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Orthodontic Practical Exercises Workbook

Course Information1

  • Unit: DENT5310 - Integrated Dental Practice 1
  • Module: Orthodontics Module (Pre-Clinical Programme)
  • Period: Semester 1, 2026

Teaching Staff

  • Module Coordinator: A/P J Mike Razza
  • Supervisors:
    • Dr Richard Lee
    • Dr Steve Naoum
    • Dr Daniel Fernandes
    • Post-Graduate Registrars

Student Identification

  • Student Name: ______________________________
  • Student ID: ________________________________

Introduction and Course Overview

Purpose of the Manual2

This manual supplements the didactic teaching and texts currently used in the DMD course. Orthodontic treatment comes in a range of complexities, most of which need to be treated at a specialist level. It is important to learn the essential aspects of clinical and laboratory procedures and the relevance of each stage. With a good understanding of the fundamentals, it will be clearer what the technical and clinical issues are, and to know when treatment is beneficial for the patient and when a specialist referral is required.

The orthodontic practical exercises simulate clinical circumstances as closely as possible. It is important that students obtain the understanding to appreciate the relevance of what is being taught. This will allow students to apply these fundamentals in a clinical environment.

Learning Resources and Preparation

This manual allows the student to review each of the practical exercises, learning outcomes, materials, and equipment required to complete each practical task. It is recommended that students preview each stage in advance to facilitate and reinforce the learning experience.

Logbook and Record Keeping

The manual is used as a logbook, which will record the continual assessment and show that all practical tasks have been completed to meet the required standard.

It is the student’s responsibility to keep all records up to date and to ensure that the manual always remains within the school. The manual is to be present for all teaching sessions, enabling the teaching staff to provide feedback and comments as required.

Assessment Criteria

The practical exercises are assessed as Clinically Acceptable or Unsatisfactory. Each practical exercise will need to be completed to a clinically satisfactory level. If a student cannot achieve a satisfactory level of competency within the scheduled time, extra sessions may be provided for remediation.

Table of Contents3

  1. Anatomy Review: Identification of Anatomical Landmarks and structures
  2. UNC Level II and III - Growth and Development
  3. Practical Exercise - Facial Form Analysis and Facial Profile Analysis
  4. Practical Exercise Cephalometrics
    • A. Cephalometric illustrative tracings
    • B. Cephalometrics glossary
  5. Practical Exercise - Space Analysis and Model Analysis

Anatomy Review4

Prior to the clinical examination, it is necessary to review the significant and major aspects of oral anatomy, including:

  • Osteology of the face
  • Osteology of the jaws
  • Major soft tissue structures of the mouth
  • Muscles of facial expression
  • Major muscles of mastication
  • Anatomy and function of the Temporo-mandibular joint
  • Anatomical features of the edentulous mouth

It is important to become familiar with these features to get the maximum benefit out of each stage.

During your evaluation of the edentulous cast, the visualisation of the relationship of the anatomical structures should enhance the appreciation of the clinical significance of these structures.

Osteology of the Face567

Sagittal ViewOsteology of the maxilla and the Mandible:
Muscles of Facial Expression:Major Muscles of Mastication:

