The benefits of orthodontic treatment are numerous and in most cases, the benefits outweigh the possible disadvantages. Orthodontic treatment can play an important role in enhancing esthetics, function, and self-esteem in patients. However, it carries with it the risks of enamel demineralization, tissue damage, root resorption, open gingival embrasures in the form of triangular spaces, allergic reactions to nickel, and treatment failure in the form of relapse. These potential complications are easily avoidable by undertaking certain precautions and timely interventions by both the orthodontist and the patient. The orthodontist must ensure that the patient is aware of the associated risks and stress the importance of the patient's role in preventing these untoward outcomes. The decision whether to proceed with the orthodontic treatment is essentially a risk-benefit analysis, where the perceived benefits of commencing treatment outweigh the potential risks. This article provides an overview of the iatrogenic possibilities of orthodontic treatment and the role of the patient as well as the orthodontist in preventing the associated risks.

Background:There is limited data about current utilization of miniscrews in orthodontic practices in India. The purpose of this survey was to obtain information on clinical utilization of miniscrews among orthodontists in India.Materials and Methods:A survey questionnaire was prepared and mailed to 2100 qualified and registered orthodontists in India.Results:A total of 1691 orthodontists responded to the survey, with a response rate of 80.52%. Among them, 952 (56.3%) had never used miniscrews in their clinical practice. Seven hundred and thirty-nine (739) (43.7%) had utilized miniscrews in their treatment, at some point of time. Among the orthodontists who used miniscrews, 463 (62.65%) used a surgical guide for positioning the miniscrews and 276 (37.35%) placed miniscrews without a surgical guide. Six hundred and thirty-four (634) (85.79%) orthodontists placed the miniscrews personally while 105 (14.21%) utilized the help of other specialists for placing the miniscrews. Among the orthodontists who used miniscrews, 76 (10.28%) utilized the help of oral surgeon to place the miniscrews while 29 (3.93%) utilized the help of periodontists to do the procedure.Conclusion:Miniscrews are a useful addition to the orthodontic armamentarium. The major indication for miniscrew was indirect anchorage in critical anchorage cases. The most important factors in determining the clinical utilization of miniscrews as a part of the treatment modality depends upon operator training and skill; fear of complications, patient refusal to accept miniscrews and the clinician's preference for conventional methods without unnecessary invasive procedure.

Orthodontic force elicits a biological response in the tissues surrounding the teeth, resulting in remodeling of the periodontal ligament and the alveolar bone. The force-induced tissue strain result in reorganization of both cellular and extracellular matrix, besides producing changes in the local vascularity. This in turn leads to the synthesis and release of various neurotransmitters, arachidonic acid, growth factors, metabolites, cytokines, colony-stimulating factors, and enzymes like cathepsin K, matrix metalloproteinases, and aspartate aminotransferase. Despite the availability of many studies in the orthodontic and related scientific literature, a concise integration of all data is still lacking. Such a consolidation of the rapidly accumulating scientific information should help in understanding the biological processes that underlie the phenomenon of tooth movement in response to mechanical loading. Therefore, the aim of this review was to describe the biological processes taking place at the molecular level on application of orthodontic force and to provide an update of the current literature.

During application of controlled orthodontic force on teeth, remodeling of the periodontal ligament (PDL) and the alveolar bone takes place. Orthodontic forces induce a multifaceted bone remodeling response. Osteoclasts responsible for bone resorption are mainly derived from the macrophages and osteoblasts are produced by proliferations of the cells of the periodontal ligament. Orthodontic force produces local alterations in vascularity, as well as cellular and extracellular matrix reorganization, leading to the synthesis and release of various neurotransmitters, cytokines, growth factors, colony-stimulating factors, and metabolites of arachidonic acid. Although many studies have been reported in the orthodontic and related scientific literature, research is constantly being done in this field resulting in numerous current updates in the biology of tooth movement, in response to orthodontic force. Therefore, the aim of this review is to describe the mechanical and biological processes taking place at the cellular level during orthodontic tooth movement.

Alcohol containing mouthrinses affect the shear bond strength of the metal orthodontic brackets bonded with composite resin (Transbond XT in the present study), more when compared with alcohol-free mouthrinses. It is, therefore, highly advisable to avoid alcohol containing mouthrinses in patients undergoing orthodontic treatment and use alcohol-free mouthrinses as adjuncts to regular oral hygiene procedures for maintaining good enamel integrity and periodontal health, without compromising the shear bond strength of the bonded metal brackets.