Limitations Of Orthodontic Treatment Research Articles

Limitations of orthodontic treatment: Class III camouflage

Class III malocclusion treatment planning in the non-growing patient can represent a challenge. The options of whether to attempt orthodontic camouflage or to treat with orthognathic surgery are affected by numerous factors, including the severity of the underlying skeletal relationship, the dento-alveolar compensation already present, the facial aesthetics, the patient's concerns and expectations, and the anatomical limits of orthodontic tooth movement. Numerous studies have tried to provide guidance by looking at the differences between groups of patients to determine whether they should be treated orthodontically or surgically. However, owing to the retrospective nature of these studies and their heterogeneity, they prove less helpful than desired. In this narrative review, the authors will look at these studies to provide some guidance for the orthodontist. CPD/Clinical Relevance: Treatment planning in Class III malocclusions can be challenging owing to the numerous factors that must be considered.

Surgical management of Class III malocclusion: A 1 year follow-up

For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left. One indication for surgery is a malocclusion too severe for orthodontics alone. It is possible now to be at least semiquantitative about the limits of orthodontic treatment in the context of producing normal occlusion as the diagrams of the “envelope of discrepancy” indicate. In this case report, we have presented orthognathic treatment plan of an adult male patient with skeletal Class III malocclusion and anterior crossbite. Patient's malocclusion was decompensated by orthodontic treatment just before the surgery and then normal jaw relationship achieved by bilateral sagittal split ramus osteotomy. Patient's dental and facial profile was improved in a total of 18 months treatment duration. One-year follow-up showed stable results.

Non-surgical profile correction in a class II malocclusion

Case report of a 17-year-old male patient, skeletal class II, convex profile, not pleased with his facial appearance and without any intention to undergo surgical treatment. He presents severe protrusion and crowding, lip incompetence and protrusion, 7mm overjet and -3mm overbite. The treatment goals were to improve lip relation and esthetics, establish a functional occlusion, to improve the profile and muscular balance. Four first premolar extractions were performed and anchorage control was accomplished with a transpalatal and lingual arch. Treatment results were very successful achieving functional occlusion, lip competence, mandibular rotation and a decrease in profile convexity without surgical treatment. It is important to know the scopes and limits of orthodontic treatment regarding soft tissues, as well as maintaining anchorage to achieve profile changes with maxillary incisor retraction.

Corrección no quirúrgica del perfil de una maloclusión clase II

Case report of a 17-year-old male patient, skeletal class II, convex profile, not pleased with his facial appearance and without any intention to undergo surgical treatment. He presents severe protrusion and crowding, lip incompetence and protrusion, 7mm overjet and -3mm overbite. The treatment goals were to improve lip relation and esthetics, establish a functional occlusion, to improve the profi le and muscular balance. Four first premolar extractions were performed and anchorage control was accomplished with a transpalatal and lingual arch. Treatment results were very successful achieving functional occlusion, lip competence, mandibular rotation and a decrease in profile convexity without surgical treatment. It is important to know the scopes and limits of orthodontic treatment regarding soft tissues, as well as maintaining anchorage to achieve profile changes with maxillary incisor retraction.

Anaesthesia for cosmetic and functional maxillofacial surgery

Both mandible and maxilla may be ‘advanced’, ‘set back’ or rotated before being fixed into new positions according to the particular skeletal problem. Sagittal split of the mandible (preserving the inferior alveolar nerve) and horizontal Le Fort I osteotomy of the maxilla (Fig. 1) are the most frequently performed procedures. These may be combined with genioplasty, an osteotomy of the mandibular symphysis to improve the profile of the chin. The combination of mandibular and maxillary (‘bi-maxillary’) surgery, though more complex, allows the greatest possible degree of correction. Surgery of the temporomandibular joint (TMJ) is frequently performed in isolation and though the popularity of open TMJ surgery has waned in recent years arthroscopy and arthrocentesis ( joint wash out) are still indicated for localized TMJ locking with pain which has not responded to conservative measures. Indications for orthognathic surgery range from the largely cosmetic correction of dental malocclusions out with the limits of orthodontic treatment, to the correction of deformity and functional problems arising from congenital head and neck conditions. Maxillary growth restriction secondary to initial surgery is a frequent indication for orthognathic surgery later on in life in cleft-palate patients. A full discussion of conditions such as Crouzon’s, Apert’s, and Treacher-Collins syndromes is beyond the context of this article and the management of these conditions generally involves more advanced orthognathic surgery. Le Fort II and III mid-face osteotomies (after the fracture patterns of Rene Le Fort 1869–1951) are used to treat these complex syndromes and are largely limited to specialized craniofacial units. Cosmetic orthognathic and functional TMJ procedures in otherwise fit and healthy patients make up a large proportion of all adult noncancer maxillofacial surgery work in the UK and are the focus of this review. Evidence is increasing to support the role of orthognathic surgery in the multi-disciplinary management of patients with severe obstructive sleep apnoea (OSA) syndrome where conservative measures such as continuous positive airway pressure and weight loss have failed. Bi-maxillary advancement is effective in patients whose site of airway collapse is principally retrolingual, either from the outset or after soft tissue procedures such as uvulopalatopharyngoplasty.

