dr. jamal hafiz

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Orthodontic Case Presentation Done By : Dr. Jamal Hafiz Al-Qadhi 2 rd Year Orthodontic Resident Supervised by : Dr. Ahmad Al-Tarawneh . Dr. Raed Al-Rbata .

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Orthodontic Case PresentationDone By:Dr. Jamal Hafiz Al-Qadhi2rd Year Orthodontic Resident

Supervised by:Dr. Ahmad Al-Tarawneh.Dr. Raed Al-Rbata.

Data of assessmentPersonal data:-Patients Initials: T. M.Address: AmmanGender: Female. Date of birth: 27/7/2000 (16 years old).Occupation: Student.Nationality: Jordanian.

Chief Complaint Spaces behind my upper anterior teeth and upper jaw is protruded

Medical History:Patient denied any medical problem.

Dental History:Pervious orthodontic treatment (4 years ago).

Orthodontic History :-Patient Started orthodontic treatment before 4 years .Upper and lower fixed appliance with treatment plan based on extraction upper 1st premolars; and she didn't wear the retainer ( Hawley retainer) because the patient wasnt motivated

Extra Oral AssessmentFrontal View

Extra Oral AssessmentProfile View

Extra Oral AssessmentOblique View

Extra Oral AssessmentSkeletal Assessment Anteroposterior:Skeletal Class II Pattern

Skeletal Assessment Vertical: Average lower facial height

Skeletal Assessment Transverse: Symmetrical face

T.M.J.

No signs of TMD(No clicking , crepitus and tenderness to palpation).Normal range of opening, lateral movement and no displacement.

Extra Oral Assessment Soft tissue Assessment

:Asymmetrical faceThe patient has slight facial AsymmetryNose deviated to left side.

Soft tissue Assessment

Incompetent lips.Average of upper & lower lip length.Convex facial profile.No habits.

Soft tissue Assessment Normal frontonasal angle 133 (Normal 115-135) Normal nasolabial angle 97 (Normal 90-110)Normal labiomental angle 115 (Normal 114-140)

Smile Aesthetics Assessment

Full crown of incisor show with slightly increased gingival show.

Smile extend to 1st molar.

smile is acceptable

Intra Oral Examination

Good Oral Hygiene.Normal frenal attachment.High gingival margin on UL2. Normal oral mucosa.Teeth Present (Permanent dentition). 87 6 5 3 2 1 1 2 3 5 6 7 8 87 6 5 4 3 2 1 1 2 3 4 5 6 7

Lower archU-shaped of lower archAnterior segment:Upright incisors and canines.Buccal segment:Rotated LR4&5Space between LL3&4Unerupted LL8

Midline shift to right 2mm

Upper archU-shaped arch.Anterior segment:Upright upper incisors & Canines.Palatally tilted UL2.Buccal segment: Previously extracted U 1STPremolars.Rotated U 1ST Molars & UL2nd premolar.

Teeth In OcclusionAnterior segmentClass II div. I incisor relationship .Lower midline shift to the right 2mm .Overjet 5 mm.Deep Complete overbite 70%.

2mm

Buccal Segment Molar relationship: More than CL II full unit Rt. & Lt sides.Canine relationship: CL II unit Rt side and CL II unit Lt side.

Study model analysisAnteroposterior O. J = 5mm.Class II 1/2unit canine More than class II full unit molar relationships.Class II unit canine and More than class II full unit molar relationships.

Study model analysisTransverse Lower midline shift to the right side 2mm.

Study model analysisVertical O. B = deep complete 70%.

Study model analysisRight side: curve of spee 2mm Left side:curve of spee 2mm

Study model analysisUpper archU shape arch form.Dental asymmetry.

Intermolar width 43mm.Intercanine width 31mm.43mm

31mm

Study model analysisLower archU shape arch form.Dental asymmetry.Intermolar width 42mm.Intercanine width 25mm

42mm25mm

Space AnalysisLower Arch:Space Available: 81mmSpace Required: 79mm+2mm (Spacing )Upper Arch:Space Available: 87mmSpace Required: 93mmSpace demand: -6 mm (Moderate Crowding)

1076.5878878 6.57106543211234566543211234569.576.565.5555.566.579.5

Bolton RatioAnterior Ratio: (3 - 3): 33/45 = 73.3% (Normal: 77.2%).

