Orthodontic treatment planning


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Introduction to Orthodontics
Fifth Year

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Orthodontic treatment planning

  1. 1. 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 treatment are:       Improve dental health Relieve crowding Correct the buccal occlusion Reduce the overbite Reduce the overjet Align the teeth The treatment plan should consider the following:      Oral health Lower arch Upper arch Buccal occlusion Choose the appliance
  2. 2. 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: 1. 2. 3. 4. Timing of treatment Complexity of treatment Predictability of success for given approach Patient's (parent's) goals and desires
  3. 3. Timing Orthodontic treatment possible at any age stage  Comprehensive Adolescence, adult  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 care.  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.
  4. 4.  Extraction of poor 1st permanent molars with balancing and compensating extraction.  Orthodontic treatment for irregularities of teeth and arch with fixed or removable appliance as necessary. Complexity      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 Patient`s goals  Interactive process: patient – doctor  Ethical and practical reasons - Success= satisfaction with outcomes - patient`s opinion is important: informed consent
  5. 5. Goals:     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 Treatment phase:  Interceptive treatment - Age 6-10 - Treat skeletal problem - Treat habits - Treat crowding - Removable appliances - Limited treatment time  comprehensive treatment - Age 11+ - Treat dental problem - Align teeth - Fixed appliances - Minimized treatment time
  6. 6. Interceptive treatment:  Treat for up to 12 months  Utilized mostly removable appliances Schwartz (upper and/or lower) Bite plate Headgear Face crib Habit breaker Auxiliary hooks for noodle elastics Removable expanders o o o o o o 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
  7. 7. Treatment plan 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 Panorama Cephalometrics Frontal 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.