Orthodontics and Dentofacial Orthopedics Case Analyis Orthopantomogram Analysis and Cephalometrics Clinique Dentiste (Doctor Gorda Dental Clinic) Dr. Joseph Russell N. Gorda (General Dentistry, Oral Surgery, Orthodontics and Dentofacial Orthopedics and Esthetic Dentistry)

1. GORDA, JOSEPH RUSSELL N.
PROJECT
DATE CLIENT
2017
CASE ANALYSIS
ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS

2. ORTHOPANTOMOGRAM ANALYSIS

4. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,45 - Stage 9
44 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

5. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,45 - Stage 9
44 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

6. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,45 - Stage 9
44 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

7. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,45 - Stage 9
44 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

8. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,45 - Stage 9
44 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

9. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,45 - Stage 9
44 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

10. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,45 - Stage 9
44 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

11. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,45 - Stage 9
44 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

12. Stage of Development:
(Nolla’s Classi
fi
cation)
18,28,38,48 - Stage 4
17,27,37,47 - Stage 9
16,26,36,46 - Stage 10
15,14,24,25,35,34,44 - Stage 9
45 - Stage 8
13,23,33,43 - Stage 9
12,11,21,22 - Stage 9
32,42 - Stage 9
31,41 - Stage 10

13. All of the permanent teeth
except 18, 28, 38, 45 and
48 (developing, unerupted
or erupting) are in
occlusion.
Infraerupted 45 and 35
(erupting).
Altered inclination of lower
incisors.

14. All of the permanent teeth
except 18, 28, 38, 45 and
48 (developing, unerupted
or erupting) are in
occlusion.
Infraerupted 45 and 35
(erupting).
Altered inclination of lower
incisors.

15. All of the permanent teeth
except 18, 28, 38, 45 and
48 (developing, unerupted
or erupting) are in
occlusion.
Infraerupted 45 and 35
(erupting).
Altered inclination of lower
incisors.

16. Presence of composite
restoration on 16, 36 and
46

17. There are no congenital
absence of teeth.
There are no
supernumerary teeth.
Absence of pathologic oral
condition.
Absence of impacted teeth.
Eruption of his teeth
coincides with age and is
normal for his age.

18. CEPHALOMETRIC ANALYSIS

20. THE TEN-ANGLE ANALYSIS
ANTEROPOSTERIOR SKELETAL
MEASUREMENTS
1. SNA - 92 (79.2 - 89.8)
2. SNB - 83 (77.1 - 86.9)
3. ANB - 9 (0 - 5)
S Na
A
B
SNA
SNB
A
N
B

21. THE TEN-ANGLE ANALYSIS
ANTEROPOSTERIOR SKELETAL
MEASUREMENTS
1. SNA - 92 (79.2 - 89.8)
2. SNB - 83 (77.1 - 86.9)
3. ANB - 9 (0 - 5)
S Na
A
B
SNA
SNB
A
N
B

22. THE TEN-ANGLE ANALYSIS
ANTEROPOSTERIOR SKELETAL
MEASUREMENTS
1. SNA - 92 (79.2 - 89.8)
2. SNB - 83 (77.1 - 86.9)
3. ANB - 9 (0 - 5)
S Na
A
B
SNA
SNB
A
N
B

23. THE TEN-ANGLE ANALYSIS
4. FACIAL ANGLE (FH / NP) - 82 (82.1
- 85.1)
INCISOR MEASUREMENTS
5. 1 / SN - 85 (98 - 108)
6. 1 / 1 - 113 (114.1 - 131.8)
S Na
A
Po
Pog
Or
1/1
FA
1/SN
UI
LI

24. THE TEN-ANGLE ANALYSIS
4. FACIAL ANGLE (FH / NP) - 82 (82.1
- 85.1)
INCISOR MEASUREMENTS
5. 1 / SN - 85 (98 - 108)
6. 1 / 1 - 113 (114.1 - 131.8)
S Na
A
Po
Pog
Or
1/1
FA
1/SN
UI
LI

25. THE TEN-ANGLE ANALYSIS
4. FACIAL ANGLE (FH / NP) - 82 (82.1
- 85.1)
INCISOR MEASUREMENTS
5. 1 / SN - 85 (98 - 108)
6. 1 / 1 - 113 (114.1 - 131.8)
S Na
A
Po
Pog
Or
1/1
FA
1/SN
UI
LI

