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EUROPEANSOCIETY

OF LINGUALORTHODONTICS

CANDIDATE NUMBER: Dr. Stefan Blasius

CASE NUMBER: 1

Year: 2010

WBLO 01

RÉSUMÉ OF CASE 1

ADULT MALOCCLUSION

NAME: Daniel S.

BORN: 21-02-1978

SEX: male

PRE-TREATMENT RECORDS:

CLASSIFICATION: Adult malocclusion

TEETH MISSING BEFORE TREATMENT: Maxillary whisdom teeth

APPLIANCE: Maxillary and mandibulary fixed lingual appliances

TREATMENT STARTED:

TREATMENT FINISHED:

ACTIVE TREATMENT TIME: 19 months

POST-TREATMENT RECORDS:

RETAINERS:

RETENTION ENDED:

AGE: 30/0

RETENTION TIME: Permanent retention

(POST-) RETENTION RECORDS:

TIME OUT OF RETENTION: Permanent retention

DATE: 22-02-2008

AGE: 30/2 DATE: 07-05-2008

AGE: 31/10 DATE: 21-12-2009

a)upper: fix retainer, Hawley

a)lower: fix retainer, Hawley

a)upper:

a)lower:

DATE: 21-12-2009

DATE: permanent

AGE: - DATE: -

CASE CATEGORY:

WBLO 02

TREATMENT PLAN:

AGE: 31/10 DATE: 21-12-2009

DIAGNOSTIC DESCRIPTION

OF THE MALOCCLUSION

A. SUMMARY

B. EXAMINATION OF HEAD AND FACE

C. FUNCTIONAL EXAMINATION

D. INTRAORAL EXAMINATION

E. DENTAL CASTS

Mandibular arch: severe rotation of 14, moderate dental crowding, rotation 12, 22

Maxillary arch: mild arch perimeter tooth mass discrepancy, accentuated curve of spee

Occlusion sagittal: right - Class II canine and molar, left - Class I canine and Class III molar

Occlusion vertical: Anterior deep bite 3,5 mm

Occlusion transversal: scissors-bite tendency of upper right first premolar

WBLO 03

CANDIDATE NUMBER: SB DATE: 07-05-2008 AGE: 30/0CASE NUMBER: 1

Patient´s chief complaint: unesthetic smile, rotation of maxillary lateral incisors

• Patient´s pogonion is shifted slightly to the right

• No signs of severe disproportions

No presence of difficulty in oral function

• Right side: Class II, left side: Class I canine and Class III molar relationship

• Midline discrepancy (mild maxillary dental midline shift to left)

• Anterior deep bite 3,5 mm

• Rotation and scissors-bite tendency of upper right first premolar

• Space deficiency and rotation of maxillary lateral incisors

• No crossbite

FRONTAL SMILING

PROFILE

WBLO 04

FACIAL PHOTOGRAPHS BEFORE TREATMENT


s.rys

Tampon

s.rys

Tampon

s.rys

Tampon

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

WBLO 05

INTRA-ORAL COLOUR PHOTOGRAPHS OF THE OCCLUSION BEFORE TREATMENT


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LATERAL SKULL RADIOGRAPH BEFORE TREATMENT


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TRACING OF LATERAL SKULL RADIOGRAPHBEFORE TREATMENT


CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 1

WBLO 08


Pretreatment Mean SD

Sagittal Skeletal Relations

Maxillary PositionS-N-A

82,7° 82º± 3.5º

Mandibular PositionS-N-B

80,6° 80º± 3.5º

Sagittal Jaw RelationA-N-B

2,1° 2º± 2.5º

Vertical Skeletal Relations

Maxillary InclinationS-N / ANS-PNS

13,3° 8º± 3.0º

Mandibular InclinationS-N / Go-Gn

24,1° 33º± 2.5º

Vertical Jaw RelationANS-PNS / Go-Gn

10,9° 25º± 6.0º

Dento-Basal Relations

Maxillary Incisor Inclination1 - ANS-PNS

116,0° 110º± 6.0º

Mandibular Incisor Inclination1 - Go-Gn

92,2° 94º± 7.0º

Mandibular Incisor Compensation1 - A-Pg (mm)

0,1 2± 2.0

Dental Relations

Overjet (mm) 2,9 3.5± 2.5

Overbite (mm) 3,6 2± 2.5

Interincisal Angle1 / 1

140,9° 132º± 6.0º

PERIAPICAL OR PANORAMIC RADIOGRAPHS

BEFORE TREATMENT

WBLO 09


ANY OTHER RADIOGRAPHS BEFORE TREATMENT

WBLO 10

If needed


No need for other radiographs

RADIOGRAPHIC ANALYSIS

BEFORE TREATMENT

A. INTRAORAL / PANORAMIC RADIOGRAPH

B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT

WBLO 11


Panoramic Radiograph:

• Absence of maxillary wisdom teeth

• Impaction of mandibular wisdom teeth

• Moderately decreased bone level according to patients age

1. Sagittal skelettal relations: position of the maxilla and the mandible within

the normal range, skelettal Class I maloccusion

2. Vertikal sklettal relations: brachyfacial pattern, posterior impaction of the

maxilla, decreased lower anterior face height

3. Dento-basal relations: proclination of the maxillary incisors, mandibular

incisors slightly uprighted

4. Dental relations: increased interincisal angle, absence of tooth 18,28,

visibility of tooth 38, 48

5. Esthetic profile: mild posterior divergent profile, increased nasolabial angle

TREATMENT PLAN

AND THE REASON FOR IT

WBLO 12


Treatment Plan:

