Department of Orthodontics and Dentofacial Orthopedics - Copy
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Transcript of Department of Orthodontics and Dentofacial Orthopedics - Copy
DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS
GURUNANAK INSTITUTE OF DENTAL SCIENCE AND RESEARCH
157/F Nilgunj Road, Sodepur, Kolkata – 700114
CASE RECORDS
NAME :-_________________________________________________________________________________________________
OPD NO.:-_______________________________________________________________________________________________
ORTHO NO.:-________________________________________________________________________________________
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DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS
GURUNANAK INSTITUTE OF DENTAL SCIENCE AND RESEARCH
157/F Nilgunj Road, Sodepur, Kolkata – 700114
CASE RECORDS
Name :- ___________________________________________________________________________________
Age/ Sex :- ___________________________________________________________________________________
OPD No. :- ___________________________________________________________________________________
Ortho No. :- ___________________________________________________________________________________
Address :- ___________________________________________________________________________________
Malocclusion :- ___________________________________________________________________________________
Mode of Treatment :- ___________________________________________________________________________________
(Removable/ Fixed :- ___________________________________________________________________________________
Myofunctional/ Surgical) :- ___________________________________________________________________________________
Treatment Commence on :- ___________________________________________________________________________________
Treatment completed on :- ___________________________________________________________________________________
Retention completed on :- ___________________________________________________________________________________
Retention completed on :- ___________________________________________________________________________________
Operator’s Name :- 1. __________________________________________________________________________
2. __________________________________________________________________________
3. __________________________________________________________________________
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Supervisor :- ___________________________________________________________________________________
DEPARTMENT OF ORTHODONTICS &DENTOFACIAL ORTHOPEDICSORTHODONTIC TREATMENT CONSENT FORM
I, _______________________________________________________________________________ fully understand that my ward
_______________________________________________________________________________________needs Orthodontic treatment.
I have also understood the need for extraction of_________________ teeth as imperative before starting the
orthodontic treatment of my ward.
I have understood that although orthodontic treatment has a high degree of success, it is still a
biomechanical procedure, so it cannot be guaranteed & that the unfavorable consequence of this
treatment :: may include the following
1. Post extraction discomfort ft swelling may occur, for which medication will be prescribed, if deemed
necessary, by the doctor.
2. Pain & discomfort of teeth & adjacent soft tissue may occur due to placement of bracket,
band % wire.
3. The treatment time will be increased if the patient doesn’t co —operate with all the instructions given
by the treating doctor
4. The treatment may be a total failure if the patient doesn’t wear elastic head gear/other appliances as
prescribed.
5. There may be a total relapse of finished treatment. if the retainers are not worn for the
required duration of time.
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6. There may be a total relapse of the treatment, if deleterious oral habits such as tongue thrusting,
mouth breathing lip sucking etc. persist after completion of treatment.
7. Relapse of the treatment may occur later due to eruption of the third molar.
8. Extraction, if not deemed necessary at the initial examination may be needed later & carried out with
due consent.
9. Accidental breakage of the wires or brackets will not be the responsibility of the doctors.
10. Tooth mobility and gum swelling may occur due to orthodontic treatment, if proper oral if proper oral
hygiene is not maintained during the treatment.
11. Poor oral hygiene may also result in permanent stains or cavities in the teeth.
12. On completion of treatment, aesthetic judgment of the treating doctor will be considered final and
unquestionable.
13. Some patients the length of the roots of the teeth may be shortened during orthodontic treatment.
Some patients are prone to this happening, some are not.
14. Occasionally problems may occur in jaw joints (T.M.J.) such as joint pain, clicking headaches or ear
problems etc.
15. Sometimes a root may have been traumatized by a previous accident or tooth may have large
fillings which can cause damage to the nerve of tooth.
16. Sometimes orthodontic appliances may be accidentally swallowed or aspirated or may initiate
damage to the oral tissue.
17. If improperly handled headgear may cause injury to the face or or eyes.
18. The treatment will be carried out by the Resident doctors.
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19. Facial photographs at regular intervals will be taken for evaluation of treatment progress.
I have also understood the prognosis and the estimated duration of the treatment will be about
2-3 years or more and retention time also varies from 1-3 years.
