Potential risks of orthodontic therapy: a critical review and conceptual framework

Abstract

This review examines some of the potential risks of orthodontic therapy along with their evidence base. The risks of orthodontic treatment include periodontal damage, pain, root resorption, tooth devitalization, temporomandibular disorder, caries, speech problems and enamel damage. These risks can be understood to arise from a synergy between treatment and patient factors. In general terms, treatment factors that can influence risk include appliance type, force vectors and duration of treatment whilst relevant patient factors are both biological and behavioural. Hence, the natural variation between orthodontic treatment plans and patients gives rise to variations in risk. A good understanding of these risks is required for clinicians to obtain informed consent before starting treatment as well as to reduce the potential for harm during treatment. After considering each of these risks, a conceptual framework is presented to help clinicians better understand how orthodontic risks arise and may therefore be mitigated.

Relationship between orthodontic treatment and dental caries: results from a national survey

“…Early dental caries, called white spot lesions, is the best known form of caries associated with orthodontic treatment 22 . Although the reported prevalence rates of dental caries in patients who receive orthodontic treatment vary widely 8,14,23 , younger patients are more likely to develop dental caries because of their immature tooth enamel and lack of appropriate oral hygiene 3,22 . A previous study 24 found that the prevalence of orthodontic treatment-related dental caries was higher in male patients than in female patients, while another study 22 found no significant sex-related difference.…”

“…However, orthodontic treatment can have undesirable consequences, including periodontal disease, root resorption, tooth devitalisation, temporomandibular disorder, caries and damage to enamel 2,3 . However, orthodontic treatment can have undesirable consequences, including periodontal disease, root resorption, tooth devitalisation, temporomandibular disorder, caries and damage to enamel 2,3 .…”

“…A meta-analysis, based on the results of 14 relevant studies, revealed that the incidence of newly developed dental caries lesions during orthodontic treatment was 45.8% 15 . In another review article, the authors reported orthodontic treatment to be a risk factor for dental caries, especially in younger patients 3 . They emphasised that clinicians should educate patients about prevention of dental caries before orthodontic treatment is initiated and should not recommend orthodontic treatment to patients who are not motivated to perform good dental hygiene.…”

“…The aims of orthodontic treatment in patients with malocclusion are to improve the aesthetics of the oral and maxillofacial area and to optimise masticatory function by changing tooth alignment 1 . However, orthodontic treatment can have undesirable consequences, including periodontal disease, root resorption, tooth devitalisation, temporomandibular disorder, caries and damage to enamel 2,3 . Dental caries that develop in patients who have received orthodontic treatment can cause inefficient mastication as well as premature tooth loss, thereby impacting quality of life 4,5 .…”

Comprehensive Treatments for Congenitally Missing Teeth and Generalized Diastema

“…However, orthodontic treatment can cause some potential risks and complications, because teeth undergone orthodontic movement may have resorption of cementum and dentine [13]. On the other hand, in some patients, it is impossible to insert even SDIs after orthodontic treatment because of the apices of the adjacent teeth roots.…”