Medcrave - The Concept of a New Dental Disease Orthodontosis and Orthodontitis
A critical prerequisite for orthodontic treatment is the understanding of and classification of malocclusion. Currently there are several classifications of malocclusion which include classic qualitative methods such as Angle [1] and more contemporary quantitative methods and indices such as Peer assessment rating (PAR) and Index of orthodontic treatment need (IOTN).
First developed in 1899, Angle's classification [2] has remarkably endured the test of time and continues to be utilized as the main language of malocclusion among orthodontic specialists. Yet, there continues to be an emerging body of literature that exposes the lack of evidence for this conventional classification of malocclusion in Class 1 (ideal), II or III. Graverly and Johnson [3] showed poor diagnostic inter-provider reliability while Siegel's survey study [4] among 34 chairpersons of Orthodontics Departments in the U.S. showed that fewer than 65% were in agreement on the meaning of a Class II sub-division.
An editorial published in the American Journal of Orthodontics in 2009 [5] stated that, although the concept of ideal occlusion has taken precedence as the ultimate goal in clinical orthodontics for some 110 years and serves as an adopted arbitrary method convention and clinical gold standard, it has no verifiable scientific validity, and that no one has yet demonstrated that ideal occlusion provides significant benefits in oral or general health, or that it significantly improves oral function.
Rinchuse and Rinchuse [6] also question the arbitrary nature of this classification that suggests a change in a stable, functional mandibular position in order to achieve a morphologic occlusion that conforms to an arbitrary ideal.It is estimated that the teeth are in contact for less than 20 minutes per day [7].
Why then should a dentist base his/her diagnosis of a patient's malpositioned teeth on the occlusion and not on the alveolar bone that is a constant 24 hours a day? Why shouldn't the same principles that apply to the evaluation of the bone and roots in the vertical dimension utilized in the field of Periodontics also apply to the field of orthodontics in the horizontal dimension? Clinical observations after two decades of orthodontics practice leads us to propose the establishment of a new classification for malpositioned teeth based on the clinical morphology and appearance of the alveolar bone and The Concept of a New Dental Disease: Orthodontosis and Orthodontitis2/5
Citation: Viazis AD, Viazis E, Pagonis TC (2014) The Concept of a New Dental Disease: Orthodontosis and Orthodontitis. J Dent Health Oral Disord Ther 1(5): 00030. DOI: 10.15406/jdhodt.2014.01.00030
ridge. This classification is a paradigm shift from the traditional orthodontic thinking and more in line with the current accepted theories found in the periodontal literature and the specialty of Periodontics.
Materials and Methods
Thousands of completed orthodontic cases, with an overwhelming majority treated non-extraction over a span of two decades of clinical practice utilizing a system of braces that upright the roots from the beginning of treatment [8-21] were subjected to photographic and radiographic evaluation. Clinical observation leads us to propose the establishment of a new classification for malpositioned teeth based on the clinical morphology of the alveolar bone and ridge:
Localized orthodontosis
This term replaces the old Angle term of Class I ideal occlusion. This condition typically has an overbite/overjet relation of 2-3mm which is adequate for anterior guidance. Orthodontosis is the non-inflammatory deficiency of the alveolar bone in the horizontal dimension caused by the displaced root(s) of the tooth, typically palatally or lingually. This results in excess soft tissue and chronic inflammation called Orthodontitis. Once the root is upright then the alveolar bone is restored and the Orthodontitis (the gingivitis from malpositioned teeth) is alleviated (Figure 1-5).
First developed in 1899, Angle's classification [2] has remarkably endured the test of time and continues to be utilized as the main language of malocclusion among orthodontic specialists. Yet, there continues to be an emerging body of literature that exposes the lack of evidence for this conventional classification of malocclusion in Class 1 (ideal), II or III. Graverly and Johnson [3] showed poor diagnostic inter-provider reliability while Siegel's survey study [4] among 34 chairpersons of Orthodontics Departments in the U.S. showed that fewer than 65% were in agreement on the meaning of a Class II sub-division.
An editorial published in the American Journal of Orthodontics in 2009 [5] stated that, although the concept of ideal occlusion has taken precedence as the ultimate goal in clinical orthodontics for some 110 years and serves as an adopted arbitrary method convention and clinical gold standard, it has no verifiable scientific validity, and that no one has yet demonstrated that ideal occlusion provides significant benefits in oral or general health, or that it significantly improves oral function.
Rinchuse and Rinchuse [6] also question the arbitrary nature of this classification that suggests a change in a stable, functional mandibular position in order to achieve a morphologic occlusion that conforms to an arbitrary ideal.It is estimated that the teeth are in contact for less than 20 minutes per day [7].
Why then should a dentist base his/her diagnosis of a patient's malpositioned teeth on the occlusion and not on the alveolar bone that is a constant 24 hours a day? Why shouldn't the same principles that apply to the evaluation of the bone and roots in the vertical dimension utilized in the field of Periodontics also apply to the field of orthodontics in the horizontal dimension? Clinical observations after two decades of orthodontics practice leads us to propose the establishment of a new classification for malpositioned teeth based on the clinical morphology and appearance of the alveolar bone and The Concept of a New Dental Disease: Orthodontosis and Orthodontitis2/5
Citation: Viazis AD, Viazis E, Pagonis TC (2014) The Concept of a New Dental Disease: Orthodontosis and Orthodontitis. J Dent Health Oral Disord Ther 1(5): 00030. DOI: 10.15406/jdhodt.2014.01.00030
ridge. This classification is a paradigm shift from the traditional orthodontic thinking and more in line with the current accepted theories found in the periodontal literature and the specialty of Periodontics.
Materials and Methods
Thousands of completed orthodontic cases, with an overwhelming majority treated non-extraction over a span of two decades of clinical practice utilizing a system of braces that upright the roots from the beginning of treatment [8-21] were subjected to photographic and radiographic evaluation. Clinical observation leads us to propose the establishment of a new classification for malpositioned teeth based on the clinical morphology of the alveolar bone and ridge:
Localized orthodontosis
This term replaces the old Angle term of Class I ideal occlusion. This condition typically has an overbite/overjet relation of 2-3mm which is adequate for anterior guidance. Orthodontosis is the non-inflammatory deficiency of the alveolar bone in the horizontal dimension caused by the displaced root(s) of the tooth, typically palatally or lingually. This results in excess soft tissue and chronic inflammation called Orthodontitis. Once the root is upright then the alveolar bone is restored and the Orthodontitis (the gingivitis from malpositioned teeth) is alleviated (Figure 1-5).
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