This document presents the orthodontic case of an 18-year-old male patient. The patient complains of problems with speech and desires an improved profile. Clinical examination reveals poor oral hygiene, a prognathic mandible, reverse overjet and overbite, proclined upper incisors, retroclined lower incisors, and bilateral posterior crossbites. Cephalometric analysis confirms the skeletal discrepancies and dental abnormalities. The treatment objectives are to correct the skeletal and dental malocclusions through orthodontic therapy to improve function, esthetics, and oral hygiene.

1. 1

2. ORTHODONTIC
CASE PRESENTATION
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3. PATIENT INFORMATION
 Name: Shahid Hidayatullah
 Gender: Male
 Age:18 years
 Occupation: labour
 Chief Complaint:
“problem during speech and
demands better profile”
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4. PATIENT HISTORY
 PMH: Insignificant
 PDH: Generalized staining of all teeth
 Medications: None
 Habits: Betel nut chewing since 4 to 5 years
 Family History: Insignificant
 Motivation: Both Internally & externally
motivated
 Expectation: Long treatment
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5. EXTRA ORAL EXAMINATION
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• Head and Neck:
•TMJ:
-- Max incisal opening of =41mm
-- Lat excursion Right = 4mm
Left = 7mm
-- Protrusion = 10mm
• Path of Closure is displaced anteriorly

6. FRONTAL ASSESSMENT
 Facial Type: Dolicofacial
 Facial Symmetry: Symmetric
 Lips Seal: Competent
 Lip Length: Upper lip = 19mm
Lower lip = 49mm
 Incisal show: 0mm
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7. PROFILE ASSESSMENT
 Profile: Concave
 Nose: Average
 Chin: Prominent
 Mentolabial Sulcus: Shallow
 Nasolabial angle: Normal
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8. FRONTALASSESSMENT
(SMILING VIEW)
 Incisal Show during smile: Full
incisal show with 3mm of gum
show
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9. INTRAORAL EXAMINATION
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10. FRONTAL VIEW
 Oral Hygiene: Poor.
Bleeding gums on
brushing. Gingiva of lower
anterior region inflammed
and blunt.
 Midline :
 Upper is On
 Lower is 4mm off
towards left side to upper
dental midline.
 Crossbite: Anterior 3 to 3
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11. OCCLUSAL VIEWS
 Rt. Upper 1 to 7 present, Unerupted right upper 8
 Lt. Upper 1 to 8 present
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12. OCCLUSAL VIEWS
 Rt Lower: 1 to 8 present
 Lt Lower: 1 to 7 present, Unerupted left lower 8
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13. BUCCAL VIEWS
 Incisor: Class III
 Canine:
 Class III bilaterally
 Molar:
 Supra class III right side
 Class III on left side
 Over jet:
 Reverse. 7mm
 Over bite:
 Reverse
 Cross bite:
 Bilateral posteriorly 7 to 7
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14. CAST ANALYSIS
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15. SPACE ANALYSIS
MAXILLA
 Space Available = 69.5mm
 Space Required = 78.5mm
 TSALD = -9.0 mm
MANDIBLE
 Space Available = 60.5mm
 Space Required = 70mm
 TSALD = -9.5mm
 CURVE OF SPEE: 2mm on average
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16. BOLTON ANALYSIS
Amount of Anterior excessive Mandibular
tooth material = 1.18 mm
Amount of Overall excessive Mandibular
tooth material = 0.42 mm
→Bolton Analysis Finding: Bolton is
insignificant.
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17. 17
EXTRA-ORAL PHOTOGRAPHS

19. 19
INTRA-ORAL PHOTOGRAPHS

21. RADIOGRAPHIC
EXAMINATION
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22. PANORAMIC RADIOGRAPH
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23. CEPHALOMETRIC ANALYSIS
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24. 24

25. SAGITTALANALYSIS
NORM PRE TX
SNA 82° ± 2° 83°
SNB 80° ± 2° 89°
ANB 2 ° ± 2 ° 6°
Wits 1mm ♂
0mm ♀ -21mm
Ant cranial base length X 74mm
Mandibular corpus length X+7 81mm
Facial angle 81° ± 4° 86°
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26. NORM PRE TX
SN-Mandibular plane 32°± 4° 35°
SN-Palatal plane 6°±4° 4°
SN-Occlusal plane 17°±4° 17°
MMA 25°± 4° 31°
Upper Occlusal 11°±4° 13°
Lower Occlusal 14°±4° 18°
Y-axis 66°± 4° 65°
Sum of posterior angles 396°±4° 395°
Ratio of PFH/AFH 65% ± 4% 64.6%
Ratio of LAFH/TAFH 54% ± 2% 59.86%
Ratio of UAFH/LAFH 80% ± 2% 68.1% 26
VERTICALANALYSIS

