CASE PRESENTATION

BY

BENOY JOSEPG IN ORTHODONTICS

SBDCHCHENNAI

CASE HISTORY:

CHIEF COMPLAINT:

A male patient by A male patient by name vijayakumar 22 name vijayakumar 22 years of age reported years of age reported to o.p with chief to o.p with chief compliant of irregularly compliant of irregularly arranged upper front arranged upper front teeth and wants the teeth and wants the problem to be problem to be correctedcorrected..

NRH

PREVIOUS ORTHODONTIC TREATMENT

NRH

PRENATAL HISTORY

condition of mother during pregnancy was

normal and it was a full term normal

delivery

POST NATAL CHILDHOOD HISTORY

combination type of feeding.

milestones development were normal

no abnormal oral habits present

no history of traumatic injury during chidhood

FAMILY HISTORY

CLINICAL EXAMINATION:

GENERAL EXAMINATION:

Patient is mesomorphic build with height of 5feet and 10inch.

Weight 84kgs.

Patient has normal gait and erect posture.

EXTRA ORAL EXAMINATION

FRONTAL VIEW:

Mesenchephalic Head

Mesoprosopic facial form

Facial symetry:symmetrical

Lips are competent.

PROFILE VIEW:•normal mentolabial sulcus.

•Acute nasolabial angle.

•.orthognathic facial profile.

•straight divergence of face.

•normal chin.

•normal Mandibular plane.

•average clinical F.M.A.

INTRAORAL EXAMINATION

Oral hygiene status is satisfactory.

Normal gingival texture.

oral mucosa and frenal attachment are normal.

Tongue size is normal.

Tonsils are normal,

Normal palatal vault present.

SOFT TISSUES:

HARD TISSUE EXAMINATION

Number of teeth present: 29

permanent dentition

The teeth are macrodontic

;RCT done on :11

Extraction of 18,38,48 was done

.

EXAMINATION OF OCCLUSION:

•U shaped Maxillary and

Mandibular arches.

•With crowding in upper and lower arches.

•Bucally erupted 23 and postioned

above 22 .

• platally placed 22 and in crossbite

with 33

•Mesially tilted and rotated 21

•Upper and lower midlines donot

coincide eachother with lower midline

shifted to right by 2mm

•Rotation in relation to 13,32,31,41and

42

ARCHES IN OCCLUSION

Class 1 molar relationship on both side with crowding in upper and lower arches

ARCHES IN OCCLUSION (OVER JET) :

Over jet of 2mm22In crossbite with 33

ARCHES IN OCCLUSION(OVER BITE):

•.lower dental midline shifted to the right by

2mm when compared to upper dental arch.

•Overbite of 1mm .

•22 in crossbite with 33

FUNCTIONAL EXAMINATION

Nasal type of breathing .

Adult deglutition .

Normal speech.,nastigation, and path of closure..

Maximum mouth opening is 46 mm and interocclusal clearance of 2 mm.

TENTATIVE CLINICAL DIAGNOSIS:

A case of Angles Class 1 malocclussion with proclined upper and lower anteriors. Crowding in upper and lower dental arches. Buccally erupted 23 and palatally erupted 22 which is in crossbite with 33

MODEL ANALYSIS :Ponts analysis :measured values are less than calculated values in the molars and premolar region , indicating expansion.Discrepancy in P.M.region=4.8mmDiscrepancy in molar regioon=7.4mm

Ashley howes analysis : canine fossa % of 40.3% indicates a boderline case.

Careys analysis : Shows discrepancy of 6.5mm of arch length tooth material discrepancy.(upper) 5mm(lower).

Boltons analysis :excessmaxillary tooth sizeOverall ratio=89.65% dis-1.8mmAnterior ratio=74.5% dis-1.7mm

DISCREPANCY CALCULATIONS

correction of crowding 3mm 8mm

levelling of curve of spee - 6mm

correction of proclination 16mm 14mm

space present 0 0

DISCREPANCY 19mm 28mm

RADIOGRAPHIC ANALYSIS (OPG)

PRE TREATMENT LATERAL CEPHALOGRAM:

SKELETAL ANALYSIS (SAGITTAL)

