The place of diagnosis in the treatment plan in dentofacial orthopedics
Plan
1. Introduction
2. Chronology of orthodontic treatment
3. The orthodontic assessment
3.1 Clinical examination
3.2 Additional examinations
3.2.1 Panoramic radiography
3.2.2 Teleradiography (profile-face)
3.2.3 Castings
3.2.4 Photographs
4- The different types of diagnosis in ODF:
4.1 Etiological diagnosis
4.2 Synthetic diagnosis
5. The place of diagnosis in the therapeutic strategy:
5.1 The place of diagnosis in etiological treatment.
5.2 The place of diagnosis in mechanical treatment .
6. Conclusion :
1. INTRODUCTION
Using the data from the clinical examination carried out during the first consultation and the additional examinations carried out during the assessment, the orthodontist analyses all of these elements to establish a precise diagnosis and a treatment plan which respond to the problems posed by the patient’s case.
2. Chronology of orthodontic treatment :
The orthodontic assessment:
In addition to the first examination, to clarify the diagnosis and establish a precise treatment plan, adapted to the patient’s case, additional examinations must be carried out: X-rays, photographs, impressions of the dental arches.
Diagnosis and treatment plan
The specialist has a mode of reasoning that allows him to define a treatment strategy and choose the device(s) best suited to each patient’s problem.
Active treatment
This is the period during which, thanks to the equipment chosen to best apply the strategy defined by the assessment and diagnosis, the teeth will be moved until the expected result is obtained.
The restraint
The result obtained must be stabilized during the period of containment by different means of containment (removable or fixed).
3. The orthodontic assessment:
In order to clarify the diagnosis and define the treatment plan, the clinical examination carried out during the first consultation is supplemented by additional examinations: X-rays, prints, photographs.
All these examinations are carried out in the office with the exception of scans which are only prescribed exceptionally.
3.1 Clinical examination
A- Anamnesis
1. General information
2. Reason for consultation
3. Personal history
* Medical history
* Stomatological history
* Tics and habits
B. Exo-oral examination
1. Examination of the face from the front
2. Examination of the face from the side
3. Examination of the soft parts
* the forehead * the cheeks * the lips * the chin
4. Examination of the ATM
C- Endo-oral examination
* Oral hygiene and mucosa
* Periodontal examination
* Dental examination
* Teeth
* Examination of separate dental arches (intra-arch)
* Examination of occlusion in ICM (inter-arch)
* Static occlusion (3 planes of space)
* Dynamic occlusion
* Examination of the closing path
D- Functional examination (swallowing-breathing-chewing-phonation)
3.2 Additional examinations
* Panoramic radiography
Panoramic radiography is an essential examination which allows:
– Detect the absence of permanent teeth (agenesis),
-Assess the child’s dental age based on the resorption of the roots of baby teeth,
– Detect the presence of additional teeth (supernumeraries and mesiodens),
– Detect cavities that are barely or not visible when examining the mouth,
-Assess the condition of the bone supporting the teeth (search for periodontal disease),
-Analyze the shape and size of tooth roots,
-Check for abnormal development of certain teeth, particularly canines and wisdom teeth (frequently impacted teeth)
-Study the good health of the maxillae and jaw joints
*Teleradiography (profile/face).
The lateral teleradiography is also part of the systematic examinations.
The examination is carried out with the patient’s head immobilized in a rigorously determined position.
As a result, it will be possible to take other images with the same orientation of the head during and after the treatment.
This radiographic examination allows:
– To examine the architecture of the skull, face and jaws with precision thanks to graphic analyses called cephalometric analyses.
– To estimate the effect that growth will have on the evolution of the case and then monitor the growth of the face and jaws,
– To verify the results of the treatment concerning the correction of the offset between the jaws and the modification of the dental axes.
* Casts: allow for precise analysis of the dental system:
*Observe the position and morphology of the teeth more easily than in the mouth,
*Measure dental crowding,
*Visualize the shape of each dental arch,
*Analyze dental occlusion (mesh between the upper and lower teeth),
*Record the initial situation to monitor progress during processing
* The photographs
Photographs of the face, mouth and teeth are taken before treatment, during treatment and at the end of treatment.
*Facial photographs
Facial photographs are very useful at the time of diagnosis for:
-Check the symmetry of the face from the front,
-Analyze the aesthetics of the profile and in particular the nose-lips-chin relationships which can be modified by the treatment,
-Assess the positioning of the teeth in the lip cleft when smiling
4-The different types of diagnosis in ODF:
4.1 The etiological diagnosis : which determines the etiology of the anomalies (I area = Hereditary /
II area = acquired).
4.2 The synthetic diagnosis : which constitutes the purpose of the orthodontic assessment , it includes:
*Dental diagnosis (Occlusion – DDM-DDD).
*Aesthetic diagnosis (profile – smile – harmony of the elements of the face).
*Skeletal diagnosis (facial typology – skeletal class – bone profile).
*Functional diagnosis (dysfunctions-para-functions).
5. The therapeutic strategy:
Once the diagnosis has been made and the treatment goals have been determined, the orthodontist will then propose solutions (treatment plans) to the patient to meet their expectations and correct the problem. These goals must be determined by the patient and the orthodontist.
5.1 The place of diagnosis in etiological treatment :
Once the clinical examination is completed, the Dg is placed, we can specify the etiology of the anomalies (I area = hereditary / II area = functional and muscular), the etiological treatment aims to:
– Restoring the balance of the Château dental corridor (tongue-lip-cheeks).
– Rehabilitation of disturbed functions (swallowing- chewing -breathing).
-The elimination of para-functions.
– Unlocking static and dynamic occlusion.
– Muscle toning of deficient groups;
“This etiological treatment constitutes a factor of stability of the results obtained at the end of treatment”.
5.2 The place of diagnosis in the treatment itself :
-No extraction of permanent teeth (small footprint);
– Enamel reduction “stripping” necessary;
-Extraction of premolars (very crowded);
-Oral surgery to be planned (removal of impacted tooth, placement of temporary bone anchors, etc.);
-Orthognathic surgery intervention (severe skeletal problem).
-Functional static and dynamic occlusion;
The choice of the device is strongly guided by the treatment strategy.
*In simple cases with little or no skeletal problem, little or no bulk the choice is wider. ( removable-fixed therapeutic-functional devices)
* The more complicated the case, the greater the jaw offset, the greater the space requirement and the more multi-ring fixed techniques are essential.
*If a malocclusion presents a severe skeletal misalignment, a decision must be made at the outset whether or not orthognathic surgery is considered;
*If the patient presents a skeletal discrepancy before the end of growth, possibility of orthopedic treatment
6. CONCLUSION
Good diagnosis = Good treatment goals = Good treatment plan = Good results.
the opposite is also true; an incorrect diagnosis will not allow optimal results to be obtained:
Wrong diagnosis = Wrong treatment goals = Wrong treatment plan = Wrong outcomes.
Good oral hygiene Regular scaling at the dentist Dental implant placement Dental x-rays Teeth whitening A visit to the dentist The dentist uses local anesthesia to minimize pain