Orthodontic Limitations in the Restorative Treatment of the Adult Patient. Narrative Review of Literature PDF

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Orthodontic Limitations in the Restorative Treatment of the Adult Patient. Narrative Review of Literature...

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Orthodontic Limitations in the Restorative Treatment of the Adult Patient. Narrative Review of Literature. According to the Royal Academy of the Spanish language and in this case its translation into English, the word ADULT (adult) comes from the Latin verb adolescere which means to grow, to feed. Adult is the past participle of this verb and literally it would mean "the one who has already grown or has already finished growing." This is the meaning that has remained in popular language when it is said that theadult is the one that "already has it or should have it all done." In contrast, adolescent, which comes from the present participle of the same verb, would mean the one who is growing up, the one who has not yet reached the end, the one who still has much to do and be.

For the thesaurus most used in the faculty to standardize scientific terms in the search for quality scientific literature, known as Mesh ((Medical Subject Headings) used by the National Library of Medicine of the United States (NLM, for the acronym of National Library of Medicine) to control vocabulary in the indexing of articles in specialized journals), which is part of the services offered by the National University of Colombia for the search for scientific information, literally the word adult means: A person who has reached growth full or maturity. (1)

This work will not be focused on orthodontics that is performed in young people but in those adults, framed within the definition set out above and that for our practical purposes should have already formed all their teeth, consolidated their skeletal formation process and established their swallowing, phonatory and masticatory habits, therefore excluding those syndromic cases considered as complicated, such as Down syndrome, patients with craniosynustosis (for example trigonocephaly, plagiocephaly) or sequelae of LPH, although, even if stabilized, they could be treated as if it were a systemically healthy patient

and they could receive care for both rehabilitation and orthodontics, under the basic principles mentioned here.

For the review of basic concepts about occlusion, the reader is recommended to expand their knowledge about this topic with the article "Evolution of Occlusal Pathology: A Review" (2) in which the main diagnoses, clinical characteristics and degree of severity of occlusal disorders.

Regarding the general individual prognosis of the tooth, it is suggested to consult the work: "Determinants of Individual Prognosis in Prosthodontics". (3)

During the time that this review lasted and prior to the formulation of this research, a classification of those concepts necessary to understand the problems that are configured due to the questions arising as a result of the care of adult patients in the postgraduate rehabilitation has been developed oral patients who have recently completed their corrective orthodontic process ..

The clinical experiences obtained during these two years observing the different cases treated in the faculty presented by residents of the last year of postgraduate studies in multi and interdisciplinary academic sessions known as presentations of completion cases, as well as the knowledge acquired over the years by the teachers who are have performed directing said clinic, who in turn directed this search during the rehabilitation student's clinical residency, have allowed the appearance of different categories that intersect with each other, giving different approaches to treat a single problem: the limitations of orthodontic treatment in the adult,Therefore, the ultimate goal of this complexity seeks the problematization of the concept of orthodontics (see Kolmogórov Complexity Theory - complex thought theories) to open the field of interdisciplinary discussion of what is known so far of the application in adults of said specialty. (4) (5) The masticatory system as a whole must achieve a functional and harmonic occlusion to respond to the demands not only of chewing, but also of swallowing, speech and of course social interaction that depend on the position of the teeth in the arches

teeth, as well as the relationship with the teeth of the opposite arch when it comes into use. (6)

The ideal occlusion is one in which the mandible is in an optimal relationship with the skull, that is, in which all the components of the masticatory apparatus function harmoniously in the best possible conditions. (7)

A diagnosis of optimal occlusion requires that the joints are healthy, that the teeth remain firm thanks to a healthy periodontium, that there is no excessive wear on the dental surfaces and that the teeth remain in a stable and adequate position.

The residents of the different postgraduate courses that attend adult patients in the Faculty of Dentistry of the National University of Colombia meet once a week during the entire cycle of studies of each specialty, to present to their professors and other colleagues a clinical case that requires to be approached in an interdisciplinary manner, which is documented in detail using the complete medical history, models, photos, X-rays, CT scans and other complementary tests in order to reach an accurate diagnosis and establish a roadmap made up of several possible plans of treatments that will be offered to the patient according to their needs and expectations.

In the same way, candidates for oral rehabilitators and orthodontists present in their last academic semester clinical cases called "completion" in order to show their clinical performance throughout the postgraduate course and present the progress of the cases to which one or the other way they contributed clinically.

It is precisely during these academic gatherings that some questions arise about how to achieve occlusal stability in the adult patient and what limitations can be found in the way of restoring the deteriorated occlusion through oral rehabilitation, prior corrective orthodontics.

Taking into account that the main requirements of the patients who attend this clinic are orthodontic and prosthetic, it is proposed to determine which are the

main aspects that behave as limitations to carry out a successful orthodontic treatment in the adult patient and how these can be solved through the different alternatives of contemporary oral rehabilitation. A general objective then emerged which was: to review the current literature on what are the main limitations of orthodontic treatment in adults and the way in which oral rehabilitation can contribute to achieving and maintaining an ideal occlusion.

