Establishing well-defined treatment goals in the field of Orthodontics is imperative to enhance diagnostic precision and mitigate the potential for treatment failure. The occurrence of treatment failures is often associated with inadequate patient cooperation or incorrect wire/brace selection, which can be attributed to misdiagnosis.
An unsuccessful orthodontic outcome can manifest in various forms, including TMJ symptoms, instability, tooth wear, periodontal deterioration, or facial asymmetry. Among the contributing factors, condylar displacement emerges as a significant cause of unstable results. Condylar displacement refers to the dislocation of the condyle from its natural position within the fossa when the patient occludes their teeth. This leads to a host of problems that may manifest at different time intervals but are, unfortunately, inevitable. As the esteemed Dr. Roth used to assert, the "fruits of orthodontic labour" become evident approximately a decade after the completion of treatment. Any alteration in the temporomandibular joints directly impacts the occlusal relationship between the upper and lower teeth, underscoring the paramount importance of achieving a correct mandibular position and condyle-fossa relationship as one of the five fundamental treatment goals.
Dr. Roth advocated for establishing goals across all areas influenced by orthodontic treatment, which can be broadly categorized into the following five domains:
The significance of condylar position as a treatment goal cannot be overstated. To reiterate, our objective is to ensure simultaneous contact of the teeth when the condyle is properly seated in an anterior superior position on the transversely cantered disc. As the jaw opens, the condyles and discs move in unison downward from their uppermost position within the fossae.
Complete or partial disc displacement triggers degenerative changes in the disc, condyle, and fossa. This alteration in the condyle's movement, coupled with changes in jaw position, ultimately leads to unfavourable changes in the facial profile, such as mandibular retrognathism and open bite.
When we establish well-defined goals for facial esthetics, we can strategically plan tooth movements, wire selection, and even consider the need for extractions. Engaging in open and transparent discussions with patients and their families regarding the achievement of facial harmony, along with other treatment goals, facilitates the exploration of potential jaw surgery as a viable option. Facial asymmetry, often observable from a frontal perspective, is closely intertwined with TMJ status, occlusal function, tooth alignment, and overall esthetics.
Dental esthetics and facial esthetics are intimately intertwined. To achieve optimal esthetics while ensuring functional occlusion, the collaboration of restorative dentists becomes indispensable in recreating the anatomical crown length that may have been compromised due to parafunctional habits, which can result in a substantial loss of tooth structure.
Regrettably, it appears that the profession has overlooked the fact that most patients require 3-4 mm of vertical overlap (overbite) between the anterior teeth to facilitate proper disclusion of the posterior teeth during functional movements. Additionally, proper mesial inclination of the canines is necessary to allow for smooth lateral mandibular movement.
Safeguarding the integrity of the periodontium that supports the teeth necessitates an adequate thickness. Excessive buccal or labial tooth inclination augments the risk of recession. Currently, there exists a prevailing trend suggesting that non-extraction therapy, aiming to fit all teeth within the arches, is sufficient to achieve ideal outcomes across all aforementioned goals. However, it is crucial to emphasize that Dr. Roth proposed a treatment philosophy based on specific objectives within each domain. Non-extraction therapy is merely a treatment modality and should not be misconstrued as a comprehensive care philosophy.
The Roth Williams TMJ Research Centre spearheads university research endeavors focused on temporomandibular joint and muscle disorders. In a ground-breaking study, the center meticulously tracks the health of individuals over time to identify risk factors contributing to the development of these conditions. Preliminary findings have unveiled a multitude of clinical, psychological, sensory, genetic, and nervous system factors that potentially heighten the risk of chronic TMJ disorders. These newfound insights expand our scientific understanding of the onset and natural progression of TMJ disorders and hold promise for the development of novel diagnostic and treatment modalities.
Furthermore, researchers leverage data derived from a TMJ implant registry and repository, which compiles comprehensive health information from patients who have undergone implantation or implant removal procedures. Recent studies utilizing this invaluable resource have played a pivotal role in guiding the planning of pain medication trials and other research initiatives.
Promising research endeavors are underway to cultivate human tissue in laboratory settings for the purpose of replacing damaged cartilage in the jaw joint. Additionally, efforts are being made to develop safer and more lifelike materials that can be employed to repair or replace diseased temporomandibular joints, discs, and chewing muscles.
Given that pain constitutes the chief complaint associated with these conditions, our esteemed scientists are engaged in a wide array of studies aimed at deepening our understanding of the pain process. This includes:
In conclusion, upholding clear treatment goals in Orthodontics is of paramount importance in enhancing diagnostic accuracy and minimizing the risk of treatment failure. By comprehensively addressing various aspects encompassing facial and dental esthetics, functional occlusion, periodontal health, and TMJ stability, we are steadfast in our commitment to delivering exemplary orthodontic care that prioritizes long-term success and patient well-being.
Sree Balaji Dental College & Hospital,
Velachery Main Road,
Chennai - 600 100. Tamilnadu, India
Phone: 044-22462179 / 22461883
Mobile: +91 73051 22279