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RICKETTS VISUAL
TREATMENT
OBJECTIVE &
SUPERIMPOSITIO
N

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

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

POINT A CHANGES WITH VARIOUS

MECHANISM:

Mechanics
Maximum Range
Headgear
- 8 mm
Class II Elastics
- 3 mm
Activator
- 2 mm
Torque
- 1 2 mm
Class III Elastics
+ 2 3 mm

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.

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

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
tissue of the face.

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