ORTHODONTIC CASE PRESENTATION

Marwa Ibrahim Halalmeh Eman Khalid Nazzal

Rahaf Hasan Ibrahim

Malak Ali Abu-aquleh

PATIENT’S BIOGRAPHY

- Name : Rula Yaseen Wardat

- Age : 22

- Gender : Female

HISTORY

Chief Complaint :

-She doesn’t like her teeth shape

-crowding anteriorly

-facial asymmetry

History of Chief Complaint :

-With eruption of permanent teeth

Medical History :- Patient denied any medical problems

Dental History :- She wear a removable appliance 4 years ago for 1 year to expand her upper jaw - Uncomplicated previous extraction 3 years ago- Previous restoration 3 months ago

Social History & Habits :-None

Extra Oral Examination

Frontal view-Symmetrical:

Asymmetrical face

- LFH ratio:

increased

Profile View

Profile angle: ConvexSkeletal Class: Class IIFMPA: average

Soft Tissue Analysis

Lip: incompetentNasolabial angle: averageUpper lip: average Lower lips: prominent

¾ View

Intra Oral ExaminationOral Hygiene: Fair

Intra-arch:Teeth number : Upper: 14 lower: 12Crowding :Upper: severe crowdingLower: mild crowdingIncisor inclination :Upper: proclined Lower: averageOther :Buccally erupted upper canines

Inter-arch/occlusion:

Anterior-posterior relation:Overjet: increased 4mmIncicor relation: II division 1Canine relation:

Right: II by ¾ unit

Left: II by ½ unitMolare relation:

Right: II by ¼ unit

Left: II by ½ unit

Vertical relation:Anterior Open bite

Transverse relation:Unilateral Cross bite without displacementCentral line :

Lower non-coincident with the upper to the right by 2 mm

Upper occlusal

Lower occlusal

Study Cast

Study CastLowerLower UpperUpper

Space analysis on upper cast• Space available : 68 mm• Space required : 79.5 mm• There is deficiency 10.5 → sever crowding

Space analysis on lower cast• Space available : 63 mm• Space required : 65.5 mm• There is deficiency 2.5 → mild crowding

Total Bolton ratio : 86.51% ( normal 91% )

Anterior Bolton ratio : 80.5% ( normal 77.3% )

Space analysis

Panaromic Radiograph

Cephalometric Cephalometric

RadiographRadiograph

Cephalometric AnalysisMeasurements Normal Pts result

Antero-Postero Skeletal Relations

SNA 82±3 86 Prognathic maxilla

SNB 79±3 75 Retrognathic mandible

ANB 3±1 8 Increased

Wits measurement

0 female 3 Increased

A-B FOP 90±5 93 normal

Vertical Skeletal Relationship

MM Angle 27±5 24 Normal

LFH/TFH 50-55% 60 % Increased

Gonial angle 126±5 134 Increased

Dento-skeletal Relation

UI/MX PLANE 108±5 120 Increased

LI/MN PLANE 92±5 110 Increased Intericisal angle 133±10 112 Decreased

Diagnosis

Patient has Class II Division I incisors relation based on skeletal class II relationship.

Complicated by :•Class II canine relationships•Class II molar relationships•Convex profile angle•Anterior open bite•increased overjet•Midline of lower teeth is not coincident with the upper to the right by 2 mm•Unilateral cross bite (right)

Treatment Plan

Aims of treatment:

1- achieve Class I incisors relationship

2- relief crowding

3- achieve Class I molar and canine relationships

4- correct the cross bite

5- increase overbite

6- overjet reduction

Means of achieving aims:-fixed appliance (upper and lower) : - anchorage control by: Nance for upper arch Fixed for lower arch

- with extraction of: 4 4 7 5- retention by : Vaccum-formed Essix Retainer

5 and 7 are badly destructed teeth

Thank you