Lina Hadi, drg., Sp.Ort.

, FISID
 Basic orthodontic records include three main types of record:
1. Study model
2. Radiographs
3. Clinical photographs / facial photographs

->Certain information to diagnosing & determining the best

possible treatment plan for each particular case. Allow the
observation of harmonious relation between soft, hard facial
tissue & facial expression.
Extraoral photograph
Intraoral photograph
• Taken before starting treatment & after completing the treatment.
• Take by potitioning the patient in such a manner the F.H plane is parallel to
the floor.

The uses;
1. Evaluation of craniofacial relationships and proportions before & after
treatment
2. Assessment of soft tissue profile
3. Propotional facial analysis and photographic analysis of A.M. Scharz
4. Important for conducting the total space analysis
5. Monitoring of treatment progress
6. Invaluable for longitudinal study of treatment & post retention follow-up
7. Detection & recording muscle imbalances
8. Detecting & recording facial asymemetry
9. Identifying patients
The principal variables are ;
 The type of camera
 The quality of the lighting
 The lenses
 The film (or the CCD)
 The background panel
 Patient positioning, and
 Camera positioning (framing) during the photographic shoot.
• The studio lighting equipment consists of a single professional flash
(System300 professional compact flash by System Imaging Ltd, UK),
which is ceiling mounted on a straight rail parallel to the background
panel.
• The total length of the rail is 0.95 m.
• The distance of the flash unit from the background is fixed at 1.6 m.
A pantograph (Friction Pantograph 3250 by I.F.F., Calenzano–
Firenze) holds the monolight and allows unrestricted vertical
adjustment.
• A rectangular 0.75x0.35 m soft box (75 Light Bank by System
Imaging Ltd, UK) fits on the flash unit, softening and diffusing the
• light. An alternative smaller and more practical soft box, 0.4x0.3 m
(Chimera Lightbanks, Boulder, Colorado, USA).
• The distance from the monolight to the subject is
fixed (about 1.1–1.2 m).
• The lighting is directed towards the subject in
all views, maintaining the flash unit at a higher
level.
• The rectangular soft box is held in a horizontal
position.
• To eliminate the problem of shadows on the
submental region and under the nasal base, the
patient holds with her hands, a small
rectangular reflecting panel of 0.35x0.7 m.
This panel is positioned horizontally against the
chest, just under the collarbone.
• The ceiling-mounted rail allows the adjustment
of the monolight to a side or central position.
• An important rule is to maintain the subject‘s
position close to the background panel itself in
order to avoid the need for an adjunctive
• flash unit to light the background panel.
• The blue background panel, 0.95 m wide and
1.10 m high, is made from a sheet of plastic
material for outdoor use.
• For clinical use, the best natural condition is a cloudy but bright
day in which the light of one source, the sun, loses its contrast by
the diffusion of the clouds, and the softened shadows on the
subject show the main direction of the light itself.

weak point:
• Its distance from the subject
• In spite of its great dimensions, makes it similar to a point light
source, which, on a clear day, produces sharp shadows.
• Two symmetric lights of the same power, relatively far from the
subject, produce unnatural lighting in which one corrects the
shadow produced by the other‘s illumination.
Extraoral photos consist of the following four ahota:

Face Face
frontal (lips frontal
relaxed) (smiling)

Profile (450)
(right side Profile
preferably- (3/4
lip relaxed) profile-
smiling)
• Framing ( patient’s face & neck with a reasonable
margin of space all around)
• Holding the camera lens in a Vertical position &
standing a reasonable distance away from patient
when taking the shot (4-5ft.)
General guideline;
a. The patient should stand with their head in Natural
Head Position, eyes looking straight into camera lens.
b. The patient should hold their teeth & jaw in a
relaxed (rest) position, lips in contact (if possible) &
in relaxed position.
c. Patient’s head is not tilted or rotatef to either side;
shot taken at 900 to the facial mid-line from the
front.
d. Ensure patient’s inter-pupillaryl line is leveled is also
important.
• Same guideline as face frontal
shot
• But the patient should be smiling
in natural way with teeth visible.
• This photo aids in visualizing the
patient’s smile esthetics & soft
tissue proportions during smiling.
• Same general guideline
• Head in NHP
• Eye’s fixed horizontally
• Whole of the right side should be
clearly visible with no obstructions
such as hair, hat, scarf.
• If possible, use ring-flash to
eliminate shadow.
• This shot convey the patient as if in
“social interaction”.
• Give information about smile
esthetica changes pre&post-
treatment
• Ask patients to turn their head
slightly to their right (about ¾ of the
way) whilr their body still in the
previous profile shot position.
• Then, instructed to look into the
camera then smile.
The Five Orthognathic/ Orthodontic Views
All five facial views are in the NHP (Natural Head Position

1.full face profile view during smiling, which

permits the study of the relationship between the
vertical & anterior–posterior position of the upper
central incisors and the rest of the face.

