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1. Orthodontic Clinical
Case Presentation
By: Murad F.Maraqa 3 rdYear Orthodontic Resident”
Supervisors: Dr. Ahmad M. AlTarawneh
Dr. Raghda Shamout
Dr. Ra’ed Al Rbatta

2. Personal Data
▪ Patient’s Name: R.S
▪ Gender: Female
▪ Age: 15Years, 8 Months
▪ Career: Student
▪ Nationality: Jordanian

3. Chief Complain
“ I don’t like how my upper teeth don’t show when I smile ”

4. Medical & Dental History
▪ Medical History:
Denied Any Medical History.
▪ Dental History:
RCT UR 6 + Amalgam filling
Restorations on the UL6 , LL6 and LR6

5. History
▪ Trauma: No history of trauma.
▪ Habits: No Habits
▪ Motivation: Internal Motivated.
▪ Growth status: Passed the growth spurt .

6. Jaw & Occlusal Functions
▪ Mastication:
Normal masticatory function.
▪ Speech:
No difficulty.
▪ TMJ:
No clicking
No Crepitus or tenderness.
No displacement
Normal opening.

7. Extra-Oral Photos
FrontalView

8. ProfileView
Extra-Oral Photos

9. Extra-Oral Photos
ObliqueView

10. Intra-Oral Photos

11. Right side Left side

12. Orthopantomogram “OPT”

13. Cephalometric Analysis
Angle Measurement Average
SNA 82 (81)+-3
SNB 82 (78)+-3
ANB 0 (2)+-2
SN-MAX 9.8 (8)+-3
Corrected
ANB
-0.5
Wits Apprasial -3 (0) +
1.77mm “f”
MMPA 26 (27)+-4
AFH Ratio 57% 55%+-2%
UI - MAX 110 (109)+-6
LI - MAN 99 (93)+-6
IIA 121 (135)+-10

14. A. Anteroposterior Assessment
▪ Profile:
Convex facial profile.

15. B. Vertical Assessment
▪ Average LAFH
▪ Upper lip in the upper 1/3
▪ Lower lip in the lower 2/3

16. C. Transverse Assessment
▪ Facial Symmetry:
The patient has asymmetrical
face.
Tip of nose deviated to the
right side.
Chin deviated to the right.
Larger Right medial 1/5s than
Left medial1/5s .
Interpupillary distance larger
than the width of the mouth.

17. E. Soft Tissue Examination
▪ Thin, competent lips.
▪ Normal tongue size and
function.
▪ Frontonasal angle: “115-135
– 130
▪ Nasolabial angle: “90-110”
– 115.
▪ Labiomental angle: “110-130”
– 140.

18. Intra-oral Examination
▪ Asymmetric smile.
▪ Reduced incisors show 30%
▪ Increased Buccal Corridor

19. Right side Left side

20. Intra-Oral Examination
▪ Teeth present:
7 7
7 7

21. Intra-Oral Examination
▪ Oral Hygiene :Poor
RCT UR 6 + Amalgam filling
Restorations on the UL6 , LL6
and LR6

22. Intra-Oral Examination
▪ Centerlines:
– Upper: shifted to the left
1mm
– Lower: shifted to the right
1mm
▪ OJ: -1.2mm
▪ OB: 20% “decreased”
▪ Crossbite on:
▪ Right: 2,1
▪ Left: 1

23. Intra-Oral Examination
▪ Right buccal segment
relationships:
 Canine:Class III 1/4
 Molar:Class I
▪ Left buccal segment
relationships:
 Canine: Class I
 Molar:Class III 1/4

24. Lower Arch
▪ U- shaped arch form.
▪ Symmetrical.
▪ No crowding.
▪ LL6 needs refilling or crowning

25. Upper Arch
▪ U- shaped arch form.
▪ Constricted Anteriorly.
▪ Palatally displaced central
incisors and right lateral incisor.
▪ Palatally inclined lateral
incisors.

