RMS orthodontic residents

1. Done By:
Dr. Mutaz H.AL-Shakhatreh
3rd Year Orthodontic Resident
Supervised by:
Dr. Ahmad Al-Tarawneh.
Dr. Raed Al-Rbata.

2. Patient’s Details
 Patient’s Initials: H.M
 Gender: Male.
 Date of birth: Dec 25th , 1985.
 Occupation: Sergeant in royal air force.
 Age at the beginning of treatment: 30 years & 8 months.

3. Chief Complaint
“I feel that my upper jaw advanced
forward, and the lower jaw is backward,
and there are spaces between my upper
teeth”

4. Relevant Medical History
“Patient Denied any Medical problems”

5. Relevant Dental History
 No regular check up.
 Multiple amalgame restorations.
 No history of oral and dental trauma.

6. Extra Oral Assessment
- Frontal -

7. Extra Oral Assessment
- Profile -

8. Extra Oral Assessment
- Skeletal -
 Mild Asymmetric Face.
 convex profile.
Skeletal Class II Pattern.
 Normal LAFH.

9. Extra Oral Assessment
- Skeletal -
 Anteroposterior:
Convex Profile.

10. Extra Oral Assessment
- Skeletal -
Vertical:
Normal LAFH.

11. Extra Oral Assessment
- Skeletal -
Transverse(non-smile):
-Mild Asymmetric Face.
The chin & nose deviated to the left.

12. Extra Oral Assessment
- Skeletal -
Transverse(smiling):
-Normal level occlusal plane
(no canting).
-upper midline to facial mildline:
Coincident.
-lower midline to upper midline:
Off to the left side by 2-mm.

13. Extra Oral Assessment
- Skeletal -
Soft Tissue:
1.A-P:
NLA: obtuse.
Marked labiomental fold.
2.Vertical:
Competent lips.
Low smile line.
3.Trasverse:
Wide smile.

14. Extra Oral Assessment
No Habits
No TMD
No Displacement

15. Intra Oral Examination
 Poor Oral Hygiene.(calculus at lower labial segment)
 Mild Gingivitis.
 Teeth Present (Permanent Stage)
7 6 5 4 3 2 1 1 2 3 4 5 6 7
7 6 5 4 3 2 1 1 2 3 4 5 6 7

16. Intra Oral Examination
- Frontal -
 Incisor Classification: Class II/1
 Centerlines: Upper Coincident with Midline of the Face.
Lower Shifted 2mm to the left.
 Overbite: complete.
 Overjet: 7mm.

17. Intra Oral Examination
- Right Buccal Segment -
 Molar Relationship: Class I
 Canine Relationship: ¼ unit Class III

18. Intra Oral Examination
- Left Buccal Segment -
 Molar Relationship: 1/2 unit Class II
 Canine Relationship: Class I

19. Intra Oral Examination
- Upper Occlusal View-

20. Intra Oral Examination
- Upper Occlusal View-
U Shaped Arch.
Multiple Restorative Teeth 6 56
No Missing Teeth.
 Rotated 1 1

21. Intra Oral Examination
- Lower Occlusal View-

22. Intra Oral Examination
- Lower Occlusal View-
 U Shaped Arch.
 No Missing Teeth.
 Rotated 2 23
 Lingually in-standing lower lateral incisor.
 Curve of Spee: 3.5mm Deep on Right side
3mm on left Side

23.  Anterposterior:
Over jet (OJ): 7 mm.
Rt.molar: class I. Lt.molar: ½ unit class II.
Rt.canine: ¼ unit class III. Lt.canine: class I.
-Study Model Analysis-

24. -Study Model Analysis-
 Vertical:
Complete Overbite.

25. -Study Model Analysis-
Rt.side: curve of spee 3.5 mm. Lt.side: curve of spee 3 mm.

26. -Study Model Analysis-
 Transverse:
the lower dental midline to the upper midline is shifted by 2 mm to the
left.

27. -Study Model Analysis-
Maxillary arch:
-Symmetry: symmetrical to a great
Extent.
-Rotation: upper central incisors.
-Intercanine width: 37 mm.
-Intermolar width: 45 mm.
Mandibular arch:
-Symmetry: asymmetric.
-Rotation: 2 135
-Intercanine width: 23 mm.
-Intermolar width: 42 mm.

28. Space Analysis
 Upper Arch:
Space Available: 86 mm
Space Needed: 78 mm
+8 mm (Spacing).
 Lower Arch:
Space Available: 71 mm
Space Needed: 64 mm
-7 mm space needed (moderate crowding).

