By : Dr Anant Jyoti Post Graduate student Dept. of Orthodontics & Dentofacial Orthopaedics
PERSONAL DETAILS
Name: Adita Aggarwal Age/Sex: 16/F Date of Birth: 8th of August ,
1996.
OPD No.: 140880 Diet: Vegeterian
PERSONAL DETAILS
Postal Address: Mongli Garden, Rampur
Road, Haldwani.
Father's Name: Mr. Sanjay Aggarwal
Occupation: Housewife
CHIEF COMPLAINT:
Highly erupting tooth in left upper front tooth region and forwardly placed upper front teeth
PRE-NATAL HISTORY:
Informer : Mother Condition of Mother during Pregnancy : Normal Delivery : Normal
POST-NATAL HISTORY:
Feeding : Breast fed until 12 months Milestones of Development : Normal
MEDICAL HISTORY:
Nothing significant reported.
FAMILY HISTORY:
No familial history of malocclusion or any orthodontic treatment.
DENTAL HISTORY:
Undergone extraction of retained deciduous tooth wrt.63 ,
5 days back.
A. PHYSICAL STATUS
CEPHALIC INDEX = Max. skull width = 155 = 83.7% Max. skull length 185 Dolicocephalic = x-75.9 Mesocephalic = 76-80.9 Brachycephalic = 81-x
BRACHYCEPHALIC
FACIAL FORM Facial Index : max. facial height = 104 = 75.3 % max. facial width 138
EURYPROSOPIC =X-83.9
MESOPROSOPIC= 84-87.9 LEPTOPROSOPIC =88-92.9
HYPERLEPTOPROSOPIC=93-X
EURYPROSOPIC
FACIAL SYMMETRY
NO GROSS ASYMMETRY
FACIAL HEIGHTS
UPPER= 62 mm MIDDLE= 50 mm LOWER= 64 mm
PROFILE
CONVEX
NASOLABIAL ANGLE
ACUTE
MENTOLABIAL SULCUS
DEEP
FMA
LOW
MAXILLA
PROGNATHIC
MANDIBLE
ORTHOGNATHIC
Lips:
Competency: competent
Upper Lip length: 18 mm Lower Lip length: 40 mm
Incisal Exposure at Postural Rest
position : 0 mm
EXTRA-ORAL PHOTOGRAPHS
17 16 15 14 13 12 11 21 22 23 24 25 26 27 47 46 45 44 43 42 41 31 32 33 34 35 36 37 Midline : Upper : Coincident Lower : To Upper - Shifted to left by 2.5 mm To Facial shifted to left by 2.5 mm .
Frenal Attachment Upper/Lower : Normal Overjet : 4mm Overbite : 5 mm, 75% coverage.
Arch Form :
Upper : Ovoid
Lower : Ovoid
Highly and labially placed teeth wrt.23. Rotations Distolingual wrt. 32 and 34
FUNCTIONAL EXAMINATION
Peri Oral musculature : Normal Freeway space : 3.5 mm at premolar region Respiration : Oro-nasal Speech : Normal Abnormal Habits : No abnormal habits Max. mouth opening: 50 mm TMJ : No history of problems related to TMJ
71+/-3 mm
72 mm
32 +/- 3 mm
36 mm
10
123+/-5
129
143+/-6
134
128+/-7
119
396+/-6
382
52-55
57
70-75
62
114 mm
103 mm
74 mm
77 mm
62% 65%
74.8 %
MAXILLA
SNA (Steiner) 82+/-2 92(89)
93.6+/-3.2
100 mm
44 +/-5 mm
55.5 mm
N - A(FH) {McNamara}
9.5 mm
Posterior Maxillary Position [ S (on PP) PNS ] Ratio of maxilla to cranial base (SN)
24.5 mm
14:20
14.8:19.2
85
86
82-95
94.5
120.2+/- 5.3
118 mm
71 +/-5 mm
80 mm
129 6.5 mm
21.6 : 19.4
5:7
5.2:6.8
PARAMETERS
NORMAL VALUE
TRACING VALUES
MAXILLO-MANDIBULAR RELN
ANB (Riedel) Wits Appraisal A B (FH) Maxillo mandibular Differential (McNamara) Facial Convexity (N-A-Pog) (Down) Maxillary base: Mandibular base 2+/-2 -1 mm (M) 0 mm(F) 4 mm 29.2+/- 3.3 -8 to 10 2:3 7
2.0 mm 3.5 mm 18 mm 13 2: 3.