Space supervision and guidance of eruption in management of lower transitional crowding: A non-extraction approach

Mandibular incisor crowding in the mixed dentition is one of the most common problems presenting to the orthodontist. Asymmetry of alignment, premature loss of primary canine(s), and disruption in arch integrity are all early benchmarks of a tooth size/arch length discrepancy in the transitional dentition that can occur independent of any skeletal discrepancy. Space supervision and guidance of eruption refer to treatment interventions during the early to mid-mixed dentition periods that influence the eruption patterns and positioning of the permanent teeth during their transition. Generally considered applicable to individuals with adequate overall arch dimensions to accommodate a normal complement of permanent teeth with an acceptable esthetic and functioning occlusion, guidance of eruption involves the implementation of directed interventions to optimize the eruption and alignment patterns of the permanent teeth as part of a non-extraction protocol.

Understanding the advances in biology of orthodontic tooth movement for improved ortho-perio interdisciplinary approach

This article provides an insight on detailed current advances in molecular understandings of periodontal ligament cells and the influence of orthodontic force on them in the light of recent advances in molecular and genetic sciences. It sequentially unfolds the cellular events beginning from the mechanical force initiated events of cellular responses to bone remodeling. It also highlights the risks and limitations of orthodontic treatment in certain periodontal conditions, the important areas of team work, orthodontic expectations from periodontal treatment and the possibility of much more future combined research to improve the best possible periodontal health and esthetic outcome of the patient.

Surgical-orthodontic treatment of a skeletal class III malocclusion

For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left. One indication for surgery obviously is a malocclusion too severe for orthodontics alone. It is possible now to be at least semiquantitative about the limits of orthodontic treatment, in the context of producing normal occlusion as the diagrams of the “envelope of discrepancy” indicate. In this case report we present orthognathic treatment plan of an adult female patient with skeletal class III malocclusion. Patient's malocclusion was decompensated by orthodontic treatment just before the surgery and then normal jaw relationship achieved by bilateral sagittal split osteotomy.

Commentary

The significance of appropriate mesiodistal angulations of the teeth in completed orthodontics patients has been highlighted by many clinicians. 1 Nance H.N. The limitations of orthodontic treatment. Part II. Am J Orthod Oral Surg. 1947; 33: 253-301 Abstract Full Text PDF Scopus (72) Google Scholar , 2 Dewel B.F. Clinical observations on the axial inclination of teeth. Am J Orthod. 1949; 35: 98-115 Abstract Full Text PDF PubMed Scopus (39) Google Scholar , 3 Dempster W.T. Adams W.J. Duddles R.A. Arrangement in the jaws of the roots of the teeth. J Am Dent Assoc. 1963; 67: 779-797 Abstract Full Text PDF PubMed Scopus (56) Google Scholar , 4 Andrews L.F. The six keys to normal occlusion. Am J Orthod. 1972; 62: 296-309 Abstract Full Text PDF PubMed Scopus (647) Google Scholar It has been reported that the final spatial orientation of each tooth should be such that it can best withstand the forces during function. 3 Dempster W.T. Adams W.J. Duddles R.A. Arrangement in the jaws of the roots of the teeth. J Am Dent Assoc. 1963; 67: 779-797 Abstract Full Text PDF PubMed Scopus (56) Google Scholar , 4 Andrews L.F. The six keys to normal occlusion. Am J Orthod. 1972; 62: 296-309 Abstract Full Text PDF PubMed Scopus (647) Google Scholar , 5 Ash M.M. Occlusion. in: Ash M.M. Wheeler’s dental anatomy, physiology and occlusion. W. B. Saunders, Philadelphia1993: 414-470 Google Scholar There are no absolute rules that can be assumed when describing tooth inclinations; however, statistical data in anatomical specimens and nonorthodontic normal occlusions have been collected and analyzed. 3 Dempster W.T. Adams W.J. Duddles R.A. Arrangement in the jaws of the roots of the teeth. J Am Dent Assoc. 1963; 67: 779-797 Abstract Full Text PDF PubMed Scopus (56) Google Scholar , 4 Andrews L.F. The six keys to normal occlusion. Am J Orthod. 1972; 62: 296-309 Abstract Full Text PDF PubMed Scopus (647) Google Scholar Andrews 4 Andrews L.F. The six keys to normal occlusion. Am J Orthod. 1972; 62: 296-309 Abstract Full Text PDF PubMed Scopus (647) Google Scholar might have been the first to give a quantitative assessment of tooth angulation as a key for normal occlusion. This concept played a role in the development of the straight-wire appliance. Panoramic evaluation of mesiodistal axial inclinations of maxillary anterior teeth in orthodontically treated subjectsAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 130Issue 1PreviewIntroduction: The objectives of this study were to evaluate, through panoramic radiographs, the mesiodistal axial inclinations of the maxillary anterior teeth at the beginning and end of nonextraction orthodontic treatment, and to compare the results with the mesiodistal axial inclinations of a control sample with normal (acceptable) occlusions. Methods: The experimental sample consisted of 40 white patients (20 male, 20 female; mean age, 14 years) with Class I maloccusions who were treated orthodontically with a standard edgewise (not preadjusted) technique without extractions. Full-Text PDF

