INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com


Name:Sai Kumar



Age: 15 yrs






Sex : M
Address:KSNB Singh,Nellore
Chief complaint :
Patient complaints of forw...
GENERAL HISTORY
Reason for taking orthodontic treatment: Esthetics
PHYSICAL STATUS
BUILD

: Mesomorphic

BODY TYPE : Athle...
EXTRA ORAL EXAMINATION


Shape of the head: Mesocephalic



Facial form : Mesoprosopic



Facial profile

:Convex



C...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Inter labial gap : 0mm
 Smile Arc :Consonant
 Lip posture and tonicity :Potentially
competent.
 Lip length :
At philtru...
Functional examination










Respiration :Nasal
Amount of incisor exposure
At rest
: 0 mm
During speech : 8 mm...









Jaw function/TMJ complaint now : (No)
History of Pain
: (No)
History of Sounds
: (No)
Joint tenderness to...
Right side

Left side

Class - I Molar relationship.

Class – II Molar relationship

End on Canine relationship.

Endon Ca...
• ‘V’ shaped arch
• symmetrical

• Midline diastema present

• ‘U’ shaped arch

• symmetrical
• Severe lower anterior
crow...
Over jet -8 mm
Overbite – 5mm
Mid line not coinciding(maxillary
dental midline shifted to right)
www.indiandentalacademy.c...
NO. of teeth present
87654321

12345678

87654321

TMJ
Rt & Lt condyles appears normal
Rt & Lt articular eminence appears ...
CEPHALOMETRIC ANALYSIS

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CVMI

COMPLETION STAGE: GROWTH
COMPLETED
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www.indiandentalacademy.com
HARD TISSUE

PRE-TREATMENT
Normal

ANB

Measured

Class

2˚

5°

II

A ⊥ to B ⊥ on FH

4mm

8mm

II

AO to BO

0 – 1mm

4m...
Effects of soft
tissues if any&

I
N
F
E
R
E
N
C
E

Basic Upper lip Normal, Thick, Thin
(14+1

17mm

Soft Tissue
chin

8mm...
MAXILLA
Norms

Max apical base

Pre Rx

iPost growth
modulation
Normal maxilla

SNA

82±2˚

81˚

⊥A–N⊥

2mm

0mm

Normal m...
Norms

131.6±4.5

Mand eff. Length

Pre Rx

Post growth
modulation

104mm

MANDIBULAR PLACEMENT
Saddle angle

123±5˚

124 ...
Pre Rx

Normal

Normal

45:55

43:57

SN – Go – Gin

32°

30°

F–M–A

25°

Post growth modulation

Mid/Lower face ht

High...
Basal plane angle
occlusal

to

25°

NF

11°

MP

14°

25°
110
140

Vert max placement

Nasion to ANS

62±2;50±4

52mm

Ma...
Per Rx

Anterior Divergent
Anterior convergent
Upward anterior rotation of
both max and mand

√

Downward anterior
rotatio...
Pre.Rx
Sagittal affected by vertical

Sagittal caused by

Retrognathic
mandible

Sagittal worsened by
Sagittal compensated...
UPPER
normal

Pre Rx

P. Gr. Mod

U1 – SN

102˚

116°

U1 – NA

22˚, 4mm

33°, 10mm

U1 - N⊥

2 – 4mm

10 mm

U1 – A Pog

...
INFERENCE

Incisor
retraction
needed

In relation to
cranium and
maxilla
For camouflage
treatment

Nasolabial angle
Lip st...
LOWER
normal

Pre Rx

L1 – FH

65°

57°

L1 – MP

95°

102°

L1 – NB

25°,4mm

25°, 4mm

L1 – A Pog

25°,4mm

P. Gr. Mod

...
LAND MARKS

Facial angle

Upper lip curvature

MEAN

90º

PATIENT
VALUES

87º

INFERENCE

Convex profile

2.5 mm

3mm

Ave...
MODEL ANALYSIS
UPPER

LOWER

Right

Left

Right

Left

10

10

6

6

7.5

7.5

6

6

8

8

7.5

7.5

7.5

8

7

7

7

7

7...
BOLTON TOOTH RATIO
OVERALL RATIO: Mand 12 TM x 100 =89.55%
Max 12 TM
1.5mm of Maxillary tooth material excess

Ant. RATIO:...
ASHLEY-HOWE ANALYSIS


UPPER
PMD = 40 mm



PMBAW = 42 mm PMBAW > PMD

Expansion possible

PMBAW 100;
TM

Boderline cas...













