Risks and benefits of orthodontic treatment Flashcards
What are the benefits of orthodontic treatment
- improvement in appearance
- improvement in function
- improvement in dental health
- psychological benefits
- reduced risk of teasing and stereotyping
What are the appearance changes from orthodontic
dental and facial
facial is more for severe
How does orthodontics improve function
o Improvement in mastication is associated with more severe malocclusions
o Speech is rarely improved by ortho due to when speech development occurs
What are the malocclusions that impact mastication
Large anterior open bites
Severe increased overjet
Marked reverse overjet
What is IOTN
o IOTN measures the dental health component and determines the benefit the patient would experience if they were to undergo orthodontic treatment
o 1 & 2 are a no need or low need so minimal benefit
o 3 is a borderline need and so there is some benefit
o 4 & 5 are a high need so there is benefit
What are the psychological benefits of orthodontic treatment
o Severe malocclusions affect facial attractiveness
o People with unattractive faces are perceived unfavourably
o Correction may improve self esteem & psychological well-being
o Impact on minor malocclusions is more variable
o Quality of life is improved
What is the IOTN pneumonic
MOCDO
What is M
missing teeth
What can result in missing teeth
impaction
hypodontia
What are the risks of impaction
Can cause root resorption of other teeth
Associated with cyst formation
Can prevent eruption
What IOTN score is associated with impacted teeth
5i
remember i for impaction
What OJ measurement has increased risk of trauma
> 6mm
o Risk made worse if incompetent lips
What IOTN score represents OJ
o IOTN a represents hypodontia
o 4a = OJ >6mm
What IOTN socre represents crossbite
4c is the highest with >2mm discrepancy between RCP and ICP
What are the risks of anterior crossbite
Risk of recession and loss of periodontal support
Can result in tooth wear
If crossbite results in displacement then can result in TMJ problems long term
Crossbites are treated in mixed dentition stage
What are the risks of posterior crossbite
A significant displacement can result in asymmetry
Requires early correction in mixed dentition
What is displacement of contact points aka
crowding
What is the risk of crowding
o Hypothetical caries risk difficulty with OH can increase caries risk
What is the IOTN score for crowding
o 4d is highest IOTN score, >4mm contact point displacement
What are the risks of overbite
o Deep traumatic overbites can result in gingival stripping on labial surfaces which can result in loss of periodontal support
What is the IOTN of overbite
o 4F = overbite with trauma
o F = overbites in IOTN
What malocclusions are associated with TMJ dysfunction
o Crossbite with displacement
o Class II with retrusive mandible
o Class III
o AOB
o No guarantee that correction will improve TMD
Should ortho be used to treat TMD
- Orthodontic treatment should never be offered to improve TMD in isolation
- If malocclusions per se does not warrant treatment, orthodontics will not be offered to patients with TMD
- Conservative treatment must be offered before any orthodontics
- Orthodontic treatment could aggravate existing TMD e.g use of intermaxillary elastics
What are the risks of orthodontic treatment
decalcification
root resorption
relapse
soft tissue trauma
recession
periodontal health
headgear injuries
enamel fracture and tooth wear
loss of vitality
allergy
poor/failed treatment
What is the risk of decalcification
o Enamel weakened
o Can get staining which are hard to deal with
o Can get frank cavitation
o Upper teeth more effected as lower teeth most likely saved by salivary buffering
How do we prevnet decalcification
- good case selection
- maintaining OH
- dietary advice
- fluoride
What is good case selection to prevent decalcification
- Good OH pre treatment
- Low caries risk
- Treatment need
- Patient motivation (are they concerned about their malocclusion)
How do we maintain good OH to prevent decal
- Before, during and after
- Interdental brushes help for cleaning around appliances
- Brush teeth after every meal
- Disclosing tablets are an aid for those who struggle
- Superfloss
What dietary advice do we give to prevent decal
- Low cariogenic diet
- Reduce frequency
What fluoride can we give to prevent decal
- Spit don’t rinse
- 2800ppm for high risk patient
- Fluoride 0.05% mouthwash, should be used in between brushing not after
- Fluoride varnish 3-4 times a year
What is root resorption
o Inevitable consequence of tooth movement
o Average is approximately 1mm over 2 years of fixed appliances
What teeth are most effected by root resorption
upper incisors > lower incisors > 6s
What pecrentage have severe root resorption
1-5%
What are the risk factors for root resorption
type of tooth movement
rot form
previous trauma
nail biting
What types of tooth movement increase risk of root resorption
- Prolonged high force
- Intrusion
- Large movements
- Torque (root movement)
What root forms are at increased risk of root resorption
- Blunt
- Pipette
- Resorbed already
What is relapse defined as
the return of features of the original malocclusion following correction
What features are prone to relapse
Lower incisors are particularly prone to relapse
Rotations
Instanding 2s
Spaces and diastemas
Class 2 division 2
Anterior open bites
Reduced periodontal support/short roots
What should we consider when selecing cases with relapse in mind
- Accept mild malocclusions
What are the disadvantages of fixed retainers
Prone to plaque & calculus build up
Can break and not notice
Need excellent oral hygiene
Require more care long term maintenance
What are the advantages of fixed retainers
In situ for life
What are the advantages of removable retainers
Remove for OH
Can wear part time
Patient control
Easy to spot problem
What can soft tissue trauma result in
pain
ulceration
What is the advice for soft tissue trauma pain
analgesia
What is the advice for ulceration
Jaggy wire appears as teeth move
Use orthodontix wax to tie them over
Cheese wax can also be used
When is recession most common
o Unpredictable
o More common when proclining lower incisors, can push through the buccal bone
How do we manage recession
Correct tx planning, avoid overexpansion
Look out for thin gingival biotypes, more prone to recession
* Delicate, highly scalloped and translucent in appearance
Warn patients
Gingival graft if required
How can orthodontics increase risk of periodontal health
o Gingivitis
o Recession
o Active periodontal disease
o Loss of periodontal support
Why must periodontal disease be stabilized prior to tx
Any periodontal disease prior to treatment can accelerate bone loss
How should headgear injuries be prevented
2 safety mechanisms: snap away traction spring & nitom facebow
How can enamel fracture/tooth wear occur
o Tooth vs bracket
o Greater risk with ceramic brackets
o Ceramic is harder than enamel
o Enamel fracture during debonding of ceramic, sheets of enamel can come off with the bracket
Who is at risk of loss of vitality
o Rare
o Higher risk if previous trauma or compromised tooth
o Warn the patient if this is the case
o Look out for discoloration (first signs)
o Avoid excessive force
How can clinicians be to blame for poor/failed tx
Poor diagnosis
Poor treatment planning
Operator technique error
How can patients be to blame for poor/failed tx
Unfavourable growth
Poor cooperation
What does chances of tx success increase with
- Severity of malocclusion
- Motivation of patient
- Operator expertise
