Case Presentation

RESUME OF THE CASE
CANDIDATE NUMBER
CASE NUMBER

SUMMARY OF THE CASE
PATIENT NAME

:SEX: Female

TYPE OF MALOCCLUSION : Angle classⅠmalocclusion with crowding
TREATMENT STARTED: AGE: 19.2years

DATE: 28/01/2014

TREATMENT ENDED: AGE: 21.3years

DATE: 01/03/2016

ACTIVE TREATMENT TIME : 2.2years
TYPE OF APPLIANCE: Lingual appliance(Kurz7th/Ormco), anchor screw,
modified transpalatal arch

BEFORE TREATMENT INTRA ORALPICTURES

AFTER TREATMENT INTRA ORAL PICTURESCANDIDATE NUMBER:

CASE NUMBER:NAME:BORN: 13/11/1994

SEX: Female

PRE-TREATMENT RECORDS: AGE: 19.0years

CLASSIFICATION: Angle Class Ⅰ malocclusion with crowding

TEETHMISSHING BEFORE
TREATMENT: NoneTREATMENT PLAN

: Extraction of four 1stbicuspids (14,24,34,44)

APPLIANCE: Lingual appliance (kurz7th/Ormco) , anchor screw,

DATE:18/11/2013

modified transpalatal arch
TREATMENT STARTED: AGE: 19.2years

DATE:28/01/2014

TREATMENT ENDED: AGE: 21.3years

DATE:01/03/2016

ACTIVE TREATMENT TIME

: 2.1years

POST-TREATMENT RECORDS: AGE: 21.3years

DATE:01/03/2016

RETAINERS: Tooth positioner

DATE:01/03/2016

RETENTION ENDED: a) upper : do

DATE:Continued: b) lower : do
RETENTION TIME:(POST-)RETENTION RECORDS: AGE:

TIME OUT OF RETENTION:DATE:

DIAGNOSTIC DESCRIPTION OF THE MALOCCLUSION
A. SUMMARY

Patient’s chief compliant was crowding and high canine. Skeletal relations were range
of normal (A-N-Pg:0.3°,S-N/Go-Gn:33.1° ). Molar relations were Angle Class Ⅰ.
Arch length discrepancy was -7.1mm in upper arch, -4.7mm in lower arch.
For improve crowding, extraction of four 1stbicuspids(14,24,34,44) were needed.
Anchorage value was needed as maximum. By using anchor screw on midpalatal andmodified transpalatal arch, maximum anchorage was achieved.
B. EXAMINATION OF HEAD AND FACE

From lateral view , patient’s profile was straight.
Frontal view was almost symmetrical.
From smile view , high canine was shown.
C. FUNCTIONAL EXAMINATION

Nothing relevant
D. INTRAORAL EXAMINATION

Molar relationship was Angle ClassⅠon both sides.
Overbite was +1.3mm and overjet was +2.6mm.
Lower midline was shifted to right 1.3mm.
Crowding was shown on both arches.
Crossbite (12,22/33,42,43)
E. DENTAL CASTS

Maxillary arch: Arch length discrepancy was -7.1mm, ovoid-shaped with crowding
mesial rotation(17) labial tipping（13,23) ,lingual tipping(12,22)
Mandibular arch: Arch length discrepancy was -4.7mm, ovoid-shaped with crowding
mesial rotation(37,47) , distal rotation(34),lingual tipping(32,42)
distal tipping(42)Occlusion Sagittal: Angle ClassⅠmolar relationship. Overjet +2.6mm.
Occlusion Vertical: Overbite +1.3mm.
Occlusion Transversal:Lower midline was shifted to right 1.3mm.
CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

FRONTAL

SMILE

45°

PROFILEFACIAL PHOTOGRAPHS BEFORE TREATMENT
CASE NUMBER

DATE:18/11/2013

AGE:19.0years

Left Buccal

Right Buccal

Upper Occlusal

CenterLower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION BEFORE TREATMENT
CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

