SANA’A UNIVERSITY

FACUALITY OF DENTISTRY
ORTHODONTIC DEPARTMENT

ORTHODONTIC

2
: ‫متابعة‬
. ‫ غمدان الحرازي‬/‫د‬
. ‫ نائلة المجاهد‬/‫د‬

: ‫الطالب‬
 Faculty of Dentistry
5th Year BDS Students
Year 2022/2023

Student Name: ‫سماح قائد عقالن‬

Group: E
Patient Name: ‫عدي قائد محمد عقالن‬
Age: 11 years Sex: Meal
Address: Sawan
Chief Complaint: The patient and his family want to align his teeth
and make them look better.

Medical History: No Medical History Dental History: Simple Extraction

Extra-oral Examination
Profile Shape of head
Convex Concave Straight Mesocephalic Dolichocephalic Brachycephalic

Facial Divergence Shape of face

Anterior posterior straight round oval square

Facial Symmetry Lips

Symmetrical asymmetrical Competent Incompetent Everted

Nasolabial Angle Mentolabial Sulcus

Normal acute obtuse normal deep shallow

Tongue size Tongue activity

Normal small-large normal tongue thrusting

T.M.J Frenum
normal pain clicking normal abnormal

Path of closure Breathing

Normal Deviated left deviated right oral nasal 1
 Intraoral Examination
6 E c 2 1 1 2 c D E 6
6 E D c 2 1 1 2 c D E 6

Gum: Normal Palate: Normal

Overjet: mm 4 Overbite: 3 mm
Molar relation: Class 1 Canine relation: No canine relation
.

Details of malocclusion
Crowding Open bite Rotation Anterior Crossbite

Spacing Deep bite Proclination Posterior Crossbite

Diagnostic aids
Study models OPG Lateral cephalometric

Occlusal radiographs Photograph Bitewing

Diagnosis:
• Spacing between anterior teeth

Etiology
• High frenum attached.

Model Cast Analysis

Erupted teeth:

6 E c 2 1 1 2 c D E 6
6 E D c 2 1 1 2 c D E 6

Mesiodistal width of upper anterior teeth:

Maxillary arch
2 1 1 2
7 mm 9 mm 9 mm 7 mm

SIU (sum of upper incisors)

SIU = 7 +9+ 9 + 7 = 32mm

Mandibular arch:

2 1 1 2
7 mm 7 mm 6.5 mm 7.5 mm

SIL (sum of incisors lower)

SIL = 7 + 7 + 6.5 +7.5 = 28 mm
 The Maxillary arch
Transverse plane:
1. Midline shifting :-
There is no shifting in the midline

2- Arch symmetry :
From the mesial pit of the 1st permanent molar to mid line
Left = 15 mm Right = 15 mm

- The arch is symmetrical .

3- Arch width by Pont's analysis :-

Posterior arch width :

Measured molar value (MMV): distance between
mesial pits of 1st permanent molars, left and right :

MMV = 42 mm
SIU = 34 mm
CMV = 76 X100 / = 7600 mm

CMV > MMV by mm, so expansion will

 Sagittal plane:
1-Rotation :
There is no Rotation
2-Drifting : There is no Drifting

3-Inclination: There is no inclination

Labial proclination of upper lateral incisors .

1- Tuberosity Size

Left = 7 mm Right = 7 mm

Vertical plane:
1- Depth of the palate = 18 mm.
2- Infra-erupted teeth:

6 6
 Mandibular Arch

Transverse plane:
1- Mid line shifting :
There is no midline shifting

2- Arch symmetry : Symmeteric

From the mesial pit of the 1st permanent molar to the midline.
Left = 20 mm Right = 20 mm

The arch is

Sagittal plane:
1) Rotation: `
There is rotation.
2

2) Drifting:
There is drifting into the lateral incisor.
 Vertical plane:
1- Infra-erupted:

there is infra -erupt in upper six right and left.

At Occlusion

Transversal plane:
1- Midline shifting :

There is no midline shifting.

2- Cross bite :

There is no cross bite

Sagittal plane:
1- Overjet = 2.5 mm.

The patient is a class 1 molar relationship.

Vertical plane:
overbite: 2.5 mm
 Conclusion of cast analysis
• An 11-year-old male patient, with class I molar relationship,
mixed dentition in upper and lower jaw, 23 erupted mixed teeth.
• There is no midline shifting.
• Overbite: 2.5 mm and Overjet 2.5 mm.
• According to Pont’s analysis, the arch is narrow and expansion
will be needed.
• Upper right central incisor inclined labially.
OPG Analysis
 Maxillary Arch
Upper right arch

