EUROPEAN SOCIETY OF LINGUAL ORTHODONTISTS Dr. Masatoshi Sana Year: ESLO 01
RÉSUMÉ OF CASE 8 CASE CATEGORY: TRANS / VERTICAL DISCREPANCY NAME: Akiko T. BORN : 15/03/1973 SEX: F PRE-TREATMENT RECORDS: AGE: 32.5years DATE:11/10/2005 CLASSIFICATION: Adult malocclusion Angle Cl II - open bite TEETH MISSING BEFORE TREATMENT: APPLIANCE: Upper & lower lingual fixed orthodontic appliance (Kurz 7th) TREATMENT STARTED: AGE: 32.9 year DATE : 15/12/2005 TREATMENT FINISHED: AGE: 35.0 years DATE: 05/04/2008 ACTIVE TREATMENT TIME: 2.3 years POST-TREATMENT RECORDS: AGE: 35.0 years DATE: 05/04/2008 RETAINERS: a) Dynamic positioner DATE: 05/04/2008 RETENTION ENDED: a) upper : not ended b) lower: not ended DATE: not ended RETENTION TIME: 2.2 years (POST-) RETENTION RECORDS: AGE: 37.2 years DATE: 24/05/2010 TIME OUT OF RETENTION: still in retention ESLO 02
DIAGNOSTIC DESCRIPTION OF THE MALOCCLUSION A. SUMMARY Patient s chief compliant was dysfunction of mastification caused by anterior open bite. B. EXAMINATION OF HEAD AND FACE From lateral view, upper and lower lip were protruded. From frontal view, symmetry was no-problem, but muscle strain of mentalis was shown. From smile view, upper incisor was protruded and severe crowding was shown. C. FUNCTIONAL EXAMINATION Patient s mastication shows disfunction. Tongue thrust habit was shown. D. INTRAORAL EXAMINATION 1, Angle class 2, Anterior open bite (11,12,13,21,22,23 / 31,32,33,41,42,43) 3, Overjet 2.7mm 4, Overbite!1.1mm 5, Crowding E. DENTAL CASTS Maxillary arch: Arch length discrepancy was -8.4mm Madibular arch: Arch length discrepancy was -2.4mm Occlusion Sagittal: Angle Class, Overjet 2.7mm Occlusion Vertical: Anterior open bite (Overbite -1.1mm) Occlusion Transversal: Upper midline shifted 0.5mm left DATE: 11/10/2005 AGE: 32.5years ESLO 03
v v v v FRONTAL SMILE v v v PROFILE 45 FACIAL PHOTOGRAPHS BEFORE TREATMENT DATE: 11/10/2005 AGE: 32.5years ESLO 04
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT CASE NUMBER:5 DATE: 11/10/2005 AGE: 32.5years ESLO 05
LATERAL SKULL RADIOGRAPH BEFORE TREATMENT DATE: 11/10/2005 AGE: 32.5years ESLO 06
TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT DATE: 11/10/2005 AGE: 32.5years ESLO 07
CEPHALOMETRIE ANALYSE TWEED MERRYFIELD Debut Tt SNA 82 ± 84.2 SNB 80 ± 76.5 ANB 2 ± 7.7 FMA 25 ±3 29.8 IMPA 87 ±3 105.0 OP/F 10 18.9 DATE: 11/10/2005 AGE: 32.5years ESLO 08!1
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 Sagittal Skeletal Relations Maxillary Position S-N-A Pretreatment Mean SD 84.2 82º ± 3.5º Mandibular Position S-N-Pg 75.5 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 8.7 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N / ANS-PNS 6.7 8º ± 3.0º Mandibular Inclination S-N / Go-Gn 37.2 33º ± 2.5º Vertical Jaw Relation ANS-PNS / Go-Gn 30.5 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1 - ANS-PNS 103.8 110º ± 6.0º Mandibular Incisor Inclination 1 - Go-Gn 105.9 94º ± 7.0º Mandibular Incisor Compensation 1 - A-Pg (mm) 6.7mm 2 ± 2.0 Dental Relations Overjet (mm) 2.7mm 3.5 ± 2.5 Overbite (mm) -1.1mm 2 ± 2.5 Interincisal Angle 1 / 1 119.9 132º ± 6.0º DATE: 11/10/2005 AGE: 32.5years ESLO 08-2
PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT DATE: 11/10/2005 AGE: 32.5years ESLO 09
ANY OTHER RADIOGRAPHS BEFORE TREATMENT DATE: 11/10/2005 AGE: 32.5years ESLO 10
