Adult Orthodontics

Question 1

Why do adults seek dental treatment?

Answer 1

• improve dental appearance
  
  • refused treatment as a child
  • lack of earlier opportunity
  • unhappy with result of earlier treatment
    
    • relapse
    • poor initial treatment
• adjunctive
  
  • facilitate restorative treatment
  • after periodontal drift
  • part of surgical correction of jaw discrepancy

Question 2

What can cause migration and spacing of upper incisors?

Answer 2

periodontal disease

Question 3

How does orthodontic treatment in adults vary from orthodontic treatment in children?

Answer 3

• lack of growth
• periodontal disease
• missing/heavily restored teeth
• physiological factors
• adult motivation

Question 4

How does growth affect adult orthodontics?

Answer 4

• adults are non-growing
• growth modification not possible
  
  • accept skeletal discrepancy
  • surgery
• overbite correction more challenging
  
  • may need tooth intrusion
• mid palatal suture closed
  
  • can only expand maxillary base with surgery

Question 5

How do periodontal tissues affect adult orthodontics?

Answer 5

• more likely to have periodontal disease
  
  • additionally loss of attachment
• requires a careful periodontal assessment
• previous support loss does not preclude ortho
  
  • active periodontal disease dose
• loss of support leads to:
  
  • tooth centre of rotation moving apically
  • anchorage value reducing

Question 6

How do missing teeth and restorations affect adult orthodontics?

Answer 6

• tooth loss
  
  • leads to tilting and drifting
• more likely to be restored
  
  • can complicate bonding
• RCT teeth
  
  • fine if obturate correctly
  • must be symptomless

Question 7

What physiological factors affect adult orthodontics?

Answer 7

• decreased cell turnover
  
  • initial movement can be slower
  • must use lighter forces

Question 8

How does adult motivation affect adult orthodontics?

Answer 8

• often very well motivated
• may request aesthetic appliances

Question 9

How can adult orthodontics be used as an adjunctive to restorative treatment?

Answer 9

• uprighting abutments
  
  • aid restoration
    
    • bridges
• intrusion of over-erupted teeth
• extrusion to increase crown length

Question 10

How can adult orthodontic be used as an adjunctive to periodontal treatment?

Answer 10

• may see tooth migration
• proclined incisors, spacing, increased overbite
• must stabilise perio first
  
  • no treatment in active perio cases
• need long term retention

Question 11

How can adult orthodontics be used an an adjunctive to orthognathic surgery?

Answer 11

• assessment and planning
  
  • orthodontist
  • maxillofacial surgeon
  • technologist
  • clinical psychologist
• pre-surgical orthodontics
  
  • align and coordinate arches
  • decompensated incisors
• surgery
  
  • post-surgery orthodontics

Question 12

What are Andrew’s 6 Keys for ideal treatment goal?

Answer 12

1. tight proximal contacts with no rotations
2. class I incisors
3. class I molars
4. flat occlusal plane or slight curve of Spee
5. long axis has slight mesial inclination
6. crowns of the canines-molars have lingual inclination

Question 13

What must be accepted in adult orthodontic cases more than young adults?

Answer 13

more likely to involve compromise

Question 14

What are the different options for adult orthodontics?

Answer 14

• traditional metal fixed appliance
  
  • metal brackets and arch wire
• ceramic brackets
  
  • improved aesthetics
  • only used in visible area
• lingual appliances
  
  • brackets placed on lingual aspect
  • improved aesthetics
  • can irritate tongue
• aligners
  
  • Invisalign
    
    • composite anchors added to teeth
• short term orthodontics
  
  • clear aligners
  • align front teeth and accept the rest
  • ‘six month smile’