Orthodontic case report

1. TREATMENT OF CLASS I ANGLE MALOCLUSION
TYPE 1 DUE TO RELAPS FROM UNFINISHED
ORTHODONTIC TREATMENT: CASE REPORT USING
THE SIMULATION OF THE TYPODONT OF THE
MANDIBULAR DENTAL MODEL

2. Introduction
Malocclusion is a condition in which there is irregularity of the teeth or the
placement of teeth that are not in place and can be considered aesthetically
unsatisfactory so that an imbalance condition is obtained both in the size and
position of the teeth, facial bones, soft tissues including lips, cheeks, and tongue.
Relapse is a state of returning to the initial form of the malocclusion after
correction. However, for the patient, relapse is defined as any change in the final
position of the tooth after treatment resulting in loss of the correction achieved in
orthodontic treatment.

3. Case Report
A 26-year-old female patient chief complaint:
misaligned upper and lower front teeth since 2008 and
wanted to have them straightened. The patient had
previously used a removable orthodontic appliances 1
year ago and wanted to make the appliance again
because the previous treatment was not completed and
resulted in his teeth being unkempt again.

4. Extra oral examination
Facial type: asymmetrical, mesoprosop
Facial profile: straight
Lips: normal
Lips relation: competent
TMJ: right deviation 0,7 mm

5. ODONTOGRAM

6. MALPOSITION

7. INTRAORAL EXAMINATION
• Oral hygine: good
• Labial frenulum: normal
• Tongue: normal
• Palate: normal
• Tonsil T1-T1
• Median line: maxillary right shifting 1 mm
• Overbite: right 3mm, left 2,5 mm
• Overjet: right 3 mm, left 5mm
• Curve of spee: right and left 2mm
• Eruption: normal
• Crossbite: -

8. DENTAL MODEL EXAMINATION
• Molar relationship: left and right
class I
• Canine relationship: left and right
class I
• Median line: maxillary right shifting
1 mm
• Overbite: right 3mm, left 2,5 mm
• Overjet: right 3 mm, left 5mm
• Curve of spee: right and left 2mm
• Crossbite: -
• Diastema: -

9. CAST ANALYSIS
ALD
Maxillary: Lack of space 1 mm on anterior region
Mandibula: lack of space 4 mm on anterior region
Bolton: patients mandibular teeth is bigger than Bolton ratio
Howes analysis: 47,5% and need expansion 1,5 mm
Pont index 14 & 24  constricted
Pont index 16 & 26  constricted

10. DIAGNOSIS
• Angle classification: angle class I type 1
• Diagnosis: angle class I type 1 with deepbite, crowding in mandible
and maxillary anterior teeth, and median line shifting.
• Etiology: the previous orthodontic treatment was not completed,
clenching, oral bad habit, history of trauma (avultion ar/ 21 then
replantated)

11. PROFFIT ACKERMAN PROBLEMS IDENTIFICATION
• Facial proportion and esthetic  face asymmetric, facial profile
straight, lip competent
• Alignment and dental arch  upper and lower anterior crowding
• Transversal relation  maxillary right shifting 1 mm
• Sagittal relation  left and right molar relation class I, left and right
canine relation class I, overjet: right 3 mm, left 5mm
• Vertical relation  overbite: right 3mm, left 2,5 mm, curve of spee
right and left 2mm

12. Treatment
• Aim of the treatment  to correct maxillary and mandibular
crowding anterior
• But in this typodont case; using mandibular typodont model
simulation

13. Treatment Progress

15. Discussion
• Malocclusion is condition in which there is an irregularity of the teeth
or the placement of teeth that are not in place and can be considered
aesthetically unsatisfactory so that an imbalance condition is
obtained both in the size and position of the teeth, facial bones, soft
tissues including lips, cheeks, and tongue.

16. Etiology of Malocclusion
Hereditary
Prenatal
trauma
Postnatal
trauma
Physical agent
Oral bad habit
Systemic
disease
Local disease Malnutrition
Relaps because
of previous
orthodontic
treatment

17. In this case
• Relapses occurred due to incomplete removable orthodontic
treatment, bad habits of the patient, namely clenching and biting
nails, a history of dental trauma in the patient, namely avulsion of
tooth 21 which was then replanted by non-medical personnel. This
case was simulated using a mandibular typodont simulation model.

18. • In the mandibular typodont simulation model, the teeth are arranged
according to the condition of the patient's original mandibular teeth,
then removable orthodontic appliances are attached according to the
design made and the z-spring is activated first until the teeth move as
expected to the left. proper position.
• After that, the z-spring is returned to a passive state and the labial
bow is activated to push the anterior teeth and the z-spring is not in a
position to restrain the movement of the teeth, so that the teeth
move in the desired position, until the desired position of the teeth is
obtained. .

19. Case prognosis
• Malposition of the anterior mandibular in the dental typodont 
corrected using removable orthodontic appliance
• Prognosis  good

20. Conclusion
• In this case report, a 26-year-old female patient with an Angle class I
type 1 malocclusion with deep bite, maxillary and mandibular
anterior crowding, and a shifting median line, was corrected using
maxillary and mandibular removable orthodontic appliances, and the
patient must be cooperative and have good motivation during the
treatment period, as well as routine control in order to achieve
occlusive function, and good esthetics.