Frontal View8

Osteology of the face: Frontal View

Major Muscles of Mastication9101112

Key - page 13

Oral Anatomy:Panoramic Anatomy:Panoramic Air Spaces

Panoramic Anatomy Key

  1. maxillary sinus
  2. pterygomaxillary fissure
  3. pterygoid plates
  4. hamulus
  5. zygomatic arch
  6. articular eminence
  7. zygomaticotemporal suture
  8. zygomatic process
  9. external auditory meatus
  10. mastoid process
  11. middle cranial fossa
  12. lateral border of the orbit
  13. infraorbital ridge
  14. infraorbital foramen
  15. infraorbital canal
  16. nasal fossa
  17. nasal septum
  18. anterior nasal spine
  19. inferior concha
  20. incisive foramen
  21. hard palate
  22. maxillary tuberosity
  23. condyle
  24. coronoid process
  25. sigmoid notch
  26. medial sigmoid depression
  27. styloid process
  28. cervical vertebrae
  29. external oblique ridge
  30. mandibular canal
  31. mandibular foramen
  32. lingula
  33. mental foramen
  34. submandibular gland fossa
  35. internal oblique ridge
  36. mental fossa
  37. mental ridges
  38. genial tubercles
  39. hyoid bone
  40. tongue
  41. soft palate
  42. uvula
  43. posterior pharyngeal wall
  44. ear lobe
  45. glossopharyngeal air space
  46. nasopharyngeal air space
  47. palatoglossal air space

Exercise 1. Anatomy Review13

I have completed a review the significant and major aspects of oral anatomy:

Signature ___________________

Date ___________________

Growth and Development

Exercise 2: UNC Level II and III - Growth and Development14

UNC Level II Unit A

I have opened and completed this on-line component:

  • Signature: ___________________
  • Date: ___________________

UNC Level II Unit B

I have opened and completed this on-line component:

  • Signature: ___________________
  • Date: ___________________

Facial Form and Profile Analysis

Analysis of facial proportions and dental-facial relationships is an essential step in the diagnosis of malocclusion. This individual exercise involves the use of simple diagnostic tools to assess the facial form of a patient.

Facial Form Analysis

Dentofacial Proportions15

Facial form analysis focuses on the evaluation of dentofacial proportions to establish a baseline for orthodontic diagnosis.

Facial ThirdsLower Facial ThirdsFacial Symmetry
Facial Planes CantFacial Fifths

Frontal View Assessment16

  1. Frontal View
  2. Symmetry
  3. Vertical and Transverse Facial Proportions
  4. Tooth Display
  5. Facial and Dental Midlines
  6. Transverse Facial Prominence
  7. Vertical Facial Prominence

Smile and Dental Esthetics

  1. Anterior Tooth Display
  2. Posterior Tooth Display: Buccal Corridors
  3. Smile Arch

Complete the following Facial Form Analysis for your two patients:

Clinical Judgment Criteria17

  1. Facial Symmetry

    • Within normal limit or asymmetric
    • If present, location of asymmetry

  2. Incisor Tooth Display

    • OK, too little, or too much (excess gingiva)

  3. Buccal Corridor Width

    • OK, too little, or too much

  4. Smile Arc

    • OK, flat, or excessive

Summary

Summarize the facial form of your patient based on the observations above.

Facial Profile Analysis

Facial profile analysis has been referred to as “the poor man’s” Cephalometric Analysis. It is performed to identify underlying skeletal relationships and serves as an important diagnostic tool for identifying patients with severe dentofacial disproportion.

Goals of Facial Profile Analysis18

  1. Establishing whether the jaws are proportionately positioned in the anterior-posterior (AP) plane of space.
  2. Evaluation of lip posture and incisor prominence.
  3. Reevaluation of vertical facial proportions and evaluation of mandibular plane angle.

Analysis Methodology

Using the right facial profile image for your patient, complete the analysis as follows:

  • Anterior-Posterior (AP) Relationship: Draw two lines—one from the bridge of the nose to the base of the upper lip, and the other from the base of the upper lip to the chin.
  • Lip Posture and Incisor Prominence:
    • Evaluate lip prominence by observing the distance each lip projects forward from a true vertical line through the depth of the concavity at its base (soft tissue A and B points).
    • Use the E-line to assess how the lip relates to the nose and chin.

Vertical Proportions19

  1. Reevaluation of vertical facial proportions and evaluation of mandibular plane angle.

Clinical Judgment Criteria

Complete the following for your two patients:

  1. Antero-Posterior Skeletal Jaw Relationship

    • Class I (Normal)
    • Class II
    • Class III

  2. Vertical Skeletal Jaw Relationship

    • Normal
    • Long face
    • Short face

  3. Tooth Support for Lip (Lip Prominence)

    • Excessive
    • Normal
    • Inadequate

Submission Requirements

  • Format: Typewritten on A4 paper (Word or PDF document).
  • Attachments: De-identified patient photographs.
  • Submission Portal: University of Western Australia’s Learning Management System (Blackboard Turnitin) for unit DENT5310.

