Dentistry Specialists talk about Traditional Orthodontics and Short-Term Orthodontics for Adults

 

The 21st century client requires evidence based treatment.

Nowadays orthodontics is different from the orthodontic treatment of the last century in three fundamental aspects:

1. Teeth and facial appearance is emphasized more than ever before. Psycho-social problems concerning the appearance have considerable influence over the quality of life of an individual, which is reflected by parents and adults interest in orthodontics regarding the appearance.  Recently, the orthodontic research has revealed that 80 percent of patients visit the orthodontist not because of a perfect bite, health and good teeth contacts, but to improve smile esthetics (Albino et al., 1981).

2. Patients are taking an active role in treatment planning. Currently, a client is not satisfied with a ‘paternalistic’ doctor who just specifies what treatment the patient needs. Informed 21st century patient chooses himself/herself the clinic in which he/she can participate in selecting treatment possibilities and alternatives.

3. Orthodontics for adults – a stage of interdisciplinary treatment. Together with other dental and medical fields, orthodontics is applied much more often to adult patients. The aim of the orthodontic treatment is not necessarily the best possible occlusion (teeth bite) or facial esthetics, but also teeth preservation, their long-term retention and treatment duration. Thus, the orthodontic treatment is being integrated into restorative dentistry that E.H. Angle (a father of modern orthodontics, the USA) was tended to separate in his teaching.  .

 

 

V.G.Kokich (The USA, 1944-2013), one of the most renowned specialists of the modern orthodontics, in the Article ‘Who determines when orthodontic treatment is complete?’ [1] that was published in the leading orthodontic magazine AJO-DO, comes to the conclusion: ‘The lesson to be learned is that the restorative dentist should help to determine when orthodontic treatment is complete’

DO NO HARM (Lat. PRIMUM NON NOCERE)

Seeking to achieve ideal occlusion in cases of teeth crowding, the majority of older generation traditional orthodontists still recommend the extraction of 2-4 premolars in order to make space for other teeth. Recently, in the West European countries the teeth extraction has been rejected by the modern orthodontists since:

1. Usually completely healthy teeth are extracted;
2. Teeth arches become narrower;
3. Oral cavity becomes smaller;
4. The amount of air and simultaneously oxygen accessing blood decreases, which provokes the occurrence of arterial hypertension, cardiovascular diseases and worsens cognitive functions;
5. Molars in the back do not have proper contacts and that may cause a temporomandibular joint dysfunction, especially for women;
6.  Facial profile changes, face acquires ageing characteristics, etc.
The courses for orthodontists in the USA and the UK have already taken place on how to expand such narrowed jaws again, place implants into the site of extracted teeth and make prosthetic crowns.

In the short-term orthodontic therapy Six Month Smiles (STO), in clinical cases of extreme teeth crowding, one of the lower front teeth is extracted instead of premolars.

Even though STO is limited by its short treatment time, this limited orthodontic treatment also has its advantages, which are not only esthetic ones. Applying the principle ‘Function  follows form’, teeth positioned harmoniously in teeth arches also improve the function. The curve of Spee improves; teeth rotations are reduced, contacts between the teeth and crown inclination improve.

 

Before and immediately after esthetic restorations/reconstructions:
direct and indirect esthetic restorations

1. BEFORE and AFTER direct restorations

The client has refused the orthodontic treatment and her front teeth were ‘aligned’ with direct esthetic restorations in one visit. In the case of teeth alignment by such method, it is necessary to cut off a part of the healthy teeth which is misaligned.

2. BEFORE and AFTER indirect restorations with ceramic veneers

The client has refused the orthodontic treatment, thus her front teeth were ‘aligned’ with indirect esthetic restorations using CEREC technology in one visit. In the case of teeth alignment by such method, it is necessary to cut off a part of the healthy teeth which is misaligned.

If a dentist refuses to ‘cut off, extract or devitalize the teeth’, due to different reasons patients often decide to ‘better do nothing than wear braces’ and because of poorer appearance they live with psycho-social  problems which have influence over their self-feeling and social behavior.

Currently, there is an additional dental service in the World, a Short-Term Orthodontic treatment Six Month Smiles (STO) which an adult client may or may not choose. Here is an example.

 

3. After the extraction of teeth and direct esthetic restorations

In 2009 a patient NB from Lithuania who resides abroad came to VivaDens complaining about
a palatal position of #12 and #22 teeth. Having categorically refused the traditional comprehensive orthodontic treatment
and due to the absence of STO at that time by the patient's request two lateral incisors were extracted and
applying direct restorations, the teeth were fixed to neighboring teeth.
The patient was informed about possible the short-term treatment result.

