drg. Lina hadi, Sp.

Ort
 Book chapter : follow up appointments :
what to check and why
 Page 60-70
 DEFINITION AND PURPOSE OF ORTHODONTIC
CONTROL

 THINGSSHOULD BE NOTICED AND DONE

DURING ORTHODONTIC CONTROL

 POST CONTROL INSTRUCTIONS

 ASSESSING TREATMENT PROGRESS

DEFINITION AND PURPOSE OF
ORTHODONTIC CONTROL
 Orthodontic control/ follow-up appointments
are an essential part of orthodontic
treatment and these fulfil a number of roles,
not only to check on the amount of tooth
movement.
 They should also be used to check on oral
hygiene, patient co-operation and to provide
praise and encouragement as appropriate.
APPOINTMENT FREQUENCY
Ideal interval = 4-6 weeks (regular intervals) 
allows plenty of time for the appliance to work
and for cellular processes involved to settle once
more

 If < 4-6 weeks  appliance may not have fully

achieved tooth movement it should do &
predispose to root resorption
 If > 4-6 weeks  treatment progress may be
delayed since the appliance will become passive
& the period of time for which the appliance
needs to be worn will be lengthened
THINGS SHOULD BE NOTICED AND
DONE DURING ORTHODONTIC
CONTROL
 Key markers that must be observed at each
follow-up appointment:
1. Whether the patient is wearing the appliance
as requested
2. Oral hygiene
3. The maintenance of the appliance
4. Tooth movement, both wanted and unwanted
YES

• Speech return normal in 1-2 days

•Able to insert & remove appliance with
ease
•Appliance becomes loose & eventually
plastically deforms
•Appliance shows signs of wear; either
tooth marks on acrylic (if
biteplanes/capping included in design) or
tarnishing of metal components
NO

• Pronounced lisp on speaking

• Difficulty when attempting to remove or
insert the appliance
• Appliance remains ‘tight’ & requires
some effort to remove
• Appliance with complete clear acrylic
with no signs of occlusal wear (and
whose wire-work is still very shiny)
Necessary to check that the appliance is
being inserted correctly by the patient and
that any active components, especially
palatal finger springs are being placed on
the correct side of each tooth
 Ifthe appliance does not seat as well as it
did at the fitting appointment  indication
that appliance has been left out the mouth
for at least a few days, allowing teeth to
move independently.
 This is especially the case in patients whose
permanent teeth are erupting or whose teeth
have been removed, allowing adjacent teeth
to tip into extraction sites
 Health of Appliance
the gingiva hygiene

Cleanliness
of teeth
 Poor
appliance Gingivitis &
hygiene Denture
Stomatitis

 Canbe significant problem. Especially in

younger patients.
 Improving the Appliance thoroughly
appliance hygiene cleaned 3 times/day

Leave appliance out at

night (except pt w/
active orthodontic
appliance)
Denture Stomatitis
+ topical miconazole
(if does not resolve
with improved oral
hygiene)
 LOOSE
WORN APPLIANCE BETWEEN
APPOINTMENTS

Increase the retention

& reactivation of active
components
Check thoroughly the overall status of appliance

Occlusal
forces
Anterior
biteplanes/
Posterior
capping

wire-work fracture? Any sharp edges?

Yes No acrylic lost?

Repair :
chairside or lab
 Wire-work  damage? Distortion or fracture?
 Distortion is usually caused by the patient
removing the appliance in wrong way , e.g.
pulling down on the labial bow, rather than
appling downward force on the clasps; inserting
the appliance with the springs in the wrong
posistion or the appliance being sat on
 Fracture of wire-work occurs where the metal
has been work hardened due to repeated
reactivation. e.g. by the arrowheads of the
Adams’ clasps or the U-loops of labial bow or
because of repeated flexion of wire due to
occlusal trauma, e.g the fly-overs of retentive
components such as clasps and labial bow
 Whenever an active, removable appliance
needs to be removed to be repaired, you
must remember that any teeth that have
been moved will start to drift back toward
their starting position within hours of the
appliance being taken out.
Compare the patient’s dentition at each visit
with the pre-treatment study models to note
details of the:
• Overjet
• Overbite
• Canine and molar relationships
• Size of any spaces (incudes measuring
spaces and checking they are not closing
during space maintenance)/ open bites
• Transverse relationships – depending on
what movement you are trying to achieve
 Aware of the direction in which unwanted
tooth movement may occur  e.g due to loss
of anchorage
Especially if there does not appear to be any
movement of the tooth/teeth that you are
attempting to move with the appliance.
o Retentive components  adjust to increase
retention
o Active components  re-activated, e.g.
springs

