RMS ortho residents

1. Presented by : Dr.Motasem Abu Zaid
3rd year Orthodontic Resident
Supervised by: Dr. Ahmad Al-Tarawenah
Dr.Raed Al-Rbatah
Royal Medical
Services
‫تعالى‬ ‫قال‬(‫بقد‬ ‫خلقناه‬ ‫شيء‬ ‫كل‬ ‫إنا‬‫ر‬)

2. Name: khaled Faraa
Age : 23 years old .
Occupation : Orthodontic
Assistant.
Marital status: Single
Place of Residence : Salt-
Jordan
Nationality: Jordanian

3. Medical history:
Denied any medical problem
Dental History:
Root canal treatment about 3
years ago.
Habits: History of thumb
Sucking discontinued by age of
5 and frequency ( 7) hours
per day.

4. My teeth are
Sticking out.

5. >NO area of bleeding on
gentle probing through
the gingival sulcus.
>Mild enamel fluorosis.
> Speech: Normal flow of
speech. No difficulties
detected
>Good range of mouth
opening

8. >Small degree of facial asymmetry

9. >Increased lower facial height.

10. > Convex facial profile.

11. >Lip incompetent.
>Lower lip protrusive
>upper lip everted.
NOTE: Lip seperated
more than 4 m.m .
TVL

12. >Acute N.L angle
>normal M.L angle

13. Upper lip length 20 m.m
Lower lip length 40 m.m

14. >Throat angle obtuse
(ideally should be 90 degrees).
>Throat length is short

15. >Steep mandibular plane angle
(indicating long anterior facial
vertical dimensions and skeletal
open bite tendency)

16. > Mild deviation nasal tip
to the right .

17. > Dental midline coincident
with skeletal midline.

18. Commissure height > philtrum height.
>Tooth show at rest more than 4 m.m.

19. >Amount of incisor and
gingival display: Maxillary
anterior teeth with 4 m.m
gingival show.
>Buccal corridors:Wide.
>The smile arc: Incisal edges of
upper anterior teeth are
parallel to the upper border
of the lower lip

20. Golden proportion for
maxillary anterior teeth is
62%.
> Height: width = 1:6.25
Indicating : Increased tooth
height or decreased tooth
width

21. > Gingival level of lateral 1.5 m.m
lower to central incisors.
>Gingival connectors between
lateral and central = connectors
between canine and lateral.

23. Intra-oral
photos

24. Overjet : 10 m.m
Severe class II
Overbite: incomplete ( Open Bite)
Midline upper and lower coincident
Class II incisors div 1

25. LeftRight
Canine : class II ½ unitCanine :class II ¼ unit
Molar: Class II ¼ unitMolar : Class II ¼ unit

26. Severe crowding
Lower incisors are retroclined
Rotated lower right lateral.
Amalgam filling LR6 and composite LL6

27. U shaped arch
Upper incisors are proclined
Mild Crowding
Amalgam fillings on UL5,UL6,UR5,UR6

29. O.J = 10 M.M
Incomplete overbite
Class II div I dental malocclusion
Date of impression
24/2/2016

30. 1177.58.579.59.56.58.57.5711U
654321123456
12777.56.55.55.567.257.57.511L
Anterior bolton ratio= 38/49.5 *100 = 77.2 %
Normal
Overall bolton ratio = 90.75/100.5 * 100 = 90.2 %
Normal

31. 33 m.mINTERCANINE
WIDTH OFTHE
UPPERARCH
35 m.mWIDTH OF UPPER
ANTERIORARCH
47 m.mWIDTH OF UPPER
POSTERIORARC 6
TO 6
25 m.mINTERCANINE
WIDTH OFTHE
LOWERARCH
33.5 m.mWIDTH OF LOWER
ANTERIORARCH
48 m.mWIDTH OF
POSTERIORARCH
6TO 6

32. Korkhause analysis(1935)
To check the length of the arch by the
summation of the Upper four incisors

35. RESULTIdeal arch
length
Arch length
2.2+18.821 M.MUPPER
ARCH
3.8-16.813 M.MLOWER
ARCH
Result:
proclined upper incisors and retroclined lower incisors
Summation of upper incisors 32.5

36. Space
need
Space
required
Space
available
1.5-78.577Upper arch
11.25 -67.2556Lower arch
Mild crowding upper arch and severe in lower arch.

37. To assess space requirement:
1. Crowding & spacing
2. Leveling of occlusal curve ,Arch width change
3. Incisors AP change
4. Angulations change
5. Inclination change

38. Lower archUpper arch
11.25-1.5-Space need
00Leveling of
curve of spee
**Arch width
016-Incisors AP
change
*0.5-Angulations
1-Inclination
11.25-19-

39. R
OPT FINDINGS:
1-Heavy amalgam on UL6,UL5. RCT UR6,UR5,LL6
mummification LR6.
2-horizontal resorption of bone between LL6 and LL7.
3-periapical lesion on LR6 and UR5.
4- LL8AND LR8 near Inferior alveolar nerve.
5- slight asymmetry of the ramus height.

41. SNA 84.6
SNB 77
ANB 7.6
MMPA 45.7
FMA 41.8

42. UI-MXP 123
LI-MNP 83.6
JARABAK ratio 55%

43. dentalSkeletalstanderSoft tissue
110123UI-
MXP
82(+-2)84SNA90-11080N.L angle
9383LI-MNP78(+-2)77SNB115-140126M.L angle
131111UI-LI2-47ANB
27(+-5)46MMPA
27(+-5)42FMPA
59%-
63%
55%Jarabak
ratio
1-1wits
0-8 m.m20-pog-Nper
2-(+-4)0A-Nperp
100118Throat
angle
55%63%L.F.H
122146Gonial angle

44. Patient is class II skeletal, has increased MMPA,
FMA, L.F.H, gonail angle and decreased
Jarabak ratio which indicates long anterior
facial vertical dimension and high angle case
complicated with proclined upper incisors
retroclined lower incisors, acute N.L angle,
and deficient chin.

45. K.F is 23 years old,denied any medical problem ,has history of
thumb sucking and mild fluorosis,complains of upper teeth
sticking out, patient is class II div 1 incisors on class II base, has
convex profile ,increased L.F.H, acute nasolabial angle and short
throat length, dentally increased overjet with incomplete
overbite, severe crowding in lower arch, badly damage LL6 and
LR6,upper incisors are proclined,dental malocclusion is class II .

46. PROBLEM LIST:
1- patient complain that his
upper teeth are proclined.
2-Mild fluorosis.
.3- Sever class II skeletal
4-Convex profile
5-Increase lower facial height.
6-deficient chin.
7-Short throat length.
8-Acute N.L angle.
9-Incomptant lip.
10-Sever crowding lower arch.
11-Retrocline lower incisors.
12-Mummifaction LR6.
13-Rotated lower right lateral.
14- Lower wisdom teeth near
alveolar nerve.
15-procline upper incisors
16-RCT UR6,UR5
17- Overjet 10 m.m
18-overbite incomplete
19-class II dental malocclusion.

47. TREATMENT AIMS :
1-Proper position of upper incisors
2- improve oral hygiene.
3-Improve profile
4-Correct vertical proportion.
5-Correct skeletal relation.
6- Great lip seal
7-correct overjet
8-correct upper and lower Inclination
9- Reduce crowding.
10-Referal for conservative to evaluate UR5,UR6.
11-Referal for surgery to evaluate of lower wisdom.
12-correct molar and canine relationship.

48. PREOPRATIVEORTHODONTIC:
-O.H.I
-upper and lower f.A .
- In maxillary arch :
1- trans palatal arch.
2-Surgically remove third molar.
3-Extraction of.
4- align teeth.
5- Establish good arch form.
-In mandibular arch:
1-lower holding arch.
2- extraction of left and right first
molar.
3-align and level.
4-Establish a good arch form.
-SURGERY:
1- Le fort 1 for maxillary
impaction to allow mandibular
autorotate and close openbite,
2- BSSO to advance mandibular.
3- Genioplasty to advance chin.
-Post-oprative:
1- light class II elastics to
guide the occlusion.
2- finishing.
Retention:
1-lower fixed retainer 3-3.
2-Upper hawley retainer.
55

49. Orthognathic surgery:
1- Increased lower facial height
2- severe class II .
3- severe crowding lower arch..
4- short throat length.
Exraction of LL6,LR6,UR5:
-Apical pathology and root treatment.
-lower crowding and correct upper
incisors inclination.
Retainer:
Fixed retainer due to rotated teeth.
Anchorage:
1-T.P.A for vertical anchorage to reduce
overeruption which is locked occlusion.
2- L.L.B FOR A/P anchorage.

50. 1- O.H.I
2- Mini implants.
Fixed appliance.3-
55
66
4- Extraction of
5- stripping upper and lower.
6- Genioplasty.
7- Retention:Fixed retainer upper and
lower.

51. The End