Case discussion

CASE DISCUSSION
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CHIEF COMPLAINT:
A male patient named Gaurav aged 12
came to the OP with the chief complaint of
“ irregular upper and lower anterior teeth.”

FAMILY HISTORY:
 Non consanguineous marriage of the
parents.
 1 elder brother.
 No history of similar malocclusion,
familial diseases or other health
problems.

GENERAL HISTORY:
 PMH:None.
 PDH: None.
 No history of earlier orthodontic
treatment.
 Patient is willing for treatment.

PRENATALHISTORY:
 Pregnancy was normal.
 Normal full term delivery.

POST NATAL HISTORY:
 Patient was breast fed.
 Reached milestones of development
at the normal age.
 No habits.

CLINICAL EXAMINATION –
GENERAL.
 Normal gait and posture.
 Mesomorphic body type.

EXTRA ORAL EXAMINATION
- FRONTAL
 Mesocephalic
head.
 Mesoprosopic face.
 Normal nasolabial
fold.
 Deep mentolabial
sulcus.
 Normal facial
proportions

EXTRA ORAL EXAMINATION
- SMILE

EXTRA ORAL
EXAMINATION-PROFILE
 Convex facial
profile.
 Posteror facial
divergence.
 Normal mandibular
plane and average
clinical FMA.

INTRA ORAL EXAMINATION:
 Normal gingiva.
 Normal depth of mucogingival sulcus.
 Normal oral mucosa and frenal
attachments.
 Normal tongue size, position and
posture.
 Normal tonsils.
 normal palate.

OVERBITE

OVERJET

INTRA ORAL
EXAMINATION:
RIGHT MOLAR RELATION LEFT MOLAR RELATION

MAXILLARY ARCH MANDIBULAR ARCH

FUNCTIONAL EXAMINATION:
 Respiration is normal.
 Deglutition is adult type.
 Speech is normal.
 Normal peri oral muscle tone.
 Maximum mouth opening: 48mm
 Inter occlusal clearance : 3mm

MODEL ANALYSIS:
 Pont’s Analysis reveals a constriction of the
arches in the premolar region by 7 mm and
by 14 mm in the molar region.
 Ashley Howe’s analysis canine fossa % is
27 %
 Carey’s analysis reveals a tooth material
excess of 7mm in upper arch and 8 mm in
the lower arch.
 Boltons anterior ratio is 90.3% and overall
ratio is 77.2%.

DISCREPANCY
CALCULATION
SPACE MAXILLARY MANDIBULAR
REQD FOR
CROWDING
7 8 mm
PROCLINATION 2mm 4
CURVE OF SPEE 4mm
TOTAL 9mm 16mm

RADIOGRAPHS – IOPA.

RADIOGRAPHS – OPG.

RADIOGRAPHS – LAT
CEPH.

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
SNA 82 +/- 2 83
SNB 80 +/- 2 75
ANB 2 +/- 2 8
SND 76 72
SN-Pog 80 77
SN-FH 7 5
WITT’S AO
AHEAD
10 mm

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
SADDLE ANGLE 123+/-5 131
ARTICULAR ANGLE 143+/-6 143
ANT CRANIAL BASE 71
POST CRANIAL BASE 32 +/- 3 34
MAND LENGTH
( aPman - Go)
69
MAX LENGTH
( aPmax - Pns)
50
MAND –MAX RATIO 3:2 2.6:2

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
Co-Gn 111-114 105
Co-A 89 89
MAX MAND DIFF 27-30 mm 16
Na to POINT A 0 to 1mm -1
Na to Pog -8 to -6mm -13

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
Ar-Ptm 37.1 +/- 2.8 40
Ptm-N 52.8 +/- 4.1 49
N-A 0 +/- 3.7 -1
N-B -5.3 +/- 6.7 --12
N-Pog -4.3 +/- 8.5 -10
A - B -1.1 -13
ANS - PNS 57.7 50
Go - Pg 83.7+/-4.6 78
Ar-Go 52+/-4.2 50www.indiandentalacademy.com