Assessment of Facial Analysis

Assessment Criteria20

CriteriaSelf-AssessmentPass/Fail
Two (2) sets of correctly oriented de-identified patient diagnostic facial photographs
Facial form analysis has been accurately completed
Profile analysis has been accurately completed
Accuracy of self-assessment – recognition of clinical acceptability

Student Self-Assessment and Assessment of Facial Analysis and Facial Profile Analysis

Exercise Status

  • Repeat Exercise
  • Modify Exercise
  • Completed Exercise

Tutor Name and Signature: ____________________ Date: __________

File Name: Orthodontic Facial Form/Profile Analyses

Exercise 3 Submission Confirmation:

  • Accurately completed and submitted online: ____________________
  • Signature/Date: ____________________

Deadlines and Timing

  • Expected time of completion: 30 minutes per assignment.
  • Due date: 11:59 PM Thursday, 2nd April 2026

Cephalometrics Exercises

You must complete the computer teaching programs on cephalometric tracing and cephalometric superimposition. The online Cephalometrics quiz UNC on-line will test your proficiency of the following topics and is based on the self-instructional material and reading material:

  1. Identification of landmarks on a cephalometric radiograph
  2. Analysis of dentofacial proportions based on construction of reference planes and both linear and angular measurements
  3. Cranial base, maxillary and mandibular superimpositions

A detailed protocol for these topics is also provided below. The Cephalometrics on-line quiz is formative.

Tracing Procedures Reference and Study Aid21

Part 1. Techniques for cephalometric tracing and landmark identification

  • Place the acetate paper, rough side up, exactly over the film, with the film oriented so the face is to the right. Tape them together, making sure the top and right side of the film and the tracing paper coincide.
  • Follow the illustration as outlined in detail within orthodonticinstruction.com Level II Growth and Development Unit B – Diagnostic Procedures Cephalometric Tracing Techniques.

Part 2. Protocol for Cephalometric analysis

(1) Reference lines

Begin the analysis by drawing the five important horizontal planes:

  • S-N plane (extend the S-N line posteriorly beyond S)
  • True horizontal plane (perpendicular to true vertical, through Or)
  • Palatal plane (extend the ANS-PNS line posteriorly beyond PNS)
  • Occlusal plane (extend a line along the occlusal surface of the molars and premolars or primary molars both posteriorly and anteriorly)
  • Mandibular plane (extend the Go-Gn line posteriorly)

Additional construction steps:

  • Drop a true vertical line (parallel to the chain) from nasion.
  • Draw a segment of a true vertical line, as a dashed line, through points A and B.
  • Draw the long axis of the maxillary and mandibular incisors.

(2) Analysis

Observe the orientation of the horizontal reference lines, and the position of points A and B relative to the true vertical line from nasion. Measure the following angles and record the values on the analysis sheet:

  • ANB

Cephalometric Measurements and Analysis222324

LANDMARK IDENTIFICATION FOR STANDARD UNC/UWA CEPHALOMETRIC ANALYSISPLACEMENT OF ANALYSIS MEASUREMENTS (Mean Values)

Angular Measurements25

  • SN-GoGn
  • Maxillary incisor to palatal plane
  • Mandibular incisor to mandibular plane
  • Interincisal angle

Linear Distances

Measure the following linear distances and record them on the analysis sheet:

  • Maxillary incisor facial surface to true vertical line through NA
  • Mandibular incisor facial surface to true vertical line through NB
  • Pogonion to true vertical line through NB

Dentofacial Relationship Summary

From your observation of jaw positions relative to the reference lines and the measurements, you can summarize the patient’s dentofacial relationships by evaluating:

  • Vertical skeletal relationships
  • Anteroposterior skeletal relationships
  • Maxillary tooth-jaw relationships
    • Anteroposterior
    • Vertical
  • Mandibular tooth-jaw relationships
    • Anteroposterior
    • Vertical

