Aligner Treatment Planning

Info cursus

The cornerstone of effective and proficient aligner therapy is anchored in meticulous treatment planning. The advent of the novel Orthodontic Treatment Planning Protocol heralds a systematic approach to our daily clinical strategies, encapsulating key considerations in Airway, Aesthetics, Function, Periodontics, and Biomechanics.
Central to our protocol is an emphasis on Risk Management. Our lecture will delve into nuanced treatment methodologies, integrating various appliances with aligners to optimize clinical outcomes.

Airway management extends beyond the superficial treatment of snoring and breathing difficulties; it encompasses a comprehensive understanding of anatomical structure, functional dynamics, and behavioral patterns. Orthodontic interventions can significantly alter structural aspects of the airway. A profound understanding is imperative, particularly in discerning whether treatment is addressing symptoms or the root cause. For instance, it's crucial to determine the etiology behind dental crowding, even in cases without historical Bolton discrepancies, as factors such as dysfunctional muscular patterns due to mouth breathing can exert detrimental forces on teeth, leading to negative coronal torque.

Dentofacial and Esthetic Planning will be explored in depth, focusing on the optimal placement of teeth within the facial framework. This includes critical analysis of jaw canting, occlusal plane discrepancies, buccal corridor spaces, and lip mobility, which are all vital in achieving a harmonious dental-facial aesthetic.

Functional considerations are pivotal in aligner treatment planning. The lecture will address the significance of mandibular positioning (centric relation), identifying both static and dynamic occlusal contacts, and determining when modification of the current function is necessary, or if the Maximum Intercuspation Position (MIP) Bite is appropriate.

Periodontal instruction will cover the integral knowledge of soft tissue health, bone integrity, and the scope and constraints inherent in tooth movement.

Lastly, Biomechanics will be discussed from a dual perspective: firstly, the application of forces required for tooth movement, and secondly, the impact of tooth structure and morphology on treatment protocols.

This comprehensive lecture aims to provide clinicians with a robust framework for aligner treatment planning that ensures efficient, successful outcomes through a multidisciplinary approach.Within the realm of interdisciplinary dental treatment, it is widely acknowledged by preeminent dental professionals that orthodontics (ortho) serves as a foundational element for the success of prosthodontic interventions. Renowned experts across various dental disciplines have gone as far as to suggest that orthodontics is transforming the field, with a progressive assertion that "ortho is the new prostho." This prompts a critical inquiry: Why should we resort to grinding healthy tooth structure and addressing merely the superficial manifestation of dental issues when we are capable of more refined interventions?

Orthodontic treatment offers the opportunity to correct malpositions of teeth, aligning them into their optimal positions, thus enhancing functionality and aesthetic outcomes. This approach prompts the reconsideration of traditional methods, particularly in the context of dental recessions. It raises questions regarding the etiology of these recessions — whether they stem from issues related to bone density, soft tissue thickness, functional habits, or a confluence of these factors and their relationship to the tooth’s positioning within the alveolar bone envelope.

Furthermore, it is imperative to evaluate the potential success of recession coverage without first addressing the repositioning of the tooth into its appropriate alveolar envelope. For dental arches that have adapted to compensate for malpositions and wear, a systematic approach must be considered to achieve the most favorable outcomes. This includes a thorough examination of the emergence profile and the cementoenamel junction (CEJ), assessing the extent to which these factors contribute to the overall stability of the dental structures.

In considering the broader scope of structural, functional, and behavioral factors that impact the airway, we are compelled to deliberate the interplay between stability and these variables. This brings to light a crucial decision-making juncture: whether our treatment focus should be directed at the underlying cause or the symptoms presented.

The quintessence of effective treatment planning lies in adopting an approach that is comprehensive and systematically prioritized. I have devised a novel protocol that stipulates the following order of considerations: 1. Airway, 2. Aesthetics, 3. Function, 4. Biomechanics, and 5. Periodontics.

Throughout this lecture series, we will examine a variety of case studies that illustrate the limitations of outdated, solely ortho-centric protocols. These examples will elucidate the necessity of an all-encompassing orthodontic treatment strategy that is well-versed in the five pivotal domains aforementioned.

The lecture aims to expand the horizons of our future treatment planning and to shed light on the predictability of such comprehensive treatment approaches. We are on the cusp of redefining the synergy between orthodontic and prosthodontic care, striving for excellence in both form and function through strategic, interdisciplinary treatment planning.