rms

1. Done by : Dr. LanaObeidat
Supervised by: Dr. Ahmad AlTarawneh
Dr. Raed Al Rbata
Dr. NancyAl Sarayrah

2. Name: A.K
Age: 15 years old
Occupation: Student
Marital status: Single
Residence: Amman
Nationality: Jordanian

3. Medical History: Denied any medical problems
Dental History: None
Habits: None

4. “My teeth are sticking
out and my lower teeth
are overlapping each
other“.

6. Anteroposterior:
Class II Skeletal Pattern

7. Vertical Assessment:
Increased lower facial height

8. Transverse:
Mild facial Asymmetry

9.  No signs ofTMD (No clicking, crepitus, and
tenderness to palpation).
 Normal range of opening, lateral
movement, and no displacement.

10. Lip tonicity and competence:
Thick, incompetent lips.

11.  Convex facial profile.

12.  Frontonasal angle: 133
(Normal 115⁰-135⁰)
 Nasolabial angle: 109
(Normal 90⁰-110⁰)
 Labiomental angle: 115
(Normal 114⁰-140)

13. • 70% crown of incisor show.
• No gingival show.
• Smile extends to canines.
• Smile is acceptable

14. Commissure height > philtrum height.
Tooth show at rest more than 7 mm.

15. • Buccal corridors: narrow.
• The smile arc: Incisal edges
of upper anterior teeth are
parallel to the upper border
of the lower lip.

16. • Golden proportion for
maxillary anterior teeth is
70%.
• Height: width
1:1

17. Gingival level of lateral 0.5 mm
lower to central incisors.
Gingival connectors between
lateral and central > connectors
between canine and lateral.

20. • Fair Oral Hygiene.
• Normal oral mucosa.
•Teeth Present in oral cavity (Permanent
dentition).
7 6 5 4 3 2 1 1 2 3 4 5 6
7 6 5 4 3 2 1 1 2 3 4 5 6 7

21.  U-shaped lower arch.
 Anterior segment:
- Crowded anterior segment
- Left canine has no space
- Lower left lateral, Lower left and
right central positioned lingually.
 Buccal segment:
Rotated LR5
 Midline shift:
2 mm to the right caused by the
lower arch

22.  U-shaped arch.
 Anterior segment:
- proclined upper incisors
- Slightly buccally positioned
upper right canine.
- Slight rotation on the upper
right 4

23.  Periodontal health: fair oral hygiene
 Dental health: staining on the upper incisors
lingually
 Carious 6 6
6 4 6

24.  Class II div. I incisor relationship
 Lower midline shifted to the right 2 mm (upon examination)
 Overjet 7 mm
 Deep Complete overbite 95%

25.  Molar relationship: L: Class I R: Class I
 Canine relationship: L: Class I R: Class I

27.  Anteroposterior
Canine : Class I
Molar: Class I
Canine : Class I
Molar: Class I

28.  Transverse
Lower midline shift to the right side 2 mm.

29.  Vertical
O.B= deep 95% complete to the soft tissue .

30. Right side: 3 mm curve of spee Left side: 3 mm curve of spee

31. Upper arch
 U shaped arch form.
 Dental Symmetry.
 Intermolar width: 43 mm.
 Intercanine width: 39mm.
 Deep palatal vault

32. Lower arch
 U shaped arch form.
 Dental Symmetry.
 Intermolar width 43mm.
 Intercanine width 27mm.

33. 11879799797811U
654321123456
11887766688912L
Anterior Bolton ratio= 40/50*100= 80 %
( normal value: 77.2± 1.65%)
Overall Bolton ratio= 94/102 * 100= 92.1%
(normal value: 91.3± 1.91%)

34. Upper ArchLower Arch
1 mm13 mmCrowding/Spacing
--Angulation change
-1 mmLeveling curve of Spee
1.5 mm-Inclination change
--Arch width change
10 mm-IncisorsA/P change

