DIAGNOSTIC SUMMARY

Name Age Gender Medical history Presented with a Class incisors relationship on a ??? Class ??? skeletal base with

vertical proportions. This is complicated by (main features starting by intra-arch then inter-arch then soft

tissue then main pathology) IOTN

CLINICAL EXAMINATION

EXTRA-ORAL FEATURES

1. Skeletal Assessment:

Antero-posterior: Skeletal Class + what is the diagnosis i.e. mandibular prognathism or retrognathisim

Chin position

Vertical Frankfort Mandibular planes angle.

lower anterior face height

Transverse : No significant facial asymmetry detected

2. Soft tissue assessment:

Lips competentency Lip trap NLA LMA Incisor show Profile in relation to E line

3. TMJ Assessment:

signs or symptoms of TMD

INTRA-ORAL FEATURES

a. General

1. Oral hygiene:

2. Soft tissues:

No abnormality detected

BPE

3. Erupted teeth present:

4. General dental condition:

Good tooth quality with no caries, discolouration or non-carious tooth substance loss.

0 0 0

0 1 0

b. Mandibular arch:

Arch shape

Crowding and spacing (better to assess the space requirement using RLSA),

crowding assessed by using Ruler to measure teeth Mesiodistal width and then

Space available in archform that represent the majority of teeth.

Incisor inclination Canine angulation COS

c. Maxillary arch:

Arch shape

Crowding and spacing (better to assess the space requirement using RLSA)

Incisor inclination

Canine angulation

COS

OCCLUSAL FEATURES

1. Incisor relationship:

2. Overjet (mm):

3. Overbite:

4. Left buccal segment relationship: Canine- Class Molar- Class

5. Right buccal segment relationship: Canine- Class Molar- Class

6. Transverse: Centrelines Posterior crossbite

7. Occlusion and mandibular Displacements: type of displacement and occlusion (group function)

8. Other occlusal features: Rotation, displaced tooth, retained

9. Mandibular displacement and deviation.

GENERAL RADIOGRAPHIC EXAMINATION

Unerupted teeth:

Teeth absent:

Teeth of poor prognosis:

Other relevant radiographic findings: No evidence of any pathology or root

resorption+hard tissue pathology

Bolton’s Tooth-Size Analysis IOTN

PROBLEM LIST

1. Oh

2. Pathology (caries, trauma, resorption, retained teeth)

3. Skeletal pattern

4. Soft tissue

5. Crowding and spacing

6. Incisors relationship

7. Anterior crossbite or posterior crossbite with associated displacement

8. Overjet

9. Overbite

10. Centreline

11. Buccal segment relationship

12. Other occlusal feature like rotation, impaction, dispklacement

AIMS AND OBJECTIVES OF TREATMENT

1. Maintain good oral hygiene throughout orthodontic treatment

2. Treatment of pathology

3. Orthodontic camouflage accepting the Class skeletal pattern

4. Improve the skeletal relationship and facial profile by modifying and accelerating the facial growth and maximize dentoalveolar compensation

5. Soft tissue feactures correction including elimination of trapping

6. Relief crowding

7. Level and align dental arches

8. Correct centre line

9. Normal overjet and correct anterior cross bite

10. Achieve Class molars, canines and incisors

11. Overbite

12. Correct transverse problem

13. Space closure

14. Coordinate dental arches with good buccal interdigitation

15. Retain the corrected result

Cephalometric interpretation

INTERPRETATION

1. Skeletal:

SNA

SNB

ANB angle of ?? suggests a ?? skeletal pattern. The Wits analysis of mm supports the presence of a ?? skeletal pattern.

The MMPA is ?? . The face height ratio is???.

2. Dental:

The upper incisors were of ???? inclination at degree

lower incisors were of ???? inclination at degree

The interincisal angle was at

The lower incisors were ?? mm ?? of A Pogonion line.

3. Soft tissue:

Nasolabial angle.

Lower lip was ??relative to Ricketts E plane.

4. Summary:

The cephalometric findings confirm the assessment of a Class?? malocclusion on a Class skeletal pattern with ?? MMPA. (The soft tissues are masking the underlying Class skeletal pattern).

5. Sources of normal values:o Jacobson (1975) Am J Orthod. 67:125-133.o Houston WJB, Stephens CD & Tulley WJ (1992)

A textbook of orthodontics. Wright, Oxford

TREATMENT PLAN

1. Request consultation advice

2. Treatment of patholgy

3. Oral hygiene instruction and tooth brushing.

4. Orthodontic treatment phase

One or two phase orthodontic treatment approach (e.g. using a functional appliance to improve the skeletal relationship and facial profile by modifying and accelerating the facial growth and maximize dentoalveolar compensation and reducing the overjet, overbite and correct the buccal segment relationship) and helping in reducing the anchorage demand in the secon stage of FA treatment

or (URA to retract upper canine and allow eruption of the posterior teeth)

then reassesss

Then finish with fixed appliances to details the occlusion.

5. Adjunctive appliance: Q helix, RME

6. Extractions:

7. Appliances:

Functional appliance design

HG prescription

URA design

Upper and lower arch pre-adjusted Edgewise appliances 0.022" x 0.028" slot (MBT

prescription)

8. Special anchorage requirements:

9. Additional dental treatment:

Build up teeth

Routine oral hygiene reviews

attendance for regular check-ups with general dental practitioner

10. Proposed retention strategy:

Upper and lower vacuum formed retainers. To be worn evening and night for a year

and following this a reduced regime will be recommended on a long term basis.

Lower bonded retainer from canine to canine to be considered for long term.

Bonded bridge or implant

11. Prognosis for stability:

A. Any skeletal change depends on Favourable growth Stable changes No posturing

B. Soft tissue correction specially the lip trap depend on Correct U incisor relationship to lower lip

C. Overjet correction depends On the control of the lower lip in class II Normal positive OJ in class III Permanent retainer

D. Proclination of the lower labial segment away from the starting inclination would be

Permanent retainer Within the exception of Mills For aesthetic reason better to be within A-Pog line

E. Overbite correction is to be maintained by An improvement in the interincisal angle The creation of a positive upper root centroid to lower incisor tip relationship. Active retainer (URA)

F. Buccal and transverse relationship maintained by Interdigitated occlusion Avoidance of changing the width of the arch Correct torque Permanent retainer