THE ORTHODONTIC FILE

THE ORTHODONTIC FILE

1. INTRODUCTION

The orthodontic file is made up of recorded documents to which must be added additional documents chosen according to the age of the patient and the specific needs highlighted by the clinical examination. 

It essentially includes additional examinations that complete and clarify the clinical examination by making it possible to measure and quantify the various anomalies observed. Some examinations are essential, such as: study models, photographs, panoramic radiography as well as profile teleradiography taken in occlusion, to which are often added other additional documents chosen according to the age of the patient (wrist radiography) and the specific needs of the treatment (cone beam).

2. Orthodontic casts
3. Definition

Orthodontic casts are a valuable document in a patient’s file; whether they are in plaster or (3D). They are positive reproductions of the patient’s dental arches and soft tissues. They allow the objective and quantitative evaluation of the occlusal and dental parameters essential for the development of the treatment plan.

Three casts  should be made : those at the start of treatment (black), those at the end of treatment (red), and those at the end of retention (green).

2. Casting and cutting

The casting will be done in extra hard orthodontic plaster (class 3) which will also be used to make the bases (conformers). They must faithfully reproduce: The teeth, the alveolar processes, the vestibules, the palate, the tuberosity region and the retromolar trigones (1 to 2 mm behind).

The casts are cut by a plaster cutter equipped with an angulator according to very precise angles.

AMERICAN SIZE

3. Interest

Orthodontic casts allow you to make:

• Analysis of intra-arch relationships : assess arch shapes, calculate DDM, identify dental malpositions and assess compensation curves.
• Analysis of inter-arch relationships : determine the Angle class, calculate the overjet and incisal overlap, note the coincidence or not of the inter-incisal midpoints, check the lateral articulation, calculate the Bolton index (DDD).
• The manufacture of devices : orthopedic and orthodontic.
• Creating a set-up : which allows you to visualize the post-therapeutic dental position (simulation of the treatment).

4. Digital castings

Plaster casts, which are fragile and cumbersome, can now be replaced by digital models. They are obtained by scanning conventional impressions or plaster models, or directly by optical impression; or even by means of a CBCT or scanner.

Their main advantages are: increased accuracy, reduced production times, saving storage space as well as quick and easy access to archived models.

3. Photography

Photographs are part of the orthodontic file because they allow the clinical examination to be completed and detailed and, above all, to preserve an objective image, a reference for subsequent comparisons.

Typically, the photographic file includes:

1. Exoral photographs

The exoral photographs from the front, from the side and the photograph(s) of the smile. 

The photograph of the smile, often taken from a three-quarter view, is increasingly being replaced or supplemented by a photograph of the smile from the side.

2. Intraoral photographs

Right and left frontal and lateral intraoral photographs, supplemented by maxillary and mandibular occlusal views.   

The use of an intraoral mirror improves the quality of these shots.

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4. X-ray

Radiographic examination is an essential tool in dentistry. It allows us to establish a diagnosis in addition to clinical data, to guide the treatment plan and to carry out good monitoring of our patients.

Several techniques are available to the practitioner, each with its own indications and limitations, we find;

• First-line X-rays  : panoramic and lateral teleradiography.
• Secondary radiographs  : occlusal bite, retro-alveolar, frontal and axial teleradiography and hand radiography.
• Third-line X-ray  : scanner and cone beam.

The X-ray prescription must take into account what is being looked for; there is no point in over-irradiating the patient unnecessarily.

THE ORTHODONTIC FILE

1. The Orthopantomogram

Panoramic radiography is the first-line examination, it is a real examination to uncover the dento-maxillary region. This radiological technique makes it possible to obtain on a single film a global image of all the dental arches. It is a simple examination, with little radiation, which allows a flattening of the curved dento-maxillary structures and is often sufficient.

After searching for radio-clear or radio-opaque images suggesting a pathology such as a cyst, tumor, etc., we study in particular: the dental formula, the dental condition and morphology, the sinuses and nasal cavities, the ATMs, the morphology of the two hemi-mandibles and their symmetry. 

This is an essential examination in the orthodontic file.

2. Teleradiography

These X-rays provide an image of the skull and face with minimal deformation, allowing for cephalometry. In addition, thanks to the standardization of the conditions for taking the image and the orientation of the head, it is possible to compare images with each other and therefore study the patient’s growth or therapeutic effects. 

Three incidences are used in dentofacial orthopedics: 

• The lateral teleradiography in norma lateralis: the most used; 
• Frontal teleradiography in norma frontalis; 
• Basal teleradiography in norma axialis.

