Diagnosis and Treatment planning Of Malocclusion

1. Diagnosis and Treatment planning Of Malocclusion

2. Diagnosis Of Malocclusion Accurate diagnosis of Orthodontic problems comes from the detailed clinical examination, data analysis and comprehensive evaluation. The correct treatment program can be planed after an adequate diagnosis of malocclusion. Therefore, the correct diagnosis and treatment plan of Orthodontic problems play an important role in the whole treatment process.

3. Classification Interview Clinical Exam Database Diagnosis (Problem list ) Analysis of Dx Records Pathology (caries, perio, etc.) Control before orthodontic treatment Interaction compromise cost/benefit other factors Orthodontic problems Priority order, A, B, C, D, etc possible solution treatment plan concept Patient parent Consult Treatment goals Treatment plan details

4. 1. Clinical examination Patients with the general situation :       Including the patient's name, sex, nationality, date of birth, birthplace and occupation information. Chief complaint and medical history Chief Complaint: Patient's chief complaint of all orthodontic treatment are the basic starting point, usually treatment plan begins to develop according to the chief complaints of patients. History: including past history, present history and genetic history

5. Chief complaint and medical history 1. The Jaw’s traumatic may cause temporomandibular joint adhesions, so it could be difficult for jaw to move and develop. 2. Dental trauma may cause the teeth adhere to the alveolar bone, so it makes the tooth move difficult. 3. long-term Systemic chronic dyspepsia may affect the normal bone tissue reconstruction in the movement of the teeth, which may lead to the loosening of mobile teeth.

6. Clinical examination Facial examination Facial profile from the Height of facial to points: a long face, short face, normal face. From the surface profile of the degree to sub-process: straight, convex , concave . Symmetry To the hypothetical median sagittal plane for the evaluation of the baseline, normal, nasal ridge, nasal tip, upper lip beads, submental vertex, arch basically located in the center line on this plane. Right and left eyes, ears, zygomatic process, nose, mouth, mandibular angle and a corresponding symmetrical teeth are symmetrical. facialRatioVertical ratio left and right ratio Evaluation of facial : photographs, body measurements, X-cephalometry

7. Profile type The profile is divided into before and after the relative position according to the soft tissue glbella, the nose, pogonion of soft : straight type, concave type, convex type

10. Dentition examination a, The development stage of occlusion: deciduous , dentition, permanent occlusion. The relationship between occlusion and age. Development of teeth and condition. Replacement of teeth, the tooth-loss situation. b, the basic situation of dentition: the number, shape, size, color, developmental status and caries status of the teeth. c, abnormal dentition parts: the part of crowded, misplaced, reversing, the open bite occlusion, lock bite occlusion and other malformations.

11. Dentition examination d, molar relationship: Class I, II, III category of relations, also known as the neutroclusion, distoclusion and mesioclusion. the two latter can be divided into full and cusp-cusp relationship e, canine relationship:can also be divided into the neutroclusion, distoclusion and mesioclusion. f, anterior relationship: Overbite Over jet

12. Class I Class II Class III

13. Overbite normal：1/3 1/2>I度>1/3 2/3>II度>1/2 III度>2/3 Over jet Normal:3.0mm I度 3-5 mm II度 5-8 mm III度 > 8 mm 1/3

14. 牙列的检查 g、牙周情况 • Slight periodontal loss: loss of attachment < 1/4 of the root length • Moderate periodontal loss: loss of attachment 1/4 to 1/3 of the root length • Severe periodontal loss: loss of attachment > 1/3 of the root length • Severe complicated periodontal loss: loss of attachment > 1/3 of the root length combined with intra -osseous defect. h、Spee`s曲线

16. Spee`s曲线

17. Oral function and temporomandibular joint a, opening /closed type and the opening /closed degree b、CR-CO c, tongue function e, swallowing function    f, the pain and Snapping of temporomandibular joints

18. Physical growth evaluation We should have a clear understanding for each patient's growth and development status, as the same abnormal performance, when the growth and development status is not the same, the treatment methods used may be different.    Evaluation of growth and development mainly relies on the physiological characteristics of patients, such as the bone age, the dental age and the secondary sexual characteristics.

19. A radiograph of the hand and wrist Far from the middle section of the middle finger epiphysis The medial sesamoid of thumb Radial epiphysis

20. Body height Body height

21. Psychological Situation In recent years, orthodontic patients at the psychological situation increase gradually. The patients which exist psychological situation usually exceed the normal requirements of the scope in the treatment, and he could be very sensitive about the existence of malocclusion, exaggerate in understanding the abnormal performance, be urgent for treatment and require a higher treatment sometimes exceeding the normal scope.

22. Oral health assessment (dental caries, gingivitis, periodontal disease, etc.) Orthodontic appliance will reduce the function of self-cleaning, the existed dental caries, gingivitis, etc must be treated before the appliance fixed to the teeth, otherwise the development of the disease may be aggravated.

23. Second, cast analysis the role of study cast at orthodontic treatment:1. Record real teeth, alveolar bone, the palate and the base bone morphology and location. 2.Dentofacial deformity analysis conducted 3. Comparisonin the course of treatment 4. Compared the efficacybefore and after treatment 5.One of the essential legal basisThe requirements for study cast 1. The cast should be extent possible, the extension of the maximum displacement of the soft tissue can reflect the situation in bone matrix. Generally it doesn’t carry out amendments to the soft tissue. The cast should include teeth, alveolar process, based bone, transitional fold, hard palate and lace cap, backwards be included maxillary tuberosity and molar pad nodule. 2.Cast must be accurate, clear and beautiful, and be able to reflect the patient's occlusion.

