1、Operator:Zhou LingSupervisor:Prof.Li Date:2013.6.61行业进步1534Development of a Problem List The Problem-Oriented approachClinical EvaluationAnalysis of Diagnostic RecordsOrthodontic ClassificationChapter outline22行业进步Analysis of Diagnostic RecordsTwo partsCephalometric analysis of dentofacial relations
2、hipsDental cast analysisto evaluate space excess or deficiency and symmetry within the dental arches3行业进步v Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis4行业进步Symmetryv Transparent ruled grid placed over dental castv Oriented to the midpalat
3、al raphe v Spot asymmetries in arch form,and tooth position5行业进步 Lateral drift of incisors (Crowding,C lost 3 blocked out)SymmetryDrift of posterior teeth（Early loss of E)6行业进步Pendulum7行业进步v Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis8行业
4、进步9行业进步vDental castv Computer algorithmSpace Analysis10行业进步 Measuring arch perimeter from the mesial of one first molar to the other,over the contact points of posterior teeth and incisal edge of anteriors.Step one:Calculation of available space片段法铜丝法11行业进步Step two:Calculation of required spaceMeasu
5、re the mesiodistal width of each erupted tooth from contact point to contact point.12行业进步Space Analysis13行业进步0101 The space available will not change because of growth.0202All the teeth are normal in size0303Correct anteroposterior position of incisors Three assumptions14行业进步InteractionProtrusionRet
6、rusionCrowding15行业进步v Crowding and protrusion are different aspects of the same phenomenon.vIf there is not enough room to properly align the teeth,the result can be crowding,protrusion,or(most likely)some combination of the two.16行业进步17行业进步18行业进步19行业进步0101 The space available will not change becaus
7、e of growth.0202All the teeth are normal in size0303Correct anteroposterior position of incisors Three assumptions20行业进步v In a child with a well-proportioned face,there is little or no tendency for the dentition to be displaced relative to the jaw during growth.vBut the teeth often shift anteriorly
8、or posteriorly in a child with a jaw discrepancy.21行业进步22行业进步0101 The space available will not change because of growth.0202All the teeth are normal in size0303Correct anteroposterior position of incisors Three assumptions23行业进步v Symmetryv Space analysisv Estimating of unerupted permanent teethv Too
9、th size analysisDental cast analysis24行业进步 25行业进步Estimating of Unerupted Permanent TeethRadiograghicPrediction table methodsCombination26行业进步Undistorted radiographic image Compensate for enlargementPeriapical radiographsPanoramic radiographs.Measurement of the teeth on radiographs27行业进步 True width o
10、f primary molarApparent width of primary molarMeasurement of the teeth on radiographs True width of unerupted PremolarApparent width of unerupted premolar=28行业进步v Accuracy is fair to good depending on the quality of the radiographs and their position in the arch.v The technique can be used in maxill
11、ary and mandibular arches for all ethnic groups.Measurement of the teeth on radiographs29行业进步 Estimating of Unerupted Permanent Teeth RadiograghicPrediction table methodsCombination30行业进步Moyers prediction Estimation from proportionality tablesMeasuring the mesiodistal width of the lower incisors Pre
12、diction the size of both the lower and upper unerupted canines and premolars31行业进步 Estimation from proportionality tables32行业进步vNorthern European white childrenvNo radiographs are required,used for the upper or lower arch.Estimation from proportionality tables33行业进步 Estimation from proportionality t
13、ables34行业进步 Estimating of Unerupted Permanent TeethRadiograghicPrediction table methodsCombination35行业进步Combination of radiographic and prediction tableIt depends!36行业进步Comparison1Radiograghic2Most practicalNorthern European white childrenNo radiograghsNo reference table3MoyersTakana&JohnstonNorther
14、n European white childrenNo radiographsDepending on the quality of the radiographs and their position in the archFor all ethnic groups.37行业进步v Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis38行业进步v Although the natural teeth match very well
15、in most individuals,approximately 5%of the population have some degree of disproportion among the sizes of individual teeth.-Tooth Size Discrepancy(TSD)Tooth Size Analysis39行业进步Tooth Size Analysis40行业进步Bolton RatioTooth Size Analysis(78.8 1.72)%(91.5 1.51)%41行业进步 A quick check for.v Anterior tooth s
