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Mini Dragon Group (ages 6-7)

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Frank Titskey
Frank Titskey

Iatrogenic Effects Of Orthodontic Treatment: Decision-Making In Prevention, Diagnosis, And Treatment UPD



In orthodontic treatment, teeth are moved in to new positions and relationships and the soft tissue and underlying bone are altered to accommodate changes in esthetics and function. Function is more important than esthetics. The speciality of orthodontics has in addition to its benefits, complications as well as risks associated with its procedures. However the benefits outweigh the risks & complications in most of the treatment cases. Few of the unwanted side effects associated with treatment are tooth discolorations, enamel decalcification, periodontal complications like open gingival embrasures, root resorption, allergic reactions to nickel & chromium as well as treatment failure in the form of relapse.




Iatrogenic Effects of Orthodontic Treatment: Decision-Making in Prevention, Diagnosis, and Treatment


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Increased life expectancy, improved socio-economic conditions along with a desire for improved self esteem has resulted in an increase of adult population seeking orthodontic treatment. Furthermore, the changing concepts of esthetics with the advent of esthetic brackets & arch wires have combined functional benefits with esthetics. In orthodontic treatment, teeth are moved into new positions and relationships and the soft tissue and underlying bone are altered to accommodate changes in esthetics and function. Function is more important than esthetics. The speciality of orthodontics has in addition to its benefits, complications as well as risks associated with its procedures. However the benefits outweigh the risks & complications in most of the treatment cases. Few of the unwanted side effects associated with treatment are tooth discolorations, enamel decalcification, periodontal complications like open gingival embrasures, root resorption, allergic reactions to nickel & chromium as well as treatment failure in the form of relapse.


Dental plaque has been established as a potential risk factor for the development of periodontal diseases and the progression of these diseases depends on the balance between microbial biofilms and immune and inflammatory host responses [1]. The undesirable side effects of orthodontic treatment are tissue damage, treatment failure & increased predisposition to dental disorders.


Gingival and Periodontal changes related to orthodontic treatment are, in general transient with no permanent damage. Loss of attachment and alveolar bone loss are known to occur during orthodontic treatment, but are reported to be temporary [28]. But if long term orthodontic treatment continues in the absence of oral hygiene, then gingival and periodontal damage takes place. Deleterious effects includes gingivitis, mucosal trauma (Fig. 3), gingival hyperplasia, marginal periodontitis, gingival recession mostly at extraction areas, loss of attachment, inter dental clefts, mostly at the vestibular aspects of extracted mandibular first premolar site, reduced width of keratinized gingiva and marginal bone and apical root resorption. Some of these undermine the stability of the orthodontic result, particularly where there is a reduction in the bone support or presence of gingival clefts or recession.


Periodontal destruction due to use of elastic bands was firstly reported in the dentistry way back in 1980s. During different phases of orthodontic treatment, small elastics or rubber bands are used for generating a continuous force to achieve individual tooth movement. Elastics have long been used for the correction of orthodontic problems such as diastema, crossbites, and malposed teeth [68]. Elastics are also used for the intentional non-surgical removal of teeth in cases of hemophilia and also in patients treated with bisphosphonates, or some other anticoagulant medication [69, 70]. As a part of reducing the expenses, many patients choose the use orthodontic rubber bands as a treatment option for closing diastemas [71]. But it is quiet common that the improper use of rubber bands can lead to severe periodontal destruction and tooth loss [72]. The periodontal destruction caused by orthodontic elastic bands could be iatrogenic [73]. There are only few published reviews of the literature and case studies in the recent years, reporting the effect of orthodontic elastic bands that are retained in the gingival tissues [74].


Decision-making in orthodontics has largely depended on obtaining optimal proximal and residual contact of teeth and improves smile and facial appearance. All the inputs required for decision-making such as model analysis, cephalometric analysis, and clinical examination have focused on ways to analyze space requirement for aligning teeth, assess growth pattern, and envisage profile improvement. The protocol of analyzing the airway and the impact of orthodontic treatment on the upper airway dynamics is seldom factored during decision-making process. Although orthognathic surgery is the best option in skeletal malocclusion, the percentage of cases that undergo this treatment modality is far less than desirable. Inadequate capacity and training to execute this treatment modality in our dental colleges and lack of insurance cover may be some of the issues restricting its practice.[3]


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