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Orthodontic assessment, diagnosis and treatment planning: part two

In the second of three papers, ROSS HOBSON aims to provide the users with the means to begin the process of orthodontic treatment planning and case selection after the initial assessment and diagnosis

FACTFILE

Ross Hobson BDS, MDS, PhD (Ncl); MDOrth, FDS RCPS (Glas); FDS RCS (Ed); FDS RCS (Eng); SFHEA is an orthodontist and partner at the Windmill Orthodontics Group in Newcastle upon Tyne. He is also training director at the IAS Academy and was previously professor of orthodontics at UCLan and senior lecturer and consultant in orthodontics at the Newcastle Dental School.

Clinical relevance

The increase in GDP delivered orthodontics is rising rapidly. Unfortunately, there has been a corresponding increase in complaints, litigation and itness to practise cases. This is largely due to a failure to correctly assess, diagnose and plan treatment. This lack of assessment, diagnosis and planning results in a failure to gain valid consent, select patients appropriate for the operator’s skills, and failure to identify patients that require referral. This second of three papers aims to explain and demystify orthodontic diagnosis and planning.

Objectives

Orthodontic treatment planning is based around correcting all of the problem list as described in the irst article in this series. Always planning correction of the problems in the ‘problem list’ and achieving an ideal outcome – that is what treatment is required to achieve a class I skeletal relationship, class I canines, class I incisors and class I molars with well aligned upper and lower arches, no crowding and no tooth size discrepancies.

This simple premise of always planning the ideal can readily be applied to all clinical situations as it provides a basis to compare any compromise treatment options and whether or not a compromise is acceptable relative to undertaking the ideal treatment, in terms of length of treatment, its extent or indeed if treatment can achieve a signiicant improvement for the patient.

In orthodontics it is essential to undertake planning in a hierarchy as below:

Ideal

Correcting all problems (skeletal and dental) to the ideal class I

Compromise one

Accepting the skeletal relationship and correcting all dental relationships to ideal, ie incisors, canines and molars to class I.

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July/August Orthodontic Practice 2019