How to Handle Mobility or Recession during Orthodontic Treatment
I. Introduction
Dr. Amanda from StraightSmile Solutions, let’s delve into the nuances of orthodontic challenges, specifically addressing concerns related to tooth mobility during Invisalign or clear aligner treatments, applicable to bar treatments. If you find yourself grappling with such issues, worry not! When doctors contact me about these cases, I often play detective, offering guidance based on crucial information. Before our consultation, I typically request a panoramic X-ray (PA), probing depths, and previous records. Tracking, progress intraoral photos, and a CBCT sagittal slice also top the checklist. Until we assess these, I recommend refraining from progressing with aligners. My goal is to decipher whether the issue stems from rapid movement or excessive forward shifts.
II. Initial Steps Before Diagnosis
● Discussion on mobility or recession during treatment
● Applies to Invisalign, clear aligners, and braces
● Addressing doctors rather than patients
III. Detective Work
● Dr. Amanda’s approach to diagnosing issues
● Emphasizing the need for information before meeting
● Detective analogy and potential need to consult or collaborate with colleagues
IV. Information Required Before Diagnosis
● List of information needed before meeting
● Number 1: Get a PA (Periapical) X-ray of the affected area
● Optional: CBCT (Cone Beam Computed Tomography)
● Include probing depths around the area
● Request both new and old PA X-rays
● Gather start X-rays and start charting for comparison
● Tracking photos explanation and importance
● Progress into oral photos with articulation or occlusion marks
● Include a Seom metric X-ray or CBCT sagittal slice
V. Holding Off on Treatment Progress
● Strong recommendation to hold off on aligner progression until diagnosis is complete
● Suggestion to remove the tooth from occlusion if necessary
● Potential use of bite bumps or retainers during the investigation
VI. Most Common Causes of Issues
● Discussion on common causes of mobility or recession
● Emphasis on moving teeth too fast
● Encouragement to learn treatment planning and understand appropriate speeds
● Importance of using adequate plastic to reduce forces and benefit oral health
● Orthodontists’ approach to smaller, frequent movements versus larger, infrequent ones
VII. Orthodontic Approach
A. Multiple iterations to optimize treatment plans
B. Emphasis on Slow and Low forces for better outcomes
C. Contrast with the potential mistakes of blindly following technician instructions
VIII. Conclusion
Addressing issues of mobility or recession during Invisalign or clear aligner treatment, and similarly for Bar’s treatment, requires a thorough diagnostic approach. When doctors encounter such challenges, gathering essential information is crucial before proceeding. This step involves obtaining a periapical X-ray or CBCT, probing depths, and historical records. Comprehensive tracking photos and progress intraoral photos with articulation marks are indispensable. Additionally, a sagittal slice X-ray or CBCT can provide valuable insights. Prioritize understanding the rate of tooth movement; favoring slow, incremental adjustments over rapid shifts is vital for long-term success. If complications arise, consider temporarily removing the tooth from occlusion. Remember, collaborating with experts and avoiding blind reliance on technicians is key to optimizing treatment plans and ensuring optimal patient outcomes. Remember, a cautious, informed approach is paramount in achieving the desired results.