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ADITA AGGARWAL. 16/F
CASE PRESENTATION
By : Dr Anant JyotiPost Graduate student Dept. of Orthodontics
& Dentofacial Orthopaedics
PERSONAL DETAILSName: 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 : MotherCondition of Mother during Pregnancy :
Normal Delivery : Normal
POST-NATAL HISTORY:Feeding : Breast fed until 12 monthsMilestones 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.
CLINICAL EXAMINATION
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-75.9Mesocephalic = 76-80.9Brachycephalic = 81-x
BRACHYCEPHALIC
FACIAL FORMFacial Index : max. facial height = 104 = 75.3
% max. facial width 138
EURYPROSOPIC =X-83.9MESOPROSOPIC= 84-87.9LEPTOPROSOPIC =88-92.9HYPERLEPTOPROSOPIC=93-X
EURYPROSOPIC
FACIAL SYMMETRY
NO GROSS ASYMMETRY
FACIAL HEIGHTS
UPPER= 62 mm MIDDLE= 50 mm
LOWER= 64 mm
PROFILECONVEX
NASOLABIAL ANGLEACUTE
MENTOLABIAL SULCUSDEEP
FMALOW
MAXILLAPROGNATHIC
MANDIBLEORTHOGNATHIC
• 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 – Angle’s Class I
Left - Angle’s 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 EXAMINATIONPeri –Oral musculature : Normal Freeway space : 3.5 mm at premolar regionRespiration : Oro-nasal Speech : Normal Abnormal Habits : No abnormal habitsMax. mouth opening: 50 mmTMJ : No history of problems related to TMJ
CEPHALO METRIC ANALYSIS
COMPOSITE ANALYSIS
PARAMETERS NORMALVALUE
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)
7 10
SADDLE ANGLE (N-S-Ar)
123+/-5 129
ARTICULAR ANGLE (S-Ar-Go)
143+/-6 134
ANALYSIS OF FACIAL SKELETON
GONIAL ANGLE (Ar-Go-Me)
128+/-7 119
BJORK SUM 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 %
PARAMETERS NORMALVALUE
TRACING VALUES
ANALYSIS OF FACIAL SKELETON
ANALYSIS OF JAW BASESPARAMETERS NORMAL VALUE TRACING VALUES
MAXILLASNA (Steiner) 82+/-2 92(89)
Effective length (Cd- A) {Mcnamara} 93.6+/-3.2 100 mm
Maxillary base length(PNS- A ┴ on PP) 44 +/-5 mm
55.5 mm
N┴ - A┴(FH) {McNamara} 0.4+/-2.3 (F)1.1+/-2.7(M)
9.5 mm
Posterior Maxillary Position[ S ┴ (on PP) – PNS ]
18 mm 24.5 mm
Ratio of maxilla to cranial base (SN) 14:20 14.8:19.2
Angle of Inclination (Se-N’ ┴ on PP ) (Schwarz)
85 86
Mandible
SNB (Steiner) 80+/-2 85(82)
SND 76 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)
71 +/-5 mm 80 mm
Saddle Angle (N-S-Ar) 123 + 5 129
Pog ┴ to N ┴ (FH) -1.8+/-4.5(F)0.3+/-3.8(M)
6.5 mm
Ratio of mandible to cranial base (SN) 21:20 21.6 : 19.4
Ramus height : Mandibular base 5:7 5.2:6.8
PARAMETERS NORMAL VALUE TRACING VALUES
ANALYSIS OF JAW BASES
PARAMETERS NORMAL VALUE TRACING VALUES
MAXILLO-MANDIBULAR RELN
ANB (Riedel) 2+/-2 7
Wits Appraisal -1 mm (M) 0 mm(F)
2.0 mm
A ┴ B ┴ (FH) 4 mm 3.5 mm
Maxillo – mandibular Differential(McNamara)
29.2+/- 3.3
18 mm
Facial Convexity (N-A-Pog)(Down)
-8 to 10 13
Maxillary base: Mandibular base 2:3 2: 3.
VERTICAL SKELETALJarabak ration (PFH/AFH) 62-65% 74.8 %
SN- [Go-Gn] (Steiner) 32 18(15)
FMA 25 13.5
Y – axis (N-S-Gn) 59.7 50(53)
Basal Plane Angle (PP-(Go-Me)) 25 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
U1- SN
NORMAL VALUE
102 +/- 2
TRACING VALUES
115(112)
U1- PP 110 + 5 120
U1- FH 107 + 5 125
U1-NA 22 23
U1-NA 4 mm 2.5 mm
U1-(A-Pog) +2 to - 4mm 7 mm
IMPA 90 103
L1-NB 25 28
L1-NB 4 mm 6.0 mm
L1-(A-Pog)(Rickett)
1+/-2 mm 1.5 mm
INTERINCISAL ANGLE 131 +/- 5 121
Steiner’s Stick Correction
7
23
28 6
Upper incisor inclination correction = 6 x .8 = 4.8 mm reqired
Lower Incisor inclination correction = 2. x .8 = 1.6 mm space available.