To meet this objective, it was necessary to develop specific objectives, which were:

to. Review the aspects that are required to achieve an ideal occlusion in the adult patient once the orthodontic correction process has finished. b. Review the main limitations of orthodontics to achieve an adequate occlusal coupling. c. To analyze the factors that influence the success and failure rates of the therapy process and occlusal adjustment, after orthodontic treatments in the adult patient. d. Provide an updated theoretical basis and in accordance with scientific evidence, which will allow in the future, through subsequent degree projects, to standardize the process of therapy and occlusal adjustment, after orthodontic treatments of patients treated in the clinics of the Faculty of Dentistry from the National University of Colombia.

This text is a narrative review of the literature that will allow the reader an updated approach to the main events that limit the correct achievement of a stable occlusion in the adult patient, to integrate to their knowledge in an organized way, different concepts necessary for good practice clinic.

To formulate and stipulate the different levels of organizational hierarchy into which the following work will be divided, the database of the interdisciplinary clinic was reviewed (composed of digital files with initial records of how the clinical case was presented, how the treatment of orthodontics, how the patient ended his

orthodontic correction phase and finally which rehabilitation option was developed) to select relevant factors that possibly contributed to not achieving all the objectives proposed for its corrective orthodontic phase and how these affected the success and stability of the occlusal treatment.

Once the main categories that make up this review were identified, they were organized in a conceptual map and an intentional bibliographic search was carried out to obtain updated scientific articles that would serve as input to enrich the discussion between the authors and serve as a database for subsequent academic consultations.

This work provides a contribution to the personal growth of the professional who performs it, by consolidating their knowledge in the rehabilitation of adult patients who have undergone orthodontic treatment and in whom some type of malocclusion persists after finishing it. In the same way, it allows better clinical practice for rehabilitators and orthodontists and other specialists in training.

With the dissemination of this work, a tool will be given at a social level to improve the quality of life of adult patients undergoing orthodontics and will allow the clinician to anticipate possible errors in their practice, by knowing and recognizing the limitations that orthodontics currently has.

1. METHODOLOGY 1.1

Type of study. Narrative Study of Literature.

one

1.2 Sample. It is composed of all the full-text articles that address the topic of Orthodontic Limitations in the Restorative Treatment of the Adult Patient that are considered relevant for the study and are available in full text in the databases: Cochrane Library, Pubmed, Wiley, Science Direct, Scielo as well as those found in an additional search carried out manually or physically in the classic books in the area of Oral Rehabilitation and orthodontics that can provide some kind of support for the review.

1.3 Collection of Information. to. The methodology to be followed is that proposed by Cochrane, for systematic reviews.

b. As this is a narrative review of the literature, the search for information was not carried out in a totally systematic way, however, three basic terms were used in English, which were combined using the Boolean operator AND: Adult (adult) Limiting Orthodontics (orthodontic)

1Please see: Comparison of systematic and narrative reviews: the example of the atypical antipsychotics, (107) and Systematic literature review X narrative review (108)

These terms were combined with terms referring to the field of research that required to be broken down.

Examples: Root resorption AND Orthodontic AND adult AND oral rehabilitation. Bonding AND orthdontic AND adult AND oral rehabilitation Imperfecta amelogenesis AND Orthodontic AND adult AND oral rehabilitation. Centric relation AND Orthodontic AND adult AND oral rehabilitation.

c. Once the key terms were defined in Spanish, the existence of the equivalent in English was verified through the portal of the United States National Library of Medicine (US National Library of Medicine - NLM link available to search for indexed medical terms or terms MeSH (Medical SubjectHeadings).

d. The key terms were determined jointly with the coordinator of the present work, trying to disarticulate the main question that needs to be solved in the development of the bibliographic review: What are the main limitations of orthodontic treatments to achieve a correct occlusal adjustment in the adult patient?

When these algorithms were defined, a deliberate scientific information search was carried out in the following databases: Cochrane Library, Pubmed, Wiley Online Library, Science Direct, Scielo, which led to indexed journals.

Through the use of search filters, it was decided to select articles under the following inclusion criteria: articles whose abstracts were in English, Portuguese or Spanish, were recent information, accepted for publication at a date after 2006. Classic articles or articles were included. of parts of books, as well as articles whose methodology consisted of meta-analyzes, systematic reviews of the literature, cases and controls, case reports, and in a few cases expert opinion.

Table 1: Publications found with keywords in the selected databases between the years 2006 - 2016. DATABASE Cochare Library Pubmed Wiley Online Library Science Direct Scielo Total:

NUMBER OF ITEMS FOUND twenty-one 78 3557 2916 5 6577

To include it in the bibliographic report, the article had to be able to be downloaded in its full version through the bibliographic resources offered by the National University of Colombia. At the same time, as exclusion criteria, those articles whose achievement was impossible through the magnetic resources offered by the university, those whose main support was based on experimentation on animal models and those articles in which the author declared to have a conflict of interest were discarded.

