ADULT
ORTHODONTICS
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandenta...
Index
• Adult ?
• History of adult orthodontics
• Adult orthodontics
• Reasons for increased interest of adults in
orthodo...
Index
• Treatment objectives
• Diagnosis
• Treatment planning :
Psychological considerations
Biomechanical considerations
...
ADULT ?
• Adult is defined as one who is fully grown, most
males 18 and above and most females of 16
and above can be cons...
HISTORY
• Kingsley, in 1880, indicated an early awareness
regarding orthodontic potential in adult patient.
• He stated, “...
HISTORY
• MacDowell(1901) was of the opinion that
after the age of 16 years, a complete and
permanent change in transition...
HISTORY
• Lischer (1912) believed that the period
from 6th
to 14th
year was a golden age of
treatment
www.indiandentalacad...
HISTORY
• In 1921 Calvin Case demonstrated the value of
orthodontic therapy in the lower anterior area for
the aged, perio...
ADULT ORTHODONTICS
• Ackerman : “Adult orthodontics is concerned
with striking a balance between achieving
optimal proxima...
Recent AAO survey : Increased % of patients >21
yrs, from 4% ten yrs ago, to almost 7% today; in
another decade’s time adu...
INCREASED INTEREST IN
THE ADULT PATIENT
Reasons
[Melsen in ‘Curent controversies in
Orthodontics’]
1] Innovations in appli...
2] Innovations in
material research –
ceramic brackets &
tooth coloured
wires
3] Role of family
dentist - Increased
desire...
4] Role of media, visual as well as print -
Articles in magazines ,news paper as well
as community programs have increased...
6] More effective management of skeletal jaw
dysplasias with advanced orthognathic surgical
techniques.
7] Reduced vulnera...
9] Ingenious approaches to anchorage management
such as implants.
10] Role of Insurance companies – in the US
11] Affluenc...
INDICATIONS (RAVINS)
1) Improvement of tooth-periodontal tissue
relationship.
2) Establishing an improved plane of occlusi...
CONTRAINDICATIONS
(BARRER)
1) Severe skeletal discrepancies.
2) Advanced local or systemic disease.
3) Excessive alveolar ...
6) Inability to prevent excessive hard/soft tissue
destruction
7)Inadequate space for tooth movt
8)Movt of teeth against o...
CONTRAINDICATIONS
(Marks and Corn)
• Advanced systemic disease
• Lack of patient motivation.
www.indiandentalacademy.com
1] Younger adults (under 35, often in their 20’s)
2] Older patients (in their 40’s and 50’s)
[Proffit-Fields]
2 GROUPS OF ...
YOUNGER GROUP
Goal –
Comprehensive treatment & maximum possible
improvement; improved quality of life.
www.indiandentalaca...
Reasons for not receiving orthodontic
treatment early
1) Did not desire treatment.
2) Were not aware of orthodontic treatm...
6) Incomplete orthodontic treatment when
younger or were uncooperative.
7) Had orthodontic treatment as children but
relap...
OLDER GROUP
Goal -
- Maintain proper dental health.
- For easy & effective control of disease &
restoration of missing tee...
Reasons for seeking orthodontic
treatment
1) Malposed teeth contributing to PDL disease.
2) Increased difficulties with ma...
ADOLESCENT vs ADULT
ORTHODONTIC PATIENT
Levitt : “In adult patient there is no growth
and only tooth movement”.
Barrer : “...
• Ackerman : “In a child ,one occasionally
calls on another specialist. On the other
hand it is a rare adult whom one trea...
• Adults – orthodontic treatment is based on
symptoms detected by the patient
• Children - treatment is based more often
o...
• Adult – seeks treatment more often for
esthetics & hence is likely to have
unreasonable expectations about the
outcome, ...
FIVE MAJOR CATEGORIES IN WHICH
ADULT PATIENTS SIGNIFICANTLY
DIFFER FROM THEIR ADOLESCENT
COUNTERPARTS
1) Clarification & i...
1) Clarification & individualization of
treatment objectives-
This requires specific study of the problem &
the indicated ...
2) The diagnostic process-
Problem oriented dental record aides
in making the appropriate diagnosis,
for it requires that ...
Diagnostic steps:
1) Collect data accurately.
2) Analyze data base.
3) Develop problem list.
4) Prepare tentative treatmen...
www.indiandentalacademy.com
Before starting the treatment, the
orthodontist needs to be prepared to
do the following:
1) Diagnose different stages of ...
3) Determine which cases require surgical
management and which ones require
incisor reangulation to camouflage the
skeleta...
3) Treatment plan selection-
More systemic & detailed analysis is
required for adults than for adolescents.
Factor affecti...
ii) Skeletal relationship.
iii) Biological consideration:
- neuromuscular maturity/adaptability .
- periodontal susceptibi...
v) Extraction therapy: 4 PM / asymmetric,
lower incisor.
vi) Anchorage requiremen: headgear /
completely erupted 1st
& 2nd...
4) Patient’s acceptance of the
treatment plan-
Patients thorough understanding of &
agreement with the recommended Rx are
...
iii) Cost of treatment: with/without
insurance cover
iv) Perceived risk/benefit ratio: more
benefits compared to minimal r...
• Vii) Negative conditioning: in the past .
viii) Positive conditioning.
www.indiandentalacademy.com
5) Achievement of treatment
objectives-
-requires specific study of the problem &
the indicated therapeutic refinements
- ...
LIMITATIONS OF TREATMENT
2 types of factors :
• Intrinsic – Biological nature
• Extrinsic – Biomechanical systems
www.indi...
INTRINSIC FACTORS
• Most marked – Adult is no longer growing, so
orthodontic Rx is limited to tooth movt & related
modelli...
• Alveolar bone – cortical bone becomes
denser & spongy bone reduces with age &
structure of bone changes from
honeycomb t...
• Teeth - adults are more likely to have
missing teeth, teeth reduced in dimension
due to attrition or teeth with large
re...
EXTRINSIC FACTORS
• Force system used differs from that used in
young, growing individuals.
• Forces used should be at a l...
• M/F ratio for a
particular tooth
movt should be
increased as per
the periodontally
compromised
state of the
dentition, t...
• In the presence of marginal bone loss,
light continuous intrusive forces should be
maintained during tooth displacement....
!!! ADULT PROBLEMS DIFFICULT
TO TREAT BY ORTHODONTICS !!!
• Deep bite – extrusion of post teeth is not
compensated for by ...
1) Dentofacial aesthetics
2) Stomatognathic function
3) Stability
4) Achieving Class I occlusion
:ADULT ORTHODONTICS -
TRE...
www.indiandentalacademy.com
ADDITIONAL ORTHODONTIC
TREATMENT OBJECTIVES
1) Parallelism of abutment teeth :
- Restoration will have better prognosis as...
www.indiandentalacademy.com
2) Most favorable distribution of teeth :
- Evenly for replacement of fixed/removable
prostheses in the individual arches
...
3) Redistribution of occlusal and incisal
forces –
Helpful in case of significant bone loss, to
maintain the occlusal vert...
5) Acceptable occlusal plane and potential
for incisal guidance at satisfactory vertical
dimension –
For a mutilated denti...
6) Adequate occlusal landmark
relationships:
- Most difficult dimension to correct &
maintain orthodontically – transverse...
7) Better lip competency and support -
Inadequate support may create change in
antero-posterior and vertical position of u...
8) Improved crown/root ratio –
In case of individual teeth bone loss, the
crown to root ratio can be improved by
decreasin...
9) Improvement/ correction of mucogingival and
osseous defects:-
Proper repositioning of prominent teeth in arch will
impr...
10) Better self maintenance of pdl health:
Location of gingival margin - determined by axial
inclination & alignment of th...
Treatment planning
Usual sequence of procedure is as follows –
• Eliminate all pathology (caries, PDL disease,
retained ro...
BIOMECHANICAL
CONSIDERATIONS:
- Control of anchorage requires that
anchor teeth should not be allowed to tip.
- Fixed appl...
• Adult patients
demand for
removable
appliance but they
are not useful in
adjunctive
treatment.
- But in case of
multiple...
Placement of brackets
• A=ideal position
– uprighting of
ant teeth (movt
of anchor teeth
is undesirable)
• B=brackets
plac...
• - In case of
reduce
periodontal
support and
bone loss ,
lighter forces
and relatively
larger
movements are
needed.
www.i...
TIMING AND SEQUENCE OF
TREATMENT:-
- Before any type of tooth movement
any caries or pulpal pathology should
be eliminated...
- Periodontal disease should be
controlled before any tooth
movement.
- Scaling, curettage and gingival graft
should be ca...
www.indiandentalacademy.com
Psychological considerations
• Children & adolescents – motivation for ortho Rx
= parent’s desire; not emotionally involve...
• Most adults – have realistic expectations, more
positive self image than average, a good deal of
ego strength.
• Interna...
• Sometimes - Rx in a pvt area if the patient
demands so;
Most adults – learning from interacting with other
patients = be...
• Adults – less tolerant of discomfort & more
likely to complain about pain after
adjustments & about difficulties in spee...
ACCORDING TO PROFFIT ADULT
ORTHODONTIC TREATMENT IS
DIVIDED IN TO 3 PARTS:
1) ADJUNCTIVE TREATMENT.
2) COMPREHENSIVE TREAT...
DIFFERENCE BETWEEN
ADJUNCTIVE TREATMENT AND
COMPREHENSIVE TREAMTMENT
IS INDISTINCT,AS ANY TREAMENT
WHICH REQUIRE MORE THAN...
ADJUNCTIVE TREATMENT-
“ Tooth movement carried out to
facilitate other dental procedures
necessary to control disease and
...
GOALS -
1) Facilitates restorative treatment by
positioning the teeth.
2) Improve periodontal health by
removing plaque ha...
PROCEDURES CARRIED OUT IN
ADJUNCTIVE TREATMENT : -
1) Uprighting posterior teeth.
2) forced eruption.
3) alignment of ante...
www.indiandentalacademy.com
THANK YOU
www.indiandentalacademy.com
www.indiandentalacademy.com
* Etiology of adult malocclusion.
* Types of adult orthodontic patients.