LINDER-HEARTH ANALYSIS

UPPER
MPV = 36mm
INDICATED.

CPV = 41 mm CPV >MPV EXPANSION IS

MMV = 49 mm CM...
Upper arch
 Space discrepancy ( Arch perimeter)
= 2mm(available)
 Space obtainable by Derotation of Molars
= 0 mm
 Spac...
Lower arch

Space discrepancy ( Arch perimeter) = 7 mm(required)
 Space required for Derotation of 34
= 0mm
 Space requ...
DIAGNOSIS AND TREATMENT PLAN
DIAGNOSIS:

ACKERMAN-PROFFIT CLASSIFICATION:
Evaluation of Facial Proportions and Esthetics:...


Angle’s Class-II subdivision Dentoalveolar
malocclusion on class I skeletal base with Class – II soft
tissue profile wi...









To level & align upper and lower arches
To correct over jet & over bite
To correct the mid line shift
To at...
Upper 4s and lower 5s
 PAE with MBT Mechanotherapy
 Leveling and Alignment.
 Type A anchorage on all sides except lower...


PHASE – I







0.016 round NiTi - 1 Month
0.016 X 0.022 NiTi – 1Month
0.017 X 0.025 NiTi – 1 Month
0.017 X 0.025...




1.
2.
3.
4.
5.

6.
7.
8.
9.
10.

Retention begins with Diagnosis and
Treatment planning.
Treatment goals include

G...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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orthodontics patient records preparation /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • Transcript of "orthodontics patient records preparation /certified fixed orthodontic courses by Indian dental academy "

