Case Presentation of Orthodontic Treatment

By: Mohammed Saleh Al-Mershed

Patient Data:

Patient Name: S.S.RFile Number: 5526

Age: 24 years.Gender: Male.Address: Buraidah – Al-Eskan.Marital Status: Married.Occupation: Student.

Nationality: Saudi.

Chief of Complaint:• I have crowding in the

lower teeth.

Medical History:• Previous surgical treatment of

Hernia (4 years ago)

• Tonsillectomy (18 years ago)

Past Dental History:•Regular attending: Yes. •Brushing: yes (Twice a daily). •Flossing: No. •Trauma: No.•Habits: No.

Family History:• No History.

Extraoral Examination:• Body Morphology :

• Built ……. Average• Height ……. Average

• Frontal view :• Face shape ……. Oval • Overall height ……. Average• Symmetry …….. Symmetric

• Lateral view :• Profile …… Straight • Chin …… Average• Nose ……. Average

• Lateral view • Upper face …… Average • Lower face ……. Average• Jaw Angle …… Average

• Lateral view:• Nasolabial angle …… Average • Labiomental fold …… Average

Functional Status:

• Lip:– Competent Lip.

• Lip contour …… Average • Incisor display ….. Average

• Swallow …. Average • Breathing …. Nasal • Speech …. Average

• Displaced Occlusion: No• TMJ: Normal• Lymph Nodes: Normal

Intraoral Examination:• Soft Tissue:

• Oral Hygiene : Fair.• Gingival condition : Healthy.• Frenum: Average.• Tonsils: Excised.• Tongue size: Average.• Tongue position: Average.

• Hard Tissue:– Permanent Dentition:

• Carious Teeth: 36, 46, 47, 16, 26, 27• Restored: 37• Missing: No

Right Side:• Canine relationship = Class 1

• Molar relation = class I

Left Side:• Canine relationship = Class 1

• Molar relation = class I

Overbite (Vertical Overlap)

• Overbite = 3 mm

Overjet (Sagittal Realshonship)

• Overjet = 3 mm

Model Analysis

Model Analysis:• Models Related by: Static maximum

intercuspation.• Dentition Stage: Permanent teeth• Teeth present and missing: All teeth are

present.

• Midline Diastema: 0 mm.

• Crossbites: No.• Curve of Spee: Normal.

1 MM

Mandibular Occlusal Maxillary Occlusal

U shape Oval Arch Form

symmetry symmetry Symmetry

31,32,43 MB No Rotations

No No Abnormal Teeth Position

No Fracture 16,26 Morphology, Wear, Fracture

19 mm 37 mm Canine Width

46 mm 50 mm Molar Width

Normal Normal Incisor Inclination

Space Analysis:Left Front Right Lower

25 23 25 Space Available

25 26 25 Space Required

0 -3 0 Discrepancy

Left Front Right Upper

22 36 23 Space Available

22 36 22 Space Required

0 0 1 Discrepancy

Molar Width:

Upper: From central fossa to the other central fossa. Lower: From mesio-buccal cusp to mesio-buccal cusp.

Lower Upper

19 mm 37 mm Canine Width

46 mm 50 mm Molar Width

Radiographic Examination

OPG• To assess the patient’s dental age based on the development

and progress of mineralization of the teeth, eruption time and exfoliation of the primary teeth.

• To evaluate present teeth, missing congenitally or impacted, ectopic eruption, malpositioned teeth….etc

• To determine the level of alveolar bone, the interdental crest, bone resorption, infrabony pockets, trabecular pattern wide marrow space or narrow trabecular spaces.

• To note the presence of any pathological lesions

Hand and Wrist Radiographs

• Predicting the pattern of growth, that is the amount, direction, duration, location and timing of the onset of pubertal growth, is important for the orthodontist when planning therapy and coordinating orthodontic treatment with the vital growth process.

Cephalometric• Uses:

– Classify the type of the face. – Show the relationship between the basal

parts of the maxilla and the mandible. – Evaluate the soft tissue profile. – Evaluate the position of the incisors in

relation to the basal parts and the soft tissue profile.

– To make a growth prediction.– Monitoring the progress of treatment. – Detecting for any abnormalities or

pathology

Sagittal RelationshipReading Norm

prognathic Max 91 82 ± 2 SNA

prognathic Mand 84 80 ± 2 SNB

Class || skeletal 7 2 ± 2 ANB

3.5 2 Adj. ANB

Class || skeletal 3 mm -2-0 Wits

Protrusive of chin 84 81 SNPog

121 130 ± 5 NSBa

Jaw InclinationReading Norm

Slight Anterior Rotation 30 32 Man.-SN

Slight Anterior Rotation 7 8 Max.-SN

Deep Bite 20 25 Max.-Man

15 10 ± 4 Max.-Occl

Increased Jaw Angle 132 126 Me-tgo-Ar

Face HightReading Norm

Increased or Decreased Upper Facial Height

40 mm N-SP’ mm

Increased or Decreased Lower Facial Height

56 mm SP’-Gn mm

Increased Lower Facial Height

71,4 79 FI

Increased Lower Facial Height

58.3 55 FP %

Tooth PositionReading Norm

Slight Increase Over Jet(Dental Class ||)

3 2 Over Jet

Slight Increase Over Bite

(Deep Bite)

3 2 Over Bite

Bimax Retroclination of Inter-incisal Angle

119 131 ┴ - ┬

Proclination 24 22 ┴ - NA

Proclination 119 108 ┴ - Max

Slight Retroclination 34

┴ - NA mm

Tooth Position

Reading Norm

Proclination 2825 NB- ┬

Proclination 9490 ┬ - Man

Proclination 84

NB - ┬ mm

72 ┬ - APog

Soft TissueReading Norm

Slight Protrusive of upper lip

-1-2

UL- EL mm

Normal lower lip 00

LL- EL mm

Normal 00

LL- HL mm

Normal Nasio-Labial angle 9290-100

Nasio-Labial

Treatment Needs:• There is crowding in the lower

anterior teeth, so the patient need more space to achieve the normal position for lower anterior.

Treatment Plane– Scaling, polishing and oral hygien instructions.– Restorative treatment:

• Carious teeth (36, 46, 47, 16, 26, 27)• Endodontic treatment (16, 26)

– Interproximal reduction for the lower anterior teeth by disking (Removal of a small amount of enamel typically 0.1 to 0.4mm)

– Follow up.

• There are 3 methods to reduce teeth interproximally:

• Abrasive Strips • Abrasive Discs • Air Rotor Stripping

• Remove up to 50% of expected enamel thickness • Start with teeth that have the thickest enamel • Sequentially strip contact points, posterior to anterior • Direct vision wherever possible • Finish with polishing strips or discs • Apply fluoride

• Abrasive Strips:– Use for anterior teeth – Use for minor tooth reduction

• Abrasive Discs:– Usually for anterior teeth – Removes more enamel than

stripping – Must finish with abrasive strips – Risk of cutting lip and gingiva – Risk excessive enamel reduction – Risk of abnormal contacts or ledges

Air Rotor Stripping – Lateral Approach:

• Place 0.020” brass indicator wire under contact point protects the interdental tissues Finishing

• Polish with carbide finishing burs, finishing diamonds, polishing discs, or hand-held finishing strips

Air Rotor Stripping – Occlusal Approach

• Occlusal approach w/ customized carbide bur

• Shoulder form allows bur to rest on mesial and distal marginal ridges.

• Avoids lowering the contact.• Stays parallel to long axis of tooth.• Reduced cutting efficiency.• Ultrafine diamond version available

commercially.

Instructions:• Must maintain good oral hygiene • Regular checkups