orthodontic Basic Priciples in Treatment Planning

7/29/2019 orthodontic Basic Priciples in Treatment Planning

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A treatment plan is a specific strategy to correct a problem , with

maximum benefits and minimum side effects to the patient.

The treatment planning is specifically designed to avoid both

under- and excessive treatment, while appropriately involving

the patient in the planning process.


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FIVE steps:

1. Management of pathological problems

2. Put the orthodontic problems in priority order

3. Note the treatment possibilities & Evaluate the possible solutions

4. Establish the treatment plan concept in an interactive session with

the patient and parents

5. Develop the detailed plan of clinical steps and procedures.


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Pathologic problems must be addressed before treatment of

orthodontic (developmental) problems can begin.

Any active disease or pathology must be under control before

treatment initiation. i.e caries, periodontal problems etc.

In complex cases, multi-disciplinary approach should be performed.


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Identify the most important problems, and the treatment plan must

focus on that problem.

The patient's perception of his or her condition is important in setting

these priorities.


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At this stage each problem is considered individually, and the

possible solutions are examined.

Broad possibilities, not details of treatment procedures, are what is

sought at this stage.

For example, in a deep-bite case, intrusion of incisors OR

extrusion of molars


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Discuss problem list outline with the patient/parents.

Discuss possible risks of treatment outcome.

Inform patient of the treatment alternatives.

Obtain written consent.


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The final step in planning treatment is specification of the treatment

method-in orthodontics, the mechanotherapy-that is to be used.

The selected treatment procedures must meet two criteria:

effectiveness in producing the desiredresult and efficiency in doing

so without wasting eitherdoctor or patient time.


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case:1

Age: 17yrs & 6months

Address: Peshawer


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Introduction

C/C

Labially placed canine

Medical/Surgical Hx:

Nil

Dental Hx:

Nil

Habits:

o Nil


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Clinical Examination

Profile: Straight

Transverse: symmetrical

Vertical: normal

Lips: competent

Nose: normal

Chin: Normal


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Front Front with Smile

Extra-oral


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Profile


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View View with Smile


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Front Over-jet

Intra-Oral


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Upper Occlusal Lower Occlusal


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Right Left


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Cast Analyses

ALD

Maxilla: -6 mm

Mandible: -5mm

Bolton analyses Anterior ratio: mandibular tooth material

excess of 2.1mm

Overall ratio: insignificant


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OPG


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Ceph


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Ceph AnalysesSagittal Analyses

SNA 81 82

SNB 78 80

ANB 3 2

Witts -2 to+2 -1

Na-A 0-1 +7

Na-Po -2 to +4 +16

Facial

angle87 89

Vertical Analyses

SN-PP 8 4

FMPA 25 11

SN-MP 32 25

PP-MP 27 18

Y-axis 59 50

LAFH/AFH 54% 55%

PFH/AFH 65% 72%

Linear Analyses

Co- A

length

98mm

Co-Gn

length

115-

118

128mm

Dento-Skeletal Analyses

UI-NA 22 26

UI-NA

Distance4mm

7mm

UI-PP 108 115

SN-UI 102 106

LI-NB 25 30

LI-NB

distance4

4mm

IMPA 90 105

UADH 30 26

UPDH 26 25

LADH 45 40

LPDH 35 34

UI-LI 135 124

Soft Tissue Analyses

Upper lip- EPlane

-3 -9mm

Lower lip- E

Plane

-2 -6

Upper Lip- S

line

0 -4

Lower Lip- S

line

0 -3

Naso-labial

Angle

102 97

Z angle 78 95Holdaway

ratio

1:1 1.3:1


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Problem list Oral Health-related problems

Carious lesions in UR6,7 LR6

Dental problems

Class II canine relation on left side

Lingual Crossbite UL4 Proclined incisors

ALD in Max -7mm and Mand -

5mm

Bolton discrepency

Soft tissue related problems

Retrusive lips


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Treatment planning

Treatment of carious lesions

Comprehensive orthodontic treatment:non-extraction pattern

Level & align both arches,correct upper arch crowding with arch

expansion. Stripping of lower incisors

Maintain ClassI molar relation

finish in ClassI canine & incisor relation

Retention with upper removable Hawley retainer & lower Fixed bonded

retainer.


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case:2

Age: 18yearsAddress: Peshawar


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Introduction

C/C

Upper front teeth are forwardly placed

Medical/Surgical Hx:

Nil

Dental Hx: Ortho treatment with fixed appliance was done in Islamabad 7years

back for 1year

Habits:

