In order to understand the contents of this subject, it is essential that the terms used frequently in the text are understood well. These basic terms are:
- Treatment of malocclusion
The above three terms are interrelated. The explanation of the term ‘malocclusion’ leads to the need to understand the term ‘orthodontics’ in the right perspective. This, in turn, leads to recognize and understand the term ‘treatment’. So, let us define malocclusion first.
Malocclusion is a condition where there is a departure from normal occlusion. So, it becomes essential to discuss some more about normal occlusion, which is collectively contributed by six basic keys. This is in line with what has been discussed by L Andrews. These basic keys are:
- Molar relationship: The mesio-buccal cusp of upper 6 occludes with the mesial surface of the mesial-buccal groove of lower 6.
- Crown angulation: The gingival portion of the long axis of each crown is distal to the incisal portion.
- Crown inclination
- No rotations
- No spaces; tight contact points
- Flat or a slight curve of SPEE
Now, let us define ‘orthodontics’
Orthodontics is a dental science that deals with the prevention and correction of arrested, perverted and abnormal development of teeth and jaws.
Now, there is a big question as to why orthodontic treatment is needed. This is done:
- To improve dental and facial aesthetics.
- To restore proper function of teeth.
- To eliminate harmful oral habits.
- To reduce caries susceptibility by increasing the cleansing capability of the teeth.
- To eliminate periodontal pathology caused due to malocclusion of teeth.
- To correct or prevent certain temperomandibular joint abnormalities.
- To aid in correction of speech defects.
- To correct malpositioning of teeth prior to construction of bridge work.
- To complement surgical correction of skeletal deformities.
- Orthodontic treatment may be necessary for postaccidental treatment of teeth loss or occlusal interference.
- To improve the looks and hence, the confidence of the patient.
Now, to commence orthodontic treatment, it is very important to diagnose the malocclusion. Diagnosing malocclusion is the art of recognizing and classifying abnormality from its features and symptoms.
Diagnosis in orthodontics should be comprehensive and not focused on a single aspect. It requires the collection of database of information and distillation from the database into a clearly stated problem list.
TREATMENT OF MALOCCLUSION
Treatment planning, on the other hand, is to synthesize the possible solutions to these specific problems into a specific treatment that is best for the particular patient. Treatment planning is the second step in the treatment of malocclusion, the first step being diagnosis of the problem.
The following sequence of steps is to be taken with a patient who has malocclusion:
- Recognize the problem and the malocclusion in an initial clinical examination—Screening.
- Collection of database (Records):
- History given by the patient
- Patient's expectations from the orthodontic treatment
- Study models
- Facial photographs
- OPG (Ortho Pentamo Grams)
- IOPA (Intra Oral Peri Apical X-rays)
- Specialized radiographs
- Distillation of the records and formation of a problem list.Initial problem lista. Orthodontic problemsb. Endodontic problemsc. Periodontic problemsd. Prosthodontic problemse. Surgical problemsDecide a step-by-step approach by prioritization of the problem as per individual case.
- Formation of orthodontic problem list as per different categories of problems.
- Alignment: Spacing and crowding
- Profile: Convex, straight, or concave
- Transverse deviation: Cross bite
- Sagital deviation: Angle's class of MO
- Vertical deviation: Deep bite, open bite
- Combination of above problems in two or three planes of spacePrioritization of the problem should be done according to chief orthodontic complaint of the patient and the nature of the problem.
- Develop a tentative treatment plan:
- Treatment possibilities
- Cost effectiveness
- Strategy that is best for a particular patient
- Develop a final treatment plan similar to one given below:Treatment Plan
Appliance Plan (on the basis of I, II, III in treatment plan)
- Goals: In response to problem list
- Anchorage source:
- Combination of the above
- Complicating factors:
- Growth potential of the patient
- Typical tooth movements required
- Poor oral hygiene
- Patient's expectations
- Cost of treatment
Retention plan (on the basis of I, II, III in the treatment plan and A, B, C in the appliance plan):
- Removable appliance
- Fixed appliance (choose technique)
- Light wire technique
- Edgewise appliance
- Preadjusted edgewise appliance
- Semi-fixed appliance
- Removable retention
- Semipermanent retention
- Permanent retention
- Consult with the patient and his/her parents about the diagnosis and the treatment plan. Treatment should begin after proper agreement is made by all parties at the consultation appointment.