Limiting Factors in Orthodontic Treatment: 2. The Biological Limitations of Orthodontic Treatment

Owing to a shortage in the orthodontic workforce in the United Kingdom, general dental practitioners carry out orthodontic treatment in selected cases. Orthodontic treatment may not always be successful due to various factors. Some of these limiting factors are related to the practitioner, others to the patients and the orthodontic appliances used. These three sets of factors were covered in the first part of this article. This second part deals with the biologic limitations of orthodontic treatment. General dental practitioners and novice orthodontic practitioners may get into difficulties by embarking upon an orthodontic treatment which may not be feasible due to various limitations imposed by the underlying biology. This article provides a brief outline of these limitations.

The limitations of orthodontic treatment.

There is probably nothing in the orthodontist's diagnostic repertoire that will precipitate an adrenaline rush faster than a first examination of a mixed dentition patient who has an obvious skeletal problem. Everyone present in the examination room expects the doctor to manage the problem with some gadget...the same way that produced favorable results for the three playmates in the neighborhood who originated the referral. But intellectually, the clinician knows conventional treatment may not be in this individual's best interest and must intuitively develop a definition of "The Limitation of Orthodontic Treatment."

Gaining Vertical Dimension for the Deep Bite Restorative Patient

The value of utilizing an orthodontic specialist in treating these patients cannot be overemphasized, but it should be borne in mind that the ultimate responsibility for the entire treatment belongs to the referring restorative dentist. Therefore, the restorative dentist must give to the orthodontist a detailed description as to where he wants the teeth to be positioned. At the same time, he should respect and appreciate the limitations of orthodontic treatment. Each case should be discussed in detail before and during treatment so that both orthodontist and restorative dentist know and understand the goals and limitations of the other. Although the authors utilized a modified Crozat technique, they feel that other appliances may produce comparable results. 5 It is suggested that the operator use any appliance which works well in his hands and yields the desired results. Often this requires modifications of basic techniques because of unique problems found in adults. Frequently in discussions of complete prosthetics, mention has been made about the problem of encroachment on freeway space to a point where the patient is uncomfortable and complains of tired muscles, teeth colliding, and so on. However, the authors have not encountered this problem in the treatment of Class II deep bite patients, although the vertical dimension has, in some instances, been increased several millimeters in the anterior region. These patients may not encounter discomfort due to the increased vertical dimension for two possible reasons: first, they are biting on soft acrylic splints or bite planes; secondly, the extended treatment periods necessary for tooth movement allow the patient to accommodate gradually. Once these patients were orthodontically treated and the restoration completed, there was little need for a long retention period, except for some severely rotated anterior teeth. It is felt that the cusp-to-fossa arrangement of the occlusion acts to retain the posterior teeth, while the lips, tongue, and cheeks act to retain the anterior teeth —this may be termed functional retention.

Postmortems in posttreatment adjustment

Proper mechanotherapy is important, but it is not the magic wand that produces ideal occlusions forever more. 23 This headlong rush with efficient tooth-moving appliances and mass-extraction techniques to complete orthodontic correction in less and less time may be taking us in the wrong direction. I am confident that, with our dependence on pattern and growth and development, we must turn to a longer period of orthodontic management in many cases. This has been one of our faults. We just do not see these patients long enough. The concept of treating the malocclusion once and then considering it finished is unphysiologic. Other abnormalities of the body are seldom handled in this manner. Thus, the philosophy of a longer period of orthodontic management and responsibility, with two or three shorter periods of orthodontic mechanotherapy, makes sense to me. This seems particularly true when one considers that we are concerned with the dominance of the morphogenetic pattern, the general health picture, the endocrine balance, the growth and developmental pattern, treatment timing, and the role of muscle function and habits, both normal and abnormal. There is one inescapable conclusion from this “reveling in realism”: Unless we recognize and discuss the problems and limitations of orthodontic treatment among ourselves, unless we present the limitations and disadvantages of a particular technique as well as the recommendations for its use, and unless we keep our patients under observation longer and observe the status of the stomatognathic system in its biologic continuum, we cannot expect a realistic and objective appreciation of our efforts by the public or by most general dentists.