* Types of adult orthodontic
treatment.
* Adjunct...
ETIOLOGY OF ADULT TOOTH
MALPOSITION:-
1) DENTAL ORIGIN
2) SKELETAL ORIGIN
www.indiandentalacademy.com
1) DENTAL ORIGIN:-
a) Faulty eruption from the
normal functional position.
b) Insufficient arch length.
c) Excessive arch ...
g) Prolonged finger and thumb
sucking habits.
h) Clenching and grinding.
i) Improper swallow pattern with
tongue thrusting...
k) Macroglossia.
l) Premature loss of deciduous teeth.
m) Loss of permanent teeth.
www.indiandentalacademy.com
2) SKELETAL ORIGIN:-
a) Cleft palate.
b) Gross mediolateral disharmony of
the craniofacial skeleton.
www.indiandentalacade...
UPRIGHTING POSTERIOR
TEETH:-
www.indiandentalacademy.com
1) If third molar is present ,
whether both second and third
molar should be uprighted.
2) Whether to upright tipped
teeth...
www.indiandentalacademy.com
3) Whether we need slight extrusion
or maintain occlusal height during
uprighting.
4) Whether premolar should be
repositio...
APPLIANCE FOR MOLAR
UPRIGHTING:-
- Partial fixed appliance.
- Anchorage.
- Placement of brackets on canine
and premolars.
...
www.indiandentalacademy.com
UPRIGHTING A SINGLE MOLAR:-
 Moderately tipped
molar:-
- 17x25 braided
s.s
- 17x25 Ni-Ti
 Severely tipped
molar:-
-19x25...
• “ T-loop”
- 17x25 s.s
- 19x25 beta-Ti
• Activation of T-loop.
www.indiandentalacademy.com
• Severely tipped
teeth:-
- Use of modified T-
loop.
www.indiandentalacademy.com
• Final position of
molars and
premolars.
• Use of open coil
spring - steel
- A Ni-Ti
• Occlusion should be
checked carefu...
RETENTION
• For shorter period
• For a longer period.
- Intracoronal wire
splint
www.indiandentalacademy.com
www.indiandentalacademy.com
FORCED ERUPTION:-
Indications:-
- Defects in cervical third .
www.indiandentalacademy.com
TREATMENT PLANING:-
- Periapical radiograph.
- Single tapering and flared and
divergent root morphology.
- Endodontic ther...
How much tooth should be extruded
can be determine by 3 factors:-
1) Location of the defect.(fracture
line)
2) Space to pl...
 Duration:-
- 1mm/week without damaging pdl.
- 3 to 6 week.
www.indiandentalacademy.com
TECHANIQUE
• Continuous flexible
wire is
contraindicated.
www.indiandentalacademy.com
2 METHODS
– With orthodontic
bracket.
– Without orthodontic
bracket.
www.indiandentalacademy.com
• Brackets are placed
more occlusally on
anchor teeth than its
ideal position.
• T-loop,
- 17x25 s.s
- 19x25 beta-Ti
www.i...
RETENTION:-
- By passively fitting rectangular arch
wire.(3 to 6 week).
www.indiandentalacademy.com
ALIGNMENT OF ANTERIOR TEETH
Indications:-
1) To improve access and permit
placement of well contoured
restorations.
2) To ...
3) To reposition closely
approximated roots and to improve
the amount of interradicular bone.
4) To position teeth so that...
* Alignment of crowed, rotated and
displaced incisors.
* Separation of approximated teeth.
www.indiandentalacademy.com
• Position teeth for single tooth
implant:-
- Minimum 6mm of space is require.
- Apices of adjacent teeth.
www.indiandenta...
Anterior diastema closure and
space redistribution:-
Causes:-
- Loss of posterior teeth.
- Small teeth.
.- Loss of bone su...
TREATMENT:-
- With Removable appliance.
- With fixed appliance.
www.indiandentalacademy.com
CROSSBITE CORRECTION:-
- It can cause functional problem and
occlusal trauma.
- Single tooth crossbite.
- Group of teeth i...
- Correction with removable
appliances.(anterior segment)
- Correction with the “through the
bite” elastics.(posterior seg...
www.indiandentalacademy.com
SUMMARY:-
There is wide variety
of etiology that can cause an adult
malocclusion. Also each patient’s
need for treatment a...
Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com
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Adult orthodont ics

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Adult orthodont ics

  1. 1. ADULT ORTHODONTICS www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. Index • Adult ? • History of adult orthodontics • Adult orthodontics • Reasons for increased interest of adults in orthodontic treatment • Indications • Contraindications • Difference between adult and adolescent patients • Limitations www.indiandentalacademy.com
  3. 3. Index • Treatment objectives • Diagnosis • Treatment planning : Psychological considerations Biomechanical considerations Periodontal considerations TMJ • Treatment : Adjunctive treatment Comprehensive treatment Surgical treatment • Conclusion www.indiandentalacademy.com
  4. 4. ADULT ? • Adult is defined as one who is fully grown, most males 18 and above and most females of 16 and above can be considered to be adults, although residual growth is left. • It is however quite impractical to determine the exact time when adulthood begins, since there is no definite age when a person reaches physical maturity. www.indiandentalacademy.com
  5. 5. HISTORY • Kingsley, in 1880, indicated an early awareness regarding orthodontic potential in adult patient. • He stated, “It may be regarded as settled fact that there are hardly any limits to the age when movement of teeth might not succeed.” www.indiandentalacademy.com
  6. 6. HISTORY • MacDowell(1901) was of the opinion that after the age of 16 years, a complete and permanent change in transition of the occlusion & hence orthodontic treatment, is almost impossible owing to the development of, - adult glenoid fossa, - density of the bones , - muscles of mastication. www.indiandentalacademy.com
  7. 7. HISTORY • Lischer (1912) believed that the period from 6th to 14th year was a golden age of treatment www.indiandentalacademy.com
  8. 8. HISTORY • In 1921 Calvin Case demonstrated the value of orthodontic therapy in the lower anterior area for the aged, periodontally affected patient. www.indiandentalacademy.com
  9. 9. ADULT ORTHODONTICS • Ackerman : “Adult orthodontics is concerned with striking a balance between achieving optimal proximal and occlusal contact of the teeth, acceptable dentofacial aesthetics, normal function and reasonable stability.” www.indiandentalacademy.com
  10. 10. Recent AAO survey : Increased % of patients >21 yrs, from 4% ten yrs ago, to almost 7% today; in another decade’s time adult pts would constitute 11% of avg orthodontic practice. • [JCO:1997:Gottleib,Nelson] www.indiandentalacademy.com
  11. 11. INCREASED INTEREST IN THE ADULT PATIENT Reasons [Melsen in ‘Curent controversies in Orthodontics’] 1] Innovations in appliance placement techniques – Direct bonding, lingual/invisible appliances www.indiandentalacademy.com
  12. 12. 2] Innovations in material research – ceramic brackets & tooth coloured wires 3] Role of family dentist - Increased desire of restorative dentists and patients for treatment of dental mutilation problems using tooth movement rather than prostheses. www.indiandentalacademy.com
  13. 13. 4] Role of media, visual as well as print - Articles in magazines ,news paper as well as community programs have increased patient awareness towards health & esthetics. 5] Better management of TMJ dysfunction. www.indiandentalacademy.com
  14. 14. 6] More effective management of skeletal jaw dysplasias with advanced orthognathic surgical techniques. 7] Reduced vulnerability to periodontal breakdown as a result of improved tooth relationships and occlusal functions. 8] A broader understanding of the biology of the tooth movement especially with regard to age changes. www.indiandentalacademy.com
  15. 15. 9] Ingenious approaches to anchorage management such as implants. 10] Role of Insurance companies – in the US 11] Affluence – Improving socioeconomic standards makes orthodontics more affordable today . www.indiandentalacademy.com
  16. 16. INDICATIONS (RAVINS) 1) Improvement of tooth-periodontal tissue relationship. 2) Establishing an improved plane of occlusion to distribute the forces of occlusion better. 3) Balancing the existing space for better prosthetic replacement. 4) Improve occlusion and coordination between the muscle and TMJ. 5) Improve patient esthetic.www.indiandentalacademy.com
  17. 17. CONTRAINDICATIONS (BARRER) 1) Severe skeletal discrepancies. 2) Advanced local or systemic disease. 3) Excessive alveolar bone loss. 4) Poor stability prognosis – tooth movt into unfavourable positions. 5) Lack of patient motivation & co-operation, resistance to wear the appliance.www.indiandentalacademy.com
  18. 18. 6) Inability to prevent excessive hard/soft tissue destruction 7)Inadequate space for tooth movt 8)Movt of teeth against occlusal opposition or into occlusal trauma 9)No improvement in PDL health, function/esthetics. 10)Negative anchorage potential – movt of teeth against inadequate anchorage. www.indiandentalacademy.com
  19. 19. CONTRAINDICATIONS (Marks and Corn) • Advanced systemic disease • Lack of patient motivation. www.indiandentalacademy.com
  20. 20. 1] Younger adults (under 35, often in their 20’s) 2] Older patients (in their 40’s and 50’s) [Proffit-Fields] 2 GROUPS OF ADULT ORTHODONTIC PATIENTS www.indiandentalacademy.com
  21. 21. YOUNGER GROUP Goal – Comprehensive treatment & maximum possible improvement; improved quality of life. www.indiandentalacademy.com
