TREATMENT PLANNING

1. Patient Parent consultation

Obtaining informed consent
2. The detailed plan
Specifying Orthodontic Mechanotherapy
 CRITICAL ISUES IN
TREATMENT PLANNING

1. Why treatment is needed ?

2. Who should do it ?
3. When is the best time to do it ?
 NEED FOR TREAMENT
Indications for Orthodontic treatment
a. Psychological Indications
b. Developmental Indications
c. Functional Indications
d. Trauma/ Disease control Indications
 Type of treatment
Evidence-based selection

Problem-oriented approach
ORTHODONTIC TRIAGE

Distinguishing moderate from

complex treatment problems
Syndrome and development
abnormalities
 Facial disproportions &
Asymmetries

Facial asymmetry
Antero posterior or vertical problems
 Excessive Dental Protrusion or
Retrusion

Recognition in the facial profile analysis

Bimaxillary Protrusion
 Problems involving dental
development
Asymmetric permanent teeth
Missing permanent teeth
Supernumerary teeth
Other eruption problems
Space problems
Other Occlusal discrepancies
Timing of treatment
TREATMENT PLANNING FOR
PRESCHOOL CHILDREN
(Primary Dentition)
Alignment problems
Incisor Protrusion Retrusion
Posterior cross bite
Antero Posterior discrepancies
Vertical problems
TREATMENT PLANNING FOR
PREADOLESCENTS (EARLY
MIXED DENTITION)
MODERATE PROBLEMS
I Space problems
a. Missing primary teeth with adequate
space maintenance
b. Localized space loss (3mm or less) space
regaining
c. Generalized moderate crowding
II Irregular / Malpositioned incisors
a. Spaced & flared maxillary incisors
b. Maxillary midline diastema
c. Anterior crossbite
d. Posterior crossbite
e. Anterior openbite
Retained primary teeth & Ectopic eruption
 SEVERE PROBLEMS
a. Skeletal problems
b. Dentofacial problems related to incisors
protrusion
c. Space discrepancies of 5mm or more
 Space discrepancies upto 4mm Non
extraction
Space discrepancies 5-9mm without
extraction or in same cases extraction of
some teeth other than third molar
Space discrepancies of 10mm or more
Require premolar extraction regardless of
III molar eruption
 SERIAL EXTRACTION
Indicated in the following cases
1. No skeletal disproportions
2. Class I molar relationship
3. Normal overbite
4. Large perimeter deficiency (10mm / more)
 The procedure consists of four
steps
Extraction of primary lateral incisors-
permanent central erupt
Extraction of primary canines - permanent
laterals erupt
Extraction of primary I molar
Extraction of the permanent first premolar
TREATMENT PLANNING FOR
ADOLESCENTS (LATE
MIXED & EARLY
PERMANENT DENTITION)

ALIGNMENT PROBLEMS
Crowding & Protrusion

Less than 1.5mm is insignificant

 There are five possible ways
1. Compensate for a small size differential by
changing the inclination of the incisors
2. Reduce the width of some teeth by interproximal
stripping of enamel
3. Build up the width of an anomalously small teeth or
teeth by adding composite resins
4. Alter normal extraction plan to compensate for size
discrepancies
5. Accept small space in one of the arches usually
distal to lateral incisors
A. TRANSVERSE PROBLEMS
- SKELETAL
- DENTAL
B. ANTERO POSTERIOR PROBLEMS
- GROWTH MODIFICATION FOR SKELETAL
PROBLEMS
- CAMOUFLAGE
C. VERTICAL PROBLEMS
- ANTERIOR OPEN BITE
- DEEP OVERBITE
 ERUPTION PROBLEMS
Impacted teeth
Generalize eruption failure
 TRAUMATIC DENTAL
DISPLACMENT &
ANKYLOSIS
TREATMENT PLANNING FOR
ORTHODONTIC PROBLEMS ON
ADULTS

Adjunctive Vs Comprehensive Treatment