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TREATMENT PLANNING (AESTHETIC (AIM: Obtaining a class I incisor and canine…

- - - - growth modification (success less predictable
      - surgery
    - - ortho camouflage
      - accept sk pattern + correct malocclusion
      - growth modification
    - - correct occlusal relationship
- - - - Correcting the inclination of a retroclined upper labial segment will require space to prevent an increase in the overjet.
      - Extra 0.5mm space required for 10 degrees change in inclination.
    - - Extra 0.5mm is required to correct vertical teeth.
      - Teeth angulated (bottom) occupy more space in the arch than those upright (top).
    - - An increased curve of Spee represents slipped contact points vertically and to level it requires space to avoid lengthening the arch.
      - Depth of curve (mm)
        3 or less
        4
        5 or more
      - Space
        requirement (mm)
        1
        1.5
        2
    - - .•Incisor proclination creates space
      - •Every 1mm of incisor retraction requires 2mm of space.
      - •Incisor retraction requires space.
      - •Similar space requirements apply in the lower arch
    - - •Mild (<4 mm).
      - •Moderate (4-8 mm).
      - •Severe (>8 mm).
  - - - anterior segment 0.25 mm per side
      - Removal of small amount of enamel on the mesial and distal aspect of teeth
      - buccal segment up to 1mm
      - handeled/automated strips,disc in contralateral handp, air rotar stripping w tungsten carbide bur, apply toical fluoride afterwards
    - - Performed in the presence of a crossbite.
      - increase in lower intercanine width is unstable.
      - 0.5mm of space is created for every 1mm of posterior expansion.
    - - 2-3 mm of space per side.
      - Using headgear.
      - Uprighting lower first molars
    - - •First premolars:
        -Teeth of choice when space requirement is moderate to severe.
        -Gives best chance of spontaneous alignment.
        -40- 60% of space will be available for the benefit of labial segment.
      - •Canines:
        -Severely displaced or ectopic.
        -If associated with pathological changes.
        -Close contact between 2 & 4 and good colour match!
      - •Incisors:
        -Poor prognosis.
        -CI buccal segments but there is lower incisor crowding.
        -Results in an increase of OJ and OB
      - •Factors affecting the choice of teeth for extraction:
        
        Pt's profile
        
        incisor ralationship
        
        amount of space required
        
        Position
        
        Prognosis
      - •Second premolars:
        -Mild to moderate space requirement.
        -Severely displaced.
        -Space closure by mesial drift of molars is indicated.
        •20-50% of space will be available for the benefit of labial segment.
      - •First permanent molars:
        -Poor prognosis.
        -Avoid in the absence of other permanent teeth and in well aligned buccal segments
        -Spontaneous alignment easier in Mx.
        -Little effect on a crowded labial segments.
        -Consider extraction of upper 6 if lower 6 extraction was necessary, but not vice
      - •Second permanent molars:
        -Facilitation of distal movement of upper buccal segment.
        -Relief of mild lower premolar crowding.
        -Provision of additional space for third permanent molars.