The Big PictureConsequences of short-term orthodontics
Section snippets
Background
Today's patients are highly interested in cosmetic dentistry, and dental professionals can be pressured to offer procedures with the goal of keeping their patients satisfied with their practice. However, adult patients often do not want to undergo full orthodontic treatment to provide comprehensive straightening of their teeth or do not desire extensive porcelain ceramic restorations. Instead they choose to undergo a short course of orthodontic treatment to achieve adequate anterior alignment
Retention Issues
Short-term orthodontic treatments are performed to reposition anterior teeth so that minimally invasive esthetic restoration can be done. The intercanine expansion and incisor proclination performed in this process are inherently unstable, so permanent retention after short-term treatment is emphasized using a removable clear retainer or a lingual bonded retainer. Nocturnal wear of clear overlay retainers (COR) is usually sufficient to maintain orthodontic alignment for the first year after
Restoration Issues
Patients suffering a relapse after short-term cosmetic orthodontics would need to have either another course of orthodontic treatment to restore alignment or undergo a more destructive restorative treatment than was originally needed so that the misalignment relapse would be disguised. If neither course is chosen, the patient will be extremely dissatisfied with the result. If either of the courses is chosen, the patient will be exposed to adverse biologic effects. Patients who undergo
Patient Management Issues
Because of these issues, patients should be given evidence-based information conveyed in a language and manner they can understand about all the possible limitations of the short-term treatment option. Some of the limitations that should be included in this information are the mean finite 10-year lifespan of porcelain veneers, the potential that a third to two thirds of sound anterior tooth substance may need to be removed for veneers or full-coverage crowns, and the possibility that if the
Discussion
When presenting alignment options to patients, practitioners must inform them of what is involved in the procedure itself, what the likely outcome is and whether it will meet their expectations, what risks are involved and what complications may develop both short-term and long-term, how any adverse developments will be managed and paid for, the alternative treatment options, and the consequences should the patient decide to do nothing. They should also inform patients about their
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Chate RAC: Truth or consequences: The potential implications of short-term cosmetic orthodontics for general dental practitioners. Br Dent J 215:551-553, 2013
Reprints available from RAC Chate, Faculty of Dental Surgery, The Royal College of Surgeons of Edinburgh, Nicolson St, Edinburgh, EH8 9DW; e-mail: [email protected]