 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
Winter 2000 Editorial:
Controlling Treatment Time
Dr. Gerald Nelson, Editor
Treatment time is easily extended, and this article will focus on one method of controlling treatment times: standardized treatment protocols.
My partners and I have developed treatment protocols in our office by talking, trying, agreeing to change, and talking again. We strive to standardize portions of treatment actions so that we do them the same way, the staff is fully familiar with the steps, and the patient can be effectively seen by more than one doctor. We have found that organized treatment protocols will also help control treatment time.To give you one example, we have identified four phases of active treatment in an extraction case:
Appliance Placement – We place the .018 appliance with pre-torqued brackets, using a prescription that accounts for slot play in the bracket/wire interface. We level with 17.5 x 17.5 heat activated NiTi wires. If headgear is needed, we start it immediately. (3–5 months)
Reset – We obtain xrays to evaluate root parallelism, and we clinically assess bracket positions. Invariably we find one or two brackets a little out of place, either vertically or mesio-distally. We schedule a work appointment to reset all brackets noted, including those identified in the xrays. If we were unable to place second molars at the start appointment, we do that at this work appointment. Now we have a nicely placed appliance. We can continue with the 17.5 x 17.5 wire to fully correct the initial alignment. (3 months).
Space closure – During this phase we coordinate arch forms, open the bite, and close space. We may use closing arches (17 x 17SS), or a 17 x 25 NiTi archwire with a built-in occlusal curve with Alastik chain. When closed, spaces are laced with light (.009) steel ligature under the archwire (10–12 months).
Detail and removal – During this phase we use our detailing arches (17.5 x 17.5 SS) to complete the treatment. This puts the lie to the term straight wire appliance, as tiny bends and torques appear (4–6 months).
We standardize these phases so that we can proceed through them routinely, and so we are also aware when they are extended. This helps control treatment time. We are not trying to treat every patient in the same way, as these procedures have little to do with the actual treatment plan.
The sequence of the treatment phases also affects treatment time. If the appliance is perfected early in treatment, the teeth move toward your goal earlier. We don’t want to go back to light leveling arches after the first two phases.
Preliminary Treatment
Often a case requires a period of preliminary treatment before the full appliance is placed. We do this because it works faster than a full appliance. The following are four instances that fit this protocol:
• Class II Correction:We want the molars in Class I before we place the full appliance. We may use a head gear or a molar distalization technique.
• Palatal Impingement: If we can allow bicuspid eruption to open the bite, we will use an upper biteplane and lower fixed appliances for four months.
• Crossbites: We will use a plastic discluding appliance to jump an individual tooth. This may require a period of expansion with a palatal expander.
• Impactions: We will bring most impactions into the mouth before placing an appliance. We typically use a lingual arch as anchorage.
Once the preliminary treatment is accomplished, we can move ahead with our basic protocols.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Copyright © 1999 - 2006 Pacific Coast Society of Orthodontists. All Rights Reserved.
Please review our legal notices and privacy policy.
Created by WebResults.