Tooth movement and alignment not just an issue for the young

This issue of RDH eVillage Focus will highlight Tooth Movement and Alignment. Tooth movement has been long recognized for younger patients but we are seeing more adults undergoing orthodontic treatment for reasons of cosmetics and health. Dental hygienists are instrumental in the process of orthodontic treatment, especially as it relates to daily self care required to maintain optimal oral hygiene and health during orthodontic therapy. The success of orthodontic treatment depends, in part, upon the oral hygiene status of the patient and their active cooperation in the treatment. This issue discusses the Damon System, Myofunctional Research Co., Oral Hygiene Care during Orthodontic Therapy, and the complicated relationship between periodontal disease and orthodontics. We will also briefly discuss short term orthodontic treatment.

One study from Italy reviewed the organization of a dental hygiene program within an orthodontic practice. Before treatment the dental hygienists motivated the patient, taught plaque control techniques, and removed hard and soft deposits. It was suggested that the dental hygienist could systematize the documents necessary to the orthodontist to study the case. The author describes the components of the recall appointment, and suggests technical hints useful for the organization of a maintenance program after treatment.(1) While we do not often see dental hygienists in an orthodontic practice, it is certainly a setting that would benefit form dental hygienists expertise. A dental hygienist in an orthodontic or other practice setting can identify malocclusion, explain the rationale for orthodontic treatment, and the indications and contraindications for such treatment. A dental hygienist can provide patients with accurate information relating to the care and maintenance of the dentition and fixed and or removable appliances, and describe the stages involved in orthodontic therapy. By promoting the oral health of patients undergoing orthodontic treatment, dental hygienists can identify and refer conditions requiring management by an orthodontist or other dental professional. The Six Month Smiles System includes clinical training about short term orthodontic treatment, including case selection and treatment planning which are fundamental components of the clinical training.(2) The company offers OrthoExact tool packages to help dentists begin to use the system. Case Processing Six Month Smiles Patient Tray Kits are the cornerstone of the Six Month Smiles system. Everything needed to treat patients is included in the custom Patient Tray Kit. Bracket specialists strategically position the clear Lucid-Lok brackets on models of patient's teeth. Custom bonding trays are then fabricated and these trays make the "braces on" appointment efficient and stress free. The Patient Tray Kit includes the necessary wires, ties, adhesive and reduction materials that you need for each patient. They also supply marketing materials such as videos, photos, logos, forms, posters, brochures, Before & After photo books, and a sample radio advertisement.Another system, SureSmile, uses advanced 3-D imaging, virtual simulations and robotically bent archwires customized for treatment.(3) When the SureSmile wire is inserted into the brackets, each tooth moves directly to the prescribed position. The teeth do not necessarily move more quickly with SureSmile, but with greater precision. SureSmile QT, brackets and wires are placed on the inside, or lingual side, of your teeth. You’ll receive the precision and accuracy of SureSmile technology without the visible signs of orthodontic treatment. In one study SureSmile patients were treated in less time to better cast/radiographic evaluation (CRE) scores for first-order rotation (AR) and interproximal space closure (IC) but on the average, malocclusions were less complex and second order root alignment was inferior, compared with patients finished with manual wire bending.(4)

Regarding invisible braces, there is Invisalign and ClearCorrect, systems where a dentist or orthodontist can straighten teeth using a series of clear, custom, removable aligners.(5,6) Each aligner moves the teeth a small fraction at a time until the teeth are straight or at the desired end-point. After 3D models and a treatment plan are created, the gradual adjustment begins. The aligners are worn at all times, except while eating and drinking or during self care, and changed about once every two weeks. Invisalign has a Reference Guide for Hygienists and a training DVD: “Educating Patients on Consequences of Malocclusion.” To see the Reference Guide for Hygienists, go to guide.

Orthodontic treatment affects plaque accumulation around orthodontic appliances, primarily around brackets and at the cervical margins of the bands due to difficulty in maintaining optimal oral hygiene. It is of concern to clinicians as these plaque deposits can lead to the development of enamel decalcification and hyperplasic gingivitis.(7) Also, transient bacteremia during the procedures of banding and debanding has been demonstrated in clinical investigations, and this condition can be a risk for the small number of orthodontic patients who are predisposed to a potential endocarditis.(8)

Glass ionomer cements (GICs) are the most frequently used material for band cementation, this material exhibits a continuous release and uptake of fluoride, which has antibacterial activities. However, conventional GICs have an antibacterial effect against a small spectrum of microorganisms and a low bactericide potential. Therefore, GICs may not avoid the plaque proliferation and development of caries and periodontal disease in some patients.

Based on the possibility of obtaining a high antibacterial control around orthodontic bands, the aim of one study was to assess the incorporation of CHD in two commercial brands of conventional GICs through their mechanical properties and antibacterial effects. The addition of chlorhexidine digluconate to conventional GICs does not negatively modify the mechanical properties and may increase the antibacterial effects around the GICs even for relatively long periods of time.

While recently in Ireland, I had the pleasure of meeting Anthony Power from Dentaltech Dental Lab.(9) Anthony explained his lab’s philosophy…”Basically we started doing colored orthodontics as a way to make dentists jobs a little easier when it comes to getting their patients excited about wearing their appliance. By letting the patient choose the color and design of their appliance - it makes them feel like they are getting something that they want. Boys usually pick their favorite team colors and their team emblem - girls like a bit of sparkle and pink (obviously! :) - but they really can have anything they want.” A great way to introduce a bit of fun into the orthodontic process!

I hope you enjoy reading this issue of RDH eVillage FOCUS. Let us here from you with ideas and suggestions for future issues!

References
1. Camorali C. The role of the dental hygienist in orthodontic practice. Prev Assist Dent. 1991 Mar-Apr; 17(2):39-43.
2. www.6monthsmiles.com/pages/dentist_home/the_system.aspx.
3. www.suresmile.com.
4. Timothy J. Alford, W. Eugene Roberts, James K. Hartsfield Jr, George J. Eckert and Ronald J. Snyder (2011) Clinical outcomes for patients finished with the SureSmile method compared with conventional fixed orthodontic therapy. The Angle Orthodontist: May 2011, Vol. 81, No. 3, pp. 383-388.
5. www.invisalign.com.
6. clearcorrect.com.
7. Sehgal VV, Shetty S, Mogra S, Bhat G, Eipe M, Jacob S, Prabu L. Evaluation of antimicrobial and physical properties of orthodontic composite resin modified by addition of antimicrobial agents—an in-vitro study. Am J Orthod Dentofacial Orthop. 2007; 131:525–529.
8. Farreta MM, Martinelli de Limab E, Motac EG, Oshimac HMS, Barthd V, and de Oliveirae SD. Can we add chlorhexidine into glass ionomer cements for band cementation? Angle Orthodontist, Vol 81, No 3, 2011.
9. www.dentallab.ie.

Sincerely,