1. Adult orthodontic treatment involves either comprehensive treatment to fully align the teeth or adjunctive treatment to facilitate other dental procedures. 2. Considerations for adult treatment include controlling dental disease before starting, using less painful methods, and involving other dentists due to limited tooth movement options. 3. Adjunctive procedures include uprighting tipped teeth to improve prosthetics, correcting crossbites, and extruding teeth to expose sound roots for crowns.

1. Adult orthodontics

2. An ADULT is defined as a person who has ceased to grow.
Biologically this happens at around 18-20 years of age.
Adults who seek orthodontic
treatment fall into 2 quite different
groups:
1. Younger adults (under 35) who
desired but did not receive
orthodontic treatment as youths and
now seek it (comprehensive
treatment).

3. the young adults who are 18-25 are generally treated as
other adolescent patients, their main concern is esthetic
and are periodontally healthy.
Adults of 26-35 years may exhibit more periodontal and
restorative problems.

4. 2. An older group (typically in their 40s or 50s) who have
other dental problems and may lack a full complement of
teeth and need orthodontics as part of a larger treatment
plan. (adjunctive orthodontic treatment)

5. Motivational factors for orthodontic
treatment in adults
1. Esthetic.
2. Prosthodontic
3. Periodontal.
4. TM dysfunction.

6. Considerations in orthodontic treatment for adults:
1. Treatment must involve all the dentists who will
play a role in the treatment. It cannot be done by
the orthodontist in isolation.
2. The absence of growth means that growth
modification to treat jaw discrepancies is not
possible and only tooth movement for camouflage or
orthognathic surgery can be applied.

7. Considerations in orthodontic treatment for adults:
3. Disease control is essential before orthodontics can
begin, this means bringing both dental and periodontal
disease under control.
4. Adult patients seek orthodontic treatment because they
want it, so they are intensely interested in their treatment
and want to understand what is happening and why.
5. Adult orthodontic patients need medications for pain
control since they are less tolerant of pain than younger
patients.

8. Treatment sequence

9. Disease control before orthodontic treatment
1. Periodontal disease must be controlled before any
orthodontic treatment otherwise rapid and
irreversible periodontal breakdown will occur. This
involves scaling, curettage, gingival grafts in
patients with minimal attached gingiva especially if
arch expansion is to be used.

10. Disease control before orthodontic treatment
2. Elimination of active caries by restoration with well-
placed amalgum or composite resins.
3. Endodontic treatment of any pulpally involved teeth
as attempting to move such teeth can cause flare up
of pulpitis and pain.
4. Cast restoration should be delayed until orthodontic
treatment is completed and final occlusal
relationship is established.

11. Disease control during orthodontic treatment
1.The use of a fully bonded orthodontic appliance is preferred for
periodontally involved adults since bands can make periodontal
maintenance more difficult.
2. Self ligating brackets or steel ligatures are preferred over
elastomeric rings, as patients with elastomeric rings have higher
levels of microorganisms in gingival plaque.

12. 3. Patients with periodontal problems must be on
maintenance schedule during orthodontic
treatment including frequent cleaning and
scaling at 2-4 months intervals or every 4-6
weeks for patients with sever periodontal
involvement.
4. The use of adjunctive chemical agents between
appointments like chlorhexidine.

13. Types of adult orthodontic treatment
Comprehensive treatment.
It requires a complete fixed appliance with or
without extraction with the goal of making
patient's occlusion as ideal as possible.
Adjunctive treatment
Is tooth movement carried out to facilitate
other dental procedures necessary to
control disease, restore function, and/or
enhance appearance.

14. Adjunctive Orthodontic Treatment
Usually it involves only part of the
dentition.
Most commonly undertaken in older adult
patients.
Treatment duration tends to be a few
months.
Long term retention is usually supplied by
the restorations.

15. Goals of Adjunctive Orthodontic Treatment
1. Improve periodontal health by eliminating plaque
harbouring areas.
2. Establish favourable crown-to-root ratio and to
position the teeth so that occlusal forces are
transmitted along the long axes of the teeth.
3. Position the teeth to facilitate restorative
treatment using conservative techniques like
implant.
4. Position the teeth to facilitate optimal esthetics
using bonding, laminates or full coverage
restorations.

16. Adjunctive Orthodontic Treatment procedures
1. Uprighting posterior teeth.
2. Alignment of anterior teeth to allow more
esthetic restoration.
3. Correction of crossbite.
4. Extrusion of badly broken down teeth to
expose sound root structure on which
crown can be placed.

17. Up righting Posterior Teeth
Loss of lower molar can lead to tipping and
drifting of adjacent teeth, poor gingival contour
and supra eruption.

18. Up righting Posterior Teeth
There are 2 ways to upright
tipped teeth:
1. By distal crown movement
which would increase the
space available for a bridge
pontic or implant.
2. By mesial root movement
which would reduces or even
close the edentulous space.

19. Up righting Posterior Teeth
As a general rule distal tipping is preferred as mesial
root movement can be very difficult especially across
old extraction site where there is extensive alveolar
bone resorption.

20. Appliances for Molar Uprighting
A partial fixed appliance is used consists of bonded brackets
on the premolars and canine in that quadrant and either a
bonded tube on the molar or molar band depending on the
periodontal condition.
for better control of anchorage a bonded canine to canine
lingual wire is used especially if 2nd and 3rd molars need to be
uprighted.

21. Uprighting can be accomplished either with:
1. a continuous flexible rectangular wire.

22. 2. or with an auxiliary uprighting spring and rigid
stabilizing wire on premolars and canine teeth.

