ORTHODONTIC CHART

PROFILE
 FACIAL PHOTOS
Profile

Straight Convex Concave

 FACIAL PHOTOS
Profile - straight

Anterior Straight Posterior

Divergent Divergent
 FACIAL PHOTOS
Lip posture

Competent lips
- slight contact when muscles are relaxed
 FACIAL PHOTOS
Lip posture

Incompetent lips
-short lips, do not form lip seal in a relaxed state
-lip seal achieved by active contraction of perioral and
mentalis muscles
 FACIAL PHOTOS
Lip posture

Everted lips
- Hypertrophied lips with weak muscular tonicity
 FACIAL PHOTOS
Nasolabial angle (aesthetic, open, closed)

- Angle formed by the columella and philtrum of the

upper lip at subnasale (mean = 100 10 degrees)
- Females slightly greater
 FACIAL PHOTOS
Chin

Acceptable Chin
 FACIAL PHOTOS
Chin

Small chin
 FACIAL PHOTOS
Chin

Large Chin
 FACIAL PHOTOS
Chin

Large Chin
 FACIAL PHOTOS
Mentolabial angle

- Angle formed by the intersection of the lower

lip and chin measured at soft tissue B point
- Should be gently curved (mean = 120 10)
 FACIAL PHOTOS
Mentolabial sulcus (deep, shallow)

Mentalis activity hyperactivity causes

puckering of the chin (strained, relaxed)
FRONTAL
FACIAL PHOTOS
 FACIAL PHOTOS
FACIAL TYPE

MESOCEPHALIC BRACHYCEPHALIC DOLICOCEPHALIC

MESOPROSOPIC EURYPROSOPIC LEPTOPROSOPIC
 Head and facial findings
Length-width (Cephalic) Index of the Head
I = greatest MD width of head x 100
greatest length of the head
 Length-width Index of the Head
Dolicocephalic = x 75.9
Mesocephalic = 76 80.9
Brachycephalic = 81 85.4
Hyperbrachycephalic = 85.5 x
 Morphological Facial Index
I = morphological facial height x 100
bizygomatic width
Facial height = N - Gn
Bizygomatic width = zy zy (zygomion)
(cheekbone)
 Morphological Facial Index
Hypereuryprosopic = x - 78.9
Euryprosopic = 79 83.9
(short and broad)
Mesoprosopic = 84 - 87.9
Leptoprosopic = 88 - 92.9
Hyperleptoprosopic = 93 - x
(long and narrow)
Short and broad
Long and Narrow
 FACIAL PHOTOS
FACIAL SYMMETRY

Symmetric Assymetric
 FACIAL PHOTOS
Nose
(acceptable, small, large)
FACIAL PHOTOS
 FACIAL PHOTOS
FRONTAL TO SMILING
GINGIVAL DISPLAY

Excessive Moderate
Acceptable Excessive

Deficient
 FACIAL PHOTOS
SMILE LINE

HIGH NORMAL LOW

INTRA-ORAL PHOTOS
 INTRA-ORAL PHOTOS
TOOTH COLOR: NORMAL, ABNORMAL
 INTRA-ORAL PHOTOS
DECALCIFICATION: SEVERE, SLIGHT, NONE
 INTRA-ORAL PHOTOS
TONSILS / ADENOIDS: PRESENT REMOVED
MODEL ANALYSIS
MODEL ANALYSIS
 MODEL ANALYSIS
DENTAL CLASSIFICATION

CLASS I CLASS II DIV 1 CLASS II DIV 2

CLASS III (SUBDIVISION R/L)

CLASS I (Angle)

SAGITTAL PLANE
Class II division 1 (Angle) Class II division 2 (Angle)

SAGITTAL
MIXED DENTITION
Class III (Angle)

