ortho sample case history 1

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CASE HISTORY

Doctors name: Date:

Patients name:

Date of Birth: Sex: Male/Female Age:

Father/Guardians Name:

Postal address:

Phone no: (Res/Off): -

Chief Complaint:

Family History:

Similar malocclusion present in Mother: Sibling:Father: None:

Significant Medical Record:

Allergy: Heart Diseases:

Epilepsy: Kidney Disease:

Diabetes: Rheumatic fever:

Trauma tothe Face /Surgery: Hepatitis:

Respiratory Disease: Tonsillectomy:

Any other condition:

Pre natal records: Negative Positive:


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Mile stones:

Teething: Normal Delayed Accelerated Walking: Normal Delayed Accelerated Speech: Normal Delayed Accelerated

Habits:

Digit sucking: Lip sucking: Oral breathing: Bruxism: Nail Biting: Tongue thrusting:

Past dental records:

1) Periodontal treatment :2) Endodontic treatment :

3) Extractions :

4) Restorations :

5) Orthodontic treatment :

Diet : Pure Veg. Mix Diet

Brushing habit : Patient cleans his / her teeth once / twice / thrice a Day with

horizontal Technique & he / she changes his / her toothbrush by every 6months.


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CLINICAL EXAMINATION

GENERAL EXAMINATION

Posture: Normal

Gait: Normal

Physique: Mesomorphic Ectomorphic Endomorphic

(Average) (Thin and tall) (Fat and Short)

Health: Healthy Sick

Growth status: Pre-pubertal Pubertal Post-Pubertal

EXTRAORAL EXAMINATION

1.Frontal view:

Cephalic type: Dolicocephalic Mesocephalic Brachycephalic

Facial type: Mesoprosopic Euryprosopic Leptoprosopic

(Average) (Broad & short) (Long & Narrow)

Symmetry: Symmetrical Asymmetrical

Facial Height: Total

Upper 1/3

Middle 1/3

Lower 1/3

Dentofacial defects/deformity:

Exposure of upper incisors:

Nasolabial angle:

Nasolabial fold:

Size of the nose: Average Large Small


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Lips Competence: Competent Potential Competent Incompetence

Size : Upper- Average Thick Thin

Lower- Average Thick Thin

Position : Upper- Normal High Low

Lower- Normal Everted Trapped

Tone : Upper- Normal Hypertonic Hypotonic

Lower- Normal Hypertonic Hypotonic

Posture : Upper- Incisal 1/3rd

Middle1/3rd

Cervical 1/3rd

Lip line active : Pleasant Toothy Gummy (mm)

Chin : Average Recessive Prominent

Mento Labial Sulcus:

Interlabial distance:

2.Profile:

Facial convexity: Straight Convex Concave

Facial divergence: Anterior Posterior Straight

Clinical FMA: Average Low High

Maxilla Normal Protrusive Retrusive

Mandible Normal Protrusive Retrusive

Position of chin: Normal Protrusive Retrusive


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TMJ

TMJ Right Left

Clicking

Crepitus

Pain

Movement


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Intra Oral Examination

Soft tissue

Gingival Condition : Good Average Poor

Plaque : Present Absent

Calculus : Present Absent

Recession:

Oral Hygiene Status : Good Fair Poor

Labial Frenum Maxillary: Normal Low High

Mandibular: Normal Low High

Tongue Size &S hape: Normal Large/Small

Posture : Normal Abnormal

Hard tissue

Palate : Average Shallow Deep

Others :

EXAMINATION OF TEETH

Dentition: Primary Mixed Permanent

Teeth Present:

Unerupted Teeth:


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Occlusion

Incisor relationship:- CL I CL II Div 1 CL II Div 2 CL III

Canine relationship- Left CLI CL II CL III

Right CL I CL II CL III

Molar Relationships: Left CL I CL II CL III

Right CL I CL II CL III

Axial Relationship:- Maxillary Incisors: Proclined Average Retroclined

Mandibular Incisors: Proclined Average Retroclined

Overjet : Overbite:

Openbite : Crossbite: -

Midline-coincident: Upper:

Lower:

Curve of Spee : Average Flat Deep

Arch Form : Upper- Expanded Normal Contracted

Lower- Expanded Normal Contracted

Teeth extracted :

Hypoplastic& malformed teeth :

Heavily restored teeth :

Non vital teeth :

Rotations :

Carious teeth :

Crowding :

Spacing :


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Functional analysis

Mandible (Function) :

Inference: -

Provisional Diagnosis:


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Cervical Vertebrae Maturation Indicators

Hand Wrist Radiograph:

PP2 - Stage (6) - Epiphysis of theproximal Phalynx of the Index finger (PP2)

has same width as the diaphysis. 2 years

before the onset of pubertal growth spurt

MP3 -Stage (8) Epiphysis of the middle

Phalynx of the middle finger has the same

width as the diaphysis. 1 year before the

onset of the pubertal growth spurt

Sesamoid Ossification (Stage 3) - First

mineralization of the Ulnar Sesamoid bone

Of the Metacarpophalyngeal joint of the

thumb (seen radiographically) shortly

before or at the beginning of the pubertal

growth spurt

MP3 Cap Stage (8) The diaphysis is

covered by the cap shaped Epiphysis, in the

middle Phalynx of the Third finger. The peak

of the pubertal growth spurt

Dp3 Union Stage (7) Union of the epiphysis

and diaphysis at the distal Phalynx of the

middle finger .End of the pubertal growth.

