orthodontic case presentation as a partial requirement for the course dent 415 -orthodontics, McGill University. Great work from all the students.

1. Orthodontic
Completed Case
Presentation
Name: A S, DMD IV, 2012
Chart #:
Date: March, 2012

2. PRE-TREATMENT

3. Initial Patient History
 Name: A.P.
 Sex: Female
 Age: 36
 Date: March, 2011
 CC: “Aesthetics; my front
teeth are overlapping and
all my teeth curve
inwards.” Pre-Treatment

4. Patient History
 Past Medical History: NSF
 Medications: None
 Allergies: None
 Past Dental History: Consistent
dental visits 2X/year
 Oral Hygiene: Good, PSR II
Pre-Treatment

5. Extra-Oral Examination
 Facial Type: Normocephalic
 Facial Proportions:
Decreased lower face height
(Mild)
 Facial Symmetry:
Symmetrical
Pre-Treatment

6. Extra-Oral Examination
 Facial Profile: Slight to
moderate convexity
 Nasolabial Angle: ~ 100
degrees
 Lips: Normal seal
 Incisor at Rest: 6 mm
Pre-Treatment

7. Neuromuscular & TMJ Examination
 Tongue at Rest: Normal
 Swallowing Pattern: Normal
 Muscles of Mastication: WNL
 TMJ: Normal articulation
Normal range of motion
Normal muscles of mastication
Pre-Treatment

8. Extra-Oral  Intra-Oral
 Facial & Dental Midlines: On
 Lower dental midline deviates 2
mm to the left upon opening
Pre-Treatment

9. Occlusion
Right Side Dental Midline Left Side
 Molar Class: I  Upper: On  Molar Class: N/A
 Canine Class: I  Lower: On  Canine Class: I
Pre-Treatment

10. Intra-Oral Examination
 Overbite: 50%  Overjet: 2 - 3 mm
Pre-Treatment

11. Intra-Oral Examination
 Teeth Present:
11-17, 21-25, 27
31-35, 37, 41-47
 Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
Pre-Treatment

12. Intra-Oral Examination
 Clinical Findings:
 Molars: Class I on right; Missing 26 & 36 on left
 Canines: Class I
 Missing: 18, 26, 28, 36, 38 & 48
 OJ: 2 mm on right; 3 mm on left
 OB: 50%
 Mild crowding on both upper & lower incisors
Pre-Treatment

13. Intra-Oral Examination
 Amount of Crowding:
Upper Arch: Mild ~ 3 mm
Lower Arch: Mild ~ 3mm
Pre-Treatment

14. Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathology
Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Pre-Treatment

15. Cephalometric Analysis
Angles Ceph. Normal
Values
Skeletal Measurements
SNA 79.5 81 ± 3
SNB 75.0 78 ± 3
ANB 4.5 3±2
Witts -4.0 2 mm ± 2mm
Facial 86.0 88 ± 4
MPAST 38.0 32 ± 3
Y axis 60.0 60 ± 4
Dental Measurements
(UI,NA) 16.0 23 ±6
(LI,NB) 23.0 27.5 ±5
(UI,LI) 135.0 130 ± 7
(LI,MP) 91.0 91.4 ± 4
Pre-Treatment

16. Dental Cast Analysis:
Curve of Spee
 Upper: Flat  Lower: Slight
Pre-Treatment

17. Dental Cast Analysis
Bolton Analysis – Ideally 77%
Tooth Upper right Upper left Ideal
Central Incisor 8.5 8.0 8.85
Lateral Incisor 5.5 6.0 6.9
Canine 6.7 7.0 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.1 5.0 5.5
Lateral incisor 5.3 5.4 6
Canine 5.4 5.2 6.95
• UA (Σ 13-23) = 41.7 mm
• LA (Σ 33-43) = 31.4 mm
• ( 31.4 / 41.7 ) x 100 = 75.3%
Pre-Treatment

18. Summary of Findings
 Dental:
 Molars: Class I on right; Missing 26 & 36 on left
 Canines: Class I
 Missing: 18, 26, 28, 36, 38 & 48
 OJ: 2 mm on right; 3 mm on left
 Increased OB (50%)
 Lower dental midline deviates 2 mm to the left upon opening
 Mild crowding on both upper & lower incisors
 Normal to tapered arch shapes
 6 mm of upper incisors showing at rest
Bolton analysis: 75.3%
 Skeletal:
 Symmetrical face; Normocephalic
 Decreased lower face height
 Slight-moderate convex profile Pre-Treatment