  22. 22. Reasons for not receiving orthodontic treatment early 1) Did not desire treatment. 2) Were not aware of orthodontic treatment. 3) Parents could not afford. 4) Were not given proper advise by family dentist. 5) No orthodontist located in the vicinity. www.indiandentalacademy.com
  23. 23. 6) Incomplete orthodontic treatment when younger or were uncooperative. 7) Had orthodontic treatment as children but relapse occurred. 8) More conscious of appearance with age. 9) Anterior teeth started to crowd or minor crowding becomes worse. 10) Dissatisfaction with the outcome of previous treatment www.indiandentalacademy.com
  24. 24. OLDER GROUP Goal - - Maintain proper dental health. - For easy & effective control of disease & restoration of missing teeth. - As an adjunctive procedure to the larger periodontal & restorative goals ; not necessarily interested in the ideal result. www.indiandentalacademy.com
  25. 25. Reasons for seeking orthodontic treatment 1) Malposed teeth contributing to PDL disease. 2) Increased difficulties with mastication. 3) Anterior spaces enlarging or new ones developing. 4) For better tooth positioning prior to prosthetic preparation. 5) Tooth interferences & mandibular slide causing TMJ problems. www.indiandentalacademy.com
  26. 26. ADOLESCENT vs ADULT ORTHODONTIC PATIENT Levitt : “In adult patient there is no growth and only tooth movement”. Barrer : “Adult, unlike the child is a relentless patient, who will not cover our deficiencies in skills or our errors in the use of mechanical procedures by helpful settling in post-treatment.” www.indiandentalacademy.com
  27. 27. • Ackerman : “In a child ,one occasionally calls on another specialist. On the other hand it is a rare adult whom one treats orthodontically without finding it necessary to collaborate with another specialist.” www.indiandentalacademy.com
  28. 28. • Adults – orthodontic treatment is based on symptoms detected by the patient • Children - treatment is based more often on signs detected by practitioners/parents. www.indiandentalacademy.com
  29. 29. • Adult – seeks treatment more often for esthetics & hence is likely to have unreasonable expectations about the outcome, is less adaptable to the appliance & is uncompromising in appraisal of the Rx results. • Brighter side – cleaner, more careful, punctual, prompt paying, much less sensitive to pain & Rx time is either same/less than that for younger patients. www.indiandentalacademy.com
  30. 30. FIVE MAJOR CATEGORIES IN WHICH ADULT PATIENTS SIGNIFICANTLY DIFFER FROM THEIR ADOLESCENT COUNTERPARTS 1) Clarification & individualization of treatment objectives 2) The diagnostic process 3) Treatment plan selection 4) Acceptance of recommended therapy 5) Achievement of treatment objectives www.indiandentalacademy.com
  31. 31. 1) Clarification & individualization of treatment objectives- This requires specific study of the problem & the indicated therapeutic refinements. www.indiandentalacademy.com
  32. 32. 2) The diagnostic process- Problem oriented dental record aides in making the appropriate diagnosis, for it requires that the patient’s problems be listed and a plan be developed to manage each problem. www.indiandentalacademy.com
  33. 33. Diagnostic steps: 1) Collect data accurately. 2) Analyze data base. 3) Develop problem list. 4) Prepare tentative treatment plan. 5) Interact with those who are involved; discuss plans and options; clarify sequence, acquire patient acceptance. 6) Create final treatment plan. www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com
  35. 35. Before starting the treatment, the orthodontist needs to be prepared to do the following: 1) Diagnose different stages of PDL disease and their associated risk factors. 2) Diagnose TMJ dysfunction before, during or after tooth movement. www.indiandentalacademy.com
  36. 36. 3) Determine which cases require surgical management and which ones require incisor reangulation to camouflage the skeletal base discrepancy. 4) Work cooperatively with team of other specialists to give the patient the best outcome. www.indiandentalacademy.com
  37. 37. 3) Treatment plan selection- More systemic & detailed analysis is required for adults than for adolescents. Factor affecting treatment plan selection: i) Existing oral pathology: - dental caries - periodontal disease - faulty restoration - TMJ adaptability - occlusal awarenesswww.indiandentalacademy.com
  38. 38. ii) Skeletal relationship. iii) Biological consideration: - neuromuscular maturity/adaptability . - periodontal susceptibility:bone loss/gingival inflammation . - rate of tooth movement. - growth. iv) Therapeutic approach available: - functional appliances. - orthognathic surgery. - restorative dentistry.www.indiandentalacademy.com
  39. 39. v) Extraction therapy: 4 PM / asymmetric, lower incisor. vi) Anchorage requiremen: headgear / completely erupted 1st & 2nd molars vii) Missing teeth: space closure without / with prostheses www.indiandentalacademy.com
  40. 40. 4) Patient’s acceptance of the treatment plan- Patients thorough understanding of & agreement with the recommended Rx are necessary. Also, an informed consent should be signed i) Sociobehavioral interaction: - Office environment: group / privacy - Team coordination, interaction: multidisciplinary approach ii) Duration of treatment. www.indiandentalacademy.com
