WORLD BOARD
OF LINGUAL
ORTHODONTISTS

APPENDIX 1
CASE PRESENTATION FORMS

1WORLD BOARD
OF LINGUAL
ORTHODONTISTSCANDIDATE NUMBER: 1
CASE NUMBER: 2
Year: 29 / 6 / 2017

WBLO 01

RÉSUMÉ OF CASE 2
CASE CATEGORY:

CLASS I MALOCCLUSION
NAME:○○○○ ○○○○

BORN:

7 / 8 / 1981

SEX:

FemalePRETREATMENT RECORDS:

AGE: 26.10 Years

CLASSIFICATION:

R & L side: Angle Class I

TEETH MISSING BEFORE TREATMENT:None

APPLIANCE:

Upper & Lower : STb appliance by ORMCO

TREATMENT STARTED:

AGE: 27.2 Years

DATE: 25 / 10 / 2008

TREATMENT ENDED:

AGE: 28.11 Years

DATE: 31 / 7 / 2010

ACTIVE TREATMENT TIME:

1.9 Years

POSTTREATMENT RECORDS:

AGE: 28.11 Years

RETAINERS:a)upper: Clear Retainer

DATE: 2 / 7 / 2008

DATE: 31 / 7 / 2010

DATE: 31 / 7 / 2010a)lower: Clear Retainer

RETENTION ENDED:a)upper: Begg Typea)lower: Spring Retainer

RETENTION TIME:

2.7 Years(POST-) RETENTION RECORDS:

AGE: 31.7 Years

TIME OUT OF RETENTION:

Continued

DATE: 9 / 3 / 2013

DATE: 9 / 3 / 2013

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DIAGNOSTIC DESCRIPTION
OF THE MALOCCLUSION
A. SUMMARY
The patient visited our office with a chief complaint of crowding.
The facial findings revealed the convex type in the lateral view, while protrusion of theupper and lower lips was observed. The intraoral findings revealed severe crowding in
the lower arch and a right-side deviation of the mandibular midline.
On the cephalometric radiogram, the sagittal skeletal measurements were the S-N-A of
91.0°, S-N-Pg of 83.5°, and A-N-Pg of 7.5°, which indicated a tendency for skeletal class
II due to maxillary protrusion. The vertical skeletal measurement was S-N/Go-Gn of 37.0°
and ANS-PNS/Go-Gn of 29.5 ° , which indicated the Dolicho-facial pattern. The dental
measurements were Mx1-ANS-PNS of 124.5°, and Md1-Go-Gn of 91.5°, which labial
tipping of the maxillary anterior teeth and the mandibular anterior teeth being normal.
The findings of the dental casts revealed that the molar relationship was Angle class I on
both sides, while the canine relationship was class I on the left side and class III on theright side. The ALD were −2.0 mm in the upper arch and −10.0 mm in the lower arch.
Based on these findings, this patient was diagnosed Angle class I maxillary protrusion
with severe crowding.

B. EXAMINATION OF HEAD AND FACE
The lateral view showed the convex type, while protrusion of the upper and lower lips wasobserved. The frontal view showed a symmetrically-shaped oval face and hypertonic chin.
When the patient smiled, the midlines of the maxillary and mandibular did not align, andthe left corner of the mouth appeared higher than the right corner.

C. FUNCTIONAL EXAMINATION
No parafunctional habits were identified. Similarly, the patient had noticed no such habits.
Moreover, no otorhinolaryngologic disease was detected. The TMJ caused no clicks, pain,
or closed lock. The tooth 23 had been ground down, suggesting bruxism.

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

WBLO 03

DIAGNOSTIC DESCRIPTION
OF THE MALOCCLUSION

D. INTRAORAL EXAMINATION
The molar relationship was Angle class I, and the canine relationship was class I on theleft side and class III on the right side. There was severe crowding in the mandibular arch.
Because of lingual transposition of the tooth 42, the midline of the mandibular arch was
deviated to the right by 4.0 mm. While the maxillary and the mandibular arches wereasymmetrical, the right premolars and molars in the maxillary and mandibular arch bothwere tipped toward the lingual side. Teeth 18 and 48 had erupted, whereas teeth 28 and38 had been extracted. Caries were observed on the mesial contact areas of the teeth 15
and 36. Inlay restoration had been performed for all premolars and molars except teeth 14
and 35.

