ALKHINA OLGA 351494 (2)

Age: 37 YO
Occupation:
Date of the first visit: JULY 2020
Chief Complaint: PAIN IN LEFT JOINT

NAP

Occlusogram

Frontal View

45˚ View
Patient’s picture, with/without smile

Profile
Patient’s picture, with/without smile

Frontal View Intraoral

Lateral View
right
left

Overjet and Overbite

Occlusal View of the Upper Arch

Occlusal View of the Lower Arch

Panoramic X-Ray – Pre tx

Right and Left Joints

Upper Cast, Occlusal View

Lower cast, occlusal view

RP mounted casts, frontal view

RP mounted casts, lateral view

RP mounted casts, posterior view

ICP Mounted casts, frontal view

ICP Mounted casts, lateral view

Curve of Spee

Curve of Wilson

Bruxcheckers Upper

Bruxcheckers Lower

Anterior control

CANINE GUIDANCE=49.2°

CANINE GUIDANCE=47.8°

Lateral cephalometric X- Ray

Cadias tracing

SCI = 52.3
OP = 8.1
RCI =44.1 R =42.9 Left =45.4
AOD =44.1 -30 =14.1
AOD R =12.9 , L =15.4
S-AOP =54.1
RAG = 46.0
LFH =46.4

ODI: 66.1 ( Open bite )
APDI:78.6 ( Class I, tend II )
FH-MP:21.7 ( Low angle )
LFH:46.4 ( Slightly increased)

CPM

Pro/Re
GUIDED
GUIDED
GUIDED
GUIDED
guided
GUIDED

Open/Close
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
guided
GUIDED

Medio right
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
guided
GUIDED

Medio left
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
GUIDED
guided
GUIDED

Bruxism

Overlay Pro/Brux

Retral Stability

Free movements

Phonetics
60-50
70-60
60-50
70-60
80-70
60-50
70-60
80-70
80-70
70-60
60-50
70-60
60-50
70-60
60-50
70-60
60-50
60-50
70-60
60-50
80-70
70-60
80-70
60-50
60-50
70-60
80-70

Overlay Pro/ Phonetics

Deglutition

Overlay Pro/Deglutition

Mastication right

Mastication left

Articulator settings

Incisal pin table

Extraoral findings:
Neck tilts to the left.
Straight profile.
Intraoral Findings:
Upper midline is 3mm to the right.
14 is missing ( extracted ).
Left side: Class I molar, Class III canine relationship, Right side : Class I molar and canine relationship.
Enamel wear on U/L anterior teeth and at the buccal surface of the lower premolars and molars.
Crowding in the LA.
Model Findings:
In RP: Same as intraoral.
No intercoronal space.
Upper midline 3mm to the right.
Poor posterior occlusal support.
Flat curve of Spee.
Negative Wilson curve.
Bruxchecker Findings:
Strong anterior interference between 12-43.
A contact interference on premolars and molars ( negative Wilson curve )
Tip- tip bruxism pattern on canines ( Steep canines )

Radiographic findings:
Mesially inclined psterior teeth.
48 is present .
Rc Tx on 16, 22.
Condylographic Findings:
CPM: RCP-ICP, RP-Forced bite : Compression in the right joint, RP- Resiliency : Reduced in the left joint
ΔΥ to the left.
Increased Bennett angle in the right joint ( Loose joint )
No resurtrusive movement in both joints during mediotrusive movements ( after correction of the intercondylar distance 95mm ) and mastication ( posteriorly displaced condyles ).
Poor retral stability.
Compression in the right joint during bruxism and deglutition.
Cephalometric findings:
SCI 52.3 ( R:51.0 , L: 53.5 0
OP 8.1
Average AOD 14.1 ( R:12.9, L:15.4 )
Average anterior guidance S-AOP 54.1
Slightly increased LFH 46.4 ( 43.2 ), reduced mandibular plane FH-MP 21.7
ODI 66.1 ( Open bite ), APDI 78.6 ( Class I , tendency Class II )

Subjective Problem List:
Pain in the left joint
Objective Problem List:
14 is missing , upper midline is shifted 3mm to the right.
Right side : Class I molar, Class III canine relationship, Left side : Class I molar and canine relationship.
No intercoronal space, poor posterior occlusal support, negative Wilson curve
ΔΥ to the right.
Compresion in the right joint.
Increased Bennett angle in the right joint( loose joint ).
Lack of resurtrusive movement of both condyles during mediotrusive movements and mastication ( posteriorly displaced condyles )
Poor retral stability.

Treatment objectives
RP is DRP. Define TRP.
Unload both joints.
Bring anteriorly both condyles.
Correct upper midline.
Open space for an implant to restore missing 14.
Make POP steeper ( Reduce AOD) to allow posterior adaptation of the mandible( In TRP mandible comes forward in a Class III relationship)
Provide Class I sequential occlusion with good posterior occlusal support, proper intercoronal space, proper anterior guidance.

TRP
R ( O/C 3)
S: 2.24mm, SCI: 63.32
X: 1.01mm
-Y: 0.53mm
Z: 2.01mm
L ( O/C 3 )
S: 3.13mm, SCI: 65.72
X: 1.24mm
Y: -0.51mm
Z: 2.86mm

TRP