Diagnosis

This paper describes the case of 19 year old Tania who became easily angered and resentful since
two years ago. She also suffers from an ache in her left jaw.
Upon closer inspection, her intraoral examination revealed scissor bite occlusion relation at
region 1 and 4, and cross bite occlusion at region 2 and 3. Values obtained from her cephalogram
revealed that she had a dental class III and skeletal class II relationship, and her maxilla and
mandible were protruded. The anterior posterior radiograph showed that her mandible
experienced horizontal deviation.
The diagnosis is dentoskeletal malocclusion, accompanied by temporomandibular joint disorder
and physiological stress. This caused her jaw to experience horizontal asymmetry. This in turn
causes a temporomandibular joint disorder, characterized by pain in the joint. The condition also
caused Tania to be self-conscious about the poor esthetic condition of her face, causing
physiological stress.

Skeletal (steiner)

mean

Patient value

interpretation

SNA

82

92

Protrusive maxilla

SNB

80

98

Protrusive mandible

ANB

Class II skeletal
malocclusion

Cephalometric analysis. Table 1 shows maxillary and mandibular protrusion. The ANB angle
was 5 suggesting a class II skeletal malocclusion. The skeletal problem was due to a combination
of maxillary and mandibular pronagthism.

Figure 1: Protrusive maxilla and mandible with Class 2 skeletal malocclusion

Dental (angles )

Ideal

Patient value

Interpretation

First molar

Class I- MB cusp of
maxillary M1 on MB
groove of mandibular
M1

Mb cusp of maxillary
M1 distal to MB
groove of mandibular
M1

Class III dental

malocclusion

Dental analysis. Table 2 shows class III dental malocclusion

Figure 2: Mb cusp of maxillary M1 distal to MB groove of mandibular M1, showing class III
dental malocclusion

Figure 3: Posterior Cross bite where the upper molars are inclined or positioned inward more
than the lower molars, and posterior scissor bite where the upper molars are positioned outward
or the lower molars are positioned inward

Figure 4: Horizontal jaw asymmetry, characterized when the lower jaw body is longer on one
side; so therefore, the chin obviously moved toward the shorter side. Horizontal asymmetry
usually develops when the growth of one side of the lower jaw is accelerated. The upper dental
arch is often normal and may not be affected by the position and shape of the lower arch.