Create realistic objectives.

The first step in planning orthodontic therapy is to establish treatment objectives. It is impossible to achieve the correct end result if the appropriate goals or objectives have not been identified before treatment. In adolescent patients with complete dentitions, orthodontic treatment objectives tend to be idealistic. After all, if a young patient has an intact dentition without restorations, ideal esthetic and occlusal treatment goals should be attainable. Some orthodontists are trapped into applying these same idealistic treatment objectives to adult patients with missing or abraded teeth, old restorations, or other complications. Idealistic treatment objectives might not be appropriate for some adults. It might be more appropriate to create realistic, not idealistic, treatment objectives. Realistic treatment objectives generally fall into 4 categories: economically realistic, periodontally realistic, restoratively realistic, and occlusally realistic. If an adult orthodontic patient were missing several teeth, the edentulous spaces created during treatment would require restoration after removal of the appliances. There could be several restorative alternatives for replacing the missing teeth. The cost of these restorative treatment plans could differ widely. If the orthodontist positions the teeth incorrectly, requiring a restorative plan that is unaffordable, the patient might not complete the treatment. Therefore, it is mandatory that orthodontists establish a treatment plan that is economically realistic or affordable for each patient. A common treatment objective in children is to align the marginal ridges of adjacent molars and premolars to produce a uniform vertical relationship of the maxillary and mandibular posterior teeth. In a nonabraded, periodontally healthy adolescent dentition, aligning the marginal ridges not only helps to establish even contact of the posterior teethwhen they are brought into occlusion, but also creates a level interproximal bony relationship between adjacent teeth. However, in an adult with interproximal bone loss andunevenwear of themolars andpremolars, themarginal ridges are poor guides for positioning the posterior teeth. In these patients, the orthodontist’s role is to establish periodontally realistic objectives and to level the bone