26. THE TEN-ANGLE ANALYSIS
7. IMPA - 98 (88.6 - 103.4)
8. FMIA - 47 (48.3 - 62.1)
VERTICAL SKELETAL
MEASUREMENTS
9. FMA - 36 (22.9 - 34.5)
Po Or
Me
Go
FMIA
LI
FMA
IMPA

27. THE TEN-ANGLE ANALYSIS
7. IMPA - 98 (88.6 - 103.4)
8. FMIA - 47 (48.3 - 62.1)
VERTICAL SKELETAL
MEASUREMENTS
9. FMA - 36 (22.9 - 34.5)
Po Or
Me
Go
FMIA
LI
FMA
IMPA

28. THE TEN-ANGLE ANALYSIS
7. IMPA - 98 (88.6 - 103.4)
8. FMIA - 47 (48.3 - 62.1)
VERTICAL SKELETAL
MEASUREMENTS
9. FMA - 36 (22.9 - 34.5)
Po Or
Me
Go
FMIA
LI
FMA
IMPA

29. THE TEN-ANGLE ANALYSIS
10. Y-AXIS - 65 (62.2 - 67.8)
Po Or
Gn
Y-Axis
S

30. Angle Case Norm Di
ff
erence Range Interpretation
SNA 92 84.5 7.5 + 5.3 Increased
SNB 83 82.0 1.0 + 4.9 Normal
ANB 9 2.5 6.5 + 2.5 Increased
FH/NP 82 85.1 -3.1 + 3.0 Decreased
1/SN 85 103.0 -18 + 5.0 Decreased
1/1 113 122.8 -10.8 + 8.7 Decreased
IMPA 98 96.0 2 + 7.4 Normal
FMIA 47 55.2 -8.2 + 6.9 Decreased
FMA 36 28.7 7.3 + 5.8 Increased
Y-AXIS 65 65.0 0 + 2.8 Normal

31. Angle Case Interpretation Analysis
SNA 92 Increased
Maxillary bone is protrusive in relation to the
cranial base.
ANB 9 Increased
Maxillary bone is more protrusive than the
mandible.
FH/NP 82 Decreased
The chin point is retrusive as compared to
the cranial base.
1/SN 85 Decreased
Maxillary central incisors are protrusive to
the cranial base.
1/1 113 Decreased
Maxillary and mandibular central incisors are
protrusive.
FMIA 47 Decreased
Mandibular central incisors are protrusive in
relation to the FHP.
FMA 36 Increased
High angle mandibular growth / vertical
grower.

32. SOFT TISSUE MEASUREMENTS
POG-NB - 1.3 MM (1 - 5 MM)
E PLANE (ESTHETIC LINE) - 7 MM (-4 -
0 MM)
Na
B
Pog
Pn
Li

33. SOFT TISSUE MEASUREMENTS
POG-NB - 1.3 MM (1 - 5 MM)
E PLANE (ESTHETIC LINE) - 7 MM (-4 -
0 MM)
INCREASED. PROTRUSIVE LOWER
LIP DUE TO MAXILLARY AND
MANDIBULAR CENTRAL INCISORS
PROTRUSION
Na
B
Pog
Pn
Li

34. INTERPRETATION
CEPHALOMETRIC TRACING OF THE
PATIENT REVEALED ANGLE CLASS I
TYPE 2 MALOCCLUSION
ATTRIBUTABLE TO A PROTRUSIVE
MAXILLA, MILDLY RETRUSIVE
MANDIBLE, PROTRUSIVE (TIPPED)
MAXILLARY AND MANDIBULAR
CENTRAL INCISORS AND
UNFAVORABLE HYPERDIVERGENT
SKELETAL GROWTH PATTERN.
Na
B
Pog
Pn
Li
FMA
IMPA
FMIA

35. DOWNS ANALYSIS
BASIC FACIAL TYPE: RETROGNATHIC
SKELETAL PATTERN:
FACIAL ANGLE: 82 (RETRUSION)
ANGLE OF CONVEXITY: 16 (- 8.5 - 10).
A-B PLANE: -12 (-9 - 0).
Na
Po
Pog
Or
FA
AOC
A
B
ABP

