CEPHALOMETRIC COMPOSITE ANALYSIS

O.P. No: 542296

Patient Name: THAHANI AGE: 10 yrs
SEX: F Doctors Name: Dr. Mariyam Zehra

COMPOSITE NORMAL PATIENT INFERENCE

SKELETAL VALUES VALUES

MAXILLA
S.N.A 82 ± 2.30 870 Forwardly placed Maxilla irt CB

Pt. A TO N perpendicular 0 ± 2 mm 9 mm Forwardly placed maxilla

EFFECTIVE MAX 85.0 + 2.3 95 mm Increased for the age by 6mm
LENGTH
MANDIBLE
S.N.B 79.2 ± 1.70 79º Normally placed
mandible wrt to CB
Pog TO N perpendicular -4.4+/-4.7mm 2 mm Normally placed chin
FACIAL ANGLE 82-95o 880 Normal
(87.8o)
EFFECTIVE MAND 106.1+3.4 mm 111 mm Increased for the age.
LENGTH For 111-114mm of mandible,
maxilla should be 88 mm, maxilla
is short by 26 mm for that
mandible

MAXIILO-MAND DIFF 21 16 mm Decreased

+2.7mm
A.N.B 30 8º Class II Skeletal Pattern
WITS APPRAISAL FEMALE (BO is AO ahead of Class II Skeletal Pattern
ahead of AO by 0 BO by 9 mm
mm)
BETA AN GLE 270 to 350 25 º Class II Skeletal Pattern
Yen angle 117-123 0 120º Class I Skeletal Pattern
VERTICAL
Mand. Plane Angle 17-280 20º AGP
Sn-GoGn 320 36º HGP
Y-AXIS 53-66 0 55º AGP
FACIAL 900 85º HGP
AXIS(McNamara)
JARABAK RATIO 62 – 65% 66.6% HGP
LAFH 67.2+/-4.7mm 63mm Decreased
DENTAL
1 TO SN 1020 122º Proclined Upper Incisors
LINEAR 4 mm 7 mm Forwardly Placed Upper Incisors
1 TO NA
DEGREE 220 35º Proclined Upper incisors

LINEAR 4mm 7 mm Forwardly Placed Lower Incisors

1 TO NB DEGREE 250 32º Proclined Lower Incisors

1 TO A-Pog 2mm 3mm Forwardlly Placed Lower

Incisors
U-1 TO L-1 1350 106º Bidental proclination
IMPA 900 101º Proclined Lower Incisors
CANT OF OCCLUSION 1.5-14 0 4º Normal
SOFT TISSUE ANALYSIS
NASOLABIAL ANGLE 900-1100 116º Increased
N/FH 0
26 ± 8 0 34º Normal nose
L/FH 0
76 ± 8 0 83º Normal lip
UPPERLIP TO E-LINE -4mm 2 mm protrusive Upper Lip
LOWERLIP TO E-LINE -2mm 2 mm protrusive Lower Lip
LOWERLIP TO S-LINE 0mm 4 mm protrusive Lower Lip
MERRIFIELDS Z- 800 ±90 62º Decreased
ANGLE
1 TO NF 27± 1.7 28mm Normal

6 TO NF 23± 1.3 21mm Decreased

UPPER LIP THICKNESS 15mm 13 mm
(2mm below pt A to the
outer border of the upper
lip)
Vermillion border of 11mm
upper lip to the labial
surface of maxillary
central incisor
LIP STRAIN 2 mm 2 mm Lip Strain

MODEL ANALYSIS

TOOTH MEASURMENTS:

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

12 7 7 7.5 8 9 9 8 8 7 7 12 113

11 7 7 7 7 6 6 7 6 7 8 11 90

6 5 4 3 2 1 1 2 3 4 5 6
BOLTON’S ANALYSIS

Overall ratio = 79.64%

Inference= Overall Maxillary tooth material excess by 14.4mm

ANTERIOR RATIO = 78%

INFERENCE: Mandibular anterior tooth material excess by 0.4 mm.

