Graber current principles and techniques free download

Anteroposterior relationships Head Orientation. Although the importance of evalu- 4. Vertical relationships ating dentofacial traits in all three planes of space has 5. Transverse relationships been emphasized, the orientation of the head, teeth, and jaws was not specified. For many years, there was a quest To fully describe the position and orientation of the to identify the most stable and reliable landmarks within dentition in the facial skeleton and its relationship to the skull to use as reference points for cephalometric the facial soft tissues is exactly analogous to what is analysis.

For over a century, anatomists and physical necessary to describe the position of an airplane in anthropologists used the Frankfort horizontal line for space i. NHP is the most 6 degrees of freedom. In orthodontics, introduction of rational physiologic and anatomic orientation for evalu- the rotational axes into the description of dentofacial ating the face, jaws, and teeth.

Many patients present with anteroposterior prob- in space so that it returns to a reproducible position lems, yet most of these individuals have some type of when he or she looks at an object infinitely far away on vertical problem as well.

Our representation of the the horizon. The same effect can be obtained by having interaction of the five major characteristics of malocclu- the patient look into his or her own eyes using a mirror sion in which both the translational and rotational com- placed about 3 feet in front of the patient.

Common to all dentitions is their effect on allel to the floor. It has also been shown that NHP is a anterior tooth display and the soft tissue drape. Their underlying skeletal patterns and resultant dental compensations e. These two analogous patients require quite different treatment plans. Longitudinal forward and backward thrust Vertical aircraft moves upward and downward Lateral aircraft moves from side to side.

Pitch, roll, and yaw are descriptors that can be used for the esthetic line of the dentition. Pitch represents the occlusal plane in sagittal view, roll is analogous to the occlusal plane in frontal view, and yaw is a way of describing rotation of the dentition and jaws around a vertical axis.

Yaw problems are manifested as midline deviations, facial asymmetries, or Angle subdivision molar relationships. Such an assume that the appearance of practically any smile can innovation would render the cephalostat obsolete. At least part of the clinical examination should be Thus, the orthodontic decision-making process today done with the head in NHP, cephalograms should be begins at the first visit with a kind of triage, whereby the taken in NHP, and the orientation of three-dimensional initial decision is merely to decide whether the patient images should be corrected to NHP.

Once NHP is has a complex condition requiring extensive records and established with a true vertical axis, the teeth and the analysis or a simpler condition primarily related to jaws can be oriented to the rest of the craniofacial enhancement of smile esthetics. After making this judg- complex by using the occlusal plane as the other refer- ment, the two processes whereby the orthodontist estab- ence plane. The difference in the less complex Complex versus Simpler Patients case relates to the variety of diagnostic records required In this chapter, the overall approach to diagnosis is rec- and the depth in which they must be assessed prior to ommended.

Nevertheless, the fact that many patients making a treatment recommendation. In short, the major seeking an orthodontic consultation have already made difference between the two diagnostic processes is the a self-diagnosis, namely that they simply want braces, robustness of the database. If treatment is entirely elec- has in certain ways changed the diagnostic ground rules. These patients or parents lengthy or complicated. The classic anatomic planes of the face are coronal, sagit- tal, and transverse.

In the Ackerman-Proffit classification, the sagit- tal plane is referred to as anteroposterior, the coronal plane is designated vertical, and the transverse plane is the same as the occlusal plane and is used as a reference for the relative widths of the dental arches and any crossbite relationships that might exist.

When the three discs representing the three planes of space are rotated, they demonstrate pitch, roll, and yaw of the occlusal plane. During a when the sagittal disc rotates, it creates pitch of the occlusal plane; clinical examination, it is important to visualize the orientation of and when the transverse plane rotates, it simulates yaw. This model makes it clear how the anteroposterior, transverse, vertical, pitch, roll, and yaw are highly dependent on one another.

As has already been stated, the key to the effective use of It has been shown that orthodontists are able to base the problem-oriented approach to orthodontic treatment their treatment-planning decisions primarily on informa- planning is to establish an appropriate database prior to tion derived from study models or photographs with generating a problem list.