E. DENTAL CASTS

Mandibular arch: Arch length discrepancy -10.0 mm
Maxillary arch: Arch length discrepancy -2.0 mm
Occlusion Sagittal: the molar Angle class Ⅰ

Over jet 4.0mm

Occlusion Vertical: Over bite 4.0mm
Occlusion Transversal: nothing particular

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

WBLO 03-02

SMILING

FRONTAL

PROFILEFACIAL PHOTOGRAPHS BEFORE TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

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Right Buccal

Upper Occlusal

Left Buccal

CenterLower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

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LATERAL SKULL RADIOGRAPH BEFORE TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

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TRACING OF LATERAL SKULL RADIOGRAPH
BEFORE TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

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CEPHALOMETRIC MORPHOLOGICALASSESSMENT 1

Pretreatment

Posttreatment

Retention/po
stretention

Mean SD

Sagittal
Skeleatal
Maxillary
Position
S-N-A

91.0

82º ±3.5º

Mandibular
Position
S-N-Pg83.5

80º ± 3.5º

Sagittal Jaw
Relation
A-N-Pg7.5

2º ± 2.5º

Maxillary
Inclination
S-N/ANSPNS

8.0

8º ± 3.0º

Mandibular
Inlination
S-N/Go-Gn

37.0

33º ± 2.5º

VerticalSkeletal
Relations

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

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CEPHALOMETRIC MORPHOLOGICALASSESSMENT 1

Pretreatment
Vertical Jaw
Relation
ANSPNS/Go-Gn

Posttreatment

Retention/po
stretention

Mean SD

25º ± 6.0º

29.5

DentoBasal
Relations

Maxillary
Incisor
Inclination
1-ANS-PNS

Mandibular
Incisor
Inclination
1-Go-GnCANDIDATE NUMBER: 1

110º ± 6.0º

124.5

94º ± 7.0º
91.5

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

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CEPHALOMETRIC MORPHOLOGICALASSESSMENT 1

Mandibular
IncisorCompensati
on
1 –A-Pg(mm)

2 ± 2.0

4.5

DentalRelationsOverjet (mm)4.0Overbite(mm)

4.0Interincisal
Angle
1/1

119.0

CANDIDATE NUMBER: 1

CASE NUMBER: 2

2º ± 2.0

2 ± 2.5132º ± 6.0º

DATE: 02/07/08

AGE:26.10

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PERIAPICAL OR PANORAMIC RADIOGRAPHSBEFORE TREATMENTWBLO 09RADIOGRAPHIC ANALYSISBEFORE TREATMENT
A. INTRAORAL / PANORAMIC RADIOGRAPH
The number of teeth was normal, and neither missing nor pulpectomized teeth wereidentified. The teeth 18 and 48 had erupted, whereas the teeth 28 and 38 had alreadybeen extracted.

B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT
The sagittal skeletal measurements were the S-N-A of 91.0°, S-N-Pg of 83.5°, and A-N-Pgof 7.5°, which indicated a tendency for skeletal class II due to maxillary protrusion. The
vertical skeletal measurements were S-N/ANS-PNS of 8.0 ° , S-N/Go-Gn of 37.0° and ANSPNS/Go-Gn of 29.5 ° , which indicated the Dolicho Facial pattern.
The dental measurements were Mx1-ANS-PNS of 124.5°, Md1-Go-Gn of 91.5°, and interincisor angle of 119.0°, which labial tipping of the maxillary anterior teeth despite the toothaxis of the mandibular anterior teeth being normal.
As for the soft tissue findings, the distance from the upper lip to the esthetic line was 0.5mm, which was normal. However, the distance from the lower lip to the esthetic line was 2.5mm, indicating slight protrusion.

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

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TREATMENT PLAN
AND THE REASON FOR IT

Treatment Plan
1.The plaque control and caries treatment.
2.Teeth 18, 14, 24, 34, 44,and 48 are extracted.
3.Leveling is performed with a nickel titanium wire.
4.En-masse retraction is performed with moderate anchorage for the upper arch andmaximum anchorage for the lower arch.
5.Intermaxillary elastics is used as needed.
6.A class I relationship should be established on both molars and canines by detailing,
and canine guidance should be obtained during lateral movement of the lower jaw.
7.Retention follow-up period.

