EUROPEAN SOCIETY OF LINGUAL ORTHODONTISTS CANDIDATE NUMBER : 13 Dr. Masatoshi Sana CASE NUMBER : Year : ESLO 01
RÉSUMÉ OF CASE 2 CASE CATEGORY: CLASS I MALOCCLUSION NAME: BORN: SEX: Yukari K. 08/03/1979 F PRETREATMENT RECORDS: AGE:24.6years DATE:04/09/2003 CLASSIFICATION: Adult malocclusion - Angle Class, Crowding TEETH MISSING BEFORE TREATMENT: 18 APPLIANCE: Upper & lower lingual fixed orthodontic appliance (Kurz 7th) TREATMENT STARTED: AGE:24.8years DATE:05/11/2003 TREATMENT ENDED: AGE:28.5years DATE:07/08/2007 ACTIVE TREATMENT TIME:.9years POSTTREATMENT RECORDS: AGE:28.5years DATE:27/08/2007 RETAINERS: a) Dynamic Positioner RETENTION ENDED: continued RETENTION TIME: 2.11years (POST-) RETENTION RECORDS: AGE:30.6years DATE: 03/10/2009 TIME OUT OF RETENTION: still in retention ESLO 02
DIAGNOSTIC DESCRIPTION OF THE MALOCCLUSION A. SUMMARY Patient s chief compliant was crowding. From patient s smile view, upper incisors were protruded. B. EXAMINATION OF HEAD AND FACE From lateral view, patient s profile was convex. Frontal view was almost symmetrical. Muscle strain of mentalis was shown,when patient lip close. From smile view, upper incisor was protruded. C. FUNCTIONAL EXAMINATION Patient s mastication and TMJ movement shows no particular problem to mention. D. INTRAORAL EXAMINATION 1, Angle class 2, Overjet 4.0mm and overbite 4.2mm 3, Upper midline was shifted to right 1.0mm 4, Narrow dental arch 5, Crowding E. DENTAL CASTS Maxillary arch: Arch length discrepancy : -7.3mm Mandibular arch: Arch length discrepancy : -8.1mm Occlusion Sagittal : Angle class, overjet 4.0mm Occlusion Vertical : overbite 4.2mm Occlusion Transversal: Upper midline shift to right 1.0mm 17.27 were buccal tipped. CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 03
v v v v FRONTAL SMILE v v v PROFILE 45 FACIAL PHOTOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 04
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 05
LATERAL SKULL RADIOGRAPH BEFORE TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 06
TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 07
CEPHALOMETRIE ANALYSE TWEED MERRYFIELD Debut Tt SNA 82 ± 77.0 SNB 80 ± 74.1 ANB 2 ± 2.9 FMA 25 ±3 29.8 IMPA 87 ±3 85.1 OP/F 10 6.5 CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 08!1
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 Sagittal Skeletal Relations Maxillary Position S-N-A Pretreatment Mean SD 77.0 82º ± 3.5º Mandibular Position S-N-Pg 74.0 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 3.0 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N / ANS-PNS 11.8 8º ± 3.0º Mandibular Inclination S-N / Go-Gn 43.1 33º ± 2.5º Vertical Jaw Relation ANS-PNS / Go-Gn 31.4 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1 - ANS-PNS 120.3 110º ± 6.0º Mandibular Incisor Inclination 1 - Go-Gn 85.8 94º ± 7.0º Mandibular Incisor Compensation 1 - A-Pg (mm) 4.7mm 2 ± 2.0 Dental Relations Overjet (mm) 5.8mm 3.5 ± 2.5 Overbite (mm) 3.4mm 2 ± 2.5 Interincisal Angle 1 / 1 122.6 132º ± 6.0º CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 08-2
PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 09
ANY OTHER RADIOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 10
RADIOGRAPHIC ANALYSIS BEFORE TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH 18. was absence. 28.38.48 was impacted. B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT 1. Sagittal Skeletal Relations: Maxilla and mandible position were retruded relative to line S-N. (SNA 77.0, SNB 74.1, ANB 2.9 ) 2. Vertical Skeletal Relations: Mandibular Inclination (S-N/Go-Gn) beyond the range of normal. 3. Dento-Basal Relations: Maxillary incisor was inclined labial. Mandibular incisor was inclined lingual. 4. Dental relations: overjet 5.8mm, overbite 3.4mm Molar relation was class 5. Esthetic Profile: Upper and Lower lip to E-line was protruded. Patient s profile was convex. CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 11
