2. Patient Data:

3. Chief of Complaint: I have crowding in the lower teeth. Medical History: Previous surgical treatment of Hernia (4 years ago) Tonsillectomy (18 years ago)

4. Past Dental History: Regular attending: Yes. Brushing: yes (Twice a daily). Flossing: No. Trauma: No. Habits: No. Family History: No History.

5. Extraoral Examination: Body Morphology :Body Morphology : Built ……. Average Height ……. Average Frontal view :Frontal view : Face shape ……. Oval Overall height ……. Average Symmetry …….. Symmetric

6. Lateral view :Lateral view : Profile …… Straight Chin …… Average Nose ……. Average Lateral viewLateral view Upper face …… Average Lower face ……. Average Jaw Angle …… Average

7. Lateral view:Lateral view: Nasolabial angle …… Average Labiomental fold …… Average

8. Functional Status: Lip:Lip: –Competent Lip. Lip contour …… Average Incisor display ….. Average Swallow …. Average Breathing …. Nasal Speech …. Average

9. Displaced Occlusion:Displaced Occlusion: No TMJ:TMJ: Normal Lymph Nodes:Lymph Nodes: Normal

10. Intraoral Examination: Soft Tissue:Soft Tissue: Oral Hygiene : Fair. Gingival condition : Healthy. Frenum: Average. Tonsils: Excised. Tongue size: Average. Tongue position: Average.

11. Hard Tissue:Hard Tissue: –Permanent Dentition: Carious Teeth: 36, 46, 47, 16, 26, 27 Restored: 37 Missing: No

12. Right Side: Canine relationship = Class 1 Molar relation = class I Left Side: Canine relationship = Class 1 Molar relation = class I

13. Overbite (Vertical Overlap) Overbite = 3 mm Overjet ( Sagittal Realshonship) Overjet = 3 mm

14. Model Analysis

15. Model Analysis: Models Related by:Models Related by: Static maximum intercuspation. Dentition Stage:Dentition Stage: Permanent teeth Teeth present and missing:Teeth present and missing: All teeth are present. Midline Diastema:Midline Diastema: 0 mm. Crossbites:Crossbites: No. Curve of Spee:Curve of Spee: Normal.

16. Mandibular OcclusalMaxillary Occlusal U shapeOvalArch Form symmetry Symmetry 31,32,43 MBNoRotations No Abnormal Teeth Position NoFracture 16,26Morphology, Wear, Fracture 19 mm37 mmCanine Width 46 mm50 mmMolar Width Normal Incisor Inclination

17. Space Analysis: LeftFrontRightLower 252325Space Available 252625Space Required 0-30Discrepancy LeftFrontRightUpper 223623Space Available 223622Space Required 001Discrepancy

18. Molar Width: Molar Width: Upper: From central fossa to the other central fossa. Lower: From mesio-buccal cusp to mesio-buccal cusp. LowerUpper 19 mm37 mmCanine Width 46 mm50 mmMolar Width

19. Radiographic Examination

20. OPG To assess the patient’s dental age based on the development and progress of mineralization of the teeth, eruption time and exfoliation of the primary teeth. To evaluate present teeth, missing congenitally or impacted, ectopic eruption, malpositioned teeth….etc To determine the level of alveolar bone, the interdental crest, bone resorption, infrabony pockets, trabecular pattern wide marrow space or narrow trabecular spaces. To note the presence of any pathological lesions

21. Hand and Wrist Radiographs Predicting the pattern of growth, that is the amount, direction, duration, location and timing of the onset of pubertal growth, is important for the orthodontist when planning therapy and coordinating orthodontic treatment with the vital growth process.

22. Cephalometric Uses:Uses: –Classify the type of the face. –Show the relationship between the basal parts of the maxilla and the mandible. –Evaluate the soft tissue profile. –Evaluate the position of the incisors in relation to the basal parts and the soft tissue profile. –To make a growth prediction. –Monitoring the progress of treatment. –Detecting for any abnormalities or pathology

24. ReadingNorm prognathic Max 9182 ± 2SNA prognathic Mand 8480 ± 2SNB Class || skeletal 72 ± 2ANB 3.52Adj. ANB Class || skeletal 3 mm-2-0Wits Protrusive of chin 8481SNPog 121130 ± 5NSBa

25. ReadingNorm Slight Anterior Rotation 3032 Man.-SN Slight Anterior Rotation 78 Max.-SN Deep Bite 2025 Max.-Man 1510 ± 4 Max.-Occl Increased Jaw Angle 132126 Me-tgo-Ar

26. ReadingNorm Increased or Decreased Upper Facial Height 40 mm N-SP’ mm Increased or Decreased Lower Facial Height 56 mm SP’-Gn mm Increased Lower Facial Height 71,479 FI Increased Lower Facial Height 58.355 FP %

27. ReadingNorm Slight Increase Over Jet (Dental Class ||) 32 Over Jet Slight Increase Over Bite (Deep Bite) 32 Over Bite Bimax Retroclination of Inter-incisal Angle 119131 ┴ - ┬ Proclination 24 22 ┴ - NA Proclination 119 108 ┴ - Max Slight Retroclination 3 4 ┴ - NA mm

28. ReadingNorm Proclination 28 25 NB- ┬ Proclination 94 90 ┬ - Man Proclination 8 4 NB - ┬ mm 7 2 ┬ - APog

29. ReadingNorm Slight Protrusive of upper lip -2 UL- EL mm Normal lower lip 0 0 LL- EL mm Normal 0 0 LL- HL mm Normal Nasio-Labial angle 92 90-100 Nasio- Labial

30. Treatment Needs: There is crowding in the lower anterior teeth, so the patient need more space to achieve the normal position for lower anterior.

31. Treatment Plane –Scaling, polishing and oral hygien instructions. –Restorative treatment: Carious teeth ( 36, 46, 47, 16, 26, 27 ) Endodontic treatment (16, 26) –Interproximal reduction for the lower anterior teeth by disking (Removal of a small amount of enamel typically 0.1 to 0.4mm) –Follow up.

32. There are 3 methods to reduce teeth interproximally: Abrasive Strips Abrasive Discs Air Rotor Stripping Remove up to 50% of expected enamel thickness Start with teeth that have the thickest enamel Sequentially strip contact points, posterior to anterior Direct vision wherever possible Finish with polishing strips or discs Apply fluoride

33. Abrasive Strips:Abrasive Strips: –Use for anterior teeth –Use for minor tooth reduction

34. Abrasive Discs:Abrasive Discs: anterior teeth –Usually for anterior teeth more –Removes more enamel than stripping –Must finish with abrasive strips –Risk of cutting lip and gingiva –Risk excessive enamel reduction –Risk of abnormal contacts or ledges

35. Air Rotor Stripping – Lateral Approach: Place 0.020” brass indicator wire under contact point protects the interdental tissues Finishing Polish with carbide finishing burs, finishing diamonds, polishing discs, or hand-held finishing strips

36. Air Rotor Stripping – Occlusal Approach Occlusal approach w/ customized carbide bur Shoulder form allows bur to rest on mesial and distal marginal ridges. Avoids lowering the contact. Stays parallel to long axis of tooth. Reduced cutting efficiency. Ultrafine diamond version available commercially.

37. Instructions: Must maintain good oral hygiene Regular checkups