risks and benefits of ortho tx Flashcards
benefits of orthodontics
3
- Appearance
* Dental
* Facial - Function
- Dental health
appearance can be
dental
facial - all 3 planes of space
psychological benefits of ortho tx
4
Severe malocclusions affect facial attractiveness
People with unattractive faces perceived unfavourably
Correction may improve self-esteem & psychological wellbeing – difficult to measure
Impact on minor malocclusions is more variable & debatable
- Quality of Life (QoL) improvement – is used to measure benefits now over psychological improvement (which is hard
what is used to measure psychological benefit
Quality of Life (QoL) improvement – is used to measure benefits now over psychological improvement (which is hard)
ortho tx can improve what
other than attractiveness and psychological benefit
function
* mastication
* speech* (but rarely speech defects)*
Improvement in function when associated with severe malocclusion
* Large anterior open bites
* Severe inc OJ
* Marked reverse OJ (class III)
IOTN dental health components categories
1 & 2 No Need/Low Need (min benefit)
3 borderline need (some benefit)
4 & 5 Need/High Need (significant benefit)
MOCDO acronym
MISSING TEETH
OVERJET
CROSSBITES
DISPLACEMENT of contact points
OVERBITES
used for IOTN
impacted teeth can cause
3 issues
- Can cause resorption
- Can be associated with cyst formation
- Supernumery teeth can prevent normal eruption
overjet (inc >6mm) can cause
2 issues
Risk of trauma to upper incisors increases with size of OJ
Worse with incompetent lips
anterior crossbites can cause
2 issues
loss of perio support
tooth wear
posterior crossbites can cause
A significant displacement may lead to Asymmetry
Early correction on prevents displacement establishing in permanent dentition
posterior crossbite causing a significant displacement needs
early correction to prevent establishment in permanent dentition
crowding and caries connection
Crowding per se not directly linked to increased risk to caries
* Caries is more to do with diet and fluoride
Crowded teeth are more difficult to clean and take longer.
crowding and periodontal disease connection
Weak association between irregular teeth & periodontal disease.
Crowding can make surfaces less accessible and harder to clean
Individual motivation rather than tooth alignment has greater effect on effective brushing.
Better OH/ awareness in Pts with previous ortho
deep traumatic overbites can cause
gingival stripping
* leading to loss in peiro support
More common to have palatal gingivae trauma than labial
Improvement of palatal gingiva after surgery (lower photos)
TMJ dysfunction and ortho tx
TMD is multifactorial
Orthodontics/TMD - evidence is very weak
* Small association between TMD and some malocclusions:- Crossbite with displacement (functional shifts), Class II with retrusive mandible, Class III, AOB BUT no guarantee correction will improve TMD.
**Ortho Tx should never be offered to improve TMD in isolation **
* If malocclusion per se does not warrant tx - ortho will not be offered to pts with TMD
* Conservative tx must be offered before any ortho
Ortho Tx could aggravate existing TMD eg using intermaxillary elastics
potential problems due to
missing/ectopic teeth
2
root resorption
cyst formation
potential problems due to
overjets (>6mm)
1
upper incisor trauma
potential problems due to
crossbites with displacment
3
tooth wear
gingival recession
asymmetric growth
potential problems due to
displacements with crowding
2
limited thread with caries and perio disease
potential problems due to
overbites
2
trauma
gingival damage
possible dental issues which can be addressed by ortho tx
5
missing/ectopic teeth
overjets >6mm
crossbites with displacment
displacment (crowding)
overbites
MOCDO
ortho tx is
for the pt
elective mostly
when are benefits of ortho tx seen
at the end of tx
can get worse during course
what is decalcification
weakens the enamel to caries
prevention of decalcification
4
Case selection
Oral hygiene
Diet advice
Fluoride
high risk of decal indicated by
3
- Pre-existing decalcification
- Erosion
- Caries history
If low or borderline need - no tx
oral hygiene to prevent decal
Before start and during
Inter-dental brush
OHI
* minimum twice per day VERY thoroughly
* after every meals
* disclosing tablets
* target gingival margins and around each bracket with toothbrushing
* interdental clean
GDPs help
OHI to prevent decal
- minimum twice per day VERY thoroughly
- after every meals
- disclosing tablets
- target gingival margins and around each bracket with toothbrushing
- interdental clean
fluoride exposure to prevent decal
options (3 main)
toothpaste
* at least twice daily
* spit don’t rinse
* switch to adult toothpaste (infant 500-1000ppm; adult 1450ppm)
* high risk pts - duraphat 2800ppm or 5000ppm; twice daily, use ordinary toothpaste at other times
mouthwash
* daily 0.05% fluoride mouthwash (225ppm)
* use in between brushing, not after
* beneficial but low compliance
* Price may be prohibitive – cheaper options – supermarket brand antiseptic m/w with F
duraphat varnish
* 22,600ppm Fluoride
* 4 monthly, for high risk pt
others (F releasing GIC)
root resorption due to ortho
prevalence
Inevitable consequence of tooth movement
Average approx. 1mm over 2 yrs fixed appliances
Any teeth but UI > LI > 6s
Mostly unnoticed
* Severe in 1-5%
root resorption risk factors
3 main
**Type of tooth movement **
* Prolonged, high force
* Intrusion
* Large movements
* Torque (root movement)
**Root form **
* blunt, pipette, resorbed already
Previous trauma
Nail biting ?
relapse is
the return of the features of the original malocclusion following correction
Very common problem
Unpredictable
Treat all cases as if potential to relapse
lower incisors particularly prone to relapse
features more prone to relapse
7
- Lower incisor crowding
- Rotations
- Instanding 2’s
- Spaces & diastemas
- Class II div 2
- Anterior open bites
- Reduced perio support/short roots
fixed retainers
cons
3
- Prone to plaque & calculus build up
- Can break and not notice
- Need excellent OH
- require long-term maintenance/more care
what are fixed retainers
Wire in incisal 1/3 not by dental papillae/gingival margin
leave in situ for life
vacuum formed retainer often made to sit over
recession due to ortho tx
prevalance
Increasing problem
Expansion, more adult treatment
May not manifest until years after
how to manage recession and ortho
Correct tx planning - teeth within bone, avoid overexpansion
Thin biotype
Warn Pt
Gingival graft
periodontal health and ortho
Gingivitis – common
Recession
Active perio disease
*** Must be treated, stabilised, maintained before ortho tx starts **
* During ortho tx – accelerates alveolar bone loss and perio destruction
* Treated as priority over continuing tx
Loss of perio support
tooth wear/enamel fracture in ortho
how
Tooth vs bracket
* Greater risk with ceramic brackets
*Ceramic harder than enamel! *
Enamel fracture during debond
loss of vitality in ortho
Rare
* More risk if previous trauma or compromised tooth
Warn patient - Discolouration or darkened, come in
Cause
* Excess force ?
* idiopathic cause
