Orthodontic case

presentation
 Personal Data
• Patient’s Name: Tayyaba Mustafa
• Father’s Name: Syed Ghulam Mustafa
• Gender: Female
• Age : 21 years
• Address: Abbottabad
 Chief Complaint
“Pain in gum area around the canines”
History
 Medical & Dental History
Medical History:
• Denied any relevant medical history.

Dental History:
• Previous visit to dentist: No
• Brushing habits: Fair
• Tooth sensitivity: No
• H/O previous cavities/ toothaches: No
• H/O trauma: No
 Social & Behavioral Status
• Habits:
Nail biting
• Motivation:
Internally Motivated.
• Social Status:
Financially Sound

No family history for malocclusion

Examination
Extra-Oral Photos:
(Frontal View)
Extra-Oral Photos:
(Anterioposterior
View)
A. Anterio-posterior Assessment:

Facial Profile
• Orthognathic
• Hypodivergent
:B. Vertical Assessment
• Decreased LAFH.

C. Transverse
Assessment:
• Symmetrical face.
 Soft Tissue
Assessment

• Competent lips

• Nasolabial angle: 94˚

“ normal 90˚ -110˚”
Intra-Oral Photo
 Intra-Oral Examination

• Oral Hygiene :
Poor
• Gingival Health :
Gingivitis
• Teeth present:
765431 134567
7654321 1234567
• Dentition:
Permanent dentition
• Supernumerary teeth:
Not present

• No other defects
 Lower arch
• U-shaped arch.
• Anterior segment:
 Both lateral incisors are
retroclined
• Posterior segment:
 No defects
 No carious tooth
 Upper arch
• U-shaped arch.
• Deep palate.
• Anterior segment:.
 Retroclined central incisors
 Missing laterals.
• Posterior segment:
 No carious tooth
Cast analysis
 Anterioposterior:
Right Left

• Molar : Class III • Molar : Class III

• Canine : Class II. • Canine : Class II.
 Transverse:

No midline discrepancy.
 Curve of spee
Right Left

4mm 3mm
Tooth Size Arch Length
Discrepancy(TSALD)
• Mandible
Space available-Space required
53.5mm-58mm
=-4.5mm (Crowding)

• Maxilla
Space available-Space required
58.5mm-65.5mm
=-7mm
 Radiographical examination

Orthopantomogram “OPG” Analysis :

• Permanent Dentition
• All teeth are present except upper lateral incisors.
• Third molars are erupting; lower right third molar is
mesioangular.
• No pathology.
• Other features look normal.
Cephalometric Analysis
Sagittal Analysis
Parameters Patient’s Normal
Values Values
SNA 81ᴼ 82 ±2⁰

SNB 79ᴼ 80⁰ ± 2⁰

ANB 2ᴼ 2⁰ ± 2⁰

Point A to N‫ו‬ 0mm 2±2mm

Pog to N| 4mm -3±4mm

Wits appraisal -3mm 0 / -1mm

Facial angle 93ᴼ 87⁰ ± 4⁰

Skeletal Class I
Vertical Analysis
Parameters Patient’s Normal
Values Values
<G0-Gn to SN 24ᴼ 32⁰ ± 4⁰

FMA 22ᴼ 25º±4º

< Y-axis 53ᴼ 60º±4º

PFH/AFH 73.2% 65% ± 4%

LAFH/AFH 50.9% 54⁰% ± 4⁰%

Hypodivergent
Dental Analysis
Parameters Patient’s Normal
Values Values
UI-NA: 4mm 4mm
distance 20ᴼ 22ᴼ
angle
LI-NB: 2mm 4mm
Distance 20ᴼ 25ᵒ
angle
Interincisal 135ᴼ 133ᵒ
angle
UI-SN 97ᴼ 102ᵒ±5ᵒ

IMPA 94ᴼ 90± 4ᵒ

Bimaxillary Retroclination
Soft Tissue Analysis
Parameters Patient’s Normal
Values Values
E-line: LS -4mm -3±2
LI -6mm -2±2
S-line: LS -1mm 0±2
LI -4mm 0±2
Z angle 82ᴼ 78± 5º
Nasiolabial 95ᴼ 102±8ᵒᵒ
angle

Retrusive Lower lip

 Diagnostic summary
• My patient, Tayyaba,21 years old, female, denied any
medical problem, presented with the chief complaint of
pain in her gums around the lower canines. She has
maxillary retroclination based on class I skeletal pattern,
short lower anterior facial height and retrusive lower lip.
• She has over jet 0.5mm, overbite 3mm, crowding inboth
arches, missing upper lateral incisors and a bilateral
posterior lingual crossbite.
• She has cl lll molar relationship in Rt and Lt side, cl II
canine relationship in both sides and a cl ll incisal
relationship.
 Problems list
Patient’s concern: Dental problems:
Pain in the gums
• Missing upper lateral incisors.
Skeletal problems: • Bimaxillary Retroclincation
• Molars are cl III on both sides.
Hypodivergent
• Canines are in cl II relationship on
Soft tissue problems: both sides.
• Incisors are also in cl II relationship.
Retrusive lower lip
  Treatment plan:
1. Leveling and alignment
2. Extraction
4 4
3. Hyrax expansion
4. Finish all relationships in class I
5. Reshaping
Thank you
Made by:
Gul Rukh Rehman
Parkha
Shaista
(Final year BDS)