IDRR APRIL -MAY -JUNE 2020 - Flipbook - Page 87
MANDIBULAR STRUCTURAL DEVIATION:
( IF FOR EXAMPLE TO THE LEFT SIDE)
Left Side:
1. Cdr-bi-Me/2 > Cdl-bi-Me/2 with the pointBiMe/2 to the left of the TN’ plane.
2. Asymmetric isosceles triangle, with the
inferior vertex to the left of the TN’ plane.
Figure 6; Mandibular positional Deviation to the Left
The above panoramic x ray shows almost
equal distance of both Cdr to bi Menton point
and Cd left to Bi- Manton point ,but the Bimenton point is shifted left to the TN ‘plane..
DISCUSSION:
Mandibular asymmetries and deviations have
always been a great diagnostic challenge and
has detrimental effect on the final treatment
outcome if they are not addressed in the
treatment planning. Various studies have
been done in the past which has given us
numerous indices and analysis to determine
this problem with very less predictable
results. Asymmetry of the maxillofacial region
was first illustrated by artist Hasse I 1887.It
was followed by detailed analysis and studies
by various researchers like Adams and health
where they found the association of condylar
hyperplasia with rheumatoid arthritis. In an
other study by L G farkas presented tables
with several components of the face. later it
was Rowe classified mandibular asymmetry
into acquired and developmental, where the
developmental included the hypoplasia of
the condyle ,ramus, neck and combination,
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ORTHODONTICS
condylar hyperplasia. Acquired includes
trauma, ankylosis, tumour, infections or
functional mandibular displacement.
Later it was Levandowsky who developed
the levandoski panoramic analysis for
mandibular asymmetry where specific
guidelines and analysis were used for the
proper diagnosis.3 This analysis was used
later by various clinicians and came up
with results which were not diagnostic
enough to use them repeatedly for assessing
mandibular asymmetries4. Here in this article
the mandibular asymmetry and deviation
was assessed by the panoramic analysis
developed by Dr.Diego tatis which gives the
treating clinician accurate measurements
regarding the deviation and also gives a very
valid information about the type of deviation
being either as structural or Positional5. This
gives the orthodontist a clear preoperative
data regarding the mandibular shift ,
particularly if the patient has TMj disorders.
This analysis will also help the TMD specialist
in planning the treatment based on the
structural or positional etiology of the
disorder.
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