RADIOGRAPHIC ANALYSIS BEFORE TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH 18.28.38.48 was impacted. Alveolar bone was no-problem. B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT 1. Sagittal Skeletal Relations: Maxillary position was in the normal range. Mandibular position was retruded. Skeletal class relation was shown.(sna 84.2, SNB 76.5, ANB 7.7 ) 2. Vertical Skeletal Relations: Mandibular Inclination (S-N/Go-GN 37.2 ) beyond the range of normal. 3. Dento-Basal Relations: Inclination of Maxillary incisor was normal, position was protrusive relative to line of A-Pg. Mandibular incisor inclined to labial, position was protruded relative to line of A-Pg. 4. Dental relations: 11.12.13.21.22.23 / 31.32.33.41.42.43 open bite overjet 2.7mm, overbite -1.1mm Molar relation was class 5. Esthetic Profile: Upper and lower lip to E-line was protruded. Patient s profile was convex. DATE: 11/10/2005 AGE: 32.5years ESLO 11
TREATMENT PLAN AND THE REASON FOR IT Treatment plan 1, Extraction (14.18.24.28.38.48) 2, Indirect bonding both arches with lingual appliances (Kurz 7 th brace) 3, Myofunctional therapy (MFT) 4, Leveling 5, Retraction of upper incisor 6, Torqing 7, Detailing The reason This case was skeletal class open bite caused from retruded mandibular. And, patient s chief compliant was dysfunction of mastication. So, mandibular advancement osteotomy was one of the treatment plan. But, patient refused osteotomy, so only orthodontic treatment (without surgery) plan was selected. For correct of crowding, upper 1 st bicuspids extraction was needed. DATE: 11/10/2005 AGE: 32.5years ESLO 12-0
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT DATE: 15/12/2005 AGE: 32.9years ESLO 12-1
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT DATE: 20/02/2006 AGE: 32.11years ESLO 12-2
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENT DATE: 15/08/2006 AGE: 33.5years ESLO 12-3
RÉSUMÉ OF THE TREATMENT CARRIED OUT INCLUDING ANY DIFFICULTIES ENCOUNTERED 10.11.2005 Diagnosis 15.12.2005 Indirect bonding to maxillary arch (Kurz 7 th brace / Ni-Ti.012) 17.12.2005 Extraction the right 1 st bicuspid 07.01.2006 Extraction the left 1 st bicuspid 20.02.2006 Indirect bonding to mandibular arch (Kurz 7 th brace / Ni-Ti.012) 17.04.2006 Started Myofunctional Therapy (MFT) 09.05.2006 Alignment maxillary and mandibular arch (TMA.016 TMA.0175".0175) 15.08.2006 Started space closing of upper anterior retraction (TMA.016".022) 07.09.2006 Started class elastics 23.01.2007 Continued space closing Started box elastics 30.07.2007 Detailing (TMA.0175".0175) 05.04.2008 Removed the appliances Started retention DATE: 05/04/2008 AGE: 35.0years ESLO 13
v v v v FRONTAL SMILE v v v PROFILE 45 FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT DATE: 05/04/2008 AGE: 35.0years ESLO 14
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION AT COMPLETION OF TREATMENT DATE: 05/04/2008 AGE: 35.0years ESLO 15
LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT DATE: 05/04/2008 AGE: 35.0years ESLO 1
TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT DATE: 05/04/2008 AGE: 35.0years ESLO 17-1
SUPERIMPOSITION AT SN-S DATE: 05/04/2008 AGE: 35.0years ESLO 17-2
Palatal Plane at ANS Mandibular Plane at Me S-N at S SUPERIMPOSITIONS of MAXILLA, MANDIBULE, PROFILE DATE: 05/04/2008 AGE: 35.0years ESLO 17-3
CEPHALOMETRIE ANALYSE TWEED MERRYFIELD Debut Tt Fin Tt SNA 82 ± 84.2 84.1 SNB 80 ± 76.5 76.8 ANB 2 ± 7.7 7.3 FMA 25 ±3 29.8 30.2 IMPA 87 ±3 105.0 100.4 OP/F 10 18.9 17.2 DATE: 05/04/2008 AGE: 35.0years ESLO 18!
