Ortho-Resto Interface Flashcards
Restorative factors which the patient does not like?
Incisor show- lip line
* Rest and Smiling
* Size/Crown form of teeth
* ‘Golden proportion’
* Colour/Shade
* Gingival level
* Recession/ Dark IP ‘triangles’
What is the golden proportion?
The central appears 60% wider than the lateral,
which appears 60% wider than the canine
What is the GS gingival profile?
Lateral margin <2mm below line
between central and canine
What to aid decision making and Tx planning?
- Shared decision making
- Careful discussion
- Focusing on patients concerns
- Model set ups (‘Kesling’ diagnostic set ups)
useful - Patient time to consider (return a ‘decision
letter’)
Name the 3 types of Ortho-resto tx?
No treatment to maintain ‘status quo’
* Restorative only
* Combined Orthodontic/restorative planning
(a) Space opening / consolidation for restorative replacement with
bridge or implant retained crown
Or
(b) Space Closure with or without restorative modification of teeth
How can mid-treatment ortho reviews change tx?
Spaciong
Tooth-root positioning
Change in restorative options
Retention management
What is the definition of retention post-ortho treatment?
- Crucial
- Maintain tooth positions
- Restorative follow up post orthodontics (2-3 months)
- Full time wear of retainers until restorative treatment complete
- Restorative phase of care may stretch to 1- 2years +
- Pressure formed or Hawley with pontics +/- bonded retainers
- Following completion of restorative treatment
- Continue with NO wear indefinitely / LIFETIME
What is the difference between simple and complex hypodontia?
- ‘Simple’ (mild)
- One tooth in any quadrant (excl. 8s)
- IOTN DHC = 4h
‘Complex’ (Moderate / Severe)
* More than one tooth in any quadrant
* IOTN DHC = 5h
What are the tx options for misisng upper laterals?
- Space opening v’s Space closure
- Contemporary approach – space closure when possible
Unilateral missing lateral contralateral likely smaller
* Might consider extraction for symmetry if space closing
Name the advantages for sdpace closure for missing upper laterals?
Advantages of Space closure
* Generally shorter treatment times
* ‘Simpler’ restorative management
* Modern composite bonding and bleaching
techniques good aesthetic results
* Evidence in literature that aesthetics
preferred by patients (Quadri et al)
* Lower maintenance ( less future financial
costs for patient )
Name the orthodontic challenges (space opening) with hypodontia?
Orthodontic Challenges with hypodontia
* Drifting /rotation of adjacent teeth
* Retained deciduous teeth (?infra occluded)
* Deep OB common
* Co-operation (lengthy tx plan)
* Opening space for implants can be difficult
* Minimum of 5.5 mm space (ideally 6.5 /7mm)
* Stability / Co-op with retention
Name the restorative challenges with hypodontia?
Restoring aesthetics and function
* Patient expectations
* Least invasive approach
* Longterm maintenance
* Co-operation of patient
* Good communication with Orthodontist
Name the 5 restorative options for missing upper laterals?
Build ups, veneers, crowns
* Dentures
* Bridges
* Implants
* (Transplants)
Describe a RRB for missing upper laterals?
Replacing single unit
* Younger adults, minimally invasive
Minimise grey “shine through” on 1 especially when replacing
missing 2
* Porcelain (E-max) design
Describe a conventional bridge for missing upper laterals?
Older patient, heavily restored
* RRBs contraindicated where large restorations
* More destructive preparation
* Failure from caries/ periapical problems
Describe the adv and dis of implants for missing upper laterals?
Advantages
* No need for tooth abutments
* Maintenance of interdental spaces
* Good for spaced dentitions
* Can be used for anchorage, subsequently used as prosthesis
itself, or to support prosthesis
Disadvantages
* Often dento-alveolar limitations (lack of bone, space)
* Placement difficulties
* Long term crestal bone loss around necks of implants
(range from 0.02 mm to 0.1 mm per year)
* Pts should understand long term maintenance issues
need for revisions
Describe the restorative consideration dor upper lateral space closure?
Gingival margin heights (orthodontic finishing)
* Reduce M-D width of canines (‘golden proportion’)
* Crown form (reduce tip and composite additions)
* Shade (bleaching)
* Upper first premolars substituting upper canines
* Orthodontic finishing increased buccal root torque and M-P rotation
Why is ortho treatment contraindicated in active perio patients?
Orthodontic treatment is contra-indicated in a patient with active periodontal disease as tooth
movement will accelerate the bone loss process.
* Orthodontic treatment can only be considered as an option when the patients periodontal health has
been stabilised
* And demonstrated disease stability and maintenance over a time period of minimum 6-12 months
* If orthodontic treatment being considered will require close liaison between the orthodontist and
restorative dentist managing the patients periodontal health
Orthodontic tx consideration to manage spacing and drifiting for periodontally stable patient?
Minimise orthodontic treatment time to reduce risk of bone loss and root resorption
* Will often mean limited objective treatment plan
* Light forces during orthodontic treatment
* Careful oral hygiene support for maintenance of periodontal health during treatment
Risks of orthodontics post-perio stability?
ncreased risk of increased bone loss if periodontal health relapses during treatment.
* Risk of increased gingival recession as teeth move
* Risk of interproximal ‘triangles’ – dark spaces between teeth as they align and spaces close
* Longterm stability of tooth postion following orthodontic treatment challenging
* Will require diligent compliance with retention regime indefinitely
