Adita Aggarwal ppt

ADITA AGGARWAL. 16/F

CASE PRESENTATION

By : Dr Anant JyotiPost Graduate student Dept. of Orthodontics

& Dentofacial Orthopaedics

PERSONAL DETAILSName: Adita Aggarwal

Age/Sex: 16/F

Date of Birth: 8th of August , 1996.

OPD No.: 140880

Diet: Vegeterian

PERSONAL DETAILS

Postal Address: Mongli Garden, Rampur Road, Haldwani.

Father's Name: Mr. Sanjay Aggarwal

Occupation: Business man

Mother's Name: Mrs. kamna

Aggarwal

Occupation: Housewife

CHIEF COMPLAINT: Highly erupting tooth in left upper front tooth

region and forwardly placed upper front teeth

MOTIVATION AND EXPECTATIONS: Externally motivated.

Reasons for taking Orthodontic Treatment: Aesthetics 

PRE-NATAL HISTORY: Informer : MotherCondition of Mother during Pregnancy :

Normal Delivery : Normal

POST-NATAL HISTORY:Feeding : Breast fed until 12 monthsMilestones of Development : Normal

MEDICAL HISTORY: Nothing significant reported.

FAMILY HISTORY:

No familial history of malocclusion or any orthodontic treatment.

GROWTH STATUS: Completion (Stage VI) 

 DENTAL HISTORY:

Undergone extraction of retained deciduous tooth wrt.63 , 5 days back.

CLINICAL EXAMINATION

A. PHYSICAL STATUS

Body Build Type: Plethoric

Height : 5ft 2 inches

Weight : 52 kg

B. EXTRA ORAL EXAMINATION

HEAD FORM CEPHALIC INDEX = Max. skull width = 155 =

83.7% Max. skull length 185 Dolicocephalic = x-75.9Mesocephalic = 76-80.9Brachycephalic = 81-x

BRACHYCEPHALIC

FACIAL FORMFacial Index : max. facial height = 104 = 75.3

% max. facial width 138

EURYPROSOPIC =X-83.9MESOPROSOPIC= 84-87.9LEPTOPROSOPIC =88-92.9HYPERLEPTOPROSOPIC=93-X

EURYPROSOPIC

FACIAL SYMMETRY

NO GROSS ASYMMETRY

FACIAL HEIGHTS

UPPER= 62 mm MIDDLE= 50 mm

LOWER= 64 mm

PROFILECONVEX

NASOLABIAL ANGLEACUTE

MENTOLABIAL SULCUSDEEP

FMALOW

MAXILLAPROGNATHIC

MANDIBLEORTHOGNATHIC

• Lips: Competency: competent

Upper Lip length: 18 mm Lower Lip length: 40 mm

Incisal Exposure at Postural Rest position : 0 mm

EXTRA-ORAL PHOTOGRAPHS

INTRA – ORAL EXAMINATION

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 Midline : Upper : Coincident Lower : To Upper - Shifted to left by 2.5 mm To Facial –

shifted to left by 2.5 mm .

Frenal Attachment Upper/Lower : Normal Overjet : 4mm Overbite : 5 mm, 75% coverage.

Inter – Arch Relation Canine – Right – Class I

Left – Cant be assessed

Molar - Right – Angle’s Class I

Left - Angle’s Class II Curve of spee – 1.5 mm+1.5mm/2 +0.5 = 2 mm

Arch Form :

Upper : Ovoid Lower : Ovoid

Highly and labially placed teeth wrt.23.

Rotations – Distolingual wrt. 32 and 34

FUNCTIONAL EXAMINATIONPeri –Oral musculature : Normal Freeway space : 3.5 mm at premolar regionRespiration : Oro-nasal Speech : Normal Abnormal Habits : No abnormal habitsMax. mouth opening: 50 mmTMJ : No history of problems related to TMJ

CEPHALO METRIC ANALYSIS

COMPOSITE ANALYSIS

PARAMETERS NORMALVALUE

TRACING VALUES

ANTERIOR CRANIAL BASE LENGTH (N-Se) 71+/-3 mm 72 mm

POSTERIOR CRANIAL BASE LENGTH (S-Ar) 32 +/- 3 mm 36 mm

ORIENTATION ANGLE(SN-FH)

7 10

SADDLE ANGLE (N-S-Ar)

123+/-5 129

ARTICULAR ANGLE (S-Ar-Go)

143+/-6 134

ANALYSIS OF FACIAL SKELETON

GONIAL ANGLE (Ar-Go-Me)

128+/-7 119

BJORK SUM 396+/-6 382

UPPER GONIAL ANGLE(Ar-Go-N)

52-55 57

LOWER GONIAL ANGLE(N-Go-Me)

70-75 62

ANTERIOR FACIAL HEIGHT(N-Me)

114 mm 103 mm

POSTERIOR FACIAL HEIGHT (S-Go) 74 mm 77 mm

JARABAK RATIO ( PFH/AFH ) 62% – 65% 74.8 %

PARAMETERS NORMALVALUE

TRACING VALUES

ANALYSIS OF FACIAL SKELETON

ANALYSIS OF JAW BASESPARAMETERS NORMAL VALUE TRACING VALUES

MAXILLASNA (Steiner) 82+/-2 92(89)