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
FACIAL AXIS 90+/-3 87
Y AXIS 66 65
Sn-Go-Gn 32 19
FMA 25 15
INCLINATION 85 85
BASAL PLANE 25 14
OCC-PAL 11 6
OCC-MAN 14 9

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
OCC-SN 14 11
Pal-SN 8+/-2 5
GONIAL ANGLE 130+/-7 106
UPPER 50-55 48
LOWER 70-75 58
SUM OF ANGLES 396 380
GONIAL ANGLE 119+/-6.5 104

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
Mx 1 to SN 102 106
Mx 1 to NA 22 23
Mx 1 to Pal 110+/-5 111
IMPA 90 110
Md 1 to NB 25 25
INTER INCISAL 132 123
Mx 1 to NA 4mm 5
Mx 1 to NPog 2-4mm 14

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
Md 1 to NPog -2 to +2 4mm
Md 1 to NB 4mm 6mm
AFH (N to Me) 105
PFH (S-Go) 80
JARABAK RATIO 62% - 65% 76
LAFH (ANS-Me) 60-62 63

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
AUFH (N – ANS) 55 45
LFH (ANS-Gn) 69 63
PNS-N 54 47
MP-HP ANGLE 25 12
ALFH (ANS- Me) 65 62
AUFH% 45% 41
ALFH% 55% 59
FACIAL INDEX 10% 18

MEASUREMENT NORMAL
AUDH 30.5+/-2.1 34
ALDH 45+/-2.1 43
PUDH 26.2+/-2 24
PLDH 35.8+/-2.6 31
CEPHALOMETRIC
EVALUATION:

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
NASOLABIAL ANGLE 102+/-8 97
Mx 1 EXPOSURE 2+/-2 7mm
INTERLABIAL GAP 2+/-2 11mm
U LIP LENGTH 24mm 20
L LIP LENGTH 50mm 24
U LIP to S LINE 5mm
L LIP to S LINE -2mm
MENTOLABIAL
SULCUS
4+/-2mm 6mm

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL
U LIP to E LINE -2 to -3
mm
2mm
L LIP to E LINE -1 TO -2
mm
-3mm
U LIP
THICKNESS
15 mm 15mm
U LIP STRAIN 16mm 13mm
SOFT TISSUE 10-12 mm 12mm
U LIP
PROTRUSION
3+/-1 mm 8mm
L LIP
PROTRUSION
2+/-1 mm -1mm

SUMMARY OF CEPHALOMETRIC
FINDINGS:
 Skeletal class II pattern
 Marked horizontal growth pattern
 Marked decrease in gonial angle
 Skeletal deep bite
 Upright upper anteriors, proclined
lower anteriors
 Patient is in initiation phase of growth

Cephalometric finding:
 It is a case of skeletal class II
malocclusion with orthognathic maxilla
and retrognathic retropositioned
mandible having a horizontal growth
pattern.

OTHER INVESTIGATIONS

FINAL DIAGNOSIS:
A case of Angle Class II div I
malocclusion with Class II skeletal bases
with orthognathic maxilla and retrognathic
retropositioned mandible.

PROBLEM LIST:
 Retrognathic, retropositioned mandible
 Severe skeletal and dental deep bite
 Crowding of anteriors
 Convex facial profile with incompetent
lips

TREATMENT OBJECTIVES:
 Enhance growth of the mandible
 Correct deep bite
 Correct crowding

TREATMENT PLAN:
 Case to be treated with 0.022 slot
Roth prescription.
 Growth modification to be carried out
using Fixed functional appliance –
Jasper Jumper.