VERTICAL SKELETAL
Jarabak ration (PFH/AFH) SN- [Go-Gn] (Steiner) FMA Y axis (N-S-Gn) Basal Plane Angle (PP-(Go-Me)) 62-65% 32 25 59.7 25 74.8 % 18(15) 13.5 50(53) 14
UPPER PHARYNX
15-20 mm
15 mm
LOWER PHARYNX
11-14 mm
10 mm
U1- SN U1- PP U1- FH U1-NA U1-NA U1-(A-Pog) IMPA L1-NB L1-NB L1-(A-Pog) (Rickett) INTERINCISAL ANGLE
131 +/- 5
121
7 23 28 6 2.5
VERTICAL
U1-NF( to NF) 27.5+/-1.7(F) 24 mm
L1-MP(toNF)
40.8+/-1.8(F)
35 mm
U6-NF(to NF)
23.1+/-1.3(F)
19.5 mm
L6-MP(to MP)
32.1+/-1.9(F)
37mm
91+/-7
12+/-4
97.5
12 85
102+/-4 25
85 14-24 mm
30 55 9 mm
15 mm
13 -14 mm 1-4 mm
12 mm
15 mm 5.5 mm
H ANGLE
7 -15
21
-2 to -4 mm -1 to 2 mm
0 mm 0 mm
-1 mm 1.5 mm
2 mm 3.5 mm
20 mm (F)
18 mm
Length of lower lip (Burstone) Ratio b/w Upper and Lower lip length Incisor show at Rest
40-46.5 (F)
47 mm
1 : 2.1
.9 : 2.2
2mm 3mm .
1 mm
CEPHALOMETRIC INFERENCE
MAXILLA Prognathic suggested by readings of SNA of 92 degrees, Effective Maxillary base length of 100 mm and maxillary base length of 55.5 mm.
MANDIBLE
Prognathic mandible suggested by SNB of 85 degrees , mandibular base length of 80 mm and Ratio of mandible to cranial base is 21.6:19.4.
MAXILLO-MANDIBULAR RELATION Class IIPattern suggested by ANB of 7 degrees, Wits Appraisal of 2.0 mm,and Facial convexity of 13 degrees .
VERTICAL SKELETAL RELATIONSHIP Horizontal growth pattern as suggested by Jarabak ratio , FMA and Y Axis. DENTOALVEOLAR RELATION Proclined maxillary and mandibular incisors suggested by all the readings. SOFT TISSUE RELATIONSHIPS
Convex profile with acute nasolabial angle,decreased upper lip thickness, protrusive upper
and lower lips and increased lower lip length
CEPHALOMETRIC INFERENCE:
towards horizontal growth pattern, proclined maxillary incisor along with acute nasolabial angle, decreased upper lip thickness, protrusive upper and lower lips and increased lower lip length.
PANOROMIC VIEW
Discrepancy
BOLTONS ANALYSIS
Sum of maxillary 12 = 96 mm Sum of mandibular 12 = 90 mm Sum of maxillary 6 = 48 mm Sum of mandibular 6 = 38 mm Total Tooth Ratio (TTR) = sum of mand. 12 x 100 sum of max. 12 = 90 x 100 = 93.75 % (91.3%) 96
= 2.4 mm excess
BOLTONS ANALYSIS
Anterior Ratio = Sum of mand. 6 x 100 Sum of max. 6 = 38 x 100 48 = 79.2% ( 77.2%)
Amount of anterior mandibular excess = Sum of Mand. 6 Sum of Max. 6 x 77.2 100 = 38 37 mm = 1 mm excess.
INFERENCE
In this patient TTR value is 93.75 %, indicating Mandibular tooth material excess. (Amount of total tooth material excess is 2.4 mm) In this patient Anterior tooth ratio is 79.2 %, hence indicating Mandibular anterior tooth material excess. (Amount of anterior tooth material excess is 1mm)
SPACE ANALYSIS
SPACE AVAILABLE Available space in arch Unerupted tooth space Derotation of posteriors Proclination of anteriors Distalisation of molar Total space available UPPER LOWER
7.0 mm _
1.6 mm -
7.0 mm
1.6 mm
SPACE ANALYSIS
SPACE REQUIREMENT Retraction of anteriors Alignment Correction of curve of Spee Correction of molar relation UPPER LOWER
7.0 mm
SPACE ANALYSIS
Space Discrepency = Space available Space required UPPER = 5.8 mm space required LOWER = 5.4 mm space required
ORTHODONTIC DIAGNOSIS
Skeletal Class II with convex profile and tendency
towards horizontal growth pattern, dental Angles Class II Subdivision of left side malocclusion with
PROBLEM LIST
Highly and labially placed teeth wrt. 23.
TREATMENT OBJECTIVES
Alignment of maxillary and mandibular anteriors.
To correct canine relation To correct molar relation
To correct overbite
To correct overjet To correct midline
TREATMENT PLAN
Fixed mechanotherapy Moderate anchorage case Unilateral extraction wrt. 44
Correction of midline.