Dr-Murad Maraqa case presentation
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Transcript of Dr-Murad Maraqa case presentation
![Page 1: Dr-Murad Maraqa case presentation](https://reader038.fdocuments.co/reader038/viewer/2022103010/58744d721a28abd53e8b565f/html5/thumbnails/1.jpg)
Orthodontic Clinical Case Presentation
By: Murad F.Maraqa 3 rd Year Orthodontic Resident”
Supervisors: Dr. Ahmad M. Al TarawnehDr. Raghda ShamoutDr. Ra’ed Al Rbatta
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Personal Data
▪ Patient’s Name: R.S▪ Gender: Female▪ Age: 15 Years, 8
Months▪ Career: Student▪ Nationality:
Jordanian
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Chief Complain
“ I don’t like how my upper teeth don’t show when I smile ”
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Medical & Dental History
▪ Medical History:Denied Any Medical History.
▪ Dental History: RCT UR 6 + Amalgam fillingRestorations on the UL6 , LL6 and LR6
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History
▪ Trauma: No history of trauma.▪ Habits: No Habits▪ Motivation: Internal Motivated.▪ Growth status: Passed the growth spurt .
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Jaw & Occlusal Functions
▪ Mastication:Normal masticatory function.
▪ Speech:No difficulty.
▪ TMJ:No clicking No Crepitus or tenderness.
No displacementNormal opening.
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Extra-Oral Photos
Frontal View
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Profile ViewExtra-Oral Photos
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Extra-Oral Photos
Oblique View
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Intra-Oral Photos
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Right side Left side
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Orthopantomogram “OPT”
L
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Cephalometric Analysis
Angle Measurement
Average
SNA 82 (81)+-3SNB 82 (78)+-3ANB 0 (2)+-2
SN-MAX 9.8 (8)+-3Corrected
ANB-0.5
Wits Apprasial
-3 (0) + 1.77mm
“f”MMPA 26 (27)+-4
AFH Ratio 57% 55%+-2%
UI - MAX 110 (109)+-6LI - MAN 99 (93)+-6
IIA 121 (135)+-10
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A. Anteroposterior Assessment
▪ Profile:Convex facial profile.
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B. Vertical Assessment
▪ Average LAFH▪ Upper lip in the upper 1/3▪ Lower lip in the lower 2/3
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C. Transverse Assessment
▪ Facial Symmetry:The patient has
asymmetrical face.Tip of nose deviated to the
right side.Chin deviated to the right.Larger Right medial 1/5s
than Left medial1/5s . Interpupillary distance
larger than the width of the mouth.
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E. Soft Tissue Examination
▪ Thin, competent lips.▪ Normal tongue size and
function.▪ Frontonasal angle: “115-
135– 130
▪ Nasolabial angle: “90-110”– 115.
▪ Labiomental angle: “110-130”– 140.
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Intra-oral Examination
▪ Asymmetric smile.
▪ Reduced incisors show 30%
▪ Increased Buccal Corridor
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Right side Left side
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Intra-Oral Examination
▪ Teeth present:
7 77 7
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Intra-Oral Examination
▪ Oral Hygiene :Poor
RCT UR 6 + Amalgam fillingRestorations on the UL6 , LL6 and LR6
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Intra-Oral Examination
▪ Centerlines:– Upper: shifted to the left
1mm– Lower: shifted to the
right 1mm
▪ OJ: -1.2mm▪ OB: 20%
“decreased”▪ Crossbite on:
▪ Right: 2,1▪ Left: 1
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Intra-Oral Examination
▪ Right buccal segment relationships: Canine: Class III 1/4 Molar: Class I
▪ Left buccal segment relationships: Canine: Class I Molar: Class III 1/4
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Lower Arch
▪ U- shaped arch form.▪ Symmetrical.▪ No crowding.▪ LL6 needs refilling or
crowning
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Upper Arch
▪ U- shaped arch form.▪ Constricted Anteriorly.▪ Palatally displaced
central incisors and right lateral incisor.
▪ Palatally inclined lateral incisors.
