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)
What are the types of aesthetic bracket?
Ceramic- break during treatment and removal, higher friction (teeth move slower)
Polycarbonate- not as strong, cheaper
What is the main issue with aesthetic brackets?
The wire remains metal
What are the issues with ceramic brackets?
Metal slot may have to be added to ceramic brackets to reduce friction
Ceramic brackets can cause wearing of lower incisal edges- so they are often not used on lowers (especially in cases with large OB)
What are the features of lingual appliances?
Brackets to lingual surfaces of teeth- better aesthetics
Digitally produced- brackets are custom made to fit teeth
CAD CAM system then communicates with milling machine (EXPENSIVE)
Inter-bracket span is smaller- more flexible wire required
What are the features of aligner technology?
Sent in a batch- many aligners sent and changes to new one every few weeks
Computerised- uses intra-oral scan
Dentist will review every so often to check progress
Mild cases- poor at tipping and torquing
Composite attachment- can help add force to the teeth to help move them to ideal positioning using aligner
Requires very compliant and motivated patient
Results may not be perfect
Requires retainers afterwards
What are the features of remote control aligner therapy?
Patient doesn’t attend dentist or orthodontist frequently after initial scan
Likely not to have radiographs
Assumes that your dental health is adequate (dangerous?)
Supervise treatment via video call
Are right patients getting right treatment?
What are the basis of short term orthodontics?
Aim to align anterior teeth and accept position of the rest (quick treatment times of 6 months)
-> marketed by GDPs
What are examples of short term orthodontic methods?
Clear aligners
Inman aligner
Six month smile
-> Preadjusted brackets in trays for indirect bonding, plus niti archwires
C-Fast- nickel titanium wires coated with PTFE tape for better aesthetics
What are the features of the Inman Aligner?
Derived from Barrer appliance- spring loaded bow to fix incisor relapse (produces degree of alignment before new retainer produced)
Uses nickel titanium wire
Compliance issue as it is removable
Gives less tooth movement than fixed
Which type of retention is often required following adult orthodontic treatment?
Dual retention- fixed and removable in combination
