Side Effects of Orthodontic Treatment › wp-content › uploads › 2020 › 05 › ... · Arch...
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Side Effects of Orthodontic Treatment
Dr. Jamilian
https://jamilian.net
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INTRA ORAL RISKS • Enamel demineralization • Enamel trauma • Enamel wear • Pulpal reaction • Root resorption • Periodontal problem • Allergy trauma
EXTRA ORAL RISKS • Allergy • Trauma • Burns • Tempromandibular disorder (TMD) SYSTEMIC RISKS • Cross infection • Infective endocarditis
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The complications associated with orthodontic treatment
are a result of multifactorial process with :
1.The patient
2.The orthodontist
3.The orthodontic appliances
4.The orthodontic procedure
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INTRA ORAL RISKS
The most important aspect of orthodontic care is to have an
extremely high standard of oral hygiene before and during
orthodontic treatment.
Arch wires, headgears and brackets may cause significant
damage either during an active phase of treatment or during
debanding and debonding.
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ENAMEL DEMINERALIZATION/CARIES/WHITE SPOT LESIONS
• Enamel demineralization, usually on smooth surfaces, is
unfortunately a common complication in orthodontics.
• It is a common negative sequel of orthodontic treatment in
the absence of proper oral hygiene.
• It is the loss of calcified tooth substance due to attack by
acidic-by-product of plague metabolism.
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Etiology
• Increase in food stagnation and increase in the retentive
sites of bacteria
• Changes in the microflora (low PH environment)
• Poor oral hygiene, Diet, long treatment time and
interproximal caries are the predictors for white spite
lesions
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Incidence
However, any tooth in the mouth can be affected,
often a number of anterior teeth show decalcification.
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In severe cases, frank cavitation is seen which
requires restorative intervention.
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PREVENTIVE MEASURES
Good oral hygiene is essential for successful orthodontic
treatment; dietary control of sugar intake is also needed in
order to minimize the risk of decalcification.
Daily fluoride rinses or fluoride gel or varnish may prevent and
reduce decalcifications. Use of fluoride throughout treatment can
prevent white spot formation surprisingly.
Other fluoride release mechanisms include fluoride
releasing bonding agents, elastic ligatures containing
fluoride, cement containing fluoride.
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Care is needed during debanding and debonding
There is the potential for enamel damage especially with
ceramic brackets
No use of chlorohexidine mouthwashes during orthodontic
treatment due to discoloration of teeth
Select small brackets
Complete coverage of enamel with cement while banding
Minimal use of looped arch wires
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TREATMENT PROCEDURE
Where demineralization is present post treatment, fluoride
application either via toothpaste, or by adjunct fluoride
mouthwash (0.05% sodium fluoride daily rinse or 0.2%
sodium fluoride weekly rinse), can be helpful in
demineralizing the lesion and reducing the unsightliness of
the decalcification. The amount of white spot is reduced 25%
by fluoride rinse
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ENAMEL TRAUMA
• When placing appliances careless
use of a band seater can result in
enamel fracture.
• Care is required when large restorations are present since
these can result in fracture of unsupported cusps.
• Debonding can also result in enamel
fracture, both with metal and
ceramic brackets.
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ENAMEL WEAR
• Wear of enamel against both metal and ceramic
brackets (abrasion) may occur.
• It is common on upper canine tips during retraction
as the cusp tip hits the lower canine brackets.
• Ceramic brackets are very abrasive and therefore
contraindicated for the lower anterior teeth where
there is any possibility of the brackets occluding with
the upper teeth.
• Carbonated drinks and pure juices are the
commonest causes of erosion and should be avoided
in patients with fixed appliances.
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Pulpal Reaction
• Some degree of pulpitis is expected with
orthodontic tooth movement which is usually
reversible or transient.
• Rarely it leads to loss of vitality, but there may be
an increase in pulpitis in previously traumatized
teeth with fixed appliances.
• Light forces are advocated with traumatized teeth
as well as baseline monitoring of vitality which
should be repeated three monthly.
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ROOT RESORPTION
• Some degree of external root
resorption is inevitably associated
with fixed appliance treatment,
although the extent is
unpredictable.
• Resorption may occur on the apical
and lateral surface of the roots
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RISK FACTORS OF ROOT RESORPTION
• The mechanism of tooth resorption is unclear.
• Root resorption is multifactorial, the risk factors which are associated with cases with root resorption are:
• Blunt shaped and short roots show a greater amount of resorption than other root forms.
• History of traumatized teeth, have an increased risk of further resorption.
• Non vital teeth and root treated teeth have an increased risk of resorption.
• Heavy forces are associated with resorption
• Use of rectangular wires
• The distance a tooth is moved
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• Type of orthodontic tooth movement by moving root
apices against cortical bone (torque) (Tooth intrusion)
• Combined orthodontic and orthognathic procedure
• Chronological age
• Inter elastic traction
• familial risk
• Systematic diseases such as hyperthyroidism, paget’s
disease
• Longer treatment duration
• Fixed appliance treatment
• On average 1–2 mm of apical root is lost during a course
of orthodontic treatment
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Treatment of impacted canines may induce resorption of the adjacent teeth because of the length of treatment time and the distance the canine is moved.
