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Orthodontics > Limitations and Risks in Orthodontics > Flashcards

Limitations and Risks in Orthodontics Flashcards

1
Q

What are the limitations in Orthodontics

A

Anatomic
Physiologic
Therapeutic

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2
Q

What are some anatomic limitations of orthodontics

A
  • Skeletal discrepancies - AP, Transverse, Vertical (size)
  • Alveolar ridge
  • Space
  • Soft tissue
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3
Q

What are the treatment options for skeletal discrepancies

A

Growth modifications (growing patients)
Orthognathic surgery (adults)

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4
Q

What is the advantages of miniscrews

A

It broadens the maximum envelope of tooth movement

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5
Q

Which can be expanded transversely more? Lower or upper jaw

A

Upper (mid-palatal suture)

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6
Q

At which arch location is most prone to transverse expansion relapse and why

A

Intercanine expansion
At the commissure of lips where there is greatest lingual force

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7
Q

How is alveolar ridge an anatomical limitation?

A

Early extraction creates an alveolar bone defect which causes risk of fenestration/dehiscence/gingival recession

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8
Q

How much can you procline incisors and what happens if you exceed this limit?

A

2mm
>2mm causes instability

But also dependent on initial position

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9
Q

What happens if you advance incisors (AP) or expand premolars and molars (transversely) too much? How much is too much transverse movement for molars

A

Risk fenestration/dehiscence/stripping of gingiva

> 3mm

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10
Q

What are some compromises due to anatomical limitations in orthodontics

A

Health
Aesthetics
Function
Stability

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11
Q

What are examples of compromises in Class II DAC patients

A

Poor upper lip support
Lower lip protrusion
Lingual relapse of lower incisors (due to forces from lips)
Periodontal risks of lower incisors

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12
Q

What are examples of compromises in Class III DAC patients

A

Poorly defined labiomental sulcus
Prominent chin
Periodontal risks (lower incisors)

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13
Q

What are examples of compromises in patients after maxillary widening

A

Dehiscense/fenestration/gingival recession on surfaces of posterior teeth - Due to violation of transverse dimensions on dentoalveolar base
Decreased buccal corridors

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14
Q

What are examples of compromises in patients after incisor proclination

A

Fuller lips
Instability (risks relapse)
Fenestration, Dehiscence, Gingival recession

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15
Q

What are some Physiologic Limitations of orthodontics

A
  • Systemic problems
  • Medications
  • Growth (growth modification, surgery)
    Age-dependent
    Genetically-programmed (diff pts respond differently)
    Unpredictably/Latency (Esp class III)
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16
Q

What are systemic problems related to orthodontics

A

Diabetes: rapid progression of alveolar bone loss
Juvenile rheumatoid arthritis: progressive severe skeletal mandibular deficiency
Acromegaly (>GH): mandibular prognathism in adult life

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17
Q

What are medications related to orthodontics

A

Bisphosphonates (Osteoporosis): Inhibits osteoclast-mediated bone resorption –> teeth may not move as expected, wary of extraction as sockets may not be able to close

Prostaglandin inhibitors eg. corticosteroids, NSAIDs –> Beware of chronic use, high doses, potent members

Agents with agonistic or antagonistic effects on various prostaglandins

18
Q

What are some therapeutic limitations of orthodontics
6+8

A

Anchorage
- Teeth vs Bone vs Soft tissue
- Periodontally compromised teeth

Type of appliance
- Removable vs fixed
- Partial vs full fixed appliances

Habits
- Digit sucking
- Forward tongue resting posture

Unrealistic expectations
Motivation/Compliance
Relapse
Smile Aesthetics
TMD
Impaction/Transposition (severity)
Ankylosis
Primary failure of eruption

19
Q

What are some compliance limitations

A
  • Multiple/Recurrent failed appointments
  • Poor compliance with wear of removable appliances/elastics or retainers
  • Repeated appliance breakage
  • Diet
  • Poor oral hygiene
20
Q

What determines if there will be relapse

A
  • Time needed for reorganization of periodontal and gingival tissues
  • Initial tooth positive vs final unstable tooth position
  • Continuation of growth pattern
  • Habits
  • Poor retention planning/compliance
  • Specific surgical movements (overdone)
21
Q

Other than orthodontics, what other components influences smile aesthetics? How can these be improved?