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Frontal View
▪ Class III Incisor relationship
▪ OJ: -1.2mm▪ OB: 20%
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Posteroanterior View
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Right Side
▪ Molar: Class I▪ Canine: Class I▪ Crossbite: 1,2
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Left Side
▪ Molar: Class I▪ Canine: Class I▪ Crossbite: 1
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Lower Cast Occlusal
▪ Intercanine width: 26 cusp tip –cusp tip
▪ Intermolar width:▪ 46 MB-MB
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Upper Cast Occlusal
▪ Intercanine width: 33 mm cusp tip – cusp tip
▪ Intermolar width:▪ 46 mm from the MB-MB▪ Normal
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Curve of Spee
▪ Left side: 1 mm
▪ Right side: 1 mm
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Tooth Size Analysis (Bolton Ratio)
▪ Over all ratio = 87.5/98▪ 90% Normal: 91.3%▪ Anterior ratio = 36.5/45.5▪ 80% “increased”– Normal: 77.2%
11 7 8 8.5 6 9 8 6 8 8 7 11.5
98 45.5
6 5 4 3 2 1 1 2 3 4 5 6 overall
anterior
11.5
7 7.5 7 6 6 6 6 6.5 7 6.5 11.5 87.5
36.5
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▪ All third molar buds are present.▪ No apparent pathology. RCT UR 6 + Amalgam filling Restorations on the UL6 , LL6 and LR6▪
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IOTN Dental Health Component
▪ Grade:
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IOTN Esthetic Component
▪ Not Applicable
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Diagnostic Summary▪ R.S is a 16 years old, female, denied any medical history. She came complaining that her upper teeth don’t show while smiling.She has poor oral hygiene.Class III Incisors relationship based on mild skeletal Class III with Average anterior facial height.She has asymmetrical face with chin deviated to the Right side. Compromised smile esthetics.She has Class I molar with Class I canine relationships on right side and a Class I molar with ClassI canine relationships on left side. OJ is -1.2mm with decreased OB to 20% “incomplete”Upper midline shifted to the left by 1 mm and lower shifted to the right by 1 mm.Mild crowding in the upper and well-aligned lower arch.Crossbite on UR 1,2and UL 1.
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Problem list
Pathological problems:– Poor O.H. Visible Plaque Accumulation– LL6 needs refilling or crowning Patient’s concern I don’t like how my upper teeth don’t show when I smile
▪ Skeletal and dental problems in transverse plane:– Chin deviated to the right side.– Upper midline shifted to the left by
1mm.– Lower midline shifted to the right by
1mm.▪ Skeletal and dental problems
in A-P :– Skeletal Class III prognathic mandible
– OJ -1.2 mm▪ Skeletal and dental problems
vertically – Decreased OB. 20%
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Treatment Aims
▪ Improve O.H.▪ Restorative treatment LL6.▪ Accept skeletal discrepancy.▪ Accept facial asymmetry ▪ Correct Anterior crossbite.▪ Correct centerlines shift.
▪ Achieve and maintain Class I molar and canine relationships.
▪ Achieve Positive OJ ▪ Increase OB.▪ Finishing and detailing of
occlusion.▪ Retain corrected results
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Treatment Plan “Non-Extraction”
1. O.H. improvement.2. Upper and Lower Fixed MBT 0.22 slot.3. Bite raising on the lower Incisors .4. Stripping in the lower arch6. Conventional Retention Upper/Lower Hawley Retainer.
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Justification
▪ OHI : Visible Plaque ▪ Camouflage :1. Patients chief complaint2. Age of the patient 3. Good vertical facial proportions4. Mild Class III skeletal within orthodontics treatment limits5. Normal soft tissue features ▪ Non –Extraction :1. Space will be provided by proclination of the upper incisors and stripping in the lower incisors ▪ Fixed appliance using MBT prescription:
– For 3D tooth movement .– Maxillary incisors palatal torque.– Retroclination of the lower incisors .
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Justification
▪ Bite Raising : Disoclussion allow freedom in movement of upper incisors
▪ Lower stripping to gain space to retrocline lower incisors .
▪ Conventional Retention :Upper and Lower Hawley 6month full time wear and 6 month night time . After Achieving overbite the results are generally stable
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Mechanics
▪ To get further proclination of ULS, use MBT in the ULS▪ Lingual crown torque on LLS ▪ Contra-lateral canine brackets (to avoid LLS
proclination)▪ Lacebacks in LA (to avoid LLS proclination)▪ Cinch back in LA (to avoid LLS proclination)▪ Closing space created by stripping on a round wire in
the lower arch will facilitate retroclination of the lower incisors.
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Thank You