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Comprehensive orthodontic diagnostic

Collecting the most complete information about the patient so that the orthodontist can make the correct diagnosis, understand how to treat the patient and satisfy his main wishes.

Comprehensive diagnostics includes:

1. Photo protocol, smile and face harmony evaluation

This stage plays an important role in controlling changes and quality of treatment. At the consultation stage, photographs are needed to visualize the patient's problem. During diagnosis, intraoral photographs are taken, photos of the teeth in a closed, open state, at different angles of the face and smiles - including the so-called “Emma test”, which shows the patient how his teeth are usually seen during speech.
The younger the person, the more visible the upper incisors are when talking and the lower ones are not visible. With age, the soft tissues descend, lose their tone and the upper teeth are less visible and the lower teeth more and more. If a patient comes to orthodontic treatment, then we pay attention to this, because we can change it and “rejuvenate” it from the point of view of perception during speech.

The patient takes up to 20 snapshots of teeth and face from different angles.

What is estimated?

  • Aesthetics of the face
  • Profile
  • Bite and condition of teeth in their positions
  • The ratio of the center line of the incisors
  • Width and arc of a smile (visibility and parallelism of the lip line)
  • The state of tooth enamel
Teeth movement can affect the position of the lips, so the orthodontist can reduce the worsening of wrinkles by increasing the height of the bite. Reducing the height of the bite leads to greater appearance of wrinkles, folds, which the doctor must necessarily take into account in the treatment plan.

More about photo protocol

2. Analysis of periodontal and soft tissue

As a rule, the orthodontist determines at this stage the symmetry of the gingival levels and verifies the need for aesthetic correction of the gums, as well as the treatment of inflammatory diseases of the periodontal tissues. Installation of brackets is possible only after solving these issues.

3. Teeth impressions

Now, few people make calculations on models; they are created more formally. In general, all this can be done on computed tomography, subject to sufficient knowledge and skills of the orthodontist. According to the cast models, the orthodontist calculates the size of the teeth, the amount of space needed, the proportionality of the teeth, whether the restoration will be necessary, how the teeth will close after treatment.

Why in the clinic Confidencia we continue to make casts?

In the Confidentiality Clinic we do not treat the patient, so that he has even teeth and everything is good only by calculations. We treat so that the smile becomes beautiful in real life.

The first and important reason is the need for models for indirect fixation.
The second reason is that they make it possible to once again see the real object alive, because CT and TRG are virtual things, and the models make it possible to visually see the bite of the patient.

It happens that the orthodontist in the process of treatment is faced with some unexpected effect for him. In the Confidentiality Clinic, we count everything “on the shore” in order to strictly follow the treatment plan that we made before fixing the brackets.

4. 3D cephalometric analysis of a CT image (a modern alternative to 2D TRG images)

Standard TRG analysis includes an assessment of the position of the teeth already in the skull space and how the teeth stand relative to the jaws, how the jaws are located relative to the skull, what size they are.

3D-diagnostics is a much larger amount of information, compared to what we see on TRG. Additionally, the position of each tooth in the bone tissue, the therapeutic condition of the teeth, and the condition of the root canals are assessed by CT. Accurately assess the causes of bite pathology and understand what causes it - a decrease in the size of the jaw or its displacement, is possible only with the help of 3D-diagnostics.

Without 3D computed tomography today, full-fledged diagnostics is not possible - this one image replaces and combines everything.

Unfortunately, not all orthodontists have tomographs and are able to analyze 3D images. Now this is the gold standard for all diagnostics and a huge plus for the patient, because not only the orthodontist, but also any other doctors involved in the treatment can comprehensively approach a single verified treatment plan with just one CT scan.

5. Smile design (and virtual setup using Insignia)

It is not enough to collect information, it is necessary to analyze it. After the diagnosis, a detailed calculation is carried out using computer programs. For example, we calculate the TRG diffraction using a special computer program, where all the important points can be arranged very accurately, and the program automatically calculates the angles of all the jaws and the inclination of the teeth. This is a really accurate calculation, not an approximate drawing on paper. The program for working with a computer tomogram allows you to extract various images of teeth at all possible angles and in all planes. In the calculation of the TRG, we have already completely switched to 3D cephalometric analysis.

Some orthodontists do not make a diagnosis at all, some do, but formally, and do not rely on it, building a treatment plan immediately at the first visit.

