Limitations and Risks in Orthodontics

Question 1

Anatomic Limitations

Answer 1

1. Skeletal discrepancies
2. Alveolar ridge
3. Space
4. Soft tissue

Question 2

Limitations of Skeletal Discrepancies

Answer 2

1. AP, vertical, transverse

Size of discrepancy

Growth modification: only possible in growing patients and limited improvement

Orthognathic surgery needed in severe cases

Question 3

Limitations of Alveolar Ridge Defect

Answer 3

1. Early extraction creates an alveolar bone defect
2. Risk of fenestration/dehiscence

Question 4

Space Constraints Limitations

Answer 4

1. Tooth size-arch length discrepancy
2. Patients with reduced arch length:
   - Proclination/protrusion of incisors
   - Expansion
   - Distal movement of molars
   - Enamel stripping
   - Extractions

Question 5

Soft Tissue Limitations

Answer 5

1. Proclination of incisors >2mm risks instability
2. Risk fenestration /dehiscence and stripping of gingiva
   - Advancement of incisors B-L
   - Dental expansion of premolars and molars >3mm

Question 6

Compromises with Class II Camouflage (Retract upper incisors and procline lower incisors)

Answer 6

1. Poor upper lip support
2. Increased lower lip protrusion
3. Lingual relapse of lower incisors
4. Periodontal risks (lower incisors)

Question 7

Compromises with Class III camouflage (Procline upper incisors, retract lower incisors)

Answer 7

1. Poorly defined labiomental sulcus
2. More prominent chin
3. Periodontal risks (lower incisors)

Question 8

Compromises with widening of maxillary arch

Answer 8

1. Decrease buccal corridors
2. May violate transverse dimensions of dentoalveolar base

Question 9

Compromises with Incisor Proclination

Answer 9

1. Fuller lips
2. Risk instability: Relapse of crowding
3. Risk fenestration, dehiscence, gingival recession

Question 10

Physiologic Limitations of Orthodontics

Answer 10

1. Systemic problems
2. Medications
3. Growth is age-dependent, genetically programmed, and unpredictability

Question 11

Systemic Problems

Answer 11

1. Juvenile rheumatoid arthritis: Progressive severe skeletal mandibular deficiency
2. Acromegaly (>GH): Mandibular prognathism in adult life

Question 12

Medications

Answer 12

1. Bisphosphonates: Inhibit osteoclast-mediated bone resorption
2. Prostaglandin inhibitors (NSAIDs, corticosteroids)

Other agents with mixed agonistic and antagonistic effects on various prostaglandins

Question 13

Limitations of Growth Modification

Answer 13

1. Age
2. Side effects
3. Magnitude of correction

Question 14

Therapeutic Limitations in Orthodontics

Answer 14

1. Unrealistic expectations
2. Motivation/compliance
3. Relapse
4. Smile esthetics
5. TMD
6. Impaction
7. Ankylosis
8. Primary failure of eruption

Question 15

Limitations of Motivation

Answer 15

1. Failed appointments
2. Poor compliance with wear of removable appliance
3. Repeated appliance breakage
4. Diet
5. Poor OH

Question 16

Limitations of Relapse

Answer 16

1. Time needed for re-organization of periodontal and gingival tissues
2. Initial tooth position
3. Final tooth position
4. Continuation of original growth pattern
5. Habits
6. Poor retention planning/compliance
7. Specific surgical movements

Question 17

Smile esthetics

Answer 17

Components cannot be influenced by orthodontics alone

1. Harmonious gingival margins
2. Tooth proportions
3. Incisor and gingival display

Question 18

Risks in Orthodontics

Answer 18

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

Question 19

Periodontal Risks of Orthodontics

Answer 19

1. Gingivitis with or without gingival hyperplasia
2. Periodontitis

Question 20

Preventive Measures for Periodontal Issues

Answer 20

1. Good OH
2. Regular recalls
3. Good periodontal health before orthodontic treatment
4. Mindful of anatomic limitations of tooth movement
5. KIV pre-orthodontic soft tissue graft in patients at high risk of gingival recession

Question 21

Prevention of Decalcification and caries

Answer 21

1. Caries controlled with good OH before and during orthodontic treatment
2. Fluoride measures
3. Dietary advice
4. Terminate treatment

Question 22

Management of White-spot lesions

Answer 22

Topical fluoride varnish

Question 23

Risk of Devitalisation in Orthodontics

Answer 23

1. Over-enthusiastic apical movement
2. History of trauma
3. Deep caries
4. Idiopathic

Question 24

Management of Devitalisation

Answer 24

1. Counsel patient of risks
2. Stabilization of endo condition before orthodontic treatment

Question 25

Risks of Root Resorption

Answer 25

Inevitable, usually not clinically significant Some patients increased susceptibility and severity Before ortho treatment, take DPT 6 months into treatment to check root status. Pause or terminate treatment if RR is severe. Start with no extractions

Question 26

Other causes of root resorption

Answer 26

1. Forced movements of roots against cortical plates 2. Root morphology 3. Dilacerations 4. History of trauma

Question 27

Precautions for Root Resorption

Answer 27

1. Avoid risk factors 2. Regularly monitor with radiographs

Question 28

Management of Root Resorption

Answer 28

1. Pause treatment 2. Terminate treatment

Question 29

Risk of Soft Tissue Inflammation in Orthodontics

Answer 29

1. Stomatitis - Removable appliances - Nance appliance 2. Traumatic ulceration 3. Allergies: Latex, nickel

Question 30

Risk of Injury by Orthodontic Appliances

Answer 30

1. Aspiration of broken or loose appliances 2. Fracture of enamel or large restorations 3. Head-gear associated risks 4. Mobility as tooth is moved into traumatic occlusion 5. Relapse