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Case presentation

*Name: Faris Shnbor


*Age: 11 years old
*Gender: Male
*Occupation: Student
*Date of examination: 9 Oct -2014

**Chief Complaint:
-Patient complained of his forwardly placed and misaligned upper incisors.
**Medical history:
-His dad claimed that Faris is medically fit and he doesn't take any medications.
**Dental history:
- multiple previous restorations, and primary teeth extractions, with no
complications
**Social history & habits :

-Patient denied any habit.


**patient motivation:
The patient was very motivated to start and follow up the treatment.

Extra-Oral Examination

Extra-Oral
photos

Extra oral
Examination
Frontal View

Extra oral examination


*Acceptable facial
balance and symmetry.
* Deviated chin
*Normal Lower anterior
Facial Height (50-55%)

Frontal view

Facial symmetry

Upper & lower facial heights

Extra oral
Examination
Profile View

Extra oral examination

Convex profile angle.


Class II skeletal
Relationship.

?????????????????

profile view

Profile view
Average FMPA.
(about 30)

Extra oral
Examination
Soft tissue analysis

Soft tissue Analysis


1. Incompetent lips

Soft tissue Analysis, Cont.


2. Reduced Nasolabial
angle

Soft tissue Analysis, Cont.

Prominent upper and


lower lips to the E-Line

Upper lip by(2mm)


lower lip by (4mm)

Soft tissue Analysis, Cont.


Paranasal area

Intra-Oral Examination

Intra-oral
photos

Intra-Oral
Examination
Upper Arch

Intra Oral Examination


Poor Oral Hygiene

Upper Arch:
Teeth Number: 12 teeth. 6
teeth/ side
Cs, Ds, Es were still present
U shaped arch
Multiple restorations
Average upper incisors
inclination
mild crowding (4 mm)
clinically ????????????

Intra-Oral
Examination
Lower Arch

Lower Arch:

Teeth Number: 12 teeth, 6


teeth per side
Cs, Ds, Es were still
present
Average Incisor inclination.
Mild crowding in the
lower anterior segment.
(2mm) clinically

Intra-Oral
Examination
Inter-arch relation ships

Anterior Posterior Relation


Increased Over Jet (8 mm)
Class II div I incisor relationship
????????
Right Side:
Canine (class II quarter unit)
Molar (class II full unit)
Left Side:
Canine (class II quarter unit)
Molar (class II full unit)

Vertical Relation:
Increased Overbite
Hyper active upper lip muscle
Gummy smile

Transverse Relation
Normal
Upper midline is coincident
with the midfacial axis
Upper and lower midline is
not concident ( lower
midline is shifted to the
right by 2mm)

Study
casts

Space Analysis
Jonhston and Tanaka
Upper Jaw

Space available: Rt 24
Space Predicted: Rt 22
Spacing
+2 mm

Lf 25
Lf 22
+3mm

Space Analysis
Johnston and Tanaka
Lower Jaw

Space available: Rt 27 Lf 27
Space Predicted: Rt 21.5
Lf 21.5
Spacing
+5.5 mm +5.5 mm

Panoramic Radiograph
Late mixed dentition
All teeth are present
No pathology
Rotated lower premolars

Lateral cephalogram

Cephalometric Land marks

Cephalometric Tracing

Normal value
interpretation

Pre- Treatment

Variable

82 3

82

SNA

79 3
mandible

retrognathic

75

SNB

13

skeletal class II

ANB

105

UI - Mx

101

LI - Mn

5126

127

Gonial angle

27 5

30

MM angle

27 5

31

FM angle

2 AO ahead of
BO

Wits measurements

50%-55%

52%

Anterior face height

0-2

1.5

Lower incisor to A-Po

905

93

A-B/FOP

13310

123

Interincisal angle

76

SN-Po

108 5
92 5

1-

873

proclined

skeletal class II

retrognathic

Diagnosis

Class II div I incisor relaionship based on class II skeletal


relationship complicated by
Increased overjet and over bite
Bilateral Class II full unit molar relationship
Mild upper and lower crowding of the current dentition
Incompetent lips
Shifted lower midline to the right by 1mm
Prominent upper and lower lips
Gummy smile

Over all Aims of Treatment


To correct incisor relationship, align the upper incisors
and relief the anterior crowding in the upper arch
To correct molar relation ships
To reduce the overjet and overbite
To correct the shifted midline
To achieve esthetically pleasing soft tissue correct the
gummy smile

Treatment plan suggestion


Phase 1
Functional appliance to stimulate the
mandibular growth and to decrease upper and
lower skeletal discrepancy
Phase 2
Reassessment of the dentition, and referal for
fixed treatment

Functional appliance
Andreasen with maxillary torquing spurs

Retention
possibly
Continue wearing the functional appliance
during phase 1

Thank you

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