ORTHODONTIC

CASE
HISTORY &
DIAGNOSIS
 LEARNING OBJECTIVES
• Record case history (C1)
• Explain protocol of clinical examination (C2)
• Demonstrate the importance of obtaining and
maintaining patients’ clinical records (C3)
• Illustrate the influence of patient’s history and clinical
examination on selection of treatment plan (C3)
Successful orthodontic treatment
begins with the correct diagnosis,
which involves patient interview,
examination and the collection of
appropriate records.
ESSENTIAL
DIAGNOSTIC AIDS
Case history
Clinical examination
Study models
Radiographs – IOPA, OPG, Bite-wing
Photographs
SUPPLEMENTARY
Lateral cephalogram
Electromygraphy
TMJ – Arthroscopy, MRI, CT
Hormonal assays/ Endocrine
Occlusograms
Diagnostic set-up
 CLINICAL
CASE HISTORY
EXAMINATION
STUDY MODELS PHOTOGRAPHS
 RADIOGRAPHS

OPG IOPA BITEWING

ELECTROMYO TMJ
-GRAPHY ARTHROSCOPY
 Kesling’s DIAGNOSTIC
OCCLUSOGRAM SET UP
CASE HISTORY
PERSONAL DETAILS
 CHIEF COMPLAINT
• The patient’s chief complaint should be recorded in
his or her own words.
• This helps the clinician in identifying the priorities
and desires of the patient.
MEDICAL HISTORY
 MEDICAL HISTORY
A number of
• Heart defects (with risk of endocarditis)
medical • Bleeding disorders
conditions • Childhood malignancies - Acute
lymphoblastic leukaemia
may impact • Diabetes
upon the • Immunosuppression
provision of • Epilepsy
• Asthma
orthodontic • Allergies.
treatment:
 GENERAL PHYSICAL
EXAMINATION

• Clue to • Way person • Way person

GAIT

POSTURE
HEIGHT & WEIGHT

physical walks stands/sits

growth and • Abnormalities • Abnormalities
maturation suggest lead to
neuromuscular malocclusion
disturbances in maxillo-
mandibular
relationships
BODY TYPE / SHELDON’S
SOMATOTYPES
ECTOMORPH /
TALL AND THIN
AESTHETIC

MESOMORPH / ATHLETIC AVERAGE

ENDOMORPH /
SHORT AND OBESE
PLETHORIC
SHAPE OF THE HEAD –
CEPHALIC INDEX
MESOCEPHALIC BRACHYCEPHALIC DOLICHOCEPHALIC
SHAPE OF THE FACE –
FACIAL INDEX
 FACIAL SYMMETRY

SYMMETRICAL ASYMMETRICAL
FACIAL ASYMMETRY
FACIAL THIRDS
– VERTICAL
FACIAL
PROPORTION

“Height “
The face can be divided into thirds.
The upper face extends from the
hairline or top of forehead (trichion)
to the base of the forehead between
the eyebrows (glabellar). The
midface extends from the base of
the forehead to the base of the nose
(subnasale). The lower face extends
from the base of the nose to the
bottom of the chin (menton). The
lower third of the face can be
further subdivided into thirds, with
the upper lip in the upper one-third
and the lower lip in the lower two-
thirds.
FACIAL FIFTHS –
TRANSVERSE
FACIAL
PROPORTION
“Width“
Transverse facial proportions
should divide approximately
into fifths (each
one the width of the eye)
COMPOSITE PHOTOGRAPHS
FACIAL PROFILE – Bridge of the nose
– Subnasale – prominent part of chin
FACIAL PROFILE – Bridge of the nose –
Subnasale – prominent part of chin/Pogonion
CONCAVE STRAIGHT CONVEX
CONVEX CONCAVE
 FACIAL DIVERGENCE –
Relationship of forehead to chin
ANTERIOR STRAIGHT POSTERIOR
POSTERIOR ANTERIOR
ANTERO-POSTERIOR JAW
RELATIONSHIP – “Poor man’s cephalometry”
Fingers pointing –
STRAIGHT/
HORIZONTAL
CLASS I
Fingers pointing –
UPWARDS
CLASS II
 Fingers pointing
– DOWNWARDS
CLASS III
 VERTICAL JAW
EXTERNAL
OCCIPITAL RELATIONSHIP
PROTRUBERENCE
Mandibular plane angle
FRANKFURT’S HORIZONTAL PLANE
Line connecting orbitale to external auditory meatus

MANDIBULAR PLANE
Line tangent to base of mandible
 AT THE
EXTERNAL
OCCIPITAL • AVERAGE ANGLE
PROTRUBERENCE

ANTERIOR TO
EXTERNAL
OCCIPITAL • HIGH ANGLE
PROTRUBERENCE

POSTERIOR TO
EXTERNAL • LOW ANGLE
OCCIPITAL
PROTRUBERENCE
LOW ANGLE HIGH ANGLE
 NASOLABIAL
ANGLE
Angle between tangent to
columella of nose and
tangent to upper lip
NORMAL VALUE - 108°
 < 108° > 108°
A O
C B
U T
T U
E S
E
Upturn nose

Retroclined upper incisors

 LIP MORPHOLOGY

INCOMPETENT

COMPETENT
POTENTIALLY
COMPETENT
 LIP MORPHOLOGY
COMPETENT INCOMPETENT
Lips are apart at
Lips are together at POTENTIALLY
rest and require
rest or upto interlabial COMPETENT excessive muscular
gap of 3mm activity to obtain
Lips are apart at
rest, but this is due a lip seal, short
to a physical upper lip,
obstruction, anatomic defects
such as the lower lip
resting behind the
upper incisors (Lip
trap)
NORMAL LIPS & ANATOMICALLY
SHORT UPPER LIPS
 INCISOR SHOW AT REST
• The amount of incisor show reducing with age in both
sexes.
• An increased incisor show is usually due to an increase
in anterior maxillary dentoalveolar height or vertical
maxillary excess. Occasionally it is due to a short
upper lip
• The average upper lip length is 22-mm in adult males
and 20-mm in females.
 INCISOR SHOW AT SMILING
• Ideally 75 to 100% of the
maxillary incisor should be
shown when smiling but this
also reduces with age.
• Some gingival display is
acceptable – up to 2-3 mm
• Increased gingival show -
‘gummy smile’
LIP STEP ACCORDING TO KORKHAUS
POSITIVE LIP STEP SLIGHTLY NEGATIVE MARKED NEGATIVE
 CHIN MORPHOLOGY
NORMAL CHIN PROMINENT/ NEGATIVE CHIN
PROMINENCE POSITIVE CHIN PROMINENCE
MENTOLABIAL SULCUS
NORMAL SHALLOW DEEP

4mm
MENTALIS MUSCLE ACTIVITY
NORMAL HYPERACTIVE
GOLF BALL APPEARANCE