Comprehensive Orthodontic Treatment

Question 1

Goal of Comprehensive Orthodontic Treatment

Answer 1

To produce the best combination of occlusion, dental and facial esthetics and stability of outcome

Question 2

What is Comprehensive Orthodontic Treatment?

Answer 2

1. Fixed orthodontic appliances
2. May involve extractions with or without orthognathic surgery
3. May involve other disciplines

Question 3

When do we procede from Phase I to Phase II?

Answer 3

Usually after permanent second molars erupt

Question 4

What is the duration of Phase I treatment?

Answer 4

1 year + Retention

Question 5

When do you start growth modification?

Answer 5

Depends on malocclusion type

Patient in late mixed dentition stage

Question 6

When do you start orthognathic surgery?

Answer 6

Until growth cessation

Except progressive deformity from growth restriction (TMJ ankyloses after trauma or infection)

Severe psychosocial issues

Question 7

Types of Brackets

Answer 7

1. Conventional Edgewise metal bracket
2. Self-ligating bracket
3. Ceramic brackets

Question 8

Components of Edgewise appliances

Answer 8

1. Brackets with/without bands
2. Arch wires
3. Elastomeric modules or wire ligatures
4. Brackets are bonded to tooth surface with composite resin adhesives

Question 9

Advantages of Aligners

Answer 9

1. Esthetics
2. Ease of oral hygiene
3. Minimal dietary restrictions
4. Control of tooth movement rate

Question 10

Disadvantages of Aligners

Answer 10

1. Compliance-dependent
2. Certain tooth movements can be challenging

Question 11

Examples of Treatment Auxillaries

Answer 11

1. Growth modification
2. Anchorage
3. Elastics

Question 12

What should you do before orthodontic treatment?

Answer 12

1. Develop multidisciplinary treatment plan and sequence
2. Disease control

Question 13

What should you do during orthodontic treatment?

Answer 13

1. Good OH control, regular dental check-ups and prophylaxis
2. Debond after confirmation form other providers
3. Immediate retention

Question 14

What should you do after orthodontic treatment?

Answer 14

Definitive restorative and periodontal treatment

Question 15

When is Growth Modification usually performed?

Answer 15

Before edgewise appliances

May need time interval growth modification and fixed appliance e.g. post-expansion

Re-evaluation of treatment plan after growth modification

Question 16

Stages during Orthodontic Treatment

Answer 16

1. Alignment and levelling
2. Space closure and AP/vertical/transverse correction
3. Finishing

Question 17

Treatment Sequence in Orthognathic Cases

Answer 17

1. Pre-surgical orthodontics to remove DAC
2. Orthognathic surgery
3. Post-surgical orthodontics

Question 18

What is the Surgery first approach?

Answer 18

1. Orthognathic surgery
2. Comprehensive orthodontic treatment

Question 19

Treatment Considerations

Answer 19

1. Medical history and medications
2. Facial balance
3. Orthodontic camouflage vs Orthognathic surgery
4. Limits of dentition
5. Crowding
6. Leeway space

Question 20

Considerations for Extractions

Answer 20

1. Medical history
2. SK discrepancies + Growth
3. Severity of space deficiency
4. Incisor inclination
5. Skeletal or dental open bite
6. Facial profile
7. Molar or canine relationships

Question 21

Common extraction patterns

Answer 21

1. U/L first premolars
2. Open bite cases: Second premolars often considered too

Question 22

Extraction pattern for Class II Orthodontics only

Answer 22

1. Upper 4s/Lower 5s
2. Upper 4s only

Question 23

Extraction pattern for Class III orthodontics only

Answer 23

1. Upper 5s/ Lower 4s
2. Lower 4s only