2.5
ANALYSIS OF DENTOALVEOLAR
RELATIONSHIP
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
PARAMETERS NORMAL VALUE
TRACING VALUES
SOFT TISSUE ANALYSISPARAMETERS NORMAL VALUE TRACING
VALUES
SOFT TISSUE FACIAL ANGLE 91+/-7 97.5
FACIAL CONVEXITY [(G-Sn) - Pog’]
12+/-4 12
NASOLABIAL ANGLE ( Legan-Burstone)a. Columella tangent to postural horizontalb. upper lip tangent to postural horizontal
102+/-4 25
85
85 30 55
NOSE PROMINENCE 14-24 mm 9 mm
BASIC UPPER LIP THICKNESS 15 mm 12 mm
UPPER LIP STRAIN 13 -14 mm 15 mm
SUPERIOR SULCUS DEPTH 1-4 mm 5.5 mm
H ANGLE 7 -15 21
SOFT TISSUE ANALYSISINTRLABIAL GAP(Stms-Stmi)
2+/-2 mm 1 mm
Mentolabial sulcus (Si-(Li-Pog) 4+/-2mm 7 mm
E-LINE (Rickett) A.UPPER LIP B.LOWER LIP
-2 to -4 mm-1 to –2 mm
-1 mm1.5 mm
S-LINE (Steiner) A.UPPER LIP B. LOWER LIP
0 mm0 mm
2 mm 3.5 mm
LIP PROMINENCE (Legan & Burstone)A.Upper Lip [Ls-(Sn-Pog’)]B.Lower Lip [Li-(Sn-Pog’)]
3+/-1 mm2+/-1 mm
5.5 mm 5.5 mm
SOFT TISSUE CHIN THICKNESS 10-12 mm 12.5 mm
SOFT TISSUE ANALYSISPARAMETERS NORMAL
VALUETRACING VALUES
Length of upper lip (Burstone)
20 mm (F) 18 mm
Length of lower lip (Burstone)
40-46.5 (F) 47 mm
Ratio b/w Upper and Lower lip length
1 : 2.1 .9 : 2.2
Incisor show at Rest 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 RELATIONClass 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
MODEL ANALYSIS
CAREY’S / ARCH PERIMETER ANALYSIS
Upper Lower
Total tooth material 75 mm 67 mm
Arch perimeter 74 mm 60 mm
Discrepancy 1 mm arch length deficient
7 mm arch length deficient
BOLTON’S ANALYSIS Sum of maxillary 12 = 96 mmSum of mandibular 12 = 90 mmSum of maxillary 6 = 48 mmSum 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
Anterior Ratio = Sum of mand. 6 x 100 Sum of max. 6 = 38 x 100 = 79.2% ( 77.2%) 48
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)
BOLTON’S ANALYSIS
SPACE ANALYSISSPACE AVAILABLE UPPER LOWER
Available space in arch
Unerupted tooth space 7.0 mm -
Derotation of posteriors - -
Proclination of anteriors - 1.6 mm
Distalisation of molar _ -
Total space available 7.0 mm 1.6 mm
SPACE ANALYSISSPACE REQUIREMENT
UPPER LOWER
Retraction of anteriors 4.8 mm -
Alignment 8.0 mm 1.0 mm
Correction of curve of Spee
- 2.0 mm
Correction of molar relation
- 4.0 mm
Space for prosthesis -
Total space required 12.8 mm 7.0 mm
SPACE ANALYSISSpace Discrepency = Space available – Space
required
UPPER = 5.8 mm space requiredLOWER = 5.4 mm space required
ORTHODONTIC DIAGNOSIS
Skeletal Class II with convex profile and
tendency towards horizontal growth pattern,
dental Angle’s 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 LISTHighly and labially placed teeth wrt. 23.Proclined maxillary incisorsOverbiteOverjetCanine relation in left sideMolar relation in left side.Midline.
TREATMENT OBJECTIVES
Alignment of maxillary and mandibular anteriors.
To correct canine relationTo correct molar relationTo correct overbiteTo correct overjetTo correct midline
TREATMENT PLANFixed mechanotherapy Moderate anchorage case Unilateral extraction wrt. 44Leveling and aligning:
Correction of rotations. Correction of curve of spee Correction of midline.
Retention
Minimum retention in maxillary and moderate retention in mandibular arch.