Particularities of the orthodontic treatment

Malocclusion is the third place in the oral diseases, the occurrence of occlusal anomalies varies between 11 al 93%; the complications that it brings could be: psychological derived from the alteration of the dentofacial aesthetics; oral function problems, including difficulties in the mobility of the jaw, pain or disorders in the temporomandibular joint and problems to chew, to swallow or to speak; and finally, problems of major susceptibility to traumatism, periodontal diseases or dental decay (Proffit, 2008; Sidlauskas & Lopatiene, 2009).

The orthodontic treatment can correct orofacial alterations, which can influence the patient's psique and social integration of the same one. Importantly, the face, the smiles and the teeth are part of the first impression of another person (Trulsson et al., 2002).

The purpose of the orthodontic treatment is to move the tooth as efficiently as be possible with the minimum of adverse effects to the tooth and the support tissues.

The requirements before initiating an orthodontic treatment are:

• Enough bone support (generally two thirds of the length of the root).

• To be sure that the occlusion will be stabilized at the ending of the treatment.

• The patient must have good health.

• The patient must be motivated and cooperator.

When placed fixed appliances, besides the brackets, the orthodontic technique use other attachments as: bands (actually preformed), wires, springs or buttons.

The length of orthodontic treatment with fixed appliances has approximately 13-15 months; nevertheless, factors so far linked to increased treatment duration include anatomy, malocclusion, direction growth, molar class, extractions, use of fixed appliances in both arches, and others (Turbill et al., 2001).

Patients who undergo orthodontic therapy have oral ecologic changes because increased retentive sites for retention of food particles, which allows the bacterial growth.

Lesions developed during orthodontic treatment could be radicular resorption, gingival recession and increase of caries risk and periodontal diseases. The enamel decalcification is one of the most common and undesirable complications of the orthodontic therapy. Some authors (Chang et al., 1999; Heintze, 1999; Zárate et al., 2004) show increase of decalcifications or white spot lesions in patient on treatment.

Demineralization of the enamel around brackets can be an extremely rapid process, which appears most frequently on the cervical and middle thirds of the buccal surfaces of the maxillary lateral incisors, mandible canines and the first premolars. The prevalence of new enamel lesions in orthodontic patients treated with fixed appliances and using fluoride toothpaste is reported to be 13 to 75 % (Derks et al., 2007).

We can find periodontal alterations after orthodontic treatment such as: generalized gingivitis after bonding and light lost of alveolar bone level and of epithelial insertion (Bollen et al., 2008).

It seems, that the bone lost could be more serious when more complex and extensive will be the orthodontic movement.

That is the reason because the maintenance of an effective oral hygiene is critical during the treatment.

We can considerate the next preventive measures in orthodontic patients:

• To evaluate the toothbrushing technique.

• To avoid the cariogenic diet.

• To evaluate the periodontal conditions during the treatment.

• To establish a continuos motivation for the oral care.

When we do a good orthodontic treatment and with a correct regime of oral hygiene, we do not have important periodontal complications.

It has been demonstrated that children who receive orthodontic therapy, at the end of this treatment, presents lower dental plaque levels and gingival bleeding that children who did not receive treatment; it could be because they have better dental alignment, but also to that the subjects modify his oral personal hygiene and attitude (Gwinnett & Ceen, 1979).

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