EUROPEAN SOCIETY OF LINGUAL ORTHODONTICS

EUROPEAN SOCIETY OF LINGUAL ORTHODONTICS CANDIDATE NUMBER: Dr. Stefan Blasius Year: 2010 WBLO 01

RÉSUMÉ OF CASE 1 CASE CATEGORY: ADULT MALOCCLUSION NAME: Daniel S. BORN: 21-02-1978 SEX: male PRE-TREATMENT RECORDS: AGE: 30/0 DATE: 22-02-2008 CLASSIFICATION: Adult malocclusion TEETH MISSING BEFORE TREATMENT: Maxillary whisdom teeth TREATMENT PLAN: APPLIANCE: Maxillary and mandibulary fixed lingual appliances TREATMENT STARTED: AGE: 30/2 DATE: 07-05-2008 TREATMENT FINISHED: AGE: 31/10 DATE: 21-12-2009 ACTIVE TREATMENT TIME: 19 months POST-TREATMENT RECORDS: AGE: 31/10 DATE: 21-12-2009 RETAINERS: a)upper: fix retainer, Hawley a)lower: fix retainer, Hawley DATE: 21-12-2009 RETENTION ENDED: a)upper: a)lower: DATE: permanent RETENTION TIME: Permanent retention (POST-) RETENTION RECORDS: AGE: - DATE: - TIME OUT OF RETENTION: Permanent retention WBLO 02

DIAGNOSTIC DESCRIPTION OF THE MALOCCLUSION A. SUMMARY Patient s chief complaint: unesthetic smile, rotation of maxillary lateral incisors B. EXAMINATION OF HEAD AND FACE Patient s pogonion is shifted slightly to the right No signs of severe disproportions C. FUNCTIONAL EXAMINATION No presence of difficulty in oral function D. INTRAORAL EXAMINATION Right side: Class II, left side: Class I canine and Class III molar relationship Midline discrepancy (mild maxillary dental midline shift to left) Anterior deep bite 3,5 mm Rotation and scissors-bite tendency of upper right first premolar Space deficiency and rotation of maxillary lateral incisors No crossbite E. DENTAL CASTS Mandibular arch: severe rotation of 14, moderate dental crowding, rotation 12, 22 Maxillary arch: mild arch perimeter tooth mass discrepancy, accentuated curve of spee Occlusion sagittal: right - Class II canine and molar, left - Class I canine and Class III molar Occlusion vertical: Anterior deep bite 3,5 mm Occlusion transversal: scissors-bite tendency of upper right first premolar CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 03

FRONTAL SMILING PROFILE FACIAL PHOTOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 04

Right Buccal Left Buccal Upper Occlusal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 05

LATERAL SKULL RADIOGRAPH BEFORE TREATMENT CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 06

TRACING OF LATERAL SKULL RADIOGRAPH BEFORE TREATMENT CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 07

CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 1 Sagittal Skeletal Relations Maxillary Position S-N-A Mandibular Position S-N-B Sagittal Jaw Relation A-N-B Vertical Skeletal Relations Maxillary Inclination S-N / ANS-PNS Mandibular Inclination S-N / Go-Gn Vertical Jaw Relation ANS-PNS / Go-Gn Dento-Basal Relations Maxillary Incisor Inclination 1 - ANS-PNS Mandibular Incisor Inclination 1 - Go-Gn Mandibular Incisor Compensation 1 - A-Pg (mm) Dental Relations Pretreatment Mean SD 82,7 82º± 3.5º 80,6 80º± 3.5º 2,1 2º± 2.5º 13,3 8º± 3.0º 24,1 33º± 2.5º 10,9 25º± 6.0º 116,0 110º± 6.0º 92,2 94º± 7.0º 0,1 2± 2.0 Overjet (mm) 2,9 3.5± 2.5 Overbite (mm) 3,6 2± 2.5 Interincisal Angle 1 / 1 140,9 132º± 6.0º CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 08

PERIAPICAL OR PANORAMIC RADIOGRAPHS BEFORE TREATMENT CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 09

No need for other radiographs ANY OTHER RADIOGRAPHS BEFORE TREATMENT If needed CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 10

RADIOGRAPHIC ANALYSIS BEFORE TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH Panoramic Radiograph: Absence of maxillary wisdom teeth Impaction of mandibular wisdom teeth Moderately decreased bone level according to patients age B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT 1. Sagittal skelettal relations: position of the maxilla and the mandible within the normal range, skelettal Class I maloccusion 2. Vertikal sklettal relations: brachyfacial pattern, posterior impaction of the maxilla, decreased lower anterior face height 3. Dento-basal relations: proclination of the maxillary incisors, mandibular incisors slightly uprighted 4. Dental relations: increased interincisal angle, absence of tooth 18,28, visibility of tooth 38, 48 5. Esthetic profile: mild posterior divergent profile, increased nasolabial angle CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 11

