In diagnosis and treatment planning, the orthodontist must recognize the various characteristics of a malocclusion or dent facial deformity; define the nature of the problem, including the etiology if possible; design a treatment strategy based on the specific needs and desires of the individual; and present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision.
Treatment planning is a crucial aspect in health care. In terms of orthodontics, it is important to consider the following aspects when arriving at a treatment plan for patients; aesthetics (consider the patient’s concerns and expectations from the treatment), oral health (consider patient motivation and the overall dentition. All patients who are to undergo orthodontic treatment need to maintain good oral health), function and stability.
Orthodontic treatment should not compromise dental health but promote good function, and it should produce as stable a result as possible.
Before a treatment plan can be devised, it is important to establish a diagnosis. An in-depth orthodontic assessment of the patient is pivotal.
Based on the patient’s concerns/expectations and the diagnosis made, a list of ‘problems’ can be made. Depending on the problems, it is possible that there may be more than one course of treatment for the patient. It is important to have a list of ‘problems’ where you can list treatment options for each ‘problem’ and present this information to the patient along with the benefits and risks of each treatment option.
Malocclusion is defined as an abnormal deviation either aesthetically, functionally or both from the ideal occlusion; the anatomically perfect arrangement of the teeth. The prevalence of malocclusions varies with a person’s age and ethnicity but not all malocclusions require treatment.
Malocclusions are the result of a combination of both genetic and environmental factors. Key factors include:
·Abnormal tooth germ position
·Dilaceration (an abnormal development in tooth shape)
·Hyper & Hypodontia
·Loss of teeth
·Patient Habits (i.e. thumb sucking)
·Retention of deciduous teeth
Malocclusions vary in severity and can sometimes be simple to treat or very complex to treat.
There are a few options for treating malocclusions with underlying skeletal problems:
This means that the discrepancy is accepted, but the teeth are moved into a Class I relationship.
This treatment is only possible in the growing patient where orthodontic appliances are used to make minor changes to the skeletal pattern.
Combined orthodontic and orthognathic surgical treatment
Surgical correction of the jaw discrepancy in combination with orthodontics is performed to produce optimum dental and facial aesthetics.
Orthognathic surgery can only be performed on patients who have completed growth.
Crowding of teeth is also common amongst the population
Treatment planning for crowding involves analyzing the space required relieving the crowding.
The amount of crowding present can be classified as: mild (<4mm), moderate (4-8mm) or severe (>8mm).
Space can be created in the following ways:
·Distal movement of molars
·Proclination of the incisors
·A combination of any or all of the above
It is of paramount importance to take all the teeth present and yet to erupt into account and to consider the prognosis of each tooth in order to arrive at a treatment plan.
After a treatment plan has been devised, informed consent has to be taken from the patient. Informed consent includes giving the patient information about the malocclusion, proposed treatment/alternatives, commitment required, duration of the treatment and the cost implications.