case presentation 3rd year

Orthodontic Case Presentation

Done By:Dr. Mutaz H.AL-Shakhatreh3rd Year Orthodontic Resident

Supervised by:Dr. Ahmad Al-Tarawneh.

Dr. Raed Al-Rbata.

Patient’s DetailsPatient’s Initials: H.MGender: Male.Date of birth: Dec 25th , 1985.Occupation: Sergeant in royal air force.Age at the beginning of treatment: 30

years & 8 months.

Chief Complaint

“I feel that my upper jaw advanced forward, and the lower jaw is backward, and there are spaces between

my upper teeth”

Relevant Medical History

“Patient Denied any Medical problems”

Relevant Dental History

No regular check up.Multiple amalgame restorations.

No history of oral and dental trauma.

Extra Oral Assessment- Frontal -

Extra Oral Assessment- Profile -

Extra Oral Assessment- Skeletal -

Mild Asymmetric Face. convex profile.Skeletal Class II Pattern. Normal LAFH.


Anteroposterior:

Convex Profile.


Vertical:

Normal LAFH.


Transverse (non-smile):

-Mild Asymmetric Face.The chin & nose deviated to the left.


Transverse (smiling):

-Normal level occlusal plane(no canting).-upper midline to facial mildline:Coincident.-lower midline to upper midline:Off to the left side by 2-mm.


Soft Tissue:1.A-P: NLA: obtuse. Marked labiomental fold.2.Vertical: Competent lips. Low smile line. 3.Trasverse: Wide smile.

Extra Oral Assessment

No HabitsNo TMDNo Displacement

Intra Oral Examination

Poor Oral Hygiene.(calculus at lower labial segment)

Mild Gingivitis.Teeth Present (Permanent Stage)

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

Intra Oral Examination- Frontal -

Incisor Classification: Class II/1Centerlines: Upper Coincident with Midline

of the Face. Lower Shifted 2mm to the left.

Overbite: complete.Overjet: 7mm.

Intra Oral Examination- Right Buccal Segment -

Molar Relationship: Class ICanine Relationship: ¼ unit Class III

Intra Oral Examination- Left Buccal Segment -

Molar Relationship: 1/2 unit Class IICanine Relationship: Class I

Intra Oral Examination- Upper Occlusal View-

Intra Oral Examination- Upper Occlusal View-

U Shaped Arch.Multiple Restorative Teeth 6 56

No Missing Teeth. Rotated 1 1

Intra Oral Examination- Lower Occlusal View-

Intra Oral Examination- Lower Occlusal View-

U Shaped Arch.No Missing Teeth.Rotated 2 23Lingually in-standing lower lateral incisor.Curve of Spee: 3.5mm Deep on Right side

3mm on left Side

Anterposterior: Over jet (OJ): 7 mm.

Rt.molar: class I. Lt.molar: ½ unit class II.

Rt.canine: ¼ unit class III. Lt.canine: class I.

-Study Model Analysis-

-Study Model Analysis-Vertical:

Complete Overbite.

-Study Model Analysis-

Rt.side: curve of spee 3.5 mm. Lt.side: curve of spee 3 mm.

-Study Model Analysis-Transverse: the lower dental midline to the upper midline is shifted by

2 mm to the left.

-Study Model Analysis-Maxillary arch:-Symmetry: symmetrical to a great Extent.-Rotation: upper central incisors.-Intercanine width: 37 mm.-Intermolar width: 45 mm.Mandibular arch:-Symmetry: asymmetric.-Rotation: 2 135-Intercanine width: 23 mm.-Intermolar width: 42 mm.

Space Analysis

Upper Arch:Space Available: 86 mmSpace Needed: 78 mm+8 mm (Spacing).

Lower Arch:Space Available: 71 mmSpace Needed: 64 mm-7 mm space needed (moderate crowding).

Bolton Ratios

Anterior Ratio (3 - 3): 79% ( Normal: 77%)

Overall Ratio (6 - 6): 89.75% ( Normal: 91%)

Pre-Treatment IOTN- Aesthetic Component -

• 5(moderate to border line need)

Pre-Treatment IOTN- Dental Health Component -

• 3.b• Sever Treatment Need.

