02 DiagnosticRecords Final

7/27/2019 02 DiagnosticRecords Final

1/9Diagnostic Records 1

2013 The Andrews Foundation All rights reserved.

Diagnostic records include clinical assessments, as well as material records.

CLINICAL ASSESSMENTSIn addition to the usual dental and medical histories there are several clinical assessments needed tomake a thorough 6E diagnosis.

DIAGNOSTIC RECORDS

1. Overall status of the orofacial complex(oral tissues, teeth, musculature, TMJs, static,and functional occlusion).

2. The Foreheads Shape:Straight (S),Rounded (R), or Angular (A).

Identify the forehead shape and record it by circlingS, R, or A, on the treatment card.

Forehead Shape: S R A G/T ______mm, G/S ______mm, FALL/FA pt. ______mm

Forehead Shapes

Straight Rounded Angular




Rounded Angular

3. The Height of the Clinical Forehead:The clinical forehead is defined as the portionof the forehead perceived to be more related to

the face than to the top of the head. For straightforeheads, the entire forehead comprises theclinical forehead and its height is measured fromglabella (G) to trichion (T).

For rounded and angular foreheads, the clinical foreheads height isthe distance between glabella (G) and superion (S). Superion is thepoint on the forehead that appears to separate the portion of theforehead that relates to the face from that which does not.

Measure the G/T (for straight foreheads) or G/S (for

rounded or angular foreheads) distance and recordit on the diagnostic sheet.


Straight Forehead




4. The Foreheads Anterior Limit Line (FALL): The FALL is a linethat passes through the foreheads facial-axis point (FFA pt.) and isparallel with the heads frontal plane. While the patients head isupright, locate the foreheads facial axis point (FFA pt.) which is inthe middle of the clinical forehead.

Instruct the patient to smile enough to fully baretheir maxillary incisors. Envision the foreheadsanterior limit line (FALL).

5. Locate Inferion (I): Inferion is a pointat the level of the FA pt. of the maxillarycentral incisor being viewed. Inferionis located by: 1) judging the AP positionof the FA pt. of the maxillary incisor ifanterior or posterior to the envisionedFALL, and 2), judging that distance inmillimeters.


The direction (+ or -) and distance (mm) judged is then recorded on the diagnosis sheet.




MATERIAL RECORDSA complete set of material diagnostic records needed for making a 6E diagnosis includes photographs(intra and extra-oral), radiographs, and study casts mounted on an articulator in centric relation.

6. The Lip to FA pt. Relationship:Measure the superior-inferiorrelationship of the FA pt. of themaxillary central incisor relative tothe lower border of the upper lip(in repose), then record thatinformation on the diagnostic sheet.

This completes the clinical assessments.Material records are now needed.

PHOTOSIntraoral:

Right, center, and left images of the arches in centric relation:

Occlusal views of both arches:




Extra-oral:

Frontal repose and smiling. Profile repose and smiling (with forehead exposed):

Photographic Composite




RADIOGRAPHS:

Lateral head film taken with the film cassette oriented verticallyto include the patients forehead in the image field. The head filmshould be taken in centric occlusion.

Panoramic should include mandibular condyles

Study casts (mounted in centric relation):

Occlusofacial SimlatorTMby Golden Eagle Orthodontics, Inc.




PREPARING THE LATERAL HEAD FILM FOR DIAGNOSIS

Materials Needed:

Lateral head film that captures the superior and inferior borders of the face including the forehead

Andrews Foundations incisor diagnostic template

Black, red, and green pencils

8x 10 acetate overlay

Two-3x 4 acetate overlays

Adhesive tape

The clinical data gathered from the patients examination recorded on the 6Es diagnostic sheet

The following steps explain how to prepare the head film for diagnosing.

Step 1. Apply 8x 10 acetate overlay to the head film.

