The objectives of treatment in dentofacial orthopedics
1. Introduction :
The criteria for finishing an orthodontic treatment correspond to the aesthetic, occlusal and functional objectives that each practitioner must set once the diagnosis has been made and when establishing their therapeutic planning. These objectives sought at the end of treatment must make it possible to obtain results whose sustainability will be effective in the short, medium and long term, in order to avoid relapse.
2-treatment objectives :
The orthodontist will consider his active treatment complete when he has achieved the goals he set at the beginning.
2.1 – Occlusal objectives : We speak of “optimal” or “balanced” occlusion when all the elements of the masticatory system (teeth-periodontium-TMJ-the neuromuscular system) are in static and dynamic balance.
A-Static occlusion:
* Intra-arcade layout :
-the proximal ridges at the same level.
-Parallelism of dental axes (dental panoramic view).
-Leveling of the occlusion curve (flat occlusion plane).
-Continuity of contact points.
-Fixed all dystopias.
-Take into account the position of the lower incisor on its base (stability factor).
*Inter-arch arrangement: At the end of treatment, the patient must be in perfect occlusal balance, characterized by punctiform contacts, of the same intensity and in maximum number to ensure the distribution of occlusal forces over the entire masticatory apparatus and avoid the appearance of malpositions.
– The sagittal direction : the commonly used classification is that of Angle.
– Molar and canine Cl I ratios (ideal).
-Therapeutic Cl II reports (after extraction of 14-24).
-Reports of therapeutic Cl III (after extraction of 34-44).
– Adequate overhang (Over jet 2mm).
-Suitable angle of attack.
– In the transverse direction , the upper arch circumscribes the lower arch by the value of half a cusp. The upper and lower inter-incisal midpoints coincide with the median sagittal plane.
– In the vertical direction :
– The anterior overlap (over bite) must be equal to 2 mm
-The support cusps establish contacts with the opposing occlusal fossae and embrasures (good meshing).
The 6 occlusion keys according to “Andrews 1972”:
1. Molar relationships : the mesiopalatine cusp of the maxillary first molar must fit into the central fossa of the mandibular first molar and the palatine cusps of the upper premolars must be in relation to the embrasures of the mandibular premolars.
2. Mesiodistal angulations of crowns : the gingival third of the longitudinal axis of the crown must be more distal than the occlusal third. The degree of version depends on the type of tooth
3. vestibulolingual inclination of the crowns : The maxillary incisors have a radiculo-lingual torque, the mandibular incisors have zero torque while the lateral sectors must have a progressive radiculo-vestibular torque which increases in the posterior direction.
4. Rotations : no teeth should be rotating.
5. Interdental contacts : in the absence of an anomaly in the mesio-distal width of the teeth or jaws, there should be no diastema remaining.
6. compensation curves : they must be weak or absent in order to allow optimal contact between the maxillary and mandibular teeth.
bl dynamic occlusion :
– Closing and opening movements must be done without interference and be straight (straight closing and opening path)
-Coincidence of the RC with the PIM (the distance between the positions of maximum intercuspation and the centric occlusion should not be greater than 2 mm.)
-lateral and propulsive movements must be carried out without any working or non-working interference.
2.2 Functional objectives:
1-Physiological (or adult ) swallowing is performed with the arches in occlusion, the mandible being stabilized by dental contact linked to the contraction of the elevator muscles, without participation of the orbicularis oris, the tip of the tongue resting on the retro-incisive papillae.
2 – Unilateral alternating chewing : the most frequent and most physiological
3-Nasal breathing
4-Phonation : correct articulation of different phonemes;
5-Mimicry : A facial expression is the result of one or more movements or positions of the skin muscles. These movements transmit to observers the emotional state of an individual. Facial expressions are a form of nonverbal communication.
2.3 Aesthetic objectives:
* Facial symmetry with respect to the median sagittal plane (MSP) of the face which passes between the two eyes, crosses the tip of the nose to fall back to the level of the philtral groove and ends in the middle of the chin. It is rectilinear.
*The horizontal planes join the pupils, the wings of the nose and the corners of the mouth. They are perpendicular to the median sagittal plane and therefore parallel to each other.
*Equality of the facial floors.
*Good dental alignment with good relationships with the lips and gums.
*More or less straight skin profile, clinically assessed by the relative position of the upper lip and chin between them and in relation to the frontal planes (vertical planes perpendicular to the Frankfurt plane passing respectively through the glabella [Izard’s anterior frontal plane] and through the suborbital point [Simon’s posterior frontal plane] .
*Good dento-labial relationships at rest:
From the front : the upper lip, at rest, must cover the vestibular surface of the incisors up to about two to three millimeters above their free edge. The lower lip covers the rest of the vestibular surface of the upper teeth.
In the transverse direction , we observe: the concordance of the maxillary inter-incisal point with the median sagittal plane
* Harmonious smile: the elevation of the upper lip should reach the neck of the maxillary incisors. While the edge of the lower lip is flush with the free edge of the upper teeth (the ideal smile arc)
2.4 Specific objectives :
-Judge the degree of harmfulness of wisdom teeth.
– Synchronization of condylar movements.
-Periodontal integrity (continuity of attached gingiva).
3. Conclusion:
Among the means which allow to avoid the recurrence of dental , alveolar and basal anomalies after their correction, it is a good finishing of the treatments which results from the realization of the occlusal, aesthetic and functional objectives determined by the orthodontist from the beginning of the treatment.
THE PLAN
1. Introduction :
2- treatment objectives
2.1 – Occlusal objectives :
A – Static occlusion:
* Intra-arcade layout
* Inter-arcade layout
The 6 keys to optimal occlusion according to “Andrew”
B- Dynamic occlusion
2.2 Functional objectives:
2.3 Aesthetic objectives
2.4 Specific objectives
3. Conclusion
Good oral hygiene Regular scaling at the dentist Dental implant placement Dental x-rays Teeth whitening A visit to the dentist The dentist uses local anesthesia to minimize pain