MEASUREMENTS NORMAL PRE-TRT

SNA 82+2 81

SNB 78+2 80

ANB 2+2 1

SND 76 78

SN-FH 7 5

Wits-appraisal Ao ahead of Bo

by 2mm

Saddle Angle N-S-AR 123+5 121

Articular Angle S-AR-Go 143+6 140

SCHWARTZ PROPORTINAL ANALYSIS

MEASUREMENTS NORMAL VALUE PRE-TRT

Ant. Cranial base 71+3 71mm

Posterior cranial base 32+3 32mm

Mand. Length(Ap man-Go) 68 70mm

Max. length(aPmax-Pns) 46.5 45mm

Length of Ramus(Co-Go) 56.3 + 3.92 55mm

MC-NAMARA ANALYSIS

Co-Gn-Mand. Length 105-107 127mm

Co-Point A(Max.length) 85mm 95mm

Maxillo-Mand. Differential) small 32

Na 1 to point A 0-1mm - 6mm

Na 1 to Pog) -4 -0 -8

BURSTONE’S ANALYSIS

MEASUREMENTS STANDARD PRE-TRT

N-A(|| to HP) 0.0+3.7 -3.5mm

N-B(||to HP) - 5.3+_6.7 -7mm

N-Pg(||toHP) -4.3+8.5 -4mm

ANS-PNS

(Max.length) 57.7+2.5 55mm

Go-Pg

(Mand.length) 83.7+4.6 78mm

Ar-Go(Ramus .ht) 52.0 + 4.2 48mm

B-Pg (||-MP) 8.9+1.7 - 10mm

SKELETAL EVALUATION – VERTICAL (values in degrees)MEASUREMENTS NORMAL PRE-TRT

Facial Axis(Ricketts) 90+3 91

FMA 25 33

Basal –plane angle Pal- MP 25 28

OCC-Sn 14 9

OP-HP(Burstone) 6.2+5.1 0

Pal-Sn 8+2 6

Gonial angle Ar-Go-Gn 130+7 133

Upper Gonial angle 50 – 55 56

Lower Gonial angle 70 –75 78

Sum of posterior angle 396 394

DENTO – ALVEOLAR ANALYSIS

Angular Measurements Normal Pre- trt

1 to SN 102 121

1 to NA 22 40

1 to Palatal plane 110+5 126

1 to MP(IMPA) 90 95

1 to NB 25 32

Inter incisal angle 132 107

Linear Measurements

1 to NA 4mm 12mm

1 to N pog 2-4mm 4mm

1 to NB 4mm 12mm 1to N pog -2 +2mm 2mm

VERTICAL PROPORTION ANALYSIS

MEASUREMENTS NORMAL PRE-TRT

Anterior Facial ht. N-Me

Posterior Facial ht. S-Go

Jarbak Ratio PFH X 100

AFH 62-65% 61.8%

Lower anteriors facial ht. medium

ANS-me (Mc Namara) 65-67mm 81mm

BURSTONE’S VERTICAL SKELETAL MEASUREMENTS

MEASUREMENTS NORMAL PRE-TRT

N-ANS(| to H.P.) Anterior

Upper facial height 50+2.4 47mm

ANS – Gn (Lower facial ht.) 61.3+3.3 62mm

PNS-N(| to HP) (Posterior

Maxillary Height) 50.6+ 2.2 48mm

M.P.H.P.angle(Posterior

Divergence of mandible) 24.2+5 34deg

A.L.F.H.(Bolton’s)(ANS-Me) 68mm

AUFH as % of ATFH 45% 43.12%

ALFH as % of ATFH 55% 56.8%

Facial proportion index.

CALFH % - AUFH% 10% 13.76%

BURSTONE’S VERTICAL DENTAL MEASUREMENTS

MEASUREMENTS NORMAL PRE-TRT

AUDH(1 to NF) 30.5.+2.1 36mm

ALDH(1 to Mp) 45.0 + 2.1 43mm

PUDH(6 to NF) 26.2+2.0 27mm

PLDH ti 6 to MP 35.8 +2.6 33mm

SOFT TISSUE ANALYSIS

LIP POSITION & FORM

MEASUREMENTS NORMAL PRE-TRT

Naso labial angle Cm- Sn- Ls 102 +8 103

Maxillary incisor exposure stms-1 2+2mm 0mm

Inter-Incisal gap(Stms-Stmi) 2+2mm 8mm

Length of upper lip(Sn-Stms) 21+-1.9mms 22mm Length of lower lip(Stmi-Gn) 5 4.3+-2.4mm 58mm

SOFT TISSUE ANALYSIS

LIP PROFILE ANALYSIS

MEASUREMENTS MEAN PRE-TRT

Upper lip to Rickett’s E line 2-3 mm behind -4mm behindLower lip to Rickett’s E line 1-2 mm behind 4mm ahead

Upper lip thickness 15mm 10mm

Soft tissue chin thickness Pog’-Pog 10-12mm 11mm

SUMMARY OF CEPHALOMETRIC ANALYSIS:

•A case of skeletal class I pattern with orthognathic maxilla and orthoganathic mandible (anti inclined maxilla).

•Average growth pattern. And average mandibular plane angle

• Upper and lower dento alveolar Proclination .

•Average nasolabial angle.

•Protrusive lower lip and upper lip in normal relation.

DIAGNOSIS:

A case of bimaxillary protrusion with

skeletal class I pattern. Angles class I

malocclusion with crowded and

rotated teeth in upper and lower

dental arches. average growth pattern.

PROBLEM LIST:

•Class II skeletal pattern .

•classII molar relation .

•Severe proclination and crowding(anterior region).

•Lip incompetency.

•Increased incisal exposure.

•Bruxism.

•Oronasal type of breathing.

•Increased overjet.

TREATMENT PLAN:

Orthodontic correction by PEA 0.022 slot.

Method of gaining space- by all fours extraction.

Maximum anchorage case considering the growth tendency and space

discrepancy –TPA AND LA

Unraveling of crowding purely by distalization of canine.

Closure of remaining spaces after unraveling by intrusion and

retraction of the anteriors.

RETENTION :

Upper removable Hawleys appliance and lower lingual bonded

retainer.