35.  Midline-Molar relationship
R L
2
Molar MolarMidline

36.  Lower arch discrepancy
-9
-9
-3
-3
- -
-1 -1
+2 -2
-8
-8
-6
-6
Crowding 3*3
6*6
Protrusion
Curve of Spee
Midline
Total 3*3
6*6
R L

37.  Anticipated treatment change
(7)
(8)
(7)
(8)2 7
Midline MolarMolar CuspidCuspid

38.  Grade 4 a
Increased overjet greater
than 6 mm and less than
9 mm.

39.  Grade 9

41. Variable Pre-
Treatment
Normal value
SNA 87º 81 ± 3
SNB 80º 78 ± 3
ANB 7º 3 ± 2
S-N/MX 10º 8 ± 3
ANB* 4
MMPA 30º 27 ± 3
FMA 30 28 ± 3
LFH 57% 55 ± 2
LAFH/LPFH 58% 61± 2
U1/Mx 124º 109 ± 6
L1/Mn 95º 93 ± 6
IIA 124º 133 ± 10
Wits
Appraisal
6 mm 1 ±1.9 F

42.  A.K is a 15 year old male, denied any medical problems,
complains of crowding in lower teeth and protruding
upper teeth . He has a class II/I incisor relationship based
on class II skeletal pattern, increased lower facial height,
incompetent thick lips, and a convex facial profile. O.J of
7 mm, deep complete O.B 95%, lower midline shift to the
right 2 mm, mildly crowded upper arch and moderate
crowded lower arch (localized anteriorly). Molar and
Canine relationships are class I on both sides

43.  Carious UR6,UL6,LR6,LR4,LL6.
 C/C “Protruding upper teeth and lower incisor crowding”.
 Skeletal:
Class II skeletal pattern, retruded chin.
Increased lower facial height.
Mild Asymmetry.
 Soft tissue:
Convex profile.
Incompetent lips.
Shallow buccal corridor.
 Dental:
Lower mid line shift 2 mm to the right.
Increased Overjet 7mm.
Deep complete over bite 95%.
Out of the arch lower right canine.
Rotated lower right 4.
Proclined upper incisors.
Bucally positioned right canine.
Lower incisor crowding.
Anterior bolton discrepancy.

44.  Treat carious UR6,UL6,LR6,LR4,LL6.
 Relieve lower anterior crowding
 Correct proclination of upper incisors
 Skeletal:
Accept Class II skeletal pattern.
Correct lower facial height.
Correct chin retrusion
Accept Mild Asymmetry.
 Soft tissue:
Achieve competent lips.
Accept smile esthetics.
 Dental:
Correct lower mid line shift 2 mm to the right.
Correct Overjet.
Correct Overbite.
Correct position of right canine.

45. (Extraction case )
1. OHI.
2. UpperTPA, headgear (high pull) , lower lingual arch
3. Extraction of:
4. Upper and lower fixed appliance (MBT).
Advancement Genioplasty.
5. Retention (upper Hawley retainer , Lower fixed
retainer).
4 4
4 4

46.  Extraction of:
To provide space for crowding, for correction of proclination, for correcting OJ.
 UsingTPA to provide vertical anchorage for upper molars, to use the space for the OJ and inclination correction , ( with
stripping in upper anterior teeth to correct Bolton discrepancy )
 Headgear for anchorage
 Using lower lingual arch to provide anchorage for lower molars, to use the space for correcting the anterior crowding
 Fixed Appliance MBT prescription slot 0.022:
 torque is needed not to tip anterior teeth while being retracted.
 Fixed Appliance
 Alignment of rotated teeth.
 Closing of spaces.
 Leveling curve of spee. ( using intrusion mechanics on the upper anterior teeth)
 Correct lower midline shift.
 Advancement Genioplasty:
To correct the retruded chin.
 Retention ( Upper Hawley retainer, Lower fixed retainer )
Upper hawley retainer: to allow settling for the upper teeth.
Lower fixed retainer: due to anterior crowding of lower arch, intercanine width changes, bodily
movement of the lower teeth.
4
4
4
4