Signature of the patient / Guardian-
Relationship to the patient
Address
CASE RECORD
OPD NO._______________________________________ ORTHO NO.____________________________________________
NAME :- _______________________________________________________________________________________________________
DATE OF BIRTH :- ____________________________ AGE / SEX _____________________________________________
EDUCATIONAL QUALIFICATION:- ___________________________________________________________________________
OCCUPATION _______________________________________________________________________________________________
NAME AND OCCUPATION OF FATHER _______________________________________________________________________
NAME AND OCCUPATION OF MOTHER______________________________________________________________________
HOME ADDRESS :- __________________________________________________________________________________________
CONTACT NO ____________________________________
Diagnostic aid Pretreatment (date )
Stage – I Stage – II Post Treatment
(Date )a) Study Models
b) Lateral Cephalogram
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c) PA Cephalogram
d) Orthopantomogram
e) IOPA X – Rays
f) Occlusal/ Bite Wing X-rays
g) Photographs
h) Hand wrist Radiographs
i) Dental scan
j) Other
HISTORY
CHIEF COMPLAINT : ___________________________________________________________________Sibling : Male _______________________Female _______________________
Parent’s Dental conditions & Malocclusion :
___________________________________________________________________
Siblings Dental conditions & Malocclusion : ________________________________________________________________
Familial diseases : ________________________________________________________________
History of previous orthodontics treatment :
___________________________________________________________________
Type of Home oral hygiene care : Brush/ Other aids
Patient’s concern for Treatment : Very Concerned / Indifferent/ Opposed
Parent’s concern for Treatment : Very Concerned / Indifferent/ Opposed
PRE-NATAL HISTORYInformer : Patient / Parent/ Other
Health of mother during pregnancy : ___________________________________________________________
Drug taken during pregnancy : __________________________________________________________
Delivery : Full Term/ Pre Mature
Type of Delivery : Normal/ Forceps/ Cesarean
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POST- NATAL-HISTORYFeeding : Brest/ Bottle/ Combined
History of childhood diseases : ___________________________________________________________
Injuries. : ________________________________________________________
HABITSDURATION INTENSITY FREQUENCY
Thumb/ Finger Sucking
Nail/ Lip BitingMouth Breathing
Tongue ThrustingBruxism
Snoring
REASON FOR SEEKING ORTHODONTIC TREATMENTEsthetic
Functional
Speech
Hygiene
ANY OTHER INFORMATION
CLINICAL EXAMINATION
PHYSICAL STATUS
Height: cm.
Weight: Kg.
EXTRA ORAL EXAMINATION:
Shape of Head : Dolicocephalic/ Mesocephalic/ Brachycephalic
Facial Form : Mesoprosopic/ Leptoprosopic/ Europrosopic
Facial Profile : Convex/ Straight/ Concave
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Facial Divergence : Straight/ Anterior Divergence / PosteriorDivergence
Facial Symmetry : ___________________________________________________________
Lip Competency : Incompetent / Potentially Competent/ Competent
Inter Labial gap : ___________________________________________________________
Incisor Display at rest : ___________________________________________________________
Incisor Display during full smile : ___________________________________________________________
Congenital anomaly : Cleft lip/ Palate /any other
Gingival display at rest : ___________________________________________________________
Gingival display during full smile : ___________________________________________________________
FUNCTIONAL EXAMINATION
RESPIRATION : Nasal/ Oral/ Oro-nasal
Lip Tonicity Upper Lip : Normal/ Hypotonic/ Hypertonic
Lower Lip : Normal/ Hypotonic/ Hypertonic
Mentalis : Normal/ Hypotonic/ Hypertonic
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Masseter : Normal/ Hypotonic/ Hypertonic
Pattern of swallowing/ deglutition : Somatic/ Visceral
Speech analysis : Normal/ AbnormalArticulated/ Non Articulated
Path of Closure : Normal/ Deviated
TMJ : Pain/Clicking/ Crepitus
Freeway Space : ___________________________________________________________
Clinical Examination
Pre- Treatment Stage Post treatmentI II
TendernessOver Joint
RightLeft
Clicking Sounds Right
Left
Muscle tenderness Right
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Temporalis Left
Masseter RightLeft
MedialPterygoid
Right
Left
Lateral Pterygoid Right
Left
Any OtherRight
Left
Lateralexcursions (mm)
Right
Left
Maximum incisal opening (mm)
Protrusion(mm)
INTRAORAL EXAMINATION
SOFT TISSUESOral Hygiene Status : Good/ Satisfactory/Poor
Gingiva : Normal/ Oedematous / Fibrous
Brushing Habits : Good/ Satisfactory/Poor
Position of Mucogingival Junction : Normal/ Abnormal
Frenal Attachment-Upper : Normal/ Abnormal
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-Lower : Normal/ Abnormal
Tongue : 1. Size
2. Shape
3. Movement
4. Posture
Oral Mucosa : ..……………………………………………………………….
