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Case presentation

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. CASE PRESENTATION A male patient named Punith, aged 12 years came to the department with chief complaint of forwardly placed upper and lower front teeth . No significant information was reveled on prenatal and postnatal history. No history of oral habits, Childhood diseases – He has history of epileptic attack at the age of 1 ½ & 3 yr age. He was under medication , but now stopped after physicians advice. Familial malocclusion History:-Yonger brother & mother has bimaxillary protrusion He is internally motivated with positive attitude towards orthodontic treatment and is citing esthetics as the main reasons for taking orthodontic treatment. Pubertal Status:- Pre-pubertal Physical Examination :- He is moderately built with 4’5” height, weighs 26 www.indiandentalacademy.com kgs with mesomorphic body type.
  3. 3. Extra oral Examination :- Mesocephalic, Leptoprosopic, Interlabial gap of 7mm www.indiandentalacademy.com Convex profile, Nasolabial angle of 87 0
  4. 4. Complex type of smile, incisor exposure www.indiandentalacademy.com of 7 mm during speech & 9mm on smile,
  5. 5. Face follows the rule of fifths & lower 1/3rd of face is more www.indiandentalacademy.com
  6. 6. Functional Examination :- He is found to have Nasal respiration No abnormality is detected in respiration & speech. TM Joint is normal both in open & closed mouth positions. He has tongue thrust during swallowing. He has 2mm of freeway space and 7mm of incisor crown length exposure during speech and 9 mm of exposure during smile. Intra oral Examination •Oral hygiene status is fair; frenal attachments are normal; oral mucosa, gingiva and tongue are normal. www.indiandentalacademy.com
  7. 7. Teeth Present 6EDC21 12CDE6 76ED321 123DE67 Spacing in the U/L anteriors with lower midline shifted to right side by 0.5 mm. Class 1 molar relation Class 1 molar relation www.indiandentalacademy.com
  8. 8. Proclined upper anteriors with spacing & ovoid arch form , Normal depth of palatal vault. Spacing in anterior segment, mild proclination of mandibular incisors , ovoid arch form. www.indiandentalacademy.com
  9. 9. RADIOGRAPHIC RECORD O.P.G. Hand wrist radiograph 7’s in stage F stage & 3, 4, 5 in stage F stage Dental age 11.5 years Cervical vertebrae: 1st stage 85 to 100 % growth remaining PP2, 1st stage 3yrs from pubertal growth spurt, approx.skeletal age www.indiandentalacademy.com 10.6 Yrs.
  10. 10. CEPHALOMETRIC ANALYSIS Relationship of Mandible Soft Tissue Analysis N Perp. Pog :(0 to -4 mm) -7mm N Pog – TH ( 87.5+/-2.5) 1040 Facial Angle :(900) 880 Nose tip to H-Line : (12mm) 3.5mm SNB : 80 850 Upper Sulcus depth : (5mm) 17.5mmEff.Mand.Lng: (114.4+/- 4.3) 106 mm Skeletal convexity at point A (-2) +7mm SND : (76) 74 Upper lip strain : (2mm) Ext. of Mand.:(76mm) 69mm Saddle Angle :(123+/-5) 122 Y Axis :(66) 700 2.5 Upper lip curvature :(2-5) 7mm Soft Tissue chin Thickness : (10-12) 0 , 0 13mm Relationship of Maxilla, and Mandible Relation to TVL Go Me – FH : (26+/-4) 300 Upper lip anterior : (3.3+/-1.7) 3mm Go Gn – Sn : (32) 360 Lower lip Anterior : (1+/- 2.2) -2mm Gonial angle :(128+/-7) 1310 A Point ‘ : ( -.3+/-1) 0.5mm Basal Plane angle:(25) B Point’ : (-7.1+/- 1.6) -15.5mm Anterior to Posterior Pogonion’ : (-3.5+/- 1.8) -15mm face height ratio : (62-65%) 33.50 62.5% Skeletal Relationship of maxilla Maxillary Incisors SNA : (820) 850 1 – NA : (4) 9mm Ext.of Max.Base : (50.3) 47mm 1 – NA : (22) 340 N Perp. To Pt. A :(0+/-2) +4mm, 1 – Pt A : (4) 10mm Eff.Max Lng:(92.1+/-4.1) 86mm 1 – SN : (102+/-2) 1180 NA – TH : (90+/-3) 920 1 – PP : (70+/-5) 57.50 Angle of Inclination : (850) 890 TVL Mx1 :(-12.1+/- 1.8) -6mm www.indiandentalacademy.com Mandibular Incisors 1 – NB : (4) 11.5mm 1 – NB : (25) 340 1 – APo Line :(1 to 2) 6mm IMPA : (90+/- 3) 1000 TVL Md1:(-15.4+/-1.9) -13mm Max.1 to Mand.1: (131) 870
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  12. 12. MODEL ANALYSIS Tanaka & Johnston and Moyers Analysis Maxilla has approximately 2-3 mm spacing in each quadrant, but mandible do not have. DIAGNOSIS A 12 yr old male patient named Punith is diagnosed as a developing vertical skeletal dysplasia with Dental class I molar relation; upper & lower ant. spacing with bimaxillary dentoaloveolar protrusion; with lip incompetence of 7 mm, and tongue thrust habit.. www.indiandentalacademy.com
  13. 13. TREATMENT OBJECTIVES To restrict the clockwise rotation of mandible. To correct tongue thrust habit To achieve lip competence. To improve facial profile To close spacing in maxillary and mandibular arch To correct midline www.indiandentalacademy.com
  14. 14. TREATMENT PLAN : Myofunctional exercises for correction of tongue thrust Vertical holding appliance in maxilla Extraction of canines in maxilla deciduous Sectional align followed by utility arch in Maxilla & Mandible till buccal teeth erupts Retraction of upper anteriors in utility arch High pull head gear during circumpubertal growth period www.indiandentalacademy.com
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