Yet, the second key to effective treatment ironing out of a few wrinkles in a smile, it is certainly planning is to thoroughly review the data contained in not necessary to have a CBCT scan, as an example, as the database. The rationale for being careful in con- part of the database. On the other hand, if an impacted structing the database is to make sure some feature of the canine is identified from viewing a panoramic radio- orthodontic condition is not being overlooked prior to graph, the highest standard of care today is to obtain compiling the problem list.

There is a minimum standard three-dimensional imaging before making any final for necessary orthodontic records, but there is no longer treatment-planning decisions Figure , A and B.

For instance, an orthodontist may choose surgically exposed and its eruption orthodontically to acquire a supplemental posteroanterior cephalometric assisted or whether some other plan might make more radiograph for an individual with asymmetry or, perhaps sense. The alternatives in this case are to either extract even better, would consider that individual a candidate the canine and try to preserve the central incisor for as for CBCT , but it is superfluous to obtain a frontal radio- long as possible or extract the central incisor with the graphic image for every candidate for treatment.

The compromised root and bring the unerupted canine into minimum standard for orthodontic records is facial and the central incisor position. When the disks representing the three Orientation of the Aesthetic Line of the Dentition planes of space shown in Figure are stacked as a Venn diagram, it shows the interactions between the anteroposterior, transverse, and Alignment, Arch Form, vertical dimensions.

The three overlapping disks and Symmetry are shown atop a disk representing dental arch alignment, symmetry, and arch form, and all four disks are shown on a box representing the framework of facial appearance, anterior tooth display, and orientation of the esthetic line of the dentition. With this classification, five or Trans-AP fewer characteristics can fully describe the den- tofacial traits of any orthodontic condition.

Transverse Yaw AP. The timing demographic information including the e-mail address of when a specific minimum standard diagnostic record should be obtained at this time. Obviously, if the call been outlined. The lateral head film is used later when is to set up an appointment for the sibling of a patient the detailed plan is generated.

A well-stated hypothesis is a question so well Just as it would be an error in taking for granted phrased that an answer is inherent in the question.

A that the parent is an old hand at orthodontics, there is well-conceived diagnosis automatically suggests alterna- an equal danger of having the caller feel the receptionist tive treatment plans. This analogy can be taken one step is talking down to them.

The ease or difficulty with further. Orthodontic treatment is to diagnosis what the which the receptionist can schedule the first appointment experiment is to a research hypothesis.

Data Collection at the First Contact. For this patient, although the position of the impacted canine and the significant resorption of the root of the central incisor can be seen clearly from the panoramic image and from the lateral cephalogram, there are many cases where the additional imaging is very useful in making a prudent decision about which tooth to extract the impacted canine or the compromised central incisor in a difficult situation like this one.

Tx complexity determined must be asked. The first, of course, is when the patient at initial patient assessment last saw his or her physician. If it was within the last year and was for a regular checkup, this usually is a One-step process Triage Two- or three-step process good sign.

Another important question is whether the patient has ever been hospitalized and, if so, for what reason. This may be Additional records for Supplemental a clue that the patient had an earlier airway problem, confirmation of plan diagnostic records which might have affected the jaw and tongue posture.

If told condition. We call this process triage. If explained after the fact, they see it as an orthodontist will be able to jointly construct a treatment plan with excuse! The next issue that must be considered is whether the as a checklist to guide the receptionist in systematically patient is taking any medications.

Occasionally a parent collecting these data. Usually, the receptionist will be is reluctant to inform the orthodontist in front of the able to glean the motivation for treatment during the child that they have seizures epilepsy but the parent first call. This is the first step in building an orthodontic will indicate that phenytoin Dilantin or some other database. This will not only At the end of the initial telephone call regarding influence the management of the child in regard to scheduling a patient evaluation, the caller should be medical emergencies but also influence tooth movement informed that if they would be kind enough to fill out a if there is gingival hyperplasia.

