Ortho-Resto Interface

Question 1

Restorative factors which the patient does not like?

Answer 1

Incisor show- lip line
* Rest and Smiling
* Size/Crown form of teeth
* ‘Golden proportion’
* Colour/Shade
* Gingival level
* Recession/ Dark IP ‘triangles’

Question 2

What is the golden proportion?

Answer 2

The central appears 60% wider than the lateral,
which appears 60% wider than the canine

Question 3

What is the GS gingival profile?

Answer 3

Lateral margin <2mm below line
between central and canine

Question 4

What to aid decision making and Tx planning?

Answer 4

• 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’)

Question 5

Name the 3 types of Ortho-resto tx?

Answer 5

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

Question 6

How can mid-treatment ortho reviews change tx?

Answer 6

Spaciong
Tooth-root positioning
Change in restorative options
Retention management

Question 7

What is the definition of retention post-ortho treatment?

Answer 7

• 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

Question 8

What is the difference between simple and complex hypodontia?

Answer 8

• ‘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

Question 9

What are the tx options for misisng upper laterals?

Answer 9

• 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

Question 10

Name the advantages for sdpace closure for missing upper laterals?

Answer 10

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 )

Question 11

Name the orthodontic challenges (space opening) with hypodontia?

Answer 11

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

Question 12

Name the restorative challenges with hypodontia?

Answer 12

Restoring aesthetics and function
* Patient expectations
* Least invasive approach
* Longterm maintenance
* Co-operation of patient
* Good communication with Orthodontist

Question 13

Name the 5 restorative options for missing upper laterals?

Answer 13

Build ups, veneers, crowns
* Dentures
* Bridges
* Implants
* (Transplants)

Question 14

Describe a RRB for missing upper laterals?

Answer 14

Replacing single unit
* Younger adults, minimally invasive

Minimise grey “shine through” on 1 especially when replacing
missing 2
* Porcelain (E-max) design

Question 15

Describe a conventional bridge for missing upper laterals?

Answer 15

Older patient, heavily restored
* RRBs contraindicated where large restorations
* More destructive preparation
* Failure from caries/ periapical problems

Question 16

Describe the adv and dis of implants for missing upper laterals?

Answer 16

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

Question 17

Describe the restorative consideration dor upper lateral space closure?

Answer 17

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

Question 18

Why is ortho treatment contraindicated in active perio patients?

Answer 18

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

Question 19

Orthodontic tx consideration to manage spacing and drifiting for periodontally stable patient?

Answer 19

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

Question 20

Risks of orthodontics post-perio stability?

Answer 20

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