A comprehensive orthodontic exam is the most important aspect of your treatment. A comprehensive exam allows your orthodontist to diagnose all the problems that contribute to imbalances in bite and the jaw relationship and compromise your smile and facial proportions. A proper diagnosis is essential in developing a customized treatment plan that is aimed to address the specific issues with your smile and your bite and meet your expectations. Dr. Khatami dedicates all the time that is needed to listen to your concerns, to thoroughly evaluate your facial proportions and harmony, your jaw relationships, your nose, chin, and lip positions from all angles, and your smile esthetic. She will then evaluate your teeth one by one and in relation to each other to determine all your esthetic and functional needs in order to provide you with not only a beautiful smile, but also a healthy and functional dentition and bite for life.
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Clinical exam starts with a discussion of your concerns and your expectations with your orthodontist. This includes your concerns about your smile, your lip projection, your facial proportion and balance and any issues you have experienced in relation to your bite and jaws. Your orthodontist will then review your medical history to evaluate your overall health and determine if any medications you take could potentially pose some limitations on tooth movement or result in overgrowth of the gum tissue during treatment. She will then review any history of trauma to your head and neck area to determine if there any changes have happened to your teeth or jaws or the bones and muscles of face and neck as a result of the previous trauma. She will also ask you questions about any possible breathing issues such as asthma or allergies and any sleep breathing disorders such as snoring and Obstructive Sleep Apnea. When necessary, your orthodontist may refer you to your medical doctor to complete a sleep study to determine the severity of the problem and proper diagnosis and treatment plan such as use of removable or orthognathic surgery to bring the lower jaw forward and open the airway during sleep. The health of your jaw joint will also be evaluated to address any possible issues with the Tempromandibular Joint (TMJ).
Photos will be taken from the front and side of your face in neutral and smiling poses. This allows your orthodontist to measure different components of your face and smile to determine any imbalances or asymmetries. More photos will be take from your teeth from the front, side and chewing surfaces to identify problems with alignment or teeth or bite.
The panoramic x-ray allows the orthodontist to see an overall picture of the jaw bones – it is a “low definition” view of the teeth. Your dentist will take “high definition” x-rays of the teeth to review for cavities, when indicated. Your orthodontist looks at the bones and the surrounding structures to identify any densities or areas of radiolucency that are outside of normal limits. She looks at the anatomy of the jaw joints and sinuses, looks for any extra or missing teeth or teeth that are stuck in bone and can not erupt on their own or are erupting in an abnormal path. In this panoramic x-ray, there are two permanent teeth missing in the upper right side of the patient (the left side of the screen).
The cephalometric x-ray allows the orthodontist to evaluate and measure the vertical and horizontal relationships of the jaw bones and teeth. The bony structures shown on the cephalometric x-ray give your orthodontist an idea of the growth potential of a growing patient. In a non-growing patient, it shows the severity of the discrepancy of the jaw proportions and the challenges in aligning the bite and decreasing or increasing the vertical overlap of the teeth. The horizontal relationship of the jaw bones determines if some teeth need to be removed in order to bring the protruding front teeth back to achieve proper bite and balance of the lips and maintain teeth within the confines of a healthy bone. Tooth movement is limited to the amount of the bone available around each tooth. If the jaw bones are too discrepant, then the position of the jaw bones needs to be changed with jaw surgery or growth modification in order to achieve a proper bite.
Study models and digital scans of your teeth allow the orthodontist to closely review the dental relationships in horizontal, vertical, and transverse dimensions. These models are used to measure the size of the teeth to determine the amount of space available for their alignment. Your orthodontist also evaluates the size of the upper teeth relative to the lower teeth to determine if the size of the teeth are proportioned correctly or there is need for removal of certain teeth or reshaping them to proper proportions.
Dr. Khatami uses the iTero scanner and digital models to simulate tooth movement at your initial examination and discuss options for your treatment.
Use of current imaging software allows your orthodontist to take linear measurements and evaluate the relationship of teeth in different dimensions.
When the path of eruption of a tooth is altered, it may not erupt naturally into the mouth or cause damage to the root of the adjacent teeth. In order to evaluate the position of those teeth accurately and detect possible damages to the surrounding structures, your orthodontist may take a 3D xray (CBCT) of that area. The image is used to evaluate the current position of the impacted tooth and determine a proper path for assisted eruption.
A comprehensive exam and data collection is essential in proper diagnosis of all the issues that compromise the esthetic of your face and smile and contribute to imbalances in your bite and function. Following a comprehensive clinical exam and analysis of all the gathered data from pictures, radiographs and models of your teeth, your orthodontist identifies and lists and prioritize all the problems in relation to facial, skeletal and dental disharmonies and use this diagnosis as a basis of a customized treatment plan to address all your esthetic and functional needs.