Case documentation and discussion for functional orthodontic case. First step is very important step, for all colloquies the best prognosis and treatment plan obtained by perfect case preparation, documentation done in Almalak Dental and orthodontic polyclinic by Dr.Auday Mansour Altaai

1. Case
presentation
Dr. AUDAY MANSOUR

2. Basic Case for Power Point
presentation in Diagnosis
Problem list
Diagnosis
Treatment objective
Treatment plan
where you are? and where you
go?

3. Example 12+12 Photos :
12: Face&Oral + 12:Model

4. CASE HISTORY
CASE NO : 4 starting date: 5-10-2009
NAME : Salem Saif Al Meqbali
AGE : 24y 7 m DOB: 15-3-1985
SEX : male
ADDRESS : AL- AIN U.A.E .
PHONE NO: (R)
NATIONALITY: UAE
WORK: POLICY OFFICER

5. From
Prof. R. Slavicek, Arabic Diagnosis Sheet
1-12
7-
8-
9/ -
10-
11-
12-
1-
2-
3-
4-
5-
6-
11-
12-
13-
14-
15- -
16-
17-
18-
19-
20-
: :
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-

10. 6 Face photos 6 Oral photos

11. 12 Model photos -RCP

13. Some patient s not accept xrays
so as conservative protocol we
usually shot them after they die we
make xray for them skull after
family approval

14.  He complained from caries, poor
alignment of teeth ,missing teeth and
deviation of mid line
Patient visit clinic without direct tmj (cms)
complains or symptoms he asking
orthodontic and conservative treatment.
• He not examined before for cms
evaluation

15. During initial clinical examination I find the
following signs :
I) Clicking in left joint.
II) Muscles pain .
III) Deviation of mid line
IV) Missing teeth

16. History of present CMS illness:-
 Patient started clicking 9-10 years ago,
clicking by wide opening or big foods bite .
 Clicking without pain and patient don’t use pain
killer medicines

17. History of present CMS illness:-
Clicking change its velocity, reproducibility
and timing
Pain in muscles increase after opening
long time
( after dental treatment)
Missing teeth long time ago

27. PHOTOGRAPH RECORDS
Frontal
Bilateral Symmetry
Profile Straight Convex Concave
Anterior Posterior Jaw Relation
Maxilla : Normal???neutral Protrusive Retrosive
Mandible :Normal???neutral Protrusive Retrosive
Vertical
Face: Normal???neutral Long Short
Lips : Lip Contact In Relaxant In Centric Occlusion
No Gummy Smile
Why American orth . Association
believing prognathic maxilla
Not
normal????????????????????????????
???????????
I think they should visit our university

28. CLINICAL EXAMINATION
Extra oral
PROFILE : straight / convex / concave
LIPS : competent/ incompetent / pot. Competent
Inter labial gap :0 mm
Facial symmetry : YES / NO
TMJ clicking : YES / NO left side no Pain

29. CLINICAL EXAMINATION
intra oral
ANGLE’S CLASS: / 1 / 11 / 111 endon
Subdivision:
Lt: drifting &missing teeth Rt cl 1 canine
Midline : U / L deviated left side
Molar Relationship : Class / 1 / 11 / 111
Canine relationship : / 1 / 11 / 111 right side

30. CLINICAL EXAMINATION
DENTAL RELATIONS:
Over bite: 70 % icp ,50% rp
Over jet 3 mm

31. Lower lip averted : YES / NO
Cross bites : NO
Occlusal plane : go to tracing
Curve Of Spee Increased: Yes / No

32. Habits : No finger Or
tongue or Lip Bad Habit
Gingival Conditions : Good / Average /
Poor
Periodontal Pockets : YES / NO

33. Carious Teeth:
Cariesed teeth On Clinical And Radiographic
Examination white
87654321 12345678
87654321 12345678
(Mark In Red For RC Treated Teeth)

34. Missing teeth No. 11,14,23 and30
because caries or mal position
Prosthesis :no

35. Individual photos records
Fracture incisal edges upper centrals
Loosing spaces of missing no 30 ,no11
and no14
Complete closing of missing no 23 space

36. Model
photos
Models in R P position
Reference plane axio -orbital
plane
After condylography
Fixed in SL REFERANCE
ARTICULATOR

37. Model
photos

38. RCP

39. Model
photos

41. Model
photos

42. Model
photos

43. 0.5 mm to right side
transversally
Downward back word both
joints sag itally and
vertically
RP TO ICP

44. RP TO ICP
There is no loading of the disc against
eminence
compression for retro joint area
Stretching of ligaments

45. MODEL PHOTOS
IN ICP POSITION WITH SIMPLE HING
ARTICULATOR
WITH VERTICAL AND HORIZENTAL
TEETH CROWNS AXISES TO
IDENTIFIED PRECIOUSE BRACKETS
POSITIONS
INDIRECT BONDING TEQ.

