EC Dental Science

Review Article Volume 22 Issue 12 - 2023

Possible Risks of Orthodontic Treatment

Ali AlShehri1*, Ziyad Alammari2, Abdulmajeed Mahrous3, Khaled Alshehry4, Hana Aleisawi1, Haya AlEid5 and Ph/ Faisal AlGhamdi6

1Consultant Orthodontist, PMAH, MOH, Riyadh, KSA
2Consultant Endodontist, PMAH, MOH, Riyadh, KSA
3Orthodontist, KFH, Madina, KSA
4Orthodontist, PSMMC, MOD, Riyadh, KSA
5Orthodontist, PMAH, MOH, Riyadh, KSA
6Co-ordinator of Vaccine & Sera, Public Health, MOH, Riyadh, KSA

*Corresponding Author: Ali AlShehri, Consultant Orthodontist, PMAH, MOH, Riyadh, KSA.
Received: November 02, 2023; Published: November 17, 2023



This review looks at some of the possible risks associated with orthodontic treatment. It is feasible to understand that these risks result from a combination of patient and treatment-related factors. The potential risks of orthodontic treatment involve pain, root resorption, pulp degeneration, periodontal damage, TMJ disfunction, dental decay, speech difficulties, and white spot lesion of the enamel. Generally, treatment factors include material and design of the appliance, the amount of force, and the length of the treatment, whereas patient factors include behaviour and compliance of the patients. As a result, the orthodontist should have a thorough grasp of these risks in order to get informed consent prior to orthodontic treatment.

Keywords: Orthodontic Treatment; Root Resorption; Pulp Degeneration; Periodontal Damage; TMJ Disfunction

