Case presentation

Dr. AUDAY MANSOUR

Basic Case for Power Point presentation in Diagnosis

Problem listDiagnosis Treatment objectiveTreatment plan

where you are? and where you go?

Example 12+12 Photos : 12: Face&Oral + 12:Model

CASE HISTORY

CASE NO : 4 starting date: 5-10-2009

NAME : Salem Saif Al Meqbali

AGE : 24y 7 m DOB: 15-3-1985SEX : male

ADDRESS : AL- AIN U.A.E .

PHONE NO: (R)NATIONALITY: UAEWORK: POLICY OFFICER

From

Prof. R. Slavicek, Arabic Diagnosis Sheet

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6 Face photos 6 Oral photos

12 Model photos -RCP

Some patient s not accept xrays so as conservative protocol we usually shot them after they die we make xray for them skull after family approval

He complained from caries, poor alignment of teeth ,missing teeth and deviation of mid line

Patient visit clinic without direct tmj (cms) complains or symptoms he asking orthodontic and conservative treatment.• He not examined before for cms evaluation

During initial clinical examination I find the

following signs :

I) Clicking in left joint.

II) Muscles pain .

III) Deviation of mid line

IV) Missing teeth

History of present CMS illness:-

Patient started clicking 9-10 years ago,clicking by wide opening or big foods bite .

Clicking without pain and patient don’t use pain killer medicines

History of present CMS illness:-

Clicking change its velocity, reproducibility

and timing

Pain in muscles increase after opening

long time

( after dental treatment)

Missing teeth long time ago

PHOTOGRAPH RECORDS

Frontal

Bilateral Symmetry

Profile Straight Convex Concave

Anterior Posterior Jaw Relation

Maxilla : Normal???neutral Protrusive Retrosive

Mandible :Normal???neutral Protrusive Retrosive

Vertical

Face: Normal???neutral Long Short

Lips : Lip Contact In Relaxant In Centric OcclusionNo Gummy Smile

Why American orth . Association

believing prognathic maxilla

Not normal???????????????????????????????????????I think they should visit our university

CLINICAL EXAMINATION

Extra oral

PROFILE : straight / convex / concave

LIPS : competent/ incompetent / pot. Competent

Inter labial gap :0 mm

Facial symmetry : YES / NOTMJ clicking : YES / NO left side no Pain

CLINICAL EXAMINATION

intra oral

ANGLE’S CLASS: / 1 / 11 / 111 endonSubdivision:

Lt: drifting &missing teeth Rt cl 1 canine

Midline : U / L deviated left side

Molar Relationship : Class / 1 / 11 / 111

Canine relationship : / 1 / 11 / 111 right side

CLINICAL EXAMINATION

DENTAL RELATIONS:

Over bite: 70 % icp ,50% rp

Over jet 3 mm

Lower lip averted : YES / NO

Cross bites : NO

Occlusal plane : go to tracing

Curve Of Spee Increased: Yes / No

Habits : No finger Or

tongue or Lip Bad Habit

Gingival Conditions : Good / Average /

Poor

Periodontal Pockets : YES / NO

Carious Teeth:

Cariesed teeth On Clinical And Radiographic Examination white

87654321 1234567887654321 12345678

(Mark In Red For RC Treated Teeth)

Missing teeth No. 11,14,23 and30

because caries or mal position

Prosthesis :no

Individual photos records

Fracture incisal edges upper centrals

Loosing spaces of missing no 30 ,no11

and no14

Complete closing of missing no 23 space

Model photos

Models in R P position Reference plane axio -orbital

planeAfter condylography

Fixed in SL REFERANCE ARTICULATOR

Model photos

RCP

Model photos

Model photos

Model photos

0.5 mm to right side transversally

Downward back word both joints sag itally and vertically

RP TO ICP

RP TO ICP

There is no loading of the disc against

eminence

compression for retro joint area

Stretching of ligaments

MODEL PHOTOS

IN ICP POSITION WITH SIMPLE HING ARTICULATOR

WITH VERTICAL AND HORIZENTAL TEETH CROWNS AXISES TO IDENTIFIED PRECIOUSE BRACKETS POSITIONS

INDIRECT BONDING TEQ.

Models

Space of missing No. 30,14 and 11

significant ally decreased

Complete closing space of missing

No.23

Anterior dental deep bite tendency (no

space for bracket of No. 27

Collapse of lower arch transversally in

molar area

Models

ICP models in lingual aspect

Regular bite left &right transversally

Lingual cusp of molars &premolars not

intercuspated in perfect way

Lower canines tips prominent and in

cranial position

No 21

S 65

S1 47

S2 67

RADIOGRAPHIC RECORDS

OPG AND CEPHALOGRAM:

OPG RECORDS :-

Congentally Missed Teeth : No un erupted NOmesially angulation:31,32,12,13

Impacted Teeth : NoRoot Dilaceration : NoAlveolar Bone Hight : No bone loss

RADIOGRAPHIC RECORDS

Periodentum Condition : No true

pockets, interproximal alveolar bone

healthy

Supernumerous Teeth : No

Root resorbation : No

Pathological Conditions : No

Brux checker

BRUX CHECKER RECORDS

• ANTERIOR AND POSTERIOR BRUX

ACTIVITY (mandible want to be more

foreword)

