Australasian Dentist Issue 89

Category 124 AustrAlAsiAn Dentist with treating adolescents with aligners is most practitioners question whether the adolescents will wear the aligners for the desired amount of time on a daily basis and for the required length of treatment. technically speaking, aligners can be very effective with adolescents if their teeth are fully erupted, they are compliant and obviously there are clinical components such as the set up, the staging of treatment, the placement and positioning of attachments based on biomechanics that will play a bit part in the final end result. With regards to younger children from the age of 8-11, there has been an enormous amount of interest treating these children with aligners in the united states – and i believe the reason was for aligner companies to increase their market share. Having said that, the cases that have been treated in this early phase of therapy by some wonderful practitioners, have demonstrated the excellent value that aligners may have with regard to early orthodontic treatment. in fact, young children up to the age of 11 are far more cooperative than the adolescents and even the adult patients as they are of the age where they want to please their parents and doctors. the main issue we have with these young children is exfoliation of deciduous teeth as it can affect the fitting of the aligners – and as such these young patients will require many scans during treatment to have the treatment plan modified as their permanent teeth start to erupt. the early treatment cases i have seen with aligners have been very impressive, but they do require a lot more work during the treatment due to the factors mentioned with exfoliation of deciduous teeth and the eruption of permanent teeth, however on the flip side, there are also less emergencies with those patient than children with conventional bands, brackets and archwires. i believe, as we increase our knowledge and expertise in this area of aligners, more treatment will be performed for younger children with aligner therapy and i think it’s important that we keep an open mind in this area. i am sure we will be having a different discussion in a few years’ time – where early treatment with clear aligners could be the standard treatment option. u Dr Geoffrey Hall Specialist orthodontist BDSc ( Mel) Cert Orth (Uni of Penn) MRACDS ( Orth) Founder and Director of OrthoED, Smilefast and CAPS geoff@orthoed.com.au TEL 1300 073 427 / 03 91080475 it’s very important we provide the best possible care for a child. if early treatment is required it needs to be explained to the patient and the parents the exact reasons for undergoing treatment at a young age, and to ensure that they realise further orthodontic therapy may be required once all the permanent teeth have fully erupted. v v v Q3 Dear Geoff, i have heard a lot about invisalign and i am now seeing a lot of Orthodontists promoting a product called “invisalign teen” and also invisalign for young children at the age of 8 or 9 although when invisalign first came to the market, it was purely a product and system designed for alignment of teeth in adults. Geoff, what are your thoughts on treating children with aligners? is it effective or just a marketing pitch? Dr tG, Melbourne Response 3 Dear tG, this is an exceptionally interesting question – as when i first started doing aligner therapy, we felt that it was only for adults. With a significant increase in knowledge and experience, traditional aligner therapy can be performed basically on any patient where we have access to the full tooth structure. this would mean that most adults and even adolescents could undergo aligner therapy. Having said that, we also know that cooperation is an important factor of aligner therapy, with patients required to wear them at least 22 hours a day, and hence the push back them through early orthodontic treatment – however, if they had a functional bite problem or by performing early orthodontic therapy i was able to change the status from a possible extraction case to a non-extraction case, then i feel that i have reduced the severity of the problem and warranted an early phase of treatment. in addition to this, it is very important that any early orthodontic treatment performed on a young child should have specific goals and a specific treatment time involved. in my practice, for the vast majority of patients undergoing early treatment, i feel that a maximum of 12 months orthodontic therapy should be employed. i like to see patients at the age of 7 or 8 years, and decide whether early orthodontic treatment would be advisable or not – and my feeling is, about 25% of children between the ages of 8 to 11 would benefit with early orthodontic therapy, and this would mean that 75% of patients are better treated once they have all their permanent teeth in place. the types of problems that i like to treat early are: u severely ectopically positioned teeth; u severe crowding issues; u Functional bite problems, either a posterior crossbite or anterior crossbite with associated functional shift; u severe skeletal problems; u significant developmental problems; u Psychological issues. this list is by no means exhaustive but diagnosing and treatment planning for a child of a young age does require a significant amount of orthodontic knowledge. it’s important that as clinicians we do not overtreat, but at the same time ColuMnIsts