Case history and diagnosis
A 25-year-old female patient presented for treatment with the chief complaint of forwardly placed upper front teeth. Extraoral clinical examination at rest revealed facial symmetry with equal vertical facial thirds. The smile analysis showed a coincident upper dental midline with the facial midline, a high lip line with increased gum show, as well as a straight smile arc. The patient presented with a mild convex profile with average clinical FMA, a protrusive upper lip with potentially competent lips. Intra-oral examination revealed class II canine and molar relationship bilaterally, increased overjet of approximately 10mm, deep impinging bite, coincident upper and lower dental midlines. The arch forms were V shaped in the upper arch and ovoid in the lower arch. Arch length tooth size analysis showed crowding in upper arch of 2mm and crowding in lower arch of 6 mm. Periodontal biotype and oral hygiene were fair. No signs of parafunctional habits were recorded. Panoramic radiography revealed full dentition, lack of bone defects, no periapical lesions and no temporomandibular joint abnormalities, with the presence of four wisdom teeth. (Fig. 1)
Cephalometric analysis (Table 1) revealed a Skeletal class I base with average ANB angle and normal facial height with an average growth pattern. Dentally, the upper incisors were forwardly positioned and proclined, while the lower incisors were upright with a decreased interincisal angle. Soft tissue analysis showed acute nasolabial angle with protrusive upper lip. The patient’s Angle classification was dental Class II division 1 with upper segments positioned anteriorly.