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orthodontic case presentation as a partial requirement for the course dent 415 -orthodontics, McGill University.Great work from all the students.
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Orthodontic Completed Case
PresentationName: A S, DMD IV, 2012Chart #:Date: March, 2012
PRE-TREATMENT
Initial Patient History Name: A.P.
Sex: Female
Age: 36
Date: March, 2011
CC: “Aesthetics; my front teeth are overlapping and all my teeth curve inwards.”
Pre-Treatment
Patient History
Past Medical History: NSF
Medications: None
Allergies: None
Past Dental History: Consistent dental visits 2X/year
Oral Hygiene: Good, PSR II
Pre-Treatment
Extra-Oral Examination
Facial Type: Normocephalic
Facial Proportions: Decreased lower face height (Mild)
Facial Symmetry: Symmetrical
Pre-Treatment
Extra-Oral Examination Facial Profile: Slight
to moderate convexity
Nasolabial Angle: ~ 100 degrees
Lips: Normal seal
Incisor at Rest: 6 mm
Pre-Treatment
Neuromuscular & TMJ Examination
Tongue at Rest: Normal
Swallowing Pattern: Normal
Muscles of Mastication: WNL
TMJ: Normal articulation Normal range of motion Normal muscles of
masticationPre-Treatment
Extra-Oral Intra-Oral
Facial & Dental Midlines: On
Lower dental midline deviates 2 mm to the left upon opening
Pre-Treatment
OcclusionRight Side Molar Class: I Canine Class:
I
Dental Midline
Upper: On Lower: On
Left Side Molar Class:
N/A Canine Class: I
Pre-Treatment
Intra-Oral Examination
Overbite: 50% Overjet: 2 - 3 mm
Pre-Treatment
Intra-Oral Examination
Teeth Present:11-17, 21-25, 2731-35, 37, 41-47
Arch Shape: Upper: Normal to taperedLower: Normal to tapered
Pre-Treatment
Intra-Oral Examination
Clinical Findings: Molars: Class I on right; Missing 26 & 36 on left Canines: Class I Missing: 18, 26, 28, 36, 38 & 48 OJ: 2 mm on right; 3 mm on left OB: 50% Mild crowding on both upper & lower incisors
Pre-Treatment
Intra-Oral Examination
Amount of Crowding:
Upper Arch: Mild ~ 3 mm
Lower Arch: Mild ~ 3mm
Pre-Treatment
Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathologyPermanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Pre-Treatment
Cephalometric AnalysisAngles Ceph.
ValuesNormal
Skeletal Measurements
SNA 79.5 81 ± 3
SNB 75.0 78 ± 3
ANB 4.5 3 ± 2
Witts -4.0 2 mm ± 2mm
Facial ∠ 86.0 88 ± 4
MPAST 38.0 32 ± 3
Y axis 60.0 60 ± 4
Dental Measurements
(UI,NA) 16.0 23 ±6
(LI,NB) 23.0 27.5 ±5
(UI,LI) 135.0 130 ± 7
(LI,MP) 91.0 91.4 ± 4
Pre-Treatment
Dental Cast Analysis:Curve of Spee
Upper: Flat Lower: Slight
Pre-Treatment
Dental Cast AnalysisBolton Analysis – Ideally 77%
• UA (Σ 13-23) = 41.7 mm• LA (Σ 33-43) = 31.4 mm
• ( 31.4 / 41.7 ) x 100 = 75.3%
Tooth Upper right Upper left Ideal
Central Incisor 8.5 8.0 8.85
Lateral Incisor 5.5 6.0 6.9
Canine 6.7 7.0 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.1 5.0 5.5
Lateral incisor 5.3 5.4 6
Canine 5.4 5.2 6.95
Pre-Treatment
Summary of Findings Dental:
Molars: Class I on right; Missing 26 & 36 on left Canines: Class I Missing: 18, 26, 28, 36, 38 & 48 OJ: 2 mm on right; 3 mm on left Increased OB (50%) Lower dental midline deviates 2 mm to the left upon opening Mild crowding on both upper & lower incisors Normal to tapered arch shapes 6 mm of upper incisors showing at rest Bolton analysis: 75.3%
Skeletal: Symmetrical face; Normocephalic Decreased lower face height Slight-moderate convex profile
Pre-Treatment
Diagnosis
Class I molar/canine Maxillary anterior crowding Mandibular anterior crowding 50% overbite Flat to slight curve of spee
Pre-Treatment
Objectives of Treatment
Pre-Treatment
Resolve patient’s chief complaint of crowding
Decrease overbite Maintain class I molar/canine
relationship Maintain nasolabial angle Maintain midlines
TREATMENTOPTIONS
Compromised Treatment Address chief complaint:
Resolve upper anterior crowding Align & level the teeth Space available in upper arch due to extracted
26, & in lower arch due to extracted 36. However, we cannot use too much of this space, as it will alter the midline alignment, & make it more difficult to replace 26 & 36 in the future.