MP3 Stage (8) Union of the epiphysis and

the diaphysis at the distal Phalynx of the

middle finger. End of the pubertal growth

RU Stage (30) Complete union of the

diaphysis and epiphysis of the radius.Skeletal Growth is finished.

In female, menarche (Onset of Menstruation) usually Occurs between stages 4 and 5

Last Skeletal maturation Stage reached:

Inference:


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MODEL ANALYSIS:

Maxillary Mandibular

Number ofteeth

Mesio-distalWidth

Total ToothMaterial

Sum ofincisors

Proclinationby direct

method

Crowding Spacing Rotation Arch Shape Arch

Symmetry

Midline

Curve ofSpee

PalatalDepth


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INDICES

1. PONTS INDEX:

Dr.Pont, a French scientist in 1880 studied normal individual and derived following index.

He found out that some co-relation exists between size of tooth and the arch width. It gives

the width of arch in premolar and molar region in relation to the sum of incisal width. This

analysis helps in:

Determining whether the dental arch is narrow or normal Determining the need of lateral expansion Determining how much expansion is possible

Width in premolar region :

=Sum of incisors X 100

80

= /80 X 100

=

Width in molar region :

=Sum of Incisors X 100

64

= /64X 100

Inference:

Region Actual

value(mm)

Calculated

value(mm)

Difference

(mm)

Inference

4|4

6|6

If the measured value is less than the calculated value, then the archis contracted.

If the measured value is more than the calculated value, then the arch is expanded.


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2. CHADDHAS INDEX:

In 1964 Dr. Chaddha modified Ponts index to suit Indian population.

Width in Premolar Region:

= Sum of Incisors X 100

82.5

= /82.5X100

=

Width in Molar Region:

=Sum of incisors X 100

63.7

= /63.5X100

=

Inference:

If the measured value is less than the calculated value, then the arch is contracted.

If the measured value is more than the calculated value, then the arch is expanded.

Region Actual value

(mm)

Calculated

value (mm)

Difference

(mm)

Inference

4|4

6|6


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3. NANCE & CAREYS INDEX:

It helps in determining the extent of discrepancy between the arch perimeter

& available bone. The arch perimeter is measured along a brass wire which is

placed touching the mesial surface of first molar over the buccal cusps of pre-

molar &incisal edges of anterior teeth on an ideal cast.

If the teeth are Proclined, the brass wire is adapted in corrected position. If

the teeth are Retroclined, the wire is adapted labial in corrected position.

Wire should be adapted on crest of alveolar ridge. The formula to calculate

linear dimension is:

LD= LA + 2x; where

o LD = Linear dimension (by brass wire method)=o LA = Sum of Incisors =o X = Mesiodistal dimension of any side 3, 4&5 =o LD = LA + 2X

=

LD measured by brass wire ----

Difference:

If the discrepancy between the arch length & tooth material is:

0-2.5mm =Minimal tooth material excess, thus non extraction case.

2.5-5mm = Second premolar extraction case.

>5mm = First premolar extraction case.

By brass wire Calculated LD Difference Inference

INFERENCE-


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4. Bolton Tooth Ratio

Ant. Ratio = MAND6TM 100 =

MAX6TM

Ant. Ratio =

Overall Ratio = MAND12TM 100 =

Max12TM

Overall Ratio =

Evaluation Chart for Bolton Analysis

Anterior Ratio Posterior Ratio

Interpretation for Bolton Analysis:

Overall Ratio --

Anterior Ratio

Max 12 Mand12 Max 12 Mand12 Mand12 Mand6

40 30.9 45.5 35 50.5 38

40.5 31.3 46 35.5 51 30

41 31.7 46.5 35 51.5 39.8

41.5 32 47 36.3 52 40.1

42 32.4 47.5 36.7 52.5 40.5

42.5 32.8 48 37.4 53 43.8

43 38.2 48.5 37.4 63.5 41.3

43.5 33.6 49 37.8 54 41.7

44 34 49.5 38.2 54.5 42.1

44.5 34.4 50 38.5 35 42.5

45 34.7

Max

12Mand12 Max

12Mand12 Mand12 40Mand12

85 77.6 94 85.8 103 94

86 78.5 96 86.7 104 95

87 79.4 96 87.6 105 95.9

88 80.3 97 88.6 108 96.8

89 81.3 98 89.5 107 97.8

90 82.1 99 90.4 108 98.8

91 83.1 100 91.3 109 99.5

92 84 101 92.2 110 100.4

93 84.9 103 93.1


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4. ASHLEY HOWES INDEX

Ashley had found a relationship between tooth width of twelve teeth anterior to second

molar and width of dental arch in first premolar region.

