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1. A CASE PRESENTATION
ORTHO-PEDO SEMINAR
GORDA, JOSEPH RUSSELL
CARREON, NICHOLA
MISIONA, MARGOT SUZAINE

2. • Patient X
• Male
• 13 years old
Chief Complaint
“Sungki-sungki po
kasi mga ngipin ko”

3. • NO SIGNIFICANT
past medical/
dental history
• NO PRIOR
ORTHODONTIC
HISTORY
• NO CONGENITAL
ABNORMALITIES
• NO TMJ
PROBLEMS

4. Tooth Color: Normal
Decalcification: None

5. Carious tooth:
7

6. Carious tooth:
6

7. Existing Restoration:
6

8. Existing Restorations:
6 6

9. Tooth Malpositions
3 1 1 2 3

10. Tooth Malpositions
4 3 2 4

11. STUDY CAST ANALYSIS
1.Classification of
Malocclusion:
Class I Type 2
2.Overjet: 5mm
3.Overbite:3mm

12. Clinically present
17 16 15 14 13 12 11 21 22 23 24 25 26 27
47 46 45 44 43 42 41 31 32 33 34 35 36 37

13. Dental Midline: 1.5mm shifted to right

14. Palatal depth: 54mm
Arch form; U: Normal L: Normal

15. Arch Dimensions
A. Intercanine Perimeter, U: 57mm
L: 45mm
B. Intercanine Width, U: 49mm
L: 29mm
C. Arch Length,
U: 42mm
L: 34mm

16. D. Arch Perimeter;
U: 93mm L: 84mm
E. Arch Width;
U: 59mm L:48mm

17. Photo Analysis
Horizontal thirds
of the face

18. Vertical fifths of
the face
Photo Analysis

19. Facial Profile
Convex

20. GORDA, JOSEPH RUSSELL N.
PROJECT
DATE CLIENT
2017
CASE ANALYSIS
ORTHO-PEDO SEMINAR 2

21. ORTHOPANTOMOGRAM ANALYSIS

23. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

24. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

25. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

26. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

27. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

28. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

29. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

30. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

31. STAGE OF DEVELOPMENT:
(NOLLA’S CLASSIFICATION)
18,28,38,48 - STAGE 4
17,27,37,47 - STAGE 9
16,26,36,46 - STAGE 10
15,14,24,25,35,34,44 - STAGE 9
45 - STAGE 8
13,23,33,43 - STAGE 9
12,11,21,22 - STAGE 9
32,42 - STAGE 9
31,41, - STAGE 10

32. ALL THE PERMANENT TEETH
EXCEPT 18, 28, 38, 35, 45
AND 48 (DEVELOPING,
UNERUPTED OR ERUPTING)
ARE IN OCCLUSION.
INFRAERUPTED 45 AND 35
(ERUPTING).
ALTERED INCLINATION OF
LOWER INCISORS.

33. ALL THE PERMANENT TEETH
EXCEPT 18, 28, 38, 45 AND
48 (DEVELOPING,
UNERUPTED OR ERUPTING)
ARE IN OCCLUSION.
INFRAERUPTED 45 AND 35
(ERUPTING).
ALTERED INCLINATION OF
LOWER INCISORS.

34. ALL THE PERMANENT TEETH
EXCEPT 18, 28, 38, 45 AND
48 (DEVELOPING,
UNERUPTED OR ERUPTING)
ARE IN OCCLUSION.
INFRAERUPTED 45 AND 35
(ERUPTING).
ALTERED INCLINATION OF
LOWER INCISORS.

35. PRESENCE OF COMPOSITE
RESTORATION ON 16, 36
AND 46

36. THERE ARE NO CONGENITAL ABSENCE
OF TEETH.
THERE ARE NO SUPERNUMERARY
TEETH.
ABSENCE OF PATHOLOGIC ORAL
CONDITION.
ABSENCE OF IMPACTED TEETH.
ERUPTION OF HIS TEETH COINCIDES
WITH AGE AND IS NORMAL FOR HIS
AGE.

