Orthodontic case presentation

Orthodontic Case Presentation

Done by : Dr. Lana Obeidat

Supervised by: Dr. Ahmad Al Tarawneh Dr. Raed Al Rbata Dr. Nancy Al Sarayrah

Patient Information

Name: A.KAge: 15 years old

Occupation: StudentMarital status: Single

Residence: AmmanNationality: Jordanian

Medical and Dental History

Medical History: Denied any medical problems

Dental History: None Habits: None

Chief Complaint

“My teeth are sticking out and my lower teeth are overlapping each other“.

Extra Oral Photos

Skeletal Assessment

Anteroposterior:Class II Skeletal Pattern

Skeletal Assessment

Vertical Assessment:Increased lower

facial height

Skeletal Assessment

Transverse:Mild facial Asymmetry

TMJ

No signs of TMD (No clicking, crepitus, and tenderness to palpation).

Normal range of opening, lateral movement, and no displacement.

Soft Tissue Assessment

Lip tonicity and competence:

Thick, incompetent lips.

Soft Tissue Assessment

Convex facial profile.

Frontonasal angle:

133 (Normal 115⁰-135⁰) Nasolabial angle:

109 (Normal 90⁰-110⁰) Labiomental angle:

115 (Normal 114⁰-140)

Soft Tissue Assessment

Smile Aesthetics Assessment

• 70% crown of incisor show.• No gingival show.• Smile extends to canines.

• Smile is acceptable

Soft Tissue Assessment

Commissure height > philtrum height.

Tooth show at rest more than 7 mm.

Smile Analysis

• Buccal corridors: narrow.

• The smile arc: Incisal edges of upper anterior teeth are parallel to the upper border of the lower lip.

Tooth Proportions

• Golden proportion for maxillary anterior teeth is 70%.• Height: width 1:1

Gingival Height , Connectors

Gingival level of lateral 0.5 mm lower to central incisors.

Gingival connectors between lateral and central > connectors between canine and lateral.

Intra Oral Photos

Intra Oral Photos

Intra Oral Examination

• Fair Oral Hygiene.• Normal oral mucosa.• Teeth Present in oral cavity (Permanent dentition).

7 6 5 4 3 2 1 1 2 3 4 5 6 7 6 5 4 3 2 1 1 2 3 4 5 6 7

Lower Arch U-shaped lower arch.

Anterior segment:- Crowded anterior segment- Left canine has no space- Lower left lateral, Lower left and

right central positioned lingually.

Buccal segment: Rotated LR5

Midline shift: 2 mm to the right caused by the lower arch

Upper Arch U-shaped arch.

Anterior segment:- proclined upper incisors- Slightly buccally

positioned upper right canine.

- Slight rotation on the upper right 4

Periodontal Health and Teeth Health Periodontal health: fair oral hygiene Dental health: staining on the upper

incisors lingually Carious 6 6

6 4 6

Anterior Segment Relationship

Class II div. I incisor relationshipLower midline shifted to the right 2 mm (upon examination)Overjet 7 mmDeep Complete overbite 95%

Buccal Segment Relationship

Molar relationship: L: Class I R: Class I

Canine relationship: L: Class I R: Class I

Study Model Analysis

Study Model AnalysisAnteroposterior

Canine : Class IMolar: Class I

Canine : Class IMolar: Class I

Study Model AnalysisTransverse Lower midline shift to the right side 2 mm.

Study Model AnalysisVertical O.B= deep 95% complete to the soft tissue .

Study Model Analysis

Right side: 3 mm curve of spee

Left side: 3 mm curve of spee

Study Model AnalysisUpper arch U shaped arch form. Dental Symmetry.

Intermolar width: 43 mm.

Intercanine width: 39mm.

Deep palatal vault

Study Model Analysis

Lower arch U shaped arch form. Dental Symmetry. Intermolar width 43mm. Intercanine width 27mm.

