timing of orthodontics treatment, envelop of discrepancy.

1. Treatment Planning
Dr. Shweta Kolhe
BDS, MDS(Orthodontist)

2. Introduction
• Outline of all the measurement that can be best instituted for
a patient so as to offer maximum, long-term benefits.
• No cook-book approach exists
• At the end of the diagnosis process the following should have
established- - clinical summary - comprehensive list of
patient’s problems (diagnosis)
• Each case should be assessed & customized treatment plan
formulated to suit the individual patients.

3. Timing of orthodontic treatment
• Many traits of the malocclusion are often seen in early part of
mixed dentition.
• Benefits of starting early treatment:
1. Reduced risk of trauma associated with proclined anterior.
2. Possible to utilize growth
3. May reduce need for extraction in future by expansion
procedures and growth modification.
4. Improve psychological benefits & self esteem
5. Often reduce need for long term future treatment.

4. Disadvantages of early treatment:
• Treatment duration may prolong as most case often need
second phase of treatment in permanent dentition phase.
• By prolonging treatment patients compliance is often
problem.
• Need prolong retention.

5. Ideal time to start treatment:
• Growth modification treatment :
– Late mixed dentition period before the shedding of second
deciduous molars.
• Routing orthodontic treatment :
– Best initiated in the early permanent dentition period.

6. Setting up goals
• From patients point’s of view:
– Basic need is to improve esthetics and functions.
• Orthodontics has additional goals :
– Providing quality treatment that remain relatively
– Achieve aesthetics, functions & stabiity.

7. Enlisting the treatment objectives
• Enlist the problem in decreasing order of priority.
• Helps to setting up objectives and coming up with possible
solution.
• Patients chief complaints and parental desires should be given
additional importance.
• Orthodontics must be realistic to level of competence, patient
co-operation, etc.,.

8. Assessment of growth potential
• Growth status of an individual is an important factor.
• Patients with growing age has numerous treatment option -
- Orthodontist can modulate growth of dento-facial
structure.
- Orthodontist can guide teeth into more favorable
position.
• In adult -
- treatment options are limited to moving teeth and
surgical correction.

9. Envelope of discrepancy.
• Proffit and Ackerman introduced the concept of the envelop of
discrepancy to graphically illustrate how much change can be
produced by various types of treatment.
• Diagrams helps simplify the relationship of the three basic
treatment possibilities for skeletal discrepancies.
– Inner circle or envelop – limits of camouflage, involving on
orthodontics
– middle envelop – limits of combined orthodontic treatment and
growth modifications.
– Outer envelop – limits of surgical correction.

10. Range of movements in antero-posterior and
vertical direction in incisal region.

11. Range of movements in antero-posterior and
vertical direction in incisal region.

12. Range of movements
in transverse and
vertical direction in
posterior region.

13. Range of movements
in transverse and
vertical direction in
posterior region.

14. Thank you