26. Cast Analysis Cast analysis Arch Length analysis: arch length is divided into three sections, the previous length, the middle of the length and posterior segment length. Arch Perimeter dental space Analysis : Arch Required Arch Available Arch space= Arch Required - Arch Available

27. · A B A the previous length,B the middle of the length and

31. Cast Analysis Cast analysis Mixed dentition space analysis prediction of Arch Required estimation from radiographsestimation from Moyertables Tanaka-Johnston prediction method Arch Available measurement

32. Estimation from radiographs The space between the demand for the four incisor according to their distance from mesial to distal . Uneruption of canine, premolar measurements x = y x₁ y₁ Conventional space analysis does not include the location of lateral incisor and profile.Analysis only shows the lack of coordination, do not reveal the location of coordination.

34. Moyer prediction table          Use four mandibular incisor to estimate the distance of lower , the maxillary canine, premolar from mesial to distal .But this estimate has a tendency to over-estimate. Low incisor 19.5 20.0 20.5 21.0 21.5 22.0 maxillary 20.6 20.9 21.2 21.3 21.8 22.0 mandibular 20.1 20.4 20.7 21.0 21.3 21.6

35. Tanaka and Johnston预测法 Mandibular canine and premolars in one quadrant can be calculated by adding 10.5 mm to half of the measured mesiodistal width of the four mandibular incisors. 下颌：2112+10.5 = 345 Maxillary canine and premolars in one quadrant can be determined by adding 11.0 mm to half of the measured mesiodistal width of the four mandibular incisors. 上颌：2112+11.0 = 345

36. Tanaka and Johnston预测法 Mandibular canine and premolars in one quadrant can be calculated by adding 10.5 mm to half of the measured mesiodistal width of the four mandibular incisors. manibular：2112+10.5 = 345 Maxillary canine and premolars in one quadrant can be determined by adding 11.0 mm to half of the measured mesiodistal width of the four mandibular incisors. maxillary：2112+11.0 = 345

37. Bolton Index          Bolton index refers to the former upper and lower teeth crown width ratio of the sum of all relations and with the upper and lower dental arch crown width ratio of the sum. Bolton index used to diagnose patients with upper and lower teeth do not tune the width of the problem. Anterior than = 6 mandibular anterior teeth crown width / 6 maxillary anterior teeth crown width all teeth than = 12 mandibular tooth crown width / 12 maxillary teeth crown width × 100% The discrepancy of Bolton index may cause the malocclusion of anterior teeth, such as overcrowding, deep overbite ,deep over jet and so on.

38. Bolton Analysis

39. curves of Spee    Measurement Methods: The ruler placed on the side of mandibular incisor teeth with the last mandibular molar on the cuspal, measure the distance between the lowest point and the ruler. Both sides of the measured value divided by the sum of two, plus 0.5mm is the correct curve of Spee `s required by the space.

40. Spee`s曲线

41. Curve of Spee Flat Deep

42. Analysis of dental arch symmetry Palate wrinkle method: In the first wrinkle on the palate and the last one to take the midpoint, make the connection between the two points and extended to measure both sides of the dental arch distance from this line to diagnose the dental arch symmetry. Coordinate Measuring : Coordinates the center line of plate aligned with the palate raphe, then measures both sides of the teeth before and after the location of buccolingual position.

45. Width evaluation Arch width can be divided into three parts:     The preceding  width (inter-canine width)     Middle arch width (first premolar width of the central inter-nest)       Posterior segment arch width (the first permanent molars between the width of the central nest)

46. the preceding width Middle arch width Posterior segment arch width

47. Pont's index             1909 Pont made an ideal arch width of the prediction methods. with the sum of four maxillary incisors divided by first premolar and first permanent molars, in the multiplied by 100, to arrive at a fixed index. Pont's indexisObtained as follow （S）×100 /80 = Ideal interpremolar width （S）×100 /64 = Ideal intermolar width （S）=sum of the diameters of the four maxillary incisors

49. 上和四个切 牙宽度之和 理想第一前 磨牙间宽度 理想磨牙 间宽度 上和四个切 牙宽度之和 理想第一前 磨牙间宽度 理想磨牙 间宽度 18 22.5 28.1 28.5 35.5 44.5 20 25 31.94 29 36 45.3 20.5 25.5 32 29.5 37 46 21 26.25 32.82 30 37.5 46.87 21.5 27 33.27 30.5 38 47.6 22 27.5 34 31 39 48.4 22.5 28 35 31.5 39.5 49.2 23 28.75 35.94 32 40 50 23.5 29.5 36.88 32.5 40.5 50.8 24 30 37 33 41 51.5 24.5 30.5 38 33.5 42 52.3 25 31 39 34 43 53 25.5 32 39.8 34.5 43.5 53.9 26 32.5 40.9 35 44 54.5 26.5 33 41.5 36 45 56.4 27 33.5 42.5 37 46.25 57.8 27.5 34 42.96 28 35 44 Pont `s index

50. alveolar bone Analysis : Base bone: mandibular arch formed, namely, dental periapical alveolar arch.base bone is stable based alveolar bone, and won’t change due to the tooth’s movement or loss. Alveolar bone: It is the bone tissue which is on the top of the base bone surrounding the teeth. It is between the teeth crown and the base bone. Alveolar bone may change due to the tooth’s movement or loss.