This orthodontic case presentation summarizes the treatment plan for a 15-year-old male patient with space between his upper and lower front teeth. The patient has a Class II skeletal pattern and incompetent thin lips. The proposed treatment plan is to extract the upper and lower wisdom teeth to allow for camouflage treatment using fixed appliances. The goals are to correct the overjet, improve the lip seal, align the teeth, and provide long-term retention using removable and fixed retainers after treatment is completed.

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

2. Personal Data
Name: D.A
Age: 15 years old
Occupation: Student
Marital status: Single
Nationality: Jordanian

3. Medical and Dental History
Medical History: Denied any medical problems
Dental History: Routine Dental Procedures
Habits: Tongue Thrusting
Motivation: Internally Motivated

4. Chief Complaint
“There is space between my upper
and lower anterior teeth”

5. Extra-Oral Photos

6. Skeletal
Assessment
(Anterioposterior)
Class II Skeletal
Pattern (convex
profile)

7. Skeletal
Assessment
(Vertical)
Average Anterior
Lower Facial Height

8. Skeletal
Assessment
(Transverse)
Mild facial
Asymmetry

9. TMJ Examination
Clicking and Crepitus : No
Tenderness to palpation : No
Displacement: No

10. Soft Tissue
Examination
Thin, incompetent
lips.
large size tongue with
thrusting.

11. Soft Tissue Examination
(Facial Angles)
Frontonasal angle: 96⁰
(Normal 115⁰-135⁰)
Nasolabial angle: 85⁰
(Normal 90⁰-110⁰)
Labiomental angle: 150⁰
(Normal 114⁰-140⁰)

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

13. Intra Oral Photos

14. Intra-Oral Examination
Poor Oral Hygiene
Normal oral mucosa
Permanent dentition
Teeth Present :
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Carious teeth : UR7 ,LL6

15. Orthopantomogram
All third molar buds are present
No apparent pathology
Restorations on the UR6 , UL6 and LR6

16. Square shaped Lower
Arch
Mild crowding
Rotated canines and
second premolars

17. U-shaped Upper Arch
No crowding
rotated Canines

18. Class II div 1 Incisor Relationship
Overbite reduced
Overjet 6 mm
Midline:
Upper Arch 1 mm to the left
Lower Arch 2 mm to the right

19. Right & Left Molars Class I
Relationship
Right Canine Class I
Left Canine Class III 1/ 4
unit

20. Study Model Analysis

21. Anteroposterior:
Right side
Molar Class I
Canine Class I
Left Side
Molar Class I
Canine Class III 1/4

22. Transverse
Midline:
Upper Arch 1 mm to the left
Lower Arch: 2 mm to the right

23. Vertical :
Overbite Reduced
Horizontal :
Overjet = 6 mm

24. Right side:1mm Curve Of Spee Left Side: 1mm Curve Of Spee

25. Lower Arch
Square shaped arch form
Intermolar(MB-MB)
width 49 mm
Intercanine(cusp tip – cusp tip)
width 29 mm

26. Upper Arch
U-shaped arch form
Intermolar(MB-MB)
width: 55mm
Intercanine(cusp tip –cusp tip)
width: 37 mm
Deep palatal vault

27. Bolton Ratio Analysis
Over all ratio = 92 /95
96.8 % Increased
Normal: 91.3%
Anterior ratio = 40 /45
88.8 % increased
Normal: 77.2%
R

28. Royal London Space Analysis

30. Visualized Treatment Objectives

31. Midline-Molar Position
R L
Molar Midline Molar
2
00
1

32. Lower arch discrepancy

33. Anticipated Treatment Change
1
2
0
0
0
0
1.5

34. IOTN
Dental Health Component
Grade 3.a

35. IOTN
Aesthetic Component
Grade Not included

36. Cephalometric Analysis

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

40. Treatment Plan(extraction
camouflage modality)
Improve Oral Hygiene
NANCE + Tongue Crib
Extraction of U4s & L5s
F.A :
Upper Andrews 0.22 slot + Lower Roth 0.22 slot prescriptions
Reshape upper permanent laterals ( peg-shaped)
Retention:
Upper Hawley Retainer(short term) + Permanent retainer (long term),
Lower V.F.R(short term)+Permanent Retainer (long term)

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)
Extraction :
Acute NLA
Incompetent lips
Bimax protrusion
Reduced Overbite
over average proclined anterior teeth
Anchorage using NANCE 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)

43. THANK YOU.