Anterior open bite,case presentation with treatment plan

Presentation

1. Patient Name : T hiraviyaraj Age / Sex : 14years /Male OP NO: 2305200030 1

2. Chief complaint : Patient complains of forwardly placed upper front teeth Family history : No relevant family history Medical history : No history of asthma, allergies, coagulation disorders, diabetes, epilepsy, heart valve conditions, high blood pressure, HIV, leukemia,pregnancy , osteoporosis, rheumatoid arthritis, transplant, xerostomia Past Dental history : No relevant dental history Pre- natal history: No H/O infection or drugs taken by mother, no nutritional disorder of mother HISTORY 2

3. Natal history : Type of delievery : Normal delivery, Full term Postnatal history: Feeding: breast feeding upto 1 ½ yrs of age. No H/O Childhood diseases, no history of trauma or fall, milestone of development - normal Habits : H/O thumb sucking till 4 years of age. No H/O lip biting, nail biting, lip sucking, Tongue thrusting, mouth breathing, bruxism

4. CLINICAL EXAMINATION General examination: Body type: Mesomorphic Built : A thletic Gait : Normal Posture :Normal 4

5. EXTRA ORAL EXAMINATION Shape of head : mesocephalic Shape of face : mesoproscopic 5

6. MACRO ESTHETICS SAGITT AL : Poorman's cephalometric analysis -Facial Profile : straight Facial divergence : Straight TRANSVERSE : Face Symmtery : symmetrical VERTICAL : Clinical FMA : average Lip competence : competent lips Naso -labial angle : avg Inter labial gap : 2 mm Shape of the nose : normorhinic Mento labial sulcus : normal Korkhaus lip step : normal Lip trap : absent Chin prominence: average chin prominence 6

7. MINI ESTHETICS UPPER DENTAL MIDLINE : coincides with facial midline DENTAL MIDLINE SHIFT : lower dental midline shifted to left by 1 mm INCISAL EXPOSURE DURING SMILE : 3mm INCISAL EXPOSURE AT REST : 0 mm GINGIVAL EXPOSURE DURING SMILE : mm SMILE LINE : reverse SMILE ARC : non consonant BUCCAL CORRIDER : 1mm 7

8. MICRO ESTHETICS Gingival architecture: scalloped, Embrasure : Type: 1 embrasure Connectors : arranged Tooth width proportion: proportionate 8

9. Total no of teeth present : - 28 permanent dentition 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 Restoration : - 36 Endodontically treated teeth: -nil Attrition : -nil Free way space : 2 mm HARD TISSUE EXAMINATION INTRA ORAL EXAMINATION 9

10. Molar relation - Angle’s class I molar relation on both sides Canine relation - class I relation on both sides Overjet - 3 mm Overbite – 0 mm Anterior open bite 10

11. ARCH SYMMETRY ARCH MAXILLA MANDIBLE shape Ushaped Ushaped Symmetry symmetrical symmetrical Alignment Maxilla Mandible Crowding absent absent Spacing 11,12,13 absent Rotations 12,13 absent Palt.contour shallow --------- 11

12. MAXILLA: s ymmetrical arch ; U shaped Palatal height- avg Rotations – NIL Spacing – NIL Tooth inclined – proclined upper anteriors MANDIBLE: S ymmetrical ; U shaped Rotations -nil Spacing – nil 12

13. SOFT TISSUE EXAMINATION Oral hygiene status : good Gingiva : normal Brushing habits : Satisfactory Frenal attachment : mucogingival Recession: - Tongue : No significant clinical findings are seen Oral mucosa : Pin k with melanin pigmentation 13

14. FUNCTIONAL EXAMINATION Respiration : nasal Deglutition : mature adult swallow Speech : normal Abnormal perioral muscle activity: absent Bruxism: absent 14

15. Muscle examination: No tenderness on palpation- Grade A0 TMJ EXAMINATION: Inspection: 45 mm mouth opening Palpation: No tenderness in preauricular area- Grade A0 JAW MOVEMENT: There is no deviation of lower jaw There is no limitation of lateral movements 15

16. 16

17. MODEL ANALYSIS 17

18. VARIOUS ANALYSIS OF STUDY CASTS A. CAREY’S ANALYSIS: Tooth material(2 nd premolar to 2 nd premolar) = 65mm Arch perimeter = 64mm Difference = 1 mm Inference: Tooth material is excess by 1 mm than arch perimeter it indicates proximal stripping B.ARCH PERIMETER ANALYSIS: Tooth material ( 2 nd premolar to 2 nd premolar) = 75.5mm Arch perimeter = 78 mm Difference = 3mm Inference: Arch perimeter is excess by 2.5mm than tooth material it indicates proximal stripping

19. C.PONT’S ANALYSIS: Sum of upper incisor = 49mm Measured premolar width= 41mm Calculated premolar width= 42.5mm Measured molar width = 52mm Calculated molar width= 53.1mm Inference: measured value is less than the calculated value in premolar and molar region , hence expansion is possible in premolar and molar region

20. E.ASHLEY-HOWE’S ANALYSIS : Total tooth material(1 st molar to 1 st molar) = 95.5mm PMBAW = 44mm PMD = 42mm % of PMBAW = 46% Inference: % of PMBAW, is 46%- Non extraction case Since PMBAW is greater than PMD expansion is possible.

