Adult Orthodontics

DEFINATION
An adult is defined as one who is fully grown,

most males of 18 or 19 and most females of 16
can be considered as adults.
----HARVEY L. LEVITT {J.C.O.1971
MAR}
Many orthodontists have been of the opinion that
very young children and adults could not or should
not be treated orthodontically.
But that idea has been changing, giving these two

groups a chance to be treated and to enjoy good
function and esthetics.
What are the differences between adult and
child orthodontics?
The basic difference is that in children we must concern
ourselves with tooth movement plus growth, whereas in adults
we are dealing strictly with tooth movement.
Why do adults seek orthodontic
treatment?
Did not want orthodontic treatment as children.
Did not know about orthodontics as children.
Parents could not afford orthodontic treatment.
Were not advised by dentist of need for
orthodontic treatment when- younger.
No orthodontist located in their vicinity when
younger.
Incomplete orthodontic treatment as children.
Non-cooperative.
Had orthodontic treatment as children, but
relapsed.
More conscious of appearance with age.
Malpositioned teeth contributing to periodontal
disease.
Increasing difficulties in mastication.
Malocclusion and mandibular slide producing
soreness in the temporomandibular joint.
Spaces between anterior teeth enlarging, or
new spaces opening up.
Anterior teeth starting to crowd or minor
crowding becoming more severe.
Prevention. Concerned about "keeping their
teeth".
Adult patients come to us after years of using
and abusing their dentitions.
Their teeth have more wear facets, shorter

cusps and shallower fossae than these same
teeth had when they erupted into the mouth .
Many have had extensive dental work:

amalgams; crowns or inlays which may be
nicely carved, but with cusp locations and
groove directions that have nothing to do with
the mandibular movements of that mouth.
Bridges and partial dentures present an entirely
different challenge in orthodontic treatment.
A high percentage of adult patients come to us

with either full-blown temporomandibular pain
dysfunction syndrome or with a subacute
condition with all the signs, but without the
subjective symptoms as yet.
many of them consume high quantities of
aspirin during a given day. Also, it is not
uncommon to find that many have chronic
neckaches, backaches, and even earaches.
TMJ associated problems.
Another common finding from our dental history

is pain in some of the posterior teeth that
cannot be related to any past dentistry or any x-
ray findings. It may be related to stress,
frequently seen in adults, which seems to
magnify the smallest occlusal prematurity.
These patients are often bruxaters or clinchers.
Because of this, they have strain or trismus in
the muscles of mastication and along the whole
kinetic chain of muscles supporting the head
and neck, which makes it extremely difficult for
us to locate centric relation occlusion during our
examination. All of these above findings are
very common in the temporomandibular pain
dysfunction patient.
Additional diagnostic procedures that we should
consider in our adult patients are:-
• A full TMJ series of x-rays:-
1. to examine the joints for pathology, and

2. to be able to compare the beginning films with progress
films
• Muscle Examination :-
A. Masseter.
B. Internal Pterygoid.
C. Anterior Belly Temporalis.
D. Middle Belly Temporalis.
E. Posterior Belly Temporalis.
F. Sternocleidomastoid.
G. Trapezius.
Splint Therapy.:-
If patients have extremely tender muscles of
mastication and have enough other TMJ
symptoms, it sometimes is advantageous to
place some kind of repositioning splint to allow
the muscles of mastication to relax and thereby
allow the mandible to rest into its centric
relation. This sometimes is helpful in convincing
the adult patient that they have a more serious
dental problem, since upon beginning splint
therapy many of them start to experience a
relaxation and comfort around their head and
neck area that they had long since forgotten.
A Full Pantographic Tracing
Stress Evaluation:-
Stress increases the severity of symptoms associated with
occlusal problems. The adult patient, especially the female
adult patient with TMJ signs and symptoms should be
evaluated regarding her exposure to stress and her handling of
stress.
Diet Evaluation.
We also find it helpful, especially with TMJ-ortho
patients, to take a diet evaluation of adult
patients. People who are tender in their chewing
muscles, whose teeth hurt, are more likely to
become hypoglycemic during the daytime,
because they are eating softer foods which are
normally higher in refined carbohydrates. The
body reaction to the initial hyperglycemia
produces hypoglycemia. If the patient is in a
hypoglycemic valley, it is likely that their
symptoms are going to be much more severe
than if they were at a normal blood level.
Conferences With Allied
Practitioners
If there is extreme wear on the teeth or
missing teeth that will have to be replaced
later, it may be very helpful to seek a
consultation with the dentist or with the
prosthodontist prior to beginning the case.
Knowing the prosthetic limitations and
problems sometimes helps to decide
whether to close spaces caused by
missing teeth or to leave the spaces open
for future bridgework.
Certainly, if there are deep periodontal
pockets, a consultation with a periodontist
is indicated before treatment is begun. I
would advocate a periodontal consultation
and deep scaling in any adult mouth prior
to beginning orthodontic treatment.
Finding Centric Relation
Using mandibular manipulation, we must
"romance" centric relation occlusion from
our patients at each appointment. The
technique used is important. If the
mandible is not supported , the patient will
go immediately into centric occlusion or
"Sunday bite" , rather than centric relation
occlusion.
The important features of a satisfactory
method are:-
1. Support for the gonial angle.
2. Gentle pressure backward and slightly

downward on the chin.
3. Slow closure by the patient until the first

"feather light" contact.
Are teeth harder to move in the
adult patient?
Does orthodontic treatment take
longer in the adult patient?
Is it more difficult to torque, or to do any kind
of root movement in the adult patient?
Can impacted canines be brought into the
mouth in the adult patient?
The only limitation that I have found in adult
treatment is in initiating tooth movement. This
may take a few more weeks than in an
adolescent. But once treatment has begun,
progress can be as fast or faster in the adult
patient due to the excellent cooperation we
receive from the adult patients.-------
DR.ROBERT C. CHIAPPONE
{J.C.O.1976 JUL.}
Advocate a full pantographic tracing.
Mounting on a fully adjustable articulator.
Terminal hinge dentistry. Sometimes, it is

necessary for teeth to be rebuilt as well,
and these patients have to be referred to a
competent dentist after orthodontic
treatment.

Adult Orthodontics

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DEFINATION

An adult is defined as one who is fully grown,

But that idea has been changing, giving these two

Their teeth have more wear facets, shorter

Many have had extensive dental work:

A high percentage of adult patients come to us

TMJ associated problems.

Another common finding from our dental history

1. to examine the joints for pathology, and

1. Support for the gonial angle.

2. Gentle pressure backward and slightly

3. Slow closure by the patient until the first

Mounting on a fully adjustable articulator.

Terminal hinge dentistry. Sometimes, it is

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