2. full face frontal view in posed smile

(social smile)
3. full face frontal view with mouth retractors

4. the close-up view of the lips at rest with

ruler

5. The close-up view of the lips in posed smile

with ruler
• Quality, standardized facial photographs either black and
white or color prints
• Patients head oriented accurately in all three planes of
space and in FH plane
• One lateral view, facing right, serious expression, lips
closed lightly to reveal muscle imbalance and disharmony
• One frontal view, serious expression
• Optional—one frontal view, serious expression
• Optional—one lateral/profile view and/or frontal view
with lips apart
• Optional—one frontal view, smiling
• Background free of distractions
• Quality lightening revealing facial contours with no
shadows in the background
• Ears exposed for purpose of orientation
• Eyes open and looking straight ahead glasses removed
1.Shape of head
the head can be classified into one of the
following three types:
 Mesocephalic: Average shape of head. They
posses normal dental arches.
 Dolicocephalic: Long and narrow head. They
have narrow dental arches.
 Brachycephalic: Broad and short head. They
have broad dental arches.

2. Facial form
Describing the face is to classify it as round,oval
or square.
 Mesoprosopic: average or normal form.
 Euryprosopic: broad and short.
 Leptoprosopic: long and narrow face form.
3. Assessment of facial symmetry
Eximined to determine dispopotions of the face in transverse & vertical planes.
Facial asymmetry can occur as a result of Congenital defect, Hemi-facial atrophy/
hypertrophy or Unilateral condylar ankylosis and hyperplasia.

4. Assessment of antero-posterior jaw

relationship
Ideally maxillary skeletal base in 2-3mm
foward of the mandibular skeletal base
when teenth in occlusion.
Use the index and the middle fingers at the
soft tissue point A & point B.
- In skeletal Class II patient, index finger is
anterior to middle finger.
- In skeletal Class III patient, the middle
finger is ahead of forefinger.
- In skeletal Class I patient, hand is an even
level
• 5. facial profile (Examined by viewing pastient
from the side.)
• The profile is assessed by joining the following
two difference lines:
1. A line joining the forehead & the soft tissue
point A (deepest point in curvature of upper
lip)
2. A line joing point A and the soft tissue pogonion
(most anterior point of the chin).
• Base on this line, 3 types of profile exist;
1. Straight profile: the two lines form a nearly
straight line.
2. Convex profile: the two lines fowm an angle
with the concavity facing the tissue. (prognatic
maxilla or retrognatic mandible as seen in a
Class II, division 1 malocclusion).
3. Concave profile: the two reference line form an
angle with the convexity towards the tissue.
(prognathic mandible or a retrognathic maxilla
as Class III malocclusion)
6. Facial divergen
Anterior or posterior inclination of the lower face
relative to the forehead.
Facial divergent can be 3 types;
 Anterior divergent: a line drawn between the
forehead & chin is inclined anteriorly towards
the chin.
 Posterior divergent: a line drawn between
the forehead & chin slants posteriorly towards
chin.
 Straight or orthognatic: the line between the
forehead & chin is straight or perpendicular to
the floor.
• 7. Assessment of vertical skeletal relationship
• Normal: distance from a point between eyebrows to the junction
of the nose with upper lip = to the distance from the latter point
to the under side of the chin.
• Also can assesed between lower border of mandible & FHplane.
 if 2 planes meet beyond the occipital region, Indicate a low
angle case or horizontal growing face.
 If 2planes meet anterior to the occipital region, indicate a high
angle case or vertical growing face.
• 8. evaluation of facial proportions
Devide into three equal third using four horizontal planes.
At the level of the hair line, the supraorbital ridge, the base
of the nose & the inferior boder of chin.
Within the lower face, the upper lip occupies a third of the
distance while the chin occupies the rest of the space.
9. Examination of lips
o Normally upper lips conver the entire labial surface of upper
anteriors except the incisal 2-3mm. Lower lip convers the entire
labial surface of the lower anterior & 2-3mm of incisal edge of
the upper anteriors. Classified into the following 4 types:

Competent • Lips are in slight contact

when the musculature is
lips relaxed.

