SEQUENCE OF ORTHODONTIC

TREATMENT

By: Doc MC
STAGES OF ORTHODONTIC
TREATMENT
1. Strap-Up/Installation of Braces
2. Leveling and Alignment
3. Bite Correction
4. Finishing
5. Stabilization
6. Removals and Retention
1. STRAP-UP/INSTALLATION OF BRACES

➢ CHECK PANORAMIC RADIOGRAPH (OPG)

o Check alveolar bone support and roots
o Check the shape of the condyle
o Presence of Impacted Teeth
o Presence of Retained Deciduous
o Presence of Pathologic Conditions
(supernumerary, periapical lesion, dilacerated
roots, ankylosis, proximity of roots to the
maxillary sinus)
1. STRAP-UP/INSTALLATION OF BRACES

➢ INITIAL DIAGNOSIS
o Chief Complaint:
o Oral Hygiene: Poor, Fair, Good
o Profile Analysis: Straight, Convex, Concave
o Lip Profile: Normal, Retrusive, Protrusive
o Presence of Cant in the Occlusal Plane
o Classification of Malocclusion
o Molar Relationship (Left and Right)
o Canine Relationship (Left and Right)
1. STRAP-UP/INSTALLATION OF BRACES

➢ INITIAL DIAGNOSIS
o Overbite (1-3 mm)
o Overjet (1-3 mm)
o Midline of U (mm)
o Midline of L (mm)
o Abnormal Oral Habits: Thumbsucking, Tongue-thrusting,
Mouthbreathing
o TMJ Disorder: Mandibular Deviation during Opening and
Closing, Clicking of TMJ (w/ or w/o pain), Clenching,
Bruxism, Medication taken
 CLASSIFICATION OF MALOCCLUSION

CLASS I
➢ Type 1: Crowding of anterior teeth
➢ Type 2: Proclined maxillary incisors
➢ Type 3: Anterior crossbite
➢ Type 4: Posterior crossbite
➢ Type 5: Mesial drifting of molars due to premature loss of
deciduous molars
➢ Type 6: Bimaxillary Protrusion
 CLASSIFICATION OF MALOCCLUSION

CLASS II Full Cusp (FC) or Cusp-Cusp

(CC)
➢Division 1: Proclined maxillary
incisors
➢Division 2: Retroclined maxillary
central incisors
 Class II
Division 1
Class II
Division 2
 CLASSIFICATION OF MALOCCLUSION

CLASS III
➢ Type 1: Edge-to-edge
➢ Type 2: Crowded mandibular incisors but no crossbite
➢ Type3: Crowded maxillary incisors, underdeveloped
maxilla and presence of anterior crossbite
Class III
Type 1
Class III
Type 2
Class III
Type 3
2. LEVELING & ALIGNMENT (8TH - 10TH visit)
GOALS:
▪ Correction of Crowding
▪ Correction of Rotation
▪ Correction of Mild Anterior Crossbite
▪ Correction of Posterior Crossbite
▪ Correction of Supraeruption and Infraeruption
▪ Correction of Mesially Tipped Molars (Bite Plane, Bite Turbos, Bite Ramps)
▪ Correction of Occlusal Plane Cant
Archwires: 12 NiTi, 14 NiTi, 16NiTi, 16SS (16X16/16X22), 18SS,
17X25SS or NiTi
PLACEMENT OF BITE TURBOS/BITE RAMPS

Purpose: To increase vertical dimension

and provide vertical clearance

It should only be 2-3mm in thickness and

applied bilaterally and is only temporary
➢ BITE TURBO - For molars

➢ BITE RAMPS – Lingual of anteriors

2. LEVELING & ALIGNMENT

How To Check
Occlusal Plane
Canting
3. BITE CORRECTION

GOALS:
▪ Correction of Rotation (Couple Mechanics)
▪ Midline Correction
▪ Overjet Correction (Exo 4s/5s/8s)
▪ Correction of Molar and Canine Relationship
o Molar – Class I or Class II Full Cusp
o Canine – Class I
▪ Closure of Spaces (Anchorage Requirement)
o E-Chain or OCS
Archwire: 18SS, 17X25SS, 19X25SS
DETERMINING THE CORRECT MIDLINE

 The dental midlines of the

upper and lower should align
with the middle of the face
 SOFT TISSUE EVALUATION

➢ ESTHETIC LINE (E-line) – upper lip should be 4 mm behind while the lower lip
should be 2 mm behind
➢ STEINER’S (S-LINE) – the most prominent points of upper and lower lip should
touch this line
4. FINISHING

GOALS:
▪ Correct Individual Tooth Positioning (19x25/21x25)
➢ First Order Bend – inset, offset, toe-in
➢ Second Order Bend – step bends, tipback bend, gable
bend
➢ Third Order Bend – lingual and buccal/labial torque
bends
▪ Midline Correction (1-3 mm)
▪ Correct Intercuspation
5. STABILIZATION
GOALS:
▪ Stabilization (3-4 months)
- Prior to stable ask the patient if he/she is satisfied with
the treatment and has no other concerns as well as
his/her chief complaints were addressed.
- If the patient has no other concern, please ask the patient
to sign the form* that he/she is allowing the dentist to
proceed with the stabilization in which no other
correction will be done after, and he/she is willing to have
retainers after removal. Please also indicate the price for
his/her retainers.
- For the dentists, do not stable too tight or too loose and
do not place ligaties to avoid unwanted tooth movement
and prevent debonding of brackets during stabilization
period.
*For Management’s approval
6. REMOVALS AND RETENTION

- Achieve a Functional Occlusion (Mutually Protected

Occlusion)
o Canine Guidance/Group Function
o Anterior Guidance
- DAs should take intraoral photos (Frontal, Left,
Right)
- Choice of Retainers:
o Hawley Retainers – for non-extraction cases
o Wrap Around Retainers – for extraction cases
▪ Within 6 months – Free readjustment
▪ More than 6 months – New retainers
 MUTUALLY PROTECTED OCCLUSION

✓ During MAXIMUM INTERCUSPATION, the posterior

teeth protect the anterior teeth
 MUTUALLY PROTECTED OCCLUSION

✓ During PROTRUSION, the anterior teeth

contact the incisal edges protecting the
canines and posterior teeth (Anterior
Guidance)
 MUTUALLY PROTECTED OCCLUSION
✓ During LATERAL EXCURSION, the upper and lower canines
contacts with each other protecting the anterior and posterior
teeth (canine guidance) or group function

Canine Guidance

Group Function
Thank you for your time!