Case presentation

PATIENTS NAME : KINZA KHURSHID

PRESENTED BY :
HADIA DURRANI
FATIMA- TU -ZAHRA
SYEDA UME RUBAB

CONTENTS

Case history
Clinical Examination
extra-oral
intra-oral

Photographs
extra-oral
intra-oral

Cast analysis
Radiographs
orthopantomogram (OPG)
lateral cephalogram

Problem list
Diagnosis
Treatment planning

HISTORY

HISTORY TAKING
BIODATA : Patients name : Kinza Khurshid
Patients age : 16
Fathers name : Khurshid Anwar
Address : Qalandrabad
Chief complaint : face asymmetric
Social status : Good
Motivation : patient motivated by parents

EXAMINATION

EXTRA-ORAL EXAMINATION
Face type : Dolichofacial
Facial symmetry : Asymmetric , deviated

towards right
Facial form : leptroprosopic

 Facial profile : Straight/orthognathic

 Lips thickness : average seal : incompetent

Nose : medium
Chin : deviated towards right
Upper dental :1mm shifted to right
to facial midline
Incisor stomion : 1mm
Path of closure : deviated

INTRA-ORAL EXAMINATION
Oral hygiene : Fair
Gingival health : Gingivitis
Periodontal status (gingival display): no

gingival display
Labial frenum : Normal
Palate : Deep
Tongue : Normal
Dentition : Permanent
Supernumerary teeth : Upper left 3

PHOTOGRAPHS

Extra oral photographs

Frontal profile with lips closed

Frontal profile with lips relaxed

Frontal profile smiling

Three quarter profile smiling

Lateral profile

Intra oral photographs

Frontal intra oral view

Right buccal view

Left buccal view

Upper occlusal view

Lower occlusal view

CAST ANALYSIS

MAXILLARY ARCH
Arch form : V-shaped
Arch symmetry : Asymmetric
Dentition : Permanent
Palate : Deep
Teeth present : 7654321 12334567
Space available : 71
Space required : 78.5
TSALD : -7.5mm
Inter-arch findings:
Left central incisor mesio-palatally rotated
Left lateral incisor palatally displaced
Supernumerary tooth bucally displaced
Left canine bucally displaced

MANDIBULAR ARCH

Arch form : V-shaped

Arch symmetry : Asymmetric
Dentition : permanent
Teeth present : 7654321 1234567
Space available : 63
Space required : 68
TSALD : -5mm
Inter-arch findings:
central incisors overlapped
lateral incisors lingually displaced
Canines buccally displaced

CAST IN OCCLUSION
INCISOR RELATIONSHIP

Class I

MOLAR RELATIONSHIP
Right side : Class I

Left side : Class I

CUSPID RELATIONSHIP
Right side : Class II
II

Left side : Class

OVERJET:

2mm

OVERBITE :
33% (2mm)

DENTAL MIDLINE RELATIONSHIP

lower dental midline 6mm deviated to right

BOLTON ANALYSIS
OVERALL BOLTON :-

Normal = 91.5
Overall Bolton =sum of mandibular 12 x 100
sum of maxillary 12
= 90 x 100
98
=91 which is normal
mandibular tooth material is relative to maxillary
tooth material

ANTERIOR BOLTON :Normal value : 77.2

Anterior Bolton = sum of mandibular 6 x 100
sum of maxillary 6
= 38 x 100
49
= 77.5 which is normal i-e
mandibular and maxillary anterior teeth
material is
relative to each other.

RADIOGRAPHS

ORTHOPANTOMOGRAPH
OPG findings
Supernumerary teeth : upper left 3
Peridontium : bone resorption in upper and lower
anterior region
Un-erupted upper
third molars

Identification of supernumerary
tooth
We have considered upper left bucally placed
second tooth as supernumerary on the basis of :
Clinical examination
Form of the tooth
Gingival health
Position of the tooth in the arch
Radiographs
Periodontal status
Root position

CEPHALOGRAM
Land marks lines and
planes

COMPOSITE ANALYSIS
There are four components of Composite
analysis : Sagittal analysis
Vertical analysis
Dental analysis
Soft tissue analysis

SAGITTAL ANALYSIS
< SNA = 80
<SNB = 78
<ANB = 2
Wits = 1mm
Point A to N =7mm
Pog to N = 8mm
Facial angle = 92

INTERPRETATION
SKELETAL COMPONENT
Sagittal analysis :
skeletal class I

VERTICAL ANALYSIS
<Go-Gn-SN= 39
FMA = 22
<Y- axis = 59
PFH/AFH = 62%
LAFH/AFH = 53%

INTERPRETATION
Vertical analysis :
normal vertical angle

DENTAL ANALYSIS
UI-NA distance : 2mm
angle : 11
LI-NB distance : 6mm
angle : 30
Inter-incisor angle = 130
UI-SN = 98
IMPA = 95

INTERPRETATION
Dental Analysis :
Slightly retroclined upper incisors
Slightly lower incisors proclined

SOFT TISSUE ANALYSIS

E-line: Upper lip = -2mm
Lower lip = +1mm
S-line :Upper lip = 1mm
Lower lip = 3mm
Z-angle = 70
Hold-away ratio= 2.5 : 1
Nasio-labial angle = 106

INTERPRETATION
Lower lip protrusive

PROBLEM LIST

PROBLEM LIST
Facial asymmetry
Supernumerary tooth upper left 3
Crowding upper and lower anterior
Slightly retroclined upper incisors
Slightly proclined lower incisors
Lower dental midline deviated towards right
Left central incisor mesio-palatally rotated
Left lateral incisor palatally displaced
Supernumerary tooth bucally displaced
Left canine bucally displaced
Central incisors overlapped
Lateral incisors lingually displaced
Canines buccally displaced

DIAGNOSIS
Skeletal class I with anterior upper and lower

arch
crowding due to anterior arch discrepancy.

TREATMENT PLANNING

Treatment objectives
Esthetic :
Correction of facial asymmetry
Alignment and leveling of teeth

Treatment planning
Extraction of supernumerary upper left bucally

placed second tooth

Space gain through extraction 4

4
4 4
Alignment of crowded upper and lower anterior
teeth

METHODS
Removable orthodontics
Fixed orthodontics