Orthodontist
Teeth Present:
Upper Right: 17, 16, 15, 14, 13, 12, 11
Upper Left: 21, 22, 23, 24, 25, 26, 27
Lower Left: 37, 36, 35, 34, 33, 32, 31
Lower Right: 41, 42, 43, 44, 45, 46, 47
Chief Concerns: Patient is concerned about the crowding of her upper and lower front teeth and wants to achieve a straighter smile. She also mentioned occasional clicking in her jaw.
Extraoral Examination
Skeletal Base (AP Relationship): Class I skeletal base with a slightly retrognathic mandible.
Vertical (FMPA): Average FMPA of 25 degrees, indicating a normodivergent facial pattern.
Lip Competency: Competent lips at rest with no strain.
Lip Trap: No evidence of lower lip trap.
TMJ: Mild clicking noted on right TMJ during opening, no pain reported.
Facial Symmetry: Symmetrical facial features.
Intraoral Examination
Oral Hygiene: Good oral hygiene with minimal plaque and no gingivitis.
Soft Tissues: Healthy soft tissues with no signs of pathology.
Upper Arch:
- Crowding: Moderate crowding in the labial segment (3mm).
- Labial Segment Inclination: Proclined upper incisors.
- Over-eruption: No significant over-eruption noted.
Lower Arch:
- Crowding: Moderate crowding in the labial segment (4mm).
- Over-eruption: No significant over-eruption noted.
Dentition: Permanent dentition present. Mild wear on incisal edges of lower anteriors.
Incisal Relationship: Class II Division 1.
Right Molar Relationship: Class I.
Right Canine Relationship: Class II.
Left Molar Relationship: Class I.
Left Canine Relationship: Class II.
Overjet: 4mm.
Overbite: 50% deep overbite, non-traumatic.
Crossbite: No crossbite present.
Mandibular Displacement: No mandibular displacement noted on closure.
Summary and Plan
Miss Eleanor Vance, a 15-year-old female, presents with concerns regarding crowded upper and lower front teeth. Clinical examination reveals a Class I skeletal base with a retrognathic mandible, Class II Division 1 incisal relationship, and moderate crowding in both arches. Her overjet is 4mm and she has a deep overbite of 50%. Her oral hygiene is good, and TMJ clicking was noted on the right side. The proposed treatment plan involves fixed orthodontic appliances for comprehensive alignment and correction of the malocclusion, likely requiring upper first premolar extractions to alleviate crowding and facilitate retraction of the proclined incisors. Following active treatment, retention will be maintained with fixed and removable retainers. Further investigation into the TMJ clicking will be carried out if symptoms worsen or become painful.
Patient/Parent Summary Letter
To: Eleanor Vance
From: Dr. Thomas Kelly
Date: 1 November 2024
Re: Summary of today's orthodontic appointment
Dear Eleanor Vance,
Thank you for attending your appointment today. This letter summarises what we discussed and the plan for your treatment.
Today we discussed your concerns about your crowded upper and lower front teeth. After a thorough examination, we found that your upper front teeth are a bit forward and your bite is deep. There is also some crowding in both your upper and lower arches. We observed a minor click in your right jaw joint, but you reported no pain.
To address these issues, we recommend treatment with fixed braces. This will help to straighten your teeth and improve your bite. It is likely that we will need to remove two of your upper back teeth to create enough space for your front teeth to move into their correct positions. Once your teeth are straight, you will need to wear retainers to keep them in their new positions. We will monitor your jaw joint, and if the clicking becomes painful or more frequent, we will investigate this further.
If you have any questions, please do not hesitate to contact the practice.
Yours sincerely,
Dr. Thomas Kelly
Consultant Orthodontist
