A new paradigm: Limited Treatment Orthodontics
Joe Noar, Chairman of BOS Ethics and Standards Committee, on the precautions essential for managing compromise treatments.
With greater availability, publicity and understanding of the benefits of orthodontic treatment and the development of a wide variety of appliance systems, orthodontics has become a viable option for many adults.
Adults often present with a mixture of complaints that may be associated with dental and facial aesthetics as well as function but are keen to avoid complex, lengthy treatment or the perfect bite. Compromise treatments are attractive as they typically involve only the anterior six teeth in one or both arches. Addressing the cosmetic concerns of an adult using limited treatment orthodontics (LTO) may be appropriate, as long as this option is presented in addition to all other viable restorative and comprehensive orthodontic options and all diagnostic criteria have been assessed.
As LTO aims to address patients’ wishes but not necessarily all aspects of their bite, planning to leave slight imperfections in the bite does not imply that the quality of treatment is poor but the patient must be made aware of the implications of this and be consented to this approach. If lifelong aftercare of the result is necessary, the patient must fully understand this before they start treatment.
If the treatment involves too great a compromise there may be long-term consequences such as tooth-wear, jaw joint discomfort or damage to dental restorations. Under such circumstances, a LTO approach would be inappropriate.
It is important to remember that as with all orthodontic treatment when carrying out LTO the risks of decalcification, periodontal disease, root resorption, devitalisation and relapse must be fully discussed with the patient.
If treatment involves input from different dental specialists the roles of each treating clinician and the timing of their intervention must be defined and made clear to the patient and if restorative intervention is being considered, the associated risks, the longevity of these restorations and the likely financial costs related to repairs and replacements should also be discussed and documented.
LTO implies a short treatment time but the long-term result should be just as secure as a more comprehensive approach. Carefully predicting the length of treatment is essential in the treatment planning and consent process so patients have realistic expectations.
Specific treatment aims and objectives should be discussed based on the presenting complaint of the patient, complicating factors and the patient’s wishes. These aims should be documented to ensure informed consent has been sought and the patient has understood the treatment offered and appreciates any possible limitations.
Joe Noar is a Consultant and Senior Honorary Lecturer at the Eastman Dental Hospital/Institute in London