If a patient is taking patient questionnaire and have it ready at the first visit, medication typically prescribed for attention-deficit dis- it will greatly facilitate the initial appointment. The caller order, the issue of potential compliance with treatment should have the option of downloading the question- should be explored further. If a patient has recently naire from the office website, having it e-mailed to been prescribed isotretinoin Accutane for severe cystic them as an attachment, or having it mailed to them as a acne, the orthodontist and patient should be aware that hard copy.

These examples should serve as a dental health history so that all positive findings promi- reminder that an orthodontist must know the contrain- nently stand out. Then a simple glance at the question- dications of orthodontic treatment and be able to rule naire alerts the clinician to the questions that require out that any of these factors are involved with any given follow-up. There are a few major questions that always patient.

They can be very persuasive, and they often goad health Meeting the Patient and Eliciting professionals into performing treatments against their the Chief Concern better judgment. If BDD is suspected, the patient and the Before the orthodontist meets the patient at the first orthodontist are both well served by seeking a consulta- appointment, the demographic and historical informa- tion with a mental health professional. Potential adult tion should be reviewed, and photographs and a pan- patients who might have a mild form of BDD may be oramic radiograph should be available.

The advent of more prevalent than currently suspected. The treatment coordinator, immediately prior or adolescents who have unrealistic expectations about to the orthodontist meeting the patient, usually takes what orthodontic treatment might accomplish for them. After briefly Perhaps the easiest and most direct way to find out reviewing these records and rallying his or her thoughts, how the patient feels about orthodontic treatment is to the orthodontist is ready to meet the patient.

Most children today think that braces are inevi- when he or she meets the patient; some find it advanta- table and thus usually answer affirmatively. Occasionally, geous to examine a child patient independently first and the reaction is a shrug of the shoulders.

Only rarely will then invite the parent to the treatment area to receive the a child say that although his or her parents think he report. It is sometimes far easier to establish rapport with should have braces, he does not want them.

For the the patient if there is no parent present. Nor should the dentist require orthodontics, an important question is whether focus on the functional implications of, for instance, a any one feature is of greater concern than another. It is crossbite with a lateral shift without appreciating the important to know this for two reasons. As we have noted, failing to address an issue that is of major concern to the for an individual with what appears to be reasonably patient. Second, to allow for the most effective treatment The greater orientation of modern family practice toward planning, it is important to take into consideration what cosmetic dentistry increases the chance that a patient may dentofacial trait or traits are most important to the patient be referred to an orthodontist for comprehensive treat- or parent when prioritizing the problem list.

From the outset, the orthodontist must determine Clinical Evaluation whether the prospective patient is a suitable candidate for treatment, because there are notable exceptions to the Although the sequence of steps in completing the data- validity of self-determination of the need for orthodontic base can vary even within a single practice, depending intervention.

One can often tell from the first moment change in one or more of their dentofacial features will whether the orthodontic problem will be largely a dental alter their sense of social well-being and quality of life.

After having assessed the overall head and face, the orthodontist then focuses on the lower face, which is most easily affected by tooth position. Lip prominence is usually described as convex, straight, or concave, and this judgment is made relative to the nose and chin. A large nose and well-developed chin can easily mask a protrusive dentition.

Similarly, the opposite situation of a small nose and weak chin can make a child appear more facially convex. Examining the parents and older siblings may give some hint regarding final dimensions of these structures. At some point but some features must be examined chairside. Assess- during the initial patient examination, the patient should either ment of the dental midline as it relates to the midline of stand and look at the horizon or be seated comfortably in a stan- dard chair with back supported and asked to look at his or her the face and the symmetry of the face are examples.

Lip image in a mirror, at a distance of approximately 3 feet i. Can the patient or does the head position [NHP]. The orthodontist is seated at the same eye patient keep his lips approximated when at rest, and is level on a wheeled chair or stool enabling an assessment to be this done with ease or strain? Does the patient, when in made in front and profile views.

Chapped lips and inflamed gingiva in the maxillary anterior region are often indications of a patient who is a mouth breather or whose oral seal is inadequate because of extremely protrusive teeth. Facial Examination. Once the visual and tactile examination of the standing or sitting up , not with the patient prone in a face is complete, an evaluation should be made of the dental chair71 Figure The frontal view should be intraoral hard and soft tissues.

