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Although it is possible that orthodontic treatment can influence the skeletal form when growth-modifying (functional) appliances are used, it has little effect on soft tissues, tooth size and arch length. Remember that it is not necessary to treat every malocclusion and the benefits to the patient should be carefully assessed prior to undertaking any orthodontic treatment. Relieve crowding The decision to extract teeth needs to be carefully considered and depends on the degree of crowding, the difficulty of the case and the degree of overbite correction.

2 JANUARY 24 2004 Treatment of ectopic canines may induce resorption of the adjacent teeth because of the length of treatment time and the distance the canine is moved. Tooth intrusion is also associated with increased risk as well as movement of root apices against cortical bone. Above the age of 11 years the risk of resorption with treatment seems to increase. Adults have shorter roots at the outset and the potential for resorption is increased. Opinion is divided on whether treatment length is associated with increased resorption.

In severe cases, frank cavitation is seen which requires restorative intervention (Figs. 2 and 3). 5 in a study on white spot formation in children treated with fixed appliances, found that half of their patients had at least one white spot after treatment, most commonly on maxillary lateral incisors. 7 found that demineralisation can occur rapidly, within the first month of fixed appliance treatment. This has obvious aesthetic implications and highlights the need for caries rate assessment at the beginning of treatment.

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