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ORTODONTICS CASE HISTORY

FINAL YEAR B.D.S.


Student Name

ROLL NO. IV B.D.S.

FINAL YEAR BDS

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CASE HISTORY
Doctors name: Patients name: Date of Birth: Father/Guardians Name: Postal address: Phone no: Chief Complaint: (Res/Off): Sex: Male/Female Age: Date:

Family History: Similar malocclusion present in Mother: Father: Significant Medical Record: Allergy: Epilepsy: Diabetes: Trauma tothe Face /Surgery: Respiratory Disease: Any other condition: Pre natal records: Negative Positive: Heart Diseases: Kidney Disease: Rheumatic fever: Hepatitis: Tonsillectomy: Sibling: None:

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Mile stones: Teething: Walking: Speech: Habits: Digit sucking: Lip sucking: Oral breathing: Bruxism: Nail Biting: Tongue thrusting: Past dental records: 1) Periodontal treatment 2) Endodontic treatment 3) Extractions 4) Restorations 5) Orthodontic treatment Diet : Pure Veg. : : : : : Mix Diet Normal Normal Normal Delayed Delayed Delayed Accelerated Accelerated Accelerated

Brushing habit : Patient cleans his / her teeth once / twice / thrice a Day with horizontal Technique & he / she changes his / her toothbrush by every 6months.

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CLINICAL EXAMINATION
GENERAL EXAMINATION
Posture: Gait: Physique: Normal Normal Mesomorphic (Average) Health: Growth status: Healthy Pre-pubertal Ectomorphic (Thin and tall) Sick Pubertal Post-Pubertal Endomorphic (Fat and Short)

EXTRAORAL EXAMINATION 1.Frontal view:


Cephalic type: Facial type: Dolicocephalic Mesoprosopic (Average) Symmetry: Facial Height: Symmetrical Total Upper 1/3 Middle 1/3 Lower 1/3 Dentofacial defects/deformity: Exposure of upper incisors: Nasolabial angle: Nasolabial fold: Size of the nose: Average Large Small Mesocephalic Euryprosopic (Broad & short) Asymmetrical Brachycephalic Leptoprosopic (Long & Narrow)

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Lips Competence: Size

Competent

Potential Competent Incompetence Average Average Normal Normal Normal Normal Incisal 1/3rd Thick Thick High Everted Hypertonic Hypertonic Middle1/3rd Thin Thin Low Trapped Hypotonic Hypotonic Cervical 1/3rd

: UpperLower-

Position

: UpperLower-

Tone

: UpperLower-

Posture

: Upper-

Lip line active : Chin :

Pleasant Average

Toothy Recessive

Gummy (mm) Prominent

Mento Labial Sulcus: Interlabial distance:

2.Profile:
Facial convexity: Facial divergence: Clinical FMA: Maxilla Mandible Position of chin: Straight Anterior Average Normal Normal Normal Convex Posterior Low Protrusive Protrusive Protrusive Concave Straight High Retrusive Retrusive Retrusive

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TMJ
TMJ Right Left

Clicking

Crepitus

Pain

Movement

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Intra Oral Examination


Soft tissue Gingival Condition Plaque Calculus Recession: Oral Hygiene Status Labial Frenum : Good Normal Normal Fair Low Low Poor High High Large/Small Abnormal : Good : Present : Present Average Poor Absent Absent

Maxillary: Mandibular:

Tongue

Size &S hape: Normal Posture : Normal

Hard tissue Palate Others EXAMINATION OF TEETH Dentition: Teeth Present: Primary Mixed Permanent : Average : Shallow Deep

Unerupted Teeth:

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Occlusion Incisor relationship:- CL I Canine relationship- Left Right Molar Relationships: Left Right CL II Div 1 CLI CL I CL I CL I Proclined CL II Div 2 CL II CL II CL II CL II Average Average CL III CL III CL III CL III CL III Retroclined Retroclined

Axial Relationship:- Maxillary Incisors: Mandibular Incisors: Overjet Openbite : : Upper: Lower: Curve of Spee : Average Arch Form Lower: UpperFlat Expanded

Proclined Overbite: Crossbite: -

Midline-coincident:

Deep Normal Contracted

Expanded

Normal

Contracted

Teeth extracted Hypoplastic& malformed teeth Heavily restored teeth Non vital teeth Rotations Carious teeth Crowding Spacing

: : : : : : : :

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Functional analysis Mandible (Function) :

Inference:

Provisional Diagnosis:

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Cervical Vertebrae Maturation Indicators