Incompetent • Morphologically short lips

thatdo not form a lip seal in
lips a relaxed state.

Everted lips • Hypertrophied lips with

weak muscular tonicity.
• 10. Examination of the nose
 Nose size: the nose one third of total facial height (form hairline
to lower border of chin)
 Nasal contour: shape of the nose can be straight, convex or
crooked as result of injuries.
 Nostrils: Oval & bilaterally symmetrical. Stenosis of nostrils
indicate impired nasal breathing.

• 11. examination of chin

 Mentolabial sulcus: is a concavity seen below the lower lip.
Deep mentolabial sulcus is seen in Class II, Division 1 malocclusion
while it is shallow in bimaxillary protrusion.
 Mentalis activity: the mentalis muscle not show any contraction
at rest.
Hyperactive mentalis activity is seen in some malocclusion Class II,
division 1 cases. Caused puckering of the chin.
 Chin position & prominence: prominent chin usually associated
with Class III malocclusions while recessive chin are common in
Class II malocclusion.
Taken include
1. Frontal view (in occlusion)
2. Left & lateral lateral view (in
occlusion)
3. Maxillary & mandibular occlusal
(using mirrors)
• Patient sitting comfortably in
dental chair & raised elbow-level
of the clinician.
• Assistant stands behind the
patient using retractor from the
wide ends to retract the patient’s
lips sideways& away from teeth
& gingivae & slightly toward the
clinician.
• The photo taken 900 to the
facial mid-line & cental incisor.
• The assistant flips the right/ left
retractor to the narrower side,
while the other side retractor
remains in place as for the
previous frontal shot.
• Asked patient to turn their head
slightly to their left/ right so the
right/ left will be facing the
clinician.
• The clinician hold the right/ left &
streches it to the extent the present
molar is visivle if possible.
• Shot is taken 900 to the premolar
area for the best visualization of
buccal segment relationship.
• Assistant now switch to the smaller
retractor set & patient’s mouth held
open.
• Retractor are inserted in a “V” shape to
retract the upper lips or reverse “V”
shape to ratract lower lips sideaways &
away from the teeth.
• Clinician insert the mirror with its wider
end inwards to capture maximum width
of the arch posteriorly & pulls it slightly
downwards/upward so whole
upper/lower arch is visible to the last
present molar.
• Instruct patient to lower their head (for
upper) or chin up ( for lower) & shot can
be taken 900 to the plane of the mirror.
• Usa Mid-palatal raph as a guide to get
the shot leveled.
 • Variation in palatal depht occurs in association with
variantion of facial form. Most dolicofacial patients
have deep palates.
• Presence of swelling in the palate can be indicative
of an impacted tooth, presence of cyst or othe
bony pathologies.
• Mucisal ulceration & indentations are feature of
Extamination traumatic deep bite
• Presence of cleft palate.
of the palate: • 3rd rugae usually in line with the canines. This is
usefull in the assessment of maxillary anterior
proclination.
 • Abnormalities tongue can upset the muscle balance &
aquilibrium leading to malocclusion.
Examination • Excessively large tongue is indicated by presence of imprints
of the teeth on lateral margin (scallop tongue).
of tongue

• Examined for inflammation, recession & other mucogingival

lesions.
• Presence poor oral hygiene
Examination • Anterior marginal gingivitis in mouth breathers.
of gingiva • Presence of traumatic occlusion
• Presence of abnormally hyperplastic gingiva
 • Maxillary labial frenulum can be thick,fibrous & attached
relatively low.
• Attachment prevents the two maxilla central incisors from
approximating each othe predisposing midline diastema.
Examination of • Abnormal frenal attachments are diagnosed by blanch test.
frenal attachment • Abnormal high attachment of mandibular labial frenulum can
caused recession of gingiva in that area.
• Lingual frenum should be examined for ankyloglossia ot
tongue-tie.
 • Teeth present inside
• Teeth unerupted
• Teeth missing
• Status of dentition (erupted or not erupted)
• Presence of caries,restoration, malformation,
hypoplasia & discoloration.
• Describe as Angle’aClass I,II,III.
Assessment of •
•
Overjet , overbite, deepbite or openbite.
Crossbite & shift in upper/lower midline.
the dentition • Rotation, displacement, intrusion and extrusion of
the tooth.
• For study their arch form & symmetry. Normal,
narrow (Vshape) or square.