Tonsils / Adenoids : ..……………………………………………………………….
HARD TISSUESNUMBER OF TEETH PRESENT : 51 52 53 54 55 61 62 63 64 65
71 72 73 74 75 81 82 83 84 85: 11 12 13 14 15 16 17 18 21 22 23 24 25 26 27 28
31 32 33 34 35 36 37 38 41 42 43 44 45 46 47 48
Number of unerupted teeth : ..……………………………………………………………….
Supernumerary /Missing teeth : ………………………………………………………...………
Size and form of teeth : ..……………………………………………………………….
Texture : Normal/ Hypoplastic (localized/ generalized)
Carious teeth : ………………………………...………………………………
Endodontically Treated : ……………………………..……………….…………………
Occlusal Wear Facets : ………………………………..……………………………….
Traumatic fractured teeth : ………………………………..……………………………….
MAXILLARY ARCHShape : ‘V’ Shaped/ ‘U’ Shaped/ SquareArch Symmetry : Symmetrical/Asymmetrical Arch Alignment : Crowding/Spacing / AlignmentPalatal Contour/ Depth : Deep/Average/ Shallow
MANDIBULAR ARCH
Shape : ‘V’ Shaped/ ‘U’ Shaped/ Square
Arch Symmetry : Symmetrical/Asymmetrical
Arch Alignment : Crowding/ Spacing/ Alignment11
ANTERO-POSTERIOR RELATIONSHIP
Molar Relation (Angle’s) :…………………………………………………………………………………..
Premolar Relation (Katz’s) :…………………………………………………………………………………..
Canine Relation (Rickett’s) :…………………………………………………………………………………..
Incisor Relation (Ballard &Weinmann) :…………………………………………………………………………………..
Overjet :……………………………………mm
VERTICAL RELATIONSHIP
Overbite :…………………………………..mm/percentage
Openbite : Anterior/ Posterior/ No
Curve of Spee :……………………………………………………………………………………
TRANSVERSE RELATIONSHIP
Crossbite :………………………………………………………………………………….
Scissors bite :………………………………………………………………………………….
Mid Line : Normal/Shifted to Left/ Right
STUDY MODEL ANALYSIS
TOOTH MEASUREMENT
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Right Left6 5 4 3 2 1 1 2 3 4 5 6
U
L
6 5 4 3 2 1 1 2 3 4 5 6
Right Left
CAREY’S ARCH PERIMETER ANALYSISUpper Lower
Total tooth material
Arch perimeter
Discrepancy
LINDER- HARTH’S & PONT’S ANALYSESLINDER- HARTH’S ANALYSIS PONT’S ANALYSIS
Premolar Index
Measured Arch Width
Calculated Arch Width
Discrepancy
Molar Index
Measured Arch Width
Calculated Arch Width
Discrepancy
ASHLEY HOWE’S ANALYSISMaxillary Mandibular
Total tooth material
Premolar Diameter
Basal Arch Width
Percentage
INFERENCES
BOLTON’S TOOTH RATIO
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Anterior Ratio: Mandibular(3-3)X 100 / Maxillary(3-3)
NORMAL OBSERVED VALUE DISCREPANCY
77.2%
Overall Ratio: Mandibular(6-6)X 100 / Maxillary(6-6) 91.3%
BOLTON’S TOOTH RATIO
Ideal proportion of tooth material of maxillary and mandibular teeth.
Anterior Ratio Overall Ratio
Max. Mand. Max. Mand. Max. Mand. Max. Mand.
