By Juan C. Echeverri, DDS, DAOS, and Elsa A. Echeverri, DDS, FAAPD O rthodontic treatment allows the clinician the opportunity to create changes in the patient’s facial and profile appearance, dental esthetic presentation, function and occlusion. If the diagnosis of orthodontic and dental issues is done correctly, the treatment options and outcome results can be positive and life changing. If there is not treatment planning, the outcome will probably reflect this, and only good luck will help the patient and the clinician. The scope of orthodontic treat-ment may be limited to changes in facial profile, dental arches and/or tooth positioning, but the results may have a deep impact on all aspects of the patient’s life. As the clinician starts to compile the required information for compre-hensive diagnosis of the potential orthodontic patient, he or she must be extremely aware that each and every patient may be similar to other current or previously treated patients. However, each has unique and individual characteristics that need consideration to create the ideal or appropriate treatment plan. This requires a methodology that resembles a checklist and has been presented in multiple studies, help-ing obtain a higher and more repeatable standard of care. The authors want to present a system they use for diagnosis and treatment planning in their patient’s orthodontic therapy. It has some of the following characteristics: ᕡ It is based mostly on elec-tronic record keeping, but may be printed. ᕢ The final compilation of diag-nosis and treatment planning can fit in one page, but reflects all areas considered to support the diagnosis and treatment plan presented. ᕣ It was created with the input of all the orthodontic team, including front desk, billing and dental assistants. This allows the whole team to have input in their area of management and know where to look for the information they need during the orthodontic treatment. ᕤ It is based on computer programs readily available that allow for higher efficiency. ᕥ The master templates may be modified, duplicated and adapted as needed, and filed in an efficient manner. This allows for file folders of specific types of patients that can be located and retrieved easily, locked and backed up electron-ically for additional safety. Tools for Treatment Planning The authors utilize the following tools and procedures for their approach to diagnosis and treat-ment planning: Clinical meeting and examina-tion of patient that includes, but is not limited to, review of medical history, previous dental history, postural position, clinical evaluation of TMJ and muscular health, peri-odontal and dental teeth structural integrity and airway health. Judge the patient and guardian’s interest, as there will be a need for coopera-tion regardless of the treatment time required. Establish the chief complaint that is the motivating desire for orthodontic treatment. If there is a genuine interest in proceeding with orthodontic treat-ment, allow your team members (clinical staff) to work with the patient obtaining panoramic, lateral cephalometric and CBCT images, study models (digital or manual), and necessary patient referrals to other DDS’s or MD’s for diagnosis or 20 Fall 2019 JAOS
Journal of the American Orthodontic Society Fall 2019: Page 20
