1. DIAGNOSTIC SUMMARY
 Name
 Age
 Gender
 Medical history
 Presented with a Class incisors relationship on a ??? Class ??? skeletal base with
vertical proportions.
 This is complicated by (main features starting by intra-arch then inter-arch then soft
tissue then main pathology)
 IOTN

2. CLINICAL EXAMINATION
EXTRA-ORAL FEATURES
1. Skeletal Assessment:
 Antero-posterior: Skeletal Class + what is the diagnosis i.e. mandibular prognathism
or retrognathisim
Chin position
 Vertical Frankfort Mandibular planes angle.
lower anterior face height
 Transverse : No significant facial asymmetry detected
2. Soft tissue assessment:
 Lips competentency
 Lip trap
 NLA
 LMA
 Incisor show
 Profile in relation to E line
3. TMJ Assessment:
 signs or symptoms of TMD
INTRA-ORAL FEATURES
a. General
1. Oral hygiene:
2. Soft tissues:
No abnormality detected
BPE
3. Erupted teeth present:
4. General dental condition:
Good tooth quality with no caries, discolouration or non-carious tooth substance loss.
0 0 0
0 1 0

3. b. Mandibular arch:
 Arch shape
 Crowding and spacing (better to assess the space requirement using RLSA),
crowding assessed by using Ruler to measure teeth Mesiodistal width and then
Space available in archform that represent the majority of teeth.
 Incisor inclination
 Canine angulation
 COS
c. Maxillary arch:
 Arch shape
 Crowding and spacing (better to assess the space requirement using RLSA)
 Incisor inclination
 Canine angulation
 COS
OCCLUSAL FEATURES
1. Incisor relationship:
2. Overjet (mm):
3. Overbite:
4. Left buccal segment relationship: Canine- Class Molar- Class
5. Right buccal segment relationship: Canine- Class Molar- Class
6. Transverse: Centrelines Posterior crossbite
7. Occlusion and mandibular Displacements: type of displacement and occlusion (group
function)
8. Other occlusal features: Rotation, displaced tooth, retained
9. Mandibular displacement and deviation.
GENERAL RADIOGRAPHIC EXAMINATION

4.  Unerupted teeth:
 Teeth absent:
 Teeth of poor prognosis:
 Other relevant radiographic findings: No evidence of any pathology or root
resorption+hard tissue pathology
Bolton’s Tooth-Size Analysis
IOTN
PROBLEM LIST
1. Oh
2. Pathology (caries, trauma, resorption, retained teeth)
3. Skeletal pattern
4. Soft tissue
5. Crowding and spacing
6. Incisors relationship
7. Anterior crossbite or posterior crossbite with associated displacement
8. Overjet
9. Overbite
10. Centreline
11. Buccal segment relationship
12. Other occlusal feature like rotation, impaction, dispklacement

5. AIMS AND OBJECTIVES OF TREATMENT
1. Maintain good oral hygiene throughout orthodontic treatment
2. Treatment of pathology
3. Orthodontic camouflage accepting the Class skeletal pattern
4. Improve the skeletal relationship and facial profile by modifying and
accelerating the facial growth and maximize dentoalveolar compensation
5. Soft tissue feactures correction including elimination of trapping
6. Relief crowding
7. Level and align dental arches
8. Correct centre line
9. Normal overjet and correct anterior cross bite
10. Achieve Class molars, canines and incisors
11. Overbite
12. Correct transverse problem
13. Space closure
14. Coordinate dental arches with good buccal interdigitation
15. Retain the corrected result

6. Cephalometric interpretation
INTERPRETATION
1. Skeletal:
 SNA
 SNB
 ANB angle of ?? suggests a ?? skeletal pattern. The Wits analysis of mm supports
the presence of a ?? skeletal pattern.
 The MMPA is ?? . The face height ratio is???.
2. Dental:
 The upper incisors were of ???? inclination at degree
 lower incisors were of ???? inclination at degree
 The interincisal angle was at
 The lower incisors were ?? mm ?? of A Pogonion line.
3. Soft tissue:
 Nasolabial angle.
 Lower lip was ??relative to Ricketts E plane.
4. Summary:
The cephalometric findings confirm the assessment of a Class?? malocclusion on a Class
skeletal pattern with ?? MMPA. (The soft tissues are masking the underlying Class skeletal
pattern).
5. Sources of normal values:
o Jacobson (1975) Am J Orthod. 67:125-133.
o Houston WJB, Stephens CD & Tulley WJ (1992)
A textbook of orthodontics. Wright, Oxford

7. TREATMENT PLAN
1. Request consultation advice
2. Treatment of patholgy
3. Oral hygiene instruction and tooth brushing.
4. Orthodontic treatment phase
 One or two phase orthodontic treatment approach (e.g. using a
functional appliance to improve the skeletal relationship and facial profile by
modifying and accelerating the facial growth and maximize dentoalveolar
compensation and reducing the overjet, overbite and correct the buccal
segment relationship) and helping in reducing the anchorage demand
in the secon stage of FA treatment
 or (URA to retract upper canine and allow eruption of the posterior
teeth)
 then reassesss
 Then finish with fixed appliances to details the occlusion.
5. Adjunctive appliance: Q helix, RME
6. Extractions:
7. Appliances:
 Functional appliance design
 HG prescription
 URA design
 Upper and lower arch pre-adjusted Edgewise appliances 0.022" x 0.028" slot (MBT
prescription)
8. Special anchorage requirements:
9. Additional dental treatment:
 Build up teeth
 Routine oral hygiene reviews
 attendance for regular check-ups with general dental practitioner
10. Proposed retention strategy:
 Upper and lower vacuum formed retainers. To be worn evening and night for a year
and following this a reduced regime will be recommended on a long term basis.
 Lower bonded retainer from canine to canine to be considered for long term.
 Bonded bridge or implant
11. Prognosis for stability:

8. A. Any skeletal change depends on
 Favourable growth
 Stable changes
 No posturing
B. Soft tissue correction specially the lip trap depend on
 Correct U incisor relationship to lower lip
C. Overjet correction depends
 On the control of the lower lip in class II
 Normal positive OJ in class III
 Permanent retainer
D. Proclination of the lower labial segment away from the starting inclination would
be
 Permanent retainer
 Within the exception of Mills
 For aesthetic reason better to be within A-Pog line
E. Overbite correction is to be maintained by
 An improvement in the interincisal angle
 The creation of a positive upper root centroid to lower incisor tip relationship.
 Active retainer (URA)
F. Buccal and transverse relationship maintained by
 Interdigitated occlusion
 Avoidance of changing the width of the arch
 Correct torque
 Permanent retainer