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105- Risks and Complications Associated
with Orthodontic Treatment
Awatef SHAAR (BAU-LB), Orthodontist.
Mohamad ABOULNASER- Orthodontist, BAU, Connecticut, USA.
Oussama SANDID- Orthodontist, D.C.D., D.U.O, C.E.S.B.B, C.E.S.O.D.F ,
S.Q.O.D.F, Paris. France.
Contact: dr.aboualnaser@hotmail.com
The Adverse Effects of Orthodontic
Treatment
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1- Tooth Decay and Enamel Decalcification
2- Periodontal Disease
3-External Apical Root Resorption
4-Patient Injuries from Orthodontic Appliances
5- Pain and Discomfort
6- Length of Treatment may vary from Estimate
7- Nickel Allergy
8- Temporo- Mandibular Joint Disorders may Occur
9- Aspiration or Ingestion of Orthodontic Appliances
- Injury from Dental Instruments
10- Post Treatment Changes in Alignment
- Abnormal Wear of Tooth Structure and Debonding Fractures
- Bacteremia after Orthodontic Banding
- Impacted Teeth 3rd Molars may Still Occur
- Tooth Mass Discrepancies may not be Resolved
- Extraction of Teeth and Supplemental Orthognathic Surgery may be Necessary
- Abnormal Growth Patterns of the Jaws
- Teeth with Questionable Vitality may be Adversely Affected
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
1- Tooth Decay and Enamel Decalcification
Toothbrushing problems.
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
2- Periodontal Disease
Toothbrushing problems.
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Solution: Tooth Brushing
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
2- Periodontal Disease
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
2-Periodontal – Recession
inclination of
mandibular incisors during orthodontic treatment.
Before trt
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After trt
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Crestal bone loss occuring with orthodontic treatment
associated with poor oral hygiene
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Periodontal – Recession
inclination of
mandibular incisors during orthodontic treatment.
www.orthofree.com
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
inclination of
mandibular incisors during orthodontic treatment.
www.orthofree.com
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
3- External Root Resorption- caused by orthodontic
treatment
Root resorption are associated with risk factors related to the orthodontic treatment such as the
duration of treatment, the magnitude of the force applied, the direction of the tooth movement, the
method of force application , the orthodontic movement. Patient-related risk factors are the individual
susceptibility on a genetic basis, some systemic diseases, anomalies in root morphology, dental
trauma, and previous endodontic treatment.
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Apical Root Resorption During Intrusion of Upper Incisors
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Continuous forces and resorption
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Brackets-Positioning Errors:
Extrusion-Intrusion-Root proximity
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Brackets-Positioning Errors:
Extrusion-Intrusion - Root proximity
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Root proximity is a major factor for screw
failure in orthodontic anchorage
A and B Screw was absolutely separate from root
B and E apex of screw appeared to touch lamina Dura
C and F Body of screw overlaid lamina dura
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
4-Patient Injuries from Orthodontic Appliances 5- Pain and
Discomfort
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Multiloop - Discomfort
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Disjoncteur- Discomfort
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Wire- Injury
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Headgear- Discomfort
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Orhodontic Face Mask- Discomfort
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Safety release mechanisms on head gear
attachment
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Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
Debanding
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Enamel Surface: After Debonding
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
6-Length of Treatment orthodontic
may vary from Estimate
• Treatment Time
• The total time required to complete treatment
may exceed the estimate.
• Poor co-operation in wearing the appliance or
the elastics the required hours per day
• Poor oral hygiene, broken appliances and
• Missed appointments can lengthen the
treatment time and affect the quality of the
results.
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
6-Length of Treatment orthodontic may vary from
Estimate
Poor Oral Hygiene Braces Poor co-operationin
wearing
the appliance or the elastics
Treatment Time: The total time required to complete treatment may exceed the estimate.