o Nil


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Profile: Convex


Vertical: Long

Lips: Incompetent

Nose: normal

Chin: normal


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Extra-oral


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Profile


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Front Over-jet

Intra-Oral


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Upper Lower

Occlusal View


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Right Left


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Smile Analysis

Frontal measurements at rest

Philtrum height 22mm

Commissure height 27mm

Interlabial gap 6mm

Amount of Incisor display 6mm

Frontal measurementsduring Smiling

Amount of incisor display+- gingival display full crown+

2.7mm gingiva

Crown Height & Width ratio 0.8

Smile arc flat

Buccal corridors 25%


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Cast Analyses

ALD Maxilla: +2.97 mm

Mandible: -5.46 mm

Bolton analyses

Anterior ratio: Insignificant


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OPG


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Ceph

C h A l


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SNA 81 82

SNB 78 73

ANB 3 9

Witts -2 to+2 4

Na-A 0-1 0

Na-Po -2 to +4 -13

Facialangle

87 83

Vertical Analyses

SN-PP 8 8

FMPA 25 28

SN-MP 32 34

PP-MP 27 26

Y-axis 59 64

LAFH/AFH 54% 59%

PFH/AFH 65% 65.7%

Linear Analyses

Co- A

length

95

Co-Gnlength

113-116

123


UI-NA 22 30

UI-NA

Distance

4mm10mm

UI-PP 108 125

SN-UI 102 119

LI-NB 25 29

LI-NB

distance

44mm

IMPA 90 101

UADH 30 36

UPDH 26 25

LADH 45 51

LPDH 35 37

UI-LI 135 106


Upper lip- EPlane

-3 +3

Lower lip- E

Plane

-2 0

Upper Lip- S

line

0 +7

Lower Lip- S

line

0 +2

Naso-labial

Angle

102 88

Z angle 78 61

Holdaway

ratio

1:1 4:9

UI-Stm 4mm 6mm


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Problem list Oral Health-related problems

Carious lesions in LL6,LR6,LL7,LR7

Skeletal problems

Class II bases

Increase lower anterior facial height

Dental problems

Class II div 1 malocclusion

Increase OJ (16mm) & OB(4mm)

V-shape upper arch

Proclined upper and lower incisors

ALD in Max. is +2.97mm & in Mand. is -5.46mm

Lower mid line shifted towards left3mm

Soft tissue related problems

Protrusive Upper lip

Incompetent lips

Wide buccal corridors

Flat smile arc

Acute Nasolabial angle


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Treatment planning

Treatment of carious lesions

Treatment strategy: surgical orthodontics[ BSSO with mandibular advancement+Lefort I with maxillary impaction]

Presurgical phase:

Ext. all 4sLevel and align both arches

Finish in Class II molar, canine and incisor relationship

Surgical phase:

LeForte I+BSSO

Post-Surgical

Occlusal settling with elastics

Finish in ClassI molar canine and incisor relation

Retention with upper removable Hawley retainer and Lower fixed bonded retainer


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Salman

case:3


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Introduction

Age: 19 yrs

Address: Peshawer

C/c

I have bite problem

Medical hx:

Nil

Dental hx:

Hx of trauma:

Fall from the roof at 2 yrs of age,resulting in mandiblefracture

Motor bike accident: at 11yrs of age, lower left 8 is extracted

Habits:

Nil


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Profile: Straight


Vertical: high

Lips: competent

Nose: normal

Chin:

normal


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Extra-oral


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Profile


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Front Over-jet

Intra-Oral


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Upper Occlusal Lower Occlusal


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Right Left


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Cast Analyses

Maxilla: -10.3 mm

Mandible: -4.7mm


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OPG


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Ceph

Ceph Analyses


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SNA 81 75

SNB 78 79

ANB 3 -4

Witts -2 to+2 -10mm

Na-A 0-1 -6mm

Na-Po -2 to +4 0

Facialangle

87 90

Vertical Analyses

SN-PP 8 5

FMPA 25 32

SN-MP 32 42

PP-MP 27 37

Y-axis 59 62

LAFH/AFH 55% 60.2%

PFH/AFH 65% 59%

Linear Analyses

Co- A

length

88mm

Co-Gnlength

111-114

140mm


UI-NA 22 30

UI-NA

Distance

4mm9mm

UI-PP 108 111

SN-UI 102 106

LI-NB 25 23

LI-NB

distance

45mm

IMPA 90 82

UADH 30 37mm

UPDH 26 31mm

LADH 45 41mm

LPDH 35 36mm

UI-LI 135 132


Upper lip- EPlane -3 -10mm

Lower lip- E

Plane

-2 0

Upper Lip- S

line

0 -4

Lower Lip- Sline

0 +3

Naso-labial

Angle

102 83

Z angle 78 78

Holdaway

ratio

1:1 5:3

UI-Stm 4mm 3mm


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Case summary

male pt,19yrs of age with a C/C of bite problem .he has previous history oftrauma,resulting in mandible fracture and ext of LL7?

Dentally, he has ClassIII Molar relation. He has anterior and posterior X-bite and AOB.UR3

is impacted . Upper midline is shifted towards Rt by 5mm.

ALD in Maxilla is -10.3mm and in Mandible it is -4.7mm.

Ceph analyses show ClassIII skeletal bases ,high-angle pattern , retroclined lower incisor ,

retrusive upper lip & acute naso -labial angle


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Problem list

Skeletal problems Class III bases due to maxillary difficiency

High-angle skeletal pattern

Dental problems

Impacted UR3

Anterior and posterior crossbite Class III relation

Anterior openbite

V-shape upper arch

Midline discrepency

Crowding in both arches

Retroclined lower incisors Soft tissue related problems

Retrusive upper lip

acute naso-labial angle


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Treatment planning

Surgical orthodontics : Le Fort I osteotomy with maxillary advancement and posterior

impaction

Pre-surgical phase

Ext U8s

RPE

Leveling and alignment of both arches,space opening for UR3,correct midline

Decompensate lower arch

Surgical phase; lefort I osteotomy

Post-surgical phase: occlusal settling, finishing in ClassI molar ,canine and Incisor

relation

Retention with upper removable Hawley retainer & lower fixed bonded retainer

orthodontic Basic Priciples in Treatment Planning

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