CLINICAL

ORTHO/DIAGNOSIS 1/24/17

» Tonsils and adenoids are a big deal with the lymphoidal growth curve
» Lower impression is extremely important to take first
» 50% of ortho diagnosis is from models
» Treatment is done from the lower arch, not the upper arch because of the midline
o The lower arch is the LIMITING arch
» Side to side orthopedics cannot be done because there is a left and right mandible
» From an esthetic view though, it is the maxillary arch
» If you don’t have a cortex, you’re anencephalic & the long range prognosis is poor
» In 1950, we switched to the lower anterior, then in 2000 we switched to the upper anterior
» Maxilla is favored for more maturation early
» DENTAL AGE
o Radiographic measurement, NOT a clinical measurement
o Must look at all the teeth and see how many are there
o At 5, you should have at least 28 permanent teeth
» We still don’t know why teeth are..
» Treatment is done to the face
» Ceph must be looked at too along with radiographs
o Must know is it male or female data
o Must know racial/ethnic background
o Must know age – months is very important*
§ CA – chronological age
o CA must be documented for the age at the time of x-ray
o Series of x-rays must be done over time to discover the changes
o The error of cephalometrics is 0.5mm/0.5 degree
» There are 5 important ages to deal with
o Chronological age – age documented in years and months
§ Maximum growth is done in the womb
§ The weight is more important than the length in measurement
§ Boys grow longer, therefore they are bigger
§ In general, any earlier maturing person is shorter because their growth stops
earlier
o Mental age – what grade you are in school
§ How well you did school socially and mentally
§ Dewey system – most of us were under this system
§ Montesorri system
o Skeletal or bone age
§ Height is very important here
§ 50% of height is for the skeletal age
§ Determined radiographically as well
o Dental age
o Emotional age
» You treat families
 o A profound amount of what we do is genetics and there can be familial traits
o Must look at the siblings when treating patients
o There can be “identical twins” and one can have congenital missing tooth while the
other does not
» Important things to look at:
o AGE is NUMBER one
o Gender
o Race
» HISTORY
o Important words in history
§ Deciduous
§ Succedaneous
• Succeed after the primary teeth
• 20 total
§ Excessional teeth
o Treating doesn’t mean you treat it immediately, it means you address it with the parent
and the child present
o Steroids is a huge problem – screws up the skeletal system with the muscular system
o Blue history form
§ One questions is the triad – walking, talking, and toilet training
§ Usually around age 10-15, males dominate in trauma
§ At 9 months though, females and males are similar in trauma incidents
o Cognitive objects vs. psychomotor objectives – cognitive is important
o Who is giving you permission to treat? The person that is responsible for payment
§ This becomes complicated with divorces
§ Grandparents are now commonly bringing their grand kids in
» Clinical EXAM
o Planes
§ Transverse – this plane is UNDERTREATED
§ Sagittal
§ Vertical – 2 planes
o This is the ORDER of maturation à must treat these planes in this order
o If you haven’t addressed the transverse plane by age 20, it will be a failure
o When you look at the face, you are looking at the SOFT tissues on top of the hard tissues
o Many times the soft tissue can mask the hard tissues
o One measurement to take is to help with the vertical plane – using a tongue depressor
o From the eyebrows up is the neural face
o From nasion to underneath the chin is where the vertical plane is defined
o Tangent to occipital point is average
» Mixed Dentition Analysis
o What is ONE standard deviation of a normal sample? 66%
o What is two standard deviations of a normal sample? 95%
o Three standard deviations 99%


o The lower 4 permanent incisors are used for MDA – because the upper laterals don’t
allow you to use the uppers