CASE PRESENTATION

• NAME: Mohammed Muzamil

• SEX : Male

• AGE : 24 years
• ADDRESS: #21, 1st main, Kasturinagar,
Bangalore.
 CHIEF COMPLAINT : Complains of unequal teeth.
 PRENATAL HISTORY : NRH
 POSTNATAL HISTORY : NRH
 CHILDHOOD DISEASES : NRH
 HABITS : NRH
 FAMILIAL MALOCCLUSION HISTORY : patient’s
sister has forwardly placed and taking treatment in
our college.
 GENERAL HISTORY

 REASONS FOR TAKING TREATMENT : Esthetics

 PATIENT’S CONCERN FOR ORTHODONTIC

TREATMENT : Irregularly placed teeth

 ATTITUDE OF THE PATIENT TOWARDS

ORTHODONTIC TREATMENT :
Positive
PHYSICAL STATUS
 Height : 5’9”

 Weight : 65 kg

 BMI : 21.2( normal)

 Gait : Normal

 Posture : Erect

 Body type : Mesomorphic

 EXTRAORAL EXAMINATION

FRONTAL VIEW
 Cephalic Index – Mesocephalic

 Facial Index – Mesoproscopic

 Lip Posture and Tonicity - potentially

Competent lips
 Facial Symmetry – No gross facial

asymmetry.
 Skeletal midline : coinciding

 Philtrum height – 20 mm

 Commissure height – 23mm

 Difference: 3 mm
70 mm

58mm

20mm

68mm
Rule of Fifths
 PROFILE VIEW

 PROFILE -Straight
 FACIAL DIVERGENCE: Straight
 SIZE OF NOSE –47mm
 SIZE OF THE CHIN – 26 mm
 NASOLABIAL ANGLE – Average
 MENTOLABIAL SULCUS – shallow
 CLINICAL FMPA - Increased
 SMILE ASSESMENT
 AMOUNT OF INCISOR EXPOSURE:
 During rest : 0 mm
 During Smile : 6mm
 Gingival exposure : 0

 BUCCAL CORRIDOR : Average

 SMILE ARC : Non consonant
OBLIQUE
VIEW
 FUNCTIONAL EXAMINATION

 RESPIRATION : Nasal
 MASTICATION : NAD
 DEGLUTITION : Mature swallow
 SPEECH : NAD
 PERIORAL MUSCLE ACTIVITY : NAD
 TMJ : mandible shifts to left side during closing.
INTRAORAL EXAMINATION
SOFT TISSUES :
• Oral Hygiene status: Satisfactory

• Gingiva : NAD
• Oral Mucosa : Normal

• Brushing habit : Twice daily

• Frenal Attachment : Mucogingival
 HARD TISSUES
 Teeth present :
8 7 6 5 4 32 1 1 2 3 4 5 6 7 8
8 7 65 4 3 2 1 1 2 D3 4 5 78
 22 crossbite
 MAXILLARY ARCH
 Shape : U shaped
 Arch Symmetry :

Symmetric
 Palatal Contour : Normal

Arch alignment :
 Palatally placed 22
 MANDIBULAR ARCH

 Shape : U shaped
 Arch Symmetry :
Symmetric
 Arch alignment:
Lingually placed 33
Retained 73
 RELATION OF MAXILLA TO MANDIBLE
 Maximum Opening : 46 mm
 Freeway Space : 3 mm
 Curve of Spee : Right 2mm Left 2mm

ANTERO-POSTERIOR RELATIONSHIP
Molar relation : Right – ClassI
Left – class I
Canine Relation : Right – class I, Left – not established
Incisor Relation : Class I

Overjet - 3 mm

VERTICAL RELATIONSHIP : - Overbite –3 mm

Lower midline shifted to left by 2mm

 Lateral
Cephalogram
OPG
 Skeletal – Sagittal
Measurements Normal Pretreatment Inference
SNA 82o 71 maxilla positioned
posterior irt anterior
cranial base
SNB 80o 74 mandible positioned
posterior in relation to
anterior cranial base
ANB 2o 3 Class I skeletal base
Yen angle 117-123o 126 Class III skeletal base
Beta angle class 1 : 27 - 35o 42 Class III skeletal base
class 2 : more acute
class 3 ; more obtuse
WITS 1mm BO is >AO by 3 mm Class III skeletal base
Saddle angle 123o +/- 5 135 Posteriorly positioned
smaller : facial prognathism glenoid fossa
larger: facial retrognathism

Articular angle 143o +/- 6 138 Normally positioned mandible

Gonial angle 130 +/- 7 120 Forward mandibular

growth pattern
Upper 52o – 55o 48 Horizontal growth
pattern
Lower 72o – 75o 72 Average growth pattern

Bjork(G+A+S) 396±6º 393 Average growth pattern

N perp Point A 0 +/- 2 mm -11mm maxilla positioned
posteriorly irt to anterior
cranial base
N perp POG 0 to- 4 mm --20mm mandible positioned
posteriorly anterior cranial
base
Effective length of maxilla(co- 98.9 +/- 4.4 82 large maxillo mandibular
pt A) 126+/- 4.7 115 differential.
Effective length of mandible
Small - 20-23mm
Differential Med- 27-30mm 33mm
Large - 30-33mm
Skeletal – Vertical
Measurements Normal Pretreatment Inference
Facial axis 0o 2 Horizontal growth pattern

Y – axis( Sn –gn / Fh) 59.4o( 53o – 66o ) 63 Average growth pattern

MPA( Go-Me/FH) 18-28 23 Average growth pattern

SN – GO - GN 32o 26 Horizontal growth pattern

JARABAK RATIO 62%– 65% 68% Hypodivergent growth

pattern
Occlusal-plane / MP 14o 15 Horizontal growth pattern

Basal plane angle 25o 16 Horizontal growth pattern

Inclination angle 80o – 85o 78 Downward and backward

inclination of palatal plane

LAFH 59-60 mm 71 Increased vertical height

Dental Alveolar Analysis
Measurements Normal Pretreatment Inference
Inter incisal angle 135o 117 Severely proclined incisors
UI - SN 102o 110 Severely proclined maxillary incisors
UI - NA 22o , 4 mm 38,12 mm Severely proclined and forwardly
placed maxillary incisors
UI – A POG 25o , 4 mm 32,10 mm Severely proclined and forwardly
placed maxillary incisors
UI – N POG 2 mm 8 mm Forwardly placed maxillary incisors
UI – PALATAL PLANE 110 122 Severely proclined incisors
U1 – NF M-30.5 -/+ 2.1 29mm Normal anterior maxillary dental
F-27.5 -/+ 1.7 height
U6 – NF M-26.2 +/- 2 25mm Normal posterior maxillary dental
F-23 +/- 1.3 height
IMPA 90o 97 Mandibular incisors are proclined
on basal bone

L1 - NB 25o , 4 mm 25, 6 mm Mandibular incisors are in line

and slightly forwardly placed on
basal bone

L1 – A POG 22o , 4 mm 27, 4mm Mandibular incisors are proclined

and positioned on basal bone

L1 – N POG - 2 to 2mm 4mm Mandibular incisors positioned

forwardly on basal bone

L1-FH 65o 56 Proclined mandibular incisors

 Soft tissue analysis
Normal Obtained Inference

E line Upper lip -4 mm -2mm Procumbent upper lip

Lower lip -2 mm 0 mm Procumbent lower lip

S line Upper lip 0 mm 2mm Procumbent upper lip

Lower lip 0 mm 2mm Procumbent lower lip

Nasolabial Angle 90 – 110 101 Average

Z angle 80o+/- 9 65 Procumbent lower lip

position
H line angle 7 to 15 15 Average chin position

Lip thickness 12mm Upper lip strain of 6mm

Lip strain 6mm present
 Schwarz analysis:
Measurements Mean(mm) Actual(mm) Inference

