Orthodontics Case Presentation

Presented by: Hala Hidayat, Munaza Malik and Shazmeen Salim

Personal Data

 Name: Hamza
 Gender: Male
 Age: 15 years
 Career: Student
 Father name: Muhammad Naveed
 Address: Abbbottabad
Chief Complaint
 “ Irregular teeth”
History

 General health: good

 Family history: -
 Medical history: -
 Trauma :No history of dental trauma
 Family history for malocclusion: -
 TMJ history: -
 Social status: good
 Habits : Pencil chewing
 Motivation :Patient is motivated( self- motivation)
Medical & Dental History
 Medical history:
Denies any medical problems
 Dental history:
RCT and Multiple fillings done
Extraoral Photos
Extraoral Examination
 Facial type: Mesiofacial
 Facial symmetry: Asymmetric
 Facial profile: Orthognathic
 Hyperdivergent
 Lips Thickness: Average
 Lip seal : Incompetent
 Nose: Medium
 Chin: Medium
 Upper dental midline to Facial midline: On
 Path of closure: normal
 Incisor stomion: 3mm
Anteroposterior Assessment

 Convex profile
Soft tissue Analysis

 Nasiolabial angle: 87º

 E line: UL -5mm
LL -2mm
 S line: UL -3mm
LL 0mm
Intraoral Photos
Intraoral Examination
 Dentition status: Permanent dentition
 Teeth present: Maxilla: 6,5, 4,3,2,1 1,2,3,4,5,6,7
Mandible: 7,5, 4,3,2,1 1, 2,3,4,5,6,7
 Caries: Filled teeth
Intraoral Examination
 Oral hygiene: Good
 Gingival health: Normal
 Periodontal status: -
 Tonsils: -
 Palate: Deep
 Tongue: normal
 Swallowing behavior : Mature
 Dentition: Permanent
 Caries: Filled
 Supernumerary teeth: -
Intraoral Examination
Class II molar relation Class II molar relation
Maxillary Arch
V shaped upper arch
 Arch symmetry: Symmetrical
 Dentition: Permanent
 Palate: Deep
 Teeth present: 7,6,5,4,3,2,1 1,2,3,4,5,6,7
 Missing teeth: -
 Crossbite: Unilateral Llingual Crossbite
4,5,6,7
4,5,6,7
 Caries: both sixes
Mandibular arch
 Arch form: U-shaped
 Arch symmetry: Symmetrical
 Dentition: Permanent
 Teeth present: 7,5,4,3,2,1 1,2,4,5,6,7
 Missing teeth: 6|
 Crossbite: Unilateral Llingual Crossbite
4,5,6,7
4,5,6,7
 Caries: left 6 and 7 filled
CEPHALOMETRIC
ANALYSIS
Parameters Patients Normal
Sagittal value values
analysis
SNA 81 82 ±2
SNB 77 80⁰ ± 2⁰
ANB 4 2⁰ ± 2⁰
Point A to N‫ו‬ -8mm 2±2
Pog to N| -4mm -3±4
Wits appraisal 0mm 0 / -1
Facial angle 81º 87⁰ ± 4⁰

Vertical
analysis
<G0-Gn to SN 40º 32⁰ ± 4⁰
FMA 41º 25º±4º
< Y-axis 70º 60º±4º
PFH/AFH 60% 65% ± 4%
LAFH/AFH 61% 54⁰% ± 4⁰%
Dental analysis

UI-NA: distance angle 5mm 4mm

33º 22ᴼ
LI-NB: Distance angle 4mm 4mm
33º 25ᵒ
Interincisal angle 123º 133ᵒ
UI-SN 114º 102ᵒ±5ᵒ

IMPA 82º 90± 4ᵒ

Soft tissue
analysis
E-line: LS -5mm -3±2
LI -2mm -2±2
S-line: LS -3mm 0±2
LI 0mm 0±2
Z angle 65º 78± 5º

Holdaway ratio 4:3 1:1

Nasiolabial angle 87º 102±8ᵒᵒ

OPG analysis:
 Permanent dentition
 No bone loss
 No supernumerary teeth
 No other pathology
Interpretation
 Sagittal analysis: Class I with tendency towards
Class II
 Vertical analysis: Slightly Hyperdivergent
 Dental analysis: Dental Class II div II
 Soft tissue analysis: Retrusive upper and
lower lips with an acute
nasolabial angle
Study Models Examination
Curve Of Spee
Rt : 2mm Lt: 2mm
Cast analysis
TSALD
 Space available – Space required ;
 (Maxilla)
 73.5mm-72.5mm=1mm
 (Mandible)
 67mm-64mm=3mm

Overall Bolton:
 Actual-Desired
 95-94=1

Anterior Bolton:
 Actual-Desired
 36.5-35.5=1
 Problem List

Developmental problems: Skeletal and dental problems in vertical plane:

o Decreased overbite
Patient’s concern: Malaligned teeth
 Alignment and symmetry:
Proclined upper incisors

Skeletal and dental problems in A-P plane: Skeletal and dental problems in transverse plane:
 Clinically convex profile • Facial Asymmetry
o Lt Molar : Class II

o Incisor class II div 1

Diagnosis
 Molar relationship Class II on both sides
 Incisor relationship Class II
 Crossbite
 Pencil chewer
 Lip Incompetence
Treatment plan
 Leveling and alignment
 Growth modification
 Habit breaker
 Fixed appliances
Thank You