Part 3. Superimposition of Cephalometric Radiographs

For superimposition of a basic tracing, see the detailed protocol below and orthodonticinstruction.com Level II Growth and Development Unit B - Diagnostic Procedures Cephalometric Superimposition:

  1. Cranial base superimposition: Superimpose your tracing on the red tracing, on the S-N line at S, and tape the two tracings together. Place a blank sheet of tracing paper over the superimposed tracings. Make a composite superimposition tracing, first reproducing the red tracing in solid lines, then using dashed lines to show differences between this and your tracing.
  2. Maxillary superimposition: Superimpose the two tracings on the lingual contour of the maxillary anterior alveolar process and the palatal plane. Make a composite tracing of the maxillary area only, showing the changes in the position of the maxillary teeth.
  3. Mandibular superimposition: Superimpose the two tracings on the lingual contour of the mandibular symphysis, the outline of the inferior alveolar canal and the crypt of the unerupted lower third molar. Make a composite tracing of the mandibular area only, showing the changes in the position of the mandibular teeth and the external contours of the mandible.

HORIZONTAL AND VERTICAL PLANES AND LOCATION FOR ANGULAR VALUES TO BE INSERTED FOR STANDARD UNC/UWA CEPHALOMETRIC ANALYSIS

MeasurementNormal WhiteNormal BlackInitialFinal
SNA81°84.7°
SNB78.2°79.2°
ANB2.8°5.5°
SN-GoGn32°38.2°
Maxillary incisor to SN plane103.8°108.9°
Mandibular incisor to Mandibular plane97.3°100°
Interincisal angle126.8°113.8°
Maxillary incisor to NA3.mm / 23.2°7.4mm / 24.1°
Mandibular incisor to NB5.4mm / 27.3°11.4mm / 36.7°
Pg to N-Perpendicular-4 to -2mm

Summary:

Glossary of Cephalometric Terms26

Nasion (N): The anterior end of the fronto-nasal suture, or junction of frontal and nasal bones. This is seen in profile as an irregular notch. The nasal bone is less dense roentgenographically than the frontal bone, making it relatively easy to follow the suture even when the notch is not apparent.

Sella turcica (S): Literally the “Turkish Saddle.” The center of the bony crypt occupied by the hypophysis cerebri (pituitary gland). Roentgenographically a very constant profile outline seen in its lateral aspect.

Porion (P): This is a machine registration of the most superior point of the external auditory meatus, not necessarily corresponding to the anthropometric landmarks in the skull proper, but nevertheless constant.

Orbitale (Or): The lowest point on the inferior bony margin of the orbit (average of two sides if two images seen).

Gnathion (Gn): The most outward and everted point on the profile curvature of the symphysis of the mandible. It is located by bisecting the angle formed by the mandibular plane and the facial plane.

Pogonion (Pg): The most anterior point on the symphysis of the mandible.

Menton (M): The most inferior point on the cross section of the symphysis of the mandible.

Gonion (Go): The most outward and everted point on the angle formed by the junction of ramus and body of the mandible on its posterior inferior aspect (average of two sides if two images seen).

Anterior nasal spine (ANS): The spinous process of the maxilla forming the most anterior projection of the floor of the nasal cavity.

Occlusal plane (OP): The general plane of the molars and premolars (use left side if two images apparent).

Frankfort plane (FH): Established on lateral headfilms by connecting the lowest point on the shadow of the left bony orbit with the uppermost part of the ear-rod.

Mandibular plane (MP): The Go-Gn line.

(SN): Sella to nasion line.

“Y” (growth) axis: Line connecting Sella with gnathion, representing approximate path of downward and forward growth of the face from beneath the cranium.

Palatal plane (PP): ANS to PNS.

Inferior alveolar nerve (IAN): The shadow cast by the bony canal in the mandibular ramus. A stable landmark for mandibular superimposition.

