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7/29/2019 orthodontic Basic Priciples in Treatment Planning
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A treatment plan is a specific strategy to correct a problem , with
maximum benefits and minimum side effects to the patient.
The treatment planning is specifically designed to avoid both
under- and excessive treatment, while appropriately involving
the patient in the planning process.
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FIVE steps:
1. Management of pathological problems
2. Put the orthodontic problems in priority order
3. Note the treatment possibilities & Evaluate the possible solutions
4. Establish the treatment plan concept in an interactive session with
the patient and parents
5. Develop the detailed plan of clinical steps and procedures.
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Pathologic problems must be addressed before treatment of
orthodontic (developmental) problems can begin.
Any active disease or pathology must be under control before
treatment initiation. i.e caries, periodontal problems etc.
In complex cases, multi-disciplinary approach should be performed.
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Identify the most important problems, and the treatment plan must
focus on that problem.
The patient's perception of his or her condition is important in setting
these priorities.
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At this stage each problem is considered individually, and the
possible solutions are examined.
Broad possibilities, not details of treatment procedures, are what is
sought at this stage.
For example, in a deep-bite case, intrusion of incisors OR
extrusion of molars
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Discuss problem list outline with the patient/parents.
Discuss possible risks of treatment outcome.
Inform patient of the treatment alternatives.
Obtain written consent.
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The final step in planning treatment is specification of the treatment
method-in orthodontics, the mechanotherapy-that is to be used.
The selected treatment procedures must meet two criteria:
effectiveness in producing the desiredresult and efficiency in doing
so without wasting eitherdoctor or patient time.
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case:1
Age: 17yrs & 6months
Address: Peshawer
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Introduction
C/C
Labially placed canine
Medical/Surgical Hx:
Nil
Dental Hx:
Nil
Habits:
o Nil
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Clinical Examination
Profile: Straight
Transverse: symmetrical
Vertical: normal
Lips: competent
Nose: normal
Chin: Normal
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Front Front with Smile
Extra-oral
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Profile
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View View with Smile
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Front Over-jet
Intra-Oral
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Upper Occlusal Lower Occlusal
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Right Left
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Cast Analyses
ALD
Maxilla: -6 mm
Mandible: -5mm
Bolton analyses Anterior ratio: mandibular tooth material
excess of 2.1mm
Overall ratio: insignificant
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OPG
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Ceph
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Ceph AnalysesSagittal Analyses
SNA 81 82
SNB 78 80
ANB 3 2
Witts -2 to+2 -1
Na-A 0-1 +7
Na-Po -2 to +4 +16
Facial
angle87 89
Vertical Analyses
SN-PP 8 4
FMPA 25 11
SN-MP 32 25
PP-MP 27 18
Y-axis 59 50
LAFH/AFH 54% 55%
PFH/AFH 65% 72%
Linear Analyses
Co- A
length
98mm
Co-Gn
length
115-
118
128mm
Dento-Skeletal Analyses
UI-NA 22 26
UI-NA
Distance4mm
7mm
UI-PP 108 115
SN-UI 102 106
LI-NB 25 30
LI-NB
distance4
4mm
IMPA 90 105
UADH 30 26
UPDH 26 25
LADH 45 40
LPDH 35 34
UI-LI 135 124
Soft Tissue Analyses
Upper lip- EPlane
-3 -9mm
Lower lip- E
Plane
-2 -6
Upper Lip- S
line
0 -4
Lower Lip- S
line
0 -3
Naso-labial
Angle
102 97
Z angle 78 95Holdaway
ratio
1:1 1.3:1
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Problem list Oral Health-related problems
Carious lesions in UR6,7 LR6
Dental problems
Class II canine relation on left side
Lingual Crossbite UL4 Proclined incisors
ALD in Max -7mm and Mand -
5mm
Bolton discrepency
Soft tissue related problems
Retrusive lips
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Treatment planning
Treatment of carious lesions
Comprehensive orthodontic treatment:non-extraction pattern
Level & align both arches,correct upper arch crowding with arch
expansion. Stripping of lower incisors
Maintain ClassI molar relation
finish in ClassI canine & incisor relation
Retention with upper removable Hawley retainer & lower Fixed bonded
retainer.
