TREATMENT PLANNING

Patient Parent consultationObtaining informed consentThe detailed planSpecifying Orthodontic Mechanotherapy

CRITICAL ISUES IN TREATMENT PLANNINGWhy treatment is needed ?Who should do it ?When is the best time to do it ?

NEED FOR TREAMENTIndications for Orthodontic treatmentPsychological IndicationsDevelopmental IndicationsFunctional IndicationsTrauma/ Disease control Indications

Type of treatmentEvidence-based selection

Problem-oriented approach

ORTHODONTIC TRIAGE Distinguishing moderate from complex treatment problemsSyndrome and development abnormalities

Facial disproportions & AsymmetriesFacial asymmetryAntero posterior or vertical problems

Excessive Dental Protrusion or RetrusionRecognition in the facial profile analysis

Bimaxillary Protrusion

Problems involving dental developmentAsymmetric permanent teethMissing permanent teethSupernumerary teethOther eruption problemsSpace problems

Other Occlusal discrepanciesTiming of treatment

TREATMENT PLANNING FOR PRESCHOOL CHILDREN (Primary Dentition)Alignment problemsIncisor Protrusion RetrusionPosterior cross biteAntero Posterior discrepanciesVertical problems

TREATMENT PLANNING FOR PREADOLESCENTS (EARLY MIXED DENTITION)MODERATE PROBLEMSI Space problemsMissing primary teeth with adequate space maintenanceLocalized space loss (3mm or less) space regainingGeneralized moderate crowding

II Irregular / Malpositioned incisorsSpaced & flared maxillary incisorsMaxillary midline diastemaAnterior crossbitePosterior crossbiteAnterior openbite Retained primary teeth & Ectopic eruption

SEVERE PROBLEMSSkeletal problemsDentofacial problems related to incisors protrusionSpace discrepancies of 5mm or more

Space discrepancies upto 4mm Non extractionSpace discrepancies 5-9mm without extraction or in same cases extraction of some teeth other than third molarSpace discrepancies of 10mm or more Require premolar extraction regardless of III molar eruption

SERIAL EXTRACTIONIndicated in the following casesNo skeletal disproportionsClass I molar relationshipNormal overbiteLarge perimeter deficiency (10mm / more)

The procedure consists of four stepsExtraction of primary lateral incisors- permanent central eruptExtraction of primary canines - permanent laterals eruptExtraction of primary I molarExtraction of the permanent first premolar

TREATMENT PLANNING FOR ADOLESCENTS (LATE MIXED & EARLY PERMANENT DENTITION)ALIGNMENT PROBLEMSCrowding & Protrusion

Less than 1.5mm is insignificant

There are five possible waysCompensate for a small size differential by changing the inclination of the incisorsReduce the width of some teeth by interproximal stripping of enamelBuild up the width of an anomalously small teeth or teeth by adding composite resinsAlter normal extraction plan to compensate for size discrepanciesAccept small space in one of the arches usually distal to lateral incisors

TRANSVERSE PROBLEMSSKELETAL DENTALANTERO POSTERIOR PROBLEMSGROWTH MODIFICATION FOR SKELETAL PROBLEMSCAMOUFLAGEVERTICAL PROBLEMSANTERIOR OPEN BITEDEEP OVERBITE

ERUPTION PROBLEMSImpacted teethGeneralize eruption failure

TRAUMATIC DENTAL DISPLACMENT & ANKYLOSISTREATMENT PLANNING FOR ORTHODONTIC PROBLEMS ON ADULTS

Adjunctive Vs Comprehensive Treatment