Compromised Treatment Option #1
Invisalign: Upper & Lower IPR to allow for improved alignment
Compromised Treatment Option #2
Full fixed: Upper & Lower Alignment & levelling Arch coordination IPR
TREATMENTDONE
Treatment Done
Patient did not want upper & lower bracketing
Unable to do complete bracketing in McGill Student Dental Clinic
Selected: Compromised Treatment Option
#1 Invisalign: Upper & Lower IPR to allow for improved
alignment
Exactly One Year Later
Post-Invisalign Treatment
Extra-Oral Intra-Oral
Facial & Dental Midlines: On
Lower dental midline deviates 2 mm to the left upon opening
Post-Invisalign Treatment
OcclusionRight Side Molar Class: I Canine Class:
I
Dental Midline
Upper: On Lower: On
Left Side Molar Class:
N/A Canine Class: I
Post-Invisalign Treatment
Intra-Oral Examination
Overbite: 30%
Overjet: 1 - 2 mm
Post-Invisalign Treatment
Intra-Oral Examination Teeth Present:11-17, 21-25, 2731-35, 37, 41-47
Arch Shape: Upper: Normal to taperedLower: Normal to tapered
Crowding:Upper: NormalLower: Normal
Post-Invisalign Treatment
Patient not satisfied with the final position of tooth #32 & tooth #41
Post-Invisalign Treatment Problems
Post-Invisalign Treatment
Dimple-maker! Dimples added to:
Tooth #32 - distal buccal incisal area Tooth #41 - distal buccal incisal area
IPR on both tooth #32 & #41 Both teeth rotated into proper position within 2
weeks Dimples then added to:
Tooth #31 - distal buccal incisal area & mesial lingual incisal area
Patient now satisfied with final results
Post-Invisalign Treatment Solution
Post-Invisalign Treatment
Post-Invisalign Treatment Solution
Post-Invisalign Treatment
Pre-Treatment
Post-Treatment
Post-Treatment
Patient Presentation
Post-Treatment
Age: 37
Date: March, 2012
Post-treatment perspective: Patient is very satisfied with the results following Invisalign
Extra-Oral Examination
Facial Type: Normocephalic
Facial Proportions: Decreased lower face height (Mild)
Facial Symmetry: Symmetrical
Pre-Treatment
Post-Treatment
No change from pre-treatment:
Extra-Oral Examination
Facial Profile: Slight to moderate convexity
Nasolabial Angle: ~ 100 degrees
Lips: Normal seal
Incisor at Rest: 6 mm
No change from pre-treatment:
Pre-Treatment
Post-Treatment
Neuromuscular & TMJ Examination
Tongue at Rest: Normal
Swallowing Pattern: Normal
Muscles of Mastication: WNL
TMJ: Normal articulation
Normal range of motion
Normal muscles of mastication
Post-Treatment
No change from pre-treatment:
Intra-Oral Examination
Overbite: 50% Overjet: 2 - 3
mm
Pre-Treatment
Post-Treatment
Decrease in both overbite & overjet
Overbite: 30% Overjet: 1 - 2
mm
Pre-Treatment
Post-Treatment
Intra-Oral Examination
Decrease in both overbite & overjet
Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
Intra-Oral Examination
Pre-Treatment
Post-Treatment
No change from pre-treatment:
Intra-Oral Examination
Pre-Treatment
Post-Treatment Amount of Crowding:
Upper Arch: Mild ~ 3 mm
Lower Arch: Mild ~ 3mm
Amount of Crowding:
Upper Arch: None
Lower Arch: None
Decrease in crowding
Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathologyPermanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Post-Treatment
Cephalometric AnalysisAngles Ceph.
