Results of Treatment
Orthodontic treatment usually proceeds as planned, and we intend to do everything possible to achieve the best results for every patient.
However, we cannot guarantee that you will be completely satisfied with your results nor can all complications or consequences be anticipated.
The success of treatment depends on your cooperation in keeping appointments, maintaining good oral hygiene, avoiding loose or broken
appliances, and following the orthodontist’s instructions carefully.
Length of Treatment
The length of treatment depends on a number of issues, including the severity of the problem, the patient’s growth and the level of patient
cooperation. The actual treatment time is usually close to the estimated treatment time, but treatment may be lengthened if, for example,
unanticipated growth occurs, if there are habits affecting the dentofacial structures, if periodontal or other dental problems occur, or
if patient cooperation is not adequate. Therefore, changes in the original treatment plan may become necessary. If treatment time is
extended beyond the original estimate, additional fees may be assessed.
Discomfort
The mouth is very sensitive so you can expect an adjustment period and some discomfort due to the introduction of orthodontic appliances.
Non-prescription pain medication can be used during this adjustment period.
Relapse
Completed orthodontic treatment does not guarantee perfectly straight teeth for the rest of your life. Retainers will be required to keep
your teeth in their new positions as a result of your orthodontic treatment. You must wear your retainers as instructed or teeth may shift,
in addition to other adverse effects. Regular retainer wear is often necessary for several years following orthodontic treatment. However,
changes after that time can occur due to natural causes, including such as tongue thrusting, mouth breathing, and growth and maturation that
continue throughout life. Later in life, most people will see their teeth shift. Minor irregularities, particularly in the lower front
teeth, may have to be accepted. Some changes may require additional orthodontic treatment or, in some cases, surgery. Some situations may
require non-removable retainers or other dental appliances made by your family dentist.
Extractions
Some cases will require the removal of deciduous (baby) teeth or permanent teeth. There are additional risks associated with the removal of
teeth which you should discuss with your family dentist or oral surgeon prior to the procedure.
Orthognathic Surgery
Some patients have significant skeletal disharmonies which require orthodontic treatment in conjunction with orthognathic (jaw) surgery.
There are additional risks associated with this surgery which you should discuss with your oral and/or maxillofacial surgeon prior to
beginning orthodontic treatment. Please be aware that orthodontic treatment prior to orthognathic surgery often only aligns the teeth,
within the individual dental arches. Therefore, patients discontinuing orthodontic treatment without completing the planned surgical
procedures may have a malocclusion that is worse than when they began treatment!
Decalcification and Dental Caries
Excellent oral hygiene is essential during orthodontic as are regular visits to your family dentist. Inadequate or improper hygiene could
result in cavities, discolored teeth, periodontal disease and/or decalcification (permanent white spots). These same problems can occur
without orthodontic treatment, but the risk is greater to an individual wearing braces or other appliances. These problems may be aggravated
if the patient has not had the benefit of fluoridated water or its substitute, or if the patient consumes sweetened beverages or foods.
Root Resorption
The roots of some patients’ teeth become shorter (resorption) during orthodontic treatment. It is not known exactly what causes root
resorption, nor is it possible to predict which patients will experience it. However, many patients have retained teeth throughout
life with severely shortened roots. If resorption is detected during orthodontic treatment, your orthodontist may recommend a pause
in treatment or the removal of the appliances prior to the completion of orthodontic treatment.
Nerve Damage
A tooth that has been traumatized by an accident or deep decay may have experienced damage to the nerve of the tooth. Orthodontic tooth
movement may, in some cases, aggravate this condition. In some cases, root canal treatment may be necessary. In severe cases, the tooth
or teeth may be lost.
Periodontal Disease
Periodontal (gum and bone) disease can develop or worsen during orthodontic treatment due to many factors, but most often due to the lack
of adequate oral hygiene. You must visit your general dentist, or if indicated a periodontist to monitor your periodontal health during
orthodontic treatment every three to six months. If periodontal problems cannot be controlled, orthodontic treatment may have to be
discontinued prior to completion.
Injury from Orthodontic appliances
Activities or foods which could damage, loosen or dislodge orthodontic appliances need to be avoided. Loosened or damaged orthodontic
appliances can be inhaled or swallowed or could cause other damage to the patient. You should inform your orthodontist of any unusual
symptoms or of any loose or broken appliances as soon as they are noticed. Damage to the enamel of a tooth or to a restoration (crown,
bonding, veneer, etc.) is possible when orthodontic appliances are removed. This problem may be more likely when esthetic (clear or
tooth colored) braces have been selected. If damage to a tooth or restoration occurs, restoration of the involved tooth/teeth by your
dentist may be necessary.
