case presentation

1. Done by : Dr. Luma Najada – 2nd yearresident.
Supervised by: Dr. Ahmad Tarawneh
Dr. Jumana Tbaishat
Dr. Bashar momani
Dr. Anwar Rahamneh

2. Name: Hala mohammad
Age: 14.5 yearsold
Occupation: student
Marital status: single
Residence: Al-salt
Nationality: Jordanian

3. Medical History: denied any medical problems.
Dental History: routine dental procedures.
Habits: none.

4. “my upper teeth are
malaligned”.
Pointing at her upper
canines.

11. 85
80
5
7.1
3
25
55
67
Variable Pre-
Treatment
Normal value
SNA º 81 ± 3
SNB º 78 ± 3
ANB 3 ± 2
S-N/MX º 8 ± 3
ANB* -
MMPA 24.4 27 ± 3
FMA 28 ± 3
LFH % 55 ± 2
Jarabak ratio % 61± 2
U1/Mx 99.7º 109 ± 6
L1/Mn 88.3º 93 ± 6
IIA 139º 133 ± 10
Wits
Appraisal
2.5 mm 1 ±1.9 F

12. Anteroposterior:
convex profile

13. Vertical Assessment:
decreased LFH

14. Transverse:
Mild Asymmetrical
face.
nose is deviated
to the right

15. Lip tonicity and competence:
• Thin strained upper lip
• normal lower lip
• High lower lip line
• competent lips

16. Convex facial profile

17.  Frontonasal angle: 122⁰
(Normal 115⁰-135⁰)
 Nasolabial angle:84.5 ⁰
(Normal 90⁰-110⁰)
 Labiomental angle:114 ⁰
(Normal 114⁰-140 ⁰)

18. •100% incisal show when smiling
• no gingival show
•Smile extends from ur4 to to ul5

19. • Buccal corridors: average
• The smile arc: the contour
of the incisal edges of the
maxillary anterior teeth
does’nt match the curvature of
the lower lip.

22. • Fair oral hygiene
•Teeth Present in oral cavity (permenant dentition)
7 6 5 4 3 2 1 1 2 3 4 5 6 7
7 6 5 4 3 2 1 1 2 3 4 5 6 7

23. U-shaped lower arch
Anterior segment:
 moderate crowding in anterior
segment
 Rotated LR3, LL3.
 Retroclined lower incisors.
Buccal segment:
 Lingually inclined

24. u-shaped arch.
Anterior segment:
 retroclined upper
incisors
 Moderate crowding
 Buccally erupted UL3.
 Rotated UR3
Buccal segment :
Rotated UL6

25. Periodontal health:
fair oral hygiene.
Carious : none
fillings :
6

26. Impacted upper and lower 8’s.

27. Class II div. 2 incisor relationship
Midlines : lower midline is deviated to the
right by 2mm
Overjet = 2 mm
Overbite = Deep 90 % complete to tooth.

28. Molar relationship: L: ¾ Class II
Canine relationship: L: ½ class II
R: Class I
R: Class I

30. Anteroposterior
Canine: Class I
Molar: Class I
Canine : ½ Class II
Molar: ¾ Class II

31. Transverse
Midlines deviated

32. Vertical
O.B= deep bite complete to tooth

33. Right side: 2mm Left side: 2mm

34. Upper arch
u shaped arch form
Dental Asymmetry
Intermolar width: 45 mm
(normal : 44.3 mm)
Intercanine width: 38 mm
(normal: 31.3)

35. Lower arch
U shaped arch form
Dental Symmetry
Intermolar width : 41 mm
(normal: 41.1 mm )
Intercanine width : 26 mm
(normal: 24.4 mm)

36. Anterior Bolton ratio= 36/46*100%= 80%
(normal value: 77.2± 1.65%)
Overall Bolton ratio= 87/88.5*100%=
91.5%
U 10.3 6.7 6.6 7.8 6.5 8 8 6.5 7.8 6.6 6.
7
10.3
6 5 4 3 2 1 1 2 3 4 5 6
L 10.4 6.7 6.7 6.6 5.8 5.7 5.7 5.8 6.6 6.7
6.7
10.4

37. Lower Arch Upper Arch
Crowding/Spacing -7mm -5 mm
Angulation change - -
Leveling curve of
Spee
-2
Inclination change +1.5 +2
Arch width change
Incisors A/P change - -
total -7.5 -3

38. s
Grade 3 d
contact point
Displacement greater than 2 les
than 4

39. Grade 3

41. 85
80
5
7.1
3
25
55
67
Variable Pre-
Treatment
Normal value
SNA º 81 ± 3
SNB º 78 ± 3
ANB 3 ± 2
S-N/MX º 8 ± 3
ANB* -
MMPA 24.4 27 ± 3
FMA 28 ± 3
LFH % 55 ± 2
Jarabak ratio % 61± 2
U1/Mx 99.7º 109 ± 6
L1/Mn 88.3º 93 ± 6
IIA 139º 133 ± 10
Wits
Appraisal
2.5 mm 1 ±1.9 F

43. All teeth are present

44. H.M is a 14.5 years old female, medicaly fit, with history of
routine dental check up, filling LR6. Presented complaining
of “ my upper teeth are malaligned “ . she has class II/II
incisor relationship based on class II skeletal pattern,slightly
decreased LFH, she has asymmetrical face with nose
deviated to the right side with compromised smile esthetics.
O.J of 2 mm, deep complete O.B to tooth. complicated lower
midline deviated to the right by 2 mm , moderate crowded
lower arch (localized anteriorly), moderate crowding in the
upper arch. Upper right 4 in scissor bite, molar on left side is
¾ class II , Canine on left side is ½ class II,.

