This guide is a treatment planning tool designed to assist you decided how to treat particular conditions. Treatments are graded by complexity and by the orthodontic technique required, and graded by the expected experience required. The goal is to provide guidance on the efficacy of treatment for a particular condition and to aid providers select cases that best match their ability.
Note, when applying this guide only general, high-level information on how each isolated condition might be treated is provided. The relationships between different conditions that exist in most patients are not addressed. In this regard, always consider each patient’s individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.
As doctors are solely responsible for the treatment they’re providing their patients, they should understand their limits and not hesitate to consult a specialist for further guidance when required.
Complexity of treatment options and their suggested experience level are graded as follows, and are ordered as shown in the diagram below by diagnosis complexity and treatment comprehensiveness:
Novice (0-15 cases)
Experienced (16-50 cases)
Advanced (>50 cases)
This guide is available to download as a PDF for your easy reference.
Click on the " > " to expand each section.
Diagnosis Options:
1. Crowding
Crowding
Mild
Expansion / Proclination / IPR Novice (0-15 cases)
Moderate
Expansion / Proclination / IPR Novice (0-15 cases)
Lower incisor extraction Experienced (16-50 cases)
Distalisation Experienced (16-50 cases)
Severe
Expansion/Proclination/IPR Novice (0-15 cases)
Lower incisor extraction Experienced (16-50 cases)
Distalisation Experienced (16-50 cases)
Bicuspid extraction with a combination treatment Advanced (>50 cases)
2. Spacing
Spacing
Mild
Close all spaces Novice (0-15 cases)
Consolidate spaces, followed by restorative dentistry if desired Novice (0-15 cases)
IPR/retract lower to create positive overjet, retract upper to close spaces Novice (0-15 cases)
Moderate
Generalised (spaces throughout)
Close all spaces Novice (0-15 cases)
Consolidate spaces, followed by restorative dentistry if desired Novice (0-15 cases)
IPR/retract lower to create positive overjet, retract upper to close spaces Novice (0-15 cases)
Localised (isolated region)
Partially close with Proligner, and follow with restorative dentistry if desired Novice (0-15 cases)
IPR/retract lower to create positive overjet, retract upper to close spaces Novice (0-15 cases)
Fully close spaces with Proligner and auxiliary or fixed treatment as needed Experienced (16-50 cases)
Severe
Partially close with restorative dentistry if desired Novice (0-15 cases)
IPR/retract lower to create positive overjet, retract upper to close spaces Experienced (16-50 cases)
Fully close spaces with Proligner and auxiliary or fixed treatment as needed Experienced (16-50 cases)
3. Narrow Arches
Narrow Arches
Dental
Both Arches
Expansion Novice (0-15 cases)
Single Arch
Expansion Novice (0-15 cases)
Expansion and/or constriction of other(s) Experienced (16-50 cases)
Skeletal
Unfused Maxilla (Teen)
Maintain narrow arches, aesthetic alignment Novice (0-15 cases)
Rapid palatal expansion followed by Proligner for alignment Advanced (>50 cases)
Fused Maxilla (Adult)
Maintain narrow arches, aesthetic alignmen Novice (0-15 cases)
Surgical expansion followed by Proligner for alignment Advanced (>50 cases)
4. Crossbite
Crossbite
Dental
Anterior
Advanced tooth and/or retract opposite Novice (0-15 cases)
Posterior
Buccal
Maintain crossbite, aesthetic alignment Novice (0-15 cases)
Expansion and/or constriction of other(s) Experienced (16-50 cases)
Lingual
Expansion and/or constriction of other(s) Experienced (16-50 cases)
Skeletal
Anterior
Anterior (see 8. Class III)
Posterior
Surgical expansion followed by Proligner for alignment Advanced (>50 cases)
Non-surgical, limited Tx. See Dental Tx options
5. Deep Bite
Deep Bite
Supra-eruption of incisors
Intrude incisors with attachments Novice (0-15 cases)
Maintain deep bite, aesthetic alignment Novice (0-15 cases)
Infra-eruption or attrition of posteriors
Maintain deep bite, aesthetic alignment Novice (0-15 cases)
Alignment by posterior extrusion with auxiliaries Experienced (16-50 cases)
Proligner plus posterior extrusion with auxiliaries Advanced (>50 cases)
6. Open Bite
Open Bite
Dental
Incisor Flared
Relative extrusion by retraction Novice (0-15 cases)
Incisor Upright
Absolute extrusion with auxiliaries Advanced (>50 cases)
Skeletal
Maintain open bite, aesthetic alignment Experienced (16-50 cases)
Pre-surgical Proligner alignment followed by surgery Advanced (>50 cases)
7. Class II
Class II
Dental (End-on Class II)
Maintain Class II, aesthetic alignment Novice (0-15 cases)
Digitise, Class II elastics as needed Experienced (16-50 cases)
IPR canine to molar Experienced (16-50 cases)
Extraction, Proligner treatment with auxiliaries and/or fixed Advanced (>50 cases)
Skeletal
Maintain Class II, aesthetic alignment Novice (0-15 cases)
Improve Class II with digitisation, Class II elastics and/or IPR as needed Experienced (16-50 cases)
IPR canine to molar Experienced (16-50 cases)
Pre-surgical Proligner alignment followed by surgery Advanced (>50 cases)
Extraction, Proligner treatment with auxiliaries and/or fixed Advanced (>50 cases)
8. Class III
Class III
Dental
Aesthetic alignment only Novice (0-15 cases)
Advance uppers by aligners/Class III elastics Experienced (16-50 cases)
Advance uppers to make space for restorative Experienced (16-50 cases)
Retract lowers after IPR Experienced (16-50 cases)
Retract lowers by extraction and close space with Class III elastics Advanced (>50 cases)
Skeletal
Aesthetic alignment only Novice (0-15 cases)
Extraction/camouflage Experienced (16-50 cases)
Surgery and Proligner treatment Advanced (>50 cases)
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