Minimising the risk of complications associated with orthodontics

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  Posted by: Dental Design      2nd March 2023

Orthodontic therapy can transform a patient’s smile and significantly improve their quality of life. However, the treatment experience can be difficult for some and so it is important for clinicians to consider the challenges faced in order to provide adequate support.[i] Not only do patients need to be educated on how to avoid or overcome issues, but they also need to be motivated to maintain compliance and oral hygiene for the best possible outcomes to be achieved.

Clinical risk factors

For example, orthodontic-induced root resorption is believed to occur in many cases, with anterior teeth more susceptible to greater root shortening. Tooth devitalisation is also a risk. Orthodontic forces can change the pulpal blood flow and compress the neurovascular bundle, even causing pulpal necrosis. Temporomandibular disorder (TMD) is another possible complication to be aware of, with occlusal changes resulting from orthodontic therapy potentially leading to masticatory dysfunction and additional patient discomfort.ⁱⁱ

To avoid these and other clinical complications, it is essential that orthodontic treatment is planned very carefully. A comprehensive assessment is crucial, collecting both photographic and radiographic evidence. Oral hygiene should be evaluated and improved where required prior to the commencement of orthodontic treatment and the patient should be well-educated on the role they will play before, during and after alignment with regards to oral health, diet and treatment compliance[ii] (especially if using removable aligners). 

Discomfort

Of course, a good final outcome alone is not enough to consider treatment a success and encourage patient satisfaction – their experience at each stage of treatment is just as important. Repositioning the teeth may cause mild to moderate discomfort or pain for patients, especially in the beginning of alignment as the teeth and gums become accustomed to the new appliances in the mouth. The actual level of pain that individuals feel is somewhat subjective, with studies suggesting that this can be impacted by age, gender, psychological state and cultural background.[iii] As pain has been shown to have a substantial effect on patient compliance during treatment – as well as negatively impacting the patient experience – it is necessary to help individuals manage it.

While not entirely avoidable, patients should be warned of the potential tenderness they could experience so they know what to expect and do not become disheartened. Though non-steroidal, anti-inflammatory drugs (NSAIDs) are often recommended for orthodontic pain management, there is some concern regarding their impact on inflammation during alignment, so short-term use is recommended. Analgesics are likely the most common method of orthodontic pain reduction, administered both pre- and post-operatively.ⁱⁱ Where clinically appropriate, or for patients with high susceptibility to pain, treatment with removable aligners may be offered in place of fixed appliances for reduced discomfort and increased patient compliance.[iv]

Oral hygiene

It is important for patients to maintain their oral hygiene before, during and after any dental treatment they undergo. However, in some situations, this can be easier said than done. With orthodontics, for example, there is a body of evidence to suggest that oral hygiene is reduced during treatment with fixed appliances.[v] [vi] This highlights the need for continuous patient education and motivation to ensure they are maintaining adequate at-home oral hygiene routines throughout treatment. Indeed, a systematic review found orthodontic oral health promotion to have a positive impact on plaque scores and gingival health in participating patients.[vii]

Fluoride supplements are recommended to combat the increased risk of caries during orthodontic treatment, and some papers suggest that high-concentration gel may be more effective than fluoride mouthwashes. This may be further supported by in-practice fluoride varnish application.[viii] In addition, interdental brushes should be used alongside toothbrushes for superior plaque control and reduced gingival inflammation or bleeding.[ix] Interestingly, the type of toothbrush used during orthodontic treatment – manual or electric – may not have an impact,[x] so focus should be on correct brushing technique. There is also some research to suggest that the use of a smartphone app may serve as a reminder and motivator to patients and help them improve their oral hygiene compliance during orthodontic treatment.[xi]

A trusted system

Aside from the above, the actual system you use will impact the success of treatment, as well as the patient’s experience. Removeable aligners have become a popular choice where they are clinically appropriate, enabling patients to optimise their treatment-related quality of life with greater convenience, reduced discomfort and easier oral hygiene.

