By Milan Chande

Severe malocclusions Interceptive orthodontics Impacted teeth Hypodontia Cleft lip and palate Craniofacial anomalies.

Severe malocclusions – To improve the dental health of a patient. This would be based upon the IOTN.

Example: A patient who has a overjet greater than 9mm is 40 % more likely to suffer from trauma to their upper incisors.

http://www.nature.com/bdj/journal/v195/n8/full/4810592a.html

Interceptive orthodontics - To act in advance to ensure the patient does not present with dental health problems in the future.

Example : The use of space maintainers with early extracted primary teeth. This will ensure that it is less likely the patient will have crowding problems in the future.

Impacted teeth – When teeth erupt in an impacted way, the teeth with the worst prognosis can be extracted and the arch aligned using orthodontic appliances.

Example: A patient with severe crowding around the canine and premolar region. The tooth with the worst prognosis could be extracted, if there is a lack of space and the teeth then realigned using orthodontic appliances.

Hypodontia – Orthodontic appliances are used to correct the malfunctioning arch alignment caused by the congenital missing of teeth.

Example: A patient with hypodontia of their canines. The first premolars can be moved into the position of the canines. They can then be restored using composite to function as canines and give better aesthetics.

Ceft lip and palate – Patients with this condition, have issues with hypodontia and also issues with anterior open bites and cross bites.

Example: Fixed orthodontic appliances can be used to move teeth into position to correct openbites and cross bites. Hypodontia can also be compensated for using appliances, were teeth are moved into position to allow proper function of mastication.

Craniofacial anomalies – Orthognathic Surgery is used to correct any skeletal discrepancies that are too severe to be treated using fixed or removable appliances. After surgery, where the skeletal pattern is corrected, orthodontics is used to align the arch in a more aesthetic manner. Such as the closing of any open bites and the correction of cross bites that may have resulted from the use of the surgery.

Adult Orthodontics for cosmetic restorative reasons

Adult Orthodontics to save a root Adult Orthodontics for distalizing an

abutment Adult Orthodontics for intrusion of severely

bruxed teeth Orthodontics to gain space for implants Orthodontics to prepare for a smile

makeover

Adult Orthodontics for cosmetic restorative reasons – By carrying out restorative treatment only, it is often seen that the end result is not as pleasant as would be if orthodontic treatment was used first.

Example: Bridges can be great when used to fill a gap. However if the gap has been there for a while, the abutments would be tilted mesially tilted. By placing a smaller abutment may not provide great aesthetics. If a removable orthodontic appliance was used to firstly straighten the abutment teeth. Then a bridge was placed. The end result would be more aesthetically pleasing.

Adult Orthodontics to save a root – orthodontics is used to change the inclination of the abutment tooth, allowing the root to be used as a post, with a good ferrule effect to ensure good longevity of the crown.

Example : A patient who has the crown fallen off a few weeks a go, may come see you. The root is in good condition, however due to the fact that a good ferrule can not be provided on the crown. The tooth must be extracted. The use of orthodontics would allow their to be a increase in space, thus allowing the tooth to be treated endotontically, then a post crown inserted and a core built up with a 2mm ferrule going all around the core.

Adult Orthodontics for distalizing an abutment – Orthodontic treatment is used when no molars are present. A premolar is moved distally using a orthodontic appliance. This then generates the space between two premolars in which a bridge can be fitted. The patient would be unwilling to have partial dentures and isn’t suitable for implants due to lack of bone levels.

Adult Orthodontics for intrusion of severely bruxed teeth – Orthodontic appliances are used to correct edge to edge occlusions which may be causing the teeth loss due to attrition. The lower incisors can be slightly intruded or upper incisors protruded, depending on space available.

Orthodontics to gain space for implants – Orthodontic treatment is used in cases were space is needed for the implant to fit.

Example: A patient with a primary tooth, with no permanent successor may need a replacement in the future. If for example the tooth root is tilted mesially or there isnt space for the implant to fit into. Orthodontics can then be used to bring the tooth root upright. The primary tooth can then be extracted when needed and the implant fitted.

Orthodontics to prepare for a smile makeover – the use of orthodontic appliances to move teeth into a better alignment. The restorative phase then consists of removal of amalgam restorations and replacement of them with composite restorations. Which would enable the patient to have a natural look, enabling them to produce a more aesthetically pleasing smile to their target audience.

Restorative Problems: Reduced Adaptive Capacity – The ability of the

patient to accept changes in their oral habits. E.g the reluctance to accept dentures.

Age changes in denture bearing area’s – bone resorption and muscle atrophy.

Root caries –exposure of the root surface, due to gingival recession. Accompanied by reduction in saliva flow rates and a decrease in self care.

Tooth wear – very common amongst the elderly. Pulpal changes – sclerosis and reduction in pulpal

capacity to repair. Reduction in manual dexterity – makes Oral

Hygiene less effective.

⇓ microcirculation ⇓ cellular reproduction, ⇓ tissue repair, ⇓ metabolic rate, ⇑ fibrosis. ⇑ Degeneration of elastic and nervous

tissue.

These result in reduced function of most body systems.

Oral soft tissues : ⇓ in the thickness of the epithelium,

mucosa, and sub-mucosa is seen. ⇓ Taste bud function. ⇑ occurs in the number and size of

Fordyce's spots (sebaceous glands), Recent evidence suggests that stimulated

salivary flow rate does not fall purely as a result of age. However, medications or systemic disease can affect salivary output.

Dental hard tissues Enamel becomes less permeable with age. Clinically, older teeth appear more brittle,

but there is no significant difference between the elastic modulus of dentine in old or young teeth.

The rate of secondary dentine formation reduces with age, but still continues.

Occlusion of the dentine tubules with calcified material spreads crownwards with age.

Toothwear is an age-related phenomenon and can be regarded as physiological in many cases.

However, excessive and pathological wear can be caused by parafunction, abrasion, erosion (dietary, gastric, or environmental), or a combination of these factors.

⇑ fibrosis and ⇓ vascularity mean that the defensive capacities of the pulp ⇓ with ⇑ age.

⇓ pulp capping is less likely to succeed. ⇑ secondary dentine ⇑ pulp calcification.

Consequence: Patient is likely to progress from reversible pulpitis to irreversible pulpitis quicker. Also more likely to see people with pulpal necrosis.

⇑ fibrosis ⇓ cellularity ⇓ vascularity and ⇓ cell turnover are found

with ⇑ age.

Consequence : Patients are more likely to develop chronic periodontitis. Due to the body being unable to repair the damage caused by bacteria around the periodontium.

http://jada.ada.org/content/138/suppl_1/5S.full

http://www.dentistrytoday.com/orthodontics/1555-everyday-uses-of-adult-orthodontics

http://www.nature.com/bdj/journal/v195/n8/full/4810592a.html

Oxford Handbook of Clinical Dentistry An Introduction to Orthodontics: By Laura

Mitchell

Milan Chande