How Orthodontists Plan Your Treatment: The UK Process Explained

Records taken at the orthodontic assessment

Before a treatment plan can be made, a complete set of orthodontic records must be gathered. These typically include a full medical and dental history, intraoral and extraoral clinical photographs, a dental panoramic tomograph (OPG) — an X-ray showing all the teeth and their roots — and a lateral cephalometric radiograph (a side-view X-ray of the skull). For aligner treatment and complex cases, a digital intraoral scan or plaster study models of the teeth are taken. Some complex or surgical cases require additional CBCT (cone beam CT) scanning. These records are not merely administrative — they form the clinical dataset from which diagnosis and planning are derived. Without complete records, any treatment plan is speculative rather than evidence-based.

Cephalometric analysis

The lateral cephalogram is used to perform cephalometric analysis — a standardised method of measuring the skeletal relationships between the upper jaw (maxilla), lower jaw (mandible), skull base, and teeth. Key measurements include the ANB angle (the relationship between the upper and lower jaw — which determines Angle's skeletal class), the inclination of the upper and lower incisors, the vertical facial proportions, and the soft tissue profile. Cephalometric analysis tells the orthodontist whether any malocclusion has a skeletal component (a jaw discrepancy) or is purely dental (a tooth position problem within normal jaws). This distinction fundamentally affects the treatment approach — a skeletal problem in a growing patient can be modified with functional appliances, whereas the same problem in an adult may require orthognathic surgery or be treated with dental camouflage.

Problem list and diagnosis

Once all records are analysed, the orthodontist constructs a problem list — a structured summary of the clinical findings. A typical problem list covers the skeletal relationship in all three dimensions (anteroposterior, vertical, and transverse), the soft tissue profile, the dental findings (overjet, overbite, crowding or spacing measurements, crossbite, centrelines), and any notable factors such as impacted teeth, root positions, bone levels, or gum recession. The problem list leads to a formal diagnosis — for example, a Class I skeletal pattern with moderate lower arch crowding and a coincident centreline — which provides the framework for everything that follows. Patients are entitled to understand their diagnosis; ask your orthodontist to explain the problem list in plain language.

Treatment objectives — dental, skeletal, soft tissue, and aesthetic

Treatment objectives translate the problem list into goals. Dental objectives specify what the end bite and tooth positions should look like — overjet and overbite targets, arch alignment goals, centreline correction, space closure or opening. Skeletal objectives address jaw position where possible — in growing patients, this might involve restricting or redirecting jaw growth; in adults, it may involve accepting the skeletal pattern and treating dentally. Soft tissue objectives consider the lip and profile changes that will result from tooth movement — for example, will retracting upper incisors in a case with a full lip profile improve or worsen the patient's facial appearance? Aesthetic objectives reflect the patient's own priorities and must be discussed and agreed. Good treatment planning integrates all four dimensions rather than optimising one at the expense of the others.

Appliance selection and alternative plans

With the problem list and objectives defined, the orthodontist selects the most appropriate appliance — fixed braces, clear aligners, a functional appliance, or a combination. Appliance selection is based on the biomechanical requirements of the case: which tooth movements are needed, how efficiently each appliance can achieve them, and what the patient's preferences and lifestyle requirements are. In most cases, more than one treatment approach is clinically viable. Good practice involves presenting the patient with the primary recommended plan and at least one alternative — explaining the clinical rationale for each, the differences in outcome, duration, and cost, and any trade-offs. A patient who understands why a particular plan is recommended, and what the alternatives would involve, is better placed to give meaningful informed consent.

Digital planning, consent, and what to ask before signing

Modern orthodontic practices use digital planning software to simulate the proposed tooth movements before treatment starts. For aligner treatment, the clinician or laboratory technician designs the movement sequence digitally, and the patient can view a 3D simulation of the planned result. For fixed brace cases, digital records help plan bracket placement and archwire sequences. Before signing the consent form, ask: What is my diagnosis? What are the treatment objectives? What alternatives were considered? What is the expected duration? What are the known risks for my specific case — root resorption, decalcification, relapse? What retainer plan is included? What happens if my teeth do not move as planned — are refinements or additional stages included? What is the total fee including retainers and any review appointments? Informed consent is not just a signature — it is a process of understanding before you agree.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.