Case presentation

Done by:
Hanady Al Masri
Abdallah Al Zireeni
Mohammad Elwir
Yahya Al Omari

Patient Name: Mohammad Baker Al Bdor

Age: 14 years old
Gender: male
Occupation: student

Chief complaint: the

patient present to the clinic

complaining about appearance of his teeth crowding
mainly .

Medical history: patient denied any relevant

medical problem.

Dental history: previous fillings and extractions .

Social history and habits: nothing is relevant .

Extra oral examination

Frontal view
Facial proportions :
Normal facial symmetry
Vertical proportion:
increased LFH
Competent lips

Profile view
profile : is convex
Nasolabial angle:
average 90-100
both upper and lower

lips are behind the E-line

Frankfort mandibular
plane angle is avarege

Smile view
smile line : high smile

line
upper coincident
midline with 2mm
right shifted mid line

Intra oral Examination

Intra oral examination

Soft tissue: mildly inflamed

Oral hygiene: poor and he needs several
restorations
Teeth present: 14 tooth in the upper jaw & 14
tooth in the lower jaw

Maxillary arch

Moderate crowding 5mm

Supernumerary adjacent to left lateral : non
fillings or extractions : class restoration on upper
right 6

Mandibular arch

crowding : moderate 5mm

present teeth : 14 tooth

fillings or extractions : lower left 6 filling

Frontal view

Class incisor relationship

Overbite: average
Overjet: increased
Upper midline coincident, with the lower being
shifted by 2mm to the right.

Right buccal view

unit Class II
Canine
Class Molar

Left buccal view

Class I Canine
class III Molar by
unit

Study Models

Space analysis on the upper

cast
Space available:
73mm
space required:
78 mm
There is deficiency of
5mm

Space analysis on the lower

cast

Space available:
71mm
Space required:
75mm
There is deficiency of 4
mm
Ant. bolton : 76.2%
average (77.2 % 1.3%)

OPG x-ray

present teeth : full upper and lower sit of teeth

bucco version impacted lower left third molar

Cephalometric analysis
variable

value

normal

SNA

79

823

SNB

77

793

ANB

31

SN to maxillary plane

10

83

Upper incisor to maxillary

plane

109

1085

Lower incisor to
mandibular plane

89

925

Wit's

-1

-1 - 1

Inter incisor angle

131

13310

Maxillary mandibular
planes angle

30

275

Total facial height

130mm

Lower facial height

7mm

Lower facial height ratio

54%

50-55%

Lower incisor to A-pog

-3

0-2

Lower lip to E plane

-1

Within 1
mm

S-N-Pog

84

863

Diagnosis :

1.
2.
3.
4.
5.
6.
7.
8.

Class incisal relation based on class skeletal relation

complicated with ;
Increased over jet.
Moderate crowding in the upper arch .
Moderate crowding in the lower arch.
Bucco-distal Rotation of upper right lateral incisor.
Bucco-distal Rotation of lower right lateral incisor.
Class molar relation in the left side by unit .
Class canine relation in the right side by unit .
shifting of the lower midline by 2mm to the right side .

Treatment plan
Our aim of treatment is :
1- Oral hygiene and patient motivation .
2- Restore the present carious liaisons .
3- Maintain class I incisor relationship
4- Alignment of upper and lower teeth by reliving crowding
5- derotate the upper and lower right lateral incisors .
6- Correcting lower shafted midline .
7- Achieve class molars and canines relation .
8- reducing over jet .

Treatment plan suggestion

This case needs:
1- applying fixed appliance for upper and lower teeth .
2-stripping of upper and lower incisors to gain space .
3-proclination of upper and lower incisors to gain space
needed .
4- de rotation of upper and lower right lateral incisors .
5- class elastics for the left side .

Other treatment options :

Extraction of all 5s to gain space , and then use fixed
appliance to realign the teeth .
But this option is not preferable because :
1- the patient profile is convex and the extraction will place
the incisors in retroclined position so this will give us ditched
in appearance of the face
2- the patient has high smile line and by the retrolclination of
the incisor the smile line will shown more higher gum smile
which is unaesthetic

Retention
Upper arch: Fixed retainer
Lower arch: Fixed retainer
circumferential fiberotomy for the upper
and lower right lateral incisors .

Thank you