Download Orthodontics for Adults

Orthodontics for Adults
by Dr. Gurkeerat Singh
Orthodontics for Adults
Adults, as the word conveys, are patients in whom active growth cessation has taken place. The number
of adult patients seeking orthodontic treatment has gone up drastically in the past few years. The
reasons for this include:
1. Did not want orthodontic treatment as children.
2. Parents or they themselves did not know about orthodontic treatment.
3. Orthodontic treatment was not advised.
4. Could not afford.
5. Concerned about appearance NOW.
6. Malocclusion has become worse.
7. Are developing complications- periodontal and / or endodontic.
8. Advised by some other specialist.
9. TMD or CMP.
10. Overall heightened concern about dental health.
Classifying Adult Patients
For all practical purposes these patients have classified into three groups:
1. Group I : 18 to 25 years of age.
2. Group II : 26 to 35 years of age.
3. Group III : 36 years and older.
This division in important; the problems faced in each group are different and / or the cumulative effects
of the previous as well as some new dimensions are added to the pre-existing problem list.
Group I patients are basically treated as other adolescent patients with no active growth potential, a
heightened awareness of deformity as well as a desire to have esthetic appliances (tooth colored
appliances).
Group II patients will show some amount of periodontal involvement and at times mutilated dentition.
The overall concern might be disproportionate to the amount of deformity present. The patient is
usually not keen to wear fixed orthodontic appliances; 'invisible' or lingual braces might be an option.
Group III patients are generally periodontally compromised and possess mutilated dentitions. The
mutilation and the periodontal complications are usually directly proportional to each other. These
patients are usually referred by other specialists prosthodontist / periodontists or endodontists. The
concern for retaining the remaining teeth is a motivational factor for majority of these patients. The
concern for esthetic and / or fixed orthodontic appliances might be a concern to some, but the duration
of treatment is generally of greater importance.
Studies done with the purpose of determining whether differences in the immediate and general social
context of a person would be reflected in different levels of recognition of and perception about
malocclusion and orthodontic treatment need have proved that increased familiarity with orthodontic
treatment does not lead to more critical judgment of dental esthetics, treatment need, and increased
valuation of straight teeth. These finding have us to believe that the patient's individual concern as well
as the motivation provided by the primary care provider are important reasons for patients to seek
orthodontic treatment.
Objectives of treating Adults:
Objectives of treating Adults are different- they are case variable, situation variable and should
encompass the theory of minimal dental manipulation of tissues for the individual case.
Treatment Considerations
General:
Medical problems associated with age may delay healing.
Prevent extractions.
Psychological:
Usually adults have high expectation.
Specific problems.
At times unrealistic expectations.
Periodontal:
Active periodontal disease usually present.
Loss of alveolar bone changes the center of resistance of teeth.
Teeth more prone to tipping.
Use of lighter forces.
Remove excess adhesive.
Minimise tooth extrusion.
Steel ligatures attract less plague.
Restorative:
Heavily restored teeth.
Bonding to porcelain / gold / metal!!
Prosthetic bridges complicate treatment planning.
Post-orthodontic treatment is always a consideration
Debulking of MO / DO / MOD amalgam restorations.
Rate of tooth movement:
Decreased initial movement.
Adult bone less reactive to mechanical forces.
Subsequetly similar rate of tooth movement.
More tipping than bodily.
Growth:
No growth potential- no functional appliances.
Intrusion mechanics.
Aesthetic:
Tooth colored or lingual appliances.
Extraction pattern may have to be modified.
TMD:
Evaluate before, during and after treatment.
Orthodontics treatment for TMD ?!!
Treatment modalities - Comprehensive Vs Adjunctive:
Adults might require either comprehensive treatment or adjunctive treatment. Patients requiring
comprehensive treatment are true orthodontic patients, whose treatment goals can be achieved solely
by the use of orthodontic appliances and / or orthognathic surgery. Adjunctive treatment is usually
undertaken as precursor to or in conjunction with other dental procedures.
Comprehensive treatment might or might not include extractions and / or orthognathic surgery (Case 1
& 2).
Adjunctive treatment is usually provided to achieve:
1. Parallelism and / or derotation of abutment teeth (Case 3, 4 & 5).
2. More favorable distribution of teeth (Case 6)
Intra-arch.
Inter-arch.
3.
Redistribution and redirection of occlusal and / or incisal forces (Case 7).
4. Improvement of periodontal health by:
Elimination of crowding (Case 8 & 9).
Elimination of spacing (Case 10 & 11).
Improvement or correction of mucogingival and osseous defects (Case 12).
5. Establishing a more favorable crown-to-root ratios.
Why do adjunctive orthodontic treatment?
May avoid the use of a fixed or removable prosthesis.
Ensuing restorative dentistry is simplified.
Endodontic therapy may be avoided.
Paths of bridgework insertion will parallel the long axes of the roots.
Periodontally compromising compensations in size and contour of crowns will not be necessary
to provide proper contacts in centric occlusion and excursive movements.
Case 1: Adult treatment with extraction.
Case 2: Adult treatment involving orthognatic surgery.
Case 3: Adjunctive treatment involving uprightening of 3rd molars.
Case 4: Adjunctive treatment involving derotation of traumatized 11.
Case 5: Adjunctive treatment involving derotation of 32 and 42.
Case 6: More favorable distribution of teeth in before orthognathic surgery.
Case 7: More favorable distribution of teeth in before prosthetic rehab.
Case 8: Improving periodontal health by the elimination of crowding (esthetic brackets).
Case 9: Elimination of crowding following periodontal breakdown (segmental lingual).
Case 10: Elimination of spacing (full arch ceramic brackets).
Case 11: Elimination of spacing (segmental lingual).
Case 12: Correction of developing osseous defect.
And certain other cases where a compromise was made to achieve acceptable results.
Various fixed retainers used and their advantages.
Retention and relapse
Long term retention generally fixed is advocated. Frequent recalls and long-term follow-up is advised.
Prosthetic rehab done immediately will aid stability.
Conclusion:
The objectives of adult orthodontic treatment are different- they are case variable, situation variable
and should encompass the theory of minimal dental manipulation of tissues for the individual case.
Chose a team of specialists and evaluate each patient and each quadrant of that patient from a long
term prospective. Conventional orthodontic wisdom without apprehension and bias when applied with
judious caution will only lead to a successful treatment in an adult patient.
Recommended for further reading:
Motivation for adult Orthodontic treatment- Breece G.L. and Nieberg L.G., JCO Pg.166-171,
1986.
A comparison of attitudes toward orthodontic treatment in British and American communitie - J.
F. C. Tulloch et al, AJO.
Segmental approach to mandibular molar uprighting - Roberts, Chacker, and Burstone, Volume
1982 Mar (177 - 184), 1997.
Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal
tissues versus those of adolescents, Boyd R. L., Leggott P. J., Quinn R. S., Eakle W. S., and
Chambers D.; AJO, 1997.
The effects of space closure of the mandibular first molar area inadults, Hom BM, Turley PK. :
Am J Orthod 1984;85:457469.
Orthodontic space closure of the edentulous maxillary first molar area in adults Goldberg D,
Turley PK.. Int J Adult Orthod Orthognat Surg 1989;4:255266.
Case Report WI Treatment of arch length deficiency in an adult male: the extraction of
compromised molars rather than pre-molars: Artun J., Mirabella A.D., Ang. Orthod. No. 5, 327
332, 199. Articles By Dr.Birte Melsen