RMS orthodontic residents

1. Orthodontic Case Presentation

2. Keep your
blood
caffeinated
!!!!!!

3. Patient’s initial: I.M
Gender: Female
Date of Birthday :
April.1995
Age :20. 11 month
Career: college student

4. Patient’s initials
:I.M
Age : 20
Career : college
student

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

7. Class three incisal
O.J=1 mm
O.B reduced ;
covering only0.5 mm
of lower incisor .

8. Panoramic view

9. Cephalometric
Analysis
79⁰SNA
78.4⁰SNB
0.6 ⁰ANB
1.6 ⁰Corrected ANB
7.1⁰SN- Maxillary plane
-1.2Wits appraisal
118 ⁰UI-Maxillary plane
87.3 ⁰LI-Mandibular plane
128 ⁰Inter-Incisal angle
31.4⁰Maxillary mandibular
planes angle (MMPA)
27.3 ⁰Frankfort mandibular
planes angle (FMPA)
56Upper anterior face
height (UAFH)
63Lower anterior face
height (LAFH)
53%Anterior facial height
ratio

10. Patient denied any medical condition .
Dental history :
Previously endodontic and restorative
treatment for the upper right 6 .
No Previous History of trauma or habits .

11. Habits : None
Motivation : Highly internal motivation
Expectations : High

12. ‘I Don’t like the space
Between my teeth especially my
upper frontals “

13. 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.

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

15. Asymmetric face
with slightly
pointed chin
shifted to the left ,
nasal tip slightly
to the right .

16. Average
lower facial
height

17. ClassThree
Skeletal
relationship.

18. 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.

23. Profile : Straight

24. Nasofrontal angle :
132degree
norm (115-135)
Nasolabial angle :
( 90-110)100 degree
Labiomental Angle:
142 degree , norm (110-
130) ,,, Obtuse!!

25. Vertical Facial
proportions :
Patient has an
average lower
facial height .

26. Average
maxillary
mandibular
plane angle.

30. Oral hygiene is good
Flourosis minaly affecting canine and premolar area.
SoftTissue : all within normal limits , firm coral pink
gingiva, prominent labial frenum.

31. Teeth present : 7654321 1234567
87654321 1234567

32. Incisal Classification : Class Three
Overjet : 1 mm
3 mm Diastema

33. 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.

34. Molar relationship : Quarter three unit.
Canine : Class one( mesialy angulated)
Cross bite : None
Flourosis on posterior teeth.

35. Flourosis on posterior teeth.
Molar relationship : class one .
Canine relationship : Class one (upright) .
Cross bite : on upper canine and 1st premolar.

36. 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) .

37. U-Shaped lower arch
Normal size tongue
Partially erupted lower right 3rd molar
Well 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)

44. I-Canine
width
33mm
I-molar width
44mm

45. I
.Molar
width
=41
I .Canine
width =27

46. COS
= 1.5

47. Crowding and spacing -Space available=71mm
space required= 66.5mm .. 4.5mm spacing
- LevelingCOS …not in need
-Arch width change … not in need ..individual tooth expansion is ignored .
IncisorA-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.
20
15
20
16

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

49. Anterior
Bolton Ratio=
76.1%

50. Overall
Bolton
ratio
=90.6%

52. -All within normal limits except for
deviated nasal septum to the right.
Normal shape of mandibular ramus
and condyle, Aug. 2015

53. Aug. 2015

54. SN
S
Po Or
A
B
Me
Go
ANS
PNS
FOP

55. NormalValueValue pre -treatmentVariable
81⁰ ± 3⁰79⁰SNA
78⁰ ± 3⁰78.4⁰SNB
3⁰ ± 2⁰0.6 ⁰ANB
1.6 ⁰Corrected ANB
8⁰ ± 3⁰7.1⁰SN- Maxillary plane
0 + 1.77 mm (Female)-1.2Wits appraisal
109⁰ ± 6⁰118 ⁰UI-Maxillary plane
93⁰ ± 6⁰87.3 ⁰(120-31.4) =88.6LI-Mandibular plane
135⁰ ± 10⁰128 ⁰Inter-Incisal angle
27⁰ ± 4⁰31.4⁰Maxillary mandibular planes angle
(MMPA)
28⁰ ± 4⁰27.3 ⁰Frankfort mandibular planes angle
(FMPA)

56. 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 .

58. 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 45
3434

59. 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.ReducedOJ.
8. ReducedOB.
9. Lower dental midline is shifted 2mm to the left.
10. Quarter three unit molar relaion at the right side.
11. Rotated
4 45
3434

60. 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.

61. DENTAL HEALTH IMROVMNT AND MINTAINANCE :
1.Treatment of carious upper left molar.
2. O.H instructions .
ORTODONTIC TREATMENT PHASE :
Camouflage;
Non extraction
Upper Lower F.A
Class 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

62. -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
Retention
Permanent 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 ???!!!

63. ‫واط‬‫اباوت‬‫يور‬
‫اووون‬
‫فيرست‬
”‫بريسنتاش‬‫ن‬
!!!!!