Step 2. Trace the following head film anatomy:

a. The soft-tissue profile, including the forehead.

b. The outline of both jaws, including the lingual border of the mandibles symphysis, the ramus, and

the condyle.

c. The positions of the maxillary and mandibular central incisors, then mark their FA pts. with a dot.

d. The functional occlusal plane

e. Mark the anterior border of the core line of each arch. This is done by envisioning the coreline on each dental cast from the occlusal perspective, measuring the AP distance betweenthe envisioned core line and the FA pt. of the incisor, then mark that distance on the head filmwith a dot.

f. Check to see if the distance between the lower border of the upper lip and the FA pt. of themaxillary incisor is the same on the head film as the distance measured and recorded on thediagnostic sheet during the clinical exam. If it is different, add a horizontal line to the tracingto indicate where the lower border of the lip was relative to the FA pt. in repose.




Step 3. Identify then mark or trace the following head film anatomy:

a. Glabella (G) it can usually be identified on the head film as the most prominent portion ofthe forehead.

b. Trichion (T) Refer to the G/T measurement previously recorded on the clinical portion of thetreatment card. Use the metric ruler on the Andrews Incisor Template to measure the G/Tdistance, then mark it with a dot.

c. Superion (S) For angular and rounded foreheads, refer to the G/S measurement recorded onthe clinical portion of the treatment card. Measure the G/S distance and mark it with a dot.

d. Foreheads Facial Axis Point (FFA pt.) For rounded and angular foreheads it is halfway betweensuperion and glabella. For straight foreheads it is halfway between trichion and glabella.

e. Inferion (I) refer to the FALL/FA judgment made during the clinical exam that was then recorded

on the diagnostic sheet. Measure that distance and direction relative to the maxillary centralincisors FA pt. on the head film and mark it with a dot.

f. Subnasale (SN)

g. Soft-tissue menton (Me)

Step 4. Trace the foreheads anterior limit line (FALL) and the foreheads clinical surface:

a. Construct the foreheads anterior limit line (FALL) by connecting the FFA pt. and inferion (I)

with a line.

b. Construct the foreheads clinical surface by connecting the dots that represent the superiorand inferior borders of the clinical forehead with a straight line. For straight foreheads, connecttrichion with glabella. For angular and rounded foreheads, connect superion with glabella.Refer to forehead shape previously recorded on the clinical portion of the diagnostic sheet.

Step 5. Compute then trace the goal anterior limit line (GALL):

a. Use the protractor on the Andrews Foundation Template to measure the acute angle formedbetween the foreheads clinical surface and the FALL. Use the following formula to compute theAP position for the goal anterior limit line (GALL).

1. For foreheads inclined between -7 and +7, the GALL and FALL are the same.

2. For foreheads inclined more than 7, advance the GALL relative to the FALL by0.5 mm for every degree that the forehead inclination is more than 7, but not beyondglabella unless the patient insists. Once computed, add the GALL to the tracing,preferably in green.




Step 6. Trace horizontal lines (perpendicular to the FALL) from glabella, subnasale, soft-tissue menton,gonion, and condylion for measuring face-height ratio.

Step 7. Add a 3x 4 acetate overlay over the maxilla, maxillary teeth, and occlusal plane.Secure it at the distal with adhesive tape. Trace the occlusal plane and the outline of the maxilla.Use the Andrews Foundations incisor template to draw the Element I position of the maxillary incisor.

Step 8. Flip the maxillary acetate out of the way and add another 3x 4 acetate overlay overthe mandible, mandibular teeth, and occlusal plane. Secure it at the distal with adhesive tape.Trace the occlusal plane and the outline of the mandible (including the entire symphysis). Use theAndrews Foundation Incisor Template to draw the Element I position of the mandibular incisor.

Step 9. Convert the head film tracing to centric relation if needed. Check the difference in theocclusion (incisor overjet) between the head film and the study casts mounted in centric relation.If there is a significant difference (greater than 1 mm) shift the mandibular 3x 4 acetate overlay toreflect the centric relation occlusion and re-secure it with adhesive tape.

02 DiagnosticRecords Final

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