45. Pathological problems :
1. poor oral hygiene
Developmental problems :
Patients’s concern : the malaligned
upper teeth.
Alignment and symmerty:
Asymmetric lower arch with 7mm crowding.
lingually inclined lower molars.
rotated LR3, LL3.
Retroclined lower incisor
Asymmetric upper arch with 5 mm crowding
retroclined upper incisors
UR4 scissor bite
rotated UL6,UR3 UL3
Skeletal and dental problems in transverse plane:
Asymmetric skeletal
upper midline deviated to the right by 2mm
lower midline deviated to the right by 2 mm

46. Skeletal and dental problems in A-Pplane:
Mild class 2 skeletal base (retrognatheic mandible)
insicor class 2 div 2
left Molar: Class II ¾
left Canine : Class II ½
Skeletal and dental problems in vertical plane:
slightly decreased LFH
increased complete OB
Soft tissue problems :
high lower lip line
obtuse nasolabial angle

47. Improve OH
Improve her smile by creating more normal gingival relationships , and smile
symmetry
Relief crowding in upper and lower arches , and level and align the arches
Correct rotated teeth
Corret retroclination of upper and lower teeth
Correct bolton discrepancy
Correct upper and lower midline shift
Correct scissor bite on upper right 4.
Accept class 2 skeletal base
Correct lower facial height.
Accept Asyymetrical face.
Achieve 2mm OJ
Achieve class I molar and class I canine relationship
Achieve class 1 incisor relationship
Achieve normal OB- correct edge-centroid relationship
Finishing and detailing of occlusion.
Retain corrected results

48. (Camouflage, non- extraction case)
1. OHI.
2. Modified Pendulum appliance with ABP -
unilateral distalization.
3. Anchorage- Nance.
4. Lower and Upper fixed appliance
5. Consider stripping in lower ant. Teeth to
provide space
6. Retention.

49. Short term:
Upper and lower hawley (full time wear
for 6 months, night time wear for another
6 months).
Long term :
Upper and lower permenant retainers from
3-3

50.  Camouflage:
 Skeletal is mild class 2 .
 Chief complain is mainly related to malaligned teeth.
 Nongrower patient.
Non –extraction:
- mild class 2 skeletal
- decreased lower facial height (deep bite)
- obtuse nasolabial angle
- Moderate crowding in the lower arch provided by IPS and
proclination of lower incisors and by uprightinng of the lingually tipped lower
buccal segment.
-Moderate crowding in upper arch. space can be gained by molar
distalization, proclination of upper incisors, and correction of rotated teeth.
 Fixed Appliance
 Alignment of teeth
 Bodily movement
 Upper and lower arch coordination
 Upper roth : normal torque values needed

51. Modified Pendulum appliance with ABP
-unilateral distalization.
-decreased LAFH -Deep overbite.
-Class II ½ unit molar relationship.
-moderate crowding in the upper arch.
-Retroclined upper incisors.
- To disocclude the teeth
Nance
-to preserve cl I molar relationship
Lower stripping :
-to gain space in lower arch
- correct Bolton dixcrepancy.
Retention ( Upper and Lower fixed retainer ),
Upper fixed retainer: presence of rotated teeth
Lower fixed retainer: prevent late anterior mandibular crowding
rotation

52. 1. Full records.
2. Separators around 6’s , lower 7’s.
3. Bands selection on 6’s , lower 7’s.
4. Cementation of bands
5. Impression for pendulum.
6. Insertion and activation of pendulum with direct bonding on lower
arch .
7. Bracket positioning of lower anterior teeth more incisally, invert
bracket on LR3
8. Start with 0.016 NiTi, 0.016*0.022 . Asymmetric lacing form day one
on the lower left side to correct midline deviation.
9. Remove pendulum with impression for nance- at the same day.
10. direct bonding of upper arch, invert bracket UL3, asymmetric
lacing from day one on upper left side.
11. Aligning by 0.016 NiTi, 0.016*0.022 NiTi
12. Interdental stripping on lower anterior teeth with Working arch wire
0.019*0.025 SS on upper and lower arch.

53. 12. Finishing and detailing
TMA wire .021* .025
Settling by posterior elastics using light wires
13 . Debonding :
Impression for retainers
Short term: modified Hawley
Long term upper , lower permanent