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orthodontics patient records preparation /certified fixed orthodontic courses by Indian dental academy
1. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2.
Name:Sai Kumar
Age: 15 yrs
Sex : M
Address:KSNB Singh,Nellore
Chief complaint :
Patient complaints of forwardly placed
upper front teeth .
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3. GENERAL HISTORY
Reason for taking orthodontic treatment: Esthetics
PHYSICAL STATUS
BUILD
: Mesomorphic
BODY TYPE : Athletic
HEIGHT
: 5.8 inches
WEIGHT
: 60 kgs
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4. EXTRA ORAL EXAMINATION
Shape of the head: Mesocephalic
Facial form : Mesoprosopic
Facial profile
:Convex
Clinical FMA
: Average angle
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8. Inter labial gap : 0mm
Smile Arc :Consonant
Lip posture and tonicity :Potentially
competent.
Lip length :
At philtrum : 17 mm
At corner of mouth : 22 mm
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9. Functional examination
Respiration :Nasal
Amount of incisor exposure
At rest
: 0 mm
During speech : 8 mm
During smile : 9 mm
Free way space: 2 mm
Curve of Spee = Rt 2mm & Lt 2 mm
Range of Motion
1) Maximum Opening 50mm 2) Protrusion 8mm
3) Rt Excursion 8mm
4) Lt Excursion 8mm
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10.
Jaw function/TMJ complaint now : (No)
History of Pain
: (No)
History of Sounds
: (No)
Joint tenderness to palpation
: (No)
Muscle tenderness to palpation : (No)
click on
Deflection of Mandible
Anterior disk displacement -
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11. Right side
Left side
Class - I Molar relationship.
Class – II Molar relationship
End on Canine relationship.
Endon Canine relationship
Class –II Incisor relationship
Class –II Incisor relationships
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18. HARD TISSUE
PRE-TREATMENT
Normal
ANB
Measured
Class
2˚
5°
II
A ⊥ to B ⊥ on FH
4mm
8mm
II
AO to BO
0 – 1mm
4mm
II
Beta angle
27˚ to 35˚
30°
I
NA – Pog
0 - 5˚
7°
I
-4˚
-4°
II
Max : Mand(ANS>PNS,GoGn)
2:3
2.26:2.73
II
Harvold’s unit length difference
Chart
14
II
AB – N.pog
Skeletal Class
II
Soft tissue Profile Angle
161˚
151°
II
Total tissue Profile angle
133˚(males)
137˚(female
)
123°
II
97 + 10
87°
I
Soft tissue facial angle
Subnasale ⊥ to chin
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-2.5±2.6
-15mm
II
19. Effects of soft
tissues if any&
I
N
F
E
R
E
N
C
E
Basic Upper lip Normal, Thick, Thin
(14+1
17mm
Soft Tissue
chin
8mm
Normal, Thick, Thin
(10+12)
Class – I
SKELETAL
Class – II
√
Class – III
Mild (2_4)
SEVERITY
Moderate
(4_6)
√
Severe (>6)
Matching
SOFT TISSUE
Compensati
ng
Aggravating
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√
20. MAXILLA
Norms
Max apical base
Pre Rx
iPost growth
modulation
Normal maxilla
SNA
82±2˚
81˚
⊥A–N⊥
2mm
0mm
Normal maxilla
CAUSE
57.7±3.5
Max size- ANS – PNS
58mm
Normal maxilla
Max effective length Co – ANS
100.9 ±3.9
90mm
Decreased
Max placement S ⊥ NF – PTM ⊥
NF
18mm
18mm
Normally placed
MANDIBULAR APICAL BASE
SNB
80±2˚
76˚
B⊥-N⊥
-2mm
Retrognathic
mandible
-9 mm
Chin
N –Pog –FH (facial angle)
CAUSE
87˚
87˚
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Normal
21. Norms
131.6±4.5
Mand eff. Length
Pre Rx
Post growth
modulation
104mm
MANDIBULAR PLACEMENT
Saddle angle
123±5˚
124 ˚ N
Post cranial base
32 – 35
40mm
Effect of gonial angle
128±7˚
126˚
Effect of ramus
orientation S – Ar –
Go
143±6˚
141˚
I
N
F
E
R
A
N
C
E
Maxilla
Fault
with
Size ( N )
Placement (Normal)
Mandible
Size ( )
Placement (Normal)
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22. Pre Rx
Normal
Normal
45:55
43:57
SN – Go – Gin
32°
30°
F–M–A
25°
Post growth modulation
Mid/Lower face ht
High
Low
Soft tissue vert. prop
20
Jarabak ratio
62-65%
75%
BJORK sum
396±6°
391
Saddle angle
123±5°
124o
Articular angle
143±6°
141o
U- Gonial angle
52-55°
560
L- Gonial angle
72-75°
700
Y- axis N –S – Gin
66°
660
Y- axis FH – S – Gn
59°
580
Facial axis (Ricketts)
90°
Compensated by Ramus Ht ?
