Diagnostic Records 1

2013 The Andrews Foundation All rights reserved.

Diagnostic records include clinical assessments, as well as material records.
CLINICAL ASSESSMENTS
In addition to the usual dental and medical histories there are several clinical assessments needed to
make 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 circling
S, 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
Diagnostic Records 2
2013 The Andrews Foundation All rights reserved.
Rounded Angular
3. The Height of the Clinical Forehead:
The clinical forehead is dened as the portion
of the forehead perceived to be more related to
the face than to the top of the head. For straight
foreheads, the entire forehead comprises the
clinical forehead and its height is measured from
glabella (G) to trichion (T).
For rounded and angular foreheads, the clinical foreheads height is
the distance between glabella (G) and superion (S). Superion is the
point on the forehead that appears to separate the portion of the
forehead 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 record
it on the diagnostic sheet.
Forehead Shape: S R A G/T ______mm, G/S ______mm, FALL/FA pt. ______mm
Straight Forehead
Diagnostic Records 3
2013 The Andrews Foundation All rights reserved.
4. The Foreheads Anterior Limit Line (FALL): The FALL is a line
that passes through the foreheads facial-axis point (FFA pt.) and is
parallel with the heads frontal plane. While the patients head is
upright, locate the foreheads facial axis point (FFA pt.) which is in
the middle of the clinical forehead.
Instruct the patient to smile enough to fully bare
their maxillary incisors. Envision the foreheads
anterior limit line (FALL).
5. Locate Inferion (I): Inferion is a point
at the level of the FA pt. of the maxillary
central incisor being viewed. Inferion
is located by: 1) judging the AP position
of the FA pt. of the maxillary incisor if
anterior or posterior to the envisioned
FALL, and 2), judging that distance in
millimeters.
Forehead Shape: S R A G/T ______mm, G/S ______mm, FALL/FA pt. ______mm
The direction (+ or -) and distance (mm) judged is then recorded on the diagnosis sheet.
Diagnostic Records 4
2013 The Andrews Foundation All rights reserved.
MATERIAL RECORDS
A 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-inferior
relationship of the FA pt. of the
maxillary central incisor relative to
the lower border of the upper lip
(in repose), then record that
information on the diagnostic sheet.
This completes the clinical assessments.
Material records are now needed.
PHOTOS
Intraoral:
Right, center, and left images of the arches in centric relation:
Occlusal views of both arches:
Diagnostic Records 5
2013 The Andrews Foundation All rights reserved.
Extra-oral:
Frontal repose and smiling. Prole repose and smiling (with forehead exposed):
Photographic Composite
Diagnostic Records 6
2013 The Andrews Foundation All rights reserved.
RADIOGRAPHS:
Lateral head lm taken with the lm cassette oriented vertically
to include the patients forehead in the image eld. The head lm
should be taken in centric occlusion.
Panoramic should include mandibular condyles
Study casts (mounted in centric relation):
Occlusofacial Simlator
TM
by Golden Eagle Orthodontics, Inc.
Diagnostic Records 7
2013 The Andrews Foundation All rights reserved.
PREPARING THE LATERAL HEAD FILM FOR DIAGNOSIS
Materials Needed:
Lateral head lm 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 lm for diagnosing.
Step 1. Apply 8x 10 acetate overlay to the head lm.
Step 2. Trace the following head lm anatomy:
a. The soft-tissue prole, 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 core
line on each dental cast from the occlusal perspective, measuring the AP distance between
the envisioned core line and the FA pt. of the incisor, then mark that distance on the head lm
with a dot.
f. Check to see if the distance between the lower border of the upper lip and the FA pt. of the
maxillary incisor is the same on the head lm as the distance measured and recorded on the
diagnostic sheet during the clinical exam. If it is different, add a horizontal line to the tracing
to indicate where the lower border of the lip was relative to the FA pt. in repose.
Diagnostic Records 8
2013 The Andrews Foundation All rights reserved.
Step 3. Identify then mark or trace the following head lm anatomy:
a. Glabella (G) it can usually be identied on the head lm as the most prominent portion of
the forehead.
b. Trichion (T) Refer to the G/T measurement previously recorded on the clinical portion of the
treatment card. Use the metric ruler on the Andrews Incisor Template to measure the G/T
distance, then mark it with a dot.
c. Superion (S) For angular and rounded foreheads, refer to the G/S measurement recorded on
the 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 between
superion 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 central
incisors FA pt. on the head lm 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 superior
and inferior borders of the clinical forehead with a straight line. For straight foreheads, connect
trichion 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 formed
between the foreheads clinical surface and the FALL. Use the following formula to compute the
AP 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 by
0.5 mm for every degree that the forehead inclination is more than 7, but not beyond
glabella unless the patient insists. Once computed, add the GALL to the tracing,
preferably in green.
Diagnostic Records 9
2013 The Andrews Foundation All rights reserved.
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 over
the 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 the
Andrews Foundation Incisor Template to draw the Element I position of the mandibular incisor.
Step 9. Convert the head lm tracing to centric relation if needed. Check the difference in the
occlusion (incisor overjet) between the head lm and the study casts mounted in centric relation.
If there is a signicant difference (greater than 1 mm) shift the mandibular 3x 4 acetate overlay to
reect the centric relation occlusion and re-secure it with adhesive tape.