Do we truly understand continual tooth movement?

Every experienced dentist is familiar with the patient who repeatedly returns to surgery seeking treatment for the same chipped front tooth.

Dentists who believe the correct course of action is a restorative veneer or crown wouldn’t be alone. However, that’s not necessarily correct, says IAS Academy clinical director Dr Tif Qureshi.

The real answer lies in a careful balance of orthodontic and restorative treatment, which takes into consideration the poorly-understood effects of continual teeth movement.

Continual tooth movement is an issue about which Dr Qureshi cares deeply. In fact, the expressive hand gesture he uses to demonstrate the phenomena is famous among IAS Academy students.

He first became aware of the problem after reading a little-known study on the subject.

The findings were ‘jaw-dropping,’ Dr Qureshi said: ‘It was telling me the teeth I had been veneering or putting fillings on, or crowning, were ultimately all moving.’ He added: ‘As someone who knows a little bit about occlusion, I knew what impact that could have on those teeth.’

Surprisingly, while orthodontists know about continual tooth movement, its effect on occlusion is less well known. Meanwhile, dentists view the issue as an orthodontic problem, when it also has significant restorative consequences.

‘It actually causes a restricted envelope of function,’ explains Dr Qureshi. ‘As a restorative dentist, seeing that in my own patients was – in my career – one of the biggest revelations I’ve had. I know that when I bring these cases to dentists on the course, it’s also the biggest eye-opening moment they’ve had.’

Dr Qureshi says the received wisdom that dentists should stay away from orthodontics is damaging to patients. And orthodontics practised without some restorative planning of position and function is equally damaging.

‘It’s why I teach it not as orthodontics but as ortho-restorative dentistry,’ he concludes. ‘Together, they give us the ideal situation.’

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