when smiling:
* slightly below gingival margin
* most of upper incisor can bve seen

Tooth Display:
* range: 1-4 mm of tooth coverage
* > 4 mm=less attractive

Gingival Display:
* ideal: 2.3 mm of tooth coverage
* Male: 0.5-1.0 mm
* Female: 0.5 mm

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20
Q

Amount of Incisor and gingival display

A

Tooth Display:
* range: 1-4 mm of tooth coverage
* > 4 mm=less attractive

Gingival Display:
* ideal: 2.3 mm of tooth coverage
* Male: 0.5-1.0 mm
* Female: 0.5 mm

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21
Q

Buccal Corridors

A

Distance b/w max posteriors (premolars) to inside of cheek
Another way to eval dental arch width
* Max dental arch width is proportional to midface width
* Broad smile=large midface/zygomatic arch width
* Narrow Smile=Narrow midface width
* ideal: 16%
* Male: 15-24%
* Female: 10-17%

Negative Space:
* Very Wide BC’s
* unesthic
* improve smile by: widen max arch

Minimal BCs:
* Females

No BCs:
* Unesthetic
* broad upper arch

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22
Q

Smile Arc

A

Incisal edge contours of max anterior teeth relative to lower lip curvature during a social smile
* Best apperance: Consonant-curvature of Lower lip is parallel to curvature of max incisors
* M/F: 1.8-3.8 mm K9 above incisal edge

Most important factor in smile esthetics
* only factor that can change smile to unesthetic by itself