    1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2.  Name:Sai Kumar  Age: 15 yrs    Sex : M Address:KSNB Singh,Nellore Chief complaint : Patient complaints of forwardly placed upper front teeth . www.indiandentalacademy.com
    3. 3. GENERAL HISTORY Reason for taking orthodontic treatment: Esthetics PHYSICAL STATUS BUILD : Mesomorphic BODY TYPE : Athletic HEIGHT : 5.8 inches WEIGHT : 60 kgs www.indiandentalacademy.com
    4. 4. EXTRA ORAL EXAMINATION  Shape of the head: Mesocephalic  Facial form : Mesoprosopic  Facial profile :Convex  Clinical FMA : Average angle www.indiandentalacademy.com
    5. 5. www.indiandentalacademy.com
    6. 6. www.indiandentalacademy.com
    7. 7. www.indiandentalacademy.com
    8. 8. Inter labial gap : 0mm  Smile Arc :Consonant  Lip posture and tonicity :Potentially competent.  Lip length : At philtrum : 17 mm At corner of mouth : 22 mm  www.indiandentalacademy.com
    9. 9. Functional examination         Respiration :Nasal Amount of incisor exposure At rest : 0 mm During speech : 8 mm During smile : 9 mm Free way space: 2 mm Curve of Spee = Rt 2mm & Lt 2 mm Range of Motion 1) Maximum Opening 50mm 2) Protrusion 8mm 3) Rt Excursion 8mm 4) Lt Excursion 8mm www.indiandentalacademy.com
    10. 10.         Jaw function/TMJ complaint now : (No) History of Pain : (No) History of Sounds : (No) Joint tenderness to palpation : (No) Muscle tenderness to palpation : (No) click on Deflection of Mandible Anterior disk displacement - www.indiandentalacademy.com
    11. 11. Right side Left side Class - I Molar relationship. Class – II Molar relationship End on Canine relationship. Endon Canine relationship Class –II Incisor relationship Class –II Incisor relationships www.indiandentalacademy.com
    12. 12. • ‘V’ shaped arch • symmetrical • Midline diastema present • ‘U’ shaped arch • symmetrical • Severe lower anterior crowding www.indiandentalacademy.com
    13. 13. Over jet -8 mm Overbite – 5mm Mid line not coinciding(maxillary dental midline shifted to right) www.indiandentalacademy.com
    14. 14. NO. of teeth present 87654321 12345678 87654321 TMJ Rt & Lt condyles appears normal Rt & Lt articular eminence appears normal 12345678 www.indiandentalacademy.com
    15. 15. CEPHALOMETRIC ANALYSIS www.indiandentalacademy.com
    16. 16. CVMI COMPLETION STAGE: GROWTH COMPLETED www.indiandentalacademy.com
    17. 17. www.indiandentalacademy.com
    18. 18. HARD TISSUE PRE-TREATMENT Normal ANB Measured Class 2˚ 5° II A ⊥ to B ⊥ on FH 4mm 8mm II AO to BO 0 – 1mm 4mm II Beta angle 27˚ to 35˚ 30° I NA – Pog 0 - 5˚ 7° I -4˚ -4° II Max : Mand(ANS>PNS,GoGn) 2:3 2.26:2.73 II Harvold’s unit length difference Chart 14 II AB – N.pog Skeletal Class II Soft tissue Profile Angle 161˚ 151° II Total tissue Profile angle 133˚(males) 137˚(female ) 123° II 97 + 10 87° I Soft tissue facial angle Subnasale ⊥ to chin www.indiandentalacademy.com -2.5±2.6 -15mm II
    19. 19. Effects of soft tissues if any& I N F E R E N C E Basic Upper lip Normal, Thick, Thin (14+1 17mm Soft Tissue chin 8mm Normal, Thick, Thin (10+12) Class – I SKELETAL Class – II √ Class – III Mild (2_4) SEVERITY Moderate (4_6) √ Severe (>6) Matching SOFT TISSUE Compensati ng Aggravating www.indiandentalacademy.com √
    20. 20. MAXILLA Norms Max apical base Pre Rx iPost growth modulation Normal maxilla SNA 82±2˚ 81˚ ⊥A–N⊥ 2mm 0mm Normal maxilla CAUSE 57.7±3.5 Max size- ANS – PNS 58mm Normal maxilla Max effective length Co – ANS 100.9 ±3.9 90mm Decreased Max placement S ⊥ NF – PTM ⊥ NF 18mm 18mm Normally placed MANDIBULAR APICAL BASE SNB 80±2˚ 76˚ B⊥-N⊥ -2mm Retrognathic mandible -9 mm Chin N –Pog –FH (facial angle) CAUSE 87˚ 87˚ www.indiandentalacademy.com Normal
