Pre-prothetic orthodontic treatment is a process required when a restorative dentist is unable to perform dental rehabilitation due to malpositioned teeth or an incorrect bite. The purpose of the orthodontic treatment is to "set the stage" for successful restorative treatment by aligning the existing teeth into a position that allows for proper rehabilitation.

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Examples of prothetic situations requiring Orthodontic pre-treatment:

1. Dental Implants:
   When the space for an implant is either too small or too large, orthodontic treatment can create the optimal spacing for the implant.

2. Restoration of malpositioned teeth:
   A tooth with poor angulation, requiring restorative treatment (e.g., a crown), may need to be aligned first to allow the restoration to fit properly.

3. Restoration of crowded teeth:
   Severe crowding may prevent proper access for restorative treatment of a specific tooth.

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Stages of pre-prothetic Orthodontic treatment

1. Restorative Consultation
   The patient is examined by the restorative dentist, who determines the need for orthodontic treatment and refers the patient to an orthodontist.

2. Orthodontic Consultation
   The orthodontist assesses the restorative dentist's request and determines if the treatment is feasible. The orthodontist also estimates the duration and the most appropriate method for achieving the desired outcome.

3. Orthodontic Documentation
   This includes X-rays, clinical photographs, 3D scans, and other imaging techniques tailored to the patient's case.

4. Completion of Orthodontic Evaluation and Treatment Planning
   A precise and individualized treatment plan is developed based on the diagnostic findings.

5. Execution of Orthodontic treatment
   The orthodontist implements the treatment plan to align the teeth in preparation for the restorative procedure.

6. Completion and Referral Back to the Restorative Dentist
   After achieving the desired alignment, the patient is returned to the referring dentist for the restorative phase.

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Orthodontic Tools for Preparatory Treatment

1. Clear Aligners

   Advantages of Clear Aligners:

   • A relatively new treatment method using transparent plastic trays.

   • The process starts with a 3D scan of the patient's teeth and jaws. This scan, along with additional images, is uploaded to a digital platform to create a computer-generated model.

   • The orthodontist modifies the model to meet clinical and biological needs, ensuring an aesthetic and feasible plan.

   • Based on this model, a set of aligners is produced. Each aligner applies incremental pressure to move the teeth gradually toward the final position.

   • Precise: Custom-made for each patient.

   • Aesthetic: Nearly invisible during treatment.

   • Comfortable: Gentle forces are applied, making the process more comfortable.

   • Suitable for most orthodontic cases.

2. Traditional Braces (Brackets):

   • The classic method involves bonding brackets to the teeth to facilitate alignment.

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Key questions about pre-prothetic orthodontic treatment

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Is it worth doing pre-prothetic orthodontic treatment?

Yes, in cases where restorative treatment is not possible due to orthodontic issues, preparatory orthodontics is the best option. This ensures that the restorative work can be carried out with minimal compromises, resulting in an excellent final outcome.

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Should You Align a Natural Tooth or Extract It for an Implant?

When deciding between aligning a natural tooth or extracting it for an implant, several considerations come into play:

Advantages of Preserving a Natural Tooth:

1. A natural tooth is biologically suited to the body and always preferable to an implant.

2. A natural tooth maintains its vertical position relative to adjacent teeth, whereas an implant does not erupt with surrounding teeth and may appear "sunken" over time.

3. A natural tooth can be moved to align with adjacent teeth, while an implant, once placed, is immobile.

4. Preserving a natural tooth avoids surgical procedures.

Advantages of Choosing an Implant:

1. An implant is often a quicker solution than orthodontic treatment.

2. Severely damaged teeth with poor prognosis may be better off extracted and replaced with an implant.

Conclusion:
In most cases involving healthy natural teeth, it is preferable to align and preserve them rather than extract and replace them with an implant.

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Treatment Duration

The duration of preparatory orthodontic treatment depends on the complexity of the case:

• Simple Cases: 6–12 months.

• Complex Cases: Longer treatment times may be required.

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Can Orthodontic Treatment Be Performed at Any Age?

Orthodontic treatment is possible at any age, but certain challenges arise with increasing age:

1. After growth has ceased, treatments aimed at stimulating or inhibiting jaw growth are no longer viable.

2. Periodontal disease, if present, may restrict or prevent orthodontic treatment.

3. Certain conditions worsen with age, making correction more time-consuming (e.g., dental crowding often becomes more severe over time).