37. CEPHALOMETRIC ANALYSIS

39. THE TEN-ANGLE ANALYSIS
ANTEROPOSTERIOR SKELETAL
MEASUREMENTS
1. SNA - 92 (79.2 - 89.8)
2. SNB - 83 (77.1 - 86.9)
3. ANB - 9 (0 - 5)
S Na
A
B
SNA
SNB
AN
B

40. THE TEN-ANGLE ANALYSIS
ANTEROPOSTERIOR SKELETAL
MEASUREMENTS
1. SNA - 92 (79.2 - 89.8)
2. SNB - 83 (77.1 - 86.9)
3. ANB - 9 (0 - 5)
S Na
A
B
SNA
SNB
AN
B

41. THE TEN-ANGLE ANALYSIS
ANTEROPOSTERIOR SKELETAL
MEASUREMENTS
1. SNA - 92 (79.2 - 89.8)
2. SNB - 83 (77.1 - 86.9)
3. ANB - 9 (0 - 5)
S Na
A
B
SNA
SNB
AN
B

42. THE TEN-ANGLE ANALYSIS
4. FACIAL ANGLE (FH / NP) - 82 (82.1
- 85.1)
INCISOR MEASUREMENTS
5. 1 / SN - 85 (98 - 108)
6. 1 / 1 - 113 (114.1 - 131.8)
S Na
A
Po
Pog
Or
1/1
FA
1/SN
UI
LI

43. THE TEN-ANGLE ANALYSIS
4. FACIAL ANGLE (FH / NP) - 82 (82.1
- 85.1)
INCISOR MEASUREMENTS
5. 1 / SN - 85 (98 - 108)
6. 1 / 1 - 113 (114.1 - 131.8)
S Na
A
Po
Pog
Or
1/1
FA
1/SN
UI
LI

44. THE TEN-ANGLE ANALYSIS
4. FACIAL ANGLE (FH / NP) - 82 (82.1
- 85.1)
INCISOR MEASUREMENTS
5. 1 / SN - 85 (98 - 108)
6. 1 / 1 - 113 (114.1 - 131.8)
S Na
A
Po
Pog
Or
1/1
FA
1/SN
UI
LI

45. THE TEN-ANGLE ANALYSIS
7. IMPA - 98 (88.6 - 103.4)
8. FMIA - 47 (48.3 - 62.1)
VERTICAL SKELETAL
MEASUREMENTS
9. FMA - 36 (22.9 - 34.5)
Po Or
Me
Go
FMIA
LI
FMA
IMPA

46. THE TEN-ANGLE ANALYSIS
7. IMPA - 98 (88.6 - 103.4)
8. FMIA - 47 (48.3 - 62.1)
VERTICAL SKELETAL
MEASUREMENTS
9. FMA - 36 (22.9 - 34.5)
Po Or
Me
Go
FMIA
LI
FMA
IMPA

47. THE TEN-ANGLE ANALYSIS
7. IMPA - 98 (88.6 - 103.4)
8. FMIA - 47 (48.3 - 62.1)
VERTICAL SKELETAL
MEASUREMENTS
9. FMA - 36 (22.9 - 34.5)
Po Or
Me
Go
FMIA
LI
FMA
IMPA

48. THE TEN-ANGLE ANALYSIS
10. Y-AXIS - 65 (62.2 - 67.8)
Po Or
Gn
Y-Axis
S

49. Angle Case Norm Difference Range Interpretation
SNA 92 84.5 7.5 + 5.3 Increased
SNB 83 82.0 1.0 + 4.9 Normal
ANB 9 2.5 6.5 + 2.5 Increased
FH/NP 82 85.1 -3.1 + 3.0 Decreased
1/SN 85 103.0 -18 + 5.0 Decreased
1/1 113 122.8 -10.8 + 8.7 Decreased
IMPA 98 96.0 2 + 7.4 Normal
FMIA 47 55.2 -8.2 + 6.9 Decreased
FMA 36 28.7 7.3 + 5.8 Increased
Y-AXIS 65 65.0 0 + 2.8 Normal

50. Angle Case Interpretation Analysis
SNA 92 Increased
Maxillary bone is protrusive in relation to the
cranial base.
ANB 9 Increased
Maxillary bone is more protrusive than the
mandible.
FH/NP 82 Decreased
The chin point is retrusive as compared to
the cranial base.
1/SN 85 Decreased
Maxillary central incisors are protrusive to
the cranial base.
1/1 113 Decreased
Maxillary and mandibular central incisors are
protrusive.
FMIA 47 Decreased
Mandibular central incisors are protrusive in
relation to the FHP.
FMA 36 Increased
High angle mandibular growth / vertical
grower.

51. SOFT TISSUE MEASUREMENTS
POG-NB - 1.3 MM (1 - 5 MM)
E PLANE (ESTHETIC LINE) - 7 MM (-4 -
0 MM)
Na
B
Pog
Pn
Li

52. SOFT TISSUE MEASUREMENTS
POG-NB - 1.3 MM (1 - 5 MM)
E PLANE (ESTHETIC LINE) - 7 MM (-4 -
0 MM)
INCREASED. PROTRUSIVE LOWER
LIP DUE TO MAXILLARY AND
MANDIBULAR CENTRAL INCISORS
PROTRUSION
Na
B
Pog
Pn
Li

53. INTERPRETATION
CEPHALOMETRIC TRACING OF THE
PATIENT REVEALED ANGLE CLASS I
TYPE 2 MALOCCLUSION
ATTRIBUTABLE TO A PROTRUSIVE
MAXILLA, MILDLY RETRUSIVE
MANDIBLE, PROTRUSIVE (TIPPED)
MAXILLARY AND MANDIBULAR
CENTRAL INCISORS AND
UNFAVORABLE HYPERDIVERGENT
SKELETAL GROWTH PATTERN.
Na
B
Pog
Pn
Li
FMA
IMPA
FMIA

54. DOWNS ANALYSIS
BASIC FACIAL TYPE: RETROGNATHIC
SKELETAL PATTERN:
FACIAL ANGLE: 82 (RETRUSION)
ANGLE OF CONVEXITY: 16 (- 8.5 - 10).
A-B PLANE: -12 (-9 - 0).
Na
Po
Pog
Or
FA
AOC
A
B
ABP

55. DOWNS ANALYSIS
BASIC FACIAL TYPE: RETROGNATHIC
SKELETAL PATTERN:
FACIAL ANGLE: 82 (RETRUSION)
ANGLE OF CONVEXITY: 16 (- 8.5 - 10).
INCREASED. PROMINENCE OF
MAXILLARY DENTAL BASE RELATIVE
TO THE MANDIBLE.
A-B PLANE: -12 (-9 - 0).
Na
Po
Pog
Or
FA
AOC
A
B
ABP

56. DOWNS ANALYSIS
BASIC FACIAL TYPE: RETROGNATHIC
SKELETAL PATTERN:
FACIAL ANGLE: 82 (RETRUSION)
ANGLE OF CONVEXITY: 16 (- 8.5 - 10).
A-B PLANE: -12 (-9 - 0).
DECREASED. CLASS II FACIAL
PATTERN.
Na
Po
Pog
Or
FA
AOC
A
B
ABP

57. DOWNS ANALYSIS
MANDIBULAR PLANE ANGLE: 36
INCREASED. UNFAVORABLE
HYPERDIVERGENT FACIAL PATTERNS.
Y-AXIS: 65
Na
Po
Pog
Or
FA
AOC
A
B
ABP
Me
Go
FMA
Gn
S
Y-Axis

58. DOWNS ANALYSIS
DENTAL PATTERN:
CANT OF OCCLUSAL PLANE: 20 (1.5 -
14)
INCREASED. CLASS II FACIAL
PATTERN
MP OP
PP
FH
COOP
UI
LI

59. DOWNS ANALYSIS
INTERINCISAL ANGLE: 113
DECREASED. INCISORS ARE TIPPED
FORWARD ON THE DENTURE BASE.
INCISOR-OP ANGLE: 62 (3.5 - 20)
INCISOR-MP ANGLE: 98
PROTRUSION OF MAXILLARY
INCISORS: 11 MM (-1 - 5 MM)
MP OP
PP
FH
UI
LI
COOP
1/1
IOP
IMPA
Pog
A
POMI

60. DOWNS ANALYSIS
INTERINCISAL ANGLE: 113
INCISOR-OP ANGLE: 62 (3.5 - 20)
INCREASED. THE TEETH ARE
INCLINED FORWARD.
INCISOR-MP ANGLE: 98
PROTRUSION OF MAXILLARY
INCISORS: 11 MM (-1 - 5 MM)
MP OP
PP
FH
UI
LI
COOP
1/1
IOP
IMPA
Pog
A
POMI

