Adult Orthodontics/Orthodontic Treatment on Mutilated Dentition

Eung-Kwon Pae, DDS, MSc, PhD

Course Objectives

1. Describe the indications for orthodontic treatment of adult patients.

2. Understand the ways in which adult orthodontic treatment may differ from that of children.

3. Understand the sequence of treatment of adult patients.

4. Understand how missing teeth or peridontal problems such as bone loss influence the mechanics of orthodontic treatment.

5. Discuss the ways in which orthodontics treatment can improve the periodontal and prothodontics condition of the adult patient.

The student should be able to:

Indications for Treatment in Adult Patients

1. Comprehensive TreatmentReasons patients seek care

• Adjunctive treatment• Invisalign • An interest in Tx

cannot be straightly translated to compliance in Tx.

Unrealistic expectations

Adjunctive Orthodontic Treatment Objectives

Parallelism of abutment teeth Favorable distribution of teeth Redistribution of occlusal and incisal forces Adequate embrasure space Acceptable occlusal plane for incisal and canine

guidance at satisfactory vertical dimension Better lip competency and support Improved crown/root ratio Improved self-maintenance capability of periodontal

health

Difficulties

Soft tissue irritation by appliance

Occlusal interference from extrusion

Difficult to maintain oral hygiene.

Takes longer than one would think

Immediately, splint them!

B. Forced eruption

Indications:

To save,

1. root exposed tooth from decay, attrition, etc.

2. Fractured tooth

3. External and internal resorption.

Cautions!

If move slowly, the alveolar bone moves together.

Ample anchorage.Check if ankylosed.

C. Minor alignment of teeth

Interproximal reduction [IPR]To increase arch length without extraction

for derotation of tooth or teeth.1/3 -1/2 mm of enamel can be removed.Diagnostic setup before doing stripping

would be beneficial.

1. Intrusion/IPR of the lower anterior segment2. Forced extrusion of the max. centrals.3. Extraction of right max. central.4. Implant and finish

Treatment sequence and timing is important because adult cases frequently involve a multi-disciplinary approach.

1. Periodontal inflammation or active pathologic conditions need to be taken care of to prevent from bone level breakdown.

2. Yet, osseous surgery must be deferred.3. Restorative procedures and endodontic

treatment should be completed first.4. Yet, crown and bridge work must be deferred.

Restorative procedures and endodontic treatment should be completed first.

Yet, crown and bridge work must be deferred.

Surgery

Orthod.

Perio.

Prothod.

Orthod.

Problems unique to adult orthodontic patients

A. Lack of growthSmall error margin (Growth can be a buffer in children)

No growth does not necessarily mean less headache.

B. Missing teethMoving teeth through an old extraction site requires a

caution.

C. Periodontal problemsCheck amount of attached gingiva. Pre- and post

periodontal surgeries.

Biomechanics in adult orthodontics

A. Ample anchorage

B. Light forces and an increased M/F ratio

Reduce Force, Increase Moment

Decision Tree

1. Decide what you can do or cannot do.

2. Determine treatment sequence and timing.

3. Cautious approach