A
  1. Harmonious gingival margins
    - intrude and restore
    - gingivectomy and crown lengthening
  2. Tooth proportions
    - Reshaping (enameloplasty)
    - Restorative options (veneers, CR)
  3. Incisor and gingival display
    - Reduces with age
22
Q

Is malocclusion the cause of TMD

A

No, it is multifactorial

23
Q

Does malocclusion affect TMD

A

High prevalence of malocclusion > prevalence of TMD by 10%

24
Q

Does ortho cure TMD

A

NO

There may be a temporary cessation of parafunctional habits (eg. grinding) during ortho treatment due to soreness

25
Q

What are some clinician factors that leads to failure in achieving treatment objectives?

A
  • Errors in diagnosis
  • Errors in treatment planning
  • Errors in technique
26
Q

What are some patient factors that leads to failure in achieving treatment objectives?

A
  • Complexity of case (true therapeutic limitations)
  • Anatomic or biologic factors
  • Choice of treatment plan
  • Unrealistic expectations
  • Compliance-related factors
27
Q

What are the risks in orthodontics

A
  1. Periodontal Issues
  2. Decalcification/Caries
  3. Devitalization
  4. Root resorption
  5. TMD
  6. Soft tissue inflammation
  7. Injury by orthodontic appliances
  8. Relapse
28
Q

What are some periodontal issues that may arise due to ortho

A
  1. Gingivitis
  2. Periodontitis (at risk patients)
  3. Apical migration of periodontal attachment (Gingival recession)
29
Q

What causes gingival recession in ortho

A
  • Movement of teeth beyond alveolar process
  • Thickness of soft tissue and alveolus
  • Frenum position
  • Periodontal disease
  • Poor oral hygiene
  • Trauma
30
Q

How does the patient prevent gingival recession due to ortho

A
  • Maintain good oral hygiene
  • Regular recalls
  • Have good oh prior to start of ortho
31
Q

How does the clinician prevent gingival recession due to ortho

A
  • Be mindful of anatomic limitations of tooth movement
  • KIV pre-orthodontic soft tissue graft in patients at high risk of gingival recession
32
Q

Is caries/decalcification risk very high in ortho

A

Wide range of prevalence

33
Q

How to prevent Caries from ortho

A
  • Good OH before and during orthodontic treatment
  • Fluoride measures
  • Dietary advice
  • Terminate treatment if there is persistent poor OH
34
Q

How can teeth be devitalised during ortho

A
  • Over-enthusiastic apical movement
  • History of trauma: increased susceptibility
  • Deep caries
  • Idiopathic
35
Q

Management of devitalised teeth

A
  • Counsel patient of risks prior to treatment
  • Stabilize endo conditions of all teeth prior to ortho
36
Q

Is root resorption always present in ortho

A

Yes it is inevitable but clinically insignificant (~1mm)

37
Q

Do all patients have the same amount of root resorption from ortho and what type of pts are more susceptible
6+4

A

No
Some patients have increased susceptibility and severity of root resorption due to:
- genetics
- high forces of magnitude
- longer treatment duration
- total apical displacement
- type of tooth movement: intrusion
- Pre-existing RR

  • Forced movement of roots against cortical plates
  • Root morphology
  • Dilacerations
  • History of trauma
38
Q

What tooth has a higher risk of root resorption

A

Maxillary incisors (3% vs <1%)

39
Q

What to do if idiopathic root resorption has been observed

A

Pause the treatment for 3 months

Terminate treatment if it recurrs

40
Q

What kind of soft tissue inflammation can arise due to rotho

A

Stomatitis
Traumatic ulceration
Allergies (Latex, Nickel)

Orthodontics (18 decks)

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