Case presentation demo from class of 2012

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orthodontic case presentation as a partial requirement for the course dent 415 -orthodontics, McGill University.
Great work from all the students.

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  • good case !! however, the treatment result showed there was an increased of vertical dimension of the patient, which demonstrated by the increased of mandibular plane and Z angles, making the patient looked more retrognathics ??? should we be concern about the facial balance ????
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Case presentation demo from class of 2012

  1. 1. Orthodontic Completed Case PresentationName: A S, DMD IV, 2012Chart #:Date: March, 2012
  2. 2. PRE-TREATMENT
  3. 3. Initial Patient History Name: A.P. Sex: Female Age: 36 Date: March, 2011 CC: “Aesthetics; my front teeth are overlapping and all my teeth curve inwards.” Pre-Treatment
  4. 4. Patient History Past Medical History: NSF Medications: None Allergies: None Past Dental History: Consistent dental visits 2X/year Oral Hygiene: Good, PSR II Pre-Treatment
  5. 5. Extra-Oral Examination Facial Type: Normocephalic Facial Proportions: Decreased lower face height (Mild) Facial Symmetry: Symmetrical Pre-Treatment
  6. 6. Extra-Oral Examination Facial Profile: Slight to moderate convexity Nasolabial Angle: ~ 100 degrees Lips: Normal seal Incisor at Rest: 6 mm Pre-Treatment
  7. 7. Neuromuscular & TMJ Examination Tongue at Rest: Normal Swallowing Pattern: Normal Muscles of Mastication: WNL TMJ: Normal articulation Normal range of motion Normal muscles of mastication Pre-Treatment
  8. 8. Extra-Oral  Intra-Oral Facial & Dental Midlines: On Lower dental midline deviates 2 mm to the left upon opening Pre-Treatment
  9. 9. OcclusionRight Side Dental Midline Left Side Molar Class: I  Upper: On  Molar Class: N/A Canine Class: I  Lower: On  Canine Class: I Pre-Treatment
  10. 10. Intra-Oral Examination Overbite: 50%  Overjet: 2 - 3 mm Pre-Treatment
  11. 11. Intra-Oral Examination Teeth Present:11-17, 21-25, 2731-35, 37, 41-47 Arch Shape:Upper: Normal to taperedLower: Normal to tapered Pre-Treatment
  12. 12. Intra-Oral Examination Clinical Findings:  Molars: Class I on right; Missing 26 & 36 on left  Canines: Class I  Missing: 18, 26, 28, 36, 38 & 48  OJ: 2 mm on right; 3 mm on left  OB: 50%  Mild crowding on both upper & lower incisors Pre-Treatment
  13. 13. Intra-Oral Examination Amount of Crowding:Upper Arch: Mild ~ 3 mmLower Arch: Mild ~ 3mm Pre-Treatment
  14. 14. Panoramic Radiograph Analysis Clinical Findings: No suspected decay or bone pathology Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36) Pre-Treatment
  15. 15. Cephalometric Analysis Angles Ceph. Normal Values Skeletal Measurements SNA 79.5 81 ± 3 SNB 75.0 78 ± 3 ANB 4.5 3±2 Witts -4.0 2 mm ± 2mm Facial 86.0 88 ± 4 MPAST 38.0 32 ± 3 Y axis 60.0 60 ± 4 Dental Measurements (UI,NA) 16.0 23 ±6 (LI,NB) 23.0 27.5 ±5 (UI,LI) 135.0 130 ± 7 (LI,MP) 91.0 91.4 ± 4 Pre-Treatment
  16. 16. Dental Cast Analysis: Curve of Spee Upper: Flat  Lower: Slight Pre-Treatment
  17. 17. Dental Cast Analysis Bolton Analysis – Ideally 77%Tooth Upper right Upper left IdealCentral Incisor 8.5 8.0 8.85Lateral Incisor 5.5 6.0 6.9Canine 6.7 7.0 7.88Tooth Lower right Lower left IdealCentral incisor 5.1 5.0 5.5Lateral incisor 5.3 5.4 6Canine 5.4 5.2 6.95 • UA (Σ 13-23) = 41.7 mm • LA (Σ 33-43) = 31.4 mm • ( 31.4 / 41.7 ) x 100 = 75.3% Pre-Treatment
  18. 18. Summary of Findings Dental:  Molars: Class I on right; Missing 26 & 36 on left  Canines: Class I  Missing: 18, 26, 28, 36, 38 & 48  OJ: 2 mm on right; 3 mm on left  Increased OB (50%)  Lower dental midline deviates 2 mm to the left upon opening  Mild crowding on both upper & lower incisors  Normal to tapered arch shapes  6 mm of upper incisors showing at rest Bolton analysis: 75.3% Skeletal:  Symmetrical face; Normocephalic  Decreased lower face height  Slight-moderate convex profile Pre-Treatment
  19. 19. Diagnosis Class I molar/canine Maxillary anterior crowding Mandibular anterior crowding 50% overbite Flat to slight curve of spee Pre-Treatment
  20. 20. Objectives of Treatment Resolve patient’s chief complaint of crowding Decrease overbite Maintain class I molar/canine relationship Maintain nasolabial angle Maintain midlines Pre-Treatment
  21. 21. TREATMENT OPTIONS
  22. 22. Compromised Treatment Address chief complaint:  Resolve upper anterior crowding  Align & level the teeth  Space available in upper arch due to extracted 26, & in lower arch due to extracted 36. However, we cannot use too much of this space, as it will alter the midline alignment, & make it more difficult to replace 26 & 36 in the future.
