Orthotown April 2023 - 42

FIG. 4: Orthodontically induced dehiscence. Note the
generalized pattern from the first bicuspid to first bicupsid.
Simply put, the orthodontic
case that is finished today
will likely have a CBCT taken
within the next five years and
therefore be evaluated for OID
that was completely missed
in a panoramic/cephalometric
postorthodontic evaluation.
FIG. 5: Overexpanded incisor position resulting from aligner therapy
and poor treatment planning. Notice the adaptive resorption of the
alveolar housing in an effort to comport to the overexpanded root
position, therefore complicating re-treatment or root repositioning.
incisors, which would be hidden by the
ceph's wide focal trough. I also believe
the dentist is obligated to mention the
OID to the patient and either follow
or refer to the periodontist even in the
absence of gingival recession.
Simply put, the orthodontic case
that is finished today will likely have
a CBCT taken within the next five
years and therefore be evaluated for
OID that was completely missed in a
panoramic/cephalometric postorthodontic
evaluation.
A short word about " standard of
care, " which is relevant at the time
the patient was in active treatment:
I believe that regardless of the diagnostic
tool used, OID has always been
considered a breach of the standard
of care. We were just were less mindful
of it.
2 Online word and social media
spreads fast-especially
negative feedback, considering
the current feedback for the DIY
aligner companies.
This is an easy one to explain; look
at online reviews for DIY aligner companies.
Despite the encouragement
to have their patients write positive
online reviews, the negative reviews
continue to grow and will likely overwhelm
any positive postings.
3 We will better understand
the correlation between
dehiscence and gingival recession.
There's no question about the correlation
between gingival recession
and orthodontic treatment. What
we don't completely understand is:
At what point does the dehiscence
result in gingival defect? How does
gingival phenotype and oral hygiene
contribute to the predictability of
gingival defects? Can orthodontic
expansion/constriction, which results
in a " washboard " gingival appearance,
change the gingival phenotype
from thick to thin? Even with higher
magnitude OID, the tissue recession
seems to lag, taking five to 10 years to
fully manifest.
APRIL 2023 | 42 | ORTHOTOWN.COM
Once we have a better understanding
of the dehiscence/gingival
recession relationship, orthodontists
will need to carefully consider how
much dental expansion/constriction is
reasonable, adding an additional layer
of complexity to even the simplest
orthodontic case (Fig. 4).
4 Poor treatment planning has
consequences other than
relapse and retreatment.
As orthodontists, if we want to treat
a case using a certain strategy and the
case relapses, do we simply re-treat?
The problem with the preceding
question: There are consequences to
poor treatment plans. Once the tooth
is orthodontically expanded (or constricted)
outside the alveolar housing,
adaptive resorption of the alveolar
process occurs, leaving a smaller alveolar
housing for future tooth repositioning
(orthodontics).
Consider the aligner case in Fig. 5,
where expansion was used to decrowd
the lower incisors. The alveolar process
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Orthotown April 2023

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