Adult Orthodontics Flashcards
What are the reasons for adults seeking orthodontic treatment?
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
Functional- less common unless severe malocclusion
How does adult orthodontic treatment differ from children?
Lack of growth
Periodontal disease
Missing/heavily restored teeth
Physiological factors
Adult motivation- usually high level
Aesthetics- may require different appliances
What are the issues with the lack of growth in adults for orthodontic treatment?
Growth modification not possible
-> Accept skeletal discrepancy or orthognathic surgery
Overbite correction more difficult
-> May need tooth intrusion- difficult movement
Midpalatal suture closed
-> Can only expand maxillary base with surgery
What are the issues with periodontal disease in adult patients who want orthodontic treatment?
Active periodontal disease precludes treatment
Loss of support leads to:
-> movement of axis of rotation apically
-> Anchorage value reducing
What are the issues with missing teeth and restorations in adult patients who want orthodontic treatment?
Tooth loss leading to drifting/tilting
More likely to be restored- can complicate bonding
Poor RCT or PA pathology will need to be treated before Ortho treatment
Which physiological factors can affect adult orthodontic treatment?
Decreased cell turnover, initial movement can be slower
-> Use lighter forces- to prevent undermining resorption
What situations may Ortho be used as an adjunct to restorative treatment in adults?
Upright abutments to aid restoration (bridges and dentures)
Intrusion of over-erupted teeth OR Extrusion to increase crown length
-> to get margin in right position for crowns
What can migration of teeth due to periodontal disease result in?
Spacing
Increased overbite
Extruded teeth- can be intruded via Ortho
What situations may Ortho be used as an adjunct to periodontal treatment?
-> Can result in improved attachments
-> Bonded wire placed to prevent relapse and give periodontal stability
-> Close spaces (but not black triangles)
Why must the consent process for use of orthodontic treatment as an adjunct to periodontal treatment be robust?
Risk of speeding up loss in teeth if perio is not stabilised
Need for life long retention
Who are the members of the MDT for orthognathic surgery?
Orthodontist
Maxillofacial surgeon
Technologist
Clinical psychologist
What are the aims of pre-surgical orthodontics prior to orthognathic surgery?
Align and coordinate dental arches,
Decompensate incisors
-> large OJ will be left to allow for mandibular advancement surgery (post surgery Ortho may also be required)
What are Andrew’s 6 keys (ideal treatment goal)?
- 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
Why may Andrews 6 keys not be fulfilled in many adult orthodontic cases?
Not achievable in some
Patients may not want this anyway- they just want an improvement in a short term preferably (they don’t have a technical goal like a clinician would)
Often involves a compromise- patient attitude and compliance dictates what is possible
What replaced fitment of SS band on every tooth in orthodontics?
The invention of acid etch and bonding made Ortho more aesthetically acceptable and more widespread
-> band still may be used if extra strength required in some regions (maybe for head gear)
