Diagnosis and Treatment planning Flashcards
Why is correct orthodontic diagnosis important?
- Orthodontic appliance can move teeth very well but can modify skeletal relationship minimally
- Severe skeletal discrepancy may require surgical intervention
What are the key factors we want to include for diagnosis?
- Description of malocclusion
- Determine cause of malocclusion
- Are causes dentoalveolar or skeletal
- Lateral cephalogram
What to if anterior cross bite is dental or skeletal?
- Dental = orthodontics
- Skeletal = orthognathic surgery
What are the objectives of orthodontic treatment?
- To produce an occlusion that is stable, functional and aesthetic
- To facilitate other forms of dentistry e.g. crowns/bridges etc
What are the aims of treatment?
- Full correction of malocclusion
- Class I incisor relationship (OJ/OB normal)
- Class I canine relationship
- Class I molar relationship (can accept Class II)
- No rotations, spaces, flat occlusal planes
What are the stages of treatment planning?
- Plan around lower arch (angulation of LLS is stable)
- Decide on treatment in lower
- Build upper arch around lower and aim for class I incisor and canine relationship
- Decide on molar relationship (class I or full unit class II molar relationship)
How do you measure arch length or space available in crowded pt?
- A + B + C + D = arch length or space available
How you measure the space required in crowding pt?
- Estimate width of all teeth anterior to first permanent molar
- 1 + 2 + 3 + 4 + 5 + 6 + 7 + 8 + 9 + 10 = space required
How do you calculate discrepancy in crowding pt?
- Work out space available e.g. 69mm
- Work out space required e.g. 74mm
- Discrepancy e.g. -5mm
What is the general principles for space required in lower arch?
- If mild of 0-4mm discrepancy then consider non-XLA (stripping) or XLA 5’s
- If moderate of 5-8mm discrepancy then consider XLA 5’s or XLA 4’s
- If severe of 8+mm discrepancy then consider XLA 4’s
What are the general principles for crowding if lower arch has a tooth extracted?
- If XLA occurred in lower arch then XLA upper arch for MR class I
- If no XLA in lower arch then either
- XLA upper arch so MR Class II
- Distalise UBS using headgear for MR class I
How can you assess crowding?
- Space required and space available
- Overlap technique
What is the overlap technique?
- Estimate how much the contact points of each tooth overlap with the adjacent tooth
- Add all measurements up
Treatment plan set out?
- Comprehensive or compromise
- Relief of crowding (XLA)
- U/L fixed appliances to fix
- Rotations and align
- Reduce OB
- Reduce OJ
- Correct incisor, molar and canine relationship to class I
- Retain using U/L thermoplastic retainers
What do you need to remember if all space from extractions are going to be utilised?-
- Need to reinforce anchorage
- Use transpalatal arch or temporary anchorage device (TADs)
