RESUMO
Abstract Severe periodontal disease is one of the most common oral diseases, as well as malocclusions, which are very frequent anomalies. It has been widely discussed if orthodontic treatment is injurious for periodontal tissues, due to an increase in dental plaque and a change in oral microflora. Factors that allow the evaluation of a patient's susceptibility have been suggested, along with some preventive measures that need to be considered during orthodontic treatment in periodontal patients. It is critical for orthodontists to take into consideration the patients' susceptibility to suffer periodontal disease, taking the necessary measures during the orthodontic treatment to minimize dental plaque retention.
Resumen La enfermedad periodontal avanzada es de las enfermedades orales más comunes, así como las maloclusiones, que son anomalías muy frecuentes. Se ha discutido ampliamente si el tratamiento de ortodoncia es perjudicial para los tejidos periodontales, debido a un aumento en la retención de placa bacteriana y un cambio en la microflora oral. Se han sugerido factores que permiten evaluar la susceptibilidad del paciente y algunas precauciones que se debe tener durante el tratamiento de ortodoncia. Es de vital importancia que el ortodoncista tome en consideración la susceptibilidad que tiene el paciente de padecer enfermedad periodontal y que durante el tratamiento tome las medidas necesarias para minimizar la retención de placa bacteriana.
Assuntos
Doenças PeriodontaisRESUMO
BACKGROUND: Post-orthodontic white-spot lesions (WSL) in esthetically relevant incisor and canine areas impair dentofacial esthetics, and preventive dentistry treatment is definitely required in case of enamel cavitations. The incidence of lingual post-orthodontic WSL and cavitation following lingual MB treatment has been reported to be distinctively decreased compared to labial MB treatment. Moreover, lingual WSL do not impair dentofacial esthetics. It was the objective of this study to calculate consequential costs of preventive dental care necessary to recover labial or lingual post-orthodontic cavitations as well as esthetically relevant WSL following either labial or lingual MB interventions. METHODS: MB treatments (labial / lingual) were simulated in 1,000,000 patients between the ages of 12-18Y, with a median residual life time expectancy of 58Y based on local mortality tables. Range of MB Tx duration was 9-45 mo. Frequencies of post-orthodontic (labial / lingual) enamel damages were derived from large-scale WSL incidence studies. Anterior composite survival rates were based on a systematic review on the subject. Within the context of the German dental fee system (GOZ 2.3 and 3.5 fee increments), simulation of costs for enamel damage treatment and re-treatment (maximum: 5x) were based on single-surface composite restorations for lingual or labial cavitations and labial WSL treatment; and lingual WSL fluoridation. RESULTS: Overall mean total costs for Tx and re-Tx of both WSLs and cavitations may sum up to 1718.91 Eur in the high-cost (GOZ 3.5) scenario for conventional MB cases, versus 19.94 Eur for lingually treated cases, given that renewal of simulated single-surface restorations takes place at 15-year intervals. When focussing on patients diagnosed with least of one WSL, and/or cavitation, these mean costs increase up to 2332.35 Eur for conventionally treated MB patients, or 65.03 Eur for lingual MB patients. CONCLUSION: Costs for repeated treatment of post-orthodontic enamel damages produced by conventional vestibular fixed appliances may easily exceed the initially higher costs associated with lingual orthodontic treatment. Judged economically in the long term, lingual MB Tx may be considered as a more cost-effective solution for a correction of malocclusion.