Case presentation 3rd year.
-
Upload
lubnaaborob -
Category
Health & Medicine
-
view
349 -
download
0
Transcript of Case presentation 3rd year.
![Page 1: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/1.jpg)
Orthodontic Case Presentation
Done By:Dr. Mutaz H.AL-Shakhatreh3rd Year Orthodontic Resident
Supervised by:Dr. Ahmad Al-Tarawneh.
Dr. Raed Al-Rbata.
![Page 2: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/2.jpg)
Patient’s DetailsPatient’s Initials: H.MGender: Male.Date of birth: Dec 25th , 1985.Occupation: Sergeant in royal air force.Age at the beginning of treatment: 30
years & 8 months.
![Page 3: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/3.jpg)
Chief Complaint
“I feel that my upper jaw advanced forward, and the lower jaw is backward, and there are spaces between
my upper teeth”
![Page 4: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/4.jpg)
Relevant Medical History
“Patient Denied any Medical problems”
![Page 5: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/5.jpg)
Relevant Dental History
No regular check up.Multiple amalgame restorations.
No history of oral and dental trauma.
![Page 6: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/6.jpg)
Extra Oral Assessment- Frontal -
![Page 7: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/7.jpg)
Extra Oral Assessment- Profile -
![Page 8: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/8.jpg)
Extra Oral Assessment- Skeletal -
Mild Asymmetric Face. convex profile.Skeletal Class II Pattern. Normal LAFH.
![Page 9: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/9.jpg)
Extra Oral Assessment- Skeletal -
Anteroposterior:
Convex Profile.
![Page 10: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/10.jpg)
Extra Oral Assessment- Skeletal -
Vertical:
Normal LAFH.
![Page 11: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/11.jpg)
Extra Oral Assessment- Skeletal -
Transverse (non-smile):
-Mild Asymmetric Face.The chin & nose deviated to the left.
![Page 12: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/12.jpg)
Extra Oral Assessment- Skeletal -
Transverse (smiling):
-Normal level occlusal plane(no canting).-upper midline to facial mildline:Coincident.-lower midline to upper midline:Off to the left side by 2-mm.
![Page 13: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/13.jpg)
Extra Oral Assessment- Skeletal -
Soft Tissue:1.A-P: NLA: obtuse. Marked labiomental fold.2.Vertical: Competent lips. Low smile line. 3.Trasverse: Wide smile.
![Page 14: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/14.jpg)
Extra Oral Assessment
No HabitsNo TMDNo Displacement
![Page 15: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/15.jpg)
Intra Oral Examination
Poor Oral Hygiene.(calculus at lower labial segment)
Mild Gingivitis.Teeth Present (Permanent Stage)
7 6 5 4 3 2 1 1 2 3 4 5 6 7 7 6 5 4 3 2 1 1 2 3 4 5 6 7
![Page 16: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/16.jpg)
Intra Oral Examination- Frontal -
Incisor Classification: Class II/1Centerlines: Upper Coincident with Midline
of the Face. Lower Shifted 2mm to the left.
Overbite: complete.Overjet: 7mm.
![Page 17: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/17.jpg)
Intra Oral Examination- Right Buccal Segment -
Molar Relationship: Class ICanine Relationship: ¼ unit Class III
![Page 18: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/18.jpg)
Intra Oral Examination- Left Buccal Segment -
Molar Relationship: 1/2 unit Class IICanine Relationship: Class I
![Page 19: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/19.jpg)
Intra Oral Examination- Upper Occlusal View-
![Page 20: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/20.jpg)
Intra Oral Examination- Upper Occlusal View-
U Shaped Arch.Multiple Restorative Teeth 6 56
No Missing Teeth. Rotated 1 1
![Page 21: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/21.jpg)
Intra Oral Examination- Lower Occlusal View-
![Page 22: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/22.jpg)
Intra Oral Examination- Lower Occlusal View-
U Shaped Arch.No Missing Teeth.Rotated 2 23Lingually in-standing lower lateral incisor.Curve of Spee: 3.5mm Deep on Right side
3mm on left Side
![Page 23: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/23.jpg)
Anterposterior: Over jet (OJ): 7 mm.
Rt.molar: class I. Lt.molar: ½ unit class II.
Rt.canine: ¼ unit class III. Lt.canine: class I.
-Study Model Analysis-
![Page 24: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/24.jpg)
-Study Model Analysis-Vertical:
Complete Overbite.
![Page 25: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/25.jpg)
-Study Model Analysis-
Rt.side: curve of spee 3.5 mm. Lt.side: curve of spee 3 mm.
![Page 26: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/26.jpg)
-Study Model Analysis-Transverse: the lower dental midline to the upper midline is shifted by
2 mm to the left.
![Page 27: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/27.jpg)
-Study Model Analysis-Maxillary arch:-Symmetry: symmetrical to a great Extent.-Rotation: upper central incisors.-Intercanine width: 37 mm.-Intermolar width: 45 mm.Mandibular arch:-Symmetry: asymmetric.-Rotation: 2 135-Intercanine width: 23 mm.-Intermolar width: 42 mm.
