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Adult Orthodontics/Orthodontic Treatment on Mutilated Dentition

Eung-Kwon Pae, DDS, MSc, PhD

Course Objectives
The student should be able to:
1. 2. 3. 4.

5.

Describe the indications for orthodontic treatment of adult patients. Understand the ways in which adult orthodontic treatment may differ from that of children. Understand the sequence of treatment of adult patients. Understand how missing teeth or peridontal problems such as bone loss influence the mechanics of orthodontic treatment. Discuss the ways in which orthodontics treatment can improve the periodontal and prothodontics condition of the adult patient.

Indications for Treatment in Adult Patients


1.

Comprehensive Treatment Reasons 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 segment 2. 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 multidisciplinary approach.
1.

2. 3. 4.

Periodontal inflammation or active pathologic conditions need to be taken care of to prevent from bone level breakdown. Yet, osseous surgery must be deferred. Restorative procedures and endodontic treatment should be completed first. 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 growth
Small error margin (Growth can be a buffer in children) No growth does not necessarily mean less headache.

A.

Missing teeth
Moving teeth through an old extraction site requires a caution.

A.

Periodontal problems
Check amount of attached gingiva. Pre- and post periodontal surgeries.

Biomechanics in adult orthodontics


A.

Ample anchorage Light forces and an increased M/F ratio


Reduce Force, Increase Moment

B.

Decision Tree
Decide what you can do or cannot do. 2. Determine treatment sequence and timing. 3. Cautious approach
1.