29. Bolton Ratios
 Anterior Ratio (3 - 3): 79% ( Normal: 77%)
 Overall Ratio (6 - 6): 89.75% ( Normal: 91%)

30. Pre-Treatment IOTN
- Aesthetic Component -
• 5(moderate to
border line need)

31. Pre-Treatment IOTN
- Dental Health Component -
• 3.b
• Sever Treatment
Need.

32. Radiographic Examination
- OPT -
 All Features Look Normal.
 No Apparent Pathology.
 All Teeth Present.
 Wisdom Teeth Erupted.

33. Radiographic Examination
- Lateral Cephalogram -

34. Cephalometric Analysis
Variable Pre-Treatment Normal Value Ceph .Interpretation
SNA 82 81 +- 3 Normal Maxilla
SNB 73.2 78 +- 3 Retrognathic Mandible
ANB 8.8 3 +- 2 Skeletal Class II
S-N/ANS-
PNS
7 8 +- 3 Normally Inclined Maxilla
Corrected
ANB
8.3
MMPA 24.4 27 +- 3 Normal Vertical Proportion
UAFH 42
LAFH 45
LAFH % 51.7% 55 +- 2 Reduced Facial Proportion
U1/Mx 103 108 +- 6 Normally Inclined Upper Incisors
L1/Mn 101 93 +- 6 Proclined Lower Incisors
IAA 137 133 +- 10 Normally Inclined Incisors
Wits
Appraisal
2 0/-1

35. Cephalometric Interpretation
 Antero-posterior :
1. Normal Maxilla.
2. Retrognathic Mandible.
3. Skeletal Class II.
 Vertical:
1.Normal Vertical Proportion.
2. Reduced lower anterior facial height.
Dental
1.Normally inclined upper incisors
2.proclined lower incisors.

36. Diagnostic Summary
A 30 year old male patient, denied any medical problems,
complaining from “ my upper jaw advanced forward, and the lower
jaw is backward, and there is spaces between my upper teeth” . He
has a class II div 1 Incisal relationship on a Class II skeletal
base, complicated by increased OJ (7mm) and Complete OB
, moderate crowding in the lower labial segment and spacing
in the upper jaw, multiple rotated teeth, and shifted lower
midline. He has a class I Molar relationship on right side
and ½ unit class II on left side and a Class I Canine on the
left side and ¼ unit Class III canine relationship on the
right side.

37. Problem List
1. Poor oral hygiene.
2. Mild gingivitis.
3. Calculus on the lower lingual segment.
4. Asymmetric face, chin & nose deviated to the left.
5. Convex profile.
6. Obtuse nasolabial angle.
7. Marked labiomental fold.
8. Class II skeletal base.
9. Moderate crowding in lower labial segment.
10. Lingual in-standing lower lateral incisor.
11. Spacing in the upper jaw.
12. Increased overjet 7mm.
13. Complete overbite.
14. Class II div 1 incisal relationship.
15. Class I molar relationship on right side and ½ unit class II on the left side.
16. midline shifted 2mm to the right.

38. Treatment Aims
Referral to Perio-clinic for Improvement of OH.
1.Skeletal:
-Achieve a corrected skeletal base relationship.
2.Soft tissue:
-Achieve a normal facial proportion.
3.Dental:
-Relieve crowding.
-Level and align the arches.
-Achieve corrected overbite (edge-centroid
relationship).
-Achieve corrected overjet.
-Achieve corrected buccal segment relationships.
- correct upper and lower midlines .

39. Treatment Plans
1st Option:
1.Initial orthodontic treatment:
 Extraction of 4 5 **to correct midline shift
 Upper and lower fixed appliance
2.Orthognathic surgery :
 Initial plan: advancement of mandible. And maxilla (to achieve
better facial esthetics )
3.Post-surgical orthodontic.
4.Finishing.
5.Retention: upper and lower fixed retainer and upper essix.

40. Justification (1):
1.Extraction of lower 4,5s to correct the moderate crowding and the
proclined lower lower labial segment.
Asymetrical extraction to correct midline shift.
2.Correct the rotated teeth.
3.Dental decompensation before surgery.
4.Surgical mandibular and maxillary advancement to correct the
skeletal discrepancy.
5.Upper and lower fixed retainer (17.5 mil braided steel archwire)
for long period of time(because of spacing and rotated incisors)
6.Upper essix as retainer after correction of deep overbite, night
time wearing (1.5mm thickness).

41. Thank You