16、ize discrepancy:2 2v Posterior tooth size discrepancy：5=5v A tooth size discrepancy of less than 1.5mm is rarely significant.Tooth Size Analysis42行业进步v Symmetryv Space analysisv Estimating of unerupted permanent teethv Tooth size analysisDental cast analysis43行业进步Analysis of Diagnostic RecordsTwo pa
17、rtsCephalometric analysis of dentofacial relationshipsDental cast analysisto evaluate space excess or deficiency and symmetry within the dental arches44行业进步 The introduction of radiographic cephalometrics is in 1934 by Hofrath in Germany and Broadbent in USA.Cephalometric analysis45行业进步Function v Or
18、iginal purposev Evaluating dentofacial proportions and clarify the anatomic basis for a malocclusion v Observing pathologic changes(Sometimes)Researching on growth patterns in the craniofacial complex.46行业进步This patient has fusion of the 1st and 2nd cervical vertebrae,with the odontoid process exten
19、ding into the margin of foramen.Function 47行业进步Function v Original purposev Evaluating dentofacial proportions and clarify the anatomic basis for a malocclusion v Observing pathologic changes(Sometimes)v Recognizing and evaluating changes brought about by orthodontic treatment.Researching on growth
20、patterns in the craniofacial complex.48行业进步Function 49行业进步 The goal of cephalometric analysis is to evaluate the relationships,both horizontally and vertically,of the five major functional components of the face.Cephalometric analysis50行业进步Cephalometric analysis51行业进步vCranial Base S，N，Po，Ba,Bov Maxi
21、lla Or，Ptm，ANS，PNS，A，UIv Mandibular Co，Go，B，LI，Pog，Me，GnCephalometric Landmarks52行业进步v S.sellav N.nasion v Po.porion v Ba.basion v BoCephalometric Landmarks53行业进步v Or.orbitale v Ptm.v ANS.Anterior nasal spine v PNS Posterior nasal spine v A.subspinale v UI.Upper IncisorCephalometric Landmarks54行业进步v
22、 Co.condylionv Go.gonionv Pog.pogonionv Me.menton v Gn.gnathionv B.supramentalv LI.lower incisor Cephalometric Landmarks55行业进步56行业进步Two methodsContemporary measurement approachCephalometric analysis via direct comparison with reference templateCephalometric analysis57行业进步Contemporary measurement app
23、roachv Choice of a Horizontal(Cranial)Reference Line.v Steiner Analysisv Sassouni Analysisv Wits Analysis58行业进步Choice of a Horizontal Reference LineAn international congress was held in Frankfort,Germany in 1882.with the choice of a horizontal reference line for orientation of skulls59行业进步“Machine p
24、orion :The upper surface of the ear rod of the cephalometric Anatomic porion”:The upper surface of the shadow of the auditory canal.Choice of a Horizontal Reference Line60行业进步61行业进步NHP(natural head position):Relaxed individuals look at a distant obiect or into their own eyes in a mirror and incline
25、their heads up and down in increasingly smaller movements until they feel comfortably positioned.Choice of a Horizontal Reference Line62行业进步Choice of a Horizontal(Cranial)Reference Line.Steiner AnalysisSassouni AnalysisWits AnalysisContemporary measurement approach63行业进步v SNA:Maxilla to the cranial
26、base 82 2 v SNB：Mandible to the CB 78 2v ANB:skeletal jaw discrepancy.v SN-MP(mandiblar plane):Vertical position of the mandible.64行业进步ANB angle is influenced by two factors:vVertical height of the face.vAnteroposterior position of nasion.65行业进步66行业进步v U1-NA（mm)v U1-NA v L1-NB（mm)v L1-NB67行业进步 The b
27、alance between the prominence of the chin and the prominence of the lower incisor:the more prominent the chin,the more prominent the incisor can be。68行业进步69行业进步70行业进步71行业进步Choice of a Horizontal(Cranial)Reference Line.Steiner AnalysisSassouni AnalysisWits AnalysisContemporary measurement approach72行
28、业进步skeletal open bite SN FH PP OP MP Sassouni Analysis73行业进步74行业进步Choice of a Horizontal(Cranial)Reference Line.Steiner AnalysisSassouni AnalysisWits Analysis75行业进步 Wits analysis（overcome the limitations of ANB as an indicator of jaw discrepancy)It is based on a projection of points A and B to the o
29、cclusal plane,along which the linear difference between these points is measured.76行业进步occlusal plane（OP）77行业进步Female:0Male:-178行业进步79行业进步v First step:pick the correct template from the set of age-different ones that represent the reference data.v Two things must be kept in mind:(1)the patients physical size (2)his or her developmental age80行业进步Cranial base superimpositionMaximum contour of the maxilla Symphysis of themandible81行业进步82行业进步83行业进步84行业进步85行业进步