ValuesNormal
Skeletal Measurements
SNA 80.0 81 ± 3
SNB 75.0 78 ± 3
ANB 5.0 3 ± 2
Witts -4.5 2 mm ± 2mm
Facial ∠ 84.0 88 ± 4
MPAST 39.5 32 ± 3
Y axis 63.0 60 ± 4
Dental Measurements
(UI,NA) 12.0 23 ±6
(LI,NB) 22.5 27.5 ±5
(UI,LI) 141.0 130 ± 7
(LI,MP) 87.5 91.4 ± 4
Post-Treatment
46
Angles Ceph.Values
Normal
Skeletal Measurements
SNA 80.0 81 ± 3
SNB 75.0 78 ± 3
ANB 5.0 3 ± 2
Witts -4.5 2 mm ± 2mm
Facial ∠ 84.0 88 ± 4
MPAST 39.5 32 ± 3
Y axis 63.0 60 ± 4
Dental Measurements
(UI,NA) 12.0 23 ±6
(LI,NB) 22.5 27.5 ±5
(UI,LI) 141.0 130 ± 7
(LI,MP) 87.5 91.4 ± 4
Angles Ceph.Values
Normal
Skeletal Measurements
SNA 79.5 81 ± 3
SNB 75.0 78 ± 3
ANB 4.5 3 ± 2
Witts -4.0 2 mm ± 2mm
Facial ∠ 86.0 88 ± 4
MPAST 38.0 32 ± 3
Y axis 60.0 60 ± 4
Dental Measurements
(UI,NA) 16.0 23 ±6
(LI,NB) 23.0 27.5 ±5
(UI,LI) 135.0 130 ± 7
(LI,MP) 91.0 91.4 ± 4
Cephalometric Changes (>1 degree
differences in blue)
Pre-Treatment Post-Treatment
Dental Cast Analysis:Curve of Spee
Upper: Flat Lower: Slight
Post-Treatment
No change from pre-treatment:
Angle Classification: Right Side: Class I molar & class I canine Left Side: Class I canine (missing tooth 26 & 36)
Dental Midline: Lower: On Upper: On
Overbite: 40%
Overjet: 1 - 2 mm
Dental Cast Analysis
Post-Treatment
Dental Cast AnalysisBolton Analysis – Ideally 77%
• UA (Σ 13-23) = 42.4 mm• LA (Σ 33-43) = 32.2 mm
• ( 32.2 / 42.4 ) x 100 = 75.9%
Tooth Upper right Upper left Ideal
Central Incisor 8.3 8.1 8.85
Lateral Incisor 5.8 5.8 6.9
Canine 7.3 7.1 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.2 4.7 5.5
Lateral incisor 5.1 5.3 6
Canine 6.1 5.8 6.95
Post-Treatment
Summary of Findings Dental:
Molars: Class I on right; Missing 26 & 36 on left Canines: Class I Missing: 18, 26, 28, 36, 38 & 48 OJ: 2 mm on right; 1 mm on left Increased OB (30%) - Decreased from 50% at pre-treatment Lower dental midline deviates 2 mm to the left upon opening Crowding issues on both upper & lower incisors resolved
(addressed CC)
Normal to tapered arch shapes 6 mm of upper incisors showing at rest Bolton analysis: 75.9%
Skeletal: Symmetrical face; Normocephalic Decreased lower face height Slight-moderate convex profile Post-Treatment
Retention: Patient does not want removable appliances
Unable to place lingual bars in McGill Student Dental Clinic
Patient therefore referred to a private orthodontist to place both upper & lower lingual bars
Patient presently applying to McGill Student Dental Multidisciplinary Clinic for placement of 2 implants to replace missing tooth 26 & 36
Future Treatment
Thank you!
