adult orthodontics ppt
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orthodonticsTRANSCRIPT
Adult Orthodontics/Orthodontic Treatment on Mutilated Dentition
Eung-Kwon Pae, DDS, MSc, PhD
Course Objectives
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.
The student should be able to:
Indications for Treatment in Adult Patients
1. Comprehensive TreatmentReasons 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 segment2. 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 growthSmall error margin (Growth can be a buffer in children)
No growth does not necessarily mean less headache.
B. Missing teethMoving teeth through an old extraction site requires a
caution.
C. Periodontal problemsCheck 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