adult orthodontics

ADULT ORTHODONTICS

DR. FITRI OCTAVIANTI

DEPARTMENT OF ORTHODONTICS USIM

•Indications and contraindications•Specific problems in adult orthodontic treatment

•Differences between adults and children

•Aesthetics orthodontics appliances•Mandibular advancement splints in treatment of obstructive sleep apnoea

WHAT WILL YOU LEARN?

Introduction

•The demand for orthodontics for adults is increasing

Two groups of adults that request orthodontic treatment

Looking for comprehensive treatment

Looking for adjunctive orthodontic treatment

•6% of adults have OJ > 7mm•9% have OB complete to palate•25% orthodontics patient in USA are adult patient

•> 70% are female

Why seek ortho treatment?1. Desire to improve dental appearance2. Treatment of relapse cases3. To facilitate restorative or periodontal

treatment4. For surgical correction of jaw

discrepancy 5. To use intraoral mandibular

advancement appliances for obstructive sleep apnoea

No age limitAestheticsFunctionalAdjunct to other treatment

INDICATIONS OF ADULT ORTHODONTICS

Medical problem-allergiesPoor oral hygieneShort root

CONTRAINDICATIONS OF ADULT ORHODONTICS

SPECIFIC PROBLEMS IN ADULT1. Lack of growth2. Periodontal disease3. Missing or heavily restored teeth4. Physiological factors affecting tooth movement5. Adult motivation and attitude towards treatment

LACK OF GROWTH

•The majority of growth changes have occurred by the end of puberty

•No scope for growth modification•Skeletal discrepancies can only be treated with orthodontic camouflage or combine orthognathic-orthodontic

•Can be difficult to reduce overbite •Extruding the molars are prone to relapse

Micro-implant used for anchorage for intrusion the anterior teeth

PERIODONTAL DISEASE

•Adults are more likely to be suffering, or have suffered from periodontal diseases

•Active periodontal disease should be treated and stabilized before orthodontic treatment begin.

MISSING OR HEAVILY RESTORED TEETH

•Tooth loss may lead to drifting and tilting of adjacent teeth and over eruption of opposing teeth into the space

•Atrophy of the alveolar bone can occur•Heavily restored teeth are more common in adults and may complicate orthodontic treatment.

•Bonding to restoration material is difficult

Atrophy of alveolus after tooth loss

Bonding bracket to restoration teeth is more difficult than to the enamel

PHYSIOLOGICAL FACTORS AFFECTING TOOTH MOVEMENT

•There is a reduced tissue blood supply and decreased cell turnover in adults

•Initial tooth movement is slower in adults •May be more painful•Lighter initial forces are advisable

ADULT MOTIVATION AND ATTITUDE TOWARDS TREATMENT

•Usually adults are well-motivated patients•Increase co-operation may compensate for slower initial tooth movement

•Adults tend to be more conscious of the appearance

•More drive towards aesthetic orthodontics•More reluctant to wear extra oral appliances

DIFFERENCES BETWEEN ADULTS AND CHILDREN

1. Medical history- medications and medical condition

2. Psychological- very demanding3. Growth- unsuitable for functional

appliances4. Previous disease- caries and periodontal5. Stability- reduce cell turnover6. Cell biology- slower cell response

AESTHETIC ORTHODONTICS APPLIANCES

Aesthetic orthodontics brackets

Lingual orthodonticsClear plastic appliances

Aesthetics orthodontics brackets

•Made from clear or tooth colored material

2 types Ceramic material

Polycarbonate (plastic bracket)

Plastic brackets

•Plastic brackets showed problems with staining and lack of stiffness, which led to deformation of brackets

•Some newer version have metal slot incorporated with plastic brackets

Plastic brackets

Plastic brackets Plastic brackets with metal slot

Plastic brackets

Ceramic bracketsmade from polycrystalline or monocrystalline

More aesthetic than plastic brackets

Ceramic brackets

•The disadvantages: •The bond strength is too strong that could cause enamel fracture

•Too much friction that reduce sliding of archwire

•Bracket breakage especially at the tie-wings•Iatrogenic enamel damage: enamel wear if teeth contacted ceramic brackets

•Problem when debonding brackets

Ceramic brackets

Ceramic brackets

Ceramic brackets

Lingual orthodontics

•Advantages:

AestheticsLess risk to labial enamel

through decalcificationPosition of the tooth can be

seen more accutarelyBite plane effect

Brackets are bonded in the lingual aspect of the teeth

•Disadvantages:Speech difficultiesTongue discomfortMasticatory difficultiesTechnical demanding for

operatorBonding and rebonding were

not easily implementedCost

Lingual appliances

Lingual appliances

Clear plastic appliances

•The “invisalign”•Similar to plastic retainer•Mild cases•Patient have to wear a series of plastic appliances to move teeth

Clear plastic appliances

Advantages Disadvantages

Excellent aestheticsComfort for patientsEase of care and oral hygiene

Limited control over root movementLimited intermaxillary correctionCost

Aligner is worn for 20 hours per

day

It is changed every 2 weeks

Each aligner will be move

the teeth 0.25-0.3

mm

It is only removed for

eating, drinking and

brushing teeth

OBSTRUCTIVE SLEEP APNOE AND MANDIBULAR ADVANCEMENT SPLINTS

Obstructive sleep apnae (OSA) is a sleep-related breathing disorder, characterised by reapeted collapse of the upper airway during sleep, with cessation of breathing

Etiology OSA:Combination of anatomical and pathophysiological factors.

Combination of retropositioned facial skeleton and reduced oro-pharyngeal dimensions at one or more site between soft palate, tongue and pharyngeal wall.

Functional impairment of upper airway dilatory muscles.

Nocturnal symtom:•Snoring•Witnessed apnoea•Choking/gasping•Nocturia•Reslessness

Daytime symtom:•Excessive daytime sleepiness

•Depression• Impared quality life

Clinical symtom:

The sympton can be worsened by certain aggravating factors:

•Alcohol consumption•Obesity•Supine position

OSA is typically classified:•Mild OSA- AHI 5-15 episodes per hour of sleep•Moderate OSA- AHI 16-30 episodes per hour of sleep

•Severe OSA- AHI >30 episodes per hour of sleep

AHI=apnoea-hypopnoea index

Treatment:•Conservative treatment: removal of aggravating factors

•Non surgical treatment -Continuous Positive Airway Pressure -Mandibular Advancement Splints

Monoblock appliance for treatment of sleep apnoea

First generation vacuum-formed mandibular advancement splint

Second generation Herbst removable mandibular advancement splint

Third generation medical dental sleep appliance

Seft-adjustment is possible anteroposteriorly , right and left lateral movement