This document discusses potential iatrogenic effects of orthodontic treatment, including intraoral effects like tooth decalcification, enamel trauma, and interproximal caries. It notes that white spot lesions are a common outcome, with incidence varying based on factors like fixed appliance type, tooth site, and oral hygiene. Prevention methods include patient education, fluoride application, and sealants. Enamel trauma can occur from metal brackets or ceramic brackets abrading teeth, and is prevented through careful positioning and use of smoother materials.

1. Clinical Relevance and Management
IATROGENIC EFFECT OF
ORTHODONTICS

2. Deleterious damage to individual patient as a result of orthodontic treatment
DEFINITION

3. TYPES OF EFFECTS
Intraoral Extraoral Systemic

4. INTRAORAL EFFECTS
Teeth
Periodontium
Soft tissue

5. Crown decalcification
due to attack by acidic by-products of plaque metabolism requires 4 elements:
• Plaque -Strep. mutans count in FA wearers
• Substrate - depends on diet
• Susceptible tooth surface - depends on patient variability
• Time - in contact with tooth surface
TEETH

6. ALSO CALLED
WHITE SPOT LESION (WSL)

8. • Highly variable 50% of patients are found to have at least one white spot
after treatment:
23% on max incisors
6.6% had cavitation
INCIDENCE

9. • Fixed App: Labially
• Removable: Palatally
• Upper canine and lateral, lower premolar and canine most commonly
affected
• May be influenced by dominant hand brushing i.e. in right- handed patient
decalcification occurs on right side through less effective cleaning
SITE

10. • Appropriate patient selection, i.e. exclude patients with poor oral hygiene
monitor patients
education programme:
• Dietary advice
- OH advice
-topical fluoride, only 13% patient comply; daily fluoride
• Mouthwash can decrease prevalence of white spot lesions -other fluoride
sources. e.g. bonding agents, elastomerics, slow release mechanisms - resin
sealants over labial surface
• Chlorhexidine rinses
• Identify, prevent or remove stagnation areas
PREVENTION

11. • Use of glass ionomer cement to bond e.g. Fuji II LC
• Fluoride release from composite resin
• MDPB - antibacterial agent incorporated into resin Compomer
• Removal of archwires for a visit
• Remove appliance (last resort)

14. The problem with RMGS that it has low initial SBS although some studies
have found no significant difference in the bracket failure rate

15. Methacryloyloxy dodecyl pyridinuim bromiide is quaternary ammonium that
has bactericidal effect
MDPB

16. INHIBITION OF PLAQUE FORMATION
IN COMPOSITE CONTAINING MDPB
Control group MDPB containing
composite

18. • Interproximal caries
• Poor oral hygiene
• Long treatment times
• Poor compliance
CLINICAL
PREDICTORS
41%of patients with
initial IPC developed
WSL
11% with no IPS
developed WSL

19. Bitewings seems
to be a good
adjunctive
method
predicting the
risk of WSL

20. WSL
Gorelick et al (1982) classification
• Stage 0 (none)
• Stage 1 (slight rim )
• Stage 2 (broad rim )
• Stage 3 (cavitation )

21. • can resolve to certain extent spontaneously
• acid/pumice microabrasion
• restorative intervention if cavitation ocurred
TREATMENT

22. A conservative procedure uses chemical and mechanical removal of 0.2mm of
the outer layer of the enamel
Hydrochloric acid and pumice
MICROABRASION

23. ENAMEL TRAUMA

24. • Metal brackets - lower 3's brackets can damage cusps of upper canines
during canine retraction
• Ceramic brackets- lower brackets can abrade 21/12
• Damage to enamel when debonding or with burs when debonding and
removing excess composite
• Careless use o f band seater
AETIOLOGY

25. • careful bracket positioning
- removal of certain brackets during canine retraction if necessary
- do not place ceramic brackets on lower incisors in cases with
increased/normal OB
• careful operating, particularly when working on 'risk' teeth e.g. heavily
restored teeth, hypoplastic teeth
• use tungsten carbide burs in slow handpiece to remove composite
care when debonding ceramic brackets
• remove composite around bases before debonding
• ceramic brackets with plastic inserts
• the use of color changing composite for ceramic brackets
• C02 lasers for debonding
• electrothermal debonders can be used
PREVENTION

26. Cordless device that generates heat , the heat is transferred to the bracket
breaking the bracket/adhesive interface
ELECTROTHERMAL DEBONDER

27. a dual color-change adhesive developed by Ormco Corporation which claims
an optimized formulation for esthetic brackets. At cooler temperatures the
adhesive possesses a blue color, which then changes to a translucent color
when the adhesive increases to warmer body temperatures. This color-change
property allows for removal of excess adhesive during bracket placement and
cleanup of the adhesive remnants after debonding once the adhesive is cooled
with air or water
COLOR CHANGE ADHESIVE

29. • AVOIDANCE if possible
• composite restorations on worn cusps/fractured teeth
TREATMENT

30. THANK YOU