Revision-Potential Risks of Orthodontic Treatment P2

Question 1

ENAMEL DAMAGE

ENAMEL COLOR ALTERATIONS

Answer 1

The color of natural teeth is changed in various ways after fixed appliances orthodontic treatment both short-term and long-term.

Question 2

ENAMEL DAMAGE-ENAMEL COLOR ALTERATIONS

Enamel structure alterations vs Enamel surface modifications
Extrinsic and intrinsic discoloration of

Answer 2

Question 3

TOOTH WEAR

Ceramic brackets

Answer 3

• Placement of ceramic brackets is contraindicated on the mandibular anterior teeth in occlusions with deep overbite and minimal overjet .
• During maxillary incisor retraction , the overbite should be reduced first so that the maxillary incisors do not contact the mandibular ceramic brackets .
• Care should also be taken not to bond ceramic brackets on the mandibular canines when they are in Class II relationship .

Question 4

Tooth wear

What contibutes to fracture/ wear/ damage of enamel?

Answer 4

• Band seaters , band removers , and brackets removal can cause fracture of enamel, or even whole cusps in heavily restored teeth.
• During removal of adhesives , the debonding burs can cause enamel damage , particularly if used in a high-speed handpiece.
• Certain components of orthodontic appliances can cause wear to opposing teeth if there is heavily occlusal contact during function .

Question 5

Enamel changes associated with the of attachments:

Answer 5

Enamel cracks

Question 6

Debonding

Answer 6

• Fractures during debonding
• Loss of uppermost layer (> 10 m) rich in F
• Increase in roughness after resin grinding

Question 7

Debonding attachments

Answer 7

• The force applied must not exceed 13MPa to prevent enamel cracks .
• Care must be exercised when debonding attachments from compromised teeth.
• Several optional methods to remove metal brackets can be used.
• A safe, simple, and efficient method for removing ceramics brackets has yet to be designed.

Question 8

Debonding: Hazards for operators

Answer 8

Question 9

INTRA-ORAL SOFT TISSUE DAMAGE

Answer 9

• Ulceration can occur during treatment as a result of direct trauma from both fixed and removable orthodontic appliances.
• Lesions generally heal within a few days without lasting effect .
• Intra-oral allergic reactions to orthodontic components are rare but have been reported in relation to nickel , latex , and acrylate .
• Management depends on the location and severity of the allergic reaction and the scope for modifying treatment.

Question 10

INTRA-ORAL SOFT TISSUE DAMAGE

Allergic reaction

Answer 10

• Orthodontic wires and brackets contain nickel and nickel allergy is increasing in frequency . Its prevalence has been reported to be approximately 10% , being more common in females . It is usually a Type IV allergic reaction related to wearing jewellery or watches and body piercing.
• Fortunately oral reactions are rare although prolonged exposure to nickel-containing oral appliances may increase sensitivity to nickel . Intraoral signs are non-specific and have been reported to include erythematous areas and severe gingivitis despite good oral hygiene.

Question 11

PULPAL INJURY

Answer 11

• Excessive apical root movement can lead to a reduction in blood supply to the pulp and even pulpal death .
• Teeth which have undergone a previous episode of trauma appear to be particularly susceptible , probably because the pulpal tissues are already compromised .
• Any teeth that have previously suffered trauma or are judged to be at risk of pulpal injury require thorough examination prior to orthodontic treatment , and any therapy should be delivered with light force and monitoring .

Question 12

EXTRA-ORAL DAMAGE

Answer 12

• It is important that when treatment planning to correct malocclusion, the impact on overall facial appearance is considered.
• Recoil injury from the elastic components of headgear poses a rare but potentially severe risk of damage to the eyes .
• Contact dermatitis is reported in approximately 1% of the population and allergic reactions may be seen on facial skin in response to components of appliances, usually nickel .

Question 13

FAILURE TO ACHIEVE TREATMENT OBJECTIVES

Answer 13

Question 14

RELAPSE

Answer 14

• Relapse is defined as the return of features of the original malocclusion following orthodontic correction .
• Retention is a method to retain the teeth in their corrected Position . It is now accepted that without retention there is a significant risk the teeth will move .
• The extend of relapse is highly variable and difficult to predict.

Question 15

IS THE RETENTION PERIOD RISK-FREE?

Answer 15

Question 16

ADVERSE EFFECTS OF IMPACTED CANINES TO OTHER TEETH

Answer 16

• Resorption on maxillary incisors after ectopic eruption of the maxillary canines is a more common phenomenon than previously reported.
• CT scanning substantially increased the detection of root resorptions on incisors adjacent to ectopically erupting maxillary canines. The sensitivity of conventional radiography was low when diagnosing the resorption.

Question 17

ADVERSE EFFECTS OF IMPACTED CANINES TO OTHER TEETH

Answer 17

Root resorption of adjacent teeth was detected in more than 2/3 of a sample of 60 untreated children and adolescents.

Question 18

ADVERSE EFFECTS OF IMPACTED CANINES TO OTHER TEETH

Answer 18

Extraction of primary canines in the mixed dentition may increase the chance of subsequent eruption of palatally displaced permanent canines in the long- term.

Question 19

When is it recommended by The American Association of Orthodontists for all children to have a check-up with an orthodontic specialist?
What age?

Answer 19

The American Association of Orthodontists recommends that all children have a check-up with an orthodontic specialist no later than age 7 .

Question 20

Potential risks of orthodontic treatment:

. These risks need to be explained to patients during the decision-making process and where possible, steps taken to manage the risk

Answer 20