• RIGHT SIDE CANINE GUIDNECE

• POSTERIOR WISDOM TEETH

INTERFERANCE

• LOWER ANTERIOR CONTACT

Brux checker

OCCLOGRAM RECORDS

1.POSTERIOR SUPPORT MORE IN RIGHT

SIDE

2.Teeth fitted better in right side than left

3. IN BRUXISM ALMOST ALL TEETH MAKE

CONTACTS

OCCLOGRAM RECORDS

4. RIGHT SIDE CANINE GUIDENCE

5. IN ICP SOME OF TEETH NOT FULLY

CONTACT

6. Missing canine and 1st molar upper left

side make lateral guidance on 1st

premolar

Mandibular Mobility

10 mm

20 mm

30 mm

40 mm

50 mm

60 mm

0 mm

MANDIBULAR MOVMENT RECORDS

1 –opening: 47 mm

No deviation

2-Opening stretch :2 mm

3-Left side :10 mm

4-Right side : 8 mm

In general no limitation movement within

average

Right Left

Record by estimated arbitrary position of

mbc and dc of No.30

TRACING FEATURE

Skeletal cl II

Skeletal open bite case

Retrouded chin sagetally

Short ramus mandible ( DPO )

(CURVE OF SPEE)

Protrusion-retrosion

Protrusion-retrosion

Open &close

SaLAM al maqbali

2224 /1o/2009

average

good good

concave CHANGING

More SYMMITRY IN SAG.,TRASVER.AND VERTICAL IN QUALITY,QUALITY,CHARACTERASTIC in protr-retr than open and close

Reciprocal clicking in left joint in open and close more loose lig. in left

average

RS/2000RS/2000

Functions

Chewing

Speech

(Respiration)

Posture

Esthetics

Stress Management

Soma

CNS

Psyche

CMS (TMJ)

NMS

Articulation (Occl.)

Structurs

Cybernetic System Chewing organ

Organism

Environment

Masticatory Organ

Summary of examination

young self control male with clicking left joint

Non myopathic case

Cooperative and accepted professional instruction s and procedures

Patient have caries teeth with accepted OH

Summary of examination

missing teeth 11,14,23,30

Patient with 1.25 occlusal index ,three

questions with answer 1 and one question 2

related to posture

subjective function analysis: muscle palpation pain in tube maxilla ,M. sterno clido mastoidous muscles, later joint pole and more in retrojoint area

Summary of examination

Patient with big restorations in 18,19 need crowns (risk of fracture buccal wall during orthodontic treatment

Patient with deviation mid line ,rotated teeth and angulated teeth

Sk. CL II Flat op average vd and average inter incisal angle sk. Open bite retrouded chin

TREATMENT

Advance treatment protocol

“sorry I can’t repair your

car breaks, but I make

your horn loudly”

My car mechanic

Aims and objectives of treatment

Improve patient oral hygiene

Fillings of caries with restore teeth morphology

Restorations of No. 17 ,18 zirconium (patient refuse esthetically gold crown in lower teeth)

Aims and objectives of treatment

Teeth alignment in upper and lower arches and improve intercuspation

Correction individual occlusal plane by extrusion of lower molars

Re-evaluation and follow up patient signs and symptoms

Restore missing teeth after ortho. With care of teeth morpho. and individual DOA

Vto with increase inclination of op

Treatment plane

Scaling polishing

Filling composite for minimum invasive

teeth and amalgam for big cavities with

care to restore teeth morphology

Crowns No. 17,18 full coverage zerconium

(Chipping)

Mouth of fish morphology ?????

I have a bad habit I like fillings carving and polishing

Upper and lower brackets pre adjusted MBT

prescription 22slot , No 27 postponed bracket

bonding because deep bite

Mini implant and up righting device for No. 31

may we remove No.32

Ha Nitinoal 12 upper and lower wire with mid

line separation in lower initial treatment

Treatment plane

Treatment plane

New condylography at intermediate phase

of treatment and another one at final

treatment phase

Re evaluation of patient objective and

subjective findings during treatment

(muscles palp.,occlogram , brux cheker,

tracing and models

Coffee breakany where we need it

Case discussion

Question 1

Did my treatment plane

correct ??

Question 2

Did I select a proper

prescription????

MBT 22 SLOT ,LACE BACK ,TIE BACK

AMERICANORTHODONTICS COMPANY

I PREFER MORE

POSITIVE TORQ.

Q 3

DID MY MINI IMPLANT TEMERARY

ANQURAG UPRIGHTING DEVICE AN

ACCEPTED WAY

IT FROM TOMAS SYSTEM

(DENTARUM)

Q 5

DID I OPEN SPACE FOR CANINE OR 1ST MOLAR ?

GUIDENCS

ESTHETIC

SUPPORT

VD

OP

Q 6

DID I OPEN OR CLOSE SPACE?

GUIDENCS

ESTHETIC

SUPPORT

VD

OP

Question no 7

What will be expected prognosis of

clicking joint??

What will be expected changes will be

happened in CMS structure during

treatment?

Question no 9999

be cool it’s the last

Did any one still in the room? after too long presentation

Sorry for all

it's too poring

Thank you