Omfs

1. SPECIAL CONSIDERATIONS IN
TREATMENT FOR ADULTS
BY:
Dr. Zafar Ul Islam
Assistant Professor Orthodontics

2. HOW MANY F DO YOU SEE IN THIS
SENTENCE?
finished files are the result
of years of scientific study
combined with the
experience of many years.

4. ADULTS
 Two groups:
1. Younger adults
2. Older adults

5. YOUNGER ADULTS
 Typically under 35
years of age often in
20s
 Seek ortho treatment
as they become
financially independent
 Goal of treatment is
improving quality of life
and maximum esthetic
improvement

6. OLDER ADULTS
 Typically in their 40s
and 50s
 Need ortho treatment
as part of larger
treatment plan
 Goal of ortho treatment
is to make control of
dental disease and
restoration of missing
teeth more effective

7. ADJUNCTIVE VS COMPREHENSIVE
ORTHODONTIC TREATMENT

8. ADJUNCTIVE TREATMENT
 Tooth movement carried out to facilitate other
dental procedures
 Involves only part of dentition
 Treatment duration is less than 1 year
 Long term retention is supplied by restorations

9. COMPREHENSIVE TREATMENT
 The goals are same as comprehensive treatment in
adolescents
 Require complete fixed orthodontic appliances
 Treatment duration exceed 1 year
 Adults are candidate for esthetically enhanced
appliances like clear aligners, lingual appliance and
ceramic brackets

10. GOALS OF ADJUNCTIVE TREATMENT
 Improve periodontal health by eliminating plaque
harboring areas and improving the alveolar ridge
contour adjacent to the teeth
 Establish favorable crown-to-root ratios and
position the teeth so that occlusal forces are
transmitted along the long axes of the teeth
 Facilitate restorative treatment by positioning the
teeth so that
 More ideal and conservative techniques (including
implants) can be used
 Optimal esthetics can be obtained with bonding,
laminate or full coverage porcelain restorations

11. PRINCIPLES OF ADJUNCTIVE TREATMENT
 Diagnostic and treatment planning considerations
 Biomechanical considerations
 Timing and sequence of treatment

12. DIAGNOSTIC AND TREATMENT PLANNING
CONSIDERATIONS
 Collection of adequate database
 Developing problem list
 Require interdisciplinary approach to patient
problems
 Supplemental radiographs are needed
 Cephalometric radiograph is usually not required
 Articulator mounted cast are needed for restorative
procedures
 Provide physiologic occlusion
 Treatment duration should be within 6 months

13. BIOMECHANICAL CONSIDERATIONS
 22 slot edgewise appliance is used
 Clear aligners can be used in some situations like
incisor crowding
 Passive placement of brackets
 Decrease forces due to periodontal support loss

14. TIMING AND SEQUENCE OF TREATMENT
 Control any active dental disease
 Teeth should be restored with RCT, fillings etc
 Crowns should be avoided
 Periodontal disease must be brought under control
 Surgical pocket elimination and osseous surgery
should be delayed

15. ADJUNCTIVE TREATMENT
1: Repositioning teeth that have drifted after
extractions or bone loss so that more ideal fixed or
removable partial dentures can be fabricated, or
so that implants can be placed

16. ADJUNCTIVE TREATMENT
2: Alignment of anterior teeth to allow more esthetic
restorations or successful splinting, while
maintaining good interproximal bone contour and
embrasure form

17. ADJUNCTIVE TREATMENT
3: Correction of crossbite if this compromises jaw
function (not all do)

18. ADJUNCTIVE TREATMENT
4: Forced eruption of badly broken down teeth to
expose sound root structure on which to place
crowns

19. COMPREHENSIVE TREATMENT IN ADULTS
 Psychological considerations
 Periodontal considerations
 Prosthetic - implant interactions
 Special aspects of orthodontic therapy for adults
 Finishing and retention

20. PSYCHOLOGICAL CONSIDERATIONS

21. PSYCHOLOGICAL CONSIDERATIONS
 Internal motivation:
adults really want
orthodontic treatment
to be done for them

22. PSYCHOLOGICAL CONSIDERATIONS
 Hidden set of
motivation: like repair
of personal
relationship, saving of
jobs, overcome
financial disaster etc.

23. PSYCHOLOGICAL CONSIDERATIONS
 Concern about the
appearance of
appliance: use of the
lingual appliance,
ceramic brackets and
clear aligners.

24. PSYCHOLOGICAL CONSIDERATIONS
 Treatment for adults in
separate areas: some
adults need privacy but
majority like interaction

25. PSYCHOLOGICAL CONSIDERATIONS
 Adults need
considerable degree of
explanation about the
procedures:

26. PERIODONTAL CONSIDERATIONS

27. PERIODONTAL CONSIDERATIONS
 Periodontal problems
increase with increasing
age
 Identify high risk patient:
bleeding on gentle
periodontal probing is
best indicator of
periodontal disease
 The active periodontal
disease must be under
control before
starting/during
orthodontic treatment

28. GINGIVAL GRAFTING
 Gingival grafts must be
placed in areas of
minimal attached
gingiva to prevent
recession

29. PERIODONTAL CONSIDERATIONS
 Procedures like
osseous recontouring
or repositioning flaps to
compensate for
gingival recession
should follow
orthodontic treatment

30. PERIODONTAL CONSIDERATIONS
 Use full bonded
appliance for
periodontally involved
adults
 Use self ligating
brackets and wire
ligatures instead of
elastomeric rings

31. PERIODONTAL CONSIDERATIONS
 Periodontal
maintenance therapy at
2 – 4 month interval is
the usual plan (more
frequent in severe
cases)
 Chlorhexidine mouth
wash between
appointments

32. PROSTHODONTIC – IMPLANT INTERACTION

33. PROSTHODONTIC – IMPLANT INTERACTION
 Adult patients need restorations such as
 Loss of tooth structure from trauma and wear/abrasion
 Gingival esthetic problems
 Missing teeth

34. PROBLEMS RELATED TO LOSS OF TOOTH
STRUCTURE
 Position the damaged,
worn teeth
buccolingually,
mesiodistally and
vertically

35. GINGIVAL ESTHETIC PROBLEMS
 Canine substitution for
lateral incisor require
canine esthetic
contouring and
extrusion to level the
gingiva

36. GINGIVAL ESTHETIC PROBLEMS
 Incisor extrusion in
cases of gingival
recession in order to
level the gingival
margin

37. GINGIVAL ESTHETIC PROBLEMS
 Black triangles
resulting from gingival
recession are resolved
by interproximal
enamel removal and
approximation of teeth

38. MISSING TEETH: SPACE CLOSURE VS
PROSTHETIC REPLACEMENT
 Space opening require
less time than space
closure in old first
molar extraction cases
 Space can be closed in
cases of tooth loss due
to juvenile periodontitis
 Bone graft is needed in
cases of old extraction
site

39. SPECIAL ASPECTS OF ORTHODONTIC THERAPY
FOR ADULTS

40. SPECIAL ASPECTS OF ORTHODONTIC THERAPY FOR
ADULTS
 Esthetic appliances in treatment of adults
 Light forces due to loss of periodontal support
 Skeletal fixation in the form of miniplates and mini
screws

41. ESTHETIC APPLIANCES
 Ceramic brackets
 Lingual appliances
 Clear aligners

42. APPLICATION OF SKELETAL ANCHORAGE
 Position teeth when no
satisfactory anchorage
is available
 Retraction of incisors
enmass
 Mesial and distal
movement of molars
 Intrusion of posterior
teeth

43. RETENTION IN ADULTS

44. RETENTION IN ADULTS
 Immediately placed
retainers after
orthodontic treatment
 Splinting of
compromised teeth
with clear vacuum
formed retainer or
wraparound retainer

45. RETENTION IN ADULTS
 Hold open bite with
miniscrew for one year
then use posterior
biteblocks

46. “KINDNESS IS THE LANGUAGE WHICH A DEAF CAN
HEAR AND A BLIND CAN SEE”
THANK YOU