Date post: | 24-Dec-2015 |
Category: |
Documents |
Upload: | abdallah-essam-al-zireeni |
View: | 30 times |
Download: | 0 times |
Case presentation
Done by:
Hanady Al Masri
Abdallah Al Zireeni
Mohammad Elwir
Yahya Al Omari
Patient Name: Mohammad Baker Al Bdor
Age: 14 years old
Gender: male
Occupation: student
Chief complaint: the patient present to the clinic
complaining about appearance of his teeth “crowding
mainly” .
Medical history: patient denied any relevant
medical problem.
Dental history: previous fillings and extractions .
Social history and habits: nothing is relevant .
Extra oral examination
Frontal view
• Facial proportions :
Normal facial symmetry
• Vertical proportion: increased LFH
• Competent lips
Profile view
• profile : is convex
• Nasolabial angle: average 90°-100°
• both upper and lower lips are behind the E-line
• Frankfort mandibular plane angle is avarege
Smile view
• smile line : high smile line
• upper coincident midline with 2mm right shifted midline in the lower jaw.
Intra oral Examination
Intra oral examination
Soft tissue: mildly inflamed
Oral hygiene: poor and he needs several restorations
Teeth present: 14 teeth in the upper jaw & 14 teeth in the lower jaw
Maxillary arch
• Moderate crowding “ 5mm”
• Supernumerary adjacent to left lateral : non
• fillings or extractions : class І restoration on upper right 6
Mandibular arch
• crowding : moderate “5mm”
• present teeth : 14 tooth
• fillings or extractions : lower left 6 filling
Frontal view
Class І incisor relationship
Overbite: average
Overjet: increased
Upper midline coincident, with the lower being shifted by 2mm to the right.
Right buccal view
• ¼ unit Class II Canine
• Class І Molar
Left buccal view
• Class I Canine
• class III Molar by ¼ unit
Study Models
Space analysis on the upper cast
• Space available:
• 73mm
• space required:
• 78 mm
• There is deficiency of 5mm
Space analysis on the lower cast
• Space available:
• 71mm
• Space required:
• 75mm
• There is deficiency of 4 mm
• Ant. bolton : 76.2%
• average (77.2 % ±1.3%)
OPG x-ray
• present teeth : full upper and lower set of teeth
• bucco version impacted lower left third molar
Cephalometric analysis normal value variable
82±3 79 SNA
79±3 77 SNB
3±1 2 ANB
8±3 10 SN to maxillary plane
108±5 109 Upper incisor to maxillary plane
92±5 89 Lower incisor to mandibular plane
-1 - 1 -1 Wit's
133±10 131 Inter incisor angle
27±5 30 Maxillary mandibular planes angle
130mm Total facial height
7mm Lower facial height
50-55% 54% Lower facial height ratio
0-2 -3 Lower incisor to A-pog
Within 1 mm
-1 Lower lip to E plane
86±3 84 S-N-Pog
Diagnosis :
• Class І incisal relation based on class І skeletal relation complicated with ;
1. Increased over jet.
2. Moderate crowding in the upper arch .
3. Moderate crowding in the lower arch.
4. Bucco-distal Rotation of upper right lateral incisor.
5. Bucco-distal Rotation of lower right lateral incisor.
6. Class ІІІ molar relation in the left side by ¼ unit .
7. Class ІІ canine relation in the right side by ¼ unit .
8. shifting of the lower midline by 2mm to the right side .
Treatment plan Our aim of treatment is :
1- Oral hygiene and patient motivation .
2- Restore the present carious liaisons .
3- Maintain class I incisor relationship
4- Alignment of upper and lower teeth by reliving crowding
5- derotate the upper and lower right lateral incisors .
6- Correcting lower shifted midline .
7- Achieve class І molars and canines relation .
8- reducing over jet .
Treatment plan suggestion
This case needs:
1- applying fixed appliance for upper and lower teeth .
2-Interproximal stripping of upper and lower incisors to gain space .
3-proclination of upper and lower incisors to gain space needed .
4- de rotation of upper and lower right lateral incisors .
5- class ІІІ elastics for the left side .
Other treatment options : Extraction of all 5’s to gain space , and then use fixed appliance to realign the teeth . But this option is not preferable because : 1- both upper and lower lips are behind E-line (the patient lips lakes for fullness),and extraction will give the required space but also will place the incisors in retroclined position so this will give us dished in appearance of the face. 2- the patient has high smile line and the retrolclination of the incisor will shown this gum smile more which is unaesthetic.
Retention
• Upper arch: Fixed retainer
• Lower arch: Fixed retainer
• circumferential fiberotomy for the upper and lower right lateral incisors .
Thank you