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Limitations of Ortho (4| Therapeutic (Smile esthetics
Gingival margin…
Limitations of Ortho
4| Therapeutic
Smile esthetics
- Gingival margin (Intrusion > Gingivectomy/Crown lengthening)
- Tooth proportions (Canine substitute #2 / Peg)
-
-
TMJ
- Ortho does not cause TMD
- Ortho does not cure TMD
Specific cases :check:
- Ankylosis
- Primary failure of eruption
- Severe impaction
1| Anatomical
Alveolar ridge
- Space
- Thickness
- No early extraction
Soft tissue
- Gingival
- Fenestration/Dehiscence (BL ridge <2/3 of tooth to be moved)
Skeletal discrepancy
- AP discrepancy
- V discrepancy
3| Mechanical
Anchorage
- Teeth
- Bone (TAD)
- Aligners
Appliance
- Fixed/Removable/Partial/Full
Habits
- Thumb sucking
- Forward tongue posture
- Mouth breathing
2| Physiological
Systemic
- DM (rapid loss of bone)
- Juvenile RA (deficiency on one side)
- Acromegaly (>GH, prognathism)
- Pregnancy (Root resorption, radiograph, perio)
Growth
- Growth modifications
- Surgery
- Late mandibular growth
Medications
- Anti-prostaglandins (NSAIDs, Steroids, slow movement)
- Bisphosphonates
Questions
- What to do with patients with reduced arch length
- Proclination of incisors
- Expansion (maxillary sutures)
- Distal movement of molars
- Enamel stripping
- Extractions
- In orthodontic movements alone, where can space be created in transverse plane
- Anterior vs Posterior (Inter-canine fixed)
- Maxillary vs Mandible (Maxillary suture)
Risks in Ortho
- Perio: Gingi (Most common), Dehescience
- OD
- Endo: Devital (Hx of trauma)/resorption (inevitable)
higher risk for maxillary incisors
- OS: Injury/TMD
- Relapse