Dr reham rawashdeh case presentation

Prepared by : Reham .A.AL.Rawashdeh

3rd year orthodontic resident

Supervisor : Dr. Ahmad.M.AL.Tarawneh Dr.Raed.Alrbata

Orthodontic Case Presentation

Keep your blood

caffeinated!!!!!!

Personal Data Patient’s initial: I.M

Gender: Female

Date of Birthday : April.1995

Age :20. 11 month

Career: college student

Patient’s initials :I.MAge : 20Career : college student

Chief Complaint : “ My upper and lower frontal teeth are spaced“

Class three incisal

O.J=1 mmO.B reduced ;

covering only0.5 mm of lower

incisor.

Panoramic view

Cephalometric Analysis

79⁰ SNA

78.4⁰ SNB

0.6 ⁰ ANB

1.6 ⁰ Corrected ANB

7.1⁰ SN- Maxillary plane

-1.2 Wits appraisal

118 ⁰ UI-Maxillary plane

87.3 ⁰ LI-Mandibular plane

128 ⁰ Inter-Incisal angle

31.4⁰ Maxillary mandibular planes angle (MMPA)

27.3 ⁰ Frankfort mandibular planes angle (FMPA)

56 Upper anterior face height (UAFH)

63 Lower anterior face height (LAFH)

53% Anterior facial height ratio

Medical & Dental History

Patient denied any medical condition .

Dental history : Previously endodontic and restorative

treatment for the upper right 6 . No Previous History of trauma or

habits .

Medical & Dental History

Habits : None

Motivation : Highly internal motivation

Expectations : High

Chief Complaint

‘I Don’t like the space Between my teeth

especially my upper frontals “

Jaw and Occlusal Function

Mastication and speech : within normal limits

TMJ: No signs of TMJ dysfunction (No clicking, no crepitus, no tenderness to palpation) and good range of opening and lateral movement, displacement on closure to the left.

Jaw and Occlusal Function

Midline : the patient face is asymmetric ; the lower midline is shifted to the left to the facial midline .

(transverse) faceAsymmetric face with slightly pointed chin shifted to the left , nasal tip slightly to

the right.

Face ( vertical)

Average lower facial height

Face ( profile view)

Class Three Skeletal relationship.

Extra-oral Frontal View

Face : triangular slightly narrow face ,asymmetric ; chin shifted to the left on closure.Nose : prominent, tip slightly to the right.

Lips : Competent ,thin average tonicity.

Extra-oral Frontal ViewBilateral symmetry

Extra-oral Frontal Viewvertical facial thirds

Extra-oral Frontal View

Extra-oral Frontal View

(Extra Oral (Profile View

Profile : Straight

(Extra Oral (Profile View

Nasofrontal angle: 132degree

norm (115-135)

Nasolabial angle : (90-110 )100 degree

Labiomental Angle:

142 degree , norm (110-130) ,,,

Obtuse!!

(Extra Oral (Profile View

Vertical Facial proportions:

Patient has an average lower facial

height.

(Extra Oral (Profile View

Average maxillary mandibular plane angle.

Extra Oral Photographs

Intra Oral Photographs

Intra Oral Photographs

Intraoral Photograph (Frontal View)

Oral hygiene is goodFlourosis minaly affecting canine and premolar area.Soft Tissue : all within normal limits , firm coral pink gingiva, prominent labial

frenum.

Intraoral Photograph (Frontal View)

Teeth present : 7654321 1234567

87654321 1234567

Intraoral Photograph (Frontal View)

Incisal Classification : Class Three

Overjet : 1 mm

3 mm Diastema

Intraoral Photograph (Frontal View)

Overbite : Reduced 0-0.5mm .Centerlines : lower centerline is shifted 2 mm to the left, upper can’t be identified.Cross bites : localized at the upper left canine , and upper 1st premolar.

Displacements: on closure to the left 3mm approximately.

Intraoral Right Lateral View

Molar relationship : Quarter three unit. Canine : Class one( mesialy angulated)

Cross bite : None

Flourosis on posterior teeth.

Intraoral Left Lateral View

Flourosis on posterior teeth.Molar relationship : class one .Canine relationship : Class one (upright) .

Cross bite : on upper canine and 1st premolar.

Intraoral Photograph ( Upper Jaw )

U –Shaped upper jaw. High attachment of labial frenum.Class one carious lesion on upper left1st molar, restored upper right 1st molar.Well aligned posterior segments ,upper right and left 1st premolars are slightly rotated in DB direction and upper left 2nd premolar ,well aligned spaced anterior segment, ( 3 mm Diastema).

Intraoral photograph (lower jaw)

U-Shaped lower archNormal size tonguePartially erupted lower right 3rd molarWell aligned buccal segments ( lower left 1st premolar is rotated slightly in MB direction ,lower left canine I rotated in mesiolingual direction , well aligned spaced anterior segment( 7 mm)

Study Models View

Study Models View

Study Models ( Frontal view )

Study Models ( Right Lateral view)

Study Models ( Left Lateral View)

(Study Models ( P-A View

Study Models ( Upper occlusal)

I-Canine width33mm

I-molar width 44mm

Study Models ( Lower occlusal)

I.Molar width =41

I .Canine width =27

Curve of Spee

COS = 1.5

Space required assessment (RLSA)Upper jaw

Crowding and spacing -Space available=71mmspace required= 66.5mm .. 4.5mm spacing

- Leveling COS …not in need-Arch width change … not in need ..individual tooth

expansion is ignored. Incisor A-P position change … not in need

Angulation change … less than 2 mm for all upper incisor (0.5 for each tooth).Torque or inclination change… about 1 mm / 5 degree for all upper centrals .