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Management of root resorption
Obtain initial records including x-ray
Use caution in moving abnormally shaped tooth
Orthodontic forces should be intermittent, light and well distributed
Follow up x-rays
Debonding
Endodontic treatment and splinting
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Pre-orthodontic treatment full-mouth radiographs
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Post-orthodontic treatment full-mouth radiographs demonstrating root
resorption
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PERIODONTAL PROBLEM
• Fixed appliances make oral hygiene difficult even for
the most motivated patients, and almost all patients
experience some gingival inflammation.
• Resolution of inflammation usually occurs a few weeks
after debond,
• Bands cause more gingival inflammation than bonds,
which is not surprising since the margins of bands are
often seated subgingivally.
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TREATMENT OF PERIODONTAL
Oral hygiene instruction is essential in all cases of
orthodontic treatment
Use of adjuncts such as electric toothbrushes,
interproximal brushes
Use of chlorhexidine free mouthwashes, fluoride
mouthwashes
Regular professional cleaning must be emphasized
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Crestal bone loss occurring with orthodontic
treatment associated with poor oral hygiene
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Allergy
• Allergy to orthodontic components intra-orally is
exceedingly rare, however, there have been studies on the
nickel release and corrosion of metals with fixed
appliances.
• There is a significant release of nickel and iron into the
saliva of patients just after placement of fixed appliances.
• There are a few cases with severe latex allergies who may
be affected by elastomeric or operators gloves.
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TRAUMA
Laceration to gingiva and mucosa
Hyperplasia between treatment sessions from the arch wire and
bonds, especially where long unsupported stretches of wire rest
against the lips.
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Trauma to the cheek from
an unusually long distal
length of arch wire resulting
in an ulcer.
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The use of dental wax over the bracket may help to reduce
trauma and discomfort, as may rubber bumper sleeving
on the unsupported archwire.
Dental wax over the bracket may help to reduce trauma and
discomfort.
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Bumper sleeve has been placed along the wire to prevent further trauma
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E X T R A - O R A L R I S K S
ALLERGY
• Allergy to nickel is more common in extra-oral settings,
most usually the headgear face bow or head strap.
• The use of sticking plaster over the area in contact with
the skin is sufficient to relieve symptoms.
• Allergy to latex and bonding materials has been reported
although these are rare.
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TRAUMA
• Following a well publicised case of eye trauma in a patient wearing
headgear a number of safety headgear products have been
designed and explicit guidelines are now available.
• These measures include safety bows, rigid neck straps and snap
release products to prevent the bow from disengaging from the
molar tubes or acting as a projectile.
• Every headgear and bow must incorporate a safety feature. Failure
to observe safety guidelines on the use of headgear is medico-legally
indefensible.
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Safety release mechanisms on head gear
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BURNS
• Burns, either thermal or chemical are possible both intra-
and extra-orally with inadvertent use of chemicals or
instruments.
• Acid etch, electro thermal debonding instruments and
sterilized instruments which have not cooled down all have the
potential to burn and care should be taken in their use.
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TEMPROMANDIBULAR DYSFUNCTION (TMD)
• Pre-existence of TMD should be recorded, and the
patient advised that treatment will not predictably
improve their condition.
• Some patients may suffer with increased symptoms
during treatment which must also be discussed at the
beginning of treatment.
• Where patients experience symptoms during
treatment, treatment should be directed at eliminating
occlusal disharmony and joint noises whilst reassuring
the patient.
• Standard treatment regimes may also be indicated e.g.
soft diet, jaw exercises.
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SYSTEMIC RISKS
CROSS INFECTION
• Spread of infection between patients, between
operator and patient and by a third party should be
prevented by cross infection procedures throughout
the surgery.
• Use of gloves, masks, sterilized instruments and
'clean' working areas are paramount.
• A medical history must be taken for every patient to
determine risk factors, although cross infection
control should be of a standard to prevent cross
contamination regardless of medical status.
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INFECTIVE ENDOCARDITIS
• Patients at risk of endocarditis should be treated in consultation with
their cardiologist and within the appropriate guidelines.
• The patient must exhibit immaculate oral hygiene, antibiotic cover
will be required for invasive procedures such as extractions,
separation, band placement and band removal.
• It is recommended that bonded attachments are used on all teeth to
negate the need for antibiotic cover for both separator and band
placement, as well as removal. This also reduces the risk of unwanted
plaque stagnation areas.
• Chlorhexidine mouthwash has been advocated prior to any fixed
treatment.
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Relapse
Any change from final tooth position at the end of treatment
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Causes of Relapse
The major causes of relapse after orthodontic treatment include
1.The elasticity of gingival fibers before PDL reorganization has been completed.
2.Cheek/lip/tongue pressures
3.Jaw growth.
4.Unfavorable growth is the major contributor to changes in occlusal relationships.
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RETAINERS
1- Removable Retainers
2- Fixed Retaine
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ESSIX
Developed in 1993 This is a polypropylene or polyvinylchloride (PVC) material,
typically .020" or. 030" thick.
Plastic removable appliance
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Advantages: Esthetic Patient is more likely to wear Inexpensive Quick fabrication Minimal bulk High strength No adjustments Usually does not interfere with speech or function
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