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A rational plan of orthodontic treatment with the aid of practical records
A RATIONAL PLAN OF ORTHODONTIC TREATMENT WITH THE AID OF PRACTICAL RECORDS"" DR. GUSTAV KORKHAUS, BONN, GERMANY
E great uncertainty with which we regard orthodontic treatment is only T Hpartially due to the choice and application of appliances. It must be solved chiefly by establishing a correct diagnosis and by determining in what direction the teeth should be moved in each case. The orthodontic diagnosis consists of an analysis and a synthesis. To explain the complexity of symptoms and to determine the facts of a case an analysis of the models and, which is even more important, of the profile photograph is necessary; and finally each separate deviation is added to another, thus forming through synthesis a definite pathologic state. The analysis of the denture must be made according to a definite plan. It must disclose all the important details in systematic order. The same logical method of examination should always be followed: first, the maxilla; then the mandible; then the occlusion. In all cases of neutroclusion and regular features, the examination can be limited to the analysis of the models.. In cases of malocclusion the relationship of the jaws with the face must be determined; that means that the amount of sagittal deviation of each jaw must be ascertained. This can be done best and surest with a profile photograph. Other methods, such as the gnathostat, roentgenograms and anthropologic measurements, may be added advantageously. After this diagnostic examination we are able to determine (1) the numerical completeness of the denture and the consequences r of premature loss of teeth; (2) the deviations of each tooth or of groups of teeth in both jaws in transverse, sagittal and vertical direction; (3) the occlusion and its deviation; (4) the relation of the denture to the facial bony structure. After this it is possible to make the diagnosis, i. e., to designate the present orthodontic anomalies according to our genetic classification which covers a few large groups of orthodontic anomalies, the origin of which science and research have been trying to determine for many years .. After these observations the questions have to be answered as to what endresult of treatment we are aiming, and by what movements of the teeth this can be attained. Unfortunately, the necessary interest in these points is often lacking in practice, although it is essential at the beginning of each treatment. The direction and the extent of force of the movements we intend to produce should be written down, but above all we should try to find out to what extent we can use the principle of combining forces, which will act at the same time. Nearly always, preparatory movements must be carried out first, as this will facilitate the function of other and more important ones. For instance, in protrusion or • A demonstration given at the Second International Orthodontic Congress, London, JulY,lli31.
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A Rational Plan of Orthodontic Treatment
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retrusion the elimination of a compression (frontal crowding) of the incisors must be considered as a preliminary requisite to the mesial displacement of the mandible. The date on which the several movements are to be brought into force must be fixed. According to our experiences these movements must be approximately fixed for their beginning and duration, so that they possibly will simplify the appliances and influence the anchorage in a favorable way. As the biologic reaction always differs with each patient, nothing definite can be said, of course, at the beginning of the treatment in regard to the time for each movement. In considering this question, I have used the term a "de" gree of reaction." By this I mean the time needed to move a tooth or a group of teeth one millimeter in a certain direction. The ent,ire diagnostic examination and the drawing-up of a plan of treatment are facilitated by the use of a little notebook in which all questions and statements are found in print, so that only figures haveLo be entered or the printed indications have to be underlined. The drawing-up of the plan of treatment in all its details is facilitated by the columns in which the movements are noted according to order, direction, size and possible duration. Should it be proved in the course of the first three months of treatment that the assumed degree of reaction is not correct but that the biologic reactions of the bone are slower or quicker, then the notations (which for this reason should be made in pencil) could be changed. In order to bring the course of the treatment under close observation, some pages have been provided with columns. All measures taken should be entered in the book, also the time used herefore. The work by the orthodontist during the period of treatment is threefold. F'irst of all it must control the course of tooth movement so far attained and must ascertain whether these movements have taken place in the time set aside for them, or if not, what have been the causes for the delay. The second part of this work is to apply the new 1'I'Wvemenis at the time fixed. The third part of the orthodontist's work is of an unproductive nature, i. e., the repairing and cleaning of the appliances. In regard to the construction of the appliance, it would be advisable to draw a sketch before beginning treatment, with all the details in different colors. The use of such a notebook will facilitate the work of the orthodontist in the diagnosis and the procedure of treatment. All necessary parts of the plan of treatment, such as photographs, roentgenograms, curves, and also a note regarding the fee agreed upon or received, should be attached to the cover of the book.