The reason for it
1.Plaque control and caries treatment allow the intraoral condition to be prepared fororthodontic treatment.
2.Extraction spaces are used to correct anterior protrusion of the maxillary and crowdingin the lower arch.
3.To correct the Crowding .
4.To correct the maxillary incisors protrusion. Because the canine relationship tends to be
Angle class III, anchorage is a moderate for the maxillary arch and the maximum for themandibular arch. However, no reinforced anchorage is determined to be necessary forthe mandibular arch in consideration of the strong anchorage provided by lingual
orthodontic.
5.The tendency for an Angle class III canine relationship is improved. Moreover,intermaxillary elastics are used as needed to align the midlines.
6.By establishing a class I relationship on both molars and canines, stabilization of
occlusion can be attempted. Functional occlusion is achieved.
7.Long-term stabilization of occlusion is attempted. The conditions of alveolar bones andteeth are monitored long term.

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 02/07/08

AGE:26.10

WBLO 12Right Buccal

Upper Occlusal

Left Buccal

CenterLower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 27/12/08

AGE:27.4

WBLO 12-1

Right Buccal

Upper Occlusal

Left Buccal

CenterLower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 18/07/09

AGE:27.11

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Right Buccal

Upper Occlusal

Left Buccal

CenterLower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BETWEEN TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 01/05/10

AGE: 28.8

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RÉSUMÉ OF THE TREATMENT CARRIED OUT
INCLUDINGANY DIFFICULTIES ENCOUNTERED
July 2008: After diagnosis, caries were treated, and teeth 18, 14, 24, 34, 44 and 48 wereextracted.
October 2008: Lingual multibracket appliances (STb appliance) were attached to theupper and lower archs. Leveling was started with .012 NiTi wire for both the upper and thelower arch. Because excessive crowding of the mandibular anterior teeth made it difficult
to attach the brackets, an open coil was inserted in the central incisor area to obtain an
adequate space. To prevent occlusal interference of the brackets on the maxillary anterior
teeth with the mandibular anterior teeth, resin was layered onto the mandibular molar
areas. In consideration of esthetic appearance, shell crowns were placed at the extraction
space.
November 2008: A bracket was attached to the mandibular central incisor, and levelingwas continued with .012 NiTi wire. For the upper arch, leveling was continued with .016
X .016 NiTi wire.
December 2008: For the upper arch, .0175 X .0175 TMA wires were used toestablishment of torque after leveling had been completed. For the lower arch, levelingwas continued with .016 copper-NiTi wire.
February 2009: For the upper arch, en-masse retraction was started with .016 X .022
stainless steel wires. Because of moderate anchorage, a technique involving sliding
mechanics was selected. For the lower arch, torque was established with .0175 X .0175
TMA wires. Moreover, the resin layered onto the mandibular molar areas was removed
because of bite rising.
April 2009: While en-masse retraction was performed for the upper arch, .016 X .022
stainless steel wires were set on the lower arch to start en-masse retraction using thesliding mechanics technique (10 months). In the middle of the retraction process, class III
elastics were used to establish a good occlusal relationship.
February 2010: Because the spaces were closed, detailing was started with .0175
X .0175 TMA wire for the upper arch and .016 TMA wire for the lower arch (5 months).
Because the brackets touched some parts in the early stages, occlusion was adjusted ateach treatment session.
July 2010: Because detailing had been completed, the appliances were removed, and thepatient was transitioned to retention follow-up.

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 31/07/10

AGE:28.11

WBLO 13SMILING

FRONTAL

PROFILEFACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 31/07/10

AGE:28.11

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Right Buccal

Upper Occlusal

Left Buccal

CenterLower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE
OCCLUSION AT COMPLETION OF TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 31/07/10

AGE:28.11

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LATERAL SKULL RADIOGRAPH
AT COMPLETION OF TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 31/07/10

AGE:28.11

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TRACING OF LATERAL SKULL RADIOGRAPH
AT COMPLETION OF TREATMENTCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 31/07/10

