Treatment Goals and Treatment Planning

Treatment goals and treatment planning is the stage at which diagnostic findings are turned into explicit objectives and a means of achieving them. The orthodontist orders the patient's problems into a prioritised list, states what the treatment should accomplish for each problem in terms of occlusion, function, and facial aesthetics, and then selects a sequence of mechanics consistent with those objectives.

Definition

Treatment goals and treatment planning is the translation of a prioritised diagnostic problem list into explicit occlusal, functional, skeletal, and soft-tissue objectives and the selection of a treatment sequence intended to achieve them.

Scope

The entry covers how a problem list is converted into objectives, the dimensions along which goals are defined (occlusal, functional, skeletal, and soft-tissue), and the idea that the plan is the route from the present situation to the stated end-point. It treats planning conceptually; it gives no individualized treatment recommendations and no mechanical prescriptions.

Core questions

• How is a diagnostic problem list converted into treatment objectives?
• Along what dimensions are orthodontic treatment goals defined?
• How do objectives constrain the choice of mechanics?
• How are competing goals, such as occlusion and profile, balanced?

Key concepts

• Prioritised problem list
• Treatment objectives
• Occlusal goals (characteristics of normal occlusion)
• Functional goals
• Soft-tissue and aesthetic goals
• Skeletal versus dental compensation
• Trade-offs among objectives

Mechanisms

Planning works backward from a defined end-point. The diagnostic findings are ranked into a problem list that distinguishes the patient's chief concern from incidental issues; each prioritised problem is then assigned an explicit objective; and the objectives jointly constrain which mechanics can deliver them. Andrews' six characteristics of normal occlusion provide a concrete description of an occlusal end-point that objectives can target, while cephalometric analyses such as Steiner's and Ricketts' express skeletal and dental goals in measurable terms. Where objectives conflict, for example between an idealised occlusion and the soft-tissue profile, the plan reflects a reasoned balance rather than the optimisation of any single measure.

Clinical relevance

Explicit, prioritised objectives make an orthodontic plan transparent and reviewable and link each intended movement to a diagnostic finding; understanding this supports critical reading of treatment rationales. This entry describes goal-setting in general terms and is not a basis for planning treatment for any individual patient.

Evidence & guidelines

Descriptions of normal occlusion, such as Andrews' six keys, function as widely cited reference targets for occlusal goals, while cephalometric norms inform skeletal and dental objectives with the caveat that norms are population-specific and interpreted alongside clinical judgement.

History

Goal-directed orthodontic planning matured as occlusal and cephalometric reference standards became available. Steiner's 1960 synthesis explicitly framed cephalometrics as an aid to planning and assessing treatment, and Andrews' 1972 description of the six keys to normal occlusion gave a concrete occlusal target derived from observation of well-aligned dentitions. The records-diagnosis-problem-list-objectives sequence was later codified in standard textbooks such as Proffit's.

Debates

How should occlusal ideals be weighed against the facial profile?

Pursuing an idealised occlusion can conflict with soft-tissue and facial objectives, and how to balance measurable occlusal targets against aesthetic and functional goals remains a central judgement in orthodontic planning.

Key figures

• Lawrence F. Andrews
• Cecil C. Steiner
• Robert M. Ricketts

Seminal works

• andrews-1972
• steiner-1960
• ricketts-1960

Frequently asked questions

What is a treatment objective in orthodontics?

It is an explicit statement of what treatment should accomplish for a prioritised problem, expressed in occlusal, functional, skeletal, or soft-tissue terms, from which the choice of mechanics follows.

Why are the six keys to normal occlusion relevant to planning?

They describe concrete characteristics of a well-aligned occlusion that can serve as a reference end-point, helping define the occlusal goals a plan aims to reach.