In the name of GOD Orthodontic treatment planning - PowerPoint Presentation

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In the name of GODSlide3

Orthodontic treatment planning

Presented by:

Dr Somayeh Heidari

Orthodontist Slide4

Reference:

Contemporary Orthodontics Chapter 7 William R. Proffit, Henry W. Fields, David M.Sarver. 2007. Mosby Slide5
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Collection adequate database

Diagnosis

Problem-oriented approachTreatment planningSlide7

The

objective

in treatment planning is to design the strategy that a wise clinician, using his/her best judgment, would employ to address the problem while maximizing benefit to the patient and minimizing cost and risk. Slide8

Avoid

both

missed opportunities (false negative or undertreatment) and excessive treatment (false positive or overtreatment) while appropriately involving the patient in the planning process.Slide9

Indications for orthodontic treatmentSlide10

Psychosocial indications

Remove, or at least alleviate, the social handicap created by an unacceptable dental and/or facial appearance.Enhance dental and facial appearance in individuals who already are socially acceptable but wish to improve their

quality of life

.

Although the

severity

of the malocclusion

correlates

with its psychosocial effect, measuring how much the teeth protrude or how irregular they are is not sufficient to determine individual treatment need.Slide11

Developmental indications

Maintain as

normal a developmental process as possible.Problems related to development of the dentition occur relatively frequently, and often orthodontic treatment is needed to maintain dental health and continue normal development.

These problems

almost always

should be corrected

when noticed

.Slide12

Functional indications

Improve jaw function and correct problems related to functional impairment.Sever malocclusion affects normal function, usually not by making it impossible, but by making it more difficult for the affected individual to

breath

,

incise

,

chew

, swallow

and speak normally.The reverse also is true: alteration or

adaptation in function

can be

etiologic

factors for

malocclusion

, by influencing the pattern of growth and

development

.Slide13

Trauma / Disease control indications

Reduce the impact on the dentition of

trauma or disease.Prevention of periodontal disease almost never

is a reason for orthodontic treatment.

Correcting

tissue impingement

by the teeth can be a

benefit

from orthodontic treatment at

any age.Although protruding incisors are

more

likely to be damage,

only

in the most

accident-prone

child is this a valid reason for reducing overjet.Slide14

Adjunctive treatment indications

Facilitate

other dental treatment, as an adjunct to restorative, prosthodontic or periodontal therapy.Slide15

Orthodontic treatment

almost always

is elective, but it can produce significant benefits in psychosocial well being, normal development, jaw function, dental/ oral health and improve outcomes in the treatment of dental disease.Orthodontics is needed if it would produce these

benefits

--- and

not

needed if it would not.Slide16

Type of treatment :

Evidence – Based selection

Treatment process should be chosen on the basis of clear evidence that the selected method is the most successful approach to that particular patient’s problem.The better the evidence, of course, the

easier

the decision.Slide17

Problem – oriented approach

Identifying the patient’s

problems evaluating the possible solutions those specific problemsThe best way

to evaluate alternative treatment methods is with a

randomized clinical trial

, with great care is taken to control variables that might affect the outcomes.

A

second acceptable way

is careful study of treatment outcomes under

well-defined conditions.Slide18

Treatment goals : The soft tissue paradigm

If we accept that both

goals and limitations of orthodontic treatment are established more by soft tissue considerations than skeletal/dental relationships, treatment planning inevitably is affected. Slide19

Primary goal

of treatment

soft tissue relationships and adaptations Facial proportions Teeth – lip and Teeth – face relationships

Soft tissue

adaptation

to the position of teeth (

stability

)Slide20

Secondary goal

of treatment

functional occlusion arrange the occlusion to minimize the chance of injurySlide21

Solving the patient’s problems

Problem oriented

diagnosis and treatment planningSlide22

Major issues in planning treatment

Once patient’s orthodontic

problems identified and prioritized, three issues must be faced as treatment planning begins: The complexity of the treatment that would be required

The

predictability

of success with a given treatment approach

The

patient’s

(and parent’s)

goals and desiresSlide23

complexity of treatment

Who

should do the treatment?Slide24

predictability of treatment

If

alternative methods of treatment are available, which one should be chosen? Based on evidence Slide25

Patient input

Most important

: treatment planning must be an interactive process.Both ethically and practically, patient must be involved in the decision making process. Slide26

Orthodontic Triage

:

Distinguishing moderate from complex treatment problemsAn adequate database and a through problem list are necessary do the triage process.Slide27

Orthodontic Triage

Step1 : Syndromes and Developmental AbnormalitiesSever problems moderate problemsUnusual facial appearance

Analysis of full-face proportions

Craniofacial

deformity or syndrome

(cleft lip or palate, hemifacial microsomia,

Crouzon’s syndrome, Treacher- Collin’s syndrome, …)

Complete evaluation by

Special team

with

medical consultants

Developmental

status

< 3%

or

> 97%

P.A Ceph

, history of

trauma

?

Excess or deficient

growth

?

- comprehensive orthodontics

True

facial

asymmetry

- surgery requiredSlide28

Multidisciplinary treatment approach

Cleft lip and palate

Crouzon’s syndrome

Treacher- Collin’s syndrome

Hemifacial microsomiaSlide29

Orthodontic Triage

Step2 : Facial Profile AnalysisSever problems moderate problemsSymmetric face

Facial profile analysis

Antero-Posterior

or

Vertical jaw

discrepancies

Skeletal

Class II and Class IIILong face and short face

Cephalometric

analysis

- Growth modification or surgery?

