Prevention In Ortho

Question 1

Describe risks and management of de mineralisation

Answer 1

White markings with eventual cavitation
Found labially with fixed and palatally with removable
Appliances create stagnation areas

Management: 
Diet and plaque control prior to tx
Placement of brackets with GI cement re. Fluoride release
Regular reviews
Post and during tx
Fluoride varnish
Topical fluoride 
Post tx 
Micro abrasion re aesthetics

Question 2

Describe risks of root resorption and it’s management

Answer 2

Average 1mm of root lost per year of tx
Incisors most commonly affected
Patients should be warned prior to 2nd course of tx

Risk factors-
Resorption present pre tx
Previous trauma
Root filled teeth at greater risk

Prevention
Light forces
Minimise tx time

If at risk radiographs 6 months into tx

Question 3

Describe risks and management of pulp damage

Answer 3

Very uncommon
Tooth movement can cause flare up in pre existing peri apical area

Risk factors-
Previously traumatised teeth
Pulp vitality can be monitored through tx
Care when removing brackets and polishing important

Question 4

Describe risks and management of gingivitis / perio problems

Answer 4

Increased gingival inflammation due to reduced access for cleaning
Some apical migration of perio attachment and bony support can occur during tx
Risk factors-
Patients on certain meds causing gingival hyperplasia - anti epileptics
Patients with diabetes

Management-
OHI
3/12 sps

Question 5

What is the risks and management of soft tissue damage

Answer 5

Traumatic ulcers
Friction against components of the appliance
Arch wire no trimmed
Poor scaling instrumentation

Management-
Wax placement on sharp wires
Chlorhexidine mw re. Ulceration

Question 6

What risk can come with placement of implants re. Ortho?

Answer 6

As there is no Ossio integration- poorer success

There is risk of perforation of roots

Question 7

What other problems may occurs

Answer 7

Allergy to metals used

TMJD re. XLA

Question 8

Describe the different types of retainers and problems which may occur

Answer 8

Essix- easily fracture
Hawlay- effective re. Rotations
Bonded retainers- reduced access for cleaning

Question 9

What are the main risks of orthodontic treatment

Answer 9

Demineralisation 
Root resorption
Pulp damage
Gingivitis
Perio disease
Soft tissue damage