Adult orthodontics Flashcards
Why do adults seek orthodontic treatment
- Improve dental aesthetics
- Functional problems (uncommon)
- Not had orthodontic tx when younger
- Unhappy with tx results
- Relapse
- As an adjunct to facilitate restorative tx, after periodontal drift or part of surgical correction of jaw discrepancy
What makes adult orthodontics different to childrens
lack of growth
may have periodontal disease
may have missing/heavily restored teeth
physiological factors
adult motivation is greater
How does growth differ in adults
No longer have rapid growth, only a small amount of growth that continues throughout life
What is the impact of growth in tx
o Have to either accept the skeletal pattern and try carry out objective treatment, possible camouflage or offer orthognathic surgery to comprehensively correct the occlusion
o Tooth movements can be more challenging for e.g when reducing overbite you rely on eruption and vertical growth of the alveolar processes which helps to reduce the overbite easily but with adults we rely more on intrusion of the incisors which can be difficult to achieve
Why can RME devices not be used in adults
as the mid-palatal suture will be closed and it can only be expanded with surgery
Does periodontal disease preclude orthodontic tx
only active disease
What is the effect of loss of periodontal support on orthodontics
Tooth centre of rotation moving apically
Anchorage value reducing
What is the impact of missing/heavily restored teeth on orthodontic tx
o Tooth loss leading to drifting/tilting
o More likely to be restored which can complicate bonding
o RCT is okay if obturated correctly and symptomless
What are the physiological factors that can effect orthodontic tx
o Decreased cell turnover in adults which means initial movement can be slower
o Need to use lighter forces as more force results in undermining resorption and mobility of the teeth
When can orthodontics be used as an adjunct to restorative
- Upright abutments to aid restoration (often prior to bridgework/dentures but particularly implants)
- Intrusion of over-erupted teeth
- Extrusion to increase crown length
When can orthodontics be used as an adjunct to periodontal treatment
- May see tooth migration which results in spacing (most common complaint)
- Proclined incisors/spacing/increased overbite
- Periodontal disease must be stable first
- Need long term retention
- Robust consent process required
Why is robust consent required for periodontal patients with ortho
o Patient should be warned that orthodontic tooth movement can bring about a further deterioration and make teeth more mobile and point them further to being lost
What long term retention should perio patients get
o Palatal bonded retainer
o Can keep spaces closed and increase life of teeth
How can orthodontics be used as an adjunct to orthognathic surgery
- Assessment/planning - Orthodontist, maxfax surgeon, technologist, clinical psychologist
- Pre-surigical orthodontics - Align and coordinate dental arches, Decompensate incisors
- Surgery
- Post-surgical orthodontics
What are andrew’s 6 keys
- Tight approximal contacts with no rotations
- Class 1 incisors
- Class 1 molars
- Flat occlusal plane or slight curve of spee
- Long axis of teeth have a slight mesial inclination except lower incisors
- The crowns of the canines back to the molars have a lingual inclination
What are the treatment options for adults
fixed appliance: composite metal bonded brackets, aesthetic brackets, aesthetic wire, lingual appliance, liner technology
What are the aesthetic brackets
Ceramic brackets
What are the disadvantages of ceramic brackets
have higher friction making trying to slide the tooth along the wire more difficult which slows tooth movement and so px should be informed of this
they have tried to incorporate metal slots inside the brackets to reduce friction
What are the features of aesthetic wire
Tooth coloured wires
NiTi coated with PTFE to improve aesthetics
PFTE can wear off and can result in even worse aesthetics than normal wire
What are the features of lingual appliances
Bonded to lingual surfaces
Brackets digitally produced
Expensive
Can move teeth in the same way as labial bonded brackets
Interbracket span is smaller however so need a more flexible wire to go between brackets
What is aligner technology
o Electronic scan taken by dentist, technicians/orthodontist produce plan and deliver aligners for tooth position
o Months of aligners, moving onto a new one every few weeks
o Composite attachments placed which allow the aligners to deliver the force
Why is use of aligner technology limited in children
Use in children is limited as their teeth have not fully erupted and retention of aligners can be a problem
What movements are limited in aligner technology
o Movements e.g torque and tipping are limited with aligners
Why is retention important for adult orthodontics
- The more mild the case, the more of a chance of relapse with no retainers
- Want dual retention – bonded retainer and essix