TREATMENT PLAN AND THE REASON FOR IT Treatment Plan: 1. Bonding maxillary and mandibulary arch with lingual fixed appliances 2. Correct Class II on the right side 3. Derotation of upper right first premolar 4. Distalisation of upper right canine 5. Correct midline discrepancy 6. Establish proper incisor angulation 7. Eliminate maxillary and mandibulary crowding 8. Detailing and Finishing 9. Retention The reason for this treatment is 1. to improve facial appearance and smile esthetics and 2. to achieve functional balance due to elimination of the scissors-bite tendency of upper right first premolar CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0 WBLO 12

TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS UPPER ARCH CANDIDATE NUMBER: SB DATE: div. AGE: div. WBLO 12-1

TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS LOWER ARCH CANDIDATE NUMBER: SB DATE: div. AGE: div. WBLO 12-2

RÉSUMÉ OF THE TREATMENT CARRIED OUT INCLUDING ANY DIFFICULTIES ENCOUNTERED Treatment Gouvernance: 1. Bonding maxillary and mandibulary arch with lingual fixed appliances 2. Correct Class II on the right side with Class II elastics 3. Derotation of upper lateral incisors appeared to being more difficult than expected (problem solved by alastic lasso-technique) 4. Establish proper incisor angulation 5. Eliminate maxillary and mandibulary crowding 6. Establish correct overjet and overbite (including levelling curve of spee) 7. Detailing and Finishing 8. Retention CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 13

SMILING FRONTAL PROFILE FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 14

Right Buccal Upper Occlusal Left Buccal Center Lower Occlusal INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION AT COMPLETION OF TREATMENT CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 15

LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 16

TRACING OF LATERAL SKULL RADIOGRAPH AT COMPLETION OF TREATMENT CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 17

CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT 2 Pretreatment Posttreatment Mean SD Maxillary Position S-N-A 82,7 82,5 82º± 3.5º Mandibular Position S-N-B 80,6 80,7 80º± 3.5º Sagittal Jaw Relation A-N-B 2,1 1,8 2º± 2.5º Maxillary Inclination S-N / ANS-PNS 13,3 13,0 8º± 3.0º Mandibular Inclination S-N / Go-Gn 24,1 24,7 33º± 2.5º Vertical Jaw Relation ANS-PNS / Go-Gn 10,9 11,6 25º± 6.0º Maxillary Incisor Inclination 1 - ANS-PNS 116,0 118,2 110º± 6.0º Mandibular Incisor Inclination 1 - Go-Gn 92,2 93,4 94º± 7.0º 0,1 2,1 2± 2.0 Overjet (mm) 2,9 2,8 3.5± 2.5 Overbite (mm) 3,6 1,9 2± 2.5 140,9 133,0 Sagittal Skeletal Relations Vertical Skeletal Relations Dento-Basal Relations Mandibular Incisor Compensation 1 - A-Pg (mm) Dental Relations Interincisal Angle 1/1 CANDIDATE NUMBER: SB DATE: 21-12-2009 132º± 6.0º AGE: 31/10 WBLO 18

PERIAPICAL OR PANORAMIC RADIOGRAPHS AT COMPLETION OF TREATMENT CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 19

RADIOGRAPHIC ANALYSIS AT COMPLETION OF TREATMENT A. INTRAORAL / PANORAMIC RADIOGRAPH Panoramic Radiograph: Moderate distal root angultion of upper right first premolar Absence of maxillary wisdom teeth Impaction of mandibular wisdom teeth (extractions will be performed by prescription in the near future) B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT 1. Sagittal skelettal relations: position of the maxilla and the mandible within the normal range, skelettal Class I maloccusion 2. Vertikal skelettal relations: brachyfacial pattern, posterior impaction of the maxilla, decreased lower anterior face height 3. Dento-basal relations: proclination of the maxillary incisors, mandibular incisors in a favourable position, correct overjet and overbite 4. Dental relations: normal interincisal angle, absence of tooth 18,28, presence of tooth 38, 48 5. Esthetic profile: mild posterior divergent profile, increased nasolabial angle CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 20

DESCRIPTION OF THE TREATMENT RESULT Treatment Result Orientation: 1. Improved smile esthetics and facial harmony 2. Occlusal relationship: Super Class I (Class I canine and mild Class III Molar relationship) 3. Correct interincisal angulation 4. Normal overjet and overbite 5. Retention objectives: permanent / lifelong retention CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 21

DESCRIPTION OF THE POST-TREATMENT EVALUATION OF RETENTION Retention Result Orientation: 1. Retention objectives: permanent / lifelong retention 2. Check stability of correct rotational position of maxillary lateral incisors and maxillary right first premolar in short intervals 3. Control stability of occlusion and stability of overjet and overbite CANDIDATE NUMBER: SB DATE: 21-12-2009 AGE: 31/10 WBLO 21-1