risk/benefit in orthodontics Flashcards
What are the benefits of orthodontic treatment?
Improvement in:
1. Appearance - dental and facial
2. Function
3. Dental health
What are the psychological benefits of ortho?
Severe malocclusion affects facial attractiveness
Correction may improve self esteem and psychological well-being
Quality of life improvement
How are children with normal dental appearanced judged as?
More intelligent
More friendly
More desirable as a friend
Less aggressive
What aspects of the occlusion are improved with ortho?
Larger anterior open bites
Severe increased OJ
Marked reverse OJ
What is the relationship between ortho and speech defects?
Ortho tx rarely improves speech defects
What does 1 or 2 on the IOTN dental health component indicate?
No need or low need for treatment (minimal benefit)
What does 3 on the IOTN dental health component indicate?
Borderline need for treatment (some benefit)
What does a 4 or 5 on the IOTN dental health component indicate?
Need or high need for treatment (significant benefit)
What does the MOCDO acronym stand for?
Missing teeth
Overjet
Crossbites
Displacement of contact points
Overbites
What are the implications of impacted teeth?
Can cause external root resorption of adjacent teeth
Can be associated with cyst formation
What is the risk of an OJ >6mm?
Risk of trauma to the upper incisors will increase with size of OJ
Worse with incompetent lips
What are the implications of anterior crossbites?
Loss of periodontal support
Can lead to tooth wear
What are the implications of posterior crossbites?
If significant can cause asymmetry
Requires early correction
What is the link between crowding and caries?
Crowding not directly linked to increased caries risk
Crowded teeth are more difficult to clean and take longer to clean
What is the link between crowding and periodontal disease?
Weak association
Crowding can make surfaces less accessible and harder to clean
Individual motivation has bigger impact on effective brushing
What are the implications of deep traumatic OBs?
Can cause gingival stripping and loss of periodontal support
How does ortho tx link to TMD?
Ortho tx should never be offered to improve TMD in isolation
If malocclusion doesn’t warrant tx - ortho should not be offered
Conservative tx must be offered first
Ortho tx could exacerbate existing TMD
What are the main risks of orthodontic tx?
Decalcification
Root resorption
Relapse
Soft tissue trauma
What are the other risks of orthodontics?
Recession
Loss of periodontal support
Headgear injuries
Enamel fracture and toothwear
Loss of vitality
Allergy
Poor/failed treatment
What are the implications of decalcification?
Weakens the enamel leading to unsightly staining and potentially cavitation and gross caries
How is decalcification prevented?
Case selection
Oral hygiene
Diet advice
Fluoride
What is the link between ortho tx and root resorption?
Inevitable consequence of tooth movement
Average approx 1mm over 2 years of fixed appliances
Most common in upper incisors, then lower incisors then first molars
Severe in 1-5% of cases
What influences the extend of root resorption?
Type of tooth movement - prolonged or high force, intrusion, large movements and torque
Root form - blunt, pipette-shaped, resorbed already
Previous trauma
Habits eg - nail biting
What is relapse and which teeth are most likely to be affected?
The return of the features of the original malocclusion following correction
Lower incisors mostly affected
Name 4 features which are more prone to relapse?
Any from:
- lower incisor crowding
- rotations
- instanding 2’s
- spaces and diastema’s
- class II division 2 malocclusion
- anterior open bites
- reduces periodontal support or short roots
How is relapse managed?
Case selection
Informed consent from patients
Providing fixed or removable retainers
What are the implications of soft tissue trauma?
Can cause pain, discomfort or ulcers
What is important to remember for bridgework post-ortho?
Quickly fit a retainer after bridge cementation to prevent relapse
When is recession most common in ortho tx?
If expansion has been carried out
More commonly caused in adult tx
May not manifest until years later
How is recession managed?
Correct tx planning
Inform patient of risk - more common in thin biotype
Gingival grafting
How does periodontal disease affect ortho tx?
Must be treated, stabilised and maintained before ortho tx starts
Ortho tx accelerates alveolar bone loss and periodontal destruction
Perio tx is a priority over continuing ortho
Use light forces when moving teeth
How is headgear trauma prevented?
Need a minimum of 2 safety mechanisms:
- snap away traction spring
- Nitom facebow
- Masel strap
How may ortho tx cause tooth wear and enamel fracture?
Brackets bonded to tooth
Greater risk in ceramic brackets
Ceramic is harder than enamel
Enamel may fracture during debonding
What is the relationship between ortho tx and loss of vitality?
Rare
Higher risk if previous trauma or compromised tooth
Warn patient of the risk
Tooth may be discoloured or darkened
May be due to excess force, or can be idiopathic
Name 3 common allergies in ortho tx
Latex
Nickel
Adhesive - colophony
What may cause poor or failed ortho tx on the clinicians side?
Poor diagnosis
Poor tx planning
Operator technique error - poor mechanics
What may cause poor or failed ortho treatment on the patients end?
Unfavourable growth
Poor cooperation with appliance wear
Repeated breakages
Poor attendance
Name 3 things that will increase ortho tx success
Severity of malocclusion
Motivation of patient
Operator expertise
What are the problems with cosmetic quick fix orthodontics?
Can only fix mild problems
Pts have unrealistic expectations
High relapse potential
Litigation prone if operator is inexperiences
