THE ORTHODONTIC FILE
I-/ INTRODUCTION
At the end of the clinical examination, the diagnosis and the resulting therapeutic approach will be established. It is understood that the diagnosis is the result of a detailed study which includes on the one hand: * clinical observation
*additional examinations such as:
footprints = models,
pictures,
radio such as: panoramic, profile teleradiography
II-/ CLINICAL OBSERVATION:
Civil status: Name, First name, age: the latter will determine the type of teeth, as well as the stage
Of growth.
Anamnesis:
1°) Reason for consultation: functional or aesthetic
2°) State of health of the patient: (impact on growth)
Pneumonia, allergy, asthma.
3°) History of orthodontic treatment: wearing or not wearing a device
4) Distorting habits: sucking the thumb or another finger; biting the lip,
or the inner side of the cheek.
5°) Possibility of similar anomalies in the parents (notion of heredity).
THE ORTHODONTIC FILE
III-/CLINICAL OBSERVATION PROPERLY SO-CALLED: Exobuccal
- Face examination:
- Nose: Examination of the base of the nose, reduced nostrils, dilated, deviated septum
Nasal, all these points will make us think of respiratory discomfort or a
Disturbed nasal breathing.
- Lips: lip thickness, height of the upper lip, knowing that the upper lip covers 2/3 of the height of the upper incisors: that is to say that the free edge of the upper incisors exceeds the upper lip by 02 mm, if the upper lip covers very insufficiently the upper incisors we will have a gummy smile.
- The furrows: – marked labiomental or not,
– Possible absence of the stomion = mouth breathing with dry lips
- The chin: (eg: absence of stomion leads to an orange peel appearance at the chin level when the patient forces his lips together.
- Cheeks: hypertonic or hypotonic cheeks which could play a role in the growth of the maxillae in the transverse direction.
- Profile review :
According to Ricketts and Izard
- According to Ricketts: the profile according to radiology is studied from the line E of R which passes through the nasal and the mental point
- The upper lip is set back from the E line by 1 mm profile
Straight
- The lower lip is flush with the E line
Upper lip protrudes: convex profile otherwise concave
- According to Izard: According to Izard the profile is studied from two planes: Simon and Izard perpendicular to the FF plane, the labio-mental package being located between these 02 planes.
We determine the profile: orthofrontal, cis frontal and transfrontal.
IV: THE ENDO-ORAL EXAMINATION:
A/ Oral hygiene:
1)- Condition of the teeth:
Supernumerary tooth: a conoid-shaped tooth that serves no purpose
Extra tooth: a complete tooth (two extra canines or a premolar)
decayed teeth –chico
2)- Presence of PB or tart.
3)- Gum problems: (gingival inflammation, healthy gum)
B/ Tooth:
- Dental formula:
- Type of teeth: mixed, permanent, temporary, adolescent
- Dental age: according to the Château formula.
Which will be compared with the civil age
- Malposition: ectopia – rotation – retained tooth.
THE ORTHODONTIC FILE
C/ Maxillae:
1)- Depth of the palatine vault: accentuated or reduced.
2)- Presence of possible arching: at the palatine or vestibular level and this in the
Case of impacted tooth.
3)- Note the shape of the Spee curve. Which can be inverted or accentuated.
D/ Soft part:
- Hallway:
Insertion of the frenulum, hypertrophy of the upper labial frenulum can lead to a
Intercisor diastema.
A low frenum insertion will require a frenumectomy; the upper and lower labial frenums must coincide with each other and on the midline.
- Plays :
We can see the imprints of the teeth on the internal faces (possibility of a tic or deforming habit such as: biting the internal face of the cheek.
- Gum:
Presence or absence of inflammatory signs which would be a contraindication for a
Orthodontic treatment.
The gum can be: thick; fibrous; thin; fragile.
- Language :
- Volume: A tongue with folds or tooth impressions on the lateral edges of the tongue may be found, which is characteristic of macroglossia.
- Tongue resting position:
- Lingual frenulum: atrophy (reduced frenulum) which would result in a low position of the tongue with all its consequences.
- Occlusion:
In the dynamic state: highlighting of prematurity, at the canine level.
The closing path: straight or deviated in the case of latero-deviation or in the case of a forward or backward slide.
- Review of functions :
- Phonation: this must be analyzed by the sound and by the supports, certain defects
Phonatorics are audible and others inaudible.
- Swallowing: By having the patient swallow a sip of water, we can note a
Exaggerated contraction of the orbicularis oris in an exaggerated manner
- Unilateral or bilateral anterior or posterior lingual interposition.
- Anterior lingual thrust.
- Breathing: nasal or labial, we will note any possible dry lips (mirror test),
Nasal mucus; frequent colds, enlarged tonsils, adenoids (mouth breathing), nocturnal swellings.
To conclude :
- Clinical observation allows information to be obtained, two scenarios arise:
Present:
- Either the dental age does not allow immediate treatment, it will be a question of summoning the child according to the evolution of certain permanent teeth.
- Either treatment appears necessary immediately, however an orthodontic file remains to be established.
THE ORTHODONTIC FILE
PRODUCTION OF THE ORTHODONTIC FILE :
- Photography:
-From the front of the patient to determine whether there is symmetry or asymmetry of the
face with the patient’s typology (normobite, deepbite and openbite).
– In profile to study the profile according to IZARD and Ricketts.
2-Panoramic X-ray:
It constitutes one of the essential elements of the orthodontic file, it allows a complete view of the jaws and teeth, possibly the ATMs, on a single film.
3- Retro-alveolar cliché:
Necessary to confirm the suspicion of a pathological process detectable on standard images: dental agenesis (absence) retained impacted tooth, also allows the calculation of the mesio-distal width of the teeth in the explored sector which are not yet on the arch.
4- Occlusal images:
Are used to appreciate the localization in the 03 planes of the space of the dystopian teeth
Bad position; restraints
5-Hand X-ray:
The assessment of bone age through the appearance of the ossification parts of the carpal bones and metacarpophalangeal ossification which will be taken as a reference. The appearance of these points mark (guide) the child’s bone growth and make it possible to precisely locate the patient’s stage of development.
6-Teleradiography : Performing cephalometry involves studying a teleradiography of the skull and face to highlight information that will complement the clinical examination.
Teleradiography is a radiological technique based on the standardization of the image, we distinguish 03 incidences:
– Frontal or facial incidence: Normafrontalis.
– In profile: Normalateralis.
– Axial: Normaaxialis.
The most used is the profile teleradiography which allows to explain the facial architecture in the sagittal and vertical plane.
On such a snapshot it is possible to plot numerous reference points and lines, which allows precise measurements to be made.
7-Castings:
Orthodontic casts cast in white orthodontic plaster must be cut according to specific presentation criteria, they allow the practitioner to review the patient’s static occlusion, the arch form; the vault, the stage of dentition, the curve of spee and to take measurements on the dental arches.
THE ORTHODONTIC FILE
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.