The orthodontic records appointment is your very first step toward a patient’s orthodontic treatment. The orthodontic record is an evaluation tool that is used by orthodontists to determine the treatment needs of the patient. These records aid the orthodontists to provide the most optimal treatment plan, making this a very important step in the process.

This process provides the orthodontists with all of the necessary information, and even more. Often times this information is not evident by the visual examination alone. Therefore it’s important to document the patient’s orthodontic problem to help determine the most appropriate treatment. These records also serve then as a means to determine progress through the treatment and post treatment to evaluate the outcome and decide what further treatment or precautions are necessary.

Before the orthodontist begins planning a proposed treatment plan these orthodontic records must be completed thoroughly. The orthodontist will study these records and determine exactly how the patient’s jaw bones and teeth are positioned and customize a unique treatment plan for each individual case. Below, you will find an extensive list of all of the factors that make up your orthodontic records:

Dental Impressions

Sometimes also referred to as alginate impressions, these guys are used to give the orthodontist an exact duplicate of a patient’s mouth. The model of the mouth is made through a process of pouring stone into an impression mold. The orthodontist uses this model to study the current positioning of a patient’s teeth and can thereby predict the relationship between the upper and lower teeth in the future.

Today, a more technologically advanced solution has emerged to enable orthodontists to obtain 3D images of a patient’s teeth and bite via a digital scanning process, digital impressions. Using a capture wand, and moving it slowly around the teeth it’s able to capture images from all angles of the teeth. Once plugged into the software, the images are stitched together to form a digital model of the patient’s mouth. This eliminates the need for the aforementioned physical impression.

Panoramic X-ray

The panoramic x-ray is a 2D display of both the upper and lower jaws and teeth shown on the same film. This type of x-ray is important for patients in their adolescence, because the dentist can easily view their developing teeth and use that to predict where they will break through in the mouth. Adult patients undergoing or considering orthodontic treatment may also have this x-ray taken in order to examine current health and level of the jaw bone.

Cone Beam CT

Yet another new technology in orthodontic imaging is the CBCT. This exam provides much more in-depth and reliable information that can be useful in orthodontic treatment and diagnosis. When using the CBCT the orthodontist is provided with a 3D view of the patient’s teeth and jaws to help and see more spatial information. This can be especially important in the case patients with a cleft palate or patients with impacted teeth. The CBCT can provide many different views for the orthodontist i.e. standard panoramic and cephalometric views.

Cephalometric Analyses

The cephalometric x-ray captures the patient from their side profile, this begins from the top of their head until just below the tip of the chin. In the cephalometric analyses is a valuable exam because it not only shows the teeth and the bone, but it also includes soft tissues which can help the orthodontist predict how the bone will structure, and its potential to change during orthodontic treatment.

While dentists and orthodontists used to use tracing paper and trace the ceph using key landmarks on the x-ray, yet again new technologies have come along to improve the accuracy and ease orthodontists. With programs like CephX, you can upload your ceph images into the cloud and with RTS (remote tracing services) within 2 business days your traces will be printable, editable, and viewable from the cloud. One of the greatest advantages of working in the cloud, is keeping track of a patient’s progress for legal reasons. If a patient claims they’ve been harmed by your practice, CephX can provide proof through their image storage anywhere and at anytime.

Once the orthodontist has received all of the completed exams and records, all of the potential treatment options are recorded into the patient’s file. Then an additional consultation with the patient is in order to discuss the potential treatment options. During this consultation a final treatment option is to be agreed upon and necessary appointments can be scheduled to begin treatment.

The wits appraisal and analysis has been around in orthodontics since 1952. The wits appraisal has become one of the most popular practices in evaluating the cephalometric evaluation of the anteroposterior relationship of the apical bases. Along with multiple other cephalometric analyses such as Rickett’s analysis the Wits analysis is still being used in practice today.

What is the Wit’s Appraisal?

The Wits appraisal was created to relate patient’s jaws anteroposteriorly to the cranial reference planes. This presents an inherent consistency of variations because of the craniofacial physiognomy.

The appraisal was intended to eliminate such inherent variations and the problems associated with relying on the ANB angle (A point nasion B point). Wits decided to come up with an alternative method to assess the sagittal jaw relationship. This method is independent of apical base relationships to cranial landmarks.

The appraisal entails projecting points A and B in two perpendicular lines, along the functional occlusal plane. Once these points have been projected they’re called AO and BO. Once you’ve measured the distance between points AO and BO the plane in between is what’s referred to as the Wit’s Appraisal.

The Original Study

The original study was performed on caucasian adults, all of whom showcased excellent occlusions. This meaning in female subjects the distance between AO and BO was exactly zero, whereas in male instances the average BO was one millimeter anterior to the AO, giving them a wits reading of approximately -1 millimeter.

This study was originally performed on Class I type malocclusions, in these cases we typically see points AO and BO coinciding in average. On the other hand, class II type in skeletal dysplasia point BO is typically posterior to point AO hence giving a positive wits appraisal. In the third scenario a class III skeletal disharmony, point AO is forward from point BO making a negative wits appraisal.

Past Studies

Ever since the introduction of the wits analysis reading, numerous papers have been written attempting to describe different populations and classes using the wits analysis measurement. For instance Kim and Vietas’ study analyzed A-P dysplasia indicators. In this study they found that the mean measurement of the Wits appraisal within their control group of adolescent caucasian males and females was comparable to previous studies with normal occlusions.

The study performed by the Foundation for Orthodontic Research by McNamara and Ellis comprised of 41 males and 81 females all with ideal facial aesthetics and normal untreated class I relationships. The recorded means found in this study were -0.72 for males and +0.93 for females. Similar studies in the South Wales population of England found nearly identical results using 25 head films of 15 year old females.

In a study by Binder in 1979, he randomly varied the positions of the points, angles, and lines on the cephalometric drawing. Regardless of the arbitrary lines, they found the same ANB angles and geometric effects. He showed in this study that for every 5 millimeter anterior displacement horizontally the ANB angle was changed by 2.5 degrees. He also utilized an upward displacement of nasion altering the role of the ANB angle by 1 degree.

All of the above findings reflect no correlations between two consecutive values when the wits appraisal is negative. When the ANB measurement is less than 4 degrees however, the wits analysis could be either positive or negative. When the ANB angle is somewhere between 4 and 8 degrees then all wits measurements will be positive. When both values are positive and the ANB measurements ranged from 1 degree to 8 degrees, the ability to predict the wits measurement is with 28% accuracy.

All in all, what the wits analysis has given us is the linear measurement, an adjunctive diagnostic aid to assess the extent of anteroposterior skeletal dysplasia and determining the reliability of the ANB angle. Today we have tools such as CephX to our advantage, this makes it easier for dentists and orthodontists to perform cephalometric analyses and tracing with complete accuracy and track progress.