From the Guidelines
Orthodontic vital signs are considered positive when there is evidence of healthy tissue response to orthodontic treatment, including normal tooth mobility, pink and firm gingival tissues, absence of significant pain, and appropriate tooth movement. This typically includes signs of normal tooth mobility, pink and firm gingival tissues, absence of significant pain beyond mild discomfort, and appropriate tooth movement in response to applied forces. During orthodontic treatment, some mild discomfort, slight tooth mobility, and minimal gingival inflammation are expected and considered normal physiological responses, as stated in the guidelines for dental diagnostic imaging in the developmental age 1. However, these responses should be transient and resolve within a few days after adjustments. The biological basis for these positive vitals relates to the controlled inflammatory process that allows for bone remodeling around teeth. When orthodontic forces are applied, they trigger a cascade of cellular events involving osteoclasts and osteoblasts that break down bone in the direction of pressure and build new bone in areas of tension, enabling tooth movement while maintaining periodontal health, as supported by the principles of orthodontic diagnosis and treatment planning 1. Some key points to consider when evaluating orthodontic vital signs include:
- The presence of dental anomalies or the need for orthodontic treatment, which may require radiographic examination, as recommended by national guidelines for dental diagnostic imaging in the developmental age 1.
- The use of panoramic radiography and teleradiography of the skull in norma lateralis, which are necessary for a correct orthodontic diagnosis and treatment planning, as stated in the guidelines 1.
- The importance of considering the patient’s age, medical and dental history, and clinical condition when determining the need for radiographic examination, as emphasized in the guidelines for dental diagnostic imaging in the developmental age 1. If a patient experiences severe pain, excessive tooth mobility, significant gingival recession, or other concerning symptoms, these would indicate negative vitals requiring immediate professional evaluation. In such cases, it is essential to reassess the orthodontic treatment plan and adjust it as necessary to ensure the best possible outcome for the patient, while prioritizing their morbidity, mortality, and quality of life. The use of CBCT scans, which provide volumetric graphic 3D representation of all anatomical bony structures, may be beneficial in complex cases, as it overcomes the limitations of ordinary 2D radiographic images, as noted in the guidelines for dental diagnostic imaging in the developmental age 1. Overall, positive orthodontic vital signs are essential for ensuring the success of orthodontic treatment and maintaining the patient’s overall oral health, and should be closely monitored throughout the treatment process, as recommended by the guidelines 1.
From the Research
Orthodontic Vital Signs
Orthodontic vital signs are considered positive when orthodontic treatment leads to improvements in airway dimensions and respiratory function. The following points highlight the conditions under which orthodontic vital signs are positive:
- Increase in airway volume: Orthodontic treatment can lead to an increase in airway volume, which is a positive sign. This has been observed in studies where patients underwent orthodontic therapy that included expanding the upper jaw and advancing the mandible 2.
- Improvement in minimum cross-sectional area: An increase in the minimum cross-sectional area of the airway is also a positive sign. This has been reported in studies where patients underwent orthodontic treatment, including maxillary expansion and mandibular advancement 2.
- Decrease in apnea-hypopnea index (AHI): A decrease in AHI is a positive sign, indicating improved sleep quality. This has been observed in studies where patients underwent orthodontic treatment, including maxillary expansion and mandibular advancement 2.
- Improvement in subjective sleep quality: An improvement in subjective sleep quality, as measured by the Epworth Sleepiness Scale (ESS), is also a positive sign. This has been reported in studies where patients underwent orthodontic treatment, including maxillary expansion and mandibular advancement 2.
- Respiratory benefits after orthognathic surgery: Orthognathic surgery, including surgically-assisted rapid palatal expansion (SARPE) or bimaxillary repositioning of the bony bases, can lead to respiratory benefits, including a decrease in mean nasal resistance 3.
Conditions for Positive Orthodontic Vital Signs
The following conditions are associated with positive orthodontic vital signs:
- Orthodontic treatment with maxillary expansion and mandibular advancement: This type of treatment has been shown to positively affect airway dimensions and respiratory function 2.
- Growth modification and non-extraction therapy with fixed appliances: This type of treatment has been shown to have positive effects on airway volume, regardless of the malocclusion 4.
- Orthognathic surgery: This type of surgery has been shown to lead to respiratory benefits, including a decrease in mean nasal resistance 3.