Adult orthodontics
1. Introduction :
Adults have just as much need as children to benefit from an aesthetic appearance and good occlusal function, which is why orthodontics is aimed at adults as well as children.
Treatment in adults presents several obstacles such as rigid and more difficult psychological attitudes than in children, as well as physiological attitudes which are characterized by the absence of growth and the weakness of the periodontium, hence certain precautions must be taken in the latter.
2. Particularities in adults:
2.1 Adult psyche:
The adult is a sensitive being, more demanding, more concerned and more difficult to convince, but also more aware of his problems.
Motivating adults to use devices is more difficult because they have difficulty accepting the unsightly appearance of visible devices and the more or less long duration of treatment, and they have difficulty tolerating the irritation and discomfort of the devices during phonation and chewing.
2.2 Facial growth and aging in adults:
We often talk about the absence of growth, but in reality growth does not stop, it continues with tiny amounts:
-The chin drops, the nose sags and widens.
-Posterior rotation increases in women.
-Anterior rotation increases in men.
-The mandibular length increases.
-The nasolabial and nasolabial furrows become more pronounced.
-The corners and stomion lower and the lips become thinner.
-Flattening of the cheekbones.
-Hollowing of the cheeks.
-Descent of the nasal tip with widening of its base.
-General muscle relaxation.
2.3 The oral cavity and dental arches of the adult :
The adult presents many malocclusions and malpositions to which are added dental abrasions, fractures, edentulations, reconstructions, prostheses complicating the clinical picture.
-Among the most common malpositions in adults, we find;
– Dental crowding characterized by a lack of space which causes the teeth to overlap.
– The diastema which is characterized by spaced teeth.
– Prognathism , due to the advancement of the lower teeth, resulting in a chin that is too forward.
– Excessive vertical overlap ,
– Malpositions which often make lip closure difficult such as bipro-alveoli and anterior open bites.
2.4 The adult periodontium :
With age the periodontium becomes more vulnerable to periodontal disease.
*Superficial periodontium:
-Retraction of the papillae with blunt marginal edge.
-Keratinization of the epithelium is less.
-Reduction of cellular activity and metabolism which reduces the possibilities of repair and healing.
*Deep periodontium:
-Increased bone density and reduced marrow spaces.
-Narrowing of the LAD due to cementum apposition on the one hand, and hypofunction of bone cells on the other hand.
– Disorganization of Sharpey’s fibers, desmodontal atrophy.
-Decreased mitotic activity of cells and vascularization.
– Slowing down of turnover and reduction of calcium activity
-The balance between formation and destruction – becomes negative, therefore decreasing bone mass.
-Reduced vascularization of the bone and periodontium
-The number of osteogenic cells and osteoid tissue becomes rare.
Adult orthodontics
2.5 Adaptation:
Adults adapt poorly to changes in the oral environment.
-The slightest inflammation results in uncontrolled resorptions.
-The periodontium slowly adapts to the changes caused by our devices.
-The adult adapts poorly to prematurity caused by glued fasteners
-The muscles adapt poorly to dental and basal variations due to the completion of brain engramming , any attempt at re-education of the tongue and lips will doom to failure.
-Bone reconstruction is slower, resulting in longer or even permanent retention.
3. Therapeutic particularities in adults :
3.1 Little or no prophylactic treatment :
From a certain age, preventive or interceptive treatments will no longer be effective and will be useless; this is conditioned by growth and neuro-muscular maturation.
3.2 Many surgical treatments:
-In the sagittal direction, skeletal shifts will be treated by surgery or by alveolo-dental compensation, because orthopedic treatments are impossible.
-In the vertical direction only surgery can change the facial divergence.
-In the transverse direction, the disjunctions are very difficult and unstable.
-The severity of the cases exceeds orthodontic possibilities.
-The amplitude of the movements is too great to be obtained orthodontically.
-Surgery helps improve aesthetics and functions.
-Pre-surgical orthodontics allows the unlocking of the occlusion and alveolo-dental decompensation.
-Post-surgical orthodontics which completes the results of the surgery in order to avoid relapse.
4. Dental movements in adults:
Travel for adults requires more precautions:
-the forces used must be very light especially during the initial phase of the movement to avoid strong hyalinization, this is possible by using Ni-Ti alloys. Once the initial phase is passed, the intensity of the force can be slightly increased.
