Risks & benefits of ortho tx.

Question 1

What are the benefits of ortho treatment?

Answer 1

Appearance - dental, facial
Function
Dental health

Question 2

What are the psychological benefits of ortho tx.?

Answer 2

QoL improvement
Severe malocclusions affect facial attractiveness
May stop bullying
Positive effect on self-esteem

Question 3

What is the MOCDO acronym and what is it used for?

Answer 3

Missing teeth
Overjet
Crossbites
Displacement of contact points
Overbites

Used to assess dhc component of IOTN

Question 4

What are the effects of impacted teeth?

Answer 4

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

Question 5

What are the effect of anterior crossbites on dental health?

Answer 5

Loss of perio support
Tooth wear

Question 6

What is the risk of doing no treatment when a patient has a deep traumatic OB?

Answer 6

Can cause gingival stripping
Loss of perio support

Question 7

Does ortho treatment fix TMD?

Answer 7

Weak evidence to suggest ortho improves TMD as it is multi-factorial

Ortho tx. should NEVER be offered to improve TMD in isolation

Conservative tx. must be offered first before any ortho

Question 8

What are the 4 main risks of ortho treatment?

Answer 8

Decalcification
Root resorption
Relapse
Gingival recession

Question 9

How do you prevent decalcification?

Answer 9

Case selection
OH
Diet advice
Fluoride

Question 10

What is the average amount of root resorption from ortho treatment?

Answer 10

Inevitable consequence of tooth movement
Average approx. 1mm over 2 years fixed appliances

Question 11

What is toothpaste recommendation for high-risk patients?

Answer 11

Duraphat
10-16years - 2800ppm
16+ - 5000ppm

Question 12

What mouthwash should you recommend for ortho patients?

Answer 12

225ppm / 0.05% F mouthwash

Question 13

What are the risk factors (other than type of tooth movement) for root resorption?

Answer 13

Root form - blunt or previous root resorption evident
Previous trauma
Chronological age - older/ adult patients
Parafunctional habits
Calcium deficiency
Perio disease

Question 14

What features are more prone to relapse?

Answer 14

Lower incisor crowding
Rotations
In-standing 2’s
Spaces and diastemas
Class II div II
AOB

Question 15

Why is perio disease a contra-indication for ortho treatment?

Answer 15

During ortho tx. accelerates alveolar bone loss and perio destruction
Must be stabilised pre-tx.

Question 16

What clinician faults are likely to give poor/ failed treatment?

Answer 16

Poor diagnosis
Poor treatment planning
Operator technique

Question 17

What patient factors are likely to give poor/ failed tx.?

Answer 17

Unfavourable growth
Poor co-operation/ motivation - with appliance wear, poor attendance, poor OH

Question 18

What does treatment success increase with?

Answer 18

Severity of malocclusion
Motivation of patient
Operator expertise

Question 19

What type of tooth movement are risk factors for root resorption?

Answer 19

Prolonged, high force
Intrusion

Question 20

What % of patients will get severe root resorption from ortho treatment?

Answer 20

1-5% will get severe root resorption of more than a third loss of root length - 4-5mm or more

Question 21

What teeth are most commonly affected by root resorption?

Answer 21

Upper central and lateral incisors

Question 22

What is most suitable treatment for white spot decalcification?

Answer 22

ICON resin infiltrate
Low viscosity resin
Fills porosity to same refractive index as enamel

Question 23

Other than fixed bonded retainers or clear-pressure formed retainers, what is another type of retainer that can be used?

Answer 23

Hawley retainer

Question 24

Give a benefit of a Hawley retainer over a pressure-formed retainer?

Answer 24

Better at allowing posterior teeth to settle into occlusion after fixed appliances - think because not propped open