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orthodontics case discussion / fixed orthodontics courses for general dentists in india

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orthodontics case discussion / fixed orthodontics courses for general dentists in india

  1. 1. CASE DISCUSSION
  2. 2. CHIEF COMPLAINT Name: Waseem Khan Age: 22 years Sex: Male Patient complains of forwardly placed upper front teeth.
  3. 3. EXTRA ORAL EXAMINATION FRONTAL AT REST FRONTAL AT SMILE
  4. 4. EXTRA ORAL EXAMINATION PROFILE AT REST PROFILE AT SMILE
  5. 5. EXTRA ORAL EXAMINATION OBLIQUE AT REST OBLIQUE AT SMILE
  6. 6. INTRA ORAL EXAMINATION FRONTAL
  7. 7. INTRA ORAL EXAMINATION MAXILLARY ARCH MANDIBULAR ARCH
  8. 8. INTRA ORAL EXAMINATION OVERJET OVERBITE RELATION RIGHT OCCLUSION LEFT OCCLUSION
  9. 9. PAST DENTAL HISTORY Patient has RC Treated 12,36,46 and ceramic crown - 12, metal crowns - 36,46
  10. 10. GENERAL HISTORY • Improvement of esthetics is prime reason for the patient to seek treatment and is positively motivated for treatment. • Patients brushes once daily and does not use any other oral hygiene aid.
  11. 11. CLINICAL EXAMINATION
  12. 12. GENERAL HEALTH STATUS • Height : 5 feet 11 inches • Weight : 78 kg • Posture : Upright • Body type : Mesomorphic • Gait : normal
  13. 13. EXTRA ORAL EXAMINATION - FRONTAL • Mesocephalic head • Mesoprosopic face. • Apparently symmetrical. • Vertical proportionality Upper – 68 mm Middle – 58 mm Lower – 67 mm • Stomium line to nose– 22 mm Stomium line to chin – 47 mm • Competent lips
  14. 14. EXTRA ORAL EXAMINATION - FRONTAL • Consonant smile arc. • 9 mm of upper incisor display (90%).
  15. 15. EXTRA ORAL EXAMINATION-PROFILE • Mild Convex facial profile. • Average nasolabial angle. • Average clinical FMA. • Deep Mentolabial sulcus.
  16. 16. FUNCTIONAL EXAMINATION • Respiration is nasal. • No TMJ or jaw function complaint. • Interocclusal clearance : 3mm • Maximum mouth opening : 47mm (45-55mm) • Protrusion 10mm • Right excursion 12mm. • Left excursion 12 mm. • Normal swallow. • Normal speech.
  17. 17. INTRA ORAL EXAMINATION SOFT TISSUE EXAMINATION: • Good oral hygiene status. • tongue- normal shape and movements. GENERALISED enamel hypoplasia
  18. 18. INTRA ORAL EXAMINATION HARD TISSUE EXAMINATION • Full complement of teeth present • RC treated 12,36,46 • Ceramic crown-12 • Metal crown-36,46. • FRACTURED 11
  19. 19. INTRA ORAL EXAMINATION HARD TISSUE EXAMINATION (MAXILLARY ARCH) • U-shaped arch. • Apparently symmetrical arch. • Rotations Mesiolabially –14, 24,25 • Spacing between maxillary incisors
  20. 20. INTRA ORAL EXAMINATION HARD TISSUE EXAMINATION (Mandibular arch) • U-shaped arch. • Apparently symmetrical arch. • Spacing between lower incisors • Curve of spee Right- 4 mm Left- 4 mm
  21. 21. INTRA ORAL EXAMINATION ANTERIOR OVERJET OVERBITE RELATIONSHIP Overjet – 5 mm Overbite – 3.5 mm Incisor relation – Class II,Div 1
  22. 22. INTRA ORAL EXAMINATION RIGHT Molar Relation –End on Canine relation –End on LEFT Molar relation– End on Canine relation – End on
  23. 23. DIAGNOSTIC RECORDS
  24. 24. ORTHOPANTOMOGRAM
  25. 25. LATERAL CEPHALOGRAM
