Treatment objectives in dentofacial orthopedics and decision criteria
I- Treatment objectives in dentofacial orthopedics
In ODF as in all other medical disciplines, the practitioner before developing a treatment plan, must first set objectives to achieve.
We distinguish between main objectives and specific objectives.
MAIN OBJECTIVES :
A. OCCLUSAL OBJECTIVES
This involves ensuring an optimal occlusal function “occlusal harmony” in both the static and dynamic states.
Aa RC and ICM
The concordance between the two positions constitutes the most favorable maxillo-mandibular relationship for establishing a good occlusion (no more than 1 mm of offset).
The search for this concordance is a primary objective in orthodontics.
Ab INTRA-ARCH ARRANGEMENT
Three essential criteria must be respected:
• The proximal crests at the same level.
• The dental axes at the end of treatment must be parallel (on panoramic radiograph).
• Leveling of the occlusal curve.
Ac INTER-ARCH RELATIONSHIPS
1 STATIC
• Class I relationship (ideal to achieve),
• Therapeutic class II relationship obtained after extraction of 14, 24.
• Class III therapeutic relationship obtained after extraction of 34, 44, to be rejected as much as possible.
2 KINETICS
• Propulsion movement: presence of the incisal guide with immediate and total disocclusion of the molars
• Laterality movement: canine function or group function and no contact on the non-working side.
B. AESTHETIC OBJECTIVES
It is the aesthetic motivation that brings the patient to consult, we seek to obtain:
– A harmony of the face,
-Improvement of the profile: obtaining a flat profile.
-Harmony of the labial relationship (presence of stomion).
-An alignment of the teeth “dental harmony”, this is the first duty of the practitioner and in the eyes of the patient, it is the only objective of the treatment.
C. FUNCTIONAL OBJECTIVES:
-Improvement of nasal breathing (disjunction of the maxilla, removal of the tonsils, etc.)
-Improvement of phonation by establishing dental alignment and reestablishing a usual lingual situation.
-Correction of the lingual position at rest and during functions.
-Achieve unilateral alternating chewing.
D. LONG-TERM SUSTAINABILITY
-The key to the stability of an ODF treatment is to place the teeth in a balanced position (CHATEAU corridor).
-Take into consideration residual growth especially in the mandible, as well as mesial eruption of wisdom teeth in some cases.
SPECIFIC OBJECTIVES
• Improve the conditions for prosthetic restoration.
• Create favorable conditions for the treatment of periodontal diseases.
II-Therapeutic decision factors :
These are the factors that will influence our therapeutic choice, and which thus allow the practitioner to optimize the chances of success of his treatment. Among these factors we can cite:
1- the age of the patient:
- civil age:
The younger the patient, the more interoceptive our treatment will be, and the greater the chances of success.
- Bone age:
This is a key factor in our therapeutic decision, especially regarding orthopedic treatment, notably for cl II and cl III.
2-The type of anomaly:
Orthopedic treatment will be opted for when faced with a skeletal anomaly (FEB, Delaire, etc.), whereas when faced with an alveolar anomaly, the treatment will often be functional.
3-The etiology of dysmorphoses:
Faced with an anomaly with a strong hereditary character (cl II/2, cl III, etc.), the risk of recurrence will be greater, so the orthodontist will ensure that an adequate retainer is used and that it is worn for a longer period, for example.
4-Facial type (Growth direction):
In orthodontics, most of the therapeutic methods used contribute to further increasing the vertical direction. This particularity must be integrated into our therapeutic choice especially when faced with dolichofacial patients.
5-The type of profile:
Certain therapeutic decisions (extractions, incisor retraction, etc.) can have a strong influence on the final profile of our patient.
6-Patient cooperation :
This is a very important factor with regard to removable treatments (single plate, FEB, Delaire mask, TIM, etc.). All these treatments require perfect cooperation from the patient to optimize their success.
Treatment objectives in dentofacial orthopedics
Wisdom teeth may need to be extracted if they are too small.
Sealing the grooves protects children’s molars from cavities.
Bad breath can be linked to dental or gum problems.
Bad breath can be linked to dental or gum problems.
Dental veneers improve the appearance of stained or damaged teeth.
Regular scaling prevents the build-up of plaque.
Sensitive teeth can be treated with specific toothpastes.
Early consultation helps detect dental problems in time.