1、正畸B組第1小組 SummaryKey information long face16-year-old girl from northeastfamilyhistory taciturnityCome with her momWeekend-opendmain troubleHyperosteogenied Mandibular mandibular protrusionAll above？High Angle underbiteHereditycircumstance ：Congenital（Macroglossia disease）Acquired（1）hyperpituitarism（

2、2）maxillary deciduous teeth early-missed、retention、Inadequate canine abrasion （3）early maxillary permanent teeth eruption（4）functional factor ：suckle、hypertrophyoftonsil、muscle dysfunction（5）bad haditOther information needed（1）Inquiry：systemicdisease、bad hadit、already treatment、Duration、family histo

3、ry、psychologicalguidance（2）inspection ：inside check：tooth count 、tooth shape、Oral hygiene 、dental arch shape、occlusal status 、Soft tissue lesionsoutside check：photograph、Symmetric face？proportion ?overlength lowed 1/3？auxiliaryexamination：X-ray：Panoramic radiograph examinationlateral cephlometricsCT

4、Other check:model analysisTMJ checkmuscular tension checkExtra oral photographs：Frontal view： horizontal：Facial is asymmetry, and it moves to right side vertical：partial length is in the 1/3 lower faces lip : the degree of closure、underlip is thicker than upper Lateral view ： facial morphology ：conc

5、ave type lip : the degree of closure、H line ，E linementolabial sulcus：shallow 、 Mandibular advancement Intra oral photographs：Frontal view ： overbite in anterior 22、23、32、33 open bite distema in 11 and 21 crowded in maxillaryLateral view ：angle ， anterior teeth is reverse overjet and reverse overbit

6、e maxillary anterior teeth ：labial inclination mandibular anterior teeth ：lingual inclination Occlusal view： dental archs are oval，crowding in the maxillary. maxillary central incisor ：torsionoral hygiene ：poorPeriodontium：healthy gingivaAlveolar bone ：the labial bone of mandible is thinLabial frenu

7、m 、 linguae frenum ： normalsoft and hard tissuesPantomography：impacted teeth：18、28、38、48 normalThe measurement itemsPermanent teeth periodsignificancemeasured value normal valueSNA 88 82.8 maxillaryprotrusionSNB 94 80.1 Mandibular protrusionANB -6 2.7 Negative，mandibular protrusionWits-17mm 85.4 man

8、dibular protrusionY axis67 66.3 mandibular protrusion; Growth before the bottomNA-PA-7 31.1 Steepness of mandibular body, large mandibular Angle, high facial heightThe measurement itemsPermanent teeth period significancemeasured value normal value Max1-SN128 105.7 maxillary central incisor is labial

9、 inclinationMand1-MP66 22.8 maxillary central incisor is labial inclination and bulgingMax1-NA9mm 5.1mmmaxillary central incisor is labial inclination and bulging is largeMand1-NB16.7 125.4 Up and down the front of the dental arch degree is relatively smallThe measurement items Permanent teeth perio

10、d significance measured value normal valueN-Me122mm 119.7mmThe height of the face is more than normalN-ANS52mm 65.8mmpartial length is in the 1/3 lower faces N-ANS/ N-Me 43% 55%partial length is in the 1/3 lower faces1、maxillary retrusion ，mandibular protrusion2、maxillary central incisor is labial i

11、nclinationmandibular central incisor is lingual inclination3、The height of the face is more than normal， maxillary growth is Inadequate, partial length is in the 1/3 lower facesConclusiontherapeutic regimenORTHODONTIC-ORTHOGNATHIC SURGERY option1Indication Class III ,mesioclusion (ANB-4,upper inciso

12、r is obviously labial tilted，lower incisor lingual tilted，anterior of deep reverse overjet)Pre-surgical orthodontic treatment AlignmentLevelingIncisal position and space closure Coordination of dental arches and coorrection of posterior crossbiteAccording to movements and decompensation of teeth , i

13、ts benificial to move bones.orthognathic surgerySagittal splint ramus osteotomyPost-surgical orthodontic treatmentAlignmentSpace closingLevelingAdjustment of anteropoetreior position incisorsCoordination of dental archesRetention MaintainerChincap CAMOUFLAGEoption2Tooth extractionincluding 2 maxillary second premolar and third molar 2 mandibular first premolars extraction and third molarcould prevent upper incisors from uprighting and change the incisor positionmaxillar protractionImplant as skeletal anchorage for maxilla protraction is an effective and stable cl