Case Review D,E,F,G

Session 3-
2022-2023
HOMEWORK!
Please complete four cases (D,E,F,G) before Session #3
ASSESSMENT IS BASED ON CLINICAL SIMULATION CASES

1. MALOCCLUSION
Identify normal occlusion or Angle classification of malocclusion
and describe the evidence-based rationale for your diagnosis.
2. SKELETAL PROBLEM
Identify normal or abnormal skeletal pattern and describe the
evidence-based rationale for its clinical significance.
3. TREATMENT PLAN
List the treatment/management plan i.e. services needed to address
patient’s clinical problems and describe why each service is
necessary.
4. SPACE MANAGEMENT
Describe space management decision in the upper arch and explain
the evidence-based rationale for your decision.
5. SPACE MANAGEMENT
Describe space management decision in the lower arch and explain
the evidence/based rationale for your decision.
PROCESS- PAUSE AFTER SIGNIFICANT FINDINGS TO
CONSIDER AN ARGUMENT TO EXPLAIN/JUSTIFY THE
PROBLEM
1.Count/map the teeth from midline by quadrant
2.Record anterior occlusion
1.Vertical: Overbite (‒ anterior open bite)
2. Sagittal: Overjet (‒ anterior crossbite)
3. Transverse: Midlines
3.Look at sagittal posterior Class I, II, III occlusion
1. Second premolar
2. Canine
4.Look at skeletal pattern-Record skeletal problem (Must be
clinically significant. Does it contribute to malocclusion or
facial deformity?-There is not always a skeletal problem)
5.Record malocclusion (Angle Classification)
6.Review Target
The student will be able to:
1. Elicit and record patient’s concerns
2. Recognize and record dental/occlusal conditions that are risk factors for malocclusion/dysfunction
A. Malocclusion
B. Tooth malposition associated pathology or dysfunction
C. Tooth malposition adjacent to an extraction site that would affect prosthodontic treatment
D. Tooth malposition related to supra eruption [hyperocclusion] EVALUATIVE
E. Tooth malposition related to trauma
F. Impacted teeth CRITERIA
“TARGET”
G. Developing teeth that are in poor positions and at risk for impaction
H. Missing teeth
I. Supernumerary teeth
J. Disturbances of dental development
K. Over retention of primary teeth
L. Premature loss of primary teeth Criteria
M. Ankylosed teeth
N. Tooth malposition related to abnormal functional conditions (listed in #5)
3. Recognize and record occlusal conditions that are risk factors formalocclusion/dysfunction
A. Overbite [Severe= 100%]
B. Overjet [Severe= 5+ mm]
Objectives
C. Open bite
D. Dental Crowding [Severe= 5+ mm]
E. Dental Spacing [Severe= 5+ mm]
F. Crossbite Goals
4. Recognize and record skeletal conditions that contribute to malocclusion and/or facial deformity
A. Skeletal Class II, Class III
B. Facial Asymmetry
C. Vertical Maxillary Excess
D. Skeletal Open Bite [Hyperdivergent]
E. Skeletal Deep Bite [Hypodivergent]
5. Recognize and record functional conditions that are risk factors for malocclusion/dysfunction
A. Labial incompetence
B. Oral Habits
C. Abnormal swallow
D. Abnormal breathing
E. Bruxism
F. Clenching
G. Functional mandibular shift
6. Record an appropriate problem list and treatment objectives
7. Record an appropriate sequential treatment plan
8. Make appropriate space management decisions for patient care :
• No space management required- Monitor/Observe
• Space maintenance (passive appliance)
• Space gaining (active appliance or IPR, extraction)
• Space closure or redistribution of spaces (active appliance or prosthesis)
CASE D
35 YEARS OLD
AFRICAN
AMERICAN FEMALE
PDH: MISSING
TEETH, EXTENSIVE
DENTAL WORKS,
HEALTH GUM
CC: “I DON’T LIKE
THE GAPS BETWEEN
MY TEETH”
 SM I LE & PROFI LE

