This is something to always be mindful of when doing orthodontics in the mixed dentition. The patient could ultimately lose teeth because of this. This sort of error can lead to the same result seen in Figure 2. If done improperly, the roots of the maxillary lateral incisors can be forced into the hard enamel crowns of the erupting permanent canines. This is often used to correct an anterior crossbite in the mixed dentition. A 2x4 typically means the placement of orthodontic brackets on both first molars and the four incisors in the same arch. Now imagine an orthodontic setup commonly called a 2x4 (figure 3). This was caused not by orthodontics but by the erupting canines. Notice the resorption on the roots of the maxillary lateral incisors in Figure 2. Because of this, I take panoramic x-rays every six to eight months in my practice.ĪDDITIONAL READING | Maxillary expansion or bicuspid extraction: A case study in orthodontics Root resorption can be evident radiographically in as little as six months of orthodontic treatment. While it is common in general dentistry to take panoramic x-rays every five years, this is too long for patients in orthodontic treatment. I recommend panoramic radiographs for this purpose.

Any orthodontic treatment should include pretreatment and post-treatment radiographs that allow visualization of the roots. Regarding root resorption, it is essential to take radiographs. It is important to document the state of the patient prior to treatment. These include photos, x-rays, and diagnostic models. While there are theories about what causes the roots of some patients to resorb more than others, there is no reliable way to predict root resorption.īefore you begin treatment, take records. If the roots become too short, the teeth can obviously become mobile or even be lost. However, some patients react more severely. In most cases, it is so insignificant that it is hardly-if at all-noticeable on successive x-rays. Root resorption (figure 1), or shortening of the roots, occurs in almost every case of orthodontic tooth movement. In this article, I will discuss the first- root resorption.

White spot lesions (also known as decalcification).

Other than death, what will cause an orthodontist to lose sleep? Four things top the list: Always make sure to check the medical history.

While treatment may have gone horribly awry, if your patient dies due to orthodontic treatment, that is the worst possible outcome. What is the worst thing that could happen? The answer, of course, is death. What good does it do to straighten teeth if in doing so you cause the patient to lose them? The point of this article is not to scare or deter you from engaging in orthodontics, but to give you a foundation that will protect both you and the patient.ĪDDITIONAL READING | Orthodontic case study using the Differential Straight-Arch Technique yields remarkable results without surgery, extractions, or headgear In other words, before you do anything to a patient, make sure that you are not making matters worse. While not specifically in the Hippocratic Oath, primum non nocere is believed to be derived from it and means first, do no harm or above all else, do no harm. I structure this education so that the learning experience will be rewarding rather than punishing, so with that in mind, I begin instruction for each new class of residents with the Golden Rule of Orthodontics: Primum non nocere. I find that orthodontics is a topic that most of my residents are eager to learn about.

'My body is eating my tooth?!' Can this be prevented? The answer is yes, by following the Golden Rule of Orthodontics.Īs chief of orthodontics at NYU Lutheran Pediatric Dental Residency and at Rady Children’s Hospital–San Diego, I regularly provide didactic and clinical instruction to nonorthodontic residents. Editor’s note: There is nothing worse than telling patients in ortho they are going to lose their tooth due to root resorption, because what you say and what they hear are two different things.

2x4 braces