Canine fossa width The canine fossa is found distal to canine eminence. The measurement

of the width from canine fossa to that of the other side gives the width of dental arch at the

apical base.

If the value is less than 37% then it indicates that there is need for the extraction If the value is in between 37% and 44% then it indicates the case is referred as

border line case

If the value is 44% or more, then it can be possible to treat without extraction

Ashley Howes Formula:

=Canine fossa width 100

Total tooth material

=

=

Inference:


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Angles Classification

Incisors:

Over jet: Over bite:

Open bite: Cross bite: -

Midline:Upper Arch:

Lower Arch:

Arch Form: Upper Arch: Lower Arch:

Curve of Spee:

Teeth Measurements:

Right Left

Molar relationship

Canine relationship

UR UL LR LL

1

2

3

4

5

67

6Ant.

TTM


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SPACE ANALYSIS

MAXILLARY ARCH

Space required1. Proclination= 2 (X-2)

=

Where x ix proclination by direct method

2. Crowding

Region Measured mesio-

distal width

Mesio- distal

width available

Total mesiodistal

width

Space required

3. Derotation of anteriors: -


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Space available1. Spacing:

2. Derotation of posteriors: -

3. Expansion: -

4.Extraction:

Mesio-distal width of 5/5 =

Anchor loss = mesiodistal width

=

Space available by extraction = space required anchor loss

=

=

Total space available is __mm, total space required is__mm

Inference:


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MANDIBULAR ARCH

Space required1. Proclination= 2 (x)

=

Where x ix proclination by direct method

2. Crowding: -

3. Derotation of anteriors: -

4. Curve of spee:

Total Space required =


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Space available1.Spacing: -

2. Derotation of posteriors: -

3. Expansion -

4. Extraction: of 5/5

Mesio-distal width of =

Anchor loss = mesiodistal width =

=

Space available by extraction = space required anchor loss

=

=

Inference:


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Summary of space analysis

Correction of Maxillary arch Mandibular arch

Space required Space available Space required Space available

Crowding

Proclination

Spacing

Curve of spee

Extraction space

Expansion

Proximal stripping

Total

Inference:


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DOWNS ANALYSIS

One of the most frequently used Cephalometric analysis. Downs analysis consist of ten

parameters of which five are skeletal & five are dental

Variable Mean Value Range Measured

value

Inference

Skeletal

Facial angle

Angle of convexity

A-B plane angle

Mandibular plane

angle

Y axis

Dental

Cant of occlusal plane

Lower incisor to

occlusal plane

Lower incisor to

mandibular plane

Interincisal angle

Upper incisor to A-

pog line


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STEINER ANALYSIS

Cecil C. Steiner developed analysis with idea of providing maximum information with least

information. He divided into three parts skeletal analysis, dental analysis, and the soft tissue

analysis

Variable Mean Value Measured value Inference

Skeletal

SNA angle

SNB angle

ANB angle

Occlusal plane angle

Mandibular plane

angle

Dental

Upper incisor to NA

angle

Upper incisor to NA

linear

Lower incisor to NB

angle

Lower incisor to NBlinear

Interincisal angle


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TWEED ANALYSISTweeds analysis makes use of three planes that form an diagnostic triangle.

The planes used are

1. Frankfort mandibular plane angle(FMPA)2. Incisor mandibular plane angle(IMPA)3. Frankfort mandibular incisor angle(FMIA)

The objective of analysis is to include determination of position of lower incisor & evaluation of

prognosis of case

Variable Mean value Range Measured

value

Inference

Frankfort mandibular

plane angle(FMPA)

Incisor mandibular

plane angle(IMPA)

Frankfort mandibular

incisor angle(FMIA)

THE WITS APPRIASAL

It is the measure of the extent to which maxilla & mandible are related to each one in Sagittal plane

AO to BO distance

Inference:


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CEPHALOMETRICSUMMARY

1)Skeletal:

A) Vertical:Rotationof mandible : Neutral Horizontal Vertical

Rotationofmaxilla : Normal Anteinclination Retroinclination

Rotation of jaw base : Divergent Convergent Same Direction

UpwardIdownward.

B) Sagittal:Maxilla : Orthognathic Retrognathic Prognathic

Mandible : Orthognathic Retrognathic Prognathic

Jawbasesrelationship : Class I Class II Class I I I

C)Transverse:

2) Dental

Incisors - Upper Lower

Molars - Upper Lower

3)SoftTissue:

Nose :

Lips :

Chin :

Profile:


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PROBLEM LIST

Skeletal:

Dento Alveolar:

Soft Tissue:


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DIAGNOSIS & TREATMENT PLAN

Diagnosis:

Probable Etiology:

Treatment Objectives:


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Provisional Treatment Plan:

Final Treatment Phase:

Alternate Treatment Plan:

Prognosis:

ortho sample case history 1

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