Orthodontic Case Presentation 45b37

ORTHODONTIC CASE PRESENTATION Marwa Ibrahim Halalmeh Eman Khalid Nazzal Rahaf Hasan Ibrahim Malak Ali Abu-aquleh

PATIENT’S BIOGRAPHY

- Name : Rula Yaseen Wardat - Age : 22 - Gender : Female

HISTORY Chief Complaint : -She doesn’t like her teeth shape -crowding anteriorly -facial asymmetry History of Chief Complaint : -With eruption of permanent teeth

Medical History : - Patient denied any medical problems Dental History : - She wear a removable appliance 4 years ago for 1 year to expand her upper jaw - Uncomplicated previous extraction 3 years ago - Previous restoration 3 months ago Social History & Habits : -None

Extra Oral Examination Frontal view -Symmetrical: Asymmetrical face - LFH ratio: increased

Profile View Profile angle: Convex Skeletal Class: Class II FMPA: average

Soft Tissue Analysis Lip: incompetent Nasolabial angle: average Upper lip: average Lower lips: prominent

¾ View

Intra Oral Examination Oral Hygiene: Fair

Intra-arch: Teeth number : Upper: 14 lower: 12 Crowding : Upper: severe crowding Lower: mild crowding Incisor inclination : Upper: proclined Lower: average Other : Buccally erupted upper canines

Inter-arch/occlusion: Anterior-posterior relation: Overjet: increased 4mm Incicor relation: II division 1 Canine relation: Right: II by ¾ unit Left: II by ½ unit Molare relation: Right: II by ¼ unit Left: II by ½ unit

Vertical relation: Anterior Open bite

Transverse relation: Unilateral Cross bite without displacement Central line : Lower non-coincident with the upper to the right by 2 mm

Upper occlusal

Lower occlusal

Study Cast

Study Cast Lowe r

Upper

Space analysis  • • •

Space analysis on upper cast Space available : 68 mm Space required : 79.5 mm There is deficiency 10.5 → sever crowding

 • • •

Space analysis on lower cast Space available : 63 mm Space required : 65.5 mm There is deficiency 2.5 → mild crowding

 Total Bolton ratio : 86.51% ( normal 91% )  Anterior Bolton ratio : 80.5% ( normal 77.3% )

Panaromic Radiograph

Cephalometric Radiograph

Cephalometric Analysis Measurem ents

Norma l

Pts

result

Antero-Postero Skeletal Relations SNA

82±3

86

Prognathic maxilla

SNB

79±3

75

Retrognathic mandible

ANB

3±1

8

Increased

3

Increased

93

normal

Wits measurem ent A-B FOP

0 female

90±5

Vertical Skeletal Relationship MM Angle

27±5

24

Normal

LFH/TFH

50-55%

60 %

Increased

Gonial angle

126±5

134

Increased

Diagnosis Patient has Class II Division I incisors relation based on skeletal class II relationship. Complicated by : •Class II canine relationships •Class II molar relationships •Convex profile angle •Anterior open bite •increased overjet •Midline of lower teeth is not coincident with the upper to the right by 2 mm •Unilateral cross bite (right)

Treatment Plan Aims of treatment: 1- achieve Class I incisors relationship 2- relief crowding 3- achieve Class I molar and canine relationships 4- correct the cross bite 5- increase overbite 6- overjet reduction

Means of achieving aims: -fixed appliance (upper and lower) : - anchorage control by: Nance for upper arch Fixed for lower arch

- with extraction of: 5 and 7 are badly destructed teeth

- retention by : Vaccum-formed Essix Retainer

4 5

4 7

Thank you