Case presentation

Done by:

Hanady Al Masri

Abdallah Al Zireeni

Mohammad Elwir

Yahya Al Omari

Patient Name: Mohammad Baker Al Bdor

Age: 14 years old

Gender: male

Occupation: student

Chief complaint: the patient present to the clinic

complaining about appearance of his teeth “crowding

mainly” .

Medical history: patient denied any relevant

medical problem.

Dental history: previous fillings and extractions .

Social history and habits: nothing is relevant .

Extra oral examination

Frontal view

• Facial proportions :

Normal facial symmetry

• Vertical proportion: increased LFH

• Competent lips

Profile view

• profile : is convex

• Nasolabial angle: average 90°-100°

• both upper and lower lips are behind the E-line

• Frankfort mandibular plane angle is avarege

Smile view

• smile line : high smile line

• upper coincident midline with 2mm right shifted midline in the lower jaw.

Intra oral Examination

Intra oral examination

Soft tissue: mildly inflamed

Oral hygiene: poor and he needs several restorations

Teeth present: 14 teeth in the upper jaw & 14 teeth in the lower jaw

Maxillary arch

• Moderate crowding “ 5mm”

• Supernumerary adjacent to left lateral : non

• fillings or extractions : class І restoration on upper right 6

Mandibular arch

• crowding : moderate “5mm”

• present teeth : 14 tooth

• fillings or extractions : lower left 6 filling

Frontal view

Class І incisor relationship

Overbite: average

Overjet: increased

Upper midline coincident, with the lower being shifted by 2mm to the right.

Right buccal view

• ¼ unit Class II Canine

• Class І Molar

Left buccal view

• Class I Canine

• class III Molar by ¼ unit

Study Models

Space analysis on the upper cast

• Space available:

• 73mm

• space required:

• 78 mm

• There is deficiency of 5mm

Space analysis on the lower cast

• Space available:

• 71mm

• Space required:

• 75mm

• There is deficiency of 4 mm

• Ant. bolton : 76.2%

• average (77.2 % ±1.3%)

OPG x-ray

• present teeth : full upper and lower set of teeth

• bucco version impacted lower left third molar

Cephalometric analysis normal value variable

82±3 79 SNA

79±3 77 SNB

3±1 2 ANB

8±3 10 SN to maxillary plane

108±5 109 Upper incisor to maxillary plane

92±5 89 Lower incisor to mandibular plane

-1 - 1 -1 Wit's

133±10 131 Inter incisor angle

27±5 30 Maxillary mandibular planes angle

130mm Total facial height

7mm Lower facial height

50-55% 54% Lower facial height ratio

0-2 -3 Lower incisor to A-pog

Within 1 mm

-1 Lower lip to E plane

86±3 84 S-N-Pog

Diagnosis :

• Class І incisal relation based on class І skeletal relation complicated with ;

1. Increased over jet.

2. Moderate crowding in the upper arch .

3. Moderate crowding in the lower arch.

4. Bucco-distal Rotation of upper right lateral incisor.

5. Bucco-distal Rotation of lower right lateral incisor.

6. Class ІІІ molar relation in the left side by ¼ unit .

7. Class ІІ canine relation in the right side by ¼ unit .

8. shifting of the lower midline by 2mm to the right side .

Treatment plan Our aim of treatment is :

1- Oral hygiene and patient motivation .

2- Restore the present carious liaisons .

3- Maintain class I incisor relationship

4- Alignment of upper and lower teeth by reliving crowding

5- derotate the upper and lower right lateral incisors .

6- Correcting lower shifted midline .

7- Achieve class І molars and canines relation .

8- reducing over jet .

Treatment plan suggestion

This case needs:

1- applying fixed appliance for upper and lower teeth .

2-Interproximal stripping of upper and lower incisors to gain space .

3-proclination of upper and lower incisors to gain space needed .

4- de rotation of upper and lower right lateral incisors .

5- class ІІІ elastics for the left side .

Other treatment options : Extraction of all 5’s to gain space , and then use fixed appliance to realign the teeth . But this option is not preferable because : 1- both upper and lower lips are behind E-line (the patient lips lakes for fullness),and extraction will give the required space but also will place the incisors in retroclined position so this will give us dished in appearance of the face. 2- the patient has high smile line and the retrolclination of the incisor will shown this gum smile more which is unaesthetic.

Retention

• Upper arch: Fixed retainer

• Lower arch: Fixed retainer

• circumferential fiberotomy for the upper and lower right lateral incisors .

Thank you