Adjunctive Adult Orthodontic Treatment

Question 1

The World Health Organization has a goal that

Answer 1

Europeans over 80 years old should have at least 20 of their own teeth. This is not true in many countries.

Question 2

Dental health programs

Answer 2

• In 1968, roughly 20% of all 50-year-old Swedish women were toothless.
• Over the ensuing years dental health improved thanks to fluoride use and progressive dental health programs.
• In 2004 just 0.3% of 50-year-old Swedish women were toothless.
• Fewer and fewer children have seen a glass of water with dentures at their grandmother’s bedside.
• But it was not so very long ago that this was a common sight.

Question 3

need for interdisciplinary treatment

Answer 3

• With an increasing number of patients keeping their teeth for longer, there is a greater need for interdisciplinary treatment of patients with complex dental problems.
• Where collaboration is needed between the orthodontist and the restorative dentist, it is helpful to see the patients jointly to formulate a coordinated and appropriate treatment plan.

Question 4

Adjunctive orthodontic treatment

Definition

Answer 4

Adjunctive orthodontic treatment is tooth movement carried out to facilitate other dental procedures necessary to control disease and to restore function.

Question 5

Orthodontic Treatment as an Adjunct to
Restorative Work

Answer 5

Orthodontic treatment in these cases does not necessarily require comprehensive correction aiming for an ideal occlusion.

Question 6

Aims of adjunctive orthodontic treatment:

Answer 6

1. Facilitate restorative work by appropriate positioning of teeth
2. Improve periodontal health by reducing areas that harbour plaque, and making simpler to maintain good oral hygiene
3. Position teeth so that occlusal forces are transmitted along their long axis, and tooth wear is more evenly distributed in the arch

Question 7

From DX to Tx Plan

Answer 7

Question 8

Timing and sequence of treatment

Answer 8

Question 9

What is the greatest challenge for orthodontists?

Answer 9

• Proper oral hygiene regimen in patients with fixed appliances prevents plaque accumulation, bleeding tendency, and loss of attachment.
• The greatest challenge for orthodontists as far as Periodontology is concerned is in making the correct periodontal diagnosis prior to initiating orthodontic treatment.
• Gentle probing elicits significant bleeding, a risk predictor for bone loss in an orthodontic patient.

Question 10

Principles of treatment planning

The therapeutic picture for every patient should emerge after considering the following factors:

Answer 10

A. The possible combinations of therapeutic solutions to the multiple problems of the patient.
B. The possibility for implementing a compromised type of treatment plan in reference to the presence of multiple dental problems in individual patients.
C. The cost-benefit relationship, not only financially, but considering more factors (cooperation, inconvenience, discomfort, pain, difficulty, duration).

Question 11

1. Uprighting of abutment teeth

Answer 11

• Following tooth loss adjacent teeth may drift into the space.
• Uprighting these abutment teeth can facilitate the placement of replacement prosthetic teeth.

Question 12

Extraction of 3rd molars is recommended when distal positioning would move it into a position where:

Answer 12

• good hygiene could not be maintained, or
• the uprighted molar would not be in functional occlusion.

In some cases both 2nd and 3rd molars have to be uprighted.

Question 13

What happens if a tooth is distally tipped

Answer 13

• Tipping a tooth distally generally extrudes it.
• Maintaining the existing occlusal level as the tooth uprights requires intrusion.

Question 14

When should a prosthesis be placed?

Answer 14

• Long delays in making the final prosthesis should be avoided.
• A prosthesis can and should be placed soon after uprighting is completed.

Question 15

2.Redistribution or closure of spaces

Answer 15

• Following tooth loss it may be possible to close the remaining space, or move a proposed abutment tooth into the middle of an edentulous span, to aid construction of a more robust prosthesis.
• If implants are required then the roots may need to be repositioned to permit surgical placement.

Question 16

3.Intrusion of over-erupted teeth

Answer 16

• One of the side effects of tooth loss is over- eruption of the opposing teeth.
• This can interfere with restoration of the space, so the over-erupted tooth can be intruded using Orthodontics.

Question 17

4.Extrusion of fractured teeth

Answer 17

• Sometimes it is necessary to extrude a fractured tooth, to bring the fracture line supragingivally to allow placement of a crown or restoration.
• There is a limit to this, as excess extrusion will reduce the amount of tooth supported by bone, reducing the crown-to-root ratio.

Question 18

5.Alignment of anterior teeth

Answer 18

• Aligning healthy teeth with restorations is not a acceptable procedure.
• Conservative treatment options (orthodontics, bleaching, enamelplasty) should be offered to the patients.
• A clinician should present only treatment options that involve predictable, conservative restorations or that preserve healthy tooth structure.

The myth of instant orthodontics: an ethical quandary.

Question 19

6.Adjunctive orthodontic applications in dental implantology

Answer 19

Orthodontics has been proposed for augmenting the resorbed alveolar bone and reforming esthetically appealing gingival margin, prior to implant placement.

(1) Orthodontic extrusion of compromised teeth to generate vertical bone volume and enhance gingival architecture.
(2) Tooth preservation and postponing orthodontic space opening to maintain bone volume in future implant site.
(3) Orthodontic implant site switching to eliminate the deficient bone volume or risky implant sites, and
(4) Provision of a rigid fixed-bonded retainer to maintain the implant site.

Question 20

Answer 20

Orthodontic forced eruption resulted in favorable bone response in the height of the palatal and interproximal bone plates but not in the labial area.