2015

2016

Space required assessment (RLSA) Lower Jaw

Space available =67mm Space required = 61mm … space=6 mm Leveling of COS … not in need A-P change .. Not in need

-Crowding and spacing

Tooth Size Analysis (Bolton Analysis)

Anterior Bolton Ratio= 76.1%

Tooth Size Analysis (Bolton Analysis)

Overall Bolton ratio =90.6%

Panoramic view

Panoramic View

-All within normal limits except for deviated nasal septum to the right. Normal shape of mandibular ramus and condyle ,

- All Permenant teeth are present

Aug. 2015

Cephalometric View

Aug. 2015

Cephalometric Analysis

SN

S

Po

Or

A

B

Me

Go

ANSPNS

FOP

Normal Value Value pre -treatment Variable

81⁰ ±3⁰ 79⁰ SNA

78⁰ ±3⁰ 78.4⁰ SNB

3⁰ ±2⁰ 0.6 ⁰ ANB

1.6 ⁰ Corrected ANB

8⁰ ±3⁰ 7.1⁰ SN- Maxillary plane

0 + 1.77 mm (Female) -1.2 Wits appraisal

109⁰ ±6⁰ 118 ⁰ UI-Maxillary plane

93⁰ ±6⁰ 87.3 ⁰(120-31.4= )88.6 LI-Mandibular plane

135⁰ ±10⁰ 128 ⁰ Inter-Incisal angle

27⁰ ±4⁰ 31.4⁰ Maxillary mandibular planes angle (MMPA)

28⁰ ±4⁰ 27.3 ⁰ Frankfort mandibular planes angle (FMPA)

……… 56 Upper anterior face height (UAFH)

.……… 63 Lower anterior face height (LAFH)

55% ±2% 53% Anterior facial height ratio

Index of Orthodontic Treatment Need Dental Health Component (IOTN)

According to the IOTN Index the patient falls into the great Need Category ; Grade4c which indicate the prescience of anterior or posterior cross bite with more than 2 mm discrepancy between CR and ICP.

Index of Orthodontic Treatment Need Aesthetic Component (IOTN)

Diagnostic Summary I.M is a 20 years old MF female patient presented at our clinic with an esthetic concern related to her “Spaced upper and lower frontal teeth “, she has good oral hygiene , mild Flourosis condition ,she has class three incisal on mild three skeletal base with an average lower facial height , highly attached upper labia frenum, this is complicated by spaced upper( midline Diastema ) and lower anterior segment, decreased OJ and OB class one canine relationship, quarter three molar relationship at the left side, class one canine and molar relationship at right side ,, lower dental midline is shifted to the left, posterior cross bite at the site of upper left canine and 1st premolar with mandibular displacement to the left at closure, and rotated

4 453434

Problem list 1 .Carious lesion on upper left 1st molar, teeth Flourosis.

2.Spaced upper frontals( Diastema) , and lower labial segment.

3.Class three skeletal pattern and facial assymetry.4.Highly attached upper labial frenum.

5.Class three incisal relationship.6 .Posterior cross bite at the site of upper left canine

and 1st premolar.7.Reduced OJ.

8 .Reduced OB.9 .Lower dental midline is shifted 2mm to the left.

10 .Quarter three unit molar relaion at the right side.11 .Rotated

4 453434

Treatment Aims

1.achieving good oral hygiene throughout orthodontic treatment.2 .Treatment of carious upper left 6,improving dental esthetics

by solving Flourosis issue .3.Close spaces.

4.Eliminate madibular displament associated with posterior cross bite.

5.Accept class three skeletal base and maximizing dentoaleveolar compensation.

6.Frenectomy of upper labial frenum.7.Level and align arches.

8.Correct centerlines.9.Normalize OJ and OB.

10 .Maintain and achieve the already class one molar and canine relationships.

11 .Coordinate dental arches with good buccal interdigitation.12.Retain the corrected results .

Treatment plan

DENTAL HEALTH IMROVMNT AND MINTAINANCE: 1.Treatment of carious upper left molar.

2 .O.H instructions . ORTODONTIC TREATMEN T PHASE :

Camouflage ;Non extraction

Upper Lower F.AClass three elastics

Periodontal PROCEDURE:Referral for periodontal department for Frenectomy +- CSF ( Rotated teeth). RETNTION PROTOCOL:

Upper( 3-3 ) and lower fixed retainer , lower (3-3) fixed retainer,(0.0175 inch multistrand ss,flexible allowing physiological tooth movment , less failure rate. Upper and lower hawley retainers after correction of crossbite and rotated

teeth

Mechanics -Increase etching time ( up to one minute) at DB

appointment; Florousis.F.A perscription (MBT); bodily movment is need ; rotated teeth ,lower labial root torque.Swap lower canines bracket; to avoid LLS proclination.Lacebacks and cinchback in L.A ; to avoid LLS proclination.Closing lower spaces on round steel wires.Class three elastics ;close spaces ,increase OJ RetentionPermanent fixed retainer upper and lower (3-3)+ upper lower Hawley retainer; Spaced teeth ,and to keep the resulted interdigitation.Refer for frenectomy prior to Debonding appointment ; Scar

may retain the achieved result of space closure!!!???

اباوت واطاووون يور

فيرست بريسنتاشن”

!!!!!