Effective length (Cd- A) {Mcnamara} 93.6+/-3.2 100 mm

Maxillary base length(PNS- A ┴ on PP) 44 +/-5 mm

55.5 mm

N┴ - A┴(FH) {McNamara} 0.4+/-2.3 (F)1.1+/-2.7(M)

9.5 mm

Posterior Maxillary Position[ S ┴ (on PP) – PNS ]

18 mm 24.5 mm

Ratio of maxilla to cranial base (SN) 14:20 14.8:19.2

Angle of Inclination (Se-N’ ┴ on PP ) (Schwarz)

85 86

Mandible

SNB (Steiner) 80+/-2 85(82)

SND 76 81(78)

Facial Angle [(N-Pog)-FH] 82-95 94.5

Effective Length (Cd-Gn) 120.2+/- 5.3 118 mm

Mandibular base length (Go-Pg)

71 +/-5 mm 80 mm

Saddle Angle (N-S-Ar) 123 + 5 129

Pog ┴ to N ┴ (FH) -1.8+/-4.5(F)0.3+/-3.8(M)

6.5 mm

Ratio of mandible to cranial base (SN) 21:20 21.6 : 19.4

Ramus height : Mandibular base 5:7 5.2:6.8

PARAMETERS NORMAL VALUE TRACING VALUES

ANALYSIS OF JAW BASES

PARAMETERS NORMAL VALUE TRACING VALUES

MAXILLO-MANDIBULAR RELN

ANB (Riedel) 2+/-2 7

Wits Appraisal -1 mm (M) 0 mm(F)

2.0 mm

A ┴ B ┴ (FH) 4 mm 3.5 mm

Maxillo – mandibular Differential(McNamara)

29.2+/- 3.3

18 mm

Facial Convexity (N-A-Pog)(Down)

-8 to 10 13

Maxillary base: Mandibular base 2:3 2: 3.

VERTICAL SKELETALJarabak ration (PFH/AFH) 62-65% 74.8 %

SN- [Go-Gn] (Steiner) 32 18(15)

FMA 25 13.5

Y – axis (N-S-Gn) 59.7 50(53)

Basal Plane Angle (PP-(Go-Me)) 25 14

AIRWAY ANALYSIS (McNAMARA)

PARAMETERS NORMAL VALUE TRACING VALUES

UPPER PHARYNX 15-20 mm 15 mm

LOWER PHARYNX 11-14 mm 10 mm

ANALYSIS OF DENTOALVEOLAR RELATIONSHIP

PARAMETERS

U1- SN

NORMAL VALUE

102 +/- 2

TRACING VALUES

115(112)

U1- PP 110 + 5 120

U1- FH 107 + 5 125

U1-NA 22 23

U1-NA 4 mm 2.5 mm

U1-(A-Pog) +2 to - 4mm 7 mm

IMPA 90 103

L1-NB 25 28

L1-NB 4 mm 6.0 mm

L1-(A-Pog)(Rickett)

1+/-2 mm 1.5 mm

INTERINCISAL ANGLE 131 +/- 5 121

Steiner’s Stick Correction

7

23

28 6

Upper incisor inclination correction = 6 x .8 = 4.8 mm reqired

Lower Incisor inclination correction = 2. x .8 = 1.6 mm space available.

2.5

ANALYSIS OF DENTOALVEOLAR

RELATIONSHIP

VERTICAL

U1-NF( to NF) 27.5+/-1.7(F) 24 mm

L1-MP(toNF) 40.8+/-1.8(F) 35 mm

U6-NF(to NF) 23.1+/-1.3(F) 19.5 mm

L6-MP(to MP) 32.1+/-1.9(F) 37mm

PARAMETERS NORMAL VALUE

TRACING VALUES

SOFT TISSUE ANALYSISPARAMETERS NORMAL VALUE TRACING

VALUES

SOFT TISSUE FACIAL ANGLE 91+/-7 97.5

FACIAL CONVEXITY [(G-Sn) - Pog’]

12+/-4 12

NASOLABIAL ANGLE ( Legan-Burstone)a. Columella tangent to postural horizontalb. upper lip tangent to postural horizontal

102+/-4 25

85

85 30 55

NOSE PROMINENCE 14-24 mm 9 mm

BASIC UPPER LIP THICKNESS 15 mm 12 mm

UPPER LIP STRAIN 13 -14 mm 15 mm

SUPERIOR SULCUS DEPTH 1-4 mm 5.5 mm

H ANGLE 7 -15 21

SOFT TISSUE ANALYSISINTRLABIAL GAP(Stms-Stmi)

2+/-2 mm 1 mm

Mentolabial sulcus (Si-(Li-Pog) 4+/-2mm 7 mm

E-LINE (Rickett) A.UPPER LIP B.LOWER LIP

-2 to -4 mm-1 to –2 mm

-1 mm1.5 mm

S-LINE (Steiner) A.UPPER LIP B. LOWER LIP

0 mm0 mm

2 mm 3.5 mm

LIP PROMINENCE (Legan & Burstone)A.Upper Lip [Ls-(Sn-Pog’)]B.Lower Lip [Li-(Sn-Pog’)]

