Diagnosis and Treatment Planning Flashcards
what are the general principles of diagnosis and treatment planning
history
examination
diagnosis
treatment plan
treatment
outcome
what occurs during diagnosis
description of malocclusion
determine causes of malocclusion
are causes dentoalveolar or skeletal
lateral cephalogram
why is correct orthodontic diagnosis important
orthodontic appliances can move teeth very well but a skeletal discrepancy would require surgery
if the diagnosis is dental what do we do
orthodontics
if the diagnosis is skeletal what do we do
orthognathic surgery
what are the objectives of orthodontic treatment
to provide an occlusion which is stable, functional and aesthetic
what does the IOTN ensure
that orthodontics go to patients who are of greatest need of them
what are the aims of treatment
full correction of malocclusion or compromise treatment
what is compromise treatment
correct certain aspects but accept others
what are the stages of treatment planning
plan around lower arch
decide on treatment in lower
build upper arch around lower and aim for class 1 incisor and canine relationship
decide on molar relationship
what do you examine in the lower arch
crowding/angulation of incisors
angulation of canines/centrelines
curve of spee
how do you examine the upper arch
crowding/angulation of incisors to max plane
angulation of canines/centrelines
what do you look at when the teeth are in ICP
incisor relationship
OJ
OB (curve of spee)
centrelines
canine relationship
molar relationship
what do you do when assessing crowding
do we need to extract teeth?
measure space available and space required
overlap technique
what do you measure for space available
the arch length
what do you measure for space required
the width of all anterior teeth to first permanent molars
how do you estimate the degree of crowding
difference between space available and space required
what factors come into how you plan treatment
aims of treatment
prognosis of individual teeth
future growth changes
aetiology of malocclusion
patients soft tissue profile
retention
stability
patient wishes
access to treatment
compliance
space requirements
what is the overlap technique to estimate crowding
measure the overlap between each teeth which overlap and add together
what would you do if you required 0-4mm space in the lower arch
extract 5s
or no extraction
what would you do if you required 5-8mm space in the lower arch
extract 5s or 4s
what would you do if you required 8+mm of space in lower arch
extract 4s
what happens if canines are left in class 2
incisors form overjet
what happens if canines are class 1
incisors are class 1
what do we need to consider about reducing overjet
can it be done by tipping or will it require bodily movement
what happens if all the space from extractions is to be used
you need to reinforce anchorage
what is the retention phase
retainers are needed to hold teeth in position after active movement
how do you write a treatment plan
diagnosis
problem list
treatment plan - list stages of tooth movement and appliances needed, estimate length of treatment
what are the treatment options
accept malocclusion
extractions only
URA
functional appliance
fixed appliance
ortho and restorative/ortho and orthognathic surgery
what are the limitations of orthodontic treatment
effects of orthodontic treatment almost purely dento-alveolar and tooth movement with small effect on skeletal pattern
tooth movement limited by shape and size of alveolar process
teeth only remain stable where there is equilibrium between forces of soft tissue, occlusion and periodontal structures
what premolar would give you more space when extracting and why
4
this is because when extracting the 5 the 6 will move forward fast
what would you do the upper when extracting from the lower arch
extract from upper arch
what would you do in the upper arch when not extracting from lower arch
extract in upper arch
utilise UBS using headgear
who does simple orthodontic treatment
GDP
who does complex orthodontic treatment
specialist practitioner or hospital specialist
what treatment should be carried out during the adolescent growth spurt and why
overbite reduction and functional appliance therapy
they rely on growth for success
if a patient wants to accept malocclusion what do we warn them of
consequences
when do we do extractions only
class 1 skeletal cases with crowding only
what is a URA used for
tipping and tilting
when is a functional appliance used
class 2 only
