Case presentation

Done by:

Hanady Al Masri

Abdallah Al Zireeni

Mohammad Elwir

Yahya Al Omari

Patient Name: Mohammad Baker Al Bdor

Age: 14 years old

Gender: male

Occupation: student

Chief complaint: the patient present to the clinic complaining about appearance of his teeth crowding

mainly .

Medical history: patient denied any relevant medical problem.

Dental history: previous fillings and extractions .

Social history and habits: nothing is relevant .

Extra oral examination

Frontal view

Facial proportions : Normal facial symmetry

Vertical proportion: increased LFH

Competent lips

Profile view

profile : is convex

Nasolabial angle: average 90-100

both upper and lower lips are behind the E-line

Frankfort mandibular plane angle is avarege

Smile view

smile line : high smile line

upper coincident midline with 2mm right shifted mid line

Intra oral Examination

Intra oral examination

Soft tissue: mildly inflamed

Oral hygiene: poor and he needs several restorations

Teeth present: 14 tooth in the upper jaw & 14 tooth in the lower jaw

Maxillary arch

Moderate crowding 5mm Supernumerary adjacent to left lateral : non fillings or extractions : class restoration on upper

right 6

Mandibular arch

crowding : moderate 5mm

present teeth : 14 tooth fillings or extractions : lower left 6 filling

Frontal view

Class incisor relationship

Overbite: average

Overjet: increased

Upper midline coincident, with the lower being shifted by 2mm to the right.

Right buccal view

unit Class II Canine

Class Molar

Left buccal view

Class I Canine class III Molar by

unit

Study Models

Space analysis on the upper cast

Space available: 73mm

space required: 78 mm

There is deficiency of 5mm

Space analysis on the lower cast

Space available: 71mm Space required: 75mm There is deficiency of 4

mm

Ant. bolton : 76.2% average (77.2 % 1.3%)

OPG x-ray

present teeth : full upper and lower sit of teeth bucco version impacted lower left third molar

Cephalometric analysis normal value variable

823 79 SNA

793 77 SNB

31 2 ANB

83 10 SN to maxillary plane

1085 109 Upper incisor to maxillary plane

925 89 Lower incisor to mandibular plane

-1 - 1 -1 Wit's

13310 131 Inter incisor angle

275 30 Maxillary mandibular planes angle

130mm Total facial height

7mm Lower facial height

50-55% 54% Lower facial height ratio

0-2 -3 Lower incisor to A-pog

Within 1 mm

-1 Lower lip to E plane

863 84 S-N-Pog

Diagnosis :

Class incisal relation based on class skeletal relation complicated with ;

1. Increased over jet. 2. Moderate crowding in the upper arch . 3. Moderate crowding in the lower arch. 4. Bucco-distal Rotation of upper right lateral incisor. 5. Bucco-distal Rotation of lower right lateral incisor. 6. Class molar relation in the left side by unit . 7. Class canine relation in the right side by unit . 8. shifting of the lower midline by 2mm to the right side .

Treatment plan Our aim of treatment is :

1- Oral hygiene and patient motivation .

2- Restore the present carious liaisons .

3- Maintain class I incisor relationship

4- Alignment of upper and lower teeth by reliving crowding

5- derotate the upper and lower right lateral incisors .

6- Correcting lower shafted midline .

7- Achieve class molars and canines relation .

8- reducing over jet .

Treatment plan suggestion

This case needs:

1- applying fixed appliance for upper and lower teeth .

2-stripping of upper and lower incisors to gain space .

3-proclination of upper and lower incisors to gain space needed .

4- de rotation of upper and lower right lateral incisors .

5- class elastics for the left side .

Other treatment options : Extraction of all 5s to gain space , and then use fixed appliance to realign the teeth . But this option is not preferable because : 1- the patient profile is convex and the extraction will place the incisors in retroclined position so this will give us ditched in appearance of the face 2- the patient has high smile line and by the retrolclination of the incisor the smile line will shown more higher gum smile which is unaesthetic

Retention

Upper arch: Fixed retainer Lower arch: Fixed retainer circumferential fiberotomy for the upper

and lower right lateral incisors .

Thank you