Good Morning

RICKETTS
VISUAL
TREATMENT
OBJECTIVE &
SUPERIMPOSIT
ION
Presented
By:
Dr. Vikas

INTRODUCTION:

A Visual Treatment Objective (VTO) is like a

blueprint used in building a house.
It is a visual plan to forecast the normal growth
of the patient and the anticipated influences of
treatment, to establish the individual objectives
we want to achieve for that patient.
Treatment for a growing patient must be
planned and directed to the face and structure
that can be anticipated in the future, not to the
skeletal structure that the patient presents
initially.
The treatment plan should take advantage of
the beneficial aspects of growth and minimize
any undesirable effects of growth, if possible.

The Visual Treatment Objective permits

the
development
of
alternative
treatment plans.
After setting up the teeth ideally within
the anticipated or grown facial
pattern, the orthodontist must decide
how far he must go with mechanics and
orthopedics to achieve his goals,
whether it is possible to achieve them,
and what the alternatives are.

A step-by-step procedure to construct a

VTO for Case X in the following
sequence (putting in average growth for
an estimated two-year period of active
treatment and the objectives :
1. the cranial base prediction
2. the mandibular growth prediction
3. the maxillary growth prediction
4. the occlusal plane position
5. the location of the dentition
6. the soft tissue of the face

Package

POINT A CHANGES WITH VARIOUS

MECHANISM:
Mechanics
Range
Headgear
mm
Class II Elastics
mm
Activator
mm
Torque
2 mm
Class III Elastics
mm
Facial Mask
mm

Maximum
-8
-3
-2
-1
+23
+24

DENTITION LOWER INCISORS:

For this exercise, superimpose on the

corpus
axis
at
PM.
Place
dot
representing the tip of the lower incisor
in the ideal position to the new
occlusion plane, which is 1mm above
the occlusion plane and 1mm ahead of
APO line

DENTITION UPPER INCISORS:

place upper incisors in good overbite

Overjet position (2.5 mm overbite,
2.5mm Overjet) with an interincisal
angle of 130+ 100. Openbite patterns at
a greater angle, deepbite patterns at a
lesser angle

SUPERIMPOSITION:

After completion of the steps, Take VTO

and superimpose it in the five
superimposition areas to establish
individual objectives for the case.
The use of superimposition areas and
evaluation areas to establish treatment
design include changes due to normal
growth and changes due to various
treatment mechanics are different for
each individual because of his individual
morphology and facial type.

In order to forecast effectively and

decide upon the correct treatment
design, it is necessary for us to
first understand the individual patient
and describe his basic facial, skeletal
and dental structures.
secondly we should be able to anticipate
normal growth in amount and direction
in the various areas of the face and the
jaws.
thirdly we should understand the
response of his individual skeletal and

The cephalometric x-ray and tracing are

used as the basic tools of treatment
design and the following four objectives
are
A
basic description of the cranial
structures.
An analysis of normal growth change
A treatment design
An evaluation of growth and treatment
results.

The five superimposition areas are used

to evaluate the face in the following
order:
1. The chin.
2. The maxilla.
3. The teeth in the mandible.
4. The teeth in the maxilla.
5. The facial profile.

SUPERIMPOSITION AREA 1 (EVALUATION

AREA 1)

The first superimposition (Basion-Nasion

at CC Point) establishes Evaluation Area
1, within which we evaluate the amount
of growth of the chin in millimeters; any
change in chin in an opening or closing
direction that may result from our
mechanics; and any change in upper
molar.
In normal growth, the chin grows down
the facial axis and the upper six year
molars also grow down the facial axis.

SUPERIMPOSITION AREA 2 (EVALUATION AREA 2)

The
second
superimposition
area
(Basion-Nasion at Nasion) establishes
Evaluation Area 2 to show any change in
the maxilla (Point A).
The Basion-Nasion-Point A Angle does
not change in normal growth. Therefore,
any change in this angle would be due
to the effect of our mechanics.
With Evaluation Area 2, we determine
whether we wish to use an orthodontic
or an orthopedic force on the maxilla
with a headgear.

SUPERIMPOSITION AREA 3 (EVALUATION

AREAS 3 AND 4)

The third superimposition area (Corpus Axis at PM)

establishes Evaluation Area 3 and Evaluation Area
4, which together evaluate any changes that take
place in the mandibular denture.
In normal growth, the lower denture remains
constant with the APO Plane (the denture plane).
In Evaluation Area 3, we evaluate whether we are
going to intrude, extrude, advance or retract the
lower incisors, which helps us determine what type
of utility arch we will use.
In Evaluation Area 4, we evaluate the lower molars
to determine what type of anchorage we need and
whether we wish to advance, upright or hold the
lower molars.

SUPERIMPOSITION AREA 4 (EVALUATION

AREAS 5 AND 6)

The fourth superimposition area (Palate at

ANS) establishes Evaluation Area 5 and
Evaluation Area 6, which together evaluate
any changes that take place in the maxillary
denture. In normal growth, upper molars and
upper incisors grow on their polar axis.
In Evaluation Area 5, we evaluate what we are
going to do with the upper molars hold,
intrude, extrude, distallize or bring them
forward.
In Evaluation Area 6, we evaluate what we are
going to do with the upper incisors intrude,
extrude, retract, advance, torque or tip them.

SUPERIMPOSITION AREA 5 (EVALUATION AREA 7)

5th Superimposition Area (esthetic plane

at the crossing of the occlusal plane)
The fifth superimposition area (Esthetic
Plane at the crossing of the Occlusal
Plane) establishes Evaluation Area 7
with which we evaluate the soft tissue
profile.
In normal growth, the face becomes less
protrusive with reference to the esthetic
plane. We use Superimposition Area 5
and Evaluation Area 7 to evaluate the
effect of our mechanics on the soft

BIBLIOGRAPHY

Robert M Ricketts, Ruel W. Bench, Carl

F.Gugino, James J. HIlgers, Robert J.
Schulhof. Bioprogressive therapy. 1st
Book. Rocky Mountain Orthodontics:
Page, 35-70

Thank You