case Presentation of sara taha ashree.pptx

Case presentation

1. Al-Azhar University Faculty of Dental Medicine ( Boys ), Cairo, Egypt Orthodontic Department Orthodontic Case Presentation Prepared By Ammar Kasem alzoubi Master Student (Department of Orthodontic s )

2. P e r s o na l H i s t or y Name: sara taha ashree Sex: female Age: 22 years Address: cairo Occupation: student

3. Diagnostic Orthodontic Records

4. Fig.1 : Pre-treatment extra-oral photographs A. Frontal view at rest B. Frontal view during smile extra-oral photographs

5. D- Left profile view C- Right profile view extra-oral photographs

6. Fig.1 : Pre-treatment diagnostic intra-oral photographs intra-oral photographs R R R L R

7. Cast photographs Fig.1 : Pre-treatment diagnostic cast photographs. R R R R L

8. Pretreatment X-ray Panoramic Radiograph

9. Lateral Cephalometric Radiograph

10. Cbct Radiograph

11. Ch i e f Comp l a i n t The Patient Said “ my upper frontal teeth have spaces and I can’t smile”

12. Me di ca l H is tor y Medical History: No medical history interfering with orthodontic treatment.

13. Denta l H is tor y De nta l Hist o ry: The patient has previous visits, scaling , polishing , restoration . Patient’s motivation toward orthodontic treatment: Patient’s motivation : Internally motivated patient.

14. Clinical Examination. Extra-oral examination

15. Symmet r y Assess me nt Rule of Fifth One fifth nearly= width of one eye Symmetry: symmetr ic face Vertical Thirds nearly equal vertical third s

16. M i dline Assess me nt Upper midline in relation to facial midline is not coincident, deviated 1 mm to the right side. Lower midline in relation to facial midline is not coincident, deviated 2 mm to the right side. Lower Midline in relation to the maxillary midline : is not coincident .

17. P r of i le Profile orthognathic Nasolabial angle Normal Mentolabial sulcus accentuated Chin Normal Size & Position of maxilla : in relation to upper face Normal Size & Position of mandible: in relation to upper face Normal Max i l lo -man d ib u lar relationship Normal

18. Extra-oral soft tissue Lip morphology Lip at rest (normal interlabial gab 0-4 mm) During Smile Gingiva Lip Lines Smi l e A r c Upper Lip normal Lower Lip normal Upper Lip normal Lower Lip normal Exposed Unexposed Consonant Flat Reversed R R

19. Intraoral Examination A- Soft tissue examination: Labial Frenum : Normal. Lingual Frenum: Normal. Gingiva: Normal. Tongue position: Normal. Tongue behavior: Normal. Tongue size : Normal. Palate: Normal R R R

20. B -Den ta l e xa min a ti o n: Missing Extracted Fractured Impaction 3 3 Attrition Carious 6 Filled Endodont i c a l l y treated Rotated Cross-bite R L

21. C-Dental Relation: Angle's Classification Class I malocclusion Molar Relationship Right Class I Left Class I Canine Relationship Right Class I Left Class I Left side Right side R L

22. D. Func t ional A n alys i s: TMJ examination: History of - pain movements - trauma - surgery - joint noise -l i m i t ed Joint noise: - clicking Pulpation: - Joint - cripitus -muscles of mustication Centric Occlusion – Centric Relation Difference (Functional Shift): O anterior sliding. O no functional shift Mandibular Closure Path from Rest Position to Occlusion: O Straight Breathing : O Nose O Mouth

23. Abnormal pressure habits : O Thumb Sucking O Tongue Thrusting O Lip Biting O Other Habits O None

24. S t ud y C as t A nalysi s Arch Symmetry: Asymmetric upper arch Ovoid arch form Asymmetric lower arch Ovoid arch form R R

25. C u r v e o f Sp ee : Right side : 1. mm Left side : 1. mm

26. Overbite and Overjet: Overjet: (2) m.m Overbite: (50%)

27. Dental Relation: Molar : Class I Canine: Class I Molar : Class I Canine: Class I Right side Left side

28. A r c h L e ng t h analysi s Maxillary Tooth Material(Ten) : 67 M ax i l l a ry A r ch perime t er : 75 Max. Discrepancy: 8 Mandibular Tooth Material (Ten) : 58 Ma n d i b u l a r A r ch perimeter: 61 Mand . Discrepancy: 3

29. Bolton Analysi s : Overall Ratio : Anterior Ratio: 92.3 % (N=91.3% ± 1.91) 77.4 % (N=77.2% ±1.65) Normal overall and anterior ratio

30. Conclusion: Upper arch: Is Asymmetrical with Taperd arch form. Lower arch: Asymmetrical with oviod arch form . curve of spee : 1.6 mm on right side and 1.8 mm on the left side. Bol t on Ana l y sis sho w e d : normal o v e r all an d a n t erio r r a ti o .

