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PubMed1999

Endodontic-orthodontic relationships: a review of integrated treatment planning challenges.

Literature review There is a paucity of information on the concise relationship between endodontics and orthodontics during treatment planning decisions. This relationship ranges from effects on the pulp from orthodontic treatment and the potential for resorption during tooth movement, to the clinical management of teeth requiring integrated endodontic and orthodontic treatment. This paper reviews the literature based on the definition of endodontics and the scope of endodontic practice as they relate to common orthodontic-endodontic treatment planning challenges. Literature data bases were accessed with a focus on orthodontic tooth movement and its impact on the viability of the dental pulp; its impact on root resorption in teeth with vital pulps and teeth with previous root canal treatment; the ability to move orthodontically teeth that were endodontically treated versus nonendodontically treated; the role of previous tooth trauma; the ability to move teeth orthodontically that have been subjected to endodontic surgery; the role of orthodontic treatment in the provision for and prognosis of endodontic treatment; and, the integrated role of orthodontics and endodontics in treatment planning tooth retention. Orthodontic tooth movement can cause degenerative and/or inflammatory responses in the dental pulp of teeth with completed apical formation. The impact of the tooth movement on the pulp is focused primarily on the neurovascular system, in which the release of specific neurotransmitters (neuropeptides) can influence both blood flow and cellular metabolism. The responses induced in these pulps may impact on the initiation and perpetuation of apical root remodelling or resorption during tooth movement. The incidence and severity of these changes may be influenced by previous or ongoing insults to the dental pulp, such as trauma or caries. Pulps in teeth with incomplete apical foramen, whilst not immune to adverse sequelae during tooth movement, have a reduced risk for these responses. Teeth with previous root canal treatment exhibit less propensity for apical root resorption during orthodontic tooth movement. Minimal resorptive/remodelling changes occur apically in teeth that are being moved orthodontically and that are well cleaned, shaped, and three-dimensionally obturated. This outcome would depend on the absence of coronal leakage or other avenues for bacterial ingress. A traumatized tooth can be moved orthodontically with minimal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treatment. If a previously traumatized tooth exhibits resorption, there is a greater chance that orthodontic tooth movement will enhance the resorptive process. If a tooth has been severely traumatized (intrusive luxation/avulsion) there may be a greater incidence of resorption with tooth movement. This can occur with or without previous endodontic treatment. Very little is known about the ability to move successfully teeth that have undergone periradicular surgical procedures. Likewise, little is known about the potential risks or sequelae involved in moving teeth that have had previous surgical intervention. Especially absent is the long-term prognosis of this type of treatment. During orthodontic tooth movement, the provision of endodontic treatment may be influenced by a number of factors, including but not limited to radiographic interpretation, accuracy of pulp testing, patient signs and symptoms, tooth isolation, access to the root canal, working length determination, and apical position of the canal obturation. Adjunctive orthodontic root extrusion and root separation are essential clinical procedures that will enhance the integrated treatment planning process of tooth retention in endodontic-orthodontic related cases.

Dental Pulp↗
PubMed1995

Predictors of fixed orthodontic treatment in 15-year-old adolescents in South Australia.

An understanding of the determinants of the provision of fixed orthodontic treatment would be beneficial in the planning of any system aimed at rationalising supply. The aim of this longitudinal study was to determine those factors which were predictive of the provision of fixed orthodontic treatment in adolescents. Baseline data, at age 13 years, on oral health, the history of orthodontic consultation and interceptive orthodontic care, a dental appearance score (DAI), socio-demographic characteristics and self and parental perceptions of both dental appearance and need for fixed orthodontic treatment were obtained from 2793 adolescents under the care of the South Australian School Dental Service who had not undergone fixed orthodontic treatment. Data on the orthodontic care provided to these adolescents in the ensuing 2 years were collected. At the end of the 24-month period 433 adolescents (15.5%) had undergone fixed orthodontic treatment. Significant bivariate associations were found between the provision of fixed orthodontic treatment and the DAI score, sex of the adolescent, familial history of fixed orthodontic treatment, income, private insurance, orthodontic consultation and interceptive orthodontic care before the age of 13 years and self and parental perceptions of both dental appearance and the need for fixed orthodontic treatment. Logistic regression was used to produce a predictive model of fixed orthodontic treatment. The model explained 30.2% of the variance, with a specificity of 0.94, a sensitivity of 0.49 and a hit rate of 0.84%. Odds ratios greater than one were found for the DAI score, private insurance, females, self and parental perception of need, higher incomes and orthodontic consultation and interceptive orthodontic care before the age of 13 years.

Adolescent↗
PubMed1996

Provision of orthodontic care to adolescents in South Australia: the type, the provider, and the place of treatment.

There are many pathways involving different providers and locations that individuals may take in obtaining, orthodontic services. The aim of this study was to document the provision of orthodontic services and establish the pathways taken toward fixed orthodontic treatment by adolescents in South Australia. Data were collected on the use of orthodontic services by a cohort of adolescents enrolled in the School Dental Service at age 13 years and again at age 15 years. By age 15 years, 83.2 per cent of the adolescents had received orthodontic consultations, 27.3 per cent had received fixed orthodontic treatment and 41.4 per cent had received other forms of orthodontic treatment (extractions, space retainers or removable appliances). The majority of fixed orthodontic treatment was supplied by orthodontists in the private sector, while extractions and removable appliances were provided mainly by public sector general dentists. Most individuals used services in both the public and private sectors and the most frequent pathway taken by the adolescents receiving fixed orthodontic treatment involved consultation in both the public and private sectors, non-fixed orthodontic treatment in the public sector and fixed orthodontic treatment in the private sector. The findings indicate wide access to orthodontic consultation and a high uptake of fixed orthodontic treatment once the adolescent sought private sector orthodontic consultation. Orthodontic care was seen to be an interactive process between public sector general dentists and private sector orthodontists.

