Potential Limitations of Orthodontic Treatment
As a rule, excellent orthodontic results can be achieved with informed and cooperative patients. Thus, the following information is routinely supplied to anyone considering orthodontic treatment in our office. While recognising the benefits of a pleasing smile and healthy teeth, you should also be aware that orthodontic treatment, like any treatment of the body, has some inherent risk limitations. These are seldom enough to contraindicate treatment but should be considered in making the decision to wear orthodontic appliances.
Decalcification (permanent markings), decay, or gum disease can occur if patients do not care for their teeth properly and thoroughly during the treatment period. Excellent oral hygiene and plaque removal is a must. Sugars and between meal snacks should be avoided as much as possible.
Teeth have a tendency to rebound to their original positions after orthodontic treatment. This is called relapse. Very severe problems have a higher tendency to relapse more and the most common area of relapse is the lower front teeth. After band/bracket removal, retainers will be placed to minimise relapse. Full cooperation in wearing these appliances is vital. We will make our correction to the highest standards and in many cases overcorrect in order to accommodate the rebound tendencies. When retention is discontinued some relapse is still a possibility.
A non-vital or dead tooth is a possibility. A tooth that has been traumatised from a deep filling or even a minor blow can die over a long period of time with or without orthodontic treatment. An undetected non-vital tooth may flare up during orthodontic movement, and require endodontic (root canal) treatment to maintain it.
In some cases the root ends of the teeth are shortened during treatment. This is called root resorption. Under healthy circumstances the shortened roots are no disadvantage. However, in the event of gum disease in later life the root resorption could reduce the longevity of affected teeth. It should be noted that not all root resorption arises from orthodontic therapy. Trauma, cuts, impaction, hormone disorders, or ideopathic (unknown) reasons can also cause root resorption.
There is also a risk that problems may occur in the temporomandibular joints (TMJ). Although this is rare, it is a possibility. Tooth alignment or bite correction can improve tooth related causes of TMJ pain but not in all cases. Stress appears to play a role in the frequency and severity of joint pain and dysfunction.
Skeletal growth disharmony
Occasionally a person who has grown normally and in average proportions may not continue to do so. If growth becomes disproportionate, the jaw relations can be affected and original treatment objectives may have to be compromised. Skeletal growth disharmony is a biological process beyond the orthodontist’s control.
The total time for treatment can be delayed beyond our estimate. Lack of facial growth, poor elastic wear or headgear cooperation, broken appliances and missed appointments are all important factors which could lengthen treatment time and affect the quality of the result.
So, please, let’s make every effort to get the best result possible. This takes cooperation from everyone – the Orthodontists, their staff, family, and most of all, the patient.