Adult Orthodontics

Dr. Tassneem Elagib, M.S

(Orthodontics, Korea), B.D.S
(Sudan)
Treatment for adults has increased and become more
popular over the years. With there being many more
options of different appliances available, adult patients are
now not worried about having treatment, as there are
appliances that can suit different life styles. Metal
appliances are still available for patients who wish to have
them, but as they are more aesthetically and socially
pleasing, more adults want to have treatment.
INDICATIONS FOR ORTHODONTIC
TREATMENT IN ADULTS
• Aesthetics: some adults may wish to improve their dental aesthetics, for
instance to relieve crowding, improve the function of the bite, for space
closure, and for reduction in an overjet.
• Prosthodontic:
–– Implants: orthodontic treatment would help to upright roots (root
paralleling) of adjacent teeth to ensure there is enough space for
placement of an implant. Average required space for an implant is 7 mm.
–– Bridges: space may need to be created or reduced to allow for
restorative work of bridges to be done from missing teeth.
Parallelism of tipped abutment teeth Maxillary right first molar supra-erupted in the
can be achieved mandibular right first molar extraction site
Mesial tilting of the right mandibular 3rd molar into the
extraction site of the 2nd molar, leading to the
decrease in the extraction space
• Periodontal:
–– Crowding of teeth: It is a proven fact that crowding of teeth leads to
accumulation of plaque, which if not removed can cause subsequent
periodontal breakdown. Once these teeth become well aligned, oral
hygiene procedures can be carried out more easily and efficiently.
–– Spacing between teeth is not only unsightly but also provides an ideal
location for food lodging. This can lead to the formation of periodontal
pockets and associated loss of bone.
Crowding associated with poor oral hygiene
• TEMPOROMANDIBULAR JOINT DYSFUNCTION:
–– The term is a symptom and encompasses a varied number of
underlying causes. It can often be the result of over-closure, caused due to
an early loss of posterior teeth or/and decrease in the lower facial height.
Differences in Treating Adult Patients
• The biggest difference in treating an adult as opposed to a child is the treatment
time, which is greatly increased due to many factors:
• Un-favourable growth: movement of teeth is not as quick in non‐growing
patients.
• Medical history: adults tend to be on more medication than children, and some
medication can have an effect on tooth movement by slowing the process down.
It has been known that some hormone replacement therapy (HRT) medication
that women take can have an effect on tooth movement as the bone firms up,
making it difficult to achieve tooth movement.
• Expectations: adults may be more demanding to treat due to possibly
having high expectations of what they wish to achieve. However, they
may be more compliant than a child regarding the brace.
• Dental disease: any previous dental disease can have an effect on
treatment, such as periodontal disease, caries, tooth wear, missing
teeth, and most importantly heavy restorations such as crowns, since
bonding of brackets is not as efficient. No orthodontic treatment should
be carried out on adult patients with active periodontal disease.
Patients must be made fully aware that any periodontal disease must be
under control first.
• Periodontal ligament: relapse is higher in an adult, as the ligament and
fibres do not adapt to their new position as quickly, therefore retention
in an adult should be increased.
Aesthetic Appliances
• Over the years many appliances have been developed and there is now
a lot more choice for adult patients, with many aesthetically and socially
pleasing options.
• Clear buccal fixed appliances are very popular today. Many adults like
this brace as it is less noticeable and can be used with white, Teflon‐
coated wires.
• Invisalign has become very popular over the years. This appliance allows
patients to remove the brace at any time. To enable this appliance to
work, patients have tooth‐coloured attachments bonded to the teeth,
helping to achieve tooth movement with the aligner in place.
• Lingual appliances are fixed appliances bonded onto the lingual/palatal
surfaces of the teeth. An advantage of this brace is that it is bonded on
the inside of the teeth, making it unnoticeable. The disadvantage is that
treatment time is increased and it is very hard to tolerate, especially on
the lower arch, as it can cause irritation to the tongue.
Lingual appliance.
CONTRAINDICATIONS FOR ORTHODONTIC TREATMENT IN
ADULTS
 Medical: The patient is medically compromised to an extent that bone
formation itself is likely to be compromised. Especially in diseases like
diabetes mellitus, the healing capacity of the tissues is much below
normal and treatment should be avoided.
 Periodontal condition of the patient is poor, with multiple mobile teeth.
Patients who do not maintain good oral hygiene are poor candidates for
orthodontic treatment irrespective of the age of the patient.
 Skeletal malocclusions, which require surgical intervention, also might
not be undertaken because of the extent of medical and for physical
condition of the patient.
 Motivation of the patient is essential: is advised not to proceed with the
treatment unless the patient is found to be deter-mined to see the
therapy through to completion.