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CASE HISTORY
Doctors name: Patients name: Date of Birth: Father/Guardians Name: Postal address: Phone no: Chief Complaint: (Res/Off): Sex: Male/Female Age: Date:
Family History: Similar malocclusion present in Mother: Father: Significant Medical Record: Allergy: Epilepsy: Diabetes: Trauma tothe Face /Surgery: Respiratory Disease: Any other condition: Pre natal records: Negative Positive: Heart Diseases: Kidney Disease: Rheumatic fever: Hepatitis: Tonsillectomy: Sibling: None:
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Mile stones: Teething: Walking: Speech: Habits: Digit sucking: Lip sucking: Oral breathing: Bruxism: Nail Biting: Tongue thrusting: Past dental records: 1) Periodontal treatment 2) Endodontic treatment 3) Extractions 4) Restorations 5) Orthodontic treatment Diet : Pure Veg. : : : : : Mix Diet Normal Normal Normal Delayed Delayed Delayed Accelerated Accelerated Accelerated
Brushing habit : Patient cleans his / her teeth once / twice / thrice a Day with horizontal Technique & he / she changes his / her toothbrush by every 6months.
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CLINICAL EXAMINATION
GENERAL EXAMINATION
Posture: Gait: Physique: Normal Normal Mesomorphic (Average) Health: Growth status: Healthy Pre-pubertal Ectomorphic (Thin and tall) Sick Pubertal Post-Pubertal Endomorphic (Fat and Short)
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Competent
Potential Competent Incompetence Average Average Normal Normal Normal Normal Incisal 1/3rd Thick Thick High Everted Hypertonic Hypertonic Middle1/3rd Thin Thin Low Trapped Hypotonic Hypotonic Cervical 1/3rd
: UpperLower-
Position
: UpperLower-
Tone
: UpperLower-
Posture
: Upper-
Pleasant Average
Toothy Recessive
2.Profile:
Facial convexity: Facial divergence: Clinical FMA: Maxilla Mandible Position of chin: Straight Anterior Average Normal Normal Normal Convex Posterior Low Protrusive Protrusive Protrusive Concave Straight High Retrusive Retrusive Retrusive
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TMJ
TMJ Right Left
Clicking
Crepitus
Pain
Movement
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Maxillary: Mandibular:
Tongue
Hard tissue Palate Others EXAMINATION OF TEETH Dentition: Teeth Present: Primary Mixed Permanent : Average : Shallow Deep
Unerupted Teeth:
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Occlusion Incisor relationship:- CL I Canine relationship- Left Right Molar Relationships: Left Right CL II Div 1 CLI CL I CL I CL I Proclined CL II Div 2 CL II CL II CL II CL II Average Average CL III CL III CL III CL III CL III Retroclined Retroclined
Axial Relationship:- Maxillary Incisors: Mandibular Incisors: Overjet Openbite : : Upper: Lower: Curve of Spee : Average Arch Form Lower: UpperFlat Expanded
Midline-coincident:
Expanded
Normal
Contracted
Teeth extracted Hypoplastic& malformed teeth Heavily restored teeth Non vital teeth Rotations Carious teeth Crowding Spacing
: : : : : : : :
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Inference:
Provisional Diagnosis:
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In female, menarche (Onset of Menstruation) usually Occurs between stages 4 and 5 Last Skeletal maturation Stage reached: Inference:
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MODEL ANALYSIS: Maxillary Number of teeth Mesio-distal Width Total Tooth Material Sum of incisors Proclination by direct method Crowding Spacing Rotation Arch Shape Arch Symmetry Midline Curve of Spee Palatal Depth Mandibular
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INDICES
1. PONTS INDEX: Dr.Pont, a French scientist in 1880 studied normal individual and derived following index. He found out that some co-relation exists between size of tooth and the arch width. It gives the width of arch in premolar and molar region in relation to the sum of incisal width. This analysis helps in: Determining whether the dental arch is narrow or normal Determining the need of lateral expansion Determining how much expansion is possible : =Sum of incisors X 100 80 = = Width in molar region : =Sum of Incisors X 100 64 = /64X 100 /80 X 100
4|4 6|6 If the measured value is less than the calculated value, then the archis contracted. If the measured value is more than the calculated value, then the arch is expanded.
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2. CHADDHAS INDEX:
In 1964 Dr. Chaddha modified Ponts index to suit Indian population.
Difference (mm)
Inference
Inference: If the measured value is less than the calculated value, then the arch is contracted. If the measured value is more than the calculated value, then the arch is expanded.
