Restorative dentists have been conflicted for quite some time over when to use orthodontics or restorative dentistry when esthetically treating their patients. Many patients don't want to wear braces especially when the result obtained can be accomplished restoratively. When treating a patient who wants their teeth aligned but doesn't necessarily want orthodontics, it's helpful to ask yourself the following six questions to compare the modes of treatment options.
1.Will restorative dentistry need to be done whether orthodontics is performed or not? One of the biggest advantages to orthodontics is that it eliminates the need to restore teeth if they are in good condition. If your patient's teeth need to be restored anyway, it may be more efficient and conservative to align them restoratively.
2. Can the desired occlusal scheme be created without orthodontic movement? A good thing to know is that there are patients who must have orthodontics in order to avoid future issues with their teeth. If restorative dentistry offers an occlusion that isn't ideal, it's best to suggest referring your patient to an orthodontist to align the teeth.
3. Are the existing papilla levels esthetically acceptable? If the papilla levels aren't acceptable, it's very easy to move them apically with surgery. It is virtually impossible to move those levels coronally with anything besides orthodontics. When you evaluate all the esthetic parameters of your patient, take note of the gingiva and papilla heights – if they aren't symmetrical it may be time for the patient to see the orthodontist.
4. Is the most apical-free gingival margin level acceptable? If you have an under-erupted tooth without recession and the gingiva is too apical, you must erupt the tooth orthodontically. If the tooth does have some recession and root exposure it's easy to alter gum levels with surgery.
5. Can restorative dentistry create an acceptable contour and arrangement? This question usually comes up in cases of diastemas or crowding. Making a diagnostic wax-up of your patient's teeth should allow you to see whether the case needs to be treated orthodontically or restoratively.
6. Can teeth be prepared and restoratively aligned without destroying them structurally? In most cases, even if it's only one tooth that will lose structure, orthodontics will be the preferred method of treatment. However, there are some patients that will opt to have troublesome teeth extracted in order to avoid braces. As with many procedures, it's important to inform your patient of all the possible options of treatment. Although many patients don't want to wear braces, laying out the pros and cons of each method will help your patient understand each option and choose the treatment appropriate for them.