19. Diagnosis
 Class I molar/canine
 Maxillary anterior crowding
 Mandibular anterior crowding
 50% overbite
 Flat to slight curve of spee
Pre-Treatment

20. Objectives of Treatment
 Resolve patient’s chief complaint of
crowding
 Decrease overbite
 Maintain class I molar/canine
relationship
 Maintain nasolabial angle
 Maintain midlines
Pre-Treatment

21. TREATMENT
OPTIONS

22. Compromised Treatment
 Address chief complaint:
 Resolve upper anterior crowding
 Align & level the teeth
 Space available in upper arch due to extracted 26, &
in lower arch due to extracted 36. However, we
cannot use too much of this space, as it will alter the
midline alignment, & make it more difficult to replace
26 & 36 in the future.

23. Compromised Treatment
Option #1
 Invisalign: Upper & Lower
 IPR to allow for improved alignment

24. Compromised Treatment
Option #2
 Full fixed: Upper & Lower
 Alignment & levelling
 Arch coordination
 IPR

25. TREATMENT
DONE

26. Treatment Done
 Patient did not want upper & lower
bracketing
 Unable to do complete bracketing in
McGill Student Dental Clinic
 Selected:
 Compromised Treatment Option #1
 Invisalign:Upper & Lower
 IPR to allow for improved alignment

27. Exactly One Year
Later
Post-Invisalign
Treatment

28. Extra-Oral  Intra-Oral
 Facial & Dental Midlines: On
 Lower dental midline deviates 2
mm to the left upon opening
Post-Invisalign Treatment

29. Occlusion
Right Side Dental Midline Left Side
 Molar Class: I  Upper: On  Molar Class: N/A
 Canine Class: I  Lower: On  Canine Class: I
Post-Invisalign Treatment

30. Intra-Oral Examination
 Overbite: 30%  Overjet: 1 - 2 mm
Post-Invisalign Treatment

31. Intra-Oral Examination
 Teeth Present:
11-17, 21-25, 27
31-35, 37, 41-47
 Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
 Crowding:
Upper: Normal
Lower: Normal Post-Invisalign Treatment

32. Post-Invisalign Treatment Problems
 Patient not
satisfied with
the final
position of
tooth #32 &
tooth #41
Post-Invisalign Treatment

33. Post-Invisalign Treatment Solution
 Dimple-maker!
 Dimples added to:
 Tooth #32 - distal buccal incisal area
 Tooth #41 - distal buccal incisal area
 IPR on both tooth #32 & #41
 Both teeth rotated into proper position within 2 weeks
 Dimples then added to:
 Tooth #31 - distal buccal incisal area & mesial lingual incisal
area
 Patient now satisfied with final results Post-Invisalign Treatment

34. Post-Invisalign Treatment Solution
Pre-Treatment
Post-Invisalign Treatment
Post-Treatment

35. Post-Treatment

36. Patient Presentation
 Age: 37
 Date: March, 2012
 Post-treatment perspective:
Patient is very satisfied with
the results following Invisalign
Post-Treatment

37. Extra-Oral Examination
No change from pre-treatment:
 Facial Type:
Normocephalic
 Facial Proportions:
Decreased lower face
height (Mild)
 Facial Symmetry:
Symmetrical
Pre-Treatment Post-Treatment

38. Extra-Oral Examination
No change from pre-treatment:
 Facial Profile: Slight to
moderate convexity
 Nasolabial Angle: ~ 100
degrees
 Lips: Normal seal
 Incisor at Rest: 6 mm
Pre-Treatment Post-Treatment

39. Neuromuscular & TMJ Examination
No change from pre-treatment:
 Tongue at Rest: Normal
 Swallowing Pattern: Normal
 Muscles of Mastication: WNL
 TMJ: Normal articulation
Normal range of motion
Normal muscles of mastication
Post-Treatment

40. Intra-Oral Examination
 Overbite: 50%  Overbite: 30%
 Overjet: 2 - 3 mm  Overjet: 1 - 2 mm
Pre-Treatment Post-Treatment
Decrease in both overbite &
overjet

