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Rational of Orthodontic Treatment

Azal Amshoosh

Emad Maaitah

24/9/13


Rational of Orthodontic Treatment .
Let us start with the definition:
Ortho means straight. Dontics means teeth.

Orthodontics: is the branch of dentistry that deals with the growth and
development of the face, oral structures and occlusion, and with the diagnosis, interception and treatment of occlusal anomalies.

Malocclusion: any features of dental alignment or occlusion at variance

from the normal. Q: What is the normal? A: To have all the teeth well aligned within the same arch line, no space, no rotation and no crowding.

Indications for the orthodontics treatment:

1- Aesthetic: the most common indication is aesthetic which means to improve the appearance. So orthodontics can improve the appearance of the teeth, the appearance of the teeth within the face and the appearance of the face. So every case should be treated according to the findings. See this is a buccally erupted canine. Before treatment teeth appearance was ugly but after treatment teeth are well aligned.

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Sometimes skeletal or jaw problems need orthognathic surgery.

2- Functional: Speech : this is debatable many patients and even doctors think orthodontics problems lead to speech problems, but if you think logically, children start to speak around the age of 1.5 to 3.5 years old, and girls usually develop it before boys. So if comes to your clinic and he/she is 12 years old, complaining of his speech, do you think his problem with speech really because of his malocclusion in permanent teeth?! We dont know! Because we dont know the occlusal type he or she had when he was baby. So according to studies some of malocclusions can affect the speech because some sounds need teeth contact or tongue to teeth contact, so to treat this speech problem you need to correct both speech and malocclusion. Studies have shown that orthodontics treatment cannot treat speech problems, but it can be carried out adjunctive to speech therapy. Mastication: some malocclusion features can affect the efficiency of mastication, e.g.: lateral open bite. So, orthodontic treatment that eliminates these features can improve the masticatory function.

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TMDS (Tempo-Mandibular Joint Dysfunction Syndrome): Again this is debatable, does malocclusion cause TMDS? Does ortho treatment relief TMDS signs and symptoms? Well, no it doesnt. It has been claimed that certain malocclusion features are linked to TMDS, these are: Deep overbite. Class lll with large negative over jet. Increased over jet. AOB (anterior open bite). Cross bite. However, association doesnt mean cause. So treatment of these features does not mean elimination of TMDS sign and symptoms. This should be clarified to patients, treatment may relief the signs and symptoms, it may increase them, and sometime treatment might do nothing to signs and symptoms. The only feature that found to be strongly associated with TMDS is cross bite with mandibular displacement (functional cross bite). Usually when you see the patient biting in the inter-cuspal position, and try to move the mandible to the retruded contact position, you may have an edge to edge or interference of the upper and lower teeth, so to get a comfortable bite for the patient, try to move his or her mandible to the left or to the right or even anteriorly to get the maximum inter-cuspation. This can cause mandibular displacement.
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So cross bite with mandibular displacement, is a functional defect that needs treatment even if the patient does not have TMDS, and this is a prophylactic treatment to prevent it. Inter-cuspal position :ICP the position of the mandible
when the cusps and sulci of both maxillary and mandibular teeth are in their greatest contact and the mandible is in its most closed position.

Retruded contact position: RCP Guided position of the

teeth in which the mandible is located with the condyles in the most retruded position in the fossae. ( free dictionary ).

3- Prosthetics: Some of the orthodontics treatment is used to prepare the teeth/jaws to receive prosthesis. e.g.: Open a space or close it. In this figure: either close the space then reshapes the canine to look like lateral incisors, or open it and then put an implant.

4- Prophylactic (dental health): Crowding and dental caries: logically, cleaning well aligned teeth is easier than cleaning crowded teeth. So you may get healthy teeth and peridontiom in patients with straight well aligned teeth. However, studies found that it isnt related to teeth alignment of the teeth but it is mainly related to patients attitude, because it is more difficult to clean teeth with fixed appliances than to clean crowded teeth.
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A patient with bad attitude toward orthodontic treatment and oral hygiene in general, shouldnt go for it Development of pathology around the teeth (impacted

teeth): prevents problems associated with impacted teeth like

dentigerous cysts and root resorption. Trauma: the most commonly affected teeth are the upper incisors and the most common damage is enamel fracture. Risk factors to trauma are: Increased over jet Over jet >6mm increase the risk of trauma by 3 times. Prominent upper incisors Incompetent lips. Attrition, fracture and gingival recession: in this figure, the tooth (lower right central incisor) with gingival recession is caused by the upper right central bite lingually to it and pushing it labially, causing dehiscence and fenestration, and so gingival recession.

*Occlusal

trauma: is a dental term that

refers to the damage incurred when teeth are left in traumatic occlusion without proper treatment. WIKIPEDIA

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Attrition: may reach the limit of occlusal trauma. Deep bite: the upper incisors fully cover the lower incisors, and the problem here is that the lower incisors may traumatize the palate.

Benefits of orthodontic treatment:

1-Improved appearance: it provides better self-esteem, 60% of children
teased about their teeth were upset by this, especially for young children, ! There is a study showed that there are some teachers think that students with well aligned, nice looking teeth are smarter!

2-Dental health: in theory, well aligned teeth are easier to keep clean. So
they will have better dental and periodontal health, but very little evidence that straighter teeth suffer less pathology.

Risks:
1- Decalcification: hypomineralization and risk of having white spot
lesion which is the early stage of dental caries, mostly around the brackets.

2- Dental caries 3- Root resorption: if we apply heavy forces it will lead to wrong
movement, thus root resorption. E.g.: doing this to finish treatment earlier.

4-Gingival recession: if you move the teeth in wrong way this may cause
gingival recession.

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5-Relapse: it is the most disappointing problem, it happens with uncooperative patients who dont wear their retainers. So always inform your patient that he/she will wear a retainer after an orthodontic treatment. 6-Medical history: E.g.: if a patient needs MRI during the treatment you have to remove all the metal (brackets and wires).

Summary:
Always, you have to weight your patient according to the risk benefit equation.

Ideal patients for orthodontic treatment are:

1-Pateints with mouth free pathology: if the patient has dental caries or periodontal problem, send him to treat this problem and then start your treatment. 2-Have good oral hygiene. 3-Cooperative: really motivated, not external motivation. 4-medically OK: however there is no medical contraindications for orthodontic treatment.

Wish you all the best in the clinical years and Please forgive me for any mistake,,, Azal Amshoosh

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