Most of an orthodontists day is spent dealing with the most types of orthodontic problems. One of my favourite sayings is protrusion plus crowding equals braces.
One would have to say that this is the “bread and butter” of the average orthodontist. Treatment however has come a long way and the leading edge of available options are the multidisciplinary cases. Most commonly these are cases involving adults but increasingly they involve young teens. What I’m talking about is people that have missing teeth in particular. In young teens this is most commonly because the permanent tooth just never formed. We call this congenital absence. There is nothing you can do to make a tooth form if it wasn't there in the first place!
In looking at these cases we need to make a couple of decisions. One of the earliest decisions to make is whether to keep the baby tooth or to get rid of it early. There are pros and cons for early removal of baby teeth. Early removal sometimes can encourage movement of the back teeth forward trying to eliminate the space. Early removal of the baby molars though can sometimes cause bone loss and this can make the future correction of the missing tooth more difficult.
The orthodontist then has to look into the future to try to plan the case so that when the patient is nineteen or twenty implants can be placed without fuss. The whole case then needs to be planned at the age of eleven or so with the very end point in mind. In these sorts of cases with implants it is increasingly common for dentists to do the implant and the restoration of the crown on top. In some cases and more complicated cases specialists can place the implants and other specialists can place the crowns.
While these decisions can be complex this is an example of a multidisciplinary case where other specialists in dentistry are involved. Complexity can escalate rapidly from here. In adult cases it is possible that there may be gum problems (involving the periodontist), impacted teeth and possibly jaw surgery (involving an oral and maxillofacial surgeon) and badly broken down teeth or regular bridgework (involving a prosthodontist). It is possible to extend this list further and further but normally multidisciplinary cases tend to involve two or three specialists and rarely more.
The critical part as in the first example is to get the planning right from the start so everybody is “on the same page”. Typically this is done by correspondence but in very complicated cases sometimes we have to get together to examine options to make sure we are choosing a path that produces the best outcome at every stage. This is the true value of multidisciplinary treatment.
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