FLCase. 1

Presented by Hyunjung ParkNew York Smile Orthodontics

History

• Date of Records: 5.17.10• CC: My teeth stick out

and I want to get braces • Age: 14 years. • Ethnicity: Hispanic• Med Hx: none• Allergy: no allergies• DH: RDV.• Ortho Hx: No• Habits: NSF• TMJ Exam: WNL

D.S. 515034

Frontal View

• Facial Type:

• Asymmetric:

• Lips are competent:

Smile Photo

• Show 50% of incisors• Maxillary midline 1 mm

Rt. to facial midline• Mand. midline shift 1 mm

Lt. to maxillary midline.• Mand. midline on to fa-

cial midline• Chin left

Profile View

• Retrognathic• Convex. • Decreased lower face

height• Soft Tissue:

– NLA: – MLS:

• Lips: – Competent.– Both lips are on the E

line.

Cephalometric Radiograph

Cephalometric Tracing

Alexander AnalysisMeasurement Reference Normal PatientSNA (angle) 82 SNB (angle) 80 ANB (angle) 2 U1 to SN (angle) 103 L1 to APo (mm) U1 to L1 (angle) 135 IMPA (angle) 95 FMA (angle) 25FMIA (angle) 60MP to Occl. (angle) 10MP to SN (angle) 32Convexity (NA to Apo) (angle) 3Holdaway ratio (PO &L1 to NB) 1:1Y-axis (SN-SGn) (angle) 60Lower lip to H-line (mm) 0Wits Appraisal (mm) -1

ABO AnalysisMeasurement Reference Normal Patient

SNA (angle) 82

SNB (angle) 80

ANB (angle) 2

SN to Go-Gn (angle) 32

FMA (angle) 25

U1 to NA (mm)

U1 to SN (angle) 103

L1 to NB (mm)

Upper lip to E-line (mm)

Lower lip to E-line (mm)

Cephalometric Diagnosis

•

Cervical Vertebral Maturation

Panoramic Radiograph

•

Intraoral Frontal View

Intraoral Buccal Views

RIGHT LATERAL VIEW LEFT LATERAL VIEW

Intraoral Occlusal Views

Maxillary Arch

Mandibular Arch

Cast Analysis

• CROWDING

• Upper : mm.

• Lower : mm.

• OVERBITE : mm.

• OVERJET : mm.

• COS : mm.

Bolton Analysis.

3-3 Excess Man/Max tooth mass:

6-6 Excess Man/Max tooth mass:

0 mm. (edge to edge) = 1 pt.

1 – 3 mm. = 0 pts.

3.1 – 5 mm. = 2 pts.

5.1 – 7 mm. = 3 pts.

7.1 – 9 mm. = 4 pts.

> 9 mm. = 5 pts.

Negative OJ (x-bite) 1 pt. per mm. per tooth =

Total =            

OVERJET

OVERBITE 0 – 3 mm. = 0 pts.

3.1 – 5 mm. = 2 pts.

5.1 – 7 mm. = 3 pts.

Impinging (100%) = 5 pts.

Total =            

ANTERIOR OPENBITE

LATERAL OPENBITE2 pts. per mm. per tooth

Total =          

0 mm. (edge to edge) = 1 pt.

then 2 pts. per mm. per tooth

Total =           

CROWDING 0 – 3 mm. = 1 pt.

3.1 – 5 mm. = 2 pts.

5.1 – 7 mm. = 4 pts.

> 7 mm. = 7 pts.

Total =       OCCLUSION

Class I to end on = 0 pts.

End on Class II or III = 2 pts. per side

Full Class II or III = 4 pts. per side

Beyond Class II or III = 1 pt. per mm. Additional

Total =           

LINGUAL POSTERIOR X-BITE1 pt. per tooth   Total =            

BUCCAL POSTERIOR X-BITE2 pts. per tooth   Total =            

CEPHALOMETRICS

ANB > 5.5 or <-1.5 = 4 pts.

Each Additional Degree = 1 pt.

SN-GO-GN27 deg. – 37 deg.

= 0 pts.

SN-GO-GN > 37 deg. =22 pts. per degree

SN-GO-GN < 27 deg. 1 pt. per degree

IMPA > 98 deg. =41 pt. per degree

Total =     

OTHER   2 pts. =     

TOTAL =

Discrepancy Index

INDICATE PROBLEM:

Diagnosis

FL 14 years old

Cephalometric Radiograph

Problem List Treatment Objectives

Limitations - Therapeutic Modifiability

Dr. Alexander Chart

Ext Borderline Non-Ext

1. Soft Tissue Profile Convex Normal Concave

2. Mandibular Incisor Position Proclined Normal Retroclined

3. Attached Periodontal Tissue Thin Compromised Healthy

4. Growth Potential Past Ending Present

5. Skeletal Pattern High angle Medium angle Low angle

6. ALD Severe Moderate Mild

7. Maxillary Intermolar Width >33mm Moderate <33mm

8. Patient compliance Poor Moderate Excellent

Right Left

Lower crowding

Lower midline

Lower incisor posi-tion

Curve of Spee

Space needed

Extractions

L6 space left

Molar relationship

Move U6

Dental VTO

Treatment Plan

• Option 1 : • Option 2 : • Option 3 :

Option 1 :

Treatment Plan

Option 2 :

Treatment Plan

Option 3 :

Treatment Plan

Literature Review

• Article 1 : • Article 2 : • Article 3 :

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