Orthodontic Treatment: Risks, Complications, and Side Effects

Posted on Dec 16, 2024 in Medicine & Health

Orthodontic Treatment: Potential Risks and Complications

Orthodontic treatment offers recognized benefits, including improvements in dental health, function, appearance, and self-esteem. However, it also carries potential risks that can be dental, skeletal, medical, or psychological. Therefore, the decision to proceed with orthodontics requires a careful comparison of risks with potential benefits. It is crucial that all dentists, even those not performing orthodontic treatment, are aware of these risks.

Classification of Risks and Complications

(Graber, et al., 2004)

  • Based on localization:
    • Local effects
    • Systemic effects
  • Based on severity:
    • Mild, reversible gingivitis
    • Moderate, reversible fracture of a ceramic crown
    • Moderate, irreversible enamel fracture during debonding
    • Severe, irreversible caries and decalcifications, severe root resorption
  • Based on the orthodontist’s role:
    • Treatment-related (e.g., enamel changes due to acid etching)
    • Patient-related (e.g., individual susceptibility or disease)
    • Passive operator intervention (e.g., lack of monitoring in cases with root resorption)
    • Medical errors (e.g., enamel damage due to improper debonding technique)

Tissue Damage

Both intra-oral and extra-oral tissues are at risk of damage during orthodontic treatment.

Enamel Fractures and Decalcification

  • Prevalence of cracks: 6% for debonded/banded teeth and 4% for untreated teeth (Zachrisson et al., 1980).
  • More cracks with chemically bonded ceramic brackets.
  • Scanning electron microscopic observation shows:
    • No enamel damage with Titanium brackets.
    • Minimal enamel exposure (porosities) with stainless steel brackets.
    • Detrimental loss with ceramic brackets (Mahajan et. Al., 2012).

Periodontium

  • Gingival Inflammation: Usually transient and does not lead to attachment loss (Polson et. Al., 1988).
  • Gingival Hyperplasia: Around orthodontic bands, usually resolves within weeks of debonding (Zachrisson, 1976).
  • Systemic Diseases: Such as diabetes or epilepsy.
  • Recession: Labial and buccal movement can reduce facial gingival dimensions (Andlin-Soboki et al., 1993).
  • Dark Triangle: Due to loss of gingival attachment (Kandasamy et. Al., 2007).

Alveolar Bone Loss

  • Uncommon and minimal; average bone loss is 0.5-1mm (Zachrisson, 1976).
  • Factors associated with alveolar bone loss:
    • Extraction
    • Torquing the teeth
    • Rapid tipping
    • Orthodontic force
    • Gingival condition
    • Pressure from the transeptal fiber
    • Individual variation

Root Resorption

  • Risk factors include:
    • Pre-treatment root form and shape (blunted, pipette shape)
    • Length of root (short root)
    • Age (adult)
    • Previous dental trauma
    • Orthodontic force (magnitude, duration)
    • Type of mechanics used
    • Treatment duration
  • Root-filled teeth can be moved safely if:
    • Teeth are clinically symptomless and radiographically satisfactory.
    • 6 months after a new root filling.
    • Radiograph is taken 6 months after the start of active treatment.

Pulp Damage

  • Patients may experience transient pulp ischemia, causing pain and discomfort.
  • Pulp death is occasionally reported (Rotstein et, al, 1991).
  • Pulp damage is unlikely with appropriate treatment mechanics and forces.

Soft-Tissue Damage

Intra-oral and extra-oral soft tissues can be damaged by:

  • Direct damage from components, materials, and instruments.
  • Indirect damage from allergic reactions to nickel and latex.

Risks for Temporomandibular Joint (TMJ)

Conflicting opinions exist. Luther (1998) concluded that orthodontic treatment does not cause or cure TMD.

Risks for Temporomandibular Dysfunction (TMD)

The effect of orthodontic treatment on TMD is debated:

  • No Effect on TMD
  • Cure TMD
  • Increase TMD

Risk for Orthodontic Damage to the Face

Proper diagnosis should consider skeletal form, tooth position, and soft tissue form to avoid detrimental effects on the profile.

Risks of Orthognathic Surgery

Major risks include:

  • Bleeding
  • Poor blood supply to the jaw segments
  • Infection
  • Unfavorable bone cuts/splits
  • Permanent numbness/tingling
  • Incorrect positioning of the jaw/segments
  • TMD; damage to teeth
  • Psychological impact

Risk of Treatment Failure

  • 4-23% failure to complete treatment (Brattstrom et.al, 1991).
  • Treatment may fail due to:
    • Patient non-compliance
    • Incorrect diagnosis
    • Incorrect management
    • Growth (e.g., Class III)
  • It is essential to discuss treatment needs with patients.

Risk of Systemic Effects

  • Psychological: Teasing, behavioral changes, discomfort.
  • Gastro-Intestinal: Accidental swallowing of small parts.
  • Cardiac: Infective endocarditis.
  • Cross Infections: Between doctor and patient.

Relapse

  • Relapse definitely occurs.
  • Due to:
    • Placing teeth in an unstable position.
    • Teeth will still move even in a stable position.
    • Teeth move throughout life.
  • Therefore, retention for life is necessary.

Conclusion

There are many potential hazards related to the patient, operator, and/or the appliance used. It is essential for orthodontists and dentists to be aware of these factors and explain them to patients before starting treatment.