Dr.

Yomna ElFiky
(BDS, MSc, Phd researcher, MOrth
CLINICAL EXAMINATION RCSEd, Autolign certified
orthodontist, EOS speaker 2023)
YOUR SOURCES!
OUTLINE
1-Clinical examination goals
2-Macroesthetics-Miniesthetics-Microesthetics
3-Extraoral examination (frontal and profile)
4-IO examination (intraarch and interarch)
OBJECTIVES OF THIS LECTURE
To be able to efficiently and quickly perform extra
and intraoral examination especially in your clinic.
DATABASE MAY BE THOUGHT OF AS DERIVED FROM ;

1-Interview data from questions

(written and oral)

2-Clinical examination of the patient

3-Evaluation of diagnostic records(acc to

2)
2-CLINICAL EXAMINATION OF THE PATIENT
There are two goals of the orthodontic clinical
examination:
(1) Evaluate and document oral health,
jaw function, facial proportions, and smile
characteristics.

(2) Decide which diagnostic records are

required.
NATURAL HEAD POSITION (NHP)
➢Reproducible,standardized
➢The patient is asked to sit upright and look straight ahead to a
point at eye level in the middle distance(This can be a point on the
wall in front of them, or a mirror so that they look into their own
eyes).
EXTRAORAL EXAMINATION
Systematic Examination of Facial and Dental Appearance

Facial proportions in all three

planes of space (macro-esthetics).

The dentition in relation to the face

(mini-esthetics)

The teeth in relation to one another

(micro-esthetics).
1-FRONTAL VIEW (VERTICALLY AND TRANSVERSELY)
 VERTICAL RELATIONSHIP=RULE OF THIRDS
➢Vertically the face is split into thirds,
with these dimensions being
approximately equidistant.
➢Any discrepancy in this rule of thirds
will give an indication of disharmony
within the facial proportions and
where this lies.
➢ Of particular relevance is an
increase or decrease in the lower
face height.
TRANSVERSE RELATIONSHIP( SYMMETRY)
Above and
Rule of below
fifths views

Midline(N’,V border,chin)
 FACIAL INDEX
The proportional relationship of facial height to width
establishes the overall facial type and the basic
proportions of the face.
BOW / STRAIGHT CALIPERS
 SOFT TISSUES

Lip relationship
The relationship of the lips should also be evaluated from the frontal view :
➢• Competent lips are together at rest;
➢• Potentially competent lips are apart at rest, but this is due to a physical
obstruction, such as the lower lip resting behind the upper incisors;
➢• Incompetent lips are apart at rest and require excessive muscular activity to
obtain a lip seal.
Lip incompetence is common in preadolescent children and competence increases
with age due to vertical growth of the soft tissues, especially in males.
SMILE

There are two types of smiles: the posed or social smile and the
enjoyment smile (also called the Duchenne smile in the research
literature).
The social smile is reasonably reproducible and is the one that is
presented to the world routinely. The enjoyment smile varies with
the emotion being displayed (for instance, the smile when you are
introduced to a new colleague differs from the smile when your
team just won the year’s most important game).
The social smile is the focus of orthodontic diagnosis.
 SMILE ESTHETICS (MINI /MICRO)
Incisal and gingival show – the full height of the maxillary incisor crowns
should be visible on smiling. Some gingival show is acceptable, but this
should not be excessive. Generally, males show less tooth substance and
gingiva than females on smiling, and in both groups this reduces with age;
therefore, a full smile gives a youthful appearance.

In adolescents and young adults, 3–4 mm of the maxillary incisor should

be displayed at rest.
 THE LIP LINE

The lip line is the vertical relationship between the upper lip and
the maxillary incisors during smiling. Ideally, the full length of the
upper incisors and the interdental papillae should be visible during
smiling.
The lip line is high when a continuous band of gingival tissue is
visible and low when less than 75% of the crown height of the
central incisors can be seen.
The lip line in females is l-2 mm higher than in males so it is
acceptable for females to show 1-2 mm of gingivae anteriorly
during smiling.
GUMMY SMILE CAUSES CHECK PHD NOTES
1-Vertical maxillary excess
2- Short upper lip: The average upper lip length is 22 mm in adult
males and 20 mm in females
3-This should not be confused with display of gingiva in childhood
because the gingival recession that accompanies eruption is
incomplete
4-Hypermobile upper lip “elevation of the upper lip(mean = 7-8
mm)”.
5-Vertical dental height: Reduced vertical dental height, as seen
with digit sucking, results in reduced incisor display.
6-Conversely, retroclination increases tooth display.
ASSIGNMENT
SMILE WIDTH
BUCCAL CORRIDORS
The space between the buccal surface of the distal-most maxillary
molar and the angle of the mouth on smiling (esthetic to avoid
denture like smile).
This relationship is affected by both the width of the dental arch
and its anteroposterior position.
SMILE ARC
SMILE ARC
•Relationship of the upper incisor edges with the lower lip

