Learn Orthodontics

Treatment planning

Orthodontic treatment planning is a complex mix of analysis, skill and judgment. It takes years of training to become competent and even then an orthodontist an will come across cases that tax their diagnostic and planning skills.

This web page aims to give a very simplistic space analysis method for planning orthodontic treatment. It does not guarantee the correct treatment plan for a patient, not should it be used as such.

The following planning method makes a number of assumptions:

  1. The case has a Class I skeletal pattern
  2. There is no tooth size discrepancy or absent teeth
  3. That the case is being planned to the ideal (i.e. class I molar and incisor relationship) outcome
  4. That fixed appliances are to be use
  5. The operator is highly skilled in the use of fixed appliances
  6. The patient is highly motivated and compliant with treatment

Plan the lower arch first

The basis of ALL orthodontic treatment plans i.e. around the lower arch, particularly the lower labial segment.

  1. Measure the crowding of right and left side in the lower labial segment
  2. Note and measure any lower centre line shift
  3. Measure any crowding in the left and right lower buccal segments

This gives the space required on the lower right and lower left side.

Plan lower extractions

Plan the Upper arch

Place the study models&#47teeth in occlusion

  1. Measure the amount of movment required to get the upper right and upper left canines to Class I
  2. Measure any crowding in the left and right upper buccal segments

This gives the space required on the upper right and lower left side.

Plan upper extractions

  1. If space required on one side is less than 2mm - consider creating space by distal movement of the buccal segments
  2. If the space required is between 2 and 4 mm - extract lower second premolar
  3. If space required is greater than 4mm - extract the first premolar ('Four or more extract a four')
  4. If space required is 6 or 7mm - extra-oral anchorage is required (upper head gear or palatal arch)
  5. If space greater than 7mm - is there a unnoticed skeletal discrepancy? or distal movement is required in addition to extractions

The cool 3R orthodontic treatment calculator