Missed appointments
Broken appliance
www.orthofree.comOussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
7- Nickel Allergy and Materials used in Orthodontics
Patch test
www.orthofree.com
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
8- Temporo- Mandibular Joint Disorders may Occur
The relationship between orthodontic treatment and temporomandibular
disorders (TMDs) has long been of interest to the orthodontist
www.DrJeffreyTucker.Meta-ehealth.com
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
BIBLIOGRAPHY
www.orthofree.com
References
Ackerman, M. (2004). Evidence-based orthodontics for the 21st century. Journal of the
American Dental Association, Vol.135, No.2, pp. 162-167, ISSN 0002-8177
Al Maaitah, E.F., Adeyemi, A.A., Higham, S.M., Pender, N. & Harrison, J.E. (2011). Factors
affecting demineralization during orthodontic treatment: a post-hoc analysis of
RCT recruits. American Journal of Orthodontics and Dentofacial Orthopedics, Vol.139,
No.2, pp. 181-191, ISSN 0889-5406
Apajalahti, S. & Peltola, J.S. (2007). Apical root resorption after orthodontic treatment - a
retrospective study. European Journal of Orthodontics, Vol.29, No.4, pp.408-412, ISSN
0141-5387
Artun, J., Van 't Hullenaar, R., Doppel, D. & Kuijpers-Jagtman, A.M. (2009). Identification of
orthodontic patients at risk of severe apical root resorption. American Journal of
Orthodontics and Dentofacial Orthopedics, Vol.135, No.4, pp. 448-455, ISSN 0889-5406
Atai, Z. & Atai, M. (2007). Side Effects and Complications of Dental Materials on Oral Cavity.
American Journal of Applied Sciences, Vol.4, No.11, pp. 946-949, ISSN 1554-3641
Bastos Lages, E.M., Drummond, A.F., Pretti, H., Costa, F.O., Lages, E.J., Gontijo, A.I.,
Miranda Cota, L.O. & Brito, R.B. (2009). Association of functional gene
polymorphism IL-1beta in patients with external apical root resorption. American
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0889-5406
Bauss, O., Röhling, J., Sadat- Khonsari, R. & Kiliaridis, S. (2008). Influence of orthodontic
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Benson, P.E., Parkin, N., Millett, D.T., Dyer, F., Vine, S. & Shah, A. (2004). Fluorides for the
prevention of white spots on teeth during fixed brace treatment. Cochrane Database
of Systematic Reviews, No.3, CD003809. DOI: 10.1002/14651858.CD003809
Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
BIBLIOGRAPHY
www.orthofree.com
Bentahar, Z., Bourzgui, F.,Zertoubi, M., EL Adioui- Joundy, S. & Morgan, G. (2005).
Dégradation électrochimique des matériaux métalliques utilisés en orthodontie.
International Orthodontics, Vol. 3, No.5, pp. 5–17, ISSN 1761-7227
Blum- Hareuveni, T., Rehany, U. & Rumelt, S. (2004). Blinding endophthalmitis from
orthodontic headgear. New England Journal of Medicine, Vol.351, No.26, pp.2774-
2775, ISSN 0028-4793
Blum- Hareuveni, T., Rehany, U. & Rumelt, S. (2006). Devastating endophthalmitis following
penetrating ocular injury during night sleep from orthodontic headgear: case report
and literature review. Graefes Archive for Clinical and Experimental Ophthalmology,
Vol.244, No.2, pp.253-258, ISSN 0721-832X
Bourzgui, F.,Sebag, M., Nadour, A. & Hamza, M. (2010). Prevalence of temporomandibular
dysfunction in orthodontic treatment. International Orthodontics, Vol.8, No.4,pp.
