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.for more details please visit www.indiandentalacademy.com

1. CASE HISTORY
Name: Rashmi
Age: 18 years
Chief compliant: complains of forwadly
placed upper front teeth.
Pre- natal and post-natal history:
nothing significant.
Childhood diseases and habits: nothing
significant.
www.indiandentalacademy.com

2. Reasons for taking orthodontic treatment:
esthetics
Patients concern for orthodontiic treatment:
positive
Attitude of patient to treatment is positive
Pubertal status: adult
Clinical examination
Build: athletic
Height: 5.3 ft
Weight: 48 kg
Body type: mesomorphic
www.indiandentalacademy.com

3. Mesofacial, slight facial assymetry,
incompetent lips, prominent gonial angle
Commisural smile, no gingival
display, incisal margins
coincident with lower lip
curve
www.indiandentalacademy.com

4. Prominent chin and gonial
angle
Straight profile, acute
nasolabial angle, lip
incompetence, short middle
third and increased lower
anterior face height
www.indiandentalacademy.com

5. Extra oral examination
Extra oral examination revealed
mesocephalic, mesofacial, straight profile
and inter labial gap of 5mm.
Functional examination :
Respiration- nasal,
Mastication- biting food from anterior teeth
is difficult
Deglutition Speech and TMJ were normal
Incisor exposure: during speech- 7 mm
during smile - 10 mm
www.indiandentalacademy.com

6. Intra oral examination
Oral hygiene status : satisfactory
Gingiva : normal
Brushing habits : brushes once daily
Position of mucogingival junction : normal
Frenal attachment : normal
Tongue : large with crenations seen on lateral borders of tongue
No of teeth present: 7-1 1-7
8-1 1-8
Patient reported a history of mesiodens extraction 6 yrs back
www.indiandentalacademy.com

7. www.indiandentalacademy.com

8. www.indiandentalacademy.com

9. 8 - 1
8 - 1 1 - 8
1 - 8
www.indiandentalacademy.com

10. Lateral Ceph
www.indiandentalacademy.com

11. Cephalometric analysis
SOFT TISSUE ANALYSIS
Facial angle (90°)-91°
Nose tip to H line (12mm)- +3mm
Upper sulcus depth (5mm)- 8mm
Projections to TVL
Upper lip anterior (3.7 ±1.2mm)- 5mm
Lower lip anterior (1.9±1.4mm)- 0
A’ point (-0.1±1.0mm)- -1mm
B’ point (-5.3±1.5mm)- -9mm
Pog’ (-2.6±1.9mm)- -5mm
Nasolabial angle (90-110°)- 79°
www.indiandentalacademy.com

12. SKELETAL
RELATION OF MAXILLA
SNA (82°)- 87
N⊥Pt. A (0±2mm)- -2mm
NA-TH (90±3°)- 88
Skeletal convexity at Pt. A (-
2±2mm)- 0mm
PNS-ANS-TH (3.5±3°)- 2
Extent of maxillary base-
49mm(51.9)
RELATION OF MANDIBLE
SNB (80°)- 85°
N⊥Pog (0±-4mm)- -3mm
Npog-TH (87.5±2.5°)- 88°
Extent of mandibular base-
78mm(79.2)
Extent of ascending ramus-
62mm(55.6)
www.indiandentalacademy.com

13. RELATION OF MAXILLA, MANDIBLE & ANTERIOR CRANIAL
BASE
ANB (2°)- 2°
Wits appraisal- aO ahead of bO by 0.5mm
Go Me-FH (26±4°)- 15°
Go Me-SN (32°)- 16°
Saddle angle (123±5°)- 119°
Articulare angle (143±6°)- 143°
Gonial angle (128±7°)- 115°
Basal plane angle (25°)- 13°
COGS
N-ANS (⊥HP)(50± 2.4mm)- 48
ANS-Gn (⊥HP)(68.6 ± 3.3mm)- 59
PNS-N (⊥HP)(50.6 ± 2.2mm)- 51
Upper1-NF (⊥NF)(27.5 ± 1.7mm)- 24
Lower 1-MP (⊥MP)(40.8 ± 1.8mm)- 39
Upper 6-NF (⊥NF)(23 ± 1.3mm)- 24
Lower 6-MP (⊥MP)(32 ± 1.9mm)- 30
www.indiandentalacademy.com

14. DENTAL
Upper incisors:
1to NA( 4mm)- 12mm
1 to NA(22° )- 40°
1 to Pt. A(4mm)- 12mm
1 to SN(102 ±2 °)-
127°
1 to PP(70 ± 5 °)- 49°
Mx 1 to TVL(-9.2 ±
2.2mm)- -4mm
Lower incisors:
1 to NB(4mm)- 7mm
1 to NB(25°)- 27°
1 to Apo line(1-2mm)-
4mm
IMPA(90 ± 3 ° )- 105°
Md 1 to TVL(-12.4 ±
2.2mm)- -12mm
INTER INCISAL ANGLE
(131°) - 112°
www.indiandentalacademy.com

15. Model analysis
Boltons tooth ratio- anterior: 73.8%
overall: 86.4%
Maxillary anterior excess: 2.3mm
Overall Maxillary excess: 5.3mm
Carey’s arch perimeter analysis:
Upper- -6 mm
Lower- -5 mm
www.indiandentalacademy.com

16. Diagnosis
18 yr old female patient Rashmi is
diagnosed as a case of skeletal class III
tendency with bimaxillary dentoalveolar
protrusion with incompetent lips midline
diastema of 2 mm secondary to
extracted mesiodens, spacing in the
upper anterior segment, lower incisor
crowding and proclination of upper and
lower incisors.
www.indiandentalacademy.com

17. Treatment objectives
To achieve lip competency
To achieve smile esthetics
To achieve proper overjet
To reduce the proclination of incisors
To close upper anterior spacing
To relieve lower anterior crowding
www.indiandentalacademy.com

18. www.indiandentalacademy.com

19. www.indiandentalacademy.com

20. -1mm -1mm
-3 -3
o o
o o
-4mm -4mm
o o
-5mm -5mm
o o
o o
-5mm -5mm
UPPER ARCH
DISCREPANCY
LOWER ARCH
DISCREPANCY
CROWDING
PROTRUSION
CURVE
OF SPEE
MIDLINE
TOTAL
www.indiandentalacademy.com

21. DENTAL VTO
INITIAL MIDLINE AND MOLAR POSITION
ANTICIPATED TREATMENT CHANGE
0
0
0
00
0
3.5 3.5
3.5 3.5
www.indiandentalacademy.com