1. Bonding maxillary and mandibulary arch with lingual fixed appliances

2. Correct Class II on the right side

3. Derotation of upper right first premolar

4. Distalisation of upper right canine

5. Correct midline discrepancy

6. Establish proper incisor angulation

7. Eliminate maxillary and mandibulary crowding

8. Detailing and Finishing

9. Retention

The reason for this treatment is

1. to improve facial appearance and smile esthetics and

2. to achieve functional balance due to elimination of the scissors-bite

tendency of upper right first premolar

TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS

UPPER ARCH

WBLO 12-1

CANDIDATE NUMBER: SB DATE: div. AGE: div.CASE NUMBER: 1

WBLO 12-2

CANDIDATE NUMBER: SB DATE: div. AGE: div.CASE NUMBER: 1

TREATMENT STEPS INTRA-ORAL OCCLUSAL VIEW COLOUR PHOTOGRAPHS

LOWER ARCH

RÉSUMÉ OF THE TREATMENT CARRIED OUT

INCLUDING

ANY DIFFICULTIES ENCOUNTERED

WBLO 13


Treatment Gouvernance:

1. Bonding maxillary and mandibulary arch with lingual fixed appliances

2. Correct Class II on the right side with Class II elastics

3. Derotation of upper lateral incisors appeared to being more difficult than

expected (problem solved by alastic lasso-technique)

4. Establish proper incisor angulation

5. Eliminate maxillary and mandibulary crowding

6. Establish correct overjet and overbite (including levelling curve of spee)

7. Detailing and Finishing

8. Retention

FRONTALSMILING

PROFILE

WBLO 14

FACIAL PHOTOGRAPHS AT COMPLETION OF TREATMENT


s.rys

Tampon

s.rys

Tampon

s.rys

Tampon

Right Buccal Left Buccal

CenterUpper Occlusal Lower Occlusal

INTRA-ORAL COLOUR PHOTOGRAPHS OF THEOCCLUSION AT COMPLETION OF TREATMENT

WBLO 15


LATERAL SKULL RADIOGRAPH

AT COMPLETION OF TREATMENT

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TRACING OF LATERAL SKULL RADIOGRAPH


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CEPHALOMETRIC MORPHOLOGICAL

ASSESSMENT 2

WBLO 18


Pretreatment Posttreatment Mean SD

Sagittal Skeletal Relations

Maxillary PositionS-N-A

82,7° 82,5° 82º± 3.5º

Mandibular PositionS-N-B

80,6° 80,7° 80º± 3.5º

Sagittal Jaw RelationA-N-B

2,1° 1,8° 2º± 2.5º

Vertical Skeletal Relations

Maxillary InclinationS-N / ANS-PNS

13,3° 13,0° 8º± 3.0º

Mandibular InclinationS-N / Go-Gn

24,1° 24,7° 33º± 2.5º

Vertical Jaw RelationANS-PNS / Go-Gn

10,9° 11,6° 25º± 6.0º

Dento-Basal Relations

Maxillary Incisor Inclination1 - ANS-PNS

116,0° 118,2° 110º± 6.0º

Mandibular Incisor Inclination1 - Go-Gn

92,2° 93,4° 94º± 7.0º

Mandibular Incisor Compensation1 - A-Pg (mm)

0,1 2,1 2± 2.0

Dental Relations

Overjet (mm) 2,9 2,8 3.5± 2.5

Overbite (mm) 3,6 1,9 2± 2.5

Interincisal Angle1 / 1

140,9° 133,0° 132º± 6.0º

PERIAPICAL OR PANORAMIC RADIOGRAPHS


WBLO 19


RADIOGRAPHIC ANALYSIS AT

COMPLETION OF TREATMENT

A. INTRAORAL / PANORAMIC RADIOGRAPH

B. INTERPRETATION OF CEPHALOMETRIC ASSESSMENT

WBLO 20


Panoramic Radiograph:

• Moderate distal root angultion of upper right first premolar

• Absence of maxillary wisdom teeth

• Impaction of mandibular wisdom teeth (extractions will be performed by

prescription in the near future)

1. Sagittal skelettal relations: position of the maxilla and the mandible within

the normal range, skelettal Class I maloccusion

2. Vertikal skelettal relations: brachyfacial pattern, posterior impaction of the

maxilla, decreased lower anterior face height

3. Dento-basal relations: proclination of the maxillary incisors, mandibular

incisors in a favourable position, correct overjet and overbite

4. Dental relations: normal interincisal angle, absence of tooth 18,28,

presence of tooth 38, 48

5. Esthetic profile: mild posterior divergent profile, increased nasolabial angle

DESCRIPTION OF THE

TREATMENT RESULT

WBLO 21


Treatment Result Orientation:

1. Improved smile esthetics and facial harmony

2. Occlusal relationship: Super Class I (Class I canine and mild Class III

Molar relationship)

3. Correct interincisal angulation

4. Normal overjet and overbite

5. Retention objectives: permanent / lifelong retention

DESCRIPTION OF THE

POST-TREATMENT EVALUATION

OF RETENTION

WBLO 21-1


Retention Result Orientation:

1. Retention objectives: permanent / lifelong retention

2. Check stability of correct rotational position of maxillary lateral incisors

and maxillary right first premolar in short intervals

3. Control stability of occlusion and stability of overjet and overbite

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