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the complete review - medicine

The Orthodontic Patient

by
Anthony J. Ireland and Fraser McDonald

general information | review summaries | our review | links | about the authors

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Our Assessment:

-- : good, broad introduction to orthodontic treatment

See our review for fuller assessment.

  From the Reviews:

• "Overall, this book is comprehensive, detailed, simply illustrated and provides a wealth of references. Despite forcing a quart into a pint pot, it is a useful addition to the library." - B. Selwyn-Barnett, British Dental Journal
  
  
• "Overall, this is a curate’s egg of a book, the good bits are ideal as an inexpensive undergraduate text, but in addition to the comments made already, the cramped lay-out of the text and absence of color illustrations make it difficult to recommend over the competition." - Richard Oliver, Journal of Orthodontics

Please note that these ratings solely represent the complete review's biased interpretation and subjective opinion of the actual reviews and do not claim to accurately reflect or represent the views of the reviewers. Similarly the illustrative quotes chosen here are merely those the complete review subjectively believes represent the tenor and judgment of the review as a whole. We acknowledge (and remind and warn you) that they may, in fact, be entirely unrepresentative of the actual reviews by any other measure.

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The complete review's Review:

       Though "principally aimed at the undergraduate dental student" and dental practitioners, The Orthodontic Patient may also be of some interest to parents of orthodontic patients (and the occasional precocious youngster who enjoys technical detail). Though technical, enough of the information is accessible enough to provide insight into, and additional information about treatment that isn't always effectively communicated by practitioners.
       The Orthodontic Patient is a general introductory text, more concerned with offering a broad overview than going too much into detail. Nevertheless, much is thoroughly discussed.
       The book begins with a chapter on Basic biological principles. Orthodontic treatment involves exerting often strong forces on teeth in order to move them. The effects of these forces are considered -- on even cellular, as well as tissue level: the basics of the biological effects of using orthodontic appliances. This, and the chapter on materials, are the most technical, but clear (and concise) enough to convey the gist to a layman.
       The second chapter considers Dentofacial classification and ideals, discussing what are considered "occlusal ideals" and classifications of occlusion. Line-drawings and photographs clearly illustrate the various points discussed, while a break-down of the PAR (peer assessment rating) index also suggests the focus of orthodontic treatment and the significance of various aspects of malocclusion (from the size of over- and cross-bites to the discrepancy between upper and lower dental midlines). (Here, as elsewhere, the authors usefully point out weaknesses: in the case of the PAR index everything from possibly favouring "alignment in the labial segments, with less emphasis on buccal segment relationships" to not taking into account possible iatrogenic damage.)
       Chapters three through six are each devoted to treatment with a different type of orthodontic device: removable appliances, functional appliances, headgear, and fixed appliances.
       The chapter on Removable appliances covers the use of these -- most notably the basic Hawley-type retainer, as well removable devices used as space maintainers and as an expansion appliance, or to deal with anterior crossbites. The authors note that, unlike fixed appliances, tooth movement with removable appliances is largely limited to tipping -- a limitation that must be recognised if the appliances are to be used properly. A general treatment-schedule is described for each of the major uses of the devices, giving a general idea of the timeframe and expected progression.
       The next chapter moves on to the more elaborate (yet generally still removable) Functional appliances. The basic idea behind these is to "utilize forces generated by the orofacial soft tissues in order to move teeth" -- generally the device fitted so that biting down on it etc. affects the position of the teeth as well mandible growth. Their use is generally indicated during the period when facial growth is rapid (age 10 to 12 for girls, 12 to 14 for boys), with some treatment commencing earlier. (Given that there is almost no facial growth in adulthood the authors remind readers that: "Functional appliances would therefore seem to be of little value in the treatment of adult patients.")
       The authors discuss the theory behind (myo-)functional appliances, and introduce several of the most widely used (Clark twin block, bionator, Fränkel, Harvold, Herbst), as well as the basic management of the appliances.
       A chapter on Headgear discusses the main types, and the two main uses (for extraoral anchorage, and extraoral traction). The great forces that can be applied are usefully discussed, as are patient-safety issues and the difficulty of accurately monitoring patient compliance.
       The chapter on Fixed appliances goes into greater detail, specifically regarding the 'pre-adjusted Edgewise appliance' or 'Straight-wire® appliance'. The brackets used in these are different for each tooth, designed to facilitate movement to an ideal tooth-position. The flexibility of fixed appliances -- allowing for first-, second-, and third-order movement -- is quite thoroughly explained, and there are many examples and illustrations of specific treatments.
       Other fixed appliances are also discussed, including the Begg appliance and lingual appliances (fitted on the inside of the teeth, and thus not as visible), with the authors listing the perceived advantages and disadvantages of the latter versus the more common labial (and thus visible) devices.
       A chapter on Materials offers additional interesting perspectives, on everything from the acrylic in removable devices to the wire used in archwires. Different types of brackets are discussed (with metal ones remaining the obvious and preferred type), as are what is involved in bonding and debonding -- always critical parts of treatment. Modern brackets are fairly easy to remove now, but the authors note that ceramic brackets are considerably more difficult to deal with.
       Multidisciplinary treatments are also considered, including restorative dentistry, oral and maxillofacial surgery, and cleft lip/palate treatment.
       And finally, there is a chapter on Iatrogenic problems, which considers possible harms and dangers, from those posed by radiography to headgear safety issues, and the possibility of harm from materials used in treatment -- everything from the threat of cross-infection to allergies. Additionally, potential intraoral damage from the treatment itself is discussed -- from the fact that "both the rate of formation and amount of plaque that develops intraorally" increases when a patient wears an orthodontic appliance to root resorbtion and bone loss issues. Particular attention should, of course, be paid to these potential dangers; the authors usefully discuss the necessary preventive measure and precautions.