![Page 28: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/28.jpg)
Space Analysis
Upper Arch:Space Available: 86 mmSpace Needed: 78 mm+8 mm (Spacing).
Lower Arch:Space Available: 71 mmSpace Needed: 64 mm-7 mm space needed (moderate crowding).
![Page 29: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/29.jpg)
Bolton Ratios
Anterior Ratio (3 - 3): 79% ( Normal: 77%)
Overall Ratio (6 - 6): 89.75% ( Normal: 91%)
![Page 30: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/30.jpg)
Pre-Treatment IOTN- Aesthetic Component -
• 5(moderate to border line need)
![Page 31: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/31.jpg)
Pre-Treatment IOTN- Dental Health Component -
• 3.b• Sever Treatment Need.
![Page 32: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/32.jpg)
Radiographic Examination- OPT -
All Features Look Normal.No Apparent Pathology.All Teeth Present. Wisdom Teeth Erupted.
![Page 33: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/33.jpg)
Radiographic Examination- Lateral Cephalogram -
![Page 34: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/34.jpg)
Cephalometric AnalysisVariable Pre-Treatment Normal Value Ceph .Interpretation
SNA 82 81 +- 3 Normal Maxilla
SNB 73.2 78 +- 3 Retrognathic Mandible
ANB 8.8 3 +- 2 Skeletal Class II
S-N/ANS-PNS
7 8 +- 3 Normally Inclined Maxilla
Corrected ANB
8.3
MMPA 24.4 27 +- 3 Normal Vertical Proportion
UAFH 42
LAFH 45
LAFH % 51.7% 55 +- 2 Reduced Facial Proportion
U1/Mx 103 108 +- 6 Normally Inclined Upper Incisors
L1/Mn 101 93 +- 6 Proclined Lower Incisors
IAA 137 133 +- 10 Normally Inclined Incisors
Wits Appraisal
2 0/-1
![Page 35: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/35.jpg)
Cephalometric InterpretationAntero-posterior :
1. Normal Maxilla. 2. Retrognathic Mandible.
3. Skeletal Class II. Vertical: 1.Normal Vertical Proportion. 2. Reduced lower anterior facial
height. Dental 1.Normally inclined upper
incisors 2.proclined lower incisors.
![Page 36: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/36.jpg)
Diagnostic SummaryA 30 year old male patient, denied any medical problems, complaining from “ my upper jaw advanced forward, and the lower jaw is backward, and there is spaces between my upper teeth” . He has a class II div 1 Incisal relationship on a Class II skeletal base, complicated by increased OJ (7mm) and Complete OB , moderate crowding in the lower labial segment and spacing in the upper jaw, multiple rotated teeth, and shifted lower midline. He has a class I Molar relationship on right side and ½ unit class II on left side and a Class I Canine on the left side and ¼ unit Class III canine relationship on the right side.
![Page 37: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/37.jpg)
Problem List1. Poor oral hygiene. 2. Mild gingivitis. 3. Calculus on the lower lingual segment. 4. Asymmetric face, chin & nose deviated to the left.5. Convex profile.6. Obtuse nasolabial angle.7. Marked labiomental fold.8. Class II skeletal base.9. Moderate crowding in lower labial segment.10. Lingual in-standing lower lateral incisor.11. Spacing in the upper jaw.12. Increased overjet 7mm.13. Complete overbite.14. Class II div 1 incisal relationship.15. Class I molar relationship on right side and ½ unit class II on the left side.16. midline shifted 2mm to the right.
![Page 38: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/38.jpg)
Treatment AimsReferral to Perio-clinic for Improvement of OH.1.Skeletal: -Achieve a corrected skeletal base relationship.2.Soft tissue: -Achieve a normal facial proportion.3.Dental: -Relieve crowding. -Level and align the arches. -Achieve corrected overbite (edge-centroid
relationship). -Achieve corrected overjet. -Achieve corrected buccal segment relationships.
- correct upper and lower midlines .
![Page 39: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/39.jpg)
Treatment Plans1st Option:1.Initial orthodontic treatment:
Extraction of 4 5 **to correct midline shiftUpper and lower fixed appliance2.Orthognathic surgery : Initial plan: advancement of mandible. And maxilla (to achieve
better facial esthetics )3.Post-surgical orthodontic.4.Finishing.5.Retention: upper and lower fixed retainer and upper essix.
![Page 40: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/40.jpg)
Justification (1):1.Extraction of lower 4,5s to correct the moderate crowding
and the proclined lower lower labial segment. Asymetrical extraction to correct midline shift.2.Correct the rotated teeth.3.Dental decompensation before surgery.4.Surgical mandibular and maxillary advancement to correct
the skeletal discrepancy.5.Upper and lower fixed retainer (17.5 mil braided steel
archwire) for long period of time(because of spacing and rotated incisors)
6.Upper essix as retainer after correction of deep overbite, night time wearing (1.5mm thickness).
![Page 41: Case presentation 3rd year.](https://reader035.fdocuments.in/reader035/viewer/2022070516/58744d601a28abd53e8b5613/html5/thumbnails/41.jpg)
Thank You