Overall Ratio: (6 - 6): 79/93= 84.9% (Normal: 91.3%).

Theres a decrease in anterior bolton ratio.

Royal London Space AnalysisUpper ArchLower Arch -6+2 Crowding/Spacing00 Angulation change0-2 Leveling curve of Spee00 Inclination change 0 0 Arch width change 0 0 Incisors A/P change

According to Royal London space analysis: - Lower Arch : 0mm. - Upper Arch : needs -6 mm.

Pre-Treatment IOTNAesthetic Component

Figure2No treatmentneed.

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Pre-Treatment IOTNDental Health ComponentGrade 4Grade 4h: Less extensive hypodontia (one tooth per Quadrant ) requiring pre-restorative orthodontics or orthodontic space closure.

Radiographic Examination OPTAll permanent teeth are present except UR&L 1st premolars.LL 3rd molar unerupted.No pathology or abnormalities could be identified.

L

Lateral Cephalogram

VariablePre-TreatmentNormal ValueSNA8181 +- 3 SNB7478 +- 3 ANB73 +- 2 S-N/MX6.58 +- 3ANB*MMPA3027 +- 3 FMPA2928-+3UFH53LFH74LAFH %58%55 +- 2 U1/Mx101109 +- 6 L1/Mn9193 +- 6 IIA135133 +- 10 Wits Appraisal+6.5mm0-+1.7 F

Diagnostic SummaryT.M 16 year old female, denied any medical problem, with good oral health, complaining of spacing behind the upper anterior teeth and her upper jaw is protruded . She has class II/I incisor relationship based on class II skeletal pattern, average lower facial height, incompetent lips, gingival recession on UL2, convex facial profile, asymmetrical soft tissue with nose deviated to the left side. She has missing UR&UL 1st premolars, O.J of 5mm, deep complete overbite 70%, lower midline shift to right 2mm, moderate crowding upper arch and spaced lower arch. She has more than class II full unit molar s on both sides, and class II unit canine relationship on right sides, class II unit canine relationship on the left side, and palataly tilted UL2 , rotated U 1st molars UL5 and LR4&5.

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Problems ListGingival recession on UL2.Spacing behind upper anterior teeth and upper jaw is protruded.Skeletal :-Class II skeletal pattern. Soft tissue:-Convex profile.Asymmetrical face.Incompetent lips.Dental :-Previously extracted upper R& L 1st premolar.Increased Overjet 5mm.Deep complete over bite 70%.Lower mid line shift 2 mm to the right.Rotated lower right 1st and 2nd premolar.Rotated upper right & left st molars and upper left 2nd premolar.Palataly tilted upper left lateral incisor.Moderated crowding in upper arch .More than class II full unit molar in right & left sides. Class II unit canine in right side and class II unit in left side.Anterior bolton discrepancy.

Treatment AimsCorrection of gingival recession (orthodontically)Correction of patient chief complaint.Accept skeletal class II pattern.Accept soft tissue problems.Correct over jet.Correct over bite(centroid relationship).Correct lower midline shift.Correct Rotated lower right 1st and 2nd premolar.Correct Rotated upper right & left st molars and upper left 2nd premolar.Correct Palataly tilted upper left lateral incisor.Correction of moderated crowding in upper arch.Achieve Class II full unit molar in right & left sides.Achieve Class I canines relationship. Accept anterior bolton discrepancy.

Treatment Plan Non-Extraction case

O.H.I .Quadhelix to derotate upper first molars and after correction replace quadhelix with TPA Use Tads or straight pull headgear to maximize anchorage.Upper and lower fixed Appliance.( Straight arch wire technique; MBT prescription slot 0.022) Retention.Upper and lower permanent retainer and VFR

Justification : Quadhelix

derotation of upper 1st molars to achieve class II full unit molars relationship .Create space to achieve class one canines relationship. Straight pull headgear or Tads to maximize anchorage .Fixed Appliance MBT prescription slot 0.022: torque is needed not to tip anterior teeth while being retracted ( they are already inclined , patient suffers from gummy smile )Bodily teeth movement is required .Correct lower midline shift.Alignment of rotated teeth.Closing of spaces.Leveling curve of spee.Retention:long term : Upper: permanent retainer from 5-5. Lower : permanent retainer from 3-3. due to patient previous lack of co-operation regarding the removable retainerShort term: Lower and upper FVR to preserve teeth in their position.

Thank You