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TREATMENT PLANNING :
PROBLEM LIST TO
SPECIFIC PLAN
DR. ALI WAQAR HASAN
FCPS – II RESIDENT IN ORTHODONTICS
UCMD UOL
TREATMENT PLANNING CONCEPTS
& GOALS
Comprehensive list of patient’s problems = Orthodontic Diagnosis
Informed concent
DENTAL CROWDING : TO EXPAND or
EXTRACT
Two controversial aspects of current orthodontic treatment planning
Incisors Tipped Lingually away from Lip can be moved farther than Upright
Incisors
More opportunity to expand Transversely than Anteroposteriorly – but
only distal to canines
Retracting the Incisors to reduce Lip Prominence requires Space within the
Dental Arch
General Rule : Lips will move 2/3rd of distance that Incisors are retracted
Retrospective Studies of Ex vs Non Ex cases = Highly variable changes
The idea that Extraction will lead to narrow Arch and Incisor Retraction & that Non
Extraction leads to Incisor Protrusion and Wider Arches is NOT WELL SUPPORTED
The more you can expand without moving Incisors forward = Satisfactory Treatment
The more you can Close Extraction spaces without over Retracting Incisors =
Satisfactory Treatment
Data from Randomized Clinical Trials for Class II Treatment outcomes are available
Adolescence, Heavy force from a rigid Jackscrew Device used for separation
(Microfracture
Maxilla opens like a Hinge superiorly, at base of Nose, also opens more
Anteriorly than Posteriorly
Heavy forces and Rapid Expansion should not be used in school children =
Risk of producing undesirable changes in nose at that age
THEORY : Rapid Force application to Posterior Teeth = Not enough Time for Tooth Movement = Force will be
Transferred to Suture = Suture will open while Teeth move Minimally
Almost always, Class II patients have Lower teeth normally positioned on the
mandible or Proclined to some extent
Result of Class II Elastics = Convex Profile with Protrusive Lower Incisors &
Prominent Lower Lip ==RELAPSE WAITING TO OCCUR
Without Lower Extractions the patient would have a Class II molar relationship,
but normal Overjet and Canine relationship at the End
If Mandibular 1st or 2nd Premolars are also Extracted = Class II Elastics can be
used to bring the Lower Molars Forward & Retract the upper Incisors,
correcting both Molar relationship and Overjet
TMJ Dysfunction ?
DISTAL MOVEMENT OF UPPER
TEETH
If Upper Molars moved Posteriorly = correct a Class II Molar Relationship and
provide space into which other Maxillary Teeth could be Retracted
More Often Maxillary 1st Molars are Rotated Mesiolingually when a Class II
Molar relationship exists
Tipping the crowns Distally to gain space is difficult, and Bodily Movement is
Difficult Still
Can be done Theoretically with a HEAD GEAR = Time Consuming & Excellent
patient compliance
Palatal Anchorage for Molar Movement can be created by
Splinting the Maxillary Premolars & including an Acrylic
Pad in splint so it contacts the Palatal Mucosa
Results from CHIN CUP THERAPY are discouraging (Lower Incisors Tipped
Lingually )
DeClerk : Light but Full Time force from Class III elastics is used from
Skeletal Anchors in Maxilla to Skeletal Anchors in Mandible, effects on
both the jaws are observed
CLASS III CAMOUFLAGE
Moderately Severe Class III = Proclining the Upper Incisors & Retracting
the Lower Incisors into Extraction space
For Short Face Patients = Growth modification involves down and back rotation of mandible
without creating anteroposterior mandibular deficiency
Which is why a short face Class III problem is more treatable than a long face one
Long Face pattern of growth is difficult to modify & elongating anterior teeth to close off
accompanying open bite is Antithesis of camouflage
Hemisection !!
Diabetes not controlled = Real risk of Periodontal Breakdown and Bone Loss
Bone Turn Over issues = Alveolar bone loss & Root Resorption
MAXILLARY INJURIES
Asymmetry with deficient growth on one side and normal on other side
HYBRID FUNCTIONAL APPLIANCE