 

In 2012, the patient's AB brother NB, who resides in Norway, came to VivaDens with request to align his teeth using the same method as for his sister. Similarly, he categorically refused the traditional comprehensive orthodontic treatment and asked to extract palatally positioned #12 and #22 teeth and make the bridge prosthesis for his #13-11 and #21-23 or likewise. After reasoned argumentation the man agreed to undergo STO treatment and was very satisfied with anticipated and received result.

4. Client's AB smile BEFORE and AFTER 7-month STO, restoration of incisal edges of 11-21 teeth and teeth whitening procedure

Given the real situation and acknowledging the right of choice of the informed client, STO with improvement of occlusion and further restorative procedures is a non-rejectable alternative and nearly always better than teeth drilling, extraction or absence of any treatment.
Of course, the traditional comprehensive orthodontics has its positive sides which explicitly need to be presented to a client, its novelties should be compared with results of other types of orthodontics, however, the informed client of the 21st century, who travels freely throughout the World, has his/her final right to choose.

5. STO – the first stage of complex interdisciplinary treatment – teeth position is improved

Short-term orthodontic treatment has its criteria according to which patients are selected whether they are suitable candidates for STO treatment [2]. The clients, especially while they are less aware of STO results, are provided with detailed information about the treatment possibilities, alternatives, risks and complexity.

STO is simpler and shorter orthodontic treatment compared with the traditional comprehensive orthodontics. It is applied for reduction of crowded teeth, corrections of gaps and teeth position in dental arch as well as for space preparation for implantation. During STO the deep bite might be corrected (possibilities for prosthesis are introduced without lengthening dental crowns periodontologically and periodontal structures are preserved), gingival contour is improved according to the principles of esthetics. After STO there is no need to drill dental enamel and worn biting edges are restored by direct composites, this way creating more perfect esthetics. Such method with similar quality of result is cost-effective and helps to preserve hard teeth tissues and periodontal tissues. The clients are pleased with minimally invasive treatment protocol.

 

6. STO is a link of complex inter-disciplinary treatment which helps to preserve hard teeth and periodontal tissue. Minimally invasive treatment protocol is greatly appreciated by clients.

All STO clinical cases of Angle I class are fully treated by articulating the occlusion in this manner: the posterior teeth hold the Shimshtok’s articulating paper in the habitual intercuspidation, canine- guided bite is created, and central line is corrected.

During the majority of Angle II class cases the occlusion is opened, inclined upper incisors are repositioned, space for mandible protrusion is created and orthodontic elastics are prescribed for occlusion correction. STO patients are strongly motivated, thus, particularly good treatment results are achieved with orthodontic elastics.

7. BEFORE and AFTER 5-month STO

 

STO corrects completely the marginal Angle III class occlusion with a frontal cross-bite. Also posterior teeth are positioned into the correct occlusion.

8. BEFORE and AFTER 8-month STO

All the other children and teenagers under 16 years of age, who have complex occlusion problems, and also orthognathic patients are referred to the traditional orthodontists for more complex orthodontic treatment.

 

Sequence of arch wires. The protocol of changing STO arch wires is the same as in the traditional comprehensive orthodontics. The arch wires are changed every month in turn: 012NiTi, 014NiTi, 016NiTi018NiTi, and 016x022NiTi. Treatment control is carried out according to the protocols recommended by the traditional orthodontics, periodontal pockets are examined before the treatment, orthopanthomogrammes  are made before and after the orthodontic treatment, also, the condition of dental hygiene and carious lesions are monitored. Professional dental hygiene is performed before STO, 3 months after STO starts and after the removal of braces.

References:

1. Kokich VG. Who determines when orthodontic treatment is complete? Am J Orthod Dentofacial Orthop 2011;140:451).
2. Ryan B. Swain, DMD. The Six Month Smiles System. Complete training manual for general dentists. Revised 3rd edition. 2011
3. Maltagliati L, et al, Avaliacao da prevalencia das seis chaves de oclusao de Andrews, em jovens brasileiros com oclusao normal natural. Revista Dental Press de Ortodontia e Ortopedia Facial, 2006. 11(1)
4. Doshi-Mehta G, Bhad-Patil WA. Efficacy of low-intensity laser therapy in reducing treatment time and orthodontic pain: a clinical investigation.Am J Orthod Dentofacial Orthop. 2012 Mar;141(3):289-97
5. J.P. Okeson. Management of Temporomandibular disorders and Occlusion, 3rd edition: 109-125, 1992, Mosby.
6. Becks H, Cowden R. Root resorption and their relation to pathologic one formation. Am J Orthod oral Sur 1942:28:513-26.