Advances in Orthodontic Treatment

Functionality and aesthetics are key considerations in patients requesting, and orthodontists recommending, orthodontic treatment. However, patients may elect to forego orthodontic treatment due to the cost and the duration of treatment. Orthodontic treatment can be provided using removable or fixed orthodontic appliances (FOAs), and current options offer improved aesthetics compared to earlier generation appliances. Many methods have been explored and developed to reduce the duration of treatment. Most recently, a device has been developed that utilizes the concept of cyclic force application to reduce the duration of orthodontic treatment. Introduction Orthodontic treatment is requested and recommended for functionality and aesthetics. Patients seek orthodontic treatment primarily for aesthetic reasons. Orthodontists typically recommend orthodontic treatment to patients for function. The number of orthodontic cases has continued to grow over time. Between 1990 and 1999, the number of orthodontic cases annually more than doubled, from approximately 25.8 million cases to more than 61 million cases. The majority of cases in 1999 were for comprehensive therapy – around 48 million, with 81.5% of these in the 10–19 age group and just over 14% in adults age 20 and over.1 The number of adult cases has increased in the last decade as the importance of aesthetics has increased and affluence has led to an increased demand. Treated cases by age and type can be found in Table 1. Table 1. Orthodontic cases Total Under age 10 Ages 10 19 Age 20 and above Comprehensive orthdontics 48,184,000 4.40% 81.50% 14.10% Interceptive orthdontics 6,412,200 53% 46.60% 0.40% Limited orthodontics 7,118,200 19.40% 56.90% 23.70% Adapted from: American Dental Association. 1999 Survey of dental services rendered Patients may elect to forego orthodontic treatment due to the cost of treatment, the duration of treatment – most cases traditionally take 1.5–2.5 years to complete – or due to the appearance of orthodontic appliances (depending on the type used). In addition, some patients have difficulty wearing orthodontic appliances, which can result in patients starting but not completing orthodontic treatment. Dental professionals may reject patients for orthodontic treatment due to an assessment that the patient will be noncompliant with treatment or noncompliant with oral hygiene requirements during orthodontic treatment. The patient’s treatment may also be discontinued due to noncompliance. The duration of treatment, oral hygiene requirements and appearance during treatment vary depending on the type of orthodontic treatment and appliances used. Table 2. Rejection of treatment