CAREY’S ARCH PERIMETER ANALYSIS

ARCH TOOTH DISCREPANCY INFERENCE

LENGTH MATERIAL
MAXILLA 90mm 89mm 1mm IPR

MANDIBLE 72mm 68mm 4mm 2nd Pre-molar

Extraction

ASHLEY HOWE’S ANALYSIS

PMD PMBAW PMBAW% INFERENCE

-Arch expansion not

MAXILLA 43 mm 51 mm
45.13% indicated

-Indicates a need for an

extraction
MANDIBLE 39mm 33mm 36.66% -arch expansion not indicated

IN MAXILLA,

PMBAW% = 45.13%
Inference: Without Extraction
IN MANDIBE,

PMBAW% = 36.6%
Inference: Indicates a need for an Extraction

DIAGNOSIS

Miss.Thahani, 10yr old female patient presents with class II malocclusion with
bidental proclination. Class II Skeletal Pattern & Average to horizontal Growth
pattern.

Dental

Class II molar relation bilaterally.

Class I canine relation on bilaterally .
Curve of Spee 2 mm
Overjet of 4 mm
Overbite of 2 mm

Skeletal

Maxilla is Increased for the age (95mm) by 6 mm and Forwardly placed wrt
cranial base
Mandible is Increased for the age (111mm) and normally placed wrt to cranial
base
Class II Skeletal Pattern,
Average to horizontal growth pattern

Soft tissue

Nasolabial Angle is normal (116º)

Lip Strain of 2 mm
Profile – convex
Lips - Incompetent
Mentolabial Sulcus- shallow
Protrusive Upper and Protrusive Lower Lips.

Treatment objectives

Correction of Skeletal Base

Correction of Bidental proclination
Correction of Rotation
TREATMENT PLAN: 1

-
1 to NB is 7 mm
To keep it at 4 mm retract by 3 mm

Lower arch:

Space required Space available

Space required Space available

Retraction = 6 mm

TOTAL = 6 mm TOTAL = 6mm

Upper Arch:
IOJ = mm
COJ = = mm
To keep it at mm retract by mm

Space required Space available

Total : Total :

Treatment sequence

Initial leveling and aligning of upper and lower arch

(IPR)
Moderate anchorage
Retraction and space closure
Finish case in Class I molar and class I canine relation.
Retention protocol
Follow up.

Appliance of choice MBT

 Discussion: PROFILE ANALYSIS OF SCHWARZ
1) Sn-Pn line
2) Upper lip – Pn
3) Lower lip regresses 1/3rd
the distance Pn-poline
4) Gn-Po
5) SN-Pog line
6) Pn-Po gnathic profile
Normal Patient value
0 17 mm
0 22 mm
Po-Pn = 12 mm 18 mm
0 4 mm
- Upper lip and lower lip are
anterior to sn-pog line
Children = 13-14 mm 22 mm
Adult = 15-17 mm
 RAKOSIS ANALYSIS

Mean value Patient Inference

value
ANALYSIS OF FACIAL SKELETON
1) Saddle Angle 123° + 5° 127° Normal
2) Articular Angle 143° + 6° 136° Decreased
3) Gonial Angle 128° + 7° 129° Normal
4) Sum 394° 392° Clock-wise growth
5) Facial Height 62 – 65% 66.6% Increased
6) Anterior cranial base length 71 mm 72 mm Increased
7) Posterior cranial base length 32 – 35 mm 33 mm Normal
ANALYSIS OF JAW BASES
1) SNA 82 + 2° 87° Increased
2) SNB 80 + 2° 79° Forwardly placed
mandible
3) ANB 2° 8° Class II skeletal pattern
4) Base plane angle 25° 22° Horizontal growth pattern
5) Inclination angle 85° 92° Forward and Upward
DISTANCE
S-N-Pr 84° 89° Forwardly placed pre-
maxilla
S-N-Id 81° 81° Normal
Pal-occlusal plane 11° 50 Decreased
MP –Occlusal plane 14° 20° Increased
Y- axis 66° 55° Decreased
1 – SN 102° 122° Proclined upper incisors
1 – Pal 70 + 5° 53° Decreased
1 – MP 90° + 3° 101° Proclined lower incisor’s
1–1 135° 106° Bidental proclination
 On discussion it has been decided to go ahead with the non-extraction
-And retention.