This should immediately assessed first in repose and then with the lips sealed to reveal the general oral health of the patient. Just as the determine if the patient manifests lip incompetence. The orthodontist should view the overall health of the child patient is then observed during facial animation while broadly, he or she should also look at oral health from speaking and smiling. After all, it is ultimately anterior the broadest possible perspective.

What has been the tooth display the smile zone over which the orthodon- caries incidence? How faithful has the child been with tist has the greatest control. The distance separating the eyes can for children before initiating orthodontic treatment. In often give a clue to this kind of problem. In a number university clinics, patients are usually not accepted for of genetic defects affecting the face and teeth, one fre- treatment until they can demonstrate adequate home quently finds hypertelorism eyes that are too far apart.

The experienced orthodontist knows that this is as Malformations of the ears may be associated with one fundamental to success in orthodontics as the appliance of the brachial arch syndromes, which can affect the that is used. Poor gingival health adversely affects tooth mandibular condyle. A patient with severe mandibular retrogna- tiful orthodontic result. It has been suspected that sys- thia at age 15 years, for instance, may have had a Pierre temic disorders such as allergies may be associated with Robin sequence and earlier in development may have root resorption.

When this hypothesis was tested, no had a more pronounced problem. Frequently, knowledge statistically significant correlations were found. The hazards of orthodontic These are clefts of the gingiva around severely protrusive treatment may be minimized with careful diagnosis and or badly rotated mandibular incisors, and gingival hyper- treatment planning.

Patients who have gingival clefts and poor tion, it is important to count the teeth. A quick check oral physiotherapy will frequently require periodontal should be made for mobility of primary or permanent surgery to provide a wider zone of attached gingiva, while teeth. In the mixed dentition, one should palpate for the those on Dilantin or equivalent drugs may require gingi- maxillary unerupted canines, since often it is not possible vectomy or gingivoplasty while under orthodontic treat- from the radiographs to ascertain whether these teeth are ment.

Both types of periodontal surgery can be performed erupting labially or palatally. It should be possible to while orthodontic appliances are in place, but early con- palpate these teeth labially. Ankylosed primary teeth sultation with the family dentist or periodontist is neces- usually appear submerged.

Tapping these teeth with the sary before proceeding with an orthodontic treatment handle of a dental instrument usually produces a some- plan. Any other tively with removing excess gingiva such as an operculum abnormalities of the hard tissues should be noted, such as distal to a permanent second molar or performing a soft enamel defects and internal or external root resorption.

This evaluation begins with checking the buccal during the gingival evaluation. Bleeding on gentle probing and labial mucosa, the tongue, and sublingual areas for is an indication of a periodontal condition that can possible abnormalities. Significant oral pathology in chil- simply be marginal gingivitis, on the one hand, or more dren is a very rare finding.

However, the orthodontist serious periodontal disease with loss of attachment and should take particular note of unusual frenum attach- alveolar bone loss at the other extreme. The basic prin- ments. Two points should be noted: ciple is that orthodontic tooth movement in the absence of inflammation is similar to the physiologic response 1. Is there a heavy frenum attachment in the area of a related to tooth migration or drift. If the same tooth maxillary midline diastema?

The diastema may or movement is attempted in the presence of inflammation, may not be caused by the frenum in such cases. The size of the tongue is often years those patients who had no surgery compared hard to assess, but some attempt should be made to evalu- favorably with those individuals who had the frenec- ate its general dimensions at rest and when protruded.

It tomy in regard to the size of the diastema. Is there gingival clefting or recession in the lower roof of his mouth with the mouth open. Inability to do incisor region near a high frenum attachment? Such this suggests ankyloglossia, and the patient may benefit an attachment often causes periodontal problems.

Speech evaluation properly belongs in the hands of Gingivitis is relatively common in children; it is generally trained speech specialists, but sometimes parents seek plaque related due to poor oral hygiene and can be exac- orthodontic treatment as a way to help their child with erbated by faulty tooth alignment such as a high labially speech problems, and an orthodontist should be able to positioned maxillary canine.