  1. Gillon R. “Medical ethics: four principles plus attention to scope”. British Medical Journal 309 (1994): 184-188.
  2. Abdelkarim A and Jerrold L. “Risk management strategies in orthodontics. Part 1: clinical considerations”. American Journal of Orthodontics and Dentofacial Orthopedics 148 (2015): 345-349.
  3. Naranjo AA., et al. “Changes in the subgingival microbiota and periodontal parameters before and 3 months after bracket placement”. American Journal of Orthodontics and Dentofacial Orthopedics 130 (2006): 275.e17-275.e22.
  4. Oliver RG and Knapman YM. “Attitudes to orthodontic treatment”. British Journal of Orthodontics 12 (1985): 179-188.
  5. Kvam E., et al. “Traumatic ulcers and pain during orthodontic treatment”. Community Dentistry and Oral Epidemiology 15 (1987): 104-107.
  6. Baricevic M., et al. “Oral mucosal lesions during orthodontic treatment”. International Journal of Paediatric Dentistry 21 (2011): 96-102.
  7. Fujiyama K., et al. “Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy”. Progress in Orthodontics 15 (2014): 64.
  8. Mandall NA., et al. “Which orthodontic archwire sequence? A randomized clinical trial”. The European Journal of Orthodontics 28 (2006): 561-566.
  9. Sandhu SS and Sandhu J. “A randomized clinical trial investigating pain associated with superelastic nickel-titanium and multistranded stainless steel archwires during the initial leveling and aligning phase of orthodontic treatment”. Journal of Orthodontics 40 (2013): 276-285.
  10. Cioffi I., et al. “Pain perception following first orthodontic archwire placement-thermoelastic vs superelastic alloys: a randomized controlled trial”. Quintessence International 43 (2012): 61-69.
  11. Bertl MH., et al. “A prospective randomized split-mouth study on pain experience during chairside archwire manipulation in self-ligating and conventional brackets”. The Angle Orthodontist 83 (2013): 292-297.
  12. Wu AKY., et al. “A comparison of pain experienced by patients treated with labial and lingual orthodontic appliances”. The European Journal of Orthodontics 32 (2010): 403-407.
  13. Bergius M., et al. “Pain in orthodontics: a review and discussion of the literature”. Journal of Orofacial Orthopedics 37 (2000): 125-137.
  14. Williams OL., et al. “Patient discomfort levels at the time of debonding: a pilot study”. American Journal of Orthodontics and Dentofacial Orthopedics 101 (1992): 313-317.
  15. Nedwed V and Miethke R-R. “Motivation, acceptance and problems of invisalign patients”. Journal of Orofacial Orthopedics 66 (2005): 162-173.
  16. Patel S., et al. “Effects of analgesics on orthodontic pain”. American Journal of Orthodontics and Dentofacial Orthopedics 139 (2011): e53-e58.
  17. Dominguez A and Velasquez SA. “Effect of low level laser therapy on pain following activation of orthodontic final archwires: a randomized controlled clinical trial”. Photomedicine and Laser Surgery 31 (2012): 36-40.
  18. Ukra A., et al. “Psychological aspects of orthodontics in clinical practice. Part one: treatment-specific variables”. Progress in Orthodontics 12 (2011): 143-148.
  19. Roscoe MG., et al. “Association of orthodontic force system and root resorption: a systematic review”. American Journal of Orthodontics and Dentofacial Orthopedics 147 (2015): 610-626.
  20. Linge BO and Linge L. “Apical root resorption in upper anterior teeth”. European Journal of Orthodontics 5 (1983): 173-183.
  21. Barbagallo LJ., et al. “Physical properties of root cementum: Part 10. Comparison of the effects of invisible removable thermoplastic appliances with light and heavy orthodontic forces on premolar cementum. A microcomputed-tomography study”. American Journal of Orthodontics and Dentofacial Orthopedics 133 (2008): 218-227.
  22. Levander E., et al. “Evaluation of root resorption in relation to 2 orthodontic treatment regimes - a clinical experimental-study”. European Journal of Orthodontics 16 (1994): 223-228.
  23. Remington DN., et al. “Long-term evaluation of root resorption occurring during orthodontic treatment”. American Journal of Orthodontics and Dentofacial Orthopedics 96 (1989): 43-46.
  24. Kalkwarf KL., et al. “Effect of apical root resorption on periodontal support”. Journal of Prosthetic Dentistry 56 (1986): 317-319.
  25. Pazera P., et al. “Severe complication of a bonded mandibular lingual retainer”. American Journal of Orthodontics and Dentofacial Orthopedics 142 (2012): 406-409.
  26. Nguyen QV., et al. “A systematic review of the relationship between overjet size and traumatic dental injuries”. European Journal of Orthodontics 21 (1999): 503-515.
  27. Bauss O., et al. “The effect of pulp obliteration on pulpal vitality of orthodontically intruded traumatized teeth”. The Journal of Endodontics 34 (2008): 417-420.
  28. Renkema AM., et al. “Gingival labial recessions in orthodontically treated and untreated individuals: a case - control study”. Journal of Clinical Periodontology 40 (2013): 631-637.
  29. Bollen A-M., et al. “The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence”. Journal of the American Dental Association 139 (2008): 413-422.
