Adult orthodontics

Question 1

Why do adults seek orthodontic treatment

Answer 1

• 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

Question 2

What makes adult orthodontics different to childrens

Answer 2

lack of growth
may have periodontal disease
may have missing/heavily restored teeth
physiological factors
adult motivation is greater

Question 3

How does growth differ in adults

Answer 3

No longer have rapid growth, only a small amount of growth that continues throughout life

Question 4

What is the impact of growth in tx

Answer 4

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

Question 5

Why can RME devices not be used in adults

Answer 5

as the mid-palatal suture will be closed and it can only be expanded with surgery

Question 6

Does periodontal disease preclude orthodontic tx

Answer 6

only active disease

Question 7

What is the effect of loss of periodontal support on orthodontics

Answer 7

Tooth centre of rotation moving apically
Anchorage value reducing

Question 8

What is the impact of missing/heavily restored teeth on orthodontic tx

Answer 8

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

Question 9

What are the physiological factors that can effect orthodontic tx

Answer 9

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

Question 10

When can orthodontics be used as an adjunct to restorative

Answer 10

• Upright abutments to aid restoration (often prior to bridgework/dentures but particularly implants)
• Intrusion of over-erupted teeth
• Extrusion to increase crown length

Question 11

When can orthodontics be used as an adjunct to periodontal treatment

Answer 11

• 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

Question 12

Why is robust consent required for periodontal patients with ortho

Answer 12

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

Question 13

What long term retention should perio patients get

Answer 13

o Palatal bonded retainer
o Can keep spaces closed and increase life of teeth

Question 14

How can orthodontics be used as an adjunct to orthognathic surgery

Answer 14

• Assessment/planning - Orthodontist, maxfax surgeon, technologist, clinical psychologist
• Pre-surigical orthodontics - Align and coordinate dental arches, Decompensate incisors
• Surgery
• Post-surgical orthodontics

Question 15

What are andrew’s 6 keys

Answer 15

• 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

Question 16

What are the treatment options for adults

Answer 16

fixed appliance: composite metal bonded brackets, aesthetic brackets, aesthetic wire, lingual appliance, liner technology

Question 17

What are the aesthetic brackets

Answer 17

 Ceramic brackets

Question 18

What are the disadvantages of ceramic brackets

Answer 18

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

Question 19

What are the features of aesthetic wire

Answer 19

 Tooth coloured wires
 NiTi coated with PTFE to improve aesthetics
 PFTE can wear off and can result in even worse aesthetics than normal wire

Question 20

What are the features of lingual appliances

Answer 20

 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

Question 21

What is aligner technology

Answer 21

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

Question 22

Why is use of aligner technology limited in children

Answer 22

Use in children is limited as their teeth have not fully erupted and retention of aligners can be a problem

Question 23

What movements are limited in aligner technology

Answer 23

o Movements e.g torque and tipping are limited with aligners

Question 24

Why is retention important for adult orthodontics

Answer 24

• The more mild the case, the more of a chance of relapse with no retainers
• Want dual retention – bonded retainer and essix