E great uncertainty with which we regard orthodontic treatment is only T Hpartially due to the choice and application of appliances. It must be solved chiefly by establishing a correct diagnosis and by determining in what direction the teeth should be moved in each case. The orthodontic diagnosis consists of an analysis and a synthesis. To explain the complexity of symptoms and to determine the facts of a case an analysis of the models and, which is even more important, of the profile photograph is necessary; and finally each separate deviation is added to another, thus forming through synthesis a definite pathologic state. The analysis of the denture must be made according to a definite plan. It must disclose all the important details in systematic order. The same logical method of examination should always be followed: first, the maxilla; then the mandible; then the occlusion. In all cases of neutroclusion and regular features, the examination can be limited to the analysis of the models.. In cases of malocclusion the relationship of the jaws with the face must be determined; that means that the amount of sagittal deviation of each jaw must be ascertained. This can be done best and surest with a profile photograph. Other methods, such as the gnathostat, roentgenograms and anthropologic measurements, may be added advantageously. After this diagnostic examination we are able to determine (1) the numerical completeness of the denture and the consequences r of premature loss of teeth; (2) the deviations of each tooth or of groups of teeth in both jaws in transverse, sagittal and vertical direction; (3) the occlusion and its deviation; (4) the relation of the denture to the facial bony structure. After this it is possible to make the diagnosis, i. e., to designate the present orthodontic anomalies according to our genetic classification which covers a few large groups of orthodontic anomalies, the origin of which science and research have been trying to determine for many years .. After these observations the questions have to be answered as to what endresult of treatment we are aiming, and by what movements of the teeth this can be attained. Unfortunately, the necessary interest in these points is often lacking in practice, although it is essential at the beginning of each treatment. The direction and the extent of force of the movements we intend to produce should be written down, but above all we should try to find out to what extent we can use the principle of combining forces, which will act at the same time. Nearly always, preparatory movements must be carried out first, as this will facilitate the function of other and more important ones. For instance, in protrusion or • A demonstration given at the Second International Orthodontic Congress, London, JulY,lli31.
608
A Rational Plan of Orthodontic Treatment
609
retrusion the elimination of a compression (frontal crowding) of the incisors must be considered as a preliminary requisite to the mesial displacement of the mandible. The date on which the several movements are to be brought into force must be fixed. According to our experiences these movements must be approximately fixed for their beginning and duration, so that they possibly will simplify the appliances and influence the anchorage in a favorable way. As the biologic reaction always differs with each patient, nothing definite can be said, of course, at the beginning of the treatment in regard to the time for each movement. In considering this question, I have used the term a "de" gree of reaction." By this I mean the time needed to move a tooth or a group of teeth one millimeter in a certain direction. The ent,ire diagnostic examination and the drawing-up of a plan of treatment are facilitated by the use of a little notebook in which all questions and statements are found in print, so that only figures haveLo be entered or the printed indications have to be underlined. The drawing-up of the plan of treatment in all its details is facilitated by the columns in which the movements are noted according to order, direction, size and possible duration. Should it be proved in the course of the first three months of treatment that the assumed degree of reaction is not correct but that the biologic reactions of the bone are slower or quicker, then the notations (which for this reason should be made in pencil) could be changed. In order to bring the course of the treatment under close observation, some pages have been provided with columns. All measures taken should be entered in the book, also the time used herefore. The work by the orthodontist during the period of treatment is threefold. F'irst of all it must control the course of tooth movement so far attained and must ascertain whether these movements have taken place in the time set aside for them, or if not, what have been the causes for the delay. The second part of this work is to apply the new 1'I'Wvemenis at the time fixed. The third part of the orthodontist's work is of an unproductive nature, i. e., the repairing and cleaning of the appliances. In regard to the construction of the appliance, it would be advisable to draw a sketch before beginning treatment, with all the details in different colors. The use of such a notebook will facilitate the work of the orthodontist in the diagnosis and the procedure of treatment. All necessary parts of the plan of treatment, such as photographs, roentgenograms, curves, and also a note regarding the fee agreed upon or received, should be attached to the cover of the book.