  41. 41. iii) Cost of treatment: with/without insurance cover iv) Perceived risk/benefit ratio: more benefits compared to minimal risks v) Appliance selection. vi) Insurance coverage www.indiandentalacademy.com
  42. 42. • Vii) Negative conditioning: in the past . viii) Positive conditioning. www.indiandentalacademy.com
  43. 43. 5) Achievement of treatment objectives- -requires specific study of the problem & the indicated therapeutic refinements - depends on : i) Dental history. ii) Ability of the orthodontist to interface the treatment plan with those of other dental specialist. iii) skills and knowledge of orthodontist and staff. www.indiandentalacademy.com
  44. 44. LIMITATIONS OF TREATMENT 2 types of factors : • Intrinsic – Biological nature • Extrinsic – Biomechanical systems www.indiandentalacademy.com
  45. 45. INTRINSIC FACTORS • Most marked – Adult is no longer growing, so orthodontic Rx is limited to tooth movt & related modelling of the alveolar process only (may vary with the age & health ) • Periodontium – primary tissue to get affected. • Norton : decreasing blood flow & vascularity with increasing age – insufficient source of progenitor(preosteoblasts) cells – delayed response to mechanical stimulus. www.indiandentalacademy.com
  46. 46. • Alveolar bone – cortical bone becomes denser & spongy bone reduces with age & structure of bone changes from honeycomb to a network • Apical displacement of marginal bone level - local factor, age related but is also due to progressive PDL disease www.indiandentalacademy.com
  47. 47. • Teeth - adults are more likely to have missing teeth, teeth reduced in dimension due to attrition or teeth with large restorations. www.indiandentalacademy.com
  48. 48. EXTRINSIC FACTORS • Force system used differs from that used in young, growing individuals. • Forces used should be at a lower level than those used in children, as adults often have PDL problems & reduced bone support. • Initial forces should be further kept low as the immediate pool of cells available for resorption is low. www.indiandentalacademy.com
  49. 49. • M/F ratio for a particular tooth movt should be increased as per the periodontally compromised state of the dentition, to counter the tipping tendency. www.indiandentalacademy.com
  50. 50. • In the presence of marginal bone loss, light continuous intrusive forces should be maintained during tooth displacement. www.indiandentalacademy.com
  51. 51. !!! ADULT PROBLEMS DIFFICULT TO TREAT BY ORTHODONTICS !!! • Deep bite – extrusion of post teeth is not compensated for by condylar growth • Posterior crossbite – arch expansion is not stable • Skeletal discrepancies – since growth is complete. www.indiandentalacademy.com
  52. 52. 1) Dentofacial aesthetics 2) Stomatognathic function 3) Stability 4) Achieving Class I occlusion :ADULT ORTHODONTICS - TREATMENT OBJECTIVES www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. ADDITIONAL ORTHODONTIC TREATMENT OBJECTIVES 1) Parallelism of abutment teeth : - Restoration will have better prognosis as excess cutting or devitalization during abutment preparation are avoided. - Allows for a better pdl response. - Allows for better retention.www.indiandentalacademy.com
  55. 55. www.indiandentalacademy.com
  56. 56. 2) Most favorable distribution of teeth : - Evenly for replacement of fixed/removable prostheses in the individual arches - Teeth should be positioned in such a way that occlusion of natural teeth can be established bilaterally between the arches. www.indiandentalacademy.com
  57. 57. 3) Redistribution of occlusal and incisal forces – Helpful in case of significant bone loss, to maintain the occlusal vertical dimension. 4) Adequate embrasure space and proper root position – Allows for better pdl health, especially when placement of restorations is necessary. www.indiandentalacademy.com
  58. 58. 5) Acceptable occlusal plane and potential for incisal guidance at satisfactory vertical dimension – For a mutilated dentition with bite collapse, the Hawley bite plane adjusted to the correct vertical height, is inserted – allows a centric relation at an acceptable vertical dimension, simulatneous bilateral neuromuscular activity; Curve of spee should be mild to flat bilaterally – unilateral orthodontic treatment of an accentuated occlusal plane should be avoided.www.indiandentalacademy.com
  59. 59. 6) Adequate occlusal landmark relationships: - Most difficult dimension to correct & maintain orthodontically – transverse sagittal vertical. - Teeth must be positioned yo achieve acceptable B-L landmarks. Post crossbites due to severe transverse skeletal dysplasias – maxillary buccal cusps contact lower central fossae with the crossover for incisal guidance in the PM or canine positions.www.indiandentalacademy.com
  60. 60. 7) Better lip competency and support - Inadequate support may create change in antero-posterior and vertical position of upper lip and increase wrinkling. Some Class II, division 1 patients (surgery rejected) – lower incisors can be placed procumbent with bilateral posterior restorations – establish incisal guidance; avoids palatal tissue irritation. Some class III’s – maxillary incisors kept more flared than normal www.indiandentalacademy.com
  61. 61. 8) Improved crown/root ratio – In case of individual teeth bone loss, the crown to root ratio can be improved by decreasing the length of clinical crown with a high speed handpiece as the tooth is erupted orthodontically. www.indiandentalacademy.com