The abstracts of the articles found were analyzed in order to determine their relevance to the study. The full texts of those articles considered relevant were then searched, which were compiled in tables classified by the keywords found to organize the articles, from the oldest to the most recent, adding important information such as Author's name, Year of publication , Type of study, Duration of the study (only if applicable), Characteristics of the sample and Results.

A total of 100 articles were selected which were read by the oral rehabilitation student and his tutor in their original language and discussed with the clinical findings found in multidisciplinary care.

Table 2: Selected publications and their typology TYPE OF STUDY Meta analysis Systematic review Controlled clinical study Another experimental Cases and controls Case series or case report Cohort Observational Expert opinion Narrative Review

NUMBER OF SELECTED ITEMS 17 9 5 5 10 26 10 6 10 two

1.4 Information Analysis to. The selected articles were read in their entirety to identify the main findings and contributions to the review of the topic of interest.

An outline of the main questions that arose in the clinical practice carried out by the oral rehabilitation student between May 2015 and December 2016 was made in the context of the multidisciplinary clinic, supported with documentary material and through this document, an attempt was made to create discussion with previously selected literature.

b. The results obtained from the review and analysis of the selected literature were condensed into a final document where it is intended to gather the main Orthodontic Limitations in the Restorative Treatment of the Adult Patient, thus allowing the beginning of the process with which it is expected to lead to the unification of criteria and concepts in the clinical evaluation of patients of the Faculty of Dentistry of the National University of Colombia.

1.5 Work Schedule Table 3: Work schedule used MONTHS (Starting in February EXERCISE

2016) one two

Initial search in bibliographic sources Analysis of abstracts and selection of literature a include in the study Obtain full texts of articles selected Reading and analysis of selected literature Preparation of the final written document.

3

4

5

6

7

8

2.Factors that are required to achieve an ideal occlusion in the adult patient / criteria for discharge in orthodontics. Establishing orthodontic treatment generally responds to the patient's need to improve bucco-facial aesthetics, while improving the patient's social adaptation, but especially the occlusal function that allows him to speak well, eat well and interact in a propitious way with the world around him. Measuring results requires comparison and to compare it is necessary to have some basic parameters. In orthodontics, different indices have been used that go back to the molar and canine classification proposed by Angle and which is still in use today.

For example, the orthodontic treatment need index (IOTN) and the peer evaluation index (PAR) have been proposed to determine the need for orthodontics as well as the final results of said intervention. However, due to their subjective nature and the possibility of introducing measurement and interpretation errors, they have been ruled out by the ABO (American Board of Orthodontics) who in turn proposes specific evaluation criteria of the results achieved through orthodontics called CRE (For the acronym Cast-Radiograph Evaluation). (8) (9) (10)

To minimize possible discrepancies between the different dentimeters or possible measuring tools, this millimeter ruler was developed to streamline and unify the measurements taken from the models and panoramic radiographs.

Figure 1: Rule proposed by The American Board of Orthodontics

Taken from https://www.americanboardortho.com/orthodontic-professionals/about-boardcertification / clinical-examination / case-report-preparation / cast-radiograph-evaluation /

A. This section of the ruler is in 1mm increments and is used to measure discrepancies in alignment, overjet, occlusal contact, interproximal contacts, and occlusal relationships. The width of the ruler is 0.5mm. B. This section of the ruler has measurement steps of 1 mm in height and is used to determine discrepancies in inferior posterior vestibule-lingual inclination. C. This section of the ruler has measurement steps 1 mm high and is used to determine discrepancies in the marginal ridges. D. This section of the ruler has measurement steps 1 mm in height and is used to determine discrepancies in superior posterior vestibule-palatal inclination

In order to quantify the success or failure of the treatments, the ABO determined specific scores that are explained below and that added together must be less than 30 so that the treatment can be considered successful.

Table 4: Specific scores for evaluation of results of orthodontic treatment according to "The American Board of Orthodontics".

Free translation of https://www.americanboardortho.com/orthodontic-professionals/aboutboard-certification / clinical-examination / case-report-preparation / cast-radiographevaluation /

Despite the great epidemiological possibilities that an instrument of these characteristics provides, it is necessary to highlight that these measures ignore additional attributes that the final result of orthodontic treatment must have in order to be considered adequate to the patient's expectations and that it corresponds to the objectives planned at the time. initiation of therapy, among which are:

Occlusal stability Adequate dental and facial aesthetics Concordance of the upper dental midline with the facial line Maintain endodontic, periodontal and tooth structure health Patient satisfaction Allow adequate rehabilitation:

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Achieve parallelism of abutment teeth to reduce the amount of tissue removed with rotary instruments for PPF fabrication

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Achieve parallelism and necessary space for dental implant placement

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More favorable distribution of abutment teeth

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Posterior tooth skew and intrusion

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Forced extrusion of teeth with partial coronal destruction to provide a better margin for the prosthetic crown favoring the splint effect

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Reset vertical dimension in posterior bite collapse syndromes or severe wear

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Recover the effectiveness and efficiency of the chewing system. (eleven)

However, there are countless extreme situations that cont...