CASE PRESENTATION

 Patient name – Anjali Tiwari

 Age/sex – 12 years/female
 O.P.D no. – 284484/15
 Date --23/FEBRUARY/16
Chief complaint :- Patient complains of irregularly placed upper and
lower front teeth
Pre Natal history :-
Condition during pregnancy – Normal
Delivery – Full term
Type – Normal
Natal History :-
No relevant history
Post Natal History
No relevant history
Dental history
First time visit for dental treatment
Child hood disease :– None

Habits :– None

Familial History :– not significant

Reasons for orthodontic treatment :– Esthetics

Attitude towards treatment :– Positive and Self motivated

Pubertal status :- Attained
CLINICAL EXAMINATION

PHYSICAL STATUS

Built – Athletic
Height – 5 feet
Weight – 42 kgs
Body type – Mesomorphic
 EXTRA ORAL EXAMINATION

Head Form - Mesocephalic

Facial Form - Mesoprosopic

LIPS:- COMPETENT

AMOUNT OF INCISOR EXPOSURE:-

DURING SPEECH – 4 mm
DURING SMILE - 7 mm
Profile - straight

Mentolabial sulcus - normal

Facial divergence : straight

divergence

Interlabial gap - 1 mm
 FUNCTIONAL EXAMINATION

Respiration – normal
Mastication – normal
Deglutition – normal
Speech – normal
Jaw function / TMJ complaint – No
Range of max opening – 47 mm
Rt. Excursion – 7 mm
Lt. excursion – 7 mm
 INTRA ORAL EXAMINATION

SOFT TISSUE
EXAMINATION

Oral hygiene status : good

Brushing habit : once a day
Gingiva : normal/coral pink
Tongue : normal
Hard Tissue Examination
No. of teeth - 14
Unerupted teeth - 18,28
Size & form of teeth - normal
Texture - smooth
Arch Shape - ‘U’ shape
Arch symmetry - asymmetrical
Arch alignment - malaligned
Palatal contour - deep (46.6%)
No. of teeth - 14
Unerupted teeth - 38,48
Size & form of teeth - normal
Texture - smooth
Arch Shape - ‘U’ shape
Arch symmetry - asymmetrical
Arch alignment - malaligned
 MAXILLOMANDIBULAR RELATIONSHIP
Antero posterior relationship :-

Molar relation = class I on right side and

end on on left side.
Canine relation = not established on both sides
Over jet = 3 mm irt 21
Over bite = 4 mm (57.14 %)
Midline is coinciding
 MODEL ANALYSIS

Arch Perimeter Analysis Carey’s Analysis

Total Tooth Material 78.5 mm 68 mm
Arch Perimeter 74 mm 63 mm

Difference 4.5 mm TTM excess 5 mm TTM excess

Bolton’s Discrepancy= 2.3 mm Maxillary anterior excess

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 Total Tooth Premolar Premolar Basal
Ashley Howe’s Material Diameter Arch Width
Analysis

Upper 98.5 mm 35 mm 43 mm

PMBAW % = Upper 43.65 %

 CEPHALOMETRIC ANALYSIS

TWEED’S MEAN VALUE PRE INFERENCE

FMA 25 34 Vertical growth

pattern
FMIA 65 50 Proclined lower
incisors
IMPA 90 96 Proclined lower
incisors

Wits - (-6) mm
 DOWN’S ANALYSIS
MEAN VALUE PRE INFERENCE

Facial Angle 87.8(82-95) 78 Normal

Angle of Covexity 0 (-8.5-10) 7 Normal

AB Plane Angle -4.6 -3 Point B is positioned ahead of

point A

Mand Plane Angle 21.9 35 Vertical growth pattern

“Y” Axis 59.4 (53-66) 70 Forwardly placed chin

Cant Of Occl Plane 9.3 (1.5-14) 18 Steep occlusal plane

Interincisal Angle 135.4(130-150.4) 118 Proclined upper and lower

incisors
L1-Occ Plane Angle 14.5 (3.5- 20) 21 Normal

L1-M Plane Angle 1.4 (-8.5-7) 6 Normal

U l to A Pog 2.7 (-1-5)mm 7 mm Forwardly placed upper incisors

 STEINER’S ANALYSIS
PARAMETERS MEAN PRE INFERENCE
VALUE
SNA 82 74 Retrognathic maxilla
SNB 80 76 Retrognathic mandible
ANB 2 -2 Class III skeletal pattern
11mm/38 Proclined upper incisors
Mx l to NA 8mm/26

7mm/29 Proclined lower incisors

Md l to NB 3mm/21

Go-GN to SN 32 32 Normative value for

growth pattern
Mx. l to Md. l 131 118 Proclined upper and lower
incisors
Soft Tissue- S Line Upper lip = 2 mm ahead of line
Lower lip = 3 mm ahead of line
 MCNAMARA’S ANALYSIS
PARAMETERS NORMAL PRE INFERENCE
VALUE
Naso-labial angle 102 97

Na-perp to pt. A 0-1 10 mm

Mand . Length 113.1 95 mm Small mandibular length
Max length 89.6 71 mm Small midfacial length
Max/Mand. 23.4 24 mm Medium
difference
Lower ant. Facial 62.6 54 mm Small lower facial height
ht
Mand to cranial 15 mm Medium sized mandible
base
L 1 – A pog 1-3mm 4 mm Normal
Proclined upper incisors
U 1- point A 4- 6 mm 11 mm
 HOLDAWAY SOFT TISSUE ANALYSIS

PARAMETERS NORMAL PRETREATMENT

VALUE VALUE

Soft Tissue Facial Angle 900 79

Upper lip curvature 2.5mm 2 mm

Skeletal Convexity at point A -2 to +2 mm 2 mm

H-line angle 70-150 18

Nose tip to H line 12mm 3 mm

Upper sulcus depth 5 mm 6.5 mm

Upper lip thickness 15mm 17 mm
PARAMETERS NORMAL PRE
VALUE
Upper lip strain 0-1 7 mm

Lower lip to H-line 0mm 1.5 mm

Lower sulcus depth 5mm 3.5 mm

Soft tissue- chin thickness 10-12mm 8 mm

E line = Upper lip = 2 mm ahead of the line

Lower lip = 0 mm
Problem List

Skeletal Problem
Retrognathic Maxilla
Retrognathic Mandible

Dental Problem
Overbite 4 mm (57.14%)
Curve of spee 3 mm
End on molar relation on the left side
Crowding in the upper and lower anteriors

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Diagnosis: Skeletal class III base and Angles
class II Subdivision malocclusion.

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 TREATMENT OBJECTIVES

 Correction of crowding.

 Correction of deep bite (57.14%)

 Correction of curve of spee

 Maintenance of class I molar relationship on right side

and correction of end on molar relation on left side
 SPACE ANALYSIS
Mandible
Space required Space available
Molar correction= 2 mm Extraction irt 34;44 = 16 mm
Curve of spee= 3 mm
Crowding = 9 mm

Total= 14 mm

Maxilla
Space required Space avaliable
Crowding = 13 mm Extraction irt 14,24 = 14 mm

Total= 14 mm
Total=14 mm
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