Dr. RAHUL VC TIWARI, SIBAR INSTITUTE OF DENTAL SCIENCES, GUNTUR, ANDHRA PRADESH, INDIA. ORTHOGNATHIC CASE PRESENTATION

1. Case presentation
orthognathic surgery
PRESENTED BY
Dr. RAHUL TIWARI
2ND YEAR MDS - PG Student
DEPT. OF ORAL & MAXILLOFACIAL SURGERY
SIBAR INSTITUTE OF DENTAL SCIENCES
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2. Patient name : P Chetan sai
Ongole B Tech 3rd yr.
Age / Sex : 19yrs/Male
Chief complaint : Complains of unaesthetic apperarence of
his face
HOPI
CONTACT NO 9010480298
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3. Case History
PMH, PDH, DRUG, FAMILY
Pre-natal history
Informer : Mother
Condition of mother : Normal
during pregnancy
Delivery : Full term
Type : Normal
Post-natal history:
Feeding : Breast fed till 1 yr
Milestones of development : Normal
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4. Childhood History:
Habits : No deleterious habits
Injuries : No relevant history
Mental Development : Normal
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5. General History :
Reasons for taking treatment
- Esthetic
Attitude of patient to treatment
- +ve
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6. Extra oral photographs
PRE TREATEMENT
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7. Extra oral photographs
PRE SURGICAL
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8. Clinical examination
General examination
Height : 5 feet 10 inches”
Weight : 68kgs
Gait & Posture : Normal
Body type : Mesomorphic
VITALS , PICKLE case/orthognathic/rt/31 8

9. Extraoral examination
Head shape: Mesocephalic
Facial type: Mesoprosopic
Facial symmetry: No gross asymmetry
detected
Clinical examination contd..
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10.  Inter canthal - 38.29mm
 Inter pupillary - 74.43mm
 Alar base width- 30.74mm
 Nose dorsum length- 38.20mm
 Upper 1/3rd - 58 mm
 Middle 1/3rd – 57 mm
 Lower 1/3rd -- 62 mm
Clinical examination contd..
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11. Stomium line to nose: 22mm
Stomium line to chin : 43mm
Lips : competent
Interlabial gap : 0mm
Clinical examination contd..
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12. Incisor exposure during smile: full crown exposure
Clinical examination contd..
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13. Facial profile : Convex
Facial divergence : Posterior divergent
Profileview
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14. Nose : Normal
Nasolabial angle : Average
Mentolabial sulcus : Deep
Throat angle : Obtuse
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15. SOFT TISSUE EXAMINATION
Oral hygiene status : Satisfactory
Gingiva : NAD
Oral Mucosa : NAD
Tongue : Normal
Intraoral examination
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16. HARD TISSUE EXAMINATION
Teeth present : 87 6 5 4 3 2 1 1 2 3 4 5 6 78
1 2 3 4 5 6 77 6 5 4 3 2 1
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17. Skeletal mid line : Dental mid line
Upper – coincides coincides
Lower – coincides coincides
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18. Upper arch : U –SHAPE
Lower arch : U –SHAPE
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19. Molar relation –Class II
Canine relation – Class II
Overjet - 6mm
Overbite – 4mm
Curve of spee 3mm on both sides
Molar relation – Class II
Canine relation – Class II
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20.  Freeway space : 3mm
 TMJ Exam : NAD
 Respiration : Nasal
Mandibular movements:
 Maximum mouth opening : 40 mm
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21. Radiographs
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22. OPG
3rd molars are seen in MAXILLARY quadrant
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23. Lateral cephalogram
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24. Burstone analysis- soft and hard tissue.
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25. M
C
N
A
M
A
R
A
A
N
A
L
Y
SI
S
Parameter Normal range Measured
value
Inference
Nasolabial angle 102°±8 95° Average
Point A to N 0±2mm 3mm Increased.
Maxillary length 91mm
Mandibular length 115-118mm 118mm Normal mand. length
Maxillomandibular
differential
20-23 ( small
25-27 (medium)
30-33 (large)
27 mm Medium
Low. ant. facial height 60-63 mm 70mm Increased
MPA 22°±4 22° Normodivergent
Facial axis angle 90.0±3.5° 93 ° Normal
Pog to N -1.8± 4.5mm -5mm Retrognathic Mandible
Maxi. incisor to pt A 4 mm 3 mm Normally up.incisors
Mand. incisor to A-Pog 1-2 mm -3 mm Backwardly placed mand.incisors
Skeletal class II, Normodivergent with backwardly placed l ower incisorscase/orthognathic/rt/31 25

26. B
J
O
R
K
’S
A
N
A
L
Y
S
I
S
Parameter Normal range Measured
value
Inference
Saddle angle 123 ± 5° 135° Retro postisioned condylar fossa
Articular angle 143 ± 6° 135° Prognathic changes
Gonial angle 130 ± 7° 117° Anticlockwise rotation of mand.
Total post angle 396° 388° Horizantal growth
Ant cranial base 71 ± 3 mm 71mm Normal
Post cranial base 32 ± 3 mm 33 mm Normal
Ramus height 44 ± 5 mm 57 mm Increased
Mand body length 71 ± 5 mm 79 mm Increased
SN – MP 36° 28 ° Hypodivergent
L1to MP 90 ± 3° 99 ° Proclined lower incisors
U1to SN 102 + 2° 102 ° Normal upper incisors
PFH(S-Go) 84
AFH(N-Me) 120
PFH/AFH % 64 ±2% 70% Horizantal growth
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27. Skeletal
A postpubertal 19yrs male patient with skeletal class II bases,
hypodivergent growth pattern and retrognathic mandible.
Dental
Angles class II DivI malocclusion with mild crowded and
Proclined lower anteriors.
Soft tissue
Mesoprosopic face with convex facial profile, soft tissues
matching skeletal base
DIAGNOSIS
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28. Problem list
1. Skeletal and dental class II
2. Backwardly placed mand.incisors
3. Retrognathic mandible
4. Mild lower anterior proclination
5. Convex profile
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29. Treatment objectives
1. Correction of skeletal and dental Class II relationship
2. Correction of proclined Lower incisors.
3. Attaining ideal overjet and overbite
4. Attaining pleasing facial profile
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30. TREATMENT PLAN
As the patient growth is completed and patient having skeletal class
II bases because of retrognathic mandible.
•BSSO should be carried out and bring mandibular advancement of
4 mm.
• If required reduction genioplasty should be done.
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31. Thank you
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