This document contains a dental examination report for a 14-year-old male patient. The patient's chief complaint is that his upper front teeth appear too prominent. The examination found a Class II malocclusion with increased overjet and overbite. Treatment aims to improve oral hygiene, restore cavities, enhance mandibular growth, and achieve a Class I occlusion. The proposed treatment plan is non-extraction with initial Twin Block appliance therapy followed by fixed appliance treatment using a pre-adjusted edgewise Roth prescription to align the teeth and improve the bite. Retention will include lower fixed and upper/lower removable retainers.

1.  Personal data
Patient’s name :M.S
Gender : Male
Date of Birth: 20th Mar 2003
Age: 14 years
Nationality: Jordanian

2.  Medical & Dental History
 Medical History:
 denied any medical problems .
 Dental History:
 Previous visits to dental clinic for check-ups
 previous root canal treatment in upper right
first molar before a year .
 Habits: No habits noticed or mentioned
 Motivation: Highly motivated.
 Expectations: High expectations.

3. Chief Complaint
“I don’t like the
appearance of my upper
anterior teeth.
They are too prominent .

4.  Jaw & Occlusal Function
 Mastication: Normal masticatory
pattern.
 Speech:
Normal flow of speech.
No difficulties detected
 TMJ:
 No signs of TMJ dysfunction (No clicking,
no crepitus, no tenderness to palpation)
 Good range of opening
 Good range of lateral movement

5.  Extra-Oral Photos
a)frontal view

6. B)profile view

7. c) oblique view

8. Extra-Oral examination
A)Skeletal assessment:
Anteroposterior assessment:
• Class II Skeletal pattern

9. A)Skeletal assessment
Transverse assessment :
• Symmetrical face

10. A)Skeletal assessment
Vertical assessment :
• Average LFH .

11. Soft Tissue Examination
Asymmetrical face.
Interpupillary distance larger
than the width of the mouth.
Larger Right side than Left side.

12. Soft Tissue Examination
• Convex profile.
• Incompetent lips.

13. Soft Tissue Examination
• Frontonasal angle:
133˚ (Normal 115⁰-135⁰)
• Nasolabial angle:
96˚ (Normal 90⁰-110⁰)
• Labio-mental angle ‘’Acute ‘’
106˚ (Normal 114⁰-140)
• Chin throat angle: “obtuse ‘’
128˚ ( Normal close to 90)

14. Intra-oral photos

15. Intra-oral Examination:
• Teeth present
7654321 1234567
7654321 1234567
• Fair oral hygiene.
• Generalized fluorosis.
• Gingival inflamed and swollen in both U&L ant. Region.

16.  Lower Arch:
A. U shape arch.
B. Anterior segment:
well aligned teeth.
C. Posterior segment:
rotated R&L 2nd premolars.
carious teeth
765 46

17.  Upper Arch:
A. U shape Arch
B. Anterior segment:
 slight proclined upper incisors.
 slight displaced palatally UR2.
C. Posterior segment:
 rotated UR&L 1st premolars.
 broken restoration UR 1st molar.
 carious teeth:
7 4 67

18.  Anterior segment
• Class II/1 incisor relationship.
• Midline is not coincident.
• Upper midline shift to the right side
1mm.
• Lower midline shift to the right side
2mm.
• Overjet: 7mm.
• Overbite: incomplete deep bite 70%.

19.  Buccal segment
 Molar relationship : class II ½ unit in Rt & Lt sides.
 Canine relationship : class II ½ unit in Rt& Lt sides.

22.  Molar relation : CII ½
 Canine relation : CII ½
 No crossbite .

23.  Molar relation : CII ½
 Canine relation : CII ½
 No crossbite .

24. • lower incisor edges are palatal to the cingulum plateau of the upper incisors .
• Incomplete deep overbite .

25. • U shape arch .
• Inter canine width
(3—3 ) = 27 mm.
• Intermolar width
(6—6) = 45 mm.
27mm
45 mm

26. • U shape Arch.
• Inter canine width (3 – 3) = 34 mm
• Inter molar width (6 – 6) = 49 mm
34 mm

27. Rt Lt
3mm

28.  Smile analysis

29. I) Lip line :
Average
Accepted

30. II) Smile arc :
curvature of maxillary incisal edge parallel with the curvature of the lower lip
smile arc— “consonant”

31. III) Upper lip curvature :
Upward upper lip curvature

32. IV) Lateral negative space
Wide buccal corridor on smiling
Not
Accepted

33. V) Smile symmetry
symmetrical smile

34. VI) Frontal Occlusal Plane
canted occlusal frontal plane
Not
Accepted

35. VII) Dental component
• Upper dental midline is not coincide with facial midline.
• Crown angulation parallelism is not coincident .

36. VIII)Gingival contour
• Gingival margin of upper Rt canine is higher than central incisors .
• Gingival margin of upper Rt lateral incisor is more near to the level of
upper central incisor .
Not
Accepted

37.  Space analysis
 Lower arch:
space available = 71
space required = 71
No crowding
 Upper arch :
space available =83
space required=80
(+3 ) = spacing

38. LowerUpper
0mm+3mmCrowding and spacing
-2mm0mmLeveling of oclusal curve
0-10mmIncisors AP position
-2mm-7mmTotal
Royal London Space Analysis

39.  Bolton Ratio
 There is increased in the lower anterior teeth.
)(%83
%100
48
40
%100
)33(
)33(
inceased
Max
Mand
RatioBoltonAnterior








)(%5.85
%100
83
71
%100
)66(
)66(
reduced
Max
Mand
RatioBoltonOverall









40.  Index Of Orthodontic Treatment Need
(IONT)
Figure 1

41. Index Of Orthodontic Treatment Need (IOTN)
• Grade 4
4a. Increase overjet > 6mm
but < 9mm.

42. -All teeth are present including 3rd molars.
-Condyles are in normal shape and position.
-Normal Maxillary sinuses.
-No bony pathology.
-RCT on UR 6.