386-398, ISSN 1761-7227
Brezniak, N. & Wasserstein, A. (2002). Orthodontically Induced Inflammatory Root
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Chapman, J.A., Roberts, W.E., Eckert, G.J., Kula, K.S. & González-C abezas, C. (2010). Risk
factors for incidence and severity of white spot lesions during treatment with fixed
orthodontic appliances. American Journal of Orthodontics and Dentofacial Orthopedics,
Vol.138, No.2, pp. 188-194, ISSN 0889-5406
Chaturvedi, T.P.& Upadhayay, S.N. (2010). An overview of orthodontic material
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BIBLIOGRAPHY
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Preoteasa, C.T.& Ionescu, E. (2011). Link between skeletal relations and root resorption in
orthodontic patients. International Journal of Medical Dentistry, Vol.1, No.3, pp. 267-
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E. (2011a) Undesirable dental hard tissue effects hypothetically linkedto
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Preoteasa, C.T., Nabil Sultan, A., Popa, L., Ionescu, E., Iosif, L., Ghica, M.V.& Preoteasa, E.
(2011b). Wettability of some dental materials. Optoelectronics And Advanced Materials
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44, 46-48, 51-52, ISSN 0305-5000
Shungin, D., Olsson, A.I. & Persson, M. (2010). Orthodontic treatment-related white spot
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105 risks and complications associated with orthodontic treatment-mohamad aboualnaser-awatef shaar-oussama sandid-orthodontist-orthodontiste (1)

  • 1. 105- Risks and Complications Associated with Orthodontic Treatment Awatef SHAAR (BAU-LB), Orthodontist. Mohamad ABOULNASER- Orthodontist, BAU, Connecticut, USA. Oussama SANDID- Orthodontist, D.C.D., D.U.O, C.E.S.B.B, C.E.S.O.D.F , S.Q.O.D.F, Paris. France. Contact: dr.aboualnaser@hotmail.com
  • 2. The Adverse Effects of Orthodontic Treatment www.orthofree.com 1- Tooth Decay and Enamel Decalcification 2- Periodontal Disease 3-External Apical Root Resorption 4-Patient Injuries from Orthodontic Appliances 5- Pain and Discomfort 6- Length of Treatment may vary from Estimate 7- Nickel Allergy 8- Temporo- Mandibular Joint Disorders may Occur 9- Aspiration or Ingestion of Orthodontic Appliances - Injury from Dental Instruments 10- Post Treatment Changes in Alignment - Abnormal Wear of Tooth Structure and Debonding Fractures - Bacteremia after Orthodontic Banding - Impacted Teeth 3rd Molars may Still Occur - Tooth Mass Discrepancies may not be Resolved - Extraction of Teeth and Supplemental Orthognathic Surgery may be Necessary - Abnormal Growth Patterns of the Jaws - Teeth with Questionable Vitality may be Adversely Affected Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 3. 1- Tooth Decay and Enamel Decalcification Toothbrushing problems. www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 4. 2- Periodontal Disease Toothbrushing problems. www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 5. Solution: Tooth Brushing www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 6. 2- Periodontal Disease www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 7. 2-Periodontal – Recession inclination of mandibular incisors during orthodontic treatment. Before trt www.orthofree.com After trt Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 8. Crestal bone loss occuring with orthodontic treatment associated with poor oral hygiene www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 9. Periodontal – Recession inclination of mandibular incisors during orthodontic treatment. www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 10. inclination of mandibular incisors during orthodontic treatment. www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 11. 