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Diagnosis and treatment planning

The most important and responsible part of orthodontic treatment is the diagnosis and planning.

Since we are dealing not only with the teeth, but with a biological organism, we need to take into account:

  • The function of dentition (status of the TMJ and masticatory muscles);
  • The type of profile and its characteristics (aesthetics of the face);
  • Condition of the teeth and bone tissue;
  • The relationship of the jaws (occlusion);
  • Lines and features of the smile (dynamic aesthetics of the face);
  • Type of growth of the patient (in the growing organism)

This requires the following examination methods:

1.X-ray control of the temporomandibular joint

Temporomandibular joint (TMJ) — this is the hinge (ginglymus) joint that connects the lower jaw to the temporal bone of the skull, located directly in front of the ear on both sides of the skull.

Temporomandibular joints are very mobile, which allows the jaw to move smoothly up and down and from side to side, making it possible for us to talk, yawn or chew. The muscles directly attached to and surrounding the joint control the movements of the jaw and hold it in a certain position.

Many patients consult us with symptoms of temporomandibular joint dysfunction, which makes diagnosis and planning of orthodontic treatment not an easy task. Such patients often require professional treatment of the joint prior to orthodontic treatment (see Dysfunction of TMJ).

2.Intra-oral and extra-oral photographs of the patient

In the photographs the doctor evaluates the symmetry and proportionality of the face, the harmony of the profile, smile line, and type of malocclusion. Digital photos are made not only at the beginning of the treatment but also on the stages of active orthodontic treatment; with their help of doctor evaluates the dynamics of treatment. Digital images of the patients are very convenient to keep and always complete the record (card) of the orthodontic patient.

3.Orthopantomography

Also known as a panoramic radiography. Without such a radiological examination it is impossible to plan orthodontic treatment.

Orthopantomography allows evaluation of such parameters:

  • fit of the crowns;
  • the quality of canal filling;
  • the condition of the bone septum;
  • the condition jaw bone tissue;
  • periapical changes ;
  • the location of wisdom teeth;
  • the status of unerupted permanent teeth ;
  • the condition of the maxillary sinuses;
  • the inclination of the roots for the correct positioning of the brackets.

4.Cephlometrics

Cephalometric analysis, or( teleroentgenography) depends on cephalometric radiography to study relationships between bony and soft tissue landmarks and can be used to diagnose facial growth abnormalities prior to treatment, in the middle of treatment to evaluate progress or at the conclusion of treatment to ascertain that the goals of treatment have been met.

The teleroentgenogramme displays bones of the facial skull and contours of the soft tissues, which makes it possible to examine their matching. Teleroentgenography is used as an important diagnostic method for correction of malocclusion, for prosthetic repair of the teeth and maxillofacial prosthetics in orthognathic surgery.

In our practice, for the calculation and analysis of TRH, we use a computer program that significantly improves the quality of the diagnosis. With this diagnosis the doctor assesses:

  • The structure of the facial skull;
  • The relationship of the jaws to different structures ;
  • Differentiation of the jaw and dental anomalies;
  • Analysis of the teeth relationship;
  • The soft tissue;
  • Forecast of growth pattern of the jaw (for children).

Without this diagnostic method it is not possible to properly diagnose and to plan orthodontic treatment.

5.X-ray study of hands.

This method of research is used in orthodontics in order to determine the so-called "osteal age" of the patient. The fact is that orthodontic treatment in certain pathologies of the bite is feasible to be provided in periods of active growth of the facial skeleton. (see Early orthodontic treatment).

At this stage, treatment planning does not end; we need to foresee the possibility of introducing other fields of dentistry (art restoration, orthopedics and Periodontics) after orthodontic treatment. A single mechanism of successful and competent orthodontic treatment is put in it, which guarantees a complete harmony of the function and aesthetics. This is what my colleagues and I call the principle of an integrated approach to planning and treatment, since without achieving the proper function of dental-maxilla apparatus, there is no guarantee of stability of the aesthetic result.