Headgears
Orthodontic headgears can cause injury to the patient. Injuries can include damage to the face or eyes. In the event of injury or
especially an eye injury, however minor, immediate medical help should be sought. Refrain from wearing headgear in situations where
there may be a chance that it could be dislodged or pulled off. Sports activities, horseplay and games should be avoided when wearing
orthodontic headgear.
Temporomandibular (Jaw) Joint Dysfunction
Problems may occur in the jaw joints, i.e., temporomandibular joints (TMJ), causing pain, headaches or ear problems. Many factors can affect
the health of the jaw joints, including past trauma (blows to the head or face), arthritis, hereditary tendency to jaw joint problems,
excessive tooth grinding or clenching, poorly balanced bite, and many medical conditions. Jaw joint problems may occur with or without
orthodontic treatment. Any jaw joint symptoms, including pain, jaw popping or difficulty opening or closing should be promptly reported to
the orthodontist. Treatment by other medical or dental specialists may be necessary.
Impacted, Ankylosed, Unerupted Teeth
Teeth may become impacted (trapped below the bone or gums), ankylosed (fused to the bone) or just fail to erupt. Oftentimes, these conditions
occur for no apparent reason and generally cannot be anticipated. Treatment of these conditions depends on the particular circumstance and
the overall importance of the involved tooth, and may require extraction, surgical exposure, surgical transplantation or prosthetic
replacement (such as implants).
Occlusal Adjustment
You can expect minimal imperfections in the way your teeth meet following the end of treatment. An occlusal equilibration procedure may be
necessary, which is a grinding method used to fine tune the occlusion. It may also be necessary to remove a small amount of enamel in between
the teeth, thereby “flattening’ surfaces in order to reduce the possibility of a relapse.
Non-Ideal Results
Due to the wide variations in the size and shape of the teeth, missing teeth, etc., achievement of an ideal result (for example, complete
closure of a space) may not be possible. Restorative dental treatment, such as esthetic bonding, crowns or bridges or periodontal therapy,
may be indicated. You are encouraged to ask your orthodontist and family dentist about adjunctive care.
Third Molars
As third molars (wisdom teeth) develop, your teeth may change alignment. Your dentist and/or orthodontist should monitor them in order to
determine when and if the third molars need to be removed.
Allergies
Occasionally, patients can be allergic to some of the component materials of their orthodontic appliances. This may require a change in
treatment plan or discontinuance of treatment prior to completion. Although very uncommon, medical management of dental material allergies
may be necessary.
General Health Problems
General health problems such as bone, blood or endocrine disorders, and many prescription and non-prescription drugs can affect your orthodontic
treatment. It is imperative that you inform your orthodontist of any changes in your general health status.
Use of Tobacco Products
Smoking or chewing tobacco has been shown to increase the risk of gum disease and interferes with healing after oral surgery. Tobacco users
are also more prone to oral cancer, gum recession, and delayed tooth movement. If you use tobacco, you must carefully consider the possibility
of a compromised orthodontic result.
Temporary Anchorage Devices
Your treatment may include the use of a temporary anchorage device(s) (i.e. metal screw or plate attached to the bone.) There are specific
risks associated with them. It is possible that the screw(s) could become loose which would require its/their removal and possible relocation
or replacement with a larger screw. The screw and related material may be accidentally swallowed. If the device cannot be stabilized for an
adequate length of time, an alternate treatment plan may be necessary. It is possible that the tissue around the device could become inflamed
or infected, or the soft tissue could grow over the device, which could also require its removal, surgical excision of the tissue and/or the
use of antibiotics or antimicrobial rinses. It is possible that the screws could break (i.e. upon insertion or removal.) If this occurs,
the broken piece may be left in your mouth or may be surgically removed. This may require referral to another dental specialist. When
inserting the device(s), it is possible to damage the root of a tooth, a nerve, or to perforate the maxillary sinus. Usually these problems
are not significant; however, additional dental or medical treatment may be necessary. Local anesthetic may be used when these devices are
inserted or removed, which also has risks. Please advise the doctor placing the device if you have had any difficulties with dental anesthetics
in the past. If any of the complications mentioned above do occur, a referral may be necessary to your family dentist or another dental or
medical specialist for further treatment. Fees for these services are not included in the cost for orthodontic treatment.