FIRST APPOINTMENT

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL CENT
OCCL
SNA 82 +/- 2 83
SNB 80 +/- 2 75
ANB 2 +/- 2 8
SND 76 72
SN-Pog 80 77
SN-FH 7 5
WITT’S AO
AHEAD
10 mm

CEPHALOMETRIC
EVALUATION:
MEASUREMENT NORMAL CENT OCCL
SADDLE ANGLE 123+/-5 131
ARTICULAR ANGLE 143+/-6 143
ANT CRANIAL BASE 71
POST CRANIAL BASE 32 +/- 3 34
MAND LENGTH
( aPman - Go)
69
MAX LENGTH
( aPmax - Pns)
50
MAND –MAX RATIO 3:2 2.6:2

CEPHALOMETRIC
EVALUATION:
Co-Gn 111-114 105
Co-A 89 89
MAX MAND DIFF 27-30 mm 16
Na to POINT A 0 to 1mm -1
Na to Pog -8 to -6mm -13

CEPHALOMETRIC
EVALUATION:
Ar-Ptm 37.1 +/- 2.8 40
Ptm-N 52.8 +/- 4.1 49
N-A 0 +/- 3.7 -1
N-B -5.3 +/- 6.7 --12
N-Pog -4.3 +/- 8.5 -10
A - B -1.1 -13
ANS - PNS 57.7 50
Go - Pg 83.7+/-4.6 78
Ar-Go 52+/-4.2 50www.indiandentalacademy.com

CEPHALOMETRIC
EVALUATION:
FACIAL AXIS 90+/-3 87
Y AXIS 66 65
Sn-Go-Gn 32 19
FMA 25 15
INCLINATION 85 85
BASAL PLANE 25 14
OCC-PAL 11 6
OCC-MAN 14 9

CEPHALOMETRIC
EVALUATION:
OCC-SN 14 11
Pal-SN 8+/-2 5
GONIAL ANGLE 130+/-7 106
UPPER 50-55 48
LOWER 70-75 58
SUM OF ANGLES 396 380
GONIAL ANGLE 119+/-6.5 104

CEPHALOMETRIC
EVALUATION:
Mx 1 to SN 102 107
Mx 1 to NA 22 23
Mx 1 to Pal 110+/-5 113
IMPA 90 112
Md 1 to NB 25 25
INTER INCISAL 132 123
Mx 1 to NA 4mm 5
Mx 1 to NPog 2-4mm 14

CEPHALOMETRIC
EVALUATION:
Md 1 to NPog -2 to +2 4mm
Md 1 to NB 4mm 6mm
AFH (N to Me) 105
PFH (S-Go) 80
JARABAK RATIO 62% - 65% 76
LAFH (ANS-Me) 60-62 63

CEPHALOMETRIC
EVALUATION:
AUFH (N – ANS) 55 45
LFH (ANS-Gn) 69 63
PNS-N 54 47
MP-HP ANGLE 25 12
ALFH (ANS- Me) 65 62
AUFH% 45% 41
ALFH% 55% 59
FACIAL INDEX 10% 18

AUDH 30.5+/-2.1 34
ALDH 45+/-2.1 43
PUDH 26.2+/-2 24
PLDH 35.8+/-2.6 31
CEPHALOMETRIC
EVALUATION:

CEPHALOMETRIC
EVALUATION:
NASOLABIAL ANGLE 102+/-8 97
Mx 1 EXPOSURE 2+/-2 7mm
INTERLABIAL GAP 2+/-2 11mm
U LIP LENGTH 24mm 20
L LIP LENGTH 50mm 24
U LIP to S LINE 5mm
L LIP to S LINE -2mm
MENTOLABIAL
SULCUS
4+/-2mm 6mm

CEPHALOMETRIC
EVALUATION:
U LIP to E LINE -2 to -3
mm
2mm
L LIP to E LINE -1 TO -2
mm
-3mm
U LIP
THICKNESS
15 mm 15mm
U LIP STRAIN 16mm 13mm
SOFT TISSUE 10-12 mm 12mm
U LIP
PROTRUSION
3+/-1 mm 8mm
L LIP
PROTRUSION
2+/-1 mm -1mm

Thank youwww.indiandentalacademy.com

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