Facial & Dental Asymmetry

Question 1

The face is never totally —.

Answer 1

symmetrical

Question 2

Severe — development of the jaws to cause a problem is
relatively rare

Answer 2

asymmetric

Question 3

A patient’s — evaluation is one of the most critical
aspects in orthodontic diagnosis

Answer 3

frontal symmetry

Question 4

Even the most esthetic faces are associated with

Answer 4

mild forms of facial
asymmetry

Question 5

The individuals seeking orthodontic treatment, are often associated
with

Answer 5

facial asymmetries that may be greater that the acceptable
norms

Question 6

Classification of Facial
Asymmetries
FACIAL ASYMMETRIES
(3)

Answer 6

Skeletal asymmetries
Functional asymmetries
Soft tissue asymmetries

Question 7

Mandibular deviation
* Hyperplastic mandible
Etiology

Answer 7

• PRENATAL CAUSES
• GENETIC
• CONGENITAL
• POSTNATAL CAUSES
• ENVIRONMENTAL

Question 8

• GENETIC
  (2)

Answer 8

• Facial cleft syndromes
• Unilateral cleft lip – cleft palate

Question 9

CONGENITAL
(4)

Answer 9

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

Question 10

ENVIRONMENTAL
(6)

Answer 10

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

Question 11

DIAGNOSIS
(3)

Answer 11

• Patient Medical History
• Clinical examination
• Para-clinical examination

Question 12

• Clinical examination
  (2)

Answer 12

• Extra-oral examination
• Intra-oral examination

Question 13

• Para-clinical examination
  (4)

Answer 13

• Radiographic examination
• Photographic analysis
• Digital videography
• Articulated study models

Question 14

EXTRA-ORAL EVALUATION
(3)

Answer 14

• Frontal
• Vertical
• Sub-Mento Vertex

Question 15

EXTRA-ORAL EVALUATION
(3)

Answer 15

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

Question 16

INTRA-ORAL EXAMINATION
(5)

Answer 16

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

Question 17

• FUNCTIONAL EXAMINATION
  (4)

Answer 17

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

Question 18

• CENTRIC RELATION
  (1)

Answer 18

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

Question 19

• CENTRIC OCCLUSION ( maximum intercuspation)

Answer 19

• 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 20

NON-FUNCTIONAL
(2)

Answer 20

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

Question 21

RADIOGRAPHIC EXAMINATION
* Taking an accurate radiograph is crucial as the — is an important
factor in radiographic assessment.

Answer 21

head position

Question 22

We can use different radiograph to evaluate asymmetry, such as:
(4)

Answer 22

• Lateral cephalogram
• Panoramic radiograph
• Sub-mento vertex view
• CBCT. (Best)

Question 23

Lower dental midline

Answer 23

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 24

SKELETAL ASYMMETRIES
* Asymmetry Treatment in Growing Individuals
(1)

Answer 24

• Orthopedic appliances in conjunction with orthodontics are used to
  help improve or correct the developing imbalance.

Question 25

* Orthopedic appliances in conjunction with orthodontics are used to help improve or correct the developing imbalance. (2)

Answer 25

* Hybrid Functional Appliances * Distraction Osteogenesis

Question 26

SKELETAL ASYMMETRIES * Asymmetry Treatment in Non-Growing Individuals. (Adults) (3)

Answer 26

* 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

Question 27

Surgical Osteotomy (4)

Answer 27

* Maxillary surgeries: * Mandibular surgeries: * Inferior body osteotomy * Genioplasty

Question 28

* Maxillary surgeries: (1) * Mandibular surgeries: (1)

Answer 28

* Le-fort I * Bilateral Sagittal Split Osteotomy (BSSO)

Question 29

FUNCTIONAL ASYMMETRIES * Deviations caused by functional shifts * Mild => * Moderate to Severe deviations =>

Answer 29

minor occlusal adjustments. orthodontic treatment to align the teeth

Question 30

NOTE: * Because functional shift can also be the result of a skeletal asymmetry, (3) may be indicated in the management of these cases.

Answer 30

rapid maxillary expansion, orthognathic surgery, and orthodontic treatment

Question 31

Occlusal Splints=Deprogrammers (1)

Answer 31

* 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 32

SOFT TISSUE ASYMMETRIES * Deformities caused by soft tissue imbalance can be treated by either (2) * Augmentations include the use of s(2) to re-contour the desired areas of the face.

Answer 32

augmentation or reduction surgery. bone grafts and silicone implants