61. DOWNS ANALYSIS
INTERINCISAL ANGLE: 113
INCISOR-OP ANGLE: 62 (3.5 - 20)
INCREASED.
INCISOR-MP ANGLE: 98
PROTRUSION OF MAXILLARY
INCISORS: 11 MM (-1 - 5 MM)
MP OP
PP
FH
UI
LI
COOP
1/1
IOP
IMPA
Pog
A
POMI

62. DOWNS ANALYSIS
INTERINCISAL ANGLE: 113
INCISOR-OP ANGLE: 62 (3.5 - 20)
INCISOR-MP ANGLE: 98
PROTRUSION OF MAXILLARY
INCISORS: 11 MM (-1 - 5 MM)
INCREASED. INCISAL EDGE IS AHEAD
OF THE A-POG LINE. PROTRUSION.
MP OP
PP
FH
UI
LI
COOP
1/1
IOP
IMPA
Pog
A
POMI

63. STEINER ANALYSIS
THREE-WAY ANALYSIS:
SKELETAL ANALYSIS
DENTAL ANALYSIS
SOFT TISSUE ANALYSIS

64. STEINER ANALYSIS
THREE-WAY ANALYSIS:
SKELETAL ANALYSIS
SNA 91
SNB 84
ANB 5
SN-OP: 13 (13 - 21)
SN-MP: 29 (27 - 37)
DENTAL ANALYSIS
SOFT TISSUE ANALYSIS
S Na
A
B
SNA
SNB
AN
B
Gn
Go
SN-MP
SN-OP

65. STEINER ANALYSIS
THREE-WAY ANALYSIS:
SKELETAL ANALYSIS
DENTAL ANALYSIS
MAXILLARY INCISOR POSITION
ANGLE: 22 (22)
DISTANCE: 6 MM (4-6 MM)
MANDIBULAR INCISOR POSITION
ANGLE: 35 (25)
DISTANCE: 13 MM (4 MM)
INCREASED. FLARED MANDIBULAR INCISORS.
INTERINCISAL ANGLE: 113 (PROTRUSION)
LOWER INCISOR-CHIN RELATIONSHIP: 11 (EQUAL TO
THE MNIP) DECREASED. UNDESIRABLE DISCREPANCY.
SOFT TISSUE ANALYSIS
Na
A
MxIP
B
U1
L1
MnIP

66. STEINER ANALYSIS
THREE-WAY ANALYSIS:
SKELETAL ANALYSIS
DENTAL ANALYSIS
SOFT TISSUE ANALYSIS
S-LINE: LIPS TOO PROTRUSIVE DUE
TO PROTRUSION OF MAXILLARY AND
MANDIBULAR INCISORS PUSHING
THE LIPS FORWARD.

67. MCNAMARA ANALYSIS
MAXILLA TO CRANIAL BASE
SOFT TISSUE EVALUATION
NASOLABIAL ANGLE: 83 (94 - 110)
DECREASED. DENTOALVEOLAR
PROTRUSION.
CANT OF UPPER LIP: 26 (6 - 22)
INCREASED. DENTOALVEOLAR
PROTRUSION.
HARD TISSUE EVALUATION
NP - POINT A: 0 MM (0 -1 MM)
NLA
NP
CANT

68. MCNAMARA ANALYSIS
MAXILLA TO MANDIBLE
ANTEROPOSTERIOR RELATIONSHIP
MID FACIAL LENGTH: 94 MM
MANDIBULAR LENGTH: 113 MM (121-124 MM)
DECREASED.
MAXILLOMANDIBULAR DIFFERENTIAL: 27 - 30
MM (SMALL SIZED INDIVIDUAL: 20 - 24 MM)
DISCREPANCY: GREATER THAN NORMAL
VALUES
MAXILLARY POSITION IS NORMAL, MANDIBLE
IS 8 - 11 MM DEFICIENT. THERE IS NO MIDFACIAL
DEFICIENCY.
Co
Gn
A

69. MCNAMARA ANALYSIS
VERTICAL RELATIONSHIP
LAFH (LOWER ANTERIOR FACIAL HEIGHT): 71
MM (66 - 67 MM)
INCREASED.
MPA: 36 (INCREASED)
FACIAL AXIS ANGLE: - 3 (0)
NEGATIVE. EXCESSIVE VERTICAL
DEVELOPMENT OF THE FACE.
EXCESSIVE LAFH CORRELATES WITH AN
INCREASED MPA. VERTICAL GROWTH PATTERN.
Co
Gn
A
ANS
Me
PTM
Ba
Na
Go
FMA

