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See all Premium member Presentation Transcript CASE PRESENTATION : Dr Shafaq Salim Dr Anosha Baqai CASE PRESENTATION Patient’s History : Patient’s History Personal Data Name : ABC Age : 11yrs Gender : Female Address : Model Colony D.O.E : Jan 25th,10 Socio-economic Status : Affording Chief complaint : Chief complaint Impaired dento-facial esthetics and function Medical history Not significant Past dental history : Past dental history No trauma Habits‣ thumb sucking‣ lip biting family history None Slide 5: Clinical examination Extra-oral examination : Extra-oral examination Frontal view : Frontal view Profile view : Profile view Frontal on smile : Frontal on smile Oblique view : Oblique view Intraoral examination : Intraoral examination 1234e6 1234e6 6e4321 65431 Frontal view : Frontal view Right lateral : Right lateral Left lateral : Left lateral Upper Occlusal view : Upper Occlusal view Lower occlusal view : Lower occlusal view Increased overjet : Increased overjet 14mm Occlusal analysis : Occlusal analysis Antero-posterior Vertical Class II cuspid & molar relationship : Class II cuspid & molar relationship Transverse : Transverse Tmj analysis Midline shift : Midline shift 3.5mm investigations : investigations investigations : investigations Cast Analysis Space Analysis Cephalometric Analysis OPG Analysis Hand-wrist Radiograph Analysis Cervical Maturation Analysis Palatal Expansion Measurement Airway analysis Slide 24: CAST ANALYSIS Cast Apart U-shaped Arch Deep Palatal Vault Normal Labial Frenum Lower Midline Shift to right 3.5mm Cast apart : Cast apart Dentition status : Dentition status Intra-orally Missing 42 Labio-Version 11,12,21,22 Torsi-version 32,31,41 Slide 27: Cast in Occlussion Molar Relationship Rt. : Half cusp class II div I Lt. : Full cusp class II div I Cuspid Relationship Rt. : Class II Lt. : Class II Incisor Relationship Incisor overjet : 14mm Overbite : 60% Cross Bite Posterior Bilateral Cast in occlusion : Cast in occlusion Slide 29: Rt. Lateral Lt. lateral Space analysis : Space analysis MAXILLARY ARCHspace discrepancy= space available - space required = 88 – 86.5 = +2.5mm MANDIBULAR ARCH space discrepancy= space available - space required = 63 – 64.8 = -1.8mm BOLTON’S ANALYSISsum of lower 12 teeth/sum of upper 12 teeth * 100 =79.5% sum of lower 6 teeth/sum of upper 6 teeth * 100=62.5% CEPHALOMETRIC ANALYSIS : CEPHALOMETRIC ANALYSIS SKELETAL analysis : SKELETAL analysis Slide 35: Sagittal ------- Vertical ------- Dental analysis : Dental analysis Slide 37: Upper Incisor -------- Lower Incisor -------- Mcnamara’s & Harvold’s : Mcnamara’s & Harvold’s Slide 39: Harvold’s -------- Mcnamara’s ------- Soft tissue analysis : Soft tissue analysis Slide 41: S-line ------- E-line ------- OPG ANALYSIS : OPG ANALYSIS Hand wrist radiograph analysis : Hand wrist radiograph analysis Hand-wrist maturation graph : Hand-wrist maturation graph Slide 46: Cervical maturation analysis : Cervical maturation analysis CERVICAL MATURATION GRAPH : CERVICAL MATURATION GRAPH Measurement of palatal expansion : Measurement of palatal expansion + + + = Upper Molar Torque Lower Molar Torque Buccal Overjet Over-correction Palatal Expansion Airway analysis : UPPER AIRWAY_Post. Pharengeal wall to middle of soft palateLOWER AIRWAY_Post pharengeal wall to post. Tongue from mandibular plane Airway analysis 17mm 13mm diagnosis : diagnosis Skeletal dental Base – II Class II,div-I with bilateral posterior cross bite Slide 54: Problem list Treatment objective : Treatment objective Treatment plan : Treatment plan Phases : Phases Plan a : Plan a Achieve rapid palatal expansion with fixed functional appliance like hyrax with bands on 14,24 & 16,26 for 6 months After 6 months twin block appliance is incorporated for mandibular advancement until desired results are achieved. Then we can go for fixed appliance therapy for minor dental corrections. Plan b : Plan b Achieve rapid palatal expansion with functional appliance like hyrax with bands on 14,24 & 16,26 for 30 days After 30 days twin block appliance is incorporated in hyrax for mandibular advancement until desired results are achieved After that fixed appliance therapy can be done for minor dental corrections Plan c : Plan c Incorporate fixed functional appliance like hyrax modified with twin block appliance until the desired result is achieved We can go for fixed appliance therapy for minor dental corrections RPE BY HYRAX : RPE BY HYRAX TWIN BLOCK APPLIANCE : TWIN BLOCK APPLIANCE FIXED APPLIANCE THERAPY : FIXED APPLIANCE THERAPY REFRENCES : REFRENCES Nicole J. Saira.:long term dentoskeletal changes with the bionator,twin block & MARA functional appliances;Angle orthodontist,vol 80,No 1,2010. Hakan Gurcan.:Long term effects of RME followed by fixed appliance,Angle orthodontist,vol 80, No 1,2010 Aldo Giancotti.:RPE in treatment of Class-II malocclusions,British Journal of orthodontics,vol 26,No 3. Maria T. O’ Reilly.:Mandibular growth changes & maturation of cervical vertebrae,Angle Orthodontics,pg 179-184,April 1988. Roberto M. A. Lima Filho.:Spontaneous correction of class II malocclusion after RPE,Angle orthodontist,vol 73, No. 6,,2003. Proffit WR, fields HW. Contemporary Orthodontics; 4th edition. St. Louis, Mo: Mosby; 2000:13. Thank you : Thank you You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.