-The forces must be intermittent to allow a resumption of vascularization of the periodontium without exceeding the latency phase.
-Due to the increase in bone density, the speed of tooth movement is slower.
-Anchorage control is more difficult due to alveolar resorptions.
-The direction of movement must be constant (no back and forth movements).
5. Adult orthodontic devices:
Due to its more delicate and demanding psychological nature, several types of equipment are offered to satisfy it:
-Fixed retainers, thermoformed gutters, prosthetic restorations.
5.1 – multi-attachment dental appliance ,
This technique consists of gluing brackets on the external face of the teeth, which will be connected to each other by a metal wire. Considered to be the most versatile and efficient device in orthodontics, braces offer the possibility of correcting the orientation of each tooth in any direction and in a very precise manner.
Adult orthodontics
5.2- Lingual orthodontics
This evolution towards more discreet devices has also spread with the diversification of demands, in particular that of an adult clientele more concerned with the aesthetics of the smile. Lingual orthodontics has been developed in this direction
It involves placing the brackets on the tongue side, on the inside of the teeth, which makes the device almost invisible.
5. 3-Removable transparent aligners
The latest in orthodontic appliances, transparent removable aligners ( Invisalign) are also part of the new concepts of invisible adult orthodontics. This is a technique without braces that uses a series of plastic aligners (also called shells) to gradually correct the positioning of the teeth.
5.4- Anchoring by mini-screws.
5.5- Fixed retention devices, thermoformed gutters, prosthetic restorations.
6. The contribution of adult orthodontics to dental specialties:
6.1 Contribution to periodontology:
-Orthodontic correction of dental versions and rotations allows alignment of crowns, makes brushing and plaque removal more effective.
-Correction of certain malocclusions (anterior suprabite and crossbites) helps eliminate occlusal trauma that causes periodontal disease and TMJ dysfunction.
-Correction of denudations and dehissance and periodontal remodeling.
– Elimination of periodontal pockets.
– Elimination of prematurities and interferences which have repercussions at the joint level.
6.2 Contribution to the prosthesis:
-Straightening of the dental axes of abutment teeth to facilitate the insertion of prostheses.
-Opening a space to place an artificial tooth and limit mutilating sizes.
-Leveling of the occlusal plane.
– Space closure to accommodate crown sizes.
– Distalization of the premolars when the molars are missing to be able to place bridges.
6.3 Contribution to orthognathic surgery: Since the adult’s growth is complete, no possibility of orthopedic treatment will be possible, only surgery can correct this discrepancy, thanks to the help provided by the orthodontist to the maxillofacial surgeon.
Pre-surgical preparation for alveolo-dental decompensation of the arches, straightening of dental axes, correction of crowding.
After orthognathic surgery, the orthodontist intervenes once again to finalize the occlusion and coordinate the two arches.
7. Conclusion:
Orthodontic care for adults is quite delicate due to the particularities they present on a psychological and periodontal level and especially the end of growth which will limit a lot of therapeutic procedures requiring surgery.
The therapeutic approach must take into consideration all these particularities, essentially the forces applied (direction, intensity, type).
The therapeutic arsenal remains varied, essentially aiming at the aesthetic and social comfort of the patient.
Adult orthodontics
The plan:
1. Introduction :
2. Particularities in adults:
2.1 Adult psyche:
2.2 Facial growth in adults:
2.3 The oral cavity and dental arches of the adult
2.4 The adult periodontium
2.5 Adaptation:
3. Therapeutic particularities in adults :
3.1 Little or no prophylactic treatment :
3.2 Many surgical treatments
4. Dental movements in adults
5. Adult orthodontic devices:
5.1 – multi-attachment dental appliance ,
5.2- Lingual orthodontics
5. 3-Removable transparent aligners
5.4- Anchoring by mini-screws.
5.5- Fixed restraint devices,
6. The contribution of adult orthodontics to dental specialties:
6.1 Contribution to periodontology
6.2 Contribution to the prosthesis:
6.3 Contribution to orthognathic surgery
7. Conclusion:
Good oral hygiene Regular scaling at the dentist Dental implant placement Dental x-rays Teeth whitening A visit to the dentist The dentist uses local anesthesia to minimize pain