Revision-Adjunctive Adult Orthodontic Treatment Flashcards
Adjunctive orthodontic treatment
Definition
Adjunctive orthodontic treatment is tooth movement carried out to facilitate other dental procedures necessary to control disease and to restore function .
Orthodontic Treatment as an Adjunct to
Restorative Work
Orthodontic treatment in these cases does not necessarily require comprehensive correction aiming for an ideal occlusion.
Aims of adjunctive orthodontic treatment:
- Facilitate restorative work by appropriate positioning of teeth
- Improve periodontal health by reducing areas that harbour plaque, and making simpler to maintain good oral hygiene
- Position teeth so that occlusal forces are transmitted along their long axis, and tooth wear is more evenly distributed in the arch
From DX to Tx Plan
Timing and sequence of treatment
What is the greatest challenge for orthodontists?
- 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.
Principles of treatment planning
The therapeutic picture for every patient should emerge after considering the following factors:
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).
- Uprighting of abutment teeth
- Following tooth loss adjacent teeth may drift into the space.
- Uprighting these abutment teeth can facilitate the placement of replacement prosthetic teeth.
Extraction of 3rd molars is recommended when distal positioning would move it into a position where:
- 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.
What happens if a tooth is distally tipped
- Tipping a tooth distally generally extrudes it.
- Maintaining the existing occlusal level as the tooth uprights requires intrusion.
When should a prosthesis be placed?
- Long delays in making the final prosthesis should be avoided.
- A prosthesis can and should be placed soon after uprighting is completed .
2.Redistribution or closure of spaces
- 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.
3.Intrusion of over-erupted teeth
- 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.
4.Extrusion of fractured teeth
- 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 .
5.Alignment of anterior teeth
- 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.