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850
24. Per Rx
Anterior Divergent
Anterior convergent
Upward anterior rotation of
both max and mand
√
Downward anterior
rotation of both max and
mand
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Post growth modulation
25. Pre.Rx
Sagittal affected by vertical
Sagittal caused by
Retrognathic
mandible
Sagittal worsened by
Sagittal compensated
Horizontal growth
pattern
UPPER INCISOR EXPOSURE
U1 exposure at rest
0mm
U1exposure in smile
9mm
ANS to Incisor (33±3/30±3)
32mm
U lip length (22-24/20)
17mm
INFERANCE
No excessive
exposure
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P.Gr.Mod
26. UPPER
normal
Pre Rx
P. Gr. Mod
U1 – SN
102˚
116°
U1 – NA
22˚, 4mm
33°, 10mm
U1 - N⊥
2 – 4mm
10 mm
U1 – A Pog
25˚ , 4mm
39°, 13 mm
U1 – N Pog
10mm
15 mm
normal
Nasolabial angle
90-110°
Pre Rx
120°
Nasal angle
Labial angle
12°
U lip thickness
15 mm
17mm
5mm
11mm
Basic U lip thickness
Lip Strain
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28. LOWER
normal
Pre Rx
L1 – FH
65°
57°
L1 – MP
95°
102°
L1 – NB
25°,4mm
25°, 4mm
L1 – A Pog
25°,4mm
P. Gr. Mod
23°,1mm
L1 – N Pog
3mm
L1 – NB – NB – Pog
1:1
2:1
Mentolabial angle
120±10°
104°
L – lip thickness
12±3
20 mm
L – lip length
40±5
45 mm
INFERENCE
Lower incisor
retraction needed
In relation to mandibular
0mm
For camouflage Rx
-3mm
Mentolabial sulcus
Supported
by
Lower lip thickness
Holdaway ratio
Lip in relation to esthetic line
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29. LAND MARKS
Facial angle
Upper lip curvature
MEAN
90º
PATIENT
VALUES
87º
INFERENCE
Convex profile
2.5 mm
3mm
Average
-2 ± 2
+3mm
Class II skeletal
7º to 15º
20º
Increased lip thickness
Nose tip to H – line
12 mm (max)
2mm
Normal
Upper sulcus depth
5 mm
6mm
Increased
Upper lip thickness
15 mm
17mm
Decreased
Upper lip strain
14 – 16
6mm
Lower lip to H – line
-1 to +2 mm
5mm
Increased LL
Lower sulcus depth
5 mm
6mm
Deep ML sulcus
10 – 12 mm
8 mm
decreased chin thickness
Skeletal convexity at A
H – line angle
Soft tissue chin thickness
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lip strain present
31. BOLTON TOOTH RATIO
OVERALL RATIO: Mand 12 TM x 100 =89.55%
Max 12 TM
1.5mm of Maxillary tooth material excess
Ant. RATIO: mand 6 TM x 100 =76.47% ,
max 6 TM
.0427 mm of maxillary tooth material excess
ARCH PERIMETER ANALYSIS
Tooth Material
:
Arch length
:
Difference
:
Upper
81mm
Lower
68 mm
83mm
61mm
2mm
(spaceavailable)
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7mm
(space required)
32. ASHLEY-HOWE ANALYSIS
UPPER
PMD = 40 mm
PMBAW = 42 mm PMBAW > PMD
Expansion possible
PMBAW 100;
TM
Boderline case
42100 = 41.7%
100.5
LOWER
PMD = 34 mm
PMBAW = 35mm PMBAW >PMD
Expansion possible
PMBAW 100;
TM
35100 = 38.88%
90
Boderline case
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33.
