The purpose of this study was to determine the esthetic, physiological, and pathological impairments in orthodontic patients at the first examination, and to determine the relationship between these impairments and morphological characteristics of malocclusions. Our study included 123 patients (44 men, 79 women)who were initially examined at Obihiro Art orthodontic clinic. The mean age at the time of first examination was 12.8 years (range : 6-47 years). The esthetic, physiological, and pathological impairments were determined from the questionnaires answered by the patients and/or their parents and from the findings made by the orthodontist. The morphological characteristics of malocclusions comprised 5 measurements : overbite (OB), overjet (OJ), ANB angle(ANB), upper arch length discrepancy(uALD), and lower arch length discrepancy(lALD). Our results showed that the most common chief complaint among the pre-orthodontic patients was esthetic impairment 111 patients(90.2%) had esthetic impairment, whereas 98 patients(79.7%) had physiological and pathological impairments. The physiological and pathological impairments were divided into 5 categories, namely, food impaction/tooth brushing disturbances (56.9%), masticatory impairment(47.2%), trauma in the oral region(39.0%), speech disturbances(36.6%), and lip closure disturbances/mouth breathing (24.4%). Analysis of relationships between these 5 categories and the patients' morphological measurements showed a significant correlation between the following 8 pairs: (1)food impaction/tooth brushing disturbances and uALD; (2) food impaction/tooth brushing disturbances and lALD; (3) masticatory impairment and OB;(4)masticatory impairment and OJ;(5)trauma in oral region and OJ;(6)speech disturbances and uALD;(7)lip closure disturbances/mouth breathing and OJ;and(8)lip closure disturbances/mouth breathing and ANB. The results of this study suggest that at the first examination, most of the orthodontic patients not only have esthetic impairments but also have physiological and pathological impairments. Moreover, these impairments and the morphological characteristics of malocclusion are closely associated.

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