AGE:28.11

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CEPHALOMETRIC MORPHOLOGICALASSESSMENT 2

Pretreatment

Posttreatment

Maxillary
Position
S-N-A

91.0

91.0

Mandibular
Position
S-N-Pg83.5

83.0

Sagittal Jaw
Relation
A-N-Pg7.5

8.0

Maxillary
Inclination
S-N/ANSPNS

8.0

8.0

Mandibular
Inlination
S-N/Go-Gn

37.0

36.5

Retention/po
stretention

Mean SD

Sagittal
Skeleatal

82º ±3.5º

80º ± 3.5º

2º ± 2.5º

VerticalSkeletal
Relations

CANDIDATE NUMBER: 1

CASE NUMBER: 2

8º ± 3.0º

33º ± 2.5º

DATE: 31/07/10

AGE:28.11

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CEPHALOMETRIC MORPHOLOGICALASSESSMENT 2

Pretreatment

Posttreatment

29.5

29.0

124.5

120.0

Vertical Jaw
Relation
ANSPNS/Go-Gn

Retention/po
stretention

Mean SD

25º ± 6.0º

DentoBasal
Relations

Maxillary
Incisor
Inclination
1-ANS-PNS

Mandibular
Incisor
Inclination
1-Go-GnCANDIDATE NUMBER: 1

110º ± 6.0º

94º ± 7.0º
91.5

85.5

CASE NUMBER: 2

DATE: 31/07/10

AGE:28.11

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CEPHALOMETRIC MORPHOLOGICALASSESSMENT 2

Mandibular
IncisorCompensati
on
1 –A-Pg
(mm)

4.5

1.0

Overjet (mm)

4.0

3.5

Overbite
(mm)

4.0

3.0

Interincisal
Angle
1/1

119.0

129.0

2 ± 2.0

DentalRelations

CANDIDATE NUMBER: 1

CASE NUMBER: 2

2º ± 2.0

2 ± 2.5132º ± 6.0º

DATE: 31/07/10

AGE:28.11

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PERIAPICAL OR PANORAMIC RADIOGRAPHSAT COMPLETION OF TREATMENTWBLO 19

RADIOGRAPHIC ANALYSIS ATCOMPLETION OF TREATMENT

A. INTRAORAL / PANORAMIC RADIOGRAPH
The extraction spaces were closed. Moreover, the extraction sockets of the third molars
healed well.
Favorable root parallelism was obtained for all teeth, whereas no root resorption wasobserved.

B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT
The cephalometric analysis values revealed no changes in skeletal measurement, such as
clockwise rotation of the mandible.
As for dental measurements, the maxillary and mandibular anterior teeth were tipped
toward the lingual with the Mx1-ANS-PNS changing from 124.5° to 120.0° and the Md1Go-Gn angle changing from 91.5° to 85.5°. Consequently, the inter-incisal angle changed
from 119.0° to 129.0°.
The sagittal positions showed changes in the Mx1 to A-Pg distance from 10.0 to 5.0 mm
and the Md1 to A-Pg distance from 4.5 to 1.0 mm. The anteroposterior positional
relationships of the maxillary and mandibular teeth were improved.
According to soft tissue findings, the degree of protrusion relative to the esthetic line
decreased from 0.5 to −2.0 mm for the upper lip and from 2.5 to 1.0 mm for the lower lip.

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 31/07/10

AGE:28.11

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DESCRIPTION OF THE
TREATMENT RESULT

Crowding, of which the patient had complained, was resolved, while a favorable Angle
class I occlusal relationship was achieved.
The cephalometric analysis values revealed few changes in skeletal measurement. As fordental measurement, the maxillary and mandibular anterior teeth were tipped toward the
lingual with the Mx1-ANS-PNS changing from 124.5° to 120.0° and the Md1-Go-Gn
changing from 91.5° to 85.5°. Consequently, the inter-incisal angle changed from 119.0° to
129.0°. The sagittal positions showed changes in the Mx1 to A-Pg distance from 10.0 to
5.0 mm and the Md1 to A-Pg distance from 4.5 to 1.0 mm. The anteroposterior positional
relationships of the maxillary and mandibular teeth were improved. According to soft tissue
findings, because anterior maxillary protrusion was resolved, the degree of protrusion
relative to the esthetic line decreased from 0.5 to −2.0 mm for the upper lip and from 2.5 to
1.0 mm for the lower lip.
The superimposed cephalograms of the pre and the post treatment revealed. Althoughanchorage was not reinforced for either the maxillary and the mandibular arch, the amountof mesial movement of the molars was minimized to 1.0 mm. This seems to be
characteristic of lingual orthodontics with strong anchorage.
On the dental casts, over jet slightly decreased from 4.0 to 3.5 mm, and over bite from 4.0
to 3.0 mm. Angle class I molar and canine relationships were established on both sides,
while canine guidance was obtained during lateral movement of the lower arch. The
midlines of the maxillary and mandibular dentition were aligned. The lingual tipped of theright molars, which was observed before treatment, was resolved, and the dental arch
became symmetrical.
This therapeutic procedure allowed completion of active treatment in a relatively shortperiod of 1.9 years.

