Comprehensive diagnostics in orthodontics

Soft tissue and periodontal analysis

The orthodontist usually determines at this stage the symmetry of the gingival levels and checks the need for aesthetic correction of the gingiva, as well as treatment of inflammatory periodontal tissue diseases. Braces can be placed only after these issues have been addressed.

Taking dental impressions

Why do we continue to make casts at Konfidencia Clinic?

At Konfidencia Clinic, we do not treat patients so that their teeth are straight and everything is fine just by calculation. We treat so that the smile is beautiful in real life.

The first and important reason is the need for models in indirect fixation. The second reason is that they give an opportunity to see a real object in person once again, because CT and TRG are virtual things, while models give an opportunity to visually see the patient's bite.

It happens that an orthodontist in the process of treatment encounters some unexpected effect and gets lost. At Konfidencia Clinic, we calculate everything «on the shore» in order to continue to strictly follow the treatment plan, which was drawn up before the braces were fixed

3D cephalometric analysis of CT images (a modern alternative to 2D TRG images)

3D diagnosis – this is a much larger volume of information compared to 3D analysis.

3D diagnosis – this is a much greater amount of information compared to what we see on a TRG. Additionally, the CT scan evaluates the position of each tooth in the bone tissue, the therapeutic condition of the teeth, the condition of the root canals of depulped teeth. Only 3D diagnostics can accurately assess the causes of bite pathology and understand what it is caused by – reduction of the jaw size or its displacement.

Without 3D computed tomography, a complete diagnosis is impossible today – this one image replaces and unites everything.

Unfortunately, not all orthodontists have tomographs and know how to analyze 3D images. This is now the gold standard of all diagnostics and a huge plus for the patient, because not only the orthodontist, but also any other doctors involved in the treatment can comprehensively approach a single verified treatment plan with just one CT image.

Smile design (and virtual set-up when using eliners)

It's not enough to gather information, you need to analyze it. After diagnosis, a detailed calculation is performed using computer programs. For example, we calculate the teleradiograph using a special computer program where all the important points can be placed very precisely and the program automatically calculates the angles of all the jaws and the inclination of the teeth. This is a really accurate calculation, not a rough drawing on paper. The CT scan program allows us to extract various images of the teeth at all possible angles and in all planes. We have already completely switched to 3D cephalometric analysis in the calculation of TRGs.

Some orthodontists do not make a diagnosis at all, some do, but formally, and do not rely on it, building a treatment plan immediately at the first visit.

We utilize the latest modern diagnostic methods, which allows us to build an accurate prognosis and treatment plan. On average, an orthodontist needs 1 to 1.5 weeks to analyze the information and develop a treatment plan.

Diagnostic Presentation

After a comprehensive analysis, the orthodontist creates a detailed diagnostic presentation. It can be up to 100 or more slides with image slices and step-by-step architecture of the orthodontic treatment outcome. By opening it, any doctor from any other clinic will be able to assess the patient's clinical situation.

A diagnostic presentation is a detailed ready-made treatment plan that the patient can use even if he or she moves to another city and continues treatment with another doctor. In Russia, this approach is practiced by only a few orthodontic clinics.

All this makes it possible to plan the treatment, predict its timing and complexity. We make all the necessary preparations in advance for a clear understanding of the treatment process at the start, not at its stages.

Discussing and choosing a treatment plan

The Konfidencia has a special visit called «Treatment Plan Discussion». At the diagnostic presentation, the orthodontist shows the patient the main points that need their attention:

• First and foremost how to correct the patient's basic queries — crowding, position and tilt of teeth.

• Afterwards, the orthodontist points out other problem areas to the patient — perhaps ones that the patient didn't notice on their own.

All patients want to know how much orthodontic treatment will cost.

A full-fledged diagnosis gives the patient the opportunity to accurately announce the final amount of treatment, as the orthodontist understands the situation in detail and is sure of the treatment plan, and therefore of its cost. If additional medical manipulations are required, such as implantation, prosthetics, restorations, this is agreed upon at once. High-quality preparation for orthodontic treatment allows minimizing the probability of «pitfalls».

And this is all not only told to the patient, but also visualized on the computer.

How are the patient's wishes taken into account in the diagnostic process?

1. First and foremost, we ask what the patient doesn't like.

2. By asking questions, we lead the patient to a more specific complaint. For example, the patient does not like the smile. What exactly does the patient mean by the phrase «don't like the smile»? He or she may not like a particular tooth or the position of the teeth in relation to each other, other patients may not like the color of the teeth.

3. When planning treatment, we proceed from the wishes of the patient. It is clear that everyone wants even teeth, but there are situations when the patient's requests can affect our plan.

   • If the patient does not want to put an implant, the orthodontist considers the possibility of closing the gaps without prosthetics.

   • If the patient does not like the displacement of the central line, the orthodontist calculates whether it is possible to move it.

   • If the patient does not like the position of one canine, but at the same time he has disproportionate skeletal jaws between each other. We will be able to correct the position of the canine, but at the same time we understand that we will not improve the bite itself, and this is one of the goals of orthodontic treatment. Not just even teeth, but also a functional bite.

Therefore, we try to describe the patient's entire situation and to make our treatment plan as close as possible to what he or she wants, if this is possible. If this is not possible, we discuss what needs to be done additionally and what the optimal result and treatment plan is.

How often is the patient recommended to visit another doctor during the diagnosis process and how are their comments taken into account?

If the orthodontist sees that only braces and tooth movement do not achieve the desired result of treatment or do not satisfy the patient's request, then the patient is always given a referral to other specialists of the clinic:

• if it is necessary to perform prosthetics of one or more teeth

• if you need to put an implant

• if you need to work with periodontitis

In any case, it is the orthodontist's responsibility to involve the appropriate specialists.

In reality, adult patients often already have dental problems, have treated teeth, teeth with decay. Visits to the hygienist and general dentist are mandatory, as the minimum for braces – clean teeth without decay.