  23. 23. Compromised Treatment Option #1 Invisalign: Upper & Lower IPR to allow for improved alignment
  24. 24. Compromised Treatment Option #2 Full fixed: Upper & Lower Alignment & levelling Arch coordination IPR
  25. 25. TREATMENT DONE
  26. 26. Treatment Done Patient did not want upper & lower bracketing Unable to do complete bracketing in McGill Student Dental Clinic Selected:  Compromised Treatment Option #1  Invisalign:Upper & Lower  IPR to allow for improved alignment
  27. 27. Exactly One Year Later Post-Invisalign Treatment
  28. 28. Extra-Oral  Intra-Oral Facial & Dental Midlines: On Lower dental midline deviates 2 mm to the left upon opening Post-Invisalign Treatment
  29. 29. OcclusionRight Side Dental Midline Left Side Molar Class: I  Upper: On  Molar Class: N/A Canine Class: I  Lower: On  Canine Class: I Post-Invisalign Treatment
  30. 30. Intra-Oral Examination Overbite: 30%  Overjet: 1 - 2 mm Post-Invisalign Treatment
  31. 31. Intra-Oral Examination Teeth Present:11-17, 21-25, 2731-35, 37, 41-47 Arch Shape:Upper: Normal to taperedLower: Normal to tapered Crowding:Upper: NormalLower: Normal Post-Invisalign Treatment
  32. 32. Post-Invisalign Treatment Problems Patient not satisfied with the final position of tooth #32 & tooth #41 Post-Invisalign Treatment
  33. 33. Post-Invisalign Treatment Solution Dimple-maker! Dimples added to:  Tooth #32 - distal buccal incisal area  Tooth #41 - distal buccal incisal area IPR on both tooth #32 & #41 Both teeth rotated into proper position within 2 weeks Dimples then added to:  Tooth #31 - distal buccal incisal area & mesial lingual incisal area Patient now satisfied with final results Post-Invisalign Treatment
  34. 34. Post-Invisalign Treatment Solution Pre-Treatment Post-Invisalign Treatment Post-Treatment
  35. 35. Post-Treatment
  36. 36. Patient Presentation Age: 37 Date: March, 2012 Post-treatment perspective: Patient is very satisfied with the results following Invisalign Post-Treatment
  37. 37. Extra-Oral Examination No change from pre-treatment:  Facial Type: Normocephalic  Facial Proportions: Decreased lower face height (Mild)  Facial Symmetry: SymmetricalPre-Treatment Post-Treatment
  38. 38. Extra-Oral Examination No change from pre-treatment:  Facial Profile: Slight to moderate convexity  Nasolabial Angle: ~ 100 degrees  Lips: Normal seal  Incisor at Rest: 6 mmPre-Treatment Post-Treatment
  39. 39. Neuromuscular & TMJ ExaminationNo change from pre-treatment:  Tongue at Rest: Normal  Swallowing Pattern: Normal  Muscles of Mastication: WNL  TMJ: Normal articulation Normal range of motion Normal muscles of mastication Post-Treatment
  40. 40. Intra-Oral Examination Overbite: 50%  Overbite: 30% Overjet: 2 - 3 mm  Overjet: 1 - 2 mm Pre-Treatment Post-Treatment Decrease in both overbite & overjet
  41. 41. Intra-Oral ExaminationPre-Treatment Post-Treatment Decrease in both overbite & overjet
  42. 42. Intra-Oral Examination No change from pre-treatment:  Arch Shape: Upper: Normal to tapered Lower: Normal to taperedPre-Treatment Post-Treatment