3+/-1 mm2+/-1 mm

5.5 mm 5.5 mm

SOFT TISSUE CHIN THICKNESS 10-12 mm 12.5 mm

SOFT TISSUE ANALYSISPARAMETERS NORMAL

VALUETRACING VALUES

Length of upper lip (Burstone)

20 mm (F) 18 mm

Length of lower lip (Burstone)

40-46.5 (F) 47 mm

Ratio b/w Upper and Lower lip length

1 : 2.1 .9 : 2.2

Incisor show at Rest 2mm – 3mm

. 1 mm

CEPHALOMETRIC INFERENCE

MAXILLA

Prognathic suggested by readings of SNA of 92 degrees, Effective Maxillary base

length of 100 mm and maxillary base length of 55.5 mm.

MANDIBLE

Prognathic mandible suggested by SNB of 85 degrees , mandibular base length of 80

mm and Ratio of mandible to cranial base is 21.6:19.4.

MAXILLO-MANDIBULAR RELATIONClass IIPattern suggested by ANB of 7 degrees, Wits Appraisal of 2.0 mm,and Facial convexity of 13 degrees .

VERTICAL SKELETAL RELATIONSHIP

Horizontal growth pattern as suggested by Jarabak ratio , FMA and Y Axis.

DENTOALVEOLAR RELATION

Proclined maxillary and mandibular incisors suggested by all the readings.

SOFT TISSUE RELATIONSHIPS

Convex profile with acute nasolabial angle,decreased upper lip thickness, protrusive upper

and lower lips and increased lower lip length

CEPHALOMETRIC INFERENCE:

Skeletal Class II accompanied with tendancy towards horizontal growth pattern, proclined maxillary incisor along with acute nasolabial angle, decreased upper lip thickness, protrusive upper and lower lips and increased lower lip length.

PANOROMIC VIEW

MODEL ANALYSIS

CAREY’S / ARCH PERIMETER ANALYSIS

Upper Lower

Total tooth material 75 mm 67 mm

Arch perimeter 74 mm 60 mm

Discrepancy 1 mm arch length deficient

7 mm arch length deficient

BOLTON’S ANALYSIS Sum of maxillary 12 = 96 mmSum of mandibular 12 = 90 mmSum of maxillary 6 = 48 mmSum of mandibular 6 = 38 mm

Total Tooth Ratio (TTR) = sum of mand. 12 x 100 sum of max. 12 = 90 x 100 = 93.75 % (91.3%) 96

Mandibular Excess = Sum of mand.. 12 teeth – Max. 12 x 91.3 100  = 2.4 mm excess

Anterior Ratio = Sum of mand. 6 x 100 Sum of max. 6 = 38 x 100 = 79.2% ( 77.2%) 48

Amount of anterior mandibular excess = Sum of Mand. 6 – Sum of Max. 6 x 77.2 100 = 38 – 37 mm = 1 mm excess.

INFERENCE•In this patient TTR value is 93.75 %, indicating Mandibular tooth

material excess.

(Amount of total tooth material excess is 2.4 mm)•In this patient Anterior tooth ratio is 79.2 %, hence indicating Mandibular anterior tooth material excess. (Amount of anterior tooth material excess is 1mm)

BOLTON’S ANALYSIS

SPACE ANALYSISSPACE AVAILABLE UPPER LOWER

Available space in arch

Unerupted tooth space 7.0 mm -

Derotation of posteriors - -

Proclination of anteriors - 1.6 mm

Distalisation of molar _ -

Total space available 7.0 mm 1.6 mm

SPACE ANALYSISSPACE REQUIREMENT

UPPER LOWER

Retraction of anteriors 4.8 mm -

Alignment 8.0 mm 1.0 mm

Correction of curve of Spee

- 2.0 mm

Correction of molar relation

- 4.0 mm

Space for prosthesis -

Total space required 12.8 mm 7.0 mm

SPACE ANALYSISSpace Discrepency = Space available – Space

required

UPPER = 5.8 mm space requiredLOWER = 5.4 mm space required

ORTHODONTIC DIAGNOSIS

Skeletal Class II with convex profile and

tendency towards horizontal growth pattern,

dental Angle’s Class II Subdivision of left side

malocclusion with highly and labially erupting

tooth wrt.23, proclined maxillary incisors along

with acute nasolabial angle, decreased upper lip

thickness, protrusive upper and lower lips and

increased lower lip length.

PROBLEM LISTHighly and labially placed teeth wrt. 23.Proclined maxillary incisorsOverbiteOverjetCanine relation in left sideMolar relation in left side.Midline.

TREATMENT OBJECTIVES

Alignment of maxillary and mandibular anteriors.

To correct canine relationTo correct molar relationTo correct overbiteTo correct overjetTo correct midline

TREATMENT PLANFixed mechanotherapy Moderate anchorage case Unilateral extraction wrt. 44Leveling and aligning:

Correction of rotations. Correction of curve of spee Correction of midline.

Retention

Minimum retention in maxillary and moderate retention in mandibular arch.