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Osama ziadat case presentation
1. Orthodontic Case Presentation
Done by : Osama Al Ziadat
3rd Year Orthodontic Resident
Supervisors: Dr. Ahmad Al Tarawneh
Dr. Raghda Shamout
Dr. Anwar Al Rahamneh
Dr. Hanan Al Habarneh
3. Medical and Dental History
Medical History: Denied any medical problems
Dental History: Routine Dental Procedures
Habits: Tongue Thrusting
Motivation: Internally Motivated
12. Smile Aesthetics
Assessment
The Buccal Corridor Ratio =
7% (Medium-broad)
100% of incisors crowns
with interproximal gingiva
only showing
The upper incisors do not
touch the lower lip and the
incisal edges not parallel to
it
37. Diagnostic Summary
D.A is a 15 year old male, denied any medical problems,
has poor oral hygiene ,tongue thrusting habit, complains
of space between his upper teeth and lower teeth. He has
a class II/I incisor relationship based on class II skeletal
pattern, Average anterior lower facial height,
incompetent thin lips, and a convex facial profile. O.J of 6
mm, reduced O.B, Upper midline shift to the left 1 mm
and lower midline shift to the right 2 mm, no crowding in
the upper arch and mildly crowded Lower arch. Molar
and Canine relationships are class I on both sides.
38. Problem List
Pathological problems:
- Poor Oral Hygiene
- Carious UR7 ,LL6
Chief Complaint:
“There is space between my upper and lower anterior teeth”
Skeletal Problems:
- Mild Skeletal class II pattern
- Mild asymmetry
Soft tissue Problems :
- Convex profile - Large tongue with thrusting habit
- Incompetent lips
Dental Problems :
- Increased overjet 6 mm(Proclined upper incisors)
- Reduced overbite
- Crossbite tendency UL5 - Rotated upper , lower canines and lower 5s
- Upper midline shifted 1 mm to the left - Anterior bolton ratio discrepancy ( small Upper 2s)
- Lower midline shifted 2 mm to the right
39. Treatment Aims
Improve oral hygiene
Treat carious teeth
Build up upper lateral incisors
Accept mild skeletal discrepancy
Accept mild facial asymmetry
Correct incompetent lips
Terminate tongue thrusting habit
Correct centerlines shift
maintain Class I molar and canine relationships
Reduce OJ
Increase OB
Correct UL5 crossbite tendency
Finishing and detailing of occlusion
Retain corrected results
41. Justification
OHI : Visible Plaque and swollen interproximal gingiva
Camouflage :
Patients chief complaint
Good vertical facial proportions
Mild Class II skeletal
Normal soft tissue features (incompetent lips can be corrected
orthodontically)
Non –Extraction :
Spaced Case with over average proclined anterior teeth
Anchorage using NANCE + LB to maintain class 1 molar
relationship
Tongue crib : to terminate tongue thrusting habit
42. Justification ( Continued)
Fixed appliance using Andrews and roth prescriptions:
For 3D tooth movement
Correct UL5 crossbite tendency using Archwires expansion
0.22 slot used for better sliding mechanics
To give least positive torque available to help in reducing O.J and
retroclination of the anterior teeth
Retention :
Upper Hawley 6month full time wear and 6 month night time +
permanent retainer(3 to 3) due to spacing and rotations
Lower V.F.R night wear (short term retention) + permanent
retainer (5 to 5)due to late mandibular incisors crowding and
rotations (long term retention to reduce possibility of relapse)