W3 - Iatrogenic Effects of Ortho - Abdalla Flashcards
Benefits of ortho tx
Scientifically minimal
- Reduces incidence of trauma in class 2 div 1 pts
- Improves self esteem (although transiently)
What is the most common risk associated with ortho tx
White spot lesions
Risk factors for developing white spot lesions with ortho (3)
Longer ortho tx times
Poor pre-tx OH
Pre-exisiting WSL
What teeth are most likely to be affected by ortho WSL? incidence rate?
50% of pts are likely to get WSL
Mx laterals most likely
How to prevent ortho WSL (3)
- Professional application of fluoride foam every 6-8 weeks
- High fluoride TP (neutrafluor)
- BEST WAY: dont start tx in pts with poor OH
- fluoride releasing ortho brackets had no effect
Why isnt high fluoride varnish recommended for white spot lesions?
Varnish will remineralise / hypermineralise the outside of the lesion
Subsurface will remain demineralised
Makes it more difficult to remineralise subsurface
Tx of ortho White spot lesions (4)
No active tx for 3 months if not cavitated
Brush with standard Fluoride TP 2x daily
Tooth Mousse
Sugar free gum
Tx for white spot lesions that havent gone away after 3 months (3) with no cavitation
Microabrasion
Bleaching
Veneers
How may root resorption occur through ortho?
Application of ortho force →
Over compression of PDL →
Hyalinization / necrosis →
Inflammatory reaction to remove necrotic tissue →
Resorption of cementum occurs simultaneously as removal of hyalinized tissue →
Resorption crater forms →
As resorption crater expands, decreases pressure exerted through force application →
Decompression causes process to reverse and cementum begins to repair →
Resorption continues until all hyalinised tissue disappears and / or force level diminishes
pt had ortho
Root resorption - severe
- Severe cases only occur in 5% of ortho cases
- Nearly ALL ortho pts will experience minor RR (up to 5% of tooth apex)
What percentage of ortho patients experience severe root resorption
<5%
Ortho root resorption risk factors (2)
- Certain directions of mvmt (intrusion)
- Treatment time
- Possible nail biting
How to manage root resorption in ortho (4)
Cease treatment for 4-6 months
Review tx objectives to prevent further damage / compromise goals
Terminate tx if possible (resto to close space instead of wires)
Reassess with radiographic examination until tx completed
What is a common side effect of removable appliances?
Gingival inflammation
What is a common side effect of removable appliances?
Gingival inflammation
What is likely to occur due to these trays?
Gingival recession
- notice blanching of soft tissues