Hand Wrist Radiograph:
PP2 - Stage (6) - Epiphysis of the proximal Phalynx of the Index finger (PP2) has same width as the diaphysis. 2 years before the onset of pubertal growth spurt MP3 -Stage (8) Epiphysis of the middle Phalynx of the middle finger has the same width as the diaphysis. 1 year before the onset of the pubertal growth spurt Sesamoid Ossification (Stage 3) - First mineralization of the Ulnar Sesamoid bone Of the Metacarpophalyngeal joint of the thumb (seen radiographically) shortly before or at the beginning of the pubertal growth spurt MP3 Cap Stage (8) The diaphysis is covered by the cap shaped Epiphysis, in the middle Phalynx of the Third finger. The peak of the pubertal growth spurt Dp3 Union Stage (7) Union of the epiphysis and diaphysis at the distal Phalynx of the middle finger .End of the pubertal growth. MP3 Stage (8) Union of the epiphysis and the diaphysis at the distal Phalynx of the middle finger. End of the pubertal growth RU Stage (30) Complete union of the diaphysis and epiphysis of the radius. Skeletal Growth is finished.

In female, menarche (Onset of Menstruation) usually Occurs between stages 4 and 5 Last Skeletal maturation Stage reached: Inference:

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MODEL ANALYSIS: Maxillary Number of teeth Mesio-distal Width Total Tooth Material Sum of incisors Proclination by direct method Crowding Spacing Rotation Arch Shape Arch Symmetry Midline Curve of Spee Palatal Depth Mandibular

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INDICES
1. PONTS INDEX: Dr.Pont, a French scientist in 1880 studied normal individual and derived following index. He found out that some co-relation exists between size of tooth and the arch width. It gives the width of arch in premolar and molar region in relation to the sum of incisal width. This analysis helps in: Determining whether the dental arch is narrow or normal Determining the need of lateral expansion Determining how much expansion is possible : =Sum of incisors X 100 80 = = Width in molar region : =Sum of Incisors X 100 64 = /64X 100 /80 X 100

Width in premolar region

Inference: Region Actual value(mm) Calculated value(mm) Difference (mm) Inference

4|4 6|6 If the measured value is less than the calculated value, then the archis contracted. If the measured value is more than the calculated value, then the arch is expanded.

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2. CHADDHAS INDEX:
In 1964 Dr. Chaddha modified Ponts index to suit Indian population.

Width in Premolar Region: = Sum of Incisors X 100 82.5 = = /82.5X100

Width in Molar Region: =Sum of incisors X 100 63.7 = = /63.5X100

Region 4|4 6|6

Actual value (mm)

Calculated value (mm)

Difference (mm)

Inference

Inference: If the measured value is less than the calculated value, then the arch is contracted. If the measured value is more than the calculated value, then the arch is expanded.

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3. NANCE & CAREYS INDEX: It helps in determining the extent of discrepancy between the arch perimeter & available bone. The arch perimeter is measured along a brass wire which is placed touching the mesial surface of first molar over the buccal cusps of premolar &incisal edges of anterior teeth on an ideal cast. If the teeth are Proclined, the brass wire is adapted in corrected position. If the teeth are Retroclined, the wire is adapted labial in corrected position. Wire should be adapted on crest of alveolar ridge. The formula to calculate linear dimension is: LD= LA + 2x; where o LD o LA o X o LD = = = = = LD measured by brass wire ---Linear dimension (by brass wire method)= Sum of Incisors = Mesiodistal dimension of any side 3, 4&5 = LA + 2X

Difference:
If the discrepancy between the arch length & tooth material is: 0-2.5mm 2.5-5mm >5mm =Minimal tooth material excess, thus non extraction case. = Second premolar extraction case. = First premolar extraction case.

By brass wire

Calculated LD

Difference

Inference

INFERENCE-

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4. Bolton Tooth Ratio


Ant. Ratio = MAND6TM 100 = MAX6TM Ant. Ratio = Overall Ratio = MAND12TM 100 = Max12TM Overall Ratio = Evaluation Chart for Bolton Analysis Anterior Ratio Posterior Ratio

Max 12

Mand12

Max 12

Mand12

Mand12

Mand6

40 40.5 41 41.5 42 42.5 43 43.5 44 44.5 45

30.9 31.3 31.7 32 32.4 32.8 38.2 33.6 34 34.4 34.7

45.5 46 46.5 47 47.5 48 48.5 49 49.5 50

35 35.5 35 36.3 36.7 37.4 37.4 37.8 38.2 38.5

50.5 51 51.5 52 52.5 53 63.5 54 54.5 35

38 30 39.8 40.1 40.5 43.8 41.3 41.7 42.1 42.5

Max 12

Mand12

Max 12

Mand12

Mand12

40Mand12

85 86 87 88 89 90 91 92 93

77.6 78.5 79.4 80.3 81.3 82.1 83.1 84 84.9

94 96 96 97 98 99

85.8 86.7 87.6 88.6 89.5 90.4

103 104 105 108 107 108 109 110

94 95 95.9 96.8 97.8 98.8 99.5 100.4

100 91.3 101 92.2 103 93.1

Interpretation for Bolton Analysis:

