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Comprehensive diagnostics in orthodontics

8 diagnostic steps to prepare for competent treatment with braces or eliners
High precision thanks to modern technology
Duration — 40 minutes
7 500 rub

Comprehensive diagnosis — is the collection of as much information about the patient as possible so that the orthodontist can make the correct diagnosis, understand how to treat the patient and meet the patient's basic wishes.

Comprehensive diagnostics include:
1
Photo protocol, assessment of smile and facial harmony
10 minutes
2
Dental impressions or scans
10 minutes
3
Smile design (and virtual set-up when using eliners)
up to 2 weeks
4
Soft tissue and periodontal analysis
10 minutes
5
3D cephalometric analysis of the CT image
10 minutes
6
Diagnostic presentation
up to 2 weeks
7
Cost of orthodontic treatment
8
Discussing and choosing a treatment plan
40 minutes

Photo protocol, assessment of smile and facial harmony

Plays an important role in monitoring changes and quality of treatment. During the consultation phase, photographs are necessary to visualize the patient's problem. At the diagnosis, intraoral photographs are taken, photos of the teeth with the teeth in the mouth, open, in different angles of the face and smile - including the so-called «Emma» test, which shows the patient how their teeth are usually visible when speaking.

The younger a person is, the more visible their lower incisors are when speaking.

The younger they are, the more visible their lower incisors are when speaking.

The younger a person is, the more the upper incisors are visible when speaking and the lower incisors are not. As a person ages, the soft tissues droop and lose tone and the upper teeth become less and less visible and the lower teeth more and more visible. If a patient comes in for orthodontic treatment, we pay attention to this because we can change this and «rejuvenate» them in terms of perception during speech.

The patient is given up to 20 dental and facial images from different angles.

What is being evaluated?

  • Facial aesthetics

  • Profile

  • Bite and condition of teeth in their positions

  • The ratio of the central line of the incisors

  • The width and arc of the smile (visibility and parallelism of the lip line)

  • The condition of the tooth enamel

Moving the teeth can affect the position of the lips, so the orthodontist can reduce the aggravation of wrinkles by increasing the bite height. Reduced bite height leads to a greater likelihood of wrinkles and folds, which the orthodontist must take into account in the treatment plan.

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

Nowadays few people do calculations on models, they are created more formally. In general, all this can be done on a CT scan, provided the orthodontist has sufficient knowledge and skills. Using plaster models, the orthodontist calculates the size of the teeth, the amount of space needed to move, looks at the proportionality of the teeth, whether restorations will be needed, how they will interlock after treatment.

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)

Standard TRG analysis involves assessing the position of the teeth already in the skull space and how the teeth stand in relation to the jaws, how the jaws are positioned in relation to the skull, and how big they are.

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?

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.

Diagnostic consultation with a leading orthodontist
  • A detailed treatment plan in 1.5 hours
  • Planning according to the concept of accelerated treatment
  • Personal curator's help
4 900 rub
10 000 rub

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5/5
15.09.2022
Updated 18.01.2024
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