36. DOWNS ANALYSIS
BASIC FACIAL TYPE: RETROGNATHIC
SKELETAL PATTERN:
FACIAL ANGLE: 82 (RETRUSION)
ANGLE OF CONVEXITY: 16 (- 8.5 - 10).
INCREASED. PROMINENCE OF
MAXILLARY DENTAL BASE RELATIVE
TO THE MANDIBLE.
A-B PLANE: -12 (-9 - 0).
Na
Po
Pog
Or
FA
AOC
A
B
ABP

37. DOWNS ANALYSIS
BASIC FACIAL TYPE: RETROGNATHIC
SKELETAL PATTERN:
FACIAL ANGLE: 82 (RETRUSION)
ANGLE OF CONVEXITY: 16 (- 8.5 - 10).
A-B PLANE: -12 (-9 - 0).
DECREASED. CLASS II FACIAL
PATTERN.
Na
Po
Pog
Or
FA
AOC
A
B
ABP

38. DOWNS ANALYSIS
MANDIBULAR PLANE ANGLE: 36
INCREASED. UNFAVORABLE
HYPERDIVERGENT FACIAL
PATTERNS.
Y-AXIS: 65
Na
Po
Pog
Or
FA
AOC
A
B
ABP
Me
Go
FMA
Gn
S
Y-Axis

39. DOWNS ANALYSIS
DENTAL PATTERN:
CANT OF OCCLUSAL PLANE: 20 (1.5 -
14)
INCREASED. CLASS II FACIAL
PATTERN
MP OP
PP
FH
COOP
UI
LI

40. DOWNS ANALYSIS
INTERINCISAL ANGLE: 113
DECREASED. INCISORS ARE TIPPED
FORWARD ON THE DENTURE BASE.
INCISOR-OP ANGLE: 62 (3.5 - 20)
INCISOR-MP ANGLE: 98
PROTRUSION OF MAXILLARY
INCISORS: 11 MM (-1 - 5 MM)
MP OP
PP
FH
UI
LI
COOP
1/1
IOP
IMPA
Pog
A
POMI

41. DOWNS ANALYSIS
INTERINCISAL ANGLE: 113
INCISOR-OP ANGLE: 62 (3.5 - 20)
INCREASED. THE TEETH ARE
INCLINED FORWARD.
INCISOR-MP ANGLE: 98
PROTRUSION OF MAXILLARY
INCISORS: 11 MM (-1 - 5 MM)
MP OP
PP
FH
UI
LI
COOP
1/1
IOP
IMPA
Pog
A
POMI

42. DOWNS ANALYSIS
INTERINCISAL ANGLE: 113
INCISOR-OP ANGLE: 62 (3.5 - 20)
INCREASED.
INCISOR-MP ANGLE: 98
PROTRUSION OF MAXILLARY
INCISORS: 11 MM (-1 - 5 MM)
MP OP
PP
FH
UI
LI
COOP
1/1
IOP
IMPA
Pog
A
POMI

43. DOWNS ANALYSIS
INTERINCISAL ANGLE: 113
INCISOR-OP ANGLE: 62 (3.5 - 20)
INCISOR-MP ANGLE: 98
PROTRUSION OF MAXILLARY
INCISORS: 11 MM (-1 - 5 MM)
INCREASED. INCISAL EDGE IS AHEAD
OF THE A-POG LINE. PROTRUSION.
MP OP
PP
FH
UI
LI
COOP
1/1
IOP
IMPA
Pog
A
POMI

44. STEINER ANALYSIS
THREE-WAY ANALYSIS:
SKELETAL ANALYSIS
DENTAL ANALYSIS
SOFT TISSUE ANALYSIS

45. STEINER ANALYSIS
THREE-WAY ANALYSIS:
SKELETAL ANALYSIS
SNA
SNB
ANB
SN-OP: 13 (13 - 21)
SN-MP: 29 (27 - 37)
DENTAL ANALYSIS
SOFT TISSUE ANALYSIS
S Na
A
B
SNA
SNB
A
N
B
Gn
Go
SN-MP
SN-OP

