Limitations And Risk

Question 1

What are 3 physiologic limitations of ortho treatment

Answer 1

Systemic problems, medication, growth.

Question 2

What systemic problems canaffect Otho treatment

list 3

Answer 2

Consider diabetes: rapid progression of alveolar bone loss
Juvenile rheumatoid arthritis: progressive severe skeletal man deficiency acromegaly causes mandibular prognathism in adult life

Question 3

Ist the medications affecting Ortho treatment.

Answer 3

Bisphosphonates: inhibit osteodast mediated bone resorption tell patients it'll be slower
Prostaglandin inhibitors (steroids /NSAID) if chronic / high dose / potent (indomethacinss limits tooth movements

Question 4

Limits of growth modification

Answer 4

Age dependent side effects if anchored on teeth

Question 5

What are therapeutic limitations: 7

Answer 5

• Anchorage- teeth us bone, Perio
  type ofappliance- fixed better at moving teeth, removable better at tipping teeth
  Habits: thumb sucking/forward resting posture tongue
  Compliance: wear, diet, oh chance of relapse aesthetics cannot be changed by Otho alone: harmonious gingival margins eg. Crown lengthening, prosthodontics treatment. tooth shape and proportions in eg. Worn tooth, peginasor, cannine substitution

Incisor gingival display
tad is multifactorial and no association w malocclusion patient might just stop grinding cos pain
impaction / severe Tras position ankyloses teeth or primary failure of eruption teeth does not respond well to Otho forces.

Question 6

What risks can patients get from ortho

Answer 6

Perio-gingi/hypeplasia/ perio/recession, patient needs to have good oh before starting treatment, maybe consider pre ortho soft tissue graft

Caries/white spot lesions: wide range in prevalence, need for prevention, if patient is shitty may have to terminate treatment
Management of aesthetics of white spot lesions maybe fluoride helps

Devitalisation: over enthusiastic apical movement, history of trauma, deep caries, idiopathic. Need to counsel patient and make sure endo is cleared

Root resorption is almost inevitable, around 1mm, teeth intrusion, total apical displacement more likely, preexisting RR plus genetic, cortical plates, root morph, dilaceration, trauma history, maxillary incisors. Maybe take 6 month exray during treatment if kenna trauma/endo/preexisting
Clinician avoid high magnitude, limit duration

Question 7

Can ortho cause TMD or cure TMD

Answer 7

Moving teeth only gives you transitional occlusal interference

Question 8

How to ortho affect soft tissue

Answer 8

Stomatitis from devices eg. nance appliance, traumatic ulceration
Allergy to nickel
Aspiration, fracture of enamel or large restorations, head gear associated jury when kids play, mobility when tooth is in bad occlusion atm