Bolton Analysis

11 8 7 9 7 9 9 7 9 7 8 11 U

6 5 4 3 2 1 1 2 3 4 5 6

11 8 8 7 7 6 6 6 8 8 9 12 L

Anterior Bolton ratio= 40/50*100= 80 %( normal value: 77.2± 1.65%) Overall Bolton ratio= 94/102 * 100= 92.1%(normal value: 91.3± 1.91%)

Royal London Analysis

Upper Arch Lower Arch

1 mm 13 mm Crowding/Spacing- - Angulation change- 1 mm Leveling curve of

Spee1.5 mm - Inclination change- - Arch width change 10 mm - Incisors A/P change

Visualized Treatment Objectives Midline-Molar relationship

R L

2

Molar

Molar

Midline

Lower arch discrepancy

-9-9

-3-3

- -

-1 -1

+2 -2

-8-8

-6-6

Crowding 3*3 6*6

Protrusion

Curve of SpeeMidlineTotal 3*3 6*6

R L

Visualized Treatment Objectives

Anticipated treatment change

(7)

(8)

(7)

(8)

2 7

Midline

Molar

Molar

Cuspid

Cuspid

Visualized Treatment Objectives

Pre-Treatment IOTNDental Health Component

Grade 4 a Increased overjet greater than 6 mm and less

than 9 mm.

Pre-Treatment IOTNAesthetic Component

Grade 9

Cephalometric Analysis

Variable Pre-Treatment

Normal value

SNA 87º 81 ± 3

SNB 80º 78 ± 3

ANB 7º 3 ± 2

S-N/MX 10º 8 ± 3

ANB* 4

MMPA 30º 27 ± 3

FMA 30 28 ± 3

LFH 57% 55 ± 2

LAFH/LPFH 58% 61± 2

U1/Mx 124º 109 ± 6

L1/Mn 95º 93 ± 6

IIA 124º 133 ± 10

Wits Appraisal

6 mm 1 ±1.9 F

Diagnostic Summary

A.K is a 15 year old male, denied any medical problems, complains of crowding in lower teeth and protruding upper teeth . He has a class II/I incisor relationship based on class II skeletal pattern, increased lower facial height, incompetent thick lips, and a convex facial profile. O.J of 7 mm, deep complete O.B 95%, lower midline shift to the right 2 mm, mildly crowded upper arch and moderate crowded lower arch (localized anteriorly). Molar and Canine relationships are class I on both sides

Problem List Carious UR6,UL6,LR6,LR4,LL6.

C/C “Protruding upper teeth and lower incisor crowding”.

Skeletal:Class II skeletal pattern, retruded chin.Increased lower facial height.Mild Asymmetry.

Soft tissue:Convex profile.Incompetent lips.Shallow buccal corridor.

Dental:Lower mid line shift 2 mm to the right.Increased Overjet 7mm.Deep complete over bite 95%.Out of the arch lower right canine.Rotated lower right 4.Proclined upper incisors.Bucally positioned right canine. Lower incisor crowding.Anterior bolton discrepancy.

Treatment Aims Treat carious UR6,UL6,LR6,LR4,LL6.

Relieve lower anterior crowding Correct proclination of upper incisors

Skeletal:Accept Class II skeletal pattern.Correct lower facial height.Correct chin retrusionAccept Mild Asymmetry.

Soft tissue:Achieve competent lips.Accept smile esthetics.

Dental:Correct lower mid line shift 2 mm to the right.Correct Overjet.Correct Overbite.Correct position of right canine.

Treatment Plan

(Extraction case )1. OHI.

2. Upper TPA, headgear (high pull) , lower lingual arch

3. Extraction of:

4. Upper and lower fixed appliance (MBT). Advancement Genioplasty.

5. Retention (upper Hawley retainer , Lower fixed retainer).

4 4

4 4

Justification Extraction of:

To provide space for crowding, for correction of proclination, for correcting OJ.

Using TPA to provide vertical anchorage for upper molars, to use the space for the OJ and inclination correction , ( with stripping in upper anterior teeth to correct Bolton discrepancy )

Headgear for anchorage

Using lower lingual arch to provide anchorage for lower molars, to use the space for correcting the anterior crowding

Fixed Appliance MBT prescription slot 0.022: torque is needed not to tip anterior teeth while being retracted.

Fixed Appliance Alignment of rotated teeth. Closing of spaces. Leveling curve of spee. ( using intrusion mechanics on the upper anterior teeth) Correct lower midline shift.

Advancement Genioplasty: To correct the retruded chin.

Retention ( Upper Hawley retainer, Lower fixed retainer ) Upper hawley retainer: to allow settling for the upper teeth.Lower fixed retainer: due to anterior crowding of lower arch, intercanine width changes, bodily

movement of the lower teeth.

4

4

4

4

The End