---------------------------------------------------------------------------------------------LATERAL SKULL RADIOGRAPH BEFORE TREATMENT

CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

---------------------------------------------------------------------------------------------TRACING OF LATERAL SKULL RADIOGRAPH
BEFORE TREATMENT
CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

---------------------------------------------------------------------------------------------

FACIAL RADIOGRAPHS BEFORE TREATMENT
CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

R---------------------------------------------------------------------------------------------PERIAPICAL OR PANORAMIC RADIOGRAPHSBEFORE TREATMENT
CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT I

Pretreatment

Sagittal Skeletal Relations

Mean SD

Sagittal Skeletal Relations

Maxillary Position
S-N-A

78.9°

82º ± 3.5º

Mandibular Position
S-N-Pg78.6°

80º ± 3.5º

Sagittal Jaw Relation
A-N-Pg0.3°

2º ± 2.5º

Vertical Skeletal Relations

Vertical Skeletal Relations

Maxillary Inclination
S-N / ANS-PNS

12.2°

8º ± 3.0º

Mandibular Inclination
S-N / Go-Gn

33.1°

33º ± 2.5º

Vertical Jaw Relation
ANS-PNS / Go-Gn

20.9°

25º ± 6.0º

Dento-Basal Relations

Dento-Basal Relations

Maxillary Incisor Inclination1 - ANS-PNS

125.1°

110º ± 6.0º

Mandibular Incisor Inclination
1 - Go-Gn

101.0°

94º ± 7.0º

Mandibular Incisor Compensation
1 - A-Pg (mm)5.3mm

2 ± 2.0mm

Dental Relations

Dental Relations

Overjet (mm)2.6mm

3.5 ± 2.5mm

Overbite (mm)1.3mm

2 ± 2.5mm

Interincisal Angle
1 /1

112.5°

132º ± 6.0º

CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

RADIOGRAPHIC ANALYSIS BEFORE TREATMENT
A. INTRAORAL / PANORAMIC RADIOGRAPH

17,27 had fillings.
18,28,38,48 were impacted.
B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT

1. Sagittal Skeletal Relations:
Maxillary and mandibular position were normal.
(S-N-A:78.9°, S-N-Pg:78.6°, A-N-Pg:0.3°)
2. Vertical Skeletal Relations:
Maxillary inclination beyond the range of normal.
Mandibular inclination was the range of normal.
Vertical jaw relation was the range of normal.
(S-N/ANS-PNS:12.2°, S-N/Go-Gn :33.1°, ANS-PNS/Go-Gn:20.9°)
3. Dento-Basal Relations:
Maxillary incisors and mandibular incisors were inclined labially.
Mandibular incisor compensation was protrusive relative to A-Pg line.
(1-ANS-PNS : 125.1°, 1-Go-Gn :101.0°, 1-A-Pg:5.3mm）
4. Dental relations:Overjet ＋2.6mm, Overbite ＋1.3mm
Interincisal angle was below the range of normal.
(1/1 112.5°）
Molar relation was classⅠ.

CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

TREATMENT PLAN AND THE REASON FOR IT
Teatment plan
1, Implantation on midpalatal
2, Placement modified transpalatal arch
3, Ligation the anchor screws with the modified transpalatal arch foranchorage reinforcement
4, Indirect bonding to both arches the lingual appliance (kurz7th brace)
5, Extraction 1st bicuspids of upper and lower (14,24,34,44) to create space
6, Extraction third molars(18,28,38,48)
7, Leveling8, Torquing
9, Retraction of upper and lower incisors
10, Detailing

The reason
From lateral cephalogram, there were no problems with skeletal relations.
Crowding and high canine were shown.(A.L.D. upper:-7.1mm, lower:4.7mm)
Upper and lower incisors were inclined labially and were protruded from
A-Pg line.
Treatment goal was to correct crowding, incisors inclination and incisors
protrusion.
Upper and lower 1st bicuspids were extracted for improve these problems.
Anchorage value was decided as maximum on both arch.
Maximum anchorage was achieved by using ligated anchor screws withmodified transpalatal arch.

