Diagnostics

The knowledge of the experienced orthodontist about

enables him/her to determine, by means of careful investigation, the nature and severity of the existing deviations as well as their causes.

A careful treatment plan must be made before every orthodontic treatment. It is the result of extensive analysis of individual findings, which leads to a comprehensive diagnosis. Only then is it possible to establish the goal of treatment, the individual steps of treatment and the method, as well as to select the appropriate devices. During treatment, it may be necessary to prepare interim reports in order to review the progress of therapy and the therapeutic concept, and to alter them if necessary.

The following reports are required for orthodontic diagnostics:

History

Asking about previous diseases (course of pregnancies, allergies, childhood diseases, operations), family-based predispositions, habits (pacifier, thumb, medication, etc.)

Clinical findings

Investigation within the mouth: teeth, gums, stage of development of teeth, position of the teeth, caries, habits in regard of brushing teeth, frenulum (band) of the tongue, cheek and lip; base of the tongue (enlarged tonsils), swallowing pattern

Investigation outside the mouth: Malfunction of the lip or cheek muscles, posture of the lips, closure of the lips, breathing through the mouth or nose, mandibular joint function, facial expression, profile, physical posture; skin problems

Analysis of jaw models

After casting models of the upper and lower jaw and fixing the position of teeth (accurate meeting of the upper and lower jaw) by means of wax templates, models are made from hard plaster of Paris. Based on these models, the nature and extent of malalignment of teeth can be determined and measurements made (comparison of symmetry, measurement of breadth and length, exact analysis of tooth forms, calculation of space, evaluation of jaw bones, etc.).

Instrumental functional analysis

In cases of forced bite (deviation of the lower jaw during closure of the jaw because of improper contact between the teeth) or in cases of extensive malposition of permanent dentition (especially in adults), the models have to be substantiated by a special instrumental functional analysis. The plaster of Paris models are mounted onto an articulator (facial frame, axiography) by means of special transfer techniques. The articulator simulates the mandibular joint of the patient and allows the investigator to imitate the motion patterns of the lower and upper jaw of the respective patient.

X-ray diagnostic procedures

Pantomogram: It shows the lower and upper jaw with all erupted and still developing teeth (too many teeth, too few teeth, deviations, stage of development of the roots, displacement), and also permits an assessment of the paranasal sinuses, the bone structure and the mandibular joints.

Individual x-rays: For detailed information about specific teeth, individual x-rays may be additionally required (e.g. overlay images in cases of displaced teeth, bite-wing images for diagnosing caries)

Lateral teleradiographs. From an x-ray of the head taken from a distance of 1.5 to 4 meters (therefore the term teleradiograph), the orthodontist obtains information about the structure of the face, the direction of growth of the jaws, the inclination of the front teeth. Special measurement of anatomic structures (manually or with a computer) allows the investigator to distinguish between bone- and tooth-related causes of malformation. Growth prognoses based on this information provide important data for planning therapy and for monitoring the course of treatment.

Frontal teleradiograph: Is only taken in specific cases of severe deviation (e.g. asymmetry of the face in adults).

X-ray of the wrist: In the period of intensive physical growth, the jaw reacts most favorably to modulatory measures. Therefore, in some adolescents, x-rays of the hand are taken to evaluate the existing stage of growth.

Photographic diagnostic procedures

Photographs of the face: Are required for the purpose of documentation as well as to design concepts of esthetic improvement, as alterations in the position of the jaw and the position of front teeth bring about enduring changes in the profile of the face and the lips.

Photographs of the mouth: For documenting the initial status. They complement the jaw models and provide accurate information about the condition of teeth at the beginning of treatment (decalcification, deviations in the form of the teeth, other special features) as well as about the condition of gums (inflammation in cases of poor oral hygiene, etc.).

Diagnostic Setup

Extensive malalignment in adolescents or adults may require a preliminary simulation of the treatment on the plaster of Paris model. By doing so, for instance in patients who require removal of teeth, it becomes easier for the physician to decide about extraction, determine the distribution of space and the dentition resulting thereof, and possibly even clearly diagnose discrepancies in the size of teeth between the upper and lower jaw before the beginning of treatment. The advantage of the diagnostic setup is that it illustrates and specifies the desired goal of treatment, which makes it easier to explain the goal to the patient as well as enhances cooperation in cases of interdisciplinary therapy between the dentist and the oral surgeon.

As in a puzzle, the individual elements of orthodontic reporting lead to the specific diagnosis for the individual patient. This diagnosis, in turn, is the basis for formulating the goal of treatment and a comprehensive therapy plan.

A carefully designed and realistic treatment plan and definition of the achievable goal of treatment will keep over-optimistic expectations in check and protect the physician and patient from disappointment!

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