Why any History of Facial Trauma should be a red flag on an Ortho or Invisalign Case
Today, we’ll look at some of the reasons why any orthodontist should be cautious with cases that have a history of oral face trauma, automotive trauma, or trauma from a bike or skateboard accident.
As an orthodontist, I keep an eye out for unusual bites or patients who discuss things like how they had braces on before getting into a car accident. Some patients report that they were in a skating or skiing accident and their bite was never the same again. Patients who report such cases should be treated with caution.
I wish to promote awareness among general dentists, pediatric dentists, and dental specialists. When a patient arrives, the standard procedure is used to examine for the PDL, laminadura, and root absorption. Any injured teeth are more likely to experience root resorption, root blending, and pupal necrosis after orthodontic therapy. It’s in every single one of them. If I noticed anything unusual in the x-ray, I would refer them to an endo before proceeding with the case. They do this occasionally, but not always.
Whatever decision endo makes is what you as an orthodontist should go with. Sometimes endo can clear it or they can tell you to follow up with frequent x-rays. Even if you didn’t notice anything funny in the x-ray or even if I didn’t send the teeth to endo, I would still flag those teeth. I would put up a popup every few months to remind me to be cautious with such a case.
You should also let the patient know that you will be monitoring their teeth every once in a while. Let the patient know that frequent x-rays will be part of the standard treatment plan if they want to proceed.
Let’s talk about bones. If an orthodontists notices that a panel has a bunch of pleats and screws, that’s a dead giveaway. The orthodontist should probably not take that patient. Such a case might require the services of a jaw surgeon. I don’t recommend that any GP take a former trauma case or a former jaw surgery case. So many things can happen and once the orthodontist starts it, they will have to finish it and they will have to manage everything that comes up. If you notice pleats and screws, it’s a no go.
Even if you don’t see plates and screws but you have heard a history of trauma and you see a funny bite or the patient mentions a bite has which has shifted, get a CBCT scan of the jaws by a company like beam readers. There are plenty of other radiology companies that do great work as well and are affordable and if you are one, I get no compensation from referring to them. If you are a good Radiology company, I would like to talk to you.
A company like beam readers would take the CBCT and charge you for the reading. You should know how you can build this extra cost into your pricing. If you go ahead and take CBCT, there is going to be an extra cost. If there is any scar tissue or a minro fracture that the patient didn’t know about. Sometimes, you get into trauma and there is a minor fracture and it doesn’t need to be set, you don’t need plates and screws as it will just heal itself. In the process of healing itself, it creates a bump or lineage or demarcation and the joint where it heals is not seamsless. Teeth don’t move predictably in that area.
Teeth don’t move well in an area of scar tissue so I would want the beam readers or a similar company to read that CBCT of the maxilla and the mandible together and look for any issues in the bone of pathology that might affect the movement of teeth.
CBCT scans are costly, but they are worthwhile. If you start moving teeth in an area where there has been trauma, it will absorb that tooth and you will be accountable. You’d be upset if I rushed into your situation as a patient. At the very least, counsel the patient. Even if there was a trauma area, you could always choose not to move that tooth. You may advise, “Don’t move tooth number 19, just lock it,” especially if you’re using invisalign or clear liner. You can still achieve a good result without moving the teeth.