Orthodontic Treatment Under IV-Sedation in a Hospital Outpatient Orthodontic Clinic

Background: Disabled children and children with congenital syndromes and orofacial anomalies show high demand for orthodontic treatment which until recently has been impossible to receive due to management difficulties. Intravenous sedation is becoming a preferred option for providing routine dental treatment of multiple appointments to various populations with special needs. Objectives: Describe experience in providing orthodontic treatment to a heterogeneous group of children with the use of deep IV sedation under spontaneous ventilation in a hospital outpatient clinic setting. Methods: We report 114 orthodontic procedures performed under deep IV sedation on 52 patients. The group of patients consisted of 52 children aged 3 to 16 years (mean=8.9 years). A substantial portion of the children (59.62%) were either physically and/or mentally disabled or suffered from oral and maxillofacial malformations such as cleft lip and palate (26.92%) and micrognathia resulting in sleep apnea (21.15%). Eight of the children underwent the entire orthodontic treatment under deep IV sedation due to lack of cooperation capabilities. Results: None of the orthodontic procedures was interrupted for any reason associated with the deep IV sedation technique. No clinically-significant adverse events (aspiration, laryngospasm, respiratory failure, cardiac arrest) were recorded during any of the reviewed procedures. Conclusion: Orthodontic treatment on anxious healthy, syndrome-affected or medically compromised children with the use of deep IV sedation under spontaneous ventilation, performed by a trained anesthesiologist, in a hospital outpatient setting is feasible. The treatment objectives are adapted individually to the specific child's cooperation capabilities and with intensive parental/caregiver's involvement, a gratifying orthodontic result can be obtained.