By:

Khola Asif
Hiba Saleem
Mahnoor Saeed
NAME: Zain-ul-abdin

GENDER: Male

AGE: 12 years

JOB: Student

FATHER’S NAME: Muhammad Hussain

ADDRESS: Habibullah Colony Abbottabad

‘Front teeth are forward’
 General health: good

 Family history: Brothers teeth are malaligned

 Trauma: No history of dental trauma

 Dental history: Previous visits to dental clinic for check ups

 Medical history: Denies any medical problems

 Social status: Good

 Habits: Lip biting, bruxism & mouth breathing

 Motivation: Patient is well motivated

 Facial type: Mesiofacial

 Facial symmetry: Symmetrical

 Facial profile: Convex

 Lips Thickness: Thick

 Lip seal: Incompetent

 Upper dental midline to facial midline: Coincides

 TMJ function: Normal

 Convex facial profile

 Acute nasolabial angle

 Symmetrical face

 Equal lateral fifths of the face

in frontal plane

 Interpupillary distance
is equal to the width of
the mouth
 Equal vertical proportions
of the face

 Mesodivergent
 Dentition status: Permanent
dentition

 Oral hygiene: Fair

 Gingival health: Gingivitis

 Tonsils: -

 Tongue: Normal

 Swallowing behavior: Mature

 Malformed teeth : None

 Impacted teeth : None

 Ectopic teeth : None

 Delayed eruption : None

 Other Bony Defects: None

 U shaped upper arch

 Arch symmetry: Symmetrical

 Dentition: Permanent

 Palate: Deep

 Teeth present:
7,6,5,4,3,2,1|1,2,3,4,5,6,7

 Missing teeth: -

 Caries: No caries present

 Arch form: U shaped

 Arch symmetry: Symmetrical

 Dentition: Permanent

 Teeth present:
7,6,5,4,3,2,1|1,2,3,4,5,6,7

 Rotated left second premolar

 Caries: not present

No midline discrepancy
 INCISOR RELATIONSHIP
Class II div I

MOLAR RELATIONSHIP
Right side: End on cusp Left side: End on cusp

CANINE RELATIONSHIP
Right side : Full cusp Class II Left side : Half unit Class II
 Curve of Spee
Left side : 2mm Right side : 2mm
Over jet: Overbite:
(Normal value: 2-4mm) (Normal value: 2-3mm)
Patient’s value: 3mm Patient’s value:3mm
Mandible:
Space available-Space required
=67.5 - 68
=0.5 (spacing)

Maxilla:
Space available-Space required
=76.1 – 72.9
=3.2 (spacing)
Overall Bolton= Sum of mandibular / sum of
maxillary 12 * 100
=88.5 / 93.9 *100
= 94.2 (mandibular excess)
Desired sum of mandibular 12= 91.3 * sum of
maxillary 12 / 100
=91.3 * 93.9 /100
=85.8
Excessive mandibular tooth material= actual
sum of mandibular 12 – desired sum of
mandibular 12
=88.5 – 85.8
=2.7
Anterior Bolton= sum of mandibular 6 /sum of
maxillary 6 * 100
=40/49 *100
=81.7 ( mandibular excess)
Desired sum of mandibular 6= 77.2 * sum of maxillary
6 / 100
=77.2/49 * 100
=37.8
Excessive mandibular tooth material= actual sum of
mandibular 6 – desired sum of mandibular 6
=40 – 37.8
=2.2
• Permanent dentition
• All teeth are present
• Right side canine: partially
erupted
• Follicles of 3rd molars are
present on both sides
• No bone loss
• No supernumerary teeth
• No caries
• No bony fractures
• No periapical lesions
• Normal maxillary sinus and TMJ
Parameters Patient’s Individual
Values Interpretation
SNA (82 ±2⁰) 83ᴼ NORMAL

SNB (80⁰ ± 2⁰) 76ᴼ Retrognathic

Mandile
ANB (2⁰ ± 2⁰) 7ᴼ Class II

Point A to N‫ו‬ -3mm Retrognathic

(2±2mm) Maxilla

Pog to N| 18mm Prognathic

(3±4mm) Mandible
Wits appraisal 0mm Normal
(0 / 1mm)
Facial angle (87⁰ 80ᴼ Retrognathic
± 4⁰) Mandile

Skeletal Class II due to retrognathic mandible

Parameters Patient’s Individual
Values Interpretation

<G0-Gn to SN 44ᴼ Hyperdivergent

(32⁰ ± 4⁰)
FMA (25º±4º) 32ᴼ Hyperdivergent
< Y-axis 73ᴼ Hyperdivergent
(60º±4º)
PFH/AFH (65% 62.3% Normodivergent
± 4%)
LAFH/AFH 59% Hyperdivergent
(54⁰% ± 4⁰%)

Hyperdivergent
Parameters Patient’s Individual
Values Interpretation

UI-NA: distance 4mm Proclined

angle (4mm 29ᴼ upper incisors
22ᴼ)
LI-NB: Distance 8mm Proclined lower
angle (4mm 33ᴼ incisors
25ᵒ)

Interincisal 112ᴼ Proclined

angle (133ᵒ) Incisors

UI-SN(102ᵒ±5ᵒ) 106ᴼ Normal

IMPA (90± 4ᵒ) 95ᴼ Proclined lower

incisors

Biaxillary Proclination of Incisors

PARAMETERS PATIENT INDIVIDUAL
VALUE INTERPRETATION

•E-Line:
•UL: (-3±2) +5.5 Protrusive upper lip
•LL: (-2±2) +5 Protrusive lower lip
•S-Line:
• UL: (0±2) +6.5 Protrusive upper lip
• LL: (0±2) +5.5 Protrusive lower lip

•Z-angle: (78±5) 59 Protrusive lips

•Holdaway 3.2 :1
ratio: (1:1)
•Nasiolabial 105 Normal
angle: (102±8)

Protrusive lips
 Sagittal analysis: Skeletal Class II due
to retrognathic mandible

 Vertical analysis: Hyperdivergent

 Dental analysis: Bimaxillary proclination

 Soft tissue analysis: Protrusive lips

& Retrusive chin
My patient, Zain-ul-Abidin, 12 years old, male, from
Abbottabad, denied any medical problem and
presented with the chief complaint of “my front teeth
are forward”.

He is a case of bimaxillary proclination of incisors

based on a skeletal Class II due
to mandibular deficiency. The patient has protrusive
and incompetent lips. He has a Class II molar, canine &
incisor relationship.

He has habits of lip biting, bruxism and mouth

breathing.
 HABITS:  PERIODONTAL DISEASE:
Lip biting, mouth breathing & bruxism. Gingivitis
 SKELETAL PROBLEMS:-
Skeletal Class II due to Retrognathic
mandible
Hyperdivergent profile
 DENTAL PROBLEMS:-
Bimaxillary proclined incisors (Class II Div 1)
Molar Relationship: Right side: end on cusp
Left side : end on cusp
Canine Relationship: Right side : full cusp
Left side : half unit
Rotated lower left 2nd premolar
Traumatic bite
 SOFT TISSUE PROBLEMS:
Protrusive lips
 Patient/Parent Consultation

 Controlling pathological problem (Gingivitis)

before starting orthodontic treatment

 Orthodontic Treatment
1) Leveling and alignment
2) Extractions of 4 4
5 5
3) High pull head gear
4) Bite Block
5) Controlling habits(mouth guard, lip bumper etc)