  62. 62. 9) Improvement/ correction of mucogingival and osseous defects:- Proper repositioning of prominent teeth in arch will improve gingival topography. Adolescents – brackets placed to level marginal ridges & cusp tips Adults – level crestal bone between adjacent CEJ’s; favorable osseous & soft tissue changes with tooth movt , diminished need for osseous/mucogingival surgery; continuous adjustment to prevent premature post teeth contact causing occlusal trauma.www.indiandentalacademy.com
  63. 63. 10) Better self maintenance of pdl health: Location of gingival margin - determined by axial inclination & alignment of the tooth. For better periodontal health, teeth should be positioned properly over their basal bone support. 11) Esthetics and functional improvement: Rx= acceptable esthetics + improved muscle function + normal speech + mastication Therapeutic occlusion = ant teeth as disarticulators; post teeth support the vertical dimension. www.indiandentalacademy.com
  64. 64. Treatment planning Usual sequence of procedure is as follows – • Eliminate all pathology (caries, PDL disease, retained roots, etc) • Orthodontic Rx • Periodontal re-evaluation (& therapy if necessary) • Prosthetic restoration (when necessary) • Orthodontic retention • Periodontal maintenance • Occlusal adjustment (grinding) whenever necessary www.indiandentalacademy.com
  65. 65. BIOMECHANICAL CONSIDERATIONS: - Control of anchorage requires that anchor teeth should not be allowed to tip. - Fixed appliance is necessary. www.indiandentalacademy.com
  66. 66. • Adult patients demand for removable appliance but they are not useful in adjunctive treatment. - But in case of multiple missing teeth removable appliance is useful. www.indiandentalacademy.com
  67. 67. Placement of brackets • A=ideal position – uprighting of ant teeth (movt of anchor teeth is undesirable) • B=brackets placed in position of max convenience- maintains existing tooth alignmentwww.indiandentalacademy.com
  68. 68. • - In case of reduce periodontal support and bone loss , lighter forces and relatively larger movements are needed. www.indiandentalacademy.com
  69. 69. TIMING AND SEQUENCE OF TREATMENT:- - Before any type of tooth movement any caries or pulpal pathology should be eliminated. - Larger restoration require detail occlusal anatomy should be carried out after orthodontic treatment is over. www.indiandentalacademy.com
  70. 70. - Periodontal disease should be controlled before any tooth movement. - Scaling, curettage and gingival graft should be carried out before treatment. - Surgical pocket elimination and osseous surgery should be carried out after orthodontic treatment. www.indiandentalacademy.com
  71. 71. www.indiandentalacademy.com
  72. 72. Psychological considerations • Children & adolescents – motivation for ortho Rx = parent’s desire; not emotionally involved in their own Rx • Adults – seek ortho Rx because they themselves want something, that is not always clearly expressed=hidde set of motivations/unrealisti expectations • Imp – explore why pt wants Rx & why now “Ortho Rx cannot repair personal relationships, save jobs, or overcome a series of financial disasters” - Proffitwww.indiandentalacademy.com
  73. 73. • Most adults – have realistic expectations, more positive self image than average, a good deal of ego strength. • Internally motivated responds well to Rx than externally motivated. • Demand for invisible orthodontic appliances- unrealistic for a patient to expect that ortho Rx can be carried out without other people knowing about it www.indiandentalacademy.com
  74. 74. • Sometimes - Rx in a pvt area if the patient demands so; Most adults – learning from interacting with other patients = beneficial • Patient handling – Adolescents = passive acceptance of what is being done Adults = considerble degree of explanation of what is happening & why; Interest in Rx does not automatically translate into compliance with instructions www.indiandentalacademy.com
  75. 75. • Adults – less tolerant of discomfort & more likely to complain about pain after adjustments & about difficulties in speech, eating & tissue adaptations. Additional chair time to meet these demands should be anticipated www.indiandentalacademy.com
  76. 76. ACCORDING TO PROFFIT ADULT ORTHODONTIC TREATMENT IS DIVIDED IN TO 3 PARTS: 1) ADJUNCTIVE TREATMENT. 2) COMPREHENSIVE TREATMENT FOR ADULTS. 3) SURGICAL TREATMENT. www.indiandentalacademy.com
  77. 77. DIFFERENCE BETWEEN ADJUNCTIVE TREATMENT AND COMPREHENSIVE TREAMTMENT IS INDISTINCT,AS ANY TREAMENT WHICH REQUIRE MORE THAN 6 MONTHS IS CALLED AS COMPREHENSIVE TREATMENT. www.indiandentalacademy.com
  78. 78. ADJUNCTIVE TREATMENT- “ Tooth movement carried out to facilitate other dental procedures necessary to control disease and restore function.” www.indiandentalacademy.com
  79. 79. GOALS - 1) Facilitates restorative treatment by positioning the teeth. 2) Improve periodontal health by removing plaque harboring areas . 3) Establishing favourable crown to root ratio and position of the teeth. www.indiandentalacademy.com
  80. 80. PROCEDURES CARRIED OUT IN ADJUNCTIVE TREATMENT : - 1) Uprighting posterior teeth. 2) forced eruption. 3) alignment of anterior teeth. 4) crossbite correction. www.indiandentalacademy.com
  81. 81. www.indiandentalacademy.com
  82. 82. THANK YOU www.indiandentalacademy.com
  83. 83. www.indiandentalacademy.com