SAGITTAL
PERMANENT DENTITION
 MODEL ANALYSIS
OVERJET, OVERBITE (mm)
 MODEL ANALYSIS
DEEP BITE (mm)
 MODEL ANALYSIS
OPEN BITE (mm)
 MODEL ANALYSIS
CURVE OF SPEE
 MODEL ANALYSIS
ARCH SHAPE
 MODEL ANALYSIS
ARCH LENGTH (mm)
 MODEL ANALYSIS
ROTATIONS
 MODEL ANALYSIS
CROWDING / SPACING
 MODEL ANALYSIS
LOCKED OUT TEETH
 MODEL ANALYSIS
PEG LATERALS
 MODEL ANALYSIS
CROSSBITE: ANTERIOR, POSTERIOR
 MODEL ANALYSIS
MIDLINE DISCREPANCY
 MODEL ANALYSIS
FRACTURED TEETH
 MODEL ANALYSIS
ARCH LENGTH DISCREPANCY
Measure MD diameter = space required
 MODEL ANALYSIS
ARCH PERIMETER
4 Linear measurements = space available
MODEL ANALYSIS
 MODEL ANALYSIS
ARCH CIRCUMFERENCE
CASE ANALYSIS
CASE ANALYSIS
Skeletal classification
Skeletal pattern;
jaw relationship N
ANB = 2
Range 0 5
<0 Class III
tendency A
>5 Class II
tendency B
Skeletal deep (low angle)/
open bite (high angle)
Vertical Growth
SN-GoGn = 31.3 S N
Range 24.4 38.2
<24.4 Low angle,
skeletal deep bite
(short)
>38.2 High angle,
Go
skeletal open bite
(long)
Gn
 Maxillary position
Maxillary position
SNA = 84.5 S
N
Range 79.2 89.8
<79.2 retrognathic
>89.8 prognathic
A
 Mandibular position
Mandibular position
SNB = 82 S
N
Range 77.1- 86.9
<77.1 retrognathic
>86.9 prognathic

B
Upper incisor position
Maxillary incisor
inclination N
1-NA () = 24.7
Range 7.6 - 31.8
<7.6 Retroclined UR A
>31.8 Proclined
UI
Upper incisor position
UI-SN angle
= upper
incisor
position

R = 96.5 109.5
N = 103
Upper incisor position

UI- FH angle
= upper
incisor
position
R = 110 120
N = 115
 Lower incisor position
Mandibular incisor
inclination N
1-NB () = 29.8
Range 23.2 - 35.8
<23.2 Retroclined
>35.8 Proclined
LI

LR B
Lower incisor position

IMPA angle
= lower incisor
position

R = 83 97
N = 90
Interincisal angle

UI LI angle
(interincisal
angle)
= dental
pattern
R = 121 140
N = 131
 Profile
soft tissue analysis
Soft tissue profile
S line
Lips should fall
within the line
Before the line
concave profile S line
Beyond the line
convex profile

Chin point
IBO CEPHALOMETRIC DATA SHEET
GROWTH STAGE
 Cervical Vertebrae Maturation
Cervical Vertebrae Maturation (C2, C3, C4)
Shapes of the cervical vertebrae differ at each
level of skeletal development
C3 and C4 change from wedge shaped, to
rectangular, to square
Become taller as skeletal maturity progresses
Inferior borders are flat when immature, but
becomes concave as a person reaches maturity
6 stages of vertebral development
6 Stages of Vertebral Development
6 Stages of Vertebral Development
Stage 1 Initiation
Beginning of adolescent
growth with 80% - 100% of
adolescent growth expected
Inferior borders flat
Vertebrae wedge-shaped
Superior vertebral border
tapered from posterior to
anterior
6 Stages of Vertebral Development
Stage 2 Acceleration
Growth acceleration begins
65 85% of adolescent
growth expected
Concavities develop in
inferior borders
Inferior of C4 still flat
Bodies nearly rectangular in
shape
6 Stages of Vertebral Development
Stage 3 Transition
Acceleration of growth towards
peak height velocity
25% - 65% of adolescent growth
expected
Distinct concavities seen in
inferior borders of C2 and C3
Concavity beginning to develop
in inferior border of C4
Bodies of C3, C4 rectangular in
shape
6 Stages of Vertebral Development
Stage 4 Deceleration
Deceleration of adolescent
growth spurt with 10%-25%
of adolescent growth
expected
Distinct concavities seen in
inferior borders of C2, C3
and C4
Bodies of C3, C4 becoming
square in shape
6 Stages of Vertebral Development
Stage 5 Maturation
Final maturation of the
vertebrae with 5% to 10% of
adolescent growth expected
More accentuated
concavities seen in inferior
borders of C2, C3 and C4
Bodies of C3, C4 nearly
square in shape
6 Stages of Vertebral Development
Stage 6 Completion
Completion of growth
Little or no adolescent
growth could be expected
Deep concavities seen in
inferior borders of C2, C3
and C4
Bodies of C3, C4 square in
shape
Greater in vertical than in
horizontal dimension
6 Stages of Vertebral Development
6 Stages of Vertebral Development
6 Stages of Vertebral Development
Handwrist radiograph
Widening
Capping
Union
Handwrist Radiograph

widening, capping, union

 Handwrist Radiograph
Skeletal maturity indicators (7)
Phalanges of the Hand
Ossification
of sesamoid

