Download THE INTERNATIONAL ASSOCIATION FOR ORTHODONTICS

THE INTERNATIONAL ASSOCIATION
FOR ORTHODONTICS
PRESENTS
THE INTERNATIONAL BOARD OF ORTHODONTICS
BOARD PRESENTATION NOTEBOOK
TEMPLATE
IBO TEMPLATE SECTION
 SECTION ONE: THE TITLE PAGE
 SECTION TWO: TABLE OF CONTENTS
 SECTION THREE: RESUME OF CASE
 SECTION FOUR: CASE REPORT
 SECTION FIVE: DIAGNOSIS
 SECTION SIX: TREATMENT OBJECTIVES
 SECTION SEVEN: TREATMENT PLAN
 SECTION EIGHT: SUMMARY OF TREATMENT OBJECTIVES
 SECTION NINE: SUMARY OF TREATMENT
 SECTION TEN: FACIAL AND INTRA-ORAL IMAGING
 SECTION ELEVEN: CEPHALOMETRIC X-RAYS AND TRACINGS
 SECTION TWELVE: CEPHALOMETRIC ANALYSIS
 SECTION THIRTEEN: CEPHALOMETRIC SUPERIMPOSITIONS
 SECTION FOURTEEN: TREATMENT HISTORY
IBO I.D: BR548
Patient Number: JJ83-103
IBO CASE I.D. JJ 83-103
AGE; 12 years, 3 months
June 17, 1983
THE FUNCTIONAL AND FIXED ORTHODONTIC
TREATMENT OF THIS CLASS II DIVISION 2
PATIENT IS PRESENTED IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS OF
THE INTERNATIONAL BOARD OF
ORTHODONTICS
DOCTOR I.D. CODE: BR548
IBO I.D: BR548
Patient Number: JJ83-103
TABLE OF CONTENTS
 Resume of Case
1
 Case Report
2-4
 Diagnosis
5-6
 Treatment Objectives
7
 Treatment Plan
8-9
 Summary of Treatment Objectives
10
 Summary of Treatment
11
 Facial and Intra-oral Imaging
12
 Cephalometric X-rays with Tracing
13
 Cephalometric Analysis
14
 Cephalometric Super Impositions
15
 Treatment History
16
IBO I.D: BR548
Patient Number: JJ83-103
RESUME OF THE CASE
 Patient I.D. – BR548
 Patient ID: JJ83-103
 Age: years, months: 7 years, 5 months
 Pre-treatment imaging – panoramic x-ray, cephalometric x-ray, full mouth xrays, occlusal film, tomogram x-rays, transcranial x-rays, etc.
 Pre-treatment Display Models
 Diagnosis: Dental Class II, division 2, Mid-Mixed Dentition, Vertical Growth
Tendency, Deficient Mid-Face Growth, Compromised Nasopharyngeal Airway
 Treatment: Phase I - Functional/Orthopedic Appliances with interim
stabilization
 Treatment start date Phase I: January 3, 1984
 In Treatment imaging: panoramic x-ray, cephalometric x-ray, full mouth x-rays,
occlusal film, tomogram x-rays, transcranial x-rays, Models etc.
 Treatment Phase II – Fixed Appliances using ControlledArch® Straight Wire
Tecnique
 Treatment start date Phase II: October 3, 1984
 In Treatment imaging: panoramic x-ray, cephalometric x-ray, full mouth x-rays,
occlusal film, tomogram x-rays, transcranial x-rays, models etc.
 Post treatment imaging: panoramic x-ray, cephalometric x-ray, full mouth xrays, occlusal film, tomogram x-rays, transcranial x-rays, etc.
IBO I.D: BR548
Patient Number: JJ83-103
 Post treatment Display Models
 Treatment finish date: June26, 1986
 Post treatment imaging plus 2 years: panoramic x-ray, cephalometric x-ray, full
mouth x-rays, occlusal film, tomogram x-rays, transcranial x-rays, etc.
