Assessing the difficulty of an orthodontic case is a crucial step in ensuring the success of dental aligner treatment. Various criteria need to be taken into account when assessing the difficulty of orthodontic cases and selecting suitable patients for this type of treatment. This evaluation not only helps to predict potential challenges, but also to select cases based on the practitioner’s clinical experience, thus guaranteeing optimal results.
Here’s a guide to the main criteria to consider.
Assessing the difficulty of cases for successful treatment with dental aligners
Assessing the difficulty of the case is a critical factor in the success of treatment with aligners. Accurate assessment is essential for successful treatment, as it enables us to anticipate challenges and adapt therapeutic strategies accordingly. Case selection based on the practitioner’s clinical experience is essential.
In the early stages of practice, it is advisable to start with simple, moderate cases, allowing experience and confidence to be gained. As the practitioner’s skills increase, it becomes possible to broaden the scope of malocclusions treated and tackle more complex cases, ensuring a controlled and effective progression in the practice of aligner orthodontics.
➡️ We offer free training courses for our partner dentists to learn how to handle more complex cases.
Criteria for assessing the difficulty of a case
1. Dental anatomy
Tooth anatomy plays an essential role in assessing the difficulty of a case. Anterior and posterior teeth require different approaches:
- Anterior teeth : Often involved in aesthetic problems such as diastemas and minor malpositions.
- Posterior teeth Engage more complex movements, especially when correcting occlusal problems or adjusting occlusal contacts.
The distinction between maxilla and mandible is also crucial, as dental movements can vary in complexity and technique depending on the jaw involvede
2. The type of movement to be performed
The dental movements required to align teeth can be simple or complex. Here are a few examples:
- Vestibulo-version Tilting movement of the teeth towards the outside of the mouth.
- Ingressions and egressions Vertical movement of teeth, either inwards (ingression) or outwards (egression).
The complexity of these movements has a direct influence on the difficulty of treatment.
3. Dento-maxillary disharmony (DMD)
Dento-maxillary disharmony, or the discrepancy between the size of the teeth and the size of the jaws, is a determining factor in assessing the difficulty of a case:
- Slight to moderate crowding Can often be corrected by minor expansions or strippings.
- Overcrowding requiring extraction More complex cases may require extraction of mandibular incisors or distalization of teeth.
4. Malocclusions
Malocclusions are classified according to their severity and the movements required to correct them:
- Class I Often treated with RIP (Interproximal Reduction), expansion or vestibulo-version.
- Class II and III : Generally involve more complex treatments, including elastics, distalization or even orthognathic surgery.
Malocclusions can be simple, moderate or difficult, depending on the combination of these criteria and the patient’s specific needs.
Examples of case classifications
To assist you in assessing the complexity of a case to be treated and improve treatment predictabilityhere’s a table summarizing the various levels of difficulty of orthodontic treatment with dental aligners:
| Complexité | Simples | Modérés | Difficiles |
|---|---|---|---|
| Malocclusions | Classe I | DDM (Dysharmonie Dento-Maxillaire) (ou classes II / III thérapeutiques) | |
| Encombrement et espacements | Encombrement et espacements légers ou moyens (RIP, expansion, vestibulo-version) | Encombrement nécessitant une extraction d’une incisive mandibulaire et/ou une distalisation | Traitements par extraction de prémolaires |
| Supraclusions | Traitement par vestibulo-version des dents antérieures | Ingressions antérieures maxillaire et/ou mandibulaire | Ingression antérieure + égression postérieure |
| Béances | Egression antérieure | Egression antérieure + 1 mm d’ingression postérieure | Egression antérieure + ingression postérieure avec mini-vis (<1mm) |
| Transversal | Inversé d’une seule dent. Alignement esthétique sans correction de l’inversé d’articulé. | Inversé de plusieurs dents | Disjonction + aligneurs |
| Classe II / III | Classe II / III d’une demi cuspide avec un encombrement mineur (RIP + Elastiques) | - Classe II / III totales sans indication d’extractions (RIP + distalisation + Elastiques) - Orthopédie | - Classe II / III avec extractions - Chirurgie orthognathique |
The importance of follow-up and reassessment during treatment
Once the treatment plan has been drawn up and the dental aligners applied, regular regular follow-up and reassessment are crucial to the success of treatment. Periodic visits allow us to check progress of tooth movement and adjust aligners if necessary.
Unforeseen events, such as unexpected tooth movements or complications, can occur, making it necessary to adapt the initial treatment plan. Ongoing communication between patient and practitioner plays a key role in managing expectations and resolving problems quickly.
By incorporating frequent reassessments, practitioners can ensure optimal results and enhance the patient experience throughout the orthodontic process.
Conclusion
Assessing the difficulty of a case to be treated with dental aligners is essential for effective treatment and optimal results. By taking into account dental anatomy, the type of movement required, dento-maxillary disharmony and malocclusions, practitioners can better select cases and adapt their treatment strategies.
With experience, dentists can gradually broaden their field of expertise and tackle increasingly complex cases, ensuring successful orthodontic practice.
