WELCOME

on
A Patient with Class-Il malocclusion With anterior open bite.
Presented by : Dr. Rashed Md. Golam Rabbani
BDS, FCPS-ll Trainee, Dept. of Orthodontics, DDCH

Supervisor : Prof. Dr. Md. Zakir Hossain

BDS, PhD(Japan) Prof. & Head, Dept. of Orthodontics, DDCH.

PARTICULARS OF THE PATIENT

Name of the patient Occupation Age Sex Date of reporting Address

: Md. Mohsin Ali : Student : 27 years : Male : 22 August, 2009 : Noakhali

PRESENTING COMPLAINTS

1. Aesthetic problem. 2. Difficulty in speech 3. Difficulty in mastication

EXTRA-ORAL EXAMINATION FACIAL FEATURE: Shape of the head : Mesocephalic Profile Analysis : Convex Facial divergent : Posterior Vertical relation : Normal Facial symmetry : Symmetrical Lips : Everted (incompetent) Upper lip line : Normal Lower lip line : Low Naso-labial angle : Acute TM joint : Normal path of closure Breathing : Both Nasal & oral

PATIENTS PHOTOGRAPH

INTRA-ORAL EXAMINATION
Stage of dentition : Permanent Teeth present :7654321 1234567 7654321 1234567 Periodontal status : Average Carious teeth : Absent Impacted tooth : Absent Missing tooth : Absent Maximum inter occlusal clearance : 44 mm Palate : Deep Tongue : Normal in size shape and forward position

OCCLUSAL RELATIONSHIP
A. Anteroposterior relation:
1. Molar relation 2. Canine relation 3. Incisor relation 4. Over jet 5.Over bite : Class-II both sides. : Class-II both sides : Undetermined : 7mm

:Open bite(-2mm)

6.Upper arch Discrepansy: -2mm 7.Lower arch discrepancy: -4mm

B. Vertical relation:
1. Open bite

C. Lateral relation:
1. Midline : Coincided

INTRA ORAL PHOTOGRAPHS

SALIENT FEATURE
My patient Md.Mohsin, 27 years of age, reported to Dhaka Dental College & Hospital on 22 August, 2009 with the complaints of aesthetic problem and difficulty in speech. On examination labially placed anterior teeth were seen. Canine and molar relationship Class-II both sides. Over jet: 7mm and open bite was found anterior segment.

PROVISIONAL DIAGNOSIS

case of Class-II anterior open bite.

malocclusion

with

AETIOLOGY

1. Inherited 2. Tongue posture & Thrusting 3. Mouth Breathing

SPECIFIC INVESTIGATION

MODEL ANALYSIS Molar Relationship Canine Relationship Incisor Relationship

: Class-II on both sides : Class-II on both sides : Open Bite

MODEL ANALYSIS

2. LATERAL CEPHALOMETRIC RADIOGRAPH

The analysis of the lateral cephalometric radiograph revealed that the patient had a skeletal class-II. SNA : 800 SNB : 740 ANB : 60 Gonial angle : 1200 IIA : 95 Mandibular plane Angel : 40 MMA: 32

3. ORTHOPANTOMOGRAPH
Shows permanent Dentition, favourable tooth angulation & no obstruction.

FINAL DIAGNOSIS

A case of Skeletal Class-II Malocclusion with anterior open bite (Sk. & Dental).

MANAGEMENT
Considering a complete set of records including photograph, model, orthopentamograph, lateral cephalometry and patients age - aim and treatment plan was established

AIM OF TREATMENT Improvement of aesthetic

To Correct the open bite. To correct the inter incisal angle. To establishment of normal over jet and over bite.

PROPOSED TREATMENT PLAN By Fixed orthodontic procedure

1. Extraction of upper and lower 1st premolars. 2. Initial leveling and alignment of upper and lower arches by multiloop arch wire(0.014) 3.Retraction of upper and lower canine & adequate anchorage maintain. 4.Arch coordination and interdigitation by updown elastic and use of box elastic to close the anterior open bite & Class-II

Treatment Mechanism & Progression:

Step 1. After attending to the oral hygiene extraction of the upper and lower 1st premolars will be done under L/A. Step-2 Initial Labeling of upper and lower arches with multiloop stainless steel wire (0.014)

Step-3 Retraction of the upper and lower canines by elastic chain (0.016 SS wire) and adequate anchorage will be prepared withT.P.A. Step-4 Lower &Upper and arch contraction by rectangular arch wire (0.017 X 0.025) using closing loops and adding incremental torque. Step-5 Arch Coordination & Interdigitation Step-6 Retention & Stability: 1.Overcorrection 2. Fixed retainer for upper and lower arch

PROGNOSIS

Favorable

ESTIMATED TIME OF TREATMENT

For fixed orthodontic procedure: 2 years

RETENTION
Active retention period is 1&1/2 years fixed retainer. Follow up schedule will be maintained for another 3 years.

Conclusion

Treatment of open bite is one of the most difficult job in orthodontics. Accurate diagnosis is essential for proper treatment planning. Proper diagnosis, elemination of etiology, early treatment and proper retention provides the possibility of satisfactory outcome.

Thank You All