21. G.BOLTON’S ANALYSIS: Maxillary total tooth material = 95.5mm Mandibular total tooth material = 89mm Maxillary anterior tooth material = 49mm Mandibular anterior tooth material = 38.5mm OVERALL RATIO: 93.1 % > 91.3% Inference: Mandibular total tooth material is excess by 1.8mm ANTERIOR RATIO= 78.5 % > 77.2% Inference: Mandibular anterior tooth is excess by 1.3mm

22. 22 LATERAL CEPH

23. Measurements Mean Actual Inference SNA SNB GO Gn to SN ANB 82 80 32 2 79 80 31 1 Retrognathic maxilla Orthognathic mandible average mandibular plane angle Skeletal class III pattern 1 to N-A 1 to N-A 1 to N-B 1 to N-B 1 to 1 angle Occl . To S-N 4mm 22 4mm 25 131 14 17 mm 56 8mm 37 93 10 Forwardly placed upper incisors proclined upper incisor Proclined lower incisor Proclined lower incisor proclined incisors Anticlockwise rotated plane Upper lip to S line Lower lip to S line 6 9 Protrusive upper lip Protrusive lower lip STEINER’S ANALYSIS

24. INFERENCE: SKELETAL : Patient exhibit skeletal class I skeletal pattern with Retrognathic maxilla & Orthognathic mandible, with Average mandibular plane angle. DENTAL : Proclined upper and proclined lower incisors with anticlockwise rotated plane SOFT TISSUE : Patient has protrusive upper and protrusive lower lip 24

25. Measurements Mean Actual Inference Facial angle (FH-N- Pog ) Angle of convexity (A- Pog -N-A) A-B Plane angle (A-B-N- Pog ) Mand.plane angle (FH-Go- Mn ) Y-axis (S- Gn ) 82-95 -8.5 to10 -9 to 0 17 -28 53-66 89 10 -3.5 28 61 Orthognathic mandible Straight profile Skeletal class I Average mandibular plane angle avg growth pattern Cant. Of occlusal plane Interincisal angle Lower incisors to occlusal plane Lower incisors to mandibular plane Upper incisors to N- Pog line 1.5 -14 130-150 3.5-20 -8.5 to 7 -1 to 5 9 93 33 97 10 avg op proclined incisors Proclined lower incisors Proclined lower incisors Forwardly placed incisors DOWN’S ANALYSIS

26. INFERENCE Skeletal Class I skeletal pattern with average mandible, average mandibular plane angle and avg growth pattern. Dental Forwardly placed upper incisor and lower incisors 26

27. Measurements Mean Actual Inference FMA FMIA IMPA 25 65 90 25 54 97 Average mandibular plane angle Proclined lower incisor Proclined lower incisor TWEED’S ANALYSIS

28. INFERENCE: Patient exhibit average mandibular plane angle with proclined lower incisors B angle - 37 Skeletal class III Witts - BO is 3mm ahead of AO Skeletal class III 28

29. Measurements Mean Actual Inference Facial axis Facial angle Mandibular plane Convexity of pt’A ’ 1 to A- Pog mm 1 to A- Pog angle 6 to PTV Lower lip to ‘E’ plane 90±3.5 87 ± 3 26 ± 4.5 2 ± 2mm 1 ± 2mm 22 ± 4 14+3mm 2 ± 2mm 84 90 27 4mm 2mm 41 26 6 Protrusive chin orthognathic mandible Average mandibular plane Skeletal class I normoclined lower incisor proclined lower incisor mesially placed molar position protrusive lower lip RICKETT’S ANALYSIS INFERENCE: Class I skeletal pattern with avg mandibular plane angle, proclined l ower incisors,protrusive lower lip

30. Measurements Mean Actual Inference Saddle angle Articular angle Gonial angle U- gonial angle L- gonial angle Sum of posterior angle Mandibular plane angle Angle of inclination Basal plane angle Pal.plane to occl.plane 123+5 143+6 128+7 52-55 72-75 396+6 32 82 25 11 124 139 131 55 75 394 33 89 33 8 Normal position of condyle irt to acb forwardly placed condyle irt to fossa average gonial angle average upper gonial angl e Average lower gonial angle horizontal growth pattern average mandibular plane angle Upward inclination of maxilla increased b asal plane angle Anticlockwise rotated RAKOSI’S ANALYSIS

31. Occl.plane to MP post. To ant. Face ht ratio Y-axis Interincisal angle 1 to SN plane 1 to palatal plane 1 to mandibular plane 14 62-65 53-66 135 102+2 70+5 90+3 25 70 60 93 140 140 98 Increased ( hyperdivergent ) horizontal growth pattern avg growth pattern proclined upper & lower incisors proclined upper incisors proclined upper incisor proclined lower incisors inclination to MP INFERENCE: SKELETAL: avg saddle angle,decreased articular angle, average gonial angle with horizontal growth pattern & ave rage mandibular plane angle DENTAL: proclined upper incisor and lower incisor .

32. Mc NAMARA ANALYSIS Measurements Mean Actual Inference N perpendicular to point A 0±2 mm -2   orthognathic maxilla N Perpendicular to pogonion 0±-4mm 1 orthognathic mandible Facial axis angle( ba –n )(PTM- Gn ) ◦ 84 prognathic chin Mandibular plane angle 26 ± 4 27 Average mandibular plane Eff.maxillary length 95.2 ± 4.3 87   Decreased Eff.mandibular length 120.6± 4.2 121 average Maxillomandibular differential 25.4 ± 3.5 35 increased Lower anterior face height( Ans -me) 65.6 ± 4.9 72   increased lower facial hgt Upper incisor to point A 4mm 17 proclined upper incisors Lower incisor to Apo line distance 2mm 9   pro clined lower Incisor Naso -labial angle 90-110 100 average nasolabial angle Upper airway 15-18mm 17 average Lower airway 11-14mm 12 average

33. INFERENCE: SKELETAL orthognathic maxilla and mandible with forwardly placed condyle in fossa, horizontal growth pattern, low mandibular plane angle, increased lower face hgt DENTAL proclined upper and proclined clined incisor SOFT TISSUE average nasolabial angle AIRWAY Average dimensions of upper and lower airway 33

34. HOLDAWAY ANALYSIS Measurements Mean Actual Inference Facial Angle(N 1 -POG 1 -FH) 90 92  protrusive lower jaw Upper Lip Curvature 2-5mm 7   deep Skelet convexity at A( NPog -A) -2±2mm - 3  class I skeletal H Line angle(N 1 -Pog 1 -H) 7 - 15 15 average chin Nose tip to H line(chin-vermilion of upper lip) 12mm 6  decreased nose tip to H line Upper sulcus depth 5mm 6   normal sulcus depth Upper lip thickness 15mm 19   increased lip thickness Upper lip strain 2mm 12  present Lower lip H line 0mm 5   increased lip thickness Lower sulcus depth 5mm 8  increased Soft tissue chin thickness 10-12mm 8   averge INFERENCE : Class I skeletal with protrusive lower jaw increased lower sulcus depth, avg chin thickness, increased upper lip strain

35. DIAGNOSIS & PROBABLE ETIOLOGY (1 ) SKELETAL: Sagittal: Skeletal class I pattern [ANB – 3:A-B-N-Pog=-3.5 , B=37] Retrognathic maxilla [SNA – 79:A-Pog-N-A=10] orthognathic mandible [SNB – 80] Vertical: Average mandibular plane angle [ sn-GoGn-31:FH-GoMn=28:mandibular plane=28 ] 35

36. (2) DENTAL: Sagittal: Angle’s class I molar relation Class I canine relation on both side Proclined upper anteriors [1 to NA – 17mm , 56 degree] Vertical: Anticlockwise rotation occlusal plane [ OP-SN-10] Transverse: lower midline shifted to left side by 1 mm 36

37. (3) SOFT TISSUE: Protrusive upper and lower lip [upper lip to s line=6mm: lower lip to S line -9mm , ; lower lip to H line – 5mm ] average nasolabial angle [ 100] 37

38. PROBLEM LIST 38 SKELETAL: Horizontal growth pattern DENTAL: Anterior open bite P roclination of upper incisor

39. TREATMENT OBJECTIVE To correct the Anterior Open Bite To correct the inclination of incisors To achieve a pleasing smile 39

40. TREATMENT PLAN Non extraction Fixed orthodontic mechanotheraphy ( mbt prescription 0.022x0.028slot) 40

41. TREATMENT PROGRESS Banding 1 st molars Bond Maxillary and mandibular teeth using 0.022 X 0.028” MBT prescription. Correction of anterior open bite by using box elastics Level and align teeth. Finishing & Detailing of occlusion. 41

42. APPLIANCE OF CHOICE Pre adjusted fully programmed straight wire appliance with MBT prescription 0.022 x 0.028 inch slot 42

43. NAME : Thiraviyaraj AGE/SEX : 14/M OP NO: 2305200030 PRETREATMENT – EXTRAORAL PHOTOGRAPH

44. PRETREATMENT – INTRAORAL PHOTOGRAPH NAME : T hiraviyaraj AGE/SEX : 23/M OP NO: 2305200030

45. PRETREATMENT – INTRAORAL PHOTOGRAPH NAME : Thiraviyaraj AGE/SEX : 14/M OP NO: 2305200030