We start with the simplest. The first point that needs to be assessed is aesthetics from the patient’s point of view (we are now talking about simple situations without complications). The patient may or may not like the result. This is the first and important question for an orthodontic patient to himself. The existing nuance here is whether this result is pleasant over time, for example, 5 years after the removal of braces. If the patient answers “like” to both questions, the treatment was successful.
Any treatment can be considered successful if the patient decides for himself the main complaints.
How else can you evaluate the results of wearing braces from the patient's point of view? This is the absence of deterioration of conditions that were before the start of treatment: for example, increased abrasion of teeth or problems with the gum. Starting orthodontic treatment with a certain state of tooth enamel, gum, joint, after treatment, the patient must finish it with the same condition or best, plus with even teeth that are well closed. Such treatment is successful. If the patient has an even dentition and a conditionally normal bite, but the joint has started to hurt, then the quality of this result is questionable.
Doctors have certain parameters, more objective and scientific, but from the point of view of an ordinary person without specialized education, it is difficult to understand. Doctors determine how canines and molars close, what kind of tork the teeth have, how much the teeth protrude from under the lips with a smile, whether the gums are visible, whether the upper teeth are parallel to the lower lip. These are the basic principles of the design of a smile, based also on the principles of the golden section.
Orthodontic treatment is a long process and you should not start it if the patient does not trust his doctor. If at the first doubt he goes to consult another clinic, then the wrong choice was made at the very beginning, at the stage of choosing “his” doctor. We highly recommend starting with a direct question to the orthodontist. “It seems to me that the tooth began to move in the wrong direction, is this normal?” - no professional will dismiss this issue, because the patient’s understanding of the current treatment is really important. It is always necessary to specify the terms for correcting such a situation. It is necessary to wait for the period voiced by the doctor and see if this is consistent with what is happening in the oral cavity. But it is undesirable to draw a conclusion on one event - during treatment, the bracket may debond and even the archwire will break. If this happens regularly, the teeth are still uneven. In the case when the orthodontist says one thing several times in a row, and another happens, then you can begin to doubt and get a consultation with another specialist.
The reasons for this can be many - this can occur due to the fault of both the patient and the doctor. The patient could bite off something hard, while fixing, saliva could get in and the bracket was badly stuck; when biting, the upper teeth could fall onto the brackets of the lower teeth. This sometimes happens and the patient needs to respond to this calmly - just sign up and rebond the bracket.
Most often, this situation is related to the fact that the doctor does not act according to the archwire replacement protocol, in which it is written in which teeth and at what stage the archwire should enter. As a rule, all problems - loss or breakdown of archwires are connected with this.
If the orthodontist announced 2 years of wearing brackets and 6 months are left, and according to the patient's feelings, not everything is in order, then you need to ask the doctor what is left to be done during these six months. If, for example, a wide tooth was removed (6th or 7th) and only half was closed since the start of treatment, and for six months the orthodontist is going to close the remaining half, this is not a very realistic estimate of orthodontic treatment.
In any case, you first need to talk with the doctor, you need to change the orthodontist only in an extreme situation. The doctor should be able to realistically answer and evaluate the situation to the patient's questions about the duration of treatment. If, for the previous few months of treatment, braces and arcs broke off, this may increase the time, but will not necessarily affect the quality of the result.
He can if he sees that with the orthodontic technique, which he is currently working, he can not cope. Optimally, all possible options are negotiated by the orthodontist and the patient before treatment, as well as the probability of tooth extraction. If your orthodontist says that he begins treatment without removal, but in the process a removal tactic may be chosen, then this is normal. But if the doctor announces treatment without removal, and already in the course of treatment there is a need to remove two teeth, then this is an unpleasant situation, extremely rare for a professional. In our clinical practice, this was only 2-3 times among 2,000 patients.
Sometimes there are controversial situations. For example, if the patient insisted on using lingual techniques despite other recommendations of the orthodontist, but after 1.5-2 years the desired result was not achieved, then it is better to install external braces and finish the treatment with them. The position of our clinic in the search for a compromise - if you need to change the technology, the patient does not suffer, including financially.
In 95% of cases, the patient already sees the result. In the case when the patient does not notice the changes, the doctor can use the photo to show the initial situation and the stages of treatment. This allows you to return the patient's confidence and increase his motivation to continue long-term treatment. Also, when the patient gets tired of treatment, this is a great tool to show the difference and continue to the ideal result.
Activation is always preceded by a small conversation with clarification of problems and wishes, then examination and explanation to the patient of the positive dynamics of treatment compared with the previous visit. Next, the orthodontist should talk about plans for today's visit, then directly carry out the activation of the system and photographing. It usually looks like a reception. A doctor who does not talk about what he is doing and why, most likely, he is not a high-level professional or is used to working on a stream.