Potential Risks of Orthodontic Treatment P1

Question 1

ROOT RESORPTION

Answer 1

• External apical root resorption caused by orthodontic tooth movement occurs regularly, but severe root shortening is, fortunately, rare.
• The etiology of root resorption is multifactorial, but apical displacement, treatment duration, and genetics play significant roles.

Question 2

ROOT RESORPTION

TREATMENT ASSESSMENT

Answer 2

Question 3

Orthodontists often think of root resorption as a single entity, but it is not. According to Proffit (2000) three situations are observed in practice

Answer 3

1. MODERATE GENERALIZED RESORPTION
2. SEVERE GENERALIZED RESORPTION
3. SEVERE LOCALIZED RESORPTION

Question 4

MODERATE GENERALIZED RESORPTION

Answer 4

1. it is probably an inevitable consequence of treatment
2. typically amounts to 1-2 mm during treatment
3. affects almost all teeth
4. no clinical consequence

Question 5

SEVERE GENERALIZED RESORPTION

Answer 5

1. we do not know why it occurs
2. it happens in the absence of orthodontic therapy as often as in treated patients
3. perhaps it is related to some type of auto-immune response
4. it is rare
5. if it happens to our patients, almost surely it is not the fault of the orthodontist

Question 6

SEVERE LOCALIZED RESORPTION

Answer 6

1. loss of more than ¼ of the root length of some teeth, usually maxillary incisors
2. is observed in 2-3% of orthodontic patients
3. it is related to the orthodontic treatment
4. one identifiable cause is movement of the root apices against the lingual cortical plate

Question 7

Once treatment with fixed appliance has begun, , when should an initial radiographic follow-up be taken?

Answer 7

Once treatment with fixed appliance has begun, , an initial radiographic follow-up is recommended at 6-9 months.

Question 8

Post-treatment

Answer 8

• A radiographic examination is mandatory, and the patient and referring dentist should be informed if a root resorption has occurred.
• If it is mild or moderate, no further action is indicated.
• If it is severe, there is risk of tooth mobility. In such a case, further follow-up and instructions to the patient are necessary.

Question 9

What is the Long-term prognosis , of a tooth with a short root?

Answer 9

Long-term, a tooth with a short root has a very favorable prognosis and need not be extracted and replaced by an implant or other restoration.

Question 10

factors that increase the risk of more severe root resorption

Answer 10

Question 11

LOSS OF PERIODONTAL SUPPORT

Answer 11

As long as a tooth can be moved within the envelope of the alveolar process, risk of the development of harmful side effects in the marginal tissue is minimal regardless of the dimensions and quality of the soft tissue.

• The thickness of the cortical laminae varies in different locations. In the incisor and canine region, the cortical bone plate at the labial aspect of the teeth is considerably thinner than at the lingual aspect.

Question 12

LOSS OF PERIODONTAL SUPPORT

The greatest challenge for orthodontists as far as periodontology is concerned is in

Answer 12

making the correct periodontal prior to initiating diagnosis orthodontic treatment.

Question 13

Answer 13

Question 14

Answer 14

Although the amount of recession does not differ, some increase in the risk for gingival recession development in the anterior teeth may be encountered in orthodontically-treated individuals compared to untreated subjects with normal occlusion.

• Good practice would suggest that it is important to identify patients at potential risk and consider the possible implications for orthodontic therapy.

Question 15

DEMINERALIZATION

What is Decalcification of the enamel surface?

Answer 15

Decalcification of the enamel surface is by far the most important iatrogenic effect of fixed appliance orthodontic therapy.

Question 16

DEMINERALIZATION

How are these lesions prevented?

Answer 16

To prevent the development of lesions and assure proper treatment, the clinician must be familiar with the major aspects of caries process and
current principles of Preventive Dentistry

• Unesthetic discoloration or resin remnants and discolored caries lesions formed during orthodontic therapy.

Question 17

DEMINERALIZATION

pH-
maxillary vs mandibular incisors-> how are they differently affected? Why are these teeth more affected?

Answer 17

• Of clinical importance is the observation that pH in the plaque on bonded maxillary incisors is generally lower than in other parts of the bonded dentition, presumably as a result of the low clearance of saliva in the area.
• Accordingly, any reservoirs of fluoride are rapidly lost.
• This loss of fluoride and the limited cariostatic effect of fluoride in the low pH in plaque perhaps explains in part why white spots lesions frequently develop on bonded maxillary incisors.

Question 18

Demineralization

How does plaque contribute to decalcification?

Answer 18

Question 19

Answer 19

Demineralized or hypomineralized enamel prior to orthodontic
ttherapy

Question 20

Answer 20

Orthodontic treatment and caries development

Question 21

demineralization

Preventive measures during treatment

Answer 21

1. Good oral hygiene
2. Fluoride dentifrice (twice daily) and rinse (once daily)
3. Avoidance of carbonated soft drinks (may induce enamel erosion)
4. Oral hygiene monitoring (i.e., gingival bleeding)
5. Complex appliances that complicate plaque removal should be avoided on the maxillary anterior teeth
6. Topical fluoride solutions, gels or varnishes

Question 22

demineralization

Answer 22

The short-term fluoride release and absence of documented enamel uptake, suggest that the glass-ionomer orthodontic adhesive tested may only provide a protective action through the reservoir mechanism.

Question 23

Answer 23

The initial burst of F release observed for the Fuit adhesive after the 1st day showed significant decrease with time, which persisted during the 60 days (p<0.05).