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 incisorspermanent 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

TRANSVERSE PROBLEMS
SKELETAL
DENTAL
ANTERO POSTERIOR PROBLEMS
GROWTH MODIFICATION FOR SKELETAL
PROBLEMS
- CAMOUFLAGE
C. VERTICAL PROBLEMS
- ANTERIOR OPEN BITE
- DEEP OVERBITE
A.
B.
-

ERUPTION PROBLEMS
Impacted teeth
Generalize eruption failure

TRAUMATIC DENTAL
DISPLACMENT &
ANKYLOSIS

TREATMENT PLANNING FOR

ORTHODONTIC PROBLEMS ON
ADULTS

Adjunctive Vs Comprehensive Treatment