Place of diagnosis in the ODF treatment plan
Accurate and complete diagnosis is fundamental to the procedures implemented for treatment and ultimate correction.
The diagnosis of the orthodontic problem includes several areas to be evaluated, from the clinical examination, functional, casts, analysis of the craniofacial structures seen through the numerous radiographic incidences and their measurements.
- Definition :
The word “diagnosis” is of Greek origin. It means “to know” (gnôsko) “through” (dia).
For Chateau , it is a mental operation which consists of grouping symptoms into syndromes, that is to say sets of symptoms testifying to a particular frequent deformation which can be due to several causes.
Diagnosis is therefore a mental exercise using the triad:
- knowledge;
- Intelligence ;
- Memory (therefore to the experience of problems experienced).
- Prerequisites for diagnosis:
To make a diagnosis you must first:
Observe; Know; Understand; Classify;
The intellectual mechanism of “feedback” or retroactivity will allow the practitioner a global and detailed view of the past, present, and future of his patient.
- Stages of diagnosis in ODF:
The orthodontic assessment results from a semiological investigation which comprises two main parts:
Patient examination and file review.
- Patient examination:
- General examination:
It begins with the first consultation, with the choice of questions which should allow us to understand the general context in which the patient is evolving and to begin to familiarize ourselves with their personality.
- Exoral examination:
Attempts to attribute to the facial structures that he examines, a functional and plastic value by considering:
- their general relationships: symmetry of bilateral structures, vertical and sagittal proportions, general shape of the profile;
- their own characteristics: length and thickness of the lips, shape of the nose and nostrils, development of the elevator muscles, etc.;
- their tone: with the help of additional palpation
- their usual posture at rest;
- their functional mode.
- Intraoral examination:
- Opening path: shape and amplitude;
- Oral health (hygiene, gum condition, presence of cavities treated or not, etc.), stage of teething;
- Dental formula;
- General shape of the arches and signs of congestion;
- Insertion of the frenulum: lips, tongue, cheek muscles;
- Occlusion reports.
- Review of functions:
- Ventilation;
- swallowing;
- chewing;
- phonation;
- Search for parafunctions.
- The orthodontic file:
The orthodontic file is made up of systematically recorded documents to which must be added selected additional documents
depending on the patient’s age and the specific needs highlighted by the clinical examination.
These are the study models , the photographs of the face, front and profile, to which is added a three-quarter smiling view, the panoramic radiograph of the jaws as well as the profile teleradiography taken in occlusion.
- Additional documents:
Retroalveolar assessment and occlusal images, frontal and axial teleradiographies , tomographies or scanners , X-rays of the hand and wrist ; analysis
in-depth occlusal examination with articulating study models and axiographic recording; observations carried out by an ENT specialist, a pediatrician, a speech therapist or a psychologist.
All these documents will usefully complement the assessment already established, confirming or refuting the preliminary hypotheses.
- Areas of diagnosis:
- Positive diagnosis :
A complete and precise description of all the anomalies that the patient presents but describes in detail the state of each structure studied (physiological or pathological), it derives from the clinical approach and includes the diagnoses:
- Skeletal and facial.
- Alveolar.
- Dental.
- Occlusal.
- Functional
- Skeletal and facial diagnosis: It is based on the evaluation of
- From the skeletal class.
- Facial divergence.
- Maxillary transverse insufficiency or any other transverse discrepancy between the two jaws;
- The patient’s asymmetry.
- Determines the bone structure involved (maxillary or mandibular or both), therapeutic sequence by the affected senses, and the choice of devices indicated according to the facial divergence.
- Alveolar diagnosis:
Established in the three directions of space in search of an isolated anomaly to be treated alone or associated with another anomaly.
- Dental Diagnosis:
Includes all dental anomalies found, regardless of number, position, size, etc. This includes DDM and DDD.
- Occlusal diagnosis:
- Search for or establish canine and molar class I.
- Restore correct dento-dental relationships.
- Functional diagnosis
Determine all parafunctions and dysfunctions that must first be treated to ensure the stability of the orthodontic result.
- Differential diagnosis :
Among the symptoms observed, it is necessary to examine those which may fall under several clinical pictures.
- Etiopathogenic diagnosis:
Research into the causes of diseases (etiology) and their mechanisms of action (pathogenesis). Gives symptoms a specific meaning that includes them as a whole, rather than considering them in isolation.
- Synthetic diagnosis:
It is a synthesis or summary of the data collected in order to find the clinical picture that best corresponds to the patient.
- Progressive diagnosis (PROGNOSIS):
Allows you to have a certain vision of the outcome of the case, in order to be able to decide whether to treat orthodontically or to refer cases with a reserved or poor prognosis to surgery.
- Goals of orthodontic diagnosis:
The primary goal of diagnosis is to lead to therapeutic decision-making . Faced with a given patient, regardless of age or sex, three questions arise:
- should we treat it?
- Should we treat it immediately?
- Should we wait to make the decision?
If the first question was answered positively, there will be:
- a secondary purpose: the development of the treatment plan;
- a tertiary purpose: estimating the prognosis.
Conclusion :
The diagnostic approach in orthodontics is an intellectual task that requires the acquisition of prior knowledge in addition to a sense of observation in order to understand and classify the types of anomalies.
All this process, with the aim of establishing a treatment plan best suited to the patient.
Place of diagnosis in the ODF treatment plan
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