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3. NANCE & CAREYS INDEX: It helps in determining the extent of discrepancy between the arch perimeter & available bone. The arch perimeter is measured along a brass wire which is placed touching the mesial surface of first molar over the buccal cusps of premolar &incisal edges of anterior teeth on an ideal cast. If the teeth are Proclined, the brass wire is adapted in corrected position. If the teeth are Retroclined, the wire is adapted labial in corrected position. Wire should be adapted on crest of alveolar ridge. The formula to calculate linear dimension is: LD= LA + 2x; where o LD o LA o X o LD = = = = = LD measured by brass wire ---Linear dimension (by brass wire method)= Sum of Incisors = Mesiodistal dimension of any side 3, 4&5 = LA + 2X
Difference:
If the discrepancy between the arch length & tooth material is: 0-2.5mm 2.5-5mm >5mm =Minimal tooth material excess, thus non extraction case. = Second premolar extraction case. = First premolar extraction case.
By brass wire
Calculated LD
Difference
Inference
INFERENCE-
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Max 12
Mand12
Max 12
Mand12
Mand12
Mand6
Max 12
Mand12
Max 12
Mand12
Mand12
40Mand12
85 86 87 88 89 90 91 92 93
94 96 96 97 98 99
Overall Ratio --
Anterior Ratio
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4. ASHLEY HOWES INDEX Ashley had found a relationship between tooth width of twelve teeth anterior to second molar and width of dental arch in first premolar region. Canine fossa width The canine fossa is found distal to canine eminence. The measurement of the width from canine fossa to that of the other side gives the width of dental arch at the apical base. If the value is less than 37% then it indicates that there is need for the extraction If the value is in between 37% and 44% then it indicates the case is referred as border line case If the value is 44% or more, then it can be possible to treat without extraction
Ashley Howes Formula: =Canine fossa width 100 Total tooth material = =
Inference:
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Left
UR 1 2 3 4 5 6 7 6Ant. TTM
UL
LR
LL
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SPACE ANALYSIS
MAXILLARY ARCH Space required
1. Proclination= 2 (X-2) = Where x ix proclination by direct method
2. Crowding Region Measured mesiodistal width Mesiodistal width available Total mesiodistal width Space required
3. Derotation of anteriors: -
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Space available
1. Spacing:
2. Derotation of posteriors: -
3. Expansion: -
= mesiodistal width =
Space available by extraction = space required anchor loss = = Total space available is __mm, total space required is__mm Inference:
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2. Crowding: -
3. Derotation of anteriors: -
4. Curve of spee:
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Space available
1.Spacing: -
2. Derotation of posteriors: -
3. Expansion -
Inference:
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Total
Inference:
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DOWNS ANALYSIS
One of the most frequently used Cephalometric analysis. Downs analysis consist of ten parameters of which five are skeletal & five are dental Variable Mean Value Range Measured value Inference
Skeletal
Facial angle Angle of convexity A-B plane angle Mandibular plane angle Y axis
Dental Cant of occlusal plane Lower incisor to occlusal plane Lower incisor to mandibular plane Interincisal angle
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STEINER ANALYSIS
Cecil C. Steiner developed analysis with idea of providing maximum information with least information. He divided into three parts skeletal analysis, dental analysis, and the soft tissue analysis Variable Mean Value Measured value Skeletal SNA angle SNB angle ANB angle Occlusal plane angle Mandibular plane angle Dental Upper incisor to NA angle Upper incisor to NA linear Lower incisor to NB angle Lower incisor to NB linear Interincisal angle Inference
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TWEED ANALYSIS
Tweeds analysis makes use of three planes that form an diagnostic triangle. The planes used are 1. Frankfort mandibular plane angle(FMPA) 2. Incisor mandibular plane angle(IMPA) 3. Frankfort mandibular incisor angle(FMIA) The objective of analysis is to include determination of position of lower incisor & evaluation of prognosis of case Variable Mean value Range Measured value Inference
THE WITS APPRIASAL It is the measure of the extent to which maxilla & mandible are related to each one in Sagittal plane AO to BO distance
Inference:
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CEPHALOMETRICSUMMARY
1) Skeletal: A) Vertical: Rotationof mandible Rotationofmaxilla Rotation of jaw base : Neutral : Normal : Divergent Horizontal Anteinclination Convergent Vertical Retroinclination Same Direction
UpwardIdownward. B) Sagittal: Maxilla Mandible : Orthognathic : Orthognathic Class I Retrognathic Retrognathic Class II Prognathic Prognathic Class III
Jawbasesrelationship : C)Transverse: 2) Dental Incisors Molars 3)SoftTissue: Nose : Lips : Upper Upper
Lower Lower
Chin : Profile:
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PROBLEM LIST
Skeletal:
Dento Alveolar:
Soft Tissue:
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Diagnosis:
Probable Etiology:
Treatment Objectives:
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Prognosis: