adult orthodontics

Question 1

characteristics of pts seeking tx

Answer 1

most under 40
most female
often heavily restored dentition

Question 2

why do adults seek tx?

Answer 2

improve dental appearance
 - refused tx as a child
 - lack of earlier opportunity
 - unhappy with result of prev tx - relapse or poor initial tx
adjunctive
 - facilitate Rx tx
 - alter periodontal drift
 - part of surgical correction of jaw discrepancy

Question 3

differences compared to children

Answer 3

lack of growth
periodontal disease - ongoing or previous
missing/heavily restored teeth
physiological factors
adult motivation

Question 4

growth

Answer 4

adults ‘non-growing’ - slow growth vertically
teeth don’t move as quickly in adult patients
growth modification not possible - accept skeletal discrepancy or surgery

Question 5

OB correction in adults

Answer 5

more difficult and takes longer
don’t have alveolar growth and rapid eruption potential
may need tooth intrusion

Question 6

how does the fusion of the midpalatal suture in adults affect treatment?

Answer 6

can only expand maxillary base with surgery

don’t use RME

Question 7

periodontal tissues

Answer 7

more likely to have PDD and LOA
need careful PD assessment
previous support loss does not preclude ortho tx but active PDD does - if not controlled ortho risks accelerating bone loss

Question 8

how does loss of support affect ortho?

Answer 8

tooth centre of rotation moving apically - tooth tips more readily
anchorage value reducing - molars

Question 9

missing teeth/restorations

Answer 9

tooth loss leading to drifting/tilting
more likely to be restored, can complicate bonding
- crowns difficult to bond retainer to
- also Rx fracture when remove appliance
RCT ok if well-obturated, symptomless and no PAP
- warn of risk of flare up esp if signs of apical pathology

Question 10

physiological factors

Answer 10

bone metabolism slows when growth completed
decreased cell turnover, initial movement can be slower
use lighter forces (otherwise can get v mobile teeth)

Question 11

adult motivation

Answer 11

often v well-motivated - self-present
can be fussier
may request “aesthetic” appliances

Question 12

adjunctive to restorative

Answer 12

upright abutments to aid restoration
- root paralleling for bridges
intrusion of over-erupted teeth
extrusion to increase crown length

Question 13

adjunctive to perio tx

Answer 13

may see tooth migration
proclined incisors, spacing, increased OB
must stabilise first
need long-term retention
warn of black triangles (if papilla lost) and risk of tooth loss
can get improvement in gingival levels following ortho alignment - potential gain in attachment

Question 14

adjunctive to orthognathic surgery

Answer 14

pre-surgical ortho 
 - align and coordinate dental arches
 - decompensate incisors
surgery
post-surgical ortho

Question 15

ideal tx goal - Andrews 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 slight mesial inclination except lower incisors
crowns of canines back to molars have a lingual inclination

Question 16

tooth coloured brackets

Answer 16

ceramic
composite/polycarboxylate
NiTi coated with PTFE

Question 17

ceramic brackets

Answer 17

very £
fracture more easily
more difficult to remove
reluctance to reposition as you just buy no you need to tx pt
slightly slower tooth movement - more friction
if U incisors occlude onto L ceramic brackets can get grooves on U incisors as ceramic harder than E - why you often have metal brackets on L teeth

Question 18

NiTi brackets coated with PTFE

Answer 18

can rub off

Question 19

lingual appliances

Answer 19

e.g. Incognito
used to use indirect bonding technique
now CADCAM custom made
v expensive

Question 20

Aligner technology e.g. Invisalign

Answer 20

removable - need compliant patient
series of aligners at 2 -weekly intervals
dot need to bond onto teeth
composite handles used to apply leverage - torque, intrude, extrude
mostly non-ext or mild crowding pts - tip and rotate

RETENTION

Question 21

short-term ortho

Answer 21

huge rise in advertising
align front teeth, accept rest
clear aligners
inman aligner
6-month smile
sectional fixed is basically short term ortho

RETENTION

Question 22

inman aligner

Answer 22

modification of Barrer appliance with NiTi components
squeeze incisors (spring and labial bow). 2 springs.

Question 23

6-month smile

Answer 23

pre-adjusted brackets in trays for indirect bonding plus NiTi archwires
Cfast, QuickStraightTeeth, Fastbraces (low friction)
GDP marketed