CASE NUMBER:

DATE:18/11/2013

AGE:19.0years

Left Buccal

Right Buccal

CenterUpper Occlusal

Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION BETWEEN TREATMENT
CASE NUMBER:

DATE:12/03/2014

AGE:19.3years

Left Buccal

Right Buccal

CenterUpper Occlusal

Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THEOCCLUSION BETWEEN TREATMENT
CASE NUMBER:

DATE:26/04/2014

AGE:19.5years

Left Buccal

Right Buccal

CenterUpper Occlusal

Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION BETWEEN TREATMENT
CASE NUMBER:

DATE:25/10/2014

AGE:19.11years

Left Buccal

Right Buccal

CenterUpper Occlusal

Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION BETWEEN TREATMENTCASE NUMBER:

DATE:26/08/2015

AGE:20.9years

RÉSUMÉ OF THE TREATMENT CARRIED OUT
INCLUDING ANY DIFFICULTIES ENCOUNTERED17/12/2013 Diagnosis
28/01/2014 Implantation(Induce mini screw /GC :1.8mm/8mm )Place modified transpalatal arch
18/02/2014 Indirect bonding to maxillary arch
(Kurz7th brace/Ni-Ti .012)
12/03/2014 Indirect bonding to mandibular arch
(Kurz7th brace/Ni-Ti .012)
01/04/2014 Extraction(14,44)
08/04/2014 Extraction(24,34)
25/10/2014 Started upper incisor retraction (TMA .017×.025)
06/12/2014 Started lower incisor retraction (S.S. .016×.022)
04/11/2015 Detailing (β-titanium .0175×.0175)
04/02/2016 Extraction (18,28,38,48)
01/03/2016 Removed the appliance, Started retention

CASE NUMBER:

DATE:01/03/2016

AGE:21.3years

FRONTAL

SMILE45°

PROFILEFACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT
CASE NUMBER:

DATE:01/03/2016

AGE:21.3years

Left Buccal

Right Buccal

Upper Occlusal

CenterLower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION AT COMPLETION OF TREATMENT
CASE NUMBER:

DATE:01/03/2016

AGE:21.3years

---------------------------------------------------------------------------------------------LATERAL SKULL RADIOGRAPH AT
COMPLETION OF TREATMENT
CASE NUMBER:

DATE:01/03/2016

AGE:21.3years

---------------------------------------------------------------------------------------------TRACING OF LATERAL SKULL RADIOGRAPH
AT COMPLETION OF TREATMENT
CASE NUMBER:

DATE:01/03/2016

AGE:21.3yearsSN at SSUPERIMPOSITIONCASE NUMBER:

DATE:01/03/2016

AGE:21.3years

ANS-PNS at ANS

Mandibular plane at Me

SUPERIMPOSITIONCASE NUMBER:

DATE:01/03/2016

AGE:21.3years

---------------------------------------------------------------------------------------------

FACIAL RADIOGRAPHS POST TREATMENT
CASE NUMBER:

DATE:01/03/2016

AGE:21.3years

R---------------------------------------------------------------------------------------------PERIAPICAL OR PANORAMIC RADIOGRAPHSAT COMPLETION OF TREATMENT
CASE NUMBER:

DATE:01/03/2016

AGE:21.3years

CEPHALOMETRIC MORPHOLOGICAL ASSESSMENT II

Pretreatment

Sagittal Skeletal Relations
Maxillary Position
S-N-A

Posttreatment

MeanSD

Sagittal Skeletal Relations
78.9°

78.9°

82º ± 3.5º

78.6°

78.7°

80º ± 3.5º

0.3°

0.2°

2º ± 2.5º

Mandibular Position
S-N-PgSagittal Jaw Relation
A-N-PgVertical Skeletal Relations