70. MCNAMARA ANALYSIS
MANDIBLE TO CRANIAL BASE
PO TO NP DISTANCE: 12 MM
(SMALLER INDIVIDUALS 6 - 8 MM)
INCREASED. RETRUSIVE MANDIBLE.
NP
Po

71. MCNAMARA ANALYSIS
DENTITION
MAXILLARY INCISOR POSITION: 5 MM
(4 - 6 MM)
MANDIBULAR INCISOR POSITION: 7
MM (1 - 3 MM)
INCREASED. RETRUSIVE
MANDIBULAR INCISORS.
NP
Po

72. MCNAMARA ANALYSIS
AIRWAY
UPPER PHARYNX: 15 MM (15 - 20
MM)
LOWER PHARYNX : 12 MM (11 - 14
MM)
UP
LP

73. WITS APPRAISAL
CLASS 1 TYPE 2 MALOCCLUSION
ANB, 9 DEGREES
“WITS,” 5 MM
S Na
A
B
OP
92
83
9
BOAO

74. Po Or
Me
Go
FMIA
LI
FMA
IMPA
TWEED ANALYSIS
THE DIAGNOSTIC FACIAL TRIANGLE
IMPA - 98 (88.6 - 103.4)
FMIA - 47 (48.3 - 62.1)
FMA - 36 (22.9 - 34.5)
HIGH MANDIBULAR PLANE ANGLE.
MANDIBULAR CENTRAL INCISORS ARE
PROTRUSIVE IN RELATION TO THE FHP.

75. TREATMENT
PLANNING AND
MECHANOTHERAPY
MARGOT SUZAINE C. MISIONA

76. After patient and diagnostic records
evaluation and financial arrangement are
done, the next procedures will follow:
1. Oral prophylaxis
2. Restoration of

77. After patient and diagnostic records
evaluation and financial arrangement are
done, the next procedures will follow:
1. Oral prophylaxis
2. Restoration of
26

78. After patient and diagnostic records
evaluation and financial arrangement are
done, the next procedures will follow:
1. Oral prophylaxis
2. Restoration of

79. After patient and diagnostic records
evaluation and financial arrangement are
done, the next procedures will follow:
1. Oral prophylaxis
2. Restoration of

80. After patient and diagnostic records
evaluation and financial arrangement are
done, the next procedures will follow:
1. Oral prophylaxis
2. Restoration of
46

81. 3. Make an
impression and
fabricate a study
cast

82. 4. Choose the
correct size of
molar bands for
the patient using
the study cast

83. 5. Placement of
separators and
patient instructions
* Allow 1 week to create space for
molar bands
6. Fitting of maxillary
and mandibular
molar bands using
bite stick and band
pusher
*Using GIC, cement maxillary and
mandibular molar bands

84. 7. Place 0.012
NiTi as archwire
for upper and
lower then
ligaties
* Cinch back on upper
archwire to prevent further
labioversion of upper incisor

85. Dispense
orthodontic
brushes,
specialized floss
and orthowax

86. 8. Check leveling
and alignment
*If leveling and alignment isn’t
achieved in 3 months, change
archwire to 0.016 NiTi then
0.016 SS

87. 9. Place coil
spring between
43 and 45 to
facilitate lingual
movement of 44

88. 10. Prescribe
¼ Class 2
Elastics to
allow retrusion
of upper
incisors

89. 10. Prescribe
¼ Class 2
Elastics to
allow retrusion
of upper
incisors

90. 10. Prescribe
¼ Class 2
Elastics to
allow retrusion
of upper
incisors

91. 10. Once
correct over
jet and over
bite is
achieved,
change
archwire into
0.016 x 0.022
NiTi
* Then change to
0.016x0.022 SS

92. 11. Eliminate
possible
spacing with
powerchain

93. 12. Check
midline, if it
needs
corrections,
use midline
elastics

94. 13. Check if
class I molar
relationship is
maintained

95. 14. Check
interdigitation
of teeth, if it
needs to be
improved, use
box elastics.

96. 15. Deband/
Debond,
deliver
retainers for
upper and
place lingual
bonded
retainers

97. 16. Recall
every 3
months