It is necessary to assess and plan a good therapeutic approach for the patient, that the Orthodontist obtains the following tests:
Study Model: Necessary to assess in situ the state of the patient’s teeth. It helps us measure the width of the arch (ovoid, tapered, square …) and space between teeth, etc.
Intraoral: (Photos of teeth) They help us to see size and position of teeth, if there is crowding or spacing between them, the relationship between arches (overjet, overbite, crossbite, scissor bite …), canine or molar relationship, assess the middle line … Etc.
Orthopantomography or Panoramic RX: Through which you can see the teeth, the roots, the wisdom teeth, the periodontal bone level, whether or not there are agenesis or supernumerary teeth…
Telerradiography or lateral X-ray of the skull: Through which you can obtain information about the anteroposterior relationship between the jaws, as well as information about the inclination of the teeth. From them, cephalometries can be carried out.
TAC: Sometimes a CT scan is required if the orthodontist wants to go into more detail about aspects such as teeth included, bone level, the state of the wisdom teeth in relation to the dental nerve …
It is the responsibility of the orthodontist to be objective and to provide the patient with all the real treatment alternatives, based on success criteria. These criteria are the following:
- ATM and healthy muscles.
- Facial balance
- Correct static and functional occlusion.
- Periodontal health.
- Dental, skeletal and growth stability.
- Maintenance or increase of the airway.
- Ability to resolve patient complaints.
Depending on the degree of orthodontic and / or surgical need, the treatments can be grouped into 3 groups:
Group 1 (G1): Corresponds to routine cases of orthodontics, which are treated without unforeseen problems. The diagnosis and treatment plan is direct and it is carried to the end without complications.
Group 2 (G2): Corresponds to the most difficult cases within the scope of orthodontics. They include those cases that contemplate facial patterns and more complicated malocclusions. These cases can be treated correctly, through dental compensation and controlling the patient’s growth (hence the importance of the first orthodontic visit around 6 years).
Group 3 (G3): This group includes patients who present facial imbalance and malocclusion, from moderate to severe, and who must be treated through the combination of orthognathic surgery and orthodontics.
The cases presented at the border of group 2 and 3 are the most complex if they are treated within group 2, that is, only with brackets. Since, although solving the existing problems, the appearance of additional problems is common, such as the inability to completely correct the occlusion, the facial imbalance, the periodontal and TMJ deterioration … and above all the patient’s dissatisfaction with the result of the treatment.
Nor should we forget that there are patients who reject recommended extractions or reduction of enamel for “Cultural Differences”. Likewise, there are certain tastes or preferences around an “Ideal Pattern”.
For all this, once again, it is clear the importance of the orthodontist in being as objective as possible and realistic in terms of choosing the right treatment for each patient.