Extent of anterior 75.4 71 Short

cranial base

Extent of ascending 62 68 Long

ramus

Extent of maxillary 55.1 45 Short

base

Extent of mandibular 84 75 Short

base
 1. Max : Mand [2 : 3] = 1.8 : 3.2

2. SN : Max [20 : 14] = 20.8: 13.2

3. SN : Mand [20 : 21] = 19.9: 21.1

Discrepancy 4. Ramus : Corpus [ 5 : 7] = 5.7: 6.3

Analysis
5. Mid face : Lower face [45 : 55] = 42.8: 57.2

6. Ideal size of Mandible = SN X 1.05 = 74.5

Size Discrepancy = Size – Corpus = 0.5 larger

7. Ideal size of Maxilla = SN X 1.05 X 2/3 = 49.6

Size Discrepancy = Size – Max size = 4.6 shorter
 TOOTH MEASUREMENTS:-

6 5 4 3 2 1 1 2 3 4 5 6 ANT 6 TM TOTAL 12 TM

UPPER 10 6 7 8 7 9 9 7 8 7 7 9.5 48 93.5

LOWER 11 7 7 7 6 6 6 6 7 7 7 10.5 42.5 97

(5.5)
 BOLTONS ANALYSIS

 ANTERIOR TOOTH RATIO : Man 6TMx100 / Max 6 TM =

79.1%
mandibular anterior tooth material excess by 1mm

 OVERALL TOOTH RATIO : Man 12 TM x 100 /Max 12 TM=

93.6%
mandibular tooth material excess by 2.2 mm
 ASHLEY HOWE’S ANALYSIS :-

Premolar Basal Arch Premolar Total tooth material Inference

Width(PMBAW) Distance(PMD) (TTM) (Expansion/No
Expansion)
UPPER 40 40 93.5 No expansion

LOWER 34 32 87.5 Expansion

PMBAW% :
 Upper :- 42.7% [Borderline]
 Lower :- 38.8% [Borderline]
CAREY’S / ARCH PERIMETER ANALYSIS

TOOTH ARCH DIFFERENCE INFERENCE

MATERIAL PERIMETER

UPPER 75mm 74mm 1mm Proximal

stripping

LOWER 66 mm 61mm 5mm Extraction of

2nd premolar
 Space Analysis
Space Required: Upper arch Lower arch
• Correction of molar R L R L
position 0 0 0 0
• Crowding
0 1 1.5
• Retraction
4 4 2 2
• Curve of Spee
0 0 0 0
• Midline
2 0 0 0
Total space required
11 5.5
Space Available:
R L R L
• Present spaces
0 1.5 0 0
• De-rotations
0 0 0 0
• Extractions 1st premolar
7 7 7 7
2nd premolar
6 7 7 7
 Diagnosis
Dentoalveolar Angle’s Class I malocclusion with upper and
lower anterior crowding and 22 cross bite in an adult patient
on a Class III skeletal base with a horizontal growth pattern.
 Problem list
Skeletal : class III skeletal base
Dental:
 Upper and lower crowding
 22 crossbite
 Retained 73
 Lingually placed 33
 Midline shift

Soft Tissue:
 Treatment objectives
 Maintaining skeletal base relationship
 Correction of Upper and lower crowding
 Correction of 22 crossbite
 Correction of lingually placed 33
 Midline correction
 Treatment Plan
 Considering the soft tissue profile of the patient, nasolabial angle,
lip thickness, lip strain, upper and lower anterior crowding, non
extraction line of treatment plan will be considered .
 Extraction of retained deciduous canine will be considered
 Mechanotherapy will be intiated using Pre-Adjusted Edgewise
appliance with 0.022 MBT slot.
 Posterior bite plane will be given and 22 crossbite will be corrected.
 Lower proximal stripping will be considered to correct lingually
placed 33
 Correction of axial inclinations will be done and occlusion will be
finished in Angle’s Class I molar relation.
 Anchorage
 Group A anchorage in upper arch
 Group A anchorage in lower arch
 Retention phase

 Upper - Begg’s wrap around retainer with permanent fixed

anterior retention.
 lower – Begg’s wrap around retainer with permanent fixed
anterior retention.