  43. 43. Intra-Oral Examination Decrease in crowding Pre-Treatment Post-Treatment Amount of Crowding:  Amount of Crowding:Upper Arch: Mild ~ 3 mm Upper Arch: NoneLower Arch: Mild ~ 3mm Lower Arch: None
  44. 44. Panoramic Radiograph Analysis Clinical Findings: No suspected decay or bone pathology Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36) Post-Treatment
  45. 45. Cephalometric Analysis Angles Ceph. Normal Values Skeletal Measurements SNA 80.0 81 ± 3 SNB 75.0 78 ± 3 ANB 5.0 3±2 Witts -4.5 2 mm ± 2mm Facial 84.0 88 ± 4 MPAST 39.5 32 ± 3 Y axis 63.0 60 ± 4 Dental Measurements (UI,NA) 12.0 23 ±6 (LI,NB) 22.5 27.5 ±5 (UI,LI) 141.0 130 ± 7 (LI,MP) 87.5 91.4 ± 4 Post-Treatment
  46. 46. Cephalometric Changes (>1 degree differences in blue)Angles Ceph. Normal Angles Ceph. Normal Values Values Skeletal Measurements Skeletal Measurements SNA 79.5 81 ± 3 SNA 80.0 81 ± 3 SNB 75.0 78 ± 3 SNB 75.0 78 ± 3 ANB 4.5 3±2 ANB 5.0 3±2 Witts -4.0 2 mm ± 2mm Witts -4.5 2 mm ± 2mmFacial 86.0 88 ± 4 Facial 84.0 88 ± 4MPAST 38.0 32 ± 3 MPAST 39.5 32 ± 3Y axis 60.0 60 ± 4 Y axis 63.0 60 ± 4 Dental Measurements Dental Measurements(UI,NA) 16.0 23 ±6 (UI,NA) 12.0 23 ±6(LI,NB) 23.0 27.5 ±5 (LI,NB) 22.5 27.5 ±5(UI,LI) 135.0 130 ± 7 (UI,LI) 141.0 130 ± 7(LI,MP) 91.0 91.4 ± 4 (LI,MP) 87.5 91.4 ± 4 46 Pre-Treatment Post-Treatment
  47. 47. Dental Cast Analysis: Curve of Spee No change from pre-treatment: Upper: Flat  Lower: Slight Post-Treatment
  48. 48. Dental Cast Analysis Angle Classification:  Right Side: Class I molar & class I canine  Left Side: Class I canine (missing tooth 26 & 36) Dental Midline:  Lower: On  Upper: On Overbite: 40% Post-Treatment
  49. 49. Dental Cast Analysis Bolton Analysis – Ideally 77%Tooth Upper right Upper left IdealCentral Incisor 8.3 8.1 8.85Lateral Incisor 5.8 5.8 6.9Canine 7.3 7.1 7.88Tooth Lower right Lower left IdealCentral incisor 5.2 4.7 5.5Lateral incisor 5.1 5.3 6Canine 6.1 5.8 6.95 • UA (Σ 13-23) = 42.4 mm • LA (Σ 33-43) = 32.2 mm • ( 32.2 / 42.4 ) x 100 = 75.9% Post-Treatment
  50. 50. Summary of Findings Dental:  Molars: Class I on right; Missing 26 & 36 on left  Canines: Class I  Missing: 18, 26, 28, 36, 38 & 48  OJ: 2 mm on right; 1 mm on left  Increased OB (30%) - Decreased from 50% at pre-treatment  Lower dental midline deviates 2 mm to the left upon opening  Crowding issues on both upper & lower incisors resolved (addressed CC)  Normal to tapered arch shapes  6 mm of upper incisors showing at rest Bolton analysis: 75.9% Skeletal:  Symmetrical face; Normocephalic  Decreased lower face height  Slight-moderate convex profile Post-Treatment
  51. 51. Future Treatment Retention: Patient does not want removable appliances Unable to place lingual bars in McGill Student Dental Clinic Patient therefore referred to a private orthodontist to place both upper & lower lingual bars Patient presently applying to McGill Student Dental Multidisciplinary Clinic for placement of 2 implants to replace missing tooth 26 & 36
  52. 52. Thank you!

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