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 Sagittal Skeletal Relations Maxillary Position S-N-A Pretreatment Posttreatment Mean SD 84.2 84.1 82º ± 3.5º Mandibular Position S-N-Pg 75.5 75.8 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 8.7 8.3 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N / ANS-PNS 6.7 7.9 8º ± 3.0º Mandibular Inclination S-N / Go-Gn 37.2 37.8 33º ± 2.5º Vertical Jaw Relation ANS-PNS / Go-Gn 30.5 30.0 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1 - ANS-PNS 103.8 102.0 110º ± 6.0º Mandibular Incisor Inclination 1 - Go-Gn 105.9 100.9 94º ± 7.0º Mandibular Incisor Compensation 1 - A-Pg (mm) 6.7mm 5.6mm 2 ± 2.0 Dental Relations Overjet (mm) 2.7mm 2.3mm 3.5 ± 2.5 Overbite (mm) -1.1mm 2.3mm 2 ± 2.5 Interincisal Angle 1 / 1 119.9 127.1 132º ± 6.0º DATE: 05/04/2008 AGE: 35.0years ESLO 18-2
PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT DATE: 05/04/2008 AGE: 35.0years ESLO 19
ANY OTHER RADIOGRAPHS AT COMPLETION OF TREATMENT DATE: 05/04/2008 AGE: 35.0years ESLO 19-1
RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH 14.18.24.28.38.48 were extracted. Lower molar were uprighted. 12 root was slightly resorbed. B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT 1. Sagittal Skeletal Relations: Maxilla and mandibular position were no change. Maxilla and mandibular relation was no change. (SNA 84.2 #84.1, SNB 76.5 #76.8, ANB 7.7 #7.3 ) 2. Vertical Skeletal Relations: Mandibular Inclination still beyond the range of normal. (S-N/Go-Gn 37.2 #37.8 ) 3. Dento-Basal Relations: Maxillary incisor inclination was no-change. From superimposition of lateral X-ray, maxillary incisor was extruded 1.1mm. Mandibular incisor inclined to lingual. (1/Go-Gn 105.9 #100.9 ) From superimposition of lateral X-ray, mandibular incisor was extruded 2.5mm. 4. Dental relations: Normal overjet and overbite. (overjet 2.7mm#2.3mm, overbite -1.1mm#2.3mm) From superimposition of lateral X-ray, maxillary molar moved mesial 1.6mm, and mandibular molar was tip backed to distal. 5. Esthetic Profile: Upper lip protrusion was improved. (Upper :1.0mm#-1.5 mm / Lower : 1.4mm#0.5mm) DATE: 05/04/2008 AGE: 35.0years ESLO 20
DESCRIPTION OF THE TREATMENT RESULT TREATMENT RESULT ORIENTATION 1) Class cuspid relationship 2) Class molar relationship, because of upper 1 st bicuspid extractions. 3) Anterior open bite was improved 4) Dysfunction of mastication was improved 5) Tongue thrust habit was improved 6) Retaining goal : lifelong DATE: 05/04/2008 AGE: 35.0years 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 DATE: 05/04/2008 AGE: 35.0years ESLO 21-2
