Orthodontic treatment planning
Treatment planning is the second most important part of orthodontic
management following the patient examination. It is divide treatment
planning into two sections, treatment aims and treatment plan.
Treatment aims (what do you want to do?) and plan (how are you
going to do it?)
Treatment aims will include, for example overjet reduction.
The plan will consider how to create space in order to accomplish
this as well as the appliance system that will be used.
Some of the problems that may need to be addressed during the
Improve dental health
Correct the buccal occlusion
Reduce the overbite
Reduce the overjet
Align the teeth
The treatment plan should consider the following:
Choose the appliance
Developing a treatment strategy:
1. Collection of data
2. Create problem list
3. Prioritize problem list
4. Develop treatment options [what is best for patient?]
5. Define specific treatment plane
Factor which determine the decision to give orthodontic Tx:
1. Nature of malocclusion and its impact on patient`s mind,
appearance, mastication, speech and durability of dentition.
2. Age of the patient and cooperation expected.
3. Prognosis expected.
4. General physical condition of patent e.g. mentally ill and epileptic
children may be left alone.
5. Oral hygiene, conditions of teeth, resorption, carious status,
hypoplasia etc. and condition of gingival and periodontium.
Other factor to consider for optimal Tx:
Timing of treatment
Complexity of treatment
Predictability of success for given approach
Patient's (parent's) goals and desires
Orthodontic treatment possible at any age stage
Two stage (early interventiuon)
1) Childhood; 2)adolescence
Problem of increased severity, immediate need
Children under 5y of age:
Encourage to maintain good oral hygiene and dental
Resorption of arch in cleft lip and cleft palate cases.
Children of 5-8y of age:
Space maintainer, guided eruption, disking etc.
Management of traumatic incisor and early straightening
of permanent incisors.
Dealing with abnormal fraenum.
Dealing with extra teeth, missing teeth and timely
removal of deciduous teeth.
Correction of incisors relation in class III and cleft cases
Dealing with the upper and lower jaw discrepancies
(anterior-posterior and lateral) by providing orthopedic
appliance, headgear, chin-cap etc.
Children of 8-12y of age:
Dealing with sucking habits and abnormal lip action.
Serial extraction procedure.
Extraction of poor 1st permanent molars with balancing and
Orthodontic treatment for irregularities of teeth and arch with
fixed or removable appliance as necessary.
Influence treatment planning
Less complex: treatment potential in general practice
More complex: referred to specialist orthodontics only
Orthodontics with orthognathic surgery
Where to draw line?
Predictability of treatment
If options, which best?
Evidence based studies best resources
Interactive process: patient – doctor
Ethical and practical reasons
- Success= satisfaction with outcomes
- patient`s opinion is important: informed consent
Develop and follow logical treatment plan.
Treat patient is estimated treatment time or less.
Minimize detrimental and iatrogenic side effects.
Anticipate problem in treatment plan
- Age 6-10
- Treat skeletal problem
- Treat habits
- Treat crowding
- Removable appliances
- Limited treatment time
- Age 11+
- Treat dental problem
- Align teeth
- Fixed appliances
- Minimized treatment time
Treat for up to 12 months
Utilized mostly removable appliances
Schwartz (upper and/or lower)
Auxiliary hooks for noodle elastics
Well tolerated at this age
Less invasive than fixed expanders
Limited space gain
Depends on patient cooperation
Usually 90% require phase II treatment
With initial crowding may require 2x4
Comprehensive Tx (fixed appliances)
Appliance on all permanent teeth
Minimize treatment time ( >24 months)
Minimized elastic / A chain use
Move posterior teeth + canines on small arch
wire for sliding mechanics
- Retract incisors on large, torqued arch wires
- All patients should be on a fluoride Rx
List existing problem
List proposed treatment
List potential treatment and informed consent
Steps of treatment planning
First evaluate the diagnostic record such as
Intra oral photo
Extra oral photo
Cast (cast analysis, other tooth displacement such as crossbite
overet, ectopic eruption….)
Basic sequence of treatment with FA
Level and align. This phase established preliminary bracket
alignment with a light round wire.
Working archwires. This phase corrects vertical discrepancies (I.e.,
open bite) and sagital position of teeth by using a heavy round
wire or rectangular archwire.
Finishing archwire. This phase idealize the position of teeth by
using light round archwires.
Retention, retention of teeth in their final position by either fixed
or removable retainers.