4. Medical & Dental History
• Medical history:
denies any medical problems
• Dental history:
Previous visits to dental clinic for check ups
Fillings LL6,LL7,UR6
Extraction LR6
5. History
• Trauma: No history of dental trauma
• Habits: No previous or on-going habits mentioned or noticed
• Motivation: Patient is motivated (self-motivation)
16. Transverse Assessment
• The patient has symmetrical face
• Facial midline showing
alignment of the middle part
of the upper lip at the vermillion
border and chin point
• Nose deviated to the right
25. Intraoral Examination
• Fair-poor Oral Hygiene
• Yellow discoloration (initial
decalcification spots) Around the
buccal side of the teeth
26. Intraoral Examination
• Central lines:
Lower shifted 4mm to the right
• Incisors classification:
Class II div 1
• OJ:
7 mm
• OB:
70%
• No Crossbites
• No Displacement
44. Diagnostic Summary
• D.L 12yrs old female pt , MF, complaining of retruded lower teeth.
Patient has fair-poor OH, a class II div 1 Malocclusion on a class II
skeletal base with average vertical dimensions with a gummy smile
and incompetent lips,she has a symmetrical Face. Complicated by
increased OJ 7mm, increased OB 70% complete to the palate. she has
a ½ unit class II molar on left side, canine on left side ½ unit class 2 ¾
on the right side, lower midline shifted to the right 4 mm, well aligned
upper and lower arches, and extracted lower right 6, COS of 3.5 mm
45. Problem List
• Skeletal problems:
• Skeletal in transverse plane:
• Symmetrical face
o
• Skeletal in A-P plane:
• Clinically convex profile
• Class 2 Skeletal base ( retrognathic mandible)
• Soft tissue problems:
Obtuse NL, LM angels
Incompetant lips
Gummy smile
Pathological problems:
• Pathological problems:
• Fair-poor OH
• Yellow discoloration around the teeth in buccal segment
• Chief Complaint:
• Her lower teeth are way behind the upper teeth
• Dental problems:
Alignment and symmetry:
Asymmetric lower arch with with 7mm spacing
Rotated teeth UL6, LR5, LR4, LR3, LL4.
Extracted LR6
Incisor class II div 1
OJ 7 mm
Increased OB
Lt Molar : ½ unit II
RT canine ¾ class 2
LT canine ½ class 2
Lower midline shifted 4mm to the right
curve of Spee 3.5 mm
46. Treatment Aims
• Improve Oral hygiene.
• Improve lower teeth position(C/C)
Skeletal:
• Improve facial profile.
• Correct skeletal discrepancy to class 1
Soft tissue:
• Achieve competent lips
• Monitor upper lip length
Dental:
• Correct OJ, OB
• Correct rotated teeth
• Open space for LR6
• Correct canine and molar relationship to class 1
• Correct lower midline
• Level curve of Spee
47. Treatment plan:
Growth modification(phase one):
1. OHI
2. Functional appliance Medium Opening Activator.
3. Retention
Camouflage non-extraction (phase 2):
1. Upper and lower fixed appliance (MBT slot 0.022)
2. Open space for LR6.
3. retention
48. Retention Protocol
Phase 1:
Inclined anterior bite plane with lower fixed appliance till reaching rigid
arch wires.
Phase 2 :
Short term: Upper Hawley retainer with anterior bite plane .
lower VFR with acrylic tooth replacing LR6.
Long term: Upper lower permanent retainer
49. Justification
Growth modification:
1. Growing and motivated patient.
2. Moderate class 2 div.1 incisor relationship.
3. Average MMPA ( increased OB)
4. Increased OJ
5. Well aligned upper and lower arches.
50. Justification
MOA:
1. Moderately displaces the mandible
2. Moderate bite opening
3. Robust.
4. Easy to repair
5. Can incorporate expansion screw
6. Capping lower incisors to prevent proclination
Fixed Appliance:
1. Bodily teeth movement is required.
2. Alignment of teeth.
3. MBT: to correct upper and lower labial segment inclination, zero tipping of upper 6 and upper 3
case less rebounding effect, increase palatal root torque of buccal segment will compensate for
tipped molars due to expansion.
51. Justification
Retention:
Inclined anterior Bite plane:
1. Maintains transvers correction
2. Allows teeth settling
3. Maintains class 2 effect
4. To allow easy transition to fixed appliance starting with lower teeth
52. Treatment details and mechanics
1. Full records
2. Impressions forfabricationofMOA and bite registrationin an edge to edge relationship.
3. Insertion on MOA and checking the fit and forward mandibularposturing
4. Give instructions howto wear and the duration(24h/day)
5. After 6-9 months Impression for inclined anterior bite plane
6. Insertion and instructions to wearnight time.
7. Wait for curve of Spee leveling
8. Seps on LL6
9. Bandingoflower molars and direct bondingon lower arch
10. Start alignment with 0.016 NiTi
11. When reaching rigid working arch wire start uprighteningoflower right 7 with uprighteningspringand direct bond upper arch
and start alignment with 0.016 NiTi
12. After reachingrigid workingarch wire start usingdifferential elastics to correct lower midline.
13. Finishingand detailingwith TMA wires
14. Debond and placement of upper and lower fixed retainers and impressions for upper Hawley and lower VFR
53. Design of MOA
• Lower incisal capping 3/3
• Anterior palatal wire 3/3 in 1.0 mm S.S wire
• Adams crib 64/46 0.7 mm S.S wire
• Acrylic connecting “sturts”/ vertical supports
• Expansion screw
54. Special mechanics
Increase lingual root torque on lower right premolars when uprighening the LR7 to
prevent lingual crown tipping.
Increase uprighteing spring arm and locate between 4 and 3 to increase flexibility
and range of the wire
While uprightening give vertical ( settling ) elastics on left side to overcome the
intrusion force on the premolar region exerted from the spring arm