40.0 30.9 48.0 37.1 85 77.6 103 94.0
40.5 31.3 48.5 37.4 86 78.5 104 95.0
41.0 31.7 49.0 37.8 87 79.4 105 95.9
41.5 32.0 49.5 38.2 88 80.3 106 96.8
42.0 32.4 50.0 38.6 89 81.3 107 97.8
42.5 32.8 50.5 39.0 90 82.1 108 98.6
43.0 33.2 51.0 39.4 91 83.1 109 99.5
43.5 33.6 51.5 39.8 92 84.0 110 100.4
44.0 34.0 52.0 40.1 93 84.9
44.5 34.4 52.5 40.5 94 85.8
45.0 34.7 53.0 40.9 95 86.7
45.5 35.1 53.5 41.3 96 87.6
46.0 35.5 54.0 41.7 97 88.6
47.0 36.3 55.0 42.5 99 90.4
47.5 36.7 100 91.3
INFERENCES
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RADIOGRAPHIC EXAMINATION
PANORAMIC RADIOGRAPH
1. Teeth Present :…………………………………………………………………………………….
2. Teeth Absent :…………………………………………………………………………………….
3. Root Resorption of Deciduous Teeth : Normal/ Abnormal
4. Root Formation of Permanent Teeth : Normal/ Abnormal
5. Character of Restoration :…………………………………………………………………………………….
6. Lamina Dura : Normal/Abnormal
7. Height of Interdental crest : Normal / Abnormal
8. Supernumerary teeth :……………………………………………………………………………………
9. Third Molar Status :…………………………………………………………………………………..
10. Pathological Condition (if any) :…………………………………………………………………………………..
Any other special observation regarding
a. DNS :…………………………………………………………………………………
b. Maxillary Sinus :………………………………………………………………………………..
c. TMJ/ Condyles :………………………………………………………………………………..
d. Any other :………………………………………………………………………………..
INTRA ORAL RADIOGRAPH
P A CEPHALOGRAM
15
HAND WRIST RADIOGRAPHS
SKELETAL MATURITY INDICATORS Hand Wrist Radiograph stage for the patient
Inference
Width-of epiphysis as wide as diaphysis SMI 1 - Third finger - proximal phalanx SMI 2 - Third finger – middle phalanx SMI 3 - Fifth finger – middle phalanx
SMI 4 - Adductor sesamoid of thumb
SMI 5 - Third finger - distal phalanx SMI 6 - Third finger – middle phalanx SMI 7 - Fifth finger – middle phalanx
SMI 8 - Third finger - distal phalanxSMI 9 - Third finger - proximal phalanx
16
SMI 10 - Third finger – middle phalanxSMI 11 - Radius.
LATERAL CEPHALOGRAM
CERVICAL VERTEBRAE STAGE FOR THE PATIENT
INTERFACE :-
1INITIATION Corresponds to SMI 1 and 2. Adolescent growth just beginning. 80% to 00% of
growth expected. Inferior borders of C2, C3.and C4 are flat. The vertebrae are
wedge shaped. Superior vertebral borders tapered from posterior to anterior.
2ACCELERATION Corresponds to SMI 3 and 4. Growth acceleration beginning. 65% to 85% or
acceleration adolescent growth expected. Concavities developing in the inferior borders of C2 and C3. The inferior border of C4 is flat. The bodies Os C3 and C4 are nearly rectangular in shape.
3TRANSITION Corresponds to SMI 5 and 6. Adolescent growth still accelerating towards
peak height velocity 25% to 65 % of adolescent growth expected. Distinct
concavities seen in the inferior borders of C2 and C3.A concavity beginning to
develop inferior border of C4. The bodies of C3 and C4 are rectangular in shape.
4DECLARATION Corresponds to SMI 7 and 8. Adolescent growth begins to decelerate
dramatically. 10% to 25% of adolescent growth expected. Distinct concavities seen in the inferior borders of C2, C3,and C4. The vertebral bodies of C3 and C4 are becoming more square in shape.
5MATURATION Corresponds to SMI 9 and 10. Final maturation of the vertebrae takes place
during this stage. 5% to 10% of adolescent growth expected. More accentuated
concavities seen in the inferior borders of C2, C3 and C4. The bodies of C3 and C4
are nearly square in shape. 17
C3
C3
C3
C3
C3
C3
6COMPLETION Corresponds to SMI 11 Growth considered to be complete. Little or no
adolescent growth is expected. Deep concavities seen in the inferior borders of C2, C3 and C4. The bodies of C3 and C4 are square or greater in vertical dimension than in horizontal dimension.
CEPHALOMETRIC EVALUATION
DOWN’S ANALYSIS
Sl no.