v v v v FRONTAL SMILE v v v PROFILE 45 FACIAL PHOTOGRAPHS AT RETENTION / POST RETENTION DATE: 24/05/2010 AGE: 37.2years ESLO 22
Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS AT RETENTION / POST-RETENTION DATE: 24/05/2010 AGE: 37.2years ESLO 23
PERIAPICAL OR PANORAMIC RADIOGRAPHS AT RETENTION / POSTRETENTION DATE: 24/05/2010 AGE: 37.2years ESLO 24-1
ANY OTHER RADIOGRAPHS AT RETENTION / POSTRETENTION DATE: 24/05/2010 AGE: 37.2years ESLO 24-2
RADIOGRAPHIC ANALYSIS AT RETENTION/POSTRETENTION A. INTRAORAL / PANORAMIC RADIOGRAPH Roots were stable. Alveolar bone 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: From superimposition of lateral X-ray upper incisor was extruded 0.2mm and lower incisors was extruded 0.7mm. 5, Esthetic Profile: Idem page 20 =stable DATE: 24/05/2010 AGE: 37.2years ESLO 24-3
LATERAL SKULL RADIOGRAPH AT RETENTION / POSTRETENTION DATE: 24/05/2010 AGE: 37.2years ESLO 24-4
TRACING OF LATERAL SKULL RADIOGRAPH AT RETENTION / POST-RETENTION DATE: 24/05/2010 AGE: 37.2years ESLO 25-1
SUPERIMPOSITION AT SN-S DATE: 24/05/2010 AGE: 37.2years ESLO 25-2
Palatal Plane at ANS Mandibular Plane at Me S-N at S SUPERIMPOSITIONS of MAXILLA,MANDIBULE,PROFILE DATE: 24/05/2010 AGE: 37.2years ESLO 25-3
CEPHALOMETRIE ANALYSE TWEED MERRYFIELD Debut Tt Fin Tt Fin Cont SNA 82 ± 84.2 84.1 83.8 SNB 80 ± 76.5 76.8 76.1 ANB 2 ± 7.7 7.3 7.7 FMA 25 ±3 29.8 30.2 30.0 IMPA 87 ±3 105.0 100.4 101.0 OP/F 10 18.9 17.2 17.3 DATE: 24/05/2010 AGE: 37.2years ESLO 26-1
CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 3 Sagittal Skeletal Relations Maxillary Position S-N-A Pretreatment Posttreatment Retention/ Postretention Mean SD 84.2 84.1 83.8 82º ± 3.5º Mandibular Position S-N-Pg 75.5 75.8 75.2 80º ± 3.5º Sagittal Jaw Relation A-N-Pg 8.7 8.3 8.6 2º ± 2.5º Vertical Skeletal Relations Maxillary Inclination S-N / ANS-PNS 6.7 7.9 8.0 8º ± 3.0º Mandibular Inclination S-N / Go-Gn 37.2 37.8 37.7 33º ± 2.5º Vertical Jaw Relation ANS-PNS / Go-Gn 30.5 30.0 29.7 25º ± 6.0º Dento-Basal Relations Maxillary Incisor Inclination 1 - ANS-PNS 103.8 102.0 101.3 110º ± 6.0º Mandibular Incisor Inclination 1 - Go-Gn 105.9 100.9 101.9 94º ± 7.0º Mandibular Incisor Compensation 1 - A-Pg (mm) 6.7mm 5.6mm 5.1mm 2 ± 2.0 Dental Relations Overjet (mm) 2.7mm 2.3mm 2.7mm 3.5 ± 2.5 Overbite (mm) -1.1mm 2.3mm 2.3mm 2 ± 2.5 Interincisal Angle 1 / 1 119.9 127.1 127.2 132º ± 6.0º DATE: 24/05/2010 AGE: 37.2years ESLO 26-2
DESCRIPTION OF RETENTION / POST-RETENTION FINDINGS LONG TERM RETENTION RESULT ORIENTATION 1) Retaining goal : lifelong 2) Occlusion is stable 3) Teeth positions are stable 4) Patient s mastication shown no-problem. DATE: 24/05/2010 AGE: 37.2years ESLO 27