Dr. D. Rudolph
What’s considered normal/ beautiful? Averages have been taken on “beautiful” people via taking records and extrapolating an average as with studies such as the Bolton study and Michigan study. They took cephs, records, etc etc (same references) as we do with our patients now. We call this the orthodontic database, which includes:
1) Diagnostic record --- lateral cephalometric, study models, 3 photos (2 facial – 1 smiling, 1
relax, and 1 profile), 5 photos of teeth (1 frontal, 2 occlusal, 2 buccal
views). So, we take 8 photos. Also, full mouth x-ray or a panoramic
2) Clinical exam
3) Pt. Interview (medical/ dental history)
Ok, now we have all these measurements, now we have to see if they deviate from the norm.
After all this we fill out our diagnosis which is our List of Problems (p25 lab manual) [this is the sheet with a bunch of squares] Which records will tell us info for each square? Which records can we use to fill these squares?
Dental info: Study model, clinical exams, x-rays (intraoral and cephalometric), pictures. For example, if we’re looking at overjet, we can see this on all of these categories and they shouldn’t contradict each other.
Facial info: photos, ceph x-ray (we can see soft tissue), clinical exam (can be more accurate and can be used to check the smile line, midline, and CR-CO shift
profile pictures: gives info on the vertical and AP form portion
frontal view: gives us info on the transverse and vertical form.
Facial form analysis (it’s the form after pg 8) helps you fill out the problem list for the facial portion.
Dental analysis form does the same thing AP/vertical/transverse/etc.
*Note: be able to fill out these forms
Facial Form Analysis (series of slides) [At this point Dr. Rudolph went over this form with a series of slides pretty much saying “normal” for most aspects!]
**This worth noting during slides**
Vertical: Upper face is from supra orbital crest to top of head
Middle face is from base of nose to supra orbital crest
Lower face is from base of nose to bottom of chin
Upper lip – base of nose to bottom of upper lip = 1/3
Compared to tip of the lower lip to bottom of chin = 2/3
AP: Nasolabial angle could be 90o but look different with upturned nose
Convex = is it maxilla too forward or mandible too far back?
Combo? See chin throat length. If we see retogenic, expect class II
Dental Form Analysis (study model, photos of teeth, ceph x-ray, intraoral x-ray, clinical exam)
Looking at these from the sides, we get AP and vertical data.
For vertical, frontal view is the best
For alignment, occlusal views, also buccal, profile and frontal
AP – molar/canine class -EE = between class I and II
-weak I = between EE and I
-Supra I = between class I and III
Also look at premolars and all teeth
Vertical – like denture teeth = want flat curve of spee
Cant of occlusal plane – sometimes one side may be lower, crooked gum line
Transverse – 6 different types of posterior crossbites:
1 tooth = simple and
1 side = unilateral.
If you just say “crossbite,” by definition, it means lingual crossbite which is upper
maxillary molar is lingual to where they should be. If buccal, must specify (it’s when maxillary teeth is outside of mandibular). You can have a unilateral dental crossbite with a shift…so posterior teeth are end to end, and the pt may shift to one side. For a child, this can be really bad. TMJ/condyle may tend to grow more on one side, leading to a permanent facial asymmetry.
Alignment- “blocked out teeth” = teeth placed buccally or lingually with no space to go back to
Ant/post- mesiodistal width of upper teeth should match the mesiodistal width of lower teeth. When you straighten teeth and these don’t match, they’re not going to fit together (more on this next time) this is also referred to the Bolton discrepancy (same thing), and it includes retained deciduous teeth, transposed teeth, ankylosed teeth, and anomalous teeth.
Slides: [on molar and canine class relationships. We need to know how to identify these!!]
**Things to note**:
-class I : mesiobuccal cusp tip of max first molar is right over the buccal groove of lower first molar
-if there is any inkling of a deviation from class I, you want to note it b/c 2 things happen with braces 1) bite opens up/ overlap of teeth tends to get less and 2) upper molars tend to come forward a bit.
-Canine class I: max canine tip points directly between lower canine and 1st premolar.
Please check this link
Hope I've helped
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Native speaker of: English, Portuguese
PRO pts in category: 4