This document discusses several key considerations for orthodontic treatment in adults. It notes that biological factors like decreased vascularity and bone density make tooth movement more difficult in adults compared to children. Proper diagnosis is important, considering issues like missing teeth and periodontal disease that can impact anchorage. Treatment objectives focus on establishing optimal occlusion and contacts while balancing aesthetics, function, and stability. Lower force levels are recommended due to reduced biological response in adults. Multidisciplinary treatment may be needed and retention requires a long-term approach.

1. Dr – Neha Agarwal

2. An important consideration in orthodontic
diagnosis an treatment planning is the age of
the patient .
In order to diagnose abnormalities of the
dento- facial complex orthodontist should
know what constitutes normalcy .
There are certain features of the developing
dentofacial complex , which are normal in a
child , however if present in an adult would
constitute malocclusions .

3. Open bite seen in the gum pad
Spacing in deciduous dentition
First Deep bite
Flush terminal plane
Ugly duckling stage
Second deepbite

4.  Chronological age of pateint at times can be
misleading and may not reflect correct age
of the pateint .
 The skeletal age or bone age is determined
by studying hand wrist radiograph .
 Dental age by studying OPG .

5. Scope for growth modification
Scope for prevention & interception
Harnessing natural growth forces
Minimize psychological distress

6. Role of growth
Limited treatment
options
Compromise on
treatment objectives

7. • OTM most effectively carried out in young pts
• Young pts exhibits increased vascularity & cellularity of PD
membrane as compared to older pts .
Vitality of
tissue
• Orthodontic & orthopedic correction more favourable during
the growth period
• Orthodontic correction can be carried out at older age also
Role of
growth
Density of
bone
• In adult patients the apical foramen is narrow, force
application during treatment may pose a greater chance of
non- vitality , root resorption & ankylosis of teeth occuring .
• In young patient, the apical foramen is wider thus there is
lesser chance of pulpal damage .
Role of apical
foramen

8. Young Adult
 Growth to work with.
 diagnostic aids are
required in both
 Growth modulation is
not possible
 Extensive diagnostic
aids because of
greater possibility of
pathosis , impaction
& periodontal
problem .

9. Young Adult
 Pt can be benifited with
orthopedic &
myofunctional
appliances .
 Can tolerate the
appliance better .
 Better periodontal
health
 Motivation is less
 Benefit can not be
taken for skeletal
correction only option is
surgery .
 Appliance tolerance is
less & bothered by the
looks of the appliance .
 Poor periodontal health
 Self motivated .

10. Young Adult
 3 treatment
objectives can be
achieved better .
 Can not appreciate
the treatment result .
 Difficult to achieve
proper treatment
objectives .
 Appreciates the
treatment result
better .

12. According to Ackerman , “adult orthodontics is
considered with striking a balance between
achieving optimal proximal & occlusal
contact of teeth , acceptable dentofacial
esthetics normal function and reasonble
stability .”
Now a days no. of child patients decreasing &
adults are increasing in orthodontic clinic

13.  Innovation in appliance.
 Advancement in lingual & invisilian .
 Acheivement of good result .
 Increased public awareness .
 Increased desire of patient & restorative
dentist .

14.  Media .
 Insurance .
 Affluence .
 Family dentist awareness.
 Esthetics .

15. 1. To improve tooth – periodontal tissue relationship.
2. To establish an improved plane of occlusion in order to distribute
forces through the broadest area possible .
3. To balance the existing space between teeth for better prosthetic
replacement .
4. To improve spaces to provide normal tooth-to- tooth contact .
5. To improve occlusion & co-ordination with the masticatory
muscles and the TMJ .
6. To satisfy the esthetic desire of the pateint

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

18. Adult who need orthodontic treatment often
have periodontal problem , the amount of bone
support to each tooth is an important
consideration .
When bone has been lost the PDL area decreases
the same amount of force produces greater
pressure in the PDL .
Loss of alveolar bone height leads to relocation of
center of resistance of the tooth .

19.  Adult treatment mechanics need not differ
from the standard techniques , they are
modified only to meet specific treatment
requirements .
 Intrusion posses difficulty , extrusion is easy
 Tipping is easy
 Rotation is easy to corect but difficult to
retain .

20.  Insufficient source of preosteoblast in adults
leads to delayed response to mechanical
stimulus .
 Norton suggested that the decreasing blood
flow & vascularity that occurs with
increasing age may provide an explanation
for the insufficient source of progenitor cells

21.  Cortical bone becomes more dense while
spongeous bone reduces with age and that
the structure changes from that of a honey
comb to a network .

22.  The apical displacement of the marginal
bone level is a local factor that influence the
biological background for tooth movement in
adults .

23.  Anchorage may be affected by poor periodontal
status and the fact that these patients may have
one or more missing teeth .

24. The biological background for orthodontic tooth
movement in adults indicates that :-
 The forces used in adults should be at a lower level
than those used in children
 The initial forces should further be kept low
because the immediate pool of cells available for
bone resorption is low .
 The moment to force ratio for a particular tooth
movement should be increased according to the
periodontal status of the individual teeth

25.  With increasing marginal bone loss , light
continuous forces should be maintained
during tooth displacement .

27.  Proper diagnostic records are required
 Lateral ceph
 OPG
 PDL status
 Full TMJ series of X – Ray
 Muscle examination
 Stress examination
 Diet evaluation

28. Adult patients report with more of :-
 Wear facets
 Shorter cusps
 Shallower fossae
 Extensive dental work
 Bridges and partial dentures

29. Adjunctive
orthodontic treatmnet
Comprehensive
orthodontic treatment
Surgical orthodontic
tretament

30.  Facilitate restorative management
 Improve the periodontal health
 Establish favuorable crown to root ratio
The adjunctive treatment procedures include :-
 Uprighting of teeth
 Force eruption
 Alignment of teeth

31.  Biological limitations
 Lower force levels
 Periodontal consideration
 Multidisciplinary approach
 Esthetic consideration
 Comfort requirements
 Biomechanical considerations

32. Appliance requisites for adults :-
 Should be simple in order to maximize co-
operation
 They should respond to light forces
 They should be fixed to maintain treatment
control
 They should be long acting
 Shorter overall treatment period

33.  Requires a team approach
 Requires accurate planning
 And percise correction

34.  May include removable retainers , operative
procedures and / or fixed retention …
 When pt have abnormal lip , tongue or cheek
muscle activities , it is incumbent on the
orthodontist to prepare the patient for long –
term use of fixed retainers .