Adult Orthodontics/Orthodontic

Treatment on Mutilated Dentition

Eung-Kwon Pae, DDS, MSc, PhD
Course Objectives
The student should be able to:
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.
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 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 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
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