We use the latest modern diagnostic methods, which makes it possible to build a verified prognosis and treatment plan. On average, an orthodontist needs from 1 to 1.5 weeks to analyze information and draw up a treatment plan.

6. Diagnostic presentation.

After a comprehensive analysis, the orthodontist makes a detailed diagnostic presentation. It can be up to 100 or more slides with sliced images and a phased architecture of building the result of orthodontic treatment. Having opened it, any doctor from any other clinic will be able to assess the patient’s clinical situation.

A diagnostic presentation is a detailed, ready-made treatment plan that a patient can use even if he moves to another city and continues treatment with another doctor. In Russia, this approach is practiced by few doctors from orthodontic clinics.

All this makes it possible to plan the treatment, predict its timing and complexity. We do all the necessary preparation in advance for a clear understanding of the treatment process at the start, and not at its stages.

7. Discussion and selection of treatment plan

There is a special visit to the Confidentiality called “Discussion of the treatment plan”. At the diagnostic presentation, the orthodontist demonstrates the patient the main points that require his attention:

  • First of all, how to correct the basic inquiries of the patient - crowding, position and inclination of the teeth.
  • After the orthodontist points the patient to other problem points — perhaps those that the patient himself did not notice.

8. All patients want to know how much orthodontic treatment will cost.

Full diagnostics gives the opportunity to accurately inform the patient of the final amount of treatment, since the orthodontist understands the situation in detail and is confident in the treatment plan and its cost. If additional medical procedures are required, such as implantation, prosthetics, and restorations, this is discussed immediately. High-quality preparation for orthodontic treatment minimizes the likelihood of "pitfalls".

And all this is not only told to the patient, but also visually shown on the computer.

How is the patient's wishes taken into account in the diagnostic process?

  1. First of all, we ask what the patient does not like.
  2. With questions we direct the patient to a more specific complaint. For example, he does not like a smile. What exactly does the patient mean by "do not like a smile"? It may not like a separate tooth or the position of the teeth relative to each other, other patients - the color of the teeth.
  3. When planning the treatment, we proceed from the desires of the patient.
    It is clear that everyone wants even teeth, but there are situations where patient requests may affect our plan.
    • If the patient does not want to put an implant, the orthodontist is considering the possibility of closing the gaps without prosthetics.
    • If the patient does not like the displacement of the central line, the orthodontist is counting on whether it is possible to move it.
    • If the patient does not like the position of one canine, but at the same time he has disproportionate skeletal jaws between each other. We can correct the position of the canine, but at the same time we understand that the bite itself will not improve, and this is one of the goals of orthodontic treatment. Not just even teeth, but also a functional bite.

Therefore, we try to describe to the patient the whole situation and to bring his treatment plan as close as possible to what he wants, if possible. If this is not possible, then we discuss what needs to be done additionally and what is the optimal result and treatment plan.

How often in the process of diagnosis is it recommended for a patient to visit another doctor and how are their comments taken into account?

If the orthodontist sees that only brackets and the movement of teeth do not achieve the desired result of treatment or do not satisfy the patient's request, then the patient is always directed to other specialists of the clinic:

  • if you need to perform prosthetics of one or more teeth
  • if you need to put an implant
  • if you need to work with periodont

In any case, the orthodontist is obliged to attract relevant specialists.

In reality, adult patients often already have dental problems, have treated teeth, and teeth with caries. A visit to a hygienist and a dentist therapist is obligatory, as at least to install brackets - clean teeth without caries.

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Clinical case report #1. Class III malocclusion, crowding treatment and prosthetic preparation.
Clinical case report #1. Class III malocclusion, crowding treatment and prosthetic preparation.

Problem: smile aesthetics and defect in bite function.
Diagnosis: the treatment of upper and lower jaw teeth misalignment and class III malocclusion, caused by increased mandible growth, and prosthetic preparation.
Therapy method chosen: orthodontic treatment using stainless steel self-ligating brackets Damon Q without teeth extraction..
Treatment time: 3 years.

 

Clinical case 2. Correction of the aesthetics of a smile and severe crowding of the dentition.
Clinical case 2. Correction of the aesthetics of a smile and severe crowding of the dentition.

Problem:  Smile Aesthetics
Diagnosis: treatment of severe crowding of the dentition.
Selected treatment method: orthodontic treatment with brackets without tooth extraction using the Damon Q metal self-ligating bracket system.
Treatment term:  2,5 years.

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