  26. 26. MODEL ANALYSIS BOLTONS ANALYSIS Anterior maxillary tooth material excess–0.6 mm Overall mandibular tooth material excess –0.1mm ARCH PERIMETER ANALYSIS 2 mm discrepancy – tooth material Excess Indicating proximal stripping CAREY’S ANALYSIS 1 mm discrepancy –tooth material Excess Indicating proximal stripping
  27. 27. MODEL ANALYSIS PONT’S ANALYSIS Calculated values greater than Measured values Expansion ASHLEY HOWE’S ANALYSIS PMD- 44 mm & PMBAW- 42 mm - EXPANSION POSSIBLE PMBAW% - 44 % indicating Borderline case
  28. 28. ANGLE MEAN ACTUA L INFERENCE FMPA 250 200 Hypodivergent IMPA 900 1150 Proclined lower incisors FMIA 650 440 Poor esthetic balance TWEED’S ANALYSIS
  29. 29. MEASUREMENTS MEAN ACTUAL INFERENCE Facial Plane 87.5±3.60 870 Average Convexity 0 ±5.10 100 Convex profile A-B Plane -4.6to3.7 90 Skeletal Class II MP angle (FH-Go-Me) 22 ± 30 200 Normodivergent Y-axis 60±40 600 Normodivergent Occ Plane (OP) 9±40 100 Average U1-L1 (angle) 135±6 0 970 Proclined anteriors L1-OP (angle) 75±40 53 Proclined lower anteriors L1-MP 92±40 116 Proclined lower anteriors U1- A-Po 2±3mm 13 mm Anteriorly positioned upper incisors DOWN’S ANALYSIS
  30. 30. STEINERS ANALYSISMEASUREMENTS MEAN ACTUAL INFERENCE SNA 820 920 Prognathic maxilla SNB 800 860 Prognathic mandible SND 76 830 forward positioned chin ANB 2±20 60 Skeletal class II Go-Gn to SN 320 180 Hypodivergent UPPER 1 to N-A 4mm +9mm Anteriorly placed and proclined incisors UPPER 1 to N-A 220 330 Proclined upper incisors LOWER 1 to N-B 4mm 10mm Anteriorly placed and proclined incisors LOWER 1 TO N-B 250 430 Proclined lower incisors UPPER 1 to LOWER 1 1310 970 Proclined anteriors OCCLUSAL TO S-N 140 100 Forward rotation of occlusal plane
  31. 31. STEINERS ANALYSIS SOFT TISSUE Upper lip 6 mm anterior to S-line lower lip 4 mm anterior to S-line. indicating protrusive upper and lower lips
  32. 32. WITS APPRAISAL • AO IS COINCIDING WITH BO. Indicating SKELETAL CLASS I
  33. 33. McNAMARA ANALYSIS MEASUREMENTS MEAN ACTUAL INFERENCE Na ┴ -Point A (mm) 0-1 1 mm Orthognathic maxilla Na ┴ -Pg (mm) 0 to-4 -7mm Retrognathic mandible Facial axis angle 00 -70 Hypodivergent MP angle (FH-Go-Me) 22 ± 40 200 Normdivergent Mx length(Co-PointA) 100±3.9 101mm Average Md length(Co-Gn) 131±4.6 121mm Decreased Mx-Md differential 30.1±3.9 20mm Decreased LAFH (ANS-Me) 71.6±4.9 67mm Average U1- Point A 4mm 9mm Anteriorly positioned upper incisors L1- A-Po 1-2mm 6mm Anteriorly positioned lower incisors Naso labial angle 90-110 0 1020 Average
  34. 34. PARAMETERS MEAN PRE RX INFERENCE Se-N (Length of Ant Cranial Base) 70.1 mm 76 mm Increased Go-Pg (Length of Mandibular Base) Se-N+3mm (79mm) 81mm Increased ANS-PNS (Length of Maxillary Base) 53.5 mm 58mm Increased Co-Go (Length of ramus) 58 mm 58mm Average ANS-PNS/ Go-Pg 2:3 2:3 Average Co-Go/ Go-Pg 5:7 5:7 Average SCHWARZ ANALYSIS
  35. 35. RAKOSI JARABAK’S ANALYSISMEASUREMENT MEAN ACTUAL INFERENCE SADDLE ANGLE 1230 ± 5 12430 Average ARTICULAR ANGLE 143 ± 60 1380 Average GONIAL ANGLE 128 ± 70 1220 Average U/ GONIAL ANGLE 52-550 550 Average L/ GONIAL ANGLE 72-750 670 Anterior rotation of MP SUM OF POSTERIOR ANGLES 396 ± 60 3840 Hypodivergent MANDIBULAR PLANE ANGLE 320 180 Hypodivergent ANGLE OF INCLINATION 850 850 Average N-PERP TO OCCLUSAL PLANE 750 800 Anticlockwise rotation of occlusal plane
