Exam case report

CASE 1
CASE REPORT CATEGORY : #
CANDIDATE ID # : 57561
PATIENT’S NAME : SUBHASH
DATE OF BIRTH : 7.10.1987
AGE /SEX : 14/Male
www.indiandentalacademy.com

PRETREATMENT RECORDS
Date of Records : 18.08.2003

EXTRA ORAL PHOTOGRAPHS

HISTORY AND ETIOLOGY
Medical : Patient was in good health.
Dental : No History of trauma
Good Dental health.
No TMJ signs and symptoms.
CR coincide with CO.
Etiology : Heredity.
Chief Complaint : Forwardly placed teeth and
inability to close lips.

INTRA ORAL PHOTOGRAPHS

DIAGNOSIS
Skeletal :
Class II Skeletal pattern ( ANB 5º ) with prognathic maxilla
(SNA 85º, N perp to pt A – 3 mm) and orthognathic
mandible ( SNB 80º). Average mandibular plane angle
( FMA 25º )
Dental :
Class I Malocclusion. Bilateral Class I molars and cuspids.
Overjet of 3 mm and overbite of 3 mm. Lower midline
shifted to the left by 1.5 mm. Spacing in upper arch and
crowding in lower arch. No TMJ signs and symptoms. CR
coincides with CO.

PRETREATMENT CASTS

PRETREATMENT TRACING
SNA : 85 º
SNB : 80º
SN Go Gn : 30º
FMA : 25º
ANB : 5º
U1 to NA : 9 mm/290
U1 to SN : 114º
L1 to NB : 11 mm/ 350
IMPA : 104º
E plane : 4 mm

PRETREATMENT OPG

TREATMENT PLAN
1. Extraction of maxillary and mandibular second bicuspids
– to alleviate crowding, aid in correction of axial
inclination of incisors and achieve the best profile.
2. Bond brackets in both upper and lower 4-4 with 0.022 X
0.028 preadjusted edgewise appliance (Roth prescription)
to begin leveling and aligning.
3. Band all the first molars and include upper and lower
second molars to reinforce anchorage.
4. Maintain Class I molar relation.
5. Retract Canine and maintain Class I canine relation.
6. Retraction of the incisors to close the space.
7. Detailing of occlusion.
8. Deband and Retain.

SPECIFIC OBJECTIVES OF TREATMENT
MAXILLA
A-P : Reduce the incisor axial inclination. Minimize molar anterior
movement.
Vertical : Mildly intrude and retract incisors to maintain existing
overbite. maintain smile line. Control extrusion of molars to
prevent worsening of mandibular plane angle.
Intermolar width : Maintain.
MANDIBLE
A-P : Relieve crowding and reduce axial inclination and retract
anteriors to close the remaining space.
Vertical : Control extrusion of molars.
Intermolar/ intercanine width : Maintain
FACIAL ESTHETICS
Improve facial balance
Improve lip competencywww.indiandentalacademy.com

APPLIANCE
Maxillary and Mandibular 0.022 Roth
prescription edgewise appliance bonded and
banded.

TREATMENT PROGRESS
• Bands with welded molar tubes were cemented to Upper and
Lower first molars.
• TPA and Lingual arch were placed.
• Maxillary and Mandibular second bicuspids were extracted.
• Brackets were bonded in U/L arches.
• Initially arches were leveled and aligned with 0.016 niti with
lacebacks for canine.
• 0.018 stainless steel wire was placed in U/L arches.
• Upper and lower second molars were bonded.
• Elastic tie back was given for retraction of first premolars and
canines.
• 0.019 X 0.025 niti wire was placed and was replaced by 0.019 X
0.025 stainless steel wire .
• Hooks were soldered in both U/L arches distal to lateral incisors
for retraction of anteriors using elastic tie back.
• Records taken for pre-debonding evaluationwww.indiandentalacademy.com

LEVELING AND ALIGNING

AFTER CANINE RETRACTION

LAST RECORDS
Date of Records : 15. 10. 2004

OPG (LAST RECORD)

LATERAL CEPHALOGRAM – LAST RECORD
SNA : 85 º
SNB : 80º
SN Go Gn : 31º
FMA : 26º
ANB : 5º
U1 to NA : 5 mm/230
U1 to SN : 108º
L1 to NB : 5 mm/ 230
IMPA : 90º
E plane : 2 mm

END OF SPACE CLOSURE

FINISHING AND DETAILING -
REBECCA POLING
ROOT ANGLE BENDS
12, 14, 24,34, 44 – roots to be moved distally
16, 26 – roots to be moved mesially
TRANSVERSE CONCERNS
17,27 – To be rotated distal in
MOLAR RELATION - Angle’s class I
OVERJET - 2.5 mm
OVERBITE - 2.5 mm
VERTICAL - Discrepancy between 14 and 16,

RESULTS ACHIEVED
MAXILLARY DENTITION
A-P : Mesial movement of molars controlled. Spacing in the anteriors
corrected. Retraction and uprighting of incisors to a more favorable
position.
Vertical : Maintained the vertical position of both the molars and the incisors.
Intermolar width : Maintained.
MANDIBULAR DENTITION
A-P : Crowding in the anterior segment relieved and the incisors retracted
bodily to close the remaining space.
Vertical : Maintained the vertical position of molars.
Intermolar width : Maintained
FACIAL ESTHETICS
Improvement of facial profile. Protrusion of the upper and lower lips
reduced.

CEPHALOMETRIC SUMMARY
AREA MEASUREMENT PRETREATMENT LAST RECORD
Max. to Cranial base SNA 85o
85o
Mand. to Cranial base SNB 80o
80o
Maxillomandibular
ANB 5o
5o
Sn to Go-Gn 30o
31o
FMA 25o
26o
Maxillary Dentition
1 to NA (mm) 9 mm 5 mm
1-SN 114o
108o
6-6 mm (casts) 45 mm 44 mm
Mandibular Dentition
1 to NB (mm) 11 mm 5 mm
IMPA 104o
90o
Soft tissue Esthetic plane 4 mm 2 mm

PRETREATMENT DISCREPANCY INDEX
OVERJET 3 mm = 1 point
OVERBITE 3 mm = 0 points
ANTERIOR OPENBITE = 0 points
LATERAL OPENBITE = 0 points
CROWDING 3 mm in lower arch = 1 points
OCCLUSION Class I = 0 points
LINGUAL POSTERIOR X-BITE = 0 points
BUCCAL POSTERIOR X-BITE = 0 points
CEPHALOMETRICS ANB 5º = 0 points
SN-Go-Gn 30º = 0 points
IMPA 104º = 6 points
OTHER Nil = 0 points
TOTAL SCORE = 8 points

DISCREPANCY INDEX ON LAST RECORDS
OVERJET 2.5mm = 0 points
OVERBITE 2.5mm = 0 points
ANTERIOR OPENBITE = 0 points
LATERAL OPENBITE = 0 points
CROWDING = 0 points
OCCLUSION Class I = 0 points
LINGUAL POSTERIOR X-BITE = 0 points
BUCCAL POSTERIOR X-BITE = 0 points
CEPHALOMETRICS ANB 5º = 0 points
SN-Go-Gn 31º = 0 points
IMPA 90º = 0 points
OTHERS Nil = 0 points
TOTAL SCORE = 0 points

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