Parameters Normal Value Treatment
Down’s Mean
Indian Mean
Pre Stage – I Stage – II Post
Skeletal1 Facial angle (N-Pog : FH) 87.8 3.6 86.5 4.0
2 Angle of Convexity (N-A : A -Pog) 0 5.1 1.5 5.8
3 AB Plane Angle (AB : N-Pog) -4.6 3.7 -3.3 4.2
4 Mand Plane Angle (FH:MP) 21.9 3.2 22.5 4.4
5 Y-Axis (S-Gn : FH) 59.4 3.8 59.8 3.0
Dental6 Cant of Occlusal Plane +9.3 3.8 8.1 5.1
7 Interincisal Plane 135.4 5.8 125 7.4
8 Lower Incisor to Occlusal Plane 14.5 3.5 23.1 5.8
9 Lower Incisor to Mand Plane 1.43 3.8 3.0 6.8
10 Upper Incisor to APog line 2.7 1.8 5.7 2.2
INFERENCE
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STEINER’S ANALYSIS
Measurement Mean India Pre Stage - I Post
1 SNA 82 0
2 SNB 80 0
3 SND 76 0
4 ANB 2 0
5 FHP to SN 6-7 0
6 Go Gn to SN 32 0
7 Occl. To S-N (Angle)
14 0
8 S -E (Linear) 22 mm
9 S - L (Linear) 51 mm
10 1 to N-A (mm) 4 mm
11 1 to N –A (angle) 22 0
12 1 to N –B (mm) 4 mm
13 1to N –B (Angle) 25 0
14 Pog to NB (mm) Not Established
15 1 to 1 (angle) 131 0
16 1 – Go Gn (angle) 93 0
17 6 –NA (Linear) 27 mm
18 6 –NB (Linear) 23 mm
‘S’ Line to Upper Lip‘S’ Line to Lower Lip
19
Acceptable Compromise
-20 00 20 40 60 80
8mm 260 6mm 240 4mm 220 2mm 200 0mm 180 2mm 160
3mm 210 3.5mm 230 4mm 250 4.5mm 270 5mm 290 5.5mm 310
INFERENCE
TWEED’S ANALYSIS
Sl No.
Parameter Norms (Degree)
Pre Stage –I Stage – II Post
1 FMA (Angle) 25
2 IMPA (Angle) 90
3 FMIA (Angle) 65
HEAD PLATE CORRECTIONFMA FMIA
30 0 Above 650
210 - 290 680
200 720
Less than 200 IMPA should not exceed 940
FMIA will range from 660 800 / more
For the patient’s FMA, an objective line is traced from the required FMIA. The distance between this objective line and the line passing through the actual axial inclination of the mandibular incisors is measured at the occlusal plane. This figure is multiplied by 2 to include right and left
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side and is added to the difference between space required and space available to yield total discrepancy.
INFERENCE
RICKETTS ANALYSISMean at 9 Yrs Age change Pre Stage –
IStage –
IIPost
Facial Axis (BaN – Ptm Gn) 900± 3.50 None
Facial Angle (FH – N Pog) 870± 30 +10 /3 Years
Mandibular Plane (FH – Go Gn)
260± 40 - 10 /3 Years
Facial Taper (N Pog – Go Gn) 680± 40 None
Lower face Height (ANS Xi – Xi PM)
470± 40 None
Mandibular Arc (DC Xi – Xi PM)
260± 40 +10 /2 Years
Convexity of Point A to N Pog 2 mm ± 2mm -1mm / 3 Years
Lower incisor to A Pog (mm) 1mm ± 2 None
Lower incisor Inclination (1 – to N Pog)
22 ±4 None
6 Distal to Pterygoid VerticalAge + 3 Add1 mm/ Year
21
Lower Lip - E Line -2mm ± 2 Decreases
INFERENCE:
McNAMARA’S ANALYSIS
Mean Pre-Treatment
Stage-I Stage -II Post treatment
Na Perpendicular to Point A 0-1 mm
Na Perpendicular to Pog Small-8 to- 6mmMedium -4 to 0Large - 2to +2
Facial axis angle(Ba-N) to (Ptm-Gn)
0±3.5°
Mand Plane angle 22°±4°
Max. Length (Co-Pt.A) ------
Mand Length (Co-Gn) ------
Maxillomandibular Difference
Small 20 - 23mmMedium 27 -30mmLarge 30-33mm
22
Lower Ant Facial Height (ANS-ME)
Small 60-62mmMedium 65-67mmLarge 70-73mm
1 to Point A 4-6 mm
Lower Incisor to A-Po Line 1-3 mm
Naso Labial Angle 90-110°
AIRWAY ANALYSISPre Stage-I Stage-II Post
UPPER PHARYNX: 15-20mm(<5mm impairment) Posterior outline of soft palate to closest point on posterior pharyngeal wall LOWER PHARYNX: 10-12mmIntersection of posterior border of tongue & the inferior border of mandible to the closest point on the posterior pharyngeal wall
INFERENCE
BJORK’S ANALYSIS
Mean Pre Treatment
Stage-I Stage II Post Treatment
Saddle Angle (N-S-Ar) 123±5°
Angle(S-Ar-Go) 143±6°
Gonial Angle (Ar-Go-Gn) 130±7°
Upper Gonial 50-55°
Lower Gonial 70-75°
Sum 396°
Anterior Cranial Base(S-N) 71±3mm
Posterior Cranial Base(S-Ar) 32±3mm
Ramus Height (Ar-Go) 44±5mm
Body Length (Go-Me) 71±5mm
SN-MP 32.5°
1 to MP 90±3°
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1 to SN 102±2°
FH (S-Go) ----
FH (N-Me) ----
FH/AFH% ----
INFERENCE
JARABAK’S ROTATIONAL INDEX
Pre Stage-I Stage-II Post
