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.

FIVE steps:
1. 2. 3.

Management of pathological problems

Put the orthodontic problems in priority order 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.

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.

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.

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

Discuss problem list outline with the patient/parents.

Discuss possible risks of treatment outcome.

Inform patient of the treatment alternatives. Obtain written consent.

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 desired result and efficiency in doing

so without wasting either doctor or patient time.

case:1
Age: 17yrs & 6months Address: Peshawer

Introduction
C/C Labially placed canine Medical/Surgical Hx: Nil Dental Hx: Nil Habits: o Nil

Clinical Examination
Profile:
Straight

Transverse:
symmetrical

Vertical:
normal

Lips:
competent

Nose:
normal

Chin:
Normal

Extra-oral
Front Front with Smile

Profile

 View

View with Smile

Intra-Oral
Front Over-jet

Upper Occlusal

Lower Occlusal

Right

Left

Cast Analyses
ALD Maxilla: -6 mm Mandible: -5mm Bolton analyses Anterior ratio: mandibular tooth material excess of 2.1mm Overall ratio: insignificant

OPG

Ceph

Sagittal Analyses
SNA SNB ANB

Ceph Analyses
Linear Analyses UI-LI 98mm Upper lip- E Plane Lower lip- E Plane Upper Lip- S line Lower Lip- S line Naso-labial Angle Z angle 0 102 135 -3 -2 0 124 -9mm -6 -4 -3 97

81 78 3

82 80 2

Co- A length

Soft Tissue Analyses

Co-Gn length UI-NA

UI-NA Distance

115118
22 4mm 108 102 25 4 90 30 26 45

128mm

Witts
Na-A Na-Po Facial angle SN-PP

-2 to+2
0-1 -2 to +4 87
Vertical Analyses

-1
+7 +16 89

Dento-Skeletal Analyses

26
7mm

UI-PP
SN-UI

115
106 30 4mm 105 26 25 40 34

LI-NB LI-NB distance IMPA UADH UPDH LADH LPDH

FMPA
SN-MP PP-MP Y-axis

25
32 27 59

11
25 18 50

78

95

Holdaway ratio

1:1

1.3:1

LAFH/AFH
PFH/AFH

54%
65%

55%
72%

35

Problem list
Oral Health-related problems
Carious lesions in UR6,7 LR6

Soft tissue related problems Retrusive lips

Dental problems
Class II canine relation on left side Lingual Crossbite UL4 Proclined incisors ALD in Max -7mm and Mand 5mm Bolton discrepency

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.

case:2
Age: 18years Address: Peshawar

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

Clinical Examination
Profile:
Convex

Transverse:
symmetrical

Vertical:
Long

Lips:
Incompetent

Nose:
normal

Chin:
normal

Extra-oral
Front Front with Smile

Profile

 View

View with Smile

Intra-Oral
Front Over-jet

Occlusal View
Upper Lower

Right

Left

Frontal measurements at rest

Smile Analysis

Philtrum height Commissure height Interlabial gap

22mm 27mm 6mm

Amount of Incisor display

6mm

Frontal measurements during Smiling

Amount of incisor display+- gingival display Crown Height & Width ratio Smile arc full crown+ 2.7mm gingiva 0.8 flat

Buccal corridors

25%

55

Cast Analyses
ALD
Maxilla: +2.97 mm Mandible: -5.46 mm

Bolton analyses
Anterior ratio: Insignificant

OPG

Ceph

Sagittal Analyses
SNA SNB ANB

Ceph Analyses
Linear Analyses UI-LI 95 Upper lip- E Plane Lower lip- E Plane Upper Lip- S line Lower Lip- S line Naso-labial Angle Z angle 0 102 135 -3 -2 0 106 +3 0 +7 +2 88

81 78 3

82 73 9

Co- A length

Soft Tissue Analyses

Co-Gn length UI-NA

UI-NA Distance

113116
22 4mm 108 102 25 4 90 30 26 45

123

Witts
Na-A Na-Po Facial angle SN-PP

-2 to+2
0-1 -2 to +4 87
Vertical Analyses

4
0 -13 83

Dento-Skeletal Analyses

30
10mm

UI-PP
SN-UI

125
119 29 4mm 101 36 25 51 37

LI-NB LI-NB distance IMPA UADH UPDH LADH LPDH

FMPA
SN-MP PP-MP Y-axis

25
32 27 59

28
34 26 64

78

61

Holdaway ratio
UI-Stm

1:1
4mm

4:9
6mm

LAFH/AFH
PFH/AFH

54%
65%

59%
65.7%

35

Problem list

Oral Health-related problems

Carious lesions in LL6,LR6,LL7,LR7

Soft tissue related problems

Protrusive Upper lip Incompetent lips Wide buccal corridors Flat smile arc Acute Nasolabial angle

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 left 3mm

Treatment planning
Treatment of carious lesions Treatment strategy: surgical orthodontics[ BSSO with mandibular advancement+
Lefort I with maxillary impaction]

Presurgical phase:
Ext. all 4s Level 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

case:3

Salman

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 mandible fracture Motor bike accident: at 11yrs of age, lower left 8 is extracted
Habits:

Nil

Clinical Examination
Profile:
Straight

Transverse:
symmetrical

Vertical:
high

Lips:
competent

Nose:
normal

Chin: normal

Extra-oral
Front Front with Smile

Profile

 View

View with Smile

Intra-Oral
Front Over-jet

Upper Occlusal

Lower Occlusal

Right

Left

Cast Analyses
Maxilla: -10.3 mm

Mandible: -4.7mm

OPG

Ceph

Sagittal Analyses
SNA SNB ANB

Ceph Analyses
Linear Analyses UI-LI 88mm Upper lip- E Plane Lower lip- E Plane Upper Lip- S line Lower Lip- S line Naso-labial Angle Z angle 0 102 135 -3 -2 0 132 -10mm 0 -4 +3 83

81 78 3

75 79 -4

Co- A length

Soft Tissue Analyses

Co-Gn length UI-NA

UI-NA Distance

111114
22 4mm 108 102 25 4 90 30 26 45

140mm

Witts
Na-A Na-Po Facial angle SN-PP

-2 to+2
0-1 -2 to +4 87

-10mm
-6mm 0 90

Dento-Skeletal Analyses

30
9mm

UI-PP
Vertical Analyses SN-UI

111
106 23 5mm 82 37mm 31mm 41mm 36mm

LI-NB LI-NB distance IMPA UADH UPDH LADH LPDH

FMPA
SN-MP PP-MP Y-axis

25
32 27 59

32
42 37 62

78

78

Holdaway ratio
UI-Stm

1:1
4mm

5:3
3mm

LAFH/AFH
PFH/AFH

55%
65%

60.2%
59%

35

Case summary
male pt,19yrs of age with a C/C of bite problem .he has previous history of trauma,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

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

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