So, would you not do a more immediate treatment in your patient in order to provide him a conservative intervention? Which benefits would that bring you?
Let’s take it slow…
Let's say you're opening your office now and a patience with the need of an extensive rehabilitation shows up. This is an expensive treatment, that will allow you to, at least, buy a new car. But... The patient’s occlusion is not right and he/she presents a severe crowding in both upper and lower jaws. Do you immediately take the case and make treatment planning indicating endodontic treatment in healthy teeth? Or... forwards the patient to a prior orthodontic treatment???
This is a common situation in the lives of rehabilitators. It is a decision that should be taken from situations of simpler cases involving only the need of ceramic veneers, to extreme cases like this.
The treatment of choice should consider that the multidisciplinary philosophy as a way to get the loyalty of our patient, that's come to our office aware of the concepts of excessive or minimal preparation. When the proposed treatment is conservative, and captivate your client inspiring trust, you certainly gain, as a consequence, a loyal indicator, based on the honesty of your planning.
In dental treatments where orthodontics is required, it is not only a differential so that interventions are more conservative. Regarding the white esthetic, to preserve as much as possible the tooth structure will affect the longevity of your work2,3.
The use of orthodontics should be seen as an immediate benefit, not in the medium or long term. The time it takes to move teeth into a more favorable position for the rehabilitation treatment, when placed on a scale, is irrelevant considering its numerous advantages. The correct positioning can avoid the need for endodontic treatment and large preparations, making it even possible to rehabilitate the patient with veneers or contact lenses. That’s great!!!!
Going a little further into the esthetic treatments seeking naturalness, we can say that even the red esthetic benefits from the orthodontic treatment. According to Garber (1995), the soft tissue restored frame must have the same three-dimensional shape of the contralateral tooth, as the key factor for a natural appearance is consider to be the surrounding soft tissue.
In addition to traditional orthodontic leveling, the Slow Orthodontic Extrusion and Fast Orthodontic Extrusion allow the recovery of lost gingival contour and the maintenance of a satisfactory gingival architecture, respectively.
When preparing or even repreparing will cause a biological width invasion because of a carious lesion, a fracture or a crack in the cervical third of the root, the tooth can be extruded rapidly with heavy forces. This way, there will be no change in gingival height, and the sub-crestal fibers will become supra-crestal. This process allows the subgingival defect to be exposed, and the tooth can be prepared, maintaining the and dimensions of the biological width. This is the Fast Orthodontic Extrusion!!!
In more difficult situations, usually caused by trauma or iatrogenic treatments, the gingival margin is uneven, and usually, with no papila. Where there is bone, there is gum... That means, the loss of bone that gives nourishment to the gum tissue, promotes this.
Restorative treatment or even the installation of an implant in this region without prior orthodontic manipulation, can generate a undesired result. And it gets even worse in the esthetic areas!
Ok! There are cases where recovery of the gingival architecture happens by gingival grafts with or without bone grafts. But.. the Slow Orthodontic Extrusion is a champion in forming new bone tissue in this region, especially when we are talking about the absence of papila. Our advantage, with all my respect to surgery, is the predictability, in addition to its wide applicability for both teeth to be restored and for those who will be replaced by implants6.
The bottom line: Orthodontics indication should never be underestimated or ignored because of an alleged "delay" to finish the case. It will surely be a gain of time, not lost. This is something that the patient will carry for the rest of his life, and the respect the dentist had towards his treatment too!!
Romanelli, J. O Diferencial da Ortodontia como tratamento prévio às restaurações com Facetas Cerâmicas ; in: Facetas, Lentes de Contato e Fragmentos Cerâmicos; 2015 Editora Ponto
Scopin de Andrade OS, Kina S, Hirata R. Concepts for an Ultraconservative Approach to Indirect Anterior Restorations. Quintess Dent Tech 2011; 34: 103-119
Scopin de Andrade OS, Romanini JC, Hirata R. Ultimate Ceramic Veneers: A Laboratory-Guided Ultraconservative Preparation Concept for Maximun Enamel Preservation. Quintess Dent Tech 2012; 35: 29-42
Garber DA. The esthetic dental implant: letting restoration be the guide. J Am Dent Assoc,1995 Mar; 126(3):319-25
Salama H, Salama M The Role of Orthodontic Extrusive Remodeling in the Enhacement of Soft and Hard Tissue Profiles Prior to Implant Placement: A Systematic Approach to the Management of Extraction Site defects. Int J Periodontics Restorative Dent. 1993 13(4): 312-334
My purpose is to help you gain autonomy through knowledge, facilitating the dentistry and communication. AND how do I do this?
I put myself in your shoed, I identify what is preventing you from being happy with your results and untie the knots by means of a simple and accessible language! I graduated from UNESP | Araçatuba; did my Master and PhD in Operative Dentistry at UNESP Araraquara | I am a Professor of Operative Dentistry at the Federal University of Pelotas | RS.
Jul, 27th 2015