Orthodontic Clear Aligners in Medically Complex Patients: A Breif Case Report on Renal Dialysis

-
Image
  Orthodontic Clear Aligners in Medically Complex Patients: A Breif Case Report on Renal Dialysis Managing orthodontic patients with renal failure on hemodialysis requires a careful balance of clinical precision and patient safety. These cases demand modifications at every level—from material selection to treatment mechanics. I recently managed a case using Maxflex™ trilayer clear aligners, and I'd like to share the key protocols that guided a safe approach. The Medical Problems: Altered bone metabolism Increased bleeding risk (due to heparin during dialysis) Higher susceptibility to plaque accumulation and infection Potential toxicity concerns from aligner sheet materials 📋 My Modified Protocol: Timing: Procedures were scheduled on non-dialysis days to minimize bleeding risk. While this was not always fully, due to the patient's fluctuating health status, I adapted accordingly. Plaque Control & Attachments: Based on clinical research and expert opinion, attachments were e...
Post a Comment

Orthodontic Iatrogenic Damage To The Periodontium

-

 




if you are intersted in this article please follow for more readings

https://myorthodonticsblogg.blogspot.com/   👈🏻


1. Periodontal disease and orthodontic treatment :

Periodontal disease includes gingivitis, alveolar bone loss (periodontitis), and loss of attached gingival support.

The periodontal reaction toward orthodontic appliances depends on multiple
factors, such as:
- Host resistance
- The presence of systemic conditions
- The amount and composition of dental plaque.
- Lifestyle factors, including smoking, can also compromise periodontal support and the negative effects of uncontrolled diabetes on periodontal support. 

Bacteria present in dental plaque are the primary causative agent of periodontal disease .


Orthodontic treatment with fixed appliances is known to induce an increase in the volume of dental plaque. However, fixed orthodontic appliances cause a shift in the type of bacteria .

Therefore, fixed orthodontic treatment may result in localized gingivitis, which rarely progresses to periodontitis.

Orthodontic treatment of patients with active periodontal disease is contraindicated as the risk for further periodontal breakdown is markedly increased (Zachrisson and Alnaes, 1973; Cardaropoli and Gaveglio, 2007)


Complete evaluation of the periodontal status, especially in adult patients, is required and control of the periodontal status is necessary prior to initiation of orthodontic treatment.


Careful examination of the level of attached gingival prior to comprehensive orthodontic treatment is necessary.


The level of attached gingival is measured from the free gingival margin to the mucogingival junction minus the depth of the gingival sulcus.

Dental movement in the labio-lingual direction can be performed within the envelope of the periodontium without harmful effects on the level of attached gingiva.

If an inadequate level of attached gingiva is present prior to orthodontic treatment, a periodontic consultation should be performed, especially if labial movement of the teeth is anticipated.

Some adults develop black triangular spaces between anterior teeth. Open gingival embrasures could occur as a complication in about one third of all adult patients due to the gingival and papillary recession as a process of aging.

It should be discussed with patients before initiating ortho treatment since this may pose esthetics concerns to the patient after removal of appliances.



Comments

Post a Comment

Popular posts from this blog

Gable Bend in Orthodontic Aligners: Concept and Application

-
  While   gable bends   are traditionally used in   fixed orthodontics   (wires and brackets), their biomechanical principle can be   simulated in aligners   through specific   tooth movements and staging . However, aligners lack direct wire bending, so the effect must be achieved differently. 1. Can Aligners Replicate a Gable Bend? Yes, but indirectly.  Since aligners apply forces through  plastic deformation  rather than wire bending, a true gable bend isn’t possible. Instead, the  same tooth movement  (root uprighting or torque control) is achieved through: Controlled crown tipping + root movement  (using optimized attachments). Sequential staging  (gradual tooth positioning). Pressure zones  (thicker aligner material in specific areas). 2. How to Mimic a Gable Bend Effect in Aligners A. For Uprighting a Single Tooth (e.g., Canine or Premolar) Attachment Design: A  vertical rectangular attachment ...
Read more

🚨Precision Cuts vs. Buttons: Making the Right Choice in Aligner Therapy🚨

-
Image
  🚨Precision Cuts vs. Buttons: Making the Right Choice in Aligner Therapy🚨 As an orthodontist working with both fixed appliances and aligners, one of the most common clinical decisions faced is: When precision cuts and buttons should be used ? Through understanding of the fundementals of biomechanics in orthodontics, this comparison might help you in your cases: Buttons - ✓ The preferred choice for Class II correction and deep bite cases ✓ Particularly effective for preventing unwanted retroclination ✓ Patient-friendly with no additional bonding required ✓ Biomechanical insight: Functions similarly to applying elastics on rectangular heavy wires in fixed appliances, offering excellent torque control and equally distibuted forces. Precision cuts- ✓ For combined movements: extrusions, rotations, and significant root control ✓ Requires bonding (which can be a patient compliance consideration) ✓ Delivers direct force application when needed ✓ Biomechanical ...
Read more

Arch wire sequencing in Orthdontics

-
Image
  if you are intersted in this article please follow for more readings https://myorthodonticsblogg.blogspot.com/       👈🏻 Arch sequencing depends on : 1-   Archwire Types 2-   Archwire Functions 3-   Archwire Sequencing according to cases (where different situations requires sequences ) 4-   Pain associated with Archwire placement and activation  INTRODUCTION        A successful orthodontic therapy depends not only on manual skills and knowledge of treatment steps but also on knowledge and choice of materials used. One of the major components of fixed orthodontic therapy is the choice of wires. Orthodontic wires are defined as devices comprising a wire conforming to the alveolar or dental arch, which is used as an anchorage for correcting irregularities in the position of teeth . Therefore, the aim of the this assignment   was to focus on the differences in the features of wires as well a...
Read more