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CASE PRESENTATIONS
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CASE 1 Name: Sarita Age: 21 Sex: female Chief complaint: forwardly placed and crooked front teeth.
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Pre treatment extra oral photos
Mesocephalic Mesofacial Incompetent lips Interlabial gap of 7mm
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Pre treatment extra oral photos
Convex facial profile Protrusive maxilla Normal Mandible High FMA Deep mentolabial sulcus
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Pre treatment intra oral photos
Angles class I molar relation Angles class I canine relation Overjet 1mm Overbite 3mm
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Pre treatment intra oral photos ď Ž
Maxillary arch: U shaped arch, symmetrical, mild anterior crowding
ď Ž
Mandibular arch: U shaped, symmetrical, moderate anterior crowding
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Pre treatment radiographs
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DOWN’S ANALYSIS: ANGLES
Mean
Range
ACTUAL
Facial angle
87.8
82 to 95
83
Angle of Convexity
0
+10 to –8
11
AB to N-Pog
-4.8
0 to –9
-8
Mandibular Plane
21.9
17 to 28
35
Y- axis
59.4
53 to 66
66
Cant of occlusal plane
9.3
1.5 to 14
13
Inter incisal angle
135.4
130 to 150.5
111
IMPA
91.4
-8.5 to +7
102
L1 to occlusal plane
+14.5
+3.5 to +20
35
UI to Apog line
+2.7
-1 to +5 mm
10
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STEINER’S ANALYSIS ANGLES
NORMAL (RANGE)
PRE TREATMENT
S
SNA
82
80
K
SNB
80
74
L
ANB
2
6
E
Go Gn to SN
32
32
T
Occl. Pl to SN
14
D
U1 to N-A(mm)
4mm
6
E
U1 to N-A (Angle)
22
22
N
L1 to N-B (mm)
4mm
12
T
L1 to N-b (Angle)
25
40
A
Int. Inc. Angle
131
111
L
Wits appraisal: AO ahead by 2.5 mm www.indiandentalacademy.com
SOFT TISSUE ANALYSIS (HOLDAWAY) ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
Facial angle
90°
87
Upper lip curvature
2.5 mm
4
Skeletal convexity to point A
-2.5mm
+6
H – line angle
7 - 15°
22
Nose tip to H line
12mm (max)
0
Upper sulcus depth
5mm
8
Upper lip thickness
15mm
15
Upper lip strain
14 – 16 mm
11
lower lip – H line
-2 1 ± 2mm
+5
Lower sulcus depth
5mm
4
Soft tissue thickness
10mm
14
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Diagnosis
Angle’s class I dental relation with skeletal class II relation due to retrognathic mandible Proclination and crowding of upper and lower anteriors Convex profile Incompetent lips High FMA
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Treatment objectives Correction of proclination Correction of crowding Achieve lip competency
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Treatment plan Extraction of all first premolars PAE mechanotherapy , 0.22 Roth prescription Alignment of teeth Retract anteriors using loop mechanics Anchorage considerations: TPA
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Photos – loop mechanics
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Photos after space closure
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Present status photos
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Radiographs
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DOWN’S ANALYSIS:
ANGLES
Mean
Range
Pre Treatment
Post treatment/ Present status
Facial angle
87.8
82 to 95
83
81
Angle of Convexity
0
+10 to –8
11
12
AB to N-Pog
-4.8
0 to –9
-8
-8
Mandibular Plane
21.9
17 to 28
35
33
Y- axis
59.4
53 to 66
66
65
Cant of occlusal plane
9.3
1.5 to 14
13
20
Inter incisal angle
135.4
130 to 150.5
111
129
IMPA
91.4
-8.5 to +7
102
95
L1 to occlusal plane
+14.5
+3.5 to +20
35
66
UI to Apog line
+2.7
-1 to +5 mm
10
7
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STEINER’S ANALYSIS ANGLES
NORMAL (RANGE)
PRE TREATMENT
PRESENT STATUS
S
SNA
82
80
82
K
SNB
80
74
75
L
ANB
2
6
7
E
Go Gn to SN
32
32
32
T
Occl. Pl to SN
14
D
U1 to N-A(mm)
4mm
6
4
E
U1 to N-A (Angle)
22
22
21
N
L1 to N-B (mm)
4mm
12
6
T
L1 to N-b (Angle)
25
40
27
A
Int. Inc. Angle
131
111
129
L
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SOFT TISSUE ANALYSIS (HOLDAWAY)
ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
POST TREATMEN T
Facial angle
90°
87
87
Upper lip curvature
2.5 mm
4
3
Skeletal convexity to point A
-2.5mm
+6
-2
H – line angle
7 - 15°
22
19
Nose tip to H line
12mm (max)
0
3
Upper sulcus depth
5mm
8
7
Upper lip thickness
15mm
15
14
Upper lip strain
14 – 16 mm
11
12
lower lip – H line
-2 1 ± 2mm
+5
3
Lower sulcus depth
5mm
4
5
Soft tissue chin thickness
10 to12 mm
14
12
Nasolabial angle
90-110 www.indiandentalacademy.com
94
100
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CASE 2
SABIR ALI AGE: 18 SEX: MALE CHIEF COMPLAINT: Forwardly placed lower jaw
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Pre Treatment Extra Oral view
Dolichocephalic Dolichofacial Concave profile Anterior facial divergence High FMA Normal maxilla Protrusive mandible Mid face deficiency 7 mm of lip incompetence Increased lower facial height
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INTRA ORAL VIEWS • • • •
Angle’s Class III molar relation Class III canine relation REVERSE Overjet – 7mm Anterior open bite
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Maxillary Arch
Canines and premolars are rotated U- shaped symmetrical arch
Mandibular Arch
Mild crowding and premolar rotations U- shaped symmetrical arch
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Pretreatment Radiographs
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Steiner's analysis SKELETAL
ANGLES
NORMAL (RANGE)
ACTUAL
SNA
82°
85 °
SNB
80°
91°
ANB
2°
-6°
Go Gn to SN
32°
37°
U1 to N-A (mm)
4mm
11mm
U1 to N-A (Angle)
22°
41 °
L1 to N-B (mm)
4mm
8 mm
L1 to N-B (Angle)
25°
23°
Int. Inc. Angle
134°
122°
DENTAL
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Burstones Analysis MALES MEAN S.D
LANDMARKS CRANIAL BASE Ar PTM (HP) PTM-N (HP) HORIZONTAL (Sk.) N-A-Pg angle N-A (HP) N-B (HP) N-Pg (HP) VERTICAL (Sk. and DENTAL) N-ANS (HP) ANS-Gn (HP) PNS-N (HP) MP-HP angle Upper incisor –NF Lower incisor-MP Upper molar-NF Lower molar-MP
PATIENT VALUE
37.1 ± 52.8 ±
2.8 3.0
38 mm 48 mm
3.9 ± 0.0 ± -5.3 ± -4.3 ±
6.4 3.7 6.7 8.5
- 13º + 3 mm +17 mm + 20mm
3.2 3.8 1.7 5.9 2.1 2.1 2.0 2.6
56mm 81mm 56 mm 28º 27 mm 43 mm 26 mm 31 mm
54.7 68.6 53.9 23.0 30.5 45.0 26.2 35.8
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± ± ± ± ± ± ± ±
MAXILLA –MANDIBLE PNS-ANS (HP) Ar-Go (linear) Go-Pg(linear) B-Pg (MP) Ar-Go-Gn angle
57.7 52.0 83.7 8.9 119.1
± ± ± ± ±
2.5 4.2 4.6 1.7 6.5
WITT’S APPRAISAL: BO ahead of AO by 20 mm Inference : Skeletal Class III
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52 mm 58 mm 89 mm 8 mm 145º
Holdaway’s analysis Mean Value
Pre Treatment
90
99
Upper lip thickness
15mm
18 mm
Upper lip strain
14 - 16
3 mm
90 - 110°
90º
5
4
Upper lip curvature
2.5
5
Lower lip to H line
-1 to +2
+8
5
0
10-12
10
Angles
Facial angle
Naso Labial angle Upper lip sulcus depth
Lower lip sulcus depth Soft tissue chin thickness
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Diagnosis
Angle’s Cl III molar relationship with Cl III Skeletal base due to retruded maxilla and prognathic mandible,
Anterior Open bite,
Reverse overjet,
Mild crowding and rotations in the upper and lower anteriors,
Concave facial profile with lip incompetence,
High FMA.
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Treatment objectives
Correction of the Skeletal base.
Alignment of upper/lower arches.
Correction of Open bite
Achievement of Lip competency.
Enhancement of facial esthetics.
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Treatment Plan
Presurgical orthodontics using 0.22 Roth prescription bracket system.
Decompensation
High Lefort I osteotomy for maxillary advancement of 4 mm.
Bilateral Sagittal Split Osteotomy for mandibular setback of 6 mm.
Post surgical Orthodontics for finishing and detailing. www.indiandentalacademy.com
Pre surgical photographs
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Surgical splints
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Surgical procedure
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2 days post surgery
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Present status
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Stiener’s analysis ANGLES
NORMAL (RANGE)
PRE TREATMENT
S
SNA
82
85 °
85 °
87 °
K
SNB
80
91°
90°
85°
L
ANB
2
-6°
-5°
2°
E
Go Gn to SN
32
37°
38°
30°
D
U1 to N-A(mm)
4mm
11mm
7mm
7.5mm
E
U1 to N-A (Angle)
22
41 °
31 °
28 °
N
L1 to N-B (mm)
4mm
8 mm
8 mm
3 mm
T
L1 to N-b (Angle)
25
23°
21°
12°
A
Int. Inc. Angle
131
122°
134°
145°
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PRE SURGICAL
POST TREATMENT
Down’s analysis ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
Facial angle
90°
99
96
Upper lip curvature
2.5 mm
3 mm
4
Upper sulcus depth
5mm
4
3
Upper lip thickness
15mm
5
17 mm
Upper lip strain
14 – 16 mm
18 mm
15 mm
lower lip – H line
-2 1 ± 2mm
+8
2
Lower sulcus depth
5mm
0
4
Soft tissue thickness
10mm
10
9
Nasolabial angle
1020
90º
102 º
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POST TREATMENT
Burstone’s analysis Measurements
Standard
Patient’s Value
Male
Pre Treatment
Ar. Ptm (\\ HP)
34.4 –39.9
38 mm
30 mm
Ptm to N
49.7 – 56.9
48 mm
58 mm
N. A. Pg (Angle)
(-2.5) – 10.3
- 13º
N.A (\\ HP)
(-3.7) – 3.7
+ 3 mm
+ 2.5 mm
N.B. (\\ HP)
(-12.8) – 4.2
+17 mm
+4.5 mm
N. Pg. (\\ HP)
(-12.8) – 4.2
+ 20mm
+ 8 mm
N. Ans (T) HP
51.5 – 57.9
56mm
53.5 mm
ANS GN (T) HP
64.8 – 72.4
81mm
PNS – N (T) HP
52.2 – 55.6
56 mm
MP-HP (Angle)
17.1 – 32.6
28º
1. NF (T) HP
28.4 – 32.6
27 mm
31 mm
1. MP (T) HP
42.0 – 45.1
43 mm
46 mm
24.2 – 28.2
26 mm
28 mm
6. NF (T) HP
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Post Treatment
-4º
75mm 53.5 mm 23 º
PNS – ANS (\\ HP)
55.2 – 60.2
52 mm
57
Ar. Go (Linear)
57.8 – 56.2
58 mm
49
Go- Pg ( Linear)
68.5 – 80.1
89 mm
87
B. Pg
7.2 – 10.6
(\\ HP)
Ar.Go- Gn (Ang)
8 mm
112.6 – 125.6
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145º
4 124
Holdaway’s analysis POST TREATM ENT
ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
Facial angle
90°
99
96
Upper lip curvature
2.5 mm
3 mm
4
Upper sulcus depth
5mm
4
3
Upper lip thickness
15mm
5
17 mm
Upper lip strain
14 – 16 mm
18 mm
15 mm
lower lip – H line
-2 1 ± 2mm
+8
2
Lower sulcus depth
5mm
0
4
Soft tissue thickness
10mm
10
9
Nasolabial angle
1020
90º
102 º
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CASE 3 Name: Shobha Age: 19 Sex: female Chief complaint: forwardly placed upper teeth and inability to close the lips
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Pre treatment extra oral photos
Mesocephalic Mesofacial Competent lips
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Orthognathic profile Normal FMA Everted lower lips
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Pre treatment intra oral photos
Class I molar relation Class I canine relation Overjet 4mm Overbite 2mm
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Pre treatment intra oral photos ď Ž
Maxillary arch: Symmetrical, U shaped,
ď Ž
Mandibular arch: Symmetrical, U shaped, mild anterior crowding
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Pre treatment radiographs
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DOWN’S ANALYSIS: ANGLES
Mean
Range
Pre Treatment
Facial angle
87.8
82 to 95
87
Angle of Convexity
0
+10 to –8
+4
AB to N-Pog
-4.8
0 to –9
-7
Mandibular Plane
21.9
17 to 28
15
Y- axis
59.4
53 to 66
58.5
Cant of occlusal plane
9.3
1.5 to 14
+8
Inter incisal angle
135.4
130 to 150.5
110
IMPA
91.4
-8.5 to +7
113
L1 to occlusal plane
+14.5
+3.5 to +20
30
UI to Apog line
+2.7
-1 to +5 mm
10
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STEINER’S ANALYSIS ANGLES
NORMAL (RANGE)
PRE TREATMENT
S
SNA
82
80
K
SNB
80
76
L
ANB
2
4
E
Go Gn to SN
32
24
T
Occl. Pl to SN
14
16
D
U1 to N-A(mm)
4mm
8
E
U1 to N-A (Angle)
22
34
N
L1 to N-B (mm)
4mm
8.5
T
L1 to N-b (Angle)
25
33
A
Int. Inc. Angle
131
110
L
Wits appraisal: AO ahead of BO by 2mm www.indiandentalacademy.com
SOFT TISSUE ANALYSIS (HOLDAWAY) ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
Facial angle
90°
89
Upper lip curvature
2.5 mm
3
Skeletal convexity to point A
-2.5mm
-1.5
H – line angle
7 - 15°
14
Nose tip to H line
12mm (max)
9
Upper sulcus depth
5mm
6
Upper lip thickness
15mm
14
Upper lip strain
14 – 16 mm
11
lower lip – H line
-2 1 ± 2mm
1
Lower sulcus depth
5mm
6
Soft tissue thickness
10mm
11
Nasolabial angle
1020 www.indiandentalacademy.com
Diagnosis Angles class I malocclusion with upper and lower proclination Lower arch crowding Orthognathic profile
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Treatment objectives Correction of proclination Correction of crowding Correction of lip strain
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Treatment plan Extraction of all second premolars Pre adjusted bracket system, 0.22 slot Align and retract anteriors
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Photos after space closure
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Radiographs
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After debanding
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With retention appliance
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Stiener’s analysis ANGLES
NORMAL (RANGE)
PRE TREATMENT
PRESENT STATUS
S
SNA
82
80
79
K
SNB
80
76
77
L
ANB
2
4
2
E
Go Gn to SN
32
24
26
D
U1 to N-A(mm)
4mm
8
5
E
U1 to N-A (Angle)
22
34
26
N
L1 to N-B (mm)
4mm
8.5
3
T
L1 to N-b (Angle)
25
33
20
A
Int. Inc. Angle
131
110
132
L
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Down’s analysis ANGLES
Mean
Range
Pre Treatment
Post treatment/ Present status
Facial angle
87.8
82 to 95
87
86
Angle of Convexity
0
+10 to –8
+4
0
AB to N-Pog
-4.8
0 to –9
-7
-7
Mandibular Plane
21.9
17 to 28
15
20
Y- axis
59.4
53 to 66
58.5
58
Cant of occlusal plane
9.3
1.5 to 14
+8
2
Inter incisal angle
135.4
130 to 150.5
110
137
IMPA
91.4
-8.5 to +7
113
91
L1 to occlusal plane
+14.5
+3.5 to +20
30
24
UI to Apog line
+2.7
-1 to +5 mm
10
5
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Holdaway’s analysis ANGLES
MEAN
PRE TREATMENT
POST TREATMENT
Facial angle
90°
89
89
Upper lip curvature
2.5 mm
3
4
Skeletal convexity to point A
-2.5mm
1.5
1.5
H – line angle
7 - 15°
14
14
Nose tip to H line
12mm (max)
9
8
Upper sulcus depth
5mm
6
6
Upper lip thickness
15mm
14
13
Upper lip strain
14 – 16 mm
11
12
lower lip – H line
-2 1 ± 2mm
1
1
Lower sulcus depth
5mm
6
6
Soft tissue chin thickness
10 to12 mm
11
11
102
98
Nasolabial angle
90-110 www.indiandentalacademy.com
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Case 4 Name: Akhil Age: 12 Sex:male Chief complaint:crooked upper and lower front teeth
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Pre treatment extra oral photos ď Ž ď Ž
Mesocephalic, mesofacial Competent lips
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Pre treatment extra oral photos
Orthognathic profile with anterior divergence Protrusive maxilla and mandible High FMA
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Pre treatment intra oral photos
Angle’s class I molar relation Deep bite, overbite 6 mm Upper midline shifted to the right Right upper canine missing Cross bite in relation to both upper lateral incisors
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Pre treatment intra oral photos Maxillary arch: • U shaped, symmetrical • Missing right canine, • Moderate anterior crowding Mandibular arch: • U shaped, symmetrical • Moderate anterior crowding • Lower left lateral incisor lingually placed
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Pre treatment radiographs
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DOWN’S ANALYSIS: ANGLES
Mean
Range
Pre Treatment
Facial angle
87.8
82 to 95
88
Angle of Convexity
0
+10 to –8
+10
AB to N-Pog
-4.8
0 to –9
-9
Mandibular Plane
21.9
17 to 28
25
Y- axis
59.4
53 to 66
58
Cant of occlusal plane
9.3
1.5 to 14
9
Inter incisal angle
135.4
130 to 150.5
140
IMPA
91.4
-8.5 to +7
90
L1 to occlusal plane
+14.5
+3.5 to +20
18
UI to Apog line
+2.7
-1 to +5 mm
6
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STEINER’S ANALYSIS ANGLES
NORMAL (RANGE)
PRE TREATMENT
S
SNA
82
88
K
SNB
80
83
L
ANB
2
5
E
Go Gn to SN
32
28
T
Occl. Pl to SN
14
D
U1 to N-A(mm)
4mm
1
E
U1 to N-A (Angle)
22
22
N
L1 to N-B (mm)
4mm
6
T
L1 to N-b (Angle)
25
24
A
Int. Inc. Angle
131
140
L
Wits appraisal: AO ahead by 1mm www.indiandentalacademy.com
SOFT TISSUE ANALYSIS (HOLDAWAY) ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
Facial angle
90°
91
Upper lip curvature
2.5 mm
5
Skeletal convexity to point A
-2.5mm
-3
H – line angle
7 - 15°
20
Nose tip to H line
12mm (max)
2
Upper sulcus depth
5mm
7
Upper lip thickness
15mm
16
Upper lip strain
14 – 16 mm
16
lower lip – H line
-2 1 ± 2mm
3
Lower sulcus depth
5mm
5
Soft tissue thickness
10mm
11
Nasolabial angle
1020
118
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Diagnosis Class molar relationship with class II skeletal relationship with prognathic maxilla and mandible Upper laterals in cross bite, upper and lower anterior crowding, Midline shift of the upper to the right Deep bite
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Treatment objectives Correction of crossbite Correction of crowding Correction of midline shift Correction of deep bite
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Treatment plan Non extraction Upper expansion with Hyrax and lower expansion with Quad helix Beggs mechanotherapy Alignment and decrowding of the arches Create space for prosthetic replacement of missing canine
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Photos
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Before debanding
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Radiographs
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Present status
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Radiographs
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Steiner's analysis ANGLES
NORMAL (RANGE)
PRE TREATMENT
PRESENT STATUS
S
SNA
82
88
89
K
SNB
80
83
84
L
ANB
2
5
5
E
Go Gn to SN
32
28
28
D
U1 to N-A(mm)
4mm
1
4
E
U1 to N-A (Angle)
22
22
20
N
L1 to N-B (mm)
4mm
6
8
T
L1 to N-b (Angle)
25
24
31
A
Int. Inc. Angle
131
140
122
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Downs analysis ANGLES
Mean
Range
Pre Treatment
Post treatment/ Present status
Facial angle
87.8
82 to 95
88
88
Angle of Convexity
0
+10 to –8
+10
+9
AB to N-Pog
-4.8
0 to –9
-9
-6
Mandibular Plane
21.9
17 to 28
25
28
Y- axis
59.4
53 to 66
58
58
Cant of occlusal plane
9.3
1.5 to 14
9
8
Inter incisal angle
135.4
130 to 150.5
140
122
IMPA
91.4
-8.5 to +7
90
96
L1 to occlusal plane
+14.5
+3.5 to +20
18
25
UI to Apog line
+2.7
-1 to +5 mm
6
8
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Soft tissue analysis (Holdaways) ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
POST TREATMENT
Facial angle
90°
91
90
Upper lip curvature
2.5 mm
5
3
Skeletal convexity to point A
-2.5mm
-3
-2
H – line angle
7 - 15°
20
15
Nose tip to H line
12mm (max)
2
-2
Upper sulcus depth
5mm
7
5
Upper lip thickness
15mm
16
15
Upper lip strain
14 – 16 mm
16
13
lower lip – H line
-2 1 ± 2mm
3
-2
Lower sulcus depth
5mm
5
5
Soft tissue chin thickness
10 to12 mm
11
11
118
107
Nasolabial angle
90-110 www.indiandentalacademy.com
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Case 5
PREETHI AGE: 16 YEARS SEX: FEMALE CHIEF COMPLIANT: Forwardly Placed Upper Anterior Teeth
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Pre treatment Extraoral examination
Mesocephalic Mesofacial Competent lips
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Convex profile Posterior divergence High FMA Protrusive maxilla Normal mandible Shallow mentolabial sulcus
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Pretreatment intra oral
Angle’s class III molar relation on the left and class I on the right side Class I canine relation Overjet 4 mm Overbite 2mm Upper midline shifted to left
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Maxillary arch: U shaped, symmetrical, spacing between central incisors ď Ž
Mandibular arch: U shaped, symmetrical ď Ž
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Pretreatment radiographs
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DOWN’S ANALYSIS: ANGLES
Mean
Range
Pre Treatment
Facial angle
87.8
82 to 95
92
Angle of Convexity
0
+10 to –8
11
AB to N-Pog
-4.8
0 to –9
-7
Mandibular Plane
21.9
17 to 28
22
Y- axis
59.4
53 to 66
55
Cant of occlusal plane
9.3
1.5 to 14
9
Inter incisal angle
135.4
130 to 150.5
95
IMPA
91.4
-8.5 to +7
113
L1 to occlusal plane
+14.5
+3.5 to +20
54
UI to Apog line
+2.7
-1 to +5 mm
14
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STEINER’S ANALYSIS ANGLES
NORMAL (RANGE)
PRE TREATMENT
S
SNA
82
92
K
SNB
80
86
L
ANB
2
6
E
Go Gn to SN
32
28
T
Occl. Pl to SN
14
13
D
U1 to N-A(mm)
4mm
9
E
U1 to N-A (Angle)
22
34
N
L1 to N-B (mm)
4mm
11
T
L1 to N-b (Angle)
25
46
A
Int. Inc. Angle
131
95
Wits appraisal: BO ahead of AO by 1mm www.indiandentalacademy.com
SOFT TISSUE ANALYSIS (HOLDAWAY) ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
Facial angle
90°
95
Upper lip curvature
2.5 mm
7
Skeletal convexity to point A
-2.5mm
-5
H – line angle
7 - 15°
22
Nose tip to H line
12mm (max)
-2
Upper sulcus depth
5mm
10
Upper lip thickness
15mm
12
Upper lip strain
14 – 16 mm
12
lower lip – H line
-2 1 ± 2mm
6
Lower sulcus depth
5mm
1
Soft tissue thickness
10mm
10
Nasolabial angle
1020
68
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Diagnosis Angles class III subdivision molar relation Upper and lower dentoalveolar protrusion Convex profile
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Treatment objectives
Correction of proclination of upper and lower anteriors Improve the facial profile Correction of molar relationship
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Treatment plan Extraction of all first premolars Alignment of teeth Retraction of the anteriors
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End of stage I
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End of stage II
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Present status
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Stiener’s analysis ANGLES
NORMAL (RANGE)
PRE TREATMENT
PRESENT STATUS
S
SNA
82
92
91
K
SNB
80
86
86
L
ANB
2
6
5
E
Go Gn to SN
32
28
23
T
Occl. Pl to SN
14
13
15
D
U1 to N-A(mm)
4mm
9
3
E
U1 to N-A (Angle)
22
34
19
N
L1 to N-B (mm)
4mm
11
6
T
L1 to N-b (Angle)
25
46
30
A
Int. Inc. Angle
131
95
132
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Downs analysis ANGLES
Mean
Range
Pre Treatment
Post treatment/ Present status
Facial angle
87.8
82 to 95
92
91
Angle of Convexity
0
+10 to –8
11
+10
AB to N-Pog
-4.8
0 to –9
-7
-7
Mandibular Plane
21.9
17 to 28
22
17
Y- axis
59.4
53 to 66
55
55
Cant of occlusal plane
9.3
1.5 to 14
9
9
Inter incisal angle
135.4
130 to 150.5
95
132
IMPA
91.4
-8.5 to +7
113
98
L1 to occlusal plane
+14.5
+3.5 to +20
54
70
UI to Apog line
+2.7
-1 to +5 mm
14
6
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Soft tissue analysis (Holdaways) POST TREATMEN T
ANGLES
MEAN
PRE TREATMENT
Facial angle
90°
95
93
Upper lip curvature
2.5 mm
7
6
Skeletal convexity to point A
-2.5mm
-3
-2
H – line angle
7 - 15°
22
16
Nose tip to H line
12mm (max)
-2
2
Upper sulcus depth
5mm
10
9
Upper lip thickness
15mm
12
10
Upper lip strain
14 – 16 mm
12
14
lower lip – H line
-2 1 ± 2mm
6
2
Lower sulcus depth
5mm
1
3
Soft tissue chin thickness
10 to12 mm
10
11
Nasolabial angle
102
68
79
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Case 6 Name: Sajida Age: 13 Sex: female Chief complaint: space between front teeth and tooth erupting out of the arch
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Pre treatment extra oral photos
Dolicocephalic Dolicofacial Competent lips
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Pre treatment extra oral photos
Convex facial profile Posterior divergence Normal maxilla Retrusive mandible Deep mentolabial sulcus
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Pre treatment intra oral photos
Angles class I molar relation Canine class III relation Overjet 2 mm Overbite 2 mm Retained left upper deciduous canine
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Pre treatment intra oral photos
Maxillary arch:
•
U shape, symmetrical,
•
Retained deciduous canine in right quadrant
•
Palatally erupted left first premolar, unerupted right first premolar
•
Unerupted second premolars
•
Rotated right lateral incisor
•
spacing between left lateral incisor and canine
Mandibular arch:
•
U shaped, symmetrical
•
Mild anterior crowding
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Pre treatment radiographs
Transposition of upper first premolars Palatally erupting upper right first premolar Impacted left upper first premolar www.indiandentalacademy.com
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DOWN’S ANALYSIS: ANGLES
Mean
Range
ACTUAL
Facial angle
87.8
82 to 95
83
Angle of Convexity
0
+10 to –8
+13
AB to N-Pog
-4.8
0 to –9
-18
Mandibular Plane
21.9
17 to 28
29
Y- axis
59.4
53 to 66
63
Cant of occlusal plane
9.3
1.5 to 14
11
Inter incisal angle
135.4
130 to 150.5
115
IMPA
91.4
-8.5 to +7
108
L1 to occlusal plane
+14.5
+3.5 to +20
38
UI to Apog line
+2.7
-1 to +5 mm
4
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STEINER’S ANALYSIS ANGLES
NORMAL (RANGE)
ACTUAL
S
SNA
82
84
K
SNB
80
78
L
ANB
2
6
E
Go Gn to SN
32
30
D
U1 to N-A(mm)
4mm
4
E
U1 to N-A (Angle)
22
20
N
L1 to N-B (mm)
4mm
9
T
L1 to N-b (Angle)
25
41
A
Int. Inc. Angle
131
115
Wits appraisal: AO ahead by 3 mm www.indiandentalacademy.com
SOFT TISSUE ANALYSIS (HOLDAWAY) ANGLES
MEAN AT 9 YEAR
ACTUAL
Facial angle
90°
86
Upper lip curvature
2.5 mm
5
Skeletal convexity to point A
-2.5mm
7
H – line angle
7 - 15°
23
Nose tip to H line
12mm (max)
2
Upper sulcus depth
5mm
10
Upper lip thickness
15mm
15
Upper lip strain
14 – 16 mm
12
lower lip – H line
-2 1 ± 2mm
4
Lower sulcus depth
5mm
5
Soft tissue thickness
10mm
9
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Diagnosis
Angle’s class I dental malocclusion with class II skeletal base due to mandibular deficiency Over retained right upper deciduous canine Spacing between upper left canine and lateral Palatally erupted left upper first premolar Impacted upper right first premolar
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Treatment objectives Alignment of upper and lower arch Close space between canine and lateral Achieve normal class I canine relationship
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Treatment plan Extraction of deciduous canine Extraction of impacted upper first premolars Extraction of lower second premolars Space closure
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Mid treatment Photos
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Present status photos
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Radiographs
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Steiner's analysis ANGLES
NORMAL (RANGE)
PRE TREATMENT
PRESENT STATUS
S
SNA
82
84
83
K
SNB
80
78
79
L
ANB
2
6
4
E
Go Gn to SN
32
30
27
D
U1 to N-A(mm)
4mm
4
3
E
U1 to N-A (Angle)
22
24
21
N
L1 to N-B (mm)
4mm
9
4
T
L1 to N-b (Angle)
25
41
28
A
Int. Inc. Angle
131
115
130
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Down’s analysis ANGLES
Mean
Range
Pre Treatment
Post treatment/ Present status
Facial angle
87.8
82 to 95
83
82
Angle of Convexity
0
+10 to –8
13
11
AB to N-Pog
-4.8
0 to –9
-18
-10
Mandibular Plane
21.9
17 to 28
29
26
Y- axis
59.4
53 to 66
63
63
Cant of occlusal plane
9.3
1.5 to 14
11
13
Inter incisal angle
135.4
130 to 150.5
115
130
IMPA
91.4
-8.5 to +7
108
100
L1 to occlusal plane
+14.5
+3.5 to +20
38
21
UI to Apog line
+2.7
-1 to +5 mm
4
4
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Holdaway’s analysis ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
POST TREATMENT
Facial angle
90°
86
86
Upper lip curvature
2.5 mm
5
4
Skeletal convexity to point A
-2.5mm
7
7
H – line angle
7 - 15°
23
22
Nose tip to H line
12mm (max)
2
7
Upper sulcus depth
5mm
10
7
Upper lip thickness
15mm
15
15
Upper lip strain
14 – 16 mm
12
14
lower lip – H line
-2 1 ± 2mm
4
3
Lower sulcus depth
5mm
5
4
Soft tissue chin thickness
10 to12 mm
9
10
Nasolabial angle
90-110
94
100
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Case 7 Name: Usha Rani Age: 23 Sex: Female Chief complaint: highly placed front tooth
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Pre treatment extra oral photos
Mesofacial Mesocephalic Competent lips
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Pre treatment extra oral photos
Convex profile Protrusive maxilla Normal FMA Shallow mentolabial sulcus
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Pre treatment intra oral photos
Angles class I molar relation Canine class I on left side Right upper canine buccally erupted Overbite 4 mm Upper midline shifted to right by 3mm Right first molars in buccal crossbite
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Pre treatment intra oral photos • • • • • • •
Maxillary arch: U shaped, asymmetrical, mild anterior crowding, buccally erupted right canine Mandibular arch: U shaped, symmetrical, Lingually locked second premolars, posterior crowding, lingually left second molar
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Pre treatment radiographs
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DOWN’S ANALYSIS: ANGLES
Mean
Range
Pre Treatment
Facial angle
87.8
82 to 95
85
Angle of Convexity
0
+10 to –8
13
AB to N-Pog
-4.8
0 to –9
-6
Mandibular Plane
21.9
17 to 28
31
Y- axis
59.4
53 to 66
66
Cant of occlusal plane
9.3
1.5 to 14
+9
Inter incisal angle
135.4
130 to 150.5
123
IMPA
91.4
-8.5 to +7
91
L1 to occlusal plane
+14.5
+3.5 to +20
26
UI to Apog line
+2.7
-1 to +5 mm
7
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STEINER’S ANALYSIS ANGLES
NORMAL (RANGE)
PRE TREATMENT
S
SNA
82
85
K
SNB
80
82
L
ANB
2
3
E
Go Gn to SN
32
35
D
U1 to N-A(mm)
4mm
4
E
U1 to N-A (Angle)
22
25
N
L1 to N-B (mm)
4mm
9
T
L1 to N-b (Angle)
25
26
A
Int. Inc. Angle
131
123
Wits appraisal: AO ahead by 3 mm www.indiandentalacademy.com
SOFT TISSUE ANALYSIS (HOLDAWAY) ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
Facial angle
90°
85
Upper lip curvature
2.5 mm
3
H – line angle
7 - 15°
16
Nose tip to H line
12mm (max)
3
Upper sulcus depth
5mm
7
Upper lip thickness
15mm
12
Upper lip strain
14 – 16 mm
8
lower lip – H line
-2 1 ± 2mm
3
Lower sulcus depth
5mm
1
Soft tissue thickness
10mm
8
Nasolabial angle
1020
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Diagnosis Angle’s class I dental malocclusion with class II skeletal base maxillary excess Buccally erupted right upper canine Upper dental midline shift to the right Severe lower posterior crowding Vertical growth pattern
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Treatment objectives Correction of the buccally placed canine Correction of the midline shift Correction of the crowding Correction of molar cross bite Correction of upper arch asymmetry
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Treatment plan Extraction of upper right first premolar and left second premolar Extraction of lower second premolars Begg’s mechanotherapy Correct upper arch asymmetry and molar cross bite by expanding the arch.
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End of stage I Photos
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Radiographs
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End of stage II photos
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Radiographs
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Present status photos
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Radiographs
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DOWN’S ANALYSIS:
ANGLES
Mean
Range
Pre Treatment
End stg 1
End stg 2
End stg 3
Facial angle
87.8
82 to 95
85
84
84
83
Angle of Convexity
0
+10 to –8
13
+10
+8
8
AB to N-Pog
-4.8
0 to –9
-6
-9
-5
5
Mandibular Plane
21.9
17 to 28
31
28
29
34
Y- axis
59.4
53 to 66
66
68
67
68
Cant of occlusal plane
9.3
1.5 to 14
+9
12
13
10
Inter incisal angle
135.4
130 to 150.5
123
130
126
121
IMPA
91.4
-8.5 to +7
91
90
88
94
L1 to occlusal plane
+14.5
+3.5 to +20
26
21
21
61
UI to Apog line
+2.7
-1 to +5 mm
7
4
7
7
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STEINER’S ANALYSIS ANGLES
NORMAL (RANGE)
S
SNA
82
K
SNB
80
L
ANB
E
PRE TREATMENT
Present status
End stg 1
End stg 2
84
82
82
80
80
80
2
3
4
2
3
Go Gn to SN
32
35
38
36
32
D
U1 to N-A(mm)
4mm
4
3
3
4
E
U1 to N-A (Angle)
22
25
21
20
24
N
L1 to N-B (mm)
4mm
9
8
6
7
T
L1 to N-b (Angle)
25
26
28
21
27
A
Int. Inc. Angle
131
123
130
127
125
85
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83
SOFT TISSUE ANALYSIS (HOLDAWAY)
ANGLES
MEAN AT 9 YEAR
PRE TREATMENT
End stg 1
End stg 2
Present status
Facial angle
90°
85
84
85
84
Upper lip curvature
2.5 mm
3
2
1
7
H – line angle
7 - 15°
16
17
15
16
Nose tip to H line
12mm (max)
3
3
5
4
Upper sulcus depth
5mm
7
6
4
9
Upper lip thickness
15mm
12
12
16
12
Upper lip strain
14 – 16 mm
8
9
8
12
lower lip – H line
-2 1 ± 2mm
3
4
4
-3
Lower sulcus depth
5mm
1
1
2
5
Soft tissue chin thickness
10 to12 mm
8
7
8
8
Nasolabial angle
90-110
96
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110
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