ODF treatment objectives and decision criteria
Visualizing treatment goals is a necessary guide for therapeutic decision-making in dentofacial orthopedics. This guide allows the practitioner to choose between several options and individualize the treatment plan for their patient.
- Occlusal objectives:
The most satisfactory goal of orthodontic treatment is optimal static and dynamic occlusion.
- Concordance between Centric Relation and Maximum Intercuspation:
90% of natural dentitions may have a maximum intercuspation position anterior to centric relation.
When orthodontic treatment is indicated, the concordance between the two positions I. CM and R. C constitutes the most favorable maxillomandibular relationship for establishing a good occlusion ( no more than 1 mm of discrepancy).
The search for this concordance is a primary objective in orthodontics, otherwise excessive abrasions, lesions of the periodontium or joint pain may appear.
- Intra-arcade arrangements : Three essential criteria must be respected:
- the proximal ridges must be at the same level;
- the dental axes , at the end of treatment, must present a certain degree of parallelism . This control of the dental axes must be carried out using a panoramic radiograph, at the final stage of active treatment using fixed technique;
- Leveling the occlusion curve is a technical necessity for most Multibrague methods.
- Inter-arcade relations:
Statics:
Class I relationships: this ideal occlusion does not always correspond to the occlusion obtained at the end of treatment;
Class II therapeutic relationships (extraction of 14 and 24);
Therapeutic Class III relationships (extraction of 34 and 44). The mesio-vestibular cusp of the first lower molar is related to the embrasure 14 and 15. Apart from this cusp, all the lower primary cusps have relationships with the crests.
This therapeutic relationship must be rejected.
Kinetics:
- during the propulsion movement, immediate disocclusion of the molars must be ensured.
- during lateral excursion movements, no cusp contact should be observed on the non-working side.
The working contacts allowing the guidance of the mandible during movement are ensured either by the canine; this is a ” canine protection”
» .
Either by the vestibular cusps of the upper teeth (supporting or primary cusps), it is a “ group protection”.
- Aesthetic objectives:
It is the aesthetic motivation that most often leads to consultation.
This shows how much the improvement of the appearance of the teeth and the face must be sought in conjunction with optimal occlusal functioning.
Face type: As a general rule, for those with accentuated long or short face types, treatment to increase or decrease facial height should be considered.
Lips: the shape, position of the lips in profile and the relationships they have with each other and with the teeth are determining factors in the therapeutic objectives and are largely under the control of the treatment.
We will look for harmonious labial relationships and the closure of the lips in the resting position.
- Functional objectives:
- Restore disturbed functions: Ventilation
Swallowing
Chewing
Phonation
- remove parafunction: Digital Suction
Onichophagy
Trichophagia Bruxism.
- long-term sustainability:
Stability: placing the teeth in a balanced position.
Stability depends on:
- muscle pressures;
- anatomical elements: short lip, toned labial strap + +, etc.;
- functional elements: persistence of dysfunctions;
- of arrangement and intercuspation;
- of residual growth;
- mesial eruption of wisdom teeth;
- periodontal morphology;
- of specific histological factors (stretching of supracrestal fibers, after correction of dental rotation.
Longevity:
Completing orthodontic treatment in good conditions most likely allows for better functioning of the stomatognathic system .
- Safety:
Avoid iatrogenic injuries to both hard and soft tissues.
- At the level of the teeth:
Coronary lesions:
A fracture of a free edge fragment after removal of rings or brackets. Leukomas:
Loss of substance at the necks in a whitish half-moon area. (Decalcification).
Root lesions: Root resorption.
- At the periodontal level: Gingival hyperplasia Gingival inflammation
At the bone level: reduction in the height of the bone septa at the extraction sites.
- Specific objectives:
- Improve nasal ventilation by disjunction of the maxilla, prescription of the ablation of the pharyngeal and/or palatine tonsils.
- Eliminate the need for prosthetic restoration: after the loss of a permanent molar, fixed orthodontic techniques allow the extraction spaces to be closed, thus avoiding prosthetic replacement in adolescents or young adults.
- The orthodontist can also contribute to balanced prosthetic rehabilitation by correcting mesio- or disto-tipped bridge support teeth or by improving the distribution of bridge pillars (distalization of a second premolar in an edentulous area).
- Create favorable conditions for the treatment of periodontal diseases: egress, for example, a tooth with an infrabony pocket, straighten a mesio-tipped molar.
Decision criteria for orthodontic treatment:
- The etiology of dysmorphoses:
Hereditary or functional origin
- Influence of growth:
Growth stage is an important factor to consider, determining whether the patient is before, during, or after the growth spurt
Growth direction: anterior rotation more favorable than posterior rotation.
- The type and severity of dysmorphosis:
The more severe the anomaly, the more difficult the treatment is to undertake in adult teeth and sometimes recourse to orthognathic surgery is unavoidable.
ODF treatment objectives and decision criteria
Wisdom teeth can cause pain if they erupt crooked.
Ceramic crowns offer a natural appearance and great strength.
Bleeding gums when brushing may indicate gingivitis.
Short orthodontic treatments quickly correct minor misalignments.
Composite dental fillings are discreet and long-lasting.
Interdental brushes are essential for cleaning narrow spaces.
A vitamin-rich diet strengthens teeth and gums.