•The upper incisor edges should be parallel with the curvature of

the lower lip on smiling
OCC PLANE CANT
SO, MINIESTHETICS:
➢Incisal show at rest and on smile
➢Smile width
➢Smile arc
➢Occ cant
MICROESTHETICS
PROFILE VIEW(ANTEROPOSTERIORLY AND VERTICALLY)
AP***

Zero Kettles’s Profile

meridian method angle
ANTEROPOSTERIOR RELATIONSHIP
An assessment should be made of the skeletal dental base relationship between the
upper and lower jaws in the anteroposterior plane.
1-This can be achieved by mentally dropping a true vertical line down from the
bridge of the nose (often called the zero meridian). The upper lip should rest on or
slightly in front of this line and the chin slightly behind.
2-Alternatively, the dental bases can be palpated labially.
• In a normal or skeletal class I relationship, the upper jaw should be approximately
2–4 mm in front of the lower;
• In a skeletal class II relationship the lower jaw is greater than 4 mm behind the
upper;
and
• In a skeletal class III relationship the lower jaw is less than 2 mm behind the upper.
3-An assessment can also be made of the angle between the
middle and lower third of the face with the profile being described
as: (12 +-4)
• Normal or straight;
• Convex; or
• Concave.
VERTICAL( RULE OF THIRDS,,MAND PLANE ANGLE)
SOFT TISSUE (NLA AND LIPS PROTRUSION)
NB
In evaluating lip protrusion, it is important to keep in mind that
everything is relative.
The larger the nose, the more prominent the chin must be to
balance it, and the greater the amount of lip prominence that will
be esthetically acceptable.

➢Lips and E-line

CASE
TEETH PROCLINATION
IO EXAMINATION
1-ORAL HEALTH**
➢Oral Health(OH,gingivitis,recession,caries, restorations,WSL,tooth
wear).
➢Affects bonding pattern, extraction pattern.
➢Any orthodontic examination should include gentle probing
through the gingival sulci, not so much to establish pocket depths as
to detect any areas of bleeding. Bleeding on probing indicates
inflammation that may extend into the periodontal ligament, and
this must be brought under control before orthodontic treatment is
undertaken
 2-FUNCTIONAL EXAMINATION
❖Tmj (Pain, opening, deviation,noise)
❖Functional shift*** 3 cases(lateral shift in unilateral
posterior crossbite where there’s actually maxillary
narrowing,,,,ant shift Sunday bite,,,ant shift pseudo class III).
❖Assignment question:
True vs pseudo class III
FUNCTIONAL ANTERIOR SHIFT
3-Intraarch
INTRAARCH

➢No of teeth
➢Arch shape ovoid, taper,square
➢Symmetry
➢Cr and spacing
➢Rotations
CROWDING
Ideally the mesiodistal widths of the teeth in each dental
arch should be measured, added together and compared
to the overall size of the arch: an arch-length analysis
BOLTON RATIOS AND TOOTH-SIZE DISCREPANCY

A tooth-size discrepancy is a disproportion amongst the sizes of

individual teeth and is a reason why it can be impossible to
achieve an ideal occlusion.
Common examples of a Bolton discrepancy include the presence of
diminutive maxillary lateral incisors and class III malocclusions,
where there is a tendency towards a relative mandibular tooth
excess.
4-INTERARCH
TRAUMATIC DEEP BITE
POSTERIOR CROSSBITES
ALSO CHECK!
Frenum upper and lower
Tongue imprints
TODAY’S QUOTE
What is the most important piece of information you got
today?
FOR ANY QUESTIONS;

Contact me on:
yomnafiky@gmail.com

Or lets meet on Tuesday/ Wednesday!