MANDIBULAR PROGNATHISM
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NAME: Sabeer Ali AGE : 19 YEARS SEX
: MALE
CHIEF COMPLAINT : Forwardly placed lower jaw, patient is not satisfied with his appearance. www.indiandentalacademy.com
CLINICAL EXAMINATION RECORDS •
ATHLETIC BUILT , MESOMORPHIC BODY TYPE,NORMAL GAIT AND ERECT POSTURE EXTRAORAL EXAMINATIONS:
• • • • • • • • •
SHAPE OF THE HEAD FACIAL FORM FACIAL PROFILE FACIAL DIVERGENCE FMA MAXILLA MANDIBLE LIPS MENTALIS
- DOLICHOCEPHALIC - DOLICHOFACIAL - CONCAVE - ANTERIOR DIVERGENCE - HIGH - NORMAL - PROTRUSIVE - 7 mm of Lip incompetency - HYPERACTIVE
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EXTRA ORAL PHOTOGRAPHS
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INTRAORAL EXAMINATION • • •
No. of teeth present -29 Periodontal status –normal Tongue size-normal
Maxillary Arch • Canines and premolars are rotated • U- shaped symmetrical arch,
MandibularArch • mild crowding and premolar rotations • U- shaped symmetrical arch, www.indiandentalacademy.com
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Antero-Posterior Relationship Molar relationship - Angle’s Class III
Incisor relationship: Overjet - REVERSE OVERJET – 8mm
Canine relationship: Class III www.indiandentalacademy.com
LATERAL CEPHALOGRAM
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OPG
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STEINER’S ANALYSIS
SKELETAL
ANGLES
NORMAL (RANGE)
PRE TREATMENT
SNA
82°
85 °
SNB
80°
91°
ANB
2°
-6°
Go Gn to SN
32°
37°
Occl. Pl to SN
14°
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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MALES MEAN S.D
LANDMARKS CRANIAL BASE Ar PTM (HP) PTM-N (HP)
PATIENT VALUE
37.1 ± 52.8 ±
2.8 3.0
38 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 25 mm 31 mm
57.7 ± 2.5 52.0 ± 4.2 83.7 ± 4.6 8.9 ± 1.7 119.1 ± 6.5 www.indiandentalacademy.com
52 mm 58 mm 89 mm 8 mm 145º
48 mm
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
54.7 68.6 53.9 23.0 30.5 45.0 26.2 35.8
± ± ± ± ± ± ± ±
MAXILLA –MANDIBLE PNS-ANS (HP) Ar-Go (linear) Go-Pg(linear) B-Pg (MP) Ar-Go-Gn angle
WITT’S APPRAISAL:
Pretreatment:: AO ahead of BO by 20 mm Inference : Sk. Cl III
Male: BO ahead of AO by 1.7mm
SOFT TISSUE ANALYSIS MEAN VALUE
PRE TREATMENT
In class III 20.9
22 mm
Upper lip thickness
15mm
18 mm
Upper lip strain
14 - 16
3 mm
90 - 110°
90º
ANGLES
Upper lip length
Naso Labial angle
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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.
Treatment Objectives: •
Alignment of upper/lower arches.
•
Correction of the Skeletal base.
•
Achievement of Lip competency.
•
Enhancement of facial esthetics.
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Treatment Plan: •
Alignment using 0.22 Roth prescription bracket system.
•
High Lefort I osteotomy for maxillary advancement.
•
Bilateral Sagittal Split Osteotomy for mandibular setback.
•
Post surgical Orthodontics for finishing and detailing.
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