TREATMENT PLAN AND THE REASON FOR IT Treatment plan 1, Extraction 1 st bicuspids (14.24.34.44) to create space 2, Head gear make for reinforcement of the source of anchorage 3, Indirect bonding both arches with lingual appliances (Kurz 7 th brace) 4, Leveling 5, Retraction of upper incisor 6, Implantation on lower buccal alveolar bone for molar mesial movement 7, Torqing 8, Detailing The reason This patient was severe crowding with high angle case. On the treatment of high angle case, prevent of mandibular-rotate to clockwise direction is important. Utilize high-pull headgear and lower molar mesial movement is effective for this point. And using implants was considered effective for molar mesial movement. CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 04/09/2003 AGE: 24.6years ESLO 12-0
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT Upper : Copper-Ni-Ti (.017!.017) CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 05/11/2003 AGE: 24.8years ESLO 12-1
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT Upper : Copper-Ni-Ti (.017!.017) Lower : Copper-Ni-Ti (.017!.017) CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 02/02/2004 AGE: 24.11years ESLO 12-2
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT Upper : TMA (.016) Lower : Copper-Ni-Ti (.017!.017) CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 30/03/2004 AGE: 25.1years ESLO 12-3
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT Upper : TMA (.016!.022) Lower : S.S. (.016!.022) CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 06/10/2004 AGE: 25.7years ESLO 12-4
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT CANDIDATE NUMBER:13 Upper : TMA (.016!.022) Lower : S.S. (.016!.022) CASE NUMBER: 2 DATE: 24/11/2004 AGE: 25.8years ESLO 12-5
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT CANDIDATE NUMBER:13 Upper : S.S. (.016!.022) Lower : S.S. (.016!.022) CASE NUMBER: 2 DATE: 25/02/2005 AGE: 25.11years ESLO 12-6
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT Upper : TMA (.0175!.0175) CANDIDATE NUMBER:13 Lower : TMA (.0175!.0175) CASE NUMBER: 2 DATE: 30/11/2005 AGE: 26.8years ESLO 12-7
RÉSUMÉ OF THE TREATMENT CARRIED OUT INCLUDING ANY DIFFICULTIES ENCOUNTERED 01.10.2003 Diagnosis Extraction (14,24,34,44) 05.11.2003 Head gear make Indirect bonding to maxillary arch (Kurz 7 th brace / Co-Ni-Ti.017!.017) 05.01.2004 Indirect bonding to mandibular arch (Kurz 7 th brace / Ni-Ti.014) 02. 02.2004 Alignment maxillary and mandibular arch (NiTi.014 low friction TMA.016!.022) 01.06.2004 Started class elastics (<U>TMA.016!.022 <L>TMA.0175!.0175) 07.10.2004 Implantation (K-1 system:1.2mm! mm) 27.10.2004 En masse retraction 10.07.2006 Detailing (TMA.0175!.0175) 06.11.2006 Extraction (28,38,48) 27.08.2007 Removed the appliances Started retention CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 13
v v v v FRONTAL SMILE v v v PROFILE 45 FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 14
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION AT COMPLETION OF TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 15
LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 1
TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 17-1
SUPERIMPOSITION AT SN-S CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 17-2
Palatal Plane at ANS Mandibular Plane at Me S-N at S SUPERIMPOSITIONS of MAXILLA, MANDIBULE, PROFILE CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 17-3
CEPHALOMETRIE ANALYSE TWEED MERRYFIELD Debut Tt Fin Tt SNA 82 ± 77.0 76.9 SNB 80 ± 74.1 74.2 ANB 2 ± 2.9 2.7 FMA 25 ±3 29.8 29.5 IMPA 87 ±3 85.1 91.0 OP/F 10 6.5 10.3 CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 18!1
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 Sagittal Skeletal Relations Maxillary Position S-N-A Pretreatment Posttreatment Mean SD 77.0 76.9 82º ± 3.5º Mandibular Position S-N-Pg 74.0 75.5 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 3.0 1.4 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N / ANS-PNS 11.8 10.6 8º ± 3.0º Mandibular Inclination S-N / Go-Gn 43.1 41.0 33º ± 2.5º Vertical Jaw Relation ANS-PNS / Go-Gn 31.4 30.4 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1 - ANS-PNS 120.3 113.3 110º ± 6.0º Mandibular Incisor Inclination 1 - Go-Gn 85.8 93.1 94º ± 7.0º Mandibular Incisor Compensation 1 - A-Pg (mm) 4.7mm 3.0mm 2 ± 2.0 Dental Relations Overjet (mm) 5.8mm 2.8mm 3.5 ± 2.5 Overbite (mm) 3.4mm 2.4mm 2 ± 2.5 Interincisal Angle 1 / 1 122.6 123.2 132º ± 6.0º CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 18-2
PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 19
ANY OTHER RADIOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 19-1
RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH Overbite changed from 3.4mm" 2.4mm Overjet changed from 5.8mm " 2.8mm 14,24,28,34,38,44,48 were extracted. No root resorption. Root parallelism was good. B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT 1. Sagittal Skeletal Relations: Maxilla and mandibular position was no-change. (SNA 77.0 "76.9, SNB 74.1 "74.2, ANB 2.9 "2.7 ) 2. Vertical Skeletal Relations: Mandibular Inclination was 2.1 closed at S-N/Go-Gn. 3. Dento-Basal Relations: Maxillary incisor well positioned relative to line ANS-PNS. Mandibular incisor well positioned relative to line Go-Gn. 4. Dental relations: Normal overjet and overbite. (overjet 5.8mm"2.8mm,overbite 3.4mm"2.4mm) 5. Esthetic Profile: Upper and Lower lip to E-line was normal. Profile was good. (Upper : 1.9mm" -2.8mm / Lower : 3.9mm" -2.2mm) CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 20
DESCRIPTION OF THE TREATMENT RESULT TREATMENT RESULT ORIENTATION 1) Patient profile and smile were improved 2) Class molar relationship 3) Severe crowding was improved 4) Mandibular inclination (S-N/Go-Gn) was closed 2.1 5) Class molar relationship 6) Retaining goal : lifelong CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 21-1
DESCRIPTION OF THE POST-TREATMENT EVALUATION OF RETENTION RETENTION RESULT ORIENTATION 1) Retaining goal : lifelong 2) Occlusion is stable 3) Teeth position are stable CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE: 27/08/2007 AGE:28.5years ESLO 21-2
v v v v FRONTAL SMILE v v v PROFILE 45 FACIAL PHOTOGRAPHS AT RETENTION CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 22
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS AT RETENTION CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 23
PERIAPICAL OR PANORAMIC RADIOGRAPH AT RETENTION / POSTRETENTION CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 24-1
ANY OTHER RADIOGRAPHS AT RETENTION / POSTRETENTION CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 24-2
RADIOGRAPHIC ANALYSIS AT RETENTION/POSTRETENTION A. INTRAORAL / PANORAMIC RADIOGRAPH Roots were parallel. Alveolar bone support was stable. Occlusion was stable. B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT 1, Sagittal Skeletal Relations: Idem page 20 =stable 2, Vertical Skeletal Relations: Idem page 20 = stable 3, Dento-Basal Relations: Idem page 20 =stable 4, Dental Relations: Idem page 20 =stable 5, Esthetic Profile: Idem page 20 =stable CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 24-3
LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 24-4
TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 25-1
SUPERIMPOSITION AT SN-S CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 25-2
Palatal Plane at ANS Mandibular Plane at Me S-N at S SUPERIMPOSITIONS of MAXILLA, MANDIBULE, PROFILE CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 25-3
CEPHALOMETRIE ANALYSE TWEED MERRYFIELD Debut Tt Fin Tt Fin Cont SNA 82 ± 77.0 76.9 77.0 SNB 80 ± 74.1 74.2 73.9 ANB 2 ± 2.9 2.7 3.1 FMA 25 ±3 29.8 29.5 29.4 IMPA 87 ±3 85.1 91.0 91.0 OP/F 10 6.5 10.3 11.8 CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 26-1
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 Sagittal Skeletal Relations Maxillary Position S-N-A Pretreatment Posttreatment Retention/ Postretention Mean SD 77.0 76.9 77.0 82º ± 3.5º Mandibular Position S-N-Pg 74.0 75.5 74.6 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 3.0 1.4 2.4 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N / ANS-PNS 11.8 10.6 11.8 8º ± 3.0º Mandibular Inclination S-N / Go-Gn 43.1 41.0 42.3 33º ± 2.5º Vertical Jaw Relation ANS-PNS / Go-Gn 31.4 30.4 30.5 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1 - ANS-PNS 120.3 113.3 114.0 110º ± 6.0º Mandibular Incisor Inclination 1 - Go-Gn 85.8 93.1 92.0 94º ± 7.0º Mandibular Incisor Compensation 1 - A-Pg (mm) 4.7 3.0 2.9 2 ± 2.0 Dental Relations Overjet (mm) 5.8mm 2.8mm 3.0mm 3.5 ± 2.5 Overbite (mm) 3.4mm 2.4mm 2.4mm 2 ± 2.5 Interincisal Angle 1 / 1 122.6 123.2 123.6 132º ± 6.0º CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 26-2
DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS LONG TERM RETENTION RESULT ORIENTATION 1) Occlusion is stable 2) Teeth positions are stable 3) Retaining goal : lifelong positioner use at night time CANDIDATE NUMBER:13 CASE NUMBER: 2 DATE:03/10/2009 AGE: 30.6years ESLO 27