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 31/07/10

AGE:28.11

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SMILING

FRONTAL

PROFILEFACIAL PHOTOGRAPHS AT RETENTION / POST RETENTIONCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 09/03/13

AGE: 31.7

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Right Buccal

Left Buccal

Upper Occlusal

CenterLower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHSAT RETENTION / POST-RETENTIONCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 09/03/13

AGE: 31.7

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LATERAL SKULL RADIOGRAPH
AT RETENTION / POSTRETENTIONCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 09/03/13

AGE: 31.7

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TRACING OF LATERAL SKULL RADIOGRAPH
AT RETENTION / POST-RETENTIONCANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 09/03/13

AGE: 31.7

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CEPHALOMETRIC MORPHOLOGICALASSESSMENT 3

Pretreatment

Posttreatment

Retention/po
stretention

Mean SD

Maxillary
Position
S-N-A

91.0

91.0

91.0

82º ±3.5º

Mandibular
Position
S-N-Pg

83.5

83.0

83.0

Sagittal Jaw
Relation
A-N-Pg

7.5

8.0

8.0

Maxillary
Inclination
S-N/ANSPNS

8.0

8.0

8.0

Mandibular
Inlination
S-N/Go-Gn

37.0

36.5

36.5

Sagittal
Skeleatal

80º ± 3.5º

2º ± 2.5º

VerticalSkeletal
Relations

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 09/03/13

8º ± 3.0º

33º ± 2.5º

AGE: 31.7

WBLO 26

CEPHALOMETRIC MORPHOLOGICALASSESSMENT 3

Pretreatment

Posttreatment

Retention/po
stretention

29.5

29.0

29.0

124.5

120.0

121.0

Vertical Jaw
Relation
ANSPNS/Go-Gn

Mean SD

25º ± 6.0º

DentoBasal
Relations

Maxillary
Incisor
Inclination
1-ANS-PNS

Mandibular
Incisor
Inclination
1-Go-GnCANDIDATE NUMBER: 1

110º ± 6.0º

94º ± 7.0º
91.5

85.5

CASE NUMBER: 2

85.5

DATE: 09/03/13

AGE: 31.7

WBLO 26-1

CEPHALOMETRIC MORPHOLOGICALASSESSMENT 3

Mandibular
IncisorCompensati
on
1 –A-Pg
(mm)

4.5

1.0

1.0

Overjet (mm)

4.0

3.5

3.5

Overbite
(mm)

4.0

3.0

3.0

Interincisal
Angle
1/1

119.0

129.0

131.0

2 ± 2.0

DentalRelations

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 09/03/13

2º ± 2.0

2 ± 2.5132º ± 6.0º

AGE: 31.7

WBLO 26-2

S-N plane at S

CANDIDATE NUMBER: 1

CASE NUMBER: 2

WBLO 28

Palatal plane at ANS

Mandibular plane at Me

CANDIDATE NUMBER: 1

CASE NUMBER: 2

WBLO 29

DESCRIPTION OF RETENTION /POST-RETENTION FINDINGS

Description of the post-treatment evaluation of retention

The patient was instructed to use clear retainers for both the upper and the lower arch allday. 1.7 years later, they were changed to the Begg-type retainer for the upper arch and aspring retainer for the lower arch. The duration of required wearing time for the retainers
was reduced to 12 hours.
2.5 years later, it was determined that the retainers needed to be worn on the upper andlower arch only during the night, and they are still being used at present. The patient has
been strictly adherent to the instructions regarding the time that the retainers are to beworn.

Description of retention/ post-retention findings

At 2.8 years after treatment, the dental arch and occlusion are stable. Althoughcomparison between post treatment and post retention revealed no changes in skeletaland dental measurements. Because lingual inclination of the mandibular anterior teeth cancause crowding, long-term retention follow-up, including adjustment of occlusion, may well
be necessary in the future for this patient.

CANDIDATE NUMBER: 1

CASE NUMBER: 2

DATE: 09/03/13

AGE: 31.7

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