Stages

Long Shortly Pubertal Maximum

before Growth Rapid Growth
Pre- growth
before
growth starts growth
growth
spurt over
growth
attained ends

Maximum Duration of Growth

Handwrist Radiograph
 Growth Direction
Y (growth) Axis
-degree of downward,
rearward, or forward S
position of the chin in
FH
relation to upper face

Sella-Gnathion to
FH Plane
Mean: 59
Horizontal growth
Gn

Vertical growth
 Growth Direction
Y (growth) Axis
-degree of downward, N
rearward, or forward S
position of the chin in
relation to upper face

Sella-Gnathion to
SN Plane
Mean: 66
Horizontal growth
Gn

Vertical growth
 Facial Axis
Facial Axis = 90 3
protrusive chin
retrusive chin
Airways
 Airways
A. Upper airway =
8-18mm
B. Lower airway =
10-12mm
 Airways
A. Upper airway = 8-18mm
- measured from a point on the posterior
outline of the soft palate to the closest
point of pharyngeal wall
- measurement is taken on the anterior half
of the soft palate outline
B. Lower airway = 10-12mm
 Airways
A. Upper airway = 8-18mm
B. Lower airway = 10-12mm
- measured from the point of intersection
of the posterior border of the tongue and
the inferior border of the mandible to the
closest point on the posterior pharyngeal
wall
 Airways
A. Upper airway =
8-18mm
B. Lower airway =
10-12mm
Vertical - Skeletal
 Vertical - Skeletal
FMA Frankfort to mandibular plane angle
= 25
Vertical grower, high angle
Horizontal grower, low angle
 Lower Anterior Facial Height
58 72 mm
ANS Me
Correlates with
maxillary length
and backward/
forward
positioning
of chinpoint
 Upper facial height /
Lower facial height
45:55% adult
50:50% child
N
NANS:ANS-Me

ANS

Me
 SN - GoGn
Vertical Growth
SN GoGn = 32 S N
Range 24.4 38.2
<24.4 Low angle,
skeletal deep bite
(short)
>38.2 High angle, Go
skeletal open bite
Gn
(long)
Sagittal - Skeletal
 Length of Maxilla and Mandible
Cond to A
(Maxillary length)
Cond to Gn
(Mandibular length)
Dental
 IMPA
Lower incisor to mandibular plane angle
90
 Wits
Point A to occlusal plane (perpendicular)
B point to occlusal plane
Measure distance
Class 1 = 1 1 mm
Class 2 = 3 mm
Class 3 = -3 mm
 Interincisal angle
Upper and lower
incisor long axis
1 = 131
<acute dental
pattern UR
>obtuse dental
pattern UI
LI
LR
 Sagittal Skeletal
ANB
Class I = 0-5 N
Class II > 5
Class III < 0
A

B
 Mx Incisor to SN
Upper incisor to SN
103 S
N
 Mn Incisor to A-Pog
Lower incisor to A-Pog plane
- 3 to 3 mm

Pog
Soft tissue
 Ricketts esthetic line
Soft tissue tip of the nose to soft tissue
chinpoint
-2mm 2 mm
 Nasolabial angle
Line tangent to base of nose and line tangent
to upper lip
96 - 118
 Steiners S line
Upper and lower lips even to line
TREATMENT OBJECTIVES / GOALS
TREATMENT OBJECTIVES / GOALS
TREATMENT PLAN AND
MECHANOTHERAPY
Interview
History
Reason for Tx

Clinical exam
Health of tissues
DATA CLASSIFICATION
Problem list
Jaw function
Facial proportions
BASE = diagnosis

Analysis of Dx records
Alignment
Protrusion / esthetics
Transverse
Pathology
Antero-posterior (caries, perio, etc)
Vertical
Control before ortho TX

Orthodontic A A Patient- Effective-

(developmental) parent
Evaluate Informed ness
Problems
B B consult Treatment Treatment
Possible
solutions plan plan
C C Alternative details
Priority plans concept
Interaction consent Efficiency
order etc etc Compromise
Cost/benefit Patient input
Other factors
END
 FACIAL PHOTOS
Nose
(acceptable, small, large)

Size: 1/3 of total facial

height (from hair to
lower border of chin)
 Maxillomandibular differential
Effective mandibular length minus midfacial
(maxillary) length
Mixed dentition: 20, 23 mm
Medium sized: 27, 30 mm
Large sized: 30, 33 mm
IDEAL:
Small: 20mm
Medium: 20-27mm
Large: 30-33 mm