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18 Orthodontics KCE Reports 77 2.1.3 Current orthodontic practice in Belgium and other Western countries Traditionally, orthodontic practitioners have assumed that their work enhanced dental health and function, thus providing greater assurance for the longevity of the dentition. Five decades ago, the British Dental Association in 1954 gave a definition of the aims of orthodontic treatment, stating "The aim of orthodontic treatment is to produce improved function by the correction of irregularities and to create not only greater resistance to disease, but also to improve personal appearance, which later will contribute to the physical well-being of the individual". Although the merit of these aims remains unquestionable, there is still controversy as to which occlusal irregularities require correction and the interpretation of these aims are still being debated f . The goal of contemporary orthodontics according to Proffit and Fields (2000) g can be summed up as the creation of the best possible occlusal relationships, within the framework of acceptable facial esthetics and stability of the occlusal result. In the contemporary orthodontic practice in Belgium and other Western countries, some of the current generally accepted indications for orthodontic treatment are: • preventing damage to the dentition by trauma • to camouflage congenitally missing teeth (by reciprocal displacement of neighbouring teeth); • to close diastemata from teeth that were lost due to trauma, • to upright or spread teeth preprosthetically (so that restorations like crown and bridgework, or fillings and other restorations can be made in an easier way - or more tooth structure saving way). • to desimpact impacted or retained teeth • to make other dental or surgical treatments easier (dental and occlusal indications) • to improve function (like speech and mastication) • to improve the dentofacial appearance (psycho-social indications, esthetics) • or a combination of the above mentioned As will be further discussed in section 2.3, there have also been evidenced some adverse effects or side-effects of orthodontic treatment in the last 15 years h , notably • gingival and periodontal problems • root resorption • decalcifications • non-improvement • relapse. Besides these purely orthodontic objectives and indications (as well as possible adverse effects) in 'regular' patients, orthodontic treatment is also highly indicated for the selected age category in children (and mostly beyond adulthood) with specific congenital craniofacial conditions of which orofacial clefts are the most prevailing. f Shaw W.C and Turbill E.A. (2007). Public Health Aspects of Oral Diseases and Disorders - Dentofacial Irregularities. pp 227- 237; Chapter 9f in Community Oral Health, Ed: Cynthia Pine and Rebecca Harris, Quintessence Books, Quintessence Publishing Co, Ltd, London, Berlin, Chicago et al g Proffit W. R. and Henry W. Fields, Jr (2000). The Orthodontic Problem. Malocclusion and Dentofacial Deformity in Contemporary Society. In Contemporary Orthodontics, 2000; Eds Proffit, with Henry W. Fields, Jr Mosby , St Louis, Philadelphia, et al h Proffit W. R. and Henry W. Fields, Jr. (2000). The biologic basis of orthodontic therapy. In Contemporary Orthodontics, 2000; Eds Proffit, with Henry W. Fields, Jr Mosby , St Louis, Philadelphia, et al
KCE Reports 77 Orthodontics 19 Orthodontic treatment of patients with orofacial clefts takes place in a multidisciplinary context (mostly in a university clinic) but also in private practice under the supervision of a coordinating multidisciplinary Cleft Palate Team. Besides an orthodontist, who in the international context often is the coordinator of the CLP-Team, the members of such a team consist of a Ear Nose Throat (ENT) specialist, a plastic or maxillofacial surgeon, a paediatrician, a psychologist, a speech therapist, a dentist, a geneticist ... who together define the treatment protocol for the patients. Of the group of patients with congenital craniofacial deviations presenting high orthodontic treatment need (IOTN 5), the patients with CLP form the largest group. It is estimated that more than of 99 % of these patients need orthodontic treatment, but with a variable duration depending on the specific problems from birth/young age to adulthood. In the combined treatments of patients with orofacial clefts, orthodontic treatment is consecutively needed i : • immediately after birth in preparation of surgical lip closure, • around 6-8 yrs for early cross bite correction or orthopedic maxillary protraction with reversed headgear in case of midfacial hypoplasia • round 8-9 yrs of age as a preparation of bone transplantation, • around 10-11 yrs as a preparation for tooth transplantation, • as anchorage preparation, • as 'regular' orthodontic treatment (around 12-16 yrs) or • as preparation for orthognathic surgery for distraction osteogenesis. So far, these specific indications of orthodontic treatment and needs are not very clear in the Belgian situation, nor does there exist adequate nomenclature to treat these patients orthodontically. 2.1.4 Objectives of the clinical part of the literature research This chapter aims to give an overview of the available literature evidence, in order to give a scientific underpinning for the current orthodontic practice in Belgium. The following points will be considered, as well in the 'normal' population as in the specific population of patients with congenital craniofacial deviations, including mainly CLP patients: • Indications and contra-indications of orthodontic treatment • Risks of orthodontic treatment • Instruments for assessing orthodontic treatment need and treatment complexity • Orthodontic treatment timing • Epidemiology and etiology of orthodontic problems • Orthodontic treatment outcome in routine practice evaluated by orthodontic practitioners and patients • Prevention versus interception of orthodontic problems • Retention and stability i http://www.uzleuven.be/schisisteam/
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