  84. 84. * Etiology of adult malocclusion. * Types of adult orthodontic patients. * Types of adult orthodontic treatment. * Adjunctive treatment: - Goals - Biomechanical considerations. - Timing and sequence. - Procedures carried out. www.indiandentalacademy.com
  85. 85. ETIOLOGY OF ADULT TOOTH MALPOSITION:- 1) DENTAL ORIGIN 2) SKELETAL ORIGIN www.indiandentalacademy.com
  86. 86. 1) DENTAL ORIGIN:- a) Faulty eruption from the normal functional position. b) Insufficient arch length. c) Excessive arch length. d) Prolonged retention of primary teeth. e) Ectopic eruption. www.indiandentalacademy.com
  87. 87. g) Prolonged finger and thumb sucking habits. h) Clenching and grinding. i) Improper swallow pattern with tongue thrusting. j) Effects of tongue pressure on the anterior teeth. www.indiandentalacademy.com
  88. 88. k) Macroglossia. l) Premature loss of deciduous teeth. m) Loss of permanent teeth. www.indiandentalacademy.com
  89. 89. 2) SKELETAL ORIGIN:- a) Cleft palate. b) Gross mediolateral disharmony of the craniofacial skeleton. www.indiandentalacademy.com
  90. 90. UPRIGHTING POSTERIOR TEETH:- www.indiandentalacademy.com
  91. 91. 1) If third molar is present , whether both second and third molar should be uprighted. 2) Whether to upright tipped teeth by distal crown tipping or by mesial root movement. www.indiandentalacademy.com
  92. 92. www.indiandentalacademy.com
  93. 93. 3) Whether we need slight extrusion or maintain occlusal height during uprighting. 4) Whether premolar should be repositioned or not. www.indiandentalacademy.com
  94. 94. APPLIANCE FOR MOLAR UPRIGHTING:- - Partial fixed appliance. - Anchorage. - Placement of brackets on canine and premolars. www.indiandentalacademy.com
  95. 95. www.indiandentalacademy.com
  96. 96. UPRIGHTING A SINGLE MOLAR:-  Moderately tipped molar:- - 17x25 braided s.s - 17x25 Ni-Ti  Severely tipped molar:- -19x25 s.s - Uprighting spring ( 17x25 beta- Ti) www.indiandentalacademy.com
  97. 97. • “ T-loop” - 17x25 s.s - 19x25 beta-Ti • Activation of T-loop. www.indiandentalacademy.com
  98. 98. • Severely tipped teeth:- - Use of modified T- loop. www.indiandentalacademy.com
  99. 99. • Final position of molars and premolars. • Use of open coil spring - steel - A Ni-Ti • Occlusion should be checked carefully. www.indiandentalacademy.com
  100. 100. RETENTION • For shorter period • For a longer period. - Intracoronal wire splint www.indiandentalacademy.com
  101. 101. www.indiandentalacademy.com
  102. 102. FORCED ERUPTION:- Indications:- - Defects in cervical third . www.indiandentalacademy.com
  103. 103. TREATMENT PLANING:- - Periapical radiograph. - Single tapering and flared and divergent root morphology. - Endodontic therapy. www.indiandentalacademy.com
  104. 104. How much tooth should be extruded can be determine by 3 factors:- 1) Location of the defect.(fracture line) 2) Space to place margin of the restoration.(1 mm) 3) An allowance for the biological width of the gingival attachment.(2www.indiandentalacademy.com
  105. 105.  Duration:- - 1mm/week without damaging pdl. - 3 to 6 week. www.indiandentalacademy.com
  106. 106. TECHANIQUE • Continuous flexible wire is contraindicated. www.indiandentalacademy.com
  107. 107. 2 METHODS – With orthodontic bracket. – Without orthodontic bracket. www.indiandentalacademy.com
  108. 108. • Brackets are placed more occlusally on anchor teeth than its ideal position. • T-loop, - 17x25 s.s - 19x25 beta-Ti www.indiandentalacademy.com
  109. 109. RETENTION:- - By passively fitting rectangular arch wire.(3 to 6 week). www.indiandentalacademy.com
  110. 110. ALIGNMENT OF ANTERIOR TEETH Indications:- 1) To improve access and permit placement of well contoured restorations. 2) To permit placement of crowns and pontics . www.indiandentalacademy.com
  111. 111. 3) To reposition closely approximated roots and to improve the amount of interradicular bone. 4) To position teeth so that implants can be placed to support restorations. www.indiandentalacademy.com
  112. 112. * Alignment of crowed, rotated and displaced incisors. * Separation of approximated teeth. www.indiandentalacademy.com
  113. 113. • Position teeth for single tooth implant:- - Minimum 6mm of space is require. - Apices of adjacent teeth. www.indiandentalacademy.com
  114. 114. Anterior diastema closure and space redistribution:- Causes:- - Loss of posterior teeth. - Small teeth. .- Loss of bone support. www.indiandentalacademy.com
  115. 115. TREATMENT:- - With Removable appliance. - With fixed appliance. www.indiandentalacademy.com
  116. 116. CROSSBITE CORRECTION:- - It can cause functional problem and occlusal trauma. - Single tooth crossbite. - Group of teeth in crossbite.(part of skeletal problem). www.indiandentalacademy.com
  117. 117. - Correction with removable appliances.(anterior segment) - Correction with the “through the bite” elastics.(posterior segment). www.indiandentalacademy.com
  118. 118. www.indiandentalacademy.com
  119. 119. SUMMARY:- There is wide variety of etiology that can cause an adult malocclusion. Also each patient’s need for treatment are different so treatment should be carried out taking his/her needs in consideration. Adjunctive treatment helps by facilitating other dental procedures to control disease and restore function. www.indiandentalacademy.com
  120. 120. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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