ORTHODONTICS SEMINAR 1

CLINICAL EXAMINATION
PATIENT
Age: 12,5 years old (menarche 11,8 years old)
Family history:
Maxillary class III (mother), primary crowding (father, mother and one brother), adult chronic
periodontitis (father)

Personal history: Mouth breather. Adenoidectomy at 6 years old. No previos orthodontic

treatment. Poor oral hygiene. No additional relevant history.
Exploration:
Mouth breather with low and posterior resting position of the tongue.
Palpation: normal
Mandibular dynamics: symmetrical mastication.

No relevant dental history

Symmetric face Do facial analysis
Nasolabial angle > 110 : retrusive

Competent lip lip

Medium smile
smile
convex profile consonant

Tr

:
Me
Sad eyes

Mouth breather
Carry out an occlusal, dental arches and dental alterations analysis, and do a
diagnosis
 class I both side
-

Sagittal plan :

.
Vertical plan : Anterior open bite

Transverse Plan Normal

'

Upper y
lower anterior crowding
-
3 -13
high canine

Low canine ( outside )

-

3-3

Arch shape
Triangular
•
:

Anterior open bite →

Take 5

€
 12.5mm 15 mm

20,0mm
20,0mm
17mm
18 mm

8.0mm
11.0mm

Addition 21-12 = Addition 21+12 =

21.5mm 32mm
Addition 543- = Addition -345= Addition 543+ = Addition +345=
21.5mm 22.0mm

Calculate the dentoalveolar discrepancy on both arches

 ↑ ↓

17 / 9 18
2027.520

21.5 2.1.5 21-5

22 32 zz

-4.5 -1-5-3.5
-
2 -4.5 -2 -

-
8-5 -

10.5
Perform: 1. Dental formula.
2. Dental age
3. Describe the skeletal and dental alterations you can observe.
 8-17-16 -15-1 4-1 3-12-11 -1 +1 + 2-13-14 -15+6+7+8
1 .

8- g- 6- 5- 4- 3- 2- 1- -1 -2-3-4-5 -6 -7 -8

M H HH HH G D= 12.9+14.2-112.4-114.1 -114.61-16.21-14-5=98.9

141s
=

Inferior teeth
crowding
s .
 EDAD
DENTAL

• A : Initial calcification
• B : fusion
• C : Complete enamel,
dentine and Pulp.
• D : root formation
• E : root smaller than crown
• F : root equal to crown
• G : open apex
• H : closed apex

Demirjian, Goldstein y Tanner. A new system of dental age assessment. Hum. Biol 45, 211. 1973
 Age Points Age Points Age Points Age
Points
:
Trace Steiner and Rickets Cephalometry
and carry out a cephalometric diagnosis:
1. Skeletal class. Relationship
between the maxillae and the cranial
base and the relationship between the
upper maxilla and the mandible.

2. Facial pattern.

3. Relationship of the incisors with

the skeletal base and between each
other

NOTE: Use the points already in place on

the radiograph.
The cephalostat rule shows millimetres
(45mm)
 SNA 80° :
Normal position of Mx

SNB 14° :

Mn retrusion

ANB 5 :
skeletal class I

SND 72° :
Mn retrusion
1- NA 4.5m

170
Mn plane 35 Long Face
tendency
-

1- NB 9.5m
Occlusal Plane 24 :

steep yo

ratiocination
Upper Incisor angle 11.5° :

4-5 normal SE 23mm

position
:

SL
35mm
:

Lower Incisor angle zz

retrootmotion

position
7-5
Protrusion

lnterincisal angle 137 normal

position
=

S line = normal
 AMOUNT OF
GROWTH
Average on
general
population
Vertical Pt (perpendicular to
Frankfurt intersecting the
pterygoid point )-A

Distance Co-Gn

Do a growth prediction using

the population averages) You
must show a cephalometric
tracing at 16 years of age.

Remember that vertically the maxilla descends 1/3 of what N-Me height increases (Nasion-Menton)
 KEYS OF THE CASE
1. Comprehensive diagnosis: Patient’s list of characteristics and problems.
(2,5 points) Open bite ,
crowding C1 4y
2. Tell whether you think it is necessary to request additional
examinations and justify why. (0.5 points) No
3. Do the Steiner box. (2 points)
4. Aims of treatment, should you decide to do any treatment at this stage.
(1 point) extract
premolar
5. Individualised treatment plan for each aim of treatment, comprehensive
treatment plan for the aims of treatment altogether (1 point)
6. Mechanics and appliances used and treatment sequence.(1 point)
7. Prognosis of each problem (2 points)

NOTE: Remember that each clinical decision you take (both for the
diagnosis and for the treatment and/or prognosis) must be supported by
bibliography and you must indicate the level of confidence of the
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