41. Intra-Oral Examination
Pre-Treatment Post-Treatment
Decrease in both overbite & overjet

42. Intra-Oral Examination
No change from pre-treatment:
 Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
Pre-Treatment Post-Treatment

43. Intra-Oral Examination
Decrease in
crowding
Pre-Treatment Post-Treatment
 Amount of Crowding:  Amount of Crowding:
Upper Arch: Mild ~ 3 mm Upper Arch: None
Lower Arch: Mild ~ 3mm Lower Arch: None

44. Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathology
Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Post-Treatment

45. Cephalometric Analysis
Angles Ceph. Normal
Values
Skeletal Measurements
SNA 80.0 81 ± 3
SNB 75.0 78 ± 3
ANB 5.0 3±2
Witts -4.5 2 mm ± 2mm
Facial 84.0 88 ± 4
MPAST 39.5 32 ± 3
Y axis 63.0 60 ± 4
Dental Measurements
(UI,NA) 12.0 23 ±6
(LI,NB) 22.5 27.5 ±5
(UI,LI) 141.0 130 ± 7
(LI,MP) 87.5 91.4 ± 4
Post-Treatment

46. Cephalometric Changes (>1 degree differences in blue)
Angles Ceph. Normal Angles Ceph. Normal
Values Values
Skeletal Measurements Skeletal Measurements
SNA 79.5 81 ± 3 SNA 80.0 81 ± 3
SNB 75.0 78 ± 3 SNB 75.0 78 ± 3
ANB 4.5 3±2 ANB 5.0 3±2
Witts -4.0 2 mm ± 2mm Witts -4.5 2 mm ± 2mm
Facial 86.0 88 ± 4 Facial 84.0 88 ± 4
MPAST 38.0 32 ± 3 MPAST 39.5 32 ± 3
Y axis 60.0 60 ± 4 Y axis 63.0 60 ± 4
Dental Measurements Dental Measurements
(UI,NA) 16.0 23 ±6 (UI,NA) 12.0 23 ±6
(LI,NB) 23.0 27.5 ±5 (LI,NB) 22.5 27.5 ±5
(UI,LI) 135.0 130 ± 7 (UI,LI) 141.0 130 ± 7
(LI,MP) 91.0 91.4 ± 4 (LI,MP) 87.5 91.4 ± 4
46
Pre-Treatment Post-Treatment

47. Dental Cast Analysis:
Curve of Spee
No change from pre-treatment:
 Upper: Flat  Lower: Slight
Post-Treatment

48. Dental Cast Analysis
 Angle Classification:
 Right Side: Class I molar & class I canine
 Left Side: Class I canine (missing tooth 26 & 36)
 Dental Midline:
 Lower: On
 Upper: On
 Overbite: 40%
Post-Treatment

49. Dental Cast Analysis
Bolton Analysis – Ideally 77%
Tooth Upper right Upper left Ideal
Central Incisor 8.3 8.1 8.85
Lateral Incisor 5.8 5.8 6.9
Canine 7.3 7.1 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.2 4.7 5.5
Lateral incisor 5.1 5.3 6
Canine 6.1 5.8 6.95
• UA (Σ 13-23) = 42.4 mm
• LA (Σ 33-43) = 32.2 mm
• ( 32.2 / 42.4 ) x 100 = 75.9%
Post-Treatment

50. Summary of Findings
 Dental:
 Molars: Class I on right; Missing 26 & 36 on left
 Canines: Class I
 Missing: 18, 26, 28, 36, 38 & 48
 OJ: 2 mm on right; 1 mm on left
 Increased OB (30%) - Decreased from 50% at pre-treatment
 Lower dental midline deviates 2 mm to the left upon opening
 Crowding issues on both upper & lower incisors resolved (addressed CC)
 Normal to tapered arch shapes
 6 mm of upper incisors showing at rest
Bolton analysis: 75.9%
 Skeletal:
 Symmetrical face; Normocephalic
 Decreased lower face height
 Slight-moderate convex profile Post-Treatment

51. Future Treatment
 Retention: Patient does not want removable
appliances
 Unable to place lingual bars in McGill Student
Dental Clinic
 Patient therefore referred to a private
orthodontist to place both upper & lower
lingual bars
 Patient presently applying to McGill Student
Dental Multidisciplinary Clinic for placement of
2 implants to replace missing tooth 26 & 36

52. Thank you!