       The overview in this book is necessarily cursory, and much only briefly touched upon. Still, The Orthodontic Patient does offer a good overview of contemporary orthodontic treatment, with only a few glaring omissions. The biggest, perhaps, is that there is no discussion of the increasingly popular fixed rapid palatal expander (RPE, also Hyrax, etc.) which raises numerous issues of physiological and even biological change that are otherwise so well-addressed in this book. (Expansion of the upper (much less lower) arch doesn't find much room in these pages, even with removable devices.) But the wide range of subjects covered make it a useful and handy reference work for students and professionals, and it can certainly be recommended as such. Extensive references at the end of each chapter also point the interested reader to additional, generally far more specific literature.

       Though written for the professional, there is enough in The Orthodontic Patient that is accessible for the interested layperson. Natural tooth movement, and attempts to artificially direct and influence it via these varied appliances is certainly of some interest to anyone curious about physiology and modern technology; some of the ingenious approaches are quite remarkable.
       Parents of children who are expected to or are undergoing orthodontic treatment might also find it of some interest, as it offers far more detail than the generally available patient-literature, as well as what information orthodontists generally are able to provide. At least touching on almost all aspects of orthodontics, the book allows parents to get a good sense of much of what they should be aware of.
       Reminders to practitioners, especially regarding patient cooperation (on everything from hygiene to wear-time), are also well worth emphasizing to parents. The shocking disconnect suggested by cited studies, that most patients wear functional appliances "half as much as they admit to", for example, suggests it is incumbent on parents to play an active role in monitoring and ascertaining appliance-wear. The authors note:

There is clear evidence that patients retain only a limited amount of the verbal information provided to them at the chairside. Simple reinforcment in the form of a printed leaflet and calendar should therefore also be given when the appliance is fitted and has certainly been shown to be effective in this respect.

Functional appliances are quite bulky and it is best to ask the patient to get used to wearing them over a period, rather than expecting perhaps full-time wear from the beginning.

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Links:

• Oxford University Press publicity page

• Removable Orthodontic Appliances by Isaacson, Muir, and Reed

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About the Authors:

       Anthony J. Ireland and Fraser McDonald are both consultants and lecturers in orthodontics.

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© 2004-2021 the complete review

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