Flat Smile Arc (non-consonant)
2 problems:
* less attractive
* Look oldder

23
Q

Inclination of Upper teeth: Tip L or R

A
  • > 2 mm from normal=Unesthic
24
Q

What are 2 important components of appearance in Tooth Proportions

A
  1. Tooth widths in relation to one another
  2. Height-Width prooprtions of individual teeth
25
Ideal Tooth Width Proportion
Golden Proportion: 62% * 1.0:0.62:0.38:0.24 * Lateral Incisor: 62% of central incisor width * Through 1st premolar
26
Central Incisor Tooth Proportions
Max Central Incisors: * Height: 10.4-11.2 * Width: 80% of Height (8.37-9.3)
27
If Maxillary Central Incisor Height is short, what are the possible causes? Possible Tx?
Possible Causes: * Incomplete eruption in childhood=further development corrects * Attrition in adults= restore missing part of crown * Xs gingival height: Crown Lengthening * Crown form distortion: facial Lamenette or complete crown
28
Connector
aka interdental contact Where adjacent teeth appear to touch Includes: * contact point * area above and below contact point Decrease in size from centrals to posteiors * moves apically Short Connector=part of problem w/black triangles
29
Embrassures
Triangular spaces incial and gingival to contact * ideal=larger than connectors Gingival Embrasure: * filled w/interdental papilla Incisor Embrasure: * Larger from central to premolars * contact points move more gingival from central to premolars
30
Black Triangle
Short interdental papilla * open gingival embrassure above connector Adults: Due to: * perio disease=loss of gingival tissue * ortho corrects crowded and rotated max incisors; connetor moves incisal Reshape teeth to correct * move contact pt apically * lengthen connector
31
Ideal Gingival Margin Levels for Centrals/Lateral/K9s
Centrals: * highest gingival margin level Lateral: * 1.5 mm lower than centrals K9: * Same level as centrals
32
Gingival Contour of Centrals/Lateral/K9s
Centrals: * Horizontal half ellipse * zenith=distal to midline Laterals: * Half-circle * Zenith=midline of tooth K9: * vertical half ellipse * zenith=distal to midline
33
Norman Kingsley
* 1850s-1st text describing ortho * 1st to use extraoral force * Pioneer in cleft palate tx
34
Edward H. Angle
Father of Modern Ortho * 1890: Concept of Occlusion
35
Angles Postulates
Upper 1st molars were the key to occlusion * MB cusp of upper molar occlueds in B groove of lower molar * Normal Occlusion=correct line of occlusion (caternary line) + normal molar relationship Best esthetics were achieved when pt had ideal occlusion
36
Angles Classes of Malocclusion
Class 1: * Normal relationship of molars * Incorrect line of occlusion due to malposed teeth, rotations, other causes Class 2: * Lower molar distally positioned relative to upper molar Class 3: * Lower molar mesially positioned relative to upper molar
37
Soft Tissue Paradigm
Soft Tissue Relationships * determine Goals & Treatment of modern ortho & orthognathic tx * Not teeth and bones Increased Focus on clinical exam * instead of dental casts and radiographs
38
Compare Angle vs Soft Tissue Paradigm: 1. Primary Tx Goal 2. Secondary Tx Goal 3. Hard & Soft Tissue Relationships 4. Diagnostic emphasis 5. Treatment Approach 6. Functional emphasis 7. Stabliiity of result
39
Compare Angle vs Soft Tissue Paradigm: 1. Primary Tx Goal 2. Secondary Tx Goal 3. Hard & Soft Tissue Relationships 4. Diagnostic emphasis 5. Treatment Approach 6. Functional emphasis 7. Stabliiity of result
40
Posterior Cross Bite
Lingually positioned Max posterior teeth * relative to mandibular teeth Narrow max dental arch
41
What differences does soft tissue paradigm make in planning tx?
Primary Goal of Tx=Soft tissue relationship and adaptations * Major determinants of facial appearance * Determine stability of ortho Secondary Goal=Functional Occlusion * TMJ Dysfunction: result of soft tissue injury around TMJ * arrange occlusion to minimize Reverse Thought process in solving the patients problems * Past: Focus on Dental & Skeletal relationships and ST would take care of itself * Now: Establish ST relationship then determine how teeth and jaws would have to arrange to meet goal
42
Overjet
Horizontal overlap of incisors * Ideal AP incisor relationship=1/3 US pop * Overjet + Class 2 malocclusion=more prevalent (Vs reverse overjet + class 3) Normal: upper incisors ahead of lower by incisal edge thickness * 2-3 mm Reverse Overjet * Aka anterior crossbit * lower incisors are in front of upper incisors
43
Overbite
Vertical overlap of incisors * Ideal Vertical Relatinship: 50% of US * Deep bite is more prevlaent than open Normal: Lower incisor edge contact lingual surface of upper * 1-2 mm Openbite: * no vertical overlap * quantify by measuring the seperation of incisors
44
Line of Occlusion:
Catenary Curve: passes through Maxilla: * molar=central fossa * k9/incisors=cingulum Mandible: * Molar: B cusp * Mandible: incisal edges
45
Irregularity index
incisor irregularity * total mm distance from contact pt on each incisor to contact point it should have * More prevalent in mandibular arch * 1/3 US Pop have at least moderate irregular incisors * 15% severe/extreme
46
Diastema
Space b/w adjacent teeeth Maxillary Midline Diastema: * common in mixed dentition * disappears or decrease width when permanent K9 erupt * Spontaneous correction if width < 2 mm
47
Girls Stages of Development:
3 stages: 3.5 years Stage 1: * start of growth spurt * breast buds appear * pubic hair appears Stage 2: 1 year after stage 1 * Peak Velocity of Physical growth * noticeable breast development * Pubic hair: darker and widespread * Axillary hair appears Stage 3: 1-1.5 years after after stage 2 * Start of Menstruation=start of stage 3 * hips broaden * Adult fat distribuiton * Breast development is complete * Growth spurt complete
48
Boys stages of development
4 stages: 5 years Stage 1: Fat Spurt=initial sign * Almost chubby-feminine fat distriubtion * Appears Obese and Awkward * Scrotum increase in size (pigmentation change) Stage 2: 1 year later * growth spurt starts * redistribution/decrease in fat * Pubic hair appears * Penis growth begins Stage 3: 8-12 months later * Peak Velocity of Growth * Axillary hair appears * Facial hair appears-Upper lip only * Muscle growth * Decrease fat: harder/more angular body form * Pubnic Hair: Adult distribution * Penis & Scrotum near adult size Stage 4: 15-24 months later * Growth spurt ends * Facial hair: Chin & Upper lip * Increase muscle strength * Pubic & Axillary Hari: Darker and widespread
49
Tooth Size Analysis
Aka Bolton Analysis Assume comparable inclinations of teeth Steps: 1. measure M-D width of every tooth 2. add each arch 3. Calculate overall and anterior ratios by dividing Mandibular/Maxillary 4. Compare to Table Idea: * overall ratio=0.913 * anterior ratio: 0.772
50
Tooth Size discrepancy
Tooth Size disproportion * upper centrals=most common * <1.5=not significant Anterior Tooth size discrepancy * compare upper and lower lateral incisors * If uppers NOT wider than lowers=discrepancy Posterior tooth size discrepancy: * compare 2nd premolars * should be equal
51
Speech difficulties related to malocclusion
52
Speech difficulties related to malocclusion
53
Class 2 Division 1: Could be caused by:
Maxillary teeth protrusion * normal jaw relationship Mandibular dficiency * Normal relationship of teeth to jaws (Both arches) Downward-backward rotations of mandible * excessive vertical growth of maxilla

Ortho Exam 1 (10 decks)

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