 Post treatment Display Models 2 years
 Active treatment time 1 years, 6 months
IBO I.D: BR548
Patient Number: JJ83-103
CASE REPORT
(an example)
MEDICAL HISTORY:
DENTAL HISTORY:
CLINICAL EVALUATIONS:
Functional Evaluation:
Soft Tissue Evaluation:
 Facial Type – dolichocephalic, mesocephalic, brachycephic.
 Facial Asymmetry
 Profile – straight, convex, concave.
 Nose – acceptable, large, small.
 Nasolabial angle – open, closed, aesthetic.
 Lips – shape, position, competency.
 Smile line – high, low, normal.
 Gingival Display – deficient, acceptable, moderate excessive.
 Tonsilar and Adenoidal tissue.
 Mentolabial sulcus – Evaluation of mentolabial crease.
 Chin – acceptable, small, large.
 Other – additional information.
IBO I.D: BR548
Patient Number: JJ83-103
Skeletal Evaluation:
 Maxilla – orthognathic, retrognatic, prognatic, other.
 Mandible - orthognathic, retrognatic, prognatic, growth direction.
 Facial Height
 Palate – size, shape, depth.
 Genetic
 Radiographic findings
 Chin
 Skeletal midlines
 Skeletal Bits.
Dental Evaluation:
 Dental Classification
 Midlines
 Overbite/overjet
 Open bites – anterior, posterior.
 Closed bites
 Cross bites – anterior, posterior.
 Model analysis
IBO I.D: BR548
Patient Number: JJ83-103
 Arch shapes
 Arch length
 Caries Index - # of restorations, hygiene, etc.
 Radiographic findings - # or restorations, missing teeth, supernumerary
teeth, impacted teeth, mesiodens, etc. impacted teeth, mesiodens, etc.
Special Considerations: This area is to add in any extraordinary circumstances that
may effect the case as a whole.
IBO I.D: BR548
Patient Number: JJ83-103
DIAGNOSIS
(an example)
An Example: In evaluation soft tissues in this individual face we see a
mesocephalic facial type with what appears to be a longer than average face
(backed up with an upper/lower anterior facial height measurement of 42 percent
to 58 percent respecively and a steeper mandibular plane than average).
The nasolabial angle is obtuse and the submental goove (sublabial sulcus) is
deeper than average. The pt is lacking lip seal secondary to a CII, division one
dental and skeletal relationship anterior to posterior and mouth breathing. Tonsils
do not appear to be a causative factor at this time but were recently removed.
Consequently, the mandible is trapped up and under the narrower than average
maxillary arch. The palate is deeper than average adding to the trapping of the
mandible and lack of correct tongue function.
This case may be diagnosed as a CII, div 1 skeleton and dentition with an
80% overbite and a 4 mm overjet. Function appears not to be abnormal except for
a faulty swallowing pattern (anterior tongue thrust) secondary to a possible past
airway problem. As the mandible is trapped up and back the patient should benefit
with our usual CII, div 1 treatment to develop the maxilla and release the mandible
for normal growth and development.
IBO I.D: BR548
Patient Number: JJ83-103
The periodontium looks healthy except for some gingival recession evident
on all four canines. This situation will be watched and these teeth will not be
bracketed until later on in treatment. The patient admits to no TMJ/TMD signs or
symptoms and his mandibular opening and lateral excursions are within normal
limits. Our usual tmd muscle palpation was negative both in relationship to
function and pain.
IBO I.D: BR548
Patient Number: JJ83-103
TREATMENT OBJECTIVES
(an example)
Functional: Help clear up mouth breathing by referral for allergies. Correct
tongue thrust by appliance interference/tongue exercises along with orthopedic and
orthodontic development of the maxilla, etc. Correction of swallowing pattern via
exercises and appliance design. Eliminate joint pain and/or noise and allow for
further normal function of both joints.
