CASE PRESENTATION

ADITA AGGARWAL. 16/F

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: Business man

Mother's Name: Mrs. kamna Aggarwal

Occupation: Housewife

CHIEF COMPLAINT:
Highly erupting tooth in left upper front tooth region and forwardly placed upper front teeth

MOTIVATION AND EXPECTATIONS:

Externally motivated. Reasons for taking Orthodontic Treatment: Aesthetics

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.

GROWTH STATUS: Completion (Stage VI)

DENTAL HISTORY:
Undergone extraction of retained deciduous tooth wrt.63 ,

5 days back.

A. PHYSICAL STATUS

Body Build Type: Plethoric Height : 5ft 2 inches Weight : 52 kg

B. EXTRA ORAL EXAMINATION

HEAD FORM

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

INTRA ORAL EXAMINATION

Teeth Present:

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.

Inter Arch Relation

Canine Right Class I

Left Cant be assessed

Molar - Right Angles Class I

Left - Angles Class II Curve of spee 1.5 mm+1.5mm/2 +0.5 = 2 mm

 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

ANALYSIS OF FACIAL SKELETON

PARAMETERS NORMAL VALUE TRACING VALUES

ANTERIOR CRANIAL BASE LENGTH (N-Se)

71+/-3 mm

72 mm

POSTERIOR CRANIAL BASE LENGTH (S-Ar)

32 +/- 3 mm

36 mm

ORIENTATION ANGLE (SN-FH) SADDLE ANGLE (N-S-Ar)

10

123+/-5

129

ARTICULAR ANGLE (S-Ar-Go)

143+/-6

134

ANALYSIS OF FACIAL SKELETON

PARAMETERS NORMAL VALUE TRACING VALUES

GONIAL ANGLE (Ar-Go-Me) BJORK SUM

128+/-7

119

396+/-6

382

UPPER GONIAL ANGLE (Ar-Go-N)

52-55

57

LOWER GONIAL ANGLE (N-Go-Me)

70-75

62

ANTERIOR FACIAL HEIGHT (N-Me)

114 mm

103 mm

POSTERIOR FACIAL HEIGHT (S-Go)

74 mm

77 mm

JARABAK RATIO ( PFH/AFH )

62% 65%

74.8 %

ANALYSIS OF JAW BASES

PARAMETERS NORMAL VALUE TRACING VALUES

MAXILLA
SNA (Steiner) 82+/-2 92(89)

Effective length (Cd- A) {Mcnamara}

Maxillary base length (PNS- A on PP)

93.6+/-3.2

100 mm

44 +/-5 mm

55.5 mm

N - A(FH) {McNamara}

0.4+/-2.3 (F) 1.1+/-2.7(M)

18 mm

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

Angle of Inclination (Se-N on PP ) (Schwarz)

85

86

ANALYSIS OF JAW BASES

PARAMETERS NORMAL VALUE TRACING VALUES Mandible SNB (Steiner) SND 80+/-2 76 85(82) 81(78)

Facial Angle [(N-Pog)-FH]

82-95

94.5

Effective Length (Cd-Gn)

120.2+/- 5.3

118 mm

Mandibular base length (Go-Pg) Saddle Angle (N-S-Ar) Pog to N (FH)

71 +/-5 mm

80 mm

123 + 5 -1.8+/-4.5(F) 0.3+/-3.8(M) 21:20

129 6.5 mm

Ratio of mandible to cranial base (SN)

21.6 : 19.4

Ramus height : Mandibular base

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

AIRWAY ANALYSIS (McNAMARA)

PARAMETERS NORMAL VALUE TRACING VALUES

UPPER PHARYNX

15-20 mm

15 mm

LOWER PHARYNX

11-14 mm

10 mm

ANALYSIS OF DENTOALVEOLAR RELATIONSHIP

PARAMETERS NORMAL VALUE TRACING VALUES 115(112) 120 125 23 2.5 mm 7 mm 103 28 6.0 mm 1.5 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

102 +/- 2 110 + 5 107 + 5 22 4 mm +2 to - 4mm 90 25 4 mm 1+/-2 mm

131 +/- 5

121

Steiners Stick Correction

7 23 28 6 2.5

Upper incisor inclination correction = 6 x .8 = 4.8 mm reqired

Lower Incisor inclination correction = 2. x .8 = 1.6 mm space available.

ANALYSIS OF DENTOALVEOLAR RELATIONSHIP

PARAMETERS NORMAL VALUE TRACING VALUES

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

SOFT TISSUE ANALYSIS

PARAMETERS NORMAL VALUE TRACING VALUES

SOFT TISSUE FACIAL ANGLE

FACIAL CONVEXITY [(G-Sn) - Pog] NASOLABIAL ANGLE ( Legan-Burstone) a. Columella tangent to postural horizontal b. upper lip tangent to postural horizontal NOSE PROMINENCE

91+/-7
12+/-4

97.5
12 85

102+/-4 25
85 14-24 mm

30 55 9 mm

BASIC UPPER LIP THICKNESS

UPPER LIP STRAIN SUPERIOR SULCUS DEPTH

15 mm
13 -14 mm 1-4 mm

12 mm
15 mm 5.5 mm

H ANGLE

7 -15

21

SOFT TISSUE ANALYSIS

INTRLABIAL GAP (Stms-Stmi) Mentolabial sulcus (Si-(Li-Pog) E-LINE (Rickett) A.UPPER LIP B.LOWER LIP S-LINE (Steiner) A.UPPER LIP B. LOWER LIP LIP PROMINENCE (Legan & Burstone) A.Upper Lip [Ls-(Sn-Pog)] B.Lower Lip [Li-(Sn-Pog)] SOFT TISSUE CHIN THICKNESS 2+/-2 mm 1 mm 4+/-2mm 7 mm

-2 to -4 mm -1 to 2 mm
0 mm 0 mm

-1 mm 1.5 mm
2 mm 3.5 mm

3+/-1 mm 2+/-1 mm 10-12 mm

5.5 mm 5.5 mm 12.5 mm

SOFT TISSUE ANALYSIS

PARAMETERS NORMAL VALUE TRACING VALUES

Length of upper lip (Burstone)

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:

Skeletal Class II accompanied with tendancy

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

CAREYS / ARCH PERIMETER ANALYSIS

Upper Total tooth material Arch perimeter 75 mm 74 mm Lower 67 mm 60 mm

Discrepancy

1 mm arch length deficient

7 mm arch length deficient

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

Mandibular Excess = Sum of mand.. 12 teeth Max. 12 x 91.3 100

= 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

4.8 mm 8.0 mm 12.8 mm

1.0 mm 2.0 mm 4.0 mm

Space for prosthesis

Total space required

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

highly and labially erupting tooth wrt.23, proclined

maxillary incisors along with acute nasolabial angle, decreased upper lip thickness, protrusive upper and lower lips and increased lower lip length.

PROBLEM LIST
Highly and labially placed teeth wrt. 23.

Proclined maxillary incisors

Overbite Overjet

Canine relation in left side

Molar relation in left side. Midline.

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

Leveling and aligning:

Correction of rotations. Correction of curve of spee

Correction of midline.

Retention Minimum retention in maxillary and moderate retention in mandibular arch.