Case 3

Personal Information

Name: BK
DOB: 07/12/2015
Age on presentation: 9 years
Gender: Female
Accompanied by her mother
Consent signed by her mother

History

Chief Complaint: Rotten teeth and skew front teeth

History of Chief Complaint:
BK, a 9-year-old, presents with concerns from her mother about the appearance of her anterior teeth, noting they are misaligned. Additionally, her mother mentioned that BK has several decayed teeth, although BK has not experienced any pain. They have not sought dental care previously, as they recently moved from the Eastern Cape and are now seeking to address her dental issues.
BK was initially seen in the undergraduate clinic, where her carious lesions were treated. Subsequently, she was referred to the MSc clinic for further evaluation and management of her aesthetic concerns.

Medical History:

BK is a healthy child with no history of significant childhood illnesses. She has no known allergies

Extra-oral examination

BK’s facial appearance is normal and symmetrical, except for small scars on her right and left cheeks and chin. There were no palpable lymph nodes. The TMJ functioned normally, and her muscles appeared relaxed, with no abnormalities detected.

Orthodontic Evaluation

Morphological Examination of the Face:
Her profile is concave with a prognathic maxilla and mandible.

Competent lips.

Occlusal analysis:

Molar classification: Class I is on both sides.

Maxillary midlines vs midsagittal plane: 1mm shift to the left.

Mandibular midline: coincides with the midsagittal plane at rest and occlusion.

Overjet: 11: 0 mm/ 21: crossbite

Overbite: 11:1:0 mm/ 21: 1mm crossbite

Crossbite: 53,11,21,22

Buccal canine bulges: Palpable

Habits: No habits

Intra-oral examination

No abnormalities were found in the tongue, frenum, or mucosa. However, there is visible plaque.

BK is in her early mixed dentition, the 11 and 21 are rotated. 16, 55, 65, 26, 36, 75, 46 are filled. 85 dislodged occlusal filling.

Radiographic Examination

No anomalies or pathologies. The bone and soft tissue anatomy appeared normal, with all permanent teeth accounted for. The estimated dental age is 8 years, corresponding to the first transitional stage. The canines are positioned favourably, and the sequence of eruptions is also favourable; however, in the 3ed quadrant, the 34 is slightly ahead of the 33 . leeway space uncompromised in all four quadrants.

Cephalometric Analysis

•Steiner Analysis:

•1/ Skeletal Analysis:

•SNA angle: 91(82+/- 2)

•SNB angle: 90(80+/- 2)

•ANB angle: 1 (2+/- 2)

•Occlusal plane angle: 11(14)

•Mandibular plane angle: 27(32)

•2/ Dental Analysis:

•Upper incisor to NA angle: 23 (22)

•Upper incisor to NA linear: 3mm (4)

•Lowe incisor to NB angle: 35(25)

•Lower incisor to NB linear: 5mm (4)

•Inter incisors angle:125 (130)

•3/ Soft Tissue Analysis:

•S-line: lips Infront of S-line 7mm.

•Deduced from the Cephalometric analysis:

•Skeletal classification:

•Skeletal Class I

•MP>: 25 Horizontal growth pattern

•Dental Analysis:

• Proclined UI.

• RetrudedUI.

• Proclined LI.

•Protruded LI.

•Bimaxillary Proclination of incisors

•Soft Tissue Analysis:

• Protrusive lips

Model Analysis

Upper Arch

Arch form: U-shape

Teeth present: 16, 55, 54, 53, 12, 11, 21, 22, 63, 64, 65, 26

11 and 21 mesially rotated

Lower Arch

Arch Form: V-shape

Teeth present: 36, 75, 74, 73, 32, 31, 41, 42, 83, 84, 85, 46

32 slightly lingually placed

Molar classification: Class I on both sides

Crossbite: 53,11,21,22

space analysis

Tanaka & Johnston Analysis

M-d width of the Permanent Incisors.

Tanaka & Johnston Analysis:

M-d width of Mandibular Permanent Incisors

6.5+6.5+6.5+6.5= 26

Estimated premolars and canine in one quadrant: ½ of the m-d width of the lower four incisors+11mm for maxilla, 10.5mm for mandible

Maxilla: 26/2+11= 24mm (1 quadrant); Mandible: 26/2+10.5= 23.5 ( 1 quadrant)

M-d width of canines&premolars in Maxilla 24x2= 48mm

M-d width of canines&premolars in Mandible 23.5x2=47mm

Space required in lower arch for incisors,canines&premolars:

47mm+26mm=73mm

Space required in upper arch for incisors,canines&premolars:

48mm+34mm=82mm

Treatment goal

1/ Derotation of 11 and 21.

2/ Correction of the anterior crossbite

Appliance design

1/ Reverse labial bow.
2/ Adam clasps 16, 26.
3/ Posterior bite plan.
4/ Expansion screw.
5/ Acrylic base-plate.

First visit

Diagnosis and treatment plan
Impression for the Orthodontic Study Model
Reinforcement of the OHI
Filling 85o (dislodged)
Fluoride application

Second visit

Reiteration of oral hygiene instruction.
Delivery of the appliance.
The anterior expansion screw was activated 4 turn= 1mm/ month.

Third visit

Starting point.

Polishing
Reinforcement of the OHI
Activation of expansion screw was activated 4 turn= 1mm/ month.

Fourth visit

Second follow up

Third follow up

Polishing.
Fluoride gel application
Reinforcement of oral hygiene instrctions
Once the 11 and 12 fully move out of the crossbite, the acrylic behind these teeth will be trimmed away from the distal aspect while remaining on the mesial side. This adjustment will enable the expansion screw to selectively apply force to the mesial aspect, facilitating their derotation.
The next appointment is scheduled for four weeks.

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