23. An open coil steel spring is used to complete molar
uprighting and close remaining spaces in the
premolar region.

24. Retention after Molar Uprighting
After uprighting is completed the molar must be
maintained in its new position until a fixed bridge or
implant is placed.
This is achieved using
either a heavy
rectangular wire engaging
the brackets passively, or
intracoronal splint that is
bonded into shallow
preparations in the
proximal enamel.

25. Crossbite correction
Posterior crossbites are corrected using cross elastics after
stabilizing the teeth in the opposing arch with heavy arch wire
to reduce extrusion of posterior teeth while crossbite is
corrected.

26. Crossbite correction
Anterior crossbites are
corrected using fixed
orthodontic appliance
on anterior teeth and
molars to control
vertical position of
anterior teeth.

27. Extrusion
Controlled extrusion (forced eruption) is used to
move a tooth that is unrestorable because of
subgingival pathology into a position that allows
treatment.

28. Control of apical infection with endodontic treatment should
be completed before extrusion of root begins.
The distance the tooth should be extruded is determined by
location of the defect, the tooth should be extruded to the
level of 3mm above alveolar crest.
Extrusion of teeth occurs most
readily and can be as rapid as
1mm/week without damage
to the PDL. Active treatment
can be completed in 3-6
weeks.

29. Extrusion Technique
1. Extrusion can be done using
stabilizing wire on adjacent teeth
and an elastomeric module
stretched between the wire and a
pin placed directly into the crown
of the tooth to be extruded.
2. Or placing stabilizing wire on the
opposing teeth and using
interarch elastics stretched
between the stabilized teeth and
a button bonded to the tooth to
be extruded.

30. After active tooth movement is completed 3-6 weeks of
stabilization is needed to allow reorganization of PDL.
If periodontal surgery is needed to recontour gingiva, it can be
done a month after completion of extrusion.
The final prosthetic treatment should be completed without
delay.
An apically repositioned flap is
used to create the correct
gingival contour

31. Alignment of anterior teeth
Adunctive orthodontic treatment to correct
malaligned teeth is indicated to:
1. Allow placement of other restorations, veneers or
implant.
2. To close small spaces between teeth.
3. To redistribute larger spaces between teeth to allow
composite buildups.

32. Alignment of anterior teeth
Alignment is achieved using:
1. Partial or complete fixed appliance with bonded brackets
on anterior teeth or all teeth and a bonded tube on first
molars for anchorage.
2. The use of a sequence of clear aligners (Invisalign, Clear
Correct).
Invisalign aligner

33. Fixed orthodontic appliance is used to distribute large spaces between
the teeth followed by composite buildups

34. Comprehensive Orthodontic Treatment
The goal is the same as for adolescents: to produce
the best combination of dental and facial
esthetics, dental occlusion, and stability of result
to maximize benefit to the patient.
It requires a complete fixed orthodontic
appliance.
Intrusion of some teeth may be needed,
orthognathic surgery may be considered to
improve jaw relationships.
The duration of treatment from braces on to
braces off exceeds 1 year.

35. Treatment Modifications for Adult Orthodontic Patients
The stages of comprehensive treatment for adults are the
same as those for adolescents but certain aspects need
modification:
1. The patient’s desire for minimally apparent
or invisible orthodontic appliance makes
adults the main candidates for esthetically
enhanced appliances like ceramic or other
nonmetallic brackets, clear aligners or
lingual orthodontics.

36. Treatment Modifications for Adult Orthodontic Patients
2. Orthodontic force must be kept light in patients
who have lost some periodontal support, because
reduced area of PDL after significant bone loss
means higher pressure in PDL from any force
with the center of resistance moved apically.

37. 3. Intrusion is often needed in the leveling of
both arches because of lack of growth, that
allow some extrusion of posterior teeth in
adolescents without leading to mandibular
rotation.

38. Treatment Modifications for Adult Orthodontic Patients
4. Skeletal anchorage in the form
of miniplates or miniscrews is
likely to be required for certain
tooth movements:
1. Intrusion of posterior teeth.
2. Protraction of posterior teeth.
3. Distal movement of posterior
teeth.
4. To support maximum
retraction and/or intrusion
of anterior teeth.

39. 5. positioning individual teeth when no other
satisfactory anchorage is available (usually because of
loss of many teeth)

40. Esthetic Appliances in Treatment of Adults
1) Ceramic or tooth colored brackets: are more desired
in treatment of adults than adolescents, their use
dose not require change in treatment procedures.
2) Lingual orthodontics: provides an invisible fixed
appliance with especially designed attachments
bonded on the lingual surface of teeth.
3) Clear aligner therapy (CAT): is almost totally limited to
adult treatment and require a quite different
approach.

41. Esthetic Appliances in Treatment of Adults
•Clear aligner therapy (CAT):
Treatment with this approach involves the use of a series
of aligners on stereolithographic casts produced from
virtual models.
Virtual tooth movement
created on virtual model
stereolithographic cast and the aligner formed
from it

42. Esthetic Appliances in Treatment of Adults
Many systems are available like Invisalign and
Clear Correct, they are usually indicated for
treatment of mild to moderate orthodontic
problems and when few teeth need to be moved.

43. RETENTION
the adult bone is more dense and less vascular,
which lead to slower rate for tooth movement
and stabilization. The more slowly the bone
forms the longer and more critical the retentive
face becomes.
A clear suck-down thermoplastic retainer is the
best choice immediately upon removing the
orthodontic appliance.