Normal skeletal, no orth.

surgery
 Missing:
-1 and 2
-4
-13
-16 OCCL

-17
-29
-32

Space closure/redistribution needed

-Major generalized spacing in maxillary
-Spacing in posterior mandibular
 -Mod overjet
-Mod overbite

DENTI TI ON

right side -
molar class III occlusion
canine class I

left side -
molar class II occlusion
class I

because of the spacing the

molars arent reliable

Class I maloclussion
 TOOTH MALPOSITION
• Vertical- up/down
• “supra (super)/infra”
• Mesio-distal tilt
• “angulation-tip (axial inclination)”
• Facial-lingual tilt
• “inclination procline/retrocline”
• “torque”
Transverse-Occlusal view
• “In/Out”
• “Rotation”
TOOTH MALPOSITION

Facial-lingual
inclination
“procline/
retrocline”
“torque”
 M ODELS

TOOTH MALPOSITION
Vertical- up/down
“supra (super)/infra”
 OCCL

TOOTH MALPOSITION
Transverse-
Occlusal view
“In/Out”
“Rotation”
 PAN

Mesio-distal angulation
(axial inclination)”
Problem List Treatment Objectives Treatment Plan

1. Malocclusion?

2. Skeletal problem?

3. OB/OJ

4. Habits?

5: Disturbances of
development?
6. Spacing/Crowding?

7. Tooth malpositions?
1. MALOCCLUSION
Identify normal occlusion or Angle classification of malocclusion and
describe the evidence-based rationale for your diagnosis.
2. SKELETAL PROBLEM
Identify normal or abnormal skeletal pattern and describe the evidence-
based rationale for its clinical significance.

Skeletal Class I coincides with Class I maloclussion.

Hypodivergent but no signi cant

3. TREATMENT PLAN
List the treatment/management plan i.e. services needed to address
patient’s clinical problems and describe why each service is necessary.

Comprehensve Orthodontic Treatment

Malocclusion Comprehensive
Orthodontic
(Complex) Treatment

Minor tooth Limited

Orthodontic
movement Treatment

Skeletal
Growth
Problem- Child, Modification
Adolescent

Skeletal Orthognathic
Problem-Adult Surgery

AND-pain,
pathology, Endo, Perio,
Restorative, Oral
dysfunction, Surgery etc.
esthetics, etc
 SPACE MANAGEMENT IS
A TWO STEP PROCESS
1. Report-Spacing or Crowding?
-Mild, Moderate, Severe
2. Consider- Tooth movement for treatment
objectives?
-Do you have enough space?
3. If COT- Space gaining or
closing/redistribution in BOTH arches
4. SPACE MANAGEMENT
Describe space management decision in the upper arch and explain the
evidence-based rationale for your decision.

Space closure needed. Possible prosthetic treatment

needs to be done.
5. SPACE MANAGEMENT
Describe space management decision in the lower arch and explain the
evidence/based rationale for your decision.

Space closure needed. Possible prosthetic treatment

needs to be done.
Age: 9½ years old male I NTRO

PMH: Asthma (taking Proventol)

Seizure disorder
Attention Deficit Disorder
(Ritalin)
Developmentally
immature

PDH: Thumbsucking,
anterior tongue thrust

CC: “My front teeth don’t come

together.”
SM I LE AND PROFI LE
Max: 1 and 2 are impacted, 3, A, B, C, 7, 8, 9, 10, H, 12,
J, 14, 15 and 16 are impacted

Mandibular: 17 and 18 are impacted, 19, K, 21, M, 23,

24, 25, 26, R, 28, T, 30, 31 and 32 are impacted OCCLU SAL
Anterior open bite
Posterior crossbite
Moderate Overjet mandibular functional shift to the right
FRONTAL
Posterior cross bite

Canine Class I maloclussion

BU CCAL
Skeletal Class I due to occlusion

CEPH
Problem List Treatment Objectives Treatment Plan

History, Pain, Pathology,

Dysfunction, Concerns…
1. Malocclusion?

