Risks and Benefits of Orthodontic Treatment Flashcards by Harry Wheeler

What are the potential benefits of orthodontic treatment?

Improvement in dental/facial appearance
Improvement in function
Improvement in overal dental health

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What are the psychological impacts of severe malocclusion?

Affect facial attractiveness

People with unattractive faces perceived unfavourably

Correction may improve self esteem and psychological wellbeing

Improvement in quality of life

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Outline some of the stereotypes noted by those with a ‘normal’ dental appearance.

Judged as:

More intelligent
More friendly
More desirable as a friend
Less aggressive

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Outline the functional benefits of orthodontic treatment.

Mastication
Speech

Improvement more pronounced in severe malocclusions, particularly AOB, increased OJ and reversed OJ.

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What is the MOCDO acronym?

Missing teeth
Overjet
Crossbites
Displacement of contact points
Overbite

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What possible complications can impacted teeth lead to?

Can cause resorption
Can be associated with cyst formation
Supernumerary teeth can prevent normal eruption.

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What risk is associated with an increased overjet of >6mm?

Risk of trauma to upper incisors
Worse with incompetent lips

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What risks are associated with anterior crossbites?

Loss of periodontal support
Toothwear

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What risks are associated with posterior crossbites?

A significant displacement which may lead to asymmetry and early correction.

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What risk does crowding pose?

Makes the teeth more difficult to clean, or make it take longer to clean them.

This can have an impact on maintaining good oral hygiene.

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What risks can deep traumatic overbites have?

Can cause gingival stripping and loss of peril support.

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What is the relationship between malocclusions and TMJ disfunction?

Small association between TMD and some malocclusions such as:

Crossbite with functional shifts
Class II with recursive mandible
Class III
AOB

Treatment does not guarantee correction or improvement of TMD.

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What is the possible risk of ortho in a patient with TMD?

Ortho should never be used in isolation to treat TMD.

Intermaxillary elastics may aggravate existing TMD.

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What are the main four risks of orthodontic treatment?

Decalcification
Root resorption
Relapse
Soft tissue trauma

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Other than the four main risks of orthodontic treatment, what less common risks are there?

Recession
Loss of periodontal support
Headgear injuries
Enamel fracture and toothier
Loss of vitality
Allergy
Poor/failed treatment

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What can the impacts of decalcification due to ortho treatment?

Unsightly staining
Frank cavitation
Gross caries

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What steps can be taken to prevent decalcification?

Case selection
Oral hygiene
Diet advice
Fluoride

What patients are determined to be ‘good patients’ for ortho treatment?

Motivated patient
Good OH pre-treatment
Low caries risk
No other risk of decal indicated

What factors in a patients history may indicate a higher risk of decalcification?

Pre-existing decalcification
Erosion
Caries history

What specific OH should be given to a patient to prevent decalcification from orthodontic treatment?

Toothbrushing and interdental brushes
Twice a day very thoroughly
After every meal
Disclosing tablets
Target gingival margins and around each bracket.

When should duraphat toothpaste be prescribed for patients?

For patients with an established higher risk.

What is root resorption in relation to orthodontic treatment?

An inevitable consequence of tooth movement

Average approximately 1mm lost over 2 years with fixed appliances.

Mostly unnoticed but severe in 1-5% of cases.

Which teeth are most at risk of root resorption?

UI > LI > 6s

Which factors can impact the severity of root resorption?

Type of tooth movement:
- Prolonged high force
- Intrusion
- Large movements
- Torque

Root form:
- Blunt
- Pipette
- Resorbed already

Previous trauma

Nail biting

What is orthodontic relapse?

The return of the features of the original malocclusion following correction.

Which teeth are particularly prone to relapse?

Lower incisors

Which types of misalignment are more likely to relapse?

Crowding, rotations, instanding laterals, AOB, spaces and diastemas, teeth with reduced periods support. Class II d2 are also at a higher risk

What are the benefits and drawbacks of removable retainers?

BENEFITS Can remove for OH Can wear part time Patient controlled Easy to spot problem/replace DRAWBACKS Requires patient compliance Can be worn and broken by parafunctional habit.

What types of removable retainer are available?

Clear occlusal retainer Pressure/vacuum formed retainer Essix retainer Hawyley type retainer

What are the benefits and drawbacks of fixed retainers?

BENEFITS Does not require patient compliance DRAWBACKS Prone to plaque and calculus build up Can break without patient noticing Needs excellent OH Requires more care/long term maintenance

What steps can be taken to manage soft tissue trauma from orthodontic work?

Analgesia Orthowax/babybel cheese wax over sharp components

Explain the nature of recession from orthodontic treatment?

An increasing problem, more common in adult patients. It may not manifest until years after treatment.

How can you manage the risk of recession from orthodontic treatment?

Correct Tx planning Avoid overexpansion Thin biotype Warn patient Gingival graft/surgery

What is the risk to gingival health from orthodontic treatment?

Gingivitis is common Recession can happen Active periodontal disease must be treated, stabilized, and maintained before ortho Tx During orthodontic treatment, alveolar bone loss and periodontal destruction is accelerated.

What mechanisms are in place to prevent headgear trauma?

Snap away traction spring Nitom facebow

How can tooth wear/enamel fracture occur during orthodontic treatment?

Tooth versus bracket Greater risk with ceramic brackets Ceramic harder than enamel Enamel fracture from debond

Describe the risk of vitality loss from orthodontic treatment?

Rare More risk if previous trauma/compromised tooth Warn patient Can be idiopathic

What allergies are relevant to note for orthodontic treatment?

Latex Nickel Adhesive - colophony

What factors lead to poor/failed orthodontic treatment?

From the clinician: - Poor diagnosis - Poor Tx planning - Operator technique error The patient - Unfavorable growth - Poor co-operation Also consider: - Severity of malocclusion - Motivation of patient - Operator expertise

What are some potential drawbacks of cosmetic quick ortho (also known as six month smiles)?

Only can fix mild problems Unrealistic patient expectations Informed choice Relapse Litigation prone in hands of inexperienced operators

What type of patients have the most to gain, and least to loose from orthodontic treatment?

Patients with severe malocclusion treated by experts.

What type of patients have the least to gain, and the most to loose from orthodontic treatment?

Patients with mild malocclusions.