Radiographic Examination- OPT -

All Features Look Normal.No Apparent Pathology.All Teeth Present. Wisdom Teeth Erupted.

Radiographic Examination- Lateral Cephalogram -

Cephalometric AnalysisVariable Pre-Treatment Normal Value Ceph .Interpretation

SNA 82 81 +- 3 Normal Maxilla

SNB 73.2 78 +- 3 Retrognathic Mandible

ANB 8.8 3 +- 2 Skeletal Class II

S-N/ANS-PNS

7 8 +- 3 Normally Inclined Maxilla

Corrected ANB

8.3

MMPA 24.4 27 +- 3 Normal Vertical Proportion

UAFH 42

LAFH 45

LAFH % 51.7% 55 +- 2 Reduced Facial Proportion

U1/Mx 103 108 +- 6 Normally Inclined Upper Incisors

L1/Mn 101 93 +- 6 Proclined Lower Incisors

IAA 137 133 +- 10 Normally Inclined Incisors

Wits Appraisal

2 0/-1

Cephalometric InterpretationAntero-posterior :

1. Normal Maxilla. 2. Retrognathic Mandible.

3. Skeletal Class II. Vertical: 1.Normal Vertical Proportion. 2. Reduced lower anterior facial

height. Dental 1.Normally inclined upper

incisors 2.proclined lower incisors.

Diagnostic SummaryA 30 year old male patient, denied any medical problems, complaining from “ my upper jaw advanced forward, and the lower jaw is backward, and there is spaces between my upper teeth” . He has a class II div 1 Incisal relationship on a Class II skeletal base, complicated by increased OJ (7mm) and Complete OB , moderate crowding in the lower labial segment and spacing in the upper jaw, multiple rotated teeth, and shifted lower midline. He has a class I Molar relationship on right side and ½ unit class II on left side and a Class I Canine on the left side and ¼ unit Class III canine relationship on the right side.

Problem List1. Poor oral hygiene. 2. Mild gingivitis. 3. Calculus on the lower lingual segment. 4. Asymmetric face, chin & nose deviated to the left.5. Convex profile.6. Obtuse nasolabial angle.7. Marked labiomental fold.8. Class II skeletal base.9. Moderate crowding in lower labial segment.10. Lingual in-standing lower lateral incisor.11. Spacing in the upper jaw.12. Increased overjet 7mm.13. Complete overbite.14. Class II div 1 incisal relationship.15. Class I molar relationship on right side and ½ unit class II on the left side.16. midline shifted 2mm to the right.

Treatment AimsReferral to Perio-clinic for Improvement of OH.1.Skeletal: -Achieve a corrected skeletal base relationship.2.Soft tissue: -Achieve a normal facial proportion.3.Dental: -Relieve crowding. -Level and align the arches. -Achieve corrected overbite (edge-centroid

relationship). -Achieve corrected overjet. -Achieve corrected buccal segment relationships.

- correct upper and lower midlines .

Treatment Plans1st Option:1.Initial orthodontic treatment:

Extraction of 4 5 **to correct midline shiftUpper and lower fixed appliance2.Orthognathic surgery : Initial plan: advancement of mandible. And maxilla (to achieve

better facial esthetics )3.Post-surgical orthodontic.4.Finishing.5.Retention: upper and lower fixed retainer and upper essix.

Justification (1):1.Extraction of lower 4,5s to correct the moderate crowding

and the proclined lower lower labial segment. Asymetrical extraction to correct midline shift.2.Correct the rotated teeth.3.Dental decompensation before surgery.4.Surgical mandibular and maxillary advancement to correct

the skeletal discrepancy.5.Upper and lower fixed retainer (17.5 mil braided steel

archwire) for long period of time(because of spacing and rotated incisors)

6.Upper essix as retainer after correction of deep overbite, night time wearing (1.5mm thickness).

Thank You

case presentation 3rd year

Health & Medicine