26. Frontal View
▪ Class III Incisor relationship
▪ OJ: -1.2mm
▪ OB: 20%

27. Posteroanterior View

28. Right Side
▪ Molar: Class I
▪ Canine: Class I
▪ Crossbite: 1,2

29. Left Side
▪ Molar: Class I
▪ Canine: Class I
▪ Crossbite: 1

30. Lower Cast Occlusal
▪ Intercanine width:
26 cusp tip –cusp tip
▪ Intermolar width:
▪ 46 MB-MB

31. Upper Cast Occlusal
▪ Intercanine width:
33 mm cusp tip – cusp tip
▪ Intermolar width:
▪ 46 mm from the MB-MB
▪ Normal

32. Curve of Spee
▪ Left side: 1 mm
▪ Right side: 1 mm

33. Tooth Size Analysis (Bolton Ratio)
▪ Over all ratio = 87.5/98
▪ 90%
Normal: 91.3%
▪ Anterior ratio = 36.5/45.5
▪ 80% “increased”
– Normal: 77.2%
11 7 8 8.5 6 9 8 6 8 8 7 11.5 98 45.5
6 5 4 3 2 1 1 2 3 4 5 6 over
all
ante
rior
11.5 7 7.5 7 6 6 6 6 6.5 7 6.5 11.5 87.5 36.5

34. ▪ All third molar buds are present.
▪ No apparent pathology.
RCT UR 6 + Amalgam filling
Restorations on the UL6 , LL6 and LR6
▪

35. IOTN Dental Health Component
▪ Grade:

36. IOTN Esthetic Component
▪ Not Applicable

37. Diagnostic Summary
▪ R.S is a 16 years old, female, denied any medical history.
She came complaining that her upper teeth don’t show while smiling.
She has poor oral hygiene.
Class III Incisors relationship based on mild skeletal Class III with Average anterior facial
height.
She has asymmetrical face with chin deviated to the Right side. Compromised smile
esthetics.
She has Class I molar with Class I canine relationships on right side and a Class I molar
with ClassI canine relationships on left side.
OJ is -1.2mm with decreased OB to 20% “incomplete”
Upper midline shifted to the left by 1 mm and lower shifted to the right by 1 mm.
Mild crowding in the upper and well-aligned lower arch.
Crossbite on UR 1,2and UL 1.

38. Problem list
Pathological problems:
– Poor O.H.Visible Plaque Accumulation
– LL6 needs refilling or crowning
Patient’s concern
I don’t like how my upper teeth don’t show when
I smile
▪ Skeletal and dental problems in
transverse plane:
– Chin deviated to the right side.
– Upper midline shifted to the left by 1mm.
– Lower midline shifted to the right by 1mm.
▪ Skeletal and dental problems in A-P :
– Skeletal Class III prognathic mandible
– OJ -1.2 mm
▪ Skeletal and dental problems
vertically
– Decreased OB. 20%

39. Treatment Aims
▪ Improve O.H.
▪ Restorative treatment LL6.
▪ Accept skeletal discrepancy.
▪ Accept facial asymmetry
▪ CorrectAnterior crossbite.
▪ Correct centerlines shift.
▪ Achieve and maintain Class I molar
and canine relationships.
▪ Achieve Positive OJ
▪ Increase OB.
▪ Finishing and detailing of occlusion.
▪ Retain corrected results

40. Treatment Plan “Non-Extraction”
1. O.H. improvement.
2. Upper and Lower Fixed MBT 0.22 slot.
3. Bite raising on the lower Incisors .
4. Stripping in the lower arch
6. Conventional Retention Upper/Lower Hawley Retainer.

41. Justification
▪ OHI :Visible Plaque
▪ Camouflage :
1. Patients chief complaint
2. Age of the patient
3. Good vertical facial proportions
4. Mild Class III skeletal within orthodontics treatment limits
5. Normal soft tissue features
▪ Non –Extraction :
1. Space will be provided by proclination of the upper incisors and stripping in the lower incisors
▪ Fixed appliance using MBT prescription:
– For 3D tooth movement .
– Maxillary incisors palatal torque.
– Retroclination of the lower incisors .

42. Justification
▪ Bite Raising : Disoclussion allow freedom in movement of upper
incisors
▪ Lower stripping to gain space to retrocline lower incisors .
▪ Conventional Retention :Upper and Lower Hawley 6month full time
wear and 6 month night time . After Achieving overbite the results
are generally stable

43. Mechanics
▪ To get further proclination of ULS, use MBT in the ULS
▪ Lingual crown torque on LLS
▪ Contra-lateral canine brackets (to avoid LLS proclination)
▪ Lacebacks in LA (to avoid LLS proclination)
▪ Cinch back in LA (to avoid LLS proclination)
▪ Closing space created by stripping on a round wire in the
lower arch will facilitate retroclination of the lower incisors.

44. Thank You