27. 27
NORM PRE TX
UI - SN 102° ± 5° 110°
UI- palatal 108° ±5° 114°
IMPA 90° ± 5° 77°
Inter-incisal angle 135° ± 5° 138°
UI-NA: Distance
Angle
3mm
22°
+10.5mm
27°
L1-NB: Distance
Angle
4mm
25°
+6.5mm
20°
Holdaway Ratio 1:1 6:2
L1-APo Line 0mm +8.5mm
DENTAL ANALYSIS

28. NORM PRE TX
E-Line: Upper Lip
Lower Lip
-3 ± 2
-2 ± 2
-9mm
0mm
S-Line: Upper Lip
Lower Lip
0 ± 2
0 ± 2
0mm
+5mm
NL Angle 102° ± 8° 95°
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SOFT TISSUE ANALYSIS

29. CEPHALOMETRIC DIAGNOSIS
 Prognathic Mandible
 Slightly high angle
 Proclined Upper incisors
 Retroclined lower incisors
 Reterocumbent Upper lip
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30. 30
Measurements Standard SD Readings Interpretation
CRANIAL BASE
Ar-ptm(parallel to HP) 37.1 2.8 31 Decreased Post.
Cranial base
length
Ptm-N(parallel to HP) 52.8 4.1 54 Normal Ant.
Cranial base
length
HORIZONTAL SKELETAL
Na-A-Pog 3.9° 6.4 -11° concave
Na-A (parallel to HP) 0.0 3.7 1mm Normal Maxilla
Na-B (parallel to HP) -5.3 6.7 12mm Prognathic
Mandible
Na-Pog (parallel to
HP)
-4.3 8.5 17mm Protrusive chin

31. 31
VERTICAL SKELETAL & DENTAL
N-ANS (Perp to HP) 54.7 3.2 57mm Normal Ant. Middle
third of face
ANS-Gn (Perp to HP) 68.6 3.8 87mm Long Ant. lower third
of face
N-PNS (Perp to HP) 53.9 1.7 60mm Long Post. Middle
third of face
MP-HP (Angle) 23° 5.9 31° Slightly increased
Vertical
U1-NF (Perp to NF) 30.5 2.1 35.5mm Increased Ant. Max.
Dental height
L1-MP (Perp to MP) 45 2.1 50mm Increased Ant. Mand.
Dental height
U6-NF (Perp to NF) 26.2 2.0 31.5mm Increased Post. Max.
Dental height
L6-Mp (Perp to MP) 35.8 2.6 35.5mm Normal Post. Mand.
Dental height

32. 32
MAXILLA MANDIBLE
ANS-PNS 57.7 2.5 55mm Normal
horizontal
max.base
length
Ar-Go (Linear) 52.0 4.2 53mm Normal
Mand.ramal
length
Go-Pog (Linear) 83.7 4.5 100.5mm Increased
Mand. Body
length
B-Pog (Parallel to
HP)
8.9 1.7 4mm Chin is
recessive?
Ar-Go-Gn 119.1° 6.5 127° Slightly
increased
angle

33. 33
DENTAL
OP upper to HP 6.2° 5.1 14° Increased occlusal
plane angle
OP lower to HP °
AB parallel to OP -1.1 2.0 -23mm Prognathic Mandible
U1-NF 111.1° 4.7 118° Slightly increased
Max. incisor
inclination
L1-MP 95.9° 5.2 74° Reteroclined Mand.
incisor inclination

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COGS INTERPRETATION
•Concave facial profile
•Prognathic mandible
•Protrusive chin position
•Long posterior middle third of face
•Long Anterior lower third of face
•Slightly increased vertical and Gonial angle
•Increased Mandibular Body length
•Increased Anterior mandibular dental height

35. PROBLEM LIST
General:
 Poor oral hygiene. Bleeding gums on brushing. Gingiva of
lower anterior region inflammed and blunt
Skeletal:
 Prognathic mandible
 High angle
Dental:
 Incisor Class III,
 Canine Class III bilaterally.
 Molar Class III on left side and Supra class III right side
 Deviated lower dental midline
 Reverse overjet and overbite
 Proclined upper incisors
 Retroclined lower incisors
 Bilateral crossbites
Soft Tissue:
 Reterocumbent upper lip.
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36. TREATMENT OBJECTIVES
 Improve & maintain the oral hygiene status
 Correction of lower jaw prognathism and chin
position
 Correction of lower dental midline.
 Correction of incisor inclinations
 Correction of reverse overjet and overbite
 Correction of increased vertical
 Correction of incisor, canine and molar relation.
 Correction of bilateral crossbites
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