The lateral teleradiography allows:

• The study of basal, alveolo-dental and cranial structures in the sagittal and vertical planes using different cephalometric analyses. 
• To determine the rate and direction of growth.
• Evaluation of results using superposition techniques during and at the end of treatment.

This examination does not provide any information on the transverse direction .

The frontal teleradiography allows:

• The analysis of dento-cranio-facial dysmorphoses in the vertical and transverse directions; therefore finds its indication in the presence of dysmorphoses of the transverse direction.
• To assess the width of the maxilla and mandible and their relationships.
• To measure the distance between canines and molars.

Basal teleradiography in norma axialis: is usually taken in ODF with the incident ray perpendicular to the  cutaneous Frankfurt plane, so-called HIRTZ incidence.

This is “a neglected view in cephalometry” however, the mandible is much better studied in axial view and allows to study its implantation on the base of the skull. Also it gives a good image of the dental complex.

3. The retro-alveolar

The retro-alveolar image is indicated as a complement to the dental panoramic to provide more precision in real dimensions of a well-defined group of teeth: inclusion, agenesis, resorption, etc. It also allows us to specify: 

• The shape and anatomy of the root.
• The condition of the dental follicle and desmodontal space.
• The existence of ankylosis.

4. The occlusal biter

This is a shot that provides a global image of the two dental arches in maxillary or mandibular occlusal view.

It accurately determines the vestibulo-lingual position of the tooth; especially included.

5. Hand X-ray

The hand and wrist region contains many small bones whose maturation allows the practitioner to read bone age and therefore place the patient on their growth curve and predict the future growth rate.

The sesamoid bone (inner surface of the first phalanx of the thumb) appears on average before the pubertal growth spurt, leaving it up to the practitioner to judge the possibility of orthopedic treatment.

6. 3D sectional imaging

Recent developments in the field of imaging have not spared our discipline and orthodontics is now benefiting from the benefits provided by cross-sectional imaging. 

Indeed, 3D cephalometric analyses are developing and should make it possible to eliminate the imprecisions inherent in conventional radiographs.  

1. The scanner : It has become a means of routine exploration, easy to access and with multiple indications, it produces sections of 1 to 10 mm thickness in the 3 directions of space with the possibility of reconstruction.
2. Denta Scan : this is a scanography technique specific to exploration in dental medicine, its main indication is the study of inclusions.
3. Cone beam : or cone beam computed tomography (CBCT) is a new radiographic imaging technique in full development which presents scanner-type results with less irradiation. More precise than a panoramic and less irradiating than a classic scanner. It allows the rays to be focused only on the area to be visualized, thus reducing irradiation.
4. Medical check-ups

Medical examinations are often necessary to establish the etiological diagnosis;

• Oro-laryngological (ENT) assessment to look for breathing obstacles that need to be removed or for obstructive sleep apnea-hypopnea syndrome
• Psychological assessment: psychoaffective disorders can generate harmful habits, sucking or biting tics, a factor in the appearance of orthodontic anomalies.
• Assessment in search of allergic terrain 

6. Conclusion

The clinical examination is essential but it is also insufficient; it must be linked to all the complementary examinations in order to establish the most precise diagnosis possible and therefore the most suitable treatment plan for each patient.

7. Bibliography

1. Bassigny F. Manual of dentofacial orthopedics. MASSON. Paris: MASSON; 1983. 
2. Boileau MJ Canal, Pierre. Orthodontics of children and young adults Volume 1: principles and therapeutic methods. Issy-les-Moulineaux: Elsevier Masson; 2011. 
3. Masson E. Clinical examination of the face in dentofacial orthopedics [Internet]. EM-Consulte. [cited 21 Oct 2021]. Available at: https://www.em-consulte.com/article/237519/examen-clinique-de-la-face-en-orthopedie-dentofaci
4. Philippe J. Beauty, normality and the average. Rev Orthop Dento Faciale. 2004 Sep 1;38(3):333‑43. 

THE ORTHODONTIC FILE

  Wisdom teeth can cause infections if not removed.
Dental crowns restore the function and appearance of damaged teeth.
Swollen gums are often a sign of periodontal disease.
Orthodontic treatments can be performed at any age.
Composite fillings are discreet and durable.
Composite fillings are discreet and durable.
Interdental brushes effectively clean tight spaces.
Visiting the dentist every six months prevents dental problems.
 

THE ORTHODONTIC FILE