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1. CASE PRESENTATION
A patient by name Sunitha .H , aged 15 years residing in
Harapanahalli Davangere District, came to the department with
chief complaint of proclined upper front teeth along with irregular
placement of teeth
No significant information was elicited on recording prenatal
and postnatal history and childhood diseases.
No history of oral habits and injuries.
Familial malocclusion History:- Has an elder and younger
brother with no similarity in arrangement of teeth to that of
Sunitha as reported by her.
She is internally motivated with positive attitude towards
orthodontic treatment and is citing esthetics is the main reasons
for taking orthodontic treatment.
Pubertal Status:- Post Pubertal since five monthswww.indiandentalacademy.com

2. Physical Examination :- She is moderately built with 5’2” in height,
weighs 38 kgs with mesomorphic body type.
Extraoral Examination :-
Mesocephalic,Mesiofacial,
convex profile,
6mm Interlabial gap
Orthognathic, Acute nasolabial
angle of 830
, Shallow
Mentolabial sulcus.
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3. Complex type of smile,
vermilion border on the right
side is elevated, Loss of
consonance, Maxillary
midline shifted to right by
2mm
Three quarter view (45 degree)
Photograph shows balanced
midface and nasal outline,
mandible is well proportion to
midface.
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4. Well proportioned face in respect to facial third analysis
and Rule of Fifths , Acute nasolabial angle, Complex
type of smile,
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5. Functional Examination :- She is found to have Oronasal type of respiration
 Food Lodgment and difficulty in shearing food stuff on right side
No abnormality is detected in deglutition and speech. TM Joint appears normal
She has 2mm of freeway space and 6mm of incisor crown length exposure during
speech and full crown + 2mm of gingival exposure during smile.
Intraoral Examination
Oral Hygiene status is fair , gingiva
is oedematous in mandibular
anterior region, Brushes once daily,
Teeth present
Enamel hypoplasia due to dental
fluorosis, endon molar relation by
1mm , buccally erupted canine,
Rotated 2nd
premolar
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7654321 1234567
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6. Endon molar relation by 1mm,
Endon canine relation
rotated maxillary 2nd
premolar ,
overjet of 5.5mm,
overbite of 2.5mm ,
Curve of Spee of 2.5mm
Maxillary Dental Midline shift to right
by 2mm , rotated premolar ,
crowding in anterior segment
Average palatal contour
Crowding in anterior Segment with
proclination and rotated right caninewww.indiandentalacademy.com

7. RADIOGRAPHIC RECORD
Examination of O.P.G.
Condyles – NAD
Closure of apex of canine tooth seen,
Half root length of 3rd
molars formed,
Dental age 14 - 16 years (approx.)
MP3 union seen , 8th
stage
Hand wrist radiograph
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8. CEPHALOMETRIC ANALYSIS
Soft Tissue Analysis
Facial Angle : 900
Nose tip to H-Line : 0 mm
Upper Sulcus depth : 9mm
Skeletal convexity at point – A : 0mm
Upper lip strain : 5mm
Upper lip curvature : 6mm
Relation to TVL
Upper lip anterior : + 7mm
Lower lip Anterior : +1mm
A Point ‘ : +.05mm
B Point’ : - 7mm
Pogonion’ : -5.5mm
S Line
Upper lip : 4mm
Lower LIP : 5mm
Skeletal
Relationship of maxilla
SNA : 790
N Perp. To Pt. A : 0mm
NA – TH : 900
Extent of Maxillary base : 44mm
Relationship of Mandible
N Perp. Pog : -3mm
N Pog – TH : 880
Extent of mandibular base : 68mm
SNB : 77
Saddle angle : 1250
Relationship of Maxilla, and Mandible
Go Me – FH : 230
Go Gn – Sn : 300
Gonial angle : 1240
Basal Plane angle : 230
Anterior to Posterior face height ratio : 64%
Dental
Maxillary Incisors
1 – NA : 13mm
1 – NA : 400
1 – Pt A – 12mm
1 – SN - 1250
1 – PP - 490
TVL Mx1 - +0.5mm
Mandibular Incisors
1 – NB : 9mm
1 – NB : 320
1 – APO Line – 8mm
IMPA - 1030
TVL Md1 - -6mm
Max.1 to Mand. 1 - 950
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9. MODEL ANALYSIS
Bolton Tooth Ratio
Anterior ratio indicates maxillary excess of 1.5mm
Overall Tooth ratio indicates maxillary excess of 2.1mm
Caries / Arch Perimeter Analysis
Maxillary difference of –5mm and mandibular difference of –4.3mm
Ashley Howe’s Analysis
P.M.B.A.W % = 38% , (Border line case )
DIAGNOSIS
15 year old post pubertal female patient by name Sunitha H. is
diagnosed as a case of skeletal class I dentoalveolar protrusion with convex
profile incompetent lips, acute nasolabial angle, Endon molar relation by
1mm, Endon canine relation, proclined upper and lower incisors, increased
overjet of 5.5mm, dental maxillary midline shift to right by 2mm, crowding in
anterior segment , rotated maxillary second premolarswww.indiandentalacademy.com

10. > Treatment objectives
* To relieve crowding and correct maxillary midline shift
* To reduce increased overjet
* To provide competent lips.
* To reduce the acute nasolabial angle
* To provide a consonant smile
Treatment plan :
> Extraction of second premolars.
> Banding of Ist and IInd molars, TPA in Maxillary Arch.
>Segmental Mechanics to be employed to retract Ist
premolars using closed coils loops made of 19x19 TMA
wire and lingual buttons with E-chain.
> After leveling aligning, enmasse retraction by reinforcing
anchorage using implants along with correction dental
midline shift.
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11. Max1 -PP 64o
Mand1 - MP 97o
Max1-Mand1 - 128o
Nasolabial angle - 97o
Treatment duration :
> Retraction of IInd premolar --> 2 months
> Leveling aligning --> 3 months.
> Enmasse retraction --> 6months.
> Finishing and detailing --> 2 months.
Total duration --> 13 months.
Retention : Removable wraparound retainer in maxillary
& mandibular arches.
6 months full time wear, 4 months night only, 2 months
alternate night, 2 months once a week.
Maxillary Mandibular
R L R L
-4.50 -0.50 -3.50 -1.00
-6.50 -6.50 -3.50 -3.50
+2.0 -2.0 -1.50 -1.50
9.0 9.0 8.50 6.00
18 14.5
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