    21. 21. Norms 131.6±4.5 Mand eff. Length Pre Rx Post growth modulation 104mm MANDIBULAR PLACEMENT Saddle angle 123±5˚ 124 ˚ N Post cranial base 32 – 35 40mm Effect of gonial angle 128±7˚ 126˚ Effect of ramus orientation S – Ar – Go 143±6˚ 141˚ I N F E R A N C E Maxilla Fault with Size ( N ) Placement (Normal) Mandible Size ( ) Placement (Normal) www.indiandentalacademy.com
    22. 22. Pre Rx Normal Normal 45:55 43:57 SN – Go – Gin 32° 30° F–M–A 25° Post growth modulation Mid/Lower face ht High Low Soft tissue vert. prop 20 Jarabak ratio 62-65% 75% BJORK sum 396±6° 391 Saddle angle 123±5° 124o Articular angle 143±6° 141o U- Gonial angle 52-55° 560 L- Gonial angle 72-75° 700 Y- axis N –S – Gin 66° 660 Y- axis FH – S – Gn 59° 580 Facial axis (Ricketts) 90° Compensated by Ramus Ht ? www.indiandentalacademy.com 850
    23. 23. Basal plane angle occlusal to 25° NF 11° MP 14° 25° 110 140 Vert max placement Nasion to ANS 62±2;50±4 52mm Maxillary rotation 85° 89o www.indiandentalacademy.com
    24. 24. Per Rx Anterior Divergent Anterior convergent Upward anterior rotation of both max and mand √ Downward anterior rotation of both max and mand www.indiandentalacademy.com Post growth modulation
    25. 25. Pre.Rx Sagittal affected by vertical Sagittal caused by Retrognathic mandible Sagittal worsened by Sagittal compensated Horizontal growth pattern UPPER INCISOR EXPOSURE U1 exposure at rest 0mm U1exposure in smile 9mm ANS to Incisor (33±3/30±3) 32mm U lip length (22-24/20) 17mm INFERANCE No excessive exposure www.indiandentalacademy.com P.Gr.Mod
    26. 26. UPPER normal Pre Rx P. Gr. Mod U1 – SN 102˚ 116° U1 – NA 22˚, 4mm 33°, 10mm U1 - N⊥ 2 – 4mm 10 mm U1 – A Pog 25˚ , 4mm 39°, 13 mm U1 – N Pog 10mm 15 mm normal Nasolabial angle 90-110° Pre Rx 120° Nasal angle Labial angle 12° U lip thickness 15 mm 17mm 5mm 11mm Basic U lip thickness Lip Strain www.indiandentalacademy.com
    27. 27. INFERENCE Incisor retraction needed In relation to cranium and maxilla For camouflage treatment Nasolabial angle Lip strain SUPPORTE D BY Lip thickness Lip in relation to esthetic line www.indiandentalacademy.com 6mm 9mm
    28. 28. LOWER normal Pre Rx L1 – FH 65° 57° L1 – MP 95° 102° L1 – NB 25°,4mm 25°, 4mm L1 – A Pog 25°,4mm P. Gr. Mod 23°,1mm L1 – N Pog 3mm L1 – NB – NB – Pog 1:1 2:1 Mentolabial angle 120±10° 104° L – lip thickness 12±3 20 mm L – lip length 40±5 45 mm INFERENCE Lower incisor retraction needed In relation to mandibular 0mm For camouflage Rx -3mm Mentolabial sulcus Supported by Lower lip thickness Holdaway ratio Lip in relation to esthetic line www.indiandentalacademy.com
    29. 29. LAND MARKS Facial angle Upper lip curvature MEAN 90º PATIENT VALUES 87º INFERENCE Convex profile 2.5 mm 3mm Average -2 ± 2 +3mm Class II skeletal 7º to 15º 20º Increased lip thickness Nose tip to H – line 12 mm (max) 2mm Normal Upper sulcus depth 5 mm 6mm Increased Upper lip thickness 15 mm 17mm Decreased Upper lip strain 14 – 16 6mm Lower lip to H – line -1 to +2 mm 5mm Increased LL Lower sulcus depth 5 mm 6mm Deep ML sulcus 10 – 12 mm 8 mm decreased chin thickness Skeletal convexity at A H – line angle Soft tissue chin thickness www.indiandentalacademy.com lip strain present
    30. 30. MODEL ANALYSIS UPPER LOWER Right Left Right Left 10 10 6 6 7.5 7.5 6 6 8 8 7.5 7.5 7.5 8 7 7 7 7 7.5 7.5 10 10 11 11 11.5 12 TM 100.5 90 ANT 6 TM 51 39 www.indiandentalacademy.com
    31. 31. BOLTON TOOTH RATIO OVERALL RATIO: Mand 12 TM x 100 =89.55% Max 12 TM 1.5mm of Maxillary tooth material excess Ant. RATIO: mand 6 TM x 100 =76.47% , max 6 TM .0427 mm of maxillary tooth material excess ARCH PERIMETER ANALYSIS Tooth Material : Arch length : Difference : Upper 81mm Lower 68 mm 83mm 61mm 2mm (spaceavailable) www.indiandentalacademy.com 7mm (space required)
    32. 32. ASHLEY-HOWE ANALYSIS  UPPER PMD = 40 mm  PMBAW = 42 mm PMBAW > PMD Expansion possible PMBAW 100; TM Boderline case     42100 = 41.7% 100.5  LOWER PMD = 34 mm  PMBAW = 35mm PMBAW >PMD  Expansion possible    PMBAW 100; TM 35100 = 38.88% 90 Boderline case www.indiandentalacademy.com
