10 - Treatment planning

Question 1

What is involved in an orthodontic diagnosis?

Answer 1

• description of the malocclusion
• the cause of the malocclusion (eg spacing, crowding, digit sucking)
• dentoalveolar or skeletal origin

Question 2

What can be used to aid diagnosis?

Answer 2

• lateral ceph
• PA ceph (rare)

Question 3

What are the objectives of orthodontic treatment?

Answer 3

• stable
• functional
• aesthetic
• facilitate other forms of dentistry

Question 4

What are aims of a full correction of a malocclusion?

Answer 4

• class I incisor relationship (OJ/OB normal)
• class I canine relationship
• class I molar relationship (can accept class II)
• no rotations, spaces and flat occlusal plane

Question 5

What are the aims of a compromised treatment?

Answer 5

• correct certain aspects whilst accepting others
• may have to work within adverse skeletal pattern and leave residual OJ

Question 6

How do you structure orthodontic treatment planning?

Answer 6

• plan around lower arch as angulation is most stable
• build upper arch around lower
• aim for class I incisor and canine relationship
• decide on molar relationship

Question 7

How can you assess crowding?

Answer 7

• measure bone with copper wire (space available)
• distal of 5 to mesial of 1 and opposite side
• measure overlap of teeth

Question 8

How can you create space in the lower arch?

Answer 8

0-4mm crowding = stripping or XLA of 5s
4-8mm crowding = XLA of 5s, if more severe XLA of 4s
8+mm crowding = XLA of 4s

Question 9

How do you create space in the upper arch?

Answer 9

• if teeth are extracted in the lower arch you should extract the opposing teeth in the upper
• if teeth are not extracted in the lower arch but space is required in the upper arch, then a class II molar relationship will result

Question 10

What are the treatment options available in orthodontics?

Answer 10

• accept malocclusion
• XLA only
• URA ± XLA
• functional appliances ± XLA
• fixed appliances ± XLA
• complex treatment with orthodontics, restorative and orthognathic surgery

Question 11

What are the limitations of orthodontic treatment?

Answer 11

• orthodontics are almost entirely involved with dento-alveolar and tooth movement
• movement is limited by size and shape of alveolar processes
• equilibrium of forces between soft tissues, occlusion and periodontal structures