Adult Ortho Flashcards
why do adults seek ortho tx?
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
describe issues here
Migration and spacing of upper incisors secondary to periodontal disease
overerupted upper right lateral,
OB common post perio disease
descrive tx needed
Alignment and intrusion of UR2 with space closure and improvement in gingival margin level,
bonded retainer needed 11-13 to prevent relapse
ortho tx improved perio here - but there are warnings to give pre ortho for perio pt
5 differences between child and adult ortho tx
- Lack of growth
- Periodontal disease
- Missing/heavily restored teeth
- Physiological factors
- Adult motivation
growth for adult ortho
Adults “non-growing”
* small degree vertical growth*
Growth modification not possible
* Accept skeletal discrepancy or surgery, likely just align teeth to arches
Overbite correction more difficult tooth movement more challenging
* May need tooth intrusion
Midpalatal suture closed 16yo
* Can only expand maxillary base with surgery - tipping teeth limited scope
periodontal tissues in adults
More likely to have periodontal disease & loss of attachment in adult pts
* Need careful periodontal assessment! (BPE in ortho exam)
Previous support loss does not preclude ortho treatment but active periodontal disease does!
Loss of support leads to:
* Tooth centre of rotation moving apically
* Anchorage value reducing
loss of perio support leads to
2
- Tooth centre of rotation moving apically
- Anchorage value reducing
missing teeth/restorations impact on adult ortho
3
- Tooth loss leading to drifting/tilting
- More likely to be restored; can complicate bonding
- RCT okay if obturated correctly & symptomless
physiological factors in adult ortho pt
2
Decreased cell turnover, initial movement can be slower inc with age
Use lighter forces
* heavy forces = undermining resorption, greater tooth mobility *
motivation of pts for adult ortho
Often very well motivated
May request “aesthetic” appliances
3 possible reasons adult have ortho as adjunct to restorative work
Upright abutments to aid restoration
Intrusion of over-erupted teeth
Extrusion to increase crown length
adult ortho as adjunct to perio tx
May see tooth migration
* Proclined incisors, spacing, increased overbite, increase root show common complaint
Must stabilise first!
* Warn possibility of inc recession, deterioration in bone levels
Need long term retention
* Bonded retainer could extend tooth lifespan as well as retain ortho
Need warning - black triangle remain,
**good consent process **
adult ortho as adjunct to orthognathic surgery
Assessment & planning
* Orthodontist, maxillofacial surgeon, technologist, clinical psychologist
Pre-surgical orthodontics
* Align and coordinate dental arches,
* Decompensate incisors
Surgery
* Post-surgical orthodontics
ideal tx goal is
adrew’s 6 keys
Tight approximal contacts with no rotations.
Class I incisors.
Class I molars.
Flat occlusal plane or slight curve of Spee.
Long axis of the teeth have a slight mesial inclination except the lower incisors.
The crowns of the canines back to the molars have a lingual inclination
andrew’s 6 keys
Tight approximal contacts with no rotations.
Class I incisors.
Class I molars.
Flat occlusal plane or slight curve of Spee.
Long axis of the teeth have a slight mesial inclination except the lower incisors.
The crowns of the canines back to the molars have a lingual inclination
usual goal for adult orthodontics compared to child involves
compromise
Usually want faster results that may not be ‘perfect’
Usually deal with their specific problems i.e. here premolars still not aligned but centrals sorted by extraction and fixed retainer
why are metal brakcets better for lower teeth?
despite aesthetic ceramic brackets existing
Can cause severe lower tooth wear – ceramic is harder than enamel, cause grooving.
Reduce risk of this post aesthetic problem use conventional metal on lowers (esp if inc OB)
what are these
Lingual appliances
Digitally produced – scan then custom made brackets, milled by CADCAM, £££
Inter-bracket span smaller – need inc flexible wire
aligner technology
good for mild movements
* harder to do torque or tipping
composite attachments can be used to deliver a force on teeth which otherwise wouldn’t be easy (i.e. tip)
need pt compliance
Invisalign, Clearstep
bonded retainer at end option to prevent relapse
short term orthodontics
Huge rise in advertising
* Align front teeth, accept rest
Limited objective fixed appliacnes
* Preadjusted brackets in trays for indirect bonding, plus niti archwires
* Focus on anterior teeth
* GDP marketed - expand practice, keep pts and get referralls
Clear aligners
Inman aligner
ortho and the GDP
Must be adequately trained and competent
* Dentist’s responsibility
Requirement to discuss and explain full range of tx options to pt
Refer to specialist if in any doubt
know how to deal with ortho emergencies - sharp wire/loose parts