Soft tissue: Should follow along with the functional correction and develop into a
more normal appearing face with good esthetics (smile line, relaxed musculature,
etc.)
Skeletal: Arrive at a good functional CI jaw to Jaw relationship for normal
function and completion of growth of the face.
Dental: Arrive at a good working and balancing CI molar and cuspid occlusion
without crowding.
IBO I.D: BR548
Patient Number: JJ83-103
TREATMENT PLAN
(an example)
Functional: Refer for allergy test, check and correct swallowing pattern via
exercises and appliance design, arrive at a good CI working and balancing
occlusion.
Soft Tissue: Should follow along with the functional correction in reversing most
of the effects of the airway problem.
Skeletal: Nitanium palatal expander in conjunction with utility arch wires to align
and develop the upper arch. The expansion arms of the appliance will be left long
and bent towards the tongue to help with tongue positioning while transverse
maxillary development is taking place. After arch development and possible
release of the trapped lower arch we may use some CII elastics for our final jaw-tojaw correction and any additional dental bite opening as needed.
Dental: The CII dental correction should proceed via the distal rotation of the
upper first molars during alignment and the freeing up of the mandible via bite
opening. As mentioned, additional anterior posterior correction may be obtained
via CII inter-arch elastic traction. Extraction of the upper and possible lower first
IBO I.D: BR548
Patient Number: JJ83-103
primary molars may be performed to allow the tongue to enter into the upper arch
during swallowing. This should affect a natural functional expansion in this area.
Coordination and fine-tuning of the arches would be accomplished after all
primary teeth are lost and secondary teeth have erupted and are in close
approximation to occlusion. This treatment plan is beginning in a late primary
dentition and finishing out in an early secondary dentition. Retention would be an
upper removable 7+7 wraparound retainer and fixed lower lingual 3-3 bonded
retainer.
IBO I.D: BR548
Patient Number: JJ83-103
SUMMARY OF TREATMENT OBJECTIVES
(an example)
Functional: This objective is mostly met. The allergies are under control via
referral and medication. Lip seal has been accomplished along with a more correct
swallowing pattern but a simple tongue thrust is still visible at times. The
mandible is functioning pain free without tmj noise or limitations during
excursions.
Soft tissue: This objective has been met. The soft tissue profile is still slightly
protrusive but this characteristic goes along with the genetic makeup of this
individual. Facial symmetry exists and the smile line is right on displaying a
beautiful full smile.
Skeletal: the jaw to jaw and jaws to cranium relationships have been improved
upon with a lesser Wits Appraisal but an ANB that is still above normal. We feel
the Wits measurements are more accurate than the ANB measurements in most
cases.
Dental: This objective has been met. We have obtained a good working and
balancing Class I occlusion with an excellent overbite/overjet relationship.
IBO I.D: BR548
Patient Number: JJ83-103
SUMMARY OF TREATMENT
(an example)
Functional: The allergies have improved with referral and medications. The
swallowing pattern is better but a simple tongue thrust still exists some of the time
– exercises continue. The joint noise has disappeared and vertical opening and
right and left lateral excursions are within normal limits.
Soft Tissue: The soft tissue profile has improved drastically. Lip seal is
accomplished. The nasolabial angle is more within acceptable limits and the
mentolabial sulcus in normal.
Skeletal: The mandible is forward in a better anterior-posterior position but the
Wits Appraisal is still positive at +2mm. Remaining growth should help finalize
these relationships into a nice looking face. The upper/lower facial height ration
has not increased much considering the type treatment performed.
Dental: The nitanium palatal expander did a fine job of developing the upper arch
and distal rotating the upper first molars. Class I occlusion was accomplished with
an overbite/overjet relationship of 2mm.