46. STEINER ANALYSIS
THREE-WAY ANALYSIS:
SKELETAL ANALYSIS
DENTAL ANALYSIS
MAXILLARY INCISOR POSITION
ANGLE: 22 (22)
DISTANCE: 6 MM (4-6 MM)
MANDIBULAR INCISOR POSITION
ANGLE: 35 (25)
DISTANCE: 13 MM (4 MM)
INCREASED. FLARED MANDIBULAR INCISORS.
INTERINCISAL ANGLE: 113 (PROTRUSION)
LOWER INCISOR-CHIN RELATIONSHIP: 11 (EQUAL TO
THE MNIP) DECREASED. UNDESIRABLE DISCREPANCY.
SOFT TISSUE ANALYSIS
Na
A
MxIP
B
U1
L1
MnIP

47. STEINER ANALYSIS
THREE-WAY ANALYSIS:
SKELETAL ANALYSIS
DENTAL ANALYSIS
SOFT TISSUE ANALYSIS
S-LINE: LIPS TOO PROTRUSIVE DUE
TO PROTRUSION OF MAXILLARY
AND MANDIBULAR INCISORS
PUSHING THE LIPS FORWARD.

48. MCNAMARA ANALYSIS
MAXILLA TO CRANIAL BASE
SOFT TISSUE EVALUATION
NASOLABIAL ANGLE: 83 (94 - 110)
DECREASED. DENTOALVEOLAR
PROTRUSION.
CANT OF UPPER LIP: 26 (6 - 22)
INCREASED. DENTOALVEOLAR
PROTRUSION.
HARD TISSUE EVALUATION
NP - POINT A: 0 MM (0 -1 MM)
NLA
NP
CANT

49. MCNAMARA ANALYSIS
MAXILLA TO MANDIBLE
ANTEROPOSTERIOR RELATIONSHIP
MID FACIAL LENGTH: 94 MM
MANDIBULAR LENGTH: 113 MM (121-124 MM)
DECREASED.
MAXILLOMANDIBULAR DIFFERENTIAL: 27 - 30
MM (SMALL SIZED INDIVIDUAL: 20 - 24 MM)
DISCREPANCY: GREATER THAN NORMAL
VALUES
MAXILLARY POSITION IS NORMAL, MANDIBLE
IS 8 - 11 MM DEFICIENT. THERE IS NO
MIDFACIAL DEFICIENCY.
Co
Gn
A

50. MCNAMARA ANALYSIS
VERTICAL RELATIONSHIP
LAFH (LOWER ANTERIOR FACIAL HEIGHT): 71
MM (66 - 67 MM)
INCREASED.
MPA: 36 (INCREASED)
FACIAL AXIS ANGLE: - 3 (0)
NEGATIVE. EXCESSIVE VERTICAL
DEVELOPMENT OF THE FACE.
EXCESSIVE LAFH CORRELATES WITH AN
INCREASED MPA. VERTICAL GROWTH
PATTERN.
Co
Gn
A
ANS
Me
PTM
Ba
Na
Go
FMA

51. MCNAMARA ANALYSIS
MANDIBLE TO CRANIAL BASE
PO TO NP DISTANCE: 12 MM
(SMALLER INDIVIDUALS 6 - 8 MM)
INCREASED. RETRUSIVE MANDIBLE.
NP
Po

52. MCNAMARA ANALYSIS
DENTITION
MAXILLARY INCISOR POSITION: 5 MM
(4 - 6 MM)
MANDIBULAR INCISOR POSITION: 7
MM (1 - 3 MM)
INCREASED. RETRUSIVE
MANDIBULAR INCISORS.
NP
Po

53. MCNAMARA ANALYSIS
AIRWAY
UPPER PHARYNX: 15 MM (15 - 20
MM)
LOWER PHARYNX : 12 MM (11 - 14
MM)
UP
LP

54. WITS APPRAISAL
CLASS I TYPE 2 MALOCCLUSION
ANB, 9 DEGREES
“WITS,” 5 MM
(CHILD: 0 MM; ADULT: 3 MM)
INCREASED. CLASS II SKELETAL
PATTERN.
S Na
A
B
OP
92
83
9
BO AO

55. Po Or
Me
Go
FMIA
LI
FMA
IMPA
TWEED ANALYSIS
THE DIAGNOSTIC FACIAL TRIANGLE
IMPA - 98 (88.6 - 103.4)
FMIA - 47 (48.3 - 62.1)
FMA - 36 (22.9 - 34.5)
HIGH MANDIBULAR PLANE ANGLE.
MANDIBULAR CENTRAL INCISORS ARE
PROTRUSIVE IN RELATION TO THE FHP.