U1-SN: Angle formed by maxillary incisor to Sella nasion line – indicates inclination of incisors to cranial base.

L1-MP: Angle formed by mandibular incisor to the mandibular plane (Go-Gn).

Assessment of Cephalometric Tracing27

CriteriaSelf-assessmentPass/Fail
Cephalometric tracing and analysis accurately identified and practical assignment has been completed
Accurately traced the soft and hard tissues of the radiograph
Accurately completed the horizontal and vertical planes
Accurately completed the landmark identification
Accurately completed the addition of the angular measurements on the cephalometric tracing
Accurately completed the written cephalometric analysis
Accuracy of self-assessment – recognition of clinical acceptability

Repeat Exercise | Modify Exercise | Completed Exercise

Tutor Name and Signature: Date:

Assignment expected time of completion: 30-45 minutes each. Assignment due date: 5:00PM Thursday, 16th April 2026

Student Self-Assessment and Assessment of Cephalometric Tracing and Cephalometric Analysis

Space Analysis and Model Analysis

Background for Space Analysis28

Purpose To measure the size of the erupted permanent teeth and estimate the size of the unerupted permanent teeth and compare this estimate to the space available between the first permanent molars.

Assumptions

  1. There is a correlation between erupted mandibular incisors and the remaining succedaneous teeth.
  2. The prediction tables are valid for your patient.
  3. Arch dimensions do not change appreciably during growth.
  4. The mesial shift is predictable.
  5. All succedaneous teeth are developing normally.

Analysis Methodology

  • Analysis used: Tanaka-Johnson Analysis.
  • Applicability: These prediction tables were derived from a sample of Caucasians of Northern European descent. They are not applicable to different racial groups.
  • Alternatives: If the patient does not fit this population, you may:
    1. Complete the analysis recognizing these limitations.
    2. Obtain long cone periapical radiographs to measure mesiodistal widths (not routine due to radiation exposure).

Materials Needed

  • Dental casts or digital images of dental casts
  • Sketched or digital image of patient’s profile
  • Pencil
  • Space analysis form
  • Boley Gauge

Instrument Preparation When performing a space analysis using real dental casts, use a modified Boley gauge. Using a slow-speed handpiece and a heatless stone, grind the square ends of the measurement tips to points to accurately measure tooth widths.

Space Analysis Procedures

Space Analysis Form Instructions29

  1. Measurement of Available Mandibular Space: Measure the four segments (a, b, c, d) on the mandibular cast. Enter each on the form and sum them to represent the total space available in the arch.

  2. Measurement of Mesio-distal Permanent Mandibular Incisor: Measure the greatest width of each incisor on the digital image and calculate the sum.

  3. Measurement of the Available Maxillary Space: Determined in the same manner as the mandibular arch (see section 1).

  4. Measurement of the Mesio-Distal Permanent Maxillary Incisor Width: Measure the greatest width of each incisor on the digital image and calculate the sum.

  5. Mandibular Space Analysis: Transcribe data to this section to determine space discrepancy (+). Use the table at the bottom of the form (based on total mandibular incisor width) to establish the size of canines and premolars for one quadrant. Calculate total space required and compare to space available.

  6. Maxillary Space Analysis: Similar to section 5, but use the mandibular incisor width to estimate the size of the maxillary canines and premolars.

  7. Skeletal Jaw Relationship: Complete using the Facial Profile Analysis to project mandibular incisor stability and space implications based on skeletal class.

  8. Occlusion of the First Permanent Molars: Observe and record each side individually from the occluded cast images.

  9. Molar Shift: Measured for patients with Class I skeletal patterns and end-to-end molars. Total the right and left sides and subtract from the space discrepancy in section 5.

  10. Lip Support: Taken from the Facial Profile analysis. Over-supported or under-supported lips indicate protrusive or regressive incisors, respectively. Arch expansion is contraindicated when incisors are protrusive.

