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A Patient with Class-Il malocclusion With anterior open bite.
Presented by : Dr. Rashed Md. Golam Rabbani
BDS, FCPS-ll Trainee, Dept. of Orthodontics, DDCH
PRESENTING COMPLAINTS
EXTRA-ORAL EXAMINATION FACIAL FEATURE: Shape of the head : Mesocephalic Profile Analysis : Convex Facial divergent : Posterior Vertical relation : Normal Facial symmetry : Symmetrical Lips : Everted (incompetent) Upper lip line : Normal Lower lip line : Low Naso-labial angle : Acute TM joint : Normal path of closure Breathing : Both Nasal & oral
PATIENTS PHOTOGRAPH
INTRA-ORAL EXAMINATION
Stage of dentition : Permanent Teeth present :7654321 1234567 7654321 1234567 Periodontal status : Average Carious teeth : Absent Impacted tooth : Absent Missing tooth : Absent Maximum inter occlusal clearance : 44 mm Palate : Deep Tongue : Normal in size shape and forward position
OCCLUSAL RELATIONSHIP
A. Anteroposterior relation:
1. Molar relation 2. Canine relation 3. Incisor relation 4. Over jet 5.Over bite : Class-II both sides. : Class-II both sides : Undetermined : 7mm
:Open bite(-2mm)
B. Vertical relation:
1. Open bite
C. Lateral relation:
1. Midline : Coincided
SALIENT FEATURE
My patient Md.Mohsin, 27 years of age, reported to Dhaka Dental College & Hospital on 22 August, 2009 with the complaints of aesthetic problem and difficulty in speech. On examination labially placed anterior teeth were seen. Canine and molar relationship Class-II both sides. Over jet: 7mm and open bite was found anterior segment.
PROVISIONAL DIAGNOSIS
malocclusion
with
AETIOLOGY
SPECIFIC INVESTIGATION
MODEL ANALYSIS
3. ORTHOPANTOMOGRAPH
Shows permanent Dentition, favourable tooth angulation & no obstruction.
FINAL DIAGNOSIS
A case of Skeletal Class-II Malocclusion with anterior open bite (Sk. & Dental).
MANAGEMENT
Considering a complete set of records including photograph, model, orthopentamograph, lateral cephalometry and patients age - aim and treatment plan was established
To Correct the open bite. To correct the inter incisal angle. To establishment of normal over jet and over bite.
Step-3 Retraction of the upper and lower canines by elastic chain (0.016 SS wire) and adequate anchorage will be prepared withT.P.A. Step-4 Lower &Upper and arch contraction by rectangular arch wire (0.017 X 0.025) using closing loops and adding incremental torque. Step-5 Arch Coordination & Interdigitation Step-6 Retention & Stability: 1.Overcorrection 2. Fixed retainer for upper and lower arch
PROGNOSIS
Favorable
RETENTION
Active retention period is 1&1/2 years fixed retainer. Follow up schedule will be maintained for another 3 years.
Conclusion
Treatment of open bite is one of the most difficult job in orthodontics. Accurate diagnosis is essential for proper treatment planning. Proper diagnosis, elemination of etiology, early treatment and proper retention provides the possibility of satisfactory outcome.