Overall Ratio --

Anterior Ratio

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4. ASHLEY HOWES INDEX Ashley had found a relationship between tooth width of twelve teeth anterior to second molar and width of dental arch in first premolar region. Canine fossa width The canine fossa is found distal to canine eminence. The measurement of the width from canine fossa to that of the other side gives the width of dental arch at the apical base. If the value is less than 37% then it indicates that there is need for the extraction If the value is in between 37% and 44% then it indicates the case is referred as border line case If the value is 44% or more, then it can be possible to treat without extraction

Ashley Howes Formula: =Canine fossa width 100 Total tooth material = =

Inference:

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Angles Classification Right Molar relationship Canine relationship


Incisors: Over jet: Open bite: Midline:Upper Arch: Lower Arch: Arch Form: Upper Arch: Lower Arch: Over bite: Cross bite: -

Left

Curve of Spee: Teeth Measurements:

UR 1 2 3 4 5 6 7 6Ant. TTM

UL

LR

LL

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SPACE ANALYSIS
MAXILLARY ARCH Space required
1. Proclination= 2 (X-2) = Where x ix proclination by direct method

2. Crowding Region Measured mesiodistal width Mesiodistal width available Total mesiodistal width Space required

3. Derotation of anteriors: -

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Space available
1. Spacing:

2. Derotation of posteriors: -

3. Expansion: -

4.Extraction: Mesio-distal width of 5/5 Anchor loss =

= mesiodistal width =

Space available by extraction = space required anchor loss = = Total space available is __mm, total space required is__mm Inference:

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MANDIBULAR ARCH Space required


1. Proclination= 2 (x) = Where x ix proclination by direct method

2. Crowding: -

3. Derotation of anteriors: -

4. Curve of spee:

Total Space required =

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Space available
1.Spacing: -

2. Derotation of posteriors: -

3. Expansion -

4. Extraction: of 5/5 Mesio-distal width of = =

Anchor loss = mesiodistal width =

Space available by extraction = space required anchor loss = =

Inference:

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Summary of space analysis


Correction of Maxillary arch Space required Crowding Proclination Spacing Curve of spee Extraction space Expansion Proximal stripping Space available Mandibular arch Space required Space available

Total

Inference:

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DOWNS ANALYSIS
One of the most frequently used Cephalometric analysis. Downs analysis consist of ten parameters of which five are skeletal & five are dental Variable Mean Value Range Measured value Inference

Skeletal

Facial angle Angle of convexity A-B plane angle Mandibular plane angle Y axis

Dental Cant of occlusal plane Lower incisor to occlusal plane Lower incisor to mandibular plane Interincisal angle

Upper incisor to Apog line

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STEINER ANALYSIS
Cecil C. Steiner developed analysis with idea of providing maximum information with least information. He divided into three parts skeletal analysis, dental analysis, and the soft tissue analysis Variable Mean Value Measured value Skeletal SNA angle SNB angle ANB angle Occlusal plane angle Mandibular plane angle Dental Upper incisor to NA angle Upper incisor to NA linear Lower incisor to NB angle Lower incisor to NB linear Interincisal angle Inference

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TWEED ANALYSIS
Tweeds analysis makes use of three planes that form an diagnostic triangle. The planes used are 1. Frankfort mandibular plane angle(FMPA) 2. Incisor mandibular plane angle(IMPA) 3. Frankfort mandibular incisor angle(FMIA) The objective of analysis is to include determination of position of lower incisor & evaluation of prognosis of case Variable Mean value Range Measured value Inference

Frankfort mandibular plane angle(FMPA)

Incisor mandibular plane angle(IMPA)

Frankfort mandibular incisor angle(FMIA)

THE WITS APPRIASAL It is the measure of the extent to which maxilla & mandible are related to each one in Sagittal plane AO to BO distance

Inference:

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CEPHALOMETRICSUMMARY
1) Skeletal: A) Vertical: Rotationof mandible Rotationofmaxilla Rotation of jaw base : Neutral : Normal : Divergent Horizontal Anteinclination Convergent Vertical Retroinclination Same Direction

UpwardIdownward. B) Sagittal: Maxilla Mandible : Orthognathic : Orthognathic Class I Retrognathic Retrognathic Class II Prognathic Prognathic Class III

Jawbasesrelationship : C)Transverse: 2) Dental Incisors Molars 3)SoftTissue: Nose : Lips : Upper Upper

Lower Lower

Chin : Profile:

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PROBLEM LIST
Skeletal:

Dento Alveolar:

Soft Tissue:

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DIAGNOSIS & TREATMENT PLAN

Diagnosis:

Probable Etiology:

Treatment Objectives:

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Provisional Treatment Plan:

Final Treatment Phase:

Alternate Treatment Plan:

Prognosis: