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The treatment planning is specifically designed to avoid both under- and excessive treatment, while appropriately involving the patient in the planning process.
FIVE steps:
1. 2. 3.
4.
5.
Identify the most important problems, and the treatment plan must
these priorities.
OR
extrusion of molars
case:1
Age: 17yrs & 6months Address: Peshawer
Introduction
C/C Labially placed canine Medical/Surgical Hx: Nil Dental Hx: Nil Habits: o Nil
Clinical Examination
Profile:
Straight
Transverse:
symmetrical
Vertical:
normal
Lips:
competent
Nose:
normal
Chin:
Normal
Extra-oral
Front Front with Smile
Profile
View
Intra-Oral
Front Over-jet
Upper Occlusal
Lower Occlusal
Right
Left
Cast Analyses
ALD Maxilla: -6 mm Mandible: -5mm Bolton analyses Anterior ratio: mandibular tooth material excess of 2.1mm Overall ratio: insignificant
OPG
Ceph
Sagittal Analyses
SNA SNB ANB
Ceph Analyses
Linear Analyses UI-LI 98mm Upper lip- E Plane Lower lip- E Plane Upper Lip- S line Lower Lip- S line Naso-labial Angle Z angle 0 102 135 -3 -2 0 124 -9mm -6 -4 -3 97
81 78 3
82 80 2
Co- A length
115118
22 4mm 108 102 25 4 90 30 26 45
128mm
Witts
Na-A Na-Po Facial angle SN-PP
-2 to+2
0-1 -2 to +4 87
Vertical Analyses
-1
+7 +16 89
Dento-Skeletal Analyses
26
7mm
UI-PP
SN-UI
115
106 30 4mm 105 26 25 40 34
FMPA
SN-MP PP-MP Y-axis
25
32 27 59
11
25 18 50
78
95
Holdaway ratio
1:1
1.3:1
LAFH/AFH
PFH/AFH
54%
65%
55%
72%
35
Problem list
Oral Health-related problems
Carious lesions in UR6,7 LR6
Dental problems
Class II canine relation on left side Lingual Crossbite UL4 Proclined incisors ALD in Max -7mm and Mand 5mm Bolton discrepency
Treatment planning
Treatment of carious lesions Comprehensive orthodontic treatment:non-extraction pattern Level & align both arches,correct upper arch crowding with arch expansion. Stripping of lower incisors Maintain ClassI molar relation finish in ClassI canine & incisor relation Retention with upper removable Hawley retainer & lower Fixed bonded retainer.
case:2
Age: 18years Address: Peshawar
Introduction
C/C Upper front teeth are forwardly placed Medical/Surgical Hx: Nil Dental Hx: Ortho treatment with fixed appliance was done in Islamabad 7years back for 1year Habits: o Nil
Clinical Examination
Profile:
Convex
Transverse:
symmetrical
Vertical:
Long
Lips:
Incompetent
Nose:
normal
Chin:
normal
Extra-oral
Front Front with Smile
Profile
View
Intra-Oral
Front Over-jet
Occlusal View
Upper Lower
Right
Left
Smile Analysis
6mm
Buccal corridors
25%
55
Cast Analyses
ALD
Maxilla: +2.97 mm Mandible: -5.46 mm
Bolton analyses
Anterior ratio: Insignificant
OPG
Ceph
Sagittal Analyses
SNA SNB ANB
Ceph Analyses
Linear Analyses UI-LI 95 Upper lip- E Plane Lower lip- E Plane Upper Lip- S line Lower Lip- S line Naso-labial Angle Z angle 0 102 135 -3 -2 0 106 +3 0 +7 +2 88
81 78 3
82 73 9
Co- A length
113116
22 4mm 108 102 25 4 90 30 26 45
123
Witts
Na-A Na-Po Facial angle SN-PP
-2 to+2
0-1 -2 to +4 87
Vertical Analyses
4
0 -13 83
Dento-Skeletal Analyses
30
10mm
UI-PP
SN-UI
125
119 29 4mm 101 36 25 51 37
FMPA
SN-MP PP-MP Y-axis
25
32 27 59
28
34 26 64
78
61
Holdaway ratio
UI-Stm
1:1
4mm
4:9
6mm
LAFH/AFH
PFH/AFH
54%
65%
59%
65.7%
35
Problem list
Skeletal problems
Class II bases Increase lower anterior facial height
Dental problems
Class II div 1 malocclusion Increase OJ (16mm) & OB(4mm) V-shape upper arch Proclined upper and lower incisors ALD in Max. is +2.97mm & in Mand. is 5.46mm Lower mid line shifted towards left 3mm
Treatment planning
Treatment of carious lesions Treatment strategy: surgical orthodontics[ BSSO with mandibular advancement+
Lefort I with maxillary impaction]
Presurgical phase:
Ext. all 4s Level and align both arches Finish in Class II molar, canine and incisor relationship
Surgical phase:
LeForte I+BSSO
Post-Surgical
Occlusal settling with elastics Finish in ClassI molar canine and incisor relation Retention with upper removable Hawley retainer and Lower fixed bonded retainer
case:3
Salman
Introduction
Age: 19 yrs Address: Peshawer C/c I have bite problem Medical hx: Nil Dental hx: Hx of trauma:
Fall from the roof at 2 yrs of age,resulting in mandible fracture Motor bike accident: at 11yrs of age, lower left 8 is extracted
Habits:
Nil
Clinical Examination
Profile:
Straight
Transverse:
symmetrical
Vertical:
high
Lips:
competent
Nose:
normal
Chin: normal
Extra-oral
Front Front with Smile
Profile
View
Intra-Oral
Front Over-jet
Upper Occlusal
Lower Occlusal
Right
Left
Cast Analyses
Maxilla: -10.3 mm
Mandible: -4.7mm
OPG
Ceph
Sagittal Analyses
SNA SNB ANB
Ceph Analyses
Linear Analyses UI-LI 88mm Upper lip- E Plane Lower lip- E Plane Upper Lip- S line Lower Lip- S line Naso-labial Angle Z angle 0 102 135 -3 -2 0 132 -10mm 0 -4 +3 83
81 78 3
75 79 -4
Co- A length
111114
22 4mm 108 102 25 4 90 30 26 45
140mm
Witts
Na-A Na-Po Facial angle SN-PP
-2 to+2
0-1 -2 to +4 87
-10mm
-6mm 0 90
Dento-Skeletal Analyses
30
9mm
UI-PP
Vertical Analyses SN-UI
111
106 23 5mm 82 37mm 31mm 41mm 36mm
FMPA
SN-MP PP-MP Y-axis
25
32 27 59
32
42 37 62
78
78
Holdaway ratio
UI-Stm
1:1
4mm
5:3
3mm
LAFH/AFH
PFH/AFH
55%
65%
60.2%
59%
35
Case summary
male pt,19yrs of age with a C/C of bite problem .he has previous history of trauma,resulting in mandible fracture and ext of LL7? Dentally, he has ClassIII Molar relation. He has anterior and posterior X-bite and AOB.UR3 is impacted . Upper midline is shifted towards Rt by 5mm. ALD in Maxilla is -10.3mm and in Mandible it is -4.7mm. Ceph analyses show ClassIII skeletal bases ,high-angle pattern , retroclined lower incisor , retrusive upper lip & acute naso -labial angle
Problem list
Skeletal problems
Class III bases due to maxillary difficiency High-angle skeletal pattern
Dental problems
Impacted UR3 Anterior and posterior crossbite Class III relation Anterior openbite V-shape upper arch Midline discrepency Crowding in both arches Retroclined lower incisors
Treatment planning
Surgical orthodontics : Le Fort I osteotomy with maxillary advancement and posterior impaction Pre-surgical phase Ext U8s RPE Leveling and alignment of both arches,space opening for UR3,correct midline Decompensate lower arch Surgical phase; lefort I osteotomy Post-surgical phase: occlusal settling, finishing in ClassI molar ,canine and Incisor relation Retention with upper removable Hawley retainer & lower fixed bonded retainer