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Case Presentation of
Orthodontic Treatment
By: Mohammed Saleh Al-Mershed
Patient Data:
Patient Name: S.S.R
File 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.
Maxillary Occlusal
Mandibular Occlusal
Arch Form
Oval
U shape
Symmetry
symmetry
symmetry
Rotations
No
31,32,43 MB
Abnormal Teeth Position
No
No
Morphology, Wear,
Fracture
Fracture 16,26
No
Canine Width
37 mm
19 mm
Molar Width
50 mm
46 mm
Incisor Inclination
Normal
Normal
Space Analysis:
Lower
Right
Front
Left
Space Available
25
23
25
Space Required
25
26
25
Discrepancy
0
-3
0
Upper
Right
Front
Left
Space Available
23
36
22
Space Required
22
36
22
Discrepancy
1
0
0
Molar Width:
Upper: From central fossa to the other central fossa.
Lower: From mesio-buccal cusp to mesio-buccal
cusp.
Upper
Lower
Canine Width
37 mm
19 mm
Molar Width
50 mm
46 mm
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
Norm
Reading
SNA
82 ± 2
91
prognathic Max
SNB
80 ± 2
84
prognathic Mand
ANB
2±2
7
Class || skeletal
Adj. ANB
2
3.5
Wits
-2-0
3 mm
Class || skeletal
SNPog
81
84
Protrusive of chin
NSBa
130 ± 5
121
Norm
Reading
Man.-SN
32
30
Slight Anterior Rotation
Max.-SN
8
7
Slight Anterior Rotation
Max.-Man
25
20
Deep Bite
Max.-Occl
10 ± 4
15
Me-tgo-Ar
126
132
Increased Jaw Angle
Norm
Reading
N-SP’ mm
40 mm
Increased or Decreased Upper
Facial Height
SP’-Gn mm
56 mm
Increased or Decreased Lower
Facial Height
FI
79
71,4
Increased Lower Facial Height
FP %
55
58.3
Increased Lower Facial Height
Norm
Reading
Over Jet
2
3
Slight Increase Over Jet
(Dental Class ||)
Over Bite
2
3
Slight Increase Over Bite
(Deep Bite)
┬-┴
131
119
Bimax Retroclination of
Inter-incisal Angle
┴ - NA
22
24
Proclination
┴ - Max
108
119
Proclination
┴ - NA mm
4
3
Slight Retroclination
Norm
NB- ┬
┬ - Man
NB - ┬ mm
┬ - APog
25
90
4
2
Reading
28
Proclination
94
Proclination
8
Proclination
7
Norm
UL- EL mm
LL- EL mm
LL- HL mm
NasioLabial
-2
0
0
90-100
Reading
-1
Slight Protrusive of upper lip
0
Normal lower lip
0
Normal
92
Normal Nasio-Labial angle
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