Always adjust the retention before

reactivating the springs.
There are other specific adjustments that are
required depending on exactly what type of
tooth movement you are trying to achieve.
POST CONTROL INSTRUCTIONS
 All appliances should be worn on a full-time
basis, 24 hours per day including in bed, eating
and at school
 Removed the appliance:
 when the patient is undertaking oral hygiene
measures
 after every meal and rinsed under a tap to
remove food debris
 during contact sports
 when swimming
 When the appliance is not being worn, it should
be kept safe in a plastic container
 Clean the appliance 3 times a day after each
meal using a toothbrush and toothpaste, over a
bowl of water to prevent damage from the
appliance being dropped into a porcelain
washbasin.
 Eating with the appliance in the mouth wil be
difficult initially, it is a good idea to eat soft food
until they get used to eating with the appliance in
place.
 The force applied to the teeth by the appliance will
take approximately 6 hours to induce the cellular
changes necessary to cause bone resorption and
deposition to commense. The discomfort begins 4-6
hours after an active appliance has been first fitted
and after each time it has been reactivated
 The discomfort lasts between 3 and 7 days and the
amount of discomfort felt varies between patients
depending on a number of appliance/tooth-related
factors, but also the patient’s pain tolerance.
 Ifthe teeth do feel very uncomfortable,
whatever analgesia the patient would
normally take to cure a headache should be
taken
 The wire or acrylic components of the
appliance may cause discomfort by rubbing
on the oral mucosa. This will only last for 10-
14 days until the oral mucosa has generated
a thicker layer of keratin toprotect it from
the appliance
 Itis necessary to re-inforce the importance
of good oral hygiene and good dietary control
at every appointment
 The use of a fluoride mouthwash at a 0.05%
concentration on a daily basis is the one
measure that has been shown to reduce the
incidence of demineralisation during
orthodontic treatment with fixed appliaces
 Follow up in 4-6 weeks
ASSESSING TREATMENT PROGRESS
 Expansion
 Measure the width between two obvious landmarks at
each review visit. Ex, the inter-molar width can be
measured between the mesio-buccal cusp tips using
dividers and a ruler
 Check the expansion by turning the screw backward and
count how many turns you are able to make, e.g if you
have asked the patient to turn the screw twice per week
and it is 6 weeks  should be able to turn backward by
121/4 turns
 The baseplate should have opened by a set number of
millimetres, calculated by multiplying the number of ¼
turns of the screw made by the patient by 0.25 mm(the
amount of expansion per ¼ turn) in the ex above, the
split in the baseplate should have widened by 3 mm.
 Whether the appliance has been left out for any reason
and some relapse of the expansion has already occurred
 appliance will not fit properly
 Moving teeth around the arch
 The position of the anchor teeth and overjet are
also checked at every review appointment.
 Measure the space you are moving the tooth into.
The space should get smaller or larger at each
visit
 If the threshold force level required for tooth
movement is exceeded, then the anchor teeth
will move.
 If anchorage as been lost, resulting in change in
molar relationship and an icrease in overjet.
 Moving teeth labialy
 Anterior crossbites are often treated very quickly
(in 3 or 4 months) in a compliant patient and
when the treatment has been planned
appropriately.
 Retroclined teeth often have some spontaneous
improvement in position-purely as an effect of
disengaging the occlusion.
 There should be an edge-to-edge incisor
relationship or better.
 Check that there is still enough occlusal
clearance to allow futher labial movement of the
relevant teeth.
 Reducing an overjet
 Check whether the overjet has reduced (use a
ruler) and whether any spaces are reducing in
size.
 This movement also stresses the anchorage, it is
absolutely essential that the molar relationship
as well as the overjet reduction is checked at
each visit.
 Trim the acrylic away from the palatal surfaces
of the upper incisors at every visit, but equally
important not to trim the acrylic back so far that
the lower incisors are no longer biting on the
acrylic
 Extrusion of incisors
 At each appointment you will need to measure
the position of the tooth that is being moved and
record this in the notes.
 Ensure that the acrylic baseplate is not hindering
the extrusive movement but also ensure that it is
kept in contact with the palatal surface of the
incisor. This is to prevent it moving palatally.
 Reduction of overbite
 In a child or adolescent patient, the overbite is
reduced very rapidly.
 Evidence of overbite reduction includes:
 The overbite is no longer complete to tooth (or
mucosa) when the appliance is out of the mouth
 There is less separation of the buccal teeth when the
appliance is in the mouth than when it was first fitted
 It is necessary to check at each visit that the posterior
teeth are not in contact when the appliance is in
place.
 If more overbite reduction is required, acrylic should
be added to the anterior biteplane so that the
posterior teeth are out of occlusion once more
 Once the teeth have moved into the
desired position, it is necessary to plan
phasing out the wearing of the
appliance together with any retention
regime.
THANK YOU