Orthodontic CASE PRESENTATIONPrepared by: Majd Hasanin
• Age: 22 Years Old• Chief Complaint: Orthodontic Consultation
Medical History: (Medically Fit).• Dental History:o Regular check up every 6 months.o Brushes 3 times / day.o Doesn’t floss.o Previously orthodontically treated for 4 yrs;(from grade 11 – 2nd year at uni).o Restorations: U: (# 16, 15, 25, 26 ), L: (#. 37, 36, 35, 45, 46, 47)…oBoth arches are restored with amalgam except for tooth # 25, amalgam has beenrecently replaced with composite restoration.o No history of oral or dental trauma.o Occlusal caries found during dental charting in teeth # 17, 27. Habit: (Chews gum 9 hrs / day & biting nails).
Norm Case InterpretationSNA 81° ± 3° 98° Prognathic maxillaSNB 78° ± 3° 92° Prognathic mandibleANB 3° ± 2° 6° Skeletal Class IISN-MxPl 8° ± 3° 6° Normally inclined maxillaMMPA 27° ± 4° 26° Normal vertical relationshipF. Prop. 55% ± 2% 57% Increased facial proportionMx Inc. to 109° ± 6° 116° Proclined upper incisorsMxPlMn Inc. to 93° ± 6° 89° Normally inclined lowerMnPl incisorsMn Inc. to +1 ± 2 +1mm Normally positioned lowerApog mm inc.Inter-incisal 135° ± 123° Normally inclined incisors 10°Upp. Lip -2±2 0.8mm Normally positioned upperto E-Line mm lipLow. Lip 0 ± 2 mm 0.6mm Normally positioned lowerto E-Line lipNLA 90° - 100° 60° Acute naso-labial angle
• Inter-arch: Maxilla: 37 mm, Mandible: 27 mm.• Anteroposterior:Over Jet (OJ) = 1 mmRt. Molar: II half unit. Lt. Molar,: I.Rt. Canine: I. Lt. Canine: II half unit.
• Vertical:• Over Bite (OB) = 4 mm ( 50 %)• Rt side: premolar touching the curve,1 mm of curveof Spee on the Lt.
• Transverse:• Lower midline to upper dental midline shift by 0.5mm to the left.
• Intra-arch (Space analysis): Upper Rt. Ft Lt. Sp. Av. 15 34 16 0 mm Sp.Req. 16 33 16 Dif. -1 +1 0 Lower Rt. Ft Lt. Sp. Av. 15 24 15.5 -4.5mm Sp. Req. 17 26 16 Dif. -2 -2 -0.5
• Maxillary arch:- Symmetry: Symmetrical to a greatextent.- rotations: U Rt Canine.- Intercaninewidth:35mm- intermolarwidth:47mm-Number of teeth: missing 1st premolars(Rt & Lt).• Mandibular arch:- Symmetry: Symmetrical to a greatextent.- rotations: L Lt Canine & 2nd Premolar.- Intercaninewidth: 27.5mm- intermolarwidth:43mm- Number of teeth: missing 1st premolars(Rt & Lt).
• Skeletal and dental problems in antro-posterior plane:• Class II skeletal pattern, slight convex profile, with slightly prognathinc maxillary & mandibular bone.• Class I malocclusion.• Molar Rt. Cl. II (half unit).• Canine Lt. Cl. II (half unit).• Slightly proclined upper incisors.•Over-jet (OJ); 1 mm.
• Skeletal and dental problems in vertical plane:• Increased overbite; 4mm (50%).• Rt side: premolar touching the curve,1 mm of curve of Spee on the Lt.
• Skeletal and dental problems in transverse plane:• No facial asymmetry.• Slight Lower midline shift, to the Lt by 0.5 mm.• No posterior cross-bite but the left 1st molar relationship is liable to a cross-bite (because of its position)..
•Alignment and symmetry in each arch:• The upper arch: Symmetry: Symmetrical to a great extent. Rotations: U Rt Canine (clockwise). Space Analysis: (0mm), no space nor crowding.• The lower arch: Symmetry: Symmetrical to a great extent. Rotations: L Lt Canine (clockwise) & 2nd Premolar (counter-clockwise). Space Analysis: (-4.5mm), moderate crowding.
Summary: Patient is 22 yr old, healthy, female, asking for orthodonticconsultation, with acute NLA. She has Class II Lt Canine relationship (by half unit) andClass II Molar relationship (by half unit) & the left side molar relationshiis liable to be shifted into a unilateral cross-bite.with increased overbite (4 mm), 50%. A Class II skeletal pattern with slightly increased facialproportion. She has moderate lower crowding with severalU & L rotations.Also with a (0.5 mm) lower midline shift to the left side.