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.