This document discusses orthodontic treatment for adults. It notes that there has been an 800% increase in adult orthodontic patients between 1970-1990 due to factors like increased awareness, innovations in appliances, and media exposure. Adult orthodontic treatment presents unique challenges compared to children due to reduced growth potential, periodontal considerations, and need for multidisciplinary care. The document outlines guidelines for comprehensive orthodontic treatment and adjunctive orthodontic treatment in adults.

1. Dr. Durga Prasad
Professor, Dept of
Orthodontics
Navodaya Dental College,
Raichur

2.  “Orthodontics includes the study of the growth and
development of the jaws and face particularly, and
the body generally as influencing the position of
the teeth;
 the study of action and reaction of internal and
external influences on the development and the
prevention and correction of arrested and
perverted development.”

3.  Prevention
 Interception
 Correction

4.  1970-1990
800% increase in adult patients

5. 1. Decrease in child patients - prevention
2. Increase in Orthodontists
3. Large adult patient pool

6. 1. Increased awareness
2. Innovations – ceramic, lingual
3. Better results
4. Advances in TMD, OGS
5. Media
6. Insurance
7. Affluence
8. Family dentist awareness
9. Beauty consciousness

7. 1. Young adults – treatment on financial
independence
2. Older adults – Other dental problems, adjunctive
treatment

8. Ravins –
1. Improve tooth-PDL relationship

9. 2. Establish an improved plane of occlusion
3. Provide normal tooth-to-tooth contact

10. 4. Manage space of missing teeth for prosthetic
replacement

11. 5. For TMDs – TMJ, muscles, occlusion
6. Aesthetic desires

12. 1. Severe skeletal discrepancies
2. Advanced local or systemic diseases
3. Excessive alveolar bone loss
4. Inability to obtain a result that the patient or
doctor will perceive as satisfactory
5. Poor stability / prognosis
6. Lack of patient motivation

13. Adults –
1. No growth potential – only tooth movement /
surgery
2. Concerned about appearance of appliance
3. Fussy, more time to adjust to appliance
4. Special periodontal considerations
5. Special general health considerations
6. Special dental considerations – missing teeth,
heavily restored teeth, crowns, bridges

14. 7. Well-motivated, co-operative
8. Appreciative of treatment
9. Special biomechanical considerations

15. 1. Attachment loss –
Loss of crestal bone….reduced PDL area… so
same amount of force produces more pressure
per unit area
Centre of resistance shifts apically…moment of
force increases

16. 1/3rd of root length apical to
alveolar crest
1/2 of root length
apical to alveolar crest
Root length apical to
alveolar crest

17. 2. Age related changes in PDL
Reduced blood flow and vascularity…reduced
progenitor cells…reduced
osteoblasts/osteoclasts… slow tooth movement
3. Age related bone changes
More cortical bone, less cancellous
bone…reduces rate of movement
4. Age related local changes
disuse atrophy of bone, soft-tissue changes

18. 1. Lower force levels than children
2. Initial forces low – less progenitor cells
3. Lesser moments
4. Light continuous forces

19. Extremely important
1. Standard
2. TMJ x-rays
3. Full-mouth IOPAs
4. Muscle exam
5. Stress evaluation
6. Diet evaluation
7. General health evaluation
8. Periodontal consultation – very important

20. Multidisciplinary approach –
1. General dentist
2. Orthodontist
3. Periodontist
4. Restorative dentist
5. Prosthodontist
6. Oral and Maxillofacial surgeon
7. Plastic surgeon

21. 1. ADJUNCTIVE Ortho treatment
2. COMPREHENSIVE Ortho treatment
3. SURGICAL Ortho treatment

22.  Tooth movement carried out to facilitate other
dental procedures necessary to control disease
and restore function
 Appliances – partial, short time
 Procedures-
1. Uprighting
2. Forced eruption
3. Alignment

23.  Ortho treatment that would take more than 6
months time
 Similar to adolescents…. Keep in mind the special
biomechanical considerations and special adult
needs.

24.  Special adult needs – Adults do not like –
1. Unaesthetic appliances
2. Pain
3. Extended treatment time
4. Personal inconvenience
5. Cost

25. 1. Simple, aesthetic, invisible
2. Light force
3. Fixed—better control
4. Long acting
5. Short over-all treatment duration

26.  Orthognathic surgeries – Maxilla and mandible in
all 3 planes of space
 Combined approach – Orthodontist and Oral
Surgeon

27.  Same general principles
 Adults more fussy … so retention plan more
critical
 Post-orthodontic stabilization + Restoration of
mutilated dentition + Cross- arch stabilization.