Posterior Facial height (S-Go)
Anterior Facial height (N-Me)
Ratio =(PFH/AFH) X 100
Ratio less than 62% expresses a vertical growth pattern,Ratio more than 65% expresses horizontal growth pattern
24
WITS APPRAISAL
(Measuring the extent of jaw disharmony in anteroposterior plane)
AO to the left of BO- Negative valueAO to the right of BO- positive value
Pre Stage-I Stage-II post
INFERENCE:
SOFT TISSUE ANALYSIS
HOLDAWAY’S ANALYSIS
Mean Pre-Treatment
Stage-I Stage-II Post Treatment
Facial Angel 91±7°
Upper Lip Curvature 2.5 mm
Skeletal Convexity at Pt.A -2 to +2 mm
H- Line Angel 7°-15°
Nose Tip – H Line 14-24mm (max)
Upper Sulcus Depth 5mm
Upper Lip Thickness 15mm
Upper Lip Strain 13-14 mm
25
Lower Lip to H-Line -1 to +2 mm
Lower Sulcus Depth 5mm
Soft tissue Chin Thickness 10-12mm
RICKETT’S E Line
Pre Stage-I Stage-II Post
Upper lip to E line (Normal: 4 mm behind)
Lower lip to E line (Normal: 2mm behind)
ANGLE OF MERRIFIELD
INFERENCE:
PHOTOGRAPHIC ANALYSIS
1. Bilateral Symmetry: A vertical tine passing through glabella, nasal tip, mid point of upper lip and
midpoint of chin bisects the face into two halves
_________________________________________________________________________________________________________________
2. Alar base width should equal intercanthal distance___________________________________________________________
3. Width of the mouth should equal distance between medial limbs (irises) of the eye
_________________________________________________________________________________________________________________
26
4. Vertical, height of midface from glabella to subnasale should be equal to vertical height of lower face
from subnasale to soft tissue menton
_______________________________________________________________________________________________________
5. Upper lip length (Sn-StmS) is 1/3rd of the tower third facial height
(Sn - Me’)[ Sn-StmS) : (Stm1 - Me’) = 1:2 ______________________________________________________________________
PROFILE VIEW
1. Profile Convexity / Concavity : ______________________________________________________________________________
2. Divergence of face : ___________________________________________________________________________________________
[Facial. angle, between true horizontal (visual axis) and N-Pog-[if less than 90 posteriorly
divergent, if more - anteriorly divergent]
3. Nasolabial angle_____________________________________________________________________________________________
Nasolabial angle, Cm - Sn Ls, is 1020 ± 8
Cm= Columella point - most anterior point on the Columella of the nose (Columella is the terminal fleshy
portion of the nasal septum)
Sn = Subnasale - the point at which nasal septum merges with the upper cutaneous lip.
Ls = Labrale superioris -anterior most point of upper lip indicating mucocutaneous border of upper lip.
DISCUSSION
27
TREATMENT FOLLOW – UP
DATE TREATMENT DONE SIGNATURE
28
COMPREHENSIVE DIAGNOSTIC ASSESSMENT
MAXILLA_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
MANDIBLE_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
GROWTH PATTERN_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
DENTITION/ OCCLUSION_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________29
SOFT TISSUE_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
TREATMENT PLAN_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
APPLIANCE DESIGN/ TYPE OF MECHANOTHERAPY_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
PROGNOSTIC ASSESSMENT_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
RETENTION CONSIDERATIONS_______________________________________________________________________________________________
_______________________________________________________________________________________________
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_______________________________________________________________________________________________
_______________________________________________________________________________________________
31