52. Models
Space of missing No. 30,14 and 11
significant ally decreased
Complete closing space of missing
No.23

53. Anterior dental deep bite tendency (no
space for bracket of No. 27
Collapse of lower arch transversally in
molar area
Models

54. ICP models in lingual aspect
Regular bite left &right transversally
Lingual cusp of molars &premolars not
intercuspated in perfect way
Lower canines tips prominent and in
cranial position

55. No 21
S 65
S1 47
S2 67

58. RADIOGRAPHIC RECORDS
OPG AND CEPHALOGRAM:
OPG RECORDS :-
Congentally Missed Teeth : No un erupted NO
mesially angulation:31,32,12,13
Impacted Teeth : No
Root Dilaceration : No
Alveolar Bone Hight : No bone loss

59. RADIOGRAPHIC RECORDS
Periodentum Condition : No true
pockets, interproximal alveolar bone
healthy
Supernumerous Teeth : No
Root resorbation : No
Pathological Conditions : No

60. Brux checker

61. BRUX CHECKER RECORDS
• ANTERIOR AND POSTERIOR BRUX
ACTIVITY (mandible want to be more
foreword)
• RIGHT SIDE CANINE GUIDNECE
• POSTERIOR WISDOM TEETH
INTERFERANCE
• LOWER ANTERIOR CONTACT

62. Brux checker

64. OCCLOGRAM RECORDS
1.POSTERIOR SUPPORT MORE IN RIGHT
SIDE
2.Teeth fitted better in right side than left
3.IN BRUXISM ALMOST ALL TEETH MAKE
CONTACTS

65. OCCLOGRAM RECORDS
4. RIGHT SIDE CANINE GUIDENCE
5. IN ICP SOME OF TEETH NOT FULLY
CONTACT
6. Missing canine and 1st molar upper left
side make lateral guidance on 1st
premolar

66. Mandibular Mobility
10 mm
20 mm
30 mm
40 mm
50 mm
60 mm
0 mm

67. MANDIBULAR MOVMENT RECORDS
1 –opening: 47 mm
No deviation
2-Opening stretch :2 mm
3-Left side :10 mm
4-Right side : 8 mm
In general no limitation movement within
average

69. Right Left

73. Record by estimated arbitrary position of
mbc and dc of No.30

74. TRACING FEATURE
Skeletal cl II
Skeletal open bite case
Retrouded chin sagetally
Short ramus mandible ( DPO )
(CURVE OF SPEE)

76. Protrusion-retrosion

77. Protrusion-retrosion

79. Open &close

81. SaLAM al maqbali
2224 /1o/2009
average
good good
concave CHANGING
More SYMMITRY IN SAG.,TRASVER.AND VERTICAL IN
QUALITY,QUALITY,CHARACTERASTIC in protr-retr than open and close
Reciprocal clicking in left joint in
open and close more loose lig. in
left
average

83. RS/2000RS/2000
Functions
Chewing
Speech
(Respiration)
Posture
Esthetics
Stress Management
Soma
CNS
Psyche
CMS (TMJ)
NMS
Articulation (Occl.)
Structurs
Cybernetic System Chewing organ
Organism
Environment
Masticatory Organ

84. Summary of examination
young self control male with clicking left
joint
Non myopathic case
Cooperative and accepted professional
instruction s and procedures
Patient have caries teeth with accepted OH

85. Summary of examination
 missing teeth 11,14,23,30
Patient with 1.25 occlusal index ,three
questions with answer 1 and one question 2
related to posture
subjective function analysis: muscle palpation
pain in tube maxilla ,M. sterno clido mastoidous
muscles, later joint pole and more in retrojoint area

86. Summary of examination
Patient with big restorations in 18,19 need
crowns (risk of fracture buccal wall during
orthodontic treatment
Patient with deviation mid line ,rotated teeth
and angulated teeth
Sk. CL II Flat op average vd and average
inter incisal angle sk. Open bite retrouded
chin

87. TREATMENT

88. Advance treatment protocol
“sorry I can’t repair your
car breaks, but I make
your horn loudly”
My car mechanic

89. Aims and objectives of treatment
Improve patient oral hygiene
Fillings of caries with restore teeth morphology
Restorations of No. 17 ,18 zirconium (patient
refuse esthetically gold crown in lower teeth)

90. Aims and objectives of treatment
Teeth alignment in upper and lower arches and
improve intercuspation
Correction individual occlusal plane by extrusion
of lower molars
Re-evaluation and follow up patient signs and
symptoms
Restore missing teeth after ortho. With care of
teeth morpho. and individual DOA

91. Vto with increase inclination of op

92. Treatment plane
Scaling polishing
Filling composite for minimum invasive
teeth and amalgam for big cavities with
care to restore teeth morphology
Crowns No. 17,18 full coverage zerconium
(Chipping)

93. Mouth of fish
morphology ?????

95. I have a bad habit I like fillings carving
and polishing

97. Upper and lower brackets pre adjusted MBT
prescription 22slot , No 27 postponed bracket
bonding because deep bite
Mini implant and up righting device for No. 31
may we remove No.32
Ha Nitinoal 12 upper and lower wire with mid
line separation in lower initial treatment
Treatment plane

100. Treatment plane
New condylography at intermediate phase
of treatment and another one at final
treatment phase
Re evaluation of patient objective and
subjective findings during treatment
(muscles palp.,occlogram , brux cheker,
tracing and models

101. Coffee break
any where we need it

102. Case discussion

103. Question 1
Did my treatment plane
correct ??

104. Question 2
Did I select a proper
prescription????
MBT 22 SLOT ,LACE BACK ,TIE BACK
AMERICANORTHODONTICS COMPANY

106. I PREFER MORE
POSITIVE TORQ.

110. Q 3
DID MY MINI IMPLANT TEMERARY
ANQURAG UPRIGHTING DEVICE AN
ACCEPTED WAY
IT FROM TOMAS SYSTEM
(DENTARUM)

112. Q 5
DID I OPEN SPACE FOR CANINE OR
1ST MOLAR ?
GUIDENCS
ESTHETIC
SUPPORT
VD
OP

113. Q 6
DID I OPEN OR CLOSE SPACE?
GUIDENCS
ESTHETIC
SUPPORT
VD
OP

114. Question no 7
What will be expected prognosis of
clicking joint??
What will be expected changes will be
happened in CMS structure during
treatment?

115. Question no 9999
be cool it’s the last
Did any one still in the room?
after too long presentation
Sorry for all
it's too poring
Thank you