3- External Root Resorption- caused by orthodontic treatment Root resorption are associated with risk factors related to the orthodontic treatment such as the duration of treatment, the magnitude of the force applied, the direction of the tooth movement, the method of force application , the orthodontic movement. Patient-related risk factors are the individual susceptibility on a genetic basis, some systemic diseases, anomalies in root morphology, dental trauma, and previous endodontic treatment. www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 12. Apical Root Resorption During Intrusion of Upper Incisors www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 13. Continuous forces and resorption www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 15. Brackets-Positioning Errors: Extrusion-Intrusion - Root proximity www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 16. Root proximity is a major factor for screw failure in orthodontic anchorage A and B Screw was absolutely separate from root B and E apex of screw appeared to touch lamina Dura C and F Body of screw overlaid lamina dura www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 17. 4-Patient Injuries from Orthodontic Appliances 5- Pain and Discomfort www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 18. Multiloop - Discomfort www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 19. Disjoncteur- Discomfort www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 20. Wire- Injury www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 21. Headgear- Discomfort www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 22. Orhodontic Face Mask- Discomfort www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 23. Safety release mechanisms on head gear attachment www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 24. Debanding www.orthofree.com Enamel Surface: After Debonding Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 25. 6-Length of Treatment orthodontic may vary from Estimate • Treatment Time • The total time required to complete treatment may exceed the estimate. • Poor co-operation in wearing the appliance or the elastics the required hours per day • Poor oral hygiene, broken appliances and • Missed appointments can lengthen the treatment time and affect the quality of the results. Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 26. 6-Length of Treatment orthodontic may vary from Estimate Poor Oral Hygiene Braces Poor co-operationin wearing the appliance or the elastics Treatment Time: The total time required to complete treatment may exceed the estimate. Missed appointments Broken appliance www.orthofree.comOussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 27. 7- Nickel Allergy and Materials used in Orthodontics Patch test www.orthofree.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 28. 8- Temporo- Mandibular Joint Disorders may Occur The relationship between orthodontic treatment and temporomandibular disorders (TMDs) has long been of interest to the orthodontist www.DrJeffreyTucker.Meta-ehealth.com Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 29. BIBLIOGRAPHY www.orthofree.com References Ackerman, M. (2004). Evidence-based orthodontics for the 21st century. Journal of the American Dental Association, Vol.135, No.2, pp. 162-167, ISSN 0002-8177 Al Maaitah, E.F., Adeyemi, A.A., Higham, S.M., Pender, N. & Harrison, J.E. (2011). Factors affecting demineralization during orthodontic treatment: a post-hoc analysis of RCT recruits. American Journal of Orthodontics and Dentofacial Orthopedics, Vol.139, No.2, pp. 181-191, ISSN 0889-5406 Apajalahti, S. & Peltola, J.S. (2007). Apical root resorption after orthodontic treatment - a retrospective study. European Journal of Orthodontics, Vol.29, No.4, pp.408-412, ISSN 0141-5387 Artun, J., Van 't Hullenaar, R., Doppel, D. & Kuijpers-Jagtman, A.M. (2009). Identification of orthodontic patients at risk of severe apical root resorption. American Journal of Orthodontics and Dentofacial Orthopedics, Vol.135, No.4, pp. 448-455, ISSN 0889-5406 Atai, Z. & Atai, M. (2007). Side Effects and Complications of Dental Materials on Oral Cavity. American Journal of Applied Sciences, Vol.4, No.11, pp. 946-949, ISSN 1554-3641 Bastos Lages, E.M., Drummond, A.F., Pretti, H., Costa, F.O., Lages, E.J., Gontijo, A.I., Miranda