Results of Treatment
Orthodontic treatment usually proceeds as planned,
a
nd we intend to do everything possible to achieve
the best results for every patient. However, we
c
annot guarantee that you will be completely satis-
fied with your results, nor can all complications
o
r consequences be anticipated. The success of
treatment depends on your cooperation in keeping
a
ppointments, maintaining good oral hygiene, avoid-
ing loose or broken appliances, and following the
o
rthodontist’s instructions carefully.
Length of Treatment
The length of treatment depends on a number of
i
ssues, including the severity of the problem, the
patient’s growth and the level of patient cooperation.
T
he actual treatment time is usually close to the
estimated treatment time, but treatment may be
l
engthened if, for example, unanticipated growth
occurs, if there are habits affecting the dentofacial
s
tructures, if periodontal or other dental problems
occur, or if patient cooperation is not adequate.
T
herefore, changes in the original treatment plan
may become necessary. If treatment time is extend-
e
d beyond the original estimate, additional fees may
be assessed.
Discomfort
The mouth is very sensitive so you can expect an
adjustment period and some discomfort due to
the introduction of orthodontic appliances. Non-
prescription pain medication can be used during
this adjustment period.
Relapse
Completed orthodontic treatment does not guaran-
tee perfectly straight teeth for the rest of your life.
Retainers will be required to keep your teeth in their
new positions as a result of your orthodontic treat-
ment. You must wear your retainers as instructed or
teeth may shift, in addition to other adverse effects.
Regular retainer wear is often necessary for several
years following orthodontic treatment. However,
changes after that time can occur due to natural
causes, including habits such as tongue thrusting,
mouth breathing, and growth and maturation that con-
tinue throughout life. Later in life, most people will
see their teeth shift. Minor irregularities, particularly
in the lower front teeth, may have to be accepted.
Some changes may require additional orthodontic
treatment or, in some cases, surgery. Some situa-
tions may require non-removable retainers or other
dental appliances made by your family dentist.
Extractions
Some cases will require the removal of deciduous
(baby) teeth or permanent teeth. There are additional
risks associated with the removal of teeth which
you should discuss with your family dentist or oral
surgeon prior to the procedure.
Orthognathic Surgery
Some patients have significant skeletal disharmonies
which require orthodontic treatment in conjunction
with orthognathic (dentofacial) surgery. There are
additional risks associated with this surgery which
you should discuss with your oral and/or maxillofa-
cial surgeon prior to beginning orthodontic treatment.
P
lease be aware that orthodontic treatment prior to
o
rthognathic surgery often only aligns the teeth
within the individual dental arches. Therefore,
p
atients discontinuing orthodontic treatment without
completing the planned surgical procedures may
h
ave a malocclusion that is worse than when they
began treatment!
Decalcification and Dental Caries
E
xcellent oral hygiene is essential during orthodontic
t
reatment as are regular visits to your family dentist.
I
nadequate or improper hygiene could result in
cavities, discolored teeth, periodontal disease and/
o
r decalcification. These same problems can occur
without orthodontic treatment, but the risk is greater
t
o an individual wearing braces or other appliances.
These problems may be aggravated if the patient
h
as not had the benefit of fluoridated water or its
substitute, or if the patient consumes sweetened
b
everages or foods.
Root Resorption
The roots of some patients’ teeth become shorter
(resorption) during orthodontic treatment. It is not
k
nown exactly what causes root resorption, nor is it
possible to predict which patients will experience it.
However, many patients have retained teeth through -
out life with severely shortened roots. If resorption
is detected during orthodontic treatment, your
orthodontist may recommend a pause in treatment
or the removal of the appliances prior to the com-
pletion of orthodontic treatment.
Nerve Damage
A tooth that has been traumatized by an accident or
deep decay may have experienced damage to the
nerve of the tooth. Orthodontic tooth movement may,
in some cases, aggravate this condition. In some
cases, root canal treatment may be necessary. In
severe cases, the tooth or teeth may be lost.
Periodontal Disease
Periodontal (gum and bone) disease can develop or
worsen during orthodontic treatment due to many
factors, but most often due to the lack of adequate
oral hygiene. You must have your general dentist,
or if indicated, a periodontist monitor your periodon-
tal health during orthodontic treatment every three
to six months. If periodontal problems cannot be
controlled, orthodontic treatment may have to be
discontinued prior to completion.
Injury From Orthodontic Appliances
Activities or foods which could damage, loosen or
dislodge orthodontic appliances need to be avoided.
Loosened or damaged orthodontic appliances
can be inhaled or swallowed or could cause other
damage to the patient. You should inform your
orthodontist of any unusual symptoms or of any
loose or broken appliances as soon as they are
noticed. Damage to the enamel of a tooth or to a
restoration (crown, bonding, veneer, etc.) is possible
when ortho dontic appliances are removed. This
problem may be more likely when esthetic (clear or
tooth colored) appliances have been selected. If
damage to a tooth or restoration occurs, restoration
of the involved tooth/teeth by your dentist may be
necessary.
Headgears
Orthodontic headgears can cause injury to the patient.
I
njuries can include damage to the face or eyes.
In the event of injury or especially an eye injury,
h
owever minor, immediate medical help should be
sought. Refrain from wearing headgear in situations
w
here there may be a chance that it could be
dislodged or pulled off. Sports activities and games
s
hould be avoided when wearing orthodontic
headgear.
Temporomandibular (Jaw)
J
oint Dysfunction
P
roblems may occur in the jaw joints, i.e., temporo-
mandibular joints (TMJ), causing pain, headaches or
e
ar problems. Many factors can affect the health of
t
he jaw joints, including past trauma (blows to the
head or face), arthritis, hereditary tendency to jaw
j
oint problems, excessive tooth grinding or clenching,
poorly balanced bite, and many medical conditions.
J
aw joint problems may occur with or without ortho-
dontic treatment. Any jaw joint symptoms, including
p
ain, jaw popping or difficulty opening or closing,
should be promptly reported to the orthodontist.
T
reatment by other medical or dental specialists
may be necessary.
Impacted, Ankylosed,
Unerupted Teeth
Teeth may become impacted (trapped below the bone
or gums), ankylosed (fused to the bone) or just fail
to erupt. Oftentimes, these conditions occur for no
apparent reason and generally cannot be anticipated.
Treatment of these conditions depends on the partic-
ular circumstance and the overall importance of the
involved tooth, and may require extraction, surgical
exposure, surgical transplantation or prosthetic
replacement.
Occlusal Adjustment
You can expect minimal imperfections in the way
your teeth meet following the end of treatment. An
occlusal equilibration procedure may be necessary,
which is a grinding method used to fine-tune the
occlusion. It may also be necessary to remove
a small amount of enamel in between the teeth,
thereby “flattening” surfaces in order to reduce the
possibility of a relapse.
Non-Ideal Results
Due to the wide variation in the size and shape of
the teeth, missing teeth, etc., achievement of an
ideal result (for example, complete closure of a
space) may not be possible. Restorative dental
treatment, such as esthetic bonding, crowns or
bridges or periodontal therapy, may be indicated.
You are encouraged to ask your orthodontist and
family dentist about adjunctive care.
Third Molars
As third molars (wisdom teeth) develop, your teeth
may change alignment. Your dentist and/or ortho-
dontist should monitor them in order to determine
when and if the third molars need to be removed.
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