Interpretation and Resources30

  • Numerical Adjustment: Results from sections 5 and 6 must be adjusted based on skeletal relationships, molar occlusion, molar shift, and lip support.
  • Further Review: Refer to online materials: “The Space Analysis and Its Interpretation”.
  • Formative Assessment: Complete the online quiz on space analysis.

Model Analysis Components

  1. Symmetry, Space and Tooth Size
    • Symmetry: Check for asymmetric position of the entire arch (facial asymmetry) or asymmetry within the arch (crowding/tooth loss).
  2. Alignment, Crowding and Spacing
    • Position of teeth on the dental arch line.
    • Overlapping contact points.
    • Rotations.
    • Space analysis.

Model Analysis and Tooth Size

  1. Tooth Size Analysis
    • Proportion of maxillary to mandibular teeth.
    • Bolton analysis for tooth size discrepancy (affects ~5% of the population).
  2. Arch Form
    • Constricted, Narrow, or “V” shaped.
    • Normal types: Tapered, Square, Ovoid.
  3. Anterior-Posterior Relationship
    • Class I, II, or III.
    • Proclined or retroclined incisors.
  4. Vertical Relationship
    • Deep Bite vs. Open Bite.
  5. Transverse Relationship
    • Narrow vs. Wide.

Individual Practical Exercise Instructions31

  • Independence: Complete this exercise without outside assistance.
  • Identification: Clearly identify your assigned model set (1-14) on the worksheet. Use your student number and name.
  • Space Analysis (Model A): Complete the analysis for Model A.
    • Orthognathic Facial Profile: Models 1A, 4A, 6A, 11A, 12A, 13A, and 16A.
    • Convex Facial Profile (Mandibular Retrusion): Models 2A, 3A, 5A…

Practical Exercise Instructions (Continued)32

  • Profile Context: Models 7A, 8A, 9A, 10A, 14A, and 15A also have a Convex Facial Profile with mandibular retrusion or mild mandibular retrusion.
  • Clinical Considerations: Lip posture is considered within normal limits. Determine incisor inclination by cast appearance only.
  • Model Analysis (Model B): Complete a Model Analysis for Model B from your assigned set.
  • Submission: Write or type conclusions on a separate A4 sheet. Include student name/number and Model number.

Model Set Assignments

Model Set 1Model Set 2Model Set 3Model Set 4
AfsarimamaghaniChanChuaFarozi
BrayCheokDalla-FontanaFerguson
CarsonChingEbrahimiGill
ChampionChotaliaFangGoh
Model Set 5Model Set 6Model Set 7Model Set 8
HadiJahromyKatariaLiang, J
HasanainJeyakumarLacisteLiew
HuJovcevskiLeeLin, L
IndrawathanKamLiang, HLin, S
Model Set 9Model Set 10Model Set 11Model Set 12
Lin, XLukNguyenPaik
LiuMaragosNozhatPintaudi
LooMollarO’HehirPoi
LowNasbaOhQawas
Model Set 13Model Set 14Model Set 15Model Set 16
QiShawTongWeerathunga
SabeanSuVarmaWinegard
SaiyedSutantoWatersYang
ScollayTangWatkinsZheng
Zhou

Assessment of Model Analysis

Student Self-Assessment and Assessment Table33

CriteriaSelf-assessmentPass/Fail
Model set(s) accurate identified and practical assignment completed
Accurately measured teeth and arch segments
Accurately calculated space analysis
Accurate summary of the space analysis
Neat and accurate Model Analysis completed on A4 sheet
All parameters of model analysis are considered and accurate
Accuracy of self-assessment – recognition of clinical acceptability

Outcome Status

  • Repeat Exercise / Modify Exercise
  • Completed Exercise
  • Tutor Name and Signature:
  • Date:

Deadlines and Logistics

  • Expected completion time: 30 minutes per assignment.
  • Due date: 5:00 PM Thursday, 30th April 2026.
  • Note: Additional space analysis forms are available in the Orthodontics Clinic.

Footnotes

  1. Original PDF page 1: 2026ThirdYearDMDSemester1WorkBook, p.1 ↩

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Graph View