2. Skeletal problem?

3. OB/OJ?

4. Midlines?

5. Spacing/Crowding?

6: Disturbances of
development?
7. Habits? Concerns?
1. MALOCCLUSION
Identify normal occlusion or Angle classification of malocclusion and
describe the evidence-based rationale for your diagnosis.
2. SKELETAL PROBLEM
Identify normal or abnormal skeletal pattern and describe the evidence-
based rationale for its clinical significance.
3. TREATMENT PLAN
List the treatment/management plan i.e. services needed to address
patient’s clinical problems and describe why each service is necessary.

COT

Malocclusion Comprehensive
Orthodontic
(Complex) Treatment

Minor tooth Limited

Orthodontic
movement Treatment

Skeletal
Problem- Growth
Child, Modification
Adolescent

Skeletal Orthognathic
Problem-Adult Surgery

AND-pain,
pathology, Endo, Perio,
Restorative, Oral
dysfunction, Surgery etc.
esthetics, etc
4. SPACE MANAGEMENT
Describe space management decision in the upper arch and explain the
evidence-based rationale for your decision.

Space gaining in maxilla

Space closure in mandible
5. SPACE MANAGEMENT
Describe space management decision in the lower arch and explain the
evidence/based rationale for your decision.
A
T
N
O
R
F

10 year old female

PMH: Allergies, tonsils and
adenoids removed at age 2
PDH: Mouth breather, thumb
sucker
CC: ”I don’t like my teeth
sticking out.”
E
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H
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M
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T
R
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C
1. MALOCCLUSION
Identify normal occlusion or Angle classification of malocclusion and
describe the evidence-based rationale for your diagnosis.
2. SKELETAL PROBLEM
Identify normal or abnormal skeletal pattern and describe the evidence-
based rationale for its clinical significance.
3. TREATMENT PLAN
List the treatment/management plan i.e. services needed to address
patient’s clinical problems and describe why each service is necessary.

Malocclusion Comprehensive
Orthodontic
(Complex) Treatment

Minor tooth Limited

Orthodontic
movement Treatment

Skeletal
Problem- Growth
Child, Modification
Adolescent

Skeletal Orthognathic
Problem-Adult Surgery

AND-pain,
pathology, Endo, Perio,
Restorative, Oral
dysfunction, Surgery etc.
esthetics, etc
3. TREATMENT PLAN
List the treatment/management plan i.e. services needed to address
patient’s clinical problems and describe why each service is necessary.

Malocclusion Comprehensive
Orthodontic
(Complex) Treatment

Minor tooth Limited

Orthodontic
movement Treatment

Skeletal
Problem- Growth
Child, Modification
Adolescent

Skeletal
Orthognathic
Problem- Surgery
Adult

AND-pain, Endo, Perio,

pathology, Restorative,
dysfunction, Oral Surgery
etc.
esthetics, etc
4. SPACE MANAGEMENT
Describe space management decision in the upper arch and explain the
evidence-based rationale for your decision.
5. SPACE MANAGEMENT
Describe space management decision in the lower arch and explain the
evidence/based rationale for your decision.
G Case 225
1. MALOCCLUSION
Identify normal occlusion or Angle classification of malocclusion and
describe the evidence-based rationale for your diagnosis.
2. SKELETAL PROBLEM
Identify normal or abnormal skeletal pattern and describe the evidence-
based rationale for its clinical significance.
3. TREATMENT PLAN
List the treatment/management plan i.e. services needed to address
patient’s clinical problems and describe why each service is necessary.
4. SPACE MANAGEMENT
Describe space management decision in the upper arch and explain the
evidence-based rationale for your decision.
5. SPACE MANAGEMENT
Describe space management decision in the lower arch and explain the
evidence/based rationale for your decision.
 HOMEWORK FOR ALL AND
COLD-CALL FOR SOME….
Session Cases On-Call
Session 2 A,B,C A

Session 3 D,E,F,G B

Session 4 H,I,J,K A

Session 5 L, M, N B