Orthodontic Assessment and Examination

The significance of conducting an orthodontic assessment and examination before proceeding with treatment cannot be overstated. Such a meticulous examination not only aids in identifying potential orthodontic issues but also facilitates the formulation of a bespoke treatment plan. 

The assessment and examination encompass an array of crucial parameters, including dental occlusion, facial symmetry, soft-tissue balance, and cephalometric measurements. By judiciously scrutinizing these essential variables, the clinician can proactively identify potential limitations and tailor the treatment approach accordingly. 

It is an indispensable step in determining the nature and extent of dental misalignment, bite discrepancies, and malocclusion. Moreover, a comprehensive examination helps ascertain the root cause of the orthodontic problem, which could be skeletal, dental, or functional in nature. 

By carefully analyzing and interpreting the collected data, the clinician can develop an individualized treatment approach that aims to correct the underlying issue while ensuring optimal oral health outcomes. In essence, a thorough orthodontic assessment is an indispensable precursor to the provision of effective and customized orthodontic care and serves as a pivotal foundation for devising an individualized treatment plan that can yield aesthetically pleasing, functionally stable, and long-lasting results.

This article aims to impart invaluable knowledge about malocclusion in its various guises. It is essential that clinicians are equipped with a thorough understanding of this to enable them to seamlessly integrate this knowledge into the cases they encounter in their daily practice.

A systematic approach is crucial when conducting an orthodontic assessment, especially as this may be the first visit to a dental clinic for some patients. In addition to gathering clear and comprehensive information, clinicians must also strive to make a favorable impression on the patient, as it impacts their decision to pursue treatment. By adopting a structured and methodical approach to the assessment, clinicians can achieve both objectives effectively, establishing a foundation of trust and confidence while also paying attention to crucial clinical details.

Listed below are the most important aspects of an orthodontic assessment that need to be evaluated when a patient presents seeking orthodontic treatment:

  • Patient Concerns
  • History, including dental history, medical history, and orthodontic history
  • Extra Oral examination, including TMJ, macro aesthetics, and mini aesthetics
  • Intra Oral examination, including dental and periodontal health, micro aesthetics, and orthodontic assessment of tooth position and malocclusion
  • Intraoral examination
  • Records

It’s important to note that each of these components should be thoroughly evaluated to provide a comprehensive and accurate diagnosis, treatment planning, and treatment outcome assessment for your patients.

Patient Concerns:

Comprehending the patient’s expectations and desires from the very beginning is key to a successful treatment outcome. As the field of orthodontics amalgamates the intricacies of both science and art, it is imperative that the clinician and patient align their objectives toward a shared end goal. Unlike other facets of dentistry, such as endodontics, where providing a “correct” result is often straightforward, orthodontics often presents patients with multiple treatment options that can lead to varying outcomes. In situations where various treatment alternatives with differing achievable results are available, it becomes crucial to ensure that the patient’s aspirations are understood completely.

The preliminary stage of every Orthodontic assessment should entail an inquiry into the patient’s impetus for seeking treatment. Has their dentist proffered a referral based on professional discretion? Is it a reflection of parental expectations? Or, has the patient harbored a personal disliking for their malposed teeth? Uncovering this information paves the way for further inquiries to gather pertinent details. Ultimately, comprehending precisely what the patient wishes to rectify enables subsequent discussions to explore the feasibility of the desired outcome. This, in turn, leads to a well-informed patient with a realistic notion of the treatment’s anticipated outcomes.

Extra-Oral Examination:

Prior to analyzing a patient’s malocclusion and intraoral condition, it is necessary to conduct a comprehensive assessment of the patient’s extraoral features. This evaluation serves to complement and expand upon the information obtained from previous discussions. The patient’s smile and dentition must be evaluated in the context of their facial structure, as this ultimately influences how they perceive themselves and how others perceive them.

A positive dental outcome that disregards the patient’s facial context would prove unsatisfactory for the patient. Moreover, this aspect of the evaluation plays a significant role in unfolding the patient’s desires and expectations. It might be possible that the patient is seeking orthodontic treatment for a facial transformation that can only be accomplished with surgical intervention.

Such information necessitates a thorough discussion between the patient and the clinician before proceeding with the treatment plan together.


Following the initial phase of the consultation appointment, the subsequent steps involve the refinement of ideas put forth by the patient as their primary concern, coupled with gaining deeper insights into the patient’s medical and dental history leading up to their current state of presentation. Typically, this entails a comprehensive inquiry into three main areas – the patient’s medical history, dental history, and whether any history of prior orthodontic treatment exists.

Taking a detailed medical, dental, and orthodontic history serves as a critical juncture in comprehending the patient’s unique needs and requirements and facilitates the clinician in gaining profound insights into the patient’s condition, thereby enabling them to identify the most effective means to attain optimal results. This is an integral step to delivering optimal treatment outcomes and achieving patient satisfaction. 

Furthermore, this stage is pivotal for patients, too, as it provides them with the assurance that their concerns are being taken seriously and addressed with sensitivity. While a structured and systematic approach is advantageous from a clinician’s standpoint, it is equally imperative to consider the patient’s perspective and strive to imbue the experience with a personalized touch.

It is noteworthy that the evaluation of the timing of physical growth is imperative in pediatric patients. Although radiographic techniques are more commonly employed, clinical observations and discourse are generally adequate. It is important to consider the patient’s age, stature, and mass, in addition to inquiring about any recent growth spurts or developmental changes associated with puberty.

Facial Proportions:

Facial proportion assessment is an essential part of orthodontic diagnosis and treatment planning. It involves the evaluation of the balance and harmony of the different facial features to determine the most suitable treatment modality for the patient. The facial proportion assessment can be divided into three main categories: macro, mini, and micro aesthetics.

Macro Aesthetics:

Macro aesthetics refer to the evaluation of the overall balance and symmetry of the face. This includes analyzing the relationships between the forehead, nose, lips, and chin, and their proportional relationships to each other. Some of the key parameters evaluated under macro aesthetics include:

  • Facial height: The vertical distance between the hairline and the chin.
  • Facial width: The horizontal distance between the zygomatic arches.
  • Facial thirds: The face is divided into three equal vertical segments – the upper, middle, and lower thirds. The relationship between these segments is evaluated for balance and harmony.
  • Facial profile: The evaluation of the projection and position of the nose, lips, and chin in relation to the forehead.

Mini Aesthetics:

Mini aesthetics refer to the evaluation of the dental and facial midline relationships. This includes analyzing the relationships between the central incisors, the dental midline, and the facial midline. Some of the key parameters evaluated under mini aesthetics include:

  • Dental midline: The imaginary line that divides the upper and lower dental arches.
  • Facial midline: The imaginary line that divides the face vertically.
  • Occlusal plane: The imaginary plane that runs through the biting surfaces of the teeth.
  • Smile arc: The curvature of the upper and lower incisors in relation to the lower lip.

Micro Aesthetics:

Micro aesthetics refer to the evaluation of individual dental and facial features. This includes analyzing the size, shape, and position of the teeth and evaluating the facial features for symmetry and harmony. Some of the key parameters evaluated under micro aesthetics include:

  • Tooth size and proportion: The size and shape of the individual teeth and their proportional relationships to each other.
  • Tooth position: The position of the teeth in relation to the dental arches and the facial midline.
  • Gingival contour: The shape and position of the gum tissue surrounding the teeth.
  • Lip and smile line: The position and curvature of the upper and lower lips and their relationship to the teeth.

By assessing these parameters, clinicians can develop a treatment plan that effectively addresses the patient’s specific needs and helps them achieve optimal facial harmony and aesthetics.

Intra-Oral Examination:

After completing the extraoral assessment, the clinician may then begin with the intraoral examination. This comprehensive evaluation encompasses various facets, including the appraisal of the malocclusion, a comprehensive evaluation of the dental and periodontal well-being, and meticulous scrutiny of the smile analysis, also referred to as micro aesthetics.

Dental and periodontal health

A complete dental assessment may not fall under the jurisdiction of an orthodontist, but it is crucial to maintain a comprehensive overview and ensure collaboration with the general dentist. The examination should include a record of present teeth, including deciduous and permanent, missing or compromised teeth, and notable restorations, such as implants, crowns, and bridges. 

The presence of significant restorations may impact treatment planning, particularly in adult patients with a heavily restored dentition. The periodontal health of the patient should also be evaluated, and it is expected that patients should have optimal periodontal health before starting treatment. Any signs of periodontal disease will delay treatment and must be communicated to the general dentist. Coordination with the general dentist is vital to ensure optimal periodontal health before starting orthodontic treatment.

Assessment of malocclusion

During an intraoral assessment for malocclusion, it is important to record specific details systematically and accurately. Initially, the incisor relationship should be measured, including overjet, depth of overbite, palatal impingement, centrelines, and deviation from facial midlines. Next, the amount of crowding and spacing is assessed using a graduated probe or approximated with experience. The Angles molar classification is also evaluated, along with the canine classification if necessary. Any variations should be recorded with detailed notes. Finally, the information gathered should be recorded with precision to ensure reliability.

The Bottom Line

To sum it up, orthodontic assessment and examination is a critical process that determines the suitability of an individual for orthodontic treatment. This process involves a comprehensive evaluation of the patient’s dental and facial structures, as well as their medical and dental history. It is essential for dental professionals to have a thorough understanding of their patient’s individual needs and goals to develop an effective treatment plan.

By carefully analyzing and interpreting the information obtained during the assessment and examination process, clinicians can provide personalized treatment that addresses the unique needs of each patient.

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