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Book Review: Iatrogenic Effects of Orthodontic Treatment: Decision-making in Prevention, Diagnosis and Treatment

In this book Roberto Justus describes some of the significant iatrogenic problems that can occur during orthodontic treatment. The bookwas publishedwith the aim to help orthodontists reduce or even eliminate some of these problems. The problems described in detail are white spot lesions, periodontal deterioration during orthodontic treatment and external apical root resorption (EARR). The author describes a method to improve the bond failure rate of resin-modified glass ionomer cements. This method includes using sodium hypochlorite (5·25%) to deproteinising the enamel surface before etching for 15–30 s with 37% phosphoric acid. The resin-modified glass ionomer cement is desirable primarily due to the sustained fluoride release this material offers and the belief this will reduce the incidence of white spot lesions. However, it is acknowledged by many orthodontists that the bond failure rate is higher for this material compared to composite resins and the author suggests that following the etch, the enamel surface should be moistened to improve bond failure rates. This section is well written and very interesting for orthodontic postgraduate students, specialists or dentists with an interest in orthodontics. Perhaps a randomized study comparing the technique suggested with a popular resin-based bonding agent would put beyond scientific doubt these questions about white spot lesions and bracket failure rates. The management of white spot lesions, should they occur, is described with emphasis on the use of low-dose fluorides to allow remineralization from with the body of the white spot lesion and CPP-APP. The second area of iatrogenic damage is the periodontal tissue around the teeth. Treatment planning, and specifically the intention to procline the lower incisor more that 2 mm is reported to increase the likelihood of a loss of periodontal support. The problems caused by over expansion of the arch, the management of anterior open bite and the error of treating dental crowding with mandibular arch expansion are all well described. All this good advice is supported with many examples of clinical cases to illustrate the points made in this comprehensive review. The last section of this book describes apical root resorption and advice for the specialist to avoid this iatrogenic problem. Orthodontic management of cases presenting with evidence of apical root resorption, together with patient with short roots vulnerable to the negative effects of this complication are illustrated. Finally, the medico legal aspects of EARR and how to avoid litigation is excellent and timely in an ever increasing litigious world. I would recommend this book to every dedicated student of the art of orthodontics.