Severe periodontal prob- discuss errors in speech that could be related to maloc- lems, however, are uncommon in children even in the clusion versus those that are not. Correcting the orth- presence of severe malocclusion, and the discovery of odontic condition is unlikely to remedy even the related bone loss should lead to suspicion of underlying systemic speech errors without associated speech therapy.

Orth- illness such as diabetes, hormonal imbalances, or blood odontic treatment will, of course, have no effect on other dyscrasias. Occasionally, aggressive juvenile periodonti- common speech errors of children, such as substituting tis rapid bone loss around central incisors and first one sound for another. An important part of the clinical exami- referred for orthodontic treatment.

If these positions do not cor- Two other periodontal problems often are observed respond, one should note the premature contacts and in patients who are candidates for orthodontic treatment. It is also a good idea to establish the dental contact position, whereas if the discrepancy is small, it age based on eruptive means, and for this purpose one is easier to use the intercuspal position. If this important can use one of several published standards. For a patient whose dental age is lagging the jaws.

Grinding or clenching of the teeth can affect considerably behind the chronologic age, the orthodon- orthodontic treatment, particularly in regard to the verti- tist frequently would prefer to wait until the late stages cal dimension. If the palpated and any crepitus or pain in the joints should be skeletal age is advanced and there is a skeletal problem, noted.

Even when severe occlusal disharmonies are however, it may be necessary to start treatment based present, children presenting for orthodontic treatment more on the pubertal growth spurt than on the dental rarely have TMD problems. The orthodontist is more age. Thus, it is important to consider the dental age, the likely to encounter these problems during or after treat- skeletal age, and the emotional age of the individual ment in older adolescents or in adults whose tolerance relating to the readiness for orthodontic treatment.

There of muscular imbalances is reduced. The tolerance of is probably no more fundamental biologic principle children for occlusal disharmonies does not mean that underlying orthodontic diagnosis and treatment plan- these are unimportant in orthodontic diagnosis. It is ning than this concept of biologic ages. A fundamentally particularly important that occlusal shifts and slides are correct treatment plan instituted at the wrong time can detected and corrected during the orthodontic treatment.

Thus, for certain kinds of problems, For a complete evaluation of TMJ function, the reader treatment timing is probably the most critical decision should refer to texts on this subject. For a further explana- Use of Radiographs during the Clinical Examina- tion of mixed dentition diagnosis and treatment plan- tion. Panoramic radiography with automatic film pro- ning, see Chapters 13 and The Ackerman-Proffit Orthogonal orthodontists. Orthodontists with access to this kind Analysis classification system can most easily be of technology usually will not perform the initial oral described by outlining its method of application.

The examination without first viewing a panoramic radio- evaluation is carried out in five steps corresponding to graph. Teeth that are present yet unerupted, impacted each of the five characteristics, or descriptors, of maloc- teeth, supernumerary teeth, and any congenitally missing clusion. In this classification, a patient with ideal occlu- teeth can be ascertained from the outset. The panoramic sion accompanied by excellent facial balance and a film will also reveal any periapical pathology or peri- balanced smile requires no descriptors at all to character- odontal breakdown.

A patient with a Class I malocclusion If treated or untreated caries is noted during the oral with crowding, but excellent balance of their face and examination, bitewing radiographs should be obtained. This is be sure that these radiographs exist and that active caries the reason only five or fewer major characteristics of any is being treated. With each succeeding year, the guide- orthodontic condition are needed to fully portray the lines for the use of radiographs in dental practice become situation.

This includes assessing anterior tooth display, as extremely important that the orthodontist keep up to well as the relative convexity and concavity and diver- date with the guidelines to minimize the amount of radi- gence of the face in profile view and vertical proportions ation used for diagnostic purposes.

As discussed previously, faces can be catego- From the panoramic radiograph, one also should rized in profile view by their relative convexity and diver- assess the amount of mineralization of the unerupted gence Figure In anterior view, the vertical teeth and, using root mineralization norms, establish the characteristics of the face can be expressed by the pro- dental age of the individual. The amount of root miner- portion of facial width and height. In doing so, patients alization can also be used for predicting the timing of present along a spectrum from short and wide brachy- tooth emergence.

