CLINICAL CASE SEMINAR

Osama Gamil
Personal data
• Patient name : Toaa Ahmed

• Age : 14

• Gender: female

• Occupation: Student

• Social behavior: Good

Chief complaint
• One of my front teeth is positioned inward.
Medical history

• Free
Past dental history

• Free
Clinical Examination
 Extra-oral photographs

Frontal non smile

• Facial type: Ovale

• Facial asymmetry: normal

• No lip seal

• Dry , cracked lower lip (mouth

breather)
 Extra-oral photographs

Frontal Smile
• 100% Incisor display on smiling

• Upper midline not coincident

with the FCL
Midline
Upper midline not coincident

with the FCL

Midline
Upper midline not coincident

with the FCL

 Extra-oral photographs

Profile
• Profile

• Nasolabial angle
 Extra-oral photographs

Profile
• Profile

• Nasolabial angle
Profile
Convex
Nasolabial angle
110 degree
Intra-oral photograph

Unfair
oral
hygiene
 In occlusion

• O J: 2 mm
• O B: 10 %
• X bite: 22
 In occlusion

• ML:
• UPPER: Not Coincident with CFL
• LOWER: Not Coincident with CFL
• U & L: Coincident
 Right buccal occlusion

• Molar class I

• Canine class I
 Left buccal occlusion

• Molar class I

• Canine class II
 Maxillary dentition

• Arch form: Ovoid, Asymmetric

 Mandibular dentition

• Arch form: Ovoid, Asymmetric

 Recommended for:
Referral for:
 Periodontal care
 Restoration of carious 16 26 36 & 46
Model analysis
Model analysis

• Overjet: 2 mm
• Overbite : 10-15%
Model analysis

• Canine relation :
• Right side: Class I
• Left side: Class II
• Molar relation:
• Right side: Class I
• Left side: Class I
• Curve of Spee:
• Slight curve
 Model analysis

Carey’s analysis

• Upper arch= 3 mm
* Space available: 68 mm * Space Required: 71 mm
(Moderate crowding)
• Lower arch = 3 mm
* Space available: 76 mm * Space Required: 79 mm
(Moderate crowding)
 Model analysis

Bolton’s Ratio

• Overall ratio= 93.07 %

• Anterior ratio= 79.17 %

Radiographic
assessment
Panorama
Lateral Cephalometry
Lateral Cephalometry
 SNA 82 82 (+/-3)
SNB 77 79 (+/-3)

ANB 5 3 (+/-2)

S-N-Pg 77 80 (+/-4)
Measurements
Facial angle 86 87 (+/-3)
Angle of convexity 8 4 (+/-4)
Skeletal

Gonial angle 126 124 (+/-5)

Cranial base angle 136 132 (+/-5)

SN to Mand.plane 36 32 (+/-5)

Sn to Pl. plane 15 9 (+/-3)

Pl. to Mand. Plane 20 23 (+/-4)

FH to Mand Plane 27 25 (+/-3)

Y axis to FH 61 61 (+/-4)
S-Go/N-Me % 64 66% (+/-5)
ANS-Me/N-Me% 58 57% (+/-3)

WITS appraisal 1 -1mm

 1 to T 111 127 (+/-8)

T to Mand.Pl 105 95
Measurements
(+/-5)
T to FHP 58 59
(+/-4)
Dental

T to NB angle 39 27 (+/-4)

T to NB mm 7 6mm (+/-2)

1 to NA angle 26 24(+/-5)

1 to NA mm 3 5mm (+/-2)

1 to FHP 118 112

(+/-6)
Measurements
Soft Tissue

Naso-labial
angle 100 (90-110)
E- line to
upper lip -1 -4 (+/-2)
E-line to
lower lip -2 (+/-2)
2
 Skeletal
Skeletal class Class I
Growth pattern Normal Growth pattern
Angle of the mandible Normal

Dental
Upper incisor Proclined
Lower incisor Proclined

Soft tissue
Profile Convex
Nasolabial angle Normal
Lower lip increased
Upper lip increased
 Problem list
Skeletal Dental Soft tissue
Skeletal Cl. I • Crossbite of upper left • Increased upper and
lateral incisor. lower lip
• Cl II canine relation on the
left side.

•Rotation of left 4 & right 5

Treatment objectives
Skeletal Dental Soft tissue
• Correction of Upper • Increased upper
lateral Crossbite and lower lip

• Correction of Cl II
canine relation

• Correction of
Rotation at left 4 &
right 5

Aim of Treatment
 Suggested treatment plan
• Fixed Appliance

• Non-extraction case

• Interproximal Stripping

• Open coil for opening space for upper lateral incisor

Thank You