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case:2
Age: 18yearsAddress: Peshawar
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Introduction
C/C
Upper front teeth are forwardly placed
Medical/Surgical Hx:
Nil
Dental Hx: Ortho treatment with fixed appliance was done in Islamabad 7years
back for 1year
Habits:
o Nil
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Clinical Examination
Profile: Convex
Transverse: symmetrical
Vertical: Long
Lips: Incompetent
Nose: normal
Chin: normal
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Front Front with Smile
Extra-oral
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Profile
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View View with Smile
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Front Over-jet
Intra-Oral
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Upper Lower
Occlusal View
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Right Left
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Smile Analysis
Frontal measurements at rest
Philtrum height 22mm
Commissure height 27mm
Interlabial gap 6mm
Amount of Incisor display 6mm
Frontal measurementsduring Smiling
Amount of incisor display+- gingival display full crown+
2.7mm gingiva
Crown Height & Width ratio 0.8
Smile arc flat
Buccal corridors 25%
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55
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Cast Analyses
ALD Maxilla: +2.97 mm
Mandible: -5.46 mm
Bolton analyses
Anterior ratio: Insignificant
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OPG
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Ceph
C h A l
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Ceph AnalysesSagittal Analyses
SNA 81 82
SNB 78 73
ANB 3 9
Witts -2 to+2 4
Na-A 0-1 0
Na-Po -2 to +4 -13
Facialangle
87 83
Vertical Analyses
SN-PP 8 8
FMPA 25 28
SN-MP 32 34
PP-MP 27 26
Y-axis 59 64
LAFH/AFH 54% 59%
PFH/AFH 65% 65.7%
Linear Analyses
Co- A
length
95
Co-Gnlength
113-116
123
Dento-Skeletal Analyses
UI-NA 22 30
UI-NA
Distance
4mm10mm
UI-PP 108 125
SN-UI 102 119
LI-NB 25 29
LI-NB
distance
44mm
IMPA 90 101
UADH 30 36
UPDH 26 25
LADH 45 51
LPDH 35 37
UI-LI 135 106
Soft Tissue Analyses
Upper lip- EPlane
-3 +3
Lower lip- E
Plane
-2 0
Upper Lip- S
line
0 +7
Lower Lip- S
line
0 +2
Naso-labial
Angle
102 88
Z angle 78 61
Holdaway
ratio
1:1 4:9
UI-Stm 4mm 6mm
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Problem list Oral Health-related problems
Carious lesions in LL6,LR6,LL7,LR7
Skeletal problems
Class II bases
Increase lower anterior facial height
Dental problems
Class II div 1 malocclusion
Increase OJ (16mm) & OB(4mm)
V-shape upper arch
Proclined upper and lower incisors
ALD in Max. is +2.97mm & in Mand. is -5.46mm
Lower mid line shifted towards left3mm
Soft tissue related problems
Protrusive Upper lip
Incompetent lips
Wide buccal corridors
Flat smile arc
Acute Nasolabial angle
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Treatment planning
Treatment of carious lesions
Treatment strategy: surgical orthodontics[ BSSO with mandibular advancement+Lefort I with maxillary impaction]
Presurgical phase:
Ext. all 4sLevel and align both arches
Finish in Class II molar, canine and incisor relationship
Surgical phase:
LeForte I+BSSO
Post-Surgical
Occlusal settling with elastics
Finish in ClassI molar canine and incisor relation
Retention with upper removable Hawley retainer and Lower fixed bonded retainer
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Salman
case:3
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Introduction
Age: 19 yrs
Address: Peshawer
C/c
I have bite problem
Medical hx:
Nil
Dental hx:
Hx of trauma:
Fall from the roof at 2 yrs of age,resulting in mandiblefracture
Motor bike accident: at 11yrs of age, lower left 8 is extracted
Habits:
Nil
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Clinical Examination
Profile: Straight
Transverse: symmetrical
Vertical: high
Lips: competent
Nose: normal
Chin:
normal
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Front Front with Smile
Extra-oral
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Profile
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View View with Smile
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Front Over-jet
Intra-Oral
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Upper Occlusal Lower Occlusal
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Right Left
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Cast Analyses
Maxilla: -10.3 mm
Mandible: -4.7mm
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OPG
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Ceph
Ceph Analyses
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Ceph AnalysesSagittal Analyses
SNA 81 75
SNB 78 79
ANB 3 -4
Witts -2 to+2 -10mm
Na-A 0-1 -6mm
Na-Po -2 to +4 0
Facialangle
87 90
Vertical Analyses
SN-PP 8 5
FMPA 25 32
SN-MP 32 42
PP-MP 27 37
Y-axis 59 62
LAFH/AFH 55% 60.2%
PFH/AFH 65% 59%
Linear Analyses
Co- A
length
88mm
Co-Gnlength
111-114
140mm
Dento-Skeletal Analyses
UI-NA 22 30
UI-NA
Distance
4mm9mm
UI-PP 108 111
SN-UI 102 106
LI-NB 25 23
LI-NB
distance
45mm
IMPA 90 82
UADH 30 37mm
UPDH 26 31mm
LADH 45 41mm
LPDH 35 36mm
UI-LI 135 132
Soft Tissue Analyses
Upper lip- EPlane -3 -10mm
Lower lip- E
Plane
-2 0
Upper Lip- S
line
0 -4
Lower Lip- Sline
0 +3
Naso-labial
Angle
102 83
Z angle 78 78
Holdaway
ratio
1:1 5:3
UI-Stm 4mm 3mm
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Case summary
male pt,19yrs of age with a C/C of bite problem .he has previous history oftrauma,resulting in mandible fracture and ext of LL7?
Dentally, he has ClassIII Molar relation. He has anterior and posterior X-bite and AOB.UR3
is impacted . Upper midline is shifted towards Rt by 5mm.
ALD in Maxilla is -10.3mm and in Mandible it is -4.7mm.
Ceph analyses show ClassIII skeletal bases ,high-angle pattern , retroclined lower incisor ,
retrusive upper lip & acute naso -labial angle
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Problem list
Skeletal problems Class III bases due to maxillary difficiency
High-angle skeletal pattern
Dental problems
Impacted UR3
Anterior and posterior crossbite Class III relation
Anterior openbite
V-shape upper arch
Midline discrepency
Crowding in both arches
Retroclined lower incisors Soft tissue related problems
Retrusive upper lip
acute naso-labial angle
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Treatment planning
Surgical orthodontics : Le Fort I osteotomy with maxillary advancement and posterior
impaction
Pre-surgical phase
Ext U8s
RPE
Leveling and alignment of both arches,space opening for UR3,correct midline
Decompensate lower arch
Surgical phase; lefort I osteotomy
Post-surgical phase: occlusal settling, finishing in ClassI molar ,canine and Incisor
relation
Retention with upper removable Hawley retainer & lower fixed bonded retainer
Recommended