ODF interrelations (PARO- Prosthesis- OCE)
- Introduction
Dentofacial orthopedics is a discipline that consists of correcting jaw malformations through orthopedic action, as well as dental malpositions through orthodontics, in order to restore the patient’s functional and aesthetic dentition and to allow harmonious growth of the face and dentition to promote correct development of orofacial functions (Bassigny and Canal, 1983).
Orthodontics alone will not be able to achieve these objectives; for this it will need the support of other dental specialties.
- ODF-Periodontology interrelationships:
- Contribution of orthodontics to periodontal therapy
Prevention of periodontal disease
-Orthodontic correction of versions and rotations allows, in addition to the realignment of crowns, the realignment of epithelial attachments making hygiene maneuvers easier and more effective. Orthodontics promotes plaque control and thus contributes to the prevention of periodontal diseases.
-It corrects migrations secondary to periodontal diseases (vestibuloversions and secondary diastemas in the anterior maxillary sector, mandibular incisor egression).
– Repositioning of the alveolodental complex :
*Overbite: It causes lesions at the level of the epithelial attachment of the lower vestibular and upper palatal gum. Orthodontic correction by intrusion is considered the primary treatment of periodontal lesions.
*Anterior crossbite: Traumatic (periodontal injury) requires orthoperiodontal treatment
*Recession: Repositioning the alveolar-dental complex in the area of muscular balance treats gingival recession caused by intense muscle pressure.
-The movement of the tooth with its periodontium causes a (real) periodontal remodeling, which allows the regeneration of the alveolar bone: orthodontic egression
– Reduction of horizontal alveolysis by orthodontic intrusion in order to increase root support.
-Prevent and treat the loss of interdental papilla
-The use of proximal enamel reduction modifies the general shape of the teeth. The orientation of the proximal faces is then made less divergent with, as consequences, on the one hand, a gain in space which allows the correction of crowding without significantly separating the roots and, on the other hand, to avoid moving the contact point:
-removal of trauma by orthodontic treatment allows faster healing of the periodontal lesion.
- Contribution of periodontics to orthodontic treatments
A/ before orthodontic treatment
-Periodontal surgery can, at any time, be included in the orthodontic treatment plan to optimize it, by preventing, helping or correcting, and finally ensuring the sustainability of the results obtained.
-Sanitation of the periodontium before orthodontic treatment:
-Moving teeth with congestive periodontal disease may cause bone loss or worsen gum recession.
Therefore, pre-orthodontic suppression of periodontal inflammation becomes necessary:
-Patient motivation and hygiene advice
-Scaling and root planing.
-Maintenance
– Sanitation surgery : In the presence of residual periodontal pockets greater than 5 mm and alveolysis greater than 50% of the root height , periodontal surgery interventions, such as mucoperiosteal sanitation flaps and aesthetic access flaps in the anterior sectors, will be carried out before orthodontic treatment,
– Mucogingival surgery . The improvement of mucogingival conditions, a problem frequently revealed during the initial orthodontic examination, is due to the shortness of the attached gum, by its thinness or its inexistence. Vestibular deepening techniques, gingival grafts will make orthodontic treatment safer.
-Frenectomy/labial frenotomy: it is indicated when the medial labial frenulum is inserted near the gingival crest resulting in a positive gingival traction test
-Lingual frenectomy: indicated in the case of a short lingual frenulum favoring its low position.
B/During orthodontic treatment
-Dental plaque control
-Correction of gingival hyperplasia: the aim of which is to remove the tissue obstacle by giving the gum a regular appearance
-Reassess the risk of gum recession occurring
C/After orthodontic treatment
– Circumferential supracrestal fibrotomy: the aim of which is to minimize the risk of recurrence of rotations under tension of the cemento-gingival and transseptal fibers.
This fibrotomy is generally performed 3 to 6 months after complete correction of a rotation
-Treatment of gum recession
– Surgery of impacted teeth: Orthodontic periodontal surgery allowing the placement of impacted teeth on the arch is one of the many
illustrations of the close and complementary relationships between periodontics and orthodontics.
-Coronary elongation by gingivectomy in the case of persistence of the gummy smile at the end of orthodontic treatment.
- ODF-OCE Interrelations
- Dental injuries caused by orthodontic appliances
Due to their prevalence and rapidity of appearance, “white spots” are among the major iatrogenic effects of orthodontic treatments.
It is the orthodontist’s responsibility to take all necessary measures to prevent or limit their development.
Prevention:
* Before orthodontic treatment: it will be necessary to carry out
-Care for all cavities,
-Treatment of pulp pathologies of carious origin,
-The restoration of the anatomical and functional integrity of the teeth used as support by orthodontic treatment,
-Preventive fillings of grooves, pits and fissures of all permanent teeth.
*During orthodontic treatment: it will be necessary to carry out:
-Patient motivation for good oral hygiene.
-Precise adaptation of the rings.
-A check-up of the teeth wearing the braces (resealing) at regular intervals of 6 months to a year.
