ORTHODONTIC

CASE PRESENTATION
EILEEN EIKA M. DELA CRUZ, DMD
PATIENTS INFORMATION

Patients Name:
EDRYL ERVIN M. DELA CRUZ

Age: 20
Chief Complaint:
Ang panget ng position ng mga ipin ko
sa gilid.
Medical History:Medically fit
Significant Dental History:
-brushes 2x a day
-no caries found
 CLINICAL EXAMINATION

Oral Hygiene: Fair

Tooth Mobility: 0
Lips: Normal
Torus: None
Gingiva: Resilient and
Pinkish Tonsil and Adenoid: Normal
Mucosa: Normal Tongue: Normal
Fistula: None
FACIAL EXAMINATION
A. SYMMETRY

Patient has
symmetrical face
FACIAL EXAMINATION
B. VERTICAL PROPORTIONS

WIDTH OF THE MOUTH SMALLER

THAN INTER PUPILLARY DISTANCE

WIDTH OF NOSE WIDER THAN

INTER CANTHAL DISTANCE

NORMAL WIDTH OF THE FACE

SHOULD BE 5X WIDTH OF THE EYE

8mm eye width

36mm face width

4mm deficiency
FACIAL EXAMINATION
C. HORIZONTAL PROPORTIONS

Upper, Middle, and

Lower face is equally
proportioned.
FACIAL TYPE

HEAD: Mesocephalic
or Mesofacial
PROFILE

Convex Profile
DIVERGENCE

Slight Posterior
Divergence because
chin is slightly
posterior than the
forehead
EXAMINATION OF THE SOFT TISSUES OF THE FACE

LIPS AT REST
- normal color and texture
-Lips are competent.
EXAMINATION OF THE SOFT TISSUES OF THE FACE

LIPS ON A SMILE

-full crowns of the lower

incisor are visible

LIPS ON FUNCTION

-Normal breathing and

swallow was observed.
EXAMINATION OF THE SOFT TISSUES OF THE FACE

NASOLABIAL ANGLE

MENTOLABIAL SULCUS
EXAMINATION OF THE SOFT TISSUES OF THE FACE

FACIAL AND DENTAL

MIDLINE: Coincides
 INTRAORAL EXAMINATION

Normal Frenal
Attachment

Presence of
Healthy Gingiva
INTRAORAL EXAMINATION

No Caries &
Composite found

tooth #16 lingually

inclined
INTRAORAL EXAMINATION

Impacted tooth
#48

Composite on
tooth #36
 INTRAORAL EXAMINATION
(RIGHT SIDE)

RIGHT
MOLAR CLASS III

-Class III CLASS III

PREMOLAR

CANINE CLASS III

 INTRAORAL EXAMINATION
(LEFT SIDE)

LEFT

MOLAR CLASS III

PREMOLAR CLASSCLASS
III III
CANINE CLASS III
CAST ANALYSIS
 CLASSIFICATION OF MALOCCLUSION

Angles System : Class III

 MIDDLINE COINCIDE

Upper dental midline

coincides with the lower
dental midline
 INCISOR RELATIONSHIP

OVERJET:

-2mm on CI Normal

-1mm on LI

OVERBITE: 2mm
Normal
Transverse Symmetry

Right 28mm

Left 27mm

Minimal Deviation
 ARCH FORM

UPPER ARCH: Paraboloid or Average

-no exostoses

-deep palatal vault

LOWER ARCH: Paraboloid or Average

-no exostoses
ARCH LENGTH

LOWER: 25mm

UPPER: 31mm
ARCH PERIMETER (ALVEOLAR ARCH LENGTH)

LOWER: 69mm

UPPER: 81mm
 Summary: no crowding on upper and lower arch

6mm 7mm 8mm 6mm 8mm 8mm 6mm 8mm 7mm 6mm
2nd 1st Canine Lateral Central Central Lateral Canine 1st 2nd
7mm 7mm 7mm 6mm 5mm 5mm 6mm 7mm 7mm 7mm

Upper Lower
Tooth size 70mm 64mm
Alveolar Arch Length 81mm 69mm

Space Needed per Arch -11mm -5mm

Space Needed per no no

Quadrant crowding crowding
ARCH WIDTH

LOWER: 47mm

UPPER: 48mm
RADIOGRAPHIC ANALYSIS
PANORAMIC XRAY

No Pathologic Oral Condition

No Supernumerary teeth
Anodontia of tooth # 28
Impaction of tooth #48
No root resorptions were observed
Bone Support is ideal.
CEPHALOMETRIC ANALYSIS
SNA (81 3.8)
determines the
protrusiveness of maxillary S
Na

bone or maxillary denture

base in relation to the
cranial base

77.2~84.8 A

78
Maxillary bone is
NORMAL in relation to
the cranial base
 SNB(78 3.0)
determines the S
Na

protrusiveness of
mandibular bone
or mandibular
denture base in
relation to the
cranial base
75~81

81 B

Mandibular bone is
NORMAL in relation to
the cranial base
ANB(2.5 2.5)
determines the position of
the maxillary denture base Na
in relation to the
mandibular base

0~5 A

2.5
position of maxillary denture
base is NORMAL in relation to
mandibular base B
FH/NP
FACIAL ANGLE
Na
(85 2.5)
determines the Po

protrusiveness of the
Or
chin point as
compared to the
cranial base

82.5~87.5

93.5

Chin is PROTRUSIVE in
relation to cranial base.
Pog
1/SN (103.0 5.0)
describes the axis of the S
Na

most protrusive upper

central incisor in relation
to the cranial base

98~108

103.5

Maxillary central incisor is

NORMAL in relation to the
cranial base.
1/1 (130 7.3)
relates the position of the
maxillary and the mandibular
central incisors to each other

122.7~137.3

125

Upper and lower

incisors are
NORMAL.
IMPA
(90 5.0)
determines the position of
the most protrusive
mandibular central incisor
to the mandibular plane

85~95

91

Mandibular incisor is
Go
NORMAL in relation to
mandibular plane.

Gn
FMIA
(65.0 5.0)
determines the position of
the most protrusive Po
mandibular central incisor
Or
in relation to the Frankfort
Horizontal Plane

60~70

62

Mandibular central incisor

is NORMAL in relation to
FHP
FMA
(25 3.0)
determines the stiffness
of the mandibular plane Po

when compared to the

Or
cranial base

22~28

22.5
Go

Growth of mandible is
NORMAL
Gn
Y axis
(59 3.7)
determines the
direction of growth
potential of the S

Po
mandible
Or

55.3~62.7

60

NORMAL growth of
mandible.
Gn
S-LINE
NORMAL: Should
Touch the S-Line

PATIENT
Upper: Touching the S-Line
(Normal)
Lower: 1mm Anterior to S-
Line (Protrusive)
A-POG
NORMAL
Upper Incisor: 4-
6mm Anterior to A-
pog
Lower Incisor: 2mm
Anterior to A-pog

PATIENT
Upper Incisor: 9mm Anterior to A-
pog (Protrusive)
pog
Lower Incisor: 8mm Anterior to
A-pog (Protrusive)
SUMMARY OF 10 ANGLE ANALYSIS

ANGLE RANGE PATIENT EVALUATION

SNA 77.2-84.8 78 Normal maxilla

SNB 75-81 82 Mandibular protrusion

ANB 0 to 5 2.5 Normal

FH/NP 82.5-87.5 93.5 Chin is protrusive

1/SN 98-108 103.5 Normal long axis inclination

122.7-
1/1 125 Normal internincisal relationship
137.3

Normal: lower incisor perpendicular to

IMPA 85-95 91 basal bone

FMIA 60-70 62 Normal

FMA 22-28 22.5 Normal

Y-AXIS 55.3-62.7 60 Normal

S-Line and A-pog
Analysis

Touching the S-Line

Upper Lip
(Normal)
S-Line
1mm Anterior to S-Line
Lower Lip
(Protrusive)

A-Pog Upper 9mm Anterior to A-pog

Incisor (Protrusive)

Lower 5mm Anterior to A-pog

Incisor (Protrusive)
DIAGNOSIS

CLASS I SKELETAL MALOCCLUSION DUE TO

MANDIBULAR PROTRUSION

CLASS III DENTAL MALOCCLUSION WITH

BILATERAL POSTERIOR CROSSBITE
TREATMENT OBJECTIVES

protrusion of upper anteriors- to give

normal overjet

to correct posterior crossbite

to improve appearance and give self-

confidence to the patient

to restore function (mastication)

TREATMENT PLAN

Upper: Protract Upper Anteriors and

Posteriors

Lower: Sequence of Archwires (Change every

2 months)
NiTi .016 until all ant teeth are aligned
NiTi .018 until all post teeth are aligned
NiTi .016x.016
NiTi .016x.022
SS Wire .017x.025
SS Wire .019x.025

Finishing Wire .021x.025

 PREPARATION (1ST MEETING)

Oral Prophylaxis
Placement of Separator
elastics and brass wire
STAGES OF TREATMENT
STAGE I ALIGNMENT AND LEVELING OF ANT TEETH

(PROTRACTION OF UPPER ANTERIORS)

Cement molar bands on tooth #16 and #26

Bond brackets on tooth #12,11,21,22

1. PROTRACT using PROTRACTION ARCH WIRE (SS .016 +

archwire sleeve + vertical loop)

- Ligate 4 upper incisors

- Activate by opening the loop every meeting until

normal overjet is achieved.
STAGE I ALIGNMENT AND LEVELING OF ANT
TEETH
(PROTRACTION OF UPPER ANTERIORS)
 STAGE I ALIGNMENT AND LEVELING OF ANT TEETH

FIG 8 CHAIN
2. AFTER
PROTRUSION: CLOSE
SPACE TO MIDLINE
11-12
3. BRACKET 11-21
21-22
REMAINING TEETH

-Use NITI .016 with

molar stop 12-13
12-22
22-23
Then mesialize canine
 STAGE I ALIGNMENT AND LEVELING OF ANT TEETH

(ARCH EXPANSION)

4. Correction of Narrow Archwidth

by:

PROTRACTION OF UPPER
POSTERIORS using :

- Bayonet bend

- Auxilliary Expansion Archwire

- bite elastics
 STAGE II ALIGNMENT AND LEVELING OF POST
TEETH

FIG 8 CHAIN
1. Preserve the
corrections done in
stage I by using: FIG 8
molar to molar
13-14
2. Close all posterior 13-23
spaces
23-24
3. Correct molar
relationship 14-15
-. stable molar occlusion 14-24 24-25
4. Correct malposed
molar

use buccal and lingual

chain when moving molar
STAGE II ALIGNMENT AND LEVELING OF POST
TEETH

FIG 8 CHAIN

15-16
15-25
25-26

16-26
 STAGE III ROOT PHASE

Correct long axis inclination by

Correction of the long
axis inclination
Correct the normal
angulation and torque
Using sequence of progressively
increasing sizes of rectangular
archwire to the biggest size the
slot can accept

Improve arch contour .016 x .016

Ligate with ligature wire

0.16 x .022
Change the archwire
when fully seated and .017 x .025
passive

.019 x .025

.021 x .025
 STAGE IV FINISHING STAGE

Objectives:

1. Idealize the alignment

2. Arch Coordination

Upper arch is bigger than

Lower

3. Settling of occlusion (1
month before bracket
removal)

A. Achieve maximum intercuspation or occlusal

contact
 REMOVAL OF BRACES

After 3 months of stabilization

1. Removal of Brackets and Buccal
Tubes. (Use Composite
Trimmer/Finishing Burs to remove
adhesives and balancing of
occlusion)
2. Oral Prophylaxis and Fluoride
3. Impression taking of Upper and
Lower Arch for fabrication of
retainers.
4. Appointment for rehab
-. retainer
-. resto
-. bleaching
RETENTION

Hawleys Retainer
on the upper for 3
years

Direct Bond fixed

lingual Retainer on
the lower for 3
years
END

Eileen Eika M. Dela Cruz, DMD