A quantitative method for the evaluation of the soft-tissue facial profile

In this study a method is introduced for the purpose of evaluating the soft-tissue profile in a quantitative manner on a profile photograph or cephalometric radiograph. Six profile angles are selected as being particularly significant in analyzing the soft-tissue profile. Angular relationships are established between upper lip, lower lip, and chin. This method was employed in examining one group of persons with normal, excellent occlusions and acceptable facial form and other groups with malocclusions. Measurements were made from photographs and were evaluated statistically. Information gained from the study of clinically excellent occlusions indicates that the straight profile does not necessarily accompany normal occlusion. This finding may be explained by the great variability which exists in the cross section of our population. The limitations of orthodontic treatment in correcting facial deformities are stressed. Special attention is called to the need for recognizing marked deficiencies in the pogonion area in the correction of malocclusions. This study indicates that a proportionate change or improvement of the soft-tissue profile does not necessarily accompany extensive dentition changes, and that, therefore, one can no longer rely entirely on a dentoskeletal analysis for accurate information on the soft-tissue facial profile changes which have occurred during orthodontic treatment.

The limitations of orthodontic treatment. II. Diagnosis and treatment in the permanent dentition

The limitations of orthodontic treatment. II. Diagnosis and treatment in the permanent dentition

The limitations of orthodontic treatment: I. Mixed dentition diagnosis and treatment

1. 1. This report is based on a large number of cases, some of which have been treated actively, and some of which have been controlled only with a preventive lingual arch for holding arch length. Most have been followed a sufficient number of years after retainers were discontinued to determine definitely whether or not the final outcome was stable. Both the stable cases and those which relapsed have been carefully analyzed by means of measurements which are herein described. 2. 2. These measurements lead me to conclude that the length of the dental arch, from the mesial of one mandibular first permanent molar to the mesial of the corresponding tooth on the opposite side, is always shortened in the transition from the mixed to the permanent dentition. Furthermore, this arch length cannot be permanently increased in mixed dentition cases through orthodontic treatment, but, on the other hand, it will decrease. The only exceptions to this generalization are cases which show an abnormally marked lingual axial inclination of mandibular incisors, ∗ ∗ One such case has been encountered in my practice, wherein mandibular incisors were tipped so far lingually by the closed bite that uprighting in treatment increased the inside measurement to the extent that even after forward positioning of first permanent molars, a net increase remained. This rarely happens; the forward positioning of molars is usually sufficient to cancel out any safe amount of forward tipping of incisors. or cases which have sustained the premature loss of deciduous canines or deciduous second molars. These exceptions are included only in the interests of accuracy and do not involve cases in which any marked increase in this distance may be expected to be maintained. 3. 3. These measurements lead me to conclude that the distance from the mesiolingual of the mandibular first permanent molar to the mandibular midline likewise always shortens in the transition from the mixed to the permanent dentition, and that this distance cannot be permanently increased through orthodontic treatment in the mixed dentition, allowing again for the same exceptions. 4. 4. It is possible, using the measurements described, to estimate accurately the prognosis of most mixed dentition cases, and to determine whether or not extraction will be necessary in permanent dentition treatment. 5. 5. Active treatment in the mixed dentition period is desirable only in Class III cases, cross-bites, and Class II, Division 1 cases wherein facial appearance is markedly affected. 6. 6. The treatment of the above cases should follow the principles discussed in this paper; that is, it must be recognized that the amount of space between mandibular first permanent molars cannot be permanently increased. Since this distance is always shortened in the transition from the mixed to the permanent dentition, the accommodation of all the teeth in the mixed dentition period in nonrotated positions constitutes overtreatment through overexpansion. The treatment of the mandibular arch in Class II, Division 1 cases requires the extraction of the deciduous canines in order to position the mandibular incisors over basal bone, without resorting to overexpansion. 7. 7. The preventive lingual arch is useful only during a short interval of time; namely, from just prior to the exfoliation of the second deciduous molars until such time as the mandibular canines and premolars have fully erupted. Such use of the preventive lingual arch is indicated only in those cases which are given a favorable prognosis by the measurements herein described.

What are the possibilities and limitations of orthodontic treatment

What are the possibilities and limitations of orthodontic treatment

What are the possibilities and limitations of orthodontic treatment

What are the possibilities and limitations of orthodontic treatment

What are the possibilities and limitations of orthodontic treatment

What are the possibilities and limitations of orthodontic treatment