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Y3T3 Orthodontics > Limitations and Risks in Orthodontics > Flashcards

Limitations and Risks in Orthodontics Flashcards

1
Q

Anatomic Limitations

A
  1. Skeletal discrepancies
  2. Alveolar ridge
  3. Space
  4. Soft tissue
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2
Q

Limitations of Skeletal Discrepancies

A
  1. AP, vertical, transverse

Size of discrepancy

Growth modification: only possible in growing patients and limited improvement

Orthognathic surgery needed in severe cases

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3
Q

Limitations of Alveolar Ridge Defect

A
  1. Early extraction creates an alveolar bone defect
  2. Risk of fenestration/dehiscence
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4
Q

Space Constraints Limitations

A
  1. Tooth size-arch length discrepancy
  2. Patients with reduced arch length:
    - Proclination/protrusion of incisors
    - Expansion
    - Distal movement of molars
    - Enamel stripping
    - Extractions
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5
Q

Soft Tissue Limitations

A
  1. Proclination of incisors >2mm risks instability
  2. Risk fenestration /dehiscence and stripping of gingiva
    - Advancement of incisors B-L
    - Dental expansion of premolars and molars >3mm
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6
Q

Compromises with Class II Camouflage (Retract upper incisors and procline lower incisors)

A
  1. Poor upper lip support
  2. Increased lower lip protrusion
  3. Lingual relapse of lower incisors
  4. Periodontal risks (lower incisors)
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7
Q

Compromises with Class III camouflage (Procline upper incisors, retract lower incisors)

A
  1. Poorly defined labiomental sulcus
  2. More prominent chin
  3. Periodontal risks (lower incisors)
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8
Q

Compromises with widening of maxillary arch

A
  1. Decrease buccal corridors
  2. May violate transverse dimensions of dentoalveolar base
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9
Q

Compromises with Incisor Proclination

A
  1. Fuller lips
  2. Risk instability: Relapse of crowding
  3. Risk fenestration, dehiscence, gingival recession
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10
Q

Physiologic Limitations of Orthodontics

A
  1. Systemic problems
  2. Medications
  3. Growth is age-dependent, genetically programmed, and unpredictability
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11
Q

Systemic Problems

A
  1. Juvenile rheumatoid arthritis: Progressive severe skeletal mandibular deficiency
  2. Acromegaly (>GH): Mandibular prognathism in adult life
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12
Q

Medications

A
  1. Bisphosphonates: Inhibit osteoclast-mediated bone resorption
  2. Prostaglandin inhibitors (NSAIDs, corticosteroids)

Other agents with mixed agonistic and antagonistic effects on various prostaglandins

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13
Q

Limitations of Growth Modification

A
  1. Age
  2. Side effects
  3. Magnitude of correction
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14
Q

Therapeutic Limitations in Orthodontics

A
  1. Unrealistic expectations
  2. Motivation/compliance
  3. Relapse
  4. Smile esthetics
  5. TMD
  6. Impaction
  7. Ankylosis
  8. Primary failure of eruption
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15
Q

Limitations of Motivation

A
  1. Failed appointments
  2. Poor compliance with wear of removable appliance
  3. Repeated appliance breakage
  4. Diet
  5. Poor OH
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16
Q

Limitations of Relapse

A
  1. Time needed for re-organization of periodontal and gingival tissues
  2. Initial tooth position
  3. Final tooth position
  4. Continuation of original growth pattern
  5. Habits
  6. Poor retention planning/compliance
  7. Specific surgical movements
17
Q

Smile esthetics

A

Components cannot be influenced by orthodontics alone

  1. Harmonious gingival margins
  2. Tooth proportions
  3. Incisor and gingival display
18
Q

Risks in Orthodontics

A
  1. Periodontal issues
  2. Decalcification/Caries
  3. Devitalization
  4. Root resorption
  5. TMD
  6. Soft tissue inflammation
  7. Injury by orthodontic appliances
  8. Relapse
19
Q

Periodontal Risks of Orthodontics

A
  1. Gingivitis with or without gingival hyperplasia
  2. Periodontitis
20
Q

Preventive Measures for Periodontal Issues

A
  1. Good OH
  2. Regular recalls
  3. Good periodontal health before orthodontic treatment
  4. Mindful of anatomic limitations of tooth movement
  5. KIV pre-orthodontic soft tissue graft in patients at high risk of gingival recession
21
Q

Prevention of Decalcification and caries

A
  1. Caries controlled with good OH before and during orthodontic treatment
  2. Fluoride measures
  3. Dietary advice
  4. Terminate treatment
22
Q

Management of White-spot lesions

A

Topical fluoride varnish

23
Q

Risk of Devitalisation in Orthodontics

A
  1. Over-enthusiastic apical movement
  2. History of trauma
  3. Deep caries
  4. Idiopathic
24
Q

Management of Devitalisation

A
  1. Counsel patient of risks
  2. Stabilization of endo condition before orthodontic treatment
25
Q

Risks of Root Resorption

A

Inevitable, usually not clinically significant

Some patients increased susceptibility and severity

Before ortho treatment, take DPT 6 months into treatment to check root status. Pause or terminate treatment if RR is severe. Start with no extractions

26
Q

Other causes of root resorption

A
  1. Forced movements of roots against cortical plates
  2. Root morphology
  3. Dilacerations
  4. History of trauma
27
Q

Precautions for Root Resorption

A
  1. Avoid risk factors
  2. Regularly monitor with radiographs
28
Q

Management of Root Resorption

A
  1. Pause treatment
  2. Terminate treatment
29
Q

Risk of Soft Tissue Inflammation in Orthodontics

A
  1. Stomatitis
    - Removable appliances
    - Nance appliance
  2. Traumatic ulceration
  3. Allergies: Latex, nickel
30
Q

Risk of Injury by Orthodontic Appliances

A
  1. Aspiration of broken or loose appliances
  2. Fracture of enamel or large restorations
  3. Head-gear associated risks
  4. Mobility as tooth is moved into traumatic occlusion
  5. Relapse

Y3T3 Orthodontics (11 decks)

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