When parents say “this teenager needs braces,” it is too early for the orthodontist to choose a system. First they assess how the teeth meet, the stage of eruption of the permanent teeth, and the state of the mouth. Diagnostics before braces are placed for a teenager help decide whether treatment can start now, which tasks have to be solved, and which appliances that will require.
At the visit the wording is often different: “The teeth are crooked, but the bite seems fine.” One uneven tooth can indeed be the main complaint, but its position cannot be judged apart from the other teeth and the opposite jaw. For the clinic this is also a question of ordering: until the plan is agreed, a request for braces remains a guess.
Two patients of the same age can be at different stages of the change from primary to permanent teeth. In one, the permanent teeth the clinician expects to include in treatment have already erupted. In the other, their position and the timing of eruption still have to be assessed. How the arches meet, and the aims of treatment, can differ too. A date of birth will not tell you which appliances to order, or when to start fitting them.
A complaint about one crooked tooth is not the same as the task of “straightening only that area.” The orthodontist judges whether there is enough space for the movement that is being considered, and how it may affect the contacts between the teeth. Looking only at the smile, it is easy to miss features of the bite that become obvious when both jaws are examined. The decision to treat one arch or both is made after the examination, not from a photograph.
In practice the conversation about braces often starts with how they look. A teenager cares what the appliance will look like, and that is a normal part of the discussion. First, though, the clinician has to state the clinical task: which teeth are expected to be moved, how they meet, and which limits have been found in this patient. After that, the conversation about the design becomes concrete.
First the orthodontist listens to the teenager and the parents, and asks about previous dental and orthodontic treatment. They then examine the face, the dental arches, the teeth, and the gums, and assess how the teeth meet. Particular attention goes to the eruption of the permanent teeth and to space in the arches. Those findings help decide which further investigations are needed for planning.
The position of the lower jaw is assessed in relation to the complaint and to how the teeth meet, not in order to choose an appliance that was already decided. Crowding that looks similar from the outside — teeth that are short of space in the arch — can go with different relationships between the arches. Photographs of two similar smiles do not mean the aims of treatment will match. At the visit this has to be explained especially often when a family arrives with a ready idea of which braces the teenager needs.
Photographs of the face and the mouth help record the starting situation and discuss it at later visits. A scan or models of the arches let their shape and the position of the teeth be studied in more detail. A photograph does not show, for example, the position of the roots. The orthodontist sets the examination findings together and decides what else the plan still needs.
Radiographs should not be turned into the same set for every teenager. Depending on the clinical task, the clinician may need information about unerupted teeth, the roots, or the relationship of the jaws. Whether a panoramic radiograph, a lateral cephalometric radiograph for jaw analysis, or a CBCT — a three-dimensional radiographic examination — is needed is decided by the specialist. Before it is ordered, it helps to state which question the investigation should answer, and whether the answer will change the plan.
After the diagnostics the clinician sets the complaint next to what the examination found. One task may concern the position of individual teeth, another their contacts when the teeth meet. Sometimes both have to be taken into account. Similar irregularities do not necessarily imply the same sequence of movements. A teenager's orthodontic treatment plan describes not only the expected result, but the stages of the work, taking the limits that were found into account.
The next decision is whether to start active treatment now, to plan preparation first, or to watch the developing bite for a time. It cannot be made only from the argument that “at this age it is already time.” If some permanent teeth are still erupting, the clinician judges how that affects the next stage. If the mouth needs preparation, that is discussed before the system is bonded and before an individual order is placed.
The state of the teeth and the gums matters here in a practical way. The clinician checks whether there are questions that have to be dealt with before the orthodontic stage, and discusses tooth care with the teenager while the appliance is worn. If the teenager complains of pain, that needs a separate dental assessment, not a wait for the date already set for bonding. The specialist decides which interventions are needed after the examination.
It helps to explain the sequence to parents directly. Diagnostics before braces are placed are not a pause before the “real” treatment. They are the stage at which the clinician checks the starting conditions and discusses a possible plan. The family can see more clearly why the decision is not made from age, or from the look of one tooth. The clinic gets a basis for ordering appliances for an agreed task.
“Can the braces be ordered now?” is a fair question once the orthodontist has defined the scope of the work. In the specification the clinician states which teeth and which jaws the appliances are for, and which parameters and components the plan provides. “Braces for a 13-year-old” does not contain that information. Age, by itself, decides neither the contents of the order nor the extent of the orthodontic treatment.
A buyer does well to separate the clinic's standard stock from an order for a particular patient. Stock is built from the clinic's own need. An individual set follows the orthodontist's agreed specification. Before that specification arrives, the range, the availability of the items that are needed, and the documents for the products can be checked. Clinical parameters should not be chosen in the dentist's place. Unclear points in the request are better resolved before the order is placed.
The working sequence is simple. The orthodontist agrees the plan and passes on the specification. The person responsible checks the items and confirms availability. If it is unclear which teeth an item is for, or which parameter the clinician meant, the request goes back for clarification. That is more reliable than guessing a set from the patient's age, especially when both the start of treatment and the contents of the appliance depend on the examination.
For information on the range of braces, and on making up an order for a clinic, write to zaykovlab@yandex.ru. If products are being chosen for a particular case, attach the specification the orthodontist has agreed. The discussion of the order then starts from the clinician's task, not from assumptions about the patient.
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