Relevance of Diagnosis. Comprehensive Diagnosis

Diagnosis: The recognition and systematic designation of anomalies; the practical synthesis of the findings, permitting therapy to be planned and indication to be determined, thereby enabling the doctor to act.

Recognizing the problem - Formulating the problem - Carrying out the necessary
examinations - Interpretation of the results – Diagnosis

Numerous observations, individual findings and analyses, which allow a broad-based decision to be made for the particular patient, are a prerequisite for a correct diagnosis in orthodontics. The informations must be objective, relevant, and accurate. The diagnostic criteria should include the entire orofacial system, yet should also be selective. Certain norms are required for diagnostics, i.e. for the assessment of abnormalities of the stomatognathic system.

Comparing to an ideal norm (e.g. eugnathia) or statistically determined mean values (e.g. Pont index) is unrealistic. Personal, individual norms do exist for each case which take into account the individual development of the masticatory system (the “individual optimum' according to Andresen, 1931). Analyzing the individual data systematically enables diagnosis to be carried out according to type. Grouping the cases together results in larger groups, so-called typical anomalies, which can be divided into further classifications. Atypical anomalies also exist, so-called borderline cases, which depend in their type and number on the respective methods of considering the case and its classification.

Comprehensive Diagnosis. Nowadays, orthodontic diagnosis should be routinely based on various methods of examination (Fig. 1). The synthesis of these various individual findings determines the orthodontic diagnosis. The individual results must be checked prior to evaluation to ensure that sufficient examinations have been carried out. and that the most relevant examinations were included, and not simply that an immense volume of data has been collected without having included the most relevant details.

Fig. 1. Essential orthodontic examinations. The seven different analytical techniques are all оf the same relevance tor orthodontic diagnosis. Prior to carrying out further examinations, the time and effort required should be compared to the possible therapeutic consequences. Even in adult cases, where more elaborate diagnostic examinations are necessary, the time and effort required must be relative to the possible results

The comprehensive diagnosis should be a summary of the most important facts and should not take insignificant secondary symptoms into account, as they are of no relevance to the treatment. The more experienced the orthodontist is. the quicker he or she will recognize the problem, select the appropriate examinations for the case, and make optimum use of it.

Certain discussions as to whether the etiological, clinical, functional, or radiographical aspects should be considered most important for the diagnosis are unwarranted. However. in some cases further examination methods may be required. For example, cinematographic or palatographic registrations should only be carried out in exceptional cases for a detailed investigation of specific problems.

Computer analysis has also been employed for orthodontic diagnostics over the past few years. The computer enables quick and accurate evaluation of the individual findings. It can correlate the various data and indicate a particular problem. However, the computer cannot make a diagnosis. The practitioner must still interpret and synthesize the data determined by electronic means and plan the therapy. The so-called computer diagnosis often includes a preprogrammed decision which usually leads to standardization of the treatment methods and results in stagnation in one's speciality.

The causes of incorrect diagnoses are usually insufficient informations or prejudiced decisions made in order to adapt the case to a particular type of treatment.