Orthodontic Know-How

Historically, general practitioners have referred their patients for orthodontic treatment to correct a variety of issues in the absence of other major restorative concerns; however, when misaligned teeth require restoration, many dentists default to more aggressive preparation to achieve the patient's goals. Whether it's about time or other patient preferences, which may not be fully informed, or simply that their restorative paradigm doesn't predominantly feature orthodontics as a tool, this approach does not align with our mission to provide conservative, minimally invasive dentistry. To address this issue, our April cover story examines the benefits of orthodontic-restorative treatment and discusses indications, protocols, resources, and how the use of clear aligners has made adding orthodontics to treatment plans faster and more patient-friendly.

Teeth that are in the correct placement do not need to be prepared as much. When teeth need to be prepared into orthodontic alignment, excess amounts of tooth structure are destroyed. So orthodontic treatment can not only help dentists be conservative but also lead to stronger restorations. I use my orthodontist on a routine basis, particularly for my younger patients with beautiful teeth who can avoid invasive veneer preparations in so many cases. Alternatively, if orthodontics will not make a significant difference, such as in cases involving a short tooth with an altered passive eruption, where crown lengthening or opening the interocclusal space posteriorly might be better options, it might not be worthwhile to incorporate-but you have to have a strong understanding of what orthodontics can accomplish in order to optimize your treatments.

If orthodontics is undeniably the best option, and the patient declines, I do not start the case. I will not compromise my treatment. The patient may not want orthodontics, but that does not mean that he or she won't ultimately accept it if I clearly explain the importance. Esthetics aside, we need to ensure that our patients receive conservative treatments that maximize long-term function. As John C. Kois, DMD, MSD, says, "There is no dentistry better than no dentistry."

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa

Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com