22 November 2021

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The management of orthodontic restraints for the general dentist

Davide Elsido

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After correction of a malocclusion, there is a risk of recurrence both because unstable tooth movements have been made as part of orthodontic treatment, and because of other uncontrollable factors such as facial growth. Continued facial growth is part of the normal aging process and has been known to occur well into middle age. It is therefore now widely accepted that most orthodontic patients require long-term fixed or mobile restraint to achieve ultimate orthodontic success.

But once fixed or mobile restraint has been achieved, is it controlled in the long term?
Does the general dentist check the orthodontic nets in his patients or do he forget about them?
And above all in the face of the fracture or the need to carry out maintenance of the restraints, how does the general dentist (GDP) behave?

Materials and Methods
In a study, published in the British Dental Journal in June 2021, the authors described how long-term orthodontic restraint is managed by general dentists (GDPs) in the UK.
General dentists were asked to complete a short, 11-question online survey on how they manage long-term orthodontic retention, a questionnaire received via a notice published in the British Dental Journal and an email sent directly to members of a company. local dental clinic.

Results
Fifty-six GDPs completed the online survey. Overall, the results highlighted poor levels of communication between orthodontists and GDPs, who in summary take responsibility for the management of long-term orthodontic restraint.

In particular:
- Only 7.1% of general dentists said they "always" receive correspondence from the orthodontist to monitor orthodontic restraint devices at the end of treatment, while 44.6% answered "never".
- 62% of GDPs said they "never" receive specific information / guides from the orthodontist on how to monitor and manage fixed or mobile restraint equipment
- only 21.4% of GDPs answered "always" to the question whether they regularly check or inspect the restraint devices of their patients during their routine general dental check-ups and only 31.4% of these "always" register results in the medical record.
- 46.4% of general dentists said their patients "rarely" wear their removable restraints for examination during their routine general dental check-ups
- if the removable retention device was fractured, 25% of GDPs would refer the patient to an orthodontist as well as in the case of a fixed retainer detached from one or more teeth, while in the case of a fractured fixed mesh, 60.6% stated that he would refer the patient to an orthodontist
- 60% of GDPs stated that they would be comfortable applying a fixed lingual mesh in well aligned teeth
- 72% stated that it is the orthodontist's job to carry out orthodontic restraints.

Conclusions
From the data of this study, which must be confirmed in other similar studies, it can be concluded that as regards the management of long-term fixed and mobile orthodontic restraints, there is very little communication between the general dentist and orthodontist, so they often fail. the controls over time of these equipment.

For additional information: Orthodontic retention and the role of the general dental practitioner