43. Cervical Vertebral Maturation
CS4 :
Peak of mandibular
growth has occurred
within 1 or 2 yrs.'
before this stage .
25% - 10% remaining.

44. Cephalometric Analysis
normalPre-
treatment
variable
81 +/-378.5SNA
78 +/-373SNB
3 +/-15.5ANB
8+/- 36.8Sn/Mx
7Corrected ANB
0mmmmWits appraisal
27+/- 424FMPA
109 +/-6116UI/Mx plane
93 +/-699LI/Mand plane
133 +/-10Interincisal
angle
27 +/-426MM angle
62mmUpper AFH
77mmLower AFH
55+/_255%Lower Face
height ratio
59-63%63%Jaraback ratio

45. Diagnostic summary
A 13 years old male, denied any medical problem, presented with concern
about the appearance of his upper front teeth are too prominent. he had
fair oral hygiene, multiple carious teeth, gingival inflammation in both
U&L ant. teeth, generalized fluorosis and broken filling with RCT on UR6.
He exhibited a class II div I incisors malocclusion on class II skeletal base,
with convex profile, average lower face height, incompetent lips and wide
buccal corridors.
Dentally, he has increased overjet 7mm ,incomplete deep overbite 70% ,well
aligned lower arch, spaced upper arch 3mm with slightly proclined upper
& lower incisors, slightly displaced UR2, rotated UR&L 1st premolars &
LR&L 2nd premolars, U&L midline shift to the right side, both molars &
canines are classII ½ unit relationship, increased Bolton ratio and curve
of spee of 3mm.

46. Problem list
 Pathological problems:
• Fair O.H.
• Generalized fluorosis.
• Multiple carious teeth.
• Gingival inflammation of U & L ant. region.
• Broken restoration on UR6.
 Patient’s concern:
My upper anterior teeth are too prominent.
 Skeletal problems:
• Class II skeletal base.
{ Retro gnathic mandible }
 Soft tissue problems:
• Incompetent lips.
• Convex profile.
• Asymmetrical face.
• Nose deviation to right side.
Dental problems:
• Increased overjet 7mm.
• Incomplete deep overbite 70%.
• Slightly proclined upper incisors
and displaced UR2.
• proclined lower incisors .
• Rotated U R&L1st premolars and
L R&L2nd premolars.
• Both midlines are shift to the
right side.
• Class II/I incisor relationship.
• Both molars and canines have
classII ½ unit relationship.
• Increased anterior Bolton ratio.
• Increased curve of spee 3mm.

47. Treatment Aims
 Improve oral hygiene.
 Restore carious teeth and broken restoration on UR6.
 Give the patient the desired appearance.
 Enhance forward growth of the mandible to improve facial profile and
mandible/cranial base relationship.
 Improve lip competency.
Accept other soft tissue problems.
 Reduce overjet and overbite.
 Correction of upper & lower incisors inclination .
Achieve class I molar and canine relationship.
 Achieve class I incisor relationship.
 Correction of rotated teeth.
 Correction the midline.
 Correction of anterior Bolton discrepancy.
 Correction of curve of spee.

48.  Treatment plan:- “ Non Extraction Case”
 O. H. I .
 Refer to perio. Clinic.
 Refer to cons. Clinic .
 1st phase :-
Functional appliance “ Twin Block appliance” .
 2nd phase :-
Upper & Lower Fixed Appliance
“ Pre-adjusted edgewise Roth prescription slot 0.022”
 Stripping in the lower anterior teeth.
 Retention:-
o Lower fixed retainer.
o Conventional upper and lower Hawley Retainer.

49.  Justification:-
I. Refer to perio clinic for management of gingival inflammation .
II. Refer to cons clinic to restore multiple carious teeth and broken restoration in UR6.
III. Growth modification appliance treatment :
 Growing patient.
 motivated patient.
 uncrowded, well aligned teeth .
 Dentally Cl ll/1 on mild Skeletal Cl II base due to deficient mandible (low SNB).
 Good vertical facial proportions.

50.  Twin Block appliance:
 Esthetics and comfort &
 Full time wear because the twin block appliances are not bulky.
 Modification in Twin block design :
 incorporated with expansion screw to maintain normal transverse relation .
 incorporated with lower incisor capping to prevent more proclination in the lower
anterior teeth.
Full time wearing the appliance
Revaluate the case every 3 months with cephalometric superimposition to evaluate
the progress .
At the end of first phase of treatment a simple upper appliance with an anterior
inclined plane was given to be worn full time for 3 - 6 months to maintain the
skeletal corrections.

51. IV. Non-extraction :
 growing patient .
 No crowding in the upper and lower arch's.
 space will be provided from stripping and de-rotation of rotated teeth
V. Fixed appliance using Roth prescription:
 For 3D tooth movement , and average torque needed .
 correction of midline “ either by stripping Or deferential elastics ’’
 Derotation of rotated teeth .
 Correction of anterior Bolton discrepancy .
 Improve the smile aesthetics “reduce the wide buccal corridor by arch wire
expansion , extrusion of UR3 for gingival contour correction’’.
 Final finishing detailing .

52. VI. Retention :
• Long term : lower anterior fixed retainer:
For more stability of lower incisors .
• Short term: upper and lower Hawley retainer :
Upper and Lower Hawley 6month full time wear and 6 month night
time .
For more settling and stability of overjet and overbite.

53. Thank You