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Book Review
5 (
); 169-170

Iatrogenic effects of orthodontic treatment: Decision making in prevention, diagnosis, and treatment

Asian Pacific Orthodontic Society, Mumbai, Maharashtra, India
YMT Dental College and Hospital, Mumbai, Maharashtra, India
Private Practice, Only Orthodontics, Mumbai, Maharashtra, India
College of Dental Surgeons, Academy of Medicine, Singapore
Department of Orthodontics, National University of Singapore, Singapore
Private Practice, Atria City Dental Group, 391-B, Orchard Road, 237784, Singapore
Thai Association of Orthodontists, Faculty of Dentistry, Mahidol University, Rajchathewi District, Bangkok, 10400, Thailand
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
This article was originally published by Wolters Kluwer and was migrated to Scientific Scholar after the change of Publisher; therefore Scientific Scholar has no control over the quality or content of this article.

How to cite this article: Vaid NR, Bryce L, Tanan J. Iatrogenic effects of orthodontic treatment: Decision making in prevention, diagnosis, and treatment. APOS Trends Orthod 2015;5:169-70.

Source of Support: Nil. Conflict of Interest: None declared.

Author: Roberto Justus

Publisher: Springer

Year: 2015

Pages: 130

Price: 159 USD Hard Cover, 100 USD E Book (Amazon), 24.99 USD Hard Cover with B/W Pics

ISBN: 978-3-319-183527(Hard Cover) 978-3-319-183524 (E-book)

Edition: 1st Ed

Iatrogenic effects are a reality with modern day mechanotherapy, which can jeopardize long-term effects of orthodontic treatment. Prof Roberto Justus has extensively researched and reviewed this area of orthodontic care through his extremely popular lectures and articles. This book is the first ever-orthodontic textbook that approaches this topic in great depth. The book is divided into three parts, focusing on white spot lesions, periodontal deterioration, and external apical root resorption (EARR).

In the first part of the book, the learning objective is minimization of the risks of enamel decalcifications as a result of orthodontic treatment, with special emphasis on enamel surface deproteinization and bonding with hybrid glass ionomer cement. The second part, focuses on prevention of periodontal deterioration, and explains how to avoid lower incisor proclination. Strategies to achieve ideal long-term alignment are described along with indications for different extraction protocols. In the third part, the etiology of EARR is deliberated, and strategies to minimize orthodontically induced EARR are discussed. Solutions on what to do, when EARR is detected in timely fashion, are also discussed.

Iatrogenic effects of orthodontic treatment is undoubtedly an excellent book for every orthodontic resident and specialist.


Table of contents

1. Prevention of White Spot Lesions (WSLs)

  • Abstract

  • Introduction

  • Detection

  • Incidence

  • Prevalence

  • Treatment

  • Natural remineralization

  • Prevention

  • Compliant methods

  • Noncompliant methods

    • RMGICs

    • Fluoride-releasing varnishes

    • Fluoride-releasing composite resins

    • Fluoride-releasing sealants

    • Non fluoride-releasing sealants

Composition of RMGICs

Setting reaction of Fuji Ortho LC

Preparation of the enamel surface

Increase in bracket shear bond strength with deproteinization

Rationale for deproteinizing enamel surfaces

  • Enamel etch-pattern types

  • Bracket shear bond strength

Increase in bracket shear bond strength by enamel moistening prior to bonding with RMGIC

Bracket failure rates

Clinical recommendations for bonding brackets with Fuji Ortho LC (guidelines)

Ligation methods in relation to WSL

Disadvantages of RMGIC

Enamel loss associated with orthodontic fixed appliances

Bracket removal recommendations (guidelines)



2. Prevention of Periodontal Deterioration/Damage



Problems associated with lower incisor proclination

  • Apical migration (recession) of the gingival margin

  • Increase in the magnitude of anterior open bite

  • Poor post-retention stability of lower incisor alignment

  • Deficient chin projection appearance and lip incompetence

Concluding remarks


3. Prevention of External Apical Root Resorption (EARR)




Risk factors

Etiology (genetic predisposition)


  • Pretreatment

  • Active treatment

  • Posttreatment

Clinical recommendations to protect patients from developing EARR (Root-Sparing Treatment Strategies)

  • Growth modification

  • Early interception

  • Serial Extraction

  • Correction of anterior open bite

  • Orthognathic surgery

Recommendations to minimize the risk of malpractice lawsuits

Concluding remarks


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