adult orthodontics Flashcards
characteristics of pts seeking tx
most under 40
most female
often heavily restored dentition
why do adults seek tx?
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
differences compared to children
lack of growth periodontal disease - ongoing or previous missing/heavily restored teeth physiological factors adult motivation
growth
adults ‘non-growing’ - slow growth vertically
teeth don’t move as quickly in adult patients
growth modification not possible - accept skeletal discrepancy or surgery
OB correction in adults
more difficult and takes longer
don’t have alveolar growth and rapid eruption potential
may need tooth intrusion
how does the fusion of the midpalatal suture in adults affect treatment?
can only expand maxillary base with surgery
don’t use RME
periodontal tissues
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
how does loss of support affect ortho?
tooth centre of rotation moving apically - tooth tips more readily
anchorage value reducing - molars
missing teeth/restorations
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
physiological factors
bone metabolism slows when growth completed
decreased cell turnover, initial movement can be slower
use lighter forces (otherwise can get v mobile teeth)
adult motivation
often v well-motivated - self-present
can be fussier
may request “aesthetic” appliances
adjunctive to restorative
upright abutments to aid restoration
- root paralleling for bridges
intrusion of over-erupted teeth
extrusion to increase crown length
adjunctive to perio tx
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
adjunctive to orthognathic surgery
pre-surgical ortho - align and coordinate dental arches - decompensate incisors surgery post-surgical ortho
ideal tx goal - Andrews 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 slight mesial inclination except lower incisors
crowns of canines back to molars have a lingual inclination
tooth coloured brackets
ceramic
composite/polycarboxylate
NiTi coated with PTFE
ceramic brackets
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
NiTi brackets coated with PTFE
can rub off
lingual appliances
e.g. Incognito
used to use indirect bonding technique
now CADCAM custom made
v expensive
Aligner technology e.g. Invisalign
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
short-term ortho
huge rise in advertising align front teeth, accept rest clear aligners inman aligner 6-month smile sectional fixed is basically short term ortho
RETENTION
inman aligner
modification of Barrer appliance with NiTi components squeeze incisors (spring and labial bow). 2 springs.
6-month smile
pre-adjusted brackets in trays for indirect bonding plus NiTi archwires
Cfast, QuickStraightTeeth, Fastbraces (low friction)
GDP marketed