Cota, L.O. & Brito, R.B. (2009). Association of functional gene polymorphism IL-1beta in patients with external apical root resorption. American Journal of Orthodontics and Dentofacial Orthopedics, Vol.136, No.4, pp. 542-546, ISSN 0889-5406 Bauss, O., Röhling, J., Sadat- Khonsari, R. & Kiliaridis, S. (2008). Influence of orthodontic intrusion on pulpal vitality of previously traumatized maxillary permanent incisors. American Journal of Orthodontics and Dentofacial Orthopedics, Vol.134, No.1, pp. 12-17, ISSN 0889-5406 Benson, P.E., Parkin, N., Millett, D.T., Dyer, F., Vine, S. & Shah, A. (2004). Fluorides for the prevention of white spots on teeth during fixed brace treatment. Cochrane Database of Systematic Reviews, No.3, CD003809. DOI: 10.1002/14651858.CD003809 Oussama SANDID - Mohamad ABOUALNASER- Awatef SHAAR
  • 30. BIBLIOGRAPHY www.orthofree.com Bentahar, Z., Bourzgui, F.,Zertoubi, M., EL Adioui- Joundy, S. & Morgan, G. (2005). Dégradation électrochimique des matériaux métalliques utilisés en orthodontie. International Orthodontics, Vol. 3, No.5, pp. 5–17, ISSN 1761-7227 Blum- Hareuveni, T., Rehany, U. & Rumelt, S. (2004). Blinding endophthalmitis from orthodontic headgear. New England Journal of Medicine, Vol.351, No.26, pp.2774- 2775, ISSN 0028-4793 Blum- Hareuveni, T., Rehany, U. & Rumelt, S. (2006). Devastating endophthalmitis following penetrating ocular injury during night sleep from orthodontic headgear: case report and literature review. Graefes Archive for Clinical and Experimental Ophthalmology, Vol.244, No.2, pp.253-258, ISSN 0721-832X Bourzgui, F.,Sebag, M., Nadour, A. & Hamza, M. (2010). Prevalence of temporomandibular dysfunction in orthodontic treatment. International Orthodontics, Vol.8, No.4,pp. 386-398, ISSN 1761-7227 Brezniak, N. & Wasserstein, A. (2002). Orthodontically Induced Inflammatory Root Resorption. Part I: The Basic Science Aspects. Angle Orthodontist, Vol.72, No.2, pp. 175-179, ISSN 0003-3219 Chapman, J.A., Roberts, W.E., Eckert, G.J., Kula, K.S. & González-C abezas, C. (2010). Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. American Journal of Orthodontics and Dentofacial Orthopedics, Vol.138, No.2, pp. 188-194, ISSN 0889-5406 Chaturvedi, T.P.& Upadhayay, S.N. (2010). An overview of orthodontic material degradation in oral cavity. Indian Journal of Dental Research, Vol.21, No.2, pp. 275- 284, ISSN 0970-9290 Dentofacial Orthopedics, Vol.126, No.6, pp. 717-724, ISSN 0889-5406
  • 31. BIBLIOGRAPHY www.orthofree.com Preoteasa, C.T.& Ionescu, E. (2011). Link between skeletal relations and root resorption in orthodontic patients. International Journal of Medical Dentistry, Vol.1, No.3, pp. 267- 271, ISSN 2066-6063 Preoteasa, C.T., Ionescu, E., Didilescu, A.C., Melescanu-Imre, M., Bencze, M.A. & Preoteasa, E. (2011a) Undesirable dental hard tissue effects hypothetically linkedto orthodontics – a microscopic study. Romanian Journal of Morphology and Embryology, Vol.52, No.3, pp. 937-941, ISSN 1220-0522 Preoteasa, C.T., Nabil Sultan, A., Popa, L., Ionescu, E., Iosif, L., Ghica, M.V.& Preoteasa, E. (2011b). Wettability of some dental materials. Optoelectronics And Advanced Materials – Rapid Communications, Vol.5, No.8, pp. 874-878,ISSN 1842-6573 Segal, G.R., Schiffman, P.H.& Tuncay, O.C. (2004). Meta analysis of the treatment-related factors of external apical root resorption. Orthodontics and Craniofacial Research, Vol.7, No.2, pp. 71-78, ISSN 1601-6335 Shah, A.A. & Sandler, J. (2006). Limiting factors in orthodontic treatment: 1. Factors related to patient, operator and orthodontic appliances. Dental Update, Vol.33, No.1, pp.43- 44, 46-48, 51-52, ISSN 0305-5000 Shungin, D., Olsson, A.I. & Persson, M. (2010). Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bondingmaterial the American Dental Association, Vol.138, No.6, pp. 739–745,747-760, ISSN 0002-8177 World Health Organization. (1946). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference in 1946, In: Basic Documents, 24.08.2011, Available from: http://www.who.int/governance/eb/who_constitution_en.pdf