A retrospective study comparing the Holdaway and Ricketts Visual Treatment Objectives (VTOs) to orthodontic treatment outcomes
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Traditionally orthodontic treatment planning was predominantly based on the dental occlusion without too much emphasis on and consideration for facial proportions and aesthetics. Predicting treatment outcomes has always been part of science. The ability to predict is important in other areas of science and medicine, and it is important in the treatment of orthodontic patients. Holdaway coined the term "visualized treatment objective" (VTO), to describe his predicted treatment outcome. Ricketts stated that all treatment planning constituted some sort of prediction. His prediction analysis allowed for forecast of the soft tissue profile which was based on the reactions of the skeletal and dental components due to orthodontic treatment. The aim of this study was to compare the predicted outcomes of two popular VTO's, viz Ricketts and Holdaway, to the actual outcomes of adult patients. The complete Holdaway VTO and Ricketts VTO were done on each pre-treatment cephalogram using the space analysis values from the records. These VTOs predicted where the soft tissue profile (nose tip to chin) would be, in relation to the H-line and E-plane respectively. The posttreatment tracings were done. The two tracings for each patient were then superimposed.