  36. 36. MEASUREMENTS MEAN ACTUAL INFERENCE N-PERP TO MANDIBULAR PLANE 650 680 Anticlockwise rotation of mandibular plane BASAL PLANE ANGLE 250 170 Hypodivergent PALATAL PLANE TO OCCLUSAL PLANE 110 60 Anticlockwise rotation of occlusal plane OCCL. PLANE TO MP 140 100 Anticlockwise rotation of mandibular plane Y AXIS 660 610 Hypodivergent INTERINCISAL ANGLE 1350 970 Proclined incisors UPPER 1 TO S-N 102+2 1230 Proclined upper incisors LOWER1 TO MAND. PLANE (IMPA) 90+30 1150 Proclined lower incisors UPPER1 TO PALATAL 70+50 520 Proclined upper incisors POSTERIOR TO ANTERIOR FACE HT. RATIO 62- 65% 89/117= 76% Decreased vertical growth
  37. 37. EXTRA ORAL EXAMINATION FRONTAL AT REST FRONTAL AT SMILE
  38. 38. EXTRA ORAL EXAMINATION PROFILE AT REST PROFILE AT SMILE
  39. 39. EXTRA ORAL EXAMINATION OBLIQUE AT REST OBLIQUE AT SMILE
  40. 40. INTRA ORAL EXAMINATION FRONTAL
  41. 41. INTRA ORAL EXAMINATION MAXILLARY ARCH MANDIBULAR ARCH
  42. 42. INTRA ORAL EXAMINATION OVERJET OVERBITE RELATION RIGHT OCCLUSION LEFT OCCLUSION
  43. 43. COMPOSITE ANALYSIS • On saggital analysis, patient has skeletal class II base with matching soft tissue pattern. • On vertical analysis, patient is showing hypodivergent growth pattern. • Dentoalveolar analysis shows proclined upper and lower anteriors. • Total space analysis shows upper arch requires 8 mm of space and lower arch requires 7 mm of space. • Divergence of jaw bases shows upper anterior rotation of lower jaw base.
  44. 44. CEPHALOMETRIC DIAGNOSIS A case of skeletal class II pattern with orthognathic maxilla and retrognathic mandible with matching soft tissue pattern, hypodivergent growth pattern with proclined upper and lower incisors(bidental proclination).
  45. 45. DIAGNOSIS An 22 year old male presents with Angle’s Class II ,Div 1 malocclusion on a Class II skeletal base, Hypodivergent growth pattern, mild convex profile, average nasolabial angle, with bidental proclination and spacing of upper and lower anteriors.
  46. 46. PROBLEM LIST FACIAL PROPORTIONS AND ESTHETICS Mild convex profile, protrusive upper and lower lips DENTAL ALIGNMENT AND SYMMETRY Proclination and spacing of upper and lower anteriors.
  47. 47. PROBLEM LIST TRANSVERSE RELATIONSHIP ANTEROPOSTERIOR RELATIONSHIP End on molar relation bilaterally VERTICAL RELATIONSHIP
  48. 48. SOFT TISSUE TREATMENT OBJECTIVES • Correction of convex profile • Correction of protrusive upper and lower lips
  49. 49. SKELETAL TREATMENT OBJECTIVES • Correction of class II skeletal base
  50. 50. DENTAL TREATMENT OBJECTIVES • Correction of spacing in upper and lower anteriors. • Correction of overjet. • Correction of proclination of upper and lower anteriors, • Correction of end on molar relation bilaterally • Leveling of curve of spee.
  51. 51. TREATMENT PLAN Case planned to be treated with extraction of 14,24,34,44 using fixed mechanotherapy. –Levelling and aligning –Space closure –Finishing and detailing.
  52. 52. PROGNOSIS AND RETENTION PLAN Probable orthodontic treatment duration – 1 ⅟2 to 2years. Prognosis – Fair Retention Upper & Lower – Bonded fixed retainer.

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