For instance, if root initiation has just facial to long and narrow dolichofacial. Average facial begun on a mandibular second premolar, it will be proportions are more or less of ovoid shape, and these approximately 4 years until this tooth reaches gingival faces are called mesofacial.

In most instances, the clinician simply classifies faces from a ver- tical standpoint as short, average, or long Figure In terms of anterior tooth display, a smile is characterized by how well the teeth and gingival fit within the smile zone, which is defined by the lips.

A more detailed analysis of facial form and appearance is pre- sented in Esthetic Orthodontics and Orthognathic Surgery19 and in Chapter 2 of this volume.

Step 2: Analysis of the Alignment and Intra-arch Symmetry. Alignment is the key word in this group; among the possibilities are ideal, crowded arch length deficiency , spaced, and mutilated. It is obviously impor- tant to count the teeth in order to ascertain which teeth are present or absent. For example, if a tooth terior divergence of the chin in relationship to the mid-face and is lingually displaced, it is said to be in linguoversion.

If upper face. Adding a description of face height, as well, nicely completes the picture see Figure Today, the important observation rests with recognizing either an increased or decreased lower face height. Long, narrow faces with increased lower face height usually have a tendency toward anterior open bite. Lower anterior face height is a reflection of the underlying skeletal pattern.

Individuals with short lower face heights usually have relatively parallel horizontal facial planes i. Patients with long lower face heights have horizontal facial planes that tend to converge posteriorly see Figure Of course, there are many exceptions to these rules. If a opposite is true of patients with short anterior face heights tooth is tipped mesially, it is in mesioaxiversion, and if i.

Bite depth is used to describe the vertical rela- If the dental midlines maxillary dental midline and tionships.

The possibilities are anterior open bite, ante- mandibular dental midline do not correspond, the fault rior deep bite, posterior open bite, or posterior collapsed should be determined by looking at the midline of the bite in the case of a mutilated dentition.

Again, one must face to decide whether the maxillary or mandibular determine whether the problem is skeletal, dentoalveolar, midline or both are at fault and whether the deviation is or a combination. A steep mandibular plane, 35 degrees the result of an intra-arch alignment issue or whether it or greater to the Frankfort plane, usually represents an is a yaw problem in which either the maxilla or mandible open bite tendency.

A depression in the lower border of has rotated slightly around an imaginary vertical axis. The faciolingual relationships of the posterior and a mandible, which rotates backward during growth. A judgment is also made as horizontal plane established as a perpendicular from the to whether the deviation from ideal proportions and true vertical plane when the individual is in the NHP. There is, of course, a continuous normal slightly inclined posteriorly , or steep sharply range from problems that are entirely skeletal to those inclined posteriorly.

As mentioned, the relative flatness that are entirely dental. Most patients have components or steepness of these planes often corresponds with verti- of both, with one or the other predominating. If a trans- cal facial height, open bites often accompany steeper verse discrepancy is detected or suspected, it is important occlusal planes, and deep bites go along with flatter to measure the disparity. Measuring the mesiopalatal occlusal planes. Whether lar first and second molars will accomplish this.

Dental there is a skeletal as well as dental component in each compensation for an underlying skeletal problem such one of the characteristics is a matter of judgment.

It is a as a constricted maxillae and narrow palatal vault is sound practice to estimate those relationships that can common in the transverse dimension. It is not unusual later be measured on the cephalogram. When the ortho- for the maxillary posterior teeth to be tipped facially to dontist trains himself or herself to make these judgments compensate for a transverse skeletal size discrepancy at the initial examination, and to substantiate the clinical between the maxillae and mandible.

If a bilateral palatal original estimate from the radiographic cephalometric crossbite were the result of constriction in maxillary analysis, diagnosis becomes a more natural process. It development, it would be called a skeletal problem. As a photographs as with lateral cephalograms.