Adolescent↗
PubMed1999

Referring adult patients for orthodontic treatment.

BACKGROUND: An increasing number of adults are undergoing orthodontic treatment, but they still make up only a small proportion of all adults who could benefit from such therapy. The purpose of this article is to illustrate the appropriateness and value of orthodontic treatment in adults. METHODS: The authors review and summarize previous studies regarding adult orthodontic treatment. Data from these studies are compared to determine the prevalence of orthodontic treatment in adults, the reasons why many adults do not seek treatment and the outcomes of orthodontic treatment in adults. In addition, the authors describe a case to demonstrate how a combination of orthodontic therapy and orthognathic surgery can facilitate and complement prosthetic rehabilitation. RESULTS: Numerous studies indicate that two-thirds to three-fourths of adults possess some form of malocclusion, yet adults make up only 15 percent of all orthodontic patients. Reasons given by adults for not seeking treatment include a lack of awareness that orthodontic treatment can be performed in adults, apprehension about possible pain or discomfort and concern about social acceptance. However, most patients who underwent orthodontic treatment reported only mild discomfort of one to two days' duration, and only 20 percent of patients felt that the appliances had an adverse social effect. Overall, patients reported high levels of satisfaction with treatment. Orthognathic surgery in addition to orthodontics may be required for the most severe problems, and is compatible with subsequent fixed and removable prosthetic treatment. CONCLUSIONS: Adjunctive and comprehensive orthodontic treatment is feasible for adults of all ages. Correction of malocclusion makes it possible to improve the quality of periodontal and restorative treatment outcomes, in addition to providing psychosocial benefits. CLINICAL IMPLICATIONS: General dentists are often the first dental professionals to suggest orthodontic treatment and to refer patients to orthodontic specialists. Moreover, with the growing emphasis on cosmetic dentistry, more adults are likely to seek information regarding orthodontic surgery. This article provides general dentists with the information needed to communicate with patients about treatment.

Adult↗
PubMed1995

The provision of orthodontic services by general dental practitioners. 2. Factors influencing variation in service provision.

Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children.

Adult↗
PubMed1975

Occlusal characteristics and tooth mobility in periodontally healthy young males classified orthodontically.

Three groups of periodontally healthy young males classified as to orthodontic status by the Handicapping Labio-Lingual Deviations Index were evaluated for various occlusal characteristics. A much larger proportion (95%) of the orthodontically normal subjects (Group I) had an Angle Class I type of occlusion than the Group II subjects requiring orthodontic care (60.5%), or the Group III subjects who had received orthodontic care (63.4%). The percentages of subjects with a "cuspid-protected" type of occlusion were larger in the orthodontically normal and orthodontically treated groups than in the group requiring orthodontic care. Anterior displacement of the mandible in closing from centric relation to the intercuspal position was found in the majority of subjects in each group. Displacement of more than 2 mm was most common in the subjects requiring orthodontic care. Only 1 of the 41 orthodontically treated subjects reported that his occlusion had been adjusted by grinding after tooth movement. There were no statistically significant differences in mean tooth mobility values between the orthodontically normal and orthodontically treated subjects. The lateral incisor tooth had a significantly lower mean mobility value in subjects whose orthodontic care included removal of the first premolar than in subjects treated without removal of the first premolar. Wear facets were common in all three groups. Based on the findings, one can conclude that orthodontic therapy was only partially successful in obtaining the objectives described as part of an ideal result. It should be noted, however, that the status of the dentition and occlusion prior to orthodontic treatment could not be determined for more than a few subjects.

Adult↗
PubMed1991

Profiling providers of orthodontic services in general dental practice.

This study was designed to ascertain whether general practitioners who provide some orthodontic treatment to a relatively large proportion of their patients tend to limit themselves to the treatment of simple cases while they continue to refer more difficult cases or whether a high volume of orthodontic treatment is linked to an expanded scope of treatment and fewer referrals. Data pertaining to volume, scope, and other correlates of orthodontic services in general practice were obtained through a survey of dentists currently in general practice in Iowa. Of 1159 questionnaires mailed out, 728 (62.8%) were returned. To determine how the values of recorded variables differ among the providers of high and low volumes of orthodontic services and to determine whether these differences are significant, chi 2 tests of independence were calculated. The results obtained were used to generate descriptive measures of the profiles of providers of a high volume of orthodontic services in general practice. These profiles indicated that providers of a high volume of orthodontic treatment (1) performed the same amount of limited orthodontic treatment as providers of a low volume of orthodontic treatment; (2) performed significantly more major orthodontic treatment; (3) used significantly more fixed appliances, functional appliances, and headgears, but not removable appliances; (4) took significantly more hours of continuing education in orthodontics; and (5) referred significantly fewer patients to orthodontic specialists. In view of the projected increase in the amount of orthodontics performed in general practice, these findings suggest that, in the future, relatively more major orthodontic treatment is likely to be provided by general practitioners.

Education, Dental, Continuing↗