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FLCase. 1
Presented by Hyunjung ParkNew York Smile Orthodontics
History
• Date of Records: 5.17.10• CC: My teeth stick out
and I want to get braces • Age: 14 years. • Ethnicity: Hispanic• Med Hx: none• Allergy: no allergies• DH: RDV.• Ortho Hx: No• Habits: NSF• TMJ Exam: WNL
D.S. 515034
Frontal View
• Facial Type:
• Asymmetric:
• Lips are competent:
Smile Photo
• Show 50% of incisors• Maxillary midline 1 mm
Rt. to facial midline• Mand. midline shift 1 mm
Lt. to maxillary midline.• Mand. midline on to fa-
cial midline• Chin left
Profile View
• Retrognathic• Convex. • Decreased lower face
height• Soft Tissue:
– NLA: – MLS:
• Lips: – Competent.– Both lips are on the E
line.
Cephalometric Radiograph
Cephalometric Tracing
Alexander AnalysisMeasurement Reference Normal PatientSNA (angle) 82 SNB (angle) 80 ANB (angle) 2 U1 to SN (angle) 103 L1 to APo (mm) U1 to L1 (angle) 135 IMPA (angle) 95 FMA (angle) 25FMIA (angle) 60MP to Occl. (angle) 10MP to SN (angle) 32Convexity (NA to Apo) (angle) 3Holdaway ratio (PO &L1 to NB) 1:1Y-axis (SN-SGn) (angle) 60Lower lip to H-line (mm) 0Wits Appraisal (mm) -1
ABO AnalysisMeasurement Reference Normal Patient
SNA (angle) 82
SNB (angle) 80
ANB (angle) 2
SN to Go-Gn (angle) 32
FMA (angle) 25
U1 to NA (mm)
U1 to SN (angle) 103
L1 to NB (mm)
Upper lip to E-line (mm)
Lower lip to E-line (mm)
Cephalometric Diagnosis
•
Cervical Vertebral Maturation
Panoramic Radiograph
•
Intraoral Frontal View
Intraoral Buccal Views
RIGHT LATERAL VIEW LEFT LATERAL VIEW
Intraoral Occlusal Views
Maxillary Arch
Mandibular Arch
Cast Analysis
• CROWDING
• Upper : mm.
• Lower : mm.
• OVERBITE : mm.
• OVERJET : mm.
• COS : mm.
Bolton Analysis.
3-3 Excess Man/Max tooth mass:
6-6 Excess Man/Max tooth mass:
0 mm. (edge to edge) = 1 pt.
1 – 3 mm. = 0 pts.
3.1 – 5 mm. = 2 pts.
5.1 – 7 mm. = 3 pts.
7.1 – 9 mm. = 4 pts.
> 9 mm. = 5 pts.
Negative OJ (x-bite) 1 pt. per mm. per tooth =
Total =
OVERJET
OVERBITE 0 – 3 mm. = 0 pts.
3.1 – 5 mm. = 2 pts.
5.1 – 7 mm. = 3 pts.
Impinging (100%) = 5 pts.
Total =
ANTERIOR OPENBITE
LATERAL OPENBITE2 pts. per mm. per tooth
Total =
0 mm. (edge to edge) = 1 pt.
then 2 pts. per mm. per tooth
Total =
CROWDING 0 – 3 mm. = 1 pt.
3.1 – 5 mm. = 2 pts.
5.1 – 7 mm. = 4 pts.
> 7 mm. = 7 pts.
Total = OCCLUSION
Class I to end on = 0 pts.
End on Class II or III = 2 pts. per side
Full Class II or III = 4 pts. per side
Beyond Class II or III = 1 pt. per mm. Additional
Total =
LINGUAL POSTERIOR X-BITE1 pt. per tooth Total =
BUCCAL POSTERIOR X-BITE2 pts. per tooth Total =
CEPHALOMETRICS
ANB > 5.5 or <-1.5 = 4 pts.
Each Additional Degree = 1 pt.
SN-GO-GN27 deg. – 37 deg.
= 0 pts.
SN-GO-GN > 37 deg. =22 pts. per degree
SN-GO-GN < 27 deg. 1 pt. per degree
IMPA > 98 deg. =41 pt. per degree
Total =
OTHER 2 pts. =
TOTAL =
Discrepancy Index
INDICATE PROBLEM:
Diagnosis
FL 14 years old
Cephalometric Radiograph
Problem List Treatment Objectives
Limitations - Therapeutic Modifiability
Dr. Alexander Chart
Ext Borderline Non-Ext
1. Soft Tissue Profile Convex Normal Concave
2. Mandibular Incisor Position Proclined Normal Retroclined
3. Attached Periodontal Tissue Thin Compromised Healthy
4. Growth Potential Past Ending Present
5. Skeletal Pattern High angle Medium angle Low angle
6. ALD Severe Moderate Mild
7. Maxillary Intermolar Width >33mm Moderate <33mm
8. Patient compliance Poor Moderate Excellent
Right Left
Lower crowding
Lower midline
Lower incisor posi-tion
Curve of Spee
Space needed
Extractions
L6 space left
Molar relationship
Move U6
Dental VTO
Treatment Plan
• Option 1 : • Option 2 : • Option 3 :
Option 1 :
Treatment Plan
Option 2 :
Treatment Plan
Option 3 :
Treatment Plan
Literature Review
• Article 1 : • Article 2 : • Article 3 :
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