Orthodontic Case Presentation

Orthodontic Case Presentation Done by : Osama Al Ziadat 3rd Year Orthodontic Resident

Supervisors: Dr. Ahmad Al Tarawneh Dr. Raghda Shamout Dr. Anwar Al Rahamneh Dr. Hanan Al Habarneh

Personal Data

Name: D.A

Age: 15 years old Occupation: Student

Marital status: Single Nationality: Jordanian

Medical and Dental HistoryMedical History: Denied any medical problems

Dental History: Routine Dental Procedures

Habits: Tongue Thrusting

Motivation: Internally Motivated

Chief Complaint There is space between my upper and lower anterior teeth

Extra-Oral Photos

Skeletal Assessment (Anterioposterior)

Class II Skeletal Pattern (convex profile)

Skeletal Assessment (Vertical)

Average Anterior Lower Facial Height

Skeletal Assessment (Transverse)

Mild facial Asymmetry

TMJ Examination

Clicking and Crepitus : No

Tenderness to palpation : No

Displacement: No

Soft Tissue Examination

Thin, incompetent lips.

large size tongue with thrusting.

Soft Tissue Examination(Facial Angles)

Frontonasal angle: 96

(Normal 115-135) Nasolabial angle: 85

(Normal 90-110)

Labiomental angle: 150

(Normal 114-140)

Smile Aesthetics Assessment

The Buccal Corridor Ratio = 7% (Medium-broad)

100% of incisors crowns with interproximal gingiva only showing

The upper incisors do not touch the lower lip and the incisal edges not parallel to it

Intra Oral Photos

Intra-Oral ExaminationPoor Oral Hygiene

Normal oral mucosa

Permanent dentition

Teeth Present :7654321 | 1234567-------------------------7654321 |1234567

Carious teeth : UR7 ,LL6

Orthopantomogram

All third molar buds are presentNo apparent pathology Restorations on the UR6 , UL6 and LR6

Square shaped Lower Arch

Mild crowding

Rotated canines and second premolars

U-shaped Upper Arch

No crowding

rotated Canines

Class II div 1 Incisor Relationship

Overbite reduced

Overjet 6 mm

Midline:

Upper Arch 1 mm to the left

Lower Arch 2 mm to the right

Right & Left Molars Class I Relationship

Right Canine Class I

Left Canine Class III 1/ 4 unit

Study Model Analysis

Anteroposterior:Right sideMolar Class ICanine Class I

Left Side Molar Class I Canine Class III 1/4

Transverse

Midline:

Upper Arch 1 mm to the left

Lower Arch: 2 mm to the right

Vertical :Overbite Reduced

Horizontal :Overjet = 6 mm

Right side:1mm Curve Of SpeeLeft Side: 1mm Curve Of Spee

Lower Arch

Square shaped arch form

Intermolar(MB-MB) width 49 mm

Intercanine(cusp tip cusp tip) width 29 mm

Upper Arch

U-shaped arch form

Intermolar(MB-MB)width: 55mm

Intercanine(cusp tip cusp tip) width: 37 mm

Deep palatal vault

Bolton Ratio Analysis Over all ratio = 92 /95 96.8 % Increased Normal: 91.3%Anterior ratio = 40 /45 88.8 % increased Normal: 77.2%

R

Royal London Space Analysis

Visualized Treatment Objectives

Midline-Molar Position

R LMolarMidline Molar2001

Lower arch discrepancy

Anticipated Treatment Change

1200001.5

IOTNDental Health ComponentGrade 3.a

IOTNAesthetic ComponentGrade Not included

Cephalometric Analysis

Diagnostic Summary D.A is a 15 year old male, denied any medical problems, has poor oral hygiene ,tongue thrusting habit, complains of space between his upper teeth and lower teeth. He has a class II/I incisor relationship based on class II skeletal pattern, Average anterior lower facial height, incompetent thin lips, and a convex facial profile. O.J of 6 mm, reduced O.B, Upper midline shift to the left 1 mm and lower midline shift to the right 2 mm, no crowding in the upper arch and mildly crowded Lower arch. Molar and Canine relationships are class I on both sides.

Problem ListPathological problems:- Poor Oral Hygiene- Carious UR7 ,LL6

Chief Complaint: There is space between my upper and lower anterior teeth

Skeletal Problems:- Mild Skeletal class II pattern- Mild asymmetry

Soft tissue Problems : - Convex profile - Large tongue with thrusting habit - Incompetent lips

Dental Problems :- Increased overjet 6 mm(Proclined upper incisors) - Reduced overbite- Crossbite tendency UL5 - Rotated upper , lower canines and lower 5s - Upper midline shifted 1 mm to the left - Anterior bolton ratio discrepancy ( small Upper 2s) - Lower midline shifted 2 mm to the right

Treatment AimsImprove oral hygieneTreat carious teethBuild up upper lateral incisors Accept mild skeletal discrepancyAccept mild facial asymmetry Correct incompetent lipsTerminate tongue thrusting habit Correct centerlines shiftmaintain Class I molar and canine relationshipsReduce OJ Increase OBCorrect UL5 crossbite tendencyFinishing and detailing of occlusionRetain corrected results

Treatment Plan(non extraction camouflage modality)Improve Oral Hygiene

NANCE + Tongue Crib , Lingual Bar

F.A :Upper Andrews 0.22 slot + Lower Roth 0.22 slot prescriptions

Retention:Upper Hawley Retainer(short term) + Permanent retainer (long term),Lower V.F.R(short term)+Permanent Retainer (long term)

JustificationOHI : Visible Plaque and swollen interproximal gingiva

Camouflage :Patients chief complaintGood vertical facial proportions Mild Class II skeletal Normal soft tissue features (incompetent lips can be corrected orthodontically)

Non Extraction :Spaced Case with over average proclined anterior teeth

Anchorage using NANCE + LB to maintain class 1 molar relationship

Tongue crib : to terminate tongue thrusting habit

Justification ( Continued)Fixed appliance using Andrews and roth prescriptions: For 3D tooth movement

Correct UL5 crossbite tendency using Archwires expansion

0.22 slot used for better sliding mechanics

To give least positive torque available to help in reducing O.J and retroclination of the anterior teeth

Retention :Upper Hawley 6month full time wear and 6 month night time + permanent retainer(3 to 3) due to spacing and rotations

Lower V.F.R night wear (short term retention) + permanent retainer (5 to 5)due to late mandibular incisors crowding and rotations (long term retention to reduce possibility of relapse)

THANK YOU.