The lateral cant of the occlusal plane roll is estimated from the examination of facial form , it is evaluated in relationship to both the intercommissure questionable whether a cephalogram is of any real diag- line and the interpupillary line Figure It may be of considerable value, however, if Step 4: Anteroposterior Dimensions Sagittal one wants to assess the results of treatment or to study Plane of Space. In this dimension, the Angle classifica- growth. Many years ago, Tom Graber, the editor of tion is used and is merely supplemented by stating whether earlier editions of this textbook, facetiously referred to a deviation is skeletal, dentoalveolar, or both.

The sagittal cephalometric norms, or to ideal occlusion as defined by cant of the occlusal plane pitch is also evaluated. Patients Angle more than a century ago? The taking into account the primary goal for that individual. There are two useful methods for ascertain- ing occlusal plane cants.

One is a tongue depressor A , and the other is a Fox plane B. Certainly the tongue depressor is more convenient because it is disposable, but for complex occlusal plane cants, particularly in the posterior region, there still is not a good substitute for the Fox plane.

It is hoped that in the era of three-dimensional imaging there will be new and more precise ways of measuring these types of cants and asymmetries. Cephalometrics as an Aid in Evaluating static two-dimensional representation of the hard tissues Skeletal and Dental Relationships involved in a complex three-dimensional system.

Prior to cephalometric anal- ent Angle classifications produced the original cephalo- ysis, these relationships were evaluated and usually metric analyses. Cephalometric analysis in modern themselves instead of guides in making decisions about usage provides more detail about these points, but even relationships.

Because the typical cephalometric analysis it should not completely supplant a careful clinical evalu- chooses one or two specific measurements from the mul- ation of the patient. Instead, certain measurements will be useful in providing information about certain patients but not so useful for others. For some individuals, a detailed cephalometric workup, using measurements taken from many different cephalo- metric analyses, will be necessary.

For other patients, it will not be necessary to make any measurements on the cephalometric film to arrive at an accurate diagnosis and reasonable treatment plan. The advent of computerized cephalometric tracing and analysis has made it extremely easy to assess a cephalometric radiograph using many different analyses. This example shows a hypothetical situation simu- and Caufield81 and Chapter 6 in Contemporary lating exuberant vertical growth of the maxillae and dentoalveolus, Orthodontics.

Nevertheless, the fundamentals of orthodon- That said, it should be pointed out that there is no tics have remained largely the same despite these dra- orthodontic technique that in the absence of a cogent matic changes. In the last condition and planning treatment based on a compre- quarter century, a shift in societal values and pressures hensive evaluation.

The many steps in the decision- has greatly influenced the decision-making process in making process in orthodontics that are quickly and orthodontics, placing greater emphasis on patient auton- seamlessly telescoped in routine practice are delineated omy.

Forty years ago, almost all orthodontists viewed here as a practical guide for everyday practice. Your email address will not be published. Vanarsdall Jr. Vig, and Greg J. Comprehensive, cutting-edge content prepares you for today's orthodontics! Orthodontics: Current Principles and Techniques, 6th Edition provides evidence-based coverage of orthodontic diagnosis, planning strategies, and treatment protocols, including esthetics, genetics, temporary anchorage devices, aligners, technology-assisted biomechanics, and much more.

New to this edition are videos and additional visuals to show concepts difficult to explain with words alone. See our Privacy Policy and User Agreement for details. Published on Jun 9,. Graber, Robert L. Vanarsdall Jr. Vig, and Greg J. Comprehensive, cutting-edge content prepares you for today's orthodontics!

New to this edition are videos and additional visuals to show concepts difficult to explain with words alone. Graber - Orthodontics Current Principles and Techniques 5th Edition Orthodontics Medicine A leading orthodontics reference, Orthodontics: Current Principles and Techniques, 5th Edition provides the latest information from the best experts in the field.

It reflects today's emerging techniques, including new information on esthetics, genetics, cone-beam and other three-dimensional technologies, and evidence-based treatment. Coverage of diagnosis and treatment ranges from basic to highly complex situations, all in a concise, extensively illustrated format. Also included with this edition is a companion website that includes an electronic version of all chapters, supplemental content in select chapters, and a complete image collection to help with research and presentations.

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