Risks and Benefits of Orthodontics Flashcards
Psychological benefits
- severe malocclusion affects facial attractiveness
- unattractive people are perceived unfavourably
- correction may improve self- esteem
- impact on minor malocclusions is more variable and debatable
- QoL improvement
Benefits of orthodontics
Improvement in
1. Appearance (dental and facial)
2. Function
3. Dental health
Benefits in Function
- mastication
- speech
- improvement when associated with severe malocclusion, such as large anterior open bites, severe increased OJ, reverse OJ
- rarely improves speech defects
IOTN Dental Health Component
1&2 - no need/ low need with min benefit
3 - borderline need with some benefit
4 & 5 - need/ high need with significant benefit
MOCDO
M - missing teeth
O - overjet
C - crossbite
D - displacement of contact points
O - overbite
Impacted teeth
- can cause resorption
- associated with cyst formation
- supernumerary teeth can prevent normal eruption
OJ of more than 6mm
- risk of trauma to upper incisors
- worse with incompetent lips
Anterior crossbites
- loss of perio support
- toothwear
Posterior crossbites
- significant displacement may lead to asymmetry and early correction
Displacement (ie: crowding)
- caries has more to do with diet and fluoride
- crowded teeth are more difficult to clean and takes longer
Deep traumatic Overbite
- cause gingival stripping
- loss of perio support
TMD and some malocclusions
- crossbite with displacement (functional shift)
- class 2 with retrusive mandible
- class 3
- AOB
Potential problems of dental anomalies
- Missing/ ectopic teeth - RR, cyst formation
- OJ >6mm - upper incisor trauma
- Crossbite - toothwear, gingival recession, asymmetric growth
- Displacement - limited threat of caries/ perio disease
- Overbite - trauma and gingival damage
Summary in short
- ortho tx are mostly elective
- benefits more apparent at end of tx
- risks throughout course of tx
- benefits must outweigh risks
Risks of ortho
- Decalcification
- RR
- Relapse
- ST trauma
- recession
- loss of periodontal support
- headgear injuries
- enamel fracture & toothwear
- loss of vitality
- allergy
- poor/failed tx
Decalcification
- weakens tooth enamel to caries
Preventing calcification
- case selection
- oral hygiene
- diet advice
- fluoride
Good case selection
- motivated pt
- good OH pre- tx
- low caries risk
Maintaining good OH
- toothbrushing and interdental brushing
- twice a day
- after every meal
- disclosing tablets
- target gingival margins and around each bracket
- GDPs help
Dietary advice
- non- cariogenic diet
- avoid snacking between meals
- avoid fizzy, diluting drinks
- avoid sport drinks
- sugar free gums to stimulate salivary buffers
How to prevent decal with fluoride?
- toothpaste
- MW
- duraphat varinish
- F releasing GIC
For high risk pt?
- Duraphat toothpaste 2800/ 5000 ppm; use twice daily
- MW 0.05% (225ppm); use in between brushing not after
- Duraphat varnish 22600ppm
Toothpaste concentration
F MW 0.05% - 225ppm
Infant TP - 500-1000 ppm
Normal TP - 1450 ppm
Duraphat TP - 2800 ppm
Root Resorption
- inevitable consequences of tooth movement
- average approx 1mm over 2 yrs fixed appliances
- any teeth but UI > LI > 6s
- severe in 1-5%
Risk factors of RR
- prolonged, high force of movement
- intrusion
- large movements
- torque root movement
- blunt, pipette, resorbed already
- previous trauma
Relapse
- lower incisors are more prone to relapse
- crowding
- rotations
- instanding laterals
- spaces and diastemas
- class 2 div 2
- anterior open bites
- reduced perio support/ short roots
Relapse prevention
- removable retainers; clear occlusal retainer; pressure/ vacuum formed/ essix/ hawley type
Fixed retainers
- prone to plaque and calculus build up
- can break and not notice
- need excellent OH
- tend to leave insitu for life
- require more care/ long term maintenance
Soft tissue trauma
- pain. discomfort
- ulceration - ortho wax
Recession
- increasing problem
- avoid overexpansion
- thin biotype
- warn patient
- gingival graft
Safety mechanisms of headgear
- snap away traction spring
- nitom facebow
Allergies?
- latex
- nickel
- adhesive - colophony
