Understanding the potential risks of malocclusion can reinforce the fact that many times orthodontic treatment can benefit a patient’s overall oral health and general wellbeing rather than aesthetics alone.
As a dental professional, you know crowded teeth can make it harder to reach the interproximal areas and lack of brushing and flossing will result in inter-proximal caries. However, most patients do not realize that poor tooth alignment is one of the leading factors in major dental problems. Additionally, over a sustained period of time a biofilm will easily form in these areas which can contribute to gingivitis and even further, periodontal disease.
Below is a case example that proves correction can be more than what meets the eye.
Gabe presented to the clinic motivated by correcting his front teeth. In particular, Gabe wished the lower teeth didn’t overlap and, overall a better smile!
From the initial records you can see that due to the amount of crowding, it is hard for Gabe to floss and clean in between the lower anterior teeth. The GDP diagnosed a fair amount of interproximal caries, along with gingivitis. Therefore, the aims of the treatment prescription were:
Upper arch: relieve crowding via proclination of the upper incisors. Proclination will also help in correcting the CL 3 incisor relationship.
Lower arch: Any proclination of the lower incisors which will affect the patient’s occlusion and increase the CL 3 incisor relationship; therefore, heavy IPR was prescribed-maximum IPR (.5mm). Lastly, use of distal bodily movement of the premolar will allow for further space creation to align the lower incisors.
Ideally, the use of class 3 elastics would be employed; however, due to loss of the UL6 we are unable to use elastics in this particular instance unless worn to the UL5 (which is plausible in many cases). Furthermore, elastics can have a tendency to extrude the teeth the buttons are connected to and with an open bite tendency (as in this case)- caution should be taken to mitigate this risk.
“The patient must be aware that his dental midlines will be improved but there is no guarantee that they will be 100% coincident at the end of treatment.”
“Encourage the patient to use chewies or other rubber bite pellets several times a day for 5-10 minutes.”
“I would consent the patient for a reduced overbite and overbite. Despite our best efforts with IPR, this is a challenging case in terms of achieving a good end result, as we cannot use class 3 elastics to aid in correcting the occlusion.”
At the refinement; you can see significant improvement in the lower anterior alignment, which in turn improved the gingival health. Additionally, given the improvement in the position of the upper anterior teeth, you can appreciate the reduction in recession on the UL1. At this stage, Gabe loved the alignment on the lower and therefore; no further treatment was prescribed for the lower arch. However, on the upper, you can appreciate that the U2s can benefit from some further de-rotation.
Not to mention, Gabe reported improvement in his home care routine as the contacts are now easier to reach!
While this case is still ongoing, this is an example of how correcting the alignment can help solve a patient’s general oral health complications such as tooth decay, halitosis, gingivitis and gingival recession. Day by day as the teeth align the patient will be able to reach areas where it used to be impossible to brush & floss.