- Extraction?

Excessive

protrusion

or

retrusion

of incisorsSlide30

Excessive protrusion or retrusion of incisor teeth often accompanies

skeletal

jaw discrepancies (skeletal problem)It is possible for an individual with good skeletal proportions to have protrusion of incisors teeth rather than crowding.Bimaxillary protrusion

( excessive protrusion of incisors

without

excessive overjet) usually is an indication for

premolar extraction

and

retraction of protruding incisors:

complex and prolonged treatmentSlide31

Because of the

profile changes

produced by adolescent growth, it is better for most children to defer extraction until late mixed dentition or early permanent dentition.It is definitely an error to begin

extraction early

and then allow the permanent

molars

to

drift forward

, because this will make effective incisor retraction

impossible. Slide32

Orthodontic Triage

Step3 : dental developmentSever problemsGood facial proportions

Review

intra-oral radiographs

for abnormalities

of dental development

Monitor:

selective extraction

? Asymmetric dental developmentRetain primary?

Prosthetic

replacement?

Missing

permanent teeth

Extract, allow permanent teeth to

drift

?

Extract, orthodontic

space closure

?

Ankylosed

permanent

teeth

Combined

surgical-orthodontic

treatment

Primary failure of eruption

Extract

supernumerary,

reposition

other teeth

Supernumerary

teeth

complicated

by position or number Slide33

Problems involving

dental development

usually need treatment as soon as they are discovered, typically during the early mixed dentition, and often can be handled in family practice.Slide34

Asymmetric dental development

if the difference is

6 months or more careful monitoring of the situation is needed often requires selective extraction

can

prevent

a sever asymmetry problem at a later time

few patients have a history of childhood

radiation therapy

to head and neckSlide35

Missing permanent teeth

is an

actual (primary predecessor is missing or lost) or potential (primary tooth is still present) most likely: mandibular second premolars and maxillary lateral incisors making the correct decision requires a careful assessment of

facial profile

,

incisor position

,

space requirements

and the

status of the primary teeth ankylosed permanent teeth fall into the same category as

missing

teethSlide36

Supernumerary teeth

in the

anterior segment of the maxilla: 90% multiple, inverted or

malformed

supernumerary teeth: often

displaced

adjacent teeth

multiple

supernumerary: complex problem, perhaps syndrome or congenital abnormality

early removal

: carefully to

minimize damage

to adjacent teeth

if causes

displacement

: surgical exposure, adjunctive periodontal surgery, and possibly mechanical tractionSlide37

Orthodontic Triage

Step3 : dental developmentModerate problemsGood facial proportions

Review

intra-oral radiographs

for abnormalities

of dental development

Single supernumerary

with uncomplicated position extract supernumerary

Retained

or

ankylosed

Monitor:

primary

teeth

Extract

and

maintain space

if

space loss or vertical displacement

Ectopic eruption

Monitor:

Reposition

?

Extract,

space regain

? Slide38

Orthodontic Triage

Step 4

: Space problemsSever problems moderate problems

Normal Dental Development

Space analysis

Prematurely missing

primary canine space

maintenance

or molar, adequate space

Localized space deficiency

due to early

Loss of primary canine or molar

space

regaining

3 mm or less

simple appliances

comprehensive treatment

? Expansion

> 3mm

? Extraction

incisor irregularity

Mixed dentition:

with

adequate

space

defer

treatment?

align

?

Older

patients: align

Slide39

Orthodontic Triage

Step 4

: Space problemsSever problems moderate problemsNormal Dental Development

Space analysis

Incisor irregularity

with

space deficiency

space management:

reduce width

primary teeth?

4mm or less

selectively extract

primary teeth?

arch

expansion

?

Comprehensive treatment

?

Expansion

> 4mm

?

Extraction

Midline diastema

No

treatment before

canines

erupt.

2mm or less

Tip

teeth together in

older

Bodily

movement, then patient,

Retain

frenectomy

> 2mm

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Orthodontic Triage

Step 5

: Other Occlusal DiscrepanciesSever problems moderate problemsOther Tooth Displacement

Evaluate in light of facial form/

Space analysis results

Widen

midpalatal

suture?

Posterior cross bite

: Skeletal Expand

surgically

?

Posterior cross bite:

Dental

Expand by

tipping

teeth

(if

no vertical/other complications

)

Include the comprehensive

Anterior cross bite

Tip

teeth with removable

plan if situation

complex

appliance

Excessive overjet

Retract (

tip

) with removable

appliance

Only

if vertical clearance

presentSlide41

Orthodontic Triage

Step 5

: Other Occlusal DiscrepanciesSever problems moderate problemsOther Tooth Displacement

Evaluate in light of facial form/

Space analysis results

Anterior open bite

primary dentition:

simple

no

treatment

mixed dentition:

Growth modification

?

complex

thumb sucking

therapy

Jaw

surgery

?

Level curve of

Spee

?

Deep overbite

Intrusion

?

Immediate

treatment

Traumatic displacementSlide42
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Thanks for your attention