    33. 33.        LINDER-HEARTH ANALYSIS UPPER MPV = 36mm INDICATED. CPV = 41 mm CPV >MPV EXPANSION IS MMV = 49 mm CMV = 54 mm CMV >MMV EXPANSION IS INDICATED. LOWER MPV = 31mm CPV = 28.23 mm IS INDICATED. MMV = 44mm INDICATED. CPV <MPV EXPANSION NOT CMV = 37.5 mm CMV < MMV EXPANSION IS NOT www.indiandentalacademy.com
    34. 34. Upper arch  Space discrepancy ( Arch perimeter) = 2mm(available)  Space obtainable by Derotation of Molars = 0 mm  Space required for correcting Canine rotations = 0mm Incisor Proclination UI to NA = 33º For ANB of 5º = 19º To retrocline = 14x0.8 = 11.2mm ►Total space required = 11.2-2=9.2 mm ►Discrepancy = 9.2mm ►Space required for molar correction on RT ___mm LT___ mm ►Hence space required on RT 4.6 mm LT 4.6 mm www.indiandentalacademy.com
    35. 35. Lower arch  Space discrepancy ( Arch perimeter) = 7 mm(required)  Space required for Derotation of 34 = 0mm  Space required for correcting Incisor =0mm  Proclination L I to NB = 25 º For ANB of 5º = 28º To procline = 3X 0.8 = 2.4mm ► ► ► Leveling Curve of Spee = 3 mm (normal) Space required to establish class I molar relation =4mm on RT Discrepancy = 7+2.4+4=13.4mm Hence space required on RT _8.7__mm LT_ 4.7_ mm www.indiandentalacademy.com
    36. 36. DIAGNOSIS AND TREATMENT PLAN DIAGNOSIS: ACKERMAN-PROFFIT CLASSIFICATION: Evaluation of Facial Proportions and Esthetics: Convex profile, Potentially competent lips Normal maxilla Retrognathic mandible Decreased chin thickness Proclined upper and lower incisors Protruded upper and lower incisors Low LAFH Obtuse nasolabial angle AcuteMentolabial sulcus Intra-Arch alignment and symmetry symmetric U & L Arch lower anterior crowding www.indiandentalacademy.com
    37. 37.  Angle’s Class-II subdivision Dentoalveolar malocclusion on class I skeletal base with Class – II soft tissue profile with proclined upper and lower incisors and severe lower anterior crowding www.indiandentalacademy.com
    38. 38.       To level & align upper and lower arches To correct over jet & over bite To correct the mid line shift To attain class I molar ,canine and incisor relationship Establishing soft tissue harmony To stabilize the corrections achieved www.indiandentalacademy.com
    39. 39. Upper 4s and lower 5s  PAE with MBT Mechanotherapy  Leveling and Alignment.  Type A anchorage on all sides except lower right quadrant.  Class II elastics on right side  After achieving class I molar relation maintain Type B anchorage in all quadrant  Finishing & Detailing.  Stability and Retention. www.indiandentalacademy.com
    40. 40.  PHASE – I      0.016 round NiTi - 1 Month 0.016 X 0.022 NiTi – 1Month 0.017 X 0.025 NiTi – 1 Month 0.017 X 0.025 SS - 1 Month 4 Months PHASE – II  0.017 X 0.025 SS Individual canine retraction - 3 Month 0.017 X 0.025 SS 4 incisors as 1 unit- 3 Month  PHASE – III      0.018 X 0.025 SS 0.019 X 0.025 SS 0.021 X 0.025 SS - 1 Month - 1 Month - 1 Month 6 Months 3 Months 13 Months SURGICAL PHASE RETENTION & STABILITY  Permanent Upper and Lower Lingual Canine to Canine bonded Retainer www.indiandentalacademy.com
    41. 41.   1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Retention begins with Diagnosis and Treatment planning. Treatment goals include  Growth Balanced soft tissue profile  Non extraction treatment when possible  Mandibular incisors upright on basal bone  Good Interincisal angle  Normal root artistic positioning  Mandibular molars upright Cuspids not expanded Normal overjet and overbite Class – I cuspids , cuspid protected occlusion. Patient is non growing. Normal MPA Decreased Interincisal angle. Retroclination of maxilla Auto rotation of mandible Down ward and backward growth rotation of body of mandible www.indiandentalacademy.com
    42. 42. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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