Vertical Skeletal Relations

Maxillary Inclination
S-N / ANS-PNS

12.2°

12.1°

8º ± 3.0º

Mandibular Inclination
S-N / Go-Gn

33.1°

32.9°

33º ± 2.5º

Vertical Jaw Relation
ANS-PNS / Go-Gn

20.9°

20.8°

25º ± 6.0º

Dento-Basal Relations

Dento-Basal Relations
Maxillary Incisor Inclination
1 - ANS-PNS

125.1°

116.9°

110º ± 6.0º

Mandibular Incisor Inclination
1 - Go-Gn

101.0°

94.6°

94º ± 7.0º

Mandibular Incisor Compensation
1 - A-Pg (mm)5.3mm3.3mm

2 ± 2.0mm

Dental Relations
Overjet (mm)Overbite(mm)Interincisal Angle
1 / 1

CASE NUMBER:

Dental Relations
2.6mm

2.6mm

3.5 ± 2.5mm

1.3mm

2.2mm

2 ± 2.5mm

112.5°

126.9°

132º ± 6.0ºPre-treatment DATE:18/11/2013

AGE:19.0years

Post-treatment DATE:01/03/2016

AGE:21.3years

INTERVER:2.1years

RADIOGRAPHIC ANALYSIS
AT COMPLETION OF TREATMENT
A. INTRAORAL / PANORAMIC RADIOGRAPH

Crowding and high canine were improved.
14,18,24,28,34,38,44,48 were extracted.
Root parallelism was good.
No root resorption.
B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT

1. Sagittal Skeletal Relations:
No significant change compared with before treatment.
( S-N-A:78.9°→78.9°, S-N-Pg:78.6°→78.7°,
A-N-Pg:0.3°→0.2°)
2. Vertical Skeletal Relations:
No significant change compared with before treatment.
(S-N/ANS-PNS:12.2°→12.1°,S-N/Go-Gn :33.1°→32.9°,
ANS-PNS/Go-Gn:20.9°→20.8°)
3. Dento-Basal Relations:
Maxillary incisors and mandibular incisors were inclined to lingual.
Mandibular incisor compensation was normal.
(1-ANS-PNS : 125.1°→116.9° ,1-Go-Gn :101.0°→94.6°,
1-A-Pg:5.3mm→3.3mm）
4. Dental relations:Overjet +2.6mm→ +2.6mm, Overbite +1.3mm→ +2.2mm
Interincisal angle was the range of normal. (1/1 112.5°→126.9°）
CASE NUMBER:

DATE:01/03/2016

AGE:21.3years

DESCRIPTION OF THE TREATMENT RESULT
Treatment result orientation
1) Crowding and high canine were improved.
2) Midline discrepancy was mostly corrected.
3) Maxillary and mandibular incisor inclination and position were improved.
4) Retention: Tooth positioner
From comparison of before and after treatment lateral cephalogram, skeletal
relations were maintained.
About dental relations, by using anchor screw and modified transpalatal arch,maximum anchorage was achieved.
From superimposition of lateral cephalogram, sufficient results were achieved.

DESCRIPTION OF THE POST-TREATMENTEVALUATION OF RETENTION
Patient use positioner at night.
Occlusion is stable.
Teeth positions are stable.

CASE NUMBER:

DATE:01/03/2016

AGE:21.3years

Left Buccal

Right Buccal

CenterUpper Occlusal

Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION BETWEEN TREATMENT
CASE NUMBER:

DATE:28/01/2014

AGE:19.2years

Left Buccal

Right Buccal

CenterUpper Occlusal

Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION BETWEEN TREATMENT
CASE NUMBER:

DATE:18/02/2014

AGE:19.3years

Left Buccal

Right Buccal

CenterUpper Occlusal

Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION BETWEEN TREATMENT
CASE NUMBER:

DATE:05/07/2014

AGE:19.7years

Left Buccal

Right Buccal

CenterUpper Occlusal

Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION BETWEEN TREATMENTCASE NUMBER:DATE:01/09/2014

AGE:19.9years