  30. Nelson PA and Artun J. “Alveolar bone loss of maxillary anterior teeth in adult orthodontic patients”. American Journal of Orthodontics and Dentofacial Orthopedics 111 (1997): 328-334.
  31. Wennström J-L. “Mucogingival considerations in orthodontic treatment”. Seminars in Orthodontics 2 (1996): 46-54.
  32. Villard NM and Patcas R. “Does the decision to extract influence the development of gingival recessions?” Journal of Orofacial Orthopedics 76 (2015): 476-492.
  33. Booth FA., et al. “Twenty-year follow-up of patients with permanently bonded mandibular canine-to-canine retainers”. American Journal of Orthodontics and Dentofacial Orthopedics 133 (2008): 70-76.
  34. Chow YC., et al. “Factors associated with the appearance of gingival papillae”. Journal of Clinical Periodontology 37 (2010): 719-727.
  35. Tarnow DP., et al. “The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla”. Journal of Periodontology 63 (1992): 995-996.
  36. Luther F. “Orthodontics and the temporomandibular joint: where are we now? Part 1. Orthodontic treatment and temporomandibular disorders”. The Angle Orthodontist 68 (1998): 295-304.
  37. Okeson JP. “Management of Temporomandibular Disorders and Occlusion”. St Louis, Missouri: Mosby, Inc (2013): 164.
  38. Manfredini D., et al. “Temporomandibular disorders assessment: medicolegal considerations in the evidence-based era”. Journal of Oral Rehabilitation 38 (2011): 101-119.
  39. McNamara JA Jr. “Orthodontic treatment and temporomandibular disorders”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 83 (1997): 107-117.
  40. Chatterjee R and Kleinberg I. “Effect of orthodontic band placement on the chemical composition of human incisor tooth plaque”. Archives of Oral Biology 24 (1979): 97-100.
  41. Heymann GC and Grauer D. “A contemporary review of white spot lesions in orthodontics”. Journal of Esthetic and Restorative Dentistry 25 (2013): 85-95.
  42. Alexander SA. “The effect of fixed and functional appliances on enamel decalcifications in early Class II treatment”. American Journal of Orthodontics and Dentofacial Orthopedics 103 (1993): 45-47.
  43. Ogaard B., et al. “Orthodontic appliances and enamel demineralization. Part 1. Lesion development”. American Journal of Orthodontics and Dentofacial Orthopedics 94 (1988): 68-73.
  44. Haydar B., et al. “Effects of retainers on the articulation of speech”. American Journal of Orthodontics and Dentofacial Orthopedics 110 (1996): 534-540.
  45. Van Der Veen MH., et al. “Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference?” European Journal of Oral Sciences 118 (2010): 298-303.
  46. Kim S., et al. “Predicting improvement of postorthodontic white spot lesions”. American Journal of Orthodontics and Dentofacial Orthopedics 149 (2016): 625-633.
  47. Akin M and Basciftci FA. “Can white spot lesions be treated effectively?” The Angle Orthodontist 82 (2012): 770-775.
  48. Feldman EW. “Speech articulation problems associated with placement of orthodontic appliances”. Journal of Speech and Hearing Disorders 21 (1956): 34-38.
  49. Stewart FN., et al. “Appliance wear: the patient's point of view”. European Journal of Orthodontics 19 (1997): 377-382.
  50. Nanci L Oliveira De Felippe., et al. “Influence of palatal expanders on oral comfort, speech, and mastication”. American Journal of Orthodontics and Dentofacial Orthopedics1 (2010): 48-53.
  51. Tanaka H. “Speech patterns of edentulous patients and morphology of the palate in relation to phonetics”. Journal of Prosthetic Dentistry 29 (1973): 16-28.
  52. Slater RD. “Speech and discomfort during lingual orthodontic treatment”. Journal of Orthodontics 1 (2013): S34-S37.
  53. Fillion D. “Improving patient comfort with lingual brackets”. Journal of Clinical Orthodontics 31 (1997): 689-694.
  54. Joseph VPRE. “The shear bond strengths of stainless steel and ceramic brackets used with chemically and light activated composite resins”. American Journal of Orthodontics and Dentofacial Orthopedics 97 (1990): 121-125.
  55. Azzeh E and Feldon PJ. “Laser debonding of ceramic brackets: a comprehensive review”. American Journal of Orthodontics and Dentofacial Orthopedics 123 (2003): 79-83.
  56. Habibi M., et al. “Comparison of debonding characteristics of metal and ceramic orthodontic brackets to enamel: an in-vitro study”. American Journal of Orthodontics and Dentofacial Orthopedics 132 (2007): 675-679.
  57. Janiszewska-Olszowska J., et al. “Effect of orthodontic debonding and adhesive removal on the enamel - current knowledge and future perspectives - a systematic review”. Medical Science Monitor 20 (2014): 1991-2001.
  58. Baumann DF., et al. “The influence of dental loupes on the quality of adhesive removal in orthodontic debonding”. Journal of Orofacial Orthopedics 72 (2011): 125-132.
  59. Gwinnett AJ and Gorelick L. “Microscopic evaluation of enamel after debonding: clinical application”. American Journal of Orthodontics 71 (1977): 651-665.
  60. Ozer T., et al. “Surface roughness of the restored enamel after orthodontic treatment”. American Journal of Orthodontics and Dentofacial Orthopedics 137 (2010): 368-374.

Ali AlShehri., et al. “Possible Risks of Orthodontic Treatment”.”. EC Dental Science 22.12 (2023): 01-10.