Cleft lip and palate
Severe malocclusions – To improve the dental
health of a patient. This would be based upon the
Example: A patient who has a overjet greater than
9mm is 40 % more likely to suffer from trauma to
their upper incisors.
Interceptive orthodontics - To act in advance
to ensure the patient does not present with dental
health problems in the future.
Example : The use of space maintainers with early
extracted primary teeth. This will ensure that it is
less likely the patient will have crowding problems
in the future.
Impacted teeth – When teeth erupt in an
impacted way, the teeth with the worst prognosis
can be extracted and the arch aligned using
Example: A patient with severe crowding around the
canine and premolar region. The tooth with the
worst prognosis could be extracted, if there is a
lack of space and the teeth then realigned using
Hypodontia – Orthodontic appliances are used
to correct the malfunctioning arch alignment
caused by the congenital missing of teeth.
Example: A patient with hypodontia of their canines.
The first premolars can be moved into the position
of the canines. They can then be restored using
composite to function as canines and give better
Ceft lip and palate – Patients with this
condition, have issues with hypodontia and also
issues with anterior open bites and cross bites.
Example: Fixed orthodontic appliances can be used
to move teeth into position to correct openbites
and cross bites. Hypodontia can also be
compensated for using appliances, were teeth are
moved into position to allow proper function of
Craniofacial anomalies – Orthognathic
Surgery is used to correct any skeletal
discrepancies that are too severe to be treated
using fixed or removable appliances. After
surgery, where the skeletal pattern is corrected,
orthodontics is used to align the arch in a more
aesthetic manner. Such as the closing of any
open bites and the correction of cross bites that
may have resulted from the use of the surgery.
Adult Orthodontics for cosmetic restorative
Adult Orthodontics to save a root
Adult Orthodontics for distalizing an abutment
Adult Orthodontics for intrusion of severely bruxed
Orthodontics to gain space for implants
Orthodontics to prepare for a smile makeover
Adult Orthodontics for cosmetic restorative
reasons – By carrying out restorative treatment only, it is
often seen that the end result is not as pleasant as would
be if orthodontic treatment was used first.
Example: Bridges can be great when used to fill a gap.
However if the gap has been there for a while, the
abutments would be tilted mesially tilted. By placing a
smaller abutment may not provide great aesthetics. If a
removable orthodontic appliance was used to firstly
straighten the abutment teeth. Then a bridge was placed.
The end result would be more aesthetically pleasing.
Adult Orthodontics to save a root – orthodontics is
used to change the inclination of the abutment tooth, allowing
the root to be used as a post, with a good ferrule effect to
ensure good longevity of the crown.
Example : A patient who has the crown fallen off a few weeks a
go, may come see you. The root is in good condition,
however due to the fact that a good ferrule can not be
provided on the crown. The tooth must be extracted. The use
of orthodontics would allow their to be a increase in space,
thus allowing the tooth to be treated endotontically, then a
post crown inserted and a core built up with a 2mm ferrule
going all around the core.
Adult Orthodontics for distalizing an
abutment – Orthodontic treatment is used when
no molars are present. A premolar is moved
distally using a orthodontic appliance. This then
generates the space between two premolars in
which a bridge can be fitted. The patient would be
unwilling to have partial dentures and isn’t suitable
for implants due to lack of bone levels.
Adult Orthodontics for intrusion of
severely bruxed teeth – Orthodontic
appliances are used to correct edge to edge
occlusions which may be causing the teeth loss
due to attrition. The lower incisors can be slightly
intruded or upper incisors protruded, depending
on space available.
Orthodontics to gain space for implants –
Orthodontic treatment is used in cases were space is
needed for the implant to fit.
Example: A patient with a primary tooth, with no permanent
successor may need a replacement in the future. If for
example the tooth root is tilted mesially or there isnt space
for the implant to fit into. Orthodontics can then be used to
bring the tooth root upright. The primary tooth can then be
extracted when needed and the implant fitted.
Orthodontics to prepare for a smile
makeover – the use of orthodontic appliances to
move teeth into a better alignment. The restorative
phase then consists of removal of amalgam
restorations and replacement of them with
composite restorations. Which would enable the
patient to have a natural look, enabling them to
produce a more aesthetically pleasing smile to
their target audience.
Reduced Adaptive Capacity – The ability of the patient to
accept changes in their oral habits. E.g the reluctance to
Age changes in denture bearing area’s – bone resorption
and muscle atrophy.
Root caries –exposure of the root surface, due to gingival
recession. Accompanied by reduction in saliva flow rates
and a decrease in self care.
Tooth wear – very common amongst the elderly.
Pulpal changes – sclerosis and reduction in pulpal capacity
Reduction in manual dexterity – makes Oral Hygiene less
⇓ cellular reproduction,
⇓ tissue repair,
⇓ metabolic rate,
⇑ Degeneration of elastic and nervous tissue.
These result in reduced function of most body
Oral soft tissues :
⇓ in the thickness of the epithelium, mucosa, and sub-
mucosa is seen.
⇓ Taste bud function.
⇑ occurs in the number and size of Fordyce's spots
Recent evidence suggests that stimulated salivary flow
rate does not fall purely as a result of age. However,
medications or systemic disease can affect salivary
Dental hard tissues
Enamel becomes less permeable with age.
Clinically, older teeth appear more brittle, but
there is no significant difference between the
elastic modulus of dentine in old or young teeth.
The rate of secondary dentine formation reduces
with age, but still continues.
Occlusion of the dentine tubules with calcified
material spreads crownwards with age.
Toothwear is an age-related phenomenon and
can be regarded as physiological in many cases.
However, excessive and pathological wear can be
caused by parafunction, abrasion, erosion
(dietary, gastric, or environmental), or a
combination of these factors.
⇑ fibrosis and ⇓ vascularity mean that the defensive
capacities of the pulp ⇓ with ⇑ age.
⇓ pulp capping is less likely to succeed.
⇑ secondary dentine
⇑ pulp calcification.
Consequence: Patient is likely to progress from
reversible pulpitis to irreversible pulpitis quicker. Also
more likely to see people with pulpal necrosis.
⇓ vascularity and ⇓ cell turnover are found with ⇑
Consequence : Patients are more likely to develop
chronic periodontitis. Due to the body being
unable to repair the damage caused by bacteria
around the periodontium.
Oxford Handbook of Clinical Dentistry
An Introduction to Orthodontics: By Laura Mitchell