LINDER-HEARTH ANALYSIS
UPPER
MPV = 36mm
INDICATED.
CPV = 41 mm CPV >MPV EXPANSION IS
MMV = 49 mm CMV = 54 mm CMV >MMV EXPANSION IS
INDICATED.
LOWER
MPV = 31mm CPV = 28.23 mm
IS INDICATED.
MMV = 44mm
INDICATED.
CPV <MPV EXPANSION NOT
CMV = 37.5 mm CMV < MMV EXPANSION IS NOT
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34. Upper arch
Space discrepancy ( Arch perimeter)
= 2mm(available)
Space obtainable by Derotation of Molars
= 0 mm
Space required for correcting Canine rotations = 0mm
Incisor Proclination
UI to NA
= 33º
For ANB of 5º
= 19º
To retrocline
= 14x0.8 = 11.2mm
►Total space required
= 11.2-2=9.2 mm
►Discrepancy
= 9.2mm
►Space required for molar correction on RT ___mm LT___ mm
►Hence space required on
RT 4.6 mm LT 4.6 mm
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35. Lower arch
Space discrepancy ( Arch perimeter) = 7 mm(required)
Space required for Derotation of 34
= 0mm
Space required for correcting Incisor =0mm
Proclination
L I to NB
= 25 º
For ANB of 5º
= 28º
To procline = 3X 0.8 = 2.4mm
►
►
►
Leveling Curve of Spee = 3 mm (normal)
Space required to establish class I molar relation =4mm on RT
Discrepancy
= 7+2.4+4=13.4mm
Hence space required on RT _8.7__mm LT_ 4.7_ mm
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36. DIAGNOSIS AND TREATMENT PLAN
DIAGNOSIS:
ACKERMAN-PROFFIT CLASSIFICATION:
Evaluation of Facial Proportions and Esthetics:
Convex profile,
Potentially competent lips
Normal maxilla
Retrognathic mandible
Decreased chin thickness
Proclined upper and lower incisors
Protruded upper and lower incisors
Low LAFH
Obtuse nasolabial angle
AcuteMentolabial sulcus
Intra-Arch alignment and symmetry
symmetric U & L Arch
lower anterior crowding
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37.
Angle’s Class-II subdivision Dentoalveolar
malocclusion on class I skeletal base with Class – II soft
tissue profile with proclined upper and lower incisors
and severe lower anterior crowding
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38.
To level & align upper and lower arches
To correct over jet & over bite
To correct the mid line shift
To attain class I molar ,canine and incisor
relationship
Establishing soft tissue harmony
To stabilize the corrections achieved
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39. Upper 4s and lower 5s
PAE with MBT Mechanotherapy
Leveling and Alignment.
Type A anchorage on all sides except lower right
quadrant.
Class II elastics on right side
After achieving class I molar relation maintain Type
B anchorage in all quadrant
Finishing & Detailing.
Stability and Retention.
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40.
PHASE – I
0.016 round NiTi - 1 Month
0.016 X 0.022 NiTi – 1Month
0.017 X 0.025 NiTi – 1 Month
0.017 X 0.025 SS - 1 Month
4 Months
PHASE – II
0.017 X 0.025 SS Individual canine retraction - 3 Month
0.017 X 0.025 SS 4 incisors as 1 unit- 3 Month
PHASE – III
0.018 X 0.025 SS
0.019 X 0.025 SS
0.021 X 0.025 SS
- 1 Month
- 1 Month
- 1 Month
6 Months
3 Months
13 Months
SURGICAL PHASE
RETENTION & STABILITY
Permanent Upper and Lower Lingual Canine to Canine bonded Retainer
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41.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Retention begins with Diagnosis and
Treatment planning.
Treatment goals include
Growth
Balanced soft tissue profile
Non extraction treatment when possible
Mandibular incisors upright on basal bone
Good Interincisal angle
Normal root artistic positioning
Mandibular molars upright
Cuspids not expanded
Normal overjet and overbite
Class – I cuspids , cuspid protected occlusion.
Patient is non growing.
Normal MPA
Decreased Interincisal angle.
Retroclination of maxilla
Auto rotation of mandible
Down ward and backward
growth rotation of body of
mandible
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42. Thank you
For more details please visit
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