ORTHODONTIC DIAGNOSIS

Diagnosis is the most critical part of orthodontic treatment. In the diagnostic phase,

• initial malocclusion (poor bite),
• growth (if applicable),
• patient primary concern (esthetics, etc),
• treatment limitations and
• treatment objectives are considered.

If a proper diagnosis is to be achieved, it is important to acquire the following;
  1. HISTORY is used to;
       a.  Assure the patients desires are addressed.
         b. Consider any systemic health factors.
         c. List any jaw dysfunction symptoms.

  2. X-RAYS & PHOTOGRAPHS are used to;
     a. Evaluate bone support of the teeth.
       b. Visualize the treatment objectives (VTO) - using computer morphing.
       c. Evaluate TM Joint (jaw joint) condition.
       d. Evaluate individual teeth condition.
       e. Scan for supernumerary (extra) teeth or anomalis (unusual) growth.

   3. ARTICULATORS
          Used to determine if the bite is in a proper relationship to the TM Joint (jaw joint).

WHY USE ARTICULATORS ??

Not all orthodontic cases require an articulator for diagnosis. But, when it becomes necessary to use one it can make a SIGNIFICANT difference in the long-term success or failure of the case.

The relationship of the jaw joint (TMJ) to a persons' bite is the "cornerstone" of correct orthodontic diagnosis. Making models of the upper and lower teeth and then holding them where most teeth mesh together tells us nothing about this most important relationship. This is where articulators come in to play. With a simple manipulation of the lower jaw and warmed wax, a set of models can be related to show how they TRULY come together when the joint is in its most correct position.

Articulators allow the upper and lower teeth to be related together in a position that is correct for the jaw joint (TMJ). When most people close their teeth together, their jaw joints are fairly close to a correct position and the orthodontic diagnosis is straight forward. Occasionally a person will have a major discrepancy between where their teeth come together and where the jaw joint is positioned - the diagnosis is then more difficult.

In the case shown below, the patient came in for an orthodontic evaluation. Her needs seemed very straight forward initially. Then when a simple manipulation of the lower jaw was performed, it became obvious that there was a serious problem with the way her jaw joint and teeth were working against each other. Upon further questioning, it was discovered that this 13 year old girl had experienced jaw joint pain in the past, premature wearing of her teeth (from bruxing) and jaw joint x-rays revealed that her left joint had sustained damage. All this from the result of her bite not lining up wi th her jaw joints.

In all the photos below, the left side is shown with the models on the articulator demonstrating her "REAL" bite and the right photos are those of her models being held with all her teeth in contact.

NOTE - this hand-held bite is how most orthodontic cases are diagnosed and therefore the reason that most of these problems are not caught at the diagnostic stage. Also, these are all "before" photos, they are not intended to show the results of case treatment - but - for the purpose of demonstrating correct and incorrect diagnosis.

In photo #1 are the articulated models (the arrows are pointing to the jaw joint elements of the articulator). Photo #2 demonstrates very simply where the patient closes her teeth together all the time - thus in her case, forcing the jaw joint into a very harmful position.

The red lines above show how the upper and lower front teeth line up. In Photo #4, the patient is practically perfect when she closes. When her models are correctly related with the articulator (#3), the lower jaw is shifted to the left about 1/4 of an inch. Notice also how her right back teeth do not line up at all. So, this young girl is putting very harsh pressures on her jaw joint when she closes - this is not something that is noticeable to the patient, but none-the-less is causing considerable harm.

 These right side views (#5 and 6) show the difference between the articulated and non-articulated models.

In these left side photos, the overbite difference is significant.

What this all adds up to is that there is a MAJOR difference between what therapy would be performed when hand-held models are compared to those on the articulator.

Not all orthodontists use articulators - we find they are an indispensable part of our practice.