CLINICAL

ORTHO/DIAGNOSIS 1/31/17

Ceph Tracing – Page 14 (Ceph Analysis & Evaluation)
» Must look at tracing first, landmarks must be correct before numbers are even
evaluated
» Nasion and A point are very difficult points to pick up
» Mean date is used to estimate growth
» Steiner chevron
» Dental alveolar --- steiner chevron
o Base of mandible and maxilla are not normal
o Lower and upper incisor are compromised
o A & B – apical base differences
o Predict the future A & B – this will help determine where you put the incisors
» Facial angle is largely affected by pogonion
o Number should be higher in males than females
o This is a SKELETAL measurement
» Angle of convexity
o Children rarely have a negative value for angle of convexity
o Negative number is more common in adults
o If the number gets into the 40 – there is likely to be skeletal dysplasia
» As you grow, the lower jaw grows down and rotates up – common for the posterior part
of the face to get longer in comparison to the front part of the face
o Facial angle should INCREASE with growth – TEST question
o Angle convexity should become SMALLER with time
o A & B should decrease with time
o FMA should decrease with time
§ A low FMA means the area under the ear is long
» Long face syndrome vs. short face syndrome patient s
o These patients are treated different
o Usually everyone starts out as short face syndrome

Study Models – Permanent Dentition Analysis
» Smallest MD width is lower central incisors
» Difference between left and right should be minimal
» The lower central is the one that is usually congenitally missing – the one near the
suture
» If your lower central measures at 6mm or greater à you have MACRODONTIA
» Total M-D width of lower centrals – should be close to 21mm
» Sum of 3, 4, 5 on one side should be close to 21mm as well
» Upper arch – near 9 on centrals is close to macrodontia
» Prominent ridges on M and D of maxillary incisors – this is seen is Asians
o These are SHOVEL shaped incisors
» The lateral incisors are the teeth that most commonly have anomalies
 » Incisor liability: M-D width of upper central and laterals compared to the M-D width of
the primary incisors
» Posterior leeway space: just in ONE quadrant in the back
» The CAUSE of tooth crowing in an arch – NOT the sizes of the teeth, it is the shapes of
the arches
» Which teeth are normally not present? FOR the MOLARS
o 3rd molars – most commonly missing
o 2nd molar – 2nd most common
o 1st molar – least common
» Normally missing for premolars?
o Its the 5, the second premolar, the most distal tooth
» Oligodontia has commonly been releated to the patient having colon cancer
» The lower arch is called the CONTAINED arch – because the upper arch goes over the
lower arch
» To change the arch form is a big deal, changes of success are very low
o Especially difficult in the lower arch
» To calculate arch space available, use the nearest half mm
o Eyeballing the amount of crowding or space avaible
o Mild crowding – less than 3mm
o Moderate crowing – 3-7mm
o Severe crowing – more than 7mm
» You can NOT regain in the lower arch more space, you will have to take something out
» ARCH form – ortho patient evaluation
o Lower arch is very commonly shaped ovoid
o If you have a tapered upper arch, you probably have a Class II, division I
malocclusion
o If you have a square upper arch, you probably have a Class II, division II
malocclusion
» Eruption sequence – primary teeth – SAME for UPPER and LOWER
o A, B, D, C, E
» Eruption sequence – permanent teeth – LOWER arch
o Lower frst molar or central incisor – 1 or 6
o 2, 3, 4, 5, 7,
» Eruption sequence – permanent teeth – UPPER arch
o First molar – 6
o 6, 1, 2, 4, 5, 3, 7, 8
» There can be variations for the permanent upper, this is the most common order but
not the most favorable

OCCLUSION STUDY MODELS – Page 13 in Section A
» Transverse
o Majority of the time the maxillary midline is coincident with the face
o Usually the lower midline is switched to the side of the crowding
o Posterior crossbite - the upper molars are lingual to the lowers
 o If you have a child that has whole quadrant that is in transverse problem, it can
usually be fixed successfully
» Sagittal
o Normal overjet is at least 2mm usually
o Angle’s CLASSIFICATION
§ Related to the models or dentition, NOT to the face
§ Classified by the maxillary permanent 1st molar with the idea that it could
never be changed because of the mala processes
§ Has to do with cusp fossa relationship of the maxillary 1st molar
§ Class 1. MB cusp of max 1st molar should fall into facial groove of
mandibular 1st molar
§ The difference between a class I and class II occlusion on ONE side is 5-
6mm
§ The difference between a class I and class III occlusion is 2-3mm
» Vertical
o If you have 50% overbite – that is considered a DEEP BITE
o If your lower incisors touch that palate, that is called an impinging bite
o Openbite: 2 types
§ 1. If you put the cast together and they don’t overlap
• Must measure the clinical crown and measure the amount of
space
§ 2. If you tip the casts up and they don’t touch