Treatment planning /certified fixed orthodontic courses by Indian dental academy

DIAGNOSIS
&
TREATMENT PLANNING
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


INTRODUCTION:
Diagnosis and

treatment planning are problem
oriented approaches.

Diagnosis -

collection of adequate data base.
- goal of scientific enquiry.
- no room for opinion or judgment
plan – synthesize best possible solution
- plan that a prudent and wise clinician
makes.
- cannot be science alone.

 Treatment


Importance of diagnostic steps in treatment planning
Case History:
Age – growth estimation – type of appliance
Chief Complaint
Medical History

General Examination: weight, built


Facial profile, head shape and arch forms


Facial and Dental Appearance:
Macro esthetics


MINI ESTHETICS

Gingival display
Smile arc
Buccal corridors


MICRO ESTHETICS
Tooth proportions
Gingival shape and contour

Embrasures




Treatment plan is an outline of all the measures that
can be instituted for a patient so as to offer
maximum, long term benefits.


NEED FOR TREATMENT
Indications of orthodontic treatment:
1) Remove or at least alleviate the social handicap.
2) Enhance dental and facial appearance.
3) Maintain normal developmental process.
4) Improve jaw functions and correct functional
problems.
5) Reduce the impact on dentition of trauma or
disease.
6) Facilitate other dental treatment.


Treatment Goals
Primary

goal of treatment is the soft tissue
relationships and adaptations.
In order to provide maximum benefit to the
patient , ideal occlusion cannot always be the
major focus of treatment plan.


 Secondary

goal of treatment becomes
functional occlusion.



Harmony of the occlusion with the temporomandibular joint.


Planning comprehensive orthodontic treatment:
1) Seperation of pathological and developmental
problems
2) Priorities for the problem list
3) Treatment possibilities
4) Factors in evaluating treatment planning
5) Development of alternative treatment approaches
6) Determination of final treatment concept
7) Selection of specific treatment approach


Pathologic vs. Developmental Problems

 An

important principle is that a patient does not
have to be in perfect health to have orthodontic
treatment

 Even

when pathologic problems are mild, they
must not be overlooked in the treatment plan


Setting Priorities for the Orthodontic Problem
List:


Priority order - most important single step.



It is always difficult for the clinician to avoid
imposing his or her own feelings at this stage,
and it is not totally inappropriate to do so.

 But

ignoring the patient's chief complaint can
lead to serious errors in planning treatment.


Treatment Possibilities:
 The

next step in the planning process is to list
the possibilities for treatment of each of the
problems, beginning with the highest priority
problem.


Factors in Evaluating Treatment Possibilities
Interaction Among Possible Solutions:
Some possible solutions to a high-priority
problem would also solve other problems, while
others would not and might even make other
things worse.

Compromise:
 In patients with many problems, it may not be
possible to solve them all. This type of
compromise has nothing to do with the
clinician's skill.

Cost-Risk/Benefit Analysis:
 Practical

considerations related to the difficulty
of various treatment procedures compared with
the benefit to be gained from them also must
be considered in evaluating treatment
possibilities.

Other Considerations:
 At

this stage, it is important to take into account
any pertinent special considerations about the
individual patient.

Patient-Parent Consultation:
Obtaining Informed Consent
 From

an ethical perspective, patients have the
right to determine what is done to them in
treatment, and increasingly they demand that
right.

It

is unethical not to inform patients of the
alternatives, including the likely outcome of no
treatment, that are possible in their case.


Common Malocclusions:
Deep bite
Open bite
Cross bite
Class II

Class III


Deep Bite:
Treatment modalities


Lip relationship



Vertical facial relationship



Inter occlusal space


During growth period


Anterior bite plane


Deep bite in adults



use of anchorage bends

 Arch

wires with
reverse curve of spee



Mini screw implants



Severe cases surgery

Open Bite:



removal of cause : habit breaking appliance


Myofunctional:


vertical chin cup



Fr-IV



Modified activator


Fixed appliance

Surgical correction


Cross Bite

developing cross bite – Tongue blade
 Catalan's appliance
 Removable appliance with Z spring
 cross bite elastics
 skeletal cross bites – face mask, chin cup
 Anterior


Class

2 malocclusion

Growing

Skeletal
class2

Maxillary
progna

Head
gear

Maxill
progn
and
mand
retro
Head
gear and
myofunc
tional

Non Growing

Dental
class 2

Skeletal
class 2

Mild to
moderat
e

Mandibula
r retrogn

Myofunc
tional
therapy

Dental
class 2

Orthodo
ntic
treatmen
t as
needed

severe

Max
prognath
ism

Mand
retrognat
hism

Surgical
maxillary
set back

camoflag
e

Surgical
mand
advancem
nt


Class III

Growing

Skeletal Cl
III

Max retro

Face
mask

Max retro
& mand
prog

Face
mask &
chin cup

Non Growing

Dental
Cl III

Dental Cl
III

Skeletal Cl
III

severe

camouflag
e

Mand
prog

Mild to
moderate

Max retro
or mand
prog


surgery

Chin cup

Treatment

plan should be re-evaluated at regular
intervals during active phase of treatment.

 This

to confirm whether the objectives set up are
being fulfilled.

Changes might

have to be made in the treatment
plan if desired changes are not taking place or if
unforeseen problems arise


Thank you
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Treatment planning /certified fixed orthodontic courses by Indian dental academy

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