ADULT ORTHODONTICS

ADULT ORTHODONTICS

Adult orthodontics is experiencing considerable growth, encouraged by the development of techniques and mechanics adapted to the age of patients.

Due to certain specific features, the treatment of an adult differs from that of a child or adolescent. Indeed, adults are individuals whose growth is complete, their psyche, their endodontic, periodontal and articular contexts are different and they most often require the intervention of different dental specialists: this is multidisciplinary orthodontics.

The treatment objectives correspond to the general objectives of orthodontics but these cannot always be achieved: it is a compromise orthodontics.

In adults, treatment can correct primary malocclusions ignored during childhood or secondary malocclusions. Thus, adult orthodontics

has many indications: periodontal, prosthetic, surgical and can intervene at different stages of the overall treatment plan.

1. Special features of adult orthodontics:
   1.  Biological characteristics:
      1.  Lack of growth:

The lack of growth in adults modifies treatment plans; thus, orthodontic treatments in adults allow action on the teeth and on the alveolar processes but have little or no effect on the bone bases.

Skeletal shifts can only be treated by orthognathic surgery or alveolodental compensations.

2. Aging of tissues:
3. Soft tissues:

During aging, soft tissues show significant changes.

• The nose droops and widens
• Lips become thinner
• The corners of the lips lower towards the chin.
• The nasolabial angle becomes more acute
• The stomion lowers. The nasolabial folds become more pronounced.

Age reduces biprotrusion because the face lengthens, the upper incisors are less vestibular, the nose becomes more prominent and the lips become thinner.

All these age-related changes must be taken into account during our treatments so as not to aggravate these morphological changes.

2. Superficial and deep periodontium:
   1. Changes in the periodontium with age:

With age, the physiology of the periodontium changes and periodontal disease becomes more common.

Superficial periodontium

Anatomical modifications .

14 02 2024 DR.MEGHERBI

• slight migration of the attachment system probably due to episodic inflammatory phenomena
• The papillae retract and the marginal gingival margin becomes blunt. Avoid moving a tooth to an area where the attached gingiva is low and thin.

Histological changes .

The superficial periodontium is characterized by progressive tissue disorganization.

The possibilities of defense and repair are then more difficult and the healing time increases. This is why we must be particularly attached to

preserve the integrity of the superficial periodontium by avoiding the appearance of lesions linked to treatment devices (ring, glue, arch, elastomeric chain).

Deep periodontium

Cement .

• cementum thickening, a reduction in the desmodontal space and a decrease in the ligament remodeling cell pool , which would slow down tooth movement.

Desmodontis , :

It is recognized that with age, the structure of the ligament becomes more irregular. There is a decrease in vascularization with arteriosclerosis of the vessels. As the renewal of cells and fibers occurs more slowly and more difficultly, tooth movement is slowed, retention time is extended, and mobility increases during treatment.

Alveolar bone .

Anatomical modifications

• almost inevitable loss of bone support. The marginal bone is pushed apically, reducing the anchorage of the tooth.

14 02 2024 DR.MEGHERBI

Histological changes: The structure of bone tissue shows marked changes with age:

• vascularization is less important, which leads to a decrease in metabolic exchanges and the supply of precursor cells;
• calcium metabolism decreases (problem of osteoporosis and hormonal deficiency, particularly in elderly women)
• The rate of bone renewal is also affected by aging.
• Bone atrophies with age and the amount of calcified tissue decreases. The total amount of bone decreases.

b-2- Consequences on dental movement:

• Tooth movement is slower in adults.
• Adult bone is characterized by decreased bone trabeculation in the medullary bone and the lamina dura has more perforations; therefore, bone resorptions are greater.
• Stabilization and healing are also slower to achieve in adults, therefore retention must be longer.

1. Adaptation:
   1. It is more difficult in adults.
   2. In the periodontium, the slightest inflammation results in uncontrolled bone resorption.
   3. Occlusally, adults have difficulty adapting to interference. Interference caused by brackets or braces can cause pain but also occlusal overloads that cause pathological tooth mobility.
   4. Occlusal disengagement with elevation plates. Thus, the occlusal finishing of cases must be careful to avoid the occurrence of TMJ dysfunction.
   5. the muscular environment of adults has difficulty adapting to

changes in the position of the teeth. The tongue and the orbicularis oris are responsible for significant relapses; the teeth are moved outside their zone of stability.

2.  Therapeutic particularities

• Supportive periodontal therapy:

It is essential to eliminate inflammation before any orthodontic treatment, especially in adults:

• Biomechanics:

The pathophysiological changes that we have mentioned will have significant repercussions on anchoring as well as on the development of force systems.

• Anchoring :

In adults, natural anchoring is often reduced:

• the number of teeth present is reduced.
• bone density is lower.
• bone height is decreased.
• periodontal disease, if present, can cause more or less significant mobility.

Different anchoring methods are available to us:

• the securing by heavy and passive wires of the teeth chosen for anchoring, connected by lingual or transpalatal arches .
• solidarity by a temporary bridge or by retention of mobile teeth.
• the use of removable plates if the number of remaining teeth is insufficient.
  • Anchorage miniscrews are an interesting alternative in adults; they are particularly indicated when orthodontic anchorage is insufficient, reduced (reduction in periodontal support) or absent (loss of teeth).

Strength :

• Shifting the center of resistance

In adults, the bone level is reduced ( periodontitis , aging) so the center of resistance of the teeth is moved towards the apex.

Thus, for the same activation if the bone is resorbed and therefore an easier version movement which can create, if not controlled, dehiscences and fenestrations. It is therefore necessary to reduce the forces.

• Force intensity

The forces used in adults must be even lighter at the time of initiation of the movement to allow physiological movement of the tooth.

• Duration of force application

Fontenelle and Melsen use continuous forces, unlike Stutzman and Petrovic who advocate intermittent forces allowing rest phases.

2. Objectives of adult orthodontics:

1. Improve aesthetics ( of the face, smile and teeth) but the general architecture of the face can only be modified in adults by surgery.
2. Obtaining a functional occlusion. In adults, two principles must be remembered:
   • respect for occlusal functions: centering, wedging and guiding of the mandible;
   • the absence of joint compression.
3. Ensuring the sustainability of the dental system through:

• to prior periodontal sanitation.
• The joint action of the periodontist and the orthodontist will contribute to achieving maximum stability of the orthodontic treatment in a suitable periodontal environment.

4. Contribute to prosthetic achievement: Orthodontics can facilitate the achievement of prosthetic rehabilitations, which are more aesthetic, more functional and more reliable.

14 02 2024 DR.MEGHERBI

3. The restraint:

Generally, fixed bonded retainers are preferred in adults for reasons of comfort, but also because they provide stability, aesthetics and function.

CONCLUSION :

Adult orthodontics is a discipline that the orthodontist must master, know and integrate into their therapeutic arsenal .

The practitioner must know both the possibilities and the limitations while providing clear and precise information to the patient.

ADULT ORTHODONTICS

  Wisdom teeth can cause pain if they erupt crooked.
Ceramic crowns offer a natural appearance and great strength.
Bleeding gums when brushing may indicate gingivitis.
Short orthodontic treatments quickly correct minor misalignments.
Composite dental fillings are discreet and long-lasting.
Interdental brushes are essential for cleaning narrow spaces.
A vitamin-rich diet strengthens teeth and gums.

ADULT ORTHODONTICS