31. Panoramic Radiograph examination: Skeletal : No radiographic evidence of pathological lesions detected. Dental : according to Nolla’s stages of tooth development: impacted of upper right and left canines,missing of maxillary and mandibular third molars)

32. Lateral cephalometric analysis

33. Maxilla to cranial base Measurements Reading Norm SD SNA 82 82 ± 4 Maxillary Depth 89 90 ± 3 A-Nasion vertical -1 1 ± 2 Measurements Reading Norm SD SNB 79 79 ± 4 B/Nasion vertical -4 -2 ± 2 Pg/Nasion vert. -2 ± 2 Facial angle 86 87 ± 3 SN-Pg 79 80 ± 4 Mandible to cranial base

34. Maxillo-mandibular relationship Reading Norm SD ANB 3 3 ± 1 A-B diff Chang 7 4 ± 4 AO-BO -2 -1 ± 2 Angle of convexity 7 4 ± 4

35. Facial Type / Growth Pattern Reading Norm SD Y-axis 59 61 ± 4 Facial axis 88 90 ± 3.5 FMA 23 25 ± 3 Pal-Mandibular 24 23 ± 4 SN-Mandibular 31 32 ± 5 SN-Palatal 7 9 ± 3 Cranial Base angle 129 132 ± 5 Gonial angle 120 124 ± 4 S-Go / N-Me 65% 66% ± 5 ANS-Me / N-Me 55% 57% ± 3

36. D e ntal Analy s is Reading Norm SD Ll- Mand 94 95 ± 5 L1- Frank 61 59 ± 4 L1 - N-B angle 23 22 ± 4 L1- N-B mm. 5 6 ± 2 L1 - A-Pg mm 3 5 ± 2 UI- SN 100 102 ± 5 U1-Frank 108 112 ± 6 UI-Palatal 107 110 ± 6 UI-NA angle 19 24 ± 5 UI-NA mm. 3 5 ± 2 Mandibular Incisors Maxillary Incisors Inter-incisal angle UI-Ll 135 127 ± 8

37. Soft tissue Reading Norm SD Nasolabial angle 105 90-120 90-120 Z angle 76 71 ± 8 H angle 12 10 ± 4 U lip /E line -4 -4 ± 2 L lip/ E line -2 -2 ± 2

38. Conclusion of cephalometric analysis Skeletal Maxilla to cranial base Normal Mandible to cranial base Normal Maxilla to mandible Normal Dental Upper incisor position Normal Upper incisor inclination Normal Lower incisor position Normal Lower incisor inclination Normal Soft tissue Naso-Labial angle Normal Mento-labial sulcus accentuated Lips Position – E line Normal

39. S P ACE ANA L YSIS Upper Lower Crowding / Spacing 8 3 Leveling occlusal curve Arch width change Incisor A/P position Incisor angulation/inclination change Total (mm) 8 3

40. Problem List Dental : Impacted of upper right and left canines Spacing of upper and lower anterior teeth. •lower dental midline not coincident in relation facial midline. •upper dental midline not coincident in relation facial midline. Deep overbite Treatment objective Canines traction. Closig the space. (l e veli n g a nd al i gnm en t o f u pper and lower teeth) . Obtaining a coincident upper and lower midline in relation to facial midline . Obtaining normal bite.

41. Extraction approach (extraction of upper right and left deciduous canines) Mechanical Strategies: • For upper arch : 1- Installment of pre-adjusted edgewise brackets(Roth prescription) 2- Installment of trans palatal arch with hooks,then canine traction to the hooks. 3- Leveling and alignment Ni-Ti round (12.14.16.18) then 16X22 Nit- ti archwire thousands of an inch. 4- Installment of S.S retangular archwire (16X22) of an inch 5-midline correction For lower arch : 5 - Installment of pre-adjusted edgewise brackets(Roth prescription) 6- Leveling and alignment Ni-Ti round (12.14.16.18) then 16X22 Nit- ti archwire thousands of an inch 7- Installment of S.S retangular archwire (16X22) thousands of an inch 8 - Finishing and occlusal settling of the case Line of orthodontic treatment and mechanical strategies :

42. Case Summery: Sara taha ashree is a 22 -year-old fe male patient whose chief complaint is: “ my upper frontal teeth have spaces and I can’t smile” Clinical examination revealed normal profile, normal extra-oral features, and normal function. and normal TMJ function. Intra-orally he has Class I molar relation on right side and left side , , deep overbite ,normal overjet and normal soft and hard tissue. Cephalometric analysis: showed skeletal Class I relation, normal upper incisor inclination, normal lower incisor inclination, and normal upper and lower lips. . Study cast analysis: Space discrepancy 8 mm in upper arch and 3 mm in lower arch . Proposed treatment: extraction approach , utilizing preadjusted edgewise fixed appliance (Roth prescription) Leveling and alignment of the upper arch and lower arch Retention: upper and lower Hawely retainer