Treatment Planning Guides

How the Guides Work

The guide is structured by clinical condition. Find your patient's clinical condition and use the provided flow chart to see some potential treatment options. Review the notes and consider your options based on your training & experience level.

Crowding: Crowding is when the teeth are too close together and have abnormal positions such as overlapping, displacement in various directions, or torsion. 

Crowding is a common malocclusion that can present in varying degrees of complexity, from mild to severe. 

A combination of approaches can be used to resolve the crowd, with the application dependent on the patient's facial profile, the dental position of the teeth, arch form, size of teeth, and buccal class relationship.

Note: This guide is intended to provide general, high-level information on how each condition could be treated. Not included are the relationships between different conditions that exist in the majority of patients. Always consider each patient's individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.

Spacing: Spacing is when there are interdental spaces and a lack of contact points between teeth.

Spacing is usually from a tooth size discrepancy, missing teeth, proclined teeth, or a combination of these.

Mild spacing can usually be corrected with the aligners by themselves. Moderate spacing can be corrected with retraction (if the teeth are proclined). The severe spacing usually requires a combination of clear aligners and restorative dentistry to correct.

Retention after treatment with clear aligners is important for all cases with spacing to prevent relapse.

Note: This guide is intended to provide general, high-level information on how each condition could be treated. Not included are the relationships between different conditions that exist in the majority of patients. Always consider each patient's individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.

Narrow Arches: Narrow arches are indicated by arches that are tapered rather than broad and U-shaped.

In narrow arch cases, the upper posterior teeth can't be seen when the patient smiles, and the teeth are usually inclined lingually.

A narrow arch can be broadened to improve the arch form and improve a smile, as long as there is enough periodontal support present to allow for healthy dental expansion.

Note: This guide is intended to provide general, high-level information on how each condition could be treated. Not included are the relationships between different conditions that exist in the majority of patients. Always consider each patient's individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.

Crossbite: A crossbite is an abnormal relationship of one or more teeth of one arch to the opposing tooth or teeth of the other arch due to labial, buccal, or lingual deviation of tooth position, or to abnormal jaw position.

It is important to find out the cause of the crossbite to be able to treat it correctly. Identifying if the crossbite is a dental crossbite or skeletal crossbite will also affect the treatment plan.

A Dental Crossbite is indicated by the displacement or buccal/lingual tipping of the teeth causing these teeth to be positioned more buccally or lingually concerning the teeth in the opposing arch.

A Skeletal Crossbite is indicated by a narrow maxillary arch and/or a wide mandibular arch. The long axis of the teeth appears to be normal in this instance, but the arches are not coordinated due to a discrepancy in arch size.

Note: This guide is intended to provide general, high-level information on how each condition could be treated. Not included are the relationships between different conditions that exist in the majority of patients. Always consider each patient's individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.

Deep bite: A deep bite is when there is an increased vertical overlapping of the mandibular anterior (lower front) teeth by the maxillary anterior (upper front) teeth, usually measured perpendicular to the occlusal plane.

A deep overbite (deep bite) is a common vertical problem and is important to correct because it will allow for improved function of the occlusion.

There are several causes of deep bites including; if the mandibular incisor teeth erupt excessively or manifest as part of class II malocclusions, or infra-eruption or attrition of posterior teeth in adult patients.

Most of these cannot be corrected without comprehensive full-mouth rehabilitation.

Note: This guide is intended to provide general, high-level information on how each condition could be treated. Not included are the relationships between different conditions that exist in the majority of patients. Always consider each patient's individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.

Open bite: An open bite is an abnormal dental condition where the anterior or posterior teeth in the maxilla do not occlude those in the mandible in any mandibular position.

Open bites can be either a dental or skeletal malocclusion. Attention needs to be paid to the patient's soft tissue profile, maxillary arch form, and mandibular angle (usually seen in a lateral cephalometric radiograph).

You can predictably correct open bites with clear aligners by tipping back the incisors, creating a relative extrusion effect to deepen the bite.

Skeletal open bites should be treated with skeletal solutions. Orthognathic surgery could be used to correct the skeletal aspect and then clear aligners to correct the dental aspect.

Note: This guide is intended to provide general, high-level information on how each condition could be treated. Not included are the relationships between different conditions that exist in the majority of patients. Always consider each patient's individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.

Class II: A Class Il molar relationship exists when the mesiobuccal cusp of the upper first molar occludes mesial to the buccal groove of the lower first molar.

As a result, all the upper teeth tend to bite forward of their corresponding teeth in the lower arch. The premolars and canines do not interdigitate properly, and the upper incisors are too far in front of the lowers. The anterior teeth usually erupt into a deep overbite. 

A Class Il molar relationship can present in varying degrees of severity.

Note: This guide is intended to provide general, high-level information on how each condition could be treated. Not included are the relationships between different conditions that exist in the majority of patients. Always consider each patient's individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.

Class III: Class III is a malocclusion where the lower teeth and/or jaw is positioned ahead relative to the upper teeth and/or jaw.

Class III malocclusions can be separated into dental and skeletal. It is extremely important to discover the etiology of the issue to successfully treat patients with Class III malocclusions.

A full Class III is mostly skeletal and may have a dental component. Cases with major skeletal discrepancies normally require a surgical/orthodontic treatment approach.

A partial Class III could be skeletal or dental and can often be treated with dental camouflage to correct the dental
relationship component.

Note: This guide is intended to provide general, high-level information on how each condition could be treated. Not included are the relationships between different conditions that exist in the majority of patients. Always consider each patient's individual dental and periodontal condition, restorative needs, facial proportions, and age when you are considering treatment options.