ClearCorrect^® is the premier aligner on the market right now. A Straumann Group brand, its ClearQuartz™ tri-layer material is designed to enhance both patient and practitioner experience. ClearCorrect^® retains 10x more of its initial force than other solutions on the market, while maintaining its shape for the duration of treatment for consistent tooth movement. Clinicians also remain in full control of treatment with the innovative ClearPilot 5.0 software. It provides the option to customise engagers, cut-outs and bite ramps, featuring smart editing tools to facilitate group tooth movement, compass tooth and compass multi-tooth editing.

Orthodontic treatment is an excellent option for many patients seeking to enhance their smile aesthetics and function. As is true in every dental discipline, patient education and accurate planning are both vital in order to minimise the risk of complications. Only then can the best results be achieved and the patient journey be optimised.  

For more information, visit www.clearcorrect-uk.com

[i] Johal A, Alyaqoobi I, Patel R, Cox S. The impact of orthodontic treatment on quality of life and self-esteem in adult patients. Eur J Orthod. 2015 Jun;37(3):233-7. doi: 10.1093/ejo/cju047. Epub 2014 Sep 11. PMID: 25214505.

[ii] Zarzycka-Kogut, Katarzyna & Pucek, Marzena & Jolanta, Szymańska. (2014). Orthodontic Treatment – Complications and Preventive Measures. Polish Journal of Public Health. 124. 10.2478/pjph-2014-0024.

[iii] Vinod Krishnan, Orthodontic pain: from causes to management—a review, European Journal of Orthodontics, Volume 29, Issue 2, April 2007, Pages 170–179, https://doi.org/10.1093/ejo/cjl081

[iv] Pereira D, Machado V, Botelho J, Proença L, Mendes JJ, Delgado AS. Comparison of Pain Perception between Clear Aligners and Fixed Appliances: A Systematic Review and Meta-Analysis. Applied Sciences. 2020; 10(12):4276. https://doi.org/10.3390/app10124276

[v] Anuwongnukroh, Niwat & Dechkunakorn, Surachai & R, Kanpiputana. (2017). Oral Hygiene Behavior during Fixed Orthodontic Treatment. Dentistry. 7. 10.4172/2161-1122.1000457.

[vi] Cantekin K, Celikoglu M, Karadas M, Yildirim H, Erdem A. effects of orthodontic treatment with fixed appliances on oral health status: A comprehensive study. Journal of Dental Sciences. 2011; 6(4);235-238 https://doi.org/10.1016/j.jds.2011.09.010

[vii] Gray D, McIntyre G. Does Oral Health Promotion Influence the Oral Hygiene and Gingival Health of Patients Undergoing Fixed Appliance Orthodontic Treatment? A Systematic Literature Review. Journal of Orthodontics. 2008;35(4):262-269. doi:10.1179/14653120722770

[viii] Berlin-Broner, Yuli & Levin, L & Ashkenazi, Malka. (2012). Awareness of orthodontists regarding oral hygiene performance during active orthodontic treatment. European journal of paediatric dentistry : official journal of European Academy of Paediatric Dentistry. 13. 187-91.

[ix] Rao, Anupama & Seema, Shah & Shankar, Kashyap & Hosdurga, Rajesh & Kumar, Vijaya & Vinita, A.. (2018). Efficacy of Interdental Brush as an Adjunct to Manual Toothbrush on Gingival Status in Patients undergoing Fixed Orthodontic Therapy: A Clinical Study. World Journal of Dentistry. 9. 355-360. 10.5005/jp-journals-10015-1562.

[x] Sharma R, Trehan M, Sharma S, Jharwal V, Rathore N. Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients. Int J Clin Pediatr Dent. 2015 Sep-Dec;8(3):181-9. doi: 10.5005/jp-journals-10005-1310. Epub 2015 Sep 11. PMID: 26628852; PMCID: PMC4647037.

[xi] Farhadifard, H., Soheilifar, S., Farhadian, M. et al. Orthodontic patients’ oral hygiene compliance by utilizing a smartphone application (Brush DJ): a randomized clinical trial. BDJ Open 6, 24 (2020). https://doi.org/10.1038/s41405-020-00050-5

 

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