A 22-year-old female presented with class II malocclusion, increased overjet of 8mm, retained primary upper lateral incisors, and spacing in the upper and lower arches. Cephalometric analysis found skeletal class I relationship with decreased anterior facial height and increased proclination of the upper and lower incisors. Treatment objectives were to correct proclined incisors, create space through extraction of all first premolars, correct overbite and molar relationship, and correct midline shift. The proposed treatment plan was to use TADs or headgear for maximum upper anchorage, extract all first premolars and retained primary laterals, and level and align the arches with fixed

1. Personal information
• Patient name : RL
• Age : 22yrs
• Sex : F
History
1. Medical history : Non contributory
2. Dental history :
Patient had been to a general dentist concerning about her retained
mobile primary teeth in upper front jaw. The dentist has referred to
consult an orthodontist for a needful appropriate treatment.

2. Chief Complaint
 Patient complains of forwardly placed upper front
teeth and a painful mobile deciduous teeth.

3. Case summary
A 22 years female presented with a class II incisal relationship on a skletal class I
base with reduced vertical dimensions complicated by an increase overjet of 8mm,
retained primary upper lateral incisors, moderate spacing in upper and lower
anteriors,

4. Extra oral examination
• Facial type : Mesocephalic.
• Anteroposterior : Skeletal class I
• Vertical Average : Deep
• Transverse : Symmetrical face
• Incisal display
- At Rest - 0mm,
- At smile - 3mm
• NLA : Reduced
• Lips : Potentially competent
• Funtional examintion : NAD

5. Intra Oral Examination
• Oral Hygiene : Good
• Occlusion:
Incisor relationship : Class II division 1
Overjet : 8mm
Overbite : 40%
Molar Relation : Class II molar relationship ½ unit bilaterally.
Canine Realtionship : Class II 1/4th realtionship
• Lower Arch
Spacing : Moderate
Incisor Inclination : Proclined
• Upper Arch
Spacing : Severe
Incisor Inclination : Proclined
Canine Position : Upright
Centre Lines : Lower Centre line is 2mm to the right
8765432B1 1B2345678
87654321 12345678
• Teeth Present

6. …

7. 1. No pathology
2. All permanent teeth present
3. Retained Upper primary laterals bilaterally
Panorama

8. Lateral cephalometry
 Pre treatment

9. Cephalometric analysis
1- Skeletal: Anteroposterior :
SNA : 82 ± 3 81
SNB : 79 ± 3 80
ANB (E) : 3 ± 1 1
Wits appraisal : 0mm + 1mm
Vertical :
MMPA : 27 ± 5 20
SN to Max. : 8 ± 3 4
Upper ant FH : 56.8 ± 3.7mm 53mm
Lower ant FH : 82.8 ± 5.6mm 56mm
Face height ratio : 55% ± 5 54.5%
2- Dental
U.I. to Mx. Plane angle : 108 ± 5 131
L.I.to Md. plane angle : 92 ± 5 109
Interincisal angle : 133 ± 10 98
3-Soft tissue
Nasolabial angle : 102 ± 8 80
Lower lip to E line : -2 mm -3mm

10. Cephalometric interpretation
Skeletal :
 Anteroposterior:
ANB 1 degrees which indicates that the case is skeletal class I pattern.
 Vertically:
The Vertical skeletal measurement shows that the anterior facial height
is slightly decreased.
Dental:
 UI. To maxillary plane angle measured at 131 degrees indicates that the upper
incisors are proclined.
 LI. To mandibular plane is 109 which is increased
 Interincisal angle is measured at 98 degrees which indicates bimaxillary
proclination.
Soft tissue :
 Average nasolabial angle measured at 80 degrees and lower lip is 3 mm behind
the Ricketts E line .

11. Cast analysis
 The patient has 6.1mm spacing in the upper and 2.6mm in the
lower arch
 Average curve of spee.
 Over jet 8mm.
 Over bite is 40 %
 Bolton ratio of the anterior teeth is :
𝑶𝒗𝒆𝒓𝒂𝒍𝒍 𝒓𝒂𝒕𝒊𝒐 =
𝟖𝟏
𝟗𝟏
𝒙 𝟏𝟎𝟎 = 𝟖𝟏. 𝟎𝟏
𝑨𝒏𝒕𝒆𝒓𝒊𝒐𝒓 𝒓𝒂𝒕𝒊𝒐 =
𝟑𝟕. 𝟔
𝟒𝟔. 𝟏
𝒙 𝟏𝟎𝟎 = 𝟖𝟏. 𝟓𝟔
So there is 2.29 mm excess tooth material in the upper arch
Rt6 Rt5 Rt4 Rt3 Rt2 Rt1 Lt1 Lt2 Lt3 Lt4 Lt5 Lt6
Up 10.2 6.2 6.5 7.8 6.3 8.7 8.7 6.3 8.3 6.6 6.5 9.8
Lo 9.6 6.2 7.1 7.1 6 5.7 5.7 5,8 7.3 6.9 6.5 9.7

12. Space analysis
lower upper
Crowding /
spacing
+ 2.6 mm + 6.1 mm
Leveling
occlusal
curve
mm mm
Arch width
change
mm mm
Incisor A/P
change
-7 mm -12mm
Angulation /
inclination
-2 mm -4mm
total -6.4 mm -9.9 mm
Space requirement
Lower Upper
Slicing mm mm
extraction +12.7mm +12.7mm
Mesialization
of posterior
-6mm -2.8mm
Residue 0.4mm 0mm
Space creation

13. Problems list
• Occlusion:
Incisor relationship : Class II division 1
Overjet : 8mm
Overbite : 40%
Molar Relation : Class II molar relationship ½ unit bilaterally.
Canine Realtionship : Class II 1/4th realtionship
• Lower Arch
Spacing : Moderate
Incisor Inclination : Proclined
• Upper Arch
Spacing : Severe
Incisor Inclination : Proclined
Canine Position : Upright
Centre Lines : Lower Centre line is 2mm to the right

14. Treatment objectives
• Correction of proclined upper and lower anteriors.
• Space creation for correction of upper and lower arch crowding through all 5’s extraction.
• Correction of overbite
• Correction of molar relationship
• Correction of midline shift

15. Treatment plan
 Anchorage :
1. Maximum anchorage in upper arch through IZM TAD OR Cervical Headgear.
2. Bonding of upper and lower second molars
3. Moderate anchorage in lower arch
 Extraction
1.Extraction of all 5’s and upper primary lateral incisors.
 Appliance Design:
1. 0.022 SLOT MBT Brackets.
2. Buccal tubes triple convertible on upper first molar and double convertible on lower first molar and
non covertibale single buccal tubes on all second molars.
3. Arch wire : 0.014, 0.016, 17*25 , 19*25 (HANT ARCH WIRE) for level and alignment ,19*25(SS)
key loop arch wire (SS), 16*16(SS) finishing,