-Limitation of the duration, surface area and number of applications of orthophosphoric acid.
-The use of bonding means without demineralization
prior enamel (glass ionomer) especially in patients with weakened enamel.
– For stripping it must be followed by a good polishing, avoiding excessive enamel reductions (0.3 to 0.4 mm at the anterior level and 0.6 mm at the posterior level)
*After orthodontic treatment: it will be necessary to carry out:
-Polishing of dental surfaces;
-Looking for possible cavities
– Fluoride prevention: Using a fluoride toothpaste twice a day allows remineralization after 2 months.
3.2 Contribution of the ODF to the OCE:
For the dentist to successfully create restorations that mimic natural anatomy, the restoration space must be sufficient in all 3 dimensions. The goal of orthodontic treatment will be to create an ideal anatomical space to accommodate the planned restorations such as:
-Opening space for the restoration of a rice grain lateral incisor.
-Closure of spaces in the case of agenesis of the laterals.
-The intrusion of an overbite tooth to allow its reconstruction.
-The unwinding of obstructions to facilitate access to a carious dental surface
-If there is subgingival root destruction, orthodontic egression will allow the healthy root part to be recovered.
-If a tooth has suffered a crown fracture, the cervical limit of the crown reconstruction may not be able to be achieved properly. Egression will allow access to it.
-Orthodontics and its role in the prevention of dental trauma: The treatment of cl II/1 or upper proalveoli in orthodontics helps to reduce dental trauma due to the exposure of the upper incisors.
3.3 Contribution of conservative dentistry to orthodontic treatment: The odontologist’s role will be to:
-Care for all decayed teeth before fitting, even if it is at the non-painful stage;
-Reconstruct the dental surface with ceramic composite in cases of dwarf teeth;
-Perform coronoplasties on canines in the case of agenesis of the lateral incisors;
-Reconstruct teeth affected by fractures.
-When there is an endo-periodontal lesion, endodontic treatment is part of the initial preparation
-In the case where the egression of a tooth is indicated for
arrange the periodontal architecture, its realization may require the grinding of a significant part
of the crown so as not to cause unacceptable over-occlusion. Prior endodontic treatment is therefore necessary here to allow coronal grinding.
- ODF-Prosthodontics interrelationships
- Contribution of ODF to the prosthesis
When the prosthesis is not functionally and aesthetically feasible due to the presence of dento-alveolar or skeletal dysmorphosis, orthodontics intervenes to correct these anomalies and allow prosthetic restorations.
-Straightening of dental axes: in order to obtain parallelism of the root axes, which will allow:
-To save tissue when cutting and to make prosthetic crowns in the axis of the tooth.
-To facilitate the insertion of removable prostheses
Example: Mesioversion of the second mandibular molar, a classic sequela of uncompensated premature extraction of the first molars, causes:
- periodontal lesions with a more or less hemorrhagic roll-like appearance, mesial root intrusion and periodontal pocket formation
- Occlusal trauma and loss of vertical dimension Orthodontic treatment aims to reopen the space that has become insufficient to place the prosthetic element and to straighten the axis, making it possible to limit coronal preparation (tissue saving) and the masticatory forces will no longer be harmful because the force transmission is done in the axis of the tooth
-Pre-implantation preparation:
-Open a space to place one or more implants
– Move the roots away from adjacent teeth (at least 7mm)
-Move a tooth to a thin bone crest (where it is not possible to place an implant ) and thus free up sufficient space for the latter (where the bone crest is wider);
-Completely extrude a root with an infra-bony pocket, then extract it to leave a flawless bony crest.
-Correction of dental extrusions: In the case of indentation, the adjacent teeth can tilt and the opposing one can egress, thus creating occlusal interferences preventing the creation of a functional prosthesis. Orthodontics aims to ingress and straighten the teeth during leveling.
-Correction of DVO losses: Posterior edentulism is responsible for the collapse of the DV with occlusal overload at the anterior level, thus giving vestibular versions with diastemas and loss of anterior guidance. The objective of the treatment is to restore the DVO by replacing the missing teeth and straightening the tilted teeth. Normalize the incisor relationships and restore functional anterior guidance in order to receive a retention or replacement prosthesis.
- Contribution of the prosthesis to the ODF
-Prosthetic reconstruction in children: Their aim is to maintain masticatory, aesthetic and phonetic functions as well as to maintain the arch length and the vertical dimension of occlusion.
-Prosthetic reconstruction in adults; Agenesis of the lateral incisors.
– Prosthetic retention
- Conclusion :
The orthodontist, periodontist, odontologist, prostodontist and other specialists must join forces to achieve a common goal. The work of each practitioner must facilitate and complement that of the other. Orthodontics alone cannot correct all malocclusions and dysmorphoses. In turn, other disciplines also need orthodontics to achieve the goals of oral cavity rehabilitation.
ODF interrelations (PARO- Prosthesis- OCE)
Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.