Tooth Eruption Crown Root apex

1 Erupted Fully formed Complete Open apex

2 erupted Fully formed Complete Open apex

c Erupted Still present 1/4 resorbed

3 Unerupted Fully formed 1/3 formed

4 Unerupted Fully formed 1/3 formed

E Erupted Still present 1/3 resorbed

5 Unerupted Fully formed 1/3 formed

6 Erupted Fully formed Complete Open apex

7 Unerupted Fully formed Absent Absent

 Maxillary Arch
Upper left arch

tooth Eruption Crown Root apex

1 Erupted Fully formed Completed Open apex

2 unerupted Fully formed 2/3 formed

C erupted Still present 1/3 resorbed

3 unerupted Fully formed 2/3 formed

D erupted Still present 1/3 resorbed

4 unerupted Fully formed 1/3 formed

E erupted Still present 1/3 resorbed

5 unerupted Fully formed 1/3 formed

6 erupted Fully formed complete Open apex

7 unerupted Fully formed Absent Absent

 Right lower arch

tooth Eruption Crown Root apex

1 erupted Fully formed Complete Open apex

2 erupted Fully formed Complete Open apex

C erupted Still present 1/3 resorbed

3 unerupted Fully formed 1/3 formed

D erupted Still present 2/3 resorbed

4 unerupted Fully formed 1/3 formed

E erupted Still present 2/3 resorbed

5 unerupted Fully formed 1/3 formed

6 Erupted Fully formed Complete Open apex

7 Unerupted Fully formed Absent Absent

 Mandobular arch
Left lower arch

tooth Eruption Crown Root apex

1 Erupted Fully formed Complete Open apex

2 Erupted Fully formed Complete Open apex

C Erupted Still present 1/3resorbed

3 Unerupted Fully formed 2/3 formed

D Erupted Still present 2/3resorbed

4 Unerupted Fully formed 1/3 formed

E Erupted Still present 2/3resorbed

5 Unerupted Fully formed 1/3 formed

6 Erupted Full formed complete Open apex

7 Unerupted Full formed Absent Absent

-
 OPG Conclusion:
• According to OPG the patient is 11 years of age,
and he is in late mixed dentition 14 deciduous are
still present 10 permanent teeth have erupted, and
still 17 permanent teeth are unerupted.
• Normal sequence and path of eruption.
• The third molars are absent in the upper and lower
arch.
• No periapical lesions
• No bony lesions
• No impacted teeth
• No supernumerary teeth
• No pathological lesions.
 Photograph Analysis
Extra-oral
Facial Profile

❖ Determined by joining 2 lines:

✓ First line: from forehead to point A(deepest point on

upper lip)
✓ Second line: from point A to pogonion (most anterior
part of chin)
✓
The patient has convex profile.
 Facial Divergence

❖ Determined by line:
✓ From forehead to pogonion (Most anterior part of chin)

Patient has slightly facial divergence.

 Rickett’s Line

❖ It's a line from the tip of the nose to the most

anterior point of chin.
✓ In this case, the upper lip are attached, and the lower lip
pretruted by 2mm, too .
 Nasolabial Angle

❖ It’s 104 degrees.

✓ Normal average = 110±10 degree.
✓ Patient has normal N.L.A .value.
 Vertical-Skeletal Relationship

❖ Determine by angle that formed by meeting two

lines, first from lower border of the mandible and the
second from Frankfort line.
✓ Value = 32 degree
✓ Normal range = 25 degree (+ or –3)

The patient has vertical growth.

 Facial Symmetry

❖ Determine by measuring distance between a line

drown in middle of the face & two lines drown in the
medial canthus on each side.
1. Right side = (8 mm)
2. Left side = (8mm)
❖ Determine by measuring distance between a line
drown in middle of the face & two lines drown on
the lateral canthus on each side.
1. Right side = (19mm)
2. Left side = (19 mm)

There’s symmetry between the two sides.

 Facial Proportions

❖ Divided the face into 3 horizontal thirds by drawing four

lines on:
1) Hair line.
2) Supra orbital margin.
3) Base of nose.
4) Inferior border of chin.
Part 1 = 43 mm.
Part 2 = 43 mm.
Part 3 = 36 mm.

- There's equal facial proportion

❖ Upper lip: It occupies approximately 1/3 of lower part
of the face (12 mm)
 Conclusion of Extra-Oral View
• The patient has mesocephalic head shape.
• Face is symmetrical.
• Facial proportions: unequal.
• Upper lip occupies nearly 1/3 of lower 1/3 of the
face.
• Competent Lips.
• Facial profile is normal convexity.
• Facial divergence is posterior divergence.
• Normal Nasolabial angle =107˚.
• Vertical growth in vertical-skeletal relationship
Intra-Oral View
 Conclusion of intra-oral View:
• Class I molar relationship
• No canine relationship as permanent
mandibular canines haven’t erupted
• No midline shifting
• Teeth have normal shape and size
• Inclination of maxillary central incisors
labially.
 Final Conclusion:
• Male, 10 years old patient.
• Class I molars relationship.
• Class I malocclusion
Overjet = 2.5 mm.

• overbite= 2.5 mm.

• Normal sequence and path of eruption
• The third molars are not present in the upper and lower
arch.

Etiology
•
 Objectives:
• Improve patient esthetic.
• Correct the diastema.
• Correct arch width (narrow upper arch).

TREATMENT PLANNING
• Oral hygiene instruction.
• Explain the importance of treatment and
motivate him.
• Review the diagnostic document to design an
appropriate appliance.
• Retention.
• Follow up.
 PROGNOSIS:
❖ Good due to:

1. Patient’s age.
2. Ability to correct the malocclusion.
3. Patient motivation and cooperation.
4. Family cooperation.

Appliance:
1. Retentive components:
Adam clasps on 6 & 6 of 0.7mm round s.s wire.
2. Active component:

labial bow
between D &E of 0.7 mm round s.s wire z spring 1&2

Anchorage:
Acrylic base plate.

Laboratory case sheet :

Done ………………^..^