IBO I.D: BR548
Patient Number: JJ83-103
FACIAL AND INTRA-ORAL IMAGING
START
mm-dd-yy
FINISH
mm-dd-yy
FINISH PLUS TWO OR MORE YEARS
mm-dd-yy
IBO I.D: BR548
Patient Number: JJ83-103
CEPHALOMETRIC X-RAYS
AND
TRACINGS
(examples)
START
mm-dd-yy
FINISH
mm-dd-yy
FINISH PLUS TWO OR MORE YEARS
mm-dd-yy
IBO I.D: BR548
Patient Number: JJ83-103
This page for tracing 1
(no page # needed)
IBO I.D: BR548
Patient Number: JJ83-103
This page for tracing 2
(no page # needed)
IBO I.D: BR548
Patient Number: JJ83-103
CEPHALOMETRIC
ANALYSIS
(examples)
START
mm-dd-yy
FINISH
mm-dd-yy
IBO I.D: BR548
Patient Number: JJ83-103
SUPER IMPOSITIONS
(an example)
FIRST
(Basion-Nasion at CC point)
Evaluate facial axis change
Evaluate chin change
SECOND
(Basion-Nasion at Nasion)
Evaluate A point change
THIRD
(Corpus Axis at PM)
Evaluate mandibular dentition
FOURTH
(Palate at Anterior Nasal Spine)
Evaluate maxillary dental change
FIFTH
(Esthetic plane at the crossing of the occlusal plane)
Evaluate soft tissue change
Blue – pre-treatment
Red – Retention
IBO I.D: BR548
Patient Number: JJ83-103
TREATMENT HISTORY
(an example)
07-19-90
07-26-90
08-15-90
08-28-90
10-03-90
11-01-90
11-21-90
12-19-91
01-03-91
01-31-91
02-20-91
02-28-91
03-29-91
05-09-91
06-06-91
07-11-91
08-15-91
09-19-91
10-17-91
11-21-91
12-19-91
01-21-92
02-20-92
03-18-92
04-16-92
05-14-92
06-11-92
07-09-92
08-06-92
09-02-92
09-03-92
12-09-92
01-07-93
03-10-94
Sep +6/\+6. Impressions for Md Crozat appliance.
PCB +6/\+6. Pl a 2X2 016X016SS UAW.
Deliver mandibular crozat appliance.
Adjust UAW for intrusion, Adjust crozat appliance – expansion
Chk +1/\+1 intrusions, adj crozat.
Adj mx 2X2 UAW for DR of +6/\+6 and intrusion of +1/\+1. Adj crozat.
Sep 6,5\. Transcranial x-ray taken.
PCB 6,5/, DB +2/\+2, -4-3-2-1\/-1-2-3-4, pl Mx 014SS overlay aw, Pl md 0175
twist aw.
Pl Md 016SS aw.
Retie aw’s
Sept+5/\+5
PCB +5+4/\+5+5, DB +3/\+3, Pl Mx 0175, Wedge /-3.
DB – 7\/-3-7, Pl Mx & Md 016N aw’s
Pl Mx 016SS faw.
Pl ocs for /5 and retie.
Adj ocs for /5, Pl Mx 020SS faw.
Relp ocs /-5
PCB /-5, Tip bend +1/\+1, new Mx 020SS faw and Md 016SS faw, crimp
distal brkt /-5 for rotation.
Retie upper & lower faw’s
Pl Md 014SS faw, step down bends +6/\+6.
Pl Md 016N faw.
RPCB /-5, Pl Md 016SS faw.
Pl Md 020SS faw.
Pl pc to close Mx anteriors, box elastics to sock in posteriors (1/4”, 6oz).
Progress models taken, wire ligation to close upper spaces.
Looking good, change box elastics to 1/8”, 6oz.
Cut md aw distal to L3’s for settling in.
Continue box elastics.
Continue box elastics.
Deband all teeth, imp